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Ethics in public health and research
Public-health ethics balances individual liberty against the common good: an intervention that restricts rights is justified only if it is effective, proportionate, necessary, the least restrictive of the alternatives, and explained transparently to the public.
Why it matters in the exam
Items on this topic pose dilemmas: compulsory isolation of a tuberculosis patient who refuses treatment, reporting an HIV carrier despite confidentiality, mandatory vaccination of health workers, a tax on sweetened drinks or movement restrictions in an epidemic – and ask which principle justifies or limits the step. The key principles are the harm principle (liberty may be restricted to prevent harm to others), proportionality, the least restrictive means, reciprocity (those restricted for the common good deserve support), justice and equity, and transparency. The Nuffield Council's intervention ladder ranks actions from providing information up to eliminating choice, and the higher the rung, the stronger the justification needed. In Israel the Patient's Rights Act is also tested – for example the role of the ethics committee, which approves treatment without consent or withholding information from the patient in the circumstances the law sets – as are the rules for human research: approval by a Helsinki committee, informed consent, reporting of serious adverse events, and a "special" medical trial (for example in genetics or fertility) that also requires approval by the supreme Helsinki committee. The principles of Good Clinical Practice (GCP) protect participants' rights and the reliability of the data. Another recurring point is the difference between clinical ethics, centred on the individual patient, and public-health ethics, centred on the whole population and the duty to protect also those who are not in the room.
Key points
- An intervention that restricts rights should be effective, proportionate, necessary and least restrictive.
- The harm principle justifies restriction to prevent harm to others.
- The Nuffield ladder ranks interventions from information to eliminating choice.
- Reciprocity, justice and transparency are part of the justification.
- Research in humans requires informed consent and Helsinki committee approval.
Summary table
| Principle | Meaning | Example |
|---|---|---|
| Harm principle | Liberty may be restricted to prevent harm to others | Isolating an infectious patient |
| Proportionality and least restrictive means | Benefit outweighs the infringement, and no less restrictive alternative exists | Directly observed therapy before detention |
| Reciprocity | Those restricted for the common good deserve support | Compensation and support for people in isolation |
| Justice and equity | Fair distribution of burdens and benefits | Allocating vaccines by risk |
| Transparency and trust | Public explanation of decisions and their reasons | Publishing the criteria for restrictions |
| Research in humans | Informed consent, Helsinki committee approval, GCP | A special trial also requires the supreme committee |
Free exam questions
במחקר קליני, מה הנוהל לגבי)SAE( Event Adverse Serious ? (the question as examined, in Hebrew)
- א. חומרתו של SAE היא תמיד Severe
- ב. בד"כ SAE .הוא אירוע תמותה
- ג. על החוקר לדווח עליו בתוך 24 שעות מרגע שהוא יודע שהתרחש, לוועדת האתיקה במשרד הבריאות
- ד. חומרתו של SAE נקבעת על ידי החוקר
כרופא נפה, קיבלת דיווח על תוצאה של 200 אנטרוקוקים צואתיים במי רחצה בחוף שבשטח הנפה .מה עליך לעשות? (the question as examined, in Hebrew)
- א. לתת הוראה למפקחי בריאות הסביבה בנפה לבצע דיגום חוזר באותו חוף
- ב. לתת הוראה למפקחי בריאות הסביבה בנפה לדגום חופים נוספים סמוכים
- ג. להמתין לתוצאת הבדיקה של חיידקי הקוליפורם הצואתי באותו חוף ורק אז להחליט מה הצעד הבא
- ד. להורות לרשות המקומית לנקוט בפעולות מתקנות מיידיות
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Sources
- Nuffield Council on Bioethics, Public health: ethical issues, 2007 — The intervention ladder; The stewardship model
- Childress et al., Public health ethics: mapping the terrain, 2002 — Journal of Law, Medicine & Ethics – justificatory conditions
- Israel, Patient's Rights Act (חוק זכויות החולה) and Public Health Regulations (Clinical Trials in Human Subjects), 1996 and 1980, as amended — Ethics committees; Helsinki committees
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.