Public Health Ethics Theory: Review and Path to Convergence

Abstract

Public health ethics is a nascent field, emerging over the past decade as an applied field merging concepts of clinical and research ethics. Because the “patient” in public health is the population rather than the individual, existing principles might be weighted differently, or there might be different ethical principles to consider. This paper reviewed the evolution of public health ethics, the use of bioethics as its model, and the proposed frameworks for public health ethics through 2010. Review of 13 major public health ethics frameworks published over the past 15 years yields a wide variety of theoretical approaches, some similar foundational values, and a few similar operating principles. Coming to a consensus on the reach, purpose, and ends of public health is necessary if we are to agree on what ethical underpinnings drive us, what foundational values bring us to these underpinnings, and what operating principles practitioners must implement to make ethical decisions. If public health is distinct enough from clinical medicine to warrant its own set of ethical and philosophical underpinnings, then a decision must be made as to whether a single approach is warranted or we can tolerate a variety of equal but different perspectives.

Des pistes de solution pour une meilleure intégration des considérations éthiques en santé publique

“…La littérature propose différents cadres assez généraux pour soutenir la réflexion quant aux dimensions éthiques de la majorité des activités en santé publique 1,[16][17][18] . La plupart de ces cadres recoupent à peu près les mêmes éléments; ils énoncent des valeurs, des principes, ainsi que des questions générales permettant d'identifier les préoccupations éthiques et de soutenir la délibération dans le but d'évaluer la justifiabilité des propositions examinées.…”

Public Health Ethics: Global Cases, Practice, and Context

“…Many established frameworks, like that of Kass, seem designed with a liberal political context in mind that gives presumptive weight to individual liberty , which may limit the range of interventions that can be justifi ed. Newer approaches to ethical analysis in public health place more emphasis on social values like equity and solidarity , although these newer approaches often are diffi cult to put into practice (Lee 2012 ). In addition, while newer approaches may offer clear reasons to justify a broader range of interventions, the reasons may be less persuasive if they do not consider the presumptive values in context.…”

Lifestyle Vaccines and Public Health: Exploring Policy Options for a Vaccine to Stop Smoking

“…Rather than prioritizing one specific framework, we embrace three values that they have in common: proportionality, respect for people and social justice (Lee, 2012). This set of values allows us to grasp ethical issues around NV as a public health strategy for smoking cessation.…”

“…Public health ethics has a tradition of exploring whether policy proposals conflict with important societal values and how to minimize possible negative effects. Multiple justificatory frameworks with a theoretical or empirical basis have been developed to facilitate the exploration (Lee, 2012). The social sciences, notably its Science, Technology and Society (STS) branch, have a track record in grasping the normativities inherent in health research and innovative health technologies (Epstein, 1996;De Vries and Horstman, 2007;Brown, 2011;Blume, 2013).…”