Transcription
[Music] So, public health ethics examines questions about the appropriateness, the rightness or wrongness of actions, at the group level.
So, let me first start by distinguishing public health ethics from the more commonly understood clinical ethics or medical ethics. So, medical ethics focuses on inter-individual issues. And there’s a fairly classic formulation of medical ethics that talks about four important principles: autonomy, that is the capacity of individuals to decide for themselves what sort of things they want or don’t want in a medical context; beneficence, that is the ability to do good; nonmaleficence, not to harm others; and then justice. And what distinguishes public health ethics from clinical ethics, or medical ethics, is its broader focus on issues related to justice, because justice relates to what is due to different groups of people within a society.
So, a classic public health ethics question, and one that’s exercised me for some time in most of my early research in public health ethics related to this, is what role does the community or the State, what power do they have over the rights of an individual when it comes to their behaviour that may pose a risk or a harm to a community? And a classic example, and how I got very deeply into public health ethics, was during the 2003 SARS outbreak in Toronto. At that time I was working as a family physician; I am also trained as a public health physician, and I was seconded to the public health unit to help work on the epidemiology of SARS, because early in the outbreak we weren’t really sure what was causing it. But as a means of actually stemming the outbreak in the community, for the first time in decades, mass quarantine was used. We were asking citizens to suspend their mobility rights if they’d been in any way, potentially, exposed to the virus. So, quarantine actually, the public health officers, the medical officers of health, actually have the power, legislatively, to exert an incredible power over individuals’ rights, such as their right to free movement, their right to communicate with others if they pose a risk.
So, public health ethics deals with that interface between what’s owed to a community and what’s owed to an individual, and many of the issues in public health ethics are about how you balance those limits. Now, we live in a liberal democracy. Most humans who live in a liberal democracy believe that they have certain rights that can’t be abrogated or overturned or limited in any way. But public health actually has the power to limit those rights, if there is a legitimate reason because of some threat to public health. Typically, those are communicable diseases, but you can see them in toxic exposures and any number of different contexts. So, that’s kind of the core of where the rebirth of public health ethics came up. And if you think about it, during the HIV/AIDS outbreak, you know, how much risk did people with HIV pose to the community? Should we sanction their, you know, identification and separation from the rest of society? So, all of those issues are very important public health issues. People who have collective power versus an individual who might have certain rights.
However, public health ethics has grown over the past two decades and now it’s a fairly advanced form of scholarship in its own right. And one of the areas that it’s most important is on theories of justice and, in particular, social justice. So, the recognition that there are deep, persistent inequalities in health and that those tend to cluster among certain populations over time, has raised health equity as one of the major areas of public health ethics. And health justice is one of the major fields of public health ethics. So, it started with kind of classic issues around control of communicable diseases and now is involved in issues around social determinants of health, health policy. And it’s important for those reasons.
Just one thing I’d also like to add is that public health ethics is as old as public health itself. In the nineteenth century Jeremy Bentham, who was the father of a philosophical school called utilitarianism, he was very influential in the British public health movement. And so, the idea that consequentialism, or the greatest good for the greatest number, was, somehow, the optimal theory for public health, is pretty much a mainstay of Anglo, or of traditions that are influenced by the British public health system, and Canada as being one. So, what we’ve found is that set of assumptions went undisturbed largely until the rise of more rights-based approaches in the late twentieth and early twenty-first century. So, public health has always been related to public health ethics and it continues to be. Mandatory vaccination, for example, is another good example of where public health powers, where the interest of the community might stand in contrast to individuals. So, do people have the right to not immunize their children when they can go to school and be vectors of illness to a larger pool of children? So, public health ethics and public health have grown together. It’s separated in the, or became, I would say, eclipsed, it became almost unthought-of that the way that people behaved was not independent of any ethics and then it became a subject of scholarly reflection in the late twentieth/early twenty-first century. [Music]