Table 1 Overview of frameworks
| Â | Kass | Childress et al. | Public Health Leadership Society | Europhen | Nuffield | Tannahill |
|---|---|---|---|---|---|---|
Title | An ethics framework for public health | Public health ethics: mapping the terrain | Principles of the ethical practice of public health. | Public policies, law and bioethics: a framework for producing public health policy across the European Union | Public health: ethical issues | Beyond evidence- to ethics: a decision-making framework for health promotion, public health and heath improvement |
Year issued | 2001 | 2002 | 2002 | 2006 | 2007 | 2008 |
Area | Public health | Public health in the USA | Public health in the USA | Public health in the EU | Public health | Health promotion, public health and health improvement |
Target group | Professionals | Public health agents | Institutions with an explicit public health mission | Policymakers in the European Union | Policymakers in government, industry, other organisations and individuals | Decision-makers |
Type of policy or intervention that is addressed | Interventions, policy proposals, research initiatives, programs | Interventions | Public health practice, including ideals and policies of institutions | Policy | Measures, policy | Policies, programs, services, activities |
Aim | To indicate ethical implications of programs, to indicate defining values of public health | To provide a rough conceptual map of public health ethics, to help thinking through and resolving conflicts between promoting public health and other moral requirements | To guide institutions by clarifying distinctive elements of public health and the related ethical principles, to provide a standard to which public health institutions can be hold accountable | To help producing common approaches to public health policy across the European Union, especially with regard to tensions between private and public interests | To help considering ethical issues of measures and policy for health improvement | To indicate the function of evidence and ethics in founding policies, to indicate what actions should be implemented |
Analytic tool | Six-Step-Questionnaire | None | None | None | Intervention-Ladder | Decision-Making Triangle |
Set of principles, values or recommendations | Values are mentioned in the text, for instance: public health seeks to improve the well-being of communities | 9 General moral considerations, for instance: producing benefits | 12 Principles of the ethical practice of public health, for instance: public health should address principally the fundamental causes of disease and requirements for health, aiming to prevent adverse health outcomes | 11 Recommendations for more effective ways of developing and implementing policy that attracts greater public support, for instance: public health should strive to create an environment that structures and facilitates individual health, wellbeing and flourishing | 10 principles (Stewardship model), for instance: acceptable public health goals include reducing the risks of ill health that result from other people's actions, such as drink driving and smoking in public places | 10 possible ethical principles, for instance: do good |
Main ethical values | Well-being Privacy and confidentiality Liberty and self-determination Distributive justice Procedural justice These values have been extracted from the description of the considerations of questions 3, 5 and 6. | Well-being Utility Distributive justice and fairness Procedural justice and participation Liberty and autonomy Privacy and confidentiality Trustworthiness Transparency and openness These values have been extracted from the nine moral considerations that are provided in appendix 2. | Well-being Individual rights Participation Empowerment Equality Evidence based Transparency Effectiveness Consent Swiftness Cultural value pluralism Respect for environment Confidentiality and privacy Professionalism Trustworthiness These values have been extracted from the twelve principles that are provided in appendix 2. | Well-being Empowerment Individual rights Liberty and autonomy Personal responsibility and duties Communitarianism Participation Transparency Accountability Trust Confidentiality and privacy Swiftness These values have been extracted from the eleven recommendations that are provided in appendix 2. | Well-being Care of the vulnerable Empowerment Autonomy Fairness and equality Liberty and self determination Openness Privacy These values have been extracted from the ten principles that are provided in appendix 2. | Well-being Equity Respect Empowerment Sustainability Social responsibility Participation Openness Accountability These values have been extracted from the ten ethical principles that are provided in appendix 2. |
Criteria for dealing with ethical conflict | -The greater the burden, the greater must be the expected public health benefit. -The more uneven the benefits and burdens are divided between groups, the greater must be the expected benefit. -Coercive programs should be kept to a minimum, should never be implemented when a less restrictive program would achieve comparable goals, and should be implemented only in the face of a clear public health need and good data demonstrating effectiveness. Disagreements about balancing burdens and benefits should be solved through a system of fair procedures that require a democratic process, including public hearings to consider minority views. | Within particular circumstances promoting the goals of public health (producing benefits, preventing harms and producing utility) may override other moral considerations (such as individual liberty or justice), provided that the following justificatory conditions are met: -Effectiveness -Proportionality -Necessity -Least infringement -Public justification Dealing with conflicts in a fair and trustworthy manner requires a process of public accountability. This involves soliciting input from the relevant publics during the formulation of public health policies as well as justifying to the relevant publics what is being undertaken after decisions have been made. | Not specified | Not specified | -The overall aim should be to achieve the desired health outcomes while minimising restrictions on people's freedom. -The more intrusive a program is, the more benefits its must create. -Ideally the principles should not be infringed, and when infringement is deemed necessary sound justification is required. -The classical harm principle, care of the vulnerable, autonomy and consent are of special importance, either because infringing them can have significant consequences, or because they are of particular relevance to public health interventions. | Documenting judgements can be of value both in consultation and in continuing constructive dialogue after decisions have been made. In case of disagreement, those who disagree may understand what decisions were based on and can argue for a different decision based on the same principles. |
Application to concrete policy issues | Yes (that is to avian influenza preparedness) | Yes (that is to screening programs) | No | Yes (that is to a smacking ban, regulation regarding wearing car seat belts, legalising cannabis, water fluoridation, compulsory immunization, smoking ban in public places) | Yes (that is to infectious disease, obesity, alcohol and smoking and fluoridation of water) | No |