Abstract
Public health is in the spotlight of public and political concern, providing a unique window of opportunity for its revitalization and restoration as a pillar of the Canadian health care system. The establishment of a Federal Public Health Agency is a critical first step. The public health community has identified key challenges toward this renewal. However, public health ethics have received little attention and, when addressed, have focussed almost exclusively on communicable diseases. The ethical issues inherent in public health transcend infectious diseases and are distinct from clinical and research ethics. Identifying and addressing ethical issues at the heart of public health, including the public interest and the common good, as well as fundamental issues related to the core functions of public health will be essential if this revitalization of public health is to be achieved. While legal and regulatory reforms are necessary, they will not be sufficient to adequately address fundamental questions of the valuing of public health or the ethical issues in public health. Elements of a research agenda on the ethical foundations of public health reform are identified here.
MeSH terms: Ethics, public health, public policy, goals
Résumé
Puisque la santé publique est actuellement au cour des préoccupations de la population et de la classe politique, la conjoncture est favorable à sa revitalisation et à sa restitution en tant que pilier du système de santé canadien. La création de l’Agence de santé publique fédérale et la nomination d’une ministre d’État à la Santé publique ont été de premières mesures essentielles. Les intervenants en santé publique ont cerné les principaux défis à relever pour assurer le renouvellement de leur discipline. Toutefois, l’éthique en santé publique a très peu été abordée, et presque exclusivement sous l’angle des maladies transmissibles. Or, les enjeux moraux de la santé publique transcendent les maladies infectieuses et diffèrent des enjeux liés aux pratiques cliniques et à la recherche. Pour réaliser la revitalisation nécessaire, il sera indispensable de répertorier et d’aborder les enjeux moraux au cour de la santé publique, comme le bien du pays et l’intérêt commun, ainsi que les enjeux fondamentaux liés aux fonctions de base de la santé publique. Des réformes des lois et des règlements sont nécessaires, mais elles ne suffiront pas à résoudre les questions fondamentales de la valeur intrinsèque de la santé publique ou des enjeux moraux à l’intérieur de la santé publique. Nous cernons ici les éléments d’un programme de recherche sur le fondement moral de la réforme de la santé publique.
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