Weighing the public good and individual rights: Public health officials developing ethics training with GVSU expert's help

A mosquito-borne illness last summer was seriously sickening people and even leading to some deaths, creating a public health crisis and calls for government officials to fight the spread of the virus by spraying insecticide.

But despite the threat of Eastern equine encephalitis, spraying was met with resistance by some who feared potential harm to pollinators or the effects on people whose health conditions made them vulnerable. Enough property owners opted out that officials couldn't spray large parts of the targeted areas.

"This situation raises ethical questions about the tension between the good of the community and the rights of individuals and how you recognize those," said Jeffrey Byrnes, assistant professor of philosophy.

The dynamic is one that is common in public health, but the resources for guidance on such ethical issues are scattered and fairly minimal, experts said. Byrnes and a student are helping officials with mid-Michigan public health departments to develop a curriculum and companion workbook to be used by local and state departments to address these issues.

The key to the training content is to understand the "underpinnings" of the kinds of ethical concepts that public health departments consider, said Anne Barna, planning, promotion and evaluation manager for the Barry-Eaton District Health Department.

"For us at the local level, quite often we have to make decisions very quickly," said Barna, '01. "One of the things this does is help you make better decisions because we thought through all of the ramifications."

This work is at the forefront of developing ethics guidelines in public health and is eyed as a model for statewide use, Barna and Byrnes said. Barna has received some funding from a grant administered by the state to set up a Capital Region Ethics Committee involving her health department as well as Ingham County, Mid-Michigan District and Livingston County departments.

The group spent last year developing, testing and refining a curriculum, Barna said. Byrnes played an important role as they worked through the review and recommendations.

"It was helpful to have that academic partnership so we didn't misunderstand anything," Barna said.

The next step involves creating a workbook with case studies and other materials to help individual departments start conversations about ethics, she said. They are planning to take the training to a few different departments in Michigan, with the hope that number will grow, and are hoping to present the curriculum at a national conference.

Barna has a long-held interest in public health ethics, one that took her to a conference in Baltimore where she happened to connect with Mallory Wietrzykowski, who is majoring in philosophy at Grand Valley. Wietrzykowski has continued to work closely with the team developing the training, particularly content for the workbook.

Wietrzykowski is eyeing a career in ethics and said the issues that arise in public health, in particular how the population interacts with environmental factors, are helpful in shaping her training in the field. She was drawn to this opportunity to apply the broader ethical considerations she has learned.

"I"m really interested in the problem-solving and seeing what is the best decision, which is not always too clear," Wietrzykowski said. "It's important to take a step back and look at all of the factors and make a good decision."

The work by Grand Valley is bolstered by a grant from the Office of Career Services. Byrnes said the collaboration is possible because of Grand Valley's commitment to a strong liberal arts education.

"What has made this possible is a broader recognition of something that GVSU has known for years: philosophy and ethics are indispensable to good decision-making and foundational to the education we provide," Byrnes said. "Grand Valley had the expertise in place and when the need arose the Philosophy Department was there to provide it."

Byrnes said this emerging area of public health ethics is where clinical ethics was a few years ago as that field began getting shaped, particularly by current events. In the case of public health, the Flint water crisis has highlighted the need to incorporate ethics into decision-making when considering public health outcomes, he said.