01.01.2013 At first hand

Editorial Salome von Greyerz. Unlike medical ethics, which are concerned with ethical dilemmas relating to the treatment of individual patients, public health ethics apply to the health sector as a whole. They constitute a basis for ethical judgements of measures taken by health authorities or private health institutions rather than on the actions of individuals such as doctors or nursing staff.

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Public health ethics are predicated on the same four basic principles as medical ethics. The principle of autonomy requires that individuals give their consent to measures such as vaccination before these can be performed. This principle also seeks to strengthen personal responsibility (for instance in the areas of prevention and health promotion) and informed self-determination for the individual (for instance in how their own patient data are handled). The principle of doing no harm (non-maleficence) obliges us to weigh up the risk of harming individuals when undertaking measures to improve the well-being of the community (vaccinations, for instance). The principle of doing good (beneficence) is interpreted in various ways. One position is that the state is obliged to "do good" only under certain circumstances and may intervene only if individual behaviour represents a threat to others (for instance it can impose a smoking ban to protect non-smokers against second-hand smoke). Another interpretation calls for a stronger obligation on the part of the state to do good. This position seeks to create general conditions that enable individuals to assume responsibility for their health. The principle of justice also constitutes a frequent major challenge, since distributive equality and distributive inequality can both be regarded as just, depending on the resources to be distributed. Help in this dilemma can be found in the principle of justice advocated by John Rawls, which states that resources should be distributed in such a way that the worst off become better off. For example, awareness activities should target people whose health skills need to be improved rather than those who are already well informed.

Thus, we too bear the responsibility of judging what we do and what we omit to do from an ethical as well as from a health-policy viewpoint.

Salome von Greyerz, Head of Health Strategies Division, Federal Office of Public Health

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