The Role of Ethics in Public Health Policy

In 1985, Ryan White, a young teenager who had contracted HIV through a blood transfusion, was barred from attending middle school in his hometown of Kokomo, Indiana.

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At that time, relatively little was known about HIV and AIDS; speculation and fear were common. Believing that Ryan’s presence posed a health risk to other children, parents and teachers pressured the principal and school board to keep him out of school. A lengthy legal battle ensued. The Indiana State Health Commissioner and the Centers for Disease Control assured the community that HIV could not be transmitted through casual contact. Yet, even after Ryan was readmitted to school, he was required to eat with disposable utensils and use a separate bathroom. Ryan and his family were ostracized and continued to receive death threats until they moved away. At his new school in Cicero, Indiana, Ryan received a much warmer welcome from staff and students who had been educated about HIV/AIDS prior to his arrival.

Rising through these tremendous difficulties, Ryan White and his family became highly regarded advocates, bringing national attention to the need for public health education and lessening the stigma associated with HIV and AIDS. After Ryan’s death in 1990, congress enacted The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, which has been reauthorized several times. The legislation created the largest federally funded program solely for people affected by HIV/AIDS; over the years, adjustments have been made to keep pace with evolving priorities, although the program retains its focus on promoting access to care for those who may not be able to afford it.

Ryan White’s story illustrates many of the ethical dilemmas that surround public health policy. For instance:

How should public health leaders adhere to the principle of “do no harm” when a health syndrome is not well understood by the public, or even by many health care professionals?
When, if ever, is it permissible to “hurt the few” (in this case, by denying individual rights and dignity) to “save the many”?
Is health care a right or a privilege? Should legislation be enacted to provide care to those who cannot afford it?
When, if ever, is it acceptable to devote government funds to address one issue (e.g., HIV/AIDS-related research, treatment, and education) as opposed to other issues that would also benefit from funding?

Today, new ethical dilemmas related to the global health epidemic of HIV/AIDS, as well as other public health issues, continue to emerge. Those who wish to shape public health policy must be able to learn from the past, examine the context surrounding an issue, and anticipate potential questions and ethical concerns.

This week, you examine the role of ethics in public health policy. In the Discussion, you assess potential ethical issues related to a specific public health issue. Also this week, you begin working on the final component of your Scholar-Practitioner Project: the Advocacy Pitch.

Analyze potential ethical dilemmas in public health issues

Apply ethical theories, morals, and principles to public health issues and interventions

Create advocacy pitches for public health issues

Learning Objectives

Students will:

Analyze potential ethical dilemmas in public health issues
Apply ethical theories, morals, and principles to public health issues and interventions
Create advocacy pitches for public health issues

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

REQUIRED READINGS

Bhattacharya, D. (2013). Public health policy: Issues, theories, and advocacy. San Francisco, CA: Jossey-Bass.

Chapter 5, “The Role of Ethics: Historical, Contemporary, and Future Perspectives” (pp.141–178)

Borza, C., Rahotă, D., Mihalache, G., Buhaş, C., & Cârjan, F. (2013). The ethical qualities of a leader in public health and preventive medicine. Romanian Journal of Functional & Clinical, Macro- & Microscopical Anatomy & of Anthropology/Revista Româna de Anatomie Functionala si Clinica, Macro si Microscopica si de Antropologie, 12(2), 154–156.
Note: Retrieved from the Walden Library databases.

Damnariu, C. D. (2012). General principles of ethics in public health. Acta Medica Transilvanica, 17(1), 145–146.
Note: Retrieved from the Walden Library databases.

Lane, C. H., & Carter, M. I. (2012). The role of evidence-based media advocacy in the promotion of tobacco control policies. Salud Pública de México , 54(3), 281–288.
Note: Retrieved from the Walden Library databases.

Lee, L. M. (2012). Public health ethics theory: Review and path to convergence. Journal of Law, Medicine, & Ethics, 40(1), 85–98.
Note: Retrieved from the Walden Library databases.

Pierce, M. W., Maman, S., Groves, A. K., King, E. J., & Wyckoff, S. C. (2011). Testing public health ethics: Why the CDC’s HIV screening recommendations may violate the least infringement principle. Journal of Law, Medicine & Ethics, 39(2), 263–271.
Note: Retrieved from the Walden Library databases.

Document: Advocacy Pitches: A Primer (PDF)
Review this document along with the documents within the Kaltura Media Uploader page on the course navigation menu in order to prepare for your Advocacy Pitch assignment due in Week 10

Discussion: Ethical Dilemmas in Public Health Policy

The Tuskegee Syphilis Study stands as a cautionary tale of the harm that can result from unethical practices or negligence in public health.

In 1932, the U.S. Public Health Service, in collaboration with the Tuskegee Institute, initiated a study of syphilis, which was a major health problem at the time. The study involved hundreds of poor, African-American sharecroppers, many of whom unknowingly had syphilis. In 1972, a multidisciplinary advisory panel reviewed the study; they halted the research after concluding that researchers failed to receive informed consent and did not give study participants proper treatment, even after penicillin became widely accepted as an effective medication for the illness. The panel called the study “ethically unjustified” because of the risks to its subjects.

In the years since the study ended, the federal government and Tuskegee University have tried to repair the tremendous damage that occurred—damage measured by the loss of many lives (of study participants, as well as their wives and children who contracted syphilis) and the ensuing mistrust of government-led programs. The legacy of this study has caused many people to question when, if ever, it is acceptable to “do bad for the good of many” and sparked discussion about what can be done to promote ethical decision-making in public health.

In this Discussion, you examine ethics as a guidepost for all public health decisions and analyze ethical implications for the public health issue and intervention you have selected for your Scholar-Practitioner Project.

To prepare for this Discussion, review Chapter 5 in the course text. Then, reflect on your public health issue and recommended intervention. What role might ethics play in regard to your issue and intervention? What ethical dilemmas may arise? How might you address such dilemmas?

BY DAY 4

Post ethical dilemmas that may arise as you approach your public health issue and recommended intervention and why. Then, explain how you might address these dilemmas by applying ethical theories, morals, and principles. Support your post with the Learning Resources and peer-reviewed sources.