Bioethics

by

Christopher Mayes, Ian Kerridge

• LAST REVIEWED: 26 January 2022
• LAST MODIFIED: 27 June 2017
• DOI: 10.1093/obo/9780199756797-0029

Introduction

Public health has made enormous contributions to global health through policies and interventions. However, public health measures have also increased human suffering through policies of forced sterilization, mandatory screening of vulnerable populations, detention of people with infectious diseases, and the quarantine and social isolation of “sick” people or communities. Until the early 21st century, the values and ethics that public health is based on have been assumed to be “good” and have not been subject to critical analysis. Since the first decade of the 21st century, however, bioethics has shifted its attention from the clinic to the public sphere, and many of the ethical issues raised by public health have become the focus both of philosophical and empirical study. Bioethics in public health addresses the tension between local and global health needs; the role of the community in decision making; the duties, obligations, and limitations of the state in relation to the provision of health care; the targeting of vulnerable populations by interventions aimed at preventing disease; and the nature and importance of ethical principles and rights in health care. This article provides a collection of resources that address the ethical theories, theoretical frameworks, key concepts, and practices of public health.

General Overviews

Since the start of the 21st century, a number of insightful and influential texts have been produced that critically review the relationship between bioethics and public health and the development of public health ethics. The history of public health ethics since the late 20th century is critically explored in Bayer and Fairchild 2004, particularly the influence of John Stuart Mill’s “harm principle” (see Ethical Theory). Beauchamp and Steinbock 1999 provides early instigation for the importance of reflecting on the ethics of public health. Childress, et al. 2002 and Buchanan 2008 address traditional bioethical principles of autonomy and justice in the context of public health practice and policy, Gostin 2002 serves as an important collection of articles on the legal and ethical aspects of public health, and Holland 2007 delivers an excellent overview addressing both ethical theory and ethical issues in public health practice. Similarly, O’Neill 2002 delivers a theoretically rigorous analysis of ethical theory in public health policy. Finally, Nuffield Council on Bioethics 2007 develops an ethical framework for public health ethics and applies it to a range of modern public health issues.

• Bayer, Ronald, and Amy L. Fairchild. 2004. The genesis of public health ethics. Bioethics 18.6: 473–492.

  DOI: 10.1111/j.1467-8519.2004.00412.x

  Examines the influence of Mill’s “harm principle” (see Ethical Theory) on public health ethics and the problems of individual versus population concerns relating to privacy, liberty, and paternalism. Bayer and Fairchild argue against the idea that bioethics provides public health with a satisfactory ethical framework. Overall, this is a critical survey of the tension between bioethics and public health.

• Beauchamp, Dan E., and Bonnie Steinbock, eds. 1999. New ethics for the public’s health. New York: Oxford Univ. Press.

  This collection examines the concepts of community and prevention in public health practice. It does not provide an ethical framework for public health, instead focusing on ethical implications of public health policies and practice. A collection of articles addressing key health challenges faced by communities, relevant for public health and health policy students.

• Buchanan, David R. 2008. Autonomy, paternalism, and justice: Ethical priorities in public health. American Journal of Public Health 98.1: 15–21.

  DOI: 10.2105/AJPH.2007.110361

  Buchanan argues that by expanding notions of autonomy, population health is improved; however, in order to promote autonomy, notions of justice need clarification. Public health is in a unique position to promote social justice, thereby securing autonomy and population health. This paper provides a useful survey of notions of justice among key contemporary theorists.

• Childress, James F., Ruth R. Faden, Ruth D. Gaare, et al. 2002. Public health ethics: Mapping the terrain. Journal of Law, Medicine & Ethics 30.2: 170–178.

  DOI: 10.1111/j.1748-720X.2002.tb00384.x

  Using the example of screening, this article examines the role of ethics in public health, particularly in negotiating tensions between individuals or communities and the wider public. Discusses key concepts of autonomy, privacy, trust, human rights, and justice and serves as a good introduction to the relationship between ethics and public health.

• Gostin, Lawrence, ed. 2002. Public health law and ethics: A reader. Berkeley: Univ. of California Press.

  A selection of government reports, articles, and court cases examining the ethical, legal, and political issues in public health theory and practice. Draws together the relationships among public health law, ethics, and human rights in a thorough and insightful way. Comprehensive companion for graduate students.

• Holland, Stephen. 2007. Public health ethics. Cambridge, UK: Polity.

  Comprising two parts, the first offers an accessible introduction to the philosophical underpinnings of the ethical theories relevant to public health. The second part examines key public health activities: epidemiology, health concepts, health promotion, immunization, and screening. A clear introduction to ethical issues and theories for the public, relevant for students or those new to the area.

• Nuffield Council on Bioethics. 2007. Public health: Ethical issues. Cambridge, UK: Cambridge Univ. Press.

  Addresses the ethical issues arising from public health strategies aiming at the improvement of population health, particularly the roles of governments, industry, and individuals. An ethical framework—the stewardship model—is developed as a guide for acceptable intervention into the lives of individuals. Suitable for health policy and public health students.

• O’Neill, Onora. 2002. Public health or clinical ethics: Thinking beyond borders. Ethics & International Affairs 16.2: 35–45.

  DOI: 10.1111/j.1747-7093.2002.tb00395.x

  O’Neill argues for public health ethics that moves beyond the emphasis on individual autonomy in the clinic and justice confined to state borders. A rigorous engagement between political philosophy and ethics in the pursuit of norms for public health policy. A text suitable for undergraduate and graduate students, particularly those interested in the negotiation between clinical ethics and public health ethics.