Most books about ethics and health focus on issues arising from individual patients and their relationships with doctors and other health professionals. More and more, however, ethical issues are challenges that face entire communities, not just individual patients. This book is an edited collection of readings that addresses these public health challenges. Many of the issues considered, such as policy for alcohol and other drugs, newly emergent epidemics, and violence prevention, are public health concerns beyond the purview of traditional bioethics. Others, such as access to health care, managed care, reproductive technologies, and genetic testing, are covered in bioethics texts, but here they are approached from the distinct viewpoint of public health. The book makes explicit the community perspective of public health, as well as the field's emphasis on prevention. It examines the conceptual issues raised by the public health perspective (i.e., what is meant by community, the common good, and individual autonomy) as well as the policies that can be developed when health problems are approached in population-based, preventive terms.
The issues that are important for the next century are discussed in this book. How will access be provided in an era of managed care and at a time when new and old diseases are emerging? Also, how do we address those issues that are becoming more apparent as the result of new technology? What are the rights of the community versus the individual? The articles in this book are the basis for a strong argument for ethics to be viewed from a public health and provider view and not just from a philosophical point of view. From this perspective, texts used by philosophers usually expose students and/or practitioners to ""contrasting and powerfully argued views on problems which are deeply disputed or in perpetual conflict and not likely to be resolved."" The editors here do not discuss issues in an abstract way, but rather with a pragmatic, eclectic approach to real life problems. The purpose is to look at fundamental questions about the duties and obligations owed by citizens to the public community. The editors and contributors make the point throughout each article chosen that public health must pay careful attention to the larger community and the rationale for promoting and protecting the health of the people if it is to prosper. They also raise some fundamental political questions such as: what is the meaning and scope of community and the balance between the market and the public realm in today's highly individualistic society? Graduate students in nursing, medical students, and social and public health students all could benefit from the discussions in each chapter. It would also be very appropriate to have professionals in those areas read and discuss the various health issuespresented. A very helpful feature is the introductory focus on aspects of ethical theory and public health. This is very helpful in setting the stage for thought and discussion for those who have not recently studied ethics. The content is organized to present material from a population perspective (i.e., sickness, race, class, and epidemiological theory). Public health is viewed from a community perspective. Timely topics such as tobacco, alcohol, and drugs, as well as the U.S. policies on violence, AIDS, and emerging diseases such as the hanta virus are discussed and are viewed from an ethical and public health perspective. Of particular interest are sections related to new technology and reproductive issues. This book would be a great adjunct to many courses related to community and public health at colleges and universities. It could also be used to spark vigorous debate among healthcare providers, especially those involved in public/community health. There are many nursing ethics texts and those related to community health, but, I am not familiar with any one which takes the approach found in this book. I would highly recommend this as a companion book in any number of nursing courses.