Childress J F, Bernheim R Gaare
Institute for Practical Ethics and Public Life, University of Virginia, Charlottesville, VA 22904, USA.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2008 Feb;51(2):158-63. doi: 10.1007/s00103-008-0444-6.
Viewing public health as a political and social undertaking as well as a goal of this activity, the authors develop some key elements in a framework for public health ethics, with particular attention to the formation of public health policies and to decisions by public health officials that are not fully determined by established public policies. They concentrate on ways to approach ethical conflicts about public health interventions. These conflicts arise because, in addition to the value of public health, societies have a wide range of other values that sometimes constrain the selection of means to achieve public health goals. The authors analyze three approaches for resolving these conflicts (absolutist, contextualist, and presumptivist), argue for the superiority of the presumptivist approach, and briefly explicate five conditions for rebutting presumptions in a process of public justification. In a liberal, pluralistic, democratic society, a presumptivist approach that engages the public in the context of a variety of relationships can provide a foundation for public trust, which is essential to public health as a political and social practice as well as to achieving public health goals.
作者将公共卫生视为一项政治和社会事业以及该活动的一个目标，在公共卫生伦理框架中提出了一些关键要素，尤其关注公共卫生政策的形成以及公共卫生官员做出的并非完全由既定公共政策决定的决策。他们专注于处理公共卫生干预措施方面伦理冲突的方法。这些冲突之所以产生，是因为除了公共卫生的价值之外，社会还有广泛的其他价值，这些价值有时会限制实现公共卫生目标手段的选择。作者分析了三种解决这些冲突的方法（绝对主义、情境主义和推定主义），论证了推定主义方法的优越性，并简要阐述了在公共辩护过程中反驳推定的五个条件。在一个自由、多元、民主的社会中，一种在各种关系背景下让公众参与的推定主义方法可以为公众信任奠定基础，而公众信任对于作为一种政治和社会实践的公共卫生以及实现公共卫生目标而言至关重要。
