ETHICS IN PUBLIC HEALTH

JANUARY 20, 2021.

DR ASAD
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Ethics - Definition
ethics
ˈɛθɪks/
noun
1.1.
moral principles that govern a person's behaviour or the conducting of an
activity.
synonyms:
"medical moral code, morals, morality, moral
ethics also enter into the question"
stand, moral principles, moral values, rights
2.2.
and
the branch of knowledge that deals with moral principles.
wrongs, principles, ideals, creed, credo, ethos
"neither metaphysics nor ethics is the home
, rules of religion"
of conduct, standards (of

(behaviour), virtues, dictates of
conscience"the ethics of journalism“)
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Law
Ethics Government

New Public Health

Public Inter
Opinion national
standards

Individual Population
Health Health
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Ethics
Ethics is a branch of philosophy that deals with
distinctions between right and wrong – with the
moral consequences of human actions.
The ethical principles that arise in epidemiologic
practice and research include:
Informed consent
Confidentiality
Respect for human rights
Scientific integrity

Last JM [ed]. A Dictionary of Epidemiology. Fourth Edition. 2000

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Why Study Ethics in PH

• Many issues of conflict between good of the

individual and good of society
• Immunization, chlorination, fluoridation
• Food fortification
• HIV/AIDs, MDRTB, DOTs vs. DOTS Plus
• Aging and chronic diseases
• Genetically modified foods
• Technology and resource allocation
• Stem cell research
• The Case-for-Action
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Ethical Issues in PH
Routinely in public health, scientific considerations
blend with political and ethical conflicts, and
questions of autonomy, individual rights, coercion,
justice, community, the common good, the norms of
research, and multi-cultural values are central.
In public health today several different types of
political and moral theory overlap, converge, and
contend with one another, including libertarian
liberalism, egalitarian liberalism, utilitarianism,
human rights frameworks, and communitarianism.
Ethics and Public Health:
http://www.asph.org/UserFiles/E Model Curriculum, ASPH,
thicsCurriculum.pdf 2003
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Ethics in PH
• Moral imperative of PH to ensure and protect the
health of the population and the individual
• Ethical foundations traditionally implicit in PH
• The right to health
• Responsibility for population health
• Renewed awareness of, and accountability
• Conflict between individual and community
rights
• Effects of doing or not doing public health
interventions or “best practices”
• New issues all the time – disasters, genocide
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New Public Health:

Individual and Population Health

Individual Health Population Health

Bioethics = human Public health = utilitarian,

rights, civil liberties paternalistic, social and
and individual legal responsibility to
autonomy approach, protect the public health,
medicalized system, community orientation,
confidentiality, privacy, accountability, universal,
personalized governmental
responsibility
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When and When Not to Act

• Public (community) right to protection and best

available standards
• Dangers/costs of not acting exceed those of acting
• Judgment, experience, evidence, ethics
• Experience of Good Public Health Practice (GPHP)
• Threats of preventable mortality or risk factors
• Public right to know
• Individual rights
• Balance of contradictions
• Accountability, transparency
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Basic Questions ???

• Does society’s responsibilities = paternalism?
• Does freedom of individual = rejection of
responsibility of the state in health?
• Do we need informed consent for all PH
interventions?
• Do individual rights over-ride social
responsibility? E.g. AIDS contact tracing
• “Precautionary Principle” = must prove zero risk
of a new medication or PH intervention?
• Equity in health?
• Adequacy of funding and its allocation?
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Old-New Battles
• UK opposition to vaccination vs. smallpox C19th
• US Opposition to public health departments in
1920s
• UK GPs oppose immunization with pertussis
(1980s) and MMR (2002+)
• AMA opposes to national health insurance 1920s +
• Civil rights vs. HIV control, 1980s US
• Anti-fluoridation 1950s to present
• Resistance to innovations e.g. MMR, Pap smear
• Anti-food fortification in Europe
• Anti-genetic engineering of food in Europe
• Polio vaccination opposition
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PH Ethical Issues
• Responsibility to protect society
• Responsibility to the individual
• Individual vs. community rights
• Government responsibility
• Corporate responsibility
• Right to health care
• Personal responsibility - self care
• Quality of care
• Freedom of choice
• Acting on evidence vs. not acting
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PH Law and Ethics

• Gov’t obligation to protect health of the population
• Power of government to legislate, tax, spend,
regulate, punish
• Restriction of personal and business liberties e.g.
seat belt laws; smoking restrictions vs. human rights
• Economic, social impact of intervention vs. non-
intervention e.g. inequities of the poor and rural
• Laws enacted by legislative bodies
• Court decisions
• Public scrutiny
• Accountability
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Individual Rights and PH Ethical Issues

• Right to quality health services
• Provider responsibility to act for benefit of
client
• Euthanasia - right to die
• Confidentiality – right to privacy
• Informed consent – right to know
• Birth control – religion vs. individual rights
• Supply and distribution of resources for health
• Incentives - disincentives
• Equity – social, ethnic, regional
• Social solidarity
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Groups at Special Risk

• Women
• Children
• Civilians in war and terror situations
• Disaster victims
• Native peoples
• Minority groups
• Prisoners
• Military
• Refugees and internal migrants
• Mentally ill
• Rural vs. urban
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Individual and Community PH Ethics

Individual Community
• Personal hygiene • Sanitation
• Immunization • Herd immunity
• Right to health care • Universal access
• Self care • Education
• Choice of provider • Gatekeeper function
• Right to know • Mandatory reporting
• Right to die • Case follow-up
• Confidentiality • Resources for health
• Privacy • Cost containment
• Informed consent • Equity
• Patients Bill of Rights • Minority and special
groups
• High risk groups
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Universal Declaration of Human Rights, 1948

Article 25.
Everyone has the right to a standard of living
adequate for the health and well-being of himself
and of his family, including food, clothing,
housing and medical care and necessary social
services etc.
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Summary
• Government responsibility to legislate, tax,
regulate and enforce for the public health
• Protection and pro-active services for the weak,
the needy, for equity and social solidarity
• Ethical considerations
• Rights of society
• Rights of individuals
• Responsibility of individuals
• Informed consent for research
• Precaution vs. inertia
• Importance of New Public Health
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Poll Question
Are Public health ethics being followed in Pakistan???

YES NO

Discussion

thanks
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CAN ANYONE LOCATE THE 23
PLACE

IM SCIENCES