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Public Health Ethics Theory: Review and Path to Convergence

Published online by Cambridge University Press:  01 January 2021

Lisa M. Lee
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Extract

For over 100 years, the field of contemporary public health has existed to improve the health of communities and populations. As public health practitioners conduct their work – be it focused on preventing transmission of infectious diseases, or prevention of injury, or prevention of and cures for chronic conditions – ethical dimensions arise. Borrowing heavily from the ethical tools developed for research ethics and bioethics, the nascent field of public health ethics soon began to feel the limits of the clinical model and began creating different frameworks to guide its ethical challenges. Several public health ethics frameworks have been introduced since the late 1990s, ranging from extensions of principle-based models to human rights and social justice perspectives to those based on political philosophy. None has coalesced as the framework of choice in the discipline of public health. This paper examines several of the most-known frameworks of public health ethics for their common theoretical underpinnings and values, and suggests next steps toward the formulation of a single framework.

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Independent
Information
Journal of Law, Medicine & Ethics , Volume 40 , Issue 1 , Spring 2012 , pp. 85 - 98
Copyright
Copyright © American Society of Law, Medicine and Ethics 2012

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References

Verweij, M. Dawson, A., “The Meaning of ‘Public’ in Public Health,” in Dawson, A. Verweij, M., eds., Ethics, Prevention, and Public Health (New York: Oxford University Press, 2007).Google Scholar
Nuffield Council on Bioethics, Public Health: Ethical Issues, 2007, available at <http://www.nuffieldbioethics.org/go/ourwork/publichealth/introduction> (last visited January 9, 2012).+(last+visited+January+9,+2012).>Google Scholar
Tauber, A. I., “Medicine, Public Health, and the Ethics of Rationing,” Perspectives in Biology and Medicine 45, no. 1 (2002): 16–30.CrossRefGoogle Scholar
See Verweij, Dawson, , supra note 1.Google Scholar
Kass, N. E., “Public Health Ethics: From Foundations and Frameworks to Justice and Global Public Health,” Journal of Law, Medicine & Ethics 32, no. 2 (2004): 232–242.CrossRefGoogle Scholar
Bayer, R. Levine, C. Wolf, S. M., “HIV Antibody Screening: An Ethical Framework for Evaluating Proposed Programs,” JAMA 256, no. 13 (1986): 1768–1774.CrossRefGoogle Scholar
Faden, R. R. Kass, N. E., “Bioethics and Public Health in the 1980s: Resource Allocation and AIDS,” Annual Review of Public Health 12, no. 1 (1991): 335–360.CrossRefGoogle Scholar
Gostin, L. Curran, W. J., “AIDS Screening, Confidentiality, and the Duty to Warn,” American Journal of Public Health 77, no. 3 (1987): 361–365.CrossRefGoogle Scholar
Beauchamp, D. E., The Health of the Republic: Epidemics, Medicine and Moralism as Challenges to Democracy (Philadelphia, PA: Temple University Press, 1988).Google Scholar
Institute of Medicine, The Future of Public Health (Washington, D.C.: National Academy Press, 1988).Google Scholar
Last, J. M., ed., A Dictionary of Public Health (New York: Oxford University Press, 2006).Google Scholar
American Public Health Association, “10 Essential Public Health Services,” available at <http://www.apha.org/programs/standards/performancestandardsprogram/resexxen-tialservices.htm> (last visited January 9, 2012).+(last+visited+January+9,+2012).>Google Scholar
Williams, J. R., “The Declaration of Helsinki and Public Health,” Bulletin of the World Health Organization 86, no. 8 (2008): 650–651.CrossRefGoogle Scholar
Dawson, A., “The Future of Bioethics: Three Dogmas and a Cup of Hemlock,” Bioethics 24, no. 5 (2010): 218–225.CrossRefGoogle Scholar
Lane, S. D. Rubinstein, R. A. Cibula, D. Webster, N., “Towards a Public Health Approach to Bioethics,” Annals of the New York Academy of Sciences 925 (2000): 25–36.CrossRefGoogle Scholar
Beauchamp, T. L. Childress, J. F., Principles of Biomedical Ethics, 6th ed. (New York: Oxford University Press, 2009).Google Scholar
Clouser, K. D., “Common Morality as an Alternative to Principlism,” Kennedy Institute of Ethics Journal 5, no. 3 (1995): 219–236; Petrini, C. Gainotti, S., “A Personalist Approach to Public-Health Ethics,” Bulletin of the World Health Organization 86, no. 8 (2008): 624–629; Petrini, C., “Ethical Issues in Public Health and Prevention,” Journal of Medicine and the Person 5, no. 3 (2007): 117–122.CrossRefGoogle Scholar
Rothman, D. J., Strangers at the Bedside (New York, New York: Basic Books, 1991).Google Scholar
Id.Google Scholar
See Beachamp, Childress, , supra note 16.Google Scholar
Kass, N. E., “An Ethics Framework for Public Health,” American Journal of Public Health 91, no. 11 (2001): 1776–1782.CrossRefGoogle Scholar
Childress, J. R. Faden, R. R. Gaare, R. D. Gostin, L. O. Kahn, J. Bonnie, R. J. Kass, N. E. Mastroianni, A. C. Moreno, J. D. Nieburg, P., “Public Health Ethics: Mapping the Terrain,” Journal of Law, Medicine & Ethics 30, no. 2 (2002): 170–178.CrossRefGoogle Scholar
Upshur, R.E.G., “Principles for the Justification of Public Health Intervention,” Canadian Journal of Public Health 93, no. 2 (2002): 101–103.CrossRefGoogle Scholar
Thompson, A. K. Faith, K. Gibson, J. L. Upshur, R. E. G., “Pandemic Influenza Preparedness: An Ethical Framework to Guide Decision-Making,” BMC Med Ethics 7 (2006): 12.CrossRefGoogle Scholar
Callahan, D. Jennings, B., “Ethics and Public Health: Forging a Strong Relationship,” American Journal of Public Health 92, no. 2 (2002): 169–176.CrossRefGoogle Scholar
Daniels, N., “Accountability for Reasonableness,” BMJ 321 (2000): 1300–1301.CrossRefGoogle Scholar
Baum, N. M. Gollust, S. E. Goold, S. D. Jacobson, P. D., “Looking Ahead: Addressing Ethical Challenges in Public Health Practice,” Journal of Law, Medicine & Ethics 35, no. 4 (2007): 657–667.CrossRefGoogle Scholar
Swain, G. R. Burns, K. A. Etkind, P., “Preparedness: Medical Ethics Versus Public Health Ethics,” Journal of Public Health Management Practice 14, no. 4 (2008): 354–357.CrossRefGoogle Scholar
Thomas, J. C., “Public Health Ethics,” available at <http://oce.sph.unc.edu/phethics/modules.htm> (last visited January 9, 2012).+(last+visited+January+9,+2012).>Google Scholar
See Kass, , supra note 21.Google Scholar
Jaffe, H. W. Hope, T., “Treating for the Common Good: A Proposed Ethical Framework,” Public Health Ethics 3, no. 3 (2010): 193–198.CrossRefGoogle Scholar
Granich, R. M. Gilks, C. F. Dye, C. DeCock, K. M. Williams, B. G., “Universal Voluntary HIV Testing with Immediate Antiretroviral Therapy as a Strategy for Elimination of HIV Transmission: A Mathematical Model,” The Lancet 373, no. 9657 (2009): 48–57.CrossRefGoogle Scholar
See Granich, , supra note 32.Google Scholar
The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Biomedical and Behavioral Research (Washington, D.C.: Department of Health, Education, and Welfare, April 18, 1979).Google Scholar
Council for International Organizations of Medical Sciences (CIOMS), International Ethical Guidelines for Biomedical Research Involving Human Subjects, available at <http://www.cioms.ch/publications/layout_guide2002.pdf> (last visited January 9, 2012).+(last+visited+January+9,+2012).>Google Scholar
See Clouser, , supra note 17.Google Scholar
See Petrini, Gainotti, , supra note 17.Google Scholar
See Petrini, , supra note 17.Google Scholar
See Clouser, , supra note 17.Google Scholar
DeGrazia, D., “Moving Forward in Bioethical Theory: Theories, Cases, and Specified Principlism,” Journal of Medicine and Philosophy 17, no. 5 (1992): 511–539.CrossRefGoogle Scholar
Mann, J. M., “Health and Human Rights,” BMJ 312, no. 7036 (1996): 924–925.CrossRefGoogle Scholar
Roberts, M. J. Reich, M. R., “Ethical Analysis in Public Health,” The Lancet 359, no. 9311 (2002): 1055–1059.CrossRefGoogle Scholar
Jennings, B., “Public Health and Civic Republicanism: Toward an Alternative Framework for Public Health Ethics,” in Dawson, A. Verweij, M., eds., Ethics, Prevention, and Public Health (New York: Oxford University Press, 2007).Google Scholar
See Petrini, Gainotti, , supra note 17.Google Scholar
See Beauchamp, Childress, , supra note 16.Google Scholar
See Beauchamp, Childress, , supra note 16, page 626.Google Scholar
See Mann, , supra note 41.Google Scholar
Talisse, R. B., On Rawls: A Liberal Theory of Justice and Justification (Belmont, CA: Wadsworth, 2001): At 14.Google Scholar
See Nuffield Council, supra note 2.Google Scholar
See Nuffield Council, supra note 2, page 153.Google Scholar
See Nuffield Council, supra note 2, page xvi.Google Scholar
See Nuffield Council, supra note 2, page 23.Google Scholar
Sustein, C. R. Thaler, R. H., “Libertarian Paternalism Is Not an Oxymoron,” University of Chicago Law Review 70, no. 4 (2003): 1159–1202.CrossRefGoogle Scholar
See Sustein, Thaler, , supra note 53, page 26.Google Scholar
Kenny, N. P. Sherwin, S. B. Baylis, F. E., “Re-visioning Public Health Ethics: A Relational Perspective,” Canadian Journal of Public Health 101, no. 1 (2010): 9–11.CrossRefGoogle Scholar
Baylis, F. Kenny, N. P. Sherwin, S., “A Relational Account of Public Health Ethics,” Public Health Ethics 1, no. 3 (2008): 196–209.CrossRefGoogle Scholar
Dawson, A., “Commentary on 'The Limits of Law in the Protection of Public Health and the Role of Public Health Ethics,” Public Health 120 (2006): 77–80.CrossRefGoogle Scholar
Petrini, C., “Theoretical Models and Operational Frameworks in Public Health Ethics,” International Journal of Environmental Research Public Health 7, no. 1 (2010): 189–202.CrossRefGoogle Scholar
See Petrini, , supra note 17, at 121.Google Scholar
See Kass, , supra note 21.Google Scholar
See Childress, et al., supra note 22.Google Scholar
See Upshur, , supra note 23.Google Scholar
See Thompson, et al., supra note 24.Google Scholar
See Baum, et al., supra note 27.Google Scholar
See Swain, et al., supra note 28.Google Scholar
See Jaffe, Hope, , supra note 31.Google Scholar
See Petrini, Gainotti, , supra note 17.Google Scholar
See Council, Nuffield, supra note 2.Google Scholar
See Kenny, et al., supra note 50.Google Scholar
See Clouser, , supra note 17.Google Scholar
See Jennings, , supra note 43.Google Scholar
See Council, Nuffield, supra note 2.Google Scholar
Bernheim, R. G., “Public Health Ethics: The Voices of Practitioners,” Journal of Law, Medicine & Ethics 31, no. 4, Supp. (2003): 104–109; Baum, N. M. Gollust, S. E. Goold, S. D. Jacobson, P. D., “Ethical Issues in Public Health Practice in Michigan,” American Journal of Public Health 99, no. 2 (2009): 369–374.CrossRefGoogle Scholar
Coughlin, S. S., “How Many Principles for Public Health Ethics?” Open Public Health Journal 1 (2008): 8–16.CrossRefGoogle Scholar
Williams, J. R., “The Declaration of Helsinki and Public Health,” Bulletin of the World Health Organization 86, no. 8 (2008): 650–652; Dawson, A., “The Future of Bioethics: Three Dogmas and a Cup of Hemlock,” Bioethics 24, no. 5 (2010): 218–225; Lane, S. D. Rubinstein, R. A. Cibula, D. Webster, N., “Towards a Public Health Approach to Bioethics,” Annals of the New York Academy of Sciences 925 (2000): 25–36.CrossRefGoogle Scholar
See Council, Nuffield, supra note 2.Google Scholar
See Petrini, Petrini, Gainotti, , supra note 17.Google Scholar
Rawls, J., Justice as Fairness: A Restatement (Cambridge, MA: Belknap Press, 2001).Google Scholar