Ortmann Leonard W., Barrett Drue H., Saenz Carla, Bernheim Ruth Gaare, Dawson Angus, Valentine Jo A., Reis Andreas
Office of Scientific Integrity, Office of the Associate Director for Science, Office of the Director, Centers for Disease Control and Prevention, Atlanta, GA, USA
Regional Program on Bioethics, Office of Knowledge Management, Bioethics, and Research, Pan American Health Organization, Washington, DC, USA
Introducing poses two special challenges. First, it is a relatively new field that combines public health and practical ethics. Its unfamiliarity requires considerable explanation, yet its scope and emergent qualities make delineation difficult. Moreover, while the early development of public health ethics occurred in a western context, its reach, like public health itself, has become global. A second challenge, then, is to articulate an approach specific enough to provide clear guidance yet sufficiently flexible and encompassing to adapt to global contexts. Broadly speaking, public health ethics helps guide practical decisions affecting population or community health based on scientific evidence and in accordance with accepted values and standards of right and wrong. In these ways, public health ethics builds on its parent disciplines of public health and ethics. This dual inheritance plays out in the definition the U.S. Centers for Disease Control and Prevention (CDC) offers of public health ethics: “A systematic process to clarify, prioritize, and justify possible courses of public health action based on ethical principles, values and beliefs of stakeholders, and scientific and other information” (CDC 2011). Public health ethics shares with other fields of practical and professional ethics both the general theories of ethics and a common store of ethical principles, values, and beliefs. It differs from these other fields largely in the nature of challenges that public health officials typically encounter and in the ethical frameworks it employs to address these challenges. Frameworks provide methodical approaches or procedures that tailor general ethical theories, principles, values, and beliefs to the specific ethical challenges that arise in a particular field. Although no framework is definitive, many are useful, and some are especially effective in particular contexts. This chapter will conclude by setting forth a straightforward, stepwise ethics framework that provides a tool for analyzing the cases in this volume and, more importantly, one that public health practitioners have found useful in a range of contexts. For a public health practitioner, knowing how to employ an ethics framework to address a range of ethical challenges in public health—a know-how that depends on practice—is the ultimate take-home message.
引入该领域带来了两个特殊挑战。其一，它是一个相对较新的领域，融合了公共卫生与实践伦理学。因其鲜为人知，需要大量解释，但它的范围和新出现的特质又使得界定颇具难度。此外，虽然公共卫生伦理学的早期发展发生在西方背景下，但其影响范围，如同公共卫生本身一样，已走向全球。那么，第二个挑战就是要阐明一种足够具体以提供明确指导，但又足够灵活且具有包容性以适应全球背景的方法。广义而言，公共卫生伦理学有助于基于科学证据并依据公认的是非价值观和标准，指导影响人群或社区健康的实际决策。通过这些方式，公共卫生伦理学建立在其母学科公共卫生和伦理学之上。这种双重传承体现在美国疾病控制与预防中心（CDC）对公共卫生伦理学的定义中：“一个基于利益相关者的伦理原则、价值观和信念以及科学和其他信息，来阐明、优先排序并证明公共卫生行动可能方案合理性的系统过程”（CDC，2011年）。公共卫生伦理学与其他实践和专业伦理学领域一样，都共享伦理学的一般理论以及一套共同储存的伦理原则、价值观和信念。它与其他这些领域的主要区别在于公共卫生官员通常遇到的挑战的性质，以及它用于应对这些挑战的伦理框架。框架提供了有条理的方法或程序，将一般伦理理论、原则、价值观和信念应用于特定领域中出现的具体伦理挑战。虽然没有一个框架是确定无疑的，但许多框架都很有用，有些在特定背景下尤其有效。本章将通过阐述一个简单明了、循序渐进的伦理学框架来作结，该框架为分析本卷中的案例提供了一个工具，更重要的是，公共卫生从业者在一系列背景下都发现它很有用。对于公共卫生从业者来说，知道如何运用伦理学框架来应对公共卫生中的一系列伦理挑战——这种技能依赖于实践——才是最终的关键收获。
