Academic journal article Environmental Health Perspectives

Ethical Perspectives for Public and Environmental Health: Fostering Autonomy and the Right to Know. (Commentary)

Academic journal article Environmental Health Perspectives

Ethical Perspectives for Public and Environmental Health: Fostering Autonomy and the Right to Know. (Commentary)

Article excerpt

In this paper we develop an ethical perspective for public and environmental health practice in consideration of the "right to know" by contrasting consequential and &ontological perspectives with relational ethics grounded in the concept of fostering autonomy. From the consequential perspective, disclosure of public and environmental health risks to the public depends on the expected or possible consequences. We discuss three major concerns with this perspective: respect for persons, justice, and ignorance. From a deontological perspective, the "right to know" means that there is a "duty" to communicate about all public health risks and consideration of the principles of prevention, precaution, and environmental justice. Relational ethics develops from consideration of a mutual limitation of the traditional perspectives. Relational ethics is grounded in the relationship between the public and public/environmental health providers. In this paper we develop a model for this relationship, which we call "fostering autonomy through mutually respectful relationships." Fostering autonomy is both an end in public health practice and a means to promote the principles of prevention, precaution, and environmental justice. We discuss these principles as they relate to practical issues of major disasters and contaminants in food, such as DDT, toxaphene, chlordane, and mercury. Key words: Canada, chlordane, DDT, environmental justice, fostering autonomy, mercury, precautionary principle, prevention, right to know, toxaphene. Environ Health Perspect 111:133-137 (2003). [Online 25 October 2002]

doi: 10.1289/ehp.4477 available via


The "right to know" has emerged in public health practice as a result of the devastating consequences from major accidents, such as the release of isocyanate in Bhopal, India, which killed 8,000 people and injured 50,000 (Hook and Lucier 2000). The accident is still causing health impacts (Dhara et al. 2002). In practical terms, the right to know has emerged in both the community and the workplace from an obligation that people should be informed of the risks they face in their daily lives (Baram and Partan 1990; Hook and Lucier 2000).

Within a narrow scope of risk communication, the right to know requires communication with the public about risks through one-way communication, as in health advisories, and two-way communication in specific situations (Lambert 1999). Both follow the "reasonable person standard" for developing and communicating information. However, the right to know should not be limited to catastrophic considerations, but should influence all public and environmental health practices, including environmental justice (Hook and Lucier 2000). Therefore, the right to know needs to be placed within the context of public and environmental health ethics.

The solutions we seek for the practical problems of moral choice depend on the perspective framework that we use (e.g., consequential ethics, deontological ethics, and environmental justice). We develop the perspective of relational ethics grounded in fostering autonomy as the basis for the right to know, environmental justice, and community-based discourse on public and environmental health practice.


The Consequential Perspective

From a consequential perspective, the rightness or wrongness of any act depends entirely on its consequences. Consequentialism in its simplest form is the moral perspective that the right action in any given situation is the one that will produce the best overall consequences, when judged from an impersonal standpoint that gives equal weight to the interests of everyone. All variations of consequentialism share the seductive idea that, so far as morality is concerned, people ought to produce the "greatest good for the greatest number," which implies we minimize evil and maximize good at the lowest possible cost. …

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