Table Of ContentAppendices
Appendix 1: Study A Interview Guide
Appendix 2: Study B Survey
Appendix 3: Study C Survey
Appendix 4: Study D Survey
Appendix 5: Study E Survey
Appendix 6: Study F Survey
Appendix 7: Ethics Approval
Appendix 8: PHERM Tool Worksheet
Appendix 9: Counterfactual Document Analysis
Appendix 10: Chi Squared Tables
Appendix 1: Study A Interview Guide
Public Health practitioner semi-structured interview guide
Thank you for agreeing to participate in this interview. It should take less than an hour of your time. We
will be discussing the topic of public health ethics, and how you approach ethical issues in your work.
Your participation in this study is voluntary and you may stop our discussion at any time. All of your
answers are entirely confidential. I will be asking you to describe ethical dilemmas you may have faced –
please do not use specific identifying information in your descriptions. If you do, this identifying
information will be removed from the data during transcription. I will be digitally audio-recording this
interview – the recording will be transferred to a password protected computer following the interview.
Do you agree to begin?
Probing questions:
1. Have you had any ethics training, specifically in public health ethics, that you can recall?
2. Can you think of an ethical dilemma that you have face in your work recently?
a. What was the core ethical conflict in that dilemma?
b. How did you resolve that dilemma?
i. Did you discuss it with colleagues? Seek ethics consultation or advice?
ii. Are there resources within your institution to help you with this type of issue?
c. Can you think of any other ethical dilemmas?
3. What resources, activities or materials do you think might be helpful in addressing ethical issues in the
public health workplace.
Appendix 2: Study B Survey!
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1. Consent Page
By clicking NEXT you are agreeing to participate in this survey regarding the development of a tool for aiding ethical
reflection in public health practice. All responses are confidential;; unique identifiers will be used only to match pre- and
post-session surveys and will then be removed. Other than your time, there are no financial costs or forseeable risks
associated with participation in this survey. The direct benefit of participation is your consideration and reflection on these
issues in preparation for Royal College examinations and for the practice of community medicine. The information
provided will also help guide further efforts to improve the application of ethical principles to public health practice and
research.
In research in ethics, as in many disciplines, people answer questions the way they THINK the investigators want them
to. PLEASE answer frankly and HONESTLY. The questions have been carefully worded to assess particular elements in
your responses, please read the questions carefully. The are 18 questions in total.
2. Unique Identifier
This identifier will allow matching if pre- and post-session surveys only.
1. Please enter the first THREE letters of your mother's maiden name.
3. Demographic Information
2. What is your current level of training?
(cid:18)(cid:17)(cid:16)(cid:15)(cid:14) PGY-1 (cid:18)(cid:17)(cid:16)(cid:15)(cid:14) PGY-2 (cid:18)(cid:17)(cid:16)(cid:15)(cid:14) PGY-3 (cid:18)(cid:17)(cid:16)(cid:15)(cid:14) PGY-4 (cid:18)(cid:17)(cid:16)(cid:15)(cid:14) PGY-5 (cid:18)(cid:17)(cid:16)(cid:15)(cid:14) Faculty
3. Please select the appropriate age-sex combination
(cid:18)(cid:17)(cid:16)(cid:15)(cid:14) Male 24-29 (cid:18)(cid:17)(cid:16)(cid:15)(cid:14) Male 30-34 (cid:18)(cid:17)(cid:16)(cid:15)(cid:14) Male >34 (cid:18)(cid:17)(cid:16)(cid:15)(cid:14) Female 24-29 (cid:18)(cid:17)(cid:16)(cid:15)(cid:14) Female 30-34 (cid:18)(cid:17)(cid:16)(cid:15)(cid:14) Female >34
4. Where did you attend medical school?
(cid:18)(cid:17)(cid:16)(cid:15)(cid:14) Ontario
(cid:18)(cid:17)(cid:16)(cid:15)(cid:14) Rest of Canada
(cid:18)(cid:17)(cid:16)(cid:15)(cid:14) Outside of Canada
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5. What public health graduate training have you completed?
(cid:18)(cid:17)(cid:16)(cid:15)(cid:14) I am currently enrolled in a University of Toronto program
(cid:18)(cid:17)(cid:16)(cid:15)(cid:14) I completed an MPH in the United States
(cid:18)(cid:17)(cid:16)(cid:15)(cid:14) I completed an MHSc or MSc in a Canadian department of Public Health
(cid:18)(cid:17)(cid:16)(cid:15)(cid:14) I completed a Masters or PhD degree in a related public health field
(cid:18)(cid:17)(cid:16)(cid:15)(cid:14) I have not done any graduate work in public health
(cid:18)(cid:17)(cid:16)(cid:15)(cid:14) Other (please specify)
4. My Views about Ethics
6. Please indicate the degree to which you agree or disagree with the following
statements.
Ethics is/are...
Strongly Agree Agree Disagree Strongly Disagree
1. A useful set of adjunct (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
considerations to aid
decision making.
2. An essential integrated (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
component of decision
making.
3. A cumbersome, but (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
necessary element of
responsible decision
making.
4. A superfluous and (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
unnecessary notion which
does not practically add
much to public health
decision making.
5. An imposition which (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
actually constrains or
impedes helpful
decisions/activities in
public health practice.
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7. Regarding public health ethics, I feel that...
Strongly Agree Agree Disagree Strongly Disagree
1. Public Health ethics is a (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
subset of medical ethics for
which a similar set of
ethical principles apply.
2. Public Health is too (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
broad and diverse to have
a single set of ethical
considerations.
3. I have never recognized (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
or been taught about
public health ethics as a
distinct discipline.
4. Apart from the legally (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
defined norms of public
health in modern liberal
democracies, no separate
notions of ethics in public
health practice are
necessary.
5. Public Health is so (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
contextual and culturally
nested, that a universal or
widely accepted set of
ethical principles is NOT
POSSIBLE.
6. Public Health is so (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
contextual and culturally
nested, that a universal or
widely accepted set of
ethical principles would
actually be UNETHICAL.
7. Public Health practice (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
and research demand a
unique set of ethical norms
which require significant
study and inquiry.
5. My Public Health Ethics Education
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8. Which, and how many, of the following activities relating to public health ethics have
you attended?
Never Once 2-4 times >5 times
I participated in an (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
UNDERGRADUTE ethics or
philosophy course which
specifically addressed
issues of public health
ethics.
I participated in a medical (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
ethics course in MEDICAL
SCHOOL which specifically
addressed issues of public
health ethics.
I participated in a course in (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
my public health
GRADUATE training which
specifically addressed
issues of public health
ethics.
I took a FULL COURSE in (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
public health ethics as part
of my training.
I have attended seminars or (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
ROUNDS which specfically
addressed issues of public
health ethics.
I read ARTICLES in peer (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
reviewed journals which
specifically address public
health ethics.
9. Please select all that apply:
With regards to my education in ethics thus far...
(cid:18)(cid:17)(cid:16)(cid:15)(cid:14) 1. I feel that I currently have adequate knowledge and skills in the field of ethics to practice in public health.
(cid:18)(cid:17)(cid:16)(cid:15)(cid:14) 2. I expect that I will aquire the skills I need in the course of the rest of my training.
(cid:18)(cid:17)(cid:16)(cid:15)(cid:14) 3. I am concerned that, by the end of my training, I may not have the skills I feel that I need in this area.
(cid:18)(cid:17)(cid:16)(cid:15)(cid:14) 4. I intend to make acquiring skills and knowledge in public health ethics a priority in my training.
(cid:18)(cid:17)(cid:16)(cid:15)(cid:14) 5. I do not believe public health ethics are an important element of public health practice and I am not concerned about aquiring these
skills.
(cid:18)(cid:17)(cid:16)(cid:15)(cid:14) 6. I am finished, or am almost finished my training and I know I do not have the skills and knowledge I need to practice ethically.
6. What is Ethics
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Almost Done!
10. Please indicate the degree to which you agree or disagree with the following
statements.
In my opinion...
Strongly Agree Agree Disagree Strongly Disagree
A universal and true set of (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
ethical principles and
norms can be derived from
rational thought.
A universal and true set of (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
ethical principles and
norms are divinely
determined and can be
derived from religious
documents.
Ethical principles and (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
norms are culturally
determined and can be set
or derived for different
societies.
Ethical principles and (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
norms are relative and
contextual and can only be
determined by each
individual person.
Ethical principles and (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
norms are not relevant so
long as social, professional
and legal conventions are
adhered to.
11. Please list 4 principles, outcomes or processes, which you believe have moral value in
public health ethical dilemmas. Please list them in the order which you believe reflects
their priority value with respect to the others.
1.
2.
3.
4.
7. Public Health Ethics
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12. Please rank the following statements by marking them as 1,2 or 3. If you do not wish to
rank a statement please use 0. You cannot use the same number for more than one
statement.
As a practicing community medicine specialist...
1 2 3 0
My primary concern is (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
whether or not I AM an
ethical
PERSONS/PHYSICIAN.
My primary concern is (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
whether or not I am
ACTING in an ethical
manner by adhering to
particular principles or
fulfilling particular duties.
My primary concern is (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21) (cid:25)(cid:24)(cid:23)(cid:22)(cid:21)
whether or not the
RESULTS of my actions or
decisions result in ethically
desirable
CONSEQUENCES and
OUTCOMES.
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Description:Appendix 1: Study A Interview Guide Appendix 4: Study D Survey please do not use specific identifying information in your descriptions. If you do
