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EMPHNET Public Health Ethics (PHE): Introduction to public health ethics (phe)

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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 EthicsEMPHNETGhaiath M. A. HusseinMBBS, MHSc. (Bioethics), PhD ResearcherEmail: [email protected] Palace Hotel, Amman, Jordan15-19 June, 2014

2. Course objectives To consider critically a range of conceptualand ethical issues that we face in public healthcare provision. To provide an opportunity to reflect criticallyon, challenge, develop and refine our ethicalpositions on particular issues. To analyze these issues using ethicalframeworks, and to assess the value of suchframeworks. 3. Course Outline Module 1: introduction to public health ethics (PHE) Module 2: ethical principles, theories and the core professionalpublic health values Module 3: ethical issues in surveillance, screening and outbreakinvestigation Module 4: ethical issues in health promotion Module 5: ethical issues in vaccination Module 6: ethical issues in public health emergencies anddisasters 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 others experiences,perspectives, arguments, etc.Ethics learning is best done independently:readings, reflections, arguments4 5. Before we start lets agree All participate tous participe Dont 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 (butdont touch the breaks please :) Priority is given to discussion than to finish the daysquota!!5 6. MODULE ONE: INTRODUCTION TOPUBLIC HEALTH ETHICS (PHE) 7. Outline for todays session The roles of the healthcare practitioner The technical and ethical differences betweenclinical care and public health practice The definition and taxonomy of ethics (ethicalissue, ethics, bioethics, clinical ethics,research ethics and public health ethics) The importance of ethics in PH practice andresearch 8. The roles of the healthcarepractitioner 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 healthMain aim Treat sick individuals (cure) Prevent healthy individuals from getting ill(prevention)Beneficiaries Individuals (healthy or sick) andfamiliesPopulation (community)Scope Clinical care, diagnosis, and treatment Health education, health promotion, andcommunity-based interventionsFields(specialties)Internal medicine, surgery, paediatrics,obstetrics and gynecology, etc.Epidemiology, health promotion, biostatisticsOccupational health, etc.Guidance Clinical guidelines, hospital policies,etc.PH guidelines, regulations, lawsExamples ofethical issuesandquestionsIssues related to the individuals rightto decide (autonomy), privacy andconfidentiality, etc.- When is it ethical to disclose apatients medical information?- How to decide which patientshould have which service (e.g. anICU bed)?Issues related to the tension between theindividual rights (interests) and the public good(interests)- When is it ethical to limit the freedom ofmovement of a patient with an infectiousdisease (e.g. in case of pandemic)?- Do parents have the right to refusevaccinating 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 dont tell the patient its a trial I need the money of this Pharmaceutical company. Shall I changethe results of my research on their drug? Ethics is about making choicesUsually hard ones ! 14. What do you think? 15. Ethical/Moral reasoning It is the process we need to go through to reacha decision about an ethical issue. It helps us to differentiate: Values and ethical principles Facts: description of the way the world is; anactual state of affairs (is) Values: judgment about the way things shouldbe (ought). Ethical principles: they are meant to guideactions. Key values in bioethics havecorresponding (e.g., principle of respect forautonomy) 16. What is ethics? A system of moral principles or standardsgoverning conduct. a system of principles by which human actionsand proposals may be judged good or bad, rightor wrong; A set of rules or a standard governing theconduct of a particular class of human action orprofession; Any set of moral principles or values recognizedby 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 goodand bad, right and wrong, that people actuallydo and should follow in a society, while ethicsis defined as the systematic study of morality. Metaethics: tries to clarify the rationalstandards and methods for the study of ethics Normative ethics: develops ethical principles,rules, and ideals that spell out standards ofgood and bad, right and wrong. It can bedivided into: moral theory and applied ethics. 18. Bioethics Bioethics: is normative ethics applied todecision-making and public policy in thedomains of biology, health care and research. It aims at the identification, analysis, andresolution of the ethical issues in almost anyfield 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 resolutionof ethical problems arising in public healthpractice and research 20. Case: TB patient to JAIL In Countristan, treatment of all TB patients is free. Patientsare expected to show to the nearest health center (HC) toreceive 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 ofthe TB patient, Mr. Contagious did not receive his doses forthe last couple of weeks. The Officer approached Mr. Contagious to persuade him totake the doses on time. The patient refused. The Officer presented an official requestto 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 forthe whole duration of the TB treatment.What are the ethical issues at stake here? 21. Whats ethically unique aboutpublic health? Public vs. individuals rights Scarcity of resources Socio-political factors: Poverty, illiteracy , minorities, vulnerability Abuse of power (Nanny State & publicengagement) Socio-cultural factors: Local beliefs vs. international guidelines Role of families and community leaders Urgency to contain public health threats Inequalities (national and international) 22. Key messages andconclusions Public health has the potential to producepublic good, but also wide-scale harms Public health ethics helps us to maximize thebenefits and minimize the harms Public health ethics helps us maintain themost important aspect of our field publictrust 23. Questions & DiscussionFeel free to contact:Ghaiath HusseinDoctoral researcher, Universityof Birmingham, UKEmail:[email protected] 24. References & Readings Frank JR. The CanMEDS 2005 physician competency framework:Better standards, better physicians, better care. Royal College ofPhysicians and Surgeons of Canada; 2005 Principles of the Ethical Practice of Public Health; Public HealthLeadership 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: mappingthe 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, BMJ2000;321:1300-1301

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