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Public Health Law and Ethics

Public Health Law and Ethics: A Reader

Edited by Lawrence O. Gostin
Copyright Date: 2010
Edition: 2
Pages: 600
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  • Book Info
    Public Health Law and Ethics
    Book Description:

    Now revised and expanded to cover today's most pressing health threats,Public Health Law and Ethicsprobes the legal and ethical issues at the heart of public health through an incisive selection of government reports, scholarly articles, and relevant court cases. Companion to the internationally acclaimed textPublic Health Law: Power, Duty, Restraint,this reader can also be used as a stand-alone resource for students, practitioners, scholars,and teachers. It encompasses global issues that have changed the shape of public health in recent years including anthrax, SARS, pandemic flu, biosecurity, emergency preparedness, and the transition from infectious to chronic diseases caused by lifestyle changes in eating and physical activity. In addition to covering these new arenas, it includes discussion of classic legal and ethical tensions inherent to public health practice, such as how best to balance the police power of the state with individual autonomy.

    eISBN: 978-0-520-94605-7
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-x)
  3. List of Illustrations
    (pp. xi-xii)
  4. List of Tables
    (pp. xiii-xiv)
  5. List of Boxes
    (pp. xv-xvi)
  6. Foreword
    (pp. xvii-xviii)
    Carmen Hooker Odom and Samuel L. Milbank

    The Milbank Memorial Fund is an endowed operating foundation that works to improve health by helping decision makers in the public and private sectors acquire and use the best available evidence to inform policy for health care and population health. The Fund has engaged in nonpartisan analysis, study, research, and communication about significant issues in health policy since its inception in 1905.

    Public Health Law and Ethics: A Readerwas the fourth of what are now twenty California/Milbank Books on Health and the Public. The publishing partnership between the Fund and the University of California Press encourages the synthesis and...

  7. Preface
    (pp. xix-xxiv)
    Lawrence O. Gostin
  8. Conventions Used in This Book
    (pp. xxv-xxvi)
  9. Abbreviations
    (pp. xxvii-xxix)
  10. INTRODUCTION: Mapping the Issues
    (pp. 1-20)

    The issues and questions presented in the theory and practice of public health are not resolved solely through scientific inquiry; rather, law and ethics also guide our efforts. Yet despite the closeness of the interplay between public health, law, and ethics, each of these three fields has its separate identity, and cross-fertilization is rare. For the most part, each field has adopted distinct terminologies and forms of reasoning. To the extent that scholars and practitioners in the fields of law and ethics have engaged in sustained examinations of issues in health, they have focused principally on medical care. This introductory...

  11. PART ONE. Foundations of Public Health Law and Ethics

    • ONE The Public’s Health
      (pp. 23-57)

      The readings in this chapter and the next examine the fields of public health and public health ethics. The first chapter contains classic readings that illuminate the core values of public health: prevention and the population-based perspective, the role of community and civic participation, the significance of social justice, and modern perspectives on the “public health system.” Chapter 2 then turns to contemporary explanations of public health ethics, examining how ethical principles and values can inform society about the justifiability of actions taken to safeguard the public’s health and safety. The readings on public health ethics analyze the inevitable trade-offs...

    • TWO Public Health Ethics
      (pp. 59-96)

      The field of public health ethics applies principles and values to evaluate the justifiability of public health actions. A central question posed is, “What are the appropriate limits on the state’s power when its exercise to safeguard the public’s health and safety interferes with individual interests?” In answering this question, ethicists take account of the personal and economic interests of individuals, as well as the collective benefits to the population of improved health and safety. This ethical analysis of public health interventions does not dictate policy choices; rather, it enables public health ethicists to identify a range of ethically appropriate...

  12. PART TWO. The Law and the Public’s Health

    • THREE Public Health Duties and Powers
      (pp. 99-133)

      The United States Constitution provides the framework for the distribution of governmental power. It divides power between the federal government and the states, separates power among the three branches of government, and limits governmental power over individuals to protect a sphere of liberty (see figure 4). Federal and state public health agencies carry out public health functions within these constitutional boundaries. Governmental actors must use their power to protect and promote the public’s health according to this constitutional design and within the scope of legislative mandates. When disputes regarding governmental powers arise, courts often determine the lawfulness of particular public...

    • FOUR Public Health and the Protection of Individual Rights
      (pp. 135-165)

      Government has a long tradition of regulating for the community’s welfare. Regulations target individuals (e.g., setting forth infectious disease powers), professionals and institutions (e.g., requiring licenses), and businesses (e.g., mandating inspections and safety standards). The previous chapter emphasized the broadpowers and dutiesof government to safeguard the public’s health. This chapter considers therestraintson government power that protect individual interests in autonomy, privacy, liberty, and property.

      The cases and commentary in this chapter trace the evolution in judicial thought on the balance between public health power and protection of individual rights. Public health jurisprudence is neither static nor...

    • FIVE Public Health Governance: Direct Regulation for the Public’s Health and Safety
      (pp. 167-193)

      The first two chapters in this part of theReaderexplored the scope and limits of the government’s public health powers. In this chapter, we examine how these powers are exercised. To achieve communal health and safety, governments have formed specialized agencies, usually in the executive branch. Local and federal agencies issue and enforce regulations to ensure occupational health and safety; prevent environmental degradation; and protect consumers from unsafe products, impure food and water, and ineffective or dangerous pharmaceuticals and medical devices. They license professionals, businesses, and institutions to ensure adequate qualifications and standards, and inspect premises and commercial establishments...

    • SIX Tort Law and the Public’s Health: Indirect Regulation
      (pp. 195-231)

      The levers of public health regulation are often viewed as being in the hands of legislatures and executive agencies. However, attorneys general and private citizens possess a powerful means of indirect regulation through the tort system. Tort litigation can be an effective method for reducing the burden of injury and disease. The courts help redress harms caused by pollution, toxic substances, unsafe pharmaceuticals or vaccines, and defective or hazardous consumer products. Figure 8 provides an image of how tort law serves as a tool for reducing a variety of harms to the population’s health.

      The goals of tort law, though...

    • SEVEN Global Health Law: Health in a Global Community
      (pp. 233-282)

      Scholars view public health law primarily as a domestic field of study. And constitutional, statutory, administrative, and tort law affecting the public’s health undoubtedly is found mainly at the federal, state, and local levels. But neither the legal system nor the health system operates in isolation. The forces of globalization heavily influence both, propelling pathogens, and even behaviors and lifestyles, across national frontiers. No state, acting alone, can ensure the conditions that will guarantee the health of its population. This has always been true, but never as obviously as in today’s world. Travel and migration, dense settlements in urban areas,...

  13. PART THREE. Public Health and Civil Liberties in Conflict

    • EIGHT Surveillance and Public Health Research: Privacy and the “Right to Know”
      (pp. 285-321)

      To achieve collective benefits, public health officials systematically collect, store, use, and disseminate vast amounts of personal information, commonly in electronic form. Public health officials monitor health status to identify health problems, diagnose and investigate health hazards, conduct research to understand health problems and find innovative solutions, and disseminate information intended to inform, educate, and empower people in matters related to their health. The data that they collect provide the basic infrastructure necessary to effect many of the common goods of community health. These data are also often personally identifiable and sensitive. Data may reveal information about a person’s lifestyle...

    • NINE Health, Communication, and Behavior
      (pp. 323-363)

      Public health authorities recognize behavior as an important determinant of health in the community. This idea is reflected mostly in modern discourse about the roles of smoking, diet, and sedentary lifestyle in the development of chronic disease, but the influence of behavior in transmitting infection (e.g., sexual or needle-sharing behavior) or causing injury (e.g., use of automobiles and firearms) is also well recognized. Researchers seek to identify effective techniques for changing people’s behavior to achieve reductions in chronic and infectious diseases, as well as in injuries. Public health assessments and interventions occur at the point of human contact, whether at...

    • TEN Medical Countermeasures for Epidemic Disease: Bodily Integrity
      (pp. 365-409)

      This chapter and the next examine the most ancient and enduring threats to health in the population—infectious diseases. The effects of epidemics on society are as destructive as those of war. For example, the estimated 50 to 100 million deaths from the Spanish influenza pandemic of 1918–20 exceed the number of combatants killed in World War I, World War II, Korea, and Vietnam combined (Johnson and Mueller 2002). And HIV/AIDS has claimed approximately 25 million lives since 1981 (UNAIDS 2008). Not surprisingly, the United States has classified HIV/AIDS as a national security priority, reasoning that it may result...

    • ELEVEN Public Health Strategies for Epidemic Disease: Association, Travel, and Liberty
      (pp. 411-447)

      Measures to control communicable diseases are not limited to biological approaches. Societies can also cope with communicable disease epidemics by separating contagious persons from the rest of the population. Public health authorities possess three overlapping powers of detention to help prevent the spread of disease: isolation of known infectious persons, quarantine of healthy persons exposed to disease, and civil commitment (compulsory hospitalization) for care and treatment. (For descriptions of these three forms of detention, see pages 428–36 and table 19 in chapter 11 of the companion text.)

      We like to think that the employment of these measures is thoughtful...

    • TWELVE Economic Liberty and the Pursuit of Public Health
      (pp. 449-478)

      Previous chapters have focused on the limits on government power to protect personal freedoms: autonomy, privacy, bodily integrity, and liberty. Individuals, however, value not only personal freedom but also economic liberty. They claim the liberty to own and use private property, run businesses, enter into contracts, and pursue trades, livelihoods, or professions.

      Market Capitalism and the profit incentive are widely valued in modern America. Citizens sometimes see government as an obstacle to achieving their financial dreams. They assert a right to freedom from government bureaucracy, taxation, and burdensome regulation. Some economists believe that regulation, if desirable at all, should redress...

  14. Part Four. The Future of the Public’s Health

    • THIRTEEN Concluding Reflections on the Field: Case Studies on Biosecurity, Genomics, and Obesity
      (pp. 481-520)

      The field of public health vastly helped improve the health and well-being of populations during the twentieth century, leading to substantial increases in life expectancy, improved sanitation and living conditions, and reductions in infectious diseases. Nevertheless, major problems, as well as remarkable opportunities, confront the field in a new century.

      This chapter offers case studies on three of the most complex and important public health challenges: bioterrorism and biosecurity, public health genomics, and obesity. Each of these challenges raises core questions regarding the proper scope of and ethic for public health, highlights the interconnectedness of domestic and global health, and...

  15. Selected Bibliography
    (pp. 521-544)
  16. Table of Cases
    (pp. 545-550)
  17. Index
    (pp. 551-562)
  18. About the Author
    (pp. 563-564)
  19. Back Matter
    (pp. 565-565)