Exploring Ethical Issues in Public Health Practice

Ethics play a crucial role in public health, shaping policies, practices and decision-making processes that affect the health and well-being of individuals, communities and populations. Upholding ethical standards and principles in public health can foster trust, equity, and social justice, ultimately improving health outcomes and well-being for all community members.

This blog post focuses on the role of ethics in public health, compares the frameworks for public health and medical ethics and highlights some ethical challenges faced by many practitioners in public health and healthcare management.

Navigating the complex landscape of public health requires the application of robust ethical theories to address pressing dilemmas. Public and clinical health workers often face ethical challenges such as balancing individual rights with community health, ensuring equitable resource allocation, and managing sensitive health data. Public health practitioners can leverage ethical frameworks to make informed decisions that promote population health and health equity.

Public health ethics frameworks guide professionals in making decisions that maximize community well-being. Utilitarianism, deontology, and virtue ethics are foundational theories that help navigate ethical issues in public health practice:

• Utilitarianism focuses on the greatest good for the greatest number of people.
• Deontology emphasizes duty and rules, ascribing virtue to the performance of duty.
• Virtue ethics centers on the moral character of individuals.

These frameworks complement bioethics principles in health care, supporting informed decision-making and promoting health equity across diverse population groups.

Medical ethics and public health ethics are interrelated, with each field supporting the other in addressing complex health dilemmas. These principles guide medical professionals, healthcare administrators, researchers and policymakers in navigating complex ethical dilemmas and ensuring that ethical values and considerations are upheld in healthcare and medical research. The fundamental principles of medical ethics, autonomy, beneficence, justice, and non-maleficence are briefly explored here.

Healthcare providers are morally obligated to seek the greatest possible good for their patients, prioritize their health and welfare, and consider the potential risks and benefits of different courses of action.¹

Non-maleficence, often expressed as “do no harm,” emphasizes the obligation to prevent unnecessary suffering, minimize risks, and avoid actions that could result in physical, psychological or emotional harm. This principle is especially important in end-of-life care and pain and symptom control.¹

Briefly, the principle of justice pertains to the fair and equitable distribution of resources, benefits, and burdens in healthcare and research. It emphasizes treating individuals fairly, without discrimination or bias, and ensuring equal access to healthcare services, treatments and research opportunities.¹

Autonomy emphasizes respecting individuals’ right to make autonomous decisions about their healthcare and treatment. It requires ensuring that patients understand all the relevant information about medical interventions or research projects before seeking their consent. Respect for autonomy also involves honoring patients’ preferences, values and choices, even if they differ from healthcare providers’ recommendations.¹

Integrating ethical guidance into public health practice is essential for addressing complex health dilemmas. The American Public Health Association (APHA) Code of Ethics, influenced by foundational ethical theories and principles, provides a comprehensive framework for guiding public health decisions.

The APHA code incorporates values such as professionalism, health justice, and inclusivity, which are crucial for promoting health equity and community well-being. Public health and healthcare management professionals will draw from the different frameworks as appropriate for the situation. This blog post provides a deeper dive into the APHA ethics code and the relationship between ethical principles in medicine and public health.

Public health professionals frequently encounter complex ethical dilemmas in their work. From ensuring informed consent and privacy to allocating scarce resources and addressing health disparities, these challenges require careful consideration and adherence to ethical principles. Understanding how public health and biomedical ethics frameworks can guide decision-making is crucial in navigating these issues.

The following sections will explore common dilemmas in public health and healthcare management, offering insights into how ethical theories and principles guide in areas such as global health, balancing public health measures with civil liberties, and research projects in clinical and public health.

Informed consent and privacy are foundational to public health and clinical practice, ensuring that individuals are fully aware of and agree to the procedures and data usage that concern them. The requirements for informed consent and privacy derive from ethical guidelines that stress the importance of respecting autonomy and maintaining trust between public health professionals and the populations they serve.

In public health, informed consent and privacy are crucial in initiatives such as vaccination programs, epidemiological research, and health surveillance. Challenges in obtaining informed consent in these contexts include communicating complex medical information, time constraints, and cultural and language barriers. Public health professionals must navigate these ethical challenges by adhering to ethical principles that promote transparency, balancing individual rights with community benefit, and the equitable distribution of resources to achieve population health.

Informed consent is an important concept to master, for ethical and practical reasons, if you wish to conduct public health research using human participants. Public health research and clinical research projects are often grant-funded. Grantmakers and universities, which frequently sponsor research projects, require that proposals be approved by an institutional research board (IRB) or research ethics board (REB). Research ethics boards and IRBs, in turn, require proof of approved informed consent forms. For example, the U.S. Department of Health and Human Services (HHS) has codified its consent requirements as part of the basic HHS Policy for the Protection of Human Research Subjects.² To explore ethical considerations in public health policy further, refer to the blog post The Role of Ethics in Shaping Public Health Policies.

In clinical healthcare settings, informed consent is vital for procedures ranging from routine examinations to complex surgeries and participation in clinical trials. Ethical challenges include ensuring patients understand the implications of their choices and addressing potential power imbalances between patients and providers. Principles such as autonomy, beneficence, and non-maleficence guide healthcare providers in respecting patients' decisions, prioritizing their welfare, and avoiding harm.

Health disparities are significant, preventable differences in health status and outcomes experienced by specific populations "disadvantaged by their social or economic status, geographic location and environment,” including some racial, ethnic, and other population groups and communities."3

The resulting health inequity is often attributable to Social Determinants of Health (SDOH). Social determinants of health encompass the conditions in which people are born, grow, live, work, and age, including socioeconomic status, education, employment, housing, transportation, and access to healthcare and social support networks.⁴ These non-medical conditions significantly drive health outcomes, with estimates suggesting they influence up to 50% of health outcomes. Addressing these determinants is essential for reducing health inequities.⁵

Growing awareness of the impact of social determinants on health disparities at both individual and population levels has highlighted the need for culturally competent public health practices. Public health ethics frameworks can guide practitioners in promoting health equity by ensuring fair distribution of resources and inclusive decision-making processes, ultimately advancing the common good and protecting vulnerable populations. Learn more about these topics and how one Kent State alumni works to improve health outcomes in diverse populations.

Resource allocation is a pivotal concern in public health, especially during emergencies. The COVID-19 pandemic underscored the necessity for fair and equitable distribution of limited resources like vaccines and therapeutics, revealing many ethical challenges. Addressing these challenges involves adhering to ethical principles such as maximizing benefit, minimizing harm, and ensuring equity in distribution, both within and among countries.⁶

In long-term public health programs, resource allocation decisions influence the effectiveness and reach of initiatives such as vaccination campaigns, campaigns to combat known public health hazards such as smoking, and preventive screenings. Ethical frameworks, such as those emphasizing health equity, guide these decisions by prioritizing disadvantaged communities and ensuring that interventions are accessible to all, thereby promoting health equity.

Biomedical research and public health research programs also face ethical challenges in allocating limited resources. Ensuring that trials and studies are inclusive and resources are distributed fairly requires balancing ethical principles like ensuring participants benefit from their involvement. This approach supports the integrity of research and ensures that findings are applicable across diverse population groups.

Balancing public health measures and civil liberties has been a complex and ongoing challenge throughout history, and the COVID-19 pandemic brought it into sharp focus. Public masking, school vaccination, and quarantine generated intense public debate in the U.S. and elsewhere. School vaccination requirements promote herd immunity, aligning with utilitarian principles of maximizing overall benefit.⁷ Mask mandates and quarantine restrictions, while limiting freedoms, respect persons by protecting the vulnerable. Ethical frameworks suggest clear communication (respect for persons) and adapting measures (proportionality) based on scientific evidence.^{8, 9} Community engagement can build trust and identify solutions that balance public health and individual concerns.

Global health ethics grapple with promoting health equity across borders. Frameworks emphasize justice, ensuring all have access to essential healthcare, regardless of location or socioeconomic status. Challenges include balancing resource allocation between countries and prioritizing interventions to maximize overall population benefit. Open dialogue and collaboration among nations are crucial for navigating these complexities.¹⁰

Proper ethical training and education can prepare public health professionals to navigate complex ethical dilemmas, uphold ethical standards and promote ethical practice. This includes training in ethical reasoning, critical thinking, communication and decision-making, as well as cultivating values such as respect and cultural humility. Public health professionals may encounter ethical dilemmas related to resource allocation, priority-setting, conflicts of interest and balancing individual rights with public health goals. Addressing these challenges requires ongoing support, mentorship and continuing education opportunities to enhance ethical competence.

Ethical considerations are paramount in public health, guiding decision-making, policy development and practice to promote health equity, protect human rights and uphold the principles of justice and fairness. Earning your master’s in public health from a program that weaves ethics into the curriculum is an excellent first step toward becoming a more ethical practitioner.

Kent State University’s online Master of Public Health program integrates a rigorous Public Health Policy, Law and Ethics course within its Health Policy and Management specialization. Students explore ethical theories and decision-making processes, learning how to apply them to real-world public health issues.

To learn more about Kent State University’s Master of Public Health program, schedule a call with an admissions outreach advisor today.