An Ethics Framework for Public Health Critique
Aaron Sweazy
Concordia University of Nebraska
Public Health Ethics
MPH 560
Dr. Shalah Watkins-Bailey
September 07, 2014
AN ETHICS FRAMEWORK FOR PUBLIC HEALTH1
An Ethics Framework for Public Health Critique
In review of the literature of An Ethics Framework for Public Health (Kass, 2001), there seems to be some problems in each of the steps which are addressed in my personal opinion. In steps one the mentioning of goals of a program come into sight. In step one of the Framework (Kass, 2001, p. 1777), Dr. Kass is quoted by saying, “A health education program in cardiac risk reduction should have as its ultimate goal (or the ultimate goal of a larger program of which it is a part) that individuals will have fewer heart attacks, not simply that individuals will learn new information or even that they will change their behavior.” Wanting “fewer” is great, but you probably will not have those fewer behaviors if you do not learn new information or change your health behavior toprevent the risk of heart attack. Although heredity could still come into play, even with those two traits being adopted(Centers for Disease Control and Prevention [CDC], 2009). In step two(Kass, 2001, p. 1778), Kass mentions the risk of assumptions quite often and how that is a negative. Without assumptions in the first place in my personal opinion, we wouldn’t test for certain ailments in society. When dealing with prevention programs most the time we are talking about reasons for really wanting to test a hypothesis. If we think eating too much peanut butter will turn us into a peanut, then we could test it (in theory), but the likelihood of you becoming Mr. Planters is a not very likely. However, if we see evidence of maybe something like a higher drinking rate in one spouse versus the other resulting significant health problems to both members of the couple from a mental health aspect and have data-based evidence as mentioned (Kass, 2001, p. 1778) then I don’t see a problem. In step three (Kass, 2001, p. 1779), as long as there is data-based evidence as mentioned in the previous sentence, I think it is asinine not to as Kass (2001, p.1779) states, “propose targeting public health intervention only to certain groups.” However, if it is just based on assumptions as to why a group should be tested, then I do concur with Dr. Kass’ statement regarding targeting groups. Step four (Kass, 2001, p. 1780) delves into the query of whether or not we can find alternative approaches in a program. Dr. Kass (2001, p. 1780) is quoted as saying; “If step 3 suggests that a program or policy carries potential or actual burdens, we are ethically required to determine whether the program could be modified in ways that minimize the burdens while not greatly reducing the program's efficacy.” Some research in my opinion should not be modified, instead if a conflict of morality lies within an individual patient and you are specifically testing how a medicine for example would work in reducing “post chemo-therapy fatigue,” that patient should not be included in the study because of the specifications of the trial require use of the medicine. However, other options for a treatment testing should be provided (when available) to that patient first if eliminated on the basis of “conflict”. This idea seems similar to not having a person on a jury because they are not fit for a particular case because of bias. Step five (Kass, 2001, p. 1780), debates if a program is implemented fairly. While I have no disagreement of fair treatment in implementation and carrying on of a program, the results in themselves could come out to look like a demographic is targeted. If everyindividual is treated the same and research done equally, I see no problem in results which may pinpoint out certain clusters of individuals which was similarly mentioned in the article (Kass, 2001, p. 1781). Finally, in step six Dr. Kass is quoted (Kass, 2001, p. 1781-1782) by saying; “we are a pluralistic society, including with regard to our notions of ethics. Different states and communities will decide differently which public health activities are appropriate and which are overly burdensome.” While the previous quote is true in many regards, it is still important to realize no matter the state an individual is from, they should be treated fairly in research to the point where their counterparts (who might be of different race, religion or gender) are treated the equal (GPO,2012).
References
Centers for Disease Control and Prevention. (2009). Heart Disease Heredity. Retrieved from
Kass, N. E. (2001, November). An Ethics Framework for Public Health . American Journal of Public Health, 91, No.11, 1776-1782. Retrieved from
United States Government Printing Office [GPO] (2012) The Constitution of the United States: With index and the Declaration of Independence (25th ed.). Washington, DC: