Rationalizing professional conduct: ethics in disease control.

BACKGROUND

Concern with ethics is central to professionalism. It is only recently, however, that epidemiologists have begun to address ethics formally akin to other professions.

METHODS

The bearing of ethics theories on the control of environmentally determined diseases is explored.

RESULTS

The rationale behind promoting environmental change depends not only on demonstrated evidence from research, but also on the potential for the change to be both effective for improving health and cost-efficient. These dependencies are shown to be value-laden, especially in terms of distributive justice, and to vary across cultures and over time. The epidemiologist is concerned with the scientific ethic which is duty-based, related to deontology or to rule utilitarian theories of ethics. In addition, public health professionals are concerned with doing the greatest good for the greatest number; it is upon this basis that much of public health decision-making rests. The value of doing good according to prevailing social mores is a consideration from virtue-based theory. Under any ethical theory, however, consideration of harmful and beneficial consequences is often involved. The duty to act in the public interest strongly influences professional conduct. Decisions for disease control thus are drawn variously from both the established ethical theories and shared ethical principles.

CONCLUSIONS

By recognizing the ethical basis for decisions, recommendations and conduct are better able to be morally justified. Furthermore, understanding the ethical framework for decisions about disease control provides an evaluative base for assessing both scientific and cultural advances. Environment, epidemiology, culture and ethics are closely intertwined.