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Ethical Frameworks in Health Impact Assessment: Balancing Utility and Justice

This document explores the ethical values inherent in Health Impact Assessment (HIA), emphasizing solidarity, equity, participation, and sustainability. It discusses the common conflicts among these principles, particularly in decision-making processes, and the challenges in measuring impacts to promote equity. The work critiques utilitarian frameworks, arguing for a deontological approach focused on justice and individual rights. It highlights the need for a clearer ethical framework in HIA, suggesting that principle-based approaches might offer a path forward for ethical decision-making in public health.

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Ethical Frameworks in Health Impact Assessment: Balancing Utility and Justice

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  1. Ethics of HIA Marco MartuzziWorld Health OrganizationRegional Office for Europe Rome, Italy

  2. Ethical values in HIA • Solidarity, equity, participation, sustainability, ethical use of evidence,… • Routinely referred to in textbooks and training • Some more clarity may be needed

  3. HIA: making decisions • Key goals • Assessing measurable impacts (and minimize them) • Promote equity • Involve / Listen / Empower  Possible conflict between these goals

  4. Environmental factors

  5. Minimizing impacts • Overall measurable impact; the most good for most people (EIA, risk assessment, community preventive medicine) • Utilitarian ethical framework, i.e. based on “utility function” = overall impact

  6. ELF and childhood leukaemia: Attributable risk in Italy

  7. Ethical frameworks • The utilitarian framework conflicts with other ethical frameworks • Typically, in HIA “environmental justice” type ethics applies • However, factors other than overall impact can be included in utility function • Equity (distributional issues) are a good candidate • A utilitarian HIA?

  8. NO • HIA, env justice, etc belong to deontological theories (as opposed to utilitarian theories) • People should not be treated as means to and end • Some actions are right or wrong, regardless of consequences • However, the principle of utility has lead to important PH progress, e.g. to immunisation (communitarian ethics)

  9. What deontological ethical framework? • Assessing measurable impacts (and minimize them) • Promote equity • Involve / Listen / Empower • Conflict of aspirations, and ethical systems

  10. Principle-based approaches • Beneficence (Assessing measurable impacts and minimize them) • Non maleficence (ditto) • Justice (Promote equity) • Authonomy (Listen / Empower) These principles “do not provide a full philosophical justification for decision making … where there is conflict it may be necessary to choose between them or assign greater weight to one” (Coughlin 2006)

  11. Conclusions • HIA ethics not utilitarian • Difference with utilitarian approaches such as risk assessment is irreducible • Utilitarian approach has some advantages, lost in HIA • The ethical framework of HIA is not always clear • Should it be clarified? • Perhaps principle-based approaches good candidate if progress is sought

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