ShareCompartir Public health ethics involves a systematic process to clarify, prioritize and justify possible courses of public health action based on ethical principles, values and beliefs of stakeholders, and scientific and other information. The problems that CDC addresses are often complex, involving multiple risk factors, multiple stakeholders, and many different perspectives on how to prevent or ameliorate health concerns and promote well-being. CDC staff use a variety of scientific tools in their work — epidemiology, behavioral and social science, communication science, laboratory science, and many others.
Distinctive Challenges of Public Health Ethics There is no standard way of organizing the ethics of clinical practice, public health and biomedical science. These distinctive fields are often presented as focal areas that fall under the broader, umbrella term of bioethics, but sometimes bioethics is presented as the equivalent of medical ethics or in contrast to public health and population-level bioethics.
Whichever approach is preferred, a key question remains: The answer lies in the distinctive nature of public health.
Public health has four characteristics that provide much of the subject matter for public health ethics: First, in public health the object of concern is populations, not individuals. Public health is, by its very nature, a public, communal good, where the benefits to one person cannot readily be individuated from those to another, though its burdens and benefits often appear to fall unevenly on different sub-groups of the population.
This raises a particular set of justificatory challenges public health ethics has to address: Whose health are we concerned with, and what sacrifices is it acceptable to ask of individuals in order to achieve it?
Is there a difference between public health and population health? And why is public health a good worth promoting? Any answer to these questions has to take account of the fact that public health measures are often based on prospective benefits, not immediately securable benefits. However, although much of the discussion surrounding public health focuses primarily on this preventive aspect, public health agencies and services also involve diagnosing and treating illnesses, with all the attendant clinical services that those activities require.
Indeed, increasingly national health systems are understood to include both preventive functions and the delivery of personal medical services. Often, these functions and services are integrated under a common political or administrative structure. Depending on the specific context in which population health is to be improved, separating public health services and functions from personal medical care services and functions may or may not make sense.
That said, policies and programs whose aim is to prevent illness and injury are paradigmatically the territory of public health. Certainly, no other social institution is generally recognized as so clearly having this remit.
Public health's commitment to prevention carries with it particular moral challenges. Eliminating or mitigating a harm that already exists is sometimes viewed as being of greater moral importance - or simply as more immediately motivating action - than long-term strategies to prevent a harm from materializing.
Although in recent years there is arguably more emphasis on prevention in health policy, preventive public health interventions continue to receive less funding and public support than medical treatments. For example, despite the increasing focus on wellness in public policy and the workplace,[ 6 ] both policy makers and the public still tend to place a higher priority on ensuring that heart patients have access to surgery and medications than on programs to prevent heart disease through diet and exercise.
Another factor that can result in prioritizing cures over prevention is that although the costs and burdens of preventive interventions occur largely in the present, the benefits of successful preventive interventions often occur in the future, and usually only to some members of the population whose identities cannot be predicted in advance and whose numbers can only be estimated probabilistically.
In some cases, the beneficiaries of preventive interventions are members of future generations, complicating the moral picture even further. Third, as noted previously, achieving good public health results frequently requires government action: Public health is focused on regulation and public policy, and relies less often on individual actions and services.
In this as in all other areas of official state action, we therefore have to address tensions among justice, security, and the scope of legal restrictions and regulations. This adds to the peculiarity of the justificatory questions surrounding public health: The same questions of trade-off between personal freedom and collective action that arise in the political arena generally thus also arise for public health.
It is in this context that concerns about paternalism typically emerge.
Fourth, public health has a definite consequentialist orientation. Promoting public health means seeking to avoid bad health outcomes and advance good ones.
As noted at the outset, in some discussions of public health ethics, this outcome-orientation is viewed as the moral justification and foundation of public health and, as with all consequentialist schemes, is presented as needing to be constrained by attention to deontological concerns such as rights, and by attention to justice-related concerns such as the fair distribution of burdens Childress et al.
While public health ethics has to engage with the traditional problems raised by its consequentialist commitments, for those who view social justice as the moral foundation of public health, considerations of justice provide the frame within which the moral implications of public health's consequentialist orientation are addressed.
These four distinctive features provide public health ethics with its basic structure and orientation. Under the first rubric, important questions arise with regard to the scope of public health: But in a global world, that assumption is not always plausible for various reasons.
Communicable diseases have a way of ignoring national boundaries, and preventive measures in one country may be futile if other countries do not follow suit.
Further questions about justice and equity across borders also arise: These questions will be discussed further in section IV, below. Depending on the particular health challenge we are concerned with, the public in question can be more local or more global than a single country's population.
National boundaries are relevant because policies and regulations are usually set by individual countries, and vary from country to country.Public health practice and ethics are intimately intertwined with public health law, which shapes the authority of the state to protect the public’s health and limits that power in the form of individual rights and structural constraints.
Stephen Holland’s second edition is an important milestonein the emerging field of public health ethics. It has a richpopulation-based perspective, demonstrating the foundationalimportance of safeguarding the public’s health.3/5(5).
In association with the Bloomberg School of Public Health, the Berman Institute conducts independent scholarship in key areas of public health and health policy, trains future bioethics scholars, policy makers, and public health professionals, and provides local, national, and international service to .
Public health ethics addresses ethical challenges in public health practice by applying relevant ethical principles and norms. Some of these principles, like respect for individual rights, are common to research ethics, clinical ethics, and bioethics.
Some are most relevant to public health, for. Public health ethics involves a systematic process to clarify, prioritize and justify possible courses of public health action based on ethical principles, values and beliefs of stakeholders, and scientific and other information.
Given the array of stakeholders and issues dealt with by local health departments (LHDs), health officials and their staff must be ready to handle ethical dilemmas that arise in day-to-day practice.