Chapter 7Organizational Ethics and Public Health Practicewith Drue H. Barrett and Richard E. Dixon

Abstract

Members of the public and stakeholder groups depend on public health agencies to safeguard the health and safety of their families and communities. Public health officials are accountable both to the public and to elected officials and governing bodies with oversight responsibilities [1]. Moreover, United States Federal agencies such as the Centers for Disease Control and Prevention (CDC), which employ many professional epidemiologists, scientists, administrators, and other professionals recognized as experts in their field, enjoy well‐deserved international reputations for excellence in public health research and practice. Similarly, academic institutions, including schools of public health and medicine, also employ many outstanding public health scientists who are accountable to their employer, students, their profession, funding agencies, and the public. Public health professionals, health advocates, elected officials, and other persons with vested interests in the integrity, well‐being, and continued progress of the public health enterprise have witnessed a range of ethical dilemmas and issues involving public health agencies and biomedical institutions. These ethical concerns, including some cases brought to public attention by whistle‐blowers, have involved federal, state, or local health agencies as well as major universities. Focus groups have suggested that ethical issues encountered by public health practitioners in the United States relate to public–private partnerships and collaborations, the allocation of scarce resources, setting of priorities, and choosing among different groups and health needs, the collection and use of data and information, and politics and relationships with other government officials and legislative bodies [2]. Surveys of public health practitioners demonstrate that ethical issues such as conflicts of interest and political pressure occur at the state and local levels [1, 2]. Other reported ethical problems included reports of conflicts of interest, instances of inadvertent release of confidential medical information by leading government agencies and health care organizations and institutions, and charges by government scientists that their research findings had been delayed or altered. These controversies occur at the intersection of politics and public health, partly because of the importance of these public health and biomedical research institutions to the public good. Alleged instances of conflicts of interest, retaliation against whistle‐blowers, and other ethical problems can also be viewed in the context of public health ethics, organizational ethics, and professional ethics.