Università Vita-Salute San Raffaele

Professore a contratto, Faculty of Philosophy

Thesis Title: Well-being: an inquiry into its natural boundaries

About

Research interests (short): equality of opportunity, enhancement, bioethics of genetics, justice in health care, human rights, Rawls.

Research interests (long).

1) The conceptual and ethical foundations of justice in health.

“Spheres of justice” is the name of my proposed approach of justice and health. It combines Rawls's Fair Equality of Opportunity (Rawls), with an influential account of basic rights (Shue), and enforced beneficence (Buchanan) in order to provide a pluralistic alternative to current socio-structural accounts of health justice (Daniels, Peter).



2) Social justice and the transmission of social disadvantage through the epigenome.

The introduction of "Social determinants of heath: the solid facts" (Marmot/Wilkinson) states that

"The new discoveries on the human genome are exciting in the promise they hold for advances in the understanding and treatment of specific diseases. but however important individual genetic susceptibilities may be, the common causes of the ill health that affects populations are environmental: they come and go far more quickly than the slow pace of genetic change because they reflect the changes in the way we live."

The goal of my research is exploring how emerging evidence of "social epigenetics" will challenge the received view, which reflects the traditional "nature/nurture" dichotomy that biology is helping us to overcome. 

Epigenetics are the study of  heritable changes of gene expression that are independent from the underlying genetic (i.e. DNA) sequence. They are sensitive to environmental clues, a feature that led some commentators to claim that epigenetics may to a certain extent vindicate some Lamarckian theses about inheritance of acquired traits.

Social epigenetics explores correlation and causation between epigenetic phenomena and social phenomena, including the distribution of the social determinants of health. Health justice requires a synthesis of the traditional epidemiological perspective emphasizing the social determinants of health and upcoming discoveries in the field of social epigenetics.

3. The human right to health.

The concept of a human right is not popular among philosophers. Many philosophers think that the currently influential political and juridical doctrine of universal human rights stretches the concept of "a right" too far, leading to "right inflation" and a  de-evaluation of the currency.

Such worries are exemplified in the current debate about the right to health. Given the moral importance of what is at stake, I believe that philosophical skepticism ought to be replaced with a more pragmatic view of the discursive role of the concept of human rights in international politics (Beitz, Wolff). Conceptual reform should not be based on a-priori philosophical considerations (that are often dogmatic) but on a more modest view of the role of political philosophy, viewed as a facilitator of the possibility of "overlapping consensus" among different "comprehensive doctrines".

The most interesting aspect of research on the human right to health regards its connection with social justice.
Claiming the human right to health against the state - when only a possibility for citizens commanding significant resources to buy legal protection - can lead to greater social inequality if it undermines the ability by the state to ensure greater social equality in the distribution of health-care resources. Since social inequality is damaging to health outcomes, the advocacy of the human right to health in an unequal society can undermine its own rationale.

On the other hand, respect for other human rights, including socio-economic rights, tends to promote better health outcomes, thus leading indirectly to the fulfillment of the human right to health.

4. Genetic enhancements.

Some people object against the possibility of modifying inheritable genetic characteristics for the better, beyond repairing genetic diseases.

I maintain that there is no principled moral distinction between genetic enhancements and other social goods.

It does not follow, however, that the decision to allow (or even promote) the development of human enhancements should be taken lightly.

The main argument against allowing unlimited freedom to manipulate the genome in ways that are authentically enhancing or neutral is the justice argument. Genetic inequalities are not morally special as such, but unlike other social inequalities that we allow or promote, there are no stable social compromises governing their generation.

Philosophy ought to interrogate itself about the broad institutional framework in which the liberty to enhance oneself and children can be exercised without compromising social fairness and stability.