PoPulationand Public HealtH etHics

Powers and Faden’s theory recognizes the interdependence of empirical and
conceptual approaches to public health ethics. That is, neither philosophical
theories of justice nor measurement of health states is sufficient in and of
itself to provide a coherent account of public health ethics.
It is important to note that often in public health ethics debates, discussions
and analyses cross these various philosophical domains, with utilitarianism
predominating in some analyses and rights-based approaches or communitybased
approaches predominating in others. It can be argued that what is most
important is explicit discussion of the moral and philosophical issues and
the will to move towards a coherent position.
Dimensions of Public Health Ethics
Ethics can be integrated into various contexts in public health. Larry Gostin
distinguishes between three areas of application in public health ethics:
ethics in public health, ethics of public health and ethics for public health. 8
Ethics in public health analyzes concerns involving the public health enterprise,
including tradeoffs between collective goods and individual interests.
The ethics of public health is concerned with the ethical dimensions of professionalism
and the moral trust that society invests in professionals to act
for the common good. Ethics for public health takes into account the value
of healthy communities and the interests of populations, with particular
emphasis on the oppressed.
Callahan and Jennings describe four broad areas for describing the field of
public health and link these to four approaches to the type of ethical analysis
required: health promotion and disease prevention; risk reduction; epidemiology
and other public health research; and structural and socio-economic
disparities. 9 Similar to Gostin’s ethics of public health, they define professional
ethics as based on professional character and virtues and involving ethical
principles regarding trust and legitimacy in the profession. Applied ethics
involves reasoning from general ethical theories to inform the profession.
Advocacy ethics is less theoretical but arguably the most pervasive in public
health. This type of analysis has a strong orientation towards equality and
social justice. Critical ethics describes an approach that attempts to combine
the strengths of each of the above. It is practically oriented toward real-life
problems, but brings larger social values and historical trends to bear. Critical
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