Public Health Ethics

Question 1

What are the three general justifications for coercive Public Health interventions?

Answer 1

* Risk to others * Protection of incompetent persons *Risk to self

Question 2

What is the ‘harm principle’?

Answer 2

As per the ‘harm principle’ the state may prevent harm to others or punish individuals for inflicting such harm

Question 3

The ‘best interests’ of the individual holds that

Answer 3

state may protect health and safety of individuals incapable of safeguarding their own interests

Question 4

Define ‘Paternalism’

Answer 4

Paternalism is ‘ the interference with a person’s liberty of action justified by reasons referring exclusively to the welfare, good, happiness, needs, interests or values of the person being coerced.

Question 5

What are the five ethical criteria for systematically evaluating government regulation?

Answer 5

Step 1: Determining whether the risk is sufficiently significant to warrant state action including assessment of nature of the risk, duration of the risk, probability of the harm and severity of the harm. Step 2: Whether the proposed regulation is likely to be effective in preventing or ameliorating the harm. Step 3: The cost of the intervention is evaluated. Step 4: The burden that the regulation will place on individuals is evaluated. Is it least restrictive Step 5: The final step is to determine whether the policy is fair.

Question 6

What are the 3 basic ethical principles explained in the Belmont report? Explain the fundamental rules/formulations for each principle.

Answer 6

* Respect for persons- Rules: 1) Individuals should be treated as autonomous agents 2) individuals with diminished autonomy should be protected. * Beneficence- Rules: 1) Do not harm. 2) Maximize possible benefits and minimize possible harms. *Justice- Formulations: 1) to each person equal share, 2) to each person according to need, 3) to each person according to individual effort, 4) to each person according to societal contribution, 5) to each person according to merit.

Question 7

When are health promotions\ campaigns considered paternalistic? Provide an example.

Answer 7

When health promotion campaigns go beyond the provision of information and systematically seek to transform the very desire and preferences of those to whom they are directed. (eg. social marketing techniques to prevent smoking.)

Question 8

What are the five justificatory conditions used to assess the relative weight of general moral consideration?

Answer 8

Effectiveness, proportionality, necessity, least infringement and public justification.

Question 9

Name four general categories covering the issues in Public Health ethics

Answer 9

1) Health Promotion and disease prevention 2) Risk reduction 3) Epidemiological and Public Health research 4) Structural and socioeconomic disparities.

Question 10

What are the different types of ethical analysis?

Answer 10

* Professional ethics- seeks out the values and standards developed by leaders of a profession to develop ethical principles. *Applied ethics- seeks to develop more general principles that can be applied to real world examples. *Advocacy ethics- uses a stance of advocacy for social goals and reforms. *Critical ethics- seeks to combine the strength of all of the above.

Question 11

Provide 4 examples of existing paternalistic policies.

Answer 11

1. seat belt laws 2. water flouridation 3. prohibition of gambling 4. prohibition of illicit drugs.

Question 12

What was the holding of State v. Solomon (1969)?

Answer 12

The holding of State v. Soloman was that the mandatory helmet law did not exceed the state’s police power or violate due process of law and was directly related to highway safety.

Question 13

In Benning v. State (1994), the plaintiffs challenged Vermont’s motorcycle law which required motorcyclists to wear reflective helmets with neck of chin straps when on highways. This challenge was based on what?

Answer 13

The challenge was based on the first amendment of the Vermont constitution guaranteeing citizens the right to liberty and safety.

Question 14

Which standard did the court use in Benning v. State?

Answer 14

The court used the standard for evaluating police power regulation expressed in State v. Solomon (1969).

Question 15

What was the decision of the court in Benning v. State?

Answer 15

Decision: The court held that the Vermont motorcycle law was not in violation of any provisions of state or federal constitutions.

Question 16

What was the reasoning of the court in Benning v. State?

Answer 16

1) there is safety risk to other users of the roadway 2) great costs to the public- not just the operator 3) the liability of injuries that occur on public roads is imposed on state so state can act to minimize the extent of injuries.

Question 17

What creates (Breyer’s) vicious circle of risk regulation?

Answer 17

Faulty public perception of risk, politics and technical uncertainties of the regulatory process.

Question 18

Name and explain the six aspects of risk perception (described by Breyer).

Answer 18

1) Rules of Thumb- people use rules of thumb rather than pros and cons for risk perception 2) Prominence- people react more strongly to events that stand out. 3) Ethics- strength of our feelings of ethical obligations seem to diminish with distance (in relationship or acquaintance). 4) Trust in experts-people cannot judge between experts when those experts disagree with each other. 5) Fixed decisions-person who has made up his mind is very reluctant to change it. 6) Mathematics- people have considerable difficulty understanding mathematical probabilities.

Question 19

In the ‘benzene case’ (Industrial Union Dept v. American Petroleum Institute), who bore the burden of evidence?

Answer 19

The Occupational Safety and Health Administration (OSHA) bore the burden of proving that long-term exposure to benzene at low levels presents a significant risk of material health impairment.

Question 20

What are different ways in which people assess risk?

Answer 20

* Risk and uncertainty- risk differs with event or other events. for example risk of cancer reduces to zero is the individual dies from a road accident injury. *Risk versus certainty- some risks are stronger/greater and more certain than others. *Comparing risk *Contrasting risk * Expression of risk *Cost of reducing a risk

Question 21

Define Public Health Ethics

Answer 21

Public health ethics may be defined as the principles and values that help guide actions designed to promote health and prevent injury and disease in the population.

Question 22

How is Public Health Ethics different from bioethics

Answer 22

Focuses on the doctor‐patient or researcher-subject relationship

Question 23

Four basic ethical principles based on Belmont report and Beauchamp & Childress

Answer 23

Principles: – Respect for persons – Beneficence – Non‐maleficence – Justice

Question 24

3 values behind Public Health Ethics

Answer 24

Communitarian – public health is founded on a sense of the social compact between all members of the community and between community and government Utilitarian – PH generally seeks the greatest benefit for the most people Social justice – PH prioritizes protecting and promoting the health of the most marginalized populations, often those who are not politically powerful

Question 25

What are the values that should guide implementation in both areas of public health policy (allocation of resources and regulation of individual’s actions)

Answer 25

Transparency – open governance; free flow of information; civic participation; public accountability “Precautionary principle” – the duty to act, even in the face of uncertainty (an obligation to act, even when data are incomplete)

Question 26

How do bioethics and Public Health ethics differ on Immunization?

Answer 26

* Consent * Autonomy * Public good ???

Question 27

Professor A wants to test a vaccine (which is not approved by the FDA) for prevention of influenza which could save millions of DALYs (disability adjusted life years). He decides to test it on his ambulatory patients since most of them are relatively healthy and do not have any other major illnesses. This vaccine is believed to have a major impact in improving public health so he decides he should just go ahead and insist his patients to take the vaccine without any consent. Since his clinic is in a poorer portion of the town, it is more likely that he will get poorer patients. Do you have any ethical concerns here?

Answer 27

1) Consent is essential here since this is biomedical research and not a PH intervention 2) Justice- Poorer patients bear most of the burden which is not fair.