Re-visioning public health ethics: a relational perspective

Area of Science:

• Public Health Ethics
• Bioethics
• Health Policy

Background:

• Canada is a leader in public health ethics.
• Current bioethical frameworks emphasize individual autonomy, which is insufficient for population-focused public health.
• Emergency preparedness and pandemic ethics have received undue focus, often in isolation from broader public health concerns.

Purpose of the Study:

• To identify concerns with the current focus on pandemic ethics.
• To highlight the limitations of individualistic ethical frameworks in public health.
• To propose a re-visioning of public health ethics using concepts of relationality.

Main Methods:

• Conceptual analysis of existing public health ethics frameworks.
• Identification of inadequacies in individualistic bioethical approaches.
• Exploration of nascent concepts: relational autonomy, relational social justice, and relational solidarity.

Main Results:

• The dominant individualistic ethical framework is inadequate for public health's focus on populations and the common good.
• Relational concepts offer a foundation for a more appropriate public health ethic.
• These principles necessitate transparent, fair, and inclusive policymaking sensitive to systemic inequalities.

Conclusions:

• A re-visioning of public health ethics is needed, centering the collective good.
• Relational principles can guide ethical responses to public health crises, including pandemics.
• Policy must address and avoid exacerbating existing inequities during crises.