From questions about how we should treat individuals with contagious illness to new thinking about how to mitigate the population health impact of globalization, public health is replete with moral issues and dilemmas (Beauchamp, 1976; Nixon et al, 2005; Dawson & Verweij, 2008).
|From health inequalities to needle-exchange to infectious disease control, and from water contamination to bio-banking to taxation schemes, public health practice and policy require making tough moral decisions, frequently under circumstances of uncertainty, and not infrequently in the face of significant material scarcity, social panic or political opposition (Nuffield Council on Bioethics, 2007; Powers & Faden, 2008). |
Until recently, public health borrowed its ethics from medicine. However, with its distinctive focus on prevention and on communities, public health is now widely viewed as being in need of its own distinct ethics and principles (Upshur, 2002; Childress et al, 2002; Callahan & Jennings, 2002; Kass, 2005). Emerging over the last 15 years out of dissatisfaction with the traditional orientations of biomedical ethics, public health ethics (PHE) involves the explicit use of concepts from ethical and political theory to discuss and evaluate collective interventions that aim to protect and promote the health of groups and populations rather than of individuals.
There has been a surge of interest in PHE that has led to the development of theoretical frameworks, empirical research agendas, and practical decision-making tools, in addition to (at least in the US if not yet in Canada) professional codes of ethics (PHLS, 2002), model course curricula (Jennings et al, 2003), and web-based public health ethics training modules
The NCCHPP is aiming to bring this emerging body of knowledge to public health actors across Canada, and to thereby increase their expertise to make public health programs and policies more responsive, just, and effective. The Centre is especially mindful of the need to become a trusted information portal, discussion hub, and virtual venue where all members of the public health community can interact and collaborate on how best to implement and support ethical decision-making in daily public health practice, and in the formulation, implementation, and evaluation of healthy public policies.
The NCCHPP has thus begun to develop documents, training modules tailored to Canadian contexts and cases, and resource collections to support the integration of public health ethics tools into policy and practices across the country. References
Beauchamp, DE. (1976). Public health as social justice. Inquiry
, 13(1), 3-14.
Callahan, D. & Jennings, B. (2002). Ethics and public health: Forging a strong relationship. American Journal of Public Health, 92(2), 169-76. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447035/pdf/0920169.pdf
Childress, J. F., Faden, R. R., Gaare, R. D., Gostin, L.O., Kahn, J., Bonnie, R. J. Kass, N.E., Mastroianni, A. C., et al. (2002). Public Health Ethics: Mapping the Terrain. The Journal of Law, Medicine & Ethics, 30, 170-178. Retrieved from: http://www2a.cdc.gov/phlp/docs/cdc.childress.web.pdf
Dawson, A. & Verweij, M. (eds.) (2008). Ethics, Prevention & Public Health. Cambridge: University Press.
Jennings B, Kahn J, Mastroianni A. & Parker, L.S. (Eds.) (2003). Ethics and public health: model curriculum. Washington DC: Association of Schools of Public Health. Retrieved from: http://www.asph.org/document.cfm?page=782
Kass, N.E. (2004). Public health ethics: From foundations and frameworks to justice and global public health. American Journal of Public Health, 32, 232-42.
Nixon, S., Upshur, R.E.G., Robertson A, Benatar S.R., Thompson A, & Daar, A. (2005). Public health ethics. In Bailey T, Caulfield T, & Ries N.M. (Eds.). Public Health Law, Ethics and Policy. Markham, Ontario: Lexis Nexis Canada, (pp. 39-51).
Nuffield Council on Bioethics. (2007). Public heath: ethical issues. Retrieved from: http://www.nuffieldbioethics.org/go/ourwork/publichealth/publication_451.html
Powers, M. & Faden, R. (2008). Social Justice: the moral foundations of public health and health policy. New-York: Oxford University Press.
Public Health Leadership Society. (2002). Principles of the Ethical Practice of Public Health. New Orleans, LA. Retrieved from http://www.phls.org/home/section/3-26/
Upshur, R.E.G. (2002). Principles for the Justification of Public Health Interventions. Canadian Journal of Public Health, 93(2):101-103. Retrieved from: http://journal.cpha.ca/index.php/cjph/article/download/217/217
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