Ethics of HIA Marco Martuzzi World Health Organization

Ethics of HIA Marco Martuzzi World Health Organization Regional Office for Europe Rome, Italy

Ethical values in HIA • Solidarity, equity, participation, sustainability, ethical use of evidence, … • Routinely referred to in textbooks and training • Some more clarity may be needed

HIA: making decisions • Key goals – Assessing measurable impacts (and minimize them) – Promote equity – Involve / Listen / Empower Possible conflict between these goals

Environmental factors

Minimizing impacts • Overall measurable impact; the most good for most people (EIA, risk assessment, community preventive medicine) • Utilitarian ethical framework, i. e. based on “utility function” = overall impact

ELF and childhood leukaemia: Attributable risk in Italy

Ethical frameworks • The utilitarian framework conflicts with other ethical frameworks • Typically, in HIA “environmental justice” type ethics applies • However, factors other than overall impact can be included in utility function • Equity (distributional issues) are a good candidate • A utilitarian HIA?

NO • HIA, env justice, etc belong to deontological theories (as opposed to utilitarian theories) • People should not be treated as means to and end • Some actions are right or wrong, regardless of consequences • However, the principle of utility has lead to important PH progress, e. g. to immunisation (communitarian ethics)

What deontological ethical framework? • Assessing measurable impacts (and minimize them) • Promote equity • Involve / Listen / Empower • Conflict of aspirations, and ethical systems

Principle-based approaches • Beneficence (Assessing measurable impacts and minimize them) • Non maleficence (ditto) • Justice (Promote equity) • Authonomy (Listen / Empower) These principles “do not provide a full philosophical justification for decision making … where there is conflict it may be necessary to choose between them or assign greater weight to one” (Coughlin 2006)

Conclusions • HIA ethics not utilitarian • Difference with utilitarian approaches such as risk assessment is irreducible • Utilitarian approach has some advantages, lost in HIA • The ethical framework of HIA is not always clear • Should it be clarified? • Perhaps principle-based approaches good candidate if progress is sought