Ethical dilemmas in the areas of health care and policy making are not new, but in recent years the frequency and diversity of these have grown considerably. All health professionals now have to consider the ethical implications of an increasing array of treatments, interventions and health promotion activities on an almost daily basis. This goes hand in hand with increasing medical knowledge, and the growth of new and innovative medical technologies and pharmaceuticals. Along with this, the same technology and knowledge is increasing professional and public awareness of new potential public health threats (e.g. pandemic influenza), all of which means that ethical concerns are going to be more central than ever before. At the level of public policy, concerns over the rising costs of health care have led to a more explicit focus on 'health promotion', and the surveillance of both 'patients' and the so-called 'worried well' which is not without difficulty.
Health professionals and policy makers also have to consider the implications of managing these risks, for example restricting individual liberty through enforced quarantine (in the wake of SARS, and more recently, swine flu) and the more general distribution of harms and benefits. Balancing the rights and responsibilities of individuals and wider populations is becoming more complex and problematic. There is clearly a need to develop this debate and this book will play a key role in opening out a discussion of public health ethics. It examines the principles and values that support an ethical approach to public health practice and provides examples of some of the complex areas which those practising, analysing and planning the health of populations have to navigate. It will therefore be essential reading for current practitioners, those involved in public health research and a valuable aid for anyone interested in examining the tensions within and the development of public health.
Introduction: Why public health ethics? ~ Stephen Peckham and Alison Hann; Part one: Public health ethics: contexts: Why ethics? What kind of ethics for public health? ~ Alan Cribb; Public health ethics: what it is and how to do it ~ Stephen Holland; Part two: Ethics and public health practice: What does it mean to 'know' a disease? The tragedy of XDR-TB ~ Ross Upshur; The evaluation of public health initiatives on smoking and lung cancer: an ethical critique ~ Peter Allmark, Angela Tod and Jo Abbott; Relevance of primary care bioethics committees In public health ethical practice in the community: an experience in an area of extreme poverty in Santiago, Chile ~ Marla Solari and Tatiana Escobar-Koch; Unlinked anonymous blood testing for public health purposes: an ethical dilemma? ~ Jessica Datta and Anthony Kessell; Constructing the obesity epidemic: loose science, money and public health ~ Alison Hann and Stephen Peckham; Politics, ethics and evidence: immunisation and public health policy ~ Alison Hann and Stephen Peckham; Avoiding mixed messages: HPV vaccines and the 'cure' for cervical cancer ~ Alison Hann and Stephen Peckham; A call for clearer vaccine exemption typology to improve population health ~ Erica Sutton and Ross Upshur; Part three: Public health ethics: developing a basis for practice: Theory and practice in public health ethics: a complex relationship ~ Angus Dawson; Conclusion: taking forward the debate ~ Stephen Peckham and Alison Hann.