Summary

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During crises, such as pandemics or environmental disasters, governments must act swiftly to prevent disease and death, often with incomplete information. The principle of proportionality serves as the established legal and ethical standard for navigating this balance. However, during times of severe crisis and uncertainty, determining the proportionality of public health actions is extremely complex, particularly when decisions are made without conclusive evidence or uniformly applicable international standards.

In Proportionality, Nikola Biller-Andorno, Julian W. März, Corine Mouton-Dorey, and Stéphanie Dagron bring together 49 scholars and practitioners from around the world to explore how proportionality can guide and shape decision-making under crisis conditions. As they argue, a fundamental challenge in this domain is reconciling the obligation to foster population health through disease prevention, detection, and intervention with the imperative to respect and protect individual rights, including autonomy and privacy. Thus, the chapters in this volume highlight the principle and the process of proportionality, in order to guide decision-making and apply proportionate measures in the face of future public health crises, whether infectious, ecological, or linked to armed conflict. This volume not only develops the key concept of proportionality from the perspectives of law, human rights, philosophy, public health ethics, and political science, but it also looks at specific proportionality issues, such as freedom of movement, gender equity, children's rights and disease prevention.

Examining how governments and health authorities navigate the delicate balance between protecting public health and safeguarding individual rights in times of crisis, Proportionality provides a comprehensive analysis on the topic. Further, it aims to guide the development of public health policies that are effective, equitable, and respectful of human rights.

Author Biography

Nikola Biller-Andorno is Chair of Biomedical Ethics and Director of the Institute for Biomedical Ethics and History of Medicine at the University of Zurich, Switzerland. Having trained as a physician and philosopher, she specializes in biomedical ethics and has held positions at University of Göttingen (DE), the World Health Organization, and the Charité, Berlin (DE). Between 2012 and 2014, she was a visiting professor and Commonwealth Fund Harkness Fellow at Harvard Medical School and Harvard School of Public Health, exploring ethical issues at the interface of healthcare management and economics; from 2016 to 2020, she held a fellowship at the Collegium Helveticum, a Swiss Institute of Advanced Studies, focused on the digital transformation of medicine. As a Past-President of the International Association of Bioethics and as Chair of the WHO Collaborating Centre Network for Bioethics, she has a keen interest in the global dimension of the key bioethical challenges our societies face.

Julian W. März is a physician, lawyer, and bioethicist currently working as a research fellow at the Institute of Biomedical Ethics and History of Medicine and the University Research Priority Program Innovative Therapies in Rare Diseases (ITINERARE) of the University of Zurich. Before joining the University of Zurich, he worked for the Division of Health Economics at the German Cancer Research Center (DKFZ) in Heidelberg for three years, where he wrote his doctoral thesis in medicine. In parallel, he has worked as a research affiliate in pharmaceutical law for the Centre for Law, Medicine and Life Sciences of the University of Cambridge and as a lecturer in public health law at the IEP de Paris, and has been a visiting scholar at the Dutch Center for RNA Therapeutics (DCRT) and the Faculty of Law of the University of Cambridge. In October 2024, März was appointed as a member of the World Health Organization (WHO) Research Ethics Review Committee (ERC) for the 2024 - 2027 term. In parallel, he is acting as lead scientific advisor for the review and reform process of the Federal Law on the Genetic Testing of Humans (GUMG) by the Swiss federal government.

Corine Mouton-Dorey is a physician and ethicist. After working as a cardiologist and researcher on myocardial metabolism in France (MD, post-graduate diploma in cardiology, DEA in cellular and molecular biology), Mouton-Dorey pursued research in the pharmaceutical industry in Paris, Frankfurt, and London (MBA at London Business School). She returned to the academic world, first at the Swiss Federal Institute of Technology in Zurich (Institute of Clinical Nutrition), then at the University of Neuchâtel (Masters in Health Law) and at the University of Zurich (UZH) at the Institute of Biomedical Ethics and History of Medicine (IBME), where she obtained her doctorate in biomedical ethics and law (new ethical framework for patient data). She coordinated a multidisciplinary approach to digital health as part of UZH's Digital Society Initiative. She is an affiliated researcher at the Institute of Biomedical Ethics and History of Medicine at the Medical Faculty of the University of Zurich. She is interested in qualitative research, social ethics and the application of care ethics to ecology.

Stéphanie Dagron is Professor of law at the University of Geneva with a special expertise in international social security law and global health law. She has a double appointment at the Faculty of Law and the Faculty of Medicine and is affiliated with the Global Studies Institute. Since 2013, Dagron practices international law in her work as a consultant for the World Health Organization (WHO) in the fields of tuberculosis, human rights, research ethics and infectious diseases. She is a member of the Swiss National Advisory Commission on Biomedical Ethics. Dagron's research focuses on the role of international law as an indispensable instrument to address global health issues and reinforce social justice.

Preface -Jerome Amir Singh
Foreword
Editors and Contributors
Notes on Editors
Notes on Contributors
Introduction
Chapter 1: Proportionality and Uncertainty in Physical Distancing Policies in U.S. States
-Justin Bernstein, Athmeya Jayaram, Brian Hutler, Jeff Jones, Travis Rieder, Anne Barnhill
Chapter 2: Proportionality and Resource Allocation in a Pandemic: The Example of Chile
-Rodrigo López Barreda and Luca Valera
Chapter 3: Proportionality in Public Health Ethics, Fear, and State of Exception: A Critical Narrative Approach -Silvia Camporesi
Chapter 4: Perceptions of Proportionality: An Empirical Study on Swiss Residents' Moral Considerations on COVID 19 Containment Measures
-Corine Mouton-Dorey, Bettina Schwind, Giovanni Spitale, Kristen Jafflin, Nikola Biller-Andorno
Chapter 5: Proportionality and the Need for Evidence: A Case Study of Outdoor Public Health Interventions for Respiratory Viruses in Australia
-Euzebiusz Jamrozik
Chapter 6: Inaction and the Proportionality Principle: A Review of the Management of the COVID-19 Pandemic in Mexico
-Felicitas Holzer, Ivette María Ortiz Alcántara, Tobias Eichinger, Nikola Biller-Andorno, Julian W. März
Chapter 7: Public Health Proportionality for Sexual and Gender Minority Youth
-Stewart Adelson, Alice Miller, Daniel Newton, Graeme Reid
Chapter 8: Responding Proportionately to the COVID-19 Pandemic in UK Long-Stay, In-Patient Pediatric Wards -Heather Draper, Caroline Redhead, Anna Chiumento, Sara Fovargue, Lucy Frith
Chapter 9: Proportionality in Public Health Law: a Case Study on Singapore's Travel Restrictions for Migrant Healthcare Workers
-Hui Yun Chan
Chapter 10: COVID-19 Restrictions in Long-Term Care Facilities in the U.S.: Unintended Consequences and Possible Lessons
-Jakub P. Hlávka, Yimin Ge, Shengjia Xu, Alexander M. Capron
Chapter 11: Proportionality Behind Locked Doors: Nursing Homes, Fundamental Rights, and Visiting Restrictions During the Corona Pandemic
-Settimio Monteverde
Chapter 12: Mobile Vaccination Teams in Long-Term Care Homes for Elderly in Germany during the COVID-19 pandemic
-Jonathan Hunger and Eva Kuhn
Chapter 13: Proportionality of the COVID-19 Measures: The European Court of Human Rights' Approach
-Helen Keller and Viktoryia Gurash
Chapter 14: Proportionality and the Swiss Courts
-Helen Keller and Violetta Sefkow-Werner
Chapter 15: The Right to Privacy, Contact Tracing, and Public Health During the COVID-19 Pandemic: The Israeli Case
-Shelly Kamin-Friedman, Maya Peled-Raz, Nadav Davidovitch
Chapter 16: The Principle of Proportionality and the Digitalisation of Epidemic Countermeasures in Hong Kong SAR
-Calvin Ho
Chapter 17: Proportionality, Epidemiological Research and Data Protection in a Pandemic
-Fruzsina Molnár-Gábor
Chapter 18: (Dis)proportionate Abortion Care Regulation and the COVID-19 Pandemic in Great Britain
-Jordan Parsons and Chloe Romanis
Chapter 19: A Proportional Response?: Abortion Exceptionalism, Telemedicine, and the COVID-19 Pandemic in Great Britain
-Rishita Nandagiri and Lucía Berro Pizzarossa

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