Ethics of Public Health Surveillance

This paper discusses the ethical justification of surveillance as a core methodology for public health. First, surveillance is distinguishing from the related concepts of screening and research. Second, it is argued that there are a number of possible reasons to support the use of surveillance, but these must be articulated and defended: surveillance contributes to the monitoring, maintenance and improvement of population health; it provides the opportunity to detect and assess the current scale of health problems, as well as the effectiveness of any interventions to address them; and it is of key relevance in priority-setting decisions. Such justifications for surveillance are powerful. However, a number of ethical concerns have been raised as surveillance activities may override or threaten some important ethical considerations. For example, informed consent may not be sought, or transfer of patient information for reasons other than those related to direct individual clinical care may occur. Where such issues arise in a research context, there are procedures in place to protect individuals from various harms, but similar protections do not tend to exist for surveillance. Of course, surveillance in such situations may still be justified – but the case needs to be made. This paper outlines a framework to aid deliberation by persons/committees required to consider ethical issues related to proposed surveillance activities in public health. The arguments are illustrated by using the example of a childhood weights surveillance activity recently proposed in Ontario, Canada.