Module 9: Case Study 3 Making Cuts In A Health Department ✓ Solved

Module 9: Case Study 3 Making Cuts in a Health Department Bu

Module 9: Case Study 3 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. 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.

References (Sources must be cited correctly in APA style according to the Ashford Writing Center. Please visit the Ashford Writing Center for more details on using APA style, or visit the corresponding APA resources available online.)

Beauchamp, T. L., & Childress, J. F. (2019). Principles of Biomedical Ethics (8th ed.). Oxford University Press.

Faden, R. R., & Beauchamp, T. L. (1986). A History and Theory of Informed Consent. Oxford University Press.

Kass, N. E. (2001). An ethics framework for public health. American Journal of Public Health, 91(11), 1776-1782. https://doi.org/10.2105/AJPH.91.11.1776

Gostin, L. O. (2000). Public Health Law: Power, Duty, Restraint. University of California Press.

Institute of Medicine. (2002). The Future of the Public's Health in the 21st Century. National Academy Press.

World Health Organization. (2009). Ethical considerations in health policy and public health. WHO.

World Health Organization. (2016). Ethics and public health: Framework for decision making. WHO.

Emanuel, E. J., Wendler, D., & Grady, C. (2004). An ethical framework for public health. The Lancet, 363(9422), 2086-2090.

CIOMS & World Health Organization. (2016). International Ethical Guidelines for Health-related Research Involving Humans. CIOMS & WHO.

Institute of Medicine. (2003). The future of the public's health in the 21st century: A framework for action. National Academies Press.

Paper For Above Instructions

Introduction. Public health budgeting operates at the intersection of resource constraints and the obligation to safeguard population health. The four bioethical principles—autonomy, beneficence, nonmaleficence (often framed as beneficence and maleficence together as a balance of benefit and harm), and justice—provide a compass for decisions about how scarce funds should be allocated. Beauchamp and Childress (2019) describe autonomy as respecting individuals’ right to participate in decisions that affect them, beneficence as maximizing well-being, nonmaleficence as avoiding harm, and justice as fair distribution of benefits and burdens. When budget decisions affect broad populations, these principles guide whether cuts protect core services, how to weigh trade-offs, and how to protect vulnerable groups (Beauchamp & Childress, 2019). This paper applies those principles to a hypothetical yet plausible budget-reduction scenario in a health department, drawing on case study cues (e.g., pages 256, 263–264) and established public health ethics frameworks to propose ethically justifiable approaches to budgeting, stakeholder engagement, and potential reinstatements of funded items.

Principle-guided budgeting. Autonomy in public health budgeting requires respect for the community’s capacity to participate in decisions that affect health. This implies meaningful opportunities for public input, transparent disclosure of budget alternatives, and clear explanations of how trade-offs affect different populations. Beneficence requires prioritizing actions that maximize population health benefits and minimize harms; in practice, this means favoring programs with proven public health impact and ensuring that reductions do not disproportionately hurt high-risk groups. Nonmaleficence (often framed within the broader principle of beneficence) demands caution to avoid policies that would cause avoidable harm, such as eliminating essential services in ways that would exacerbate inequities. Justice demands attention to fair distribution of resources and outcomes, ensuring that cutbacks do not systematically disadvantage the poor, Racial/ethnic minorities, children, or people with disabilities. Together, these principles support a proportionality assessment—are the benefits of a given cut greater or less than the harms it causes, especially to vulnerable groups (Beauchamp & Childress, 2019; Kass, 2001). In practical terms, a justice-centered approach would require explicit consideration of how each budget line affects equity and health disparities (Gostin, 2000; Institute of Medicine, 2002).

Decision-making process and stakeholder voice. The case study invites reflection on who should have a voice in budget decisions, how many and which stakeholders should be involved, and what discourse rules should govern deliberation. Deliberative democracy principles suggest inclusive, transparent processes where stakeholders representing affected communities—especially the most vulnerable—participate, with clear criteria for deliberation, time for input, and mechanisms to translate input into policy options (Kass, 2001; World Health Organization, 2009). Rules of discourse should emphasize evidence-based discussion, respect for dissent, and safeguarding against coercive influence by powerful actors. The final decision should rest on explicit rationales that connect stakeholder input, ethical reasoning, and anticipated health outcomes (Faden & Beauchamp, 1986; Institute of Medicine, 2002). These norms align with a comprehensive ethical framework that balances respect for autonomy with obligations to prevent harm and promote social justice (Beauchamp & Childress, 2019).

Ethical norms essential to budget decisions. Beyond the four principles, several norms are central to deciding on public health budget changes. The least restrictive means principle encourages preserving core public health functions while implementing targeted efficiencies. Proportionality requires that the public health gains justify any infringement on services, particularly for groups with elevated risk. Transparency and accountability ensure that recipients of services understand the rationale behind cuts and alternatives. Accountability also entails monitoring adverse effects and adjusting policies accordingly (Gostin, 2000; Kass, 2001; World Health Organization, 2016). The Institute of Medicine’s framework emphasizes accountability to the public and the ethical obligation to protect population health through prudent stewardship of limited resources (Institute of Medicine, 2002).

Two service areas and no-cost alternatives. Page 256 reportedly highlights service areas most affected by budget cuts. Suppose two areas—immunization programs and communicable disease surveillance—are substantially reduced. A no-cost alternative would involve maximizing efficiency through reallocation of existing staff time, extending outreach through community partnerships, and leveraging current digital platforms to maintain coverage. For example, immunization outreach could shift to school-based campaigns, volunteer health workers with proper training could supplement staff during peak times, and digital reminders could reduce no-show rates without new expenditures. Similarly, surveillance activities could be maintained via data-sharing agreements that optimize existing systems, along with targeted analysis using current personnel, rather than purchasing new software or expanding lab capacity (WHO, 2009; Beauchamp & Childress, 2019). While these no-cost options may preserve essential functions, a careful trade-off analysis is necessary to ensure that disease prevention is not compromised and that equity considerations remain central (Kass, 2001; Institute of Medicine, 2002).

Reinstating items with new funding. If a surge in funding becomes available to reinstate one bulleted item, the four bioethical principles guide which, if any, deserve prioritization. If any item has broad population-level benefit with low risk of harm and minimal inequitable impact, it should be considered first. In Beauchamp and Childress’s terms, prioritizing high-benefit, low-harm interventions aligns with beneficence and justice, supported by autonomy if communities value and understand the choice. If no item meets these criteria—or if reinstating one would still impose disproportionate burdens on vulnerable groups—the prudent strategy may be to allocate the funds to system-wide improvements (e.g., data quality, workforce training) to maximize long-term health gains while safeguarding equity (Beauchamp & Childress, 2019; Gostin, 2000). Stakeholders should be informed of the ethical rationale and the anticipated population impacts, including anticipated changes in health disparities. The emphasis remains on transparency, equity, and data-driven assessment (Institute of Medicine, 2002; World Health Organization, 2016).

Conclusion. Ethically sound budget decisions in public health require more than mathematical optimization; they demand a principled approach that centers autonomy, beneficence, nonmaleficence, and justice, complemented by deliberative engagement and transparent rationale. By employing evidence-based, equity-focused analyses and no-cost or low-cost optimization strategies where possible, health departments can protect essential services while minimizing harm to vulnerable populations. When additional funds become available, a careful, principle-driven evaluation should determine which items best promote population health without exacerbating health inequities, with clear communication to stakeholders about the ethical basis for those choices (Faden & Beauchamp, 1986; Kass, 2001; WHO, 2016).

References

  1. Beauchamp, T. L., & Childress, J. F. (2019). Principles of Biomedical Ethics (8th ed.). Oxford University Press.
  2. Faden, R. R., & Beauchamp, T. L. (1986). A History and Theory of Informed Consent. Oxford University Press.
  3. Kass, N. E. (2001). An ethics framework for public health. American Journal of Public Health, 91(11), 1776-1782. https://doi.org/10.2105/AJPH.91.11.1776
  4. Gostin, L. O. (2000). Public Health Law: Power, Duty, Restraint. University of California Press.
  5. Institute of Medicine. (2002). The Future of the Public's Health in the 21st Century. National Academies Press.
  6. World Health Organization. (2009). Ethical considerations in health policy and public health. WHO.
  7. World Health Organization. (2016). Ethics and public health: Framework for decision making. WHO.
  8. Emanuel, E. J., Wendler, D., & Grady, C. (2004). An ethical framework for public health. The Lancet, 363(9422), 2086-2090.
  9. CIOMS & World Health Organization. (2016). International Ethical Guidelines for Health-related Research Involving Humans. CIOMS & WHO.
  10. Institute of Medicine. (2003). The future of the public's health in the 21st century: A framework for action. National Academies Press.

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