PUBLIC HEALTH ETHICS

Question 1

WHAT IS PUBLIC HEALTH?

Answer 1

WHAT WE, AS A SOCIETY, DO COLLECTIVELY TO ASSURE THE CONDITIONS IN WHICH PEOPLE CAN BE HEALTY

Question 2

WHAT IS PH ETHICS?

Answer 2

PH ETHICS IS CONCERNED WITH ETHICAL ASPECTS OF INDIVIDUAL, COLLECTIVE OR INSTITIONAL BEHAVIOURS THAT AFFECT THE HEALTH OF THE ‘PUBLIC’, RATHER THAN THE HEALTH OF ANY SINGLE SPECIFIED INDIVIDUAL

Question 3

DIFFERENCE BETWEEN CLINICAL AND PUBLIC HEALTH ETHICS?

Answer 3

• CLINICAL ETHICS MORE INDIVIDUAL BASED, RATHER THAN POPULATION BASED
• CLINICAL ETHICS OPERATES AT THE LEVEL OF THE PATIENT/HEALTHCARE PROFESSIONAL RELATIONSHIP

Question 4

DIFFERENT WAYS IN WHICH THE ‘PUBLIC’ OF PUBLIC HEALTH CAN BE THOUGHT OF?

Answer 4

POLITICAL PUBLIC (THE COLLECTIVE TO WHOM GOVERNMENTS HAVE PUBLIC HEALTH DUTIES AND ON WHOM COERCIVE MEASURES MAY BE ENACTED IN THE PUBLIC INTEREST
LOCAL COMMUNITIES (SOME MAY FORM COLLECTIVES TO IMPROVE E.G. LOCAL ENVIRONMENTS AND FACILITIES IN WAYS THAT PROMOTE HEALTH)
NUMERICAL PUBLIC OR TARGET POPULATION (COMPRISED OF INDIVIDUALS WHO MATTER EQUALY AND WHOSE COLLECTIVELY IMPROVED PROSPECTS IS THE GOAL OF PH MEASURES

Question 5

PUBLIC HEALTH ETHICS IS OFTEN ASSOCIATED WITH WHICH THEORY OF MORALITY? WHY?

Answer 5

UTILITARIANISM (MAXIMISING HAPPINESS/ UTILITY)
REQUIRS US TO CHOOSE ACTIONS THAT BRING ABOUT THE GREATEST GOOD - WHICH ACCORDS WITH THE ENDS OF PUBLIC HEALTH (BUT BURDENS/HARMS NEED TO BE TAKEN INTO CONSIDERATION: MAXIMISING HAPPINESS WHIL MINIMISING SUFFERING)
(BUT TO DO THIS WE NEED TO QUANTIFY THE ‘GOOD’ SO THAT ALTERNATIVES CAN BE COMPRED: QALYs)

Question 6

CENTRAL ETHICAL ISSUE IN PUBLIC HEALTH?

Answer 6

PH MEASURES MAY REQUIRE THE IMPOSITION OF SOME BURDEN ON INIVIDUALS FOR THE BENEFIT OF OTHERS

• RESTRICTIONS OF PERSONAL FREEDOMS OR LIBERTY (E.G. QUARANTINE, MASK WEARING, SMOKING FREE ZONES, TAXATION OF UNHELTHY FOODS, FLUORIDATION OF WATER…)
• SHORT TERM REDUCTION IN WELLBEING (VACCINATION, BLOOD AND OTHER TESTS, PH INSPECTIONS..)
• INVASION OF PRIVACY/LOSS OF CONFIDENTIALITY (CONTACT TRACING, EPIDELIOLOGICAL DATA COLLETION…)

Question 7

UPSHUR (2002) PRINCIPLES FOR THE JUSTIFICATION FOR PH INTERVENTIONS:

Answer 7

• PARTICULARLY USEFUL FOR MANDATORY MEASURES
  1) HARM (ACCEPTABLE TO LIMIT LIBERTY TO PREVENT HARM)
  2) LEAST RESTRICTIVE/COERCIVE MEANS POSSIBLE
  3) RECIPROCITY (DUTY TO HELP INDIVIDUALS AND COMMUNITIES TO DISCHARGE THEIR PH DUTIES WHEN COMPLYING CREATES A BURDEN; e.g. if you ask people to work from home, ensure they get pay as normally etc, if we are asking hcps to work with infectious people, we need to ensure effective ppe)
  4) TRANSPARENCY (REASONING FOR DECISIONS MUST BE CLEARLY COMMUNICATED, FREE FROM POLITICAL INTERFERENCE AND SHOULD INCLUDE PUBLIC ENGAGEMENT)

Question 8

WHEN ARE COERCIVE MEASURES MOSTLY USED IN PH? WHAT ARE THE ALTERNATIVES?

Answer 8

• COERCION IS MORE PROPORTIONATE AND JUSTIFIABLE WHEN URGENT ACTION IS NEEDED TO LIMIT HARMS, AS IN EMERGENCIES
• ALTERNATIVE APPROACHES ARE NEEDED TO PROMOTE HEALTH (E.G. HEALTHY EATING, WEIGHT REUCTION, SMOKING CESSTION ATTENDANCE FOR SCREENING…)
  / ALTERNATIVES CAN BE E.G. INCENTIVES, DISINCENTIVES, NUDGING (GENTLY ENCOURAGING) –> HESE MEASURES ARE EASIER TO RESIST
• THES EINTERVENTIONS ARE COMPETING WITH INDUSTRIES ENCOURAGING PEOPLE TO KEEP UP THEIR UNHEALTHY HABITS

Question 9

INCENTIVES VS DISINCENTIVES IN PH?

Answer 9

• INCENTIVES OFFER REWARDS TO ENCOURAGE COMPLIANCE (LESS COERCIVE,BUT STILL CRITICISED BECAUSE IT CAN FACILITATE A ‘DESERVING V UNDESERVING POOR’ MINDSET, E.G. GIVING FREE GYM MEMBERSHIP..)
• DISINCENTIVES ARE PENALITIES FOR FAILURE TO COMPLY (SUGAR TAX, SMOKE FREE ZONES…)

Question 10

NUDGING IN PH?

Answer 10

• MORE SUITBLE ‘MANIPULATION’ THAN INCENTIVES OR DISINCENTIVES
• EXAMPLE: PRODUCT PLACING: IDEA IS TO INFLUENCE A BHAVIOUR WHILST RETAINING CHOICE
• HOWEVER, UNCONSCIOUS INFLUENCES MAY UNDERMINE CHOICE TO A GREATER DEGREE THAN THE MORE TRANSPARENT INCENTIVES/DISINCENTIVES
• THEY MAY ALSO DEPEND ON MAKING ONE DECISION HARDER TO ENACT THAN OTHER (E.G. OPTING OUT RATHER THAN OPTING IN)

Question 11

COERCIVE VS NON-COERCIVE MEASURES IN PH: APPLICABILITY?

Answer 11

• OVERRIDING AUTONOMY BY COERCIVE/MANDATORY MEASURES IS ARGUEBLY ONLY JUSTIFIED WHERE IT WILL PREVENT HARM TO OTHERS AND IS THEREFORE LARGELY ASSOCIATED WITH TRANSMISSABLE DISEASE
• NON-COERCIVE METHODS OF INCLINING PEOPLE TO ADOPT HEALTHY BEHAVIOURS MAY BE PATERNALISTIC, I.E. UNDERMINE OR THREATEN THEIR AUTONOMY IN THEIR BEST INTEREST (ALTHOUGH HARD PATERNALISM CAN BE COERCIVE!!!)

Question 12

ETHICS OF/IN/FOR PH? (GOSTIN, 2001)

Answer 12

ETHICS OF PH: PROFESSIONALISM ISSUES (E.G. TRUSTWORTHINESS IN THE PURSUIT OF THE COMMON GOOD AND THE DUTIES TO THE PUBLIC)
ETHICS IN PH: ETHICAL DIMENSIONS OF THE PURSUIT OF PUBLIC HELTH(E.G. JUSTIFYING TRADE-OFFS AND PRIORITIES, BALACING HARM MINIMISTION AND LIMITATIONS TO INDIVIDUAL LIBERTY)
ETHICS FOR PH: CONCEIVED AS THE ADVOCACY ROLE FOR PRACTITIONERS (E.G. DEFENDING LEAST POWERFUL IN THE SOCIETY, PROMOTING THE MOST APPROPRIATE VALUES TO HEALTH SUH S MORE EQUALITY OF OPPORTUNITY)

Question 13

IMPACT OF THE PANDEMIC ON NON-COVID HEALTHCRE SERVICES (ETHICAL PERSPECTIVE)?

Answer 13

• INCREASED WAITING TIMES
• APPOINTMENTS TURNED DIGITAL, WHICH CREATED SOME BARRIERS AND MINIMISED EXPERIENCES
• GREAT FOCUS ON POPULTION RATHER THAN INDIVIDUAL OUTCOMES AS DRIVER FOR DECISIONS
• SOME STRAIN TO PATIENT-HCP RELATIONSHIP
• DISTRESSING (E.G. NOT BEING ABLE TO ALLOW BOTH PARENTS IN A HOSPITAL WITH THEIR VERY ILL CHILD, STRICT VISITING RULES)
• MENTAL HEALTH PANDEMIC FOR STAFF
• ‘SILVER STANDARD’ CARE CAN BE JUSTIFIED IN A TIME OF EMERGENCY BUT JUSTIFICATION NEES O BE UNDERSTOOD BY PRACTITIONERS AND PATIENTS ALIKE
• EXPECTATIONS NEED TO BE MANAGED ACCORDINGLY + TRANSPARENCY!!!!!!!!!!!!!!!!!!!!!!
• GREATER PUBLIC CONSULTATION RE VALUES APPLIED IS REQUIRED