1. Ethical Issues in Public Health and Health Services
Chapter 15
Ethical Issues in Public Health and Health Services

2. The Cardinal Principles of Medical Ethics
Autonomy:
Includes privacy, individual liberty, freedom of choice, and self-control.
Beneficence:
Includes doing no harm and promoting the welfare of others.

3. The Cardinal Principles of Medical Ethics
Justice:
Includes equality of opportunity, equity, and access in addition to equity of benefits.

4. Overarching Public Health Principles
Provision of care on the basis of health need, without regard to race, religion, gender, or ability to pay.
Equity in the distribution of resources.
Respect for human rights.

5. Ethical Issues in Developing Resources
The ethical issues in developing resources involve health personnel, facilities, drugs and equipment, and knowledge.
An adequate supply of personnel and facilities is needed to provide health care without discrimination or bias.

6. Ethical Issues in Developing Resources
Resource development must be diverse enough to ensure a variety of personnel and facilities.
Public health ethics focus on the importance of research in assessing system performance, including equity of access and medical outcomes.

7. Ethical Issues in Economic Support
Every individual should have equitable access to health services.
However, inappropriate financial barriers to health care do exist.
As a result, economic disparities between the rich and the poor have a major impact on the health status of the population.

8. Ethical Issues in Organization of Services
Services should be organized and distributed in accordance with health needs and the ability to benefit.
A health system must decrease geographic inequalities and must be culturally relevant to the population it serves.

9. Ethical Issues Related to Managed Care
Conflicting goals of cost-containment and assurance of access to quality services.
Debate over who decides what is medically necessary.

10. Ethical Issues Related to Managed Care
Question of whether patients are permitted to sue managed care plans.
Dilemma between a patient’s interests and organizational profits.

11. Ethical Issues in Management of Health Services
Organization
Staffing
Budgeting
Supervision
Consultation

12. Ethical Issues in Management of Health Services
Procurement
Logistics
Records and reporting
Coordination
Evaluation

13. Ethical Issues in the Delivery of Care
A central concern involves the rationing of medical services.
In the field of mental health, the conflict between the needs and legal rights of patients and the need for protection of society present major dilemmas for health care professionals.

14. Ethical Issues in the Delivery of Care
Concerns over patient privacy and personal choice.
Public health statutes may conflict with these concerns since they require the reporting of certain diseases and events for epidemiological purposes or for the specific protection of the public.

15. Ethical Issues in Assuring Quality of Care
Peer Review
Requires some invasion of the patient’s privacy and the physician’s confidential relationship with his/her patient.
Practice Guidelines
Involve some interference with physician autonomy, but will provide protection for both the patient and provider.

16. Ethical Issues in Assuring Quality of Care
Report cards
Present a conflict in determining the appropriate and accurate measures of quality.
Malpractice suits
Raise questions of equity since many patients are not compensated for medical injuries.

17. Mechanisms for Resolving Ethical Issues in Health Care
Ombudsmen
Institutional review boards
Ethics committees
Standards set by professional associations
Practice guidelines
Financing mechanisms
Courts of law