Ethics and Public Health – A South African Perspective

Abstract

The aim of this chapter is to discuss ethical considerations from a public health perspective in South Africa as distinct from medical ethics. The ethical principles of autonomy, beneficence, non-maleficence and justice as practised in clinical medicine cannot always be applied to public health situations as the philosophy is different. After the introduction, the first section of this chapter focuses on the meaning of public health. Public health is directed at the broader population or communities and therefore, moves beyond health care and medicine to address the social determinants of health. Public health attempts to address issues of inequities, social justice and human rights to promote and protect the health of populations. The second section of the chapter focuses on defining public health ethics. In the third section, some key public health ethical frameworks and related principles used in decision making and justifications for public health action are described, highlighting their similarities and differences. The fourth section focuses on the current dilemmas around public health ethics in South Africa using case studies as illustrations. The chapter concludes by underscoring the relevance of public health ethical frameworks for healthcare professionals of all disciplines. The importance of including public health ethics in their training is also emphasised so that they can make it explicit in their practice.