Module Case Study

Making Cuts in a Health Department Budget

1. Explain how the four bioethical principles should guide budgetary decisions in the public health realm. The bioethical principles are autonomy, beneficence, maleficence, and justice.

2. Examine how these final decisions were made in terms of: who should have a voice in this decision, how many and which stakeholders should be involved, what rules of discourse should be followed and how would you reach that final decision (i.e. what is the deciding factor).

3. Describe the ethical norms that should be essential in making a decision about reducing or expanding a public health budget?

4. Page 256 of the case study shows the service areas that are most affected by the budget cuts. Select two of these areas and determine a "no cost" alternative to reduce the negative effects of this service reduction/elimination. (A more detailed view of the specific elements being cut can be found on pages 263 and 264 of the case study.)

5. Imagine you suddenly came into enough funding to reinstate one of the bulleted items on pages 263-264. Reviewing these elements under the four bioethical principles, which (if any) would you add back into the budget and why? If you did not add any of these back into the budget, what would you do with the extra funds? Explain to your stakeholders why you came to your conclusion.

Text Book: Ethics and Public Health: Model Curriculum by Bruce Jennings, Jeffrey Kahn, Anna Mastroianni and Lisa S. Parker.