Personal or Public Health?

  • Muireann Quigley
  • John Harris
Part of the International Library of Ethics, Law, and the New Medicine book series (LIME, volume 42)


Intuitively we feel that we ought (to attempt) to save the lives, or ameliorate the suffering, of identifiable individuals where we can. But this comes at a price. It means that there may not be any resources to save the lives of others in similar situations in the future. Or worse, there may not be enough resources left to prevent others from ending up in similar situations in the future. This chapter asks whether this is justifiable or whether we would be better served focusing on public health in the form of preventative medicine. It looks briefly at the supposed difference between benefiting individuals and benefiting populations by considering the difference between interventions aimed at ‘rescue’ and those which are preventative. It then considers the rule of rescue in the health care setting, and looks at some of the reasons stemming from this that we might have for allocating resources to rescue interventions. If these reasons do not provide adequate justification for preferring these types of interventions, then the implication is that our current mode of resource allocation may need to be revised in favour of a more public health-oriented model.


Public health individual health rule of rescue identifiable non-identifiable statistical victims discounting the future 


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  1. Bayer, R. and Fairchild, A.L. 2004. “The Genesis of Public Health Ethics.” Bioethics 18(6): 473–492.PubMedCrossRefGoogle Scholar
  2. Brazier, M. and Harris, J. 1996. “Public Health and Private Lives.” Medical Law Review 4(2): 171–192.PubMedGoogle Scholar
  3. Broome, J. 1994. “Discounting the Future.” Philosophy & Public Affairs 23(2): 128–156.CrossRefGoogle Scholar
  4. Boylan, M. 2004. “What is Public Health?” Public Health Policy and Ethics, ed. M. Boylan. Dordrecht: Kluwer, pp. ix–xiii.Google Scholar
  5. Chan, S. and Harris, J. “Free Riders and Pious Sons–Why Science Research Remains Obligatory.” Bioethics Online Early Articles Published: 25-Apr-2008.Google Scholar
  6. Charlton, B.G. 1993. “Public Health Medicine–a Different Kind of Ethics.” Journal of the Royal Society of Medicine 86: 194–195.PubMedGoogle Scholar
  7. Childress, J.F., Faden, R.R., Gaare, R.D., Gostin, L.O., Kahn, J., Bonnie, R.J., Kass, N.E., Mastroianni, A.C., Moreno, J.D., Nieburg, P. 2002. “Public Health Ethics: Mapping the Terrain.” Journal of Law, Medicine & Ethics 30: 170–178.CrossRefGoogle Scholar
  8. De Jong, M.D., Tran, T.T., Truong, H.K., Vo, M.H., Smith, G.J., Nguyen, V.C., Bach, V.C., Phan, T.Q., Do, Q.H., Guan, Y., Peiris, J.S., Tran, T.H., Farrar, J. 2005. “Oseltamivir Resistance During Treatment of Influenza A (H5N1) Infection.” New England Journal of Medicine 353: 2667–2672.PubMedCrossRefGoogle Scholar
  9. Diehr, P., Derleth. A., Cai, L., and Newman A.B. 2007. “The Effect of Different Public Health Interventions on Longevity, Morbidity, and Years of Healthy Life.” BMC Public Health 7: 52.PubMedCrossRefGoogle Scholar
  10. Harris, J. 1980. Violence and Responsibility. London, Boston and Henley: Routledge and Kegan Paul.Google Scholar
  11. Harris, J. 1994. “Does Justice Require That We Be Ageist?” Bioethics 8(1): 74–84.PubMedCrossRefGoogle Scholar
  12. Harris, J. 1996. “What Is the Good of Health Care?” Bioethics 10(4): 269–292.PubMedCrossRefGoogle Scholar
  13. Harris, J. 1997. “What the Principal Objective of the NHS Should Really Be.” British Medical Journal 314(7081): 669–672.PubMedGoogle Scholar
  14. Harris, J. 2002. “Identity, Prudential Concern and Extended Lives: A Response to Walter Glannon.” Bioethics 16(3): 284–291.PubMedCrossRefGoogle Scholar
  15. Harris, J. 2003. “Consent and End of Life Decisions.” Journal of Medical Ethics 29(1): 10–16.PubMedCrossRefGoogle Scholar
  16. Harris, J. 2005. “The Age-Indifference Principle and Equality.” Cambridge Quarterly of Healthcare Ethics 14(1): 93–99.PubMedCrossRefGoogle Scholar
  17. Harris, J. 2007. Enhancing Evolution. Princeton and Oxford: Princeton University Press.Google Scholar
  18. Harris, J. and Sulston, J. 2004. “Genetic Equity.” Nature Reviews Genetics 5: 796–800.PubMedCrossRefGoogle Scholar
  19. Hope, T. 2001. “Rationing and Life-Saving Treatments: Should Identifiable Patients have Higher Priority?” Journal of Medical Ethics 27: 179–185.PubMedCrossRefGoogle Scholar
  20. Institute of Medicine, Committee for the Study of the Future of Public Health. 1988 The Future of Public Health. Washington DC: National Academy Press.Google Scholar
  21. Jenni, K.E. and Lowenstein, G. 1997. “Explaining the Identifiable Victim Effect.” Journal of Risk and Uncertainty 14: 235–257.CrossRefGoogle Scholar
  22. Jonsen, A.R. 1986. “Bentham in a Box: Technology Assessment and Health Care Allocation.” Law, Medicine & Health Care 14: 172–174.Google Scholar
  23. Kamm, F.M. 2000. “Does Distance Matter Morally to the Duty of Rescue?” Law and Philosophy 19: 655–681.Google Scholar
  24. Lindgren, P., Fahlstadius, P., Hellenius, M.L., Jönsson, B., and De Faire, U. 2003. “Cost-effectiveness of Primary Prevention of Coronary Heart Disease Through Risk Factor Intervention in 60-Year-Old Men from the County of Stockholm–a Stochastic Model of Exercise and Dietary Advice.” Preventative Medicine 36(4): 403–409.CrossRefGoogle Scholar
  25. McKie, J. and Richardson, J. 2003. “The Rule of Rescue.” Social Science & Medicine 56: 2407–2419.CrossRefGoogle Scholar
  26. Mill, J. S. (1962). Utilitarianism, ed. M. Warnock. London: Collins/Fontana.Google Scholar
  27. Miller, A. (1961). All My Sons. Harmondsworth: Penguin.Google Scholar
  28. Pamuk, E.R., Wagener, D.K., and Molla, M.T. 2004. “Achieving National Health Objectives: The Impact on Life Expectancy and on Healthy Life Expectancy.” American Journal of Public Health 94(3): 378–383.PubMedCrossRefGoogle Scholar
  29. Parfit, D. 1984. Reasons and Persons. Oxford: Clarendon Press, pp. 356ff.Google Scholar
  30. Parfit, D. (1978) “Innumerate Ethics.” Philosophy & Public Affairs 7(4): 285–301.Google Scholar
  31. Schwappach, D.L.B., Boluarte, T.A., and Suhrcke, M. 2007. “The Economics of Primary Prevention of Cardiovascular Disease–a Systematic Review of Economic Evaluations.” Cost Effectiveness and Resource Allocation 5: 5.PubMedCrossRefGoogle Scholar
  32. Segal, L., Dalton, A.C., and Richardson J. 1998. “Cost-Effectiveness of the Primary Prevention of Non-insulin Dependent Diabetes Mellitus.” Health Promotion International 13(3): 197–209.CrossRefGoogle Scholar
  33. Taurek, J. 1977. “Should the Numbers Count?” Philosophy & Public Affairs 6: 293–316.Google Scholar

Copyright information

© Springer Science + Business Media B.V 2008

Authors and Affiliations

  • Muireann Quigley
    • 1
  • John Harris
    • 2
    • 3
  1. 1.Centre for Social Ethics and Policy and the Institute of Science, Ethics and Innovation in the School of LawUniversity of ManchesterUK
  2. 2.University of ManchesterUK
  3. 3.Institute of Science, Ethics and Innovation in the School of LawUK

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