Abstract

This paper uses six policy problems in public health to illustrate the complexity of value considerations in decision-making, and derives an ethic for health protection policies based on the primacy of non-harming. In the first part, health policy is shown to require value considerations beyond simple utilitarianism. In the second, the author posits that much of health impairment can be traced to erosions of health outside the immediate control and consent of the individual. Accordingly, he argues that health impairing actions on the part of others warrant strict regulations in spite of the paternalistic nature of such interventions. The priority for these interventions should be set along a gradient of vulnerability and autonomy, with the greatest hazards to non-consent giving persons warranting the greatest controls. Special attention to fetuses and developing infants is thereby justified, and actions which prevent harms are shown to have priority over those which mitigate harms, ameliorate their effects or promote good.