摘要：Bioethical debate has been characterized from the beginning by the central importance placed on autonomy. This is because bioethics has, until now, been concerned with the relationship between doctor and patient in a clinical context or, alternatively, with the rights of individuals involved in biomedical research. The increased involvement of bioethics in the domain of public health, however, makes it necessary to refer to other principles and values, thus shaping a new responsibility-focused bioethics that extends itself beyond the early boundaries of this discipline. A serious philosophical reflection on public health ethical issues may widen and enrich the young academic field of bioethics. Bioethics, in fact, suffers from an individual-centered approach because its attention is mainly directed toward medicine and medical research, which are concerned with the individual level. Public health, however, focuses on the population level and is concerned with the lives of the whole population or of large subgroups of the population. Here, I try to show that the ethos of medicine and medical research cannot be transported as such into the realm of public health measures, because that would make public health measures very difficult to implement. Next, I establish the significance of responsibility rather than autonomy as central to public health ethics. At the same time, I stress the difference between retrospective and prospective responsibility, showing that only the latter is a good candidate for public health ethics. I then show that there is no opposition between autonomy and responsibility, because responsibility necessarily includes respect for autonomy. This argument could be useful for bioethics itself, because responsibility permits the overcoming of the old conflict between beneficence and autonomy, which has been the main problem of bioethics since it began. Responsibility, in fact, represents a good balance between the 2, as I show when I distinguish the 2 senses of responsibility: to answer to someone and to answer for someone. Finally, I propose some examples of possible applications of this responsibility-centered model of public health ethics. Public health interventions should reach the right balance between the 2 principal meanings of responsibility. This model stands between the libertarian perspective, which gives priority to the individual and allows only a minimal state, and the collectivist point of view, which aims to promote the greatest aggregate benefit, by considering individual rights as dependent on the shared will of the community.
