Academic journal article Canadian Journal of Public Health

Re-Visioning Public Health Ethics: A Relational Perspective

Academic journal article Canadian Journal of Public Health

Re-Visioning Public Health Ethics: A Relational Perspective

Article excerpt

ABSTRACT

Canada is in the forefront of thinking about the unique and complex issues of contemporary public health ethics. However, an inordinate focus on the urgent issues of emergency preparedness in pandemic and reliance on bioethical analysis steeped in the autonomy and individual rights tradition of health care and research do not serve adequately as the basis for an ethic of public health with its focus on populations, communities and the common good.

This paper describes some concerns regarding the focus on pandemic ethics in isolation from public health ethics; identifies inadequacies in the dominant individualistic ethics framework; and summarizes nascent work on the concepts of relational autonomy, relational social justice and relational solidarity that can inform a re-visioning of public health ethics. While there is still much work to be done to further refine these principles, they can help to reclaim and centre the common and collective good at risk in pandemic and other emergency situations. Minimally, these principles require a policymaking process that is truly transparent, fair and inclusive; is sensitive and responsive to the workings of systemic inequalities; and requires public recognition of the fact that we enter any crisis with varying degrees of inequity. Public policy response to crisis must not forseeably increase existing inequities.

Key words: Ethics; social justice; community; solidarity

La traduction du résumé se trouve à la fin de l'article. Can J Public Health 2010;101(1):9-11.

Mots clés : éthique; justice sociale; communauté; solidarité

Canada has a proud tradition of making substantial conceptual advances in public health. With the renewed global interest in public health generated by the H1N1 pandemic, Canada is poised to make significant contributions to the development of a new public health ethics that is firmly grounded in a commitment to the health of populations and communities and to the reduction of health inequalities. However, we are concerned that this opportunity may be squandered by an inordinate focus on issues of emergency-preparedness to the exclusion of the full range of public health concerns1,2 and an ongoing reliance on bioethical analysis steeped in the individual rights/autonomy discourse of clinical and research ethics.3-5

In this paper, we describe some concerns regarding the focus on pandemic ethics in isolation from public health ethics; identify inadequacies in the dominant individualistic ethics framework; and summarize our nascent work on the relational concepts that inform our re-visioning of public health ethics.6

Pandemic ethics: A narrow vision

The 2003 Canadian experience of the SARS near-pandemic brought home the reality of fundamental ethical concerns in times of emergency threats to public safety. Among the issues that were identified are restrictions of civil liberties, privacy, the duty of care, the right of health care workers to refuse dangerous work, the right of noninfected patients to access care facilities, the fair distribution of scientific credit for research discoveries, and patent protection.7,8 While these are important issues, we have argued that,

"[f]rom the perspective of pandemic planning and public health, this is an odd and limited list of concerns - a list that likely would not have been generated but for the fact that the analysis remains steeped in an individual rights discourse inherited from clinical ethics and research ethics, and consonant with the dominant moral and political culture."6

Indeed, this analysis situates pandemic as a largely personal health care issue when it is in fact a global public health issue.

To date, the principle-based approach to ethics generated for clinical care and research, and involving respect for autonomy (of individuals), beneficence, non-maleficence and justice9 has dominated ethical reflection in all health areas. …

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