To explore convergence and divergence in ethical stances of public health and of members of the population regarding acceptability of harm reduction interventions, in particular needle exchange programs.
Forty-nine semi-structured interviews were conducted with French-speaking residents of Quebec City. Content analysis was done to explore the views of the respondents with regard to injection drug users (IDUs) and interventions addressed to them, as well as Quebec policies on harm reduction.
Four main categories of social representations about IDUs have emerged from the discourses of the respondents. IDU were represented as: suffering from a disease (n = 17); victim of a situation that they could not control (n = 14); having chosen to use drugs (n = 12); or delinquent people (n = 6). Those social representations were associated with different ethical stances regarding acceptability of harm reduction interventions. Main divergences between respondents' ethical positions on harm reduction and public health discourses were related to the value of tolerance and its limits.
The Quebec City population interviewed in this study had a high level of tolerance regarding needle distribution to drug addicts. Applied ethics could be a useful way to understand citizens' interpretation of public health interventions.
As interconnections between health, ideology and politics become increasingly acknowledged, gaps in the literature also become visible in terms of analytic frameworks to engage these issues and empirical studies to understand the complexities. 'Critical public-health ethics' provides such an analytic lens. This article presents the results of a critical public-health ethics analysis of the government of Canada's international response to HIV. This qualitative study involved in-depth, semi-structured interviews with 23 experts on Canada's international response over time. Descriptive, thematic and theoretical analyses revealed an underlying dilemma between Canada's philanthropic desire to 'do the right thing' for the broader public good and Canada's commitment to its own economic growth and other forms of self-interest. Related to this tension were four conspicuous areas of silence in the data: (1) The relative absence of moral vocabulary for discussing Canada's duty to respond to the global HIV pandemic. (2) Scant reference to solutions based on poverty reduction. (3) Little awareness about the dominance of neoliberal economic rationality and its impact on HIV. (4) Limited understanding of Canada's function within the international economic order in terms of its role in poverty creation. Our study has implications for Canada and other rich nations through its empirical contribution to the chorus of calls challenging the legitimised, institutionalised and normative practice of considering the economic growth of wealthy countries as the primary objective of global economic policy.
This commentary introduces critical public health ethics as an innovative lens for considering Canada's role in global health. Arising from the relatively young field of public health ethics, this analytic perspective sheds light on questions regarding public health policy, research and practice that often remain shaded from view because of traditional ways of thinking about public health. The advantage of a critical public health ethics lens is illustrated through the example of Canada's role in scaling up access to HIV treatments in developing countries.
1) To describe a public health intervention aimed at reducing the risk of HIV transmission by seropositive people who are unwilling or unable to take precautions to counter HIV transmission; 2) To document ethical principles that help front-line health care professionals arrive at justifiable decisions and actions.
Front-line health care professionals dealing with these cases.
Intervention developed by la Direction de la santé publique de l'Agence de la santé et des services sociaux de Montreal.
A comité d'aide aux intervenants (CAI) was struck to advise health care professionals. To document the ethical principles that help front-line health care professionals in these situations, we undertook a multiple case study based on the committee's approach to counselling care providers for each of the 26 cases dealt with by the CAI between November 1996 and January 2003.
We identified 7 ethical pitfalls: expecting immediate ideal results; simplification of complex situations; generalizing uncritically from a particular case; uncritical ethical bias against coercive measures; inability or refusal to recognize and accept limits; failure to anticipate unintended consequences of an action; acting on incomplete, unvalidated, or unverifiable information.
A process of mutually exercised critical reflection can help health care professionals to identify and avoid ethical pitfalls and arrive at justifiable decisions and actions.
The Danish National Board of Health has expressed its commitment to social equality in health, evidence-informed health promotion and public health ethics, and has issued guidelines for municipalities on health promotion, in Danish named prevention packages. The aim of this article is to analyse whether the Board of Health adheres to ideals of equality, evidence and ethics in these guidelines.
An analysis to detect statements about equity, evidence and ethics in 10 health promotion packages directed at municipalities with the aim of guiding the municipalities towards evidence-informed disease prevention and health promotion.
Despite declared intentions of prioritizing social equality in health, these intentions are largely absent from most of the packages. When health inequalities are mentioned, focus is on the disadvantaged or the marginalized. Several interventions are recommended, where there is no evidence to support them, notwithstanding the ambition of interventions being evidence-informed. Ethical considerations are scanty, scattered and unsystematically integrated. Further, although some packages mention the importance of avoiding stigmatization, there is little indicating how this could be done.
Including reduction of health inequalities and evidence-informed and ethically defendable interventions in health promotion is a challenge, which is not yet fully met by the National Board of Health. When judged from liberal ethical principles, only few of the suggested interventions are acceptable, i.e., those concerning information, but from a paternalistic view, all interventions that may actually benefit the citizens are justified.