ETHICAL ANALYSIS IN PUBLIC HEALTH PRACTICE: A MULTI-SECTORAL MIXED-METHODS STUDY

Abstract

Rationale: All decisions in public health practice involve implicit value judgements, and many involve explicit reference to ethical principles. Despite the increased awareness, interest and literature in Public Health Ethics in the past decade, there remains little understanding of what public health practitioners or trainees mean by ethics, what meta-ethical foundations shape their approach to ethical dilemmas, and what prior training in ethics they have had or wish to have. This study aims to answer some of these questions and will serve as the basis for the development of resources to aid public health decision-making. Method: Qualitative and quantitative data were collected from public health practitioners by means of paper and web-based surveys, as well as structured interviews. Data was coded and analysed using SPSS 15. Results: 16/20 trainees, 70/150 Canadian practitioners, and 508/2058 American practitioners responded to the survey; 10 interviews were conducted. There was remarkable heterogeneity of responses regarding prioritization of values and meta-ethical justification of ethical norms. Respondents reported little training in ethics and considerable in enhancing their skills. Conflict between ethical imperatives and the law were a prominent feature of American, but not Canadian respondents. Conclusions: Public Health practitioners hold a variety of disparate views regarding ethics in public health. These translate into different understandings of the goals and means of public health, with far reaching implications in all spheres of practice. A Public Health Ethical Reflection tool was developed to enhance ethical awareness in goal setting, planning and implementation of public health interventions.