An ethics framework for public health and avian influenza pandemic preparedness.

Public health as an organized discipline began more than 100 years ago to improve the health, primarily, of populations rather than of individuals. Given its population-based focus, however, public health is forever facing dilemmas concerning the appropriate extent of its reach and when the work of public health professionals is infringing on individual liberties in ethically troublesome ways. Nonetheless, there have been few attempts to articulate an ethics of public health, despite the discipline’s long and impressive history. Bioethics, as a discipline, helps health care professionals identify and respond to moral dilemmas in their work. This paper suggests that the contexts out of which bioethics emerged —medical care and human research — were oriented to a different set of concerns than those typically occurring in public health. While the founders of bioethics articulated principles equally relevant for public health, the more specific action guides and codes of health care ethics that have followed are an imperfect fit for public health. Codes of medical and research ethics generally give high priority to individual autonomy, a priority that cannot be assumed to be appropriate for public health practice. A framework of ethics analysis geared specifically for public health is needed, both to provide practical guidance for public health professionals and also to highlight the defining values of public health, values that differ in morally relevant ways from values that define clinical practice and research. A first attempt at such a framework is offered here.