Question

Apply ethical theory to provide rationale for a proposed public health intervention

Answer 1

Public health ethics (PHE) is a relatively new field of applied ethics, and is concerned with the moral implications of a diverse range of activities aiming to protect or improve population health. It is an interdisciplinary field that has to take into account both moral and factual considerations, in health policy and health sciences. Public Health (PH) practice differs considerably from medical practice: while the latter is primarily concerned with the health of individual patients, the former focuses on the health of populations. Protecting and promoting health and preventing diseases constitute the primary objectives of PH interventions, rather than treating sick individuals. Often, collective efforts of the community are required to achieve PH goals. It is therefore widely acknowledged that ethical inquiries in PH need a different approach than traditional biomedical ethics.

Articulations of PHE also tend to emphasize the role of social justice compared to the predominance of autonomy in the bioethical literature. Now that the field of PHE is developing a unique focus and a language of its own, including a code of ethics disseminated by the American Public Health Association, the future of PHE may well be global health ethics, focusing on issues of global justice. As PHE evolves from its nascent stage of reflection to a place of action and application in the national and global arenas, two interrelated developments will need to occur: (1) public health professionals, including practitioners, policymakers, and scholars, will need a richer understanding of the ethical challenges practitioners face on a daily basis and (2) scholars will need to develop useful tools (i.e., frameworks) that practitioners may employ for identifying and tackling these ethical challenges. Broadly speaking, PHE helps guide practical decisions affecting population or community health based on scientific evidence and in accordance with accepted values and standards of right and wrong. In these ways, PHE builds on its parent disciplines of public health and ethics. This dual inheritance plays out in the definition the U.S. Centers for Disease Control and Prevention (CDC) offers of PHE: “A systematic process to clarify, prioritize, and justify possible courses of PH action based on ethical principles, values and beliefs of stakeholders, and scientific and other information”. PHE shares with other fields of practical and professional ethics both the general theories of ethics and a common store of ethical principles, values, and beliefs.

To arrive at transparent, consistent, and justified results, ethical analysis in PH should follow a clearly defined methodological approach. Any framework for PHE thereby has to meet at least two fundamental requirements: (1) as a tool for normative inquiry, the framework must be based on an explicit ethical justification. This is a requirement of any ethical analysis: normative claims about what is morally acceptable must be justified by an underlying ethical theory or at least an explicit ethical approach. A transparent normative basis allows those who act upon the analysis (e.g., PH professionals) and those who are affected by the analysis (e.g., the target population) to assess the validity of the resulting claims. (2) A framework for PHE should provide practical guidance for the various people working within or related to the field of PH. It therefore should include a methodological approach that relates the general normative considerations such as ethical norms, values, and principles and the available empirical evidence to concrete PH interventions, programs, or policies.

Historically, the field of bioethics has largely focused on individuals – most prominently professional ethics for physicians and nurses – in the context of medical treatment and research. Bioethical considerations have been oriented toward informed consent on treatment and research, reproductive and end-of-life decision-making, and applications of emerging technologies in personal health care. It differs from these other fields largely in the nature of challenges that public health officials typically encounter and in the ethical frameworks it employs to address these challenges.