Ethics In Public Health Case Study Due In 16hrs

Ethics in Public Health Case Study

[WLO: 3] [CLO: 6]

Prior to beginning work on this assignment, read Chapter 5 in your textbook, the Principles of the Ethical Practice of Public Health (Links to an external site.)Links to an external site. article, and the appropriate pages from Ethics and Public Health: Model Curriculum according to the module you choose below.

For your assignment,

• Select one of the modules presented in the instructions below.
• Provide accurate and appropriate responses to the five worksheet questions associated with the module’s case study.
• Explain your answers using critical thinking and research.

Step 1: Select one of the following case studies located in Ethics and Public health: Model Curriculum for your paper and use the associated worksheet to complete the assignment.

Choose one of the following:

• Module 4: Community-Based Practice and Research: Collaboration and Sharing Power
  • Read the introductory information: pages 103 to 118 (15 pages)
  • Read Case Study 1: Providing Culturally Appropriate Services in a Changing Community: pages 119 through 122 (4 pages)
  • Use the worksheet: Module 4: Case Study 1: Providing Culturally Appropriate Services in a Changing Community
• Module 7: Ethical Issues in Environmental and Occupational Health.
  • Read the introductory information: pages 159 through 169 (10 pages)
  • Read Case Study 1: Environmental Injustice in Homer, Louisiana: pages 170 through 173 (4 pages)
  • Use worksheet: Module 7: Case Study 1: Environmental Injustice in Homer, Louisiana
• Module 9: Public Health and Health System Reform: Access, Priority Setting, and Allocation of Resources
  • Read the introductory information: pages 241 through 252 (12 pages)
  • Read Case Study 3: Making Cuts in a Health Department Budget, including the fact sheet on page 256 and pages 263 through 267 (6 pages)
  • Use the worksheet: Module 9: Case Study 3: Making Cuts in a Health Budget Department Budget

Step 2: Download the worksheet for your selected module and address the questions in the worksheet using complete sentences.

Please know that although this is not a formal written paper, you still need to use APA formatting.

Your completed worksheet

• Must use double-spacing with 1-inch margins
• Must include a separate title page with the following:
  • Title of paper
  • Student’s name
  • Course name and number
  • Instructor’s name
  • Date submitted
    For further assistance with the formatting and the title page, refer to APA Formatting for Word 2013 (Links to an external site.)Links to an external site..
• Must document any information used from sources in APA style as outlined in the Ashford Writing Center’s Citing Within Your Paper (Links to an external site.)Links to an external site.
• Must use at least two additional scholarly, peer-reviewed, or credible sources in addition to the course text and case study itself to support your answers to the case study questions. The Ashford University Library is a great place to find resources. Watch the Ashford University Library Quick ‘n’ Dirty (Links to an external site.)Links to an external site. tutorial for research tips.
  • The Scholarly, Peer Reviewed, and Other Credible Sources (Links to an external site.)Links to an external site. table offers additional guidance on appropriate source types. If you have questions about whether a specific source is appropriate for this assignment, please contact your instructor. Your instructor has the final say about the appropriateness of a specific source for a particular assignment.
• Must include a separate references page that is formatted according to APA style as outlined in the Ashford Writing Center. See the Formatting Your References List (Links to an external site.)Links to an external site. resource in the Ashford Writing Center for specifications.

  5 Public Health Ethics, Law, and Policy

  benkrut/iStock/Thinkstock

  Learning Outcomes

  After reading this chapter, you should be able to

  • Explain the relationship between ethics and public health work.

  • List the central assumptions of the Public Health Code of Ethics.

  • Summarize the importance of key public health cases.

  • Illustrate how policies and laws are utilized in public health efforts.

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  Section 5.1 The Role of Ethics in Public Health

  The ethics, morals, laws, policies, and legislation involved in public health can become very confusing, even for those who work in the field. This chapter provides a brief overview of each of these elements, plus examples of their importance and function in the public health realm. In public health, it is important to understand and differentiate between terms such as ethics and morals, as they can be vastly different in practice. The Public Health Leadership Society’s principles of ethical practice are also key to understanding how and why public health offi- cials make policy recommendations.

  Lastly, this chapter discusses the difference between policy and law, focusing on how policy shapes public health, including its responsibilities and its outcomes. The role of policy briefs, their purpose, and how they are written is explored, and examples of existing policies that became laws and how they have worked within the public health realm are summarized.

  5.1 The Role of Ethics in Public Health Morals and ethics are very much alike in many respects, and the terms are often used inter- changeably; however, they are not the same concepts. Morals are an individual’s principles of right and wrong. They set the stage for acceptable behaviors and beliefs. Morals are not uni- versal, and they are highly individualized, often shaped by upbringing and culture. A person living in House A on Street A may believe that elbows on the table during dinner is unaccept- able (it is “wrong,” or immoral), while a person living in House B on Street B may believe that elbows on the table at meal time is fine (it is “right,” or moral).

  Ethics are principles that govern a person’s behavior because they are rules provided by an external source, such as codes of conduct in a community setting or a workplace. Ethics are more universal and common to a set community. For example, the community of residents on Street B are Amish, and those on Street A are not Amish. The community ethical code in the Amish community (everyone on Street B) would state that elbows on the table are unethical behaviors. This is now considered a principle governed by an external source (the Amish community). So, while the person living in House B on Street B may have a moral belief that elbows on the table are fine, the community of Street B says it is unethical. This is where ethics and morals can collide. In most situ- ations, the ethics of the community outweigh the morals of the individual.

  In public health, morals and ethics collide fre- quently in decision-making. Vaccinations against certain diseases are good examples of this colli- sion. For instance, the state of Pennsylvania might represent the community and mandate vaccination. In this case, Pennsylvania is the external source that sets the code of conduct—the ethical standards for those who live in the state. But there may be many individuals in the state who personally disagree with this code and refuse vaccination. The individuals’ moral beliefs collide with the overarching community’s code.

  Ridofranz/iStock/Thinkstock Personal and cultural beliefs about allowing terminally ill or dying patients to refuse treatment or request physician-assisted suicide may conflict with laws.

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  Section 5.1 The Role of Ethics in Public Health

  Who wins? Who is right? If the law intervenes, it will usually be the community ethical stan- dards that will be upheld; however, if there are no laws, the individual’s morals may stand.

  A national law states that all children must receive vaccinations before attending school. In this case, if an individual is opposed to vaccination yet has a child who needs to attend school, the individual must abide by the law in order to send the child to school.

  As noted in the vaccination example, laws do not always agree with every single community’s morals, but the laws are established to protect that society as a whole. In many cases, laws truly conflict with ethics and morals. For example, it is illegal to kill another human being, even in cases of physician-assisted suicide for dying, or terminal, patients. However, some cultures and individuals believe that it is ethical to allow a person to die with dignity rather than live in pain. Individually, people may believe that physician-assisted suicide is also right. In this case, ethics and morals are similar, but the law prohibits the intended action.

  Research and Clinical Ethics The idea that ethics plays a role in public health is relatively new. More widely understood are the concepts of research ethics and clinical ethics. Research ethics involves the protections of human subjects who are taking part in a study. This usually includes a plethora of disclo- sures and permissions. Most people won’t encounter the concept of research ethics unless they are part of a research project.

  Clinical ethics is more commonly understood because it is encountered in doctor’s offices, clinics, hospitals, and all health-related organizations and facilities. Clinical ethics addresses issues that arise within the patient care realm. Privacy and confidentiality of the patient are the most common ethical practices in the clinical setting, the importance of which contrib- uted to the law known as the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This law requires the protection and safeguarding of all personal health information. Ethically, it seems obvious that health information should be private, and many offices had already been keeping it private before the law was passed because it was valued as important. Making it law transformed this ethical practice into a legal requirement.

  Public health is quite different from clinical health, and, therefore, the focus areas of ethics in both arenas are different. Clinical ethics is related to the treatment of disease and injury, while public health ethics is important in the prevention of disease and injury. Table 5.1 shows a comparison of the two.

  The terms principles and values appear frequently in this chapter, and both play a key role in the ethical practice of public health. However, whose principles and values are being consid- ered? While all people have values of some sort, public health values are rooted in science and community in an effort to prevent disease and injury, protect the public from harm, and pro- mote health and well-being (Barrett et al., 2016). Public health professionals do not use their morals when making decisions that will affect the public. Public health values rest on two ideas: that most health interventions rely upon the community’s acceptance, cooperation, and participation to be successful, and that public health must gain a community’s trust to be able to function effectively. These are the guiding values of public health and the basis for all actions that public health professionals perform at the local, state, federal, and global levels.

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  Section 5.1 The Role of Ethics in Public Health

  Ethics and Public Health Decision-Making In all public health activities, principles and values provide the framework and justification for decision-making. In essence, every aspect of public health must adhere to an ethical frame- work. The CDC (2017w) follows three core functions when applying an ethical framework to its activities:

  1. Identify and clarify the ethical dilemma. 2. Analyze the dilemma in terms of alternative courses of actions plus whatever result-

  ing consequences may occur. 3. Resolve the dilemma through decision-making that incorporates and balances the

  guiding principles and values.

  This framework comes with several key questions to help public health professionals walk through the process to determine the next steps.

  Core Function 1: Identifying and Clarifying the Ethical Dilemma When examining a potential intervention in public health, the first step is to provide the foun- dation on which to base the decision. These questions are usually discussed at length:

  • What are the risks, harms, and/or concerns? • What are the public health goals? • What is the scope of legal authority? That is, what laws and regulations may or may

  not apply?

  Table 5.1: Comparison between clinical and public health ethics

  Clinical ethics Public health ethics

  Medical interventions by clinical professionals Range of interventions by various professionals

  Individual benefit Social, community, or population benefit

  Seeks to avoid harm based on the provider’s fiduciary relation to the patient

  Seeks to avoid harm based on collective action

  Respect for individual patients Relational autonomy of interdependent citizens (community)

  Professional duty for patients over provider Duty to community over individual

  Based on trustworthiness of physician and medical profession

  Based on law

  Informed consent from individual Community consent through consensus

  Limited to treating patients equally and ensuring universal access to health care

  Concern with social justice regarding health and achieving health equity

  Source: Adapted from “Public Health Ethics: Global Cases, Practice, and Context,” by L. W. Ortmann, D. H. Barrett, C. Saenz, R. G. Bernheim, A. Dawson, J. A. Valentine, and A. Reis, in D. H. Barrett, L. W. Ortmann, A. Dawson, C. Saenz, A. Reis, and G. Bolan (Eds.), Public Health Ethics: Cases Spanning the Globe (Vol. 3, p. 23), 2016, Geneva, Switzerland: Springer International Publishing, Open Access.

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  Section 5.1 The Role of Ethics in Public Health

  • What are the moral norms of the community? • Are there any similar cases that provide legal or ethical guidance?

  Consider the potential issues of requiring motorcyclists to wear helmets. In this situation, public health officials have to analyze the risks to, and concerns of, the rider as well as those who may be affected, such as the rider’s family, those who pay for the medical services and costs, and other people on the road. The ethical dilemma is “What harm would come if hel- mets were required for all motorcyclists?”

  This function of the framework also examines community norms. Is there a social concern with motorcyclists not wearing helmets across the state? Is there a strong advocacy call for helmet use? What economic issues would result if helmets were required? Obviously, there is the cost of the helmet, but there is also the cost of medical care in the event an accident occurs. Some people in opposition to the helmet laws state that it violates their personal rights to make their own choices. Supporters of the laws claim that those who get into acci- dents and succumb to head trauma drain medical resources—especially those who do not have insurance. It is an injury that can be prevented just by wearing a helmet.

  States’ opinions on the helmet law vary based on the answers to these questions. Some have no laws or require only passengers under age 17 to wear a helmet; others require everyone on a motorcycle to wear one (Insurance Institute for Highway Safety, 2018). The state of New York requires the use of helmets and has since 1967 (Insurance Institute for Highway Safety, 2018). Refer to A Closer Look for another example of a state examining an ethical dilemma in public health.

  A Closer Look: Applying the Ethical Framework to Alaska Smoking Laws

  While Alaska has one of the most lenient smoking laws in the United States, smoking is prohibited in schools, childcare facilities, most health care facilities, and elevators (American Lung Association, 2016). However, the state government has left the door open for communities to take matters into their own hands, which includes establishing stricter regulations if they wish to do so.

  While public health professionals view the ban as a lifesaving measure, others see it as an attack on personal rights. This is an ethical dilemma that the state cautiously addressed by leaving the main decisions in the hands of each municipality. The state law takes into consideration the rights of smokers by not banning the practice under one law.

  (continued)

  Stefan Malloch/iStock/Thinkstock Alaska has one of the most lenient smoking laws in the United States. Communities can apply stricter regulations if they wish to but are not required to do so.

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  Section 5.1 The Role of Ethics in Public Health

  Core Function 2: Analyzing the Dilemma This function revolves around options. Three key points are considered:

  • What are the short- and long-term options given the responses to the questions from Core Function 1?

  • What are the ethical concerns of each option? • Are there other considerations that should be reviewed, such as privacy, commit-

  ments, or transparency?

  One such public health dilemma received considerable attention and review at this step of the ethical framework: bicycle helmet usage. In the early 1970s, the issue gained momen- tum in Australia, where a significant number of bicyclists died from head injuries. The Royal Australian College of Surgeons actively campaigned to raise awareness of head injuries and their prevention through the use of helmets. Shortly after the campaign went into effect, Aus- tralia became the first country to require helmets for bicyclists, in the early 1990s (Rachele,

  A Closer Look: Applying the Ethical Framework to Alaska Smoking Laws (continued)

  The compromise was simple: If a community desires to allow smoking, it must designate specific locations and clearly mark them with signage. This is to protect the health of those who do not wish to inhale secondhand smoke, as the law states that everyone has the right to clean air. The signage is helpful, but some municipalities did desire to go beyond the state’s law. As a result, some major cities and smaller towns adopted stronger policies based on residents’ desires (see Core Function 1 of the ethical decision-making framework):

  • Sitka, November 18, 2005: Banned smoking in all enclosed workplaces, including restaurants but exempting bars

  • Anchorage, July 1, 2007: Banned smoking in all workplaces, bars, and restaurants • Juneau, January 2, 2008: Banned smoking in bars and restaurants (but not other

  workplaces) • Nome, September 20, 2011: Banned smoking in bars, restaurants, outdoor stadiums,

  vehicles when used for public transportation, and all enclosed workplaces