Contemporary biomedical ethics and environmental ethics share a common ancestry in Aldo Leopold's and Van Rensselaer Potter's initial broad visions of a connected biosphere. Over the past five decades, the two fields have become strangers. Public health ethics, a new subfield of bioethics, emerged from the belly of contemporary biomedical ethics and has evolved over the past 25 years. It has moved from its traditional concern with the tension between individual autonomy and community health to a wider focus on social (...) justice and solidarity. Public health has a broad focus that includes individual, community, and environmental health. Public health ethics attends to these broad commitments reflected in the increasing concern with the connectedness of health of individuals to the health of populations, to the health of animals, to the health of the environment; it is well situated to reconnect all three “fields” of ethics to promote a healthier planet. (shrink)

For over 100 years, the field of contemporary public health has existed to improve the health of communities and populations. As public health practitioners conduct their work – be it focused on preventing transmission of infectious diseases, or prevention of injury, or prevention of and cures for chronic conditions – ethical dimensions arise. Borrowing heavily from the ethical tools developed for research ethics and bioethics, the nascent field of public health ethics soon began to feel the limits of the clinical (...) model and began creating different frameworks to guide its ethical challenges. Several public health ethics frameworks have been introduced since the late 1990s, ranging from extensions of principle-based models to human rights and social justice perspectives to those based on political philosophy. None has coalesced as the framework of choice in the discipline of public health. This paper examines several of the most-known frameworks of public health ethics for their common theoretical underpinnings and values, and suggests next steps toward the formulation of a single framework. (shrink)

Public health ethics is a nascent field, emerging over the past decade as an applied field merging concepts of clinical and research ethics. Because the “patient” in public health is the population rather than the individual, existing principles might be weighted differently, or there might be different ethical principles to consider. This paper reviewed the evolution of public health ethics, the use of bioethics as its model, and the proposed frameworks for public health ethics through 2010. Review of 13 major (...) public health ethics frameworks published over the past 15 years yields a wide variety of theoretical approaches, some similar foundational values, and a few similar operating principles. Coming to a consensus on the reach, purpose, and ends of public health is necessary if we are to agree on what ethical underpinnings drive us, what foundational values bring us to these underpinnings, and what operating principles practitioners must implement to make ethical decisions. If public health is distinct enough from clinical medicine to warrant its own set of ethical and philosophical underpinnings, then a decision must be made as to whether a single approach is warranted or we can tolerate a variety of equal but different perspectives. (shrink)

Teaching competency in bioethics has been a concern of the field since its start. In 1976, The Hastings Center published the first report on the teaching of contemporary bioethics. Graduate programs culminating in an MA or PhD were not needed at the time, concluded the report. “In the future, however,” the report speculated, “the development and/or changing social priorities may at some point allow, or even require, the creation of new academic structures for graduate education in bioethics.” Although that future (...) might be upon us, the creation of a terminal degree in bioethics has its detractors. Scholars have debated whether bioethics is a discipline with its own methods and theoretical grounding, a multidisciplinary field bringing various professional perspectives to bear on particular types of problems, a set of problem-solving skills to resolve moral disagreements, or something else entirely. Whether or not efforts to develop the methods and theory of bioethics have matured to the point that it is now a discipline in the strictest sense, new bioethics training programs have appeared at all postsecondary levels. In this essay, we examine the number and types of U.S. programs and degrees in this growing field. (shrink)

Meat is a multi-billion-dollar industry that relies on people performing risky physical work inside meat-processing facilities over long shifts in close proximity. These workers are socially disempowered, and many are members of groups beset by historic and ongoing structural discrimination. The combination of working conditions and worker characteristics facilitate the spread of SARS-CoV-2, the virus that causes COVID-19. Workers have been expected to put their health and lives at risk during the pandemic because of government and industry pressures to keep (...) this “essential industry” producing. Numerous interventions can significantly reduce the risks to workers and their communities; however, the industry’s implementation has been sporadic and inconsistent. With a focus on the U.S. context, this paper offers an ethical framework for infection prevention and control recommendations grounded in public health values of health and safety, interdependence and solidarity, and health equity and justice, with particular attention to considerations of reciprocity, equitable burden sharing, harm reduction, and health promotion. Meat-processing workers are owed an approach that protects their health relative to the risks of harms to them, their families, and their communities. Sacrifices from businesses benefitting financially from essential industry status are ethically warranted and should acknowledge the risks assumed by workers in the context of existing structural inequities. (shrink)

Volume 20, Issue 10, October 2020, Page 61-63.

The Presidential Commission for the Study of Bioethical Issues was created by President Obama in 2009 to identify and promote policies and practices that ensure scientific research, health care delivery, and technological innovation are conducted in socially and ethically responsible manners. The bioethics commission is an independent and thoughtful group of experts who advises the President and, in so doing, strives to educate the nation on bioethical issues. As part of the effort to promote policies and practices ensuring the ethical (...) conduct of research, innovation, and health care delivery, the bioethics commission staff, in consultation with commission members, has used the bioethics commission reports to develop pedagogical materials for traditional and nontraditional educational settings. The goal is to use contemporary issues addressed by the bioethics commission to support teaching of bioethics ideas, principles, and theories across the major areas of study and practice. (shrink)

We argue that the current ethical and regulatory framework for permissible risk levels in pediatric research can be helpfully understood in terms of children’s moral right to adequate protection from harm. Our analysis provides a rationale for what we propose as the highest level of permissible risk in pediatric research without the prospect of direct benefit: what we call “relatively minor” risk. We clarify the justification behind the usual standards of “minimal risk” and “a minor increase over minimal risk” and (...) explain why it is permissible to impose any risks at all on child participants who do not stand to benefit directly from enrollment in research. Finally, we illuminate some aspects of the concept of “best interests.”. (shrink)

Public health emergencies expose social injustice and health disparities, resulting in calls to address their structural causes once the acute crisis has passed. The COVID-19 pandemic is highlighting and exacerbating global, national, and regional disparities in relation to the benefits and burdens of undertaking critical basic public health mitigation measures such as physical distancing. In the United States, attempts to address the COVID-19 pandemic are complicated by striking racial, economic, and geographic inequities. These synergistic inequities exist in both urban and (...) rural areas but take on a particular character and impact in areas of rural poverty. Rural areas face a diverse set of structural challenges, including inadequate public health, clinical, and other infrastructure and economic precarity, hampering the ability of communities and individuals to implement mitigation measures. Public health ethics demands that personnel address both the tactical, real-time adjustment of typical mitigation tools to improve their effectiveness among the rural poor as well as the strategic, longer-term structural causes of health and social injustice that continue to disadvantage this population. (shrink)

The first Ethics Bowl competition was established in the 1990s by Dr. Robert Ladenson of the Illinois Institute of Technology to help students reason through ethical challenges they will face in their personal and professional lives, and help them develop responsibilities as citizens of a democracy. Since then, the Ethics Bowl format and its pedagogical goals have been adapted to many other academic disciplines and a variety of student and professional populations. Our aim was to quantify the growth of the (...) Ethics Bowl concept by enumerating and describing extant Ethics Bowl programs, outlining both pedagogical goals and operational aspects. Using respondent-driven sampling, we identified 20 Ethics Bowl programs across the globe, reaching tens of thousands of participants annually, and an additional two programs preparing to launch in the near future. We conclude by making recommendations for pedagogical and operational dimensions of the programs. (shrink)

For the first time, the revised Common Rule specifies that public health surveillance activities are not research. This article reviews the historical development of the public health surveillance exclusion and implications for other foundational public health practices.

In their article “The Bioethics of Environmental Injustice: Ethical, Legal, and Clinical Implications of Unhealthy Environments,” Ray and Cooper (2024) invite us to prioritize environmental health...

The aim of this book is to understand what Deleuze and Guattari mean by "art." Stephen Zepke argues that art, in their account, is an ontological term and an ontological practice that results in a new understanding of aesthetics. For Deleuze and Guattari understanding what art "is" means understanding how it works, what it does, how it "becomes," and finally, how it lives. This book illuminates these philosophers' discussion of ontology from the viewpoint of art-and vice versa-in a thorough questioning (...) of aesthetic criteria as they are normally understood. (shrink)

There are no national recommendations for routine screening for sickle cell trait, nor is there guidance on whether or how to notify donors that they might be tested or identified as having sickle cell trait. As a result, the organizations that collect blood have implemented variable policies about whether and how to inform prospective donors of the possible screening and discovery of this noncommunicable condition. The question of what they should do is related to the broader question of how to (...) handle incidental and secondary findings. In a recent report, the Presidential Commission for the Study of Bioethical Issues outline a framework for handling such findings in the clinical, research, and direct‐to‐consumer contexts. While the commission's report did not directly address incidental and secondary findings in the public health context of blood donation, it made several overarching recommendations that apply in all contexts where such findings might arise. This essay outlines the special issues raised by discovering sickle cell trait in blood donation and considers the implications of the commission's framework for that problem. (shrink)

Ethical considerations from both the clinical and public health perspectives have been used to examine whether it is ethically permissible to mandate the seasonal influenza vaccine for healthcare workers (HCWs). Both frameworks have resulted in arguments for and against the requirement. Neither perspective resolves the question fully. By adding components of justice to the argument, I seek to provide a more fulsome ethical defence for requiring seasonal influenza immunisation for HCWs. Two critical components of a just society support requiring vaccination: (...) fairness of opportunity and the obligation to follow democratically formulated rules. The fairness of opportunity is informed by Rawls’ two principles of justice. The obligation to follow democratically formulated rules allows us to focus simultaneously on freedom, plurality and solidarity. Justice requires equitable participation in and benefit from cooperative schemes to gain or profit socially as individuals and as a community. And to be just, HCW immunisation exemptions should be limited to medical contraindications only. In addition to the HCWs fiduciary duty to do what is best for the patient and the public health duty to protect the community with effective and minimally intrusive interventions, HCWs are members of a just society in which all members have an obligation to participate equitably in order to partake in the benefits of membership. (shrink)

The study of Theodor Adorno has largely ignored or dismissed the enigmatic and provocative moments in his writing on the body. Dialectics of the Body corrects this gap by arguing that Adorno's analysis of reified society emanates and returns to the body and that hope and desire are present throughout Adorno's philosophy.

As has become tradition, executive directors of United States’ presidential bioethics committees offer reflections about their experience shortly after the orderly shutdown of the commission staff. After the records are filed according to government records regulations; after all the staff members, who are hired into temporary positions that must be renewed every two years, have secured permanent employment; after preparations are made to ensure that the next commission staff (should there be one) has a budget and standard operating procedures in (...) order to begin its work in a timely manner; after the lights are turned out for the last time, the executive director makes the final climb up the stairs into the sunlight and reflects on the whirlwind. There is much about my work with the Presidential Commission for the Study of Bioethical Issues that deserves comment, but one aspect of the commission that has been especially valuable to me is its work to educate the nation on bioethical issues. This is, moreover, a contribution in which the commission staff was central, and it is one that, as an ethics educator myself, I will cherish deeply. (shrink)

From accessible and affordable health care to old or new reproductive technologies, human or animal research, and beyond, the justice and well‐being of our society depends on the ability of key groups—such as scientists and health care providers—along with members of the public to identify the key issues, articulate their values and concerns, deliberate openly and respectfully, and together find the most defensible ways forward.The Presidential Commission for the Study of Bioethical Issues and The Hastings Center are committed to improving (...) the ethical literacy of the American public in the domain of bioethics. But what are the best educational practices to spur and support these sorts of societal conversations? And where are the greatest gaps in our collective knowledge of how best to inspire and increase moral understanding, analytical thinking in the moral domain, and professional integrity? (shrink)

Drawing on her 35-year plus experience in the classroom, Lisa Lee has transformed her extensive and authentic teaching experience into a contagious passion and energy with a specialization in Gifted and Talented programs and a focus on the students who don't always fit in a box. The Heart of Teaching is a book about her experience as a teacher, and the students she both taught and learned from, and the lessons she garnered as someone who always taught from the heart.

Giving Voice to Values as a Professional Physician: An Introduction to Medical Ethics by Ira Bedzow (2019, Routledge) is a short and accessible volume that introduces practical ethical decision mak...