When anyone is thinking of making a decision about an issue related to public health they may find the following ethical principles helpful. However, this list only describes some of the important factors to think about. Not all of the principles will always be relevant, and no one principle will always take priority. The type of disease in question (e.g. how it is passed from person-to-person, what symptoms it causes, etc.) will also be important in deciding what action to take.
(a) Common good: Many public health actions require collective activities that are organized by the state to work for the good of the population or the common good (e.g. restaurant inspections). Creating and maintaining public health is only possible when public policies allow such actions to protect the common good.
(b) Solidarity: Solidarity recognizes what some people call “relational personhoodâ€: the fact that people are not simply individuals but are part of the communities within which they live. Important values are promoted when people are able to support each other and stand together against a common threat to their wellbeing.
(c) Equity: Public health ethics needs to pay attention to the ways some people can become disadvantaged or privileged as a result of their background or baseline conditions with special attention paid to those who are most disadvantaged.
(d) Reciprocity: Where society benefits from the actions of individuals or communities who are contributing to public health, society must try to “re-pay” such individuals and communities for their efforts (e.g. making sure that people who are confined to their homes to prevent possible transmission of disease have enough food and means of communication with family and friends).
(e) Least restrictive means: Interventions should be the least restrictive to the individual as possible, and more extreme measures (e.g. forced confinement to home) should only be used if less extreme measures have failed (e.g. voluntary confinement to home).
(f) Necessity: The proposed action must be necessary to prevent an avoidable health threat.
(g) Effectiveness: The proposed public health action should be based on the best possible evidence in terms of being effective at preventing or improving specific health conditions.
(h) Proportionality: The public health benefits of an action must outweigh the personal costs to individuals.
(i) Harm: Public health actions that go against an individual’s wishes must only be put into place to prevent harm to others.
(j) Individual Liberty: In a public health crisis, restrictions to individual freedom should be proportional, necessary, relevant, employ the least restrictive means, and be applied equitably (see above for definitions).
(k) Privacy: Individuals have a right to privacy in health care. In a public health crisis, it may be necessary to override this right to protect the public from serious harm.
(l) Trust: During a public health crisis, decision makers must work hard at maintaining the trust of stakeholders (patients, health care providers, various health care and community organizations, and the public). Trust is enhanced by the principle of transparency (see below).
(m) Duty to provide care: For all health care professionals, there are ethical codes that relate to the duty to provide care and to respond to suffering. In public health emergencies, health care providers will have to weigh the demands of their professional roles against their duties to their own health, and to friends and families.
(n) Stewardship: Those who are governing and making decisions must be guided by stewardship. This principle implies trust, ethical behaviour, and good decision making. Decisions regarding the public health action should be made in an attempt to achieve the best patient health and public health outcomes given the unique circumstances of the public health issue at hand.