Building infrastructure in public health ethics: Lessons from a local health department

Every day public health officials grapple with decisions that present ethical challenges such as how to allocate scare resources and how to respect individual rights while protecting the public good.  Given these challenges, an effective public health ethics process for decision-making has become a critical component of public health practice and is now included in the public health accreditation standards for state and local health departments.  While options for implementing a local public health ethics process range from basic to elaborate, local health departments can scale these activities to meet their needs.  An effective ethics process, especially one that involves community stakeholders, can increase transparency, promote trust, and thereby lead to wider acceptance of health department decisions, recommendations and policies.  This presentation will describe our experience establishing a public health ethics activity within the Clark County, Washington health department, including the challenges we faced, the benefits we realized, and the impact it has had on public health department decision-making.  The session will provide practical examples of how a local health department can implement an ethics committee and integrate it into its practice.   Key components for ensuring the success of the ethics committee, such as engaging leadership support, identifying and involving community stakeholders, developing a committee charter and integrating an ethics framework, will be discussed.   The speaker will also highlight the important benefits that result from having a structured process for examining ethical issues in public health practice and how to best evaluate the impact of the ethics process.