PoPulationand Public HealtH etHics

ethics understands dilemmas not only as the result of behaviours of disease
organisms and individuals, but also from institutional arrangements and
prevailing structures of cultural attitudes and social power.
Ethical Frameworks
For public health ethics to contribute to applied public health policy and
practice, it must be understood as a type of applied ethics and relevant to the
quotidian concerns that arise therein. Most practitioners have little inclination
to engage with the finer points of moral theory and so, in many cases, they
will rely on tools such as frameworks to assist in reflection on ethical issues.
Frameworks can be useful because they attempt to capture what is relevant
to ethical reflection in a particular area of practice. They help to simplify and
make explicit factors relevant to a decision. However, they can also be problematic
if they are applied blindly. 10 It is important that the framework be
relevant to the particular area under discussion, and any framework will yield
a poor answer if it does not capture all of the factors relevant for a particular
issue. The idea of a framework should be regarded as a metaphor: frameworks
are simply ‘frames’, a way of looking at a problem in a systematic fashion.
Susan Sherwin uses the metaphor of lenses to illustrate how to employ ethical
theory in practice. 11 Similar to how the various different powers of resolution
found on a microscope provide different perspectives and details of cellular
structure, and different powers of a telescope permit varying resolution of
objects at a distance, different ethical theories illuminate different morally
relevant considerations. No one theory will describe and analyze the same issue
in the same way. Hence, familiarity, experience and practice are required.
Frameworks aim to assist in thinking through an ethical issue, but they will
not supply all of the answers, and individual judgment is still required.
Many operational frameworks and principles have been proposed for the
analysis of ethical issues in public health practice. As noted, many of these
have played a prominent role in pandemic planning documents. Nancy Kass
has articulated an ethics framework that provides six primary questions to
be addressed in relation to the ethical dimensions of any proposed public
health program. 12 Childress et al. enumerate five considerations to be weighed
when analyzing the ethical dimensions of public health action. These include
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