Teaching ethics in public health programmes is not routine everywhere – at least not in most schools of public health in the European region. Yet empirical evidence shows that schools of public health are more and more interested in the integration of ethics in their curricula, since public health professionals often have to face difficult ethical decisions.

Although the effectiveness of some tobacco programs and policies has been clearly demonstrated in reducing the overall population smoking prevalence, the health benefits are not equally distributed across all socio-economic classes; a situation that clearly runs against the equalitarian ethos of most modern states. In this article, we evaluate the benefits of using Sen’s Capability Approach as a theory of social justice to guide public health program and policy development in a way that would prevent the further increase of inequalities (...) in health outcomes. Starting from four consensual goals of tobacco control practice (i.e. that individuals live a smoke-free life, that smokers quit smoking, that non-smokers are protected from exposure to second-hand smoke and that smoking cessation support is accessible) we found that besides the standard interventions (e.g. education on the harms of smoking, policies to reduce exposure to SHS) an iniquity-proof tobacco control program needs also to address the lack of options of underprivileged people in affordable smoke-free settings and in leisure activities. We conclude that an ethical tobacco prevention program needs to address the broader social determinants of health such as the socio-economic policies that put a strain on people’s capacity to shun or quit smoking. (shrink)

BackgroundFrance has long been a country of immigration and in some respects may be seen to have a generous policy with respect to asylum seekers and access to health care for migrants. The French state notably provides healthcare access for undocumented migrants, through state medical aid and since 1998 has had a humanitarian policy for granting temporary residence permits for medical reason to migrants. Within a context of political debate, reform and tightening immigration control we will examine this latter policy (...) focusing especially on the dilemmas that arise for physicians of migrant patients when they are requested to write medical certificates as part of a TRPMR application. In a 2017 reform the key role of making recommendations on the granting or not of permits was handed over to Ministry of the Interior health inspectors. Recommendations are made after perusal of medical certificates established by the migrant’s physician and complementary evidence.Main bodyThe writing of medical certificates by a physician would seem straightforward. This is far from the case since it raises a number of ethical dilemmas. These occur within a physician-patient relationship embedded within a social contract between the State, the physician and the migrant patient. To clarify the ethical issues arising 3 vignettes based on practice within an infectious disease unit at a large Paris hospital have been developed. The vignettes highlight ethical dilemmas in the care for migrants with tuberculosis, chronic hepatitis, and HIV / AIDS. We will go on to reflect on issues of social justice and responsibility for the health of migrants within a globalized world.ConclusionsCriteria for residence permit delivery appear less than clear-cut and are interpreted in a restrictive way. Neither are the consequences of refusing a residence permit taken into account. We call for an empirical transnational ethics study involving countries implementing similar TRPMR policies. We also call for inclusion of lobbying competences into the medical undergraduate curricula, in order to breed future generations of physicians skilled in defending social justice. (shrink)