Resolution of Ethical Tensions

Community and stakeholder involvement is perhaps the best means to minimize ethical tensions that may inform policy formulation. The reason for such a bold assertion is due to the values of a Health Impact Assessment (HIA) as set forth by the International Association for Impact Assessment (IAIA) and Gothenburg consensus papers (Tannahill & Douglas 2014). The values include a democratic process involving relevant stakeholders, equitable distribution of outcomes, sustainability of measures to be implemented, ethical use of evidence and an all-inclusive approach to health (Tannahill & Douglas 2014; Malekafzali 2013).

While reading the two articles about Health Impact Assessment (HIA), the inherent ethical principles - beneficence and nonmaleficence - the values and general structure all make it a viable option to ethical decision-making. Upon further reading, one finds that HIA shares some similarities with Community-based Participatory Research (CBPR). Just like the name suggests, CBPR involves members of a community to set research objectives and assess its needs for proper planning and evaluation purposes (Coreil 2010). Hence CBPR is more closely associated with the contextualist approach as is HIA in resolving ethical conflicts due to their reliance on real world phenomena and data collection to make informed decisions. The Tannahill & Douglas (2014) definition of an HIA gives the impression that it makes use of the presumptivist approach to addressing ethical conflicts and tensions when formulating policy. The presumptivist approach, according to Bernheim et al. (2015) is closely aligned with the contextualist approach. In democratic societies, preeminence is given to either individual liberty or public health depending on the situation. With HIA’s goal of improving the equitable distribution of resources in order to improve health outcomes of vulnerable populations, public health tends to be accorded greater preeminence.