Repertoire - Ethics Frameworks for Public Health

We have compiled a list of ethics frameworks for public health, with links to the original documents (if they are freely available). In addition, we have produced 7 short, adapted summaries of frameworks that present their main elements in such a way that they can be directly put to use in practice. We intend to add to this list as new frameworks become available or as we learn of others. Please let us know about any frameworks that we should add to this repertoire. We will also continue to produce the adapted summary versions.
Updated in February 2021.
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Alberta Health. (2016). Alberta's ethical framework for responding to a pandemic influenza. Available at: https://open.alberta.ca/dataset/5ae20e2c-4d4a-4251-bf05-dcdf32d0cd97/resource/5621dbe3-4b27-4c37-9073-58d762312d6f/download/apip-pandemic-ethics-framework-2016.pdf

 

Baum, N. M., Gollust, S. E., Goold, S. D., & Jacobson, P. D. (2007). Looking ahead: Addressing ethical challenges in public health practice. Global Health Law, Ethics and Policy, Winter 2007, 657-667. Available at: http://deepblue.lib.umich.edu/bitstream/handle/2027.42/75478/j.1748-720X.2007.00188.x.pdf?sequence=1&isAllowed=y
Our adapted summary is available at: http://www.ncchpp.ca/docs/2016_eth_frame_baum_En.pdf   

 

Baylis, F., Kenny, N. P., & Sherwin, S. (2008). A relational account of public health ethics. Public Health Ethics, 1(3), 196–209. For information (paywall):  https://academic.oup.com/phe/article-abstract/1/3/196/1570681

 

BC Centre for Disease Control (BCCDC). (2015). BCCDC Ethics Framework and Decision-Making Guide. Available at: http://www.bccdc.ca/resource-gallery/Documents/Guidelines%20and%20Forms/Guidelines%20and%20
Manuals/BCCDC_Ethics_Framework_Decision_Making_Guide.pdf

 

BC Centre for Disease Control & BC Ministry of Health. (2020). Covid-19 ethical decision making framework. Available at:
https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/covid-19/ethics_framework_for_covid_march_28_2020.pdf

 

Berlinger, N., Wynia, M., Powell, T., Hester, D. M., Milliken, A., (...) & Jenks, N. P. (2020). Ethical framework for health care institutions responding to novel coronavirus SARS-CoV-2 (COVID-19) & Guidelines for institutional ethics services responding to COVID-19. The Hastings Center, March 16, 2020. Available at: https://www.thehastingscenter.org/ethicalframeworkcovid19/

 

Bernheim, R. Gaare, Nieburg, P., & Bonnie, R. J. (2007). Ethics and the practice of public health. In R. A. Goodman, R. E. Hoffman, W. Lopez, G. W. Matthews, M. Rothstein, & K. Foster (Eds.), Law in public health practice, pp. 110-135. Oxford: Oxford University Press. For information (paywall): http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780195301489.001.0001/acprof-9780195301489
Our adapted summary is available at: http://www.ncchpp.ca/docs/2016_eth_frame_bernheim_En.pdf 

 

Bernstein, J., Hutler, B., Rieder, T., Faden, R., Han, H., & Barnhill, A. (2020). An ethics framework for the Covid-19 reopening process. Berman Institute of Bioethics, Johns Hopkins University, May 2020. Available at:
https://bioethics.jhu.edu/wp-content/uploads/2019/10/FINAL-SNF-Agora-Covid-19.pdf

 

Breunis, L. J., Been, J. V., de Jong-Potjer, L., Steegers, E. A. P., de Beaufort, I. D., [...] & M'hamdi, H. I. (2020). Incentives for smoking cessation during pregnancy: An ethical framework. Nicotine & Tobacco Research, 2020, 1553–1559. Available at: https://academic.oup.com/ntr/article/22/9/1553/5680163   

 

Canadian Nurses Association. (2006). Public health nursing practice and ethical challenges. Ethics in Practice for Registered Nurses, February 2006, 12 pp. Ottawa: Canadian Nurses Association. Available at: http://cna-aiic.ca/~/media/cna/page-content/pdf-en/ethics_in_practice_jan_06_e.pdf  

 

Carter, S. M., Rychetnik, L., Lloyd, B., Kerridge, I. H., Baur, L., Bauman, A., Hooker, C., & Zask, A. (2011). Evidence, ethics and values: A framework for health promotion. American Journal of Public Health, 101(3), 465-472. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036693/pdf/465.pdf  

 

Childress, J. F. & Bernheim, R. G. (2015). Introduction: A framework for public health ethics. In R. G. Bernheim, J. F. Childress, R. J. Bonnie and A. L. Melnick (Eds.), Essentials of Public Health Ethics. Burlington, MA: Jones and Bartlett Learning. Available at: http://samples.jbpub.com/9780763780463/Chapter1.pdf (N.b.: 20 MB).

 

Childress, J. F., Faden, R. R., Gaare, R. D., Gostin, L. O., Kahn, J., Bonnie, R. J., Kass, N. E., Mastroianni, A. C., Moreno, J. D., & Nieburg, P. (2002). Public Health Ethics: Mapping the Terrain. Journal of Law, Medicine & Ethics, 30(2), 169–177. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1748-720X.2002.tb00384.x/epdf

 

Désy, M., Filiatrault, F., & Laporte, I. (2012). A tool for ethical analysis of public health surveillance plans. In Canadian Institutes of Health Research – Institute of Population and Public Health, Population and Public Health Ethics: Cases from Research, Policy, and Practice (pp. 52-57). Toronto, Ottawa: University of Toronto Joint Centre for Bioethics. Available at: http://www.jcb.utoronto.ca/publications/documents/Population-and-Public-Health-Ethics-Casebook-ENGLISH.pdf

 

Désy, M., St-Pierre, J., Leclerc, B., Couture-Ménard, M-È., Cliche, D., & Maclure, J. (2020). Cadre de réflexion sur les enjeux éthiques liés à la pandémie de COVID-19. Available at: https://www.inspq.qc.ca/publications/2958 (in French).

 

Emanuel, E. J., Persad, G., Kern, A., Buchanan, A., Fabre, C., [...] & Richardson, H. S. (2020). An ethical framework for global vaccine allocation. Science 369(6509), pp. 1309-1312. Available at:
https://science.sciencemag.org/content/369/6509/1309/tab-pdf

 

Fielding, J., Sullivan, S. G., Beard, F., Macartney, K., Williams, J., [...] & McVernon, J. (2021). Constructing an ethical framework for priority allocation of pandemic vaccines. Vaccine, 2021. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779078/pdf/main.pdf

 

Filiatrault, F., Désy, M., and Leclerc, B. (2015). Framework of Values to Support Ethical Analysis of Public Health Actions. Montréal: Institut national de santé publique du Québec. Available at: https://www.inspq.qc.ca/en/publications/2285

 

Fry, C. (2007). Making values and ethics explicit: a new code of ethics for the Australian alcohol and other drugs field. Canberra: Alcohol and other Drugs Council of Australia. Available at: https://www.youthaodtoolbox.org.au/sites/default/files/documents_global/ADCA%20code%20of%20ethics.pdf

 

Gostin, L. (2003). Public health ethics: Tradition, profession and values. Acta Bioethica, 2003; año IX, No 2, 177-188. Available at: http://www.scielo.cl/pdf/abioeth/v9n2/art04.pdf.

 

Gostin, L., Mann, J. M., & Gostin, L. (1994). Towards the development of a human rights impact assessment for the formulation and evaluation of public health policies. Health and Human Rights, 1(1), 58-80. Available at: http://academic.udayton.edu/richardghere/NGO%20Man/Gostin%20article.pdf

 

Grill, K. & Dawson, A. (2015). Ethical frameworks in public health decision-making: Defending a value-based and pluralist approach. Health Care Analysis, 2015, July 14. Available at: http://link.springer.com/article/10.1007/s10728-015-0299-6/fulltext.html 

 

Gruskin, S. & Daniels, N. (2008). Justice and human rights: Priority setting and fair deliberative process. American Journal of Public Health, 98(9), 1573-1578. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2509612/pdf/0981573.pdf

 

Guttman, N. & Salmon, C. T. (2004). Guilt, Fear, Stigma and Knowledge Gaps: Ethical Issues in Public Health Communication Interventions. Bioethics, 18(6). Retrieved from:
http://onlinelibrary.wiley.com/wol1/doi/10.1111/j.1467-8519.2004.00415.x/full (paywall).
Our adapted summary is available at: http://www.ncchpp.ca/docs/2017_eth_frame_guttman_salmon_En.pdf   

 

Kass, N. E. (2001). An ethics framework for public health. American Journal of Public Health, 91(11), 1776–1782. Available at: http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.91.11.1776
Our adapted summary is available at: http://www.ncchpp.ca/docs/2016_eth_frame_kass_En.pdf   

 

Ismail, S. J., Hardy, K., Tunis, M. C., Young, K., Sicard, N., & Quach, C. (2020). A framework for the systematic consideration of ethics, equity, feasibility, and acceptability in vaccine program recommendations. Vaccine, 38(36), 5861-5876. Available at: https://www.sciencedirect.com/science/article/pii/S0264410X20306964?via%3Dihub

 

Liu, Y., Salwi, S., & Drolet, B. (2020). Multivalue ethical framework for fair global allocation of a Covid-19 vaccine. Journal of Medical Ethics, 2020. Available at: https://jme.bmj.com/content/medethics/early/2020/06/12/medethics-2020-106516.full.pdf

 

Marckmann, G., Schmidt, H., Sofaer, N., & Strech, D. (2015). Putting public health ethics into practice: A systematic framework. Frontiers in Public Health, February 2015, 3(23), 8 pp. Available at: http://journal.frontiersin.org/article/10.3389/fpubh.2015.00023/full
Our adapted summary is available at:
http://www.ccnpps.ca/docs/2019_eth_frame_Marckmann_En.pdf  

 

New Zealand Ethics Advisory Committee. (2007). Getting through together: Ethical values for a pandemic. Wellington: Ministry of Health. Available at: http://neac.health.govt.nz/system/files/documents/publications/getting-through-together-jul07.pdf  

 

Nuffield Council on Bioethics. (2007). Public health: Ethical issues. Available at: 
http://nuffieldbioethics.org/wp-content/uploads/2014/07/Public-health-ethical-issues.pdf (report - 225 pp.)
http://nuffieldbioethics.org/wp-content/uploads/2014/07/Public-Health-short-guide.pdf (guide - 9pp.).

 

Ondrusek, N., Willison, D., Haroun, V., Bell, J., & Bornbaum, C. (2015). A risk screening tool for ethical appraisal of evidence-generating initiatives. BMC Medical Ethics, 16(47). Available at: http://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-015-0039-3  This document outlines and accompanies the online risk screening tool developed by Public Health Ontario. The risk screening tool is available here: https://www.publichealthontario.ca/en/About/Research/Ethics/Pages/Ethics-support-forms-and-tools.aspx  

 

Public Health Agency of Canada. (2017). Framework for ethical deliberation and decision-making in public health: A tool for public health practitioners, policy makers and decision-makers. Available at: http://publications.gc.ca/pub?id=9.818019&sl=0

 

Public Health Agency of Canada. (2020). Public health ethics framework: A guide for use in response to the COVID-19 pandemic in Canada. Available at: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/canadas-reponse/ethics-framework-guide-use-response-covid-19-pandemic.html  

 

Public Health Leadership Society. (2002). Principles of the ethical practice of public health. Available at: https://www.apha.org/-/media/files/pdf/membergroups/ethics/ethics_brochure.ashx     

 

Public Health Ontario. (2020). Public health emergency preparedness framework and indicators. Available at: https://www.publichealthontario.ca/-/media/documents/w/2020/workbook-emergency-preparedness.pdf?la=en

 

Schröder-Bäck, P., Duncan, P., Sherlaw, W., Brall, C., & Czabanowska, K. (2014). Teaching seven principles for public health ethics: Towards a curriculum for a short course on ethics in public health programmes. BMC Medical Ethics, 2014, 15:73. Available at: http://www.biomedcentral.com/content/pdf/1472-6939-15-73.pdf.
Our adapted summary is available at: http://www.ncchpp.ca/docs/2016_eth_frame_schroder-back%20_En.pdf.

 

Selgelid, M. J. (2009). A moderate pluralist approach to public health policy and ethics. Public Health Ethics, 2(2), 195–205. Available at: http://phe.oxfordjournals.org/content/2/2/195.full.pdf+html 

 

Shared health/Soins communs Manitoba. (2020). Covid-19 ethics framework: Information for providers. Available at: https://sharedhealthmb.ca/covid19/providers/ethics-framework/

 

Tannahill, A. (2008). Beyond evidence—to ethics: a decision-making framework for health promotion, public health and health improvement. Health Promotion International, 23(4), 380-390. Available at: http://heapro.oxfordjournals.org/content/23/4/380.full.pdf+html  

 

ten Have, M., van der Heide, A., Mackenbach, J., & de Beaufort, I. D. (2012). An ethical framework for the prevention of overweight and obesity: A tool for thinking through a programme's ethical aspects. European Journal of Public Health, 23(2), 299-305. Available at: http://eurpub.oxfordjournals.org/content/23/2/299.long  
Our adapted summary is available at: http://www.ncchpp.ca/docs/2016_eth_frame_tenHave_En.pdf

 

Thompson, A. K., Faith, K., Gibson, J. L., & Upshur, R. E. G. (2006). Pandemic influenza preparedness: An ethical framework to guide decision-making. BMC Medical Ethics, 7(12). Available at: http://www.biomedcentral.com/1472-6939/7/12  

 

Upshur, R. E. G. (2002). Principles for the justification of public health intervention. Canadian Journal of Public Health, 93(2), 101-103.  Available at: http://www.jcb.utoronto.ca/people/publications/cjph2002.pdf
Our adapted summary is available at: http://www.ncchpp.ca/docs/2016_eth_frame_upshur_En.pdf  

 

Valiani, S., Terrett, L., Gebhardt, C., Prokopchuk-Gauk, O., & Isinger, M. (2020). Development of a framework for critical care resource allocation for the COVID-19 pandemic in Saskatchewan. Canadian Medical Association Journal, 192(37), E1067-73. Available at:
https://www.cmaj.ca/content/cmaj/192/37/E1067.full.pdf 

 

Weinstock, D. (2020). A harm reduction approach to the ethical management of the Covid-19 pandemic. Public Health Ethics, 13(2), 166–175. Available at: https://academic.oup.com/phe/advance-article/doi/10.1093/phe/phaa026/5899250

 

Willison, D., Ondrusek, N., Dawson, A., Emerson, C., Ferris, L., Saginur, R., Sampson, H., & Upshur, R. E. G. (2012). A framework for the ethical conduct of public health initiatives. Public Health Ontario. Available at: http://www.publichealthontario.ca/en/eRepository/PHO%
20%20Framework%20for%20Ethical%20Conduct%20of%20Public%20Health%20Initiatives%20
April%202012.pdf
  Also, this shorter document discusses the framework and provides a table of its Ten guiding questions: Willison, D. J., Ondrusek, N., Dawson, A., Emerson, C., Ferris, L. E., Saginur, R., Sampson, H., & Upshur, R. (2014). What makes public health studies ethical? Dissolving the boundary between research and practice. BMC Medical Ethics, 15(61), 1-6. Available at: http://bmcmedethics.biomedcentral.com/articles/10.1186/1472-6939-15-61

 

Winnipeg Regional Health Authority. (2015). Ethical Decision-Making Framework: Evidence Informed Practice Tool. Winnipeg: Winnipeg Regional Health Authority, Ethics Services. Available at: http://www.wrha.mb.ca/extranet/eipt/EIPT-037.php

 

World Health Organization (WHO). (2017). WHO guidelines on ethical issues in public health surveillance. Geneva: World Health Organization. Available at: https://www.who.int/ethics/publications/public-health-surveillance/en/

 
 

The production of the NCCHPP website has been made possible through a financial contribution from the Public Health Agency of Canada.