Edmond J. Safra Center for Ethics

Harvard School of Public Health

"The fellowship permitted each of us to structure our year as we saw fit. The weekly seminar served, as it were, as the spine, organizing the week and providing a degree of common focus. The first group of seminars were devoted to role obligations, a concept which I, like many philosophers, have never found very interesting. Now I realize that it can be, and I will take what I have been exposed to here to my own teaching. The fellowship year has been one of the most stimulating and enjoyable years of my life."

Daniel Wikler, from Report on the Ethics Fellowship Year 1994-95


From advancing scientific discovery to training international leaders, the Harvard School of Public Health (HSPH) is dedicated to improving the health of populations worldwide. Ethical elements of health issues such as the AIDS/HIV epidemic, humanitarian emergencies, environmental hazards, and inequities in medical care have been the catalyst for numerous teaching and research initiatives at the School and have encouraged a longstanding relationship between the HSPH and the Ethics Center. Over the past decade, the School has expanded its faculty and curriculum to ensure that the ethical dimensions of public health receive the same high level of analytic scrutiny and prominence as other aspects of the field. Courses on ethics in public health practice and ethics in the delivery of health care services are required for all Master's of Public Health students but are taken by many students in other programs as well. A variety of courses focused on specific areas of interest help students keep pace with the profession's changing array of ethical challenges. Electives have focused on topics such as health and human rights, ethics and health disparities, research ethics, individual and social responsibility for health, and justice and resource allocation.

Marc Roberts and Troy Brennan, longtime Faculty Associates of the Ethics Center, helped to shape the School's ethics program and the required course "The Ethical Basis of Public Health Practice." Roberts's work focuses on health sector reform around the world including its philosophical basis. He also co-leads an School initiative on the role of trust in the health care system. In 2002, Roberts and Brennan were joined at the School by two additional Ethics Center former fellows, Norman Daniels and Daniel Wikler, whose appointments were part of a major expansion of the School's ethics program by former Dean Barry R. Bloom. Daniels, who came to the School from Tufts University, has done extensive work on distributive justice and health policy, philosophy of science, ethics, political and social philosophy, and medical ethics. He is course director for the Health Policy PhD/Ethics track and leads a discussion group on justice and health. Wikler was formerly Senior Staff Ethicist for the World Health Organization (WHO) and a faculty member at the University of Wisconsin. His research and writing focus on distributive justice and the rationing of health care.

Program on Ethical Issues in International Health Research

Opportunities to expand the School's reach to individuals around the world have come through the Program on Ethical Issues in International Health Research, directed by Richard Cash and made possible by a grant from the National Institutes of Health. The Program offers courses, conducts workshops on research ethics at the School and abroad, and, through its fellowships, hosts several international fellows each academic year. The Program's activities have included a five-day course for 60 participants in Nigeria in collaboration with the School's AIDS Prevention Initiative and a weekly seminar taught by Wikler and Cash for participants in the Fellowship program.

Human Subjects Research Committee

The Human Subjects Research Committee, the School's institutional review board, is involved in activities designed to improve the protection of human research subjects in the U.S. and abroad. With Brennan's departure in 2006, HSPH professors Ichiro Kawachi and David Studdert became co-chairs of the Committee. In collaboration with the WHO's Human Subjects Committee, Cash and Wikler taught a course on ethical issues in international health research at the first annual National Bioethics Conference in Mumbai, India, in 2006 and collaborated with WHO staff to produce a casebook on ethical issues in international health research.

Collaboration

School faculty regularly collaborate on ethics-related projects with academic and professional colleagues across Harvard and around the globe. Public health faculty constituted one-third of the core committee that, in 2005, launched the University's Program in Ethics and Health, an interdisciplinary bioethics initiative that focuses on critical issues in global population and health. Dan Wikler served as Committee chair for the Program's inaugural conference, "Population Bioethics: Mapping an Agenda." Norman Daniels, who has led seminars in the Division of Medical Ethics, was a speaker at a conference on Equality and the New Global Order, cosponsored by, among others, the Ethics Center and the Program on Justice, Economics, and Welfare. Daniels offered a course on ethics and health policy at Harvard Law School, at the invitation of the Petri-Flom Center for Health Law Policy, Biotechnology, and Bioethics. Daniels also works with the Mexican government to put in place a fair process for making decisions about expanding the benefit package of its catastrophe insurance plan.

Since its establishment in 1993, the School's François-Xavier Bagnoud Center for Health and Human Rights has facilitated a wide array of educational programs, research, and publications that explore ethics and international human rights from multiple professional perspectives. Under the direction of Stephen Marks, the Center fosters collaboration and partnerships with health and human rights practitioners, government and nongovernmental organizations, academic institutions, and international agencies. Farther afield, one of the School's many collaborative projects with the World Health Organization helped to facilitate a meeting where Wikler, the Medical School's Dan Brock, and Visiting Scholar Ole F. Norheim spoke with Thailand's Ministry of Public Health about the topic of renal replacement therapy under Thailand's national health insurance plan.

Other HSPH-WHO initiatives have focused on the ethical issues facing health authorities preparing for a possible pandemic of avian influenza, and the growing commercial trade in kidneys from living unrelated donors. For the past several years, Richard Cash and Dan Wikler have conducted training sessions in China designed to improve the country's capacity for ethical review of research. Their work was made possible through a National Institutes of Health grant that brought together representatives of the WHO, Ministry of Health of the People's Republic of China, and public health colleagues in China.

The study of ethics at the School has a wide-ranging ripple effect as graduates, faculty, and program participants interact with populations across the globe. By strengthening the role of ethical considerations in policy debate, health care delivery, and research, the School continues its important work of promoting public health as a fundamental human right.