Ethical Dilemma in Public Health Essay Paper

Ethical Dilemma in Public Health Essay Paper

a “current event” ethical dilemma in public health

Whose responsibility is health? Is it purely a matter of individual choice or do governments have a role to play? What about others, such as businesses, employers and health professionals: do they also have responsibilities? Discussions of these issues in the media reveal a whole spectrum of views. These vary from considering any curbing of our freedom to do as we please as infringements by the pernicious “nanny state”, to crying “someone should do something” to tackle public-health problems such as obesity, excessive drinking or smoking.Ethical Dilemma in Public Health Essay Paper





The central ethical dilemma, therefore, in public health, is to balance respect for individual freedom and liberty with the responsibility of governments to provide their citizens with some degree of protection in relation to health. Nowadays, few would argue with governments’ role in ensuring that certain basic services, such as clean air and water, are provided. Measures that were previously hotly contested and seen as “nanny state interference”, such as pasteurization of milk and fortification of white bread, are no longer contentious.Ethical Dilemma in Public Health Essay Paper

But in the 21st century in developed countries, many of the major questions of public-health policy relate to so-called “lifestyle factors” that influence the risks of major killers such as heart disease and cancer. Here people often refer to “lifestyle choices”, but the notion of “choice” can be troublesome, as choices are often constrained by the actions of others, such as industry and government, and by socioeconomic, environmental and genetic factors. Therefore, the ethical justification for government intervention to promote public health deserves close scrutiny.Ethical Dilemma in Public Health Essay Paper

In traditional bioethics, much emphasis is placed on the freedom of the individual. However, in public-health policy, some measures might constitute minor infringements of a person’s freedom but bring about significant benefit for a large number of people, hence the need to balance freedoms with community benefits.Ethical Dilemma in Public Health Essay Paper

In November 2007, the Nuffield Council on Bioethics published a report Public health: ethical issues,1 based on the findings of a working party that I chaired. The report tackles these very issues and sets out a model for public-health ethics which we call the “stewardship model”. The term stewardship in this context has previously been used by WHO2 and the King’s Fund.3 In our considerably expanded version, we provide a framework that specifies the responsibilities that liberal governments have in terms of addressing the needs of the population as a whole. Ethical Dilemma in Public Health Essay Paper  Our stewardship model recognizes that governments should not coerce people or restrict their freedom unnecessarily. It also stresses that governments have a responsibility to provide the conditions under which people can lead healthy lives. In addition to protecting its citizens from harm caused by others, the “stewardship state” has a particular responsibility for reducing health inequalities and protecting the health of vulnerable groups such as children.Ethical Dilemma in Public Health Essay Paper

One of the ways in which the somewhat abstract philosophical model is translated into policy is by applying what we call the “intervention ladder”. This is a tool that enables one to rank public-health measures according to their coerciveness or intrusiveness. The higher up the ladder an intervention ranks, the stronger the need for justification and sound evidence for implementation. An example of a measure at the top of the ladder is that of compulsory quarantine or isolation in the event of an outbreak of infectious disease; both clearly involve a significant infringement of liberty. We suggest that these measures may be ethically justified where the harm to others can be significantly reduced.Ethical Dilemma in Public Health Essay Paper

Public-health ethics are also an important consideration at an international level. One area we consider is that of the activities of tobacco companies in developing countries and the concept of corporate social responsibility. It is well established that tobacco is a highly harmful product. In many developed countries, companies adhere to harm reduction strategies, such as bans on advertising and restricting the availability of tobacco to children. If tobacco companies are serious about their responsibilities, they will universalize such practices in all areas in which they operate.Ethical Dilemma in Public Health Essay Paper

The international context also matters in the case of infectious disease, since infections do not respect national borders. Furthermore, countries differ in their capacities to monitor and respond to outbreaks. The Nuffield Council’s Working Party argued that the stewardship model can also be applied at the global level. In this context it means that developed countries have obligations to assist developing ones, for example in terms of enhancing surveillance capacity. Ethical Dilemma in Public Health Essay Paper  At the same time, developing countries have obligations to cooperate with international surveillance and control efforts, although clearly the terms of cooperation require close scrutiny. In the report, we discuss Indonesia’s recent refusal to share influenza virus isolates with the WHO-sponsored surveillance system Ethical Dilemma in Public Health Essay Paper

In conclusion, public-health ethics is important for three main reasons: (i) the fundamental issues raised in public health over the role of governments; (ii) the shortcomings of existing models in bioethics for dealing with such issues; and (iii) the global relevance of health and public health that makes these issues so pertinent. Ethical Dilemma in Public Health Essay Paper

Focus on a “current event” ethical dilemma in public health. Apply the principles of the ethical practices of public health to resolve the issue (see page 125 of the textbook). You may integrate recommendations based on conclusions from public health acts and principles to support your position. Select three other peers’ postings and provide feedback on the presented resolution. Offer further suggestions, details, or examples.a “current event” ethical dilemma in public health.Ethical Dilemma in Public Health Essay Paper

a “current event” ethical dilemma in public health


HLT 605 Grand Canyon Week 2 Assignment

Ethical Dilemma in Public Health Essay Paper

Public Health Reform

Submit a paper (1,250-1,500 words) focusing on public health reform. Provide an overview of the current status of public health in the United States.

Review a portion of the Affordable Care Act and present the strengths and weaknesses of the plan, as well as make suggestions for plan improvement.Ethical Dilemma in Public Health Essay Paper

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.Ethical Dilemma in Public Health Essay Paper

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.Ethical Dilemma in Public Health Essay Paper

HLT 605 Grand Canyon Week 2 DQ 2

State agencies typically follow one of two general structure models: the free-standing agency model or the super agency model. What are the pros and cons of each model? Which model do you think is “ideal” for a state agency and why? Ethical Dilemma in Public Health Essay Paper




While ethics in health care dates back at least to the times of Hippocrates, Sun Si Miao,1 and Ibn Sina (Avicenna),2 the field of “bioethics” did not emerge until after World War Two. The birth of bioethics was stimulated by a confluence of factors. First, the Nazis’ medical experiments on concentration camp prisoners heightened concerns about the vulnerability of human subjects in medical research. Second, rapid advances in medicine, including reproductive health, organ transplantation and genetics, raised questions about the purpose and limits of medical technology. Third, post-war civil rights movements led to growing attention to the power imbalances between physicians and patients and the corresponding need to empower patients to control their own health-care decisions.Ethical Dilemma in Public Health Essay Paper

In recent years, there have been efforts to broaden the scope of ethical analysis in health care to focus more directly on public-health issues.3 In contrast to the traditional emphasis of bioethicists on the physician–patient relationship, public-health ethics focuses on the design and implementation of measures to monitor and improve the health of populations. In addition, public-health ethics looks beyond health care to consider the structural conditions that promote or inhibit the development of healthy societies. From a global perspective, key issues in public health ethics include the following:Ethical Dilemma in Public Health Essay Paper

Disparities in health status, access to health care and to the benefits of medical research – For example, questions about resource allocation depend in part on value judgments about the relative importance of small improvements in quality of life for a large portion of the population as compared with a life-saving intervention that would benefit only a few people.

Responding to the threat of infectious diseases – Efforts to contain the spread of infectious diseases raise difficult questions about the appropriateness of restricting individual choices to safeguard other people’s welfare. Examples include the use of isolation and quarantine for tuberculosis and pandemic influenza.Ethical Dilemma in Public Health Essay Paper

International cooperation in health monitoring and surveillance – The implementation of the International Health Regulations4 reflects the commitment of countries to collective action in the face of public-health emergencies. Defining the scope of countries’ obligations to act collectively, and determining how those obligations should be enforced, will inevitably raise difficult ethical dilemmas.Ethical Dilemma in Public Health Essay Paper

Exploitation of individuals in low-income countries – Current practices in medical research, for example, may expose participants to significant risks without a benefit for themselves or their communities. Defining and enforcing foreign research sponsors’ obligations to local participants is therefore a critical ethical issue. In the area of organ transplantation, the growing practice of “transplant tourism” exposes individuals living in poverty to significant health risks while also raising broader questions about the commodification of the human body.Ethical Dilemma in Public Health Essay Paper

Health Promotion – The growing public-health threats of noncommunicable diseases, including those caused in part by unhealthy behaviours such as smoking, poor diet or lack of exercise, have raised the question of the extent to which public-health authorities should interfere with personal choices on health.Ethical Dilemma in Public Health Essay Paper

Participation, transparency, and accountability – As an ethical matter, the process by which decisions are made is as important as the outcome of the decisions. In the area of medical research, much attention has been devoted in recent years to strengthening systems for informed consent and community oversight. Once such systems are in place, the next step will be to develop mechanisms for evaluating their effectiveness.Ethical Dilemma in Public Health Essay Paper

Since it was founded 60 years ago, ethics has been at the heart of WHO’s mission to protect and promote the global community’s health. Activities in ethics have been undertaken by many programmes and departments, as well as WHO’s regional offices. For example, in 1994, the Regional Office for the Americas (AMRO/PAHO) created a regional programme on bioethics5,6 In 2002, WHO’s Director-General Dr Gro Harlem Brundtland created an Ethics and Health Initiative,Ethical Dilemma in Public Health Essay Paper   which has since served as a focal point for the ethics activities throughout the organization. Examples include the publication of Guidance on ethics and equitable access to HIV treatment and care (jointly with UNAIDS)7 and of Ethical considerations in developing a public health response to pandemic influenza.8 WHO also contributes to regional capacity-strengthening efforts in ethics, in close collaboration with Member States. For example, the project Networking for Ethics on Biomedical Research in Africa (NEBRA) sought to strengthen African countries’ capacity to engage in effective ethical review processes.Ethical Dilemma in Public Health Essay Paper


Articulating ethical and evidence-based policy options is one of WHO’s six core functions.10 WHO’s 60th anniversary and the 30th anniversary of Alma-Ata provide a particular opportunity to reflect on ethical values and dilemmas arising in the field of public health. Ethical Dilemma in Public Health Essay Paper