In lieu of an abstract, here is a brief excerpt of the content:Public Health Ethics: Health by the NumbersMartina Darragh (bio) and Pat Milmoe McCarrick (bio)Hippocrates had nothing to say about public health. Rather, the idea that a government should protect its citizens from disease by maintaining sanitary conditions has its origin in Renaissance humanities texts, and the notion that physicians have public health responsibilities emerged in the works of such Enlightenment authors as Johann Peter Frank, Benjamin Rush, and John (...) Gregory (II, Coughlin and Beauchamp 1996). When the spread of infectious diseases such as typhoid and cholera accompanied the growth of the Industrial Revolution, England was the first to respond by passing the Public Health Act of 1848. The motivation for this reform was not based in humanitarian concerns but in the realization that unsanitary conditions were costly to industry. “... [The] founders of the public health movement were guided by nineteenth century utilitarian moral theories... the greatest good for the greatest number... accompanied by a growing appreciation for the innate value and dignity of mankind... however, the rights and autonomy of individuals have not always been respected in pursuing these important objectives” (I, Coughlin 1995, p. 1).Public health projects have dramatically improved global health status. One measure of their success is that “... most poor people now live longer, on average, than the wealthiest people a century ago” (I, Beaglehole and Bonita 1997, p. 13) These projects are not limited to such activities as disinfecting sewers. “Public health is what we, as a society, do to collectively assure the conditions in which people can be healthy. This requires that continuing and emerging threats to the health of the public be successfully countered. These threats include immediate crises, such as the AIDS epidemic; enduring problems, such as injuries and chronic illness; and impending crises foreshadowed by such developments as the toxic by-products of a modern economy” (I, Institute of Medicine (IOM) 1988, p. 1) The practice of public health has embraced this IOM challenge and includes the subspecialties of epidemiology, health promotion and education, public health administration, international health, maternal and child health, biostatistics, environmental health, and nutrition. This annotated bibliography focuses on epidemiology, [End Page 339] health promotion and education, and public health administration, and includes a wide variety of opinions on each topic.EpidemiologyAt first glance, it is hard to see what ethical issues could arise in population studies of the causes and control of illness. Disclosure of risk information in the clinical encounter is complicated by issues of uncertainty with regard to the data itself. Causation and causal inference may be affected by “wish bias,” leading to studies that use the same data but reach widely varying conclusions (II, Weed 1997). Given the complexity of the statistical calculations used to validate public health recommendations, and mass media’s portrayal of them, the public may be unintentionally deceived by population-based recommendations (V, Seedhouse 1997; II, Lupton 1995). With the addition of genetic screening, another layer of statistical complexity is added to this mix (VI, Stone and Steward 1996).Health Promotion and EducationIncreased life expectancy brought about by advances in public health has raised a new set of problems. With the realization that illness can be promoted in part by individual life-style choices, population-based recommendations about risk factors become important in the clinical encounter. This shift is not without difficulties; one author notes that he has yet to receive any risk information from his physicians, even when he asks “the experts” (V, Dugdale 1998). This may be due in part to the fact that “... public health lacks a vocabulary with which to speak about and identify commonalities among health problems experienced by very different populations” (IV, Mann 1997, p. 8). Furthermore, the mix of disciplines informing health promotion activities (sociology, psychology, recreation medicine, and the like) creates an illusion of shared ethics where none exists, which in turn leads to programs based on value systems that may not be meaningful for the populations they serve (V, Seedhouse 1997).Given these factors, a number of authors are skeptical of introducing public health measures into the clinical encounter. “We might do well to encourage people to live lives of modified hedonism so that they might... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Taking Sides: Clashing Views in Death and Dying ed. by William J. Buckley and Karen S. FeldtZoe BernatskyTaking Sides: Clashing Views in Death and Dying Selected, edited, and with introduction by William J. Buckley and Karen S. Feldt new york: mcgraw-hill, 2013. 576 pp. $63.00If you are searching for a textbook that inspires students to think critically by examining diverse positions around contemporary bioethics issues related to death (...) and dying, Taking Sides: Clashing Views in Death and Dying is an engaging and effective learning tool that is well structured and a compelling read. As part of a series of Taking Sides textbooks, this volume examines eighteen issues clustered around seven themes: (1) end-of-life decision making; (2) caregiver end-of-life decision making; (3) treatment requests and decisions regarding pain and futility; (4) assisted suicide; (5) determining definitions of death; (6) hospice, policy, and costs of dying; and (7) dying and death as cultural performances. Units for each theme include an introduction, pro and con arguments, a summary, and a list of additional resources.The book offers a wealth of wisdom through thought-provoking scenarios, forward-looking themes, and scholarly articles. Readers are presented with real-life controversies, such as how depression or advanced directives influence the [End Page 214] end-of-life decision-making process, and how advocates affect the quality of end-of-life care. Other topics covered include the right to effective pain management, the use of palliative sedation for intractable symptoms, and withholding or withdrawing futile treatment including artificial nutrition and hydration. Also debated are concerns surrounding the provision of assisted suicide and the criteria for establishing brain death; issues regarding access to hospice; the impact of identifying with a specific religious orientation; and the reception of culturally competent care.Individuals are often forced abruptly into end-of-life decisions without time for extensive reflection about the meaning of life and death. The weightiness of the outcomes and the intensity of the experience, combined with the apprehension so many of us feel about death and dying, can overwhelm individuals and families. This book promotes thoughtful deliberation about such matters from both professional and personal perspectives. The inclusion of a section on caregiver decision making that highlights compassion fatigue is a unique and valuable contribution to the overall topic. Social, cultural, and religious influences that increase comfort (or pain) in dying patients and the unique experience of grief for those who remain are also given attention.The greatest strength of this text is the “Taking Sides” approach, which introduces the reader to divergent positions on ethical issues. The articles are well selected from recent scholarship and orient readers who may be unfamiliar with medical and ethical terminology and concepts. The presentation of contradictory positions demonstrates the true-to-nature complexity of ethical decisions and inspires the reader to further reflection, and the extensive list of resources provides a rich opportunity for further study. The book is an easy read, and the units and themes can be surveyed independently, making it a helpful resource for introductory courses on moral theology or ethics; a digital “Instructor’s Resources Guide” provides sample questions for academic purposes. Since death and dying is a universal issue, the anticipated audience is extensive.While this text provides an excellent introduction to the ethical dilemmas around death and dying, there are particular areas that are not addressed, such as decision-making in the case of neonates, children, or those with preexisting psychiatric disorders or other disabilities. A valuable addition to the book would have been the presentation of a framework for dealing with the complex challenges of death and dying, such as the virtue ethics framework offered by Lydia Dugdale in the 2015 publication Dying in the Twenty-First Century. But although the book does not add new material to existing debates, the clarity with which it presents each argument will help to orient those less familiar with bioethical issues. [End Page 215]Zoe BernatskyNewman Theological CollegeCopyright © 2016 Society of Christian Ethics... (shrink)