1. ETHICAL PRINCIPLES & ISSUES IN PUBLIC HEALTH Dept. of Public Health

2. Learning Objectives To review ethical principles and issues in public health 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

3. Principles of Health Care Ethics B eneficence B eneficence the obligation of health care providers to help people in need N on-maleficence N on-maleficence the duty of health care providers to do no harm

4. A utonomy the right of a person to choose & follow his or her own plan of life & action J ustice (or equity) the ethical concept of treating everyone in a fair manner U tility maximizing the total benefits for the populations involved Principles of Health Care Ethics (cont’d)

5. Issue to discuss: W hat is ‘equity’ & what is ‘equality’?

6. General agreement Each person should have an equal right to basic liberties, e.g. freedom of speech, assembly, & thought 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 Each person has a right to equal opportunities, e.g. education

7. If the resources are fixed then they could be distributed: to each person an equal share to each person an equal share to each person according to individual needs to each person according to individual needs to each person according to individual efforts to each person according to individual efforts to each person according to societal contributions to each person according to societal contributions to each person according to merit to each person according to merit

8. EQUITY Equal resources/use of services Equal resources/use of services Equal health Equal health Fair innings Fair innings Equal access/utilization according to need Equal access/utilization according to need Treatment according capacity to benefit Treatment according capacity to benefit

9. 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

10. 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

11. Issues What tensions exist b/w protection of the public health & protection of individual rights? What tensions exist b/w protection of the public health & protection of individual rights? How should scarce resources be allocated & used? How should scarce resources be allocated & used? What should be the balance b/w expenditures & quality of life in cases of chronic & terminal illness? What should be the balance b/w expenditures & quality of life in cases of chronic & terminal illness?

12. 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?

13. Thank you…..