In defence of a single body of clinical and public health, medical ethics
Authors
Jean-Pierre Unger
Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Belgium
Ingrid Morales
Office de la Naissance et de l’Enfance, French Community of Belgium, Chaussée de Charleroi 95, B-1060 Brussels, Belgium
Pierre Paepe
Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Belgium
Michel Roland
Département de Médecine Générale, Université Libre de Bruxelles, Route de Lennik, 808, BP 612/1, B-1070 Brussels, Belgium
Keywords:
Medical ethics, Public health ethics, Disease control, Clinical integration, Doctor-patient relationship
Abstract
Since some form of dual clinical/public health practice is desirable, this paper explains why their ethics should be combined to influence medical practice and explores a way to achieve that.
Main text
In our attempt to merge clinical and public health ethics, we empirically compared the individual and collective health consequences of two illustrative lists of medical and public health ethical tenets and discussed their reciprocal relevance to praxis.
The studied codes share four principles, namely, 1. respect for individual/collective rights and the patient’s autonomy; 2. cultural respect and treatment that upholds the patient’s dignity; 3. honestly informed consent; and 4. confidentiality of information. However, they also shed light on the strengths and deficiencies of each other’s tenets. Designing a combined clinical and public health code requires
fleshing out three similar principles, namely, beneficence, medical and public health engagement in favour of health equality, and community and individual participation; and
adopting three stand-alone principles, namely, professional excellence, non-maleficence, and scientific excellence.
Finally, we suggest that eco-biopsychosocial and patient-centred care delivery and dual clinical/public health practice should become a doctor’s moral obligation.
We propose to call ethics based on non-maleficence, beneficence, autonomy, and justice – the values upon which, according to Pellegrino and Thomasma, the others are grounded and that physicians and ethicists use to resolve ethical dilemmas – “neo-Hippocratic”. The neo- prefix is justified by the adjunct of a distributive dimension (justice) to traditional Hippocratic ethics.
Conclusion
Ethical codes ought to be constantly updated. The above values do not escape the rule. We have formulated them to feed discussions in health services and medical associations. Not only are these values fragmentary and in progress, but they have no universal ambition: they are applicable to the dilemmas of modern Western medicine only, not Ayurvedic or Shamanic medicine, because each professional culture has its own philosophical rationale.
Efforts to combine clinical and public health ethics whilst resolving medical dilemmas can reasonably be expected to call upon the physician’s professional identity because they are intellectual challenges to be associated with case management.
Keywords: Medical ethics, Public health ethics, Disease control, Clinical integration, Doctor-patient relationship
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