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Friday, 22 March 2013

Public Health Ethics - a must read release for public health professionals

It is not very often a book comes along that has the potential for significant in how we practice public health.  Much has been hinted to in respect of public health ethics, but relatively little definitive documented. 

Population and Public Health Ethics:  Cases from research, policy and practice is a treasure chest of real examples combined with some excellent analyses which lay out the foundations for ethical public health practice.   Solid introductory discussions of frameworks should make this book required reading for all public health trainees, and innumerable lessons for those already in practice may help refine their current practices. 

While the basis within the book is that of utilitarianism, acknowledgement of the influence of other frameworks of ethical practice is enlightening. Specific discussion of cases by various different ethicists demonstrate subtle differences in approach, although cases are widely disparate.  Research, policy and practice ethical issues are explored through real practice problems submitted by practitioners in Canada.

A common thematic that seems to shine through is that some public health practitioners interpret scenarios with a different ethical perspective.   The conflicting interpretations are not well discussed within the book and provide ample room for stimulating discussion. 

At issue, is that while most public health practitioners will utilize a utilitarian approach, oftentimes the clients we serve may make their decisions bound from different ethical frameworks.  Clear examples exist from groups with entrenched religious beliefs such as polygamy and refusal of blood products or vaccines.  More common and couched in shades of grey are when public health professionals run into persons entrenched in libertarian beliefs where the state has no role in individual or family decisions, or even capitalism where individuals believe the greatest benefit to society is in amassing wealth and distribution through benevolence rather that state facilitated equity.

Another ethical dilemma unaddressed in the book comes from where professional disciplines have conflicting codes of ethics.  Clearly this underlies some of the case scenarios, but is unexplored where issues such as a nursing focus on the provider-patient relationship is not balanced with a duty to population wellbeing as explicitly stated in the medical discipline.  Many other health professionals codes of ethics have no mention of a duty to society where nursing and medicine do. 

Despite some gaps, this is a book that should be read, and likely reread to assimilate the subtleties.  It will go a long way to helping resolve many of those situations where one member of the team refuses stating that such actions are “unethical”, and this is a welcomed reference for such situations.

Download the CIHR sponsored book for free from Joint centre for Bioethics Public Health Ethics

Thanks to Ted Schrenker for announcing the book on the CHNET blog even though he discloses as being both an author and analyst.  

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