A final note on ethical practice
Just as there are frequent debates about ethics in medicine—about who should have the last available hospital bed, or whether life should be ended or extended—public health practitioners are engaged in a range of ethical debates. Over the course of the twentieth century there have been debates about whether water should be fluoridated, whether the use of seatbelts should be mandatory, whether smoking should be banned, whether people with infectious diseases should be quarantined, whether all groups (despite marital status, sexual orientation, ethnic background for example) should be able to access services equally, whether employees or employers should bear responsibility for workplace accidents, whether marijuana should be decriminalised, and so on.
Public health practitioners are called upon on a daily basis to make judgements about how to act in the interests of the community, now and into the future. As such, public health practitioners need to have an understanding of the global picture and, at the same time, an appreciation of how these larger societal forces shape the lives of individuals and groups of people. A central dilemma in public health practice is to sort through questions of right and wrong, and find a workable and acceptable balance between societal interests and individual rights, and between state regulation and individual choice.
Many ethical issues in society are debated over a number of years before they are resolved. These debates occur in the political arena, in social and institutional settings, within professional and industry associations, across community networks, in the courts, and in the media. These debates are often informed by international agreements, such as