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Public Health Service Ethics

Public Health Service Ethics. New Tools for Planning and Implementation. Mark E White, MD, FACPM. Objective. Introduce you to tools of public health ethics Give examples of how you may use them Summarize results of meetings. Take Home Messages.

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Public Health Service Ethics

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  1. Public Health Service Ethics • New Tools for Planning and Implementation Mark E White, MD, FACPM

  2. Objective • Introduce you to tools of public health ethics • Give examples of how you may use them • Summarize results of meetings

  3. Take Home Messages • Public health ethics come from you and your society • Public health ethics are tools for planning and implementation • You must assert your views • Consider the views of others openly in planning • Use public health ethics to make the world a better place

  4. Why Bother with Ethics? • Explicitly considering ethical perspectives in planning allows you to make fairer, more effective and efficient decisions • Openly discussing ethics makes it easier to build consensus, even with those who disagree

  5. Every decision has an ethical dimension

  6. 20th Century Global Health Ethics • The Golden Rule: If you take the king’s gold, you take the king’s rules (funders dictate ethics) • Individualistic ethics • Communitarian ethics 8

  7. Public Health Practice • Improving a specific population’s health by making systematic interventions based on • Science • Management • Consensus building • Ethics • Examples: surveillance, outbreak investigations, program implementations, evaluations

  8. Public Health Program Cycle Planning Justification Advocacy & Consensus Building Monitoring & Evaluation Implementation 9

  9. Advocate, persuade Clarify priorities, assumptions and targets Open, fair processes Clarify progress towards objectives Persuade, advocate Where Ethics Can Help Planning Justification Consensus Building Monitoring & Evaluation Implementation 10

  10. Common Ethical Issues • Prioritizing services (science based, fair) • Distributing services fairly geographically and socially (fair, effective) • Follow up on recommendations of studies (duty) • Restrict freedom (quarantine) 18

  11. What are Ethics Anyway? • Values: “health is good” • Principles are goals: “Help others as you would like to be helped” • Processes: clarify, prioritize, justify possible courses of action • Based on ethical principles, values of stakeholders scientific information From Drue Barrett, CDC, 2007 7

  12. Values Come From You People usually list several, including: • Better population health: “Everyone can live healthy, productive lives” • Social justice: “Everyone treated fairly” • Equity: “Everyone gets an equal chance” • Solidarity: “We are in this together.” • Duty: “Health workers should take care of people with flu. • Autonomy

  13. Principles of Public Health Ethics • Based on value of justice • Inclusiveness/solidarity • Duty/Professionalism “Health workers risk their lives fighting avian influenza” • Science 17

  14. Organizational Ethics: Principles & Processes • Contribute to Public Health Public Health Ethical principles • Accountability • Transparency • Efficiency • Effectiveness

  15. Public Health • Based on justice • Population is patient • Rights of community > individuals • Do the most good for the most people • Protect all, including minorities • Don’t restrict freedom unless absolutely necessary

  16. Research Ethics • Based on autonomy/individual rights • Usually coercive • Protect interests of subjects • Assumes no benefit to subjects • Assumes possible harm to subjects • Very high standards of proof, documentation

  17. Clinical Ethics • Based on autonomy/individual rights • Usually coercive • Protect autonomy of patients • Privacy • Patient must approve • Provider works for pateint

  18. Why not Combine Ethics? • Public Health aims to improve the health of populations • Clinical practice and research aim to improve health of individuals • Public health ethics most useful in planning and implementing interventions • Public health ethics are tools, rarely coercive

  19. Putting Perspectives Together • Cultural relativism: • Cup half empty: nobody agrees completely • Cup half full: everybody agrees on some things • Problem: Western individualists have driven the discussion so far • Opportunity: Engage Middle Eastern, Asian, Latin American, African cultures • You must speak out for your values! 15

  20. Relative Importance of Principles

  21. Take Home Messages • Public health ethics come from you • Public health ethics are tools for planning and implementation • You must assert your views • Consider the views of others openly in planning • Use public health ethics to make the world a better place

  22. Thank You

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