Introduction to Public Health Ethics 2: Philosophical and Theoretical Foundations

In this second¹ of three briefing notes² on public health ethics, we provide an overview of various philosophical and theoretical perspectives that have informed the development, evolution, and application of public health ethics throughout its short history. We believe it is important for public health practitioners to understand these ideas because they inform, either explicitly or implicitly, ethical decision making in public health practice. They also provide a foundation for the public health ethics frameworks that are presented and discussed in our third briefing note.³ 

A broad range of ethical and political philosophies and theories have been used to provide justification for public health ethical decision making, particularly in situations in which competing values are at stake. The more traditional ethical theories and principles related to utilitarianism and contractarianism are commonly used in ethical frameworks for decision making in health care more broadly, but have also been applied in public health. A critique of these frameworks for application to public health is emerging. Recently, developments in feminist, relational, and public health ethics have drawn on a grouping of concepts and philosophical perspectives that are either integral to or congruent with a democratic communitarian philosophy. These newer developments have, to date, had limited translation into practical public health ethics frameworks, with a few exceptions. In the next briefing note, we discuss and critique a variety of public health ethics frameworks, drawing on the philosophical and theoretical foundations discussed in this paper.