Buchanan David R
School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 01003, USA.
Am J Public Health. 2008 Jan;98(1):15-21. doi: 10.2105/AJPH.2007.110361. Epub 2007 Nov 29.
With attention to the field of public health ethics growing, significant time has been devoted to identifying a sound ethical justification for paternalistic interventions that override individual autonomy to prevent people from adopting unhealthy behaviors. Efforts focused on specifying the conditions that warrant paternalism, however, are largely misplaced. On empirical and ethical grounds, public health should seek instead to expand individual autonomy to improve population health. To promote autonomy, the field should redirect current efforts toward clarifying principles of justice. Although public health's most highly visible stance is associated with an egalitarian conception of "social justice," it is imperative that public health professionals address gaping divisions in public understandings of justice. I present recommendations for initiating this process.
随着对公共卫生伦理领域的关注不断增加，人们投入了大量时间来确定一种合理的伦理依据，以支持那些为防止人们采取不健康行为而凌驾于个人自主权之上的家长式干预措施。然而，专注于明确证明家长式作风合理性的条件的努力在很大程度上用错了地方。基于实证和伦理依据，公共卫生应转而寻求扩大个人自主权以改善人群健康。为促进自主权，该领域应将当前的努力方向转向阐明正义原则。尽管公共卫生最引人注目的立场与“社会正义”的平等主义概念相关联，但公共卫生专业人员必须解决公众对正义理解中存在的巨大分歧。我提出了启动这一进程的建议。
