Defense Date


Graduation Date

Fall 12-17-2021


One-year Embargo

Submission Type


Degree Name



Health Care Ethics


McAnulty College and Graduate School of Liberal Arts

Committee Chair

Dr. Gerald Magill

Committee Member

Dr. Joris Gielen

Committee Member

Dr. Peter Osuji


public health, substance use disorder, ethics, bioethics, harm reduction


The goal of the dissertation is to undertake an analysis of substance use disorders that focuses on a public health ethics perspective. The ethical argument focuses upon justifying the use of harm reduction and is primarily concerned with the current opioid crisis. While substance abuse/misuse over the course of history has been identified as a public health concern, this dissertation presents substance use disorders over the course of the lifespan, examining various contexts in which it can affect daily living and health outcomes. It achieves this by analyzing substance use disorders through the lens of the socioecological model of public health. This premise frames the foundation for this dissertation's central argument; namely, that governmental and healthcare organizations have an ethical imperative to provide equitable care to individuals with substance use disorders. Only after having established this normative foundation does this dissertation address obstacles to improving health outcomes of individuals with substance use disorders and offer suggestions for how to overcome deficits in various aspects of society for such individuals.

This dissertation explores the ethical justification for developing a centralized strategy for addressing substance use disorder as a public health concern and not a criminal justice issue.

The analysis provides an historical and contemporary view of substance use in the United States and globally to illustrate the need for change at various levels of society regarding how we perceive and respond to substance use disorders. The discussion of the public health ethical approach to substance use disorder informs the stance that governmental and healthcare organizations are uniquely situated to intervene to reduce stigma, increase access to diagnosis and treatment in various forms and reduce the incidence of substance use disorders such as opioid use disorder.

This approach emphasizes the impact various social interactions at the individual, interpersonal, organizational, community, and public policy levels have on the creation and perpetuation of stigma associated with substance use disorders; recognizing that because social norms and biases are slow to change without authoritarian influence and changes in the legal system, reform efforts need to focus on policy change to improve health outcomes for individuals with substance use disorders This provides a normative framework to hold governmental, healthcare and community organizations accountable for ineffective and/or outdated policies and procedures that have a negative effect on individuals with substance use disorders. Together, these concepts provide an ethical framework to advocate for system-wide changes in the ways that public and private sectors of society approach and interact with health-related concerns pertaining to individuals with substance use disorders.