The complex interplay of ethical theories in public health decision-making can be seen when navigating the intricate terrain of health priority setting. This reflection explores the tensions between consequentialism, distributive justice, capabilities approach, ethical egoism, and relational ethics in public health prioritisation.
Public Health Student | Public Health Expert | Health Minister |
Childhood Immunisation | Childhood Immunisation | Childhood Immunisation |
Breast Cancer Screening | Anti-Smoking Campaign for Children | Elderly Carers Support |
Anti-Smoking Campaign for Children | Schizophrenia Treatment | Anti-Smoking Campaign for Children |
Dental Care (U/18) | Breast Cancer Screening | Breast Cancer Screening |
Intensive Care for Premature Babies | Dental Care (U/18) | Cycle Pathways on Busy Roads |
Schizophrenia Treatment | Bariatric Surgery for Obese Adults | Dental Care (U/18) |
Elderly Carers Support | Intensive Care for Premature babies | Hip Replacements 75+ |
Bariatric Surgery for Obese Adults | Elderly Carer Support | Intensive Care for Premature Babies |
Hip Replacements for 75+ | Hip Replacements for 75+ | Schizophrenia Treatment |
Cycle Pathways on Busy Roads | Cycle Pathways on Busy Roads | Bariatric Surgery for Obese Adults |
Initial Approach: Consequentialism and Utilitarianism
At the onset, the approach to prioritisation was largely consequentialist, particularly utilitarian, aimed at maximising health benefits for the largest number of people. However, this approach risked overlooking minority groups with unique health needs, demonstrating a potential pitfall of utilitarianism in perpetuating health inequities.
A Nuanced Approach: Distributive Justice and Capabilities Approach
The lens of a public health expert shifted the prioritisation approach towards a blend of distributive justice, which advocates for a fair distribution of health benefits, and the capabilities approach, which emphasises enhancing individuals' abilities to lead a fulfilling life. These perspectives foregrounded underserved issues, such as schizophrenia, balancing considerations of equity and individual empowerment.
The Political Perspective: Ethical Egoism
Assuming the role of a health minister added an additional layer of complexity, introducing the challenge of balancing ethical ideals with political realities. Quick, visible results often took precedence, reflecting ethical egoism, which sometimes conflicted with the principles of justice, equity, and population wellbeing fundamental to public health ethics.
Conflict with Clinical Ethics
Contrasting public health ethics with clinical ethics, which prioritises individual patient care, revealed potential tensions in priority setting, especially in resource-limited scenarios. This illuminated the need for a careful balance between population health and individual care considerations.
The Role of Values and Relational Ethics
Reflecting on these shifting priorities highlighted the crucial role of values in decision-making processes and the unavoidable influence of personal life experiences. This insight underscored the importance of relational ethics, which emphasise the importance of relationships and social context in ethical dilemmas.
Conclusion
Ethical decision-making in public health involves a delicate balance of diverse ethical theories, data-driven insights, and personal values. The exercise of prioritising health issues shed light on this complex interplay, emphasising the importance of evidence-informed empathy and ethically grounded pragmatism in public health decision-making.