Soskolne C L
Department of Health Services Administration and Community Medicine, Faculty of Medicine, University of Alberta, Edmonton, Canada.
Public Health Rev. 1991;19(1-4):311-21.
Concern with ethics is central to professionalism. It is only recently, however, that epidemiologists have begun to address ethics formally akin to other professions.
The bearing of ethics theories on the control of environmentally determined diseases is explored.
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.
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.
对伦理的关注是专业精神的核心。然而，直到最近，流行病学家才开始像其他专业一样正式探讨伦理问题。
探讨伦理理论对环境决定疾病控制的影响。
推动环境变化背后的基本原理不仅取决于研究得出的已证实证据，还取决于这种变化在改善健康方面有效且具有成本效益的可能性。这些依存关系被证明是充满价值判断的，尤其是在分配正义方面，并且会因文化和时间的不同而有所变化。流行病学家关注基于义务的科学伦理，这与道义论或伦理的规则功利主义理论相关。此外，公共卫生专业人员关注为最大多数人带来最大利益；公共卫生决策大多基于此。根据主流社会习俗做好事的价值是基于美德理论的考量。然而，在任何伦理理论下，往往都涉及对有害和有益后果的考量。为公共利益行事的义务强烈影响专业行为。因此，疾病控制决策从既定的伦理理论和共同的伦理原则中以各种方式得出。
通过认识到决策的伦理基础，建议和行为能够更好地在道德上得到辩护。此外，理解疾病控制决策的伦理框架为评估科学和文化进步提供了一个评估基础。环境、流行病学、文化和伦理紧密相连。
