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Nancy M. Baum, MHS, Sarah E. Gollust, PhD, Susan D. Goold, MD, MHSA, MA and Peter D. Jacobson, JD, MPH

Nancy M. Baum, Sarah E. Gollust, and Peter D. Jacobson are with the Department of Health Policy and Management, School of Public Health, University of Michigan, Ann Arbor. Susan D. Goold is with the Department of Internal Medicine, and the Bioethics Program, University of Michigan, Ann Arbor.

Correspondence: Requests for reprints should be sent to Nancy M. Baum, MHS, 109 Observatory M-3141 SPH-II, Ann Arbor, MI 48109 (e-mail: nmbaum{at}umich.edu).

Objectives. We sought to ascertain the types of ethical challenges public health practitioners face in practice and to identify approaches used to resolve such challenges.

Methods. We conducted 45 semistructured interviews with public health practitioners across a range of occupations (e.g., health officers, medical directors, sanitarians, nurses) at 13 health departments in Michigan.

Results. Through qualitative analysis, we identified 5 broad categories of ethical issues common across occupations and locations: (1) determining appropriate use of public health authority, (2) making decisions related to resource allocation, (3) negotiating political interference in public health practice, (4) ensuring standards of quality of care, and (5) questioning the role or scope of public health. Participants cited a variety of values guiding their decision-making that did not coalesce around core values often associated with public health, such as social justice or utilitarianism. Public health practitioners relied on consultations with colleagues to resolve challenges, infrequently using frameworks for decision-making.

Conclusions. Public health practitioners showed a nuanced understanding of ethical issues and navigated ethical challenges with minimal formal assistance. Decision-making guides that are empirically informed and tailored for practitioners might have some value.