Public Health Ethics: Mapping the Terrain

James F. Childress; Ruth R. Faden; Ruth D. Gaare; Lawrence O. Gostin; Jeffrey Kahn; Richard J. Bonnie; Nancy E. Kass; Anna C. Mastroianni; Jonathan D. Moreno; Phillip Nieburg

doi:10.1111/j.1748-720x.2002.tb00384.x

journal article Jan 01, 2002

Public Health Ethics: Mapping the Terrain

James F. Childress Ruth R. Faden Ruth D. Gaare Lawrence O. Gostin

Jeffrey Kahn Richard J. Bonnie Nancy E. Kass Anna C. Mastroianni Jonathan D. Moreno Phillip Nieburg

Journal of Law, Medicine & Ethics Vol. 30 No. 2 pp. 170-178 · Cambridge University Press (CUP)

View at Publisher Save 10.1111/j.1748-720x.2002.tb00384.x

Abstract

Public health ethics, like the field of public health it addresses, traditionally has focused more on practice and particular cases than on theory, with the result that some concepts, methods, and boundaries remain largely undefined. This paper attempts to provide a rough conceptual map of the terrain of public health ethics. We begin by briefly defining public health and identifying general features of the field that are particularly relevant for a discussion of public health ethics.Public health is primarily concerned with the health of the entire population, rather than the health of individuals. Its features include an emphasis on the promotion of health and the prevention of disease and disability; the collection and use of epidemiological data, population surveillance, and other forms of empirical quantitative assessment; a recognition of the multidimensional nature of the determinants of health; and a focus on the complex interactions of many factors—biological, behavioral, social, and environmental—in developing effective interventions.

Topics

No keywords indexed for this article. Browse by subject →

References

24

[1]

Mill (1976)

[2]

Beauchamp (2001)

[3]

3. We recognize that there are different views about the ultimate moral justification for the social institution of public health. For example, some communitarians appear to support public health as an instrumental goal to achieve community. Others may take the view that the state has a duty to ensure the public's health as a matter of social justice. Although these different interpretations and others are very important for some purposes, they do not seriously affect the conception of public health ethics that we are developing, as long as public health agents identify and inform others of their various goals.

[4]

13. See Faden, Geller, Powers, , supra note 11 Gostin, , supra note 4, at 199–201.

[5]

Kawachi (2000)

[6]

Stern (1996)

[7]

10.2105/ajph.91.11.1776

[8]

14. In rare cases, it may be ethically justifiable to limit the disclosure of some information for a period of time (for example, when there are serious concerns about national security, about the interpretation, certainty, or reliability of public health data; or about the potential negative effects of disclosing the information, such as with suicide clusters).

[9]

2. Committee for the Study of the Future of Public Health, Division of Health Care Services, Institute of Medicine, The Future of Public Health (Washington, D.C.: National Academy Press, 1988): at 1.

[10]

23. See Gostin, , supra note 4, at 21.

[11]

1. Our definition builds on the definition of health systems offered by the World Health Organization: Health systems include “all the activities whose primary purpose is to promote, restore, or maintain health.” See World Health Report 2000 Health Systems: Improving Performance (Geneva: World Health Organization, 2000): at 5.

[12]

Gostin (2000)

[13]

Faden (1991) 10.1093/oso/9780195065725.003.0001

[14]

9. This justificatory condition is probably the most controversial. Some of the authors of this paper believe that the language of “necessity” is too strong. Whatever language is used, the point is to avoid a purely utilitarian strategy that accepts only the first two conditions of effectiveness and proportionality and to ensure that the non-utilitarian general moral considerations set some prima facie limits and constraints and establish moral priorities, ceteris paribus.

[15]

Nieburg

[16]

Mann "“Medicine and Public Health, Ethics and Human Rights,”" The Hastings Center Report (1997) 10.2307/3528660

[17]

Nagel (1995)

[18]

7. We do not explore here the overlaps among public health ethics, medical ethics, research ethics, and public policy ethics, although some areas of overlap and difference will be evident throughout the discussion. Further work is needed to address some public health activities that fall within overlapping areas — for instance, surveillance, outbreak investigations, and community-based interventions may sometimes raise issues in the ethics of research involving human subjects.

[19]

17. Id. at 16–17, 156.

[20]

22. Mann, , supra note 21, at 10. Mann thought that the language of ethics could guide individual behavior, while the language of human rights could best guide societal-level analysis and response. See Mann, , supra note 21, at 8; Marks, supra note 21, at 131–38. We disagree with this separation and instead note the overlap of ethics and human rights, but we endorse the essence of Mann's position on human rights.

[21]

Daniels "“Limits to Health Care: Fair Procedures, Democratic Deliberation, and the Legitimacy Problem for Insurers,”" Philosophy and Public Affairs (1997) 10.1111/j.1088-4963.1997.tb00082.x

[22]

10.1001/jama.264.18.2416

[23]

8. Recognizing universalizability by attending to past precedents and possible future precedents does not preclude a variety of experiments, for instance, to determine the best ways to protect the public's health. Thus, it is not inappropriate for different states, in our federalist system, to try different approaches, as long as each of them is morally acceptable.

[24]

10.1136/bmj.321.7272.1300

Cited By

640

Interventions to address antimicrobial resistance: an ethical analysis of key tensions and how they apply in low- income and middle-income countries

Sunil Pokharel, Bipin Adhikari · 2024

BMJ Global Health

Enhancing the implementation and integration of mHealth interventions in resource-limited settings: a scoping review

Wilson Tumuhimbise, Stefanie Theuring · 2024

Implementation Science

Nudge me, help my baby: on other-regarding nudges

Hafez Ismaili M'hamdi, Medard Hilhorst · 2017

Journal of Medical Ethics

Trans Fat Bans and Human Freedom

David Resnik · 2010

The American Journal of Bioethics

Metrics

640

Citations

24

References

Details

Published: Jan 01, 2002
Vol/Issue: 30(2)
Pages: 170-178
License: View

Authors

University of Virginia School of Law, University of Virginia

Cite This Article

James F. Childress, Ruth R. Faden, Ruth D. Gaare, et al. (2002). Public Health Ethics: Mapping the Terrain. Journal of Law, Medicine & Ethics, 30(2), 170-178. https://doi.org/10.1111/j.1748-720x.2002.tb00384.x

Public Health Ethics: Mapping the Terrain

You May Also Like