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BMC Public Health
Published in: BMC Public Health 1/2017

Open Access 01-12-2017 | Research article

Ethical issues in public health surveillance: a systematic qualitative review

Authors: Corinna Klingler, Diego Steven Silva, Christopher Schuermann, Andreas Alois Reis, Abha Saxena, Daniel Strech

Published in: BMC Public Health | Issue 1/2017

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Abstract

Background

Public health surveillance is not ethically neutral and yet, ethics guidance and training for surveillance programmes is sparse. Development of ethics guidance should be based on comprehensive and transparently derived overviews of ethical issues and arguments. However, existing overviews on surveillance ethics are limited in scope and in how transparently they derived their results. Our objective was accordingly to provide an overview of ethical issues in public health surveillance; in addition, to list the arguments put forward with regards to arguably the most contested issue in surveillance, that is whether to obtain informed consent.

Methods

Ethical issues were defined based on principlism. We assumed an ethical issue to arise in surveillance when a relevant normative principle is not adequately considered or two principles come into conflict. We searched Pubmed and Google Books for relevant publications. We analysed and synthesized the data using qualitative content analysis.

Results

Our search strategy retrieved 525 references of which 83 were included in the analysis. We identified 86 distinct ethical issues arising in the different phases of the surveillance life-cycle. We further identified 20 distinct conditions that make it more or less justifiable to forego informed consent procedures.

Conclusions

This is the first systematic qualitative review of ethical issues in public health surveillance resulting in a comprehensive ethics matrix that can inform guidelines, reports, strategy papers, and educational material and raise awareness among practitioners.
Appendix
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Footnotes
1
We do not want to imply that those types of articles are problematic. In fact we believe that context- or issue-specific analysis can serve a vital function in informing practitioners. The articles published so far were, however, not sufficient as evidence base for the development of guidelines where comprehensiveness and systematic reduction of bias is attempted.
 
2
We are aware that the term risk is generally used to denote harm potential, however, this is not how it is used here. With the introduction of the above definition we are not making any conceptual claims with regards to risk, but introduced the terms risk and conflict pragmatically to delineate the two different types of ethical issues.
 
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Metadata
Title
Ethical issues in public health surveillance: a systematic qualitative review
Authors
Corinna Klingler
Diego Steven Silva
Christopher Schuermann
Andreas Alois Reis
Abha Saxena
Daniel Strech
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2017
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-017-4200-4

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