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To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-8519.2008.00698.x Byline: SABINA GAINOTTI (1), NICOLA MORAN (2), CARLO PETRINI (3), DARREN SHICKLE (4) Keywords: infectious diseases; public health ethics; public health law; Europe Abstract: ABSTRACT Increases in international travel and migratory flows have enabled infectious diseases to emerge and spread more rapidly than ever before. Hence, it is increasingly easy for local infectious diseases to become global infectious diseases (GIDs). National governments must be able to react quickly and effectively to GIDs, whether naturally occurring or intentionally instigated by bioterrorism. According to the World Health Organisation, global partnerships are necessary to gather the most up-to-date information and to mobilize resources to tackle GIDs when necessary. Communicable disease control also depends upon national public health laws and policies. The containment of an infectious disease typically involves detection, notification, quarantine and isolation of actual or suspected cases; the protection and monitoring of those not infected; and possibly even treatment. Some measures are clearly contentious and raise conflicts between individual and societal interests. In Europe national policies against infectious diseases are very heterogeneous. Some countries have a more communitarian approach to public health ethics, in which the interests of individual and society are more closely intertwined and interdependent, while others take a more liberal approach and give priority to individual freedoms in communicable disease control. This paper provides an overview of the different policies around communicable disease control that exist across a select number of countries across Europe. It then proposes ethical arguments to be considered in the making of public health laws, mostly concerning their effectiveness for public health protection. Author Affiliation: (1)Italian National Institute of Health, National Center for Epidemiology, Surveillance and Health Promotion (2)Social Policy Research Unit (SPRU) at the University of York in the United Kingdom (3)Italian National Institute of Health (4)University of Leeds in the United Kingdom Article note: Sabina Gainotti, National Institute of Health, National Centre of Epidemiology, Surveillance and Health Promotion, via Giano della Bella 34, Rome 00162, Italy. T: 00390649904245 F: 00390649904303, Email: sabina.gainotti@iss.it

First we give an overview of the historical development of public health. Then we present some public-health deontology codes and some ethical principles. We highlight difficulties in defining ethics for public health, with specific reference to three of them that concern: (i) the adaptability to public health of the classical principles of bioethics; (ii) the duty to respect and safeguard the individual while acting within the community perspective that is typical of public health; and (iii) the application-oriented nature of public health and the general lack of attention towards the ethical implications of collective interventions (compared with research). We then mention some proposals drafted from North American bioethics "principles" and utilitarian, liberal and communitarian views. Drawing from other approaches, personalism is outlined as being the theory that offers a consistent set of values and alternative principles that are relevant for public health. Une traduction en francais de ce resume figure a la fin de l'article. Al final del articulo se facilita una traduccion el espanol. Nous commencons pardonner un apercu de l'evolution historique de la sante publique. Puis nous presentons certains codes deontologiques et principes ethiques de cette discipline. Nous mettons en lumiere les difficultes pour definir une ethique de la sante publique, en decrivant plus explicitement trois d'entre elles qui concernent: (i) les possibilites d'adaptation de la sante publique aux principes classiques de la bioethique, (ii) le devoir de respect et de sauvegarde de l'individu Iorsqu'on agit dans l'interet de la collectivite, caracteristique de la sante publique ; (iii) la nature appliquee de cette discipline et le manque general d'interet pour les implications ethiques des interventions collectives (par comparaison avec la recherche). Nous mentionnons ensuite certaines propositions elaborees a partir des "principes" bioethiques en vigueur en Amerique du Nord et de points de vue utilitaires, liberaux et collectifs. En s'appuyant sur d'autres approches, le personnalisme est presente comme une theorie offrant un jeu coherent de valeurs et de principes de substitution applicables a la sante publique. En primer lugar se ofrece aqui una panoramica del desarrollo hist6rico de la salud publica, para presentar a continuacion algunos codigos deontolegicos en materia de salud publica y determinados principios eticos. Destacamos las dificultades que entrana la definicion de una etica en salud publica, dedicando especial atencion a tres de ellas relacionadas con: (i) la adaptabilidad de les principios clasicos de bioetica a la salud publica; (ii) el deber de respetar y proteger a les individuos aunque se adopte la perspectiva comunitaria caracteristica de la salud publica; y (iii) el hecho de que la salud publica esta orientada a las aplicaciones y de que en general se presta poca atencion a las implicaciones eticas de las intervenciones colectivas (en comparacion con la investigacion). Por Ultimo, se mencionan algunas propuestas elaboradas a partir de "principios" de bioetica emanados de America del Norte y de nociones utilitaristas, liberales y comunitarias. Partiendo de otras perspectivas, el personalismo se perfila corne una teoria que brinda un conjunto coherente de valores y principios alternativos pertinentes para la salud publica., The past and present of public health In developed countries, where high standards of living have been achieved, public health is often viewed as a sort of secular faith providing [...]

Abstract Background Overcrowding in emergency department (EDs) is partly due to the use of EDs by nonurgent patients. In France, the authorities responded to the problem by creating primary care units (PCUs): alternative structures located near hospitals. The aims of the study were to assess the willingness of nonurgent patients to be reoriented to a PCU and to collect the reasons that prompted them to accept or refuse. Methods We carried out a cross sectional survey on patients' use of EDs. The study was conducted in a French hospital ED. Patients were interviewed about their use of health services, ED visits, referrals, activities of daily living, and insurance coverage status. Patients' medical data were also collected. Results 85 patients considered nonurgent by a triage nurse were asked to respond to a questionnaire. Sex ratio was 1.4; mean age was 36.3 +/- 11.7 years. Most patients went to the ED autonomously (76%); one third (31.8%) had consulted a physician. The main reasons for using the ED were difficulty to get an appointment with a general practitioner (22.3%), feelings of pain (68.5%), and the availability of medical services in the ED, like imaging, laboratory tests, and drug prescriptions (37.6%). Traumatisms and wounds were the main medical reasons for going to the ED (43.5%). More than two-thirds of responders (68%) were willing to be reoriented towards PCUs. In the multivariate analysis, only employment and the level of urgency perceived by the patient were associated with the willingness to accept reorientation. Employed persons were 4.5 times more likely to accept reorientation (OR = 4.5 CI (1.6-12.9)). Inversely, persons who perceived a high level of urgency were the least likely to accept reorientation (OR = 0.9 CI (0.8-0.9). Conclusions Our study provides information on the willingness of ED patients to accept reorientation and shows the limits of its feasibility. Alternative structures such as PCUs near the ED seem to respond appropriately to the growing demands of nonurgent patients. Reorientation, however, will be successful only if the new structures adapt their opening hours to the needs of nonurgent patients and if their physicians can perform specific technical skills.

First we give an overview of the historical development of public health. Then we present some public-health deontology codes and some ethical principles. We highlight difficulties in defining ethics for public health, with specific reference to three of them that concern: (i) the adaptability to public health of the classical principles of bioethics; (ii) the duty to respect and safeguard the individual while acting within the community perspective that is typical of public health; and (iii) the application-oriented nature of public health and the general lack of attention towards the ethical implications of collective interventions (compared with research). We then mention some proposals drafted from North American bioethics "principles" and utilitarian, liberal and communitarian views. Drawing from other approaches, personalism is outlined as being the theory that offers a consistent set of values and alternative principles that are relevant for public health. [ABSTRACT FROM AUTHOR]

The article discusses the development of the evaluation of professional practices (EPP). It is said that upon approval of the law that obliges medical personnel to continually evaluate their practice, decrees and procedures specifying the means for implementing EEP were published. However, the development of procedures is said to have caused confusion as to who is responsible for the said procedures. It is suggested that specialty societies be integrated in the EEP development process.

In public health ethics, as in bioethics, utilitarian approaches usually prevail, followed by Kantian and communitarian foundations. If one considers the nature and core functions of public health, which are focused on a population perspective, utilitarianism seems still more applicable to public health ethics. Nevertheless, faulting additional protections towards the human person, utilitarianism doesn't offer appropriate solutions when conflicts among values do arise. Further criteria must be applied to protect the fundamental principles of respect for human life. Personalism offers similar advantages to utilitarianism but warrants more protection to the human person. We suggest a possible adaptation of personalism in the specific field of public health by means of four principles: absolute respect for life or principle of inviolability; subsidiarity and the "minimum" mandatory principle; solidarity; justice and non discrimination.