Ethics and Public Health

Selected resources from The Hastings Center.

Bioethics Briefings:

Public health encompasses what society does to assure the conditions that are necessary for its members to be healthy, including economic, social, and environmental factors. The public health tradition adopts a preventative orientation and views health from the population-level, guided by a commitment to social justice. Read our briefing to consider the question: What are the potential trade-offs and synergies between collective goods and individual interests in healthcare?

From Hastings Bioethics Forum:

New York City’s Involuntary Commitment Plan: Fulfilling a Moral Obligation?
After a string of violent crimes involving mentally ill people who are homeless, New York City Mayor Eric Adams announced a plan for police and emergency medical workers to involuntarily remove people with severe mental illness from the streets and bring them to hospitals for psychiatric evaluation. Mayor Adams said we have a “moral obligation” to help people who are mentally ill. But is this plan moral?
Should Ethicists Be at the Table in Public Health Policy Deliberations?
In a recent article in The New England Journal of Medicine, Ezekiel Emanuel and colleagues clearly illustrate the relevance of ethical considerations to policy deliberations concerning public health emergencies. But do ethicists belong at the table?
Philanthropy is Not Enough: Oil and Gas Giants Must Consider Medical Ethics
Given the well-known environmental and health risks of oil and gas drilling, oil and gas giants that enter developing nations routinely offset these risks with charitable investments. Are these investments sufficient? Do the funds go where they are needed? Answering this question raises ethical issues that need greater attention.
Public Health Officials and Gun Rights Advocates Must Work Together
In rural Virginia, where I live, there is strong support for the right to own and carry guns. For more than a decade, I have shared public health, mental health, and other scientific findings with the leadership of a statewide Second Amendment rights advocacy group, especially regarding the leading number of deaths by firearms: suicide. We do not agree on what firearms laws and policies might be or do to prevent suicides, but we have sustained our conversations and respectfully learned from each other’s point of view. Such conversations are hard to have.
Treating Gun Violence as a Public Health Threat: Not Exactly What We Meant
This week, the United States saw two momentous public health events: one million deaths attributed to Covid and the 198th mass shooting of the year. Both the pandemic and gun shootings are threats to public health that are not being adequately addressed.
Rugged American Individualism is a Myth, and It’s Killing Us
The American myth of rugged individualism, which often means “pulling yourself up by your own bootstraps,” is outdated, was never completely accurate. It is on full display during the coronavirus pandemic, contributing to cases and deaths.
C.D.C.’s Latest Mask Guidance: Science, Politics, and Public Health
The C.D.C.’s latest policy guidance that people who have been fully vaccinated against the coronavirus virus no longer need to wear face masks indoors gets the science right, but policymaking wrong.
Bruce Springsteen: The Latest Celebrity DWI
It was especially disappointing to read about Bruce Springsteen’s recent arrest for suspicion of driving while intoxicated (DWI). Here’s hoping the famous rocker will use his arrest to refocus attention on a risky and dangerous behavior that is thoroughly preventable.
Science in the Biden White House: Eric Lander, Alondra Nelson, and the Legacy of Lewis Thomas
Science has replaced populism in the White House. For the first time, the president’s science advisor will be elevated to cabinet rank. There are other good omens, as well.
Motivated Ignorance: A Challenge for Science Communication and Democracy
Many people are deeply interested in the political process and awash in relevant information., but nevertheless often grossly misinformed, holding confident but unfounded opinions at odds with widely accessible evidence The recent riot at Capitol Hill is just one illustration–albeit a horrifying one–of such misinformation and its potential consequences. The anti-vaccine movement is another example.
Resisting Public Health Measures, Then and Now
One of the most surprising aspects of the Covid-19 pandemic for those of us who teach the history of public health is how unwilling many Americans have been to adopt health measures to protect others. Over the Thanksgiving holiday, tens of millions of Americans traveled, despite the fact that the Centers for Disease Control and Prevention urged them to stay home and the overall death rate from the coronavirus is approaching 300,000. Should recent events make us revisit aspects of the history of public health? And how can these stories inform future public health efforts during pandemics?
Are Physicians Hypocrites for Supporting Black Lives Matter Protests and Opposing Anti-Lockdown Protests? An Ethical Analysis
Physicians have been vocal in condemning the anti-lockdown protests while endorsing and even participating in the Black Lives Matter protests. This has led to criticism of the medical community for being inconsistent and hypocritical. What does an ethical analysis reveal?
Lawsuits of Last Resort: Employees Fight for Safe Workplaces during Covid-19
As more workplaces open up, a seldom-used legal action is being taken against employers charged with inadequately protecting employees from the coronavirus: public nuisance lawsuits.
Pandemic Language
Social-Change Games Can Help Us Understand the Public Health Choices We Face
Before there was the Covid-19 pandemic, there was Pandemic. This tabletop game, in which players collaborate to fight disease outbreaks, debuted in 2007. Expansions feature weaponized pathogens, historic pandemics, zoonotic diseases, and vaccine development races. Game mechanics modelled on pandemic vectors provide multiple narratives: battle, quest, detection, discovery. There is satisfaction in playing “against” disease–and winning. Real pandemic is not as tidy as a game. But can games support understanding about the societal challenges we now face? Yes.
After the Surge: Prioritizing the Backlog of Delayed Hospital Procedures
The rewards of social distancing are beginning to accrue in former hotspots such as Seattle, the New York metropolitan area, and the San Francisco Bay Area, where the number of new Covid-19 cases requiring hospitalization is declining. Assuming the rewards hold in the face of pressures to reopen the economy, hospitals will now face challenges of reopening their own nonpandemic services for patients whose elective surgeries and other procedures were postponed. Which patients should get priority?
Individual Freedom or Public Health? A False Choice in the Covid Era
When scientists first suggested population-wide social distancing as the only feasible way to suppress Covid-19, they were the first to admit it may not work in a free society. We are now months into placing mass restrictions on human behavior to suppress a virus that lacks an effective vaccine or treatment. Now is the time to ask: is this the authoritarian nightmare many feared, or will freedom and democracy survive Covid-19?
Beyond the Covid Crisis—A New Social Contract with Public Health
Covid-19 is teaching us the stern lesson that economic well-being and health justice are two sides of the same coin. To weather pandemics and restore the social contact that economic life demands, we need to sign a new social contract with public health.
Show Me Your Passport: Ethical Concerns About Covid-19 Antibody Testing as Key to Reopening Public Life
Around the world, governments are looking for safe ways to lift unprecedented restrictions on public activities to curb the spread of Covid-19. So-called immunity passports could be key to the effort to selectively ease restrictions for people presumed to be immune to the virus. But there are scientific and ethical questions to be worked out before they can be deployed. .
Ethics and Evidence in the Search for a Vaccine and Treatments for Covid-19
In the rush to find a Covid-19 vaccine and one or more drugs to treat the deadly disease, concerns are being raised that ethical standards for conducting human clinical trials and the evidentiary standards for determining whether interventions are safe and effective, might be loosened.
U.S. and Canada: Being Good Neighbors in the Pandemic
Canada has a fraction of the number of cases of Covid-19 as the U.S. Canadians feel vulnerable. But Canadians and Americans need to find ways to build and maintain trust within and across our borders.
The Price of Going Back to Work Too Soon
We Need International Medical Graduates to Help Fight Covid-19. Immigration Policies Keep Them Away
Coronavirus Response Is Insufficient for Vulnerable New Yorkers
Health Care for Obesity and Eating Disorders: What Needs to Change
The theme of National Eating Disorder Awareness (NEDA) week , “Come as you are: Hindsight is 20-20,” is designed to encourage those recovering from eating disorders to reflect on their journeys towards body acceptance. It also affords doctors and other health professionals an opportunity to evaluate how well they are doing to help patients reach this goal.
Report from China: Ethical Questions on the Response to the Coronavirus
Hastings Center fellows in China discuss ethical questions about the response to the spreading coronavirus.
The Public Charge Rule Is a Eugenic Policy
From Outcry to Solidarity with Migrants: What Is the Good We Can Do?
Another June. Another public outcry about cruelty as policy harming migrants in United States custody. This summer, the photo of a drowned family, Óscar Alberto Martínez Ramírez and his daughter, Valeria, of El Salvador, shocks the conscience. Reporters are documenting the inhumane conditions in a Border Patrol facility where hundreds of children have been held. How should our field respond?
Forced from Home: Evicting Immigrants from Public Housing Harms Children’s Health
The federal government’s proposed rule to disqualify families from public housing if any member is undocumented will harm children, families, and cities.
Staying in Their Lane: Health Professionals Must Address Gun Violence
In the wake of the recent Twitter fight between the National Rifle Association and U.S. physician groups over whether doctors should speak out about firearm policy issues, we argue that professionalism actually requires that doctors take a leadership role in gun…
Immigrant Health and the Moral Scandal of the “Public Charge” Rule
A long-anticipated policy change proposed by the Trump administration that would count the use of many federally-subsidized programs against immigrants currently eligible to use them threatens public health and would undermine ethical practice in health professions and systems. The policy would…
Newspaper Op-Eds Should Disclose Authors’ Industry Ties
Earlier this month, The Seattle Times published an op-ed by Samuel Browd, medical director of Seattle Children’s Sport Concussion Program, on the risks of brain injury in youth sports. Dr. Browd acknowledged troubling research on the dangers of repetitive brain trauma, but…
The Only PhD Scientist in Congress Speaks About Truth, Politics, and Human Flourishing
At a time when facts are distorted, disregarded, and ignored in policy making and political discourse, the need in Washington for seekers and defenders of truth has perhaps never been greater. I discussed the state of affairs with Representative Bill Foster,…
Is it Time to Regulate the Sale of Sugar to Minors?
In “Tackling Obesity and Disease: The Culprit Is Sugar; the Response is Legal Regulation,” published in the Hastings Center Report, Lawrence O. Gostin describes four coordinated interventions that have been effective at controlling peoples’ tobacco consumption and which can serve as…
After Hurricane Harvey, Injustice in Houston
Hurricane Harvey dissipated in September, but much of the destruction that it wreaked on Texas and Louisiana remains. When addressing residential concerns, disaster relief officials prioritize the newly homeless over the chronically homeless, choosing to protect the previously privileged over the…
After the Election Bioethics Faces a Rocky Road
Academic bioethics has never been popular with Republicans. Libertarians dislike academic bioethics because it seems too elitist and anti-free market. Religious thinkers worry it is technocratic, soulless and crassly utilitarian. Now with Trumpism add a populist disdain for expertise, experts and…
Lincoln’s Promise: Congress, Veterans, and Traumatic Brain Injury
Perhaps we were naïve. Our plan was relatively simple: we would chart the legislative evolution of programs for veterans with traumatic brain injuries (TBI) to identify policy gaps for this underserved and vulnerable population. With recent media attention highlighting the U.S….
The Good of the Body
The December 2015 United Nations meeting on climate change was an historic moment for global efforts to reduce harmful carbon emissions. While it gained the agreement about the future good of the planet, it made clear that there is a long…
Responding to Zika: Ethical Challenges of Zoonotic Diseases
The World Health Organization will hold an emergency committee meeting on the pandemic reemergence of Zika virus and the explosive increase in reported cases of congenital microcephaly in Brazil possibly linked to Zika on February 1. The virus is a mosquito-borne infection in…
Responding to Ebola: Health Care Professionals’ Obligations to Provide Care
As health care institutions in the United States prepare for Ebola patients, many have adopted the policy that those providing hands-on care should come from a pool of volunteers. Given the mixed history of health care providers’ willingness to care for patients during…
How Bioethicists Can Help Reduce Global Health Inequities
The state of global health is a major concern. Despite advances in medicine and medical care and massive growth of the global economy, health in the world is characterized by widening disparities within and between countries; lack of access to even…
Belief in a Just World: A Case Study in Public Health Ethics
Why did portraying a married, working, loving, family-oriented, and religious couple with a disabled child bring out consistently negative reactions among the public toward allowing this family access to government-subsidized health care for their children? The answer may lie in a…

Sugar, Taxes, & Choice

First published: 08 December 2019

Abstract

Population obesity and associated morbidities pose significant public health and economic burdens in the United Kingdom, United States, and globally. As a response, public health initiatives often seek to change individuals’ unhealthy behavior, with the dual aims of improving their health and conserving health care resources. One such initiative—taxes on sugar-sweetened beverages—has sparked considerable ethical debate. Prominent in the debate are arguments seeking to demonstrate the supposed impermissibility of SSB taxes and similar policies on the grounds that they interfere with individuals’ freedom and autonomy. Commentators have often assumed that a policy intended to restrict or change private individuals’ consumption behavior will necessarily curtail freedom and, as a corollary, will undermine individuals’ autonomy with respect to their consumption choices. Yet this assumption involves a conceptual mistake. To address the misunderstanding, it’s necessary to attend to the differences between negative liberty, freedom of options, and autonomy. Ultimately, concerns about negative liberty, freedom, and autonomy do not provide strong grounds for opposing SSB taxes.

Asylum, Refuge, and Justice in Health

First published: 03 July 2019

Abstract

Given the profound influence of social media and emerging evidence of its effects on human behavior and health, bioethicists have an important role to play in the development of professional standards of conduct for health professionals using social media and in the design of online systems themselves. In short, social media is a bioethics issue that has serious implications for medical practice, research, and public health. Here, we inventory several ethical issues across four areas at the intersection of social media and health: the impact of social networking sites on the doctor-patient relationship, the development of e-health platforms to deliver care, the use of online data and algorithms to inform health research, and the broader public health consequences of widespread social media use. In doing so, we review discussions of these topics and emphasize the need for bioethics to focus more deeply on the ways online technology platforms are designed and implemented. We argue that bioethicists should turn their attention to the ways in which consumer engagement, bias, and profit maximization shape online content and, consequently, human behavior and health. We also offer a set of recommendations and suggest future directions for addressing ethical challenges in these domains.

First published: 21 February 2019

Abstract

In “Social Media, e-Health, and Medical Ethics,” in this issue of the Hastings Center Report, Mélanie Terrasse, Moti Gorin, and Dominic Sisti address and suggest recommendations for several ethical issues central to the systematic ethical analysis of the effects of social media on clinical practice, health services research, and public health. The topic is as timely as it is important: social media data collected by device and web applications are constantly increasing and might have both individual and public health benefits. The authors focus their analysis primarily on the health care context. Yet the implications of the intersection of social media data and research warrant focused consideration, as even the most thorough ethical analysis in the clinical context is not necessarily directly applicable in the research context. While many ethical issues are present in both settings, the research context poses new challenges and calls for consideration of distinct factors. In particular, because the legal framework is less protective in research, critical ethical analysis of the research-specific issues and considerations is essential to the ethical conduct of research using social media data as well as to the design and operation of social media device and web applications themselves.

Taking a Systems Approach to Chronic Illness in Old Age

First published: 11 October 2018

Abstract

We are living through a demographic transition from a world in which there were lots of young people and very few older adults to one in which the numbers in these age groups are becoming more evenly balanced. One reason for this is that more of us are living into our seventies, eighties, nineties, and beyond. That is the good news. Unfortunately, the chance of developing chronic illnesses (including diabetes, arthritis, and dementia) is typically higher for people in these older age groups than for those who are younger. Because we do not know how to cure these illnesses, many of us will spend at least some of this extra time with one or more chronic illness. While we are more likely than in the past to live into older age, we are likely to be living with illness when we get there. That raises a challenge: how should we respond to this change?

Housing, the Built Environment, and the Good Life

First published: 11 October 2018

Abstract

At any age, the pursuit of a good life is easier in a physical environment that promotes health, supports activities important to self-fulfillment, and facilitates connections to the larger community. In old age, the home and neighborhood environments are particularly important: they are the locations where older people spend most their time, and they can have a great impact on independence, social connection, feelings of self-worth, and physical and emotional well-being.

Within the urban planning field, home and neighborhood characteristics are important dimensions of debates about the measurement of human progress and quality of life, particularly as an alternative to purely economic measures. They are also key issues in public health, particularly as they relate to physical, social, and mental well-being. Here, we focus on how to improve the fit of environments for people as they age.

Proposed Regulations Favor Providers’ Conscience Rights over Patients’ Rights

First published: 16 August 2018

Abstract

In establishing a new Conscience and Religious Freedom Division within the Office of Civil Rights of the Department of Health and Human Services and issuing new proposed regulations, the Trump administration has significantly expanded the power of health care providers over the medical choices of patients and has privileged the moral agency of health care providers over that of individual patients. When finalized, these regulations will replace those promulgated during the Obama administration, just as those regulations replaced those promulgated in 2008 by the Bush administration. The 2018 proposed regulations interpret the federal conscience statutes more broadly than either of these predecessors. Among the many significant provisions in the proposed rules are definitional terms that reach a broader range of individuals and activities, the absence of balancing interests, and a powerful enforcement structure.

Defining Misprescribing to Inform Prescription Opioid Policy

First published: 16 August 2018

Abstract

Prescription opioid policies too often reflect over a century’s worth of moralizing about the nature of opioid use disorder, the value of pain, and the meaning of suffering. The social and legal penalties to prescribers run in one direction—avoid overprescribing, however defined, at all costs. The lack of shared definitions is problematic for formulating and evaluating opioid policy. For example, the variant definitions of “misuse,” “abuse,” and “addiction” complicate estimates of morbidity. There are also no widely accepted definitions of misprescribing and overprescribing. I offer here a modest attempt at the categorization of misprescribing: inadvertent overprescribing, corrupt overprescribing, qualitative overprescribing, quantitative overprescribing, multiclass overprescribing, and underprescribing.

Are Obese Children Abused Children?

First published: 16 August 2018

Patient Care to Public Health to Synthetic Biology

First published: 19 February 2018

Abstract

The January-February 2018 issue of the Hastings Center Report includes pieces addressing patient care concerns that lie at the original core of bioethics and pieces that reflect the field’s growing breadth. Among the pieces getting at the original core is an article by philosopher Daniel Brudney on the moral values underpinning surrogate decision-making. The article and the two commentaries that follow it contribute to the debate on the moral authority of surrogate decision-makers. Several items in the issue take up matters of public health and health policy. For example, the lead article, by Nir Eyal, examines the ethics of using inconvenience—waiting lists and the like—to constrain the consumption of health care services, and a commentary by Lawrence Gostin examines the regulation of sugary beverages. A supplement to the issue contains a special report about the tools and processes used to assess the impact of emerging technologies, with a focus on synthetic biology.

Tackling Obesity and Disease: The Culprit Is Sugar; the Response Is Legal Regulation

First published: 19 February 2018

Abstract

It is staggering to observe the new normal in America: 37.9 percent of adults are obese, and 70.7 percent are either obese or overweight. One out of every five minors is obese. The real tragedy, of course, is the disability, suffering, and early death that devastates families and communities. But all of society pays, with the annual medical cost estimated at $147 billion. The causal pathways are complex, but if we drill down, sugar is a deeply consequential pathway to obesity, and the single greatest dietary source is sugar-sweetened beverages (SSBs). The copious amount of sugar in the American diet is no accident. Industry practices and regulatory failures have fueled this explosion. Yet there are sensible, effective interventions that would create the conditions for healthier behaviors. What are the key interventions, and how can we overcome the social, political, and constitutional roadblocks? Tobacco control offers a powerful model, suggesting that success requires a suite of interventions working in concert: labeling, warnings, taxation, portion sizes, product formulation, marketing restrictions, and bans in high-risk settings such as schools and hospitals. Each intervention deserves detailed analysis, but I’m kick-starting scholarly and policy conversation by systematically laying out the major legal tools.

Raising the Stakes for Nondiscrimination Protections in the ACA

First published: 19 February 2018

Abstract

In the struggle over the durability of the Affordable Care Act, defenders of the ACA stand guard at many fronts. A major contribution of the ACA to nondiscrimination law, however, appears increasingly vulnerable. The ACA established significant new nondiscrimination protections for patients under section 1557 and its implementing regulations. Several of these regulations—including protections on the basis of gender identity and pregnancy termination—are now under reconsideration at the Department of Health and Human Services, after a nationwide injunction lasting almost a year. Nondiscrimination laws matter, of course, because they promote equal access to health care. But focusing on discriminatory behavior alone is a narrow view of the purpose and potential of nondiscrimination rules—and underestimates the stakes of softening section 1557. To evaluate these protections, we must consider not only their impacts on discriminatory behavior but also their behavioral and attitudinal impacts on patients and communities. This is because supportive or stigmatizing rules can exert an expressive effect: laws communicate information about prevailing social norms, they give some norms greater authority by virtue of the state’s support, and they can shape community values. Through these expressive impacts, nondiscrimination laws may affect not only discriminatory behavior in health activities but also the attitudes, beliefs, and decisions of people who are legally protected.

Community Engagement and Field Trials of Genetically Modified Insects and Animals

First published: 19 February 2018

Abstract

New techniques for the genetic modification of organisms are creating new strategies for addressing persistent public health challenges. For example, the company Oxitec has conducted field trials internationally—and has attempted to conduct field trials in the United States—of a genetically modified mosquito that can be used to control dengue, Zika, and some other mosquito-borne diseases. In 2016, a report commissioned by the National Academies of Sciences, Engineering, and Medicine discussed the potential benefits and risks of another strategy, using gene drives. Driving a desired genotype through a population of wild animals or insects could lead to irreversible genetic modification of an entire species. The NASEM report recommends community, stakeholder, and public engagement about potential uses of the technology, and it argues that the engagement should occur as research advances, well before gene drives are deployed. Yet what “engagement” means in practice is unclear. This article seeks clarity on this problem by offering a justification for community engagement and drawing out implications of this argument for the implementation and desired outcomes of community engagement.

Community engagement is essential when it comes to research that would release genetically modified insects or animals into the environment. By contrast, obtaining informed consent from people who live near such a proposed field trial is neither necessary nor sufficient. Drawing on the epistemic and moral arguments for deliberative democracy, I propose two discrete mechanisms of community engagement: community advisory boards and deliberative forums, neither of which has been systematically incorporated into research governance. The proposed mechanisms would engender respect for persons who live near field trials, even when the results of deliberation override some individuals’ preferences. Community engagement foregrounds the community in our thinking about humans’ relationship to nature, and it implies that deciding to release genetically modified insects or animals into the wild ought to be a collective decision, not one made by product developers, policy-makers, private companies, research funders, or scientists alone.

On Nudgin g Health

First published: 19 February 2018

Abstract

Ideas of nudging, choice architecture, and libertarian paternalism have sparked much controversy. Some find in them a long-sought optimal harmonization of the commitments to beneficent, welfare-increasing influence and to respecting persons, whereas people on the opposite end see in them an especially sinister form of control. One area in which these ideas are of greatest importance is health care, where improving people’s decisions, under the constraint of respect for persons, is a vital concern. Nudging Health: Health Law and Behavioral Economics, edited by Glenn Cohen, Holly Fernandez Lynch, and Christopher Robertson, is the first book dedicated to this important topic. This anthology of twenty-four chapters, with section introductions and a foreword by Cass Sunstein, presents a wide spectrum of perspectives on both the promise and the difficulties in applying choice architecture to health care. The short and readable chapters, written for the book, cover questions of public health law and policy, clinical practice, medical ethics, and political philosophy. They present a synopsis of the types of questions that nudging brings up in health care broadly construed, offer new analyses, and provide much fodder for thought.

First published: 24 November 2017

Abstract

For observers of pharmaceutical regulation and the Food and Drug Administration, these are uncertain times. Events in late 2016 raised concerns that the FDA’s evidentiary standards were being weakened, compromising the agency’s ability to adequately perform its regulatory and public health responsibilities. Two developments most directly contributed to these fears—the approval of eteplirsen, a treatment for Duchenne muscular dystrophy, against the recommendations of both FDA staff and an advisory committee and the December 2016 signing of the 21st Century Cures Act, which encouraged greater use by the FDA of “real-world” evidence not obtained through randomized controlled trials. The arrival of the Trump administration—with its deregulatory, industry-friendly approach—has only amplified concerns over the future of the FDA. It is too early to know whether the recent developments are truly harbingers of an FDA less likely to prevent unsafe or ineffective products from reaching the market. But elements in the two events—the role of patient narratives in deliberations regarding eteplirsen and the enthusiasm for real-world evidence in the 21st Century Cures Act—raise critical issues for the future of evidence in the FDA’s work. The rigorous, inclusive approach under way to consider issues related to real-world evidence provides a model for a similarly needed inquiry regarding public participation in FDA decision-making.

Public Health Autonomy: A Critical Reappraisal

First published: 24 November 2017

Abstract

The Hill Burton Act, which was signed into law in 1946 and ended in 1997, was one of the most significant forces that shaped the health care system we have today. Providing grants and loans for the construction and expansion of hospitals across the country, it required beneficiary hospitals to give some amount of uncompensated care to the poor and uninsured in return.

The act not only led to our health care system’s current emphasis on the acute-care hospital as the primary site of health care delivery, but it also had a profound effect on nursing, fully involving the profession in an acute-care world. The act created jobs for nurses at an unprecedented level. There are over 3.4 million nurses in the United States, and in 2013, 63 percent of all nurses worked for hospitals. Nursing education continues to emphasize acute care, despite the calls for shifting the curriculum to more community-based content and experiences that focus on health promotion and wellness for individuals, families, and communities. It is my premise that the nursing profession and all who profess to be committed to promoting health have a moral obligation to help the nation adopt a Hill-Burton Act of the twenty-first century that will focus on building healthy communities, supporting families in ways that promote health, and helping individuals to live healthier lives. This would require a shift in resources from a costly health care system to investing in community development, whether job creation, building safe places to play and exercise, providing access to affordable and nutritious foods, advancing the quality of education, or other approaches to addressing and improving the social determinants of health. Making this kind of investment would speak to the principles of beneficence, least harm, and justice, particularly for socioeconomically stressed communities.

Quarantine Controversy: Kaci Hickox v. Governor Chris Christie

First published: 06 May 2016

Abstract

Nurse Kaci Hickox is among the “Ebola Fighters” honored by Time magazine as its 2014 Person of the Year, having treated Ebola patients in Sierra Leone while volunteering with Médecins Sans Frontieres. When she returned to the United States in October 2014, she was quarantined in New Jersey for three days before returning home to Maine under the terms of a negotiated release. A year later, in October 2015, Hickox filed suit in federal court against Governor Chris Christie and New Jersey health officials, claiming that the quarantine violated her civil rights. Her complaint asserts that New Jersey officials lacked the authority to quarantine her because she did not pose a significant risk of transmission. The lawsuit raises important questions about disease-transmission risk, the inability of science to rule out certain theoretical risks, and the state’s power to quarantine. It also demonstrates that population health depends on respecting individual liberty and using the best available epidemiological data to set public health policy.

A Vaping Matter: E-cigarette Use in Health Care Organizations

First published: 10 November 2015

Abstract

Although there is no federal legislation yet on e-cigarettes, the U.S. Food and Drug Administration proposed regulations in April 2014 that would prohibit sales of e-cigarettes to anyone under eighteen and require that they be approved by the FDA as a tobacco product and carry warning labels for consumers on their packaging. (The proposed regulations have been characterized as conservative, however, because they do not restrict e-cigarettes that are fruit or candy flavored or restrict advertising, which tends to target young consumers.) Only three U.S. states have extended the same restrictions placed on tobacco products to e-cigarettes; however, eighteen states have passed legislation enacting use restrictions on venues such as schools, state property, or workplaces. Until there is applicable legislation at the federal, state, or municipal levels, health care organizations will have to develop institutional policies if they wish to consistently address the use of e-cigarettes by patients and visitors on their property.

A Buyer’s Market? Fixing the Price for Human Ova for Assisted Reproduction

First published: 10 November 2015

Abstract

The Wall Street Journal article “Putting a Price on a Human Egg” triggered extensive media coverage of a rather unusual challenge to payments made to women providing ova for use in assisted reproduction. In Kamakahi v. American Society for Reproductive Medicine and Society for Assisted Reproductive Technologies, plaintiffs claim that ASRM and SART policies adopting limits on such payments violate the federal antitrust prohibition against price fixing.In 2007, an ASRM Ethics Committee Report, confirming a 2000 report, asserted that, “[a]lthough there is no consensus on the precise payment that oocyte donors should receive, at this time sums of $5,000 or more require justification and sums above $10,000 are not appropriate.” SART is an affiliate organization of ASRM and counts as its members 90 percent of the clinics providing assisted reproductive technologies in the United States. SART requires that its members “[adhere] to all ASRM/SART Guidelines including ethical, practice, advertising, and laboratory.” The plaintiffs in Kamakahi claim that the agreement among SART members to abide by the ASRM policy restricts competition among agencies procuring oocytes and produces lower payments than women would otherwise be able to negotiate. It is through the requirement that SART members adhere to ASRM ethical guidelines that ethics goes to market and encounters antitrust law.

Ethicists continue to debate whether payment for oocytes inappropriately commodifies the human body, and ASRM policy consistently refers to their procurement as the “donation process” and to women who participate as “donors.” Nevertheless, in the context of antitrust law, the procurement of oocytes is a business and clearly falls within the reach of antitrust restrictions on business conduct.

Justice Roberts Gets It

First published: 28 September 2015

Abstract

Opponents of the Affordable Care Act have attempted to topple it in court by challenging the legality of two of its three legs. Three years ago, in NFIB v. Sibelius, Chief Justice Roberts narrowly upheld the constitutionality of the individual mandate, in a 5-to-4 decision that characterized the mandate as an optional tax rather than as a regulatory command. This year, on June 25, the health policy community exhaled a giant sigh of relief when the Supreme Court upheld the subsidy leg of the ACA structure. In King v. Burwell, Justice Roberts again wrote the majority opinion (this time for six members that included Justice Kennedy), ruling as a matter of statutory interpretation that subsidies for insurance premiums are available not just through state-based exchanges but also through the federal exchange.

First published: 09 July 2014

Abstract

There are no national recommendations for routine screening for sickle cell trait, nor is there guidance on whether or how to notify donors that they might be tested or identified as having sickle cell trait. As a result, the organizations that collect blood have implemented variable policies about whether and how to inform prospective donors of the possible screening and discovery of this noncommunicable condition. The question of what they should do is related to the broader question of how to handle incidental and secondary findings. In a recent report, the Presidential Commission for the Study of Bioethical Issues outline a framework for handling such findings in the clinical, research, and direct-to-consumer contexts. While the commission’s report did not directly address incidental and secondary findings in the public health context of blood donation, it made several overarching recommendations that apply in all contexts where such findings might arise. This essay outlines the special issues raised by discovering sickle cell trait in blood donation and considers the implications of the commission’s framework for that problem.

Obesity, Liberty, and Public Health Emergencies

First published: 11 June 2014

Abstract

Widespread obesity poses a serious challenge to health outcomes in the developed world and is a growing problem in the developing world. There has been a raft of proposals to combat the challenge of obesity, including restrictions on the nature of food advertising, the content of prepared meals, and the size of sodas; taxes on saturated fat and on calories; and mandated “healthy-options” on restaurant menus. Many of these interventions seem to have a greater impact on rates of obesity than does simply providing information about health risks and healthier lifestyles. The more interventionist policy options have, however, been implemented only slowly, in large part because of criticisms that they are unjustified infringements on the liberty of consumers. Food industry groups, free-market think tanks, and the popular press regard measures that incentivize or penalize particular food and lifestyle choices as unjustifiable state regulation of purely self-regarding behavior.

To counteract the liberty-oriented position, those who favor a more interventionist role for the state have recently argued for labeling obesity as a public health emergency. By labeling obesity as a public health emergency, policy-makers could override concerns about individual liberty in order to pursue more interventionist policies designed to guide consumer choices toward healthier lifestyles. In this paper, we argue that, contrary to initial appearances, obesity possesses some of the morally relevant features of public health emergencies, though we do not argue that it actually constitutes one.

Tobacco Endgame: The Poverty Conundrum

First published: 12 May 2014

Abstract

There is no more striking public health triumph than the demise of the “brown plague.” The cigarette was once the accoutrement of a good life, but smoking is now a tragic habit of the poor. By the mid-1960s, half of all men and a third of women in the United States smoked. Today the national prevalence is 18 percent, with rates in major cities below 15 percent. A suite of policies drove down smoking rates—antismoking campaigns, taxation, clean air laws, package labeling, and marketing curbs. These policies, and the resultant behavior changes, however, have diminishing returns. Is it possible that tobacco rates will remain relatively stagnant? If so, what “endgame” strategies might drive rates to negligible levels, say, lower than 5 percent? And if society does achieve such an audacious goal, how attentive should it be to the problems of social justice?

Counterterrorism, Ethics, and Global Health

First published: 12 May 2014

Abstract

The intersection of national security, foreign policy, and health has been explored in a number of arenas, but little attention has been devoted to the ethical issues surrounding the global health impact of current counterterrorism policy and practice. In this essay, we’ll review a range of harms to population health traceable to counterterrorism operations, identify concerns involving moral agency and responsibility—specifically of humanitarian health workers, military medical personnel, and national security officials and operatives—and highlight two interrelated policy issues: the need for a conception of national security that incorporates a cosmopolitan concern for health, and the need for shared health governance, including governance of activities affecting health.

Silencing Marcellus: When the Law Fractures Public Health

First published: 14 March 2014

Abstract

We tend to think of conflict as bad and compromise as good. But how should we view conflict that exposes potential threats to the environment and health? And what about a compromise between litigants that may adversely affect the interests of third parties or undermine public health? There can be few places in the country where this issue has become more pressing than in my home state, Pennsylvania. The hydraulic fracturing of natural gas in the Marcellus Shale has transformed lives and landscapes here, mainly in rural communities with low-income populations. The Hallowich family is a case in point.

The Undocumented Unwell

First published: 11 January 2013

Abstract

Nell Toussaint is not well. In recent years, she has been diagnosed with uterine fibroids, uncontrolled hypertension, nephrotic syndrome, poorly controlled diabetes, hyperlipidemia, and a pulmonary embolism. She also suffers from decreased mobility, shortness of breath, and-perhaps not surprisingly, given her other ailments-anxiety. Toussaint is an indigent undocumented immigrant living in Canada who has been trying to secure medical coverage in the federal courts. In the process, she has sacrificed the medical confidentiality that most of us ordinarily enjoy.

Toussaint first came to Canada from Grenada as a visitor in 1999 and remained after the term of her visa expired. At first, she earned enough to sustain a living, but in 2006, her health began to deteriorate, and she was no longer able to work. Although she has received some medical care since then, it has been sporadic, on an emergency basis, and at great expense. When Toussaint applied for medical health coverage under Canada’s Interim Medical Health Program, which covers the cost of emergency medical care for legally admitted indigents, her application was rejected. She challenged the decision in federal court on the grounds that her right to life and security of the person under the Canadian Charter had been violated and that the denial of coverage was discriminatory.

Obesity: Chasing an Elusive Epidemic

First published: 18 December 2012

Abstract

Obesity may be the most difficult and elusive public health problem this country has ever encountered. Unlike the classical infectious diseases and plagues that killed millions in the past, it is not caused by deadly viruses or bacteria of a kind amenable to vaccines for prevention, nor are there many promising medical treatments so far. While diabetes, heart disease, and kidney failure can be caused by obesity, it is easier to treat those conditions than one of their causes. I call obesity elusive partly because of the disturbingly low success rate in treating it, but also because it requires changing the patterns, woven deeply into our social fabric, of food and beverage commerce, personal eating habits, and sedentary lifestyles. It also raises the most basic ethical and policy questions: how far can government and business go in trying to change behavior that harms health, what are the limits of market freedom for industry, and how do we look upon our bodies and judge those of others?

Lessons to Improve the Efficiency and Equity of Health Reform

First published: 13 September 2012

Abstract

The recent Supreme Court decision on several provisions of the Patient Protection and Affordable Care Act provides an opportunity to address two kinds of design flaws in the legislation whose correction would both improve economic efficiency and some important dimensions of equity.

The Court’s view that the mandate is a tax is consistent with the general economic view that defines a tax as “a compulsory payment for public purposes.” This was the viewpoint I took in my earlier work as well. However, there is considerable difference, disagreement, and ambiguity about the public purpose sought by the ACA payment. The primary purpose of the mandate in my work and in arguments for the mandate in Massachusetts was to try to get as many people as possible to have at least some insurance coverage. A secondary consequence of a mandate is to shore up community rating, although community rating per se does not contribute (and generally is harmful) to the goal of covering a greater proportion of the population.

Child Safety, Absolute Risk, and the Prevention Paradox

First published: 25 April 2012

Abstract

Imagine you fly home from vacation with your one-and-a-half-year-old son who is traveling for free as a “lap child.” In the airport parking lot, you put him into his forward-facing car seat, where he sits much more contentedly than he did in the rear-facing one that was mandatory until his first birthday. After he falls asleep on the way home, you transfer him to his crib without waking him, lowering the side rail so you can lift him in more easily.

Many parts of this idyllic parenting picture are deemed unacceptably risky according to recent child safety proposals. While these proposals all aim to improve child safety, their possible impact is unclear because there has been little discussion of the absolute risk and risk reduction involved in each. And while precise figures are lacking, rough estimates indicate that the magnitudes are quite small. I will argue that this risk and benefit data raises important questions about the proposals, including whether parents might reasonably believe that the small absolute risk reduction offered by the proposed changes does not justify the attendant burdens. This possibility—termed the “prevention paradox” in other contexts—highlights ethical and theoretical challenges in this area of public health.

First published: July 2008

Abstract

Childhood obesity may have severe long-term consequences for health—indeed, for the overall course of a person’s life. Do these harms amount to a problem of social justice? And if so, what should be done about it? Parents are usually granted considerable leeway to make decisions that affect their children’s health. Social and moral theory has often overlooked the family, however, leaving us with an inadequate understanding of parental autonomy and of how social policy may influence it.

Health Care and Equality of Opportunity

First published: March 2007

Abstract

One widely accepted way of justifying universal access to health care is to argue that access to health care is necessary to ensure health, which is necessary to provide equality of opportunity. But the evidence on the social determinants of health undermines this argument.

Justice and the Human Development Approach to International Research

First published: January 2005

Abstract

The debate over when medical research may be performed in developing countries has steered clear of the broad issues of social justice in favor of what seem more tractable, practical issues. A better approach will reframe the question of justice in international research in a way that makes explicit the links between medical research, the social determinants of health, and global justice.

The Smallpox Vaccination of Health Care Workers: Professional Obligations and Defense against Bioterrorism

First published: September 2003

Abstract

Health care workers have not gone along with President Bush’s request that they be vaccinated against smallpox in order to prepare the nation’s health care system for a terrorist attack using the virus. But there is no professional moral obligation to receive the vaccination—either as a matter of public health or as a matter of national security.

Policy as Product: Morality and Metaphor in Health Policy Discourse

First published: May 1999

Abstract

Where we once spoke in military terms, we now often wield the language of the market: health care is a “product” and we are its “providers” and “consumers.” The market metaphor constrains in various ways our vision of the goals we pursue in making health policy, of the options available to us in pursuing them, indeed—because policy implies a certain view of moral agency—of the way we relate to each other.

From The Hastings Center Bioethics Timeline:

1946: Hill-Burton Act

Congress enacted the Hospital Survey and Construction Act (Hill-Burton Act), which provides for hospitals, nursing homes, and other health facilities grants and loans for construction and modernization. Intended to insure 4.5 hospital beds per 1,000 people, the Act made hospital care more readily available in many parts of the United States.

1946: Guatemala Syphilis Studies

The Syphilis Study Section of the National Institutes of Health-approved grants for Public Health Service researchers to study intentional infection with syphilis, gonorrhea, and chancroid, followed by treatment with newly available penicillin. The studies, involving more than 1,300 Guatemalan soldiers, prisoners, and mental patients, began in 1946 and ended in 1948. The studies remained buried in the archives until 2010.

1962: Congress Passes Kefauver-Harris Amendment

The Kefauver-Harris amendment to the Federal Food, Drug and Cosmetic Act, which mandated safety and efficacy testing prior to the marketing of drugs, is passed by Congress. It was written in response to the Washington Post’s front-page expose of the thalidomide tragedy, in which about 8,000 infants with missing or malformed limbs were linked to thalidomide’s widespread usage among pregnant women (mostly in Europe) after having taken the drug for nausea.

1964: Surgeon General’s Report on Smoking

Surgeon General Luther Terry issues Smoking and Health, a report using epidemiological studies to demonstrate that cigarette smoking caused lung cancer and likely heart disease. This was a landmark study in both the history of public health and health activism.

1965: Letter Questioning Tuskegee Study

Detroit physician Irwin Schatz writes to the U.S. Public Health Service questioning the morals of the Tuskegee Study of Untreated Syphilis in the Negro Male, but his letter is ignored. Seven years later, there would be widespread outrage when details of the study went public.

1965: Congress Passes Medicaid and Medicare

Despite opposition from the American Medical Association, two governmental health insurance programs are passed: Medicaid, which insures the indigent, and Medicare, which insures those 65 and older. The implementation of Medicare, along with the 1963 Fourth Circuit Court of Appeals case mandating desegregation of hospitals and linking desegregation with federal funding policies, transformed hospitals from among the most segregated to the most integrated institutions in the nation. The National Medical Association, which represents the interests of African American patients and physicians, supported both Medicaid and Medicare.

1971: Publication of John Rawls’ A Theory of Justice

John Rawls proposes a theory of justice that provides an alternative to utilitarian theories of justice and addresses concerns about the distribution of benefit. His theory is a form of social contract theory. While his work does not address health policy, it profoundly influences subsequent ethical analysis regarding the fair distribution of health care and other health-related interventions.

J. Rawls, A Theory of Justice (Harvard University Press, 1971)

1972: Tuskegee Syphilis Study Revealed

The study of “Untreated Syphilis in the Negro Male” was begun by the U.S. Public Health Service in 1932. In the mid-1960s, Peter Buxton, a PHS venereal disease investigator in San Francisco, found out about the Tuskegee study and expressed concerns to his superiors that it was unethical. The PHS formed a review committee but ultimately opted to continue the study with the goal of tracking participants until all had died so that autopsies could be performed and project data could be analyzed. Buxton then leaked the story to a reporter friend who passed it on to a fellow reporter. Jean Heller of the Associated Press broke the story in July 1972, prompting public outrage and forcing the study to shut down.

J. Heller, “Syphilis Victims in U.S. Study Went Untreated for 40 Years,” New York Times, July 26, 1972. https://www.nytimes.com/1972/07/26/archives/syphilis-victims-in-us-study-went-untreated-for-40-years-syphilis.html

1973: Patient’s Bill of Rights

AHA Patient’s Bill of Rights

1973: Final Report of the Tuskegee Syphilis Study Ad Hoc Advisory Panel Is Submitted to the U.S. Public Health Service

The Advisory Panel described the study as ethically unjustified and recommended that a permanent national board be established with authority to regulate federally supported research involving human subjects.

https://biotech.law.lsu.edu/cphl/history/reports/tuskegee/complete%20report.pdf

1976: Ebola Outbreak

In 1976, the first cases of Ebola virus were discovered near the Ebola River in Zaire (now known as the Democratic Republic of Congo). From the moment of its discovery until the present day, the disease has been a focus of controversy as narratives about scientific triumphalism conflicted with anthropological observations of cultural imperialism in the guise of science. Although indigenous cultural beliefs and practices were blamed for preventing effective treatment of the disease, a major cause of the virus’s spread turned out to be improper sterilization of needles, i.e., so-called scientific medicine. The outbreak was ultimately contained by traditional epidemiological methods of contact tracing, isolation, and quarantine.

https://www.sciencemag.org/news/2014/08/part-one-virologists-tale-africas-first-encounter-ebola

https://www.sciencemag.org/news/2014/08/part-two-virologists-tale-africas-first-encounter-ebola

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62382-5/fulltext

Acquired Immune Deficiency Syndrome is recognized by the U.S. Centers for Disease Control (CDC).

https://www.nytimes.com/1982/05/11/science/new-homosexual-disorder-worries-health-officials.html

1985: Public Health Service Task Force Report on Women’s Health Issues

The first federal effort to examine women’s health issues which recognizes that women have different health issues than men. It led to the inclusion of women in human subject’s research.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1424718/pdf/pubhealthrep00101-0075.pdf

1985: Heckler Report

Report of the Secretary’s Task Force on Black and Minority Health resulted in the creation of the Office of Minority Health in the Office of Health and Human Services.

https://www.ahrq.gov/research/findings/nhqrdr/chartbooks/blackhealth/part2.html

1995: Ebola Outbreak

https://www.sciencemag.org/news/2014/08/part-one-virologists-tale-africas-first-encounter-ebola

https://www.sciencemag.org/news/2014/08/part-two-virologists-tale-africas-first-encounter-ebola

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62382-5/fulltext

In their book, Powers and Faden bring our attention to the principle of justice in securing public health and designing health policy. They point out the nondistributional aspects of justice.

M. Powers and R. Faden, Social Justice: The Moral Foundations of Public Health and Health Policy(New York: Oxford University Press, 2006). https://global.oup.com/academic/product/social-justice-9780195375138?cc=us&lang=en&

2006: Approval of the Human Papilloma Virus Vaccine

This vaccine is first approved and may prevent up to 90% of cervical cancers. This first vaccine to protect women against cervical cancer received an expedited review through a priority review process.

https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet

2006: Publication of Sudhir Anand, Fabienne Peter, and Amartya Sen’s Public Health, Ethics, and Equity

This edited volume recognizes the importance of equity in public health ethics. It provides an interdisciplinary understanding of health equity and promotes the recognition of ethical issues in public health. It includes contributions from philosophers, anthropologists, economists, and public-health specialists on five major themes: defining health equity, health equity and social justice, responsibilities for health, and ethical issues in health evaluation.

S. Anand, F. Peter, and A. Sen, Public Health, Ethics, and Equity (Oxford: Oxford University Press, 2006). https://global.oup.com/academic/product/public-health-ethics-and-equity-9780199276370?cc=us&lang=en&

2010: The Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act was signed into law by President Obama on March 23, 2010. One of its principal aims was to expand insurance coverage to millions of uninsured Americans.
Patient Protection and Affordable Care Act, 42 U.S.C. § 18001 et seq. (2010).

www.healthcare.gov/where-can-i-read-the-affordable-care-act/

www.ehealthinsurance.com/resources/affordable-care-act/history-timeline-affordable-care-act-aca

2010: Founding of the Patient-Centered Outcomes Research Institute (PCORI)

The U.S. Congress authorizes the creation of PCORI, an independent nonprofit nongovernmental organization to improve the quality and relevance of evidence to help patients, caregivers, and clinicians to make better-informed health care decisions. The creation of PCORI reflects a shift towards empowering patients by giving them a more active role in making decisions about their care and managing their own health.

www.pcori.org

2019: Novel Coronavirus (SARS-CoV-2) Outbreak in Wuhan, China

The outbreak of the 2019 coronavirus disease (COVID-19) was first reported on December 31, 2019 in Wuhan China.

www.who.int

2020: Coronavirus (SARS-CoV-2) Pandemic

Massive outbreaks of Covid-19 (the illness caused by SARS-CoV-2) arise initially in China, rapidly becoming a pandemic, overwhelming health systems in Italy, Iran, Spain, and Brazil, as well as New York, California, Florida, Texas, Arizona, and many other countries, states, and cities. Resource shortages prompt development and implementation of plans for contingency and crisis standards of care. The latter were rarely implemented, despite apparent need, which forced consideration of public health ethics and ethically justifiable strategies to allocate scarce resources, such as ICU beds and mechanical ventilators, often focusing on the role of equity. Debates also arise around the relative value and costs of nonpharmaceutical interventions, especially “social distancing” measures such as masking, quarantine, and economic shutdowns. Extreme examples of racial, ethnic, and socioeconomic disparities in Covid-19 infection rates and outcomes are also reported. Though these disparities were not surprising given longstanding, well-documented underlying disparities in health care, they draw particular attention as they are reported at almost the same time as the emergence of widespread protests over racial injustice in policing, sparked by the murder of George Floyd (see below).

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it

2020: Black Lives Matter Movement (George Floyd protests)

Created in 2013 in response to the death of Trayvon Martin and subsequent acquittal of his killer, the Black Lives Matter movement in 2020 becomes a massive “international response to state-sanctioned violence and anti-Black racism,” galvanizing around the videotaped, brutal killing of an unarmed black man named George Floyd by police officers in Minneapolis. Protests over police killings sweep many U.S. cities and the focus quickly expands to encompass racial injustice (and anti-Black racism in particular) in health care and other areas where the legacy of “scientific racism” perpetuates white privilege and structural discrimination again Black and brown people.

https://blacklivesmatter.com/about/

Ethics and Public Health

Bioethics Briefings:

From Hastings Bioethics Forum:

From Hastings Center Report:

From The Hastings Center Bioethics Timeline:

1946: Hill-Burton Act

1946: Guatemala Syphilis Studies

1962: Congress Passes Kefauver-Harris Amendment

1964: Surgeon General’s Report on Smoking

1965: Letter Questioning Tuskegee Study

1965: Congress Passes Medicaid and Medicare

1971: Publication of John Rawls’ A Theory of Justice

1972: Tuskegee Syphilis Study Revealed

1973: Patient’s Bill of Rights

1973: Final Report of the Tuskegee Syphilis Study Ad Hoc Advisory Panel Is Submitted to the U.S. Public Health Service

1976: Ebola Outbreak

1981: Gay-Related Immunodeficiency (GRID), later redubbed AIDS

1985: Public Health Service Task Force Report on Women’s Health Issues

1985: Heckler Report

1995: Ebola Outbreak

2006: Publication of Madison Powers and Ruth Faden’s Social Justice: The Moral Foundations of Public Health and Health Policy

2006: Approval of the Human Papilloma Virus Vaccine

2006: Publication of Sudhir Anand, Fabienne Peter, and Amartya Sen’s Public Health, Ethics, and Equity

2010: The Patient Protection and Affordable Care Act

2010: Founding of the Patient-Centered Outcomes Research Institute (PCORI)

2019: Novel Coronavirus (SARS-CoV-2) Outbreak in Wuhan, China