Klingler Corinna, Barrett Drue H, Ondrusek Nancy, Johnson Brooke R, Saxena Abha, Reis Andreas A
Institute of Ethics, History & Theory of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany (Ms Klingler); Public Health Ethics Unit, Office of Scientific Integrity, Office of the Associate Director for Science, Office of the Director, Centers for Disease Control and Prevention, Atlanta, Georgia, USA (Dr Barrett); Science Office, Public Health Ontario, Toronto, Ontario, Canada (Dr Ondrusek); Department of Reproductive Health and Research & UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland (Dr Johnson); and Global Health Ethics Unit, Health Systems and Innovation Cluster, World Health Organization, Geneva, Switzerland (Drs Saxena and Reis).
J Public Health Manag Pract. 2020 Mar/Apr;26(2):E12-E22. doi: 10.1097/PHH.0000000000000734.
Public health institutions increasingly realize the importance of creating a culture in their organizations that values ethics. When developing strategies to strengthen ethics, institutions will have to take into account that while public health research projects typically undergo thorough ethics review, activities considered public health practice may not be subjected to similar oversight. This approach, based on a research-practice dichotomy, is increasingly being criticized as it does not adequately identify and manage ethically relevant risks to those affected by nonresearch activities. As a reaction, 3 major public health institutions (the World Health Organization, US Centers for Disease Control and Prevention, and Public Health Ontario) have implemented mechanisms for ethics review of public health practice activities. In this article, we describe and critically discuss the different modalities of the 3 approaches. We argue that although further evaluation is necessary to determine the effectiveness of the different approaches, public health institutions should strive to implement procedures to ensure that public health practice adheres to the highest ethical standards.
公共卫生机构越来越意识到在其组织中营造一种重视道德规范的文化的重要性。在制定加强道德规范的策略时，机构必须考虑到，虽然公共卫生研究项目通常会接受全面的伦理审查，但被视为公共卫生实践的活动可能不会受到类似的监督。这种基于研究与实践二分法的方法越来越受到批评，因为它没有充分识别和管理对受非研究活动影响的人具有伦理相关性的风险。作为回应，3个主要的公共卫生机构（世界卫生组织、美国疾病控制与预防中心和安大略省公共卫生厅）已经实施了对公共卫生实践活动进行伦理审查的机制。在本文中，我们描述并批判性地讨论这3种方法的不同模式。我们认为，尽管需要进一步评估以确定不同方法的有效性，但公共卫生机构应努力实施程序，以确保公共卫生实践符合最高的道德标准。
