Course Goals

1. Course Goals HSM 775Bioethics for Public Health Professionals

2. To sensitize public health professionals to the moral dimensions of professional life and practice • Life is complex • Ethical issues embedded • Potential for good and bad consequences • Ethics is branch of philosophy • Concerns of ethics • Professional relationships

3. To develop in public health students skills of ethical analysis • Cognitive skills required • Ethics is science of the moral • Concepts, principles, and rules • Problem solving practical • Choices have consequences • Critical thinking key to discriminating good from bad

4. To introduce public health professionals to the array of ethical issues that are currently encountered in the practice of public health • Myriad of issues • Science and technology • Population explosion • Value differences

5. To foster in public health professionals respect for disagreement and toleration of ambiguity • Ethics precise and rigorous, however . . . • Equally virtuous disagree • Grounds must be rational • Toleration critical • Life is ambiguous • Situations were no definitive behavior ideal

6. To assist public health professionals in explicating the moral responsibilities incurred in becoming a member of the public health profession • Cooperative relationship • Professional promise • Good of public and professional • Seeking the good—ethics • Terms of just cooperation

7. To enable students to attain the competencies of a public health professional • Decision making in ethics • Professional ethics • Clinical ethics • Organizational ethics • Social ethics

8. To motivate public health professionals continued learning in ethics • Authentic education • Positive attitude • Motivation to seek further opportunities for learning

9. Disclaimer • No intent to disavow any ethical tradition • Pluralistic society • Concepts basic and reasonable • Not knowingly inconsistent with any religion or culture

10. Questions?Comments?

11. Public Health in Context “The Ends and Means of Health Care”

12. What Is Health? • World Health Organization: • “Health is complete social well being.” • Daniel Callahan: • “Health is the individual’s experience of well-being and integrity of mind and body.”

13. What are the Means of Achieving the Goal of Health? • Economic Resources • Human Behavior: • Knowledge/Education • Personal Motivation • Access to “Medicine” • Public Health

14. Health Care • According to Callahan, health care consists of “organized methods [deriving from health policy] to promote the health of the members of a society, ordinarily encompassing the fields of public health and medicine.” • Furthermore he states: “a society’s health policy will be the organization of those methods into some overall financial and distributional structure designed to pursue the general goals of health care and, ultimately, of health.”

15. Distinctions/Questions • Goals of healthpolicy/goals of health care/goals of health? • Ends of health care determined inductively or normatively? • Goals of medicine/goals of health care? • Medicine as a profession?Medicine as a social construct? • Allocation of resources: what can be made available/what should be made available?

16. Why Must Reconsidering the Goals of Health Care Be So Important Now? • New biomedical knowledge and technological innovation • Heavy economic pressures on current system(s). • Rise of chronic disease • Aging populations • Medicalization of problems once considered non-medical • Improved understanding of behavioral determinants of health • Appreciation of socio-economic status on health

17. Hastings Center Project:Goals of Medicine • The prevention of disease and injury, and the promotion of health (HPDP: “HippyDippy”) • The relief of pain and suffering • The care and cure of those with a malady, and the care of those who cannot be cured. • The avoidance of a premature death and the pursuit of a peaceful death Priority?

18. Politics and Policy Why is it not possible to drive health policy forward toward a consensus? • Large pluralistic society versus small homogenous one • The important role of the “market.” • The unabated drive for constant biomedical progress and technological innovation. • The increase in health care costs due to combination of market forces and progress which are responded to with managerial and economic techniques, not a reconsideration of goals.

19. Public Health • Public health, with medicine, is the other principal ingredient in health care. • Are the goals of public health different than those of medicine?

20. Public Health • Characteristic mark is interest in population, not individual, health • Focus on overall trends of morbidity and mortality and their causes • Epidemiology is the key discipline for measuring these trends • Focus on: • disease and infection surveillance • food and water safety • sanitation • health promotion/disease prevention • Immunizations, smoking cessation, wellness education, and like such programs can have a greater affect on health care than can the provision of good medical care.

21. Proximate Goals forHealth Care • Ultimate versus proximate • Goal setting linked to ethics: ethics of ends and ethics of means • Three policy directions offered by Callahan: • Goals responsive to the needs of population sub-groups • Goals that enhance population health • Goals that facilitate equitable health care