Public health, responsibility and english law: Are there such things as no smoke without ire or needless clean needles?

Medical Law Review

Volumn 17, Issue 1, 2009, Pages 127-139

  Coggon, John ^a  

^a UNIVERSITY OF MANCHESTER   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

EMERGENCY HEALTH SERVICE; HUMAN; LEGAL ASPECT; NOTE; PREVENTIVE HEALTH SERVICE; PRISON; PUBLIC HEALTH SERVICE; SMOKING; SOCIAL BEHAVIOR; UNITED KINGDOM;

EMERGENCY SERVICES, PSYCHIATRIC; GREAT BRITAIN; HUMANS; NEEDLE-EXCHANGE PROGRAMS; PRISONS; PUBLIC HEALTH PRACTICE; SMOKING; SOCIAL RESPONSIBILITY;

EID: 63549114879     PISSN: 09670742     EISSN: 14643790     Source Type: Journal    
DOI: 10.1093/medlaw/fwn028     Document Type: Note

References (85)

1. L.O. Gostin, Public Health Law: Power, Duty, Restraint (University of California Press 2008) at 4.
2. At 199-200.
3. At 200.
4. Though not all of those held in police custody - at 208.
5. At 200-201.
6. Ibid.
7. At 201-202.
8. At 202-204.
9. At 206-207.
10. At 297.
11. At 209.
12. At 210.
13. (SI 2007/765).
14. At [1].
15. At [4].
16. The question posed in the title of Allen's analysis of this case: N. Allen, 'A Human Right to Smoke?' (2008) 158 (7326) New Law Journal 886-7.
17. At [20] and [23].
18. At [19] and [20].
19. At [24].
20. At [35-39].
21. At [39].
22. As described by Pill L.J. at [50].
23. At [56]-[75].
24. Pretty v. United Kingdom (2002) 35 E.H.R.R. 1.
25. At [64].
26. R (Countryside Alliance) v. Attorney General [2007] U.K.H.L. 52
27. see [2008] E.W.H.C. 1096 (Admin) at [66]-[71].
28. At [74].
29. At [90].
30. At [94].
31. At [40]-[48].
32. At [98].
33. At [104].
34. At [99]-[105] especially [105].
35. At [101].
36. Ibid.
37. At [102].
38. At [76]-[88].
39. At [110]-[124].
40. At [112].
41. de Freitas v. Permanent Secretary of Ministry of Agriculture [1999] A.C. 69.
42. At [116].
43. At [117].
44. At [123]
45. At [125].
46. At [131]-[134].
47. At [132].
48. At [132] and [133].
49. See, e.g. the new journal Public Health Ethics; the special issue of the journal Public Health (2006) 120, 1-87
50. S. Anand, F. Peter and A. Sen (eds), Public Health, Ethics, and Equity (Oxford University Press 2004)
51. M. Powers and R. Faden, Social Justice - the Moral Foundations of Public Health Policy, (Oxford University Press 2006)
52. R. Bayer, L.O. Gostin, B. Jennings, B. Steinbock (eds), Public Health Ethics - Theory, Policy, and Practice (Oxford University Press 2007)
53. A. Dawson and M.Verweij, Ethics, Prevention, and Public Health, (Oxford University Press 2007)
54. L.O. Gostin, supra n. 1.
55. See also Nuffield Council on Bioethics, Public Health - Ethical Issues (Nuffield 2007).
56. See O. O'Neill, 'Public Health or Clinical Ethics: Thinking Beyond Borders' (2002) 16(2) Ethics and International Affairs 35-45
57. B. Jennings, 'Public Health and Civic Republicanism: Toward an Alternative Framework for Public Health Ethics' in A. Dawson and M. Verweij, ibid.
58. J. Coggon, 'Harmful Rights Doing? The Perceived Problem of Liberal Paradigms and Public Health' (2008) 34 (11) Journal of Medical Ethics 798-801.
59. See M. Brazier, '"Do No Harm" - Do Patients Have Responsibilities Too?' [2006] C.L.J. 397-422.
60. For analysis and exploration of the utility of distinguishing these concepts, see P. Bielby, 'The Conflation of Competence and Capacity in English Medical Law: A Philosophical Critique' (2005) 8 Medicine, Health Care and Philosophy 357-369.
61. See L.O. Gostin (ed.) Public Health Law and Ethics - a Reader (University of California Press 2002), Ch. 4.
62. The definition comes from the (United States) Institute of Medicine in The Future of Public Health.
63. See Gostin, ibid, p. xix.
64. Robyn Martin argues to the conclusion that 'public health practice is an exercise in risk assessment'. There is a state role not only to assess risk levels, but also to establish what constitutes an acceptable level of risk of harm to, inter alia, health: R. Martin, 'The limits of law in the protection of public health and the role of public health ethics' (2006) 120 Public Health 71-80.
65. As Angus Dawson notes in his commentary on Martin's paper, 'public health activity is primarily focused on reducing or eliminating the risk of harm. That is why public health interventions can be contentious'. See A. Dawson, 'Commentary on "The limits of law in the protection of public Health and the Role of Public Health Ethics"' (2006) 120 Public Health 77-80. It is important to recognise, then, that state responsibility for health will often involve probable rather than certain benefits, or benefits that can be demonstrated to have materialised in a specific case.
66. M. Brazier and John Harris, 'Public Health and Private Lives' [1996] Medical Law Review 171-192.
67. At 207.
68. At 210.
69. See Department of Health, 'Prevention of Infection among Injecting Drug Users' in Hepatitis C Strategy for England (14/02/2005), available at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/Browsable/DH_5026218 (accessed 10/11/08), paras 11-14.
70. Department of Health, Key Principles of Prevention in Prisons, available at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/Browsable/DH_5026224 (accessed 10/11/08), para. 41.
71. For a useful account and assessment of regulatory approaches to public health, including reflection on the role of law, see R. Brownsword, 'Public Health, Private Right, and the Common Law' (2006) 120 Public Health 42-51.
72. See further the analysis in C. Chinkin, 'Health and Human Rights' (2006) 120 Public Health 52-60.
73. See also D. Feldman, 'The Contribution of Human Rights to Improving Public Health' (2006) 120 Public Health 61-70.
74. M. Brazier, supra n. 50
75. Coggon, supra n. 49.
76. O. O'Neill, supra n. 49, p. 36.
77. For example, in G, N, and B, Allen is critical of the Court's conclusion that detained psychiatric patient could not be a 'status' for the purposes of Article 14 ECHR, not least in light of the Shelley decision. Allen also notes as a general observation on this point the difference in the approach of the English courts and that of the ECtHR. N.Allen, supra n. 16.
78. In the context of public health, various such frameworks have been advocated, including, for example, a stewardship model, see e.g. Nuffield Council on Bioethics, supra n. 48
79. K. Jochelson, Nanny or Steward? The Role of Government in Public Health (King's Fund 2005)
80. a Kantian model, see e.g. O.O'Neill, supra n. 49
81. a libertarian model, see e.g. P. Skrabanek, The Death of Humane Medicine and the Rise of Coercive Healthism (St Edmundsbury Press 1994)
82. a republican model, see e.g. B. Jennings, supra n. 49
83. a social justice model, see e.g. M. Powers and R. Faden, supra n. 48
84. a Rawlsian model, see e.g. N.Daniels, Just Health (Cambridge University Press 2008).
85. I am very grateful to Neil Allen, Richard Ashcroft, Angus Dawson and Kirsty Keywood for their helpful comments on an earlier draft of this note. I also gratefully acknowledge the support of the British Academy Postdoctoral Fellowship Scheme.