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Ethics refer to the formulated regulations and values adopted by a community and accepted as the expected code of conduct (Bayer 2007, p.7). Morality should not be mistaken for ethics, as it is itself a part of ethics. Public health ethics is the code of conduct that is accepted as the proper guide for professionals who affect public health in the execution of their duties.
Since there are no set rules for all areas of public health, the code of conduct is defined through a consensus. This is because the diversity of the public health is difficult to confine within any set definition. Therefore, a moral code in form of public health ethics that professionals whose duty is related to public health should observe in the execution of their duties and responsibilities is necessary.
Prior to the middle of the twenty first century, medical and public health practitioners thought that the best way to administer the practice of public health was through common sense and simple logic. This guide was not a standard parameter for every professional public health officer. Health officials depended on their professional judgment to make decisions, which they thought were best for the community concerned.
After the Second World War, liberal practitioners and students began questioning the moral standing of some of the practices of German doctors during the war (Bayer 2007, p.4). The controversy regarding the issue led to the discarding of the classical dogma of the public health ethics.
The new generation of practitioners demanded the setting up of a new set of standards for practice. In addition, the activists demanded ethically sensitive education that would endow the practitioners the moral orientation necessary for proper and beneficial public health practice. This argument emphasizes on the importance of public health ethics and the legality of the term itself.
The word “public health ethics” is a term used to describe certain standards or policies. These standards cannot be given a reference term arbitrarily since this reference term denotes the existence of the said standards.
Consequently, abolishing the term “public health ethics” means that the said standards and parameters cease to exist. Raising the argument on whether to abolish the term automatically refers to abandonment of the reference of the term. Furthermore, this raises another debate whether the term, which covers a wide field constituting of diversified disciplines, is appropriate to use in reference to the field.
Another perspective is on whether there should be any governing ethics in the public health sector. Despite these varying interpretations, the debate lies squarely on the existence and application of governing ethics in the public sector.
Revolutionaries questioned the classical assumption that the decision of a professional public health officer was undisputable in the society. The logical decision had to be accompanied by suitable ethical standing to be endorsed by the majority in the society.
Health practitioners’ practices such as artificial life support, artificial methods of conception, and the use of human specimen in medical research were unacceptable as morally right as much as they were accepted as the most logic inclinations of any professional public health officer.
In contrast to the clinical practice, the public health sector had to develop an ethical code since strict regulations with set penalties were inapplicable in the field. Furthermore, the public health officials do not have a confidential relationship with their subjects unlike the clinical doctors.
The public health field requires transparency and accountability by the authorities since the practice encompasses the welfare of scores of people, unlike the medical field, which deals with individual needs of a person at any single instance.
Application of logic is viewed as impossible since no single logical perspective on an issue can be obtained from the public. The reformist of the twenty first century sought to separate the principles of practice in the public sector from the influence of the regulations of the medical and clinical field (Bayer 2007, p.4).
Another addendum to the controversy on the legality of existence of ethics is the diversification of the public health ethics into two major ideologies, the professional ethics and the applied ethics.
Professional ethics apply the principles and values of the society receiving the services, while applied ethics apply the logical reasoning of the professional officer. Applied ethics leave the judgment on a decision to the discretion of the practitioner. In addition, the practitioner uses the knowledge regarding the field to make the decision, which he or she thinks has then most favorable moral standing in the society.
A properly planned public health ethics policy is advocated as the effective remedy in the public health sector (Bayer 2007, p.6). Beliefs, religious institutions and doctrines affect the public health ethics.
However, the admissibility of religion as a governing factor in the formation of public health ethics is questionable since religious doctrines are subject to controversy and debate. Moreover, beliefs and doctrines cannot be proved on physical basics that they hold any practical implication in the health sector.
Research in the health sector may involve practices and experiments that have counterproductive results towards the society. Although it is incontrovertibly true that there have been major achievements in the public health sector through research, the nature and extent of the reach schemes may be limited by the public health ethics.
Consequently, a deadlock emerges on how and where to put a boundary governing research projects within the public health ethics code. This raises another debate on whether the public health ethics should be a written down policy with strict regulations, or whether a professional should define and apply the ethics in an individual manner (Eckstein 2003, p.150).
Human life in whatever form and capacity is deemed precious. Public health professionals play a major role in the protection of life. However, the equality of public health services has never been realized anywhere in the world. The rich and influential individuals are always at a position to afford high quality services, while the poor rely solely on the government to offer whatever health care services it can afford.
Therefore, the choice of the nature of public health care services is determined by financial ability. This fact, and the theory that there should be ethics to determine the general nature of services the public gets, seems to form a paradox. In this respect, the moral foundation of the ethics is found to be unsatisfactory (Boylan 2004, p.64).
Another setback to the integrity of public health ethics is the lack of definite standards for morals. Morals depend on a society’s values and behavioral inclinations. They are said to be dependent on culture and custom, and a relative phenomenon. This renders the public health ethics a formulation by the aristocratic and bureaucratic class to strengthen their hold on the society (Merson et al 2006, p.55).
However, the society may put itself in jeopardy by accepting the ideology that morals are not common to all people and are functional within a particular group that embraces them.
Consequently, an element in a society has the freedom to suggest any kind of moral justification on a particular pervasive act if the act itself has never been experienced by that particular society and perspectives are localized within communities or geographical regions. The importance of some form of ethics is manifested by this need of some ethical parameters when taking action on a public health problem (Seedhouse1998, p. 22).
Another argument that brings controversy into the public health care ethics is the discretion of the public healthcare professional in choosing between doing what is within the set ethics if any and doing what is best for the community. Often, a public health worker has knowledge and experience in the field of specialization such that the professional knows when an action is beyond the governance of ethics.
The professional may choose not to exceed the boundaries of ethics in a bid to solve a problem that needs emergency attention since the ethics allow him or her to do so. It is argued that practitioners affecting the public health sector should be allowed to decide on the most appropriate action for the community they are serving (Novick 2008, p.154).
Seeking to restrict practitioners within certain regulations gives them justification to strictly outline their duty in professions that otherwise requires a lot of dedication and sacrifice. These kinds of ethics may erode the noble nature of the public health sector and could reduce the efficacy of public health workers. An example of this freedom is manifested in clinical medicine where doctors’ responsibilities cannot be monitored closely.
The doctor does what is best for the patient and some level of trust has to exist between the two parties. However, the doctor has the freedom to abstain from providing the patient with the most effective treatment since the ethics may not require him or her to do so (Ashcroft et al 2007, p.25). This illustrates how the administration of public health ethics could become irrelevant if applied strictly.
This theory stipulates that although ethics must be present in the public health, the priority of the application of these ethics may come either below or above the worker’s professional authority. In addition, the argument states that abolishment of the public health ethics altogether may result in an imbalance, which in turn presents the danger of losing the concept of accountability in the discipline.
The application of the ethics should be structured in such a way that when solving a problem, there is a criterion for determining which opinion is to be considered first. This suggests that there are times when the health professional’s opinion will come first, and other times when the set code of conduct will be considered first (Ashcroft et al 2007, p.27).
Public health cannot be specialized or integrated into other fields. It is a multidisciplinary field, which incorporates aspects of the government, politics, social values and the economy. Professionals in all these areas are responsible for the formation of a sound public health sector. Coining ethics, which covers the conduct of the players in all these disciplines, could be a difficult task.
Professionals from each discipline can argue that their field is entitled to the same consideration as the public health sector on issues of mutual importance. This position makes it difficult for these professionals to account for their actions in relation to the public health sector.
Moreover, this situation seeks to prove that ethics formulated within the public health sector to govern all aspects of the society in relation to the public health are unrealistic. However, the term “public health ethics” can be used to refer to code of conducts formulated within each sector of the society’s existence to regulate, govern or guide the nature of the relationship between different disciplines and health.
In this form, the term “public health ethics” will take different meanings in the respective disciplines. Consequently, the importance of the health of the population is magnified (Peckham & Hann 2010, p.22). This kind of magnification is warranted since public health is a critical requirement for the stability of all other disciplines.
Public health can also be sufficiently justified as a purely academic field where academicians analyze the relationship between various disciplines in public health issues. An academic field is an area of study, which identifies the problems affecting certain issues and the solutions to these problems.
The existence of public health ethics as an academic discipline is not debatable since it involves research and dissemination of knowledge. However, application and practicability of the findings and the principles developed by this study could prove to be a controversial (Peckham & Hann 2010, p.24).
The study and research work seek to establish an efficient healthcare system for the population. Effective research can only be done under public health since it covers all the aspects affecting the healthcare sector in a certain area. There must be an existence of a comprehensive field, which is the public health ethics, if research on the health sector it to be generalized.
Facts concerning various determinants of the quality of the healthcare such as epidemiology cannot be analyzed without the existence of the field of public health ethics (Eckstein 2003, p.34). Although public health ethics is a discipline with controversies ranging from the legality of its existence to the limits of its application, it has survived criticism.
In analysis of all aspects of the public health ethics, the term has carried some broad meanings in it. The word “public health ethics” has questionable grounds when applied directly to clinical medicine and other closely related fields such as nursing. However, the term has proved to be of cardinal importance in describing the conduct of all professionals in the society who affect the quality of the healthcare system.
Its usefulness has been expounded by its impacts. Every aspect of the government and social structure is more aware of the role of public health ethics in building a more effective healthcare system (Lee 2010, p.33).
The term is used to instigate responsibility in professionals from various disciplines putting the public health at the forefront of the priorities of every individual (Gostin 2002, p.24). Finally, one can conclude that the term” public health ethics ” cannot be easily discarded, but can be applied to give different meanings to avoid the perspective that the healthcare profession is being given an undeserved favor.
The public population is the most important part of any country, state and the whole world. This component of the society plays a significant role in all aspect of development as it struggles to make progress in the social, economic and political aspects of the daily life. It is therefore significantly important for the public health sector’s management to deliver effective and efficient services to the public.
Decisions made by solely considering professional and technical knowledge are most likely to be unfavorable to the public. When dealing with a large population, the people’s opinion matters a lot. Therefore, the concerned individuals must act in a way that is approved by the public (Peckham & Hann 2010, p.18).
This kind of conduct can be governed by some guiding principles that are not necessarily rules or laws laid down by the constitution. The guiding principles must be based on the concerned society’s morals and values. Such an approach ensures that ethics bestow responsibilities on all professionals holding positions that deal with issues of public health in the society.
In this regard, public health ethics are necessary in distinguishing the governing principles from the regulations of various public sectors and particularly the clinical practice ethics (peckham & Hann 2010, p.20). In addition, Public health ethics are important for guiding social, political and economic institutions.
Professionals are guided by the ethical morals in finding solutions to problems of great significance in the health sector rather than being guided by the limits set by the law or whatever influencing authorities advocate. Public health ethics ensure that public health issues are dealt with moral accountability, which must be observed by all members of the society.
References
Ashcroft, R. E. (2007). Principles of health care ethics (2nd ed.). Chichester, West Sussex, England: John Wiley & Sons.
Bayer, R., & Beauchamp, D. E. (2007). Public health ethics: theory, policy, and practice. Oxford: Oxford University Press.
Boylan, M. (2004). Public health policy and ethics. Dordrecht: Kluwer Academic Publishers.
Eckstein, S. (2003). Manual for research ethics committees (6th ed.). New York: Cambridge University Press.
Gostin, L. O. (2002). Public health law and ethics: a reader. Berkeley [u.a.: University of California Press [u.a.].
Lee, L. M. (2010). Principles & practice of public health surveillance [edited by] Lisa M. Lee… [et al.]. (3rd ed.). Oxford: Oxford University Press.
Merson, M. H., Black, R. E., & Mills, A. (2006). International public health: diseases, programs, systems, and policies (2nd ed.). Sudbury, Mass.: Jones and Bartlett.
Novick, L. F., Morrow, C. B., & Mays, G. P. (2008). Public health administration: principles for population-based management (2nd ed.). Sudbury, Mass.: Jones and Bartlett Pub.
Peckham, S., & Hann, A. (2010). Public health ethics and practice. Bristol, UK: Policy.
Seedhouse, D. (1998). Ethics: the heart of health care (2nd ed.). Chichester: John Wiley.
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