Teaching public health ethics

Teaching public health ethics has been recognised as patchy and somewhat theoretically incoherent for some years. Despite Beauchamp and Childress' work being widely known and used within health care its various principles have been criticised by a number of writers for, among other things, their inherent cultural relativism. This article suggests how a broader ethically oriented approach to the ever-changing field of public health might be pursued - so that a professional public health practitioner might be prepared for a lifelong career of ethical activism. Informed by the pedagogic philosophy of Freire it assumes the development of a module within an MPH programme. If, as is widely acknowledged, we are dealing with essentially a corpus of values, the challenge for an educator of public health ethics is how do we inculcate those values effectively and efficiently? How do we prepare students for as yet unrecognised ethical problems that they might confront? How do we assess such teaching? We know that even in clinical practice gaps appear between accepted ethical principles and actual practice. Within public health the conflicts generated by rival claimants and the contradictions of applying principles at a societal level become even clearer as action to control a situation might restrict the rights of others. This makes it even more important that students are exposed to learning experiences which will equip them adequately for a lifetime of practice. Traditional didactic approaches need to be supplemented with additional modalities such as case studies and role playing. Such case studies might encompass macro policy issues or micro operational issues. Other approaches could include citizen juries, examining international agreements and codes of practice, debates and encouraging explicit reflective practices. The importance of repetition, teachers as role models, courses which themselves demonstrate ethical practice, and a variety of methods are emphasized.