The 21st century has witnessed several changes and developments in the healthcare sector. Changes, such as the widespread use of information communication technology (ICT) in the health sector, have revolutionized the dispensation of healthcare in the nation and unearthed several public health ethical and legal issues. In their day-to-day operations, different stakeholders of the health sector, such as healthcare professionals and patients, have to make several ethical and legal decisions on the prevention, treatment, and management of diseases. Contemporary public health practice is multifaceted and grounded in ethical and legal imperatives that have resulted in the emergence of several ethical and legal issues, such as patient confidentiality and euthanasia, factors that impact the dispensation of quality healthcare.
Modern-day public health is regulated by a complex interplay of ethical rules and legal standards. The health sector is regulated by different rules, laws, and ethics designed to ensure the dispensation of quality healthcare services. Ethical standards and legal rules, though different in nature, are solely focused on the protection of the lives and health of both healthcare practitioners and patients (Carter et al., 2020). Legal rules, which regulate public health, are enacted by relevant governmental institutions and have a legal basis compared to ethical standards that are universal principles integral in healthcare practice (Gunawardane, 2020). Ethical and legal issues arise when public health practice clashes with the ethical and legal imperatives upon which healthcare dispensation is based. For example, an ethical issue, on patient confidentiality, may arise when a healthcare practitioner makes public the private information of their clients.
The main legal issues in contemporary public health are majorly concerned with the notions of bodily integrity and confidentiality. The public health legal issue of patient confidentiality is closely linked to that of surveillance and privacy. Public health agencies and practitioners collect, analyze, use, and disclose innumerable amounts of personal health information in their aim to prevent, control, and treat diseases. According to Shawahna (2020), both domestic and international public health laws require healthcare professionals to report to relevant agencies specific health information collected from the general public. For example, U.S.A.’s public health legislation, Health Insurance Portability and Accountability Act (HIPAA) provides broad exemptions for public health data (Davenport & Kalakota, 2019). On the one hand, the collection, usage, and sharing of personal health information infringe on individuals’ right to privacy. On the other hand, without the collection, usage, and sharing of people’s personal health information, public health practitioners cannot develop interventions to prevent, treat, and manage highly infectious diseases, such as COVID-19. The public health legal issue of confidentiality can only be managed properly through the enactment of adequate regulations that balances the need for the protection of personal information and that of disease prevention and treatment.
The issue of bodily integrity is a public health legal issue that questions the legality of forced treatment and vaccination. In their bid to prevent, treat, or manage highly infectious diseases, such as tuberculosis, public health agencies have the power to compel vaccination, medical examinations, and treatment (Maher et al., 2019). For example, the Patients’ Charter for Tuberculosis Care, an international treaty on the rights and responsibilities of people with tuberculosis (TB), empowers public health agencies to compel the treatment of non-responsible TB patients (Maher et al., 2019). Public health practice is grounded on the ethical principle of utilitarianism that advocates for doing the greater good in society. Thus, for the sake of preventing the death and misery of a large number of people in society, public health agencies are legally mandated to quarantine, treat, and even vaccinate individuals suffering from highly infectious diseases. Shawahna (2020) argues that the utilitarian nature of public health is critically important in preventing or controlling the spread of infectious diseases, but they also interfere with people’s fundamental rights, particularly that of bodily integrity. Individuals have the right to reject treatment interventions as they have a fundamental right to the integrity of their bodies (Shawahna, 2020). The legal issue of bodily intervention can be tackled by developing safeguards that restrict compulsory state therapeutic powers to highly infectious and dangerous diseases.
Ethical issues in contemporary public health practice are often centered on the issues of informed consent and physician-assisted suicide. The ethical issue of informed consent has formed an integral element of global healthcare practice since the enactment of the Nuremberg Code in 1945 (Davenport & Kalakota, 2019). The concept of informed consent requires healthcare professionals to provide their patients and research subjects with an in-depth understanding of the risks and benefits of a treatment intervention or study (Sims et al., 2019: Davenport & Kalakota, 2019). Both patients and research subjects have to consent in writing that they completely understand the interventions they are to be subjected to. The issue of informed consent is quite contentious in public health practice and research as it limits the scope of medical and nursing research. According to Gunawardane (2020), public health agencies cannot effectively prevent and manage diseases without performing medical and nursing research currently made difficult and expensive by the limiting scope of the ethical issue of informed consent. The scope of the ethical issue of informed consent needs to be limited to enhance intensive and expansive public health research.
The concept of physician-assisted suicide (PAS) and euthanasia are ethical issues that highlight the clash between public health practice and individuals’ fundamental right to determine their fate. According to Gunawardane (2020), PAS involves the provision of a competent patient with a medical prescription that will end their life. PAS is quite different from euthanasia as it requires a patient to self-administer the medication that will take his or her life. Euthanasia, however, refers to the process of deliberately ending a patient’s life with the sole intention of relieving him or her from pain and suffering (Gunawardane, 2020). Unlike PAS, in the practice of euthanasia healthcare professionals are involved in taking away a patient’s life. Both PAS and euthanasia are quite contentious and hotly debated. On the one hand, people argue that individuals have the right to determine their fate and should, therefore, be allowed to end their life whenever they deem fit. On the other hand, individuals argue that public health is concerned with the prevention of death through the treatment of diseases and, therefore, should prohibit both PAS and euthanasia. The public health issue of PAS and euthanasia is quite contentious and can only be solved through a legislative process.
Developments in the healthcare sector highlight several ethical and legal issues in public health practice. Legal issues, such as bodily integrity and confidentiality, highlight the clashing interests of public health and people’s fundamental rights. Moreover, ethical issues, such as informed consent, PAS, and euthanasia, also impact the scope of public health practice, and thus, have the potential to affect the dispensation of quality healthcare. The legal and ethical issues affecting healthcare must be harmonized to improve the quality of both nursing and medical practice.
Carter, S. M., Rogers, W., Win, K. T., Frazer, H., Richards, B., & Houssami, N. (2020). The ethical, legal, and social implications of using artificial intelligence systems in breast cancer care. The Breast, 49, 25-32.
Davenport, T., & Kalakota, R. (2019). The potential for artificial intelligence in healthcare. Future healthcare journal, 6(2), 94. https://doi.org/10.7861/futurehosp.6-2-94
Gunawardane, G. (2020). Legal and Ethical Issues Affecting Health Care Marketing. World Scientific Book Chapters, 359-407. https://doi.org/10.1142/9789813279520_0013
Maher, N. A., Senders, J. T., Hulsbergen, A. F., Lamba, N., Parker, M., Onnela, J. P., … & Broekman, M. L. (2019). Passive data collection and use in healthcare: A systematic review of ethical issues. International Journal of Medical Informatics, 129, 242-247. https://doi.org/10.1016/j.ijmedinf.2019.06.015
Sims, M. H., Hodges Shaw, M., Gilbertson, S., Storch, J., & Halterman, M. W. (2019). Legal and ethical issues surrounding the use of crowdsourcing among healthcare providers. Health informatics journal, 25(4), 1618-1630.
Shawahna, R. (2020). Facilitating ethical, legal, and professional deliberations to resolve dilemmas in daily healthcare practice: a case of driver with breakthrough seizures. Epilepsy & Behavior, 102, 106703. https://doi.org/10.1016/j.yebeh.2019.106703