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Lectures and small group discussions focus on ethical theory and current ethical issues in public health and health policy, including resource allocation, the use of summary measures of health, the right to health care, and conflicts between autonomy and health promotion efforts. Student evaluation based on class participation, a group project, and a paper evaluating ethical issues in the student's area of public health specialization.
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Description
Course Objectives
By the end of this course, students should be able to:- Identify and define moral issues in the context of public health practice.
- Distinguish between a moral issue or argument and other types of issues or arguments.
- Articulate moral arguments for or against public health policies or practices.
By the end of each week (lecture + discussion), students should be familiar with the questions/concepts listed below:
>Â Session 1: FGM and Community Health Education in Niger
- Understand what it means to give moral reasons in discussions of policy/public health.
- Be familiar with the basics of different ethical theories.
- Recognize tensions between:
- Relativism vs. Universalism (essentialism)
- Role obligations vs. Ordinary obligations
- Duties to identified others vs. Duties to statistical others
- Duties to relations vs. Duties to strangers
>Â Session 2: 3x5 Case
- Understand the strengths and weaknesses of various frameworks used in the moral analysis of public health issues.
- Recognize circumstances in which one framework might be more useful than another.
- Can the frameworks be used in conjunction with each other?
- Are any of the frameworks useful for the types of problems you are interested in?
>Â Session 3: MCHIP Case
- Understand the effect of competing conceptions of justice in health policy.
- Understand distinctions between:
- Positive & Negative rights
- Rights to health vs. Rights to health care
- Legal vs. Moral rights
- Understand special moral issues concerning children in health policy.
- Understand the role that empirical data plays in moral analysis of health policy.
>Â Session 4: Obesity
- Understand various arguments concerning the extent to which the state should be able to legislate personal behavior/"the good life."
- Understand the link between policy goals and the moral justification of policies
>Â Session 5: Flu Case
- Be able to discuss ethical considerations in the prioritization of scarce resources.
- Practice analyzing moral challenges in public health while working within a group/committee/team environment.
>Â Session 6: CEA & Summary Measures of Health
- Understand the tensions among different maximizing approaches in distributive justice.
- Understand the values embedded in different maximizing and priority setting methodologies.
- Understand the ethical challenges inherent in the use of summary measures of health for priority setting.
- Be able to discuss merits of different ways to conduct priority setting in the face of disagreement
>Â Session 7: 10/90 Case
- Understand the distinctions between and within these terms:
- Poverty
- Equality
- Equity
- Understand/Review implications of competing theories of justice.
- Understand tensions between demands of global and domestic justice.
>Â Session 8: B/W Infant Mortality Ratio
- Identify what's at stake in targeting disparities
- Inequality vs. Position of worst off
- Understand different considerations in justice for individuals vs. groups.
- Understand implications of the formal principle of equality in ideal societies vs. real societies.
- Understand cost-effectiveness considerations in targeting disparities.
- Understand Public Health as Social Justice.
You will partner with other students in your discussion section to provide an analysis of the influenza vaccine allocation case study handed out during the first class session. Each group will work to identify the ethical issues involved and to recommend and justify a course of action on ethical grounds. Additionally, you will individually provide a 1-2 paragraph critique of the recommendations developed by a group in the alternate discussion section. Detailed instructions will be provided along with the case study. This is a pass/fail assignment, i.e., full credit (10pts) will be awarded to students that pass.
You will be responsible for developing an original case study presenting a moral dilemma that you will subsequently analyze for your final project. Case study development is worth 10 points toward your final grade. Detailed instructions will be provided in a separate handout.
| Session | Topic | Readings |
|---|---|---|
| 1 | Ethics: Theory and Practice | Required: Beauchamp, T. and Walters, L. Contemporary Issues in Bioethics, 6 th Edition. CA: Wadsworth Publishers. 2003. Chapter 1, pp. 1-37. Gostin L. "Public Health Law, Ethics, and Human Rights: Mapping the Issues." In Gostin L. (ed) Public Health Law and Ethics: A Reader. University of California Press. 2002. pp 10-15 (excerpt on public health ethics). Recommended : Macklin, R. Against Relativism. NY: Oxford University Press. 1999. Chapter 1, pp. 1-23. Little, MO. "Why a Feminist Approach to Bioethics?" Kennedy Institute of Ethics Journal. 6(1): 1-18. Christakis, N. "The Distinction Between Ethical Pluralism and Ethical Relativism: Implications for the Conduct of Trans-cultural Research" in Vanderpool, H., Ed. The Ethics of Research Involving Human Subjects. MD: University Publishing Group Inc. 1996. Chapter 11. pp:261-280. |
| 2 | Public Health Ethics | Required: American Public Health Association. Principles for the Ethical Practice of Public Health. New Orleans: Public Health Leadership Society. 2003. Kass, N. "Toward an Ethics of Public Health."American Journal of Public Health. 91(11): 1776-1782. 2001. Childress, J., Faden, R., Gaare, R., Gostin, L., Kahn, J., Bonnie, R., Kass, N., Mastroianni, A., Moreno, J., Nieburg, P. "Public Health Ethics: Mapping the Terrain." Journal of Law, Medicine, and Ethics. 30(2): 170-8. 2002. Norman Daniels and James E. Sabin. "Accountability for Reasonableness", Chapter 4. In: Setting Limits Fairly. New York: Oxford University Press, 2002. Recommended: Faden, R., Kass, N., and Powers, M. "Warrants for Screening Programs: Public Health, Legal and Ethical Frameworks" in Faden, R., Geller, G., and Powers, M., Eds. AIDS, Women and the Next Generation: Towards a Morally Acceptable Public Policy for HIV Testing of Pregnant Women and Newborns. Oxford: Oxford University Press. 1991. Chapter 1: pp: 3-26. Beauchamp, D. "Community: The Neglected Tradition of Public Health. "Hastings Center Report. 15(6):28-36. 1985. Mann, J. "Medicine and Public Health, Ethics, and Human Rights." Hastings Center Report. 27(3)6-13. 1997. O'Neill, O. "Public Health or Clinical Ethics: Thinking Beyond Borders." Ethics and International Affairs. 16(2): 35-45. 2002. |
| 3 | Social Justice and the Right to Health Care | Required: Daniels, Norman. "Justice, Health, and Health Care." In: Medicine and Social Justice. Rosamond Rhodes, Margaret P. Battin, and Anita Silvers, eds. New York: Oxford University Press, pp. 6-24. 2002. Hessler, Kristen. And Allen Buchanan. "Specifying the Content of the Human Right to Health Care." In: Medicine and Social Justice. Rosamond Rhodes, Margaret P. Battin, and Anita Silvers, eds. New York: Oxford University Press, 2002. pp. 84-96. Recommended: Beauchamp, T., and Childress, J. Principles of Biomedical Ethics, 5 th edition. NY: Oxford University Press. 2001. Chapter 6. pp.225-282. Beauchamp, DE. "Public Health as Social Justice." Inquiry 13(1): 3-14. 1976. |
| 4 | Autonomy, Civil Liberties, and Public Health | Required: Bayer R & Moreno J. "Health promotion: ethical and social dilemmas of government policy." Health Aff (Millwood). 1986 Summer;5(2):72-85 Faden RR, Faden AI. "The ethics of health education as a public health policy." Health Educ Monogr. 1978 Summer; 6(2):180‑97. Kersh R. and Morone J. "The Politics of Obesity: Seven Steps to Government Action." Health Affairs. 21(6): 142-153. |
| 5 | Influenza Group Project | Stand on Guard for Thee: Ethical Considerations in Preparedness Planning for Pandemic Influenza. A Report of the University of Toronto Joint Centre for Bioethics Pandemic Influenza Working Group. November 2005. Available:Â http://www.utoronto.ca/jcb/home/documents/pandemic.pdf |
| 6 | The Ethics of Measuring Health | Required: Gold MR, Stevenson D, Fryback DG. "HALYs and QALYs and DALYs, Oh My: Similarities and Differences in Summary Measures of Population Health." Annu Rev Public Health, 23:115-34. 2002. Brock DW. "Ethical Issues in the Use of Cost-Effectiveness Analysis for the Prioritization of Health Resources." In Handbook of Bioethics: Taking Stock of the Field from a Philosophical Perspective, George Khushf (ed). Springer-Verlag Telos (March 2004). Recommended : Murray CJL, Salomon JA, Mathers CD. "A Critical Examination of Summary Measures of Population Health." In Summary Measures of Population Health: Concepts, Ethics, Measurement and Applications. Christopher Murray, Joshua Salomon, Colin Mathers, & Alan Lopez (eds). World Health Organization. 2002. |
| 7 | Poverty, Power, and Health Inequalities (PART I) | Required: Gwatkin DR. "Health inequalities and the health of the poor: what do we know? What can we do?"Â Bull World Health Organ. 2000; 78(1):318. Pogge T. "Responsibilities for poverty-related ill health."Â Ethics Int Aff, 2002; 16(2)71-9. Recommended: Nagel, T. "Equality" in Mortal Questions. Cambridge University Press; Reissue edition (May 2, 1991). Chapter 8, pp 106-128. |
| 8 | Poverty, Power, and Health Inequalities (PART II) | Powers, M. and Faden R. "Racial and Ethnic Disparities in Health Care: An Ethical Analysis of When and How They Matter." In: Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. 2002. IOM Report. Singer P. One World: The Ethics of Globalisation. Chapters 1 & 5. 2002. Recommended: Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Executive Summary. Institute of Medicine. 2002. |
Course content
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- The “3 by 5” Problem 00:55:00
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- State MCHP Policy 00:55:00
- Obesity and “Fat Taxes” 00:55:00
- The Use of Cost-Effectiveness in Priority Setting 00:55:00
- Reducing the Burden of Infant Mortality 00:55:00
Instructor
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