How Teaching Public Health Ethics Differs from Teaching Clinical Ethics: Applying Theories of Justice to Cases

Some bioethicists draw upon the terms microethics and macroethics to emphasize important distinctions between clinical and public health ethics issues. One way to motivate students' appreciation of how clinical ethics often features person-to-person (microethical) moral deliberation and public health ethics often features systemic, social, and political (macroethical) moral deliberation is to draw upon different theories of justice and apply them to cases. I'll draw upon several different theories of justice to consider different problems in healthcare ethics. Theories of distributive justice, for example, refer to the distribution of goods, services, opportunities, and access to goods, services, and opportunities. Reparative justice refers to questions about whether, how, and when to compensate citizens who have suffered past injustices or present injustices that are produced by historically entrenched patterns of oppression. Retributive justice refers to questions about whether, how, and when punishments or penalties for incurring harms to oneself or others should be determined and executed. Structural justice refers to questions about how power and knowledge are produced and promulgated in societies and their institutions; exploitation, marginalization, powerlessness, cultural imperialism, and violence are five prominent concepts in theories of structural justice.

In this session, I will model consideration of these concepts by contrasting their applications to clinical ethics cases and public health ethics cases. I will also describe important challenges to teaching these concepts well, particularly to health professions students and trainees.