Description
This comprehensive presentation by Ms. Esther Mumbuluma provides a clear introduction to the field of public health ethics. It distinguishes public health ethics from clinical ethics by focusing on populations, community well-being, and the balancing of individual rights with the collective good. The material outlines core ethical principles such as respect for persons, beneficence, non-maleficence, justice, solidarity, and reciprocity. It presents practical ethical frameworks, including the Justificatory Conditions (effectiveness, least infringement, necessity, proportionality, and public justification), to guide decision-making. Contemporary ethical challenges are explored using examples from the COVID-19 pandemic, such as lockdowns, vaccine mandates, and contact tracing. This resource is essential for university students, lecturers, and public health practitioners at the diploma, degree, and postgraduate levels seeking to understand and apply ethical reasoning to policies, interventions, and resource allocation in public health. Download these notes to build a strong foundation for navigating complex ethical dilemmas in population health.
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PUBLIC HEALTH ETHICSMs. Esther MumbulumaMPH Health Policy and Management; University of ZambiaMSoSciHealth Research Ethics; University of KwaZulu Natal Introduction •Focuses on populations rather than individuals •Balances individual rights with collective good •Interdisciplinary: combines ethics, law, public policy, and health •Example: Mandatory vaccination during epidemics Why Ethics in Public Health Matters •Protects vulnerable groups •Ensures fairness in resource allocation •Guides response during public health emergencies •Builds public trust and accountability Core Ethical Principles in Public Health •Respect for persons – dignity, autonomy •Beneficence – doing good •Non-maleficence – avoid harm •Justice – fairness, equity •Solidarity – shared responsibility •Reciprocity – support for those at risk Public Health vs. Clinical Ethics Clinical Ethics Public helath ethics Individual focus population focus Patient autonomy community well-being Confidentiality surveillance, data sharing Informed consent sometimes overridden for public good Ethical Frameworks in Public Health • Childress et al. (2002) Justificatory Conditions: • Effectiveness: Does the intervention achieve its goals? • Least Infringement: Are there less intrusive options? • Necessity: Is the intervention essential for public health? • Proportionality: Do the benefits outweigh the harms? • Public Justification: Is the rationale transparent and acceptable? COVID-19 •Ethical challenges: •Lockdowns vs. freedom of movement •Vaccine mandates and equity •Contact tracing and privacy •Global disparity in vaccine access Common Ethical Dilemmas •Quarantine and isolation •Health resource allocation (e.g., ICU beds) •Surveillance vs. privacy •Risk communication and transparency •Access to experimental treatments Applying Ethics in Practice •Engage communities •Ensure transparency •Use participatory approaches •Monitor and evaluate ethical impacts •Integrate ethics into policymaking and training References • Childress, J. F., Faden, R. R., Gaare, R. D., Gostin, L. O., Kahn, J., Bonnie, R. J., ... & Nieburg, P. (2002). Public health ethics: Mapping the terrain. The Journal of Law, Medicine & Ethics, 30(2), 170–178. https://doi.org/10.1111/j.1748-720X.2002.tb00384.x • Kass, N. E. (2001). An ethics framework for public health. American Journal of Public Health, 91(11), 1776–1782. https://doi.org/10.2105/AJPH.91.11.1776 • Gostin, L. O., Bayer, R., & Fairchild, A. L. (2003). Ethical and legal challenges posed by severe acute respiratory syndrome: Implications for the control of severe infectious disease threats. JAMA, 290(24), 3229–3237. https://doi.org/10.1001/jama.290.24.3229 • World Health Organization (WHO). (2017). Guidance on ethics of public health surveillance. Geneva: WHO. https://www.who.int/publications/i/item/9789241512657 • Gostin, L. O., & Wiley, L. F. (2020). Public health law: Power, duty, restraint (3rd ed.). University of California Press. • Schröder-Bäck, P., Duncan, P., Sherlaw, W., Brall, C., & Czabanowska, K. (2014). Teaching seven principles for public health ethics: Towards a curriculum for a short course on ethics in public health programmes. BMC Medical Ethics, 15(1), 73. https://doi.org/10.1186/1472-6939-15-73 • Upshur, R. E. G. (2002). Principles for the justification of public health intervention. Canadian Journal of Public Health, 93(2), 101– 103. https://doi.org/10.1007/BF03404547 • World Health Organization (WHO). (2021). Ethics and COVID-19: Resource allocation and priority-setting. https://www.who.int/publications-detail-redirect/WHO-2019-nCoV-Ethics_Resource_allocation-2020.1
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