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Individual Responsibility for Promoting Global Health: The Case for a New Kind of Socially Conscious Consumption

Published online by Cambridge University Press:  01 January 2021

Nicole Hassoun
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Abstract

The problems of global health are truly terrible. Millions suffer and die from diseases like tuberculosis, HIV/AIDS, and malaria. One way of addressing these problems is via a Global Health Impact labeling campaign (http://global-health-impact.org/). If even a small percentage of consumers promote global health by purchasing Global Health Impact products, the incentive to use this label will be substantial. One might wonder, however, whether consumers are morally obligation to purchase any these goods or whether doing so is even morally permissible. This paper suggests that if the proposal is implemented, purchasing Global Health Impact labelled goods is at least morally permissible, if not morally required. Its argument should, moreover, be of much more general interest to those considering different kinds of ethical consumption.

Type
Independent Articles
Information
Journal of Law, Medicine & Ethics , Volume 44 , Issue 2: Ethical and Legal Issues in Pediatrics , Summer 2016 , pp. 319 - 331
Copyright
Copyright © American Society of Law, Medicine and Ethics 2016

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References

Boldrin, M. and Levine, D., Against Intellectual Monopoly (Cambridge: Cambridge University Press, 2008).Google Scholar
Center for Disease Control, World TB Day, March 24th 2005, 2005, Division of Tuberculosis Elimination, available at <http://www.cdc.gov/nchstp/tb/WorldTBDay/2005/resources_progress_elimination.htm> (last visited May 2, 2008); UNICEF, “Millennium Development Goals: Combat AIDS/HIV, Malaria, and Other Diseases,” available at <http://www.unicef.org/mdg/disease.html> (last visited April 29, 2016) and UNAIDS, World AIDS Day 2004: Women, Girls, HIV and AIDS (2004), AIDS Epidemic Update, UNAIDS, available at <http://www.unaids.org/wad2004/report.html> (last visited May 2, 2008).+(last+visited+May+2,+2008);+UNICEF,+“Millennium+Development+Goals:+Combat+AIDS/HIV,+Malaria,+and+Other+Diseases,”+available+at++(last+visited+April+29,+2016)+and+UNAIDS,+World+AIDS+Day+2004:+Women,+Girls,+HIV+and+AIDS+(2004),+AIDS+Epidemic+Update,+UNAIDS,+available+at++(last+visited+May+2,+2008).>Google Scholar
Hassoun, N., “Global Health Impact,” Developing World Bioethics, 12, no. 3 (2012):121-134; Hassoun, N., Globalization and Global Justice: Shrinking Distance, Expanding Obligations (Cambridge: Cambridge University Press, 2012).Google Scholar
Id.; Hassoun, N., “The Global Health Impact Index,” PLoS ONE 10, no. 12 (2015): e0141374.CrossRefGoogle Scholar
See supra note 2 and see C. Jaap. 2015. “Rxto–OTC Switches Represent Huge Market Potential. Pharmaceutical Development Group,” available at <http://www.pharmdevgroup.com/rx-to-otc-switches-represent-huge-market-potential/> (last visited April 29, 2016); VisionGain, “The Global OTC Pharmaceutical Market 2010-2025,” 2010, available at < https://www.visiongain.com/Report/500/The-Global-OTC-Pharmaceutical-Market-2010-2025> (last visited May 5, 2016).+(last+visited+April+29,+2016);+VisionGain,+“The+Global+OTC+Pharmaceutical+Market+2010-2025,”+2010,+available+at+<+https://www.visiongain.com/Report/500/The-Global-OTC-Pharmaceutical-Market-2010-2025>+(last+visited+May+5,+2016).>Google Scholar
Hassoun, N., “The Global Health Impact Malaria Index,” American Journal of Tropical Medicine and Hygiene, 15-0409 (2016); Hassoun, supra note 4.Google Scholar
For support, see id.; Hassoun, N., “The Global Health Impact Index,” PLoS ONE 10, no. 12 (2015a): e0141374; Hassoun, N., Global Health Impact: Extending Access on Essential Medicines, (Oxford: Oxford University Press, under-contract); see Hassoun, supra note 4.Google Scholar
For defense, see: Hassoun, N., “Human Rights and the Minimally Good Life,” Res Philosophica 90, no. 3 (2013): 413-438; see Hassoun, supra note 3; Hassoun, N., “The Human Right to Health?” Philosophy Compass 10, no. 4 (2015): 275–283.Google Scholar
Daniels, N., Just Health: Meeting Health Needs Fairly (New York: Cambridge University Press, 2008).Google Scholar
Pecoul, B., Chirac, P., Trouiller, P. and Pinel, J., “Access to Essential Drugs in Poor Countries A Lost Battle?” The Journal of the American Medical Association 281, no. 4 (1999): 361-367.Google Scholar
I set aside for the purposes of this paper any questions about the corporate agency of companies, but see: Hassoun, supra note 3.Google Scholar
If this is not true of every company, the argument here can be modified appropriately.Google Scholar
t'Hoen, E., “TRIPS, Pharmaceutical Patents and Access to Essential Medicines: Seattle, Doha and Beyond,” Chicago Journal of International Law 3, no. 1 (2002): 27-46.Google Scholar
Barnard, D., “In the High Court of South Africa, Case No. 4138/98: The Global Politics of Access to Low-Cost AIDS Drugs in Poor Countries,” Kennedy Institute Ethics Journal 12, no. 2 (2002): 159-174.CrossRefGoogle Scholar
Office of the United States Trade Representative, “Schwab Announces Results of Chile IPR Review, Cites Deteriorating Review,” 2007, available at <https://ustr.gov/archive/Document_Library/Press_Releases/2007/January/Schwab_Announces_Results_of_Chile_IPR_Review,_Cites_Deteriorating_Performance.html> (last visited May 5, 2016); McDermott, J., “A Morality Tale on AIDS,” Address by Congressman Jim McDermott, 2006, available at <www.house.gov/mcdermott/sp060619.html> (last visited June 20, 2006); Global Health Watch, Global Health Watch 2005-2006: An Alternative World Health Report (New York: Zed Books, 2005): at 106.Google Scholar
De Wet, P.. 2014. “Motsoaledi: Big Pharma's ‘Satanic’ Plot is Genocide,” Guardian & Mail, January 17, 2014, available at <http://mg.co.za/article/2014-01-16-motsoaledi-big-pharmassatanic-plot-is-genocide> (last visited May 5, 2016). (last visited May 5, 2016).' href=https://scholar.google.com/scholar?q=De+Wet,+P..+2014.+“Motsoaledi:+Big+Pharma's+‘Satanic’+Plot+is+Genocide,”+Guardian+&+Mail,+January+17,+2014,+available+at++(last+visited+May+5,+2016).>Google Scholar
M. Angell, The Truth about the Drug Companies: How They Deceive Us and What To Do about It (New York: Random House, 2004); Faunce, T. and Lexchin, J., “‘Linkage’ Pharmaceutical Evergreening in Canada and Australia,” Australia & New Zealand Health Policy 4 (2007): 8; see Boldrin and Levine, supra note 1, at 241-276; Saul, S., “The Generic Drug Scandal,” New York Times, June 18, 2008, available at <http://www.nytimes.com/2008/06/18/business/worldbusiness/18iht-19drug.13813132.html?_r=3&scp=4&sq=Hatch-Waxman%20Act&st=cse&> (last visited April 29, 2016); Pollack, A., “Biotechnology Companies Try to Ward Off Generic Drugs,” New York Times, December 28, 2000, available at <http://www.nytimes.com/2000/12/28/business/biotechnology-companies-try-to-ward-off-generic-drugs.html> (last visited April 29, 2016); Schacht, W. and Thomas, J., “The ‘Hatch-Waxman’ Act: Selected Patent-Related Issues,” Congressional Research Service Report for Congress, The Library of Congress, 2002, available at <http://congressionalre-search.com/RL31379/document.php?study=The+Hatch-Waxman+Act+Selected+Patent-Related+Issues> (last visited April 29, 2016); Mossinghoff, G., “Overview of the Hatch-Waxman Act and Its Impact on the Drug Development Process,” Food and Drug Law Journal 54, no. 2 (1999): 187-194; Pollack, A., “Orphan Drug Law Spurs Debate,” New York Times, April 30, 1990, available at <http://www.nytimes.com/1990/04/30/business/orphan-drug-law-spurs-debate.html?pagewanted=all&src=pm> (last visited April 29, 2016).Google Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
Id. Not all orphan drugs are imporant medicines as this paper uses the term. Moreover, this paper uses “important medicines” to refer to medicines for which there is great need in developing countries, not necessarily those on the WHO's essential medicines list.Google Scholar
See supra note 17: Angell; Faunce and Lexchin; Boldrin and Levine, at 241-276; Saul; Pollack; Schacht and Thomas; Mossinghoff; and Pollack.Google Scholar
Flynn, S., Hollis, A., and Palmedo, M., “An Economic Justification for Open Access to Essential Medicine Patents in Developing Countries,” Journal of Law, Medicine & Ethics 37, no. 2 (2009): 184-208.Google Scholar
Id.Google Scholar
Id.Google Scholar
Chen, S. and Ravallion, M., “How Have the World's Poorest Fared since the Early 1980s?” World Bank Research Observer 19 (2004): 141-169.CrossRefGoogle Scholar
See id.; Flynn et al., supra note 23; Boldrin and Levine, supra note 1.Google Scholar
See Global Health Watch, supra note 15.Google Scholar
See Barnard, supra note 14; Steinbrook, R., “Closing the Affordability Gap for Drugs in Low-Income Countries,” New England Journal of Medicine 357, no. 20 (2007): 1996-1999.CrossRefGoogle Scholar
See t'Hoen, supra note 13.Google Scholar
World Trade Organization (WTO), “TRIPS and Public Health,” 2006, available at <http://www.wto.org/english/tratop_e/trips_e/pharmpatent_e.htm> (last visited April 29, 2016); Goodwin, P., “Right Idea, Wrong Result - Canada's Access to Medicines Regime,” American Journal of Law & Medicine 34, no. 4 (2006): 567-584.Google Scholar
Beall, R. and Kuhn, R., “Trends in Compulsory Licensing of Pharmaceuticals Since the Doha Declaration: A Database Analysis,” PLoS Medicine 9, no. 1 (2012): e1001154.CrossRefGoogle Scholar
Some note that the TRIPS agreement does not greatly hinder access to essential medicines as defined by the WHO. See Attaran, A., “How Do Patents and Economic Policies Affect Access to Essential Medicines in Developing Countries?” Health Affairs 23, no. 3 (2004): 155-166. This paper does not use this (cost-sensitive definition) of “important medicines” and patents do restrict access to important drugs for diseases like HIV/AIDS. See World Health Organization. “Access to AIDS Medicines Stumbles on Trade Rules,” Bulletin of the World Health Organization, 2006, available at <http://www.who.int/bulletin/volumes/84/5/news10506/en/> (last visited April 29, 2016).CrossRefGoogle Scholar
This does presume that agents besides states can violate rights, but the conception of rights at issue may still be institutional. See discussion below.Google Scholar
Nickel, J., Making Sense of Human Rights, 2nd ed. (New York: Wiley, 2008); see Hassoun, supra note 3.Google Scholar
See Hassoun (2013), supra note 8; Hassoun, N., Globalization and Global Justice: Shrinking Distance, Expanding Obligations, (Cambridge: Cambridge University Press, 2012); Hassoun, (2015), supra note 8.Google Scholar
It is more plausible that, to violate rights, patents have to make people worse off than they could otherwise be. This paper will, however, set aside the question of whether or not any “oughtimplies-can” clause is appropriate for constraining human rights claims.Google Scholar
See, for instance, Graboswki, H., “Patents, Innovation and Access to New Pharmaceuticals,” Journal of International Economic Law 5, no. 4 (2002): 849-860.CrossRefGoogle Scholar
See Boldrin and Levine, supra note 1, at 241-276; Bessen, J., Patent Failure: How Judges, Bureaucrats, and Lawyers Put Innovators at Risk (Princeton: Princeton University Press, 2008).Google Scholar
Ibid.Google Scholar
See Bessen, supra note 39.Google Scholar
Even in developing countries it is not clear that stronger patent protection will spur innovation. See Shah, A. K., Warsh, J., and Kesselheim, A., “The Ethics of Intellectual Property Rights in an Era of Globalization,” Journal of Law, Medicine, & Ethics 41, no. 4 (2013): 841-851, at 848.CrossRefGoogle Scholar
Pogge, T., World Poverty and Human Rights, 2nd ed. (Cambridge: Polity Press, 2008).Google Scholar
Ibid.Google Scholar
Trouiller, P., Torreele, E., Olliaro, P., White, N., Foster, S., Wirth, D., and Pécoul, B., “Drugs for Neglected Diseases: A Failure of the Market and a Public Health Failure?” Tropical Medicine and International Health 6, no. 11 (2001): 945-951, at 11.Google Scholar
Towse, A. et al., Drugs and Vaccines for Developing Countries, Office of Health Economics, available at <https://faculty.fuqua.duke.edu/~dbr1/research/developing-Oxford.pdf> (last visited May 17, 2016).Google Scholar
Laxminarayan, R., Bhutta, Z., Duse, A., Jenkins, P., O'Brien, T., Okeke, I. N., Pablo-Mendez, A., and Klugman, K. P., “Drug Resistance,” in Jamison, D., Breman, J., Measham, A., Alleyne, G., Claeson, M., Evans, D., Jha, P., Mills, A., and Musgrove, P., eds., Disease Control Priorities in Developing Countries (Washington, D.C: World Bank, 2006): 1031-1051; Choe, J., “Fewer Drugs, More Superbugs: Strategies to Reverse the Problem,” The Alliance for the Prudent Use of Antibiotics 30, no. 1 (2011): 1.Google ScholarPubMed
Hollis, A. and Pogge, T., Making New Medicines Accessible for All: A Report of Incentives for Global Health, The Health Impact Fund, 2008, available at <http://machif.com/wp-content/uploads/2012/11/hif_book.pdf> (last visited February 1, 2011).Google Scholar
Hubbard, T. and Love, J., “A New Trade Framework for Global Healthcare R&D,” PLoS Biology 2, no. 2 (2004): e52.Google Scholar
Médecins Sans Frontières (MSF), “Untangling the Web of Antiretroviral Price Reductions,” 16th Edition, July 2013, available at <http://www.msfaccess.org/sites/default/files/AIDS_Report_UTW16_ENG_2013.pdf> (last visited April 29, 2016).+(last+visited+April+29,+2016).>Google Scholar
It is obviously impossible to fully defend this claim here. Nonetheless, I believe it is unlikely that companies could argue that their obligations to share-holders — or other stake-holders — outweigh, or over-ride, obligations to respect the basic human rights at issue.Google Scholar
Significant argument would be necessary to show that these apparent rights violations are spurious or justified.Google Scholar
See Hassoun, supra note 11.Google Scholar
See Nickel, supra note 35. The leaves the question of what constitutes adequate protection quite open; it need only preclude protections that fail to prevent widespread deprivation.Google Scholar
Moreover, companies may sign corporate codes of conduct and have something like a duty of fair play to extend access on essential medicines to the poor given that they are granted monopoly protection of new inventions via patents. See Hsieh, N., “Voluntary Codes of Conduct For Multinational Corporations: Coordinating Duties of Rescue and Justice,” Business Ethics Quarterly 16, no. 2 (2006): 119-135; UN Global Compact, The Ten Principles (New York, United Nations, 2013). United Nations Global Compact. 2013. “Overview of the UN Global Compact.” New York, NY: United Nations.Google Scholar
See Hollis and Pogge, supra note 48, at Ch. 6.Google Scholar
Perhaps some of the arguments below about the obligations of individual consumers can be extended to say much more about companies' individual obligations.Google Scholar
See Gosselin, A., Global Poverty and Individual Responsibility (Lanham: Rowman & Littlefield, 2009); Pogge, supra note 43; Wenar, L., “Responsibility and Severe Poverty,” in Pogge, T., ed., Freedom from Poverty as a Human Right (New York: United Nations Educational, Scientific and Cultural Organization, 2007): at 255-274.Google Scholar
Further philosophical work is necessary here to state this more precisely. Perhaps saying something like “at least one of its major causal determinants” will suffice if one can explain what counts as “major.”Google Scholar
See Boldrin and Levine, supra note 1, at 241-276.Google Scholar
See Bessen, supra note 39.Google Scholar
See Nickel, supra note 35; Hassoun, supra note 11.Google Scholar
Id. (Nickel). The idea here is not just that capacities but social role matters and this seems to drive much of the discussion of companies' responsibilities with respect to access to important medicines, in particular. See Lee, J.-Y. and Hunt, P., “Human Rights Responsibilities of Pharmaceutical Companies in Relation to Access to Medicines,” Journal of Law Medicine & Ethics 40, no. 2 (2012): 220-233.Google Scholar
Id. (Nickel).Google Scholar
Id. (Nickel).Google Scholar
See Lee and Hunt, supra note 63.Google Scholar
Significant philosophical work is necessary to explain what being well-placed amounts to exactly. Here we are only concerned with the right to access important medicines. If, however, we were concerned to promote health more generally, some institutions may be well-placed to help people access essential medicines, while others are well-placed to help them access the social determinants of health. All things considered, those who can help people access the social determinants of health might have greater responsibility for taking action given the importance of these determinants to promoting health. Though, presumably, institutions well-placed to promote access to important medicines should still do so.Google Scholar
See Hassoun, supra note 3.Google Scholar
See Hassoun, supra note 11.Google Scholar
The idea that, in principle, the obligations correlative to all rights are held universally, or collectively, helps respond to Onora O'Neil's worry that there are no in-principle obligation bearers for positive rights. See O'Neill, O., “The Dark Side of Human Rights,” International Affairs 81, no. 2 (2005): 427-439; see Hassoun, supra note 3.Google Scholar
This line of argument is suggested by Thomas Dunfee's nice adaptation of Peter Singer's pond argument to the case of corporations' duties to respond to the AIDS epidemic. See Dunfee, T., “Do Firms with Unique Competencies for Rescuing Victims of Human Catastrophes Have Special Obligations? Corporate Responsibility and the AIDS Catastrophe in Sub-Saharan Africa,” Business Ethics Quarterly 16, no. 2 (2006): 185-210.Google Scholar
Of course, these can always be improved: see Shah, N., “Pharmaceutical Supply Chains: Key Issues and Strategies for Optimisation,” Computers and Chemical Engineering 28 (2004): 929-941.CrossRefGoogle Scholar
See Lee and Hunt, supra note 63.Google Scholar
See the Global Fund to Fight Aids, Tuberculosis, and Malaria, 2013, available at <http://www.theglobalfund.org/en/> (last visited April 29, 2016); International Federation of Pharmaceutical Manufacturers & Associations, 2013, available at <http://www.ifpma.org/> (last visited May 5, 2016).+(last+visited+April+29,+2016);+International+Federation+of+Pharmaceutical+Manufacturers+&+Associations,+2013,+available+at++(last+visited+May+5,+2016).>Google Scholar
The average company making a contribution is alleviating <2% of the burden of these diseases. A rough rule of thumb for assigning responsibility might be this: Other things equal, if essential medicines received their proportional share of research and development funding, what percentage of the global burden of disease would each company have to alleviate for the companies together to address the access problem? Back of the envelop calculations of contributions suggest that it is unlikely that most companies are fulfilling their obligations for the diseases in the index. See: Hassoun, supra note 6; Hassoun, supra note 4.Google Scholar
Murphy, L., “Institutions and the Demands of Justice,” Philosophy & Public Affairs 27, no. 4 (1998): 251-291.CrossRefGoogle Scholar
Moreover, many consumers vote for, and support, governments that help extend rights-violating intellectual property rights internationally and set research and development priorities that do not address global needs.Google Scholar
I set aside hard questions about merely doing vs. intending actions that do have bad consequences (or would otherwise violate rights).Google Scholar
Though patents do restrict access to some drugs, there are many different HIV/AIDS medicines under patent, for instance. See WHO, supra note 33.Google Scholar
The conclusion that individuals are implicated in rights violations would follow on many different accounts of responsibility. It will suffice for this paper's purposes if the kind of responsibility at issue is some kind of moral liability.Google Scholar
Gallaugher, J., “Data Asset in Action: Technology and the Rise of Wal-Mart,” Information Systems: A Manager's Guide to Harnessing Technology, 2010, available at <http://www.flatworldknowledge.com/pub/gallaugher/41219#ftn.fwk-gallaugher-fn11_042> (last visited April 30, 2016).Google Scholar
Moreover, it is plausible that we are all implicated in the causal process by which companies are able to violate rights and fail to fulfill their moral obligations – though we can describe this process many ways. See: Lepora, C. and Goodin, R., On Complicity and Compromise (Oxford: Oxford University Press, 2013).Google Scholar
Ostrom, E., Governing the Commons (Cambridge: Cambridge University Press, 1990).Google Scholar
Walton, A., “The Common Arguments for Fair Trade,” Political Studies 61, no. 3 (2013): 691-706.Google Scholar
It is also unfortunate that it is the sickest members of developed countries that will bear the burden but, again, our world is not ideal.Google Scholar
Hussain, W., “Is Ethical Consumerism an Impermissible Form of Vigilantism?” Philosophy and Public Affairs 40, no. 2 (2012): 111-143, at 123, nt. 16.CrossRefGoogle Scholar
Id.Google Scholar