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Received: 1 December 2016 Accepted: 7 December 2016

DOI: 10.1111/jep.12707

BOOK REVIEW

Selfinterest for the greater good. Review of Deckers, J Health care as defined by Deckers includes anything that promotes
health and wellbeing. It is this right to holistic health care, and its asso-
(2016). Animal (De)liberation: Should the Consumption
ciated duties, that sets the stage for the discussion of dietary choices.
of Animals Be Banned? London: Ubiquity Press Fulfilling these duties requires us to consider the ways in which our
diets affect ourselves and those around us, both immediately and
The medical and public health communities continue to in large part across temporal and geographic boundaries (p 6).
view the consumption of animals as a personal ethical decision sepa- The definition of health is then further expanded by acknowledg-
rate from the promotion of human health. While some change in ing a modern interpretation of bioethics that recognizes nonhuman
animal product consumption might be advocated for based on connec- animal interests in conjunction with those of humans. As a result, our
tions to chronic disease or the contributions of meat consumption to efforts to achieve holistic health must also consider any duties
environmental harms, 13
recommended reductions generally appear towards nonhuman entities (p 9). This is an important point of distinc-
to be modest and take the form of either general encouragements to tion from past rightsbased work on animal consumption because
eat less processed meats or 1dayaweek efforts like Meatless Deckers recognizes animal interests only as mediated through the
Mondays. Bioethicist Jan Deckers offers a timely and fresh perspective primary moral obligation of meeting our own holistic health care duties
on the issue of animal consumption, pushing the boundaries of current rather than as a direct interest in animal wellbeing. Deckers states this
discourse by arguing for the widespread adoption of vegan diets based point concisely noting that the most important interest that human
on a holistic definition of human health. His new book draws from moral agents ought to consider in relation to the consumption of
moral philosophy, empirical qualitative data, his own experiences with animal products is their interest in their own health, holistically
animals, and a review of several bodies of scientific literature to inform conceived (p 5). This selfinterested approach is remarkably clever
a new theory of qualified moral veganism. This approach clearly from a public health perspective since it recognizes animal wellbeing
expands on the current small body of research documenting the links while still allowing human interests to trump animal interests as
between human health and animal interests, which has so far stopped needed without creating a moral inconsistency. At its heart, Deckers'
short of arguing for the widespread adoption of vegan diets. 4,5
Inevita- book lays out an ethical framework in which our concern for both
bly, some readers may feel dismissive of the conclusions before even other humans and other living organisms is borne primarily out of
reading the book, but even sceptics of vegan diets may want to engage selfinterest, with the notable caveat that we have an interest in being
with the text given its novel perspectives and line of reasoning. moral.
Deckers embraces both speciesism and the prioritization of human
health, perspectives often thought to be dismissive of veganism, and
still ends up with a compelling argument for what he terms the vegan 1 | NEGATIVE GLOBAL HEALTH IMPACTS
project. FROM ANIMAL REARING
Deckers prefaces his work by making it clear that he believes
health is all that should matter in bioethics. This streamlined approach Underpinning Deckers' analysis of holistic health and diets is a moral
is possible thanks to the adoption of an expansive, or holistic, notion of theory on positive and negative global health impacts (GHIs). First
health that includes not only physical and psychological health but also developed in his earlier work,8,9 the concept measures the effects
Nussbaum's idea of a healthy life as flourishing and Caney's focus on
6
of human actions on health. In short, Deckers argues that our
human rights.7 Deckers explains that this definition of health also actions generate some volume of GHI and the aforementioned duty
includes moral health. As a result, the promotion of personal health for holistic health care requires us to maximize positive GHIs while
may also involve the fulfilment of moral duties to other people. This minimizing negative GHIs. To achieve this, we must (1) prioritize
is perhaps not the most conventional definition of health for practi- more important interests and duties over less important ones and
tioners but certainly one that comes across as reasonable to the pres- (2) fulfill our duties in the way that creates the smallest possible
ervation of human wellbeing. While he argues that people do not have amount of negative GHIs (p 7).
a right to health, since it cannot be ensured because of factors outside For nonethicists, the GHI concept may take multiple readings to
of human control, he does lay out a prima facie right to health care. fully grasp. Simplifying the relationship between the positive and neg-
Again, this term is defined expansively, which can at times be confus- ative GHIs of an action, as well as the comparison of GHIs between
ing given the US shorthand of using health care to mean medical care. actions, to a basic set of equations might help readers to better

J Eval Clin Pract. 2017;23:11011104. wileyonlinelibrary.com/journal/jep 2017 John Wiley & Sons, Ltd. 1101
1102 BOOK REVIEW

visualize GHIs at work. Additionally, a number of practical questions persuasively suggests that most people are not fulfilling their moral
arise. It appears challenging to determine the specific GHIs for any imperative to reduce negative GHIs when they choose to eat animal
set of actions (although Deckers rightfully proposes that ecological products.
footprints could work as a proxy for some negative GHIs), and it is also
not entirely clear who should be determining and weighing GHIs.
Deckers implies that governments should take on the role, but even 2 | QUALIFIED MORAL VEGANISM
governments may be inclined to attribute inordinately high levels of
positive GHIs to actions that bring them immediate economic or In chapter 2, Deckers builds on his exploration of negative GHIs to add
political gain, while minimizing negative GHI calculations for future consideration of the impacts of our consumption choices on nonhuman
generations or other nations. If GHIs can be added up in a fashion animals and how this impacts our moral health. Deckers moves beyond
similar to a conventional costbenefit analysis, it would also be impor- animal welfare reasoning to argue that killing is wrong even if painless
tant to consider the appropriate discount rate for harms and benefits but in the process also rejects elements of the moral frameworks
to future generations. It is possible that the GHI framework is meant outlined by prominent animal rights scholars Singer,11 Cochrane,12
to be applied more theoretically rather than for concrete numerical and Regan13 for making what he views as unjustifiable distinctions
analysis, but it strikes me that the framework could provide a useful between different types of living organisms (pp 7375). Deckers instead
alternative to dollardriven costbenefit analysis if it could be opera- suggests a prima facie right of all living things with health interests to
tionalized further in future work. All of that aside, from a theoretical not have those interests harmed (p 103) but also lays out what he terms
perspective, the obligation to minimize harms while fulfilling holistic animalist and evolutionist reasoning to justify eating plants but not
health care duties is clearly appealing and intuitive for those in public animals. Under these principles, holistically defined human health
health professions. requires that humans attribute some degree of moral significance
Deckers then asks if we are eating in a way that fulfills our duty (albeit less than what we give to humans) to animals, whether they
for health care and minimizing negative GHIs. More specifically, he be dead or alive, because they are biologically more closely related to
asks if human beings who consume particular animal products in our species than other (nonanimal) organisms are; and those animals
particular situations fail to minimise negative GHIs (p 8). The most who are biologically closer to us than other animals are (p 80).
obvious point that detractors will raise at this stage is to question As a policy scholar rather than a bioethicist, I cannot offer a full
if vegan diets are in fact healthful. If they are not, direct health critique of these arguments other than to note that much of the liter-
harms could offset the positive GHIs from vegan diets. Deckers ature advocating for animal interests embraces an antispeciesist plat-
preempts this concern both by acknowledging the small number of form.14,15 Embracing speciesism may make Deckers' approach to
circumstances where animal consumption may be necessary and veganism more palatable to the mainstream public since human inter-
with an appendix summarizing the nutrition science literature on ests ultimately take precedence, although I would anticipate pushback
vegan diets. Although I note that this should not strictly speaking on this point from some animal rights scholars. Additionally, Deckers
have been a necessary defense since the American Dietetic Associa- could perhaps have struck a better balance in this chapter between
tion has stated since 2009 that appropriately planned vegetarian considering the impacts of animal consumption on animals and the rel-
diets, including total vegetarian or vegan diets, are healthful, nutri- evance of those impacts to human moral health. Given that the moral
tionally adequate, and may provide health benefits in the prevention component of human health may be the least well recognized by prac-
and treatment of certain diseases.10 titioners, this seems like a missed opportunity to further develop the
With the exploration of nutritional effects of consuming, and not argument for why moral consideration of animals is critical to the pro-
consuming, animals covered elsewhere, Deckers moves on to spend motion of health, holistically defined.
most of chapter 1 laying out the harms to humans from the rearing Ultimately, Deckers uses this speciesist argument in conjunction
of farmed animals. More specifically, he provides wellgrounded explo- with the GHI framework to develop a theory of qualified moral vegan-
rations of the connections between farmed animals and zoonoses, land ism, which may be the greatest and most innovative contribution of
use, water use and pollution, and fossil fuel usage and climate change. this work. This moral position does not demand veganism in all situa-
He also touches on occupational health and inequities for those work- tions and recognizes that some humans may face justifiable social, per-
ing in the farmed animal sector, although this could easily have been a sonal, and ecological reasons for continued animal consumption. On
full section in and of itself. While the first half of this chapter likely the whole, however, vegan diets should become the default diets
offers few new facts for scholars already engaged with food systems for the majority of the human population (p 99). This approach to
questions, it provides a helpful summary for those who are new to veganism strikes me as significantly more palatable to the public health
the field or who may not have previously considered the connections and medical communities than the Francionian16 argument for vegan-
between farmed animals and human health. The second half of the ism as a moral baseline. Given all of the direct and moral harms from
chapter picks up on Deckers' GHI framework and argues that many farmed animal consumption and rearing, qualified moral veganism
people who consume animal products create more negative GHIs than seems like a pragmatic and wellreasoned solution for many of our
those who abstain and that vegan diets could reduce negative GHIs most pressing public health problems. Certainly, some animal
(p 41). The chain of reasoning is compelling, and while it is always advocates may argue for a stricter moral baseline, but it strikes me as
possible to argue the minutiae of specific studies on the impacts of difficult to craft a rational argument that Deckers' interpretation of
farmed animals on human health, the overall collection of evidence holistic health would call for anything less than this.
BOOK REVIEW 1103

3 | A QU A LI F I E D B A N O N A N I M A L this goal, and Deckers appears to caution that policy campaigns


CONSUMPTION focused primarily on animal welfare improvement could be counter
to the vegan project as they may strengthen the idea that people
The crux of the whole argument, however, is that while many people should be allowed to use animals for food in situations where doing
may agree that the presented evidence and ethical arguments are so cannot be justified (p 121). The obvious incremental policy to the
sound, history suggests that relatively few individuals will ever get qualified ban may be the proposed changes to agricultural subsidies,
around to adopting a vegan diet. Deckers recognizes this challenge but it would be helpful to identify additional policy steps along the
and argues that policy reforms are needed as a response to people's way.
unwilling or unwitting failures to embrace health care duties related The lack of concrete detail on what a qualified ban would actually
to animals (p 11). Specifically, he uses chapter 3 to outline a 3pronged look like represents the primary limitation of the book, albeit one that
approach consisting of is perhaps to be expected from a moral philosophy book and hopefully
one that sets the stage for more direct dialogue about the best policy
approach for actually implementing this vision. Given that the text is
1. Educating people about qualified moral veganism;
freely available under a Creative Commons License from Ubiquity
2. Increasing the cost of animal products, primarily by ending subsi- Press, followup dialogue could be forthcoming and inclusive of practi-
dies for harmful animal agriculture; and tioners, advocates, and academics. Readers would benefit from prior
3. A qualified ban on the consumption of animal products, with the exposure to bioethics frameworks, but the text is accessible and
ambition to create such a ban known as the vegan project. engaging enough that it would make a good selection for introductory
and more advanced courses on public health and medical ethics. While
From a public health policy perspective, moving upstream to it may be overly optimistic to expect widespread changes in diets or
consider policy interventions strikes me as a sound approach for narratives about health in the near term, Deckers' book sets the stage
addressing social norms as deeply ingrained as carnism. For example, for much needed critical discussions to move us closer to an expansive
smokefree indoor air legislation has created substantial changes in definition of human health.
social norms for tobacco use.17 That said, the political feasibility of
this final goal must be addressed. Even in the realm of tobacco control, Linnea I. Laestadius PhD MPP
where there is longrecognized evidence of negative GHIs that vastly Assistant Professor of Public Health Policy and Administration
outweigh any positives, Western governments have not found it polit- Joseph J. Zilber School of Public Health, University of Wisconsin
ically feasible to institute overall bans on smoking. The barriers to Milwaukee, Milwaukee, WI, USA
change on animal consumption may be even more significant, even
with a qualified rather than absolute ban. Past efforts to modify the RE FE RE NC ES
US dietary guidelines to advise reduced consumption of animal prod- 1. Kaluza J, kesson A, Wolk A. Processed and unprocessed red meat
18 consumption and risk of heart failure: prospective study of men. Circ
ucts faltered in the face of corporate opposition, and even environ-
Heart Fail. 2014;7(4):552557. doi: 10.1161/CIRCHEARTFAILURE.
mental nonprofits have been hesitant to advise the adoption of 113.000921
vegan diets.19,20 Deckers acknowledges these barriers to change and 2. Chan DSM, Lau R, Aune D, et al. Red and processed meat and colorec-
explores public opinion about animals in chapter 4 but still remains tal cancer incidence: metaanalysis of prospective studies. PLoS One.
2011;6(6):e20456. doi: 10.1371/journal.pone.0020456
hopeful and argues that supporters of qualified moral veganism must
contribute to political and legislative reforms to reduce the likelihood 3. McMichael AJ, Powles JW, Butler CD, Uauy R. Food, livestock produc-
tion, energy, climate change, and health. Lancet. 2007;370(9594):
that people will not fulfil their duties when they make choices about 12531263. doi: 10.1016/S0140-6736(07)61256-2
what to eat (p 107). As a moral position, this obligation for support 4. Akhtar A. Animals and Public Health. 1st ed. London: Springer; 2012.
does make sense, and I appreciate Deckers including a call to action
5. Akhtar A. The need to include animal protection in public health poli-
even in the face of stiff industry and political opposition. cies. J Public Health Policy. 2013;34(4):549559.
Deckers does not outline exactly what a qualified ban on consum- 6. Nussbaum M. Beyond compassion and humanity. Justice for nonhu-
ing animal products would look like in practice. Significant questions man animals. In: Nussbaum M, Sunstein C, eds. Animal Rights: Current
Debates and New Directions. Oxford: Oxford University Press;
arise about who would determine what counts as a justifiable need
2004:299320.
for animal products and how the allocation of animal products would
7. Caney S. Human rights, climate change, and discounting. Environ Polit.
be managed in this system. He suggests that the harmbenefit analysis 2008;17(4):536555. doi: 10.1080/09644010802193401
present in current European Union directives for animal testing 8. Deckers J. Negative GHIs, the right to health protection, and future
approvals may serve as an entry point for legal reform (p 119). How- generations. Bioeth Inq. 2011;8:165. doi: 10.1007/s11673-011-9295-1
ever, scaling up a review process from research institutions to millions 9. Deckers J. What policy should be adopted to curtail the negative global
of individuals making dinner choices appears to present logistical chal- health impacts associated with the consumption of farmed animal prod-
ucts? Res Publica. 2010;16(1):5772. doi: 10.1007/s11158-010-9117-z
lenges. That said, regulated access to an agricultural product is not
10. Craig WJ, Mangels AR. American Dietetic Association. Position of the
unprecedented, and the US medical marijuana industry may hold les-
American Dietetic Association: vegetarian diets. J Am Diet Assoc.
sons here. It would also be valuable to identify incremental policies, 2009;109(7):12661282.
perhaps equivalent to locationspecific smokefree air laws, on the 11. Singer P. Rethinking Life and Death. The Collapse of Our Traditional
way to a qualified ban. Clearly, not all policies are equally suitable for Ethics. Oxford: Oxford University Press; 1995.
1104 BOOK REVIEW

12. Cochrane A. Animal Rights Without Liberation: Applied Ethics and Human 18. Evich Bottemiller H. Meat industry wins round in war over federal
Obligations. New York: Columbia University Press; 2012. nutrition advice. Politico. Available at http://www.politico.com/story/
13. Regan T. The Case for Animal Rights. Oakland, CA: Univ of California 2016/01/2015dietaryguidelines217438. Published January 7,
Press; 2004. 2016. Accessed November 27, 2016.

14. Singer P. Speciesism and moral status. Metaphilosophy. 2009; 19. Laestadius LI, Neff RA, Barry CL, Frattaroli S. We don't tell people
40(34):567581. what to do: an examination of the factors influencing NGO deci-
15. Bekoff M. Deep ethology, animal rights, and the great ape/animal pro- sions to campaign for reduced meat consumption in light of
ject: resisting speciesism and expanding the community of equals. J climate change. Glob Environ Chang. 2014;29:3240. doi: 10.1016/
Agric Environ Ethics. 1997;10(3):269296. j.gloenvcha.2014.08.001
16. Francione G. The abolition of animal exploitation. In: Francione G,
20. Laestadius LI, Neff RA, Barry CL, Frattaroli S. Meat consumption and
Garner R, eds. The Animal Rights Debate: Abolition or Regulation? New
climate change: the role of nongovernmental organizations. Clim
York: Columbia University Press; 2010:1102.
Change. 2013;120(1):2538.
17. Wakefield M, Forster J. Growing evidence for new benefit of clean
indoor air laws: reduced adolescent smoking. Tob Control.
2005;14(5):292293. doi: 10.1136/tc.2005.013557