Looking Ahead: Addressing Ethical Challenges in Public Health Practice

Ethical challenges in public health can have a significant impact on the health of communities if they impede efficiencies and best practices. Competing needs for resources and a plurality of values can challenge public health policymakers and practitioners to make fair and effective decisions for their communities. In this paper, the authors offer an analytic framework designed to assist policymakers and practitioners in managing the ethical tensions they face in daily practice. Their framework is built upon the following set of six considerations: determining population-level utility of the proposed action; demonstrating evidence of need and effectiveness of actions; establishing fairness of goals and proposed implementation strategies; ensuring accountability; and, assessing expected efficiencies and costs associated with the proposed action. Together, these considerations create a structured guide to assist decision-makers in identifying potential ethical challenges and in assessing the moral considerations that underlie public health practice - and possibly even, if the conditions are met, reduce the creation of ethical tension. Although the authors'empirical experiences provide the basis for the framework advanced here, their approach remains to be tested and evaluated by public health practitioners.     

Managing incidental findings in human subjects research: analysis and recommendations.

No consensus yet exists on how to handle incidental findings (IFs) in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are findings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed.     

A Reconsideration of the Political Significance of Shared Responsibility Agreements

The 1996–2007 Howard Coalition government introduced Shared Responsibility Agreements in 2005 to allocate discretionary funding to indigenous communities in a “mutually responsible” way. The policy was widely criticized as an ineffective and ideologically driven “showpiece”. Its significant governance‐building dimensions went without comment. Through the deployment of the conceptual tools of contract and governance, SRAs established new and depoliticised relationships between government and indigenous peoples, replacing the centralized political structure of the Aboriginal and Torres Strait Islander Commission. The future of the policy under the Rudd Government is uncertain, but understanding the impacts and implications of SRAs remains important.     

Mary Wollstonecraft on Politics and Friendship

How, exactly, might friendship be relevant to politics? Friendship between political actors can be hypothesised to have specific effects; friendship between individuals in society can be hypothesised to have specific political outcomes; or friendship and politics can be understood to be conceptually connected. Mary Wollstonecraft makes friendship a central concept in her political theory of social justice and good government. This article analyses how politics and friendship are related in her texts, exploring her arguments that friendship in society is a condition of just government, but also suggesting that for Wollstonecraft friendship and citizenship are congruent with one another, and hence that the connection between politics and friendship is conceptual as well as causal.