Doctors and global health security: What role for ethics and regulation?

In an interconnected world, the potential for the rapid cross-border spread of health threats is growing with often wide-ranging social, political and economic consequences for nation-states, and tragic consequences for their citizens’ health and wellbeing. When such threats occur, doctors are often on the frontline in terms of treating infected individuals, as well as engaging in risk assessment and management at the population level. National and international ethical and regulatory obligations have an influential role in the performance of such work. The growing prominence of a securitization approach to managing health threats raises a number of ethical and regulatory concerns about how this will impact upon doctors’ adherence to such obligations, particularly where they are confronted with competing political, military or security imperatives. In this chapter, such concerns are examined through the concept of medicalization in global health security research, which describes the way in those with medical expertise seek to extend their influence and power through engagement with securitization discourse and practices in managing health threats. It is argued that taking account of the key roles played by ethics and regulation in medical practice in such circumstances provides a fuller and more nuanced account of how the process of medicalization is impacted by both the individual patient-doctor relationship and the management of health threats at the population level. Future research in the area would benefit from drawing on socio-legal insights into patient-doctor relations, as well as empirical analysis of how medicalization translates into practice in different securitized environments.