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Ethical Issues in Public Health Practice in Michigan

Ethical Issues in Public Health Practice in Michigan. Sarah E. Gollust, Nancy M. Baum, MHS, Susan D. Goold, MD, MHSA, MA, and Peter D. Jacobson, JD, MPH Public Health Systems Research Interest Group Annual Meeting June 7, 2008. Background.

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Ethical Issues in Public Health Practice in Michigan

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  1. Ethical Issues in Public Health Practice in Michigan Sarah E. Gollust, Nancy M. Baum, MHS, Susan D. Goold, MD, MHSA, MA, and Peter D. Jacobson, JD, MPH Public Health Systems Research Interest Group Annual Meeting June 7, 2008

  2. Background • Academic distinction made between bioethics and public health ethics • Limited empirical evidence on the extent to which public health practitioners experience ethical challenges in daily work

  3. Project Goals • Build empirical base for public health ethics • Identify ethical issues practitioners experience in their daily work • Gain understanding of methods of resolution

  4. Methods • Site selection: 13 local health departments (LHDs) selected for variation in: • Geographic location • Population characteristics • Governance structure • Recruitment: snowball sampling, starting with health officers at each LHD

  5. Source: Michigan’s Guide to Public Health for Local Governing Entities, November 2006, MALPH

  6. Characteristics of Participating Agencies + 1 City Department Employee and 1 County Commissioner (neither affiliated with sites above)

  7. Occupations of Study Participants

  8. Methods, cont. • Semi-structured, mostly face-to-face interviews with 45 practitioners to identify: • Ethical issues faced in practice • Underlying values • Processes for resolution • Demographics and personal exposure to ethics • Qualitative coding and analysis of transcripts

  9. Results

  10. Ease Discussing Ethics • Few practitioners rely on ethical constructs or use the “language” of ethics • No difficulty identifying or discussing ethical issues

  11. Ethical Challenges - 5 Major Themes 1) Appropriate use of public health authority Balancing public health benefits with individuals’ autonomy or businesses’ economic viability 2)Decisions related to resource allocation Choosing among populations/programs Allocating scarce resources Allocating practitioners’ time

  12. 5 Major Themes, cont. 3) Political interference in practice Politics dictates programming, not evidence Focus on political “issues of the day” rather than community needs 4) Assuring standards of quality care Across different populations During emergencies

  13. 5 Major Themes, cont. 5) Questioning the role or scope of public health Traditional protection from infectious disease vs. Safety net vs. Inclusion of social determinants of health

  14. Public Context • Professional ethics • Personnel issues, managing employees • Public sector duties • Relationships with private sector • Conflicts of interest

  15. Public Health Values • Diversity of values, no clear hierarchy or focus across participants • Helping the most vulnerable • Using public funds efficiently • Being consistent • Being data-driven • Being fair • Greatest good for the greatest numbers of people • Personal responsibility

  16. Resources Used to Resolve Ethical Challenges • Consultation with colleagues • Reliance on personal experience • Reliance on personal moral grounding • Almost no use of formal frameworks

  17. Discussion

  18. Discussion • Practitioners recognize that their work demands nuanced, ethically-laden decisions • Sense of “doing the right thing” animates practitioners’ daily practice

  19. Discussion • Few differences in major types of ethical issues across practitioners and departments • Practitioners use little formal assistance to process and resolve ethical issues • Creating effective frameworks to assist practitioners will be a challenge

  20. Contribution to Public Health Systems Research • Qualitative research informs the interactive effects of policy and the organizational environment on practice • Identifies how systems-level factors (e.g., funding restrictions) affect practitioners’ daily work

  21. Contribution to Public Health Systems Research • Recognizes that ethical decision-making is an integral part of delivering public health services • E.g., decisions allocating resources • May suggest ways to design a system that facilitates ethical decision-making and reduces ethical conflict

  22. Acknowledgements • Greenwall Foundation • Robert M. Pestronk (study consultant) • 45 public health professionals for offering us their considerable insights

  23. More information • My email: sgollust@umich.edu • Study publications: • Baum et al. Looking Ahead: Addressing Ethical Challenges in Public Health Practice. Journal of Law, Medicine, and Ethics. 2007; 35(4): 657-667. • Gollust et al. Politics and Public Health Practice: Left and Right Meets Wrong and Right. Journal of Public Health Management and Practice. 2008; Forthcoming.

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