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Preparedness: Medical Ethics Versus Public Health Ethics

Swain, Geoffrey R. MD, MPH; Burns, Kelly A. PhD; Etkind, Paul DrPH, MPH

Journal of Public Health Management and Practice: July-August 2008 - Volume 14 - Issue 4 - p 354–357
doi: 10.1097/01.PHH.0000324563.87780.67

Medical ethics generally applies to individual interactions between physicians and patients. Conversely, public health ethics typically applies to interactions between an agency or institution and a community or population. Four main principles underlie medical ethics: autonomy, nonmaleficence, beneficence, and justice. By contrast, public health ethical principles address issues such as interdependence, community trust, fundamentality, and justice. In large part because of the significant community-level effects of public health issues, medical ethics are suboptimal for assessing community-level public health interventions or plans—especially in the area of emergency preparedness. To be effective, as well as ethical, public health preparedness efforts must address all of the core principles of public health ethics.

This study discusses four public health principles and stresses public health preparedness efforts to address them.

Geoffrey R. Swain, MD, MPH, is Chief Medical Officer for the City of Milwaukee Health Department, Center Scientist at Milwaukee's Center for Urban Population Health, and Associate Professor of Family Medicine and Population Health Sciences at the University of Wisconsin School of Medicine and Public Health. Dr Swain is Vice President of the Wisconsin Public Health Association and serves on the National Immunization Advisory Committee of the National Association of County and City Health Officials.

Kelly A. Burns, PhD, is an Assistant Professor of philosophy at Dominican University, specializing in 20th Century continental philosophy and ethics.

PaulEtkind, DrPH, MPH, is the Deputy Director and Epidemiologist of the Division of Public Health and Community Services of the City of Nashua, New Hampshire.

The authors thank Paul A. Biedrzycki, MPH, MBA, from the City of Milwaukee Health Department, who provided helpful comments and feedback on this manuscript.

Corresponding Author: Geoffrey R. Swain, MD, MPH, City of Milwaukee Health Department, 841 N Broadway, Room 315, Milwaukee, WI 53202 (

© 2008 Lippincott Williams & Wilkins, Inc.