Camps Victoria, Hernández-Aguado Ildefonso, Puyol Angel, Segura Andreu
1Universitat Autònoma de Barcelona and Victor Grifols y Lucas Foundation, Barcelona, Spain.
2Miguel Hernandez University, SESPAS, the Spanish Society of Public Health and Health Management and Ciberesp, Alicante, Spain.
Public Health Rev. 2015 Aug 25;36:6. doi: 10.1186/s40985-015-0008-x. eCollection 2015.
Training in public health ethics is not at the core of public health programmes in Europe. The fruitful progress of the United States could stimulate the European schools of public health and other academic institutions to develop specifically European teaching programmes for ethics that embrace both transatlantic innovations and some adaptations based on the evolution of moral values in European societies. This paper reviews the arguments for a European public health ethics curriculum and recommends the main features of such a programme. Europe shares common values and, above all, the three major ethical principles that were socially and politically crystallized by the French Revolution: liberty, equality, and fraternity. Fraternity, otherwise known as solidarity, although rarely mentioned in the literature on ethical issues, is the moral value that best defines the European concept of public health expressed as a common good, mutual aid, and a collective or shared responsibility for health of the population. Specific political motivations were responsible for the origin of European health systems and for current policy proposals led by the European Union, such as Europe's commitments, at least in theory, to: reduce social inequities in health and to develop the health in all policies approach. These and other initiatives, albeit not exclusively European, have political and legal repercussions that pose unique ethical challenges. Europe combines homogeneity in social determinants of health with heterogeneity in public health approaches and interventions. It is therefore necessary to develop training in ethics and good government for all public health workers in Europe, especially since a large segment of the population's health depends on actions and decisions adopted by the European Commission and its regulatory agencies as well as for non EU European Region countries. Based on these arguments, the paper concludes with several recommendations for a common nucleus for the ethics curriculum in Europe.
公共卫生伦理培训并非欧洲公共卫生项目的核心内容。美国在此方面取得的丰硕进展可能会促使欧洲的公共卫生学院及其他学术机构开发专门针对欧洲的伦理教学项目，这些项目既要涵盖跨大西洋的创新理念，又要根据欧洲社会道德价值观的演变进行一些调整。本文回顾了设立欧洲公共卫生伦理课程的相关论点，并推荐了该课程的主要特色。欧洲拥有共同的价值观，最重要的是，还有法国大革命在社会和政治层面所明确的三大伦理原则：自由、平等和博爱。博爱，也就是团结，尽管在伦理问题的文献中很少被提及，但它是最能界定欧洲公共卫生概念的道德价值观，即公共卫生是一种公益、互助以及对民众健康的集体或共同责任。欧洲卫生系统的起源以及欧盟当前主导的政策提议，比如欧洲至少在理论上所承诺的：减少健康方面的社会不平等以及推行“健康融入所有政策”的方针，都有着特定的政治动机。这些举措以及其他举措，尽管并非欧洲所独有，但都产生了政治和法律影响，带来了独特的伦理挑战。欧洲在健康的社会决定因素方面具有同质性，但在公共卫生方法和干预措施上却存在异质性。因此，有必要为欧洲所有公共卫生工作者开展伦理与善治方面的培训，尤其是鉴于很大一部分民众的健康取决于欧盟委员会及其监管机构以及非欧盟欧洲区域国家所采取的行动和做出的决策。基于这些论点，本文最后针对欧洲伦理课程的共同核心内容提出了若干建议。
