Academic journal article Public Health Reviews; Rennes

Integrating Ethics in Public Health Education: The Process of Developing Case Studies

Academic journal article Public Health Reviews; Rennes

Integrating Ethics in Public Health Education: The Process of Developing Case Studies

Article excerpt


The 20th century provided horrendous examples of violence, neglect, injustice, suffering and death that resulted from disregard of fundamental values and goals of public health (PH). This was characterized by genocide based on eugenics and Nazi extreme political racist ideologies with the industrialized murder of millions of innocents in "ethnic purity" programs. These travesties demonstrated the importance of clarifying, strengthening, and promulgating the humanity, justice, and equality inherent in the ethical practices of public health. Following the Holocaust of World War II, the world responded in various ways by setting new standards of international law, human rights, and health ethics, which initially grew out of the Nuremberg Trials on war crimes and abusive medical research.

The outcomes of this international ethical reassessment have been codified in various United Nations charters of human rights and genocide, as well as in setting standards on human subject research like those set forth by the World Medical Association in the Declaration of Helsinki [1]. In the United States lessons from the Tuskegee syphilis experiments led to the Belmont Report, which outlined ethical principles of biomedical and behavioral research [2, 3]. In the ongoing legacy of these ethical standards, the education of public health professionals in public health ethics has a distinct and important role. Moreover, continuing failings and problems, such as the failure in some areas and policies to adopt evidence-based public health measures, reinforce the importance of high ethical standards in the public health profession [4]. However, until recently, the field has been slow to meet this educational responsibility.


Public health ethics is only one facet of societal ethics education more generally. Ethics education should not be restricted to the public health workforce but should be part of education in many fields of higher education, as well as in primary and secondary education. The rationale for ethics education in public health depends on the proposition that disagreements and conflict are inevitable in public health policy and practice. However, disagreements and conflicts can be reduced and overcome. Common rules and values for cooperative and peaceful living are achievable despite being faced with new religious and racist based ideologies well into the 21st century.

Ethics should be an integral consideration in developing training objectives and competencies for public health professionals, taking into account societal values; scientific evidence; and the socio-cultural, political, and economic contexts. Development of educational material for public health ethics requires addressing not only formal education in public health bachelor's and master's degree programs, but also in medical, nursing, and social science-related fields including economics and social work. In addition, educational materials should be developed with a focus on the the broader community in general.

As with any education program, regardless of the subject matter, achieving effective training and competencies when discussing PH ethics requires careful planning and some background preparation by the discussion leader or facilitator. Educators who have a good grasp of the issues on all sides of a question (whatever their own personal convictions might be) are in a position to guide the discussion so that the participants are led not only to discover and express ethical issues themselves but also to think thoroughly about them. Moreover, it is important to familiarize teachers of public health with strategies for analyzing ethical questions in concrete cases or situations. One such strategy that has been developed and widely used in bioethics and PH ethics education during the past few years places a focus on the analysis of particular fact patterns, or "cases", which lend themselves to an analysis of the ethical dimension of the actions and decisions that were made or should have been made in that case. …

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