Most people are familiar with clinical ethics, which have to do with individual interactions, usually between a health-care professional and a patient. Population health ethics is a little more unfamiliar. Rod Knight describes this emerging field as a matter of balancing individual and population interests and considering the social context within which decisions about population health interventions are made – considering, as he says, “what is morally permissible and what isn’t.”
Knight, a doctoral student in the School of Population and Public Health at the University of British Columbia and the recipient of a CAHR doctoral research award, is looking specifically at questions around HIV screening in different social contexts. British Columbia, in fall 2011, became the first province in Canada to make screening an “opt-out” process rather than “opt-in.” What this means is that screening will be routinely offered to everyone, rather than simply to those who ask for it. It’s an approach that was recommended by the United States’ Centers for Disease Control back in 2006 and is also being implemented in British Columbia. This raises any number of issues and provides a timely case example for Knight to consider as part of his doctoral research.
“I’m not saying it’s wrong, I’m not saying it’s right,” says Knight. “But we need to look at the implications and consequences, both intended and unintended.”
Knight’s research is part of a larger study examining screening practices in other locations, including Rio de Janeiro, Brazil, and Kigali, in Rwanda. These cities are using more targeted screening approaches and strategies.
Knight has two goals for his doctoral work. The first is to inform ethical and effective ways to intervene at a population level to address HIV. The second, however, is broader reaching.
“I really hope to bring to the forefront that we ought to consider the ethics of everything we do in public health,” he says.
Receiving a doctoral research award through CAHR has made a huge difference to his work, Knight says.
“It’s provided me with the privilege of engaging in scholarly pursuits,” he says. “And I want to emphasize that it is a privilege.”
Among the benefits of receiving the award, says Knight, is that it’s provided him with the capacity to develop two operating grant proposals to the Canadian Institutes of Health Research with his supervisor, Dr. Jean Shoveller, both of which were successful and are helping to support his further doctoral research.
“It’s complex, interesting and important work that examines the ‘balance’ of individual and collective interests and health outcomes,” says Dr. Shoveller. “While population health ethics is a somewhat nascent field, it has serious implications for practice.”
Knight also was able to attend the annual CAHR conference in April 2012, where he was able to see the latest HIV research and network with both other trainees and the top researchers in the field. He has also presented his research at the 11th World Congress of Bioethics in June 2012.
As for the future, Knight is sure about one thing – he will remain in academia, where he hopes to continue to focus on the ethics of HIV screening.