Public health ethics consultation at the Centers for Disease Control and Prevention

The public health problems that the Centers for Disease Control and Prevention (CDC) addresses are often complex, involving multiple risk factors, multiple stakeholders with different perspectives, values, and beliefs, and many different ideas on how to prevent or ameliorate health problems. There may also be incomplete scientific evidence or gaps in relevant public health laws resulting in uncertainty about the best course of action. Although ethical decision making has always been integral to all CDC decision making, a systematic, deliberate ethical analysis process provides value by ensuring that decisions are in agreement with public health and other societal values and are supported by those who are affected by the actions.  In order to support development of public health ethics infrastructure, In 2005 CDC established the Public Health Ethics Committee (PHEC).  One of PHEC’s accomplishments has been the creation of a public health ethics consultation service that provides input when a CDC program identifies an area of ethical uncertainty or conflict for which it wishes to obtain guidance.  The consultation process adopted by CDC involves a systematic, yet flexible, 9-step approach to clarifying the issues, determining the pertinent ethical principles and values, and identifying possible alternative courses of action.  An additional unique component of CDC’s ethics consultation capacity is the Ethics Desk in the CDC Emergency Operations Center which was established to provide consultation on ethical issues that arise in the course of emergency response activities.  This presentation will describe the public health ethics infrastructure at CDC and the training requirements for those participating in the consultation process, discuss practical aspects of conducting a public health ethics consult within a government agency, and illustrate how a public health ethics consultation process can aid in routine and emergency public health decision making.  Examples of common ethical issues that arise in public health practice and descriptions of both formal and informal approaches to the consultation process will be provided.  In addition, the presentation will describe how CDC is supporting state and local health departments to build capacity to identify, analyze and resolve ethical issues in the practice of public health.