Table 1 Ethical principles proposed as important in the justification of public health interventions

Upshur¹³

‘Harm principle'

Power should only be exercised over individuals against their will to prevent harm to others. Derived from J. S. Mill's harm principle

Least restrictive or coercive means

More restrictive and coercive means should only be used when less restrictive and coercive means have failed

Reciprocity

Public health interventions may require sacrifices and lead to costs for individuals or communities. Society should seek to compensate those impacted and facilitate their continued roles

Transparency

All stakeholders should be involved in decision-making, which should be a clear and accountable process, and as free from political and domination of specific interests as possible

Childress et al.²³

Effectiveness

If infringing moral considerations, there must be evidence that public health will be protected

Proportionality

Probable health benefits must outweigh adverse effects from infringement of moral considerations, such as autonomy

Necessity

Not all interventions that are effective and proportionate are necessary. If there are alternatives, the least morally problematic should be chosen

Least infringement

On meeting the first three principles, infringement of moral considerations should be minimised. For example, if autonomy is infringed, the least restrictive alternative should be sought

Public justification

Where interventions infringe moral considerations, this should be justified publicly. This should be democratic and transparent to establish accountability²²and build public trust

Klugman²²

Solidarity

A utilitarian principle, built on equity (benefits should be shared fairly), community autonomy (community representatives decide), and paternalism (infringement of liberty), in which communities come together to improve health

Efficacy

Evidence that the intervention should be successful in reaching goals, is scientifically sound, and socially, politically, and culturally feasible

Integrity

The nature and culture of a community should be preserved and respected. The community should be involved in developing interventions so they are consistent with their values

Dignity

All in communities are of equal worth, deserve the same moral respect, and should be treated accordingly. Wherever possible, the least restrictive intervention should be chosen