Identifying and Resolving Ethical Dilemmas: A Study of Public Health and Preventive Medicine Physicians

Background: In 2007 the American College of Preventive Medicine initiated a survey on public health ethics with the goals of better understanding how members identify and resolve ethical dilemmas in their work, and developing a Code of Ethics for the profession. As part of a related study, a similar survey was administered to Canadian public health practitioners.

Method: An invitation to a web-based survey was emailed to all current ACPM members. The survey included quantitative and qualitative elements which were analyzed using SPSS and open-coding thematic techniques respectively.

Results: 508 (of 1838) respondents completed the survey. There was considerable heterogeneity on questions relating to fundamental values in public health, the balance of population versus individual interests and the role of the law and authority in decision-making when these come in conflict with personal ethical principles. The most often cited ethical conflicts arose regarding resource scarcity, conflicts between personal and employers values, and the collection of data and information. Though the phrase “social justice” itself did not feature prominently, related themes of equity, fairness and justice were often cited. These results differ considerably from the survey of Canadian public health practitioners.

Conclusions: Public health physicians regularly encounter significant ethical dilemmas in their work. They differ somewhat on fundamental notions of public health ethics but are supportive of the development of Code of Ethics. Differences of opinion regarding the goals and means of public health have significant implications for collaborative practice.