SH3/Lectures/Population health ethics

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• Smoking advertisements
  • Prosmoking ideas: a) these diseases are rare b) rational adults should be able to choose to decide/coercion c) smokers die young, cheaper for economy
• Vaccinations
  • Different between forced treatment for TB vs people have choice in immunisation of children
  • We as a society don't want to override the parent-child bond
  • Can use a less police-like way to get immunity up
• Alcohol and opening hours of pubs
  • Newcastle - opening hours were restricted to close at 1am - reduced violence on the streets
  • Could we roll this out everywhere?

Public health policy possible answers

• “A public health intervention is morally justifiable if it saves lives, no matter how much distress it causes”
• “A public health intervention is morally justifiable if (and only if) there are 2 lives lost per million lives saved.” (Too many deaths is unacceptable but too few suggests that the intervention is too expensive)

These are both a joke - there is no one-size fits all answer

• Gut feelings for right and wrong. Origins of gut feeling:
  • Prejudices
  • Family
  • Experience
  • Thoughtful reflection
  • Influential teachers
  • Role models
  • Money
  • Golden rules e.g. do unto others ...
• Ethics
  • Identify ethical issues in any given situation
  • Consider and question your assumptions
  • Decide upon possible courses of action - with reasons
• Ethics = knowing the right thing to do
• Public health ethics
  • Virtue ethics (Aristotle) - courage, temperance, generosity, magnifience, greatness of soul, even temper, friendliness, truthfulness, wit, justice. Be in the middle, not too extreme.
    • How much 'courage' is virtuous?
    • Does this just reflect social values of the time?
    • "Virtuous" acts can have negative outcomes
  • Deontological ethics (Kant)
    • Act in a way that you want everyone to act always
    • Treat other people as having intrinsic value, not merely as a means to your own end
    • Problems: what about outcomes? What about the community?
  • Utilitarianism
    • Whatever gives the 'best' outcome
    • The greatest happiness for the greatest number
    • Problems: doesn't take into account individual people (autonomy)
• Medical ethics (principles based ethics)
  • Autonomy, justice, beneficence, non-maleficence
  • Doesn't tell you what to do if a particular principles clash
• Medical ethics not as useful for public health ethics (which is targeted at populations. In fact, public health ethics is done with utilitarian theory),
  • But there are problems with utilitarianism
  • Need to consider human rights - protect the interests of the individuals
  • But what if the interests of individuals clash with those of the population
• Liberalism
  • The state should interfere
    • Only when your actions are causing harm to somebody else
    • but The point of the government is to protect individuals...
    • but how do we deal with the people at the bottom???
• Communitarian ethics
  • Create a good society; environmental considerations
  • But - who decides?

Public health ethics principles

Like the medical ethics principles, but for public health

• Maximise health/wellbeing
• Just distribution of health/wellbeing
• Transparent process
• Least restrictive means
• Truthfulness
• Reciprocity
• Privacy

Nuffield intervention ladder

Is the UK's solution to public health ethics

What is the right thing to do?

• Fid out what is going on
• Consider your gut feelings
• Listen to others
• Think about theories and principles
• Find out what has been done before
• Look at professional guidelines
• Consider the law

Think about all of these ideas and whether or not they are right