What is Ethics? The Webster dictionary defines ‘ethics’ as discipline dealing with what is good and bad and with moral duty and obligation. It can also be defined as norms for conduct that distinguish between acceptable and unacceptable behavior or alternatively as a method, procedure, or perspective for deciding how to act and for analyzing complex problems and issues (
1). This latter portion of the definition gets to the applied aspect of knowledge of ethics especially in dealing with complex public health problems and making a systems change.
There are diverse branches of ethics such as bioethics (implications of technology affecting human life), medical ethics (which primarily deals with patient-provider relationships and conduct of medical research involving human subjects), research ethics, and business ethics (
2).
Why do we need ethics? Ethics is important to us because without it our actions would be random and aimless. We need ethics to organize our goals and actions and to accomplish our values. In essence, ethics evaluates those actions, and the values that underly them. It determines which values should be pursued, and which should not (
3). The need for ethics arises from the fact that different professions have to establish a moral credibility for their field. In our field this needs to be translated into morally acceptable conduct and efforts to resolve ethical dilemmas related to public health practice (
4). There are primarily five sources of ethical standards, which we use in practice including the utilitarian approach, the rights approach, the fairness or justice approach, the common good approach, and the virtue approach. When an ethical problem arises an integration of these approaches can assist in ethical-decision making (
5).
The ethics field in health is governed by various codes of ethics such as principles of medical ethics (
6), international code of ethics (
7), Coalition of National Health Education Organizations code of ethics for health educators (
8), Society for Public Health Education code of ethics (
9) and the American Public Health Association code of ethics for public health (
10). The purpose of having a variety of codes is to encompass the various health practitioners who practice individualized medicine as well as population level health.
The last decade has seen the evolution of public health ethics from a nascent effort of building a public health code of ethics (
10) to a full-blown use of ethical principles and practices related to public health curriculum implementation (
11), public health practice, and public health workforce development at the national level. Public health ethics, which was largely eclipsed by medical ethics (
12) and bioethics fields in the past (
13), has emerged as an important domain of public health practioners, health policy makers, and academicians. More and more public health professionals grapple with the issue of a delicate balance between individualistic civil liberties and the communitarian orientation-that is lessening the focus on individual rights and increasing the focus on communal responsibilities (
14). Diverse ethical challenges are now becoming apparent. These arise from addressing public health issues related to health promotion, risk reduction, epidemiology and public health research and elimination of health disparities (
15).
Ethical approaches can be placed into categories such as a) professional ethics (ethical principles and guidelines followed by a profession), b) Applied ethics (ethical conduct as applied to the real world), c) Advocacy ethics (advocacy for social goals and health reforms) and d) critical ethics (community involvement in discussions related to ethics in public health policy decisions) (
15).
Public health ethics, by which we mean ethics applied to making well considered public health decisions when confronted with public health problems/issues and dilemmas typically faced by public health practitioners. Principles, which underlie the practice of public health ethics, are not restricted to the common ones such as beneficence, nonmaleficence, respect for autonomy and justice but also involve larger principles of connectedness, solidarity, and communal responsibility.
Should ethics continue to be taught in schools of public health and perhaps with a more emphasis? A survey conducted more than a decade ago to assess the amount of ethics instruction offered in schools of public health revealed that only 4% of the 24 schools surveyed required ethics instruction. Most of the schools (79%) offered short-courses, seminar series or invited lectures on ethical topics (
16). There are series of debatable questions, which need to be considered if ethics need to be taught in schools and/or programs of public health.
Research has shown that teaching ethics in terms of theory does not necessarily translate into an ethical behavior in terms of public health practice (
16). This knowledge –behavior gap is well known in health literature. Many questions remain unanswered such as, why and how do we teach ethics in schools and programs of public health? Is there a curriculum, which reaches out to a variety of target audience that enters the public health field? In an article by Coughlin (
17) clear guidelines are drafted for ethics instruction in schools and programs of public health in terms of objectives to be attained, curricular goals to be reached and challenges to be addressed.
Hence, the primary purpose of this paper was to conduct a narrative literature review, which addressed: a) role of ethics in developing curriculum in programs and schools of public health, b) ethics-related instruction in schools and programs of public health and the role of ethics in developing a competent public health workforce.
