Ethics

• Health-related stigmatization is a social process that involves the formation or reinforcement of negative social representations of certain groups of individuals, who are labelled based on health problems considered preventable or within their control.
• Behaviours, lifestyles, living conditions or other personal characteristics are attached to a moral evaluation which designates “good” or “bad” diseases, and “good” or “bad” patients. These persons are considered responsible and blamed for the risk to their health and, if applicable, for the risk to which they expose other persons. Persons so targeted suffer damage to their identity which, in extreme cases, is reduced to the health problem or characteristic. Whether real, anticipated, or perceived, stigmatization vilifies individuals and groups; it results in or worsens their social disqualification.
• The consequences of damaged identity and social disqualification vary in terms of form and intensity. For ex…

The literature in public health ethics and other key documents exhibit a wide variety of values that offer many potential guides for assessing or orienting action. Among these many values, which ones are most relevant for conducting ethical analysis of public health actions? And are they valid for all public health interventions, or only some? How are these values defined?

This Framework of Values to Support Ethical Analysis of Public Health Actions was produced precisely to address these questions, some of which were clearly expressed by members of the Table de coordination nationale de santé publique (TCNSP) [A public health coordination body for Québec]. The values proposed here were selected based on not only research reported in the public health ethics literature, but also the experience of the Comité d’éthique de santé publique (CESP) [public health ethics committee], as well as the committee’s discussions with the members of the TCNSP. These values, in our view, appe…

In 2013, after 10 years of existence, the Comité d’éthique de santé publique [Public Health Ethics Committee] (CESP) felt compelled to review the experience that it had developed with regard to its specific mandate to provide ethical reviews of surveillance plans. This document summarizes all the ethical concerns identified by the Committee through the review of the different surveillance plans that were submitted to it between the time of its establishment and 2012. This summary of the opinions allows the Committee to cast a broader critical look on the ethical reflection surrounding the practice of ongoing surveillance of the population's health status and its determinants.

The ethical concerns outlined in the present summary essentially translate "field" knowledge, that is, they are drawn from the deliberative experience of the CESP through its review of surveillance plans that were submitted to it between 2003 and 2012. The critical examination of the Committee’s experie…

Public health actors analyzing policy options usually try to assess and compare the expected effects of policies on the health of the population. They can take on neutral brokering roles, simply providing the best available information to decision makers, or they can also engage in advocacy-related analysis. Whatever their role, those looking at policy options often try to answer — or are asked by others to answer — questions such as the following: Which option will result in broader social benefits, including but not restricted to health benefits? Which option will be less costly, financially, socially, and otherwise? Who will benefit and who will pay for each option, and when will these benefits and costs accrue? Which policy option will provide “the biggest bang for the buck”?

Various social factors, such as education, income, work, living environment, housing, lifestyle and access to services, determine an individual’s state of health. These interact in varying combinations throughout the life course. Inequitable distribution of these factors, or health determinants, among groups generates considerable health differences among people within a community or a country, or between countries. The gaps, or unequal distribution of health status, linked to these determinants within a population are referred to as social inequalities in health (SIH). These inequalities are not inevitable and could be reduced, according to the World Health Organization (WHO). The problem of social inequalities in health is vast and complex: unequal power dynamics and exclusion, as well as certain policies and social norms and practices, generate social and health disparities.

Data on the scope of SIH in Québec speak for themselves. The differences between socioeconomic gro…

The Romaine project offers a good illustration of all the risks of implementing major development projects in northern Quebec. The first major hydroelectric site in many years to be established so close to a small community, this project is opening the way for many other large-scale projects. Havre-Saint-Pierre is one of the eight municipalities which, along with the two Aboriginal communities of Ekuanitshit and Nutashkuan, constitute the Regional County Municipality (RCM) of Minganie on the North Shore. Havre-Saint-Pierre is the central point of Minganie and the seat of the RCM and of many governmental, municipal and regional services. The local economy, traditionally centered on fishing, has branched out in recent years.

Hydro-Québec's Romaine project is aimed at the development of a 1 550 MW hydroelectric complex on the Romaine river north of the municipality. Construction work on this complex consisting of four generating stations began in May 2009 and should continue un…

One issue that has unquestionably raised concern among the public, governments, institutions and international organizations is obesity, and, in particular but not solely, childhood obesity. (World Health Organization [WHO], 2003, 2005; Delisle, 2004; Dériot, 2005). The reasons for this concern are numerous, including the fact that excess weight produces social consequences (The Canadian Medical Association [CMA], 2007, p. 6; Katzmarzyk & Janssen, 2004; National Institute of Health and Medical Research [INSERM], 2005, pp. 49-54) related to economic efficiency (Suhrcke, McKee, Sauto Arce, Tsolova & Mortensen, 2006, cited by AMC, 2007, pp. 5-6; Cusset 2008), health care (for France: Detournay et al., 2000), infrastructure development, etc. While the importance of this issue should not be diminished, there has nevertheless been a sort of catastrophic sensationalism in which obesity is referred to as an epidemic (for an example of this way of presenting the situation, see Faeh,…

Public health ethics (PHE) is a relatively new field of study that encourages interdisciplinary discussion of moral issues related to the theory and practice of public health and preventive medicine. Emerging over the last 15 years out of dissatisfaction with the traditional orientations of biomedical ethics, PHE involves the explicit use of concepts from ethical, social and political theory to discuss and evaluate collective interventions that aim to protect and promote the health of groups and populations rather than of individuals.

This document has two aims. The first is to serve as a timely introduction to the field of PHE as applied to policy and practice responses to what was perhaps the most visible recent global public health threat, the global influenza AH1N1 pandemic. It is based on a review of the literature on this subject carried out by the National Collaborating Centre for Healthy Public Policy (NCCHPP) between May and August of 2009. The review does not…

This document provides a survey of the explicit goals, ethical principles, and ethics-related recommendations put forward by a selection of salient national, sub-national and international pandemic preparedness plans and policies. It is designed to provide a concise preliminary comparison of prominent ethical frameworks in order to stimulate examination of the relevance and utility of such tools for deliberation and justification in the context of an actual public health emergency. It does not claim to be exhaustive, and reflects the information and resources available at the time the review was carried out. The survey may be useful to health sector and other authorities as they reflect on their experiences, as well as to other professionals engaged in evaluating whether, how, and which existing ethical frameworks contribute to actual deliberation and decision making during routine and emergency public health practice in different contexts. It may also serve as a primer for further…