In this chapter we explore the relationship between the environment, ethics and public health (Kessel, 2006). To do this we take the theme of climate change and public health (with climate representing the natural environment), and we examine the relationship between our climatic environment and public health ethics. We illustrate the changing relationship between public health and the environment, and examine the place of ethics in the relationship between the environment and public health. In particular, we critique the status of utilitarianism as a moral foundation for public health. The importance of environmental justice, environmental philosophy and development ethics to the future of public health are discussed.

Background: definitions and methods

As an introduction to this chapter it is important to refer to some difficulties around definitions, and also to briefly describe the methods used. To philosophers definitions are often key to their debates. For one philosopher in particular, Ludwig Wittgenstein, issues to do with definitions are at the root of all philosophical problems (Elliott, 2001). A look at the words used in the title of this chapter readily illustrates the challenges of writing on this topic. To Socrates, ethics was about how we ought to live, and why. More contemporarily, however, ethics has been divided into normative ethics (systematic examination of organized theories) and speculative (or reflective) ethics (Honer et al., 2006). In this chapter we look at moral theories as well as adopting a more speculative approach.

Introduction

In this chapter we describe unlinked anonymous blood testing for human immunodeficiency virus (HIV) and other diseases, and examine the ethical issues associated with this system of seroprevalence testing. We argue that the views of participants have been missing from ethical debates about seroprevalence monitoring, and propose that the issue of informed consent for inclusion in such programmes should be revisited. We introduce our own current scientific research which explores this issue.

A discussion about the ethics of unlinked anonymous testing of blood should be placed within wider contemporary debates in the arenas of public health, clinical medicine and medical research. The first such debate focuses on the balance between individuals’ rights and the appropriate role of government in infringing on those rights for broader public health interests or concerns. Connected to this is the extent to which the traditional doctor–patient relationship extends to public health, and the degree of public health paternalism that is acceptable. The second debate centres on the boundaries of informed consent in medical research, particularly in relation to the use of human tissue, and the extent to which information contained in medical records can be utilised for research purposes.

In relation to the first debate, there has been strong criticism of government in recent times, particularly in the mass media, for its ‘nanny state’ approach to interventions in, for example, the areas of smoking, alcohol and diet. More recently the notion of ‘stewardship’ (Jochelson, 2005) in public health rejects these negative associations, and advocates that government should have a role to play in protecting the health of citizens, preventing them from harming themselves or others, and promoting healthy behaviour. In this view, public health interventions should not be thought of as unwanted restrictions imposed by a ‘nanny’ on powerless children, but as actions that favour both individuals and society more widely, as prescribed by a ‘steward’ administering and protecting citizens’ interests.