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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