What are the three general justifications for coercive Public Health interventions?
* Risk to others * Protection of incompetent persons *Risk to self
What is the 'harm principle'?
As per the 'harm principle' the state may prevent harm to others or punish individuals for inflicting such harm
The 'best interests' of the individual holds that
state may protect health and safety of individuals incapable of safeguarding their own interests
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.
What are the five ethical criteria for systematically evaluating government regulation?
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.
What are the 3 basic ethical principles explained in the Belmont report? Explain the fundamental rules/formulations for each principle.
* 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.
When are health promotions\ campaigns considered paternalistic? Provide an example.
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.)
What are the five justificatory conditions used to assess the relative weight of general moral consideration?
Effectiveness, proportionality, necessity, least infringement and public justification.
Name four general categories covering the issues in Public Health ethics
1) Health Promotion and disease prevention 2) Risk reduction 3) Epidemiological and Public Health research 4) Structural and socioeconomic disparities.
What are the different types of ethical analysis?
* 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.
Provide 4 examples of existing paternalistic policies.
1. seat belt laws 2. water flouridation 3. prohibition of gambling 4. prohibition of illicit drugs.
What was the holding of State v. Solomon (1969)?
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.
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?
The challenge was based on the first amendment of the Vermont constitution guaranteeing citizens the right to liberty and safety.
Which standard did the court use in Benning v. State?
The court used the standard for evaluating police power regulation expressed in State v. Solomon (1969).
What was the decision of the court in Benning v. State?
Decision: The court held that the Vermont motorcycle law was not in violation of any provisions of state or federal constitutions.
What was the reasoning of the court in Benning v. State?
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.
What creates (Breyer's) vicious circle of risk regulation?
Faulty public perception of risk, politics and technical uncertainties of the regulatory process.
Name and explain the six aspects of risk perception (described by Breyer).
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.
In the 'benzene case' (Industrial Union Dept v. American Petroleum Institute), who bore the burden of evidence?
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.
What are different ways in which people assess risk?
* 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
Define Public Health Ethics
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.
How is Public Health Ethics different from bioethics
Focuses on the doctor‐patient or researcher-subject relationship
Four basic ethical principles based on Belmont report and Beauchamp & Childress
Principles: – Respect for persons – Beneficence – Non‐maleficence – Justice
3 values behind Public Health Ethics
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
What are the values that should guide implementation in both areas of public health policy (allocation of resources and regulation of individual’s actions)
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)
How do bioethics and Public Health ethics differ on Immunization?
* Consent * Autonomy * Public good ???
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?
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.