Rauprich O
Institut für Medizinische Ethik und Geschichte der Medizin, Ruhr-Universität Bochum, Markstrasse 258a, Bochum, BRD.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2008 Feb;51(2):137-50. doi: 10.1007/s00103-008-0442-8.
The goal of public health is to maximise health, and to promote the common good. These two assumptions frequently give rise to claims that public health is founded on utilitarian or communitarian ethics, respectively. In this paper, these claims are critically examined and rejected. It is neither plausible to assume utilitarian goals in public health nor to propose a utilitarian account of public health ethics. The idea of public health as health-related utilitarianism rests on a misconception of utilitarian ethics. Once this misconception is realised, the seeming appeal of public health to utilitarianism quickly fades. Communitarianism, in turn, fails to serve as a comprehensive and systematic ethical account. Some moderate appeals to more communal spirit for public health are well taken, although not exclusive communitarian. Other more extreme proposals of communitarians, e.g. to exercise public-health police power and public-health paternalism, are to be taken with great care. Thus, it is concluded that there is a need for an ethical foundation of public health different from both utilitarianism and communitarianism.
公共卫生的目标是使健康最大化，并促进共同利益。这两个假设常常分别引发关于公共卫生是基于功利主义或社群主义伦理的主张。在本文中，这些主张将受到批判性审视并被否定。在公共卫生中假定功利主义目标既不合理，提出功利主义的公共卫生伦理观也不合理。将公共卫生视为与健康相关的功利主义这一观点基于对功利主义伦理的误解。一旦认识到这种误解，公共卫生对功利主义表面上的吸引力就会迅速消退。社群主义则无法作为一种全面系统的伦理解释。适度呼吁公共卫生要有更多社群精神是合理的，尽管并非排他性的社群主义。社群主义者的其他一些更极端提议，例如行使公共卫生警察权力和公共卫生家长主义，需要谨慎对待。因此，得出的结论是，需要一个不同于功利主义和社群主义的公共卫生伦理基础。
