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LETTER |
Nancy E. Kass is with the Department of Health Policy and Management, Bloomberg School of Public Health, and the Phoebe R. Berman Bioethics Institute, Johns Hopkins University, Baltimore, Md.
Correspondence: Requests for reprints should be sent to Nancy E. Kass, ScD, Hampton House 344, 624 N Broadway, Baltimore, MD 21205 (e-mail: nkass{at}jhsph.edu).
Gruskin raises important questions about the relationship between ethics and human rights as a tool for analyzing proposed public health policies. She suggests that ethics frameworks may be derivative of human rights frameworks. Indeed, the relationship between ethics and human rights has been discussed by several commentators. Clearly, while the language used by the 2 approaches may differ, in no way are they inconsistent in terms of what they would deem acceptable from a public policy perspective.
In trying to draw distinctions between the 2 approaches, Jonathan Mann suggested, in a 1997 article that human rights analysis should be used to resolve public health dilemmas while ethics analysis should be used for individual, bedside dilemmas.1 Sharing a taxi with Jonathan shortly after the publication of his piece, I argued that, to the contrary, ethics are directly relevant for questions of public health, as is the language of human rights. A clear difference between human rights and ethics, however, is that the former, as Gruskin describes, are grounded in international human rights law.
I am grateful for the suggestion that my own and subsequent frameworks for public health ethics analysis ought to require explicitly that public health policies be consistent with international human rights law. An ethics framework, however, pushes us further to examine which of 2 policy alternatives, both acceptable from a human rights perspective, is ethically preferable. Indeed, the threshold for legal acceptability has been, and ought to be, lower than the threshold for ethical acceptability. It is in the space between the 2 that an ethics analysis is critical.
It is also important to note that while most questions of public health policy will concern government-sponsored programs, professionals employed by nongovernmental entities often have similar struggles over how best to implement public health programs. Those working with foundations, universities, nongovernmental organizations, and private industry often must decide how to target health education campaigns, how to distribute public health goods, and how to design public health research. The language of human rights, reserved for violations of governments against their own citizens, will not fully satisfy the needs of those conducting public health work through nongovernmental sectors.
Human rights and ethics have strong overlaps and draw from similar traditions.2 Nonetheless, the fact that human rights analysis is founded in law, by definition, makes it a starting point, rather than a final tool, for ethics analysis of public health policy.
References
1. Mann JM. Medicine and public health, ethics and human rights. Hastings Center Rep. 1997;27:6–13.
2. Beyrer C, Kass N. Human rights, politics, and research ethics review. Lancet. In press.
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