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Abstract
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This article refers to:
The PHERCC Matrix. An Ethical Framework for Planning, Governing, and Evaluating Risk and Crisis Communication in the Context of Public Health Emergencies
Spitale, G., F. Germani, and N. Biller-Andorno. 2024. The PHERCC matrix. An ethical framework for planning, governing, and evaluating risk and crisis communication in the context of public health emergencies. The American Journal of Bioethics 24 (4):67-82. doi: 10.1080/15265161.2023.2201191.
Spitale et al. (Citation2024) address a public health ethics question of great importance: How should governments communicate with the public during public health emergencies? The article highlights several distinct facets of public health communication and proposes a variety of solutions for avoiding common pitfalls that arise during "Public Health Emergency Risk Crisis and Communication" (PHERCC, to follow the authors). We applaud the authors taking a serious and much-needed look at this question. In what follows, we raise a few critical comments about their framework and ethical tradeoffs in PHERCC.
Our first critical comment concerns a methodological assumption underpinning the framework--namely, that the three fundamental values in the framework would not conflict in the context of PHERCC:
We defined the PHERCC process, we identified relevant ethical principles, geared toward guaranteeing respect for autonomy and fairness across the whole process, and we propose the application of said principles in each step. There are two assumptions with meta-ethical relevance in this reasoning. First, that there are no tradeoffs between effectiveness, fairness, and autonomy; on the contrary, that aiming for fairness and respect for autonomy can increase the effectiveness of PHERCC actions. (Spitale et al. Citation2024, 73, emphasis added)
We were intrigued by this assumption. After all, public health ethics frameworks often focus on tradeoffs between values such as effectiveness, fairness, and autonomy. Think, for instance, of Childress et al.'s influential article, "Public Health Ethics: Mapping the Terrain" (Childress et al. 2002), where a fundamental "practical question" that needs to be addressed is "how can we resolve conflicts between [general moral considerations, such as producing benefits or respecting autonomous choices and actions]," (Childress et al. Citation2002, 171). We wondered whether the authors believed there were features about PHERCC that warranted optimism that value conflict would not arise--despite the prevalence of such conflict in other areas of public health policymaking. We were especially curious about the assumption of congruence because the authors themselves hint at one such potential ethical conflict. They discuss the importance of respecting privacy--presumably grounded in considerations of respect for autonomy or fairness understood as respect for basic liberties--but also acknowledge that in emergencies, violations of privacy might yield significant health gains, which utilitarian reasoning would ostensibly support (Spitale et al. Citation2024, 67). This discussion of privacy--and the assertion that PHERCC efforts must incorporate privacy protections--seems to assume that there can be tradeoffs between privacy and public health effectiveness and therefore these tradeoffs must be managed. They recommend that PHERCC should align with the Siracusa Principles, which articulate standards that must be met when governments respond to a public emergency in a way that restricts or limits human rights; for example, one standard is that "in applying a limitation, a state shall use no more restrictive means than are required for the achievement of the purpose of the limitation." (American Association for the International Commission of Jurists 1984). The Siracusa Principles, themselves, assume that there can be tradeoffs between having a more effective emergency response and human rights; the Principles specify that certain ways of responding to those tradeoffs--for example, limiting rights more than is strictly necessary--are unacceptable.
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