1. Ethics of HIA Marco Martuzzi World Health Organization Regional Office for Europe Rome, Italy

2. Ethical values in HIA Solidarity, equity, participation, sustainability, ethical use of evidence,… Routinely referred to in textbooks and training Some more clarity may be needed

3. HIA: making decisions Key goals –Assessing measurable impacts (and minimize them) –Promote equity –Involve / Listen / Empower  Possible conflict between these goals

4. Environmental factors

5. Minimizing impacts Overall measurable impact; the most good for most people (EIA, risk assessment, community preventive medicine) Utilitarian ethical framework, i.e. based on “utility function” = overall impact

6. ELF and childhood leukaemia: Attributable risk in Italy

7. Ethical frameworks The utilitarian framework conflicts with other ethical frameworks Typically, in HIA “environmental justice” type ethics applies However, factors other than overall impact can be included in utility function Equity (distributional issues) are a good candidate A utilitarian HIA?

8. NO HIA, env justice, etc belong to deontological theories (as opposed to utilitarian theories) People should not be treated as means to and end Some actions are right or wrong, regardless of consequences However, the principle of utility has lead to important PH progress, e.g. to immunisation (communitarian ethics)

9. What deontological ethical framework? Assessing measurable impacts (and minimize them) Promote equity Involve / Listen / Empower Conflict of aspirations, and ethical systems

10. Principle-based approaches Beneficence (Assessing measurable impacts and minimize them) Non maleficence (ditto) Justice (Promote equity) Authonomy (Listen / Empower) These principles “do not provide a full philosophical justification for decision making … where there is conflict it may be necessary to choose between them or assign greater weight to one” (Coughlin 2006)

11. Conclusions HIA ethics not utilitarian Difference with utilitarian approaches such as risk assessment is irreducible Utilitarian approach has some advantages, lost in HIA The ethical framework of HIA is not always clear Should it be clarified? Perhaps principle-based approaches good candidate if progress is sought