“A Really Tough Border to Cross”: Teaching Interdisciplinary Ethics within a ‘Medicine-Public Health Divide'

Ethical issues and analyses focused on individuals in a clinical context may differ from the ethical issues and analyses needed in a population-based public health framework. While a “public health ethics” has been conceptualized and recognized as distinct from biomedical ethics, it may be useful now to begin to consider the connections, interactions and interrelationships that link the two ethical perspectives. Recognition of the linkages between biomedical ethics and public health ethics can lead to an integrated view of healthcare ethics that cross-cuts healthcare delivery, disease prevention, health promotion and health policy. For example, conflicts between physicians and families regarding appropriate medical treatment near the end-of-life are usually viewed as involving individually-focused values and decisions with implications for those directly involved. But such individual ethical decisions are also linked to public health issues if the continuation of inappropriate care requires repeated use of antibiotics, giving rise to resistant strains of bacteria, or leads to a demoralization of the healthcare work force if clinicians are asked to act against their professional values. This paper will explore issues in teaching ethics from an interdisciplinary perspective that crosses the ethical boundaries of the ‘medicine-public health divide' and focuses on the concept of an integrated healthcare ethics. An integration of individual ethical decision making within the social/public health context of ethics may highlight alternative views of ethical priorities and ultimately contribute to health policy development.