“Principlism is a normative ethical framework which is used to navigate practical decision-making in the delivery of health care services” (Mundeva, Snyder, Ngilangwa, & Kaida, 2018). Ethical principles that are applied to health care strategy aid in decision making. Public health covers a wide array of topics, in particular, bioethics and law. Bioethics applies ethical principles to the field of medicine and healthcare. Ethics is the discipline of the conceptions around good and bad, right and wrong which lead to legal regulation of the law.
The Institute of Medicine defines public health as “what we, as a society, do collectively to assure the conditions for people to be healthy” (The Hastings Center, 2020). With that being said, how can we assure that we are doing everything to ensure optimal conditions for communities? Or making sure the ethical principles are adhered to today or any day? For instance, there are several improvement ideas for accountability roles in place in low-income countries, specifically, as it relates to case management for people living with HIV and AIDS. (Matthew, 2020)
The systematic review, in an article by Hastings and Mundeva, et al., evaluates accountability and its relation to public health bioethical principles. Health systems are made up differently in low-income countries than those in high-income countries. Both types of countries have their own set of problems but each countries issues can be equally distributed and resolved with the same strategies. There are several effects from the low accountability.
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Are these care delivery arrangements effective? How do these arrangements provide privacy to the individuals in the community? These health systems reviewed were also found to affect the data privacy of clients because their client information were extracted from databases such as CDSR, PubMED, Embase, Health Technology Assessment Database, CINAHL, PsycINFO, and the World Health Organization Database, just to name a few. Accountability can improve through training and compensation (Mundeva, Snyder, Ngilangwa, & Kaida, 2018).
Public health should achieve community health in a way that respects the rights of individuals in the community. It is in this way that a constitutional foundation of a reasonable public servant holds value in public health and through constitutional law, “violating individuals’ constitutional rights and what constitutional procedural due process, free speech, privacy, and equal protection” will be obsolete for physicians to abuse.
The ethical principles applied to medical problems provide a solution to legal issues as it relates to communities and individuals. Bioethics and the law combine to develop several constitutional foundations which are followed through the ethical principles. The six ethical principles which can be applied to public health laws discussed in this paper are listed as follows:
Public health should achieve community health in a way that respects the rights of individuals in the community. If there is a way to continuously represent for individuals who are unable to be advocates for themselves, it would be through these principles that public health professionals can do their part in making sure patients are respected. One violation which comes to mind is that of the respect of a person’s body but in a way where a physician will not respect a patient in life threatening situations.
Whether it may be by form of legal will, or through directives giving through hospital forms for the patient to decide upon their life. These types of decisions take time, but some physicians coerce a patient into making a rushed decision based on medical costs and/or insurance. Whether useful or not, the Federal Patient Self-Determination Act exists and (Alves Pedrosa, 2018) requires all health care providers to inform patients of their rights under state law to make medical decisions and to execute advance directives.
Public health policies, programs, and priorities should be developed and evaluated through processes that ensure an opportunity for input from community members. It is through the Constitution that people are protected and afforded the right to free speech. The 1st amendment translates into this principle by assuring that the community can be heard. For instance, there are some trace free speech violations when in one article “Reasonable Accommodation of Conscientious Objection in Health Care is Morally and Legally Required” some individuals have been deprived of their rights in environments such as “hospitals and specialized clinics” (Powell, 2019).
For example, in an obstetrics clinic, in 2019, President Obama by way of President Trump, enacted the Final Conscience Rule Protecting Health Care Entities and Individuals, which would prevent a violation of an individual free speech, speaking out against abortion. People may have a “conscientious objection” to one issue but can still have the right to speak and place their input about their disagreement. A person’s right to speech can be an opportunity to provide insight to a program or policy during development or evaluation.
Public health should advocate and work for the empowerment of disenfranchised community members, aiming to ensure that the basic resources and conditions necessary for health are accessible to all. It is a civil right for citizens to be legally guided by licensed health care advocates in a way that is at a high level standard of care. Sometimes people in these areas are unable to advocate for themselves and experience the effects of paternalism which can keep a group of people paralyzed and unable to speak out about their issues. Serious issues of paternalism or the stripping of an individual’s autonomy in health care include cases where physicians (Fernandez-Ballesteros, et al., 2019) tell patients what is good for them, without regard to the patient’s own needs and interests.
Public health should seek the information needed to implement effective policies and programs that protect and promote health. Public health professionals have the duty to constantly research strategy, continue training, and provide interventions for periodic review of healthcare. For example, under the Constitution, the Tenth Amendment reserves for the state “police power” (King & Smith, 2016). This means that the states have the power to “implement programs to protect the ‘health, safety, morals, and general welfare’ of the community.
Unfortunately, a part of the law that violates the principle of autonomy because parens patriae, a long-standing common-law doctrine, gives the state the power to make decisions for those who cannot speak for themselves, but it seems that the state was already prepared for this dichotomy; Both agents combined work to justify the requirement for state newborn screening (King & Smith, 2016).
Public health institutions should provide communities with the information they have that is needed for decisions on policies or programs and should obtain the community’s consent for their implementation. It is important to inform the community when needed of any health dangers which may threaten the wellbeing of society. Patients have the right to informed consent and this rule is guided by the principles of justice, autonomy, and beneficence. Physicians and other healthcare providers have a duty to do what is best for their patient and should receive information of consent based upon the patient’s health. This respect is afforded to the community.
Public health institutions should protect the confidentiality of information that can bring harm to an individual or community if made public. Exceptions must be justified on the basis of the high likelihood of significant harm to the individual or others. In this case, data privacy for the individual is a great example which is managed through the principle of non-maleficence.
Jane Orient wrote a letter or statement to the Oversight and Investigations Subcommittee, House Energy and Commerce Committee about federal vaccine mandates. Vaccines are in place today by science to reach total immune state or herd immunity. She gave a great argument opposing federal vaccine mandates. Orient also mentioned something very valuable in her argument that “the regulation of medical practice is a state function, not a federal one”.
She said this because vaccine mandates are a part of the state medical guidelines. There should not be federal intrusion into a state run guideline. Simply put “governmental preemption of patients’ or parents’ decisions about accepting drugs or other medical interventions is a serious intrusion into individual liberty, autonomy, and parental decisions about child rearing” (Orient M.D. & Physicians and Surgeons, 2019).
The policy on mandatory vaccines is considered a public health threat by some because, unknowingly, to the lower and middle classes, the Vaccine Injury Compensation Program has paid some $4 billion in damages. And these patients have not even received their damages yet. For instance, “the whole-cell pertussis vaccine was withdrawn from the U.S. market, a decade later than from the Japanese market, because of reports of severe brain damage” (Orient, 2019). All of these threatening vaccines have been replaced with so-called safer, but less effective brands (Orient, 2019).
In a study by the Lancet Infectious Diseases, for measles, they report that it is four to five times worse following pre-vaccination (Fefferman & Naumova, 2015). Here are a list of issues that Congress should consider:
- Manufacturers should make more “monovalent” vaccines; Mixed vaccines such as MMR is considered less safe.
- Efforts and research to report vaccine adverse effects are being suppressed.
- Congress should look at researching whether vaccines are actually causing birth defects in children or maybe are weakening children’s immune system. For example, Zika and rubella virus effects on developing humans. Are their genetic codes/make-up being mutated or compromised in some way?
- Vaccines are not the only way to control the spread of disease
Vaccinated people (Orient, 2019) can still transmit measles or any other virus themselves even if they are not sick themselves. Why should people become vaccinated if there is a possibility for transmittal even so? There should only be mandates for people who have life threatening immune compromising diseases such as sickle cell disease, which weakens your immune system but even that may be taking it too far. In the end, people should be able to exercise their rights to refuse vaccinations.
In conclusion, ethical principles are in place to ensure that patients are given respect and that the rights afforded to the community are followed by healthcare professionals. Ethical principles also protect the community and make it possible to remain autonomous and receive the best medical care. It is great to know that most of our ethical principles run parallel with constitutional foundations which add another level of protection through state law.
