Public Health Ethics, Paternalism, Autonomy and Justice

This report focuses on how government interferes in the lives of individual towards the good of a society, the concept of paternalism, autonomy and justice. It also discusses about the limits of paternalism, a clarification on the principles of justice. It also provides information of the public health ethics and the harm principles.

Running head: PUBLIC HEALTH
PUBLIC HEALTH
Name of the Student
Name of the university
Author’s note

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Introduction
Public health ethics and autonomy had been a surge these years. Although medications
focus on individual health, health of the population is mainly alarmed with the health of the
entire population which is different from the responsibility in catering to individual patients.
Public health is more concerned with the societal accountability to care for the health of the
entire populace. And this is where paternalism and breaching of public autonomy comes in to
being. This report focuses on how government interferes in the lives of individual towards the
good of a society, the concept of paternalism, autonomy and justice. It also discusses about the
limits of paternalism, a clarification on the principles of justice. It also provides information of
the public health ethics and the harm principles.
Paternalism
Law and the public attitude identify the protection of health as a core function of the
government. Public health actions are sometimes featured as invasive. Today many public health
measures were accepted cordially which were once thought as intrusive, controversial and
misguided (Buchanan 2008). The initiatives for public health includes the efforts to encourage
an open information for facilitating informed decision making, save the persons from being
harmed by the other persons of the group (Kelly 2013).
Information which is free and unbolt enables individuals to make informed choices and
reduce the likelihood of the misinformation. Considering the growing field of public health

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ethics, significant time has already been given to identify the ethical justifications of the
paternalistic interventions that collide with the person's autonomy from preventing the
individuals from adopting harmful behavior (Kelly 2013). On ethical and empirical grounds
public health should seek instead of expanding the individual autonomy for improving the public
health. Public health is concerned to protect and promote the health of the population (Buchanan
2008). Collective interventions can often require government initiatives. For example the CDC
and the FDA are in part or in whole public agencies related to health.
One of the views of the public health ethics regarding the ethical foundation of the public
health is an embargo to the maximum welfare. Paternalism in public health is mainly found in
issues like seatbelts and motorcycle helmet laws, policies to restrict certain substances, excise
taxes and advertising bans on unhealthy products, propose tax breaks for the ones having low
blood pressure, body mass index (Mullin 2014). So the justification for the paternalistic
interventions of the government is quite justified here as it is for the health and the well being of
the population,, that is for the greater good (Kelly 2013). The ethics of concern here is that
prevention of harm to others for the purpose of infectious disease control is ethically defensible.
Thwarting the choice of a person for their own good in preventing chronic diseases is quite
acceptable. Hence there are few initiatives that government take up are against the choice of the
public. Many public health professionals put forward the argument behavioral interventions are
acceptable as persons provide their informed consent for treatments such as smoking cessation
classes. Such interventions do not pose harm in case of an individual but becomes a problem
when the same law is applied for the masses, where the chance of gaining individual consent is
nearly impossible (Lee 2012).

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Clarifying principles of justice
It is important to differentiate between the term autonomy and positive freedom. One can
remain restricted still autonomous. The critical point lies in the position of deciding the
acceptable reasons behind the consent (Carter et al. 2012). Public may think that individuals may
do what they want to survive and should be responsible for any decisions they make. It may act
as unfair to burden those individuals who actually make healthy choices and yet they have to pay
high health care taxes supporting those who take up imprudent choices.
Harm principle and ethics in public health
Opposed to this perception, health professionals can argue that it is the responsibility of
the society to bear the responsibility of the unhealthy behaviors. Marmot and Wilkinson have
pointed out the powerful linkage between the health status and social position. Ross Upshur
introduced four public health principles such as the harm principle, the principle of least
restraining means, the reciprocity principle and the transparency principle. These principles
conduct the decisions when public health policies are justified (Lee 2012). The harm principle
states that a government can impose restriction over a person if there is a chance for other getting
harmed. The least restrictive principles may help one to choose which of the actions are really
justified. For achieving the public health goals, least restrictive means should be employed. If the
least restrictive means fail to achieve the public health goal then public heath would move to a
more coercive level (Lombardi et al. 2016). This is how the government moves from education
to facilitation and discussion and then to restriction.

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Conclusion
In the end it can be said that public health requires engaging the public directly in
creating a society in which every citizen will feel supported characterized by integrity, dignity
and mutual responsibility. The goal of the public health professionals is to check that people
have adequate opportunities for achieving good health. Furthermore, other things being equal,
the society in which individuals choose to behave responsibly, than being forced against their
will, paying of taxes is justified. The main aim is to improve the quality of life of the people.

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References
Buchanan, D.R., 2008. Autonomy, paternalism, and justice: ethical priorities in public
health. American Journal of Public Health, 98(1), pp.15-21.
Carter, S.M., Kerridge, I., Sainsbury, P. and Letts, J.K., 2012. Public health ethics: informing
better public health practice. New South Wales public health bulletin, 23(6), pp.101-106.
Kelly, J., 2013. Libertarian paternalism, utilitarianism, and justice.
Lee, L.M., 2012. Public health ethics theory: review and path to convergence. The Journal of
Law, Medicine & Ethics, 40(1), pp.85-98.
Lombardi, M., Miyagishima, K. and Veneziani, R., 2016. Liberal egalitarianism and the Harm
Principle. The Economic Journal, 126(597), pp.2173-2196.
Mullin, A., 2014. Children, paternalism and the development of autonomy. Ethical Theory and
Moral Practice, 17(3), pp.413-426.