One major area of discourse and debate concerns the power of public health as an agent of the state to restrict individual choice in efforts to prevent disease and promote health. Many public health activities try to influence individual actions, though they may do so in more or less restrictive ways. Public health policy may eliminate choice altogether through, for example, compulsory quarantine of patients with infectious disease; restrict choice by, for example, banning smoking in public places or fluoridating public water supplies; guide choice through disincentives e.
The analysis of which of these actions are or are not ethically and politically justifiable is often informed by the harm principle , originally articulated by John Stuart Mill in his essay On Liberty.
Mill qualifies the principle in several ways, for example, making exceptions for children and those cared for by others. But, in general the principle justifies state interference with individual liberty only when individual actions pose serious harm to others. Or, consider the dietary choices of an adult who is also a parent of small children.
Such examples suggest that apparently self-regarding choices related to diet might be other-regarding in significant respects. Nonetheless, the distinction between self- and other-regarding behavior has been invoked persuasively in clear cases, for example, to justify the quarantine of individuals with infectious disease that can easily be transmitted or bans on smoking in public spaces to protect others from the harmful effects of second-hand smoke. Cases where harm to others is absent or less easily established stir much more debate because they raise the specter of paternalism.
Paternalism occurs when the state or an individual interferes with the preferences of a person for her own benefit e. Indeed, public health action often seeks to influence human behavior that arguably does no harm to others. Because chronic diseases now account for the majority of deaths, and personal behaviors make a nontrivial contribution to their onset and progression McGinnis et al. The least controversial tactics for promoting behavior change are educational in nature-providing people with information, whether it be the calorie content of foods, the health effects of certain behaviors, and so on.
Educational campaigns are not coercive, as individuals can choose to heed them or not, and they can be argued to support more informed and thus autonomous citizens. Even Mill would likely have endorsed non-controversial public education campaigns for this reason Nuffield Bioethics Council Educational strategies, however, often fail to produce behavior change, particularly among socially disadvantaged groups.
Take obesity, which disproportionately affects minority and low socioeconomic groups.
Education initiatives are most effective for individuals who have the time, interest, motivation, and resources to act on the information and opportunities made available. People who work long hours or double shifts, or who lack access to affordable gyms or safe spaces to walk or exercise, for example, may not have the time, energy, or financial resources to change habits that are embedded in ways of life. Thus, strategies based on education, information, and individual choice can reproduce or even exacerbate health disparities between more and less advantaged groups Link, Phelan ; Link To address this challenge, social and material conditions may be remade to support health and healthy choices.
In the case of obesity, such measures might include regulating food production e. This structural approach to public health is, however, often criticized in political contexts such as the United States, where personal responsibility for health and other goods and individualism are highly valued. Debate over responsibility for health is not new Reiser but it has intensified in the last few decades. One prominent way this debate has played out in U. Private employers and state governments have ramped up their wellness programs, offering employees a variety of goods to participate in health screenings, on-site exercise programs, among other activities.
While most programs use rewards in some form, the use of penalties is also on the upswing. Critics oppose such programs on numerous grounds. Responsibility lies not with these individuals, critics charge, but rather with social institutions and society at large.
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Agents of public health often claim that health inequalities associated with social class, race, and ethnicity constitute a social injustice because they are caused, at least in part, by socially controllable factors. Systematic analyses of social justice and health equity are relatively recent Marchand et al. Such analyses have taken up a number of basic questions, including: Are social inequalities in health unjust? Which inequalities are most urgent?
What constitutes a fair distribution of health? A fundamental question concerns the place of social justice as an ethical construct in public health. Is social justice the moral foundation of public health? This view has its defenders Powers, Faden ; Robertson ; however, it has not been a standard view. Rather, it is widely assumed that public health and health policy should aim to produce the most health benefits, or aggregate health, in a population Brock This utilitarian goal, which aims to maximize aggregate health, is distinct from the distributive goal to produce a fair distribution of health.
Although public health activities and health policies may produce more health and reduce health inequalities, health initiatives very often reproduce or exacerbate disparities because, as already noted, better off people tend to benefit sooner and disproportionately from many health promotion interventions Mechanic ; Frohlich One common strategy to address this problem is implementing interventions that target vulnerable subgroups.
Such targeting may take a variety of forms, such as focused media campaigns, cash stipends, and social and health care services.
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But targeting also carries an ethical risk-the further marginalization and stigmatization of minority and socio-economically marginalized groups. As commentators have noted, the pursuit of social justice entails not only distributive goals, such as reducing health disparities, but also recognition goals Fraser , Young , Anderson This demand of justice has been variously described but generally refers to a form of basic respect for persons that, at the very least, protects non-dominant groups from discrimination and marginalization based on group membership, such as race, ethnicity, gender, sexual orientation, nationality, social class, and so on.
Racism and sexism are paradigmatic examples of transgression of basic respect in this sense. Recognition may be further elaborated to include the idea that all persons have an equal opportunity to participate as peers in public life and to have a voice in important public issues, particularly those that directly affect them Fraser , Anderson Recognition in this sense lends ethical support to a core value of public health-the notion of participation in health. Participation has long been a basic principle of public health practice and an essential component of health equity Commission on the Social Determinants of Health Participation in health is variously defined but generally the idea refers to a collaborative process that equitably engages community members, organizational representatives, researchers, among others in knowledge creation and social change Rifkin ; Robertson, Minkler ; Wallerstein, Bernstein ; Israel et al.
Participatory processes are defended on grounds that the research and action that result will be more effective, fulfill an obligation of procedural justice , and produce more equitable outcomes Wallerstein, Duran ; Dankwa-Mullen et al. They may also protect non-dominant communities from health interventions that further marginalize and stigmatize them Blacksher and may go some distance in cultivating trust between research institutions and community partners Yarborough et al.
When should communicable diseases be reported to public health authorities? Each state has specific statutes that identify specific diseases with public health implications, such as communicable diseases, which require reporting. If you are not sure whether reporting is required or advised, contact your local public health authority for guidance. Beyond this legal requirement lies the ethical question of when it is justified to potentially violate confidentiality to protect the public's health.
It is ethically justified to disclose a diagnosis to public health authorities if the risk to the public has the following features:. Case 1 below discusses this question in the context of a patient with sexually transmitted disease. This is a controversial area in law, and the law varies by state.
The ethical justification for treatment of a patient against his will is based on balancing the risk to the public versus respecting the patient's personal freedom see discussion of the harm principle above. If the magnitude of risk to the public is great, many states allow for involuntary treatment. Health care providers have obligations, however, to use the least restrictive means to achieve the therapeutic goal. An involuntary hospital stay is the most restrictive, necessary only when there is high risk of infecting others as well as evidence of non-adherence to outpatient treatment.
A less restrictive approach utilizes directly observed therapy, in which a designated provider or case worker observes the patient taking his medications at home or in another outpatient setting. Case 2 below discusses this question in the context of a patient with active multi-drug resistant pulmonary tuberculosis. Sometimes there are preventive health interventions that provide minimal or no benefit to the individual, yet provide substantial collective benefit to the public's health.
Immunization is a good example. If most of the people in a region are vaccinated, those who are not vaccinated are also protected from the contagious disease because the likelihood of an outbreak is low. This is known as herd or community immunity. Hence vaccination protects others, especially infants and those with compromised immunity due to chemotherapy, for example. If a patient refuses a legally required immunization e.
The action-oriented will choose what they will pursue, joining together to do what they can to make for a more ethical society. Hopefully, they can become the core of the sorely needed ethical constituency. The public will observe that some people are actually combating the abuses, rather than merely going along with them in the pattern of the past. In the end, they might join the developing ethical constituency. While our society tends to give awards and celebrate all sorts of activities, nothing is done to identify highly ethical behavior, honor it and award it.
It is suggested that we find a way to make such public awards, and seek a sponsor to fund it. Similarly, an institution could be established to provide a formal location to house a small cadre devoted to providing continuity to the effort of making our society a more ethical one. The aim is not radial reform, but rather to clean up our society to some extent or at least stem the fouling. There are just too many ethical scandals on the highest levels of our society giving wrong signals.
Someone should take responsibly and do something about it so as to make for a more ethical society. If not you, then who? Read more Read less. Kindle Cloud Reader Read instantly in your browser. Product details File Size: September 22, Sold by: Related Video Shorts 0 Upload your video. Customer reviews There are no customer reviews yet.
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Share your thoughts with other customers. Write a customer review. Amazon Giveaway allows you to run promotional giveaways in order to create buzz, reward your audience, and attract new followers and customers. Learn more about Amazon Giveaway. Praxis Praxis is an independent not for profit entity that combines University of Sydney, Monash University and Bellberry.
It aims to be a hub to facilitate and foster the sharing of knowledge on research ethics. Praxis offers a wide range of online, face-to-face and intensive courses in research ethics, governance and methods to researchers, research site managers and allied professions. It also includes appendices with selected resources on designing a clinical ethics service and conducting case consultations. Bioethics Tools These tools are meant to help medical practitioners reason through difficult cases of provide a different perspective that may help clarify complex situations. Ethics Toolkit for Students This toolkit provides those who have just started to embark on a medical career with a general introduction to common ethical problems they may encounter, and practical ways of thinking about ethical issues.
Maurice Young Centre for Applied Ethics University of British Columbia to assess situations and assist the ethical decision-making process. Monash University Clinical Ethics Resource This online resource can assist clinicians in their responses to a wide range of ethical issues that arise in clinical practice and research.
It comprises a series of modules on issues of life and death, organ donation, confidentiality, legal aspects, genetics and conflict of interest. These include the establishment of agreements and protocols between indigenous people and researchers. Clinical Ethics This journal features original peer-reviewed research papers on issues in clinical ethics, case studies with extensive commentary from experts and updates on important legal developments.
Public Health Ethics: Ethical Topic in Medicine
The journal has a vast selection of articles on ethics and related topics. Journal of Bioethical Inquiry The Journal of Bioethical Inquiry seeks to create a multidisciplinary forum where scholars and practitioners can publish their research, critical reflections, and analyses of bioethical issues and practice.
It welcomes contributions from perspectives that are less commonly published in existing journals. Journal of Medical Ethics The Journal of Medical Ethics is a leading international journal that reflects the whole field of medical ethics, seeks to promote ethical reflection and conduct in scientific research and medical practice. It includes a series on Ethics and Law.
Its focus is the core activities of medicine. Standards and Ethics Guidance for Doctors A guide published by an independent organisation in the United Kingdom that helps to protect patients and improve medical education and practice. Professionalism, Ethics and Law. Cambridge University Press, Melbourne This book is a useful guide for issues that arise in medical practice.