ETHICAL PRINCIPLES &

ISSUES IN PUBLIC HEALTH

Dept. of Public Health

 Learning Objectives
 To review ethical principles and
issues in public health

Required reading:
 Calman KC and Downie RS. Ethical principles and
ethical issues in public health. In: Detels R and
Breslow L, eds. Oxford Textbook of Public Health,
4th edition. New York: Oxford University Press, 2002,
pp. 387- 400
Principles of Health Care Ethics

Beneficence
the obligation of health care
providers to help people in need

Non-maleficence
the duty of health care providers to
do no harm
Principles of Health Care Ethics
(cont’d)
•Autonomy
the 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
•Utility
maximizing the total benefits for
the populations involved
Issue to discuss:

What is ‘equity’ & what is ‘equality’?

General agreement
 Each person should have an equal right to
basic liberties, e.g. freedom of speech,
assembly, & thought
 Each person has a right to equal
opportunities, e.g. education
If the resources are fixed then they
could be distributed:
 to each person an equal share
 to each person according to individual
needs
 to each person according to individual
efforts
 to each person according to societal
contributions
 to each person according to merit
EQUITY
 Equal resources/use of services
 Equal health
 Fair innings
 Equal access/utilization according to need
 Treatment according capacity to benefit
 Rosenau & Roemer (1999):
The general assumptions of a public
health ethic:

1. Provision of care on the basis of

health need without regard to race,
religion, gender, sexual orientation,
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
 Issues
 What tensions exist b/w protection of
the public health & protection of
individual rights?
 How should scarce resources be
allocated & used?
 What should be the balance b/w
expenditures & quality of life in cases
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…..