Book contents
nine - Politics, ethics and evidence: immunisation and public health policy
Published online by Cambridge University Press: 05 July 2022
Summary
This chapter explores the relationship between ethics and practice and the basis upon which public health interventions can be applied. The justification for vaccination programmes is based on differing values and principles and therefore vaccination requires an exploration of ethical approaches. The chapter explores what kinds of ethical approaches public health practitioners can adopt in support of developing and implementing public health programmes. This has been a recurrent theme in this book and the area of immunisation is a particularly useful one to explore in this context.
Introduction
Public health interventions are rarely without harmful as well as beneficial effect. As Kenny and Giacomini (2005) argue:
when many people – as well as societal constructs such as institutions and economies – are affected in many ways by every decision, the moral quandaries arise not in the question of whether to harm or benefit but how to harm and benefit: whom, how much, how certainly, in what ways, and so forth … The quintessential ethical problem of the public policy maker is how to define, identify, justify, and distribute inevitable benefits and harms, rather than simply striving to ensure benefit and avoid harm. (p 254)
This is a well-recognised dilemma in all public policy, but public health raises important questions about not only the degree or distribution of harm or benefit but also how to define those harms and benefits. For example, a key debate in public health is the extent to which it is right to intervene to restrict a person's liberty to protect them and/or others from harm. In addition policy makers may formulate policy that needs to look good, not necessarily be good for purely self-interested political goals, or because seeming to do something is seen as promoting the greatest benefit.
In this chapter we examine some of these issues, using vaccination programmes as a case study. It is not our intention to question the benefit or otherwise of any particular vaccination programme or to argue that any specific programme is right or wrong, but rather to use the example of vaccination to explore public health ethics and to examine the link between ethics, evidence and public health policy.
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- Public Health Ethics and Practice , pp. 137 - 154Publisher: Bristol University PressPrint publication year: 2009