INTRODUCTION

Although “public health ethics” as a concept has existed for less than two decades, political leaders and medical officials have long made moral and value-laden decisions designed to protect the health of the community. History, by revealing the social and cultural forces that inform scientific policies, is an ideal approach for understanding the controversies that have arisen in public health – both before and after they were termed “ethical” in nature (Fee 1993). This chapter will focus on public health ethics in the United States since 1900, drawing, where appropriate, on events that occurred prior to the twentieth century and in other countries. It will highlight a series of controversies that have characterized public health ethics, explicitly noting the relevance of these issues for modern ethicists, health officials, clinicians, and the general public.

In contrast to medical practice, which emphasizes the care of specific patients, and bioethics, which stresses patients’ rights, public health is concerned with health and disease among populations. Although public health interventions are justified in terms of their potential benefit to the populace, they may do so by restricting the liberties of other citizens. Thus, a central theme of public health ethics is the tension between protecting the overall health of such populations and the rights of specific individuals who live in these communities.