The European Journal of Public Health Advance Access originally published online on August 23, 2007
The European Journal of Public Health 2007 17(6):542; doi:10.1093/eurpub/ckm087
Editorials |
Public health ethics in Europe—let ethicists enter the public health debate
Els L. M. Maeckelberghe1 and Peter Schröder-Bäck2
1 Health Sciences/Medical Ethics, University Medical Centre Groningen, Ant. Deusinglaan 1, NL - 9713 AV Groningen, The Netherlands
2 Landesinstitut für den Öffentlichen Gesundheitsdienst NRW /, Institute of Public Health NRW, Westerfeldstr. 35/37, D- 33611 Bielefeld, Germany
Correspondence: Dr. Els L.M. Maeckelberghe, Health Sciences/Medical Ethics, University Medical Centre Groningen, Ant. Deusinglaan 1, NL - 9713 AV Groningen, The Netherlands, tel.: +31 (0)50 363 79 85, fax.: +31 (0)50 363 30 59, e-mail: E.L.M.Maeckelberghe{at}med.umcg.nl
Public health and ethics are undeniably bound together. Many people in public health even see the multidisciplinary public health as a moral endeavour: to protect the health of whole populations and to draw special attention to the weaker members of societies.1,2 Some of the challenges of the 21st century are: deciding what justice demands from Public Health programmes, what health inequalities are permissible from a moral point of view, how to conduct morally acceptable research with vulnerable groups, how and when individual rights have to give way to public interest and how to evaluate public health interventions ethically.3,4
In the medical field, ethicists have established a strong foothold in developing bioethics as a firm partner discipline. Bioethics has delivered frameworks for encountering ethical problems in the clinic and in other patient-physician or patient-researchers encounters. It is, however, only recently that trained ethicists have focussed their attention to population health systematically. This late involvement is surprising because public health is characterized by a huge inherent moral tension: to find the balance between the social good (the public's health) and the rights and goods of the individual.
Ethicists should assist public health practitioners and scientists with these moral challenges. They can develop a view on what a public health ethics framework demands from us in Europe.5 How should we deal with a plurality of values? How to appreciate different notions of health? What concept of justice is appropriate in a European context in which health care crosses borders?
Practising ethics is collaborative in nature.6 What is morally relevant and what needs philosophical clarification can only be identified when public health scientists and practitioners alongside with ethicists pool their expertise. In and through this collaboration, these partners express what the moral endeavour of public health is about. Practitioners by sharing the moral understandings of their practices, scientists by identifying the relevance of interventions and policies and philosophers by clarifying concepts, analysing arguments and framing the underlying ethical choices.
Take the example of public health campaigns: what notion of citizenship is being endorsed when individuals are asked to participate in ‘healthy life-style campaigns’? Practitioners enlighten us about how these campaigns work: what are individuals supposed to do, how are they supported, who is the target population, who benefits from these campaigns, etc scientists provide the necessary know-how: e.g. how to be effective and how to measure the efficiency and efficacy of the programme; ethicists ponder about the notion of ‘healthy’ and whether that contributes to an acceptable idea of what is ‘good’ for the public. Together, these partners come to express a view on what the ethical guidelines for a healthy life-style campaign should be.
In order to promote public health ethics in Europe, the European Public Health Association (EUPHA) intends to create a section dedicated to this topic. This section is to be a forum for developing methodological and normative frameworks of public health ethics. The output of this section can inform and counsel European public health scientists and practitioners—and on the other hand give empirical and scientific input to the ethics discourses in philosophical departments. Both discourses will benefit from this interdisciplinary work.
A further task of this section will be to assist the EUPHA and its sections in formulating ethical positions regarding the various issues in public health, within the organization as well as when joining the debate in the public domain.
References
1 Mackenbach J. Kos, Dresden, Utopia ... A Journey through idealism past and present in Public Health. Eur J Epidemiol (2005) 20:817–26.[CrossRef][Web of Science][Medline]
2 Powers M, Faden R. Social justice: the moral foundations of public health and health policy (2006) Oxford: Oxford University Press.
3 Beauchamp D, Steinbock B, (Hrsg). New ethics for the public's health (1999) Oxford: Oxford University Press.
4 Childress JF, Faden RR, Gaare RD, et al. Public health ethics: mapping the terrain. J Law Med Ethics (2002) 30:170–78.
5 Schröder P. Public-Health-Ethik in Abgrenzung zur Medizinethik. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz (2007) 50:103–11.[CrossRef]
6 Verkerk M, Lindemann H, Maeckelberghe E, et al. Enhancing reflection: an interpersonal exercise in ethics education. Hastings Center Report (2004) 34:31–8.[Web of Science][Medline]
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