Received: 1 December 2016 Accepted: 7 December 2016
DOI: 10.1111/jep.12707
BOOK REVIEW
Selfinterest for the greater good. Review of Deckers, J
(2016). Animal (De)liberation: Should the Consumption
of Animals Be Banned? London: Ubiquity Press
The medical and public health communities continue to in large part
view the consumption of animals as a personal ethical decision sepa-
rate from the promotion of human health. While some change in
animal product consumption might be advocated for based on connec-
tions to chronic disease or the contributions of meat consumption to
environmental harms, 13
recommended reductions generally appear
to be modest and take the form of either general encouragements to
eat less processed meats or 1dayaweek efforts like Meatless
Mondays. Bioethicist Jan Deckers offers a timely and fresh perspective
on the issue of animal consumption, pushing the boundaries of current
discourse by arguing for the widespread adoption of vegan diets based
on a holistic definition of human health. His new book draws from
moral philosophy, empirical qualitative data, his own experiences with
animals, and a review of several bodies of scientific literature to inform
a new theory of qualified moral veganism. This approach clearly
expands on the current small body of research documenting the links
between human health and animal interests, which has so far stopped
short of arguing for the widespread adoption of vegan diets. 4,5
Inevita-
bly, some readers may feel dismissive of the conclusions before even
reading the book, but even sceptics of vegan diets may want to engage
with the text given its novel perspectives and line of reasoning.
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
project.
Deckers prefaces his work by making it clear that he believes
health is all that should matter in bioethics. This streamlined approach
is possible thanks to the adoption of an expansive, or holistic, notion of
health that includes not only physical and psychological health but also
Nussbaum's idea of a healthy life as flourishing and Caney's focus on
6
human rights.7 Deckers explains that this definition of health also
includes moral health. As a result, the promotion of personal health
may also involve the fulfilment of moral duties to other people. This
is perhaps not the most conventional definition of health for practi-
tioners but certainly one that comes across as reasonable to the pres-
ervation of human wellbeing. While he argues that people do not have
a right to health, since it cannot be ensured because of factors outside
of human control, he does lay out a prima facie right to health care.
Again, this term is defined expansively, which can at times be confus-
ing given the US shorthand of using health care to mean medical care.
J Eval Clin Pract. 2017;23:11011104. wileyonlinelibrary.com/journal/jep
Health care as defined by Deckers includes anything that promotes
health and wellbeing. It is this right to holistic health care, and its asso-
ciated duties, that sets the stage for the discussion of dietary choices.
Fulfilling these duties requires us to consider the ways in which our
diets affect ourselves and those around us, both immediately and
across temporal and geographic boundaries (p 6).
The definition of health is then further expanded by acknowledg-
ing a modern interpretation of bioethics that recognizes nonhuman
animal interests in conjunction with those of humans. As a result, our
efforts to achieve holistic health must also consider any duties
towards nonhuman entities (p 9). This is an important point of distinc-
tion from past rightsbased work on animal consumption because
Deckers recognizes animal interests only as mediated through the
primary moral obligation of meeting our own holistic health care duties
rather than as a direct interest in animal wellbeing. Deckers states this
point concisely noting that the most important interest that human
moral agents ought to consider in relation to the consumption of
animal products is their interest in their own health, holistically
conceived (p 5). This selfinterested approach is remarkably clever
from a public health perspective since it recognizes animal wellbeing
while still allowing human interests to trump animal interests as
needed without creating a moral inconsistency. At its heart, Deckers'
book lays out an ethical framework in which our concern for both
other humans and other living organisms is borne primarily out of
selfinterest, with the notable caveat that we have an interest in being
moral.
1 | NEGATIVE GLOBAL HEALTH IMPACTS
FROM ANIMAL REARING
Underpinning Deckers' analysis of holistic health and diets is a moral
theory on positive and negative global health impacts (GHIs). First
developed in his earlier work,8,9 the concept measures the effects
of human actions on health. In short, Deckers argues that our
actions generate some volume of GHI and the aforementioned duty
for holistic health care requires us to maximize positive GHIs while
minimizing negative GHIs. To achieve this, we must (1) prioritize
more important interests and duties over less important ones and
(2) fulfill our duties in the way that creates the smallest possible
amount of negative GHIs (p 7).
For nonethicists, the GHI concept may take multiple readings to
fully grasp. Simplifying the relationship between the positive and neg-
ative GHIs of an action, as well as the comparison of GHIs between
actions, to a basic set of equations might help readers to better
2017 John Wiley & Sons, Ltd. 1101
1102
visualize GHIs at work. Additionally, a number of practical questions
arise. It appears challenging to determine the specific GHIs for any
set of actions (although Deckers rightfully proposes that ecological
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
governments may be inclined to attribute inordinately high levels of
positive GHIs to actions that bring them immediate economic or
political gain, while minimizing negative GHI calculations for future
generations or other nations. If GHIs can be added up in a fashion
similar to a conventional costbenefit analysis, it would also be impor-
tant to consider the appropriate discount rate for harms and benefits
to future generations. It is possible that the GHI framework is meant
to be applied more theoretically rather than for concrete numerical
analysis, but it strikes me that the framework could provide a useful
alternative to dollardriven costbenefit analysis if it could be opera-
tionalized further in future work. All of that aside, from a theoretical
perspective, the obligation to minimize harms while fulfilling holistic
health care duties is clearly appealing and intuitive for those in public
health professions.
Deckers then asks if we are eating in a way that fulfills our duty
for health care and minimizing negative GHIs. More specifically, he
asks if human beings who consume particular animal products in
particular situations fail to minimise negative GHIs (p 8). The most
obvious point that detractors will raise at this stage is to question
if vegan diets are in fact healthful. If they are not, direct health
harms could offset the positive GHIs from vegan diets. Deckers
preempts this concern both by acknowledging the small number of
circumstances where animal consumption may be necessary and
with an appendix summarizing the nutrition science literature on
vegan diets. Although I note that this should not strictly speaking
have been a necessary defense since the American Dietetic Associa-
tion has stated since 2009 that appropriately planned vegetarian
diets, including total vegetarian or vegan diets, are healthful, nutri-
tionally adequate, and may provide health benefits in the prevention
and treatment of certain diseases.10
With the exploration of nutritional effects of consuming, and not
consuming, animals covered elsewhere, Deckers moves on to spend
most of chapter 1 laying out the harms to humans from the rearing
of farmed animals. More specifically, he provides wellgrounded explo-
rations of the connections between farmed animals and zoonoses, land
use, water use and pollution, and fossil fuel usage and climate change.
He also touches on occupational health and inequities for those work-
ing in the farmed animal sector, although this could easily have been a
full section in and of itself. While the first half of this chapter likely
offers few new facts for scholars already engaged with food systems
questions, it provides a helpful summary for those who are new to
the field or who may not have previously considered the connections
between farmed animals and human health. The second half of the
chapter picks up on Deckers' GHI framework and argues that many
people who consume animal products create more negative GHIs than
those who abstain and that vegan diets could reduce negative GHIs
(p 41). The chain of reasoning is compelling, and while it is always
possible to argue the minutiae of specific studies on the impacts of
farmed animals on human health, the overall collection of evidence
BOOK REVIEW
persuasively suggests that most people are not fulfilling their moral
imperative to reduce negative GHIs when they choose to eat animal
products.
2 | QUALIFIED MORAL VEGANISM
In chapter 2, Deckers builds on his exploration of negative GHIs to add
consideration of the impacts of our consumption choices on nonhuman
animals and how this impacts our moral health. Deckers moves beyond
animal welfare reasoning to argue that killing is wrong even if painless
but in the process also rejects elements of the moral frameworks
outlined by prominent animal rights scholars Singer,11 Cochrane,12
and Regan13 for making what he views as unjustifiable distinctions
between different types of living organisms (pp 7375). Deckers instead
suggests a prima facie right of all living things with health interests to
not have those interests harmed (p 103) but also lays out what he terms
animalist and evolutionist reasoning to justify eating plants but not
animals. Under these principles, holistically defined human health
requires that humans attribute some degree of moral significance
(albeit less than what we give to humans) to animals, whether they
be dead or alive, because they are biologically more closely related to
our species than other (nonanimal) organisms are; and those animals
who are biologically closer to us than other animals are (p 80).
As a policy scholar rather than a bioethicist, I cannot offer a full
critique of these arguments other than to note that much of the liter-
ature advocating for animal interests embraces an antispeciesist plat-
form.14,15 Embracing speciesism may make Deckers' approach to
veganism more palatable to the mainstream public since human inter-
ests ultimately take precedence, although I would anticipate pushback
on this point from some animal rights scholars. Additionally, Deckers
could perhaps have struck a better balance in this chapter between
considering the impacts of animal consumption on animals and the rel-
evance of those impacts to human moral health. Given that the moral
component of human health may be the least well recognized by prac-
titioners, this seems like a missed opportunity to further develop the
argument for why moral consideration of animals is critical to the pro-
motion of health, holistically defined.
Ultimately, Deckers uses this speciesist argument in conjunction
with the GHI framework to develop a theory of qualified moral vegan-
ism, which may be the greatest and most innovative contribution of
this work. This moral position does not demand veganism in all situa-
tions and recognizes that some humans may face justifiable social, per-
sonal, and ecological reasons for continued animal consumption. On
the whole, however, vegan diets should become the default diets
for the majority of the human population (p 99). This approach to
veganism strikes me as significantly more palatable to the public health
and medical communities than the Francionian16 argument for vegan-
ism as a moral baseline. Given all of the direct and moral harms from
farmed animal consumption and rearing, qualified moral veganism
seems like a pragmatic and wellreasoned solution for many of our
most pressing public health problems. Certainly, some animal
advocates may argue for a stricter moral baseline, but it strikes me as
difficult to craft a rational argument that Deckers' interpretation of
holistic health would call for anything less than this.
BOOK REVIEW
3 | A QU A LI F I E D B A N O N A N I M A L
CONSUMPTION
The crux of the whole argument, however, is that while many people
may agree that the presented evidence and ethical arguments are
sound, history suggests that relatively few individuals will ever get
around to adopting a vegan diet. Deckers recognizes this challenge
and argues that policy reforms are needed as a response to people's
unwilling or unwitting failures to embrace health care duties related
to animals (p 11). Specifically, he uses chapter 3 to outline a 3pronged
approach consisting of
1. Educating people about qualified moral veganism;
2. Increasing the cost of animal products, primarily by ending subsi-
dies for harmful animal agriculture; and
3. A qualified ban on the consumption of animal products, with the
ambition to create such a ban known as the vegan project.
From a public health policy perspective, moving upstream to
consider policy interventions strikes me as a sound approach for
addressing social norms as deeply ingrained as carnism. For example,
smokefree indoor air legislation has created substantial changes in
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,
where there is longrecognized evidence of negative GHIs that vastly
outweigh any positives, Western governments have not found it polit-
ically feasible to institute overall bans on smoking. The barriers to
change on animal consumption may be even more significant, even
with a qualified rather than absolute ban. Past efforts to modify the
US dietary guidelines to advise reduced consumption of animal prod-
18
ucts faltered in the face of corporate opposition, and even environ-
mental nonprofits have been hesitant to advise the adoption of
vegan diets.19,20 Deckers acknowledges these barriers to change and
explores public opinion about animals in chapter 4 but still remains
hopeful and argues that supporters of qualified moral veganism must
contribute to political and legislative reforms to reduce the likelihood
that people will not fulfil their duties when they make choices about
what to eat (p 107). As a moral position, this obligation for support
does make sense, and I appreciate Deckers including a call to action
even in the face of stiff industry and political opposition.
Deckers does not outline exactly what a qualified ban on consum-
ing animal products would look like in practice. Significant questions
arise about who would determine what counts as a justifiable need
for animal products and how the allocation of animal products would
be managed in this system. He suggests that the harmbenefit analysis
present in current European Union directives for animal testing
approvals may serve as an entry point for legal reform (p 119). How-
ever, scaling up a review process from research institutions to millions
of individuals making dinner choices appears to present logistical chal-
lenges. That said, regulated access to an agricultural product is not
unprecedented, and the US medical marijuana industry may hold les-
sons here. It would also be valuable to identify incremental policies,
perhaps equivalent to locationspecific smokefree air laws, on the
way to a qualified ban. Clearly, not all policies are equally suitable for
1103
this goal, and Deckers appears to caution that policy campaigns
focused primarily on animal welfare improvement could be counter
to the vegan project as they may strengthen the idea that people
should be allowed to use animals for food in situations where doing
so cannot be justified (p 121). The obvious incremental policy to the
qualified ban may be the proposed changes to agricultural subsidies,
but it would be helpful to identify additional policy steps along the
way.
The lack of concrete detail on what a qualified ban would actually
look like represents the primary limitation of the book, albeit one that
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
freely available under a Creative Commons License from Ubiquity
Press, followup dialogue could be forthcoming and inclusive of practi-
tioners, advocates, and academics. Readers would benefit from prior
exposure to bioethics frameworks, but the text is accessible and
engaging enough that it would make a good selection for introductory
and more advanced courses on public health and medical ethics. While
it may be overly optimistic to expect widespread changes in diets or
narratives about health in the near term, Deckers' book sets the stage
for much needed critical discussions to move us closer to an expansive
definition of human health.
Linnea I. Laestadius PhD MPP
Assistant Professor of Public Health Policy and Administration
Joseph J. Zilber School of Public Health, University of Wisconsin
Milwaukee, Milwaukee, WI, USA
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