Abbasi Mahmoud, Majdzadeh Reza, Zali Alireza, Karimi Abbas, Akrami Forouzan
Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Community Based Participatory Research Center and Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Med Health Care Philos. 2018 Sep;21(3):387-402. doi: 10.1007/s11019-017-9813-y.
Given the evolution of the public health (PH) and the changes from the phenomenon of globalization, this area has encountered new ethical challenges. In order to find a coherent approach to address ethical issues in PH policy, this study aimed to identify the evolution of public health ethics (PHE) frameworks and the main moral values and norms in PH practice and policy. According to the research questions, a systematic search of the literature, in English, with no time limit was performed using the main keywords in databases Web of Science (ISI) and PubMed. Finally, the full text of 56 papers was analyzed. Most of the frameworks have common underpinning assumptions and beliefs, and the need to balance PH moral obligation to prevent harm and health promotion with respect for individual autonomy has been specified. As such, a clear shift from liberal values in biomedical ethics is seen toward the community's collective values in PHE. The main moral norms in PH practice and policy included protecting the population against harm and improving PH benefits, utility and evidenced-based effectiveness, distributive justice and fairness, respect for all, privacy and confidentiality, solidarity, social responsibility, community empowerment and participation, transparency, accountability and trust. Systematic review of PHE frameworks indicates utilization of the aforementioned moral norms through an practical framework as an ethical guide for action in the PH policy. The validity of this process requires a systematic approach including procedural conditions.
鉴于公共卫生（PH）的演变以及全球化现象带来的变化，该领域面临着新的伦理挑战。为了找到一种连贯的方法来解决公共卫生政策中的伦理问题，本研究旨在确定公共卫生伦理（PHE）框架的演变以及公共卫生实践和政策中的主要道德价值观和规范。根据研究问题，使用科学网（ISI）和PubMed数据库中的主要关键词，对英文文献进行了无时间限制的系统检索。最后，对56篇论文的全文进行了分析。大多数框架都有共同的基本假设和信念，并且明确了需要在预防伤害和促进健康的公共卫生道德义务与尊重个人自主权之间取得平衡。因此，可以看到从生物医学伦理中的自由主义价值观向公共卫生伦理中的社区集体价值观的明显转变。公共卫生实践和政策中的主要道德规范包括保护人群免受伤害、提高公共卫生效益、效用和循证有效性、分配正义与公平、尊重所有人、隐私和保密、团结、社会责任、社区赋权与参与、透明度、问责制和信任。对公共卫生伦理框架的系统评价表明，通过一个实用框架来运用上述道德规范，作为公共卫生政策行动的伦理指南。这一过程的有效性需要一种包括程序条件在内的系统方法。
