Course Goals

HSM 775

Bioethics for Public Health Professionals

To sensitize public health professionals to the moral dimensions of professional life and practice

• Life is complex• Ethical issues embedded• Potential for good and bad

consequences• Ethics is branch of philosophy• Concerns of ethics• Professional relationships

To develop in public health students skills of ethical analysis

• Cognitive skills required• Ethics is science of the moral• Concepts, principles, and rules• Problem solving practical• Choices have consequences• Critical thinking key to

discriminating good from bad

To introduce public health professionals to the array of ethical issues that are currently encountered in the practice of public health

• Myriad of issues• Science and technology• Population explosion• Value differences

To foster in public health professionals respect for disagreement and toleration of ambiguity

• Ethics precise and rigorous, however . . .

• Equally virtuous disagree• Grounds must be rational• Toleration critical• Life is ambiguous• Situations were no definitive

behavior ideal

To assist public health professionals in explicating the moral responsibilities incurred in becoming a member of the public health profession

• Cooperative relationship• Professional promise• Good of public and professional• Seeking the good—ethics• Terms of just cooperation

To enable students to attain the competencies of a public health professional

• Decision making in ethics• Professional ethics• Clinical ethics• Organizational ethics• Social ethics

To motivate public health professionals continued learning in ethics

• Authentic education• Positive attitude • Motivation to seek further

opportunities for learning

Disclaimer

• No intent to disavow any ethical tradition

• Pluralistic society• Concepts basic and reasonable• Not knowingly inconsistent with any

religion or culture

Questions?Comments?

Public Health in Context

“The Ends and Means of

Health Care”

What Is Health?

• World Health Organization:– “Health is complete social well

being.”

• Daniel Callahan:– “Health is the individual’s

experience of well-being and integrity of mind and body.”

What are the Means of Achieving the Goal of

Health?

• Economic Resources

• Human Behavior:– Knowledge/Education– Personal Motivation

• Access to “Medicine”

• Public Health

Health Care

• According to Callahan, health care consists of “organized methods [deriving from health policy] to promote the health of the members of a society, ordinarily encompassing the fields of public health and medicine.”

• Furthermore he states: “a society’s health policy will be the organization of those methods into some overall financial and distributional structure designed to pursue the general goals of health care and, ultimately, of health.”

Distinctions/Questions

• Goals of health policy/goals of health care/goals of health?

• Ends of health care determined inductively or normatively?

• Goals of medicine/goals of health care?

• Medicine as a profession?Medicine as a social construct?

• Allocation of resources: what can be made available/what should be made available?

Why Must Reconsidering the Goals of Health Care Be So

Important Now? • New biomedical knowledge and

technological innovation• Heavy economic pressures on

current system(s).• Rise of chronic disease• Aging populations• Medicalization of problems once

considered non-medical• Improved understanding of

behavioral determinants of health• Appreciation of socio-economic

status on health

Hastings Center Project:Goals of Medicine

• The prevention of disease and injury, and the promotion of health (HPDP: “HippyDippy”)

• The relief of pain and suffering• The care and cure of those

with a malady, and the care of those who cannot be cured.

• The avoidance of a premature death and the pursuit of a peaceful death

Priority?

Politics and Policy

Why is it not possible to drive health policy forward toward a consensus?

• Large pluralistic society versus small homogenous one

• The important role of the “market.”• The unabated drive for constant

biomedical progress and technological innovation.

• The increase in health care costs due to combination of market forces and progress which are responded to with managerial and economic techniques, not a reconsideration of goals.

Public Health

• Public health, with medicine, is the other principal ingredient in health care.

• Are the goals of public health different than those of medicine?

Public Health

• Characteristic mark is interest in population, not individual, health

• Focus on overall trends of morbidity and mortality and their causes

• Epidemiology is the key discipline for measuring these trends

• Focus on:– disease and infection surveillance– food and water safety– sanitation– health promotion/disease prevention

• Immunizations, smoking cessation, wellness education, and like such programs can have a greater affect on health care than can the provision of good medical care.

Proximate Goals for

Health Care• Ultimate versus proximate

• Goal setting linked to ethics: ethics of ends and ethics of means

• Three policy directions offered by Callahan:– Goals responsive to the needs of

population sub-groups– Goals that enhance population

health– Goals that facilitate equitable

health care