Course: Ethical Issues in Public Health

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Course Description

Lectures and small group discussions focus on ethical theory and current ethical issues in public health and health policy, including resource allocation, the use of summary measures of health, the right to health care, and conflicts between autonomy and health promotion efforts. Student evaluation based on class participation, a group project, and a paper evaluating ethical issues in the student's area of public health specialization.

Course Objectives

By the end of this course, students should be able to:

  • Identify and define moral issues in the context of public health practice.
  • Distinguish between a moral issue or argument and other types of issues or arguments.
  • Articulate moral arguments for or against public health policies or practices.

Course Requirements

By the end of each week (lecture + discussion), students should be familiar with the questions/concepts listed below:

> Session 1: FGM and Community Health Education in Niger

  • Understand what it means to give moral reasons in discussions of policy/public health.
  • Be familiar with the basics of different ethical theories.
  • Recognize tensions between:
    • Relativism vs. Universalism (essentialism)
    • Role obligations vs. Ordinary obligations
    • Duties to identified others vs. Duties to statistical others
    • Duties to relations vs. Duties to strangers

> Session 2: 3x5 Case

  • Understand the strengths and weaknesses of various frameworks used in the moral analysis of public health issues.
  • Recognize circumstances in which one framework might be more useful than another.
    • Can the frameworks be used in conjunction with each other?
    • Are any of the frameworks useful for the types of problems you are interested in?

> Session 3: MCHIP Case

  • Understand the effect of competing conceptions of justice in health policy.
  • Understand distinctions between:
    • Positive & Negative rights
    • Rights to health vs. Rights to health care
    • Legal vs. Moral rights
  • Understand special moral issues concerning children in health policy.
  • Understand the role that empirical data plays in moral analysis of health policy.

> Session 4: Obesity

  • Understand various arguments concerning the extent to which the state should be able to legislate personal behavior/"the good life."
  • Understand the link between policy goals and the moral justification of policies

> Session 5: Flu Case

  • Be able to discuss ethical considerations in the prioritization of scarce resources.
  • Practice analyzing moral challenges in public health while working within a group/committee/team environment.

> Session 6: CEA & Summary Measures of Health

  • Understand the tensions among different maximizing approaches in distributive justice.
  • Understand the values embedded in different maximizing and priority setting methodologies.
  • Understand the ethical challenges inherent in the use of summary measures of health for priority setting.
  • Be able to discuss merits of different ways to conduct priority setting in the face of disagreement

> Session 7: 10/90 Case

  • Understand the distinctions between and within these terms:
    • Poverty
    • Equality
    • Equity
  • Understand/Review implications of competing theories of justice.
  • Understand tensions between demands of global and domestic justice.

> Session 8: B/W Infant Mortality Ratio

  • Identify what's at stake in targeting disparities
    • Inequality vs. Position of worst off
  • Understand different considerations in justice for individuals vs. groups.
  • Understand implications of the formal principle of equality in ideal societies vs. real societies.
  • Understand cost-effectiveness considerations in targeting disparities.
  • Understand Public Health as Social Justice.

Participation and Attendance

Full participation credit (15pts) will be given to students who regularly contribute to their weekly discussion sections. The small group nature of the discussion sections are designed to create an environment in which every student should feel free to speak up. Completion of the required readings for each week and attendance at the Monday lectures are essential in preparing students to contribute to their discussion sections.

Full attendance credit (15pts) will be given to students who miss no more than two (2) total class periods (lectures or discussion sections). No attendance points will be awarded to any student who misses more than two (2) total class periods. Allowances will be made for students with extenuating circumstances.

Influenze Group Project

You will partner with other students in your discussion section to provide an analysis of the influenza vaccine allocation case study handed out during the first class session. Each group will work to identify the ethical issues involved and to recommend and justify a course of action on ethical grounds. Additionally, you will individually provide a 1-2 paragraph critique of the recommendations developed by a group in the alternate discussion section. Detailed instructions will be provided along with the case study. This is a pass/fail assignment, i.e., full credit (10pts) will be awarded to students that pass.

Original Case Study

You will be responsible for developing an original case study presenting a moral dilemma that you will subsequently analyze for your final project. Case study development is worth 10 points toward your final grade. Detailed instructions will be provided in a separate handout.

Final Paper

For your final assignment, you will provide a detailed moral analysis of the original case study and moral dilemma that you will develop. This paper is worth 50 points towards your final grade. Detailed instructions will be provided in a separate handout.

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