I.

Public Health Ethics

Public Health is the assessment of communities, the development of policy to

address the needs and assets of communities, and the assurance of health of the
individuals in those communities. According to the Centers of Disease Control and
Prevention (CDC) Foundation, Public health is the science of protecting and
improving the health of families and communities through promotion of healthy
lifestyles, research for disease and injury prevention and detection and control of
infectious diseases. Overall, public health is concerned with protecting the health of
entire populations.

Public Health Ethics differs from bioethics in its valuation of interdependence

over autonomy and its recognition of the connection between the wellness of people
and the wellness of their communities.

Purpose of Public Health:

1. Prevent epidemics and spread of disease

2. Protect against environmental hazards
3. Prevent injuries
4. Promote and encourage healthy behaviors
5. Respond to disasters and assist communities in recovery
6. Assure the quality and accessibility of services

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Core public health functions and 10 essential public health services

Assessment- A core public health function, assessment is the regular collection,

analysis, and sharing of information about health conditions, risks, and resources in
a community.

- Allows public health practitioners to see the landscape in which they are
operating, much as a clinician caring for an individual patient will first
conduct a health history and perform a physical assessment of the
patients signs and symptoms.
1. Monitor the health status of populations (e.g., community health
profile, vital statistics, and health status).
2. Diagnose and investigate health hazards, disease, and infection in the
community (e.g., epidemiologic surveillance systems, laboratory support).

Policy Development- the second core function of public health, it uses information
gathered during assessment to develop local and state health policies and to direct
resources toward those policies.

3. Inform, educate, and empower people about health issues (e.g., health
promotion and social marketing).

4. Mobilize community partnerships and action to identify and solve

health problems (e.g., convening and facilitating community groups to
promote health).

5. Develop policies and plans that support individual and community

health efforts (e.g., leadership development and health system planning).

Assurance- the third core public health function, it focuses on the availability of
necessary health services through the community. It includes maintaining the ability
of both public health agencies and private providers to manage day-to-day
operations and the capacity to respond to critical situations and emergencies.

- Translate identified need and policy support into the provision of quality
services.
6. Enforce laws and policies that protect health and ensure safety (e.g.,
enforcement of sanitary codes to ensure safety of environment).

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 7. Link people to needed personal health services and ensure the
provision of health care when otherwise unavailable (services that
increase access to health care).
8. Ensure competent public and personal health care workforce (e.g.,
education and training for all public health care providers).
9. Evaluate effectiveness, accessibility, and quality of personal and
population-based health services (e.g., continuous evaluation of public
health programs).
10.Research for new insights and innovative solutions to health problems
(e.g., links with academic institutions and capacity for epidemiologic and
economic analyses).

II. Public Health Values Versus Biomedical Ethical Principles

Biomedical Ethical Principles Public Health Values

Autonomy is the right for an individual to The value of interdependence recognizes
self-govern by rational principles and to that each persons right to autonomy is
make his or her own choices free from not limitless but is interrelated with the
coercion. boundaries of the rights of others.
Nonmaleficence reflects the maxim The value of participation is congruent
stated in the Hippocratic Oath to first, with the concept of consent for public
do no harm. health.
Beneficence is the principle of seeking The value of scientific evidence
the best interests of an individual highlights the duty to look beyond
through careful weighing of risks and impassioned opinion or hunches, by
benefits. using of the full range of scientific tools
in public health decision-making so that
risks and benefits are weighed with a
heavy reliance on integration of the
scientific method and the highest-quality
evidence available.
Justice describes the duty to act fairly
and equitably when balancing
competing claims, including for
distribution of scarce resources, respect

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for individuals rights, and respect for
morally defensible laws.

4
 The following values and beliefs are key assumptions inherent to a public
health perspective. They underlie the 12 Principles of the Ethical Practice of Public
Health.

HEALTH

1. Humans have a right to the resources necessary for health.

The Public Health Code of Ethics affirms Article 25 of the Universal

Declaration of Human Rights, which states in part Everyone has the right to a
standard of living adequate for the health and well-being of himself and his
family...

COMMUNITY

2. Humans are inherently social and interdependent.

Humans look to each other for companionship in friendships, families, and

community; and rely upon one another for safety and survival. Positive relationships
among individuals and positive collaborations among institutions are signs of a
healthy community. The rightful concern for the physical individuality of humans
and ones right to make decisions for oneself must be balanced against the fact that
each per- sons actions affect other people.

3. The effectiveness of institutions depends heavily on the publics

trust.

Factors that contribute to trust in an institution include the following actions

on the part of the institution: communication; truth telling; transparency (i.e., not
concealing information); accountability; reliability; and reciprocity. One critical form
of reciprocity and communication is listening to as well as speaking with the
community.

4. Collaboration is a key element to public health.

The public health infrastructure of a society is composed of a wide variety of

agencies and professional disciplines. To be effective, they must work together well.
Moreover, new collaborations will be needed to rise to new public health challenges.

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5. People and their physical environment are interdependent.

People depend upon the resources of their natural and constructed

environments for life itself. A damaged or unbalanced natural environment, and a
constructed environment of poor design or in poor condition, will have an adverse
effect on the health of people. Conversely, people can have a profound effect on
their natural environment through consumption of resources and generation of
waste.

6. Each person in a community should have an opportunity to

contribute to public discourse.

Contributions to discourse may occur through a direct or a representative

system of government. In the process of developing and evaluating policy, it is
important to discern whether all who would like to contribute to the discussion have
an opportunity to do so, even though expressing a concern does not mean that it
will necessarily be addressed in the final policy.

7. Identifying and promoting the fundamental requirements for health

in a community are of primary concern to public health.

The way in which a society is structured is reflected in the health of a

community. The primary concern of public health is with these underlying structural
aspects. While some important public health programs are curative in nature, the
field as a whole must never lose sight of underlying causes and prevention. Because
fundamental social structures affect many aspects of health, addressing the
fundamental causes rather than more proximal causes is more truly preventive.

BASES FOR ACTION

8. Knowledge is important and powerful.

We are to seek to improve our understanding of health and the means of

protecting it through research and the accumulation of knowledge. Once obtained,
there is a moral obligation in some instances to share what is known. For example,
active and informed participation in policy-making processes requires access to

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relevant information. In other instances, such as information provided in confidence,
there is an obligation to protect information

9. Science is the basis for much of our public health knowledge.

The scientific method provides a relatively objective means of identifying the

factors necessary for health in a population, and for evaluating policies and
programs to protect and promote health. The full range of scientific tools, including
both quantitative and qualitative methods, and collaboration among the sciences is
needed.

10. People are responsible to act on the basis of what they know.

Knowledge is not morally neutral and often demands action. Moreover,

information is not to be gathered for idle interest. Public health should seek to
translate available information into timely action. Often, the action required is
research to fill in the gaps of what we dont know.

11. Action is not based on information alone.

In many instances, action is required in the absence of all the information one
would like. In other instances, policies are demanded by the fundamental value and
dignity of each human being, even if implementing them is not calculated to be
optimally efficient or cost-beneficial. In both of these situations, values inform the
application of information or the action in the absence of information.

ETHICAL CONSIDERATION

PUBLIC-HEALTH ETHICS
focuses on the design and implementation of measures to monitor and
improve the health of populations
looks beyond health care to consider the structural conditions that promote
or inhibit the development of healthy societies

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In public health practice, principles such as beneficence often carry more weight
than the principle of autonomy.

How does public health balance the interests of individuals with the
interests of the broader public?

Many public health activities try to influence individual actions, though they
may do so in more or less restrictive ways. Public health policy may eliminate choice
altogether through, for example, compulsory quarantine of patients with infectious
disease; restrict choice by, for example, banning smoking in public places or
fluoridating public water supplies; guide choice through disincentives (e.g., taxes on
health-harming goods, such as sugary beverages) and incentives (e.g., tax breaks
on health-promoting goods); or inform choice through, for example, food labeling or
media campaigns

Harm principle, originally articulated by John Stuart Mill

The only purpose for which power can be rightfully exercised over any
member of a civilized community against his will, is to prevent harm to others. His
own good, either physical or moral, is not a sufficient warrant (Mill 1989)

BENEFICENCE OR PATERNALISM

What is paternalism and who is responsible for health?

Cases where harm to others is absent or less easily established stir much
more debate because they raise the specter of paternalism. Paternalism occurs
when the state or an individual interferes with the preferences of a person for her
own benefit (e.g., to promote her health) (Childress et al. 2002).

Indeed, public health action often seeks to influence human behavior that
arguably does no harm to others.

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 The least controversial tactics for promoting behavior change are educational
in nature-providing people with information, whether it be the calorie content of
foods, the health effects of certain behaviors, and so on.

Educational strategies, however, often fail to produce behavior change,

particularly among socially disadvantaged groups

To address this challenge, social and material conditions may be remade to

support health and healthy choices. In the case of obesity, such measures might
include regulating food production (e.g., government choices about which foods to
subsidize, banning excess sodium in processed foods), prohibiting the sale of soda
and other sugary beverages in schools, and planning communities that will promote
walking, recreation, and otherwise positive social connections.

This structural approach to public health is, however, often criticized in

political contexts such as the United States, where personal responsibility (for
health and other goods) and individualism are highly valued

Responsibility lies not with these individuals, critics charge, but rather with
social institutions and society at large. This claim of social responsibility for health is
a critical plank in a larger argument that health (and/or the social determinants
thereof) should be subject to considerations of social justice. Agents of public health
often claim that health inequalities associated with social class, race, and ethnicity
constitute a social injustice because they are caused, at least in part, by socially
controllable factors

What constitutes a fair distribution of health?

Public health and health policy should aim to produce the most health
benefits, or aggregate health, in a population. This utilitarian goal, which aims to
maximize aggregate health, is distinct from the distributive goal to produce a fair
distribution of health.Although public health activities and health policies may
produce more health and reduce health inequalities, health initiatives very often
reproduce or exacerbate disparities because, as already noted, better off people

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tend to benefit sooner and disproportionately from many health promotion
interventions

One common strategy to address this problem is implementing interventions

that target vulnerable subgroups.

III. The Ethical Practice of Public Health

Ethical Principle Core Functions and Example of Ethical

Corresponding Dilemma
Essential Public Health
Services
1. Public Health should address Assessment: Alcoholism lads to
fundamental causes of disease Diagnose and many chronic
and requirements for health, investigate causes of conditions. Should a
aiming to prevent adverse disease. public health
health outcomes. Policy Development: practitioner focus on a
Inform, educate, and patients alcoholism
empower communities before addressing his
on prevention. Develop or her symptoms of
policies to prevent chronic hepatitis?
adverse health
outcomes.
This Principle gives priority not only to prevention of disease or promotion of
health, but also at the most fundamental levels. Yet the principle acknowledges that
public health will also concern itself with some immediate causes and some curative
roles. For example, the treatment of curable infections is important to the
prevention of transmission of infection to others. In the case of the ethical dilemma,
the practitioner must focus first on his curative role which is to address the
symptoms of chronic hepatitis and then focus on the patients alcoholism to not
only help with the resolution of hepatitis but also for prevention of other chronic

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diseases that is entirely attributable to alcohol such as psychotic disorders, alcoholic
cardiomyopathy, alcoholic gastritis and others.

Ethical Principle Core Functions and Example of Ethical

Corresponding Dilemma
Essential Public Health
Services
2. Public Health should achieve Assessment: Monitor Community leaders are
community health while health of communities concerned with the
respecting the rights of to identify threats. influx of fast-food
individuals in the community. Diagnose and restaurants in their
investigate those town. Fast-food
threats with attention restaurants are drawn
to the human rights of to the town because of
those involved. the number of college
Policy Development: students who eat fast
Develop policies that food, enjoy it, and say
move the community they require it to
toward health accommodate their
considering both the lifestyle. What is the
rights of the individual responsibility of the
and the protection of community and what
the community. are their options?
Assurance: enforce
laws on protection of
confidentiality and
individual rights as well
as laws that protect
the health of
communities.
This Principle identifies the common need in public health to weigh the
concerns of both the individual and the community. There is no ethical principle that
can provide a solution to this perennial tension in public health. We can highlight,
however, that the interest of the community is part of the equation, and for public
health it is the starting place in the equation; it is the primary interest of public

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health. Fast food, with its low nutritional value, high fat, calorie and sodium content,
poses negative consequences to ones health as it has been associated with
obesity, diabetes, and cardiovascular conditions. Community leaders can increase
awareness of the effects of fast food through television and online advertisements,
brochures, and flyers. In addition, physicians should be encouraged to educate their
patients as well. Policies should be made on fast food chains to use healthier
options in the ingredients such as reducing trans-fat. Still, there remains the need to
pay attention to the rights of individuals when exercising the police powers of public
health.

Ethical Principle Core Functions and Example of Ethical

Corresponding Dilemma
Essential Public Health
Services
3. Public Health Policies, Policy Development: Research on a pressing
programs, and priorities should Mobilize community health issue in an
be developed and evaluated partnerships so action urban community is
through processes that ensure is based on mutual being conducted by
an opportunity for input from understanding of the the local hospital. A
community members. aims and impact of the participatory model for
change. Develop the study has been
policies with input from proposed but will take
those impacted by the more time and
policy. resources. Does the
Assurance: Evaluate need for a fast turn-
the impact of policies, around on data to
programs, and benefit the community
priorities on the outweigh the
intended outcome as importance of
well as unintended community
consequences. engagement in the
process?
A process for input can be direct or representative. In either case, it involves
processes that work to establish a consensus. While democratic processes can be
cumbersome, once a policy is established, public health institutions have the

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mandate to respond quickly to urgent situations. Since it is a pressing health issue,
a fast turnaround time on the data is paramount to benefit the community.
However, the input from the community or community engagement should not end
once a policy or program is implemented. There remains a need for the community
to evaluate whether the institution is implementing the program as planned and
whether it is having the intended effect. The ability for the public to provide this
input and sense that it is being heard is critical in the development and
maintenance of public trust in the institution.

Ethical Principle Core Functions and Example of Ethical

Corresponding Dilemma
Essential Public Health
Services
4. Public health should advocate Public development: Do inmates being
and work for the empowerment Inform, educate and released from
of the disenfranchised empower community incarceration require
community members. so they have increased transitional services
locus of control to from a public health
make change happen. perspective? What is
Mobilize community the threat to the
partnerships to community of this
enhance the linkages group is not
to services of empowered?
vulnerable population
Though disenfranchised, these people are still part of the community and
their participation can be of great help to the community. Rather than being idle and
do nothing, they can be of benefit in terms of work force/man power for the
community. The marginalized sectors of the community can be taught how to
manage, lead and organize small programs for the community. Example of which is
Bojo River Cruise in Aluginsan, most of the people managing the river cruise are
those marginalized people in Aluginsan. But before they were able to manage, the
LUGs allocated a budget for their training and education in managing such
community program.

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 Ethical Principle Core Functions and Example of Ethical
Corresponding Dilemma
Essential Public Health
Services
5. Public health should seek the Assessment: An urban health
information needed to stringent monitoring to department receives
implement effective policies and determine and ensure gift from a wealthy
programs that protect and existing policies are donor, which must be
promote health effective or to check if used to implement a
there is a need for community gardening
revision project; the donor is a
Policy development: gardening enthusiast
develop set of rules to and just moved to the
follow to address the city. The health
current issues department is dubious
Assurance: Evaluation that the community
of current policies and gardening project will
programs. Research work without
proposed changes to significant investment
policy by determining of personnel and
improved services that oversight, but does not
would be appropriate wish to lose the funds.
for the community How should the health
department proceed?
Before any programs should be made, one should research first if the
program will benefit the community, will it be practical given with the certain
budget given to make such programs, will the people participate in the said
program. These questions needed to be answered so that the resources allocated to
that said program will not go to waste. After such programs are made, regular
monitoring should be implemented so that its efficacy will be maintained and it will
be up to date to address the current problems in the community.

Ethical Principle Core Functions and Example of Ethical

Corresponding Dilemma
Essential Public Health

14
 Services
6. Public health institutions Policy development: A highway may be built
should provide communities with Educate the in a rural part of the
information needed for decision community about state to allow residents
making and obtain the factors that may quick access to major
communitys consent for their involve their health cities and also allow
implementation. and involve the trucks to travel more
community in decision efficiently in their
making delivery routes. There
is opposition from
residents who say they
did not ask for the road
and are being used as
an excuse to increase
highway toll revenue
from trucks. How could
this have been handled
differently? How does
this impact public
health?
Before any projects should be made, it is important to inform and explain to
the community that there will be projects going to be made for their benefit. If no
information will be given, the community might not understand its purpose and
would see it as a nuisance or dubious project just to get funds.

Ethical Principle Core Functions and Example of Ethical

Corresponding Dilemma
Essential Public Health
Services
7. Public health institutions Assessment: Monitor A pertussis outbreak is
should act in a timely manner on health to identify suspected in a densely
the information they have within health threats in an populated part if the
then resources and mandate efficient and respond in state; the governor
given to them by the public. an organized manner. does not wish to create
a panic by

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 broadcasting the
suspected cases
publicly. What is the
responsibility of the
health authority?
As the public health officer, one should know when and how to intervene.
Fear of public anxiety and panic is a shallow reason to not publicize the outbreak. It
should instead be an opportunity to educate and give guidance to the public, most
especially the governor. The ignorance that the public has could not only risk them
of the exposure but also pose the risk of underreported cases and untreated
diseases.

Ethical Principle Core Functions and Example of Ethical

Corresponding Dilemma
Essential Public Health
Services
8. Public health programs and Assurance: Link to/ A new population of
policies should incorporate a provide case in a Iraqi refugees have
variety of approaches that culturally competent been resettled in
anticipate and respect diverse manner so that both Midwest town hit hard
values, beliefs, and cultures in access to care and by the 2008 recession.
the community. quality of care Public health leaders
provided are assured. are concerned about
potential tension
between the residents
and the new arrivals
that are both in need
of jobs, public
assistance and medical
care. How is this a
public health issue?
This becomes a public health dilemma because the refugees are now part of
the community. They are not just at risk of having health concerns but also a threat
to the health of their neighboring communities. Despite the differences in culture,
both communities should realize that they are one already and neglecting one after

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the other would only end to greater ordeals.

Ethical Principle Core Functions and Example of Ethical

Corresponding Dilemma
Essential Public Health
Services
9. Public health programs and Policy Development: A neighborhood
policies should be implemented Develop policies to revitalization program
in a manner and most enhances protect the cohesive promises mixed
a physical and social and collective strength income housing in an
environment. of communities area with a history of
Assurance: Enforce crimes, but with an
laws to protect the entrenched
community physically neighborhood
and socially. association and
residents who have
lived there since the
1980's. What are the
potential
consequences of this
program to the
physical and social
environment?
Similar to demolition orders that have been implemented, both parties are
affected severely. A home has always been the comforting nest of every human.
The familiarity to the environment and the people makes it even more precious. A
sudden order for change would create stress and even crises to the affected
members. This would physically affect them because surely there will be resistance
and it could lead to chaos. In the social perspective, a new set of neighbors to get
acquainted with will be another stir to what was once so familiar. Thus, as a public
health officer, these details should also be considered.

Ethical Principle Core Functions and Example of Ethical

Corresponding Dilemma
Essential Public Health

17
 Services
10. Public health institutions Assessment: A young man submits
should protect confidentiality of Diagnose and himself to the clinic for
information that may bring harm investigate with the STI and tested positive
if made public. privacy and protection for syphilis. He shares
of the community in that he is a commercial
mind sex worker. What are
Policy development: the ramifications of
develop policies to conducting contact
protect the community tracing to him, his
when a high likelihood relationship partner,
of harm exists. and clients? What type
Assurance: Enforce of behavioral
rules to ensure that interventions should
rights of the individual take place?
to autonomy do not
impact the health of
the community.
Following the laws in public health, the patient still has to convey to the
practitioners his previous sexual partners, including the establishment he worked.
His previous contact could not then be advised to submit themselves for testing as
protective measure, all the while respecting confidentiality by not disclosing the
patients identity. The patient will then be advised to refrain from further intimate
contact while he is still considered infectious. In line with local health laws, he has to
ensure medical clearance before resuming work.

Ethical Principle Core Functions and Example of Ethical

Corresponding Dilemma
Essential Public Health
Services
11. Public health institutions Assurance: Ensure A prestigious physician
should ensure the professional competent workforce with many years of
competence of public health to protect the safety of experience working as
employees. those being cared for a hospital physician
and ensure the takes over as medical

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 evolution of the director of a public
practice. health department to
finish out his time
before retirement.
What are the possible
ramifications of this
appointment?

The new medical director must know his duty and responsibilities that comes with
his new appointment, and ensure that he will live up to it. His background could be
of an advantage since he is already exposed to the hospital environment, however,
since he lacks background in public health, he can either expose himself more to it
or seek advice from previous medical directors in handling the job. He now has the
prerogative to continue being the medical director depending if he feels competent
or not.

Ethical Principle Core Functions and Example of Ethical

Corresponding Dilemma
Essential Public Health
Services
12. Public health institutions and Policy development: A public health
employees should engage in Mobilize community advocacy organization
collaborations and affiliations in partnerships that link applies and receives
ways that build the publics trust communities to public funding from a
and institutions effectiveness. health entities such as pharmaceutical
health departments or company to implement
advocacy organizations the program they want
to promote to do in years. The
understanding and funder stipulates that
collaboration. any materials
produced must be
cobranded with their
logo and partnering
physicians must agree

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 to visits from
pharmaceutical
representative. What
are the ethical
implications of this
sponsorship?
Advocacy organizations and pharmaceutical companies are two key stakeholders
that are in contact with each other on mutual respect and a guaranteed
independency. However, advocacy organizations have to be clear about lines that
they are not willing to cross. When pharmaceutical companies asks for more than
the advocacy organizations is willing to provide, the mutual respect and
independency is compromised and the organizations still has to stay focused on the
core mission and avoid initiating programs simply to chase more funding.

IV. Case Analysis

Summary: a 24-year-old married student came into a student health clinic
for a routine pelvic examination and Pap smear. An assay for gonorrhea
and chlamydia was performed. The patient was told that the public health
authority has been notified and the patient is advised of need for
treatment and her responsibility to notify her sexual partners so that they
may also be treated.

1. Patients right to be informed: As with other testing, screening of

sexually transmitted infections (STIs) should be voluntary and undertaken
only with the patients understanding of what testing is planned. The
patient should be informed that she will be tested unless she declines; be
provided with oral or written information about the infections she is being
tested for and the meanings and courses of action for positive and
negative results; and be given an opportunity to ask questions and to opt
out of screening if she chooses. Consent for screening and diagnostic tests
are generally incorporated in the patients informed consent for medical
care documentation and a separate consent for STI screening is typically
not needed.

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 2. Can the patient prevent notification of the public health
department? The patient cannot prevent the student health center from
notifying the public health authority of her positive result. Health
information otherwise protected under the Health Insurance Portability
and Accountability Act may be disclosed without patient authorization to
public health authorities for the purpose of preventing or controlling
disease, injury, or disability. Syphilis, gonorrhea, chlamydia, chancroid, HIV
infection, and IDS are currently reportable in each state. HIV and STI
reports are kept strictly confidential.

However, chlamydia and gonorrhea are not reportable in the Philippines setting
based on the Notifiable Communicable Diseases in the Philippines (RA 3573).

List of Notifiable Communicable Diseases in the Philippines (RA 3573):

Immediately Reportable
1. Acute flaccid paralysis "hot cases"
2. Anthrax
3. Human Avian Influenza
4. Severe Acute Respiratory Syndrome (SARS)
5. Adverse event following Immunization
6. Any disease outbreak
7. Any clustering of patients with similar disease or syndromes
8. Meningococcal disease

Immediate reporting upon laboratory confirmation

1. Polio
2. Cholera
3. Measles
4. HIV/AIDS

Weekly Reportable
1. Acute bloody diarrhea
2. Acute hemorrhagic fever syndrome
3. Acute viral hepatitis
4. Acute flaccid paralysis
5. Bacterial meningitis
6. Cholera
7. Dengue
8. Diptheria
9. Japanese Enchephalitis
10. Influenza
11. Leptospirosis
12. Malaria
13. Neonatal tetanus
14. Non-neonatal tetanus

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 15. Paralytic shellfish poisoning
16. Pertussis
17. Rabies
18. Typhoid and paratyphoid fever

The patient in this scenario is a 24-year-old student who has a legitimate

concern about the privacy of her personal relationship and the impact of a
disclosure of her protected health information on her primary relationship. Clinical
staff can be instrumental in putting the infection in perspective by explaining the
prevalence of chlamydia in the patients age cohort, the ease of transmission with
sexual contact, and the likelihood that partners can be infected without showing
signs or symptoms. Clinical staff can also assist the patient in preparing for the
disclosure of the infection to her partner(s) by preparing through role play, scripting,
or planning. It is vital that clinical staff assess the situation for possibility of
aggression toward the patient upon disclosure and assist the patient in seeking
services for intimate partner violence if this is a possibility.

Traditional patient referral: The patient informs the partner(s) of infection and
the partner must seek access to treatment.
Bring your own partner referral: The patient informs the partner(s) of
infection and brings them to the clinic for treatment.
Provider-assisted referral: The provider or staff contacts the partner(s) for
treatment and encourages the partner(s) to come in for treatment and also to
disclose other potentially exposed individuals who may need to be notified.
Confidentiality is maintained during this process.
Disease Intervention Specialist (DIS) referral: A specially trained health
worker (DIS) interviews the patient with the STI, performs confidential
contact investigation of the patients identified partner(s), investigates
partner(S) additional contacts, and provides prevention counselling and
confidential treatment referral for all identified contacts to interrupt the chain
of transmission.
Expedited partner therapy: Either the patient or a public health worker
delivers the medications or a prescription from the clinic to the partner. Note
that expedited partner therapy is not allowed in all states. Clinicians should
check the laws and regulations in their public health jurisdiction.
V. Summary

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 Public health is the assessment of communities, the development of
policy to address the needs and assets of communities, and the
assurance of health of the individuals in those communities.
Public health ethics differs from bioethics in its valuation of
interdependence over autonomy and its recognition of the
connection between the wellness of people and the wellness of
their communities.
Disease investigation and interruption of the chain of transmission
are public health essential services. Individuals participate in public
health through screening for STIs.
The public is protected from infections and their sequelae by the
interruption of infection through mandatory public reporting and
public health partner testing and treatment infrastructure.
Clinicians and laboratories should familiarize themselves with
applicable reporting requirements within their public health
jurisdiction. Contact state and local public health officials to clarify
any questions about reporting requirements as well as to discuss
regulations related to contact tracking (eg. Partner notification) and
expedited therapy.

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 VI. References

Principles of the ethical practice of public health. (2002). New Orleans, La.?: Public
Health Leadership Society

Public Health Ethics. (n.d.). Retrieved February 24, 2017, from

http://depts.washington.edu/bioethx/topics/public.html

Campbell, A. V. (2017). Bioethics: the basics (1st ed.). Abingdon, Oxon: Routledge.

Toy, E. C., MD, Raine, S. P., MD, JD, LLM, MEd, & Cochrane, T. I., MD, MBA. (2015).
Case files: medical ethics and professionalism. New York: McGraw-Hill.

https://pubs.niaaa.nih.gov/publications/arcr352/155-173.htm

http://publichealth.lacounty.gov/qi/corefcns.htm

https://www.cdc.gov/nphpsp/documents/essential-phs.pdf

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