Ethical Frameworks in Public Health

I feel very fortunate to be studying public health at this time in our lives. We are facing unprecedented public health actions through policies that are aimed at protecting people from both real and existential threats.

My university degree started in 2018 with my acceptance to the School of Public Health and Social Policy. Mid-way through that degree, our world went into lock-down, and suddenly public health was at the forefront of every major news outlet, social media feed, and government public broadcast.

As a student of public health, I began to sympathize with our public health officers, ministers of health, and anyone responsible for creating impactful policies that are aimed at protecting the population.

The Vaccine Mandate

Photo by National Cancer Institute on Unsplash

Every medical doctor knows that there is a risk/harm ratio to medical treatments. In many cases, the risk of harm outweighs the benefits to potential treatment. “Acceptable risk” is considered when the benefits to the patient outweigh the potential risk of side effects.

On the population level, risk/harm analysis takes on a whole other scale of impact, when considering protecting people en masse.

According to the Canadian Medical Protective Association, “the patient must have been given an adequate explanation about the nature of the proposed investigation or treatment and its anticipated outcome as well as the significant risks involved and alternatives available.” (1) Consent may be bypassed in an emergency situation, such that “there must be demonstrable severe suffering or an imminent threat to the life or health of the patient” (1).

Since we are technically in an emergency situation, governments now have the authority to put forward public health measures in response to the stated threat.

Yet, informed consent remains a crucial part of decision making with any medical treatment in Canada.

Finding an Appropriate Ethical Framework

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Public health officials need to measure the potential benefits of the policy being implemented and the potential for harm.

For example, lock-downs were used to protect the hospital system from being overwhelmed, but lock-downs also were shown to have negative impacts for children’s mental health and families in BC (2).

Now with vaccine mandates, public officials need to weigh the potential benefit of vaccination with the potential risk of harm from restricting access to those who choose not to vaccinate. 

In either case, when considering lock-down, or vaccine mandates, the consequences for our population as a whole are vast.

These are not easy decisions to make.

For the “Greater Good”

One dilemma that policy makers face right now is how to frame public health decisions in an ethical way.

Photo by Lukas on Unsplash

So much more is at stake than the private relationship with one’s medical doctor.

We need to weigh the potential harm to our medical system, which cannot bear to be overwhelmed by emergencies, the risk of lock-downs versus vaccine mandates, and the dilemma of allowing a virus to spread unchecked.

We are also measuring the rights and freedoms of individuals to choose vaccination versus the consequences of those choices to society.

One way to frame vaccine mandates, which can justify restrictions to workplaces and public spaces, is an argument for the “greater good”.

If “for the greater good” our healthcare workers need to be vaccinated, there is a consequence to those whose choose not to, leading to a small migration of workers out of the field of healthcare.

Applying a Different Lens

In my academic studies we looked at the social determinants of health (SDOH) as the foundation for understanding population health (HLTH 300). It is often found, for example, that after public health emergencies, that some populations are disproportionately impacted (3). Even natural disasters tend to hit certain groups more than others, where social inequalities contributed to the impact of the disaster (4).

So, lock-downs and vaccines are one way to address the current crisis. Another is a thorough examination of the social determinants of health, so that we understand how it is that certain people are more susceptible, what makes our whole population or whole medical system vulnerable, and what protective factors are at play which contribute to resilience and community wellness.

For those interested in learning more, and gaining the skills to evaluate population health in a critical way, consider applying for a Bachelor’s or Master’s degree with the University of Victoria’s School of Public Health and Social Policy.

Both are available online through the Faculty of Human and Social Development and can be found here: Learn Online: Department of Human and Social Development

For my part, I am grateful that my education is so relevant to current affairs. I encourage others who are interested in this field to apply.

I think that the past two years have shown me that we need more people with knowledge about public health, and with the ability to think critically about public health policy.

 

(1) https://www.cmpa-acpm.ca/en/advice-publications/handbooks/consent-a-guide-for-canadian-physicians#informed%20consent

(2) https://www.cbc.ca/news/canada/british-columbia/children-mental-health-covid-19-report-bc-1.5798568

(3) https://vancouver.ca/files/cov/pdi-covid-current-state-report-january-2021.pdf

(4) https://theconversation.com/hurricane-damage-harms-the-most-vulnerable-reveals-inequality-and-social-divides-159678

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