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Signature Assignment: My Growth as a Moral Agent and Team Member


Respond to the following prompts. Use APA style (1” margins, 12-point Times New Roman Font, double spaced throughout, page numbers on the top right of each page). This should generate a paper that is 5-8 pages in length. You will have a couple of references. Include citations in your text in APA style and a references page in APA style.

Part I – Ethical Case Analysis

* Success tip: Most students lose points on this section because they don’t follow the directions to analyze the case using 3 ethical theories or principles, or they analyze the case from the perspective of making a personal decision rather than from the perspective of a public health professional making a policy recommendation.

Paragraph 1:

Select one of the cases we discussed this semester. Select a case that you found particularly challenging to your own personal beliefs or that generated some robust discussion in your team. Briefly summarize the salient points of the case. Be sure to cite the textbook and include it on your reference list.

Case Study:

Provided in uploaded file

Paragraph 2 (note: if you need to break this section into more than one paragraph, that’s okay):

Identify and clearly describe the conflicting priorities in this case. Analyze the case using at least three ethical theories or principles. For example, “From a deontologic perspective, the public health professionals in this case have a duty to….” or “Applying the priniciple of autonomy, the correct course of action would be…..” Discuss possible positive and negative implications of acting on each of these theories or principles.

Paragraph 3:

Identify the course of action you would choose and why. Describe your own core beliefs that inform this decision. Describe how you developed these beliefs.

Think about a teammate who took a position different from yours. Describe their position and what you understand about why they took this position. (I encourage you to meet with one another and talk about this to gain clarity).

My teammates had similar positions.

What did your team conclude about this case, and why?

This is the course of action my team took (directly from our discussion post):

Which course of action will your team choose?

– Hi team, from what I’ve read most of you agree to maintain the funds in maternal-child health care. I personally feel like it’s our obligation to fix a situation like infant mortality before it gets worse. There are so many women who require education on what to take while pregnant and how to take care of themselves. I don’t think shifting resources would help at this moment because there is still a chance of infant mortality rates going up. This is what I would decide however, y’all are more than welcome to add to this.

What is the justification for your decision? (Which ethical principles take priority and why?)- The justification for this decision is beneficence by not doing any harm by maximizing the possible benefits and justice by doing the right thing in the maternal-child health program.

Part II – My Growth

Paragraph 1:

This paragraph addresses your understanding of yourself as a moral agent. Start by describing what your understanding was at the beginning of the semester. Did you start out seeing yourself as someone who can make ethical decisions and act on them? How much power and responsibility did you believe you had at the beginning of the semester.

Describe your current understanding of yourself as a moral agent. How has your understanding of yourself changed over the course of the semester?

Finally, how do you still need to grow? Write a goal for your own growth and briefly describe actions you will take to continuing growing as a moral agent and ethical professional.

Paragraph 2:

This paragraph addresses your ability to work on a team of health professionals to make ethical choices. Start by describing your ability to solve problems with a team at the beginning of the semester.

At the begining of the semester I didn’t participate with responding to my teammates posts, this has now improved.

Describe how you have grown in your ability to work on a team. What has changed? Describe how you contributed to your team this semester.

Finally, identify points where you still need to grow in your ability to work effectively on a team of diverse professionals making difficult decisions. What could you have done better this semester as a team member? Write a goal for your continued growth as a team member and briefly describe actions you will take to continue developing teamwork skills.

One area of growth for myself is being aware of any biases I may have.


Write a concluding paragraph tying the paper together by summarizing your major points of growth this semester.

Public Health Ethics Analysis
Volume 3
Edited by
Michael J. Selgelid
Monash University , Melbourne , Australia
3.8 Case 4: Black-White Infant Mortality: Disparities,
Priorities, and Social Justice
Erika Blacksher
Department of Bioethics and Humanities
University of Washington
Seattle , WA , USA
e-mail: eb2010@u.washington.edu
Susan D. Goold
Department of Internal Medicine and Department of Health Management
and Policy Center for Bioethics and Social Sciences in Medicine
University of Michigan
Ann Arbor , Michigan , USA
This case is presented for instructional purposes only. The ideas and opinions expressed
are the authors’ own. The case is not meant to refl ect the offi cial position, views, or
policies of the editors, the editors’ host institutions, or the authors’ host institutions.
3.8.1 Background
Preterm births, the leading cause of infant mortality, are increasing annually worldwide
(World Health Organization 2012 ). The United State s shares company with Nigeria,
India, and Brazil among the top ten countri es with the highest numbers of preterm births
and ranks 31st among Organisation for Economic Co-operation and Development (OECD)
nations in infant mortality (OECD 2010 ). Within the United States, racial and ethnic
disparities in infant mortality remain entrenched and have increased (MacDorman and
Mathews 2009 ). U.S. health policy leaders have made the elimination of health disparities a top
public health priority (Centers for Disease Control and Prevention 2011 ;
U.S. Department of Health and Human Services 2011 ). Infant mortality is an important
area of focus for eliminating disparities, both in its own right and because the rate of
infant mortality serves as an indicator of the nation’s health due to its association with
maternal health, social and economic conditions, racial discrimination, access to health
care, and public health practices (MacDorman and Mathews 2009 ).
During the twentieth century, U.S. infant mortality declined 93 % (MacDorman
2011 ). In 1900, about 100 infants died per 1000 live births. By 2000, that number
fell to 6.89. During the last half of the twentieth century, the rate of black infant
mortality dropped dramatically. In 1950, black infant mortality was 43.9 deaths per
1000 live births compared with 26.8 deaths per 1000 live births among whites
(Mechanic 2002 ). But by 1998 black infant mortality fell to 13.8 deaths per 1000
live births compared with 6.0 deaths per 1000 live births among whites. As these
numbers show, both groups made signifi cant absolute gains, with blacks gaining
more in absolute terms—a reduction of 30.1 for blacks and 20.8 for whites. Yet,
black infant mortality still remained about twice that of whites.
N. Daniels
These disparities have persisted in the twenty-fi rst century. In 2006, non- Hispanic
black women experienced the highest rate of infant mortality, with 13.4 infant
deaths per 1000 live births, while non-Hispanic white women had a considerably
lower rate, with 5.6 infant deaths per 1000 live births. Citing a 2006 report from the
National Healthy Start Association, MacDorman and Mathews ( 2009 ) report that
programmatic efforts to reduce disparities in black-white infant mortality have had
some successes at local levels, but eliminating the disparities is diffi cult.
The U.S. Centers for Disease Control and Prevention and the U.S. Department of
Health and Human Services have prioritized both the elimination of health disparities and
improvement in overall population health. These twin goals—one distributive, the other
aggregative—are separate and sometimes confl ict (Anand 2004 ).
Increases in health disparities often accompany advances in aggregate gains in population health
(Mechanic 2007 ). Although this case is specifi c to the United State s, the
dilemma is not. Data show that signifi cant progress on child mortality has been made
in many countries but that this overall success is often coupled with increased
inequalities between advantaged and disadvantaged groups (Chopra et al. 2012 ). In
China and India, for example, disparities in mortality persist between boys and girls
younger than 5 years, a function of entrenched gender discrimination (You et al.
2010 ). These examples raise challenging questions about how ethically to assess
such cases and set priorities for the allocation of scarce public health resources.
3.8.2 Case Description
You serve as the director for the local health department in a racially segregated
urban city in the Midwest with one of the greatest concentrations of African
Americans in the United States. The city has a long history of civil rights activism
that led to protests and marches that ultimately empowered and mobilized black
communities and organizations. Your health department has a history of prioritizing
maternal-child health and the elimination of black-white disparities in infant mortality in its
programs, an investment of resources affi rmed by the city residents
through the department’s community outreach program and planning processes.
Chronic underfunding of public health, made worse by the economic downturn,
has resulted in drastic and unprecedented reductions in the public health budget. In
consultation with your staff and community board of health, you have raised the
possibility of redirecting resources from maternal-child health into other programs
based on a number of practical and ethical considerations. As with national statistics, the city has
seen signifi cant declines in black infant mortality, even as blackwhite disparities remain. You
note that although the maternal-child health programs
are cost-effective, their impact on reducing black-white disparities seems to have
stalled. Other programs appear to meet targets more consistently. To help support
these other programs, you note that allocating resources to more effective programs
provides more “health” per dollar, thus meeting the utilitarian demand to maximize
overall health, which many view as the primary goal of public health and health
policy (Powers and Faden 2006 ). In addition, although black-white disparities in
3 Resource Allocation and Priority Setting
infant mortality persist, blacks have made signifi cant gains, declining more than
whites in some decades. You note that remaining inequalities could be deemed ethically
acceptable by some standard s of equity , such as the “maximin” principle .
Although this distributive principle is subject to interpretation (Van Parijs 2003 ), it
is generally understood to require that social and economic inequalities work to
benefi t society’s least advantaged groups. Thus, inequalities (even signifi cant ones)
are morally acceptable as long as the least advantaged have signifi cantly benefi ted
(Powers and Faden 2006 ).
The director of community outreach proposes that the health department not
make this decision unilaterally, but instead listen to community opinions on these
questions of priorities and fairness. He suggests that the health department collaborate with
community partners to host a series of public forums. He insists that a
topic of such historic and contemporary concern to the community must be subject
to public deliberation. Despite having a history of supporting community discussions, you are
concerned about the cost of community forums, noting that they will
drain resources from an already slim budget.

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