Continuing the conversation about public health ethics: education for public health professionals in Europe.

Abstract

Aristotle In this issue of Public Health Reviews, we turn our attention again to public health ethics. In our 2012 issue dedicated to this topic, we published 17 papers on a variety of aspects of ethical public health practice. In that issue, Aceijas et al. surveyed European schools of public health and reported that of the 40 schools responding, a large majority stated that they included ethics in their academic programs [1]. However, the content and nature of teaching was variable and often taught in an unsystematic way. These results are similar to other studies conducted in the United Kingdom [2] and the United States [3]. European schools of public health expressed interest in improving the teaching of public health ethics and asked the Association of Schools of Public Health in the European Region (ASPHER) for support.In response to this request, the editors of Public Health Reviews gathered papers that focus on teaching public health ethics. In the introductory piece, Towards Public Health Ethics, Royo-Bordonada and Roman-Maestre report on the relationship between practice and ethics, examining the raison d'etre of ethics and providing a justification for the need for ethics in public health practice. This and the other papers included in this issue-developed in collaboration with the ASPHER Working Group on Ethics and Values in Public Health-examine various topics including what we should teach, how we should teach it.An important related question is why we should teach public health ethics. Fundamentally, we must teach public health ethics because ethical practice creates and maintains public trust and public health cannot function without public trust. To serve the public-whether through controlling an outbreak of an infectious disease, preparing for or responding to public health emergencies, or reducing the impact of non-communicable diseases-communities and individuals must trust our decisions and actions. This trust grows in large part from past successes, transparent and participatory decision making, and ethical management of the inevitable moral tensions that arise in our work.There is certainly no reason to believe that public health practitioners start from an unethical or immoral stance; quite the contrary, in fact, the vast majority of public health professionals are drawn to the field because of its noble mission. This mission includes a bent toward social justice, mitigating health disparities, and consideration of the community perspective. Solving challenging public health problems, however, requires more than a moral stance [4]. It often requires choosing between two undesirable actions or reconciling tension between competing reasonable interests. These types of ethical decision points are not exceptional; public health practitioners report facing such tensions and challenges in their daily work [5, 6]. Given the numerous and diverse stakeholders affected by public health interventions and the complex systems in which we work, public health professionals must have skills to negotiate solutions that meet diverse, and often conflicting needs. We must prepare public health professionals to move beyond a naive approach of responding to ethical tensions according to their personal moral compass and equip them with skills to recognize ethical dimensions of their work, articulate them, consider possible paths forward, and implement decisions based on both scientific and ethical grounds [4].We must, however, consider past ethical failures and abuses with which public health officials were directly or indirectly involved. While we believe that most public health professionals feel a calling to the mission of public health, the history of the field contains a number of serious ethical lapses. Some of these abuses were located in a particular institution or region and involved wrongful medical interventions-such as eugenics using sterilization and killing for racial purification-purportedly justified by a larger public health objective [7-9]. …