Moral frameworks for public health, with Nathalie Egalité and Allan Arturo González Estrada
This seminar examines some of the moral frameworks proposed or implemented for public health in two different contexts: those put forward by psychiatrist and philosopher Frantz Fanon in the 1950s-60s, and by philosophers shaping public health policy in 19th and early 20th century Costa Rica.
Colonial Algeria, Social Medicine: Moral Imperatives in Fanon’s Physician Writing
A key figure in postcolonial thought, psychiatrist Frantz Fanon wrote extensively about the effects of social determinants on the health of patients under his care. Theorising on the impacts of colonialism, war, economic marginalisation, and repressive state interventions in Algeria, he further denounced the actions and attitudes of his physician colleagues who collectively opposed social change. This paper argues that distinct moral imperatives pertaining to public health and social medicine can be discerned in Fanon’s literary treatment of patients. Close reading reveals that Fanon perceived duties and responsibilities towards patients, health institutions, and the whole of society. Fanon articulated a moral vision for revolutionary social medicine. Empowering patients through culturally informed care, he reformed the hospital as a space for healing, community and solidarity. He broke ground recognising racism as a public health issue. Moreover, he advocated for political liberation to improve material conditions of care. Fanon’s texts, embedded in a larger transformative project, remain morally instructive for contemporary evaluations of writing about public health.
Epidemics and ethics in Costa Rica
A young Costa Rican republic witnessed two significant outbreaks of disease within the first 35 years of declaring independence. During that time, Costa Rica did not have an ethical framework for managing such significant public health crises. One of the few philosophers of that era in Costa Rica was José Maria Castro Madriz, first president of Costa Rica, with a PhD in Philosophy: Castro Madriz drew his inspiration from French philosophers like Jean Jacques Burlamaqui, and his ideas created a moral framework for many of the significant interventions of the mid-nineteenth century. By the 20th century, new outbreaks challenged a now more established state, and public institutions could confront these health crises by drawing on novel ideas like Marxism. But these public health measures were not easily accepted by many Costa Rican citizens, creating significant conflict between the state and the citizenry. The similarities of the ethical conflicts between the state and the citizens, bears a striking resemblance to the world’s most recent public health crisis: SARS-CoV-2.
Nathalie Egalité is the inaugural John P. Murphy Fellow in Medical Humanities at Cleveland Clinic Lerner College of Medicine. Trained in philosophical ethics and with a PhD in Medical Humanities from the University of Texas Medical Branch, she has conducted research on projects at the intersection of research, clinical care, and public health and has published on ethical issues in genetics, mental health, and racism in medicine.
Allan Arturo González Estrada
Allan Arturo González Estrada is the head of the Philosophy Department at Universidad Nacional, Costa Rica. He has a Masters in Bioethics and a PhD in Philosophy, and carries out research on applied ethics, bioethics, philosophy of mind, and epistemology.
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