J Epidemiol Community Health: first published as 10.1136/jech.55.12.855 on 1 December 2001. Downloaded from J Epidemiol Community Health 2001;55:855–857 855

Glossary

Ethics in epidemiology and public health I. Technical terms

D L Weed, R E McKeown

Ethics in epidemiology and public health has Beneficence (see also: Prima facie, Principles emerged from several sources: most obvious is and Principlism, Utility and Utilitarianism) the discipline of bioethics, with its theories, Literally, doing good; in bioethics, a prima facie methods, case studies, and familiar textbooks. principle underlying utilitarian approaches. Bioethics has primarily been focused upon Implies an obligation to promote benefits of medical ethics and research ethics and only things judged to be good, typically balancing recently has turned its attention to public produced goods against risks or harms. In pub- health. Another source of scholarship is philo- lic health, beneficence implies acting in the best sophical ethics. Here the sourcebooks are the interest of the population or society as a writings of Aristotle, Kant, Mill, Rawls, and whole.56 many others, the so called “high ground” philosophers of the past 2000 years.1 Philo- Bioethics (see also: Ethics) A field of inquiry and academic discipline at sophical ethics provides a rich lode from which 7 to mine theories and concepts and to observe the intersection of ethics and the life sciences. intellectual trends. A third source for ethics in Emerging with an emphasis upon problems epidemiology and public health is closer to faced in the practice of medicine and biomedi- home and is not so closely connected to cal research, bioethics has overlapping areas of bioethics nor philosophical ethics. Public scholarship and application: theory and health practitioners and scholars have written method, clinical practice, regulatory policy, research practice, cultural and social concerns,8 about the ethical problems that underlie 9 professional practice. Advocacy, coercion, and and recently, public health and epidemiology. scientific misconduct are a few representative Case or Case study (see also: Casuistry) examples, but there are many others, including A detailed description of a concrete situation privacy, conflicts of interest, and the rights of requiring ethical analysis and a resultant judg- vulnerable communities. ment or action. Cases provide specific circum- Given the scope and connectedness of these stances involving a patient (in medical ethics), sources, a vast number of words and phrases a study participant or group (in research http://jech.bmj.com/ could be included in a glossary on ethics in ethics) or a population (in public health epidemiology and public health. To organise ethics). Cases are typically grouped by subject what could be a very long list, we identify two matter and as such represent the input to the categories of terms. There are the more techni- methods of practical ethical reasoning.10 cal terms of ethics, such as casuistry, commu- nitarian ethics, obligations, and virtues. These Casuistry (see also: Case or Case study, we define below in the first installment of the Principles and Principlism, Specification) glossary. There are also more applied terms— A method of practical ethical reasoning empha- equipoise, informed consent, privacy and the sising particular cases over theories or princi- on October 3, 2021 by guest. Protected copyright. precautionary principle—representing impor- ples. From paradigm cases and the selection of tant practical issues with significant ethical morally relevant maxims indicating the right content. These will appear in a second install- judgment or action, the user of casuistry finds ment. As the discipline of public health ethics generalisable guidance for judgments and matures, we expect to see many other terms actions when confronted with similar cases. surface. More importantly, we hope to see Casuistry is not incompatible with the methods OYce of Preventive more scholarly discussions of ethical issues. of principlism and specified principlism.11–13 Oncology, Division of Cancer Prevention, Communitarian ethics National Cancer Autonomy (see also: Respect for Persons) An approach to ethics emphasising communal Institute, EPS T-41, Literally, self ruling. Related to, and sometimes values, the common good, social goals, and 6130 Executive Blvd, used in lieu of the bioethical principle of Bethesda, MD traditional practices. Closely aligned with the 20892–7105, USA respect for persons. Implies intentionality and cooperative virtues and a community’s shared freedom from coercion. In the Kantian tradi- understanding of the good life. Often pitted Correspondence to: tion, autonomy implies freely embracing a against liberal individualism (that is, rights- Dr Weed ([email protected]) moral obligation.2 In public health, individual based approaches) in its militant forms, a Accepted for publication autonomy may be limited by interventions moderate communitarian view makes room for 13 June 2001 applied to populations.34 individual rights.41415

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Deontological (see also: Respect for persons) Respect for persons (see also: Autonomy, A duty-based theoretical approach to ethics, Deontological, Prima facie, Principles and associated with the philosopher Kant. Right Principlism) actions stem from freely embraced obligations A prima facie principle in bioethics underlying to universal moral imperatives, such as the the obligation for informed consent in research obligation to respect persons as ends and not as and decisions regarding study design and means.25 interventions. From the Kantian tradition: per- sons should be treated as ends in themselves and not as means to an end. Implies two Ethics (see also: Bioethics) distinct moral requirements: acknowledge au- A philosophical discipline concerned with tonomy and protect those with diminished understanding how human beings should act, autonomy.46 what is good, and what kind of life is best. Rights Justice (see also: Prima facie, Principles and Justified claims made by individuals or groups Principlism) upon others and based on a system of rules In bioethics, a prima facie principle implying authorising us to aYrm or demand what is due. equity or fairness, especially regarding the fair Possessing a right validly constrains others distribution in the population of benefits and from interfering with the exercise of that right. risks of research, health care, or other goods. Moral rights are claims justified by moral prin- Contrasted with retributive justice operating in ciples and are correlated with obligations. In the criminal justice system.16 17 public health, a broadly defined set of human rights are often asserted.19 20 21 Non-maleficence (see also: Beneficence, Prima Specification (see also: Principles and facie, Principles and Principlism) Principlism) Literally, not causing harm. A prima facie A methodological technique for interpreting a principle in bioethics, sometimes subsumed more general ethical principle to bring its under the principle of beneficence. An obliga- implications closer to—to better “apply” it tion traditionally at the heart of medical to—actions and decisions. Specification may ethics—the “first do no harm” component of be used to resolve conflicts among, to balance, the Hippocratic Oath—non-maleficence can or to rank principles. In public health, the Pre- be seen as distinct from the obligation to cautionary Principle is a specified version of produce good. the more general principle of beneficence.12 22 23

Obligation (see also: Principles and Utility and Utilitarian Principlism, Rights) An approach to ethics asserting that one should Used interchangeably with duty. That which is always strive to produce the greatest possible required, although tempered by competing balance of good over harm. Historically, identi- duties. Obligations are correlated with rights. fied with social reform movements of 18th In epidemiology and public health, profes- century England. Classically expressed as the sional role obligations derive from basic ethical obligation to produce the greatest good for the

principles and are articulated in codes of greatest number; more recent accounts empha- http://jech.bmj.com/ professional conduct. sise optimisation of benefits and harms.42021

Prima facie (see also: Principles and Values Principlism, Specification) Concepts used to explain how and why things A term used to describe bioethical principles as matter. Values are involved wherever we distin- neither rules of thumb nor absolute prescrip- guish between things good and bad, better or tions but rather as binding in all cases unless an worse. Values are characterised as scientific, obligation found in one principle conflicts with professional, cultural, social, personal, family, on October 3, 2021 by guest. Protected copyright. another. In such situations, balancing of religious, and organic (for example, health). competing principles is undertaken using the Scientific values include: objectivity, accuracy, technique of specification.18 generalisability, validity and others. Values are pervasive in epidemiology and public health.24–26 Principles and Principlism (see also: Beneficence, Justice, Nonmaleficence, Prima Virtues facie, Respect for Persons, Specification) Character traits—not skills nor techniques— Four prima facie principles remain at the cen- that make an individual a good professional tre of education and debate in bioethics: practitioner, and help her to do her work well. beneficence, nonmaleficence, respect for per- For epidemiologists, the virtues of excellence, sons, and justice. They provide the source of integrity, honesty, self eVacement, and pru- rules for ethical decisions (for example, truth dence are important examples. Virtue is not telling, privacy, informed consent, etc). Rules easily taught but may be learned by example are not deduced from principles (that is, from mentors.14 27 principlism) but rather arise from specification. Users of casuistry may also refer to principles 1 Blackburn S. Think. New York: Oxford University Press, when selecting maxims.418 1999.

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