This is a series of presentations I gave in the Eastern Mediterranean Public Health Network (EMPHNET)'s Public Health Ethics (PHE) course that was held in Amman in June 2014. It is a revised introduction to public health ethics.

1. Introduction to Public Health Ethics
EMPHNET
Ghaiath M. A. Hussein
MBBS, MHSc. (Bioethics), PhD Researcher
Email: ghaiathme@gmail.com
Regency Palace Hotel, Amman, Jordan
15-19 June, 2014

2. Course objectives
• To consider critically a range of conceptual
and ethical issues that we face in public health
care provision.
• To provide an opportunity to reflect critically
on, challenge, develop and refine our ethical
positions on particular issues.
• To analyze these issues using ethical
frameworks, and to assess the value of such
frameworks.

3. Course Outline
• Module 1: introduction to public health ethics (PHE)
• Module 2: ethical principles, theories and the core professional
public health values
• Module 3: ethical issues in surveillance, screening and outbreak
investigation
• Module 4: ethical issues in health promotion
• Module 5: ethical issues in vaccination
• Module 6: ethical issues in public health emergencies and
disasters
• Module 7: ethical issues in global health and research
• Module 8: ethical codes and frameworks

4. Learning methods
• Presentations (by facilitators and you ;),
• Small group discussions,
• problem/case discussion,
• Learn from each other’s experiences,
perspectives, arguments, etc.
Ethics learning is best done independently:
readings, reflections, arguments
4

5. Before we start… let’s agree
– All participate … tous participe… الكل يشارك
– Don’t hesitate to ask or to say what you think
– Doing at least one reading before coming
– Listen as much you want to be listened to
– Mobiles Silent or vibrating
– If needed, fell free to leave the training venue
– Feel free to suggest changes in the training plan (but
don’t touch the breaks please :)
– Priority is given to discussion than to ‘finish the day’s
quota’!!
5

6. MODULE ONE: INTRODUCTION TO
PUBLIC HEALTH ETHICS (PHE)

7. Outline for today’s session
• The roles of the healthcare practitioner
• The technical and ethical differences between
clinical care and public health practice
• The definition and taxonomy of ethics (ethical
issue, ethics, bioethics, clinical ethics,
research ethics and public health ethics)
• The importance of ethics in PH practice and
research

8. The roles of the healthcare
practitioner
• Practitioner
• Researcher
• Educator
• Counsellor
• Manager/administrator
• Advocate
(Frank JR. (Ed.), 2005)

9. Key definitions and concepts
– What is Public Health about?
– What is ethics/bioethics?
– What is Public Health Ethics?
– What is an ethical issue?

10. Source: http://professiongal.com/
TELL ME ABOUT PUBLIC HEALTH

11. What is Public Health about?
Aspect Clinical care Public health
Main aim Treat sick individuals (cure) Prevent healthy individuals from getting ill
(prevention)
Beneficiaries Individuals (healthy or sick) and
families
Population (community)
Scope Clinical care, diagnosis, and treatment Health education, health promotion, and
community-based interventions
Fields
(specialties)
Internal medicine, surgery, paediatrics,
obstetrics and gynecology, etc.
Epidemiology, health promotion, biostatistics
Occupational health, etc.
Guidance Clinical guidelines, hospital policies,
etc.
PH guidelines, regulations, laws
Examples of
ethical issues
and
questions
Issues related to the individuals’ right
to decide (autonomy), privacy and
confidentiality, etc.
- When is it ethical to disclose a
patient’s medical information?
- How to decide which patient
should have which service (e.g. an
ICU bed)?
Issues related to the tension between the
individual rights (interests) and the public good
(interests)
- When is it ethical to limit the freedom of
movement of a patient with an infectious
disease (e.g. in case of pandemic)?
- Do parents have the right to refuse
vaccinating their children?

12. Which one would you drink?

13. Less Embarrassing Choices
• I need to pass the exam..cheat or not?
• I need my experiment finished… don’t tell the patient it’s a trial
• I need the money of this Pharmaceutical company. Shall I change
the results of my research on their drug?
• …
Ethics is about making choices…
Usually hard ones !

14. What do you think?

15. Ethical/Moral reasoning
• It is the process we need to go through to reach
a decision about an ethical issue.
• It helps us to differentiate:
– Values and ethical principles
– Facts: description of the way the world is; an
actual state of affairs (“is”)
– Values: judgment about the way things should
be (“ought”).
– Ethical principles: they are meant to guide
actions. Key values in bioethics have
corresponding (e.g., principle of respect for
autonomy)

16. What is ethics?
• A system of moral principles or standards
governing conduct.
• a system of principles by which human actions
and proposals may be judged good or bad, right
or wrong;
• A set of rules or a standard governing the
conduct of a particular class of human action or
profession;
• Any set of moral principles or values recognized
by a particular religion, belief or philosophy;
• The principles of right conduct of an individual.
(UNESCO/IUBS/Eubios Living Bioethics Dictionary version 1.4)

17. Morality and Ethics…
• Morality: the beliefs and standards of good
and bad, right and wrong, that people actually
do and should follow in a society, while ethics
is defined as the systematic study of morality.
• Metaethics: tries to clarify the rational
standards and methods for the study of ethics
• Normative ethics: develops ethical principles,
rules, and ideals that spell out standards of
good and bad, right and wrong. It can be
divided into: moral theory and applied ethics.

18. Bioethics
• Bioethics: is normative ethics applied to
decision-making and public policy in the
domains of biology, health care and research.
• It aims at the identification, analysis, and
resolution of the ethical issues in almost any
field that is related to human life and health.
• Domains:
– Clinical/medical ethics -Research ethics
– Public health ethics -Environmental ethics
– Resource allocation ethics -Organizational ethics, etc.

19. Public Health Ethics (PHE)
• Public Health Ethics (PHE):
– the identification, analysis, and resolution
of ethical problems arising in public health
practice and research

21. Case: TB patient to JAIL
• In Countristan, treatment of all TB patients is free. Patients
are expected to show to the nearest health center (HC) to
receive the treatment under direct observation (DOTS).
• The HC keeps a record of ‘which patient had which dose’.
• The TB officer in that region of Coutristan noted that one of
the TB patient, Mr. Contagious did not receive his doses for
the last couple of weeks.
• The Officer approached Mr. Contagious to persuade him to
take the doses on time.
• The patient refused. The Officer presented an official request
to the Attorney General (AG) in the region saying that “Mr.
Contagious presents danger to the public.”
• The AG issued an Order of Arrest against Mr. Contagious for
the whole duration of the TB treatment.
What are the ethical issues at stake here?

22. What’s ethically unique about
public health?
• Public vs. individuals’ rights
• Scarcity of resources
• Socio-political factors:
– Poverty, illiteracy , minorities, vulnerability
– Abuse of power (‘Nanny State’ & public
engagement)
• Socio-cultural factors:
– Local beliefs vs. “international guidelines”
– Role of families and community leaders
• Urgency to contain public health threats
• Inequalities (national and international)

23. Key messages and
conclusions
• Public health has the potential to produce
public good, but also wide-scale harms
• Public health ethics helps us to maximize the
benefits and minimize the harms
• Public health ethics helps us maintain the
most important aspect of our field – public
trust

24. Questions & Discussion
Feel free to contact:
Ghaiath Hussein
Doctoral researcher, University
of Birmingham, UK
Email:
ghaiathme@gmail.com

25. References & Readings
• Frank JR. The CanMEDS 2005 physician competency framework:
Better standards, better physicians, better care. Royal College of
Physicians and Surgeons of Canada; 2005
• Principles of the Ethical Practice of Public Health; Public Health
Leadership Society (2002)
• Ethics and Public Health: Model Curriculum. Ed. Bruce Jennings et al.
(2003)
• Childress JF, Faden RR, Gaare RD, Gostin LO, Kahn J, Bonnie RJ, Kass NE,
Mastroianni AC, Moreno JD, Nieburg P: Public health ethics: mapping
the terrain. J Law Med Ethics 2002, 30:170-8.
• Public health: disconnections between policy, practice and research.
Jansen et al. Health Research Policy and Systems 2010, 8:37
• Ethical issues in epidemiologic research and public health practice.
Steven S Coughlin. Emerging Themes in Epidemiology 2006, 3:16
• Accountability for reasonableness. Norman Daniels, BMJ
2000;321:1300-1301