Glossary

Concept, principle, or value

Definition

Reference

Accountability for reasonableness

Framework that requires that the rationale or reasons underlying health-care-limiting decisions be made publicly available. Moreover, “fair-minded” individuals – those who seek cooperation with others on mutually justifiable terms – must agree on the applicability of these reasons to health care delivery in resource-constrained settings.

Daniels N, Sabin JE. Setting limits fairly: can we learn to share medical resources? New York: Oxford University Press; 2002.

Autonomy

Most often taken to refer to the ability of an individual to be his or her own person, to make his/her own choices on the basis of his/her own motivations, without manipulation by external forces. However, others in a more Kantian tradition see autonomy as being firmly related to accepting and acting on the basis of one’sobligations, i.e. acting morally, the precise opposite of doing what one wants.

Christman J. Autonomy in moral and political philosophy. In: Zalta EN, editor. The Stanford encyclopedia of philosophy (spring 2011 edition). Stanford (CA): Stanford University; 2011 (http://plato.stanford. edu/archives/spr2011/entries/autonomy-moral/,).

O’Neill O. Autonomy and trust in bioethics. Cambridge: Cambridge University Press; 2002 

Beneficence

Principle requiring that governments, health care providers, and researchers do good for, provide benefit to, or make a positive contribution to the welfare of populations, patients and study participants.

Beauchamp TL, Childress JF. Principles of biomedical ethics, sixth edition. New York: Oxford University Press; 2008.

Bioethics

The field of enquiry that examines ethical issues arising from the “creation and maintenance of the health of living things”. Bioethics is much broader than medical ethics, and includes all ethical issues in medicine, the life sciences and biomedical research.

Dawson A. The future of bioethics: three dogmas and a cup of hemlock. Bioethics. 2010;24(5):218–25.

Confidentiality

The obligation to keep information secret unless its disclosure has been appropriately authorized by the person concerned or, in extraordinary circumstances, by the appropriate authorities.

Ethical considerations in developing a public health response to pandemic influenza. Geneva: World Health Organization; 2007 (http://apps.who.int/iris/bitstream/10665/70006/1/WHO_CDS_EPR_ GIP_2007.2_eng.pdf?ua=1,).

Dignity

 A term used to suggest the idea of human worth or value. It is often used to link to the idea of persons as being of value. “The notion of dignity is used to mark a threshold, a kind of respect and care beneath which the treatment of any human being should never fall”.

Casebook on human dignity and human rights. Paris: United Nations Educational, Scientific and Cultural Organization; 2011 (Bioethics Core Curriculum, Casebook Series, No. 1).

Distributive justice

(see also Equity)

A set of principles that provide “moral guidance for political processes and structures that affect the distribution of economic benefits and burdens within societies”. It is generally thought to be difficult, if not impossible, to distribute health. However, there are a number of factors that may be considered relevant to the just distribution of health (including income, wealth, utility), the number of possible persons involved (individuals or groups), and differences in how the distribution should be made (equality, maximization, etc.). Egalitarianism is one example of a distributive justice principle.

Lamont J, Favor C. Distributive justice. In: Zalta EN, editor. The Stanford encyclopedia of philosophy (spring 2013 edition). Stanford (CA): Stanford University; 2013 (http://plato.stanford.edu/archives/ spr2013/entries/justice-distributive/).

Egalitarianism

A belief in equality. However, egalitarians disagree about what it is that should be equal, for example whether people are entitled to equal opportunities, an equal share of resources, or whatever level of opportunities and resources are necessary to generate equal results.

Arneson R. Egalitarianism.  In: Zalta EN, editor. The Stanford encyclopedia of philosophy (summer 2013 edition). Stanford (CA): University of Stanford; 2013 (http://plato.stanford.edu/archives/sum2013/ entries/egalitarianism/).

Equity

(see also Distributive Justice)

Equity focuses on equal outcomes and this may require an unequal distribution of some good to bring about the equal outcome. Health equity requires responding to “differences in health which are not only unnecessary and avoidable but, in addition, are considered unfair and unjust”.

Whitehead M. The concepts and principles of equity and health. Copenhagen: WHO Regional Office for Europe; 1990 (EUR/ICP/RPD 414 7734r; http://whqlibdoc.who.int/euro/-1993/EUR_ICP_RPD_414. pdf).

Ethics

Branch of knowledge concerned with questions about right versus wrong conduct and what constitutes a good or bad life, as well as the justificatory  basis for such questions.

Deigh J. An introduction to ethics. Cambridge: Cambridge University Press; 2010.

Human rights

Fundamental freedoms and rights enshrined in a set of universal legal statements. Some of the most important characteristics of human rights are that: they are acknowledged in international declarations; states and state actors are obliged to respect them; they cannot be waived or taken away (although the enjoyment of particular human rights may be limited in exceptional circumstances); they are interdependent and inter-related; and they are universal.

The United Nations system and human rights: guidelines and information for the Resident Coordinator System approved on behalf of the Administrative Committee on Coordination (ACC) by the Consultative Committee on Programme and Operational Questions (CCPOQ) at its 16th Session, Geneva, March 2000.

Informed consent

Agreement to a certain course of action, such as treatment or participation in research, on the basis of complete and relevant information by a competent individual without coercion .

Eyal N. Informed consent. In: Zalta EN, editor. The Stanford encyclopedia of philosophy (fall 2012 edition). Stanford (CA): Stanford University; 2012 (http://plato.stanford.edu/archives/fall2012/entries/ informed-consent/)

Justice

A highly contested concept that can, roughly, be thought of as giving people what they deserve. See also: Equity and Distributive justice. 

Sreenivasan G. Justice, inequality and health. In: Zalta EN, editor. The Stanford encyclopedia of philosophy (spring 2011 edition). Stanford (CA): Stanford University; 2011 (http://plato.stanford.edu/ entries/justice-inequality-health/, accessed 4 March 2015).

Liberty

A highly contested and complex concept that is often presented as freedom from such things as the interference, influence, or control of others. However, other accounts of liberty focus on authenticity, self-realization, or even appropriate relations with others.

Gaus G, Courtland SD. Liberalism. In: Zalta EN, editor. The Stanford encyclopedia of philosophy (spring 2011 edition). Stanford (CA): Stanford University; 2011 (http://plato.stanford.edu/archives/spr2011/entries/liberalism/).

Non-maleficence

A principle requiring that health care providers and researchers do not inflict undue harm, either intentionally or through negligence. 

Beauchamp TL, Childress JF. Principles of biomedical ethics, sixth edition. New York: Oxford University Press; 2008.

Principle

A broad but fundamental norm which can provide justification for more specific rules or standards. For example, it is often claimed that informed consent (a standard) is necessary because of the need to respect autonomy (a principle).

Goldman AH. Rules, standards, and principles. In: LaFollette H, editor. The international encyclopedia of ethics. Malden (MA): Blackwell; 2013:4676–84

Privacy

Privacy seeks to protect a person from scrutiny by others. Respect for privacy implies that a person should not be expected to share personal information unless they so choose. Any violation of privacy requires ethical justification although it might be outweighed by other considerations in some cases (i.e. for the protection of the common good).

McKeown RE, Weed DL. Ethics in epidemiology and public health. II. Applied terms. J Epidemiol Community Health. 2002;56(10):739–41. 

Procedural justice

Discussion of the values and processes necessary to bring about a just outcome. For example, where resources are scarce and rationing is needed,  a procedurally just outcome would provide clear and justifiable reasons for the decisions made.

Daniels N, Sabin JE. Setting limits fairly: can we learn to share medical resources? New York: Oxford University Press; 2002.

Proportionality

The balancing of the positive features and benefits of a particular intervention, policy, or research study against its negative features and effects, when deciding whether or not to implement it.

Childress JF, Faden RR, Gaare RD, Gostin LO, Kahn J, Bonnie RJ et al. Public health ethics: mapping the terrain. J Law Med Ethics. 2002;30(2):170–8.

Public good

A commodity or service that meets the following two criteria: it is practically non-excludable (i.e. no one can be excluded from consumption, irrespective of individual contributions to provision) and non-rival (i.e. consumption by some does not reduce the benefits of consumption accrued by others). For example, the eradication of smallpox counts as a public good because it meets these criteria.

Deneulin S, Townsend N. Public goods, global public goods and the common good. Int J Soc Econ. 2007;34(1–2):19–36.

Public health ethics

The field of enquiry that examines ethical issues and dilemmas relevant to the protection and promotion of population health and the collective actions necessary to achieve these aims.

Dawson A, Verweij M. Public health ethics: a manifesto. Public Health Ethics. 2008;1(1):1–2.

Reciprocity

A principle that focuses on “providing something in return for contributions that people have made”. In some cases this can be a strict matching between an action, such as participation in research, and compensation for any harm caused. In other cases, reciprocity  may be less direct and involve more general contributions for the benefit of others or society in general.

Equity and fair process in scaling up antiretroviral treatment: potentials and the challenges in the United Republic of Tanzania: case study. Geneva: World Health Organization; 2006 (http://whqlibdoc.who.int/ publications/2006/9241593644_eng.pdf).

Social justice

A concept focused on the root causes and existence of inequalities in society and the need to explicitly address them. In some cases, this may require a redistribution of resources to compensate for existing inequalities and further actions to prevent their perpetuation.

Guidance on ethics of tuberculosis prevention, care and control. Geneva: World Health Organization; 2010 (http://whqlibdoc.who.int/publications/2010/9789241500531_eng.pdf).

Solidarity

A social relation in which a group, community, or nation stands together. It is often appealed to in discussions about justifications for the welfare state or shared risks through insurance pooling, and in thinking about how states might defend the interests of vulnerable groups within their population.

Guidance on ethics of tuberculosis prevention, care and control. Geneva: World Health Organization; 2010 (http://whqlibdoc.who.int/publications/2010/9789241500531_eng.pdf).

Utilitarianism

 A set of theories centred on the principle of utility which is often taken to require that any action should maximize benefits for the greatest number of people. 

Sinnott-Armstrong W. Consequentialism. In: Zalta EN, editor. The Stanford encyclopedia of philosophy (spring 2014 edition). Stanford (CA): Stanford University; 2014).

Value

Concept that is “used to explain how and why things matter. Values are involved wherever we distinguish between things as good and bad, better or worse.” Values are central to ethical judgements. Often, the place to start in a discussion about what ought to be done is to make clear what values are most relevant and what weight should be attached to them.

Weed DL, McKeown RE. Ethics in epidemiology and public health. I. Technical terms. J Epidemiol Community Health. 2001;55(12):855–7.