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Introduction
Currently working on Ethics of Maternal Immunization, in collaboration with the World Health Organization.
Additional affiliations
February 2005 - present
October 1999 - April 2013
October 1994 - December 1999
Publications
Publications (131)
Nudges have been proposed as an effective tool to stimulate influenza vaccination uptake in healthcare workers. However, the success of such nudges in practice is heavily reliant on their acceptance by the intended healthcare worker population, which has not been thoroughly examined to date. This study investigated healthcare workers’ acceptability...
Food and beverage firms are frequently criticised for their impact on the spread of non-communicable diseases like obesity and diabetes type 2. In this article we explore under what conditions the sales and marketing of unhealthy food and beverage products is irresponsible. Starting from the notion of ordinary morality we argue that firms have a du...
The title of the article in the initial online publication was mixed up with copy editing information. The original article has been corrected.
In this paper, we critically review three assumptions that govern the debate on the legitimacy of nudging interventions as a policy instrument: (1) nudges may violate autonomous decision-making; (2) nudges lend themselves to easy implementation in public policy; and (3) nudges are a simple and effective mean for steering individual choice in the ri...
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The responsibility of the food and beverage industry for noncom-municable diseases is a controversial topic. Public health scholars identify the food and beverage industry as one of the main contributors to the rise of these diseases. We argue that aside from moral duties like not doing harm...
During the last decade, the concept of One Health has become the international standard for zoonotic disease control. This call for transdisciplinary collaboration between professionals in human, animal and environmental health has produced several successes in zoonotic disease control, surveillance and research. Despite the lack of a clear definit...
Objectives
Screening has generally been met with enthusiasm, and, in some cases, has been associated with demonstrable reductions in morbidity and mortality. In other cases, the balance of benefits and harms may be less clear and may evolve over time. Recommendations to reduce (de-intensify) or stop screening altogether (de-implementation) have occ...
Nudging is considered a promising approach for behavioural change. At the same time, nudging has raised ethical concerns, specifically in relation to the impact of nudges on autonomous choice. A complexity is that in this debate authors may appeal to different understandings or dimensions of autonomy. Clarifying the different conceptualisations of...
In this article, we explore the debate on corporate citizenship and the role of business in global governance. In the debate on political corporate social responsibility it is assumed that under globalization business is taking up a greater political role. Apart from economic responsibilities firms assume political responsibilities taking up tradit...
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In this article, we critically reflect on the responsibilities that the food industry has for public health. Although food companies are often significant contributors to public health problems (e.g., obesity, type 2 diabetes), the mere possibility of corporate responsibility...
Some screening tests for donor blood that are used by blood services to prevent transfusion-transmission of infectious diseases offer relatively few health benefits for the resources spent on them. Can good ethical arguments be provided for employing these tests nonetheless? This paper discusses-and ultimately rejects-three such arguments. Accordin...
Due to its emphasis on experiential interests, animal ethics
tends to focus on individuals as the sole unit of moral concern. Many issues in animal ethics can be fruitfully analysed in terms of obligations towards individual animals, but some problems require reflection about collective dimensions of animal life
in ways that individualist approache...
There has been increased interest in the potential of maternal immunisation to protect maternal, fetal, and infant health. Maternal tetanus vaccination is part of routine antenatal care and immunisation campaigns in many countries, and it has played an important part in the reduction of maternal and neonatal tetanus. Additional vaccines that have b...
Liitle J, Nicholls SG, Clifford T, Sikora L, Atwere P, Ashcroft R, Newson A, Potter B, Brehaut J, Graham I, Wilson M, Lavis J, Grimshaw J, Verweij M, Dawson A, Coyle D, Kemper A, Botkin J, Dunfield L.
Introduction: Population-based screening programs exist for a range of conditions and populations, and is generally met with enthusiasm, and, in som...
The availability of costly safety measures against transfusion-transmissible infections forces Western countries to confront difficult ethical questions. How to decide about implementing such measures? When are such decisions justified? As a preliminary to addressing these questions, we assessed which concerns shape actual donor blood safety policy...
There is potential for influenza vaccine programmes to make a substantial impact on severe disease in low-resource settings, however questions around vaccine composition and programmatic issues will require special attention. Some countries may benefit from immunization programmes that provide year-round supply of vaccine; however the best way to e...
Due to its emphasis on experiential interests, animal ethics tends to focus on individuals as the sole unit of moral concern. Many issues in animal ethics can be fruitfully analysed in terms of obligations towards individual animals, but some problems require reflection about collective dimensions of animal life in ways that individualist approache...
Given the ethical aspects of vaccination policies and current threats to public trust in vaccination, it is important that governments follow clear criteria for including new vaccines in a national programme. The Health Council of the Netherlands developed such a framework of criteria in 2007, and has been using this as basis for advisory reports a...
The growing prevalence of obesity and related conditions such as Type II diabetes is held by many to be a major public health problem in developed countries, and increasingly in developing countries as well (Popkin et al., 2012). If we wish to tackle this problem, it will be a major task. Individuals will have to change their consumption and exerci...
The contribution briefly introduces the PHM Ethics project and the PHM methodology. Within the PHM-Ethics project, a set of tools and modules had been developed that may assist in the evaluation and assessment of new technologies for personal health monitoring, referred to as "PHM methodology" or "PHM toolbox". An overview on this interdisciplinary...
Novel care-technologies possess a transformational potential. Future care and support may be provided via monitoring technologies such as smart devices, sensors, actors (robots) and Information and Communication Technologies. Such technologies enable care provision outside traditional care institutions, for instance in the homes of patients. Health...
Current thinking on the development of molecular microbial characterisation techniques in public health focuses mainly on operational issues that need to be resolved before incorporation into daily practice can take place. Notwithstanding the importance of these operational challenges, it is also essential to formulate conditions under which such m...
Newborn screening consists of taking a few drops of blood from a baby's heel in the first week of life and testing it for a list of disorders. In the United States and most countries in Europe, newborn screening programs began in the 1960s and 1970s with screening for phenylketonuria (PKU), a rare metabolic disease that causes severe and irreversib...
De GGD Hart voor Brabant krijgt een melding van een acute hepatitis B-infectie bij een alleenstaande, 40-jarige man die bij zijn ouders woont. De anamnese bevat slechts 1 aanwijzing voor een potentiële bron: een callgirl uit Litouwen, die hier in Nederland werkt via een escortbureau. De man heeft al vaker van haar diensten gebruik gemaakt, maar hij...
Op 25 februari 2009 crashte een passagiersvliegtuig van Turkish Airlines vlak voor de landing op Schiphol. Het toestel had 125 passagiers en 7 bemanningsleden aan boord. Negen personen overleden, 120 raakten gewond. De ernstig gewonden onder hen hadden botbreuken, hersenschuddingen en open wonden; ze werden behandeld in 11 ziekenhuizen en 2 traumac...
Een student geneeskunde bleef ondanks meerdere behandelingen maandenlang drager van Meticillineresistente Staphylococcus aureus (MRSA). Het MRSA-dragerschap werd ontdekt nadat de KNO-arts een ooruitstrijk afnam in verband met een oorinfectie. Nadat de student driemaal zonder succes was behandeld werd een contactonderzoek gestart en werden 3 MRSA-po...
Open Peer Commentary to Blumenthal-Barby, J. S., and H. Burroughs. 2012. Seeking better health care outcomes: The ethics of using the “nudge.” American Journal of Bioethics 12(2): 1–10.
In dit artikel stellen we ter discussie of het passend is om in het kader van de hielprikscreening
ouders te informeren over dragerschap bij hun kind en zo ja, om dat dan standaard
te doen of alleen op verzoek. We doen dit aan de hand van de casus sikkelcelziekte,
maar mutatis mutandis geldt hetzelfde voor (dragerschap voor) CF. Daarbij beperken we...
Dit is het laatste artikel in een serie ethische casusbesprekingen.
Het doel van deze serie is om te laten zien hoe ethische
reflectie kan bijdragen aan verantwoorde keuzes in infectieziektebestrijding.
Duurzaamheid wordt geassocieerd met ‘milieuvriendelijk’ en ‘respect voor de natuur’. Als het gaat om duurzaam antibioticagebruik roept dat echter vragen op. Antibiotica zijn immers middelen die we produceren om bepaalde vormen van ‘natuurlijk’ leven, namelijk bacteriën, te bestrijden.
Since 1996 AIDS patients can be treated effectively with combinations of antiretroviral drugs. From the beginning this treatment
has been very expensive and therefore unaffordable and unavailable for millions of patients in developing countries. As a
result, pharmaceutical companies have been criticised because for their price policies and for hold...
WHO have long called for universal vaccination against hepatitis B worldwide. However, in north-western Europe low incidence of the disease has fueled debate whether targeted or universal vaccination strategies are the way to go for. Careful assessment has made it clear that the extensive targeted hepatitis B vaccination programmes in the Netherlan...
During the Parliamentary Enquiry on Fraud in the Dutch Construction Industry, CEOs gave various responses to the accusation
that their companies were involved in fraud. Some responses only offer explanations of what had happened, but other responses
were aimed to take away the blame that fell upon the companies and their executives. In this comment...
Since 1996 AIDS patients can be treated effectively with combinations of antiretroviral drugs. From the beginning this treatment
has been very expensive and therefore unaffordable and unavailable for millions of patients in developing countries. As a
result, pharmaceutical companies have been criticised because for their price policies and for hold...
As more and more new vaccines are developed and brought to the market, governments have to make decisions about which vaccinations to include in public programmes. This paper describes the experience in the Netherlands in developing a framework for assessing whether a vaccination should be included in the National Immunization Programme (NIP). Bear...
One of the societal problems in a new influenza pandemic will be how to use the scarce medical resources that are available
for prevention and treatment, and what medical, epidemiological and ethical justifications can be given for the choices that
have to be made. Many things may become scarce: personal protective equipment, antiviral drugs, hospi...
Vaccinatie van medewerkers in de ouderenzorg resulteert in indirecte bescherming van ouderen die at risk zijn voor een influenza-infectie.
De bereidheid tot vaccinatie is onder medewerkers in de ouderenzorg over het algemeen laag. Wij vinden dat instellingen in
de ouderenzorg de morele plicht hebben om vrijwillige vaccinatieprogramma's tegen influe...
Collective immunization is indispensable for the protection of public health. Yet the common good of attaining high vaccination rates can sometimes conflict with the interests of individuals who consider foregoing vaccination for themselves or for their children. Vaccination policies therefore raise ethical problems. While more and more vaccines ar...
Vaccination of health care workers (HCW) in long-term care results in indirect protection of patients who are at high-risk for influenza. The voluntary uptake of influenza vaccination among HCW is generally low. We argue that institutions caring for frail elderly have the responsibility to implement voluntary programmes for vaccination against infl...
Advances in genomics will open up opportunities in the fields of genetic testing, early diagnosis and disease treatment. While neonatal screening is the field of application par excellencefor these developments, the debate on its potential benefits and drawbacks is mainly theoretically driven and based on the opinions of professionals.
We conducted...
Since decades, neonatal screening has been considered an uncontroversial public health programme. Most industrialised countries screen for some diseases like phenylketonuria (PKU) and congenital hypothyroidism. These conditions can be relatively well treated, either in the form of dietary restrictions, or by supplementing the children with the subs...
American Public Health Association - Annual Meeting
The current neonatal screening program ("the heel prick") involves taking a few drops of blood from almost every newborn in the Netherlands to determine whether the child is suffering from one of three congenital disorders: phenylketonuria, congenital hypothyroid, or adrenogenital syndrome. This study investigated the preferences and views of paren...
Ethical IssuesMedicalization and Concerns about the Good LifeThe Scope of Obligations to Avoid Causing IllnessConclusion
References
If we have a duty not to infect others, how far does it go? This question is often discussed with respect to HIV transmission, but reflection on other diseases like influenza raises a number of interesting theoretical issues. I argue that a duty to avoid infection not only yields requirements for persons who know they carry a disease, but also for...
Invasive pneumococcal disease in childhood causes meningitis, sepsis and pneumonia. Current pneumococcal vaccines are estimated to prevent 50% of Dutch pneumococcal meningitis and 40% of pneumococcal sepsis. In 2001, the Health Council of The Netherlands emphasised the importance of universal pneumococcal vaccination of small children. However, the...
Efficient procedures for obtaining informed (proxy) consent may contribute to high influenza vaccination rates in nursing homes. Yet are such procedures justified? This study's objective was to gain insight in informed consent policies in Dutch nursing homes; to assess how these may affect influenza vaccination rates and to answer the question whet...
A consensus development meeting was held to evaluate whether or not in the Netherlands all requirements were fulfilled for implementation of population screening with FOBT for colorectal cancer, or whether consensus was present that fulfilment by additional research or organisational actions could be obtained within 2-3 years. There was consensus t...
Ethical issues arise in discussion of both the content and implementation of collective immunisation programmes. In this paper we propose and discuss seven principles that may guide reflection and debate in this controversial area. Whilst this paper is not intended to be a final and complete account of the relevant principles for collective immunis...
Thanks to developments in genomics,dietary recommendations adapted to genetic riskprofiles of individual persons are no longerscience fiction. But what are the consequencesof these diets? An examination of possibleimpacts of genetically tailor-made diets raisesmorally relevant concerns that are analogous to(medical-ethical) considerations aboutscre...
Although studies show the relation between influenza immunization of health care workers and the benefits for residents
in nursing homes, compliance to vaccination is still low. In this article we explore and discuss two specific moral
reasons for nursing home professionals to accept vaccination. These special reasons derive from two sources: the
r...
The futility debate may be considered as an effort to provide a clear and justified borderline between physician and patient decision-making authority. In this paper we argue that the search for a definition of futility that provides physicians with a final argument in discussions about life-prolonging treatment, is misplaced. An acceptable and mea...
Influenza vaccination is a common procedure in most Dutch nursing homes and the average vaccination rate is high. This does not mean that there are no discussions concerning policies and practice of influenza immunisation. In a questionnaire we asked nursing home physicians what reasons they encounter in practice for the refusal or withdrawal of va...
Influenza is a major cause of morbidity and mortality
among residents of nursing homes. Many nursing homes
therefore aim at high vaccination rates. To meet this aim
some homes use tacit consent policies, in which the
vaccine is given unless residents or their proxies state that
they do not want it. Such policies deviate from standard
(express) cons...
Unexpected findings in identifiable stored blood samples after analysis without consent: moral arguments for and against disclosure: Obtaining informed consent for using blood samples in research is mandatory. However, sometimes no consent is obtained for analysis of identifiable blood samples in a second study. As a result, a moral dilemma raises...
Many nursing homes have an influenza vaccination policy in which it is assumed that express (proxy) consent is not necessary. Tacit consent procedures are more efficient if one aims at high vaccination rates. In this paper I focus on incompetent residents and proxy consent. Tacit proxy consent for vaccination implies a deviance of standard proxy co...
Preventive Medicine between Obligation and Aspiration is a study of ethical questions regarding mass screening, vaccination, and health policy programmes. These interventions aim to enhance public health but may also constrain personal autonomy and cause harm, and influence our moral views. So far, these issues have hardly been subject to systemati...
Preventive medicine is sometimes criticised as it contributes to medicalization of normal life. The concept ‘medicalization’ has been introduced by Zola to refer to processes in which the labels ‘healthy’ and ‘ill’ are made relevant for more and more aspects of human life. If preventive medicine contributes to medicalization, would that be morally...
Projects
Projects (5)
To develop insects as sustainable feed for a circular economy, we (1) investigate insect production, especially focussing on insect health, insect welfare and the intrinsic value of insects, (2) investigate health and welfare of livestock that is fed with insects and (3) conduct an economic analysis of the value chain development, i.e. the development of an integrated set of activities to deliver a valuable product. To achieve our aim, an interdisciplinary research approach (ethics, economics, biology), and the involvement of a wide range of stakeholders are required.
Fly larvae are important insects to be used as feed because they have an excellent nutritional quality and can be reared sustainably on a variety of organic waste streams. Thus, we focus on two fly species that are currently produced as feed for livestock: the Black Soldier Fly (BSF) (Hermetia illucens) and the House Fly (HF) (Musca domestica).
To provide a conceptual analysis and ethical justification(s) of different kinds of vaccination, focusing on relevant self- and other-directed motives; especially in relation to the question of whether—and to what extent—individuals ought to vaccinate and governments ought to regulate vaccination for the sake of others.