PoPulationand Public HealtH etHics

Twenty years on, things have changed. Recent public health events, such as
the saRs outbreak and the Walkerton e-coli outbreak, as well as the growing
obesity problem and recognition of the ongoing disparities in health both in
Canada and globally, have reinforced the need for ethical reflection in practice.
The H1n1 influenza pandemic revealed a range of ethical issues most conspicuously
relating to priority setting and data sharing. Each of these events
raised significant ethical issues, some of which were handled well, others for
which it is evident that a better job could have been done.
In this brief introduction, I will highlight some key features of public health
ethics. To that end, I will briefly discuss the differences between public
health ethics and bioethics; address the context of the application of ethics
in public health; outline the role of ethical frameworks and ethical theory;
and examine the growing relevance of public health ethics to public health
policy. I will conclude by arguing for the need for core competencies in public
health ethics.
How is public health ethics different from bioethics?
Public health ethics can be differentiated from much-better-known forms of
ethics rooted in biomedicine and the traditions of ethics in the health professions.
Modern health-care ethics takes its departure from the analysis of
ethical issues as they arise in medical practice, particularly in the context of
the application of new technologies in health care. The most influential theoretical
elaboration is a principle-based approach as articulated by Thomas
Beauchamp and James Childress. 1 Their well-known framework requires
weighing and balancing considerations of respect for persons enshrined in
the principle of autonomy, concerns for promoting welfare and well being
through the principle of beneficence, avoiding doing harm as encapsulated
in the principle of non-maleficence and concerns for justice. The first three
principles apply primarily in terms of interactions between individuals;
consideration of them typically plays out in a health-care provider/patient relationship.
Only considerations of justice require the integration of the views
of the broader community. Much bioethics scholarship, therefore, has been
concerned with individual-level ethical issues.
Public health ethics focuses more on issues related to the interaction of individuals
and communities, reflecting on collective responsibilities and common
12