PoPulationand Public HealtH etHics

Aside from the values implicitly or explicitly raised by decision-makers and
reviewers, an effective ethics analysis will identify and seek to balance the
values of those impacted by the decision as well as other values that are accepted
within the broader social context. For example, a cornerstone of public
health ethics is the value of social justice.* An ethics analysis that does not
include review of this value would be incomplete. But again, while we will
likely all agree that social justice is important when we decide what tobaccocessation
strategies to support, what exactly we mean by this may be very
different. The meanings we attach may span treating everyone equitably, maximizing
overall happiness, building community solidarity, seeking equality
of outcome or achieving equality of opportunity. Each of these would lead to
different distribution schemes. It is thus also important to name commonly
accepted norms in society and then to include it in the discussion of weighing
and balancing what should matter most.
Closing Thoughts
Ethics analysis of system-level public health issues requires disciplined and
rigorous attention both to the content of the discussion and the way the
discussion happens; that is, who is involved and how these individuals are
treated. I have highlighted some of the complexities of the content that require
attention in this case study, but this remains only part of the equation.
Decision makers and analysts need to pay attention to both the what and the
how of the discussion, and build skills in both areas, in order to undertake
meaningful ethics analysis.
* See for example Tulchinsky, T. H., Varavikova, E. A. (2010). What is the “New Public Health”?
Public Health Reviews, and Buchanan, D. R. (2000). An ethic for health promotion: Rethinking the
sources of human well-being. New York, NY: Oxford University Press.
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