PUB HLTH 7108 - Public Health Ethics
North Terrace Campus - Semester 2 - 2015
General Course Information
Course Code PUB HLTH 7108 Course Public Health Ethics Coordinating Unit Public Health Term Semester 2 Level Postgraduate Coursework Location/s North Terrace Campus Units 3 Contact Intensive - a minimum of 36 hours Available for Study Abroad and Exchange N Restrictions Available to Grad Cert, Grad Dip, MPH students only Course Description This course uses the analytical tools provided by ethics and social philosophy to examine public health research, policy and practice. The course includes both foundational elements - an introduction to utilitarianism, liberalism and communitarianism as ethical frameworks for public health - and the application of these elements to aspects of: epidemiological research; health promotion; disease prevention and control; public health research and practice in international settings; community based practice and research; and public health policy.
The full timetable of all activities for this course can be accessed from Course Planner.
Course Learning Outcomes
1 Analyse and solve problems, synthesise and integrate information and ideas, and make logical arguments from evidence and theory; 2 Describe and appropriately apply the core theoretical perspectives and concepts in public health ethics; 3 Identify, analyse and justify a decision for ethical problems in public health; 4 Work productively with others to analyse and make an informed decision about an ethical problem of public health importance 5 Demonstrate higher order thinking skills with respect to the resolution of ethical problems in public health.
University Graduate Attributes
This course will provide students with an opportunity to develop the Graduate Attribute(s) specified below:
University Graduate Attribute Course Learning Outcome(s) Knowledge and understanding of the content and techniques of a chosen discipline at advanced levels that are internationally recognised. 1-36, 5 The ability to locate, analyse, evaluate and synthesise information from a wide variety of sources in a planned and timely manner. 1-5 An ability to apply effective, creative and innovative solutions, both independently and cooperatively, to current and future problems. 1, 3-5 Skills of a high order in interpersonal understanding, teamwork and communication. 4 A commitment to continuous learning and the capacity to maintain intellectual curiosity throughout life. 5 An awareness of ethical, social and cultural issues within a global context and their importance in the exercise of professional skills and responsibilities. 1, 5
Required ResourcesThis course encourages and expects participants to read widely in order to gain a full understanding of the scope of public health ethics.
There is a set text for the course:
Holland S. Public Health Ethics. Cambridge: Polity Press, 2007.
This text is available through UniBooks at the University of Adelaide, University of South Australia (City East campus) and Flinders University book shops.
In addition, a reading list has been compiled which contains other required and recommended reading for the course. References and links are available on MyUni
Recommended ResourcesAdditional reading, along with lecture notes and other teaching aids, will be made available to students electronically through MyUni.
Online LearningLogin to MyUni using your Username and Password. Once logged on to MyUni, you will find the information displayed is customised to present only details relevant to you and the online content for courses that you are studying.
Learning & Teaching Activities
Learning & Teaching ModesTeaching in Public Health Ethics begins from the assumption that you have a wealth of professional and personal ideas and experience and that our role as teachers is to tap into your knowledge and skills and build on them. We assume that you are willing and able to prepare fully for classes, to participate in discussions and to carry your share of the workload. While there are formal seminars and set readings, there are also many opportunities for you to be more involved in setting agendas, defining the focus of learning, and pursuing areas of interest and need.
The course is built around examples of public health practice. People learn best when they are able to put developing knowledge and skills into practice. We believe that this is the most effective way of learning and the course has a range of seminars, tutorials and a major group project to facilitate this process. In addition, we have key concepts and theoretical issues threaded throughout the course. The intertwining of these issues is fundamental to many public health issues and to the identification, analysis and resolution of ethical problems.
The information below is provided as a guide to assist students in engaging appropriately with the course requirements.As a general rule in any university course, you will need to allow a minimum of three independent study hours for every hour undertaken in formal class work contact. This time is needed for such activities as reading for the topic, preparation for activities in class and work on assignments.
Time Period Task Total Hours Prior to start of course Reading and preparation 20 During the course Lectures and seminars
Group work (preparation for group assessment task)
After the course Reading
Work on assignments
Learning Activities Summary
Topic Lecture 1 Background and Theoretical Tools Introduction to Public Health Ethics
Overview of Ethical Theory
Utilitarianism: Why Outcomes Matter in public Health
Liberalism: Why Rights Matter in Public Health
Communitarianism: Why communities matter in public health
2 Core Topics in Public Health Ethics Equity and Fairness
Themes and Tensions in Public Health Ethics
Ethics of Health Promotion
3 Topics in Public Health Ethics Organisational Ethics
Ethics and Vulnerable Populations
Ethical reasoning and public health
4 Topics in Public Health Ethics TBA (specific content changes each year
And is finalised ~ July or August
5 Topics in Public Health Ethics TBA (specific content changes each year
And is finalised ~ July or August
Specific Course RequirementsN/A
Small Group Discovery ExperienceN/A
The University's policy on Assessment for Coursework Programs is based on the following four principles:
- Assessment must encourage and reinforce learning.
- Assessment must enable robust and fair judgements about student performance.
- Assessment practices must be fair and equitable to students and give them the opportunity to demonstrate what they have learned.
- Assessment must maintain academic standards.
Assessment Task Assessment Type Weighting Learning Outcome(s) being addressed Group Project Presentation Summative 25% 1-5 Case Study in Public Health Ethics (500 words) Formative N/A 3, 5 Reflections on Case Study (1500 words) Summative 25% 1-3, 5 Major Essay (3500 words) Summative 50% 1-3, 5
Assessment Related RequirementsN/A
Assessment DetailTask 1: Group Project
The group project is an opportunity for students to work together in small groups to analyse and come to a conclusion about a defined ethical issue, which will be introduced on Tuesday afternoon.
Each group will be provided with the same scenario. You will be asked to:
Identify the ethical issues raised in the scenario;
Use ethical tools and principles to analyse and evaluate these ethical issues; and
Come to a decision about the ethically correct course of action, and give reasons justifying this decision.
Each group will give a 15-minute presentation on Friday afternoon. There is time allocated during the week for groups to prepare their presentations.
Task 2: Analysis of, and reflections on, a public health issue
This task has two components:
Write a case study (approximately 500 words) which presents an ethical dilemma you have confronted. You will need to provide information on the time, context, your interpretations/analysis and conclusions.
You may use any of a range of sources of information for this paper. For example, you may:
Use your work experiences;
Ask colleagues to describe an ethical problem they have experienced;
Describe a problem you have encountered yourself as a user of health services;
Use an issue reported in the media;
Ask family or friends to describe a problem they have encountered as users of health services.
You do not have to be involved in the problem yourself, but it must be something from ‘real life’ and it must be something that is of broader relevance to the health of the public.
For the paper, you should do two things:
Briefly describe the problem along the following lines:
Who is involved? What information about the people involved in this situation is relevant?
What is the context or setting? Which aspects of this setting are most important?
Where and when is the issue set?
If the issue is one on which some resolution has been reached, how have things turned out?
Very briefly outline what you regard as the key ethical arguments concerning this issue. At this stage, we expect only a very preliminary description. Obviously, the course is designed to help you understand and develop these arguments!
On Day 1 of the course, you will discuss these issues with other students. On Day 5, you will have an opportunity to present your preliminary reflections on how the course has influenced your understanding of the ethical issue you have identified.
Based on the original 500-word paper, write an essay of approximately 1000 words, in two parts:
First Part: Prepare an ethical analysis of the issue you brought with you to Public Health Ethics. In undertaking this analysis, you should make use of those aspects of the course content that are most appropriate to your issue. The following questions may be helpful as a guide:
What resolution, outcome and/or policy is the most ethically acceptable?
What ethical frameworks, principles and arguments will support this position?
What counterarguments might be offered? How would you refute them?
Second Part: In what ways has Public Health Ethics influenced your understanding of this issue?
Task 3: Essay
This essay, of approximately 3500 words, is a piece of individual work designed to develop the ability to carefully consider, analyse and propose a resolution for an ethical issue of public health importance. There will be a choice of four topics:
The Federal HPV Vaccination Programme
In late 2006 Gardasil (a vaccine which prevents infection with some strains of HPV, associated with cervical cancer and genital warts) was approved by the PBAC for government subsidy under the Pharmaceutical Benefits Scheme. In 2007 the Australian Government began a federally funded national HPV Vaccination Programme (funded under the Immunise Australia Program); between 2007 and 2008 12-18 year old girls were offered vaccination in a school-based programme, while until the end of 2009 13-26 year old girls and women were offered the vaccine through GPs and community immunisation services. There is currently an ongoing publicly funded school-based programme for girls in their first year of secondary school. However, there has been ongoing controversy regarding the HPV vaccination programme, due to the circumstances under which it was approved by the PBAC, and resistance in some segments of the community to the vaccination of pre-teen girls against a sexually transmitted disease.
Briefly outline the ethical issues regarding the implementation of the national HPV vaccination programme. Choose one of these issues, analyse it, and offer a resolution.
Colgrove J. The ethics and politics of compulsory HPV vaccination. N Engl J Med. 2006 Dec 7; 355(23): 2389-91.
Zimmerman RK. Ethical analysis of HPV vaccine policy options. Vaccine 2006 May 29; 24(22): 4812-20.
Haas M et al. Drugs, sex, money and power: An HPV vaccine case study. Health Policy 2009 92: 288-295.
WHO Position Paper on HPV Vaccine. At <http://www.who.int/immunization/documents/positionpapers/en/index.html> (Scroll down to ‘Human Papillomavirus’).
Yudin MH. “HPV Vaccination: Time to End the Debate.” Opinions in Pediatric and Adolescent Gynaecology 23 2010: 55-56.
End Stage Renal Disease in Indigenous Australians
Indigenous Australians, particularly those living in rural and remote areas, have an incidence of End Stage Renal Disease (ESRD) many times higher than that of non-Indigenous Australians. The optimal treatment for ESRD is kidney transplantation; however, indigenous ESRD patients are only 1/3 to ½ as likely to receive a kidney transplant, and in fact are less likely to be put on the transplant waiting list. In allocating donor kidneys, weight is placed on HLA-matching between donor and recipient, and other factors which maximise the chances of a good outcome. However, this has raised concerns about inequities of access for indigenous patients.
Identify the ethical issues involved, analyse them, and make some suggestion/s for how they might be resolved.
Lowe M, Kerridge IH, Mitchell KR. `These sorts of people don’t do very well’: race and allocation of health care resources. Journal of Medical Ethics 1995 21: 356-360.
Anderson I. The ethics of the allocation of health resources. In G Coslishaw and B Morris eds., Race Matters: Indigenous Australians and `Our’ Society. Canberra: Aboriginal Studies Press, 1997, pp191-208.
McDonald SP and Russ GR. Burden of end-stage renal disease among indigenous peoples in Australia and New Zealand. Kidney International 2003 63 Suppl. 83: S123-S127.
O’Sullivan C, Brady SJ, Lawton PD, and Love CM. Everybody’s Business. Nephrology 2004 9: S117-S120.
Australian Medical Association. Institutionalised Inequity: Not Just a Matter of Money. Australian Medical Association Report Card Series 2007: Aboriginal and Torres Strait Islander Health. At <http://www.ama.org.au/node/3229>
PSA Screening for Prostate Cancer
Prostate cancer is a leading cause of cancer death in men worldwide. Screening for prostate cancer by means of the prostate-specific antigen (PSA) test has become widespread in Australia, the UK and the USA, and is regarded as a safe and simple method of detecting early prostate cancer. However, there has been controversy over whether PSA testing should be routine: the Cancer Council Australia, and similar bodies overseas, do not recommend its routine adoption, as the costs and harms associated with overdiagnosis and overtreatment may outweigh the benefits. Instead, it is recommended that individual men make informed decisions about whether to undergo PSA testing.
Identify and analyse the ethical issues involved, and argue either in favour of, or against, the adoption in Australia of a PSA screening programme.
Stark J et al. Prostate Cancer Screening: the controversy continues. BMJ 2009 Oct 3; 339: 784-786.
Justman S. Uninformed Consent: Mass Screening for Prostate Cancer. Bioethics early view (online), published May 2010. <http://www3.wiley.interscience.com/journal/123442696/abstract>
Andriole G, et al. The Case for Prostate Cancer Screening with Prostate-Specific Antigen. European Urology Supplements 2006 5: 737-745.
Cancer Council Australia. Position Statement: Prostate Cancer. <http://www.cancer.org.au/Healthprofessionals/PositionStatements/prostatecancer.htm>
Pinnock CB. PSA testing in general practice: can we do more now? MJA 2004; 180; 19 April: 379-381.
You are welcome to select a topic of relevance to public health ethics that interests you and to negotiate an essay question based around this topic. Please note that the essay question MUST be discussed and agreed with the topic convenor in advance.
SubmissionBoth essays must be submitted via email to the Course Coordinator by midnight on the due date.
Policy on Extensions and Late Submission
Must be requested, at the latest, by the last working day before the due date of submission;
Will generally be granted only on medical or genuine compassionate grounds;
Must be made to the Course Coordinator;
Documentary supporting evidence such as a medical certificate, counsellor’s letter or police report (in the case of lost computers, car and household theft etc.) may be required when requesting an extension.
Marks will be deducted when assignments for which no extension has been granted are handed in late.
The procedure is as follows:
All assignments, including those handed in late, will be assessed on their merits.
In the case of late assignments, marks will then be deducted from the mark awarded, at the rate of 5 percentage points of the total possible per day. E.g., if an assignment which is 2 days late is awarded 65% on its merits, the mark will then be reduced by 10% (5% per day for 2 days) to 55%. If that same assignment is 4 days late its mark will be reduced by 20% (5 marks per day for 4 days) to 45%. And so on.
The Discipline reserves the right to refuse to accept an assignment that is more than 7 days late.
The Course Coordinator will endeavour to return marked essays to students within two weeks of submission.
Students who are not satisfied with a particular assessment can raise their concerns with the Course Coordinator. This must be done within 10 business days of the notification of the mark or return of the assignment. Raising a concern in this way does not constitute a formal complaint, and the majority of issues are resolved at this stage. In order to qualify for a re-mark, you will need to provide a substantive reason as to why your original mark is incorrect. This should relate to the academic quality of the work.
Remarking of any piece of work will be performed on a clean copy of the original by a person who has not been informed of either the original grade or of the first marker’s comments. The result of the remark will be recorded as the final mark even if it is lower than the original.
If you are still dissatisfied, any formal written complaints about assessment will be handled under the University’s Student Complaints Policy which is available on the University web site at <http://www.adelaide.edu.au/policies/100>. Section 5.3.1b of this Policy states, inter alia, that students are usually required to initiate the formal complaint process within 10 business days for assessment complaints.
Grades for your performance in this course will be awarded in accordance with the following scheme:
M10 (Coursework Mark Scheme) Grade Mark Description FNS Fail No Submission F 1-49 Fail P 50-64 Pass C 65-74 Credit D 75-84 Distinction HD 85-100 High Distinction CN Continuing NFE No Formal Examination RP Result Pending
Further details of the grades/results can be obtained from Examinations.
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