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How public health ethics applies to palliative, dementia care
  • By Marian Chu
  • Published 2017.10.25 09:48
  • Updated 2017.10.25 09:48
  • comments 0

Public health ethics applies to not just health issues but all sectors of life, according to Angus Dawson, professor of bioethics and director of Sydney Health Ethics at the University of Sydney.

Angus Dawson, a professor of bioethics and director of Sydney Health Ethics at the University of Sydney, presents his lecture, “In defense of substantive public health ethics,” at the National Bioethics Committee’s Asia-Pacific Regional Meeting for National Ethics/Bioethics Committees (AP-NEC) held in downtown Seoul Tuesday.

Professor Dawson spoke at the National Bioethics Committee’s Asia-Pacific Regional Meeting for National Ethics/Bioethics Committees (AP-NEC) Tuesday to present the overreaching influence of public health ethics in everyday life.

Dawson defined public health as the health of a population or group that can be attained through collective action. Public health ethics, defined as a set of moral principles, beliefs, and values that guide people in making choices about medical care, is often employed by government officials to make health care decisions.

“The government in the background is trying to ensure food, water, and air quality is safe, among other things. All kinds of background activity are often too invisible,” the Australian expert said. “It only becomes visible after a problem. Public health is the foundation of public health ethics.”

Public health ethics also impacts the way one dies, and consequently the quality of life one has, according to Dawson.

“If you focus on ideas like human flourishing, then having a good death [is important.] It goes back to the ancient Greeks. Death was a part of life and how you die is important in the overall assessment of the life,” he said. “There is a general tendency now to prolong death with too much emphasis on high technology intervention. It’s unfortunate.”

Meanwhile, the Korean government announced Friday that it would allow patients the right to die with dignity, starting a pilot project that accepts medical consent forms from patients or their guardians in refusing palliative or life-sustaining care.

Related: Patients can refuse medical care at end-stage of their lives

The recent announcement was met with surprise from the public as a country with a peculiar history that made it strictly against euthanasia and assisted deaths in the past, according to a Korean Bioethics Committee official who spoke at the session.

A court ruling made eight years ago – where the wife of a severely impaired alcoholic who needed to undergo surgery repeatedly requested the overseeing doctor to discharge her husband – turned the country’s physicians generally against euthanasia. The doctor complied with her request upon which the patient died immediately. The lower court ruled the doctor guilty of assisted murder. Following the lower court ruling, many doctors have been reluctant to stop life-sustaining treatment.

Now as a country ranked to have the highest life-expectancy rate in the world, those in the medical field have been grappling with the question of how to care for those in the final stages of their lives. The recent government ruling seems to be an effort to partly ameliorate some of the ethical concerns involved in the dying process, according to local industry experts.

Regarding other end-of-life care such as dementia care, Dawson noted personal habits that prevent the disease are critical in maximizing social benefit.

“You have to consider that if people live longer, there will be more dementia cases,” Dawson said. “We may reduce the risk of dementia through having a good diet, exercise, and physical and mental activity that includes social interaction.”

The elderly in Asian countries fare better than those in Western nations because of the emphasis on respecting the old in Asian societies, pointing to the interesting concept of how social customs change public health, the professor noted.

“Part of end-of-life care such as dementia care could include involving elderly people into the community since social interaction stimulates the brain and reduces dementia,” Dawson said. “In many parts of Asia and Korea, there are public spaces to incorporate elderly people thanks to the tendency to respect the elderly.”

Encouraging social interaction for the elderly could reduce the number of dementia patients, thereby decrease the number of people in hospitals, and ultimately lower social health care costs, Dawson added, stressing the importance of individual action leading to a collective social outcome.


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