Jason Behrmann, Marie-Josée Potvin, Vardit Ravitsky, and Bryn Williams-Jones argue that curriculum improvements are needed to support Canadian ethics educators in their training of future public health professionals
The recent Ebola outbreak highlights the complexity of contemporary public health interventions that pose challenging ethical issues at the interface between research (e.g., the use of experimental medicines), health policy (e.g., resource allocation), and professional practice (e.g., who and how to intervene). And so public health professionals – whether they are frontline workers, researchers, or decision-makers – need to be equipped to deal with these challenges.
The field of public health is comprised of students, practitioners and researchers from a diversity of academic backgrounds; as such, they may come to this field with various norms of practice or codes of ethics, some of which may not be well aligned. To do their jobs well, they must interact with a diversity of other professionals (e.g., clinicians, scientists, and policy-makers) and at multiple levels (e.g., from the local to the global), all the while respecting the cultural diversity of the populations they serve. Such complex professional work environments thus require thorough and nuanced professional and public health ethics education. Yet, few jurisdictions have adopted either a formal professional code of ethics for public health, or a model curriculum for public health ethics education, and there are merely a handful of ethics-related teaching resources for continuing education in this field. As a result, trainees and professionals may not know where to turn for guidance, feel ill-equipped to negotiate divergent obligations arising from different codes of ethics (e.g., clinical vs. community-centered) and have difficulties addressing sensitive issues in research collaborations or policy development. Ethics resources dealing with the key issues may thus remain distant from or inaccessible to the public health professionals dealing with the challenges raised by situations such as the current Ebola outbreak.
Knowledge about ethics education in public health programs is scant at best, and limited to European and US contexts. For the rest of the world, there is little evidence of where, when and how ethics is taught or learned, and public health ethics curricula, teaching methods, and resources are generally still in their infancy.
Our aim is to develop a national model for ethics curricula. This will first require that we know more about the current status of public health ethics education in Canada. More specifically, it is essential to know: (1) what content is currently being taught, and by whom. (Are there any gaps in content? Are the methods of instruction appropriate? Are educators well-qualified?) And (2) whether this content aligns with the practical needs of public health professionals and researchers. (Is ethics training practical and pertinent?) These questions can, we argue, be best answered through the use of empirical methods, specifically through surveys and systematic literature reviews.
To document the current state of ethics education in Canada, we believe that a survey targeting ethics educators and directors of university public health programs should be done to explore the following topics:
a) Is ethics a required or elective component in your programs?
b) What is the level of ethics training of your ethics instructors?
c) Are there plans to further develop ethics training?
d) How important is it to include ethics in your programs?
To ensure that the ethical challenges that practitioners face in their day-to-day settings are addressed in their ethics education, a systematic review of the international public health ethics and professional literatures should explore the following issues:
a) What are ethical challenges faced by professionals in their daily practice?
b) Do professionals feel that they obtained sufficient training in ethics?
c) What ethics resources do they require?
d) What recommendations exist for developing/implementing model public health ethics curricula or continuing education programs internationally?
We believe that the results of these two studies would help shed light on whether there are, in fact, any gaps between academic approaches and practitioner needs in current public health ethics education. This empirical data would thus provide a starting point for building a dialogue between educators and practitioners, and help bridge any divides between key learning objectives and methods, and the actual ethical challenges faced in public health.
Considering the complexity of ethical issues in public health – as exemplified by the current Ebola crisis – as well as the overlapping scientific, political, social and cultural roles that public health professionals are expected to play, more attention is required to their training needs. We propose an empirical approach to building a knowledge base regarding the current state of ethics education in Canadian public health programs as the basis on which to elaborate a national discussion of public health ethics education, one that may serve as a model for other countries and regions. The outcome of such a discussion would be a curriculum, or set of curricula, designed to impart to the next generation of public health professionals the ethical tools needed to deal with the diverse and often challenging ethical issues they face in their daily practice and research.
Vardit Ravitsky is an Associate Professor in Bioethics at the Université de Montréal.