Section I Introduction to Public Health Ethics
1 Public Health Ethics: Global Cases, Practice, and Context ... 3
Leonard W. Ortmann , Drue H. Barrett , Carla Saenz , Ruth Gaare Bernheim , Angus Dawson , Jo A. Valentine , and Andreas Reis 1.1 Introduction ... 3
1.2 Public Health ... 5
1.3 Ethics ... 9
1.4 Public Health Ethics ... 19
1.5 Ethical Frameworks ... 27
1.6 A Three-Step Approach to Public Health Decision Making ... 28
References ... 33
2 Essential Cases in the Development of Public Health Ethics ... 37
Lisa M. Lee , Kayte Spector-Bagdady , and Maneesha Sakhuja 2.1 Introduction ... 37
2.2 Case Study: Jacobson v. Massachusetts ... 39
2.3 Case Study: U.S. Public Health Service Research on Sexually Transmitted Disease: Alabama and Guatemala ... 44
2.4 Case Study: The New York City A1C Registry ... 50
2.5 Conclusions and Implications ... 54
References ... 55
Section II Topics in Public Health Ethics 3 Resource Allocation and Priority Setting ... 61
Norman Daniels 3.1 Resource Allocation in Public Health ... 61
3.2 Collective Lessons from the Cases ... 62
3.3 Specifi c Ethical Issues in Resource Allocation ... 65
3.4 Decision-Making Process ... 69
References ... 70
3.5 Case 1: Priority Setting and Crisis of Public Hospitals in Colombia ... 71
References ... 74
3.6 Case 2: Intersection of Public Health and Mental Health: Meeting Family Needs ... 74
References ... 79
3.7 Case 3: Public-Private Partnerships: Role of Corporate Sponsorship in Public Health ... 80
References ... 83
3.8 Case 4: Black-White Infant Mortality: Disparities, Priorities, and Social Justice ... 84
References ... 86
3.9 Case 5: Priority Setting in Health Care: Ethical Issues ... 87
References ... 89
3.10 Case 6: Critical Care Triage in Pandemics ... 90
References ... 93
4 Disease Prevention and Control ... 95
Michael J. Selgelid 4.1 Introduction ... 95
4.2 Mandatory Treatment and Vaccination ... 95
4.3 Disease Screening and Surveillance ... 97
4.4 Stigma ... 98
4.5 Access to Care ... 99
4.6 Health Promotion Incentives ... 100
4.7 Emergency Response ... 101
4.8 Conclusion ... 102
References ... 103
4.9 Case 1: Mandatory Vaccination in Measles Outbreaks ... 103
References ... 107
4.10 Case 2: Public Health Approaches to Preventing Mother-to-Child HIV Transmission ... 108
References ... 111
4.11 Case 3: Newborn Bloodspot Screening: Personal Choice or Public Health Necessity? Storage and Ownership of Newborn Bloodspots... 111
References ... 114
4.12 Case 4: Decoding Public Health Ethics and Inequity in India: A Conditional Cash Incentive Scheme—Janani Suraksha Yojana ... 116
References ... 119
4.13 Case 5: HIV Criminalization and STD Prevention and Control ... 120
References ... 124
4.14 Case 6: Ethics of Administering Anthrax Vaccine to Children ... 125
References ... 128
4.15 Case 7: Non-adherence to Treatment in Patients with Tuberculosis: A Challenge for Minimalist Ethics ... 129
References ... 132
4.16 Case 8: Mass Evacuation ... 132
References ... 135
5 Chronic Disease Prevention and Health Promotion ... 137
Harald Schmidt 5.1 Introduction ... 137
5.2 Individuals ... 140
5.3 Formal and Informal Health Workers ... 141
5.4 Governments (At Different Levels) ... 144
5.5 Corporate Entities ... 147
5.6 Case Studies ... 149
References ... 151
5.7 Case 1: Municipal Action on Food and Beverage Marketing to Youth ... 153
References ... 157
5.8 Case 2: Obesity Prevention in Children: Media Campaigns, Stigma, and Ethics... 158
References ... 161
5.9 Case 3: Obesity Stigma in Vulnerable and Marginalized Groups ... 162
References ... 166
5.10 Case 4: Water Fluoridation: The Example of Greece ... 167
References ... 170
5.11 Case 5: The Prohibition of Smoking in Public Places in Bulgaria... 172
References ... 175
6 Environmental and Occupational Public Health ... 177
Bruce Jennings 6.1 Environment and Workplace: Key Venues for Public Health ... 177
6.2 Population Benefi ts, Individual Rights, and Ethically Acceptable Risk ... 180
6.3 Systems and Power: The Ethical Importance of Ecological and Social Context ... 183
References ... 185
6.4 Case 1: Assessing Mining’s Impact on Health Equity in Mongolia ... 186
References ... 190
6.5 Case 2: Exceptions to National MRSA Prevention Policy for a Medical Resident with Untreatable MRSA Colonization ... 191
6.6 Case 3: Safe Water Standards and Monitoring
of a Well Construction Program ... 195
References ... 198
6.7 Case 4: Implementation of Global Public Health Programs and Threats to Personal Safety ... 199
References ... 201
7 Vulnerability and Marginalized Populations ... 203
Anthony Wrigley and Angus Dawson 7.1 Introduction ... 203
7.2 Different Approaches to the Concept of Vulnerability ... 204
7.3 Concerns Surrounding Approach (V2): Universal Condition ... 205
7.4 Concerns Surrounding Approach (V3): Specifi c Attributes, Contexts, or Groups ... 206
7.5 Concerns Surrounding Approach (V4): Overarching Concepts ... 207
7.6 Simplifying the Concept of Vulnerability (V5): The Moral-Marker Approach ... 208
References ... 210
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 ... 211
References ... 215
7.8 Case 2: Medical Tourism and Surrogate Pregnancy: A Case of Ethical Incoherence ... 216
References ... 220
7.9 Case 3: Compulsory Treatment for Injection Drug Use after Incarceration ... 220
References ... 224
7.10 Case 4: Unanticipated Vulnerability: Marginalizing the Least Visible in Pandemic Planning ... 226
References ... 229
7.11 Case 5: Can Asylum Seeking Be Managed Ethically? ... 230
References ... 233
7.12 Case 6: Tuberculosis Screening, Testing, and Treatment among Asylum Seekers ... 235
References ... 239
8 International Collaboration for Global Public Health ... 241
Eric M. Meslin and Ibrahim Garba 8.1 Introduction ... 241
8.2 The Rise of Globalization and Global Health ... 242
8.3 Ethics Frameworks for Global Health ... 246
8.4 Summary ... 253
References ... 253
8.5 Case 1: The Ethics of HIV Testing Policies ... 256
References ... 259
8.6 Case 2: Just Allocation of Pre-exposure Prophylaxis
Drugs in Sub-Saharan Africa ... 260
References ... 262
8.7 Case 3: Drug Trials in Developing Countries ... 263
References ... 265
8.8 Case 4: Ethical Issues in Responding to International Medication Stock-Outs ... 266
References ... 269
8.9 Case 5: Transmitting Cholera to Haiti... 270
References ... 274
8.10 Case 6: Perilous Path to Middle East Peace: The Sanctions Dilemma ... 274
References ... 278
8.11 Case 7: Advancing Informed Consent and Ethical Standards in Multinational Health Research ... 279
References ... 283
9 Public Health Research ... 285
Drue H. Barrett , Leonard W. Ortmann , Natalie Brown , Barbara R. DeCausey , Carla Saenz , and Angus Dawson 9.1 Introduction ... 285
9.2 What Is Different About Public Health Research? ... 287
9.3 Ethical Considerations for Protecting the Public during Health Research ... 289
9.4 How Ethical Challenges Can Arise in Public Health Research: Lessons Learned from Cases ... 296
9.5 Conclusions ... 297
References ... 298
9.6 Case 1: To Reveal or Not to Reveal Potentially Harmful Findings: A Dilemma for Public Health Research ... 300
References ... 303
9.7 Case 2: Ethical Challenges in Impoverished Communities: Seeking Informed Consent in a Palestinian Refugee Camp in Lebanon ... 305
References ... 309
9.8 Case 3: Improving Review Quality and Effi ciency of Research Ethics Committees to Enhance Public Health Practice in Africa ... 310
References ... 313
9.9 Case 4: Internet-Based HIV/AIDS Education and Prevention Programs in Vulnerable Populations: Black Men Who Have Sex with Men ... 314
References ... 317
Index ... 319
