PoPulationand Public HealtH etHics

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esearch 2 Inevitably children will be found who are “at risk.” Surveillance does not normally include follow up of individuals as the focus is on measuring the magnitude of trends and changes in populations, while screening is intended to identify “at-risk” individuals with the objective of ‘personal’ intervention. A screening program may follow surveillance, but it would, arguably, be unethical to introduce one without good evidence about the scale of the problem. Surveillance is the initial priority to ensure good baseline statistics for future interventions, which could include a screening program. 3 There are good reasons not to obtain active consent. The chances of any risk of harm can be reduced so as to be minimal. Consent is often not sought for routine surveillance and active consent will be difficult to obtain in school settings. Such consent could have a negative impact on participations rates and, therefore, on the robustness of the data. Another option would be to not seek consent at all. However, given that there is some risk of harm (e.g., stigmatization) passive consent seems the best balance between the different considerations. 4 This problem can be addressed if key messages to children and parents about healthy eating and physical activity continue. Scenario shift » Alternate study participants (adolescents): The program could be implemented in high schools, changing the age of the surveillance activity to an older population (13–18-year-old teenagers). Adolescents may be capable of consenting to the surveillance themselves, reducing or removing the need for parental consent. In this scenario active consent could be sought. » Alternate activity (screening): Each child would be given his or her results and follow up would occur for children identified as being “at risk.” » Alternate consent process (active consent): An active consent process is implemented that will seek written consent from parents for each child. This may result in fewer children participating, making the sample not representative of the population. PoPulation anD Public HealtH etHics 24
Questions for discussion 1 Is this surveillance initiative appropriate? 2 Can you explain why you consider this surveillance ethically appropriate or not appropriate? 3 If the project sought active consent from parents, would this increase the case for follow up of “at-risk” children? 4 What are the health unit’s obligations for action after this activity? acknowleDgeMents This case was initially prepared for a presentation at the Ontario Public Health Association conference in 2009 reporting on the use of cases for teaching public health ethics to Ontario public health professionals. reFerences 1 The Public Health Agency of Canada. (2011). Obesity in Canada: A joint report from the Public Health Agency of Canada and the Canadian Institute for Health Information. Her Majesty the Queen in Right of Canada, 2011, Cat.: HP5- 107/2011E-PDF, ISBN: 978-1-100-18133-2 Retrieved from: http://secure.cihi.ca/ cihiweb/products/Obesity_in_canada_2011_en.pdf 2 Singh A. S., Mulder C., Twisk J. W., van Mechelen W. & Chinapaw M. J. (2008). Tracking of childhood overweight into adulthood: a systematic review of the literature. Obesity Reviews, Sept:(5):474–88. Epub 2008. Mar 5. Obesity Surveillance in School Children 25
Page 1 and 2: PoPulationand Public HealtH etHics
Page 3 and 4: contents Acknowledgements - page 5
Page 5: acknowleDgeMents The Partners would
Page 8 and 9: » Create a tool to support instruc
Page 10 and 11: Each of the discussants took on thi
Page 12 and 13: Twenty years on, things have change
Page 14 and 15: intervention (say reduction in mort
Page 16 and 17: ethics understands dilemmas not onl
Page 18 and 19: priority setting. 17 Once more, usi
Page 20 and 21: 6 See for example the WHO Commissio
Page 22 and 23: obesity surveillance in scHool cHil
Page 26 and 27: esearch Case discussion in response
Page 28 and 29: It would be ideal to get active inf
Page 30 and 31: esearch participation, leading to a
Page 32 and 33: to sHare or not to sHare? Secondary
Page 34 and 35: esearch Scenario shift » What if t
Page 36 and 37: esearch Many different parties have
Page 38 and 39: esearch of his concern for people w
Page 40 and 41: esearcH etHics anD conFlicts oF int
Page 42 and 43: esearch and non-public information
Page 44 and 45: esearch reFerences 1 Public Health
Page 46 and 47: esearch Key ethical dimensions Perh
Page 48 and 49: esearch such support, seen across t
Page 50 and 51: esearch Proposed resolution Enablin
Page 52 and 53: a tool For etHical analysis oF Publ
Page 54 and 55: esearch are explicit. In Quebec, su
Page 56 and 57: esearch reFerences 1 Bayer, R. and
Page 58 and 59: Part two Policy
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policy 6 NHS Blood and Transplant.
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policy public trust might also incl
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policy lived in certain regions in
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policy 4 Zou, S., Musavi, F., Notar
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policy Case description For nearly
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policy 3 Economic conditions could
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policy essential to examine the his
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policy lMICs. Evidence-based introd
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policy governments, regional develo
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First nations Drinking water Polici
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policy federal government was aware
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policy reFerences 1 Health Canada.
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policy Core issue Case study author
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policy Additional issues It may be
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policy Arguably, an exception might
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policy Case Following the pharmaceu
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policy 3 What potential harms may b
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policy in the “anti-cancer vaccin
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policy adults may choose for themse
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policy Men also suffer some HPV-cau
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ManDatory iMMunization oF local Pub
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policy for exemptions and declinati
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policy Case discussion in response
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policy the degree of infringement o
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Part tHree Practice
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practice Case The Inquiry found tha
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practice Questions for discussion 1
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practice is a basic ethical obligat
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practice harm is remote, the cost/b
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practice that the professional plac
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practice or equitably reaching your
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practice In what follows, I will de
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practice will end up having to comp
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practice Getting Clear on What’s
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practice Cervical cancer is relativ
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practice Case discussion in respons
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practice principle should only be t
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practice potentially cause the gene
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practice Nations’ constitutional
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practice sanitation and poor housin
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practice Decision making While the
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practice resolution calling for the
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practice Second, the process of oil
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practice contributing to “contrac
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practice How might the decision and
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practice The ethical principle of b
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practice Identify the options avail
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