Creating a dynamic ethical framework for public health policy: Paul Farmer's theory of structural violence

Drafting ethical codes is helpful to guide public health professionals in their decision-making process, but it does not take long before these codes seem too static or become obsolete. New legislation, advances in medical technology and expanded medical knowledge through research requires constant ethical examinations into health care delivery and public health policy. Often, principles within ethical codes conflict with one another and professionals must choose which to prioritize. Accordingly, public health professionals need a more pragmatic ethical theory for reasoning through difficult decisions. This paper will discuss critiques of popular ethical codes, principles and theories used by public health professionals and offer an alternative.

Founded on Dr. Paul Farmer’s theory of structural violence, I integrate elements of Deontology, care ethics and social justice theories in an attempt to provide a dynamic model of ethics applied to all levels of public health systems. Farmer’s theory of structural violence explains how current policies directly or indirectly justify inequality in the distribution of resources. My translation of Farmer’s analysis into theory explores ethical physician-patient relationships, health care systems and public resource access. With support from thinkers such as Farmer, Thomas Pogge, Martha Nussbaum and Amartya Sen, I argue that an appropriate public health policy needs to reconceptualize disease to include political, economic and social contexts. Using Farmer-based principles such as universal protection from harm, I build a theory of public health ethics that incorporates intrinsic human dignity, equity and solidarity in order to achieve a universal right to survive.