Bioethics in Public Health

Question 1

What are the 4 bioethical principles?

Answer 1

1. autonomy
2. non-malficience
3. beneficience
4. justice

Question 2

What is autonomy?

Answer 2

the right or condition of self government

Question 3

What are elements of autonomy?

Answer 3

1. Obtaining informed consent for treatment
2. facilitating and supporting patients’ choices regarding treatment options
3. allowing patients to refuse treatments
4. disclosing comprehensive and truthful information, diagnoses, and treatment options to patients
5. maintaining privacy and confidentiality

Question 4

What is informed consent?

Answer 4

Informed consent is respecting a person’s autonomy to make personal choices based on the appropriate appraisal of information about the actual or potential circumstances of a situation

Question 5

Importance of informed consent?

Answer 5

1. Assess risk benefit ratio
2. Reduce misunderstandings/confusion
3. Protects researcher from legal issues
4. Observes the right of autonomy (self-rule)

Question 6

Elements of informed consent?

Answer 6

1. Threshold elements (preconditions)
   - Competence (to understand and decide)
   - Voluntariness (in deciding)
2. Information elements
   - Disclosure (of material information)
   - Recommendation (of a plan)
   - Understanding (comprehension)
3. Consent elements
   - Decision (in favor of a plan)
   - Authorization (of the chosen plan)

Question 7

What is non-maleficence?

Answer 7

The obligation to do no harm
- Non-maleficence is the maxim or norm that one ought not to inflict evil or harm

Question 8

What is beneficencnce?

Answer 8

To do good
- The principle of beneficence consists of performing deeds of “mercy, kindness, friendship, charity and
the like”

Question 9

What is paternalism?

Answer 9

The deliberate overriding of a patient’s opportunity to exercise autonomy because of a perceived obligation of beneficence
- usually applied by governments e.g. Use Police power

Question 10

What are the roles of beneficence?

Answer 10

1. Protect and defend the rights of others.
2. Prevent harm from occurring to others.
3. Remove conditions that will cause harm to others.
4. Help persons with disabilities.
5. Rescue persons in danger.

Question 11

What is justice?

Answer 11

refers to fairness, treating people equally (equality) and without prejudice, and the equitable distribution (equity) of benefits and burdens, including assuring fairness in biomedical research

Question 12

What is distributive justice?

Answer 12

refers to the fair allocation of resources, whereas social justice represents the position that benefits and burdens should be distributed fairly among members of a society, or ideally that people in a society should have the same rights (human rights), benefits, and opportunities.

Question 13

What is an ethical dilemma?

Answer 13

is a situation in which an individual is compelled to choose between two actions that will affect the welfare of a
sentient being, and both actions are reasonably justified as being good, neither action is readily justified as being good, or the goodness of the actions is uncertain.

Question 14

Main social issues with ethical implications involved in the Tuskegee experiment?

Answer 14

1. Justice
2. equality
3. rights
4. discrimination (only blacks)
5. lie/deception
6. lack of respect
7. loss of trust

Question 15

What are the bioethical principles were violated by the Tuskegee study?

Answer 15

1. Autonomy
   - there was no informed consent
2. Justice
   - unequal treatment with others
   - Not given treatment for syphilis when
   actually it was available
3. Non-maleficence
   - Harm of study participants by spinal tap without anaesthesia
4. Beneficence
   - not giving the participants the available treatment
5. Truth telling
   - Lie that they were treating participants for ‘Bad blood’
6. unfair subject selection

Question 16

Ethical principles for conducting clinical or biomedical research?

Answer 16

1. Value – aimed at the enhancement of health knowledge - the research should provide information on how to tackle the ailment under study.
2. Independent review - unaffiliated individuals must review the research periodically.
3. Informed consent - potential participants ought to be made aware of the research, and their consent sought.
4. Respect for enrolled subjects - subject’s rights as autonomous beings ought to be respected and protected
5. Scientific validity - the research must be scientifically rigorous.
6. Fair subject selection - scientific objectives rather than vulnerability ought to be considered.
7. Favourable risk-benefit ratio - risk in research must be minimized and benefit enhanced.

Question 17

Elements required for international research?

Answer 17

1. Social or scientific value
2. Favorable risk benefit ratio
3. Fair-subject selection
4. Independent review
5. Informed consent
6. Respect for potential and enrolled subjects

Question 18

What is public health law?

Answer 18

A form of public health policy that integrates concepts from law, medicine, health care and public health

Question 19

What are the roles of public health law?

Answer 19

1. Provides the legal basis for public health practice
2. Creates a mission for PH authorities
3. Assigns the functions
4. Specify manner in which PH professional exercise their authority

Question 20

What is the rule of human rights in public health?

Answer 20

Human rights are a set of entitlements under international law
1. Privacy and confidentiality
2. Autonomy to participate in health-related decisions
3. Adequate quality of basic amenities i.e. food, housing
4. Communication
5. Choice of medical providers
6. Respect for the dignity of persons, including the rights to security and freedom from discrimination