[ad_1]
Public health decision-makers have not always been transparent to the public during the Covid-19 pandemic, often failing to adequately explain the rationale behind decisions such as mask mandates, isolation and quarantine policies, mandatory testing and remote evacuations. Working and learning. In many cases, public health leaders say that the data models they rely on have varying accuracy and reliability, that the available evidence evolves and needs reevaluation, and that reasonable people are “following the science” without realizing it. How to translate data into policy may not be agreed upon. In fact, authorities sometimes rely on “good lies” to deliberately misrepresent facts to support their decisions, communicate or maintain stability.1 Often a policy is morally justifiable simply because it is legally permissible.
These methods have eroded public trust, hindered the adoption of covid mitigation measures, and fueled social movements against health policies and authorities. Once the overly simplistic mantra of “following science” was exposed, different sections of society chose for themselves which guidelines to follow.
One way to prevent the resulting ineffective public health campaigns and further polarization of the population may be to include ethicists in public health teams. Although this approach would not have prevented all wrongdoing, it could have alerted policymakers to a more transparent and accountable approach by adequately warning policymakers of the dangers associated with opacity.
More than 2 years into the Covid-19 pandemic—and despite heated battles over how to balance health, economic, social, and educational issues—public health officials have yet to integrate systematic input from ethicists into their decision-making processes. Instead, they rely primarily on ethical analysis by physicians, epidemiologists, and other public health professionals, most of whom lack extensive training or experience in applied ethics. Because public health ethics has its own standards and principles, much can be gained by collaborating with experienced ethicists.
Public health institutions have long struggled with approaches to integrating ethical analysis into their workflows.2, 3 The Centers for Disease Control and Prevention (CDC) has a Division of Public Health Ethics, however, a major CDC publication; Ethical guidance for public health emergency preparedness and responseIt has not been updated since 2008.4 None of the dozens of epidemic-related resources provided by the National Association of County and City Health Officials detail how to incorporate ethics or ethics professionals into public health decision-making. The lack of practical guidance and educational opportunities in this area is particularly troubling in the context of the nation’s public health system: the United States has more than 3,000 local public health departments and more than 13,000 public school districts, each with significant decision-making authority.
Several factors contribute to the lack of professionals trained in public health ethics. Although any accredited school of public health must offer ethics content, few graduate programs have mandatory ethics courses and most cover only a limited number of ethical topics. Even in the field of bioethics, public health ethics takes a back seat to ethical issues related to patient care, new technologies, and research safeguards, and an ethicist trained in a clinical or research orientation may not be able to translate their knowledge to the public. Health policy. Some public health decision makers may believe that they can engage in ethical analysis without outside consultation.
Although there is no universal public health ethics framework, in the United States, the field grew rapidly during the first years of the AIDS epidemic and began to be integrated after 2000. For example, the pioneers of public health ethics first practiced blinding (testing of blood drawn after an HIV test for other purposes and without identifying information). They support stopping this surveillance method when it happens.5
Public health ethics is distinguished from other fields of bioethics by emphasizing community values and social justice. Balancing individual autonomy and the common good are central, but public health ethical frameworks do not begin with a focus on individual interests. Public health ethics emphasizes principles of good governance that require balancing democratic participation and technocratic knowledge, promoting transparency while protecting privacy, and building and maintaining trust.2 Public health decision-making does not occur in a political vacuum, and policymakers must consider the interests of different constituencies. Although decisions made outside of ethics may be ethically sound, making a point to consistently include ethicists in decision-making processes ensures robust discussion of ethical issues.
Integrating ethicists into public health workflows involves operational and training considerations. Ethics units could be created within public health departments, enabling more efficient workflows, or regional bioethics advisory committees could be established, providing an independent voice not subject to agency or political pressure. Where ethics units or committees are not feasible, public health professionals may seek ethics consultation, and boards of health may integrate ethicists into their teams. States or regions may partner with schools of public health to facilitate these efforts.
Some of these methods have been used: Michigan counties have created regional outbreak ethics committees, and Ohio has worked with Ohio State University ethicists on specific outbreaks. The Defense Advanced Research Projects Agency frequently asks external ethics committees to advise on the community and ethics of technological innovations.
It is important to ensure that ethicists qualified for such roles are trained to consider practical public health concerns. Ethicists must have a strong understanding of public health conceptual frameworks, research methods, and public health politics. Must be prepared to translate ethical theory into current and practical recommendations; And they need to recognize that their role in public health policymaking is as nonpartisan advisors. The best advisors briefly identify the strengths and weaknesses of various possible courses of action; The goal should be to provide concise and impartial advice based on the intersection of values and evidence.
To be sure, training and hiring ethicists is not a panacea for epidemic policymaking concerns, nor is an ethical perspective the only thing that should be consistently incorporated into public health workflows. Important societal questions include how well ethical decisions should be informed and what role ethicists should play in helping society understand complex public health issues. Public health ethicists, however, can help determine how to incorporate diverse perspectives into public health discussions. They can also make valuable contributions to public discussions about policy decisions that impact community health, clarifying and clarifying complex trade-offs and data and policy limitations.
Even when an ethical perspective is included in the discussion, public health leaders and agencies may not have the authority to influence policy, particularly in states where public health mandates are pre-established by legislatures. Independent organizations—such as the American Public Health Association, which often weigh in on policy issues and have a formal public health code of ethics—can therefore play a more active role in highlighting ethical issues related to public health policymaking.
Lawmakers, state officials and members of the public have called for a review of the U.S. government’s emergency preparedness and response to the outbreak. An immunization bill that would establish a commission to review America’s response to Covid-19 has bipartisan congressional support. Some states, such as Indiana, have created panels to review policies such as the pandemic response to rethink their public health systems.
Both initiatives will be important to include ethicists in these initiatives and integrate strategic issues into public health practice to advance their role and strategies in COVID-19 policymaking. Public health professionals must address complex questions of health, equity, and social justice. We believe it is important to intentionally and strategically engage ethics professionals in these decisions.
[ad_2]
Source link
