The Genesis of Public Health Ethics

Abstract

As bioethics emerged in the 1960s and 1970s and began to have enormous impacts on the practice of medicine and research--fuelled, by broad socio-political changes that gave rise to the struggles of women, African Americans, gay men and lesbians, and the antiauthoritarianism impulse that characterised the New Left in democratic capitalist societies--little attention was given to the question of the ethics of public health. This was all the more striking since the core values and practices of public health, often entailing the subordination of the individual for the common good, seemed opposed to the ideological impulses of bioethics. Of what relevance is autonomy-focused bioethics for public health, with its mix of justifications including those that are either implicitly or explicitly paternalistic or that seek to impose strictures on individuals and communities in the name of collective welfare? To examine the deep divide between the central commitments of bioethics and the values that animate the practice of public health, we focus on a series of controversies implicating the concepts of privacy, liberty, and paternalism. Recognising the role of moral values in decision-making was a signal contribution of bioethics in its formative period. Over the past three decades a broad array of perspectives emerged under the rubric of bioethics but individualism remains central. As we commence the process of shaping an ethics of public health, it is clear that bioethics is the wrong place to start when thinking about the balances required in defence of the public's health.

How to Think about Health Promotion Ethics

“…It is generally accepted that public health interventions should use the least coercive means available, 80 and for good reason: past coercive policies (e.g., forcing people to have HIV tests early in the epidemic) frequently undermined trust in public health as an institution. 4 Health promotion is not immune: for example, employees might be forced to participate in a workplace health exercise program. 16 So when might coercion or paternalism be justified?…”

An Outcome Measure in Schizophrenia: Mortality

“…We also need to examine the moral value we place on autonomy, the basis of modern bioethics, 50 as applied to the population with severe mental illness. Is it for the patient's benefit that autonomy has become our highest value, trumping what used to motivate physicians-that is, doing good?…”

Public Health Ethics: some useful resources

“…The proper limits of this paternalism are a commonly discussed problem in public health ethics. 5,18,19 This highlights that, because public health measures are often undertaken by the state, both decision making in public health and ethical reasoning about public health are inevitably political. Political philosophy, closely related to moral philosophy, is an important intellectual resource for public health ethics.…”