SlideShare ist ein Scribd-Unternehmen logo
1 von 36
Downloaden Sie, um offline zu lesen
PUBLIC HEALTH ETHICS:
ETHICS OF PUBLIC HEALTH AND HEALTH PROMOTION
ETHICS OF DISASTERS AND EMERGENCY MEDICINE.
RESOURCE ALLOCATION
King Fahad Medical City (May 11, 2016)
Ghaiath Hussein, MBBS, MHSc. (Bioethics)
Doctoral Researcher, Uni. Of Birmingham
■ This presentation is based on Hussein GM, Alkabba AF, Kasule
OH. Professionalism and Ethics Handbook for Residents (PEHR):
A Practical Guide. Ware J, Kattan T (eds). 1st Edition. Riyadh,
Saudi Arabia: Saudi Commission for Health Specialties, 2015.
AND
■ Training material presented to the East Mediterranean Public
Health Network (EMPHNET) course on Public Health Ethics
(Amman, 2014)
■ The technical and ethical differences between clinical care and
public health practice
■ The importance of ethics in PH practice and research
■ concepts of surveillance, screening, and outbreak investigation
■ The ethical issues in surveillance and screening
■ Concepts and scope of health promotion
■ Discuss the ethical issues that arise from health promotion
■ Theoretical models for resource allocation
ETHICAL ISSUES IN
PUBLIC HEALTH & HEALTH
PROMOTION
■Tell me
about public
health
Source: http://professiongal.com/
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?
– the identification, analysis, and resolution of
ethical problems arising in public health practice
and research
Public health ethics (KFMC,11.05.2016)
■ 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?
■ 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)
Philosophical
•Deontological
•Utilitarian (act &
rule)
•Rights-based
•Virtue
•Casuistry
•Social-contract
•Principlism
Religious
•Islamic ethics &
jurisprudence
(Purposes of Law
‘Sharia’)
•Christian ethics
•Jewish Ethics
•?Oriental
Philosophies
(Buddhist,
Confucian, etc.)
Guiding Principles
•Utility
•Efficiency
•Liberty
•Transparency
•Participation
•Review and
revisability
•Effectiveness
•Fairness
•Reciprocity
•Solidarity
■ Utility: acting so as to produce the greatest good.
■ Efficiency: calls for minimizing the resources needed to produce a
particular result or maximizing the result that can be produced
from a particular set of resources.
■ Liberty: one should impose the least burden on personal self-
determination that is necessary to achieve a legitimate goal
■ Fairness: “treating like cases alike”
■ Reciprocity: individuals (professionals) accept of the risk in
executing their duties would engender reciprocal duties on the
part of the community to them
■ Proportionality: actions taken proportional to need
Examples
of ethical
issues in
public
health
■Surveillance,
screening, &
outbreak
investigation
■Health Promotion
■ Definition:
– “the continuous, systematic collection, analysis and
interpretation of health-related data needed for the
planning, implementation, and evaluation of public
health practice.” (WHO)
■ Functions:
– early warning system;
– document the impact of an intervention, or track
progress towards specified goals; and
– monitor and clarify the epidemiology of health
problems
■ "the presumptive identification of unrecognized disease
or defect by the application of tests, examinations, or
other procedures which can be applied rapidly.” (ICC,
WHO)
■ Examples:
– Premarital genetic
– Prenatal genetic
– Paediatric genetic
– Cancer genetic
■ Definition
“activities undertaken to
establish the existence of an
outbreak, describe the
outbreak, and to identify the
source, transmission
mechanism and contributory
factors, as a basis for outbreak
response.” (NZ CDC)
Steps:
1. Verify the diagnosis
2. Confirm the outbreak
3. Case definition
4. Descriptive epidemiology
5. Develop a hypothesis
6. Test the hypothesis
7. Refine hypothesis / Execute
additional studies
8. Implement control and
prevention measures
9. Communicate findings
•Privacy
•Confidentiality
•Autonomy (consent)
Data/sample
collection
•Benefits
•Harms
•Autonomy (consent)
Methods used
•Justice
•TrustOutcomes
‘Preventive’ Mastectomy
■ “I carry a “faulty” gene, BRCA1, which sharply increases my risk of developing
breast cancer and ovarian cancer.
■ My doctors estimated that I had an 87 percent risk of breast cancer and a 50
percent risk of ovarian cancer,
■ Once I knew that this was my reality, I decided to be proactive and to minimize
the risk as much I could.
■ I made a decision to have a preventive double mastectomy.
■ I am writing about it now because I hope that other women can benefit from my
experience.
■ I wanted to write this to tell other women that the decision to have a mastectomy
was not easy. My chances of developing breast cancer have dropped from 87
percent to under 5 percent.
■ I am fortunate to have a partner, Brad Pitt, who is so loving and supportive. Brad
was at the Pink Lotus Breast Center, where I was treated, for every minute of the
ETHICAL ISSUES IN
DISASTERS
Let’s give it a thought …
■What do we mean by a disaster?
■Natural vs. manmade
■Any examples from EMR?
Disproportional
burden
COI (®Tamiflu,
vaccine)
Resource allocation
Consent
Public engagement
Sub-optimal
products
Surveillance
(research?)
Inequalities
Trials (review)
Loss of
property
&work
hours
Access to
care
Restricted
movement
Confidenti
ality
Professional
duty
■ Individual liberty
■ Protection of the public from harm
■ Proportionality
■ Reciprocity
■ Transparency
■ Privacy
■ Protection of communities from
undue stigmatisation
■ Duty to provide care
■ Equity
■ Solidarity
(Singer et al., 2003)
■ Do (public) health
professionals have the
duty to provide
healthcare services
even if that would
endanger their lives?
■ What are the factors
that help us draw that
extent?
(Source: Case Studies of Ethics During a Pandemic, McDougall, 2010)
■ Maria is a 35-year-old family physician and mother of three children
aged 4-8. She works in a primary care clinic in a main hospital and is
one of 12 doctors practising in the clinic.
■ Her husband, hearing the media reports, is concerned that she may
become ill or bring home illness to her family because of the increased
exposure at work. He encourages her not to go to work. Maria is
concerned for the care of her children. They attend a day care centre.
Her husband works in an accounting firm. She is also worried about
abandoning her patients and increasing the workload of her
colleagues, many of whom, like her, have young families.
■ First Set of Questions
– What are your initial thoughts and feelings about this?
– What do you think are the most important considerations for Maria in making her
decision?
– Would your opinion change if the day care centre was closed? Why?
■ Maria decides she will go to work. She is concerned that her clinic
lacks the appropriate amount of protective equipment. The
clinical group meets and decides that they are committed to
providing care to people with influenza, but will only do so if the
ministry of health provides appropriate protective equipment.
■ 2nd group of questions:
– What do you think of the clinical group's decision?
– Do you think society has an obligation to health care workers in the event of a
pandemic outbreak?
– One of Maria's colleagues is close to retirement. He has diabetes and heart disease.
He tells the clinic that he will not come to work as he feels the risk to his own health
is too great.
– In your view, is the health status of a health care worker an acceptable reason not to
respond to a pandemic virus?
The influenza outbreak is now well advanced. Many people are sick, including a large
number of health care workers. Many health care providers in hospitals and clinics are
not showing up for work. Many refuse to work because they fear infection.
■ Should health care providers face consequences for refusing to show up for work?
■ If no, why? If yes, what sorts of penalties do you think would be fair?
The government has now officially declared a health emergency. It is enacting
legislation mandating health care workers to participate in the efforts to control the
outbreak.
■ What do you think about this possibility?
■ Do you think such laws would violate the rights of health care workers?
Final Questions
– In your view, is it justifiable for health care providers to refuse to provide care?
– Who should make these kinds of decisions?
– How should these kinds of decisions be made? In the absence of a consensus, how should
■ Informed choices and
respect for autonomy
■ Responsibility
■ Altruism
■ Reciprocity
■ Justice
“the process of enabling people to increase control over, and to improve,
their health. It moves beyond a focus on individual behaviour towards a
wide range of social and environmental interventions”. (WHO)
RATIONING AND
RESOURCE ALLOCATION
Public health ethics (KFMC,11.05.2016)
■ Utilitarianism:
– Theory: resources being allocated to less expensive treatments or services that provide the greatest
benefit.
– Practice: QALY.
■ Equity and Distributive Justice
– Theory: “equals should be treated equally, and unequals treated unequally in proportion to the
relevant inequalities”. The need not only the benefit gained from an intervention.
– Practice: ensure that those in poorest health, or greatest need
■ Autonomy:
– individuals have a right to determine/choose what is in their own best interest
■ Beneficence/Non-maleficence:
– Healthcare providers should act in the interest of their clients/patients and NOT to
harm them
■ ‘distributive’ Justice/fairness:
– All groups have an equal right to health services regardless of race, gender, age,
income, or any other characteristic.
How should we decide on who gets what?
■Concept of need
■Concept of utility
■Non-comparative concept
■Privileging concept or ‘social worth’
■ What does resource allocation affect? How?
Breadth
• the population covered?
• application of criteria
• means-testing (e.g.,
excluding those with
higher incomes),
• employment (e.g.,
excluding self-employed
people),
• excluding people from
eligibility (e.g., those
who do not meet certain
requirements),
• or by allowing people to
opt out.
Scope
• Which services?
• excluding services from
the benefits package
• effectiveness,
• comparative
effectiveness,
• cost-effectiveness,
• health technology
assessments (HTAs),
• clinical guidelines or
quality assurance
Depth
• extent or cost share to
which services are
covered
• selective charges (co-
payments) for
inefficient services,
• reduced charges for
especially valuable ones
(value-based insurance
design)
THEORETICAL MODELS
FOR RESOURCE
ALLOCATION
Ezekiel J. Emanuel" Justice and Managed Care: Four Principles for the Just Allocation of Health Care
Resources,” Hastings Center Report 30, no. 3 (2000): 8-16.
Daniels N, Sabin JE. The ethics of accountability in managed care reform. Health Aff (Millwood) 17[5],
50-64. 1998
■ Improving Health Should Be the Primary Goal:
– The allocation of resources should aim at and be justified by the
improvement in people's health
■ Patients and Members Should Be Informed:
– Patients/community should be informed about the allocation of
health care resources … and justification for the allocation.
■ Patients and Members Should Have the Opportunity to Consent.
– Patients/community should be given the opportunity to consent to
the allocation of health care resources that will affect them.
■ Conflicts of Interest Should Be Minimized:
– People entrusted to allocate health care resources should not make
allocating decisions under conditions that could reasonably be
expected to be influenced by direct, personal financial benefits or
Condition Description
Relevance • Priority setting decisions must rest on reasons (including
evidence and principles) that fair-minded participants
(stakeholders) can agree are relevant
• These can involve managers, clinicians, patients, and
consumers in general (three key foci are underlined)
Publicity Priority setting decisions and their rationales must be
publicly accessible
Appeals The priority setting process must include a mechanism for
revising decisions in light of further evidence or principles
that other stakeholders might contribute
Enforcement There must be voluntary or public regulation of the
process to ensure that the first three conditions are met
■ Within its efforts to control the spread of Pandemic
Influenza A H1N1 during the Hajj season (2010), the
Saudi government was able to provide a total of
2,500,000 doses of the newly produced vaccine.
■ The pilgrims are estimated to be 3,500,000; the
working staff who are in contact with pilgrims (entries,
security & health) are about 120,000 persons
■ Who should have the vaccine? Who’s first?
■ 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

Weitere ähnliche Inhalte

Was ist angesagt?

EMPHNET Public Health Ethics (PHE): Introduction to public health ethics (phe)
EMPHNET Public Health Ethics (PHE): Introduction to public health ethics (phe)EMPHNET Public Health Ethics (PHE): Introduction to public health ethics (phe)
EMPHNET Public Health Ethics (PHE): Introduction to public health ethics (phe)Dr Ghaiath Hussein
 
Concept of Public Health and Primary Health Care (PHC)
Concept of Public Health and Primary Health Care (PHC)Concept of Public Health and Primary Health Care (PHC)
Concept of Public Health and Primary Health Care (PHC)Zulfiquer Ahmed Amin
 
Ethical & professional issues in epidemiology
Ethical & professional issues in epidemiologyEthical & professional issues in epidemiology
Ethical & professional issues in epidemiologyDhan Pandey
 
Health systems strengthening
Health systems strengtheningHealth systems strengthening
Health systems strengtheningJuan Seclen
 
Social medicine community medicine,preventive medicine, community health
Social medicine community medicine,preventive medicine, community healthSocial medicine community medicine,preventive medicine, community health
Social medicine community medicine,preventive medicine, community healthsirjana Tiwari
 
Evidence for Public Health Decision Making
Evidence for Public Health Decision MakingEvidence for Public Health Decision Making
Evidence for Public Health Decision MakingVineetha K
 
Health policy in developing countries
Health policy in developing countriesHealth policy in developing countries
Health policy in developing countriesDr. Ankit Mohapatra
 
Understanding the Importance of Public Health
Understanding the Importance of Public HealthUnderstanding the Importance of Public Health
Understanding the Importance of Public HealthGreen Hope University
 
Evolution of public health- Dr Subraham Pany
Evolution of public health- Dr Subraham PanyEvolution of public health- Dr Subraham Pany
Evolution of public health- Dr Subraham PanySubraham Pany
 
Disease causation. lecture 2021 2022 class-1
Disease causation. lecture 2021 2022 class-1Disease causation. lecture 2021 2022 class-1
Disease causation. lecture 2021 2022 class-1Tauseef Jawaid
 
Health Systems and Health Care Services
Health Systems and Health Care ServicesHealth Systems and Health Care Services
Health Systems and Health Care ServicesPrabesh Ghimire
 
Social determinants of health
Social determinants of healthSocial determinants of health
Social determinants of healthDr. Anees Alyafei
 
Ottawa charter and jakarta declaration
Ottawa charter and jakarta declarationOttawa charter and jakarta declaration
Ottawa charter and jakarta declarationkavita yadav
 

Was ist angesagt? (20)

EMPHNET Public Health Ethics (PHE): Introduction to public health ethics (phe)
EMPHNET Public Health Ethics (PHE): Introduction to public health ethics (phe)EMPHNET Public Health Ethics (PHE): Introduction to public health ethics (phe)
EMPHNET Public Health Ethics (PHE): Introduction to public health ethics (phe)
 
Public health
Public healthPublic health
Public health
 
Concept of Public Health and Primary Health Care (PHC)
Concept of Public Health and Primary Health Care (PHC)Concept of Public Health and Primary Health Care (PHC)
Concept of Public Health and Primary Health Care (PHC)
 
Health policy
Health policyHealth policy
Health policy
 
Medical ethics and public health
Medical ethics and public healthMedical ethics and public health
Medical ethics and public health
 
Introduction to Public Health Ethics
Introduction to Public Health EthicsIntroduction to Public Health Ethics
Introduction to Public Health Ethics
 
Globalisation and Health
Globalisation and HealthGlobalisation and Health
Globalisation and Health
 
Ethical & professional issues in epidemiology
Ethical & professional issues in epidemiologyEthical & professional issues in epidemiology
Ethical & professional issues in epidemiology
 
Health systems strengthening
Health systems strengtheningHealth systems strengthening
Health systems strengthening
 
Social medicine community medicine,preventive medicine, community health
Social medicine community medicine,preventive medicine, community healthSocial medicine community medicine,preventive medicine, community health
Social medicine community medicine,preventive medicine, community health
 
Evidence for Public Health Decision Making
Evidence for Public Health Decision MakingEvidence for Public Health Decision Making
Evidence for Public Health Decision Making
 
Health policy in developing countries
Health policy in developing countriesHealth policy in developing countries
Health policy in developing countries
 
Epidemiology
EpidemiologyEpidemiology
Epidemiology
 
Understanding the Importance of Public Health
Understanding the Importance of Public HealthUnderstanding the Importance of Public Health
Understanding the Importance of Public Health
 
Evolution of public health- Dr Subraham Pany
Evolution of public health- Dr Subraham PanyEvolution of public health- Dr Subraham Pany
Evolution of public health- Dr Subraham Pany
 
Public health powerpoint
Public health powerpointPublic health powerpoint
Public health powerpoint
 
Disease causation. lecture 2021 2022 class-1
Disease causation. lecture 2021 2022 class-1Disease causation. lecture 2021 2022 class-1
Disease causation. lecture 2021 2022 class-1
 
Health Systems and Health Care Services
Health Systems and Health Care ServicesHealth Systems and Health Care Services
Health Systems and Health Care Services
 
Social determinants of health
Social determinants of healthSocial determinants of health
Social determinants of health
 
Ottawa charter and jakarta declaration
Ottawa charter and jakarta declarationOttawa charter and jakarta declaration
Ottawa charter and jakarta declaration
 

Andere mochten auch

Medical ethical dilemma
Medical ethical dilemmaMedical ethical dilemma
Medical ethical dilemmaModupe Sarratt
 
Medical Ethics: Public Health and Human Rights
Medical Ethics: Public Health and Human RightsMedical Ethics: Public Health and Human Rights
Medical Ethics: Public Health and Human RightsMd Jahirul Islam Sojib
 
Ethical and legal issues in community health nursing and
Ethical and legal issues in community health nursing andEthical and legal issues in community health nursing and
Ethical and legal issues in community health nursing andAmu Jogipur
 
Medical ethics and public health (2)
Medical ethics and public health (2)Medical ethics and public health (2)
Medical ethics and public health (2)Dr. Dharmendra Gahwai
 
Chapter 12 scarce allocation
Chapter 12 scarce allocationChapter 12 scarce allocation
Chapter 12 scarce allocationSandy Thunell
 
Ethics in Public Health, Health Care, Health Research and the Biomedical Scie...
Ethics in Public Health, Health Care, Health Research and the Biomedical Scie...Ethics in Public Health, Health Care, Health Research and the Biomedical Scie...
Ethics in Public Health, Health Care, Health Research and the Biomedical Scie...Dr. Hatem El Dabbakeh
 
5530: Chapter 16
5530: Chapter 165530: Chapter 16
5530: Chapter 16bodo-con
 
The place of ethics
The place of ethicsThe place of ethics
The place of ethicsadeleepenner
 
Public health laws
Public health lawsPublic health laws
Public health lawssurendra2695
 
Final test april 2010 (with answer key)
Final test april 2010 (with answer key)Final test april 2010 (with answer key)
Final test april 2010 (with answer key)Alex Venome
 
Professional Ethics and competence
Professional Ethics and competenceProfessional Ethics and competence
Professional Ethics and competenceAshish Kelwa
 
EMPHNET-PHE course: Module six ethical issues in public health emergencies an...
EMPHNET-PHE course: Module six ethical issues in public health emergencies an...EMPHNET-PHE course: Module six ethical issues in public health emergencies an...
EMPHNET-PHE course: Module six ethical issues in public health emergencies an...Dr Ghaiath Hussein
 
Genetic Enhancement- Need for Genetic Enhancement
Genetic Enhancement- Need for Genetic EnhancementGenetic Enhancement- Need for Genetic Enhancement
Genetic Enhancement- Need for Genetic EnhancementKK CHANDEL
 
Health Legislations - Dr. Suraj Chawla
Health Legislations - Dr. Suraj ChawlaHealth Legislations - Dr. Suraj Chawla
Health Legislations - Dr. Suraj ChawlaSuraj Chawla
 
Ethical Dilemmas
Ethical DilemmasEthical Dilemmas
Ethical DilemmasSahil Daw
 

Andere mochten auch (17)

Medical ethical dilemma
Medical ethical dilemmaMedical ethical dilemma
Medical ethical dilemma
 
Medical Ethics: Public Health and Human Rights
Medical Ethics: Public Health and Human RightsMedical Ethics: Public Health and Human Rights
Medical Ethics: Public Health and Human Rights
 
Ethical and legal issues in community health nursing and
Ethical and legal issues in community health nursing andEthical and legal issues in community health nursing and
Ethical and legal issues in community health nursing and
 
Ethical dilemma powerpoint
Ethical dilemma powerpointEthical dilemma powerpoint
Ethical dilemma powerpoint
 
Ethics
EthicsEthics
Ethics
 
Medical ethics and public health (2)
Medical ethics and public health (2)Medical ethics and public health (2)
Medical ethics and public health (2)
 
Chapter 12 scarce allocation
Chapter 12 scarce allocationChapter 12 scarce allocation
Chapter 12 scarce allocation
 
Ethics in Public Health, Health Care, Health Research and the Biomedical Scie...
Ethics in Public Health, Health Care, Health Research and the Biomedical Scie...Ethics in Public Health, Health Care, Health Research and the Biomedical Scie...
Ethics in Public Health, Health Care, Health Research and the Biomedical Scie...
 
5530: Chapter 16
5530: Chapter 165530: Chapter 16
5530: Chapter 16
 
The place of ethics
The place of ethicsThe place of ethics
The place of ethics
 
Public health laws
Public health lawsPublic health laws
Public health laws
 
Final test april 2010 (with answer key)
Final test april 2010 (with answer key)Final test april 2010 (with answer key)
Final test april 2010 (with answer key)
 
Professional Ethics and competence
Professional Ethics and competenceProfessional Ethics and competence
Professional Ethics and competence
 
EMPHNET-PHE course: Module six ethical issues in public health emergencies an...
EMPHNET-PHE course: Module six ethical issues in public health emergencies an...EMPHNET-PHE course: Module six ethical issues in public health emergencies an...
EMPHNET-PHE course: Module six ethical issues in public health emergencies an...
 
Genetic Enhancement- Need for Genetic Enhancement
Genetic Enhancement- Need for Genetic EnhancementGenetic Enhancement- Need for Genetic Enhancement
Genetic Enhancement- Need for Genetic Enhancement
 
Health Legislations - Dr. Suraj Chawla
Health Legislations - Dr. Suraj ChawlaHealth Legislations - Dr. Suraj Chawla
Health Legislations - Dr. Suraj Chawla
 
Ethical Dilemmas
Ethical DilemmasEthical Dilemmas
Ethical Dilemmas
 

Ähnlich wie Public health ethics (KFMC,11.05.2016)

Epcm l17 ethical and legal issues in public health
Epcm l17 ethical and legal issues in public healthEpcm l17 ethical and legal issues in public health
Epcm l17 ethical and legal issues in public healthDr Ghaiath Hussein
 
Current ethical issues in PH Final.pptx
Current ethical issues in PH Final.pptxCurrent ethical issues in PH Final.pptx
Current ethical issues in PH Final.pptxKeirelEdrin
 
Chapter12
Chapter12Chapter12
Chapter12bholmes
 
M. Pharm: Research Methodology and biostatics
M. Pharm: Research Methodology and biostatics M. Pharm: Research Methodology and biostatics
M. Pharm: Research Methodology and biostatics SONALI PAWAR
 
EMPHNET-PHE course: Module03 ethical issues in surveillance, screening and ou...
EMPHNET-PHE course: Module03 ethical issues in surveillance, screening and ou...EMPHNET-PHE course: Module03 ethical issues in surveillance, screening and ou...
EMPHNET-PHE course: Module03 ethical issues in surveillance, screening and ou...Dr Ghaiath Hussein
 
Schwitzer keynote to ISDM 2013 Lima, Peru
Schwitzer keynote to ISDM 2013 Lima, PeruSchwitzer keynote to ISDM 2013 Lima, Peru
Schwitzer keynote to ISDM 2013 Lima, PeruGary Schwitzer
 
Ethical and Human Rights Concerns in Global HealthChapter Fou.docx
Ethical and Human Rights Concerns in Global HealthChapter  Fou.docxEthical and Human Rights Concerns in Global HealthChapter  Fou.docx
Ethical and Human Rights Concerns in Global HealthChapter Fou.docxdebishakespeare
 
Clinical Practice Guideline For Disease Prevention
Clinical Practice Guideline For Disease PreventionClinical Practice Guideline For Disease Prevention
Clinical Practice Guideline For Disease PreventionLucie Nicolas
 
AMA Code Of Medical Ethics
AMA Code Of Medical EthicsAMA Code Of Medical Ethics
AMA Code Of Medical EthicsLaura Arrigo
 
Weitzman ECHO COVID-19: Promoting Risk Reduction in the COVID-19 Environment
Weitzman ECHO COVID-19: Promoting Risk Reduction in the COVID-19 EnvironmentWeitzman ECHO COVID-19: Promoting Risk Reduction in the COVID-19 Environment
Weitzman ECHO COVID-19: Promoting Risk Reduction in the COVID-19 EnvironmentCHC Connecticut
 
Engaging Patients in Antimicrobial Resistance and Stewardship
Engaging Patients in Antimicrobial Resistance and StewardshipEngaging Patients in Antimicrobial Resistance and Stewardship
Engaging Patients in Antimicrobial Resistance and StewardshipCanadian Patient Safety Institute
 
L1 - Oral epidemiology-introduction .ppt
L1 - Oral epidemiology-introduction .pptL1 - Oral epidemiology-introduction .ppt
L1 - Oral epidemiology-introduction .pptNarmathaSRaja
 
International nurses day 2019
International nurses day 2019International nurses day 2019
International nurses day 2019subhasarada1977
 

Ähnlich wie Public health ethics (KFMC,11.05.2016) (20)

Epcm l17 ethical and legal issues in public health
Epcm l17 ethical and legal issues in public healthEpcm l17 ethical and legal issues in public health
Epcm l17 ethical and legal issues in public health
 
Current ethical issues in PH Final.pptx
Current ethical issues in PH Final.pptxCurrent ethical issues in PH Final.pptx
Current ethical issues in PH Final.pptx
 
Chapter12
Chapter12Chapter12
Chapter12
 
M. Pharm: Research Methodology and biostatics
M. Pharm: Research Methodology and biostatics M. Pharm: Research Methodology and biostatics
M. Pharm: Research Methodology and biostatics
 
Public Health Reflection Paper
Public Health Reflection PaperPublic Health Reflection Paper
Public Health Reflection Paper
 
History Of Public Health Essay
History Of Public Health EssayHistory Of Public Health Essay
History Of Public Health Essay
 
EMPHNET-PHE course: Module03 ethical issues in surveillance, screening and ou...
EMPHNET-PHE course: Module03 ethical issues in surveillance, screening and ou...EMPHNET-PHE course: Module03 ethical issues in surveillance, screening and ou...
EMPHNET-PHE course: Module03 ethical issues in surveillance, screening and ou...
 
Ethics In Public Health Essay
Ethics In Public Health EssayEthics In Public Health Essay
Ethics In Public Health Essay
 
Public Health Principles
Public Health PrinciplesPublic Health Principles
Public Health Principles
 
Schwitzer keynote to ISDM 2013 Lima, Peru
Schwitzer keynote to ISDM 2013 Lima, PeruSchwitzer keynote to ISDM 2013 Lima, Peru
Schwitzer keynote to ISDM 2013 Lima, Peru
 
Ethical and Human Rights Concerns in Global HealthChapter Fou.docx
Ethical and Human Rights Concerns in Global HealthChapter  Fou.docxEthical and Human Rights Concerns in Global HealthChapter  Fou.docx
Ethical and Human Rights Concerns in Global HealthChapter Fou.docx
 
Clinical Practice Guideline For Disease Prevention
Clinical Practice Guideline For Disease PreventionClinical Practice Guideline For Disease Prevention
Clinical Practice Guideline For Disease Prevention
 
AMA Code Of Medical Ethics
AMA Code Of Medical EthicsAMA Code Of Medical Ethics
AMA Code Of Medical Ethics
 
EPIDEMIOLOGY .pptx
EPIDEMIOLOGY  .pptxEPIDEMIOLOGY  .pptx
EPIDEMIOLOGY .pptx
 
Public Health Assessment Essay
Public Health Assessment EssayPublic Health Assessment Essay
Public Health Assessment Essay
 
Weitzman ECHO COVID-19: Promoting Risk Reduction in the COVID-19 Environment
Weitzman ECHO COVID-19: Promoting Risk Reduction in the COVID-19 EnvironmentWeitzman ECHO COVID-19: Promoting Risk Reduction in the COVID-19 Environment
Weitzman ECHO COVID-19: Promoting Risk Reduction in the COVID-19 Environment
 
Engaging Patients in Antimicrobial Resistance and Stewardship
Engaging Patients in Antimicrobial Resistance and StewardshipEngaging Patients in Antimicrobial Resistance and Stewardship
Engaging Patients in Antimicrobial Resistance and Stewardship
 
L1 - Oral epidemiology-introduction .ppt
L1 - Oral epidemiology-introduction .pptL1 - Oral epidemiology-introduction .ppt
L1 - Oral epidemiology-introduction .ppt
 
Ethics Of Prisoners
Ethics Of PrisonersEthics Of Prisoners
Ethics Of Prisoners
 
International nurses day 2019
International nurses day 2019International nurses day 2019
International nurses day 2019
 

Mehr von Dr Ghaiath Hussein

نظرية التطور عند المسلمين (بروفيسور محمد علي البار
نظرية التطور عند المسلمين (بروفيسور محمد علي البارنظرية التطور عند المسلمين (بروفيسور محمد علي البار
نظرية التطور عند المسلمين (بروفيسور محمد علي البارDr Ghaiath Hussein
 
10 Tips to make your search in Google Scholar more effective.pdf
10 Tips to make your search in Google Scholar more effective.pdf10 Tips to make your search in Google Scholar more effective.pdf
10 Tips to make your search in Google Scholar more effective.pdfDr Ghaiath Hussein
 
Ethical considerations in research during armed conflicts.pptx
Ethical considerations in research during armed conflicts.pptxEthical considerations in research during armed conflicts.pptx
Ethical considerations in research during armed conflicts.pptxDr Ghaiath Hussein
 
Medically Assisted Dying in (MAiD) Ireland - Mapping the Ethical Terrain (May...
Medically Assisted Dying in (MAiD) Ireland - Mapping the Ethical Terrain (May...Medically Assisted Dying in (MAiD) Ireland - Mapping the Ethical Terrain (May...
Medically Assisted Dying in (MAiD) Ireland - Mapping the Ethical Terrain (May...Dr Ghaiath Hussein
 
Research or not research (JCB 17.11.21).pptx
Research or not research (JCB 17.11.21).pptxResearch or not research (JCB 17.11.21).pptx
Research or not research (JCB 17.11.21).pptxDr Ghaiath Hussein
 
Medically assisted dying in (MAiD) Ireland - mapping the ethical terrain
Medically assisted dying in (MAiD) Ireland - mapping the ethical terrainMedically assisted dying in (MAiD) Ireland - mapping the ethical terrain
Medically assisted dying in (MAiD) Ireland - mapping the ethical terrainDr Ghaiath Hussein
 
الجوانب الأخلاقية في العلاج الجيني
الجوانب الأخلاقية في العلاج الجينيالجوانب الأخلاقية في العلاج الجيني
الجوانب الأخلاقية في العلاج الجينيDr Ghaiath Hussein
 
الضرر في العمل الطبي-البروفيسور جمال جار الله
الضرر في العمل الطبي-البروفيسور جمال جار اللهالضرر في العمل الطبي-البروفيسور جمال جار الله
الضرر في العمل الطبي-البروفيسور جمال جار اللهDr Ghaiath Hussein
 
العلاج الجيني والاخلاق
العلاج الجيني والاخلاقالعلاج الجيني والاخلاق
العلاج الجيني والاخلاقDr Ghaiath Hussein
 
القتل الرحيم و النظرة الإسلامية له
القتل الرحيم و النظرة الإسلامية لهالقتل الرحيم و النظرة الإسلامية له
القتل الرحيم و النظرة الإسلامية لهDr Ghaiath Hussein
 
القواعد الفقهية لتخصص التخدير (2)
القواعد الفقهية لتخصص التخدير (2)القواعد الفقهية لتخصص التخدير (2)
القواعد الفقهية لتخصص التخدير (2)Dr Ghaiath Hussein
 
المقارنة بين الفلسفات الغربية والمقاربة الإسلام
المقارنة بين الفلسفات الغربية والمقاربة الإسلامالمقارنة بين الفلسفات الغربية والمقاربة الإسلام
المقارنة بين الفلسفات الغربية والمقاربة الإسلامDr Ghaiath Hussein
 
تحديد الوفاة بالقرائن الدماغية الدكتور محمد زهير
تحديد الوفاة بالقرائن الدماغية الدكتور محمد زهيرتحديد الوفاة بالقرائن الدماغية الدكتور محمد زهير
تحديد الوفاة بالقرائن الدماغية الدكتور محمد زهيرDr Ghaiath Hussein
 
الاحتضار والموت والمنظور الشرعي له التعامل مع المحتضر والميت طلب عدم الإنعاش...
الاحتضار والموت والمنظور الشرعي له  التعامل مع المحتضر والميت طلب عدم الإنعاش...الاحتضار والموت والمنظور الشرعي له  التعامل مع المحتضر والميت طلب عدم الإنعاش...
الاحتضار والموت والمنظور الشرعي له التعامل مع المحتضر والميت طلب عدم الإنعاش...Dr Ghaiath Hussein
 
إسهامات الفقهاء والأطباء في تطبيق القواعد الفقهية
إسهامات الفقهاء    والأطباء في تطبيق القواعد الفقهيةإسهامات الفقهاء    والأطباء في تطبيق القواعد الفقهية
إسهامات الفقهاء والأطباء في تطبيق القواعد الفقهيةDr Ghaiath Hussein
 
جراحات التجميل ـ محاضرة كلية الطب
جراحات التجميل ـ محاضرة كلية الطبجراحات التجميل ـ محاضرة كلية الطب
جراحات التجميل ـ محاضرة كلية الطبDr Ghaiath Hussein
 
حقوق المريض ـ الحوار الوطني
حقوق المريض ـ الحوار الوطنيحقوق المريض ـ الحوار الوطني
حقوق المريض ـ الحوار الوطنيDr Ghaiath Hussein
 
حقوق المريض في الاسلام
حقوق المريض في الاسلامحقوق المريض في الاسلام
حقوق المريض في الاسلامDr Ghaiath Hussein
 
دراسة حالة وتقديمها
دراسة حالة وتقديمهادراسة حالة وتقديمها
دراسة حالة وتقديمهاDr Ghaiath Hussein
 
سوء الممارسة الطبية 1
سوء الممارسة الطبية 1سوء الممارسة الطبية 1
سوء الممارسة الطبية 1Dr Ghaiath Hussein
 

Mehr von Dr Ghaiath Hussein (20)

نظرية التطور عند المسلمين (بروفيسور محمد علي البار
نظرية التطور عند المسلمين (بروفيسور محمد علي البارنظرية التطور عند المسلمين (بروفيسور محمد علي البار
نظرية التطور عند المسلمين (بروفيسور محمد علي البار
 
10 Tips to make your search in Google Scholar more effective.pdf
10 Tips to make your search in Google Scholar more effective.pdf10 Tips to make your search in Google Scholar more effective.pdf
10 Tips to make your search in Google Scholar more effective.pdf
 
Ethical considerations in research during armed conflicts.pptx
Ethical considerations in research during armed conflicts.pptxEthical considerations in research during armed conflicts.pptx
Ethical considerations in research during armed conflicts.pptx
 
Medically Assisted Dying in (MAiD) Ireland - Mapping the Ethical Terrain (May...
Medically Assisted Dying in (MAiD) Ireland - Mapping the Ethical Terrain (May...Medically Assisted Dying in (MAiD) Ireland - Mapping the Ethical Terrain (May...
Medically Assisted Dying in (MAiD) Ireland - Mapping the Ethical Terrain (May...
 
Research or not research (JCB 17.11.21).pptx
Research or not research (JCB 17.11.21).pptxResearch or not research (JCB 17.11.21).pptx
Research or not research (JCB 17.11.21).pptx
 
Medically assisted dying in (MAiD) Ireland - mapping the ethical terrain
Medically assisted dying in (MAiD) Ireland - mapping the ethical terrainMedically assisted dying in (MAiD) Ireland - mapping the ethical terrain
Medically assisted dying in (MAiD) Ireland - mapping the ethical terrain
 
الجوانب الأخلاقية في العلاج الجيني
الجوانب الأخلاقية في العلاج الجينيالجوانب الأخلاقية في العلاج الجيني
الجوانب الأخلاقية في العلاج الجيني
 
الضرر في العمل الطبي-البروفيسور جمال جار الله
الضرر في العمل الطبي-البروفيسور جمال جار اللهالضرر في العمل الطبي-البروفيسور جمال جار الله
الضرر في العمل الطبي-البروفيسور جمال جار الله
 
العلاج الجيني والاخلاق
العلاج الجيني والاخلاقالعلاج الجيني والاخلاق
العلاج الجيني والاخلاق
 
القتل الرحيم و النظرة الإسلامية له
القتل الرحيم و النظرة الإسلامية لهالقتل الرحيم و النظرة الإسلامية له
القتل الرحيم و النظرة الإسلامية له
 
القواعد الفقهية لتخصص التخدير (2)
القواعد الفقهية لتخصص التخدير (2)القواعد الفقهية لتخصص التخدير (2)
القواعد الفقهية لتخصص التخدير (2)
 
المقارنة بين الفلسفات الغربية والمقاربة الإسلام
المقارنة بين الفلسفات الغربية والمقاربة الإسلامالمقارنة بين الفلسفات الغربية والمقاربة الإسلام
المقارنة بين الفلسفات الغربية والمقاربة الإسلام
 
تحديد الوفاة بالقرائن الدماغية الدكتور محمد زهير
تحديد الوفاة بالقرائن الدماغية الدكتور محمد زهيرتحديد الوفاة بالقرائن الدماغية الدكتور محمد زهير
تحديد الوفاة بالقرائن الدماغية الدكتور محمد زهير
 
الاحتضار والموت والمنظور الشرعي له التعامل مع المحتضر والميت طلب عدم الإنعاش...
الاحتضار والموت والمنظور الشرعي له  التعامل مع المحتضر والميت طلب عدم الإنعاش...الاحتضار والموت والمنظور الشرعي له  التعامل مع المحتضر والميت طلب عدم الإنعاش...
الاحتضار والموت والمنظور الشرعي له التعامل مع المحتضر والميت طلب عدم الإنعاش...
 
إسهامات الفقهاء والأطباء في تطبيق القواعد الفقهية
إسهامات الفقهاء    والأطباء في تطبيق القواعد الفقهيةإسهامات الفقهاء    والأطباء في تطبيق القواعد الفقهية
إسهامات الفقهاء والأطباء في تطبيق القواعد الفقهية
 
جراحات التجميل ـ محاضرة كلية الطب
جراحات التجميل ـ محاضرة كلية الطبجراحات التجميل ـ محاضرة كلية الطب
جراحات التجميل ـ محاضرة كلية الطب
 
حقوق المريض ـ الحوار الوطني
حقوق المريض ـ الحوار الوطنيحقوق المريض ـ الحوار الوطني
حقوق المريض ـ الحوار الوطني
 
حقوق المريض في الاسلام
حقوق المريض في الاسلامحقوق المريض في الاسلام
حقوق المريض في الاسلام
 
دراسة حالة وتقديمها
دراسة حالة وتقديمهادراسة حالة وتقديمها
دراسة حالة وتقديمها
 
سوء الممارسة الطبية 1
سوء الممارسة الطبية 1سوء الممارسة الطبية 1
سوء الممارسة الطبية 1
 

Kürzlich hochgeladen

Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectiondrhanifmohdali
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...Shubhanshu Gaurav
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyMedicoseAcademics
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.pptRamDBawankar1
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 

Kürzlich hochgeladen (20)

Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissection
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
 
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before Pregnancy
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 

Public health ethics (KFMC,11.05.2016)

  • 1. PUBLIC HEALTH ETHICS: ETHICS OF PUBLIC HEALTH AND HEALTH PROMOTION ETHICS OF DISASTERS AND EMERGENCY MEDICINE. RESOURCE ALLOCATION King Fahad Medical City (May 11, 2016) Ghaiath Hussein, MBBS, MHSc. (Bioethics) Doctoral Researcher, Uni. Of Birmingham
  • 2. ■ This presentation is based on Hussein GM, Alkabba AF, Kasule OH. Professionalism and Ethics Handbook for Residents (PEHR): A Practical Guide. Ware J, Kattan T (eds). 1st Edition. Riyadh, Saudi Arabia: Saudi Commission for Health Specialties, 2015. AND ■ Training material presented to the East Mediterranean Public Health Network (EMPHNET) course on Public Health Ethics (Amman, 2014)
  • 3. ■ The technical and ethical differences between clinical care and public health practice ■ The importance of ethics in PH practice and research ■ concepts of surveillance, screening, and outbreak investigation ■ The ethical issues in surveillance and screening ■ Concepts and scope of health promotion ■ Discuss the ethical issues that arise from health promotion ■ Theoretical models for resource allocation
  • 4. ETHICAL ISSUES IN PUBLIC HEALTH & HEALTH PROMOTION
  • 5. ■Tell me about public health Source: http://professiongal.com/
  • 6. 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?
  • 7. – the identification, analysis, and resolution of ethical problems arising in public health practice and research
  • 9. ■ 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?
  • 10. ■ 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)
  • 11. Philosophical •Deontological •Utilitarian (act & rule) •Rights-based •Virtue •Casuistry •Social-contract •Principlism Religious •Islamic ethics & jurisprudence (Purposes of Law ‘Sharia’) •Christian ethics •Jewish Ethics •?Oriental Philosophies (Buddhist, Confucian, etc.) Guiding Principles •Utility •Efficiency •Liberty •Transparency •Participation •Review and revisability •Effectiveness •Fairness •Reciprocity •Solidarity
  • 12. ■ Utility: acting so as to produce the greatest good. ■ Efficiency: calls for minimizing the resources needed to produce a particular result or maximizing the result that can be produced from a particular set of resources. ■ Liberty: one should impose the least burden on personal self- determination that is necessary to achieve a legitimate goal ■ Fairness: “treating like cases alike” ■ Reciprocity: individuals (professionals) accept of the risk in executing their duties would engender reciprocal duties on the part of the community to them ■ Proportionality: actions taken proportional to need
  • 13. Examples of ethical issues in public health ■Surveillance, screening, & outbreak investigation ■Health Promotion
  • 14. ■ Definition: – “the continuous, systematic collection, analysis and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice.” (WHO) ■ Functions: – early warning system; – document the impact of an intervention, or track progress towards specified goals; and – monitor and clarify the epidemiology of health problems
  • 15. ■ "the presumptive identification of unrecognized disease or defect by the application of tests, examinations, or other procedures which can be applied rapidly.” (ICC, WHO) ■ Examples: – Premarital genetic – Prenatal genetic – Paediatric genetic – Cancer genetic
  • 16. ■ Definition “activities undertaken to establish the existence of an outbreak, describe the outbreak, and to identify the source, transmission mechanism and contributory factors, as a basis for outbreak response.” (NZ CDC) Steps: 1. Verify the diagnosis 2. Confirm the outbreak 3. Case definition 4. Descriptive epidemiology 5. Develop a hypothesis 6. Test the hypothesis 7. Refine hypothesis / Execute additional studies 8. Implement control and prevention measures 9. Communicate findings
  • 18. ‘Preventive’ Mastectomy ■ “I carry a “faulty” gene, BRCA1, which sharply increases my risk of developing breast cancer and ovarian cancer. ■ My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, ■ Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. ■ I made a decision to have a preventive double mastectomy. ■ I am writing about it now because I hope that other women can benefit from my experience. ■ I wanted to write this to tell other women that the decision to have a mastectomy was not easy. My chances of developing breast cancer have dropped from 87 percent to under 5 percent. ■ I am fortunate to have a partner, Brad Pitt, who is so loving and supportive. Brad was at the Pink Lotus Breast Center, where I was treated, for every minute of the
  • 20. Let’s give it a thought … ■What do we mean by a disaster? ■Natural vs. manmade ■Any examples from EMR?
  • 21. Disproportional burden COI (®Tamiflu, vaccine) Resource allocation Consent Public engagement Sub-optimal products Surveillance (research?) Inequalities Trials (review) Loss of property &work hours Access to care Restricted movement Confidenti ality Professional duty
  • 22. ■ Individual liberty ■ Protection of the public from harm ■ Proportionality ■ Reciprocity ■ Transparency ■ Privacy ■ Protection of communities from undue stigmatisation ■ Duty to provide care ■ Equity ■ Solidarity (Singer et al., 2003) ■ Do (public) health professionals have the duty to provide healthcare services even if that would endanger their lives? ■ What are the factors that help us draw that extent?
  • 23. (Source: Case Studies of Ethics During a Pandemic, McDougall, 2010) ■ Maria is a 35-year-old family physician and mother of three children aged 4-8. She works in a primary care clinic in a main hospital and is one of 12 doctors practising in the clinic. ■ Her husband, hearing the media reports, is concerned that she may become ill or bring home illness to her family because of the increased exposure at work. He encourages her not to go to work. Maria is concerned for the care of her children. They attend a day care centre. Her husband works in an accounting firm. She is also worried about abandoning her patients and increasing the workload of her colleagues, many of whom, like her, have young families. ■ First Set of Questions – What are your initial thoughts and feelings about this? – What do you think are the most important considerations for Maria in making her decision? – Would your opinion change if the day care centre was closed? Why?
  • 24. ■ Maria decides she will go to work. She is concerned that her clinic lacks the appropriate amount of protective equipment. The clinical group meets and decides that they are committed to providing care to people with influenza, but will only do so if the ministry of health provides appropriate protective equipment. ■ 2nd group of questions: – What do you think of the clinical group's decision? – Do you think society has an obligation to health care workers in the event of a pandemic outbreak? – One of Maria's colleagues is close to retirement. He has diabetes and heart disease. He tells the clinic that he will not come to work as he feels the risk to his own health is too great. – In your view, is the health status of a health care worker an acceptable reason not to respond to a pandemic virus?
  • 25. The influenza outbreak is now well advanced. Many people are sick, including a large number of health care workers. Many health care providers in hospitals and clinics are not showing up for work. Many refuse to work because they fear infection. ■ Should health care providers face consequences for refusing to show up for work? ■ If no, why? If yes, what sorts of penalties do you think would be fair? The government has now officially declared a health emergency. It is enacting legislation mandating health care workers to participate in the efforts to control the outbreak. ■ What do you think about this possibility? ■ Do you think such laws would violate the rights of health care workers? Final Questions – In your view, is it justifiable for health care providers to refuse to provide care? – Who should make these kinds of decisions? – How should these kinds of decisions be made? In the absence of a consensus, how should
  • 26. ■ Informed choices and respect for autonomy ■ Responsibility ■ Altruism ■ Reciprocity ■ Justice “the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions”. (WHO)
  • 29. ■ Utilitarianism: – Theory: resources being allocated to less expensive treatments or services that provide the greatest benefit. – Practice: QALY. ■ Equity and Distributive Justice – Theory: “equals should be treated equally, and unequals treated unequally in proportion to the relevant inequalities”. The need not only the benefit gained from an intervention. – Practice: ensure that those in poorest health, or greatest need ■ Autonomy: – individuals have a right to determine/choose what is in their own best interest ■ Beneficence/Non-maleficence: – Healthcare providers should act in the interest of their clients/patients and NOT to harm them ■ ‘distributive’ Justice/fairness: – All groups have an equal right to health services regardless of race, gender, age, income, or any other characteristic.
  • 30. How should we decide on who gets what? ■Concept of need ■Concept of utility ■Non-comparative concept ■Privileging concept or ‘social worth’
  • 31. ■ What does resource allocation affect? How? Breadth • the population covered? • application of criteria • means-testing (e.g., excluding those with higher incomes), • employment (e.g., excluding self-employed people), • excluding people from eligibility (e.g., those who do not meet certain requirements), • or by allowing people to opt out. Scope • Which services? • excluding services from the benefits package • effectiveness, • comparative effectiveness, • cost-effectiveness, • health technology assessments (HTAs), • clinical guidelines or quality assurance Depth • extent or cost share to which services are covered • selective charges (co- payments) for inefficient services, • reduced charges for especially valuable ones (value-based insurance design)
  • 32. THEORETICAL MODELS FOR RESOURCE ALLOCATION Ezekiel J. Emanuel" Justice and Managed Care: Four Principles for the Just Allocation of Health Care Resources,” Hastings Center Report 30, no. 3 (2000): 8-16. Daniels N, Sabin JE. The ethics of accountability in managed care reform. Health Aff (Millwood) 17[5], 50-64. 1998
  • 33. ■ Improving Health Should Be the Primary Goal: – The allocation of resources should aim at and be justified by the improvement in people's health ■ Patients and Members Should Be Informed: – Patients/community should be informed about the allocation of health care resources … and justification for the allocation. ■ Patients and Members Should Have the Opportunity to Consent. – Patients/community should be given the opportunity to consent to the allocation of health care resources that will affect them. ■ Conflicts of Interest Should Be Minimized: – People entrusted to allocate health care resources should not make allocating decisions under conditions that could reasonably be expected to be influenced by direct, personal financial benefits or
  • 34. Condition Description Relevance • Priority setting decisions must rest on reasons (including evidence and principles) that fair-minded participants (stakeholders) can agree are relevant • These can involve managers, clinicians, patients, and consumers in general (three key foci are underlined) Publicity Priority setting decisions and their rationales must be publicly accessible Appeals The priority setting process must include a mechanism for revising decisions in light of further evidence or principles that other stakeholders might contribute Enforcement There must be voluntary or public regulation of the process to ensure that the first three conditions are met
  • 35. ■ Within its efforts to control the spread of Pandemic Influenza A H1N1 during the Hajj season (2010), the Saudi government was able to provide a total of 2,500,000 doses of the newly produced vaccine. ■ The pilgrims are estimated to be 3,500,000; the working staff who are in contact with pilgrims (entries, security & health) are about 120,000 persons ■ Who should have the vaccine? Who’s first?
  • 36. ■ 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