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Public health and human rights forge a new health ethic
Helen Keleher
School of Health and Social Development, Deakin University, Burwood, VIC
Abstract
A just public health agenda is derived from the ethical dimensions of public health policy. To put this another way, a public health ethic involves consideration of the health impact and health outcomes of public health policy, to advance notions of health rights. This essay will outline public health and just health tenets to explain the basis of health rights. To illustrate this argument, the primary discussion will be about women's reproductive health rights in relation to abortion, but the argument can be (and to some extent has been) tested with other public health issues such as heroin use. Rather than enter the polemic of `rights' to abortion, the public health response requiring better management of difficult health issues and improved health outcomes, calls for recognition and realisation of a public health ethic. That ethic is not related to religious beliefs or moral positions but is derived from the pragmatism of medical and social approaches.
Ethics and morality are not interchangeable terms. Ethics is a much broader notion that' has greater authority than morality. While both morality and ethics are concerned with how we live and how we should act, morality is characteristically narrow, with a more personal orientation and derivation (Annas 1992). Personal morality is closely tied to feelings of moral duty and obligation, but duty and obligation are also contained in ethics. Laws should not, and cannot, be concerned with the enforcement of morals (Charlesworth 1993), because there is no social consensus to define what is the public morality. Laws cannot coerce people to adopt a particular moral position because a liberal society accepts a pluralism of moral positions. More significantly than a mere acceptance of a plurality of moral positions is the understanding that ethical pluralism is the mark of a tolerant, liberal society. Ethical pluralism in the sphere of health, holds autonomy as a the core value, that is the right to make a conscientious and autonomous moral decision for oneself. Even though ethical theory does contain notions of moral duty or obligation (Annas 1992) to oneself or towards others, autonomy means that if I am to act in an ethical or moral way I must [decide and] choose for myself what I am going to do' (Charlesworth 1993:10). This freedom to choose, without coercive force of others, is termed moral autonomy which may well involve the notion of a moral choice. These notions are different to, and able to be distinguished from, personal morality.
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