PoPulationand Public HealtH etHics

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esearch reFerences 1 Public Health Agency of Canada. (2004). Core competencies for public health in Canada release 1.0. Public Health Agency of Canada. Retrieved from: http:// www.publications.gc.ca/collections/collection_2008/. . ./HP5-51-2008E.pdf 2 Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, and Social Sciences and Humanities Research Council of Canada. (2010). Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. Retrieved from: http://www.pre.ethics.gc.ca/eng/ policy-politique/initiatives/tcps2-eptc2/Default 3 Upshur, R. E. G. (2002). Principles for the justification of public health intervention. Can J Pub Health. 2002;93:101–103. Figure 1. cHilD DeveloPMent screening algoritHM The current screening algorithm is shown in grey and the validation study algorithm is shown in black. Post-Partum Screening All families in Province are screened after birth for developmental risk “High-risk” on original screen OR In-depth Assessment Other intake screening All families with children age zero–6 that are referred or self-refer are screened for developmental risk Positive for 1 or more risk factors on new screen High Risk Moderate Risk Low Risk PMC Home visiting program Refer to appropriate programs & agencies No intervention needed PoPulation anD Public HealtH etHics 44 No Risk Factors No Risk Factors No further screening Every 5th Family
Case discussion in response to researcH etHics anD conFlicts oF interest at a local Public HealtH DePartMent Christopher McDougall Health Policy, Management & Evaluation, and Joint Centre for Bioethics University of Toronto, Toronto ON CHRIstoPHeR.MCDougall@utoRonto.Ca Introduction One thing is certain in this case: the Provincial Ministry for Children (PMC), through its lack of transparency and heavy-handedness in introducing a possibly legitimate and laudable change to public health practice, has succeeded primarily in alienating the front-line professionals essential to that practice, as well as in raising their suspicions about the motives behind the transition. Indeed, the PMC has so mismanaged the development and implementation of a standardized screening tool to improve identification of children at risk of suboptimal development that there is insufficient space here for a respectable analysis of the research ethics questions raised by the authors, let alone of the public health dimensions of the case. Bearing in mind the ampleness of the existing literature on the application of research ethics principles to population-screening projects, the availability of tools for distinguishing between research and other evaluative activities in public health,* the meagreness of the information by which to adjudicate between the conflicting views of the PMC and the Public Health Department (PHD) and the focus in this volume on the distinctiveness of public health ethics analysis, I propose to use the research ethics angle mainly as a springboard toward less-commonly discussed matters of population health practice and policy as they relate to early childhood development screening and support programs. * The most notable of these for Canadian health professionals is perhaps the suite of ARECCI guides and tools developed recently in Alberta (http://www.aihealthsolutions.ca/arecci/ areccitools.php). Research Ethics and Conflicts of Interest at a Local Public Health Department 45
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 24 and 25: esearch 2 Inevitably children will
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 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
Page 60 and 61: policy being increasingly introduce
Page 62 and 63: policy behaviour. Therefore, the et
Page 64 and 65: policy 18 Chapman, S. and Freeman,
Page 66 and 67: policy through outdoor smoking, any
Page 68 and 69: policy that this is an injustice. W
Page 70 and 71: DeFerring blooD Donation FroM Men w
Page 72 and 73: policy 26 per cent of new infection
Page 74 and 75: policy 6 NHS Blood and Transplant.
Page 76 and 77: policy public trust might also incl
Page 78 and 79: policy lived in certain regions in
Page 80 and 81: policy 4 Zou, S., Musavi, F., Notar
Page 82 and 83: policy Case description For nearly
Page 84 and 85: policy 3 Economic conditions could
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Page 88 and 89: policy lMICs. Evidence-based introd
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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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using PersonalizeD letters oF invit
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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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alberta oil sanDs A toxic mixture o
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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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wHose role is it to Deal witH socie
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practice same artisanal miners to d
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practice The ethical principle of b
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practice Identify the options avail
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