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please look at the slides read the case study and create a script on slide “Our perspective” that i can present during my presenataion. case study is chapter 7 case study #4 so you have an idea what the subject is about
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Public Health Ethics Analysis 3
Series Editor: Michael J. Selgelid
Drue H. Barrett · Leonard W. Ortmann
Angus Dawson · Carla Saenz
Andreas Reis · Gail Bolan Editors
Public Health
Ethics: Cases
Spanning the Globe
Public Health Ethics Analysis
Volume 3
Edited by
Michael J. Selgelid
Monash University, Melbourne, Australia
During the 21st Century, public health ethics has become one of the fastest growing
subdisciplines of bioethics. This is the first book series dedicated to the topic of
public health ethics. It aims to fill a gap in the existing literature by providing
thoroughgoing, book-length treatment of the most important topics in public health
ethics—which have otherwise, for the most part, only been partially and/or
sporadically addressed in journal articles, book chapters, or sections of volumes
concerned with public health ethics. Books in the series will include coverage of
central topics in public health ethics from a plurality of disciplinary perspectives
including: philosophy (e.g., both ethics and philosophy of science), political science,
history, economics, sociology, anthropology, demographics, law, human rights,
epidemiology, and other public health sciences. Blending analytically rigorous and
empirically informed analyses, the series will address ethical issues associated with
the concepts, goals, and methods of public health; individual (e.g., ordinary citizens’
and public health workers’) decision making and behaviour; and public policy. Inter
alia, volumes in the series will be dedicated to topics including: health promotion;
disease prevention; paternalism and coercive measures; infectious disease; chronic
disease; obesity; smoking and tobacco control; genetics; the environment; public
communication/trust; social determinants of health; human rights; and justice. A
primary priority is to produce volumes on hitherto neglected topics such as ethical
issues associated with public health research and surveillance; vaccination;
tuberculosis; malaria; diarrheal disease; lower respiratory infections; drug resistance;
chronic disease in developing countries; emergencies/disasters (including
bioterrorism); and public health implications of climate change.
More information about this series at http://www.springer.com/series/10067
Drue H. Barrett • Leonard W. Ortmann
Angus Dawson • Carla Saenz • Andreas Reis
Gail Bolan
Editors
Public Health Ethics:
Cases Spanning the Globe
Editors
Drue H. Barrett
Office of Scientific Integrity, Office of the
Associate Director for Science, Office of
the Director
Centers for Disease Control and Prevention
Atlanta, GA, USA
Angus Dawson
Center for Values, Ethics and the Law in
Medicine, Sydney School of Public Health
The University of Sydney
Sydney, Australia
Andreas Reis
Global Health Ethics
Department of Information, Evidence
and Research
World Health Organization
Geneva, Switzerland
Leonard W. Ortmann
Office of Scientific Integrity, Office of the
Associate Director for Science, Office of
the Director
Centers for Disease Control and Prevention
Atlanta, GA, USA
Carla Saenz
Regional Program on Bioethics
Office of Knowledge Management,
Bioethics, and Research
Pan American Health Organization
Washington, DC, USA
Gail Bolan
Division of STD Prevention
National Center for HIV/AIDS, Viral
Hepatitis, STD and TB Prevention
Centers for Disease Control and Prevention
Atlanta, GA, USA
ISSN 2211-6680
ISSN 2211-6699 (electronic)
Public Health Ethics Analysis
ISBN 978-3-319-23846-3
ISBN 978-3-319-23847-0 (eBook)
DOI 10.1007/978-3-319-23847-0
Library of Congress Control Number: 2015960197
© The Editor(s) (if applicable) and The Author(s) 2016. This book is published open access.
Open Access This book is distributed under the terms of the Creative Commons AttributionNoncommercial 2.5 License (http://creativecommons.org/licenses/by-nc/2.5/) which permits any
noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and
source are credited.
The images or other third party material in this chapter are included in the work’s Creative Commons
license, unless indicated otherwise in the credit line; if such material is not included in the work’s
Creative Commons license and the respective action is not permitted by statutory regulation, users will
need to obtain permission from the license holder to duplicate, adapt or reproduce the material.
This work is subject to copyright. All commercial rights are reserved by the Publisher, whether the whole
or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations,
recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or
information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made.
Printed on acid-free paper
This Springer imprint is published by Springer Nature
The registered company is Springer International Publishing AG Switzerland
Disclaimer
The contents of this casebook represent the opinions, findings, and conclusions of
the authors and do not necessarily reflect the official position, views, or policies of
the editors, the editors’ host institutions, or the authors’ host institutions.
v
Preface
Public health ethics can be seen both as the application of principles and norms to
guide the practice of public health and as a process for identifying, analyzing, and
resolving ethical issues inherent in the practice of public health. Public health ethics
helps us decide what we should do and why. Although the practice of public health
has always considered ethical issues, the emergence of public health ethics as a
discipline is relatively new. Although rooted in bioethics and clinical and research
ethics, public health ethics has many characteristics that set it apart. The defining
characteristics are its focus on achieving social goods for populations while respecting individual rights and recognizing the interdependence of people.
Currently there are few practical training resources for public health practitioners that consider ethical issues and dilemmas likely to arise in the practice of public health. In public health ethics training, we have found it advantageous to use
cases to illustrate how ethical principles can be applied in practical ways to decision
making. The use of cases encourages reflection and discussion of ethics, reinforces
basic ethical concepts through application to concrete examples, highlights practical decision making, allows learners to consider different perspectives, and sensitizes learners to the complex, multidimensional context of issues in public health
practice. The case-based approach (known as casuistry) contrasts with the theoretical approach to considering moral principles, rules, and theories. By describing
scenarios, cases allow the learner to use ethical principles in the context of a realistic situation that sheds light on ethical challenges and illustrates how ethical principles can help in making practical decisions.
This casebook comprises a broad range of cases from around the globe to highlight the ethical challenges of public health. For those new to public health ethics,
Section I introduces public health ethics. Chapter 1, “Public Health Ethics: Global
Cases, Practice, and Context” by Ortmann and colleagues, summarizes basic
concepts and describes how public health ethics differ from bioethics, clinical
ethics, and research ethics. The chapter also includes an approach for conducting an
ethical analysis in public health. In Chap. 2, “Essential Cases in the Development of
Public Health Ethics,” Lee, Spector-Bagdady, and Sakhuja highlight important
vii
viii
Preface
events that shaped the practice of public health and explain how practitioners
address and prevent ethical challenges.
Section II is organized into chapters that discuss the following public health
topics:
•
•
•
•
•
•
•
Resource allocation and priority setting
Disease prevention and control
Chronic disease prevention and health promotion
Environmental and occupational public health
Vulnerability and marginalized populations
International collaboration for global public health
Public health research
We have invited some of the leading writers and thinkers in public health ethics
to provide an overview of the major ethical considerations associated with each
topic. The topic overviews offer the authors’ perspectives about applicable ethical
theories, frameworks, and tools and draw attention to the cases that follow. The
cases are meant to highlight the ethical issues in practice. Each represents the work
of authors from around the globe who responded to a solicitation from the U.S.
Centers for Disease Control and Prevention. We worked with the authors to ensure
that each case included a concise articulation of a public health situation that raises
ethical tensions, challenges, or concerns that require decisions or recommendations
from public health officials or practitioners. The cases are presented in a standard
format that includes a background, case description, discussion questions, and references. However, we also allowed for variation in the amount of detail provided in
each section and the approach used to set up the case. Our goal was to include just
enough contextual information to orient the reader who is not an expert in the case
topic. We include the case setting, population, or intervention in question, legal or
regulatory landscape, and questions to stimulate discussion on core ethical issues.
Each case—although fictionalized—is as realistic as possible to reflect the ethical
challenges that public health practitioners face daily. Sometimes the cases were
based on actual or composite events. In these instances, the case details were modified to exclude identifying information that could be considered private, sensitive,
or disputable by others involved in the case.
We deliberately did not attempt to provide a resolution or solution for the cases.
Often in public health practice, there is no single correct answer. Instead, ethical
analysis in public health is a process to identify the ethical dimensions of the options
available and to arrive at a decision that is ethically justifiable, through deliberation
and consideration of relevant facts, values, and contexts.
The cases and other writings in this book represent the opinions, findings, and
conclusions of the authors and do not necessarily reflect the official position, views,
or policies of the editors, the editors’ host institutions, or the authors’ host institutions. We decided which topic category to place the case in to best distribute the
cases across chapters. However, you may note that some cases cross topic areas and
could just as easily have been included in another chapter.
Preface
ix
This casebook is written for public health practitioners, including frontline workers, field epidemiology trainers and trainees, and managers, planners, and decision
makers with an interest in learning about how to integrate ethical analysis in their
day-to-day public health practice. However, the casebook will also be useful to
instructors in schools of public health and public health students as well as to academic ethicists who can use the book to teach public health ethics and distinguish it
from clinical and research ethics.
Our hope is that the casebook will increase awareness and understanding of public health ethics and the value of ethical analysis in public health practice in all of its
forms. This includes applied public health research; public health policy development, implementation, and evaluation; and public health decision making in national
and international field settings and training programs. By emphasizing prospective
practical decision making, rather than just presenting a theoretical academic discussion of ethical principles, we hope this casebook will serve as a useful tool to support instruction, debate, and dialogue about the nature of ethical challenges
encountered in public health practice and how to resolve these challenges. We recommend discussing the cases in small groups and using the discussion questions,
the ethical framework described in Chap. 1, and the information provided in the
topic area overview sections as a starting place for exploring the ethical issues
reflected in the cases. The ultimate goal of case-based learning is to develop skills
in ethical analysis and decision making in daily public health practice. The ethical
framework provides a convenient tool for putting our ideas into practice.
Atlanta, GA, USA
Atlanta, GA, USA
Sydney, Australia
Washington, DC, USA
Geneva, Switzerland
Atlanta, GA, USA
Drue H. Barrett, PhD
Leonard W. Ortmann, PhD
Angus Dawson, PhD
Carla Saenz, PhD
Andreas Reis, MD
Gail Bolan, MD
Contents
Section I
Introduction to Public Health Ethics
1 Public Health Ethics: Global Cases, Practice, and Context ………………
Leonard W. Ortmann, Drue H. Barrett, Carla Saenz,
Ruth Gaare Bernheim, Angus Dawson, Jo A. Valentine,
and Andreas Reis
1.1
Introduction …………………………………………………………………………
1.2
Public Health ……………………………………………………………………….
1.3
Ethics………………………………………………………………………………….
1.4
Public Health Ethics ……………………………………………………………..
1.5
Ethical Frameworks ……………………………………………………………..
1.6
A Three-Step Approach to Public Health Decision Making ……….
References ………………………………………………………………………………………
2 Essential Cases in the Development of Public Health Ethics …………….
Lisa M. Lee, Kayte Spector-Bagdady, and Maneesha Sakhuja
2.1
Introduction …………………………………………………………………………
2.2
Case Study: Jacobson v. Massachusetts …………………………………..
2.3
Case Study: U.S. Public Health Service Research on Sexually
Transmitted Disease: Alabama and Guatemala…………………………
2.4
Case Study: The New York City A1C Registry…………………………..
2.5
Conclusions and Implications ………………………………………………..
References ………………………………………………………………………………………
3
3
5
9
19
27
28
33
37
37
39
44
50
54
55
Section II Topics in Public Health Ethics
3 Resource Allocation and Priority Setting…………………………………………
Norman Daniels
3.1
Resource Allocation in Public Health ……………………………………..
3.2
Collective Lessons from the Cases …………………………………………
3.3
Specific Ethical Issues in Resource Allocation …………………………
61
61
62
65
xi
xii
Contents
3.4
Decision-Making Process ……………………………………………………..
References ………………………………………………………………………………………
3.5
Case 1: Priority Setting and Crisis of Public
Hospitals in Colombia…………………………………………………………..
References ………………………………………………………………………………………
3.6
Case 2: Intersection of Public Health and Mental
Health: Meeting Family Needs ………………………………………………
References ………………………………………………………………………………………
3.7
Case 3: Public-Private Partnerships: Role of Corporate
Sponsorship in Public Health …………………………………………………
References ………………………………………………………………………………………
3.8
Case 4: Black-White Infant Mortality: Disparities,
Priorities, and Social Justice ………………………………………………….
References ………………………………………………………………………………………
3.9
Case 5: Priority Setting in Health Care: Ethical Issues………………
References ………………………………………………………………………………………
3.10 Case 6: Critical Care Triage in Pandemics……………………………….
References ………………………………………………………………………………………
69
70
4 Disease Prevention and Control ………………………………………………………
Michael J. Selgelid
4.1
Introduction …………………………………………………………………………
4.2
Mandatory Treatment and Vaccination ……………………………………
4.3
Disease Screening and Surveillance ……………………………………….
4.4
Stigma ………………………………………………………………………………..
4.5
Access to Care……………………………………………………………………..
4.6
Health Promotion Incentives ………………………………………………….
4.7
Emergency Response ……………………………………………………………
4.8
Conclusion ………………………………………………………………………….
References ………………………………………………………………………………………
4.9
Case 1: Mandatory Vaccination in Measles Outbreaks ………………
References ………………………………………………………………………………………
4.10 Case 2: Public Health Approaches to Preventing
Mother-to-Child HIV Transmission ………………………………………..
References ………………………………………………………………………………………
4.11 Case 3: Newborn Bloodspot Screening: Personal Choice
or Public Health Necessity? Storage and Ownership
of Newborn Bloodspots…………………………………………………………
References ………………………………………………………………………………………
4.12 Case 4: Decoding Public Health Ethics and Inequity
in India: A Conditional Cash Incentive
Scheme—Janani Suraksha Yojana ………………………………………….
References ………………………………………………………………………………………
4.13 Case 5: HIV Criminalization and STD
Prevention and Control …………………………………………………………
References ………………………………………………………………………………………
95
71
74
74
79
80
83
84
86
87
89
90
93
95
95
97
98
99
100
101
102
103
103
107
108
111
111
114
116
119
120
124
Contents
xiii
4.14 Case 6: Ethics of Administering Anthrax Vaccine to Children ……
References ………………………………………………………………………………………
4.15 Case 7: Non-adherence to Treatment in Patients
with Tuberculosis: A Challenge for Minimalist Ethics ………………
References ………………………………………………………………………………………
4.16 Case 8: Mass Evacuation ………………………………………………………
References ………………………………………………………………………………………
125
128
5 Chronic Disease Prevention and Health Promotion …………………………
Harald Schmidt
5.1
Introduction …………………………………………………………………………
5.2
Individuals …………………………………………………………………………..
5.3
Formal and Informal Health Workers ……………………………………..
5.4
Governments (At Different Levels) ………………………………………..
5.5
Corporate Entities ………………………………………………………………..
5.6
Case Studies ………………………………………………………………………..
References ………………………………………………………………………………………
5.7
Case 1: Municipal Action on Food and Beverage
Marketing to Youth ……………………………………………………………….
References ………………………………………………………………………………………
5.8
Case 2: Obesity Prevention in Children: Media
Campaigns, Stigma, and Ethics………………………………………………
References ………………………………………………………………………………………
5.9
Case 3: Obesity Stigma in Vulnerable
and Marginalized Groups ………………………………………………………
References ………………………………………………………………………………………
5.10 Case 4: Water Fluoridation: The Example of Greece ………………..
References ………………………………………………………………………………………
5.11 Case 5: The Prohibition of Smoking in Public
Places in Bulgaria…………………………………………………………………
References ………………………………………………………………………………………
137
6 Environmental and Occupational Public Health ……………………………..
Bruce Jennings
6.1
Environment and Workplace: Key Venues for Public Health ……..
6.2
Population Benefits, Individual Rights, and Ethically
Acceptable Risk …………………………………………………………………..
6.3
Systems and Power: The Ethical Importance
of Ecological and Social Context ……………………………………………
References ………………………………………………………………………………………
6.4
Case 1: Assessing Mining’s Impact on Health
Equity in Mongolia ………………………………………………………………
References ………………………………………………………………………………………
6.5
Case 2: Exceptions to National MRSA Prevention Policy
for a Medical Resident with Untreatable MRSA Colonization …..
References ………………………………………………………………………………………
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132
132
135
137
140
141
144
147
149
151
153
157
158
161
162
166
167
170
172
175
177
177
180
183
185
186
190
191
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xiv
Contents
6.6
Case 3: Safe Water Standards and Monitoring
of a Well Construction Program ……………………………………………..
References ………………………………………………………………………………………
6.7
Case 4: Implementation of Global Public Health Programs
and Threats to Personal Safety ……………………………………………….
References ………………………………………………………………………………………
195
198
199
201
7 Vulnerability and Marginalized Populations……………………………………
Anthony Wrigley and Angus Dawson
7.1
Introduction …………………………………………………………………………
7.2
Different Approaches to the Concept of Vulnerability ……………….
7.3
Concerns Surrounding Approach (V2): Universal Condition ……..
7.4
Concerns Surrounding Approach (V3): Specific Attributes,
Contexts, or Groups ……………………………………………………………..
7.5
Concerns Surrounding Approach (V4):
Overarching Concepts …………………………………………………………..
7.6
Simplifying the Concept of Vulnerability (V5):
The Moral-Marker Approach …………………………………………………
References ………………………………………………………………………………………
7.7
Case 1: Reducing Sudden Infant Death Syndrome
in a Culturally Diverse Society: The New Zealand Cot
Death Study and National Cot Death Prevention Programme …….
References ………………………………………………………………………………………
7.8
Case 2: Medical Tourism and Surrogate Pregnancy:
A Case of Ethical Incoherence ……………………………………………….
References ………………………………………………………………………………………
7.9
Case 3: Compulsory Treatment for Injection Drug Use
after Incarceration ………………………………………………………………..
References ………………………………………………………………………………………
7.10 Case 4: Unanticipated Vulnerability: Marginalizing
the Least Visible in Pandemic Planning …………………………………..
References ………………………………………………………………………………………
7.11 Case 5: Can Asylum Seeking Be Managed Ethically? ………………
References ………………………………………………………………………………………
7.12 Case 6: Tuberculosis Screening, Testing, and Treatment
among Asylum Seekers …………………………………………………………
References ………………………………………………………………………………………
203
8 International Collaboration for Global Public Health ……………………..
Eric M. Meslin and Ibrahim Garba
8.1
Introduction …………………………………………………………………………
8.2
The Rise of Globalization and Global Health …………………………..
8.3
Ethics Frameworks for Global Health……………………………………..
8.4
Summary …………………………………………………………………………….
References ………………………………………………………………………………………
8.5
Case 1: The Ethics of HIV Testing Policies ……………………………..
References ………………………………………………………………………………………
241
203
204
205
206
207
208
210
211
215
216
220
220
224
226
229
230
233
235
239
241
242
246
253
253
256
259
Contents
Case 2: Just Allocation of Pre-exposure Prophylaxis
Drugs in Sub-Saharan Africa …………………………………………………
References ………………………………………………………………………………………
8.7
Case 3: Drug Trials in Developing Countries …………………………..
References ………………………………………………………………………………………
8.8
Case 4: Ethical Issues in Responding to International
Medication Stock-Outs …………………………………………………………
References ………………………………………………………………………………………
8.9
Case 5: Transmitting Cholera to Haiti……………………………………..
References ………………………………………………………………………………………
8.10 Case 6: Perilous Path to Middle East Peace:
The Sanctions Dilemma ………………………………………………………..
References ………………………………………………………………………………………
8.11 Case 7: Advancing Informed Consent and Ethical Standards
in Multinational Health Research …………………………………………..
References ………………………………………………………………………………………
xv
8.6
9 Public Health Research ………………………………………………………………….
Drue H. Barrett, Leonard W. Ortmann, Natalie Brown,
Barbara R. DeCausey, Carla Saenz, and Angus Dawson
9.1
Introduction …………………………………………………………………………
9.2
What Is Different About Public Health Research? ……………………
9.3
Ethical Considerations for Protecting the Public
during Health Research …………………………………………………………
9.4
How Ethical Challenges Can Arise in Public Health
Research: Lessons Learned from Cases …………………………………..
9.5
Conclusions …………………………………………………………………………
References ………………………………………………………………………………………
9.6
Case 1: To Reveal or Not to Reveal Potentially
Harmful Findings: A Dilemma for Public Health Research ……….
References ………………………………………………………………………………………
9.7
Case 2: Ethical Challenges in Impoverished Communities:
Seeking Informed Consent in a Palestinian Refugee
Camp in Lebanon …………………………………………………………………
References ………………………………………………………………………………………
9.8
Case 3: Improving Review Quality and Efficiency
of Research Ethics Committees to Enhance Public
Health Practice in Africa ……………………………………………………….
References ………………………………………………………………………………………
9.9
Case 4: Internet-Based HIV/AIDS Education
and Prevention Programs in Vulnerable Populations:
Black Men Who Have Sex with Men………………………………………
References ………………………………………………………………………………………
260
262
263
265
266
269
270
274
274
278
279
283
285
285
287
289
296
297
298
300
303
305
309
310
313
314
317
Index ………………………………………………………………………………………………….. 319
Contributors
Rima Afifi, PhD, MPH Department of Health Promotion and Community Health,
Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
Waleed Al-Faisal, PhD Department of Family and Community Medicine, Faculty
of Medicine, Damascus University, Damascus, Syrian Arab Republic
Primary Health Care, Dubai Health Authority, Dubai, United Arab Emirates
Silviya Aleksandrova-Yankulovska, MD, PhD, DSc Faculty of Public Health,
Department of Public Health Sciences, Medical University of Pleven, Pleven,
Bulgaria
Aikaterini A. Aspradaki, PhD, MA, DDS Joint Graduate Programme in Bioethics,
University of Crete, Crete, Greece
Drue H. Barrett, PhD Office of Scientific Integrity, Office of the Associate
Director for Science, Office of the Director, Centers for Disease Control and
Prevention, Atlanta, GA, USA
Michael T. Bartenfeld, MA Children’s Preparedness Unit, Disability and Health
Branch, Division of Human Development and Disability, National Center on Birth
Defects and Developmental Disabilities, Centers for Disease Control and Prevention,
Atlanta, GA, USA
Carrie Bernard, MD MPH CCFP FCFP Department of Family and Community
Medicine, University of Toronto, Toronto, ON, Canada
Department of Family Medicine McMaster University, Hamilton, ON, Canada
Ruth Gaare Bernheim, JD, MPH Department of Public Health Sciences,
University of Virginia, Charlottesville, VA, USA
Divya Kanwar Bhati, BSc, MSc, MBA World Health Organization Collaborating
Centre for District Health System Based on Primary Health Care, Indian Institute of
Health Management Research University, Jaipur, Rajasthan, India
xvii
xviii
Contributors
Dhrubajyoti Bhattacharya, JD, MPH, LLM Department of Population Health
Sciences, School of Nursing and Health Professions, University of San Francisco,
San Francisco, CA, USA
Erika Blacksher, PhD Department of Bioethics and Humanities, University of
Washing
