Christian Munthe, Department of Philosophy, Göteborg University, Sweden
Public Health Ethics 2008 1(1):39-52; doi:10.1093/phe/phn006
Website: <http://phe.oxfordjournals.org/cgi/content/full/1/1/39>
“……..While promoting population health has been the classic goal of public
health practice and policy, in recent decades, new objectives in terms of
autonomy and equality have been introduced. These different goals are
analysed, and it is demonstrated how they may conflict severly in several ways,
leaving serious unclarities both regarding the normative issue of what goal
should be pursued by public health, what that implies in practical terms, and
the descriptive issue of what goal that actually is pursued in different contexts.
A basic conflict of perspective is handled by integrating the ideas of public
health striving for health-related autonomy and equality, resulting in a prioritarian
oriented population approach to health-related autonomy. This integrated goal is
demonstrated to constrain itself in several ways attractive from the point of view
of the classic goal, but several serious problems remain.
For this reason, a model where all of the three goals are integrated into one
coherent structure where they can be assigned varying degrees of importance
relative to the level of population health is described. It is argued that this model
avoids the problems set out earlier, and is actually normatively preferable to the
classic goal alone. It is furthermore argued that the model may be employed as a
useful tool for descriptive ethics, as well as a vehicle for international harmonisation
of public health policies. A number of practical implications regarding, e.g., the
importance of respecting autonomy and the allocation of public health resources are
noted, as are a battery of questions for further research………..”
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