What a time to be launching a new regional public health ethics network. If the study of ethics asks questions about how we should we live and act towards each other, and if our cultures and our politics takes that up to a societal level, we are watching the era of the liberal democratic post-war social contract and the assumption of gradually increasing prosperity and equality, being battered by waves of disillusion, nationalism, globalisation, terrorism, austerity and other forces. Oh to be in England, now that Brexit’s here!
Our public services are creaking and crumbling as rising demand and expectation meets falling resource; inequalities are rampant and we are changing and degrading the environment on which we rely, as never before.
And yet on the other hand, there is no limit to the number of examples you can find every day of people striving to help their fellow humans in need and distress; and the internet can help to make organising and amplifying this easier and more immediate.
And finally, the rise of information and bio-technologies and their many consequences will start to raise whole new questions about what it means to be human, and how we value humanity, beyond those we have faced in our lifetimes.
Clearly there is no better time than now to be thinking about ethical principles that might guide our personal thinking and professional practice in changing times… and no better place to be located than in a local authority!
We all live in some or other locality, and local government sits at the centre of the web of a “Place” where needs and resources, self-interest and community spirit, power and vulnerability, conflict and compromise all swirl around in a glorious, and sometimes very inglorious, mix. And sooner or later everyone working in the public realm realises that nowhere in the system is there an all-wise and all-powerful “them” to make sure it all works out in the end. It’s just the sum or you and me and us making it work as best we can… or buggering it all up.
And part of doing our best is bringing an ethical dimension to our decision making alongside all the technical, scientific, legal, ideological, commercial, cultural and purely self-serving considerations.
I and my colleagues are faced with some very practical questions about social justice. How to balance different needs and deploy the state’s scarce resources. How to work in a democracy, when those who are most vulnerable may have the quietest voices – and may, as in a place like Bath, be in a minority. And then there is our duty to the present compared to the future: sustainability as intergenerational equity.
In my discussions with councillors and others about priorities, I sometimes make the point that there are no tools, or equations or algorithms that can say conclusively and “scientifically” how we should compare and rank, or what we should spend our resources and efforts on. However clever our needs assessments and cost-benefit methodologies become, and even if we had a far better evidence base than our current threadbare offering, we would still need to look into our shared, or contested, values and beliefs to choose between things that are as intrinsically un-comparable as a cot on a neonatal unit, domestic care for people with dementia, a cycle-path, a cookery course for a young mother, training for staff to raise awareness and skills around domestic abuse, or an apprentice scheme, an affordable house, a library, clean air policies… and about a thousand more things I could mention. Obviously it isn’t all just about priorities for resources, but any of you who work in a council will know that it’s a subject much on corporate and DPH minds just now…
Now it isn’t easy to identify a neat package of ethical principles that can be applied to real situations with their wicked webs of conflict, dilemma and unpredictable consequence. As a doctor I think that the principles of medical ethics still have some relevance for us, but of course public health practice brings wider considerations, both in taking population level views and in considering the enormous range of things that impact on public health and wellbeing outside individual treatments.
Working in a political organisation, I am struck by the way different ideas of social justice map, at least to some extent, onto some of our political views and ideologies, not surprisingly. And there may be a practical dimension to this insight. Because while flatly disagreeing with a politician’s view of, for example, the “nanny state” may well be unproductive; shifting the grounds of the debate to one about libertarianism and its place among other possible theories of social justice, may open up a bit of space for real dialogue and even the potential for changing minds – and here we must be willing to challenge to our own views too.
I have some optimism, possibly misplaced, that generating a discussion framed in terms of ethical principles may be one of the keys to us engaging in discussions of politics and policy, from a platform of professional credibility and personal integrity, without raising the barriers that we might if we used more overtly political language.
Now maybe that’s all a load of simplistic nonsense, but if so we now have a network of folk who can tell me so and come up with some better ideas.
Director of Public Health
Bath and North East Somerset
I qualified as a doctor in 1986 and after a bit of experience in paediatrics in London I went abroad first to the MRC tropical medicine research unit in the Gambia, and then for about ten years I worked in international medical relief with MSF, Oxfam and Merlin in various countries in Africa and Asia and also in the UK. I then trained in public health in Berkshire and Sheffield, worked for ten years as a DPH and consultant in Derbyshire and finally arrived in BaNES in 2013. I live in Bath with a dog, a motorcycle and a wife and have two allegedly grown-up sons.