Public Health Ethics: Mapping the Terrain

Journal of Law, Medicine and Ethics - Tập 30 Số 2 - Trang 170-178 - 2002
James F. Childress1, Ruth Faden2, Ruth D. Gaare2, Lawrence O. Gostin3, Jeffrey Kahn4, Richard J. Bonnie5, Nancy Kass2, Anna C. Mastroianni6, Jonathan D. Moreno5, Phillip Nieburg7
1University of Virginia, USA
2Johns Hopkins University, Baltimore, United States
3Bloomberg School of Public Health
4Jeffrey Kahn, M.P.H., Ph.D., is Director of the Center for Bioethics at the University of Minnesota and a professor in the Department of Medicine at the University of Minnesota Medical School.
5University of Virginia, Charlottesville, United States
6University of Washington, Seattle, United States
7Centers for Disease Control and Prevention, Atlanta, United States

Tóm tắt

Public health ethics, like the field of public health it addresses, traditionally has focused more on practice and particular cases than on theory, with the result that some concepts, methods, and boundaries remain largely undefined. This paper attempts to provide a rough conceptual map of the terrain of public health ethics. We begin by briefly defining public health and identifying general features of the field that are particularly relevant for a discussion of public health ethics.Public health is primarily concerned with the health of the entire population, rather than the health of individuals. Its features include an emphasis on the promotion of health and the prevention of disease and disability; the collection and use of epidemiological data, population surveillance, and other forms of empirical quantitative assessment; a recognition of the multidimensional nature of the determinants of health; and a focus on the complex interactions of many factors—biological, behavioral, social, and environmental—in developing effective interventions.

Từ khóa


Tài liệu tham khảo

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3. We recognize that there are different views about the ultimate moral justification for the social institution of public health. For example, some communitarians appear to support public health as an instrumental goal to achieve community. Others may take the view that the state has a duty to ensure the public's health as a matter of social justice. Although these different interpretations and others are very important for some purposes, they do not seriously affect the conception of public health ethics that we are developing, as long as public health agents identify and inform others of their various goals.

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14. In rare cases, it may be ethically justifiable to limit the disclosure of some information for a period of time (for example, when there are serious concerns about national security, about the interpretation, certainty, or reliability of public health data; or about the potential negative effects of disclosing the information, such as with suicide clusters).

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1. Our definition builds on the definition of health systems offered by the World Health Organization: Health systems include “all the activities whose primary purpose is to promote, restore, or maintain health.” See World Health Report 2000 Health Systems: Improving Performance (Geneva: World Health Organization, 2000): at 5.

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9. This justificatory condition is probably the most controversial. Some of the authors of this paper believe that the language of “necessity” is too strong. Whatever language is used, the point is to avoid a purely utilitarian strategy that accepts only the first two conditions of effectiveness and proportionality and to ensure that the non-utilitarian general moral considerations set some prima facie limits and constraints and establish moral priorities, ceteris paribus.

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7. We do not explore here the overlaps among public health ethics, medical ethics, research ethics, and public policy ethics, although some areas of overlap and difference will be evident throughout the discussion. Further work is needed to address some public health activities that fall within overlapping areas — for instance, surveillance, outbreak investigations, and community-based interventions may sometimes raise issues in the ethics of research involving human subjects.

17. Id. at 16–17, 156.

22. Mann, , supra note 21, at 10. Mann thought that the language of ethics could guide individual behavior, while the language of human rights could best guide societal-level analysis and response. See Mann, , supra note 21, at 8; Marks, supra note 21, at 131–38. We disagree with this separation and instead note the overlap of ethics and human rights, but we endorse the essence of Mann's position on human rights.

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8. Recognizing universalizability by attending to past precedents and possible future precedents does not preclude a variety of experiments, for instance, to determine the best ways to protect the public's health. Thus, it is not inappropriate for different states, in our federalist system, to try different approaches, as long as each of them is morally acceptable.

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