title: Putting public health ethics into practice: a systematic framework.
abstract: It is widely acknowledged that public health practice raises ethical issues that require a different approach than traditional biomedical ethics. Several frameworks for public health ethics (PHE) have been proposed; however, none of them provides a practice-oriented combination of the two necessary components: (1) a set of normative criteria based on an explicit ethical justification and (2) a structured methodological approach for applying the resulting normative criteria to concrete public health (PH) issues. Building on prior work in the field and integrating valuable elements of other approaches to PHE, we present a systematic ethical framework that shall guide professionals in planning, conducting, and evaluating PH interventions. Based on a coherentist model of ethical justification, the proposed framework contains (1) an explicit normative foundation with five substantive criteria and seven procedural conditions to guarantee a fair decision process, and (2) a six-step methodological approach for applying the criteria and conditions to the practice of PH and health policy. The framework explicitly ties together ethical analysis and empirical evidence, thus striving for evidence-based PHE. It can provide normative guidance to those who analyze the ethical implications of PH practice including academic ethicists, health policy makers, health technology assessment bodies, and PH professionals. It will enable those who implement a PH intervention and those affected by it (i.e., the target population) to critically assess whether and how the required ethical considerations have been taken into account. Thereby, the framework can contribute to assuring the quality of ethical analysis in PH. Whether the presented framework will be able to achieve its goals has to be determined by evaluating its practical application.
authors.affiliation: Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-University Munich , Munich , Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Marckmann
authors.affiliation: Department of Medical Ethics and Health Policy, Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA.
authors.forename: Harald
authors.initials: H
authors.lastname: Schmidt
authors.affiliation: Centre of Medical Law and Ethics, The Dickson Poon School of Law, King's College London , London , UK.
authors.forename: Neema
authors.initials: N
authors.lastname: Sofaer
authors.affiliation: Institute for History, Ethics and Philosophy of Medicine, Centre for Ethics and Law in the Life Sciences (CELLS), Hannover Medical School , Hannover , Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Strech
keywords: ethical theory; ethics; health policy; program evaluation; public health practice