By Stephanie Massot, Public Health Practicum Student at Health Nexus
This is the third blog post in a series on public health ethics. This post focuses on how to apply public health ethics to your work.
I am starting to feel as though public health ethics is like a good sandwich you have made yourself. If you have been following my last two blog posts in this series, you will be more familiar with your philosophical orientation and differentiating between bioethics, public health ethics, and health promotion ethics. These make up the main protein and key ingredients to a good public health ethics sandwich. If you have made a sandwich before, you are going to know what your favourite ingredients are – mine is always cheese and Dijon mustard! If it is your first time making a sandwich or you have been given new ingredients, there will be a new process and new discoveries. Guidance on making a sandwich is important. You need to know how to bring your ingredients together.
In public health ethics, frameworks have been developed to provide assistance to practitioners who are deliberating an ethical issue in different contexts. Strengths of frameworks include making values explicit and thinking through potential unintended consequences of proposed interventions, from policies to programs. The National Collaborating Centre for Healthy Public Policy (NCCHPP) has an extensive list of ethics frameworks for public health. Going back to the sandwich analogy, what you use to ‘frame’ your ingredients, from a challah bun to rye bread, will change your eating experience. For instance, Nancy Kass provides a list of questions in her framework (great summary from NCCHPP) and Andrew Tannahill focuses on a list of principles or ‘principlism’ to guide his framework.
Principlism is a ‘broad approach of identifying a set of principles to be considered and specified when facing a decision that may contain ethical issues1 and a practical tool for practitioners who are not familiar with public health ethics. Principles can be separated into substantive and procedural categories:
I was recently reading Unison Health and Community Services’ workbook (jam-packed with tasty ingredients) for community based evidence-informed practice. What I noticed was that an ethical framework(s) was not provided, even for the evaluative learning tools. Referring to another tool such as the Community Ethics Toolkit, could support you to consider and dialogue about public health ethics.
Just like you might not enjoy the idea of combining certain ingredients on your sandwich (pickles and peanut butter anyone?), there will be conflicts between principles that will require deliberation. Frameworks for public health ethics will need refinement, perhaps they will even need to be combined, for your context – only through practice will you find out how to best apply them. For an excellent case study check out: ‘Getting Through Together: Ethical Values for a Pandemic’. The Ministry of Health in New Zealand worked closely with Māori communities because ‘shared values give us a shared basis for decisions.’ Now how about that sandwich?
1 MacDonald, M. (2015). Introduction to Public Health Ethics 3: Frameworks for Public Health Ethics. National Collaborating Centre for Healthy Public Policy. Montréal, Québec.