As the actions of individuals have an impact on the health of others, Matthias Egger emphasises the ethical responsibility for public health. | Image: Nicolas Brodard

In contrast to medical ethics, whose origins lie in the Nuremberg trials and can actually be traced back to the Hippocratic oath, ‘public health ethics’ is a relatively young discipline. It was not until 2002 that the American Public Health Association published its ‘Principles of the Ethical Practice of Public Health’. While medical ethics focuses on the doctor-patient relationship, public health ethics addresses the relationship between citizens and institutions, governmental or otherwise.

Medical ethics stresses the autonomy of individuals and the need for informed consent – in other words, the process of getting permission before a healthcare intervention or before enrolling someone in clinical research. It obliges one to do good to people, and to avoid harm. In public health ethics, this principle of autonomy is supplemented and qualified by the principle of interdependence: the actions of one individual usually affect other people. For example, by vaccinating hospital staff against influenza, high-risk patients can be protected. This is what the Swiss National Covid-19 Science Taskforce is recommending, based on an assessment of the scientific evidence.

The principle of underpinning public health recommendations with scientific evidence is one of the key values in ethical public health practices. Opinions and assumptions should not determine the advantages or disadvantages of public health measures. Instead, any discussion of such measures must be based on sound scientific data. It is therefore an ethical imperative to involve science in public health decisions, especially during a public health crisis. In Switzerland, politicians tend to involve the scientific community only at a late stage, so there is an urgent need to clarify in advance what the role and involvement of scientists will be in any future crises.

I think there are also other things we can learn from the ‘Principles of the Ethical Practice of Public Health’. One is the principle of participation: public health measures should always be planned and implemented with the involvement of the affected population. How societal participation can be facilitated effectively in a public health crisis such as Covid-19 is one of many important topics that need urgent interdisciplinary research.