Bioethics in Public Health

Abstract

The need to adapt clinical bioethics to the issues raised by public health policies and interventions did not become obvious till the later 1990s. The interpersonal principlist approach was inappropriate for the social concerns of public health, although autonomy, beneficence, nonmaleficence, and justice had to be incorporated and adapted to collective scenarios. Autonomy touches on the basic concern of developing public policies that avoid undue limitation of individual free will, and justice is of major import when reflecting on inequality and the allocation of scarce resources. Interventions designed to prevent disease and promote health are expected to be beneficial at the population level, and care must be taken to respect human rights in the understanding that basic rights and public health are mutually supportive.

Public health bioethics has up till now developed along the general lines of responsibility, prevention, and precaution. Responsibility is a core value, but not easy to determine when agents are impersonal institutions and accountability cannot be rendered to anonymous collectives. Prevention is basically a technical endeavor, required to be effective—problem-solving—and efficient—sustainable cost/benefit ratio—its ethical component addressing the just distribution of preventive policies. Precaution refers to decision-making in uncertainty, its ethical value having often been overshadowed by strategic negotiations of vested interests.