摘要：More than 100 years ago, public health began as an organized discipline, its purpose being to improve the health of populations rather than of individuals. Given its population-based focus, however, public health perennially faces dilemmas concerning the appropriate extent of its reach and whether its activities infringe on individual liberties in ethically troublesome ways. In this article a framework for ethics analysis of public health programs is proposed. To advance traditional public health goals while maximizing individual liberties and furthering social justice, public health interventions should reduce morbidity or mortality; data must substantiate that a program (or the series of programs of which a program is a part) will reduce morbidity or mortality; burdens of the program must be identified and minimized; the program must be implemented fairly and must, at times, minimize preexisting social injustices; and fair procedures must be used to determine which burdens are acceptable to a community. Public health as an organized discipline began more than 100 years ago, with the goal of improving the health, primarily, of populations rather than of individuals. Given its population-based focus, however, public health continually faces dilemmas concerning the appropriate extent of its reach and at what point the work of public health professionals is infringing on individual liberties in ethically troublesome ways. Nonetheless, there have been few attempts to articulate an ethics of public health. Bioethics, as a discipline, helps health care professionals identify and respond to moral dilemmas in their work. In this article I suggest that the contexts out of which bioethics emerged—medical care and human research—were oriented toward a different set of concerns than those typically arising in public health. While the founders of bioethics articulated principles equally relevant for public health, the more specific action guides and codes of health care ethics that have followed are an imperfect fit for public health. Codes of medical and research ethics generally give high priority to individual autonomy, a priority that cannot be assumed to be appropriate for public health practice. A framework of ethics analysis geared specifically for public health is needed, both to provide practical guidance for public health professionals and to highlight the defining values of public health, values that differ in morally relevant ways from values that define clinical practice and research. A first attempt at such a framework is offered here.
