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Institute of Biomedical Ethics and History of Medicine (IBME)

Dissertation Rodrigo Lopez Barreda

Towards a deeper understanding of agency. Bridging the gap between clinical ethics and public health ethics


There is a tension between clinical ethics and public health ethics. While the former tends to be focused on the decision-making process, the latter emphasises the final result or outcome of public health policies. Moreover, individual level analysis deals with autonomy and social level analysis with justice. These two interests may actually clash in some situations.
This work proposes agency as a new way to conceptualise the self-rule principle, which may be used at both individual and social levels. Furthermore, this concept not only provides reasonable arguments for clinical ethics and public health ethics analysis, but can also be used in real-world scenarios. Through five sections, five articles, different dimensions of the problem are discussed, such as definitions, implications for clinical practice and public health interventions, as well as empirical operationalisation.

Using the Capabilities Approach as framework, it will be shown that agency is indeed a valuable concept in both clinical and public health ethics, and can be used as a common ground for addressing discrepancies in moral judgements between them. Moreover, it is explained that agency at the individual level requires a social support that makes it impossible to isolate individuals from the social group. At the same time, it claims that individuals’ agency has to be taken into account when assessing and planning public health policies, linking the social level to the individual level.