ETHICAL PRINCIPLES & ETHICAL PRINCIPLES & ISSUES IN PUBLIC HEALTHISSUES IN PUBLIC HEALTH

Dept. of Public HealthDept. of Public Health

Learning ObjectivesLearning Objectives

To review ethical principles and To review ethical principles and issues in public healthissues in public health

Required reading:Required reading: Calman KC and Downie RS. Ethical principles and Calman KC and Downie RS. Ethical principles and

ethical issues in public health. In: Detels R and ethical issues in public health. In: Detels R and Breslow L, eds. Breslow L, eds. Oxford Textbook of Public HealthOxford Textbook of Public Health, , 4th edition. New York: Oxford University Press, 2002, 4th edition. New York: Oxford University Press, 2002, pp. 387- 400pp. 387- 400

Principles of Health Care EthicsPrinciples of Health Care Ethics

BBeneficenceeneficence

the obligation of health care the obligation of health care providers to help people in needproviders to help people in need

NNon-maleficenceon-maleficence

the duty of health care providers the duty of health care providers to do no harmto do no harm

•Autonomythe right of a person to choose & follow his or her own plan of life & action

•Justice (or equity)the ethical concept of treating everyone in a fair manner

•Utilitymaximizing the total benefits for the populations involved

Principles of Health Care Ethics Principles of Health Care Ethics (cont’d)(cont’d)

Issue to discuss:Issue to discuss:

WWhat is hat is ‘equity’‘equity’ & what is & what is ‘equality’‘equality’??

General agreementGeneral agreement

Each person should have an equal Each person should have an equal right to basic liberties, e.g. freedom right to basic liberties, e.g. freedom of speech, assembly, & thoughtof speech, assembly, & thought

Each person has a right to equal Each person has a right to equal opportunities, e.g. educationopportunities, e.g. education

If the resources are fixed then they If the resources are fixed then they could be distributed:could be distributed: to each person an equal shareto each person an equal share to each person according to to each person according to

individual needsindividual needs to each person according to to each person according to

individual effortsindividual efforts to each person according to societal to each person according to societal

contributionscontributions to each person according to meritto each person according to merit

EQUITYEQUITY

Equal resources/use of servicesEqual resources/use of services Equal healthEqual health Fair inningsFair innings Equal access/utilization according to Equal access/utilization according to

needneed Treatment according capacity to Treatment according capacity to

benefitbenefit

Rosenau & Roemer (1999):Rosenau & Roemer (1999):

The general assumptions of a The general assumptions of a public health ethic:public health ethic:

1.1. Provision of care on the basis of Provision of care on the basis of health need without regard to health need without regard to race, religion, gender, sexual race, religion, gender, sexual orientation, or ability to payorientation, or ability to pay

Rosenau & Roemer (1999):

2. Equity in distribution of resources, giving due regard to vulnerable groups in the population, e.g. ethnic minorities, migrants, children, pregnant women, the poor, the handicapped

3. Respect for human rights, including the right to autonomy, privacy, liberty, and health & well-being, keeping in mind social justice considerations

IssuesIssues What tensions exist b/w protection of What tensions exist b/w protection of

the public health & protection of the public health & protection of individual rights?individual rights?

How should scarce resources be How should scarce resources be allocated & used?allocated & used?

What should be the balance b/w What should be the balance b/w expenditures & quality of life in cases expenditures & quality of life in cases of chronic & terminal illness?of chronic & terminal illness?

Issues (cont’d)• What are appropriate limits on the use

of expensive medical technology?• What obligations do health care

insurers & providers have to meet the ‘right to know’ of patients as consumers?

• What responsibility exists for the young to finance health care for older persons?

• What obligation exists for government to protect the most vulnerable sectors of society?

Thank you…..Thank you…..