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.     

New Labour and the politics of depoliticisation

A number of commentators in the 1980s sought to explain the character of the Thatcher administration. By contrast, relatively little work has been produced that seeks to analyse the principles and governing strategies of the Blair government. Focusing primarily on economic management, this article offers a characterisation of statecraft under Blair in terms of the politics of depoliticisation. In summary, it argues that the Blair government has fused aspects of traditional economic management with new initiatives to create a powerful tool of governing organised on the basis of the principle of depoliticisation. Depoliticisation as a governing strategy is the process of placing at one remove the political character of decision-making. State managers retain arm's-length control over crucial economic and social processes whilst simultaneously benefiting from the distancing effects of depoliticisation. As a form of politics it seeks to change market expectations regarding the effectiveness and credibility of policy-making in addition to shielding the government from the consequences of unpopular policies.     

Sir Alexander Cadogan and Lord Halifax's 'Damascus road' conversion over the Godesberg terms 1938

The article challenges the recent perception that Lord Halifax was the hero of the Czech crisis in 1938, when in fact the real credit for his revolt against the Godesberg terms belonged to Sir Alexander Cadogan, the Permanent Under-Secretary at the Foreign Office. It does on to argue that Halifax was ill suited by nature to be Foreign Secretary and that his subsequent record shows him to have been a natural appeaser, still loyal to Chamberlain, who argued for an accommodation with Hitler in the summer of 1940.     

Court Management of AIDS Disputes: A Sociolegal Analysis

Historically, disease scares reveal contradictions in the social order. We postulate that courts focus on depoliticizing social tensions revealed by AIDS, legitimating the routines of dominant parties in the AIDS sociolegal network. At the same time, courts deviate from their normal practices try upholding the claims of subordinate parties in this network, particularly people living with AIDS (PWAs) and their allies. Our analysis of 36 AlDS-related court rulings, published during the formative years of AIDS litigation in the United States, supports the notion that courts operate as "double-edged" institutions. To explain the duality of judicial decision making, we concentrate on the powers of social and cultural factors rather than on the doctrinal judgments of the courts. We trace how relational attributes, evident in contestants' characteristics (e.g., plaintiff/defendant, status differentials) and the nature of claims (i.e., restrictive/expansive), combine to account for wins for dominant parties and how other combinations of these attributes define wins for subordinate parties. We also show how judges combine specific interpretational attributes in the text of their rulings (e.g., use of divisive AIDS metaphors, deference to medical authority) to justify wins. We consolidate these findings to discuss how PWAs and their allies might use the courts to their advantage and point out the ways in which the changing epidemiology of AIDS in the United States limits the use of courts.     

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