Verweij Marcel
Ethics Institute, Utrecht University, P.O. Box 80103, NL-3508 TC Utrecht, The Netherlands.
Bioethics. 2005 Aug;19(4):323-35. doi: 10.1111/j.1467-8519.2005.00446.x.
If we have a duty not to infect others, how far does it go? This question is often discussed with respect to HIV transmission, but reflection on other diseases like influenza raises a number of interesting theoretical issues. I argue that a duty to avoid infection not only yields requirements for persons who know they carry a disease, but also for persons who know they are at increased risk, and even for those who definitely know they are completely healthy. Given the numerous ways in which human interaction facilitates the spread of communicable diseases, a maximum level of precaution would be very demanding--possibly unreasonably demanding. The 'over-demandingness problem' is mostly invoked as a criticism of utilitarianism, as this theory requires moral agents to always maximise general welfare, even at significant cost for themselves. However, I argue that, with respect to precautions against infectious diseases like influenza, utilitarianism is able to avoid the over-demandingness problem. A contractualist account, on the other hand, whilst able to explain how one's obligations to avoid infection can be limited, given that other persons have opportunities and responsibilities to protect themselves, in the end requires precautions that raise the over-demandingness problem.
如果我们有不传染他人的义务，那么这一义务的范围有多广？这个问题常围绕艾滋病毒传播展开讨论，但对流感等其他疾病的思考引发了一些有趣的理论问题。我认为，避免感染的义务不仅对那些知道自己携带疾病的人提出了要求，对那些知道自己感染风险增加的人也有要求，甚至对那些确定自己完全健康的人也有要求。鉴于人际互动促进传染病传播的方式多种多样，最高程度的预防措施要求极高——可能高到不合理的程度。“要求过高问题”大多被用作对功利主义的批评，因为该理论要求道德主体始终最大化总体福利，即便这会给自己带来巨大代价。然而，我认为，在预防流感等传染病方面，功利主义能够避免要求过高问题。另一方面，契约论的解释虽然能够说明，鉴于其他人有自我保护的机会和责任，一个人避免感染的义务如何能够受到限制，但最终却要求采取会引发要求过高问题的预防措施。
