Public Health

In recent American politics, there has become a larger atmosphere of distrust regarding the pre-existing representative democratic system as well as the criminal justice system. This topic has quickly come more and more into focus following the 2016 Presidential Election and then throughout the ongoing COVID-19 pandemic and civil unrest. However, America is not the only country that is challenging the preexisting systems, there are many countries (e.g., Canada, UK, Australia, etc.) who have recently seen opposition to government action. Throughout (...) all of these instances one questions arises: can we trust the government? In an article on the dysfunction of state institutions, Börzel poses that the systems we have in place may have originally been trusted with good reason but have eroded over time. Meanwhile, other authors (i.e., Levi) ask the question of why it even matters if we can’t trust our government, since dismantling and rebuilding them would take too long and might not even be possible. I would like to explore the nature of the systems of governance and the role of trust within them, diving into whether or not we can trust governments and then an application of this information. (shrink)

The COVID-19 pandemic has been overwhelming public health-care systems around the world. With demand exceeding the availability of medical resources in several regions, hospitals have been forced to invoke triage. To ensure that this difficult task proceeds in a fair and organised manner, governments scrambled experts to draft triage guidelines under enormous time pressure. Although there are similarities between the documents, they vary considerably in how much weight their respective authors place on the different criteria that they propose. Since most (...) of the recommendations do not come with ethical justifications, analysing them requires that one traces back these criteria to their underlying theories of distributive justice. In the literature, COVID-19 triage has been portrayed as a value conflict solely between utilitarian and egalitarian elements. While these two accounts are indeed the main antipodes, I shall show that in fact all four classic theories of distributive justice are involved: utilitarianism, egalitarianism, libertarianism, and communitarianism. Detecting these in the documents and classifying the suggested criteria accordingly enables one to understand the balancing between the different approaches to distributive justice—which is crucial for both managing the current pandemic and in preparation for the next global health crisis. (shrink)

In the one-for-one business model, a purchaser of, for example, a pair of shoes simultaneously purchases a pair of shoes for a child in need. This model, popularized by TOMS shoe company in 2006, has been remarkably successful. The driving force behind the success is most likely the emotional appeal of the one-for-one idea. The TOMS model has been criticized, however—not just for being less effective than advertised, but for arguably doing more harm than good. Whether or not this latter (...) charge is true, the TOMS story serves as an illustrative starting point for an exploration of the ways in which commonsense thinking about charity and philanthropy is often wrong. Examining these criticisms will set the stage for an examination of the influential “effective altruism” movement and invite the reader to think more deeply about different ways of doing good in the world. (shrink)

The COVID-19 global pandemic has shone a light on several important ethical questions, ranging from fairness in resource allocation to the ethical justification of government mandates. In addition to these institutional issues, there are also several ethical questions that arise at the interpersonal level. This essay focuses on several of these issues. In particular, I argue that, despite the insistence in public health messaging that avoiding infecting others constitutes ‘saving lives’, virus transmission that results in death constitutes an act of (...) killing. Whether this killing is wrongful depends on several factors. I consider one intuitively plausible view—namely, that in many cases, killing via unintentional transmission is not wrongful, because the parties in question have implicitly waived their rights against this harm, often via reciprocal risk imposition. I argue that this view is mistaken, but that its central insight can be better captured by identifying the appropriate standards of blame that we ought to apply during a pandemic. I conclude by showing how these conclusions can be fruitfully applied to certain institutional questions, such as helping to justify restricting government mandates. (shrink)

Machine intelligence already helps medical staff with a number of tasks. Ethical decision-making, however, has not been handed over to computers. In this proof-of-concept study, we show how an algorithm based on Beauchamp and Childress’ prima-facie principles could be employed to advise on a range of moral dilemma situations that occur in medical institutions. We explain why we chose fuzzy cognitive maps to set up the advisory system and how we utilized machine learning to train it. We report on the (...) difficult task of operationalizing the principles of beneficence, non-maleficence and patient autonomy, and describe how we selected suitable input parameters that we extracted from a training dataset of clinical cases. The first performance results are promising, but an algorithmic approach to ethics also comes with several weaknesses and limitations. Should one really entrust the sensitive domain of clinical ethics to machine intelligence? (shrink)

The ethical question is whether university mask mandates should be relaxed. I argue that the use of face masks by healthy individuals has uncertain benefits, which potential harms may outweigh, and should therefore be voluntary. Systematic reviews by the World Health Organization (WHO) and Cochrane Acute Respiratory Infections concluded that the use of face masks by healthy individuals in the community lacks effectiveness in reducing viral transmission based on moderate-quality evidence. The only two randomized controlled trials of face masks published (...) during the pandemic found little to no benefit. Without high-quality evidence, it is difficult to justify a requirement rather than a recommendation. Notwithstanding, one might argue that the precautionary principle justifies mask mandates. If the precautionary principle can justify implementing mask mandates due to the risk of forgoing possible benefit, then it might also be able to justify not implementing mask mandates due to the risk of potential harm caused by the intervention. It is commonly thought that there is little to lose from the use of face masks, but this is not necessarily true. It is possible that masks have done more harm than good. (shrink)

Short overview of the From Small Beginnings Project and its relevance for resisting eugenics in contemporary society.

In response to the COVID-19 pandemic, large-scale research and pharmaceutical regulatory processes have proceeded at a dramatically increased pace with new and effective, evidence-based COVID-19 interventions rapidly making their way into the clinic. However, the swift generation of high-quality evidence and the efficient processing of regulatory authorisation have given rise to more specific and complex versions of well-known research ethics issues. In this paper, we identify three such issues by focusing on the authorisation of Molnupiravir, a novel antiviral medicine aimed (...) at reducing the ability of SARS-CoV-2 to multiply in the body, for clinical use by the National Health Service in England and the concomitant testing of Molnupiravir through the large-scale PANORAMIC randomised control trial. By analysing the ways in which the authorisation and clinical use of Molnupiravir complicate standard approaches to clinical equipoise, standard of care, and participant consent in the PANORAMIC randomised control trial we will explain some of ethical implications for clinical trials that aim to study the efficacy and safety of new COVID-19 and other therapeutics when conditional authorisation has already been granted and when such treatments have already been made available to patients by national health providers. (shrink)

Gay men have been severely affected by the AIDS crisis, and gay subjectivity, sexual ethics, and politics continue to be deeply influenced by HIV to this day. PrEP (Pre-Exposure Prophylaxis) is a new, drug-based HIV prevention technique, that allows disentangling gay sex from its widespread, 40 yearlong association with illness and death. This article explores PrEP's fundamental impact on gay subjectivity, sexual ethics, and politics. It traces the genealogy of gay politics regarding homophobia and HIV stigma, suggesting a new biopolitical (...) and body political framework that accounts for the agency of activists as well as pharmapower, and proposing that PrEP is an example of democratic biopolitics. Highlighting the entanglement of medical technology, sexual ethics, and politics, the article shows how conservative and homonormative gay politics developed as a reaction to HIV stigma and how, by overcoming this stigma, PrEP enables a new era of intersectional queer politics and solidarities. It thereby develops a Foucauldian account of sexual liberation beyond the repression hypothesis that accounts for the ambivalence of sexual subjectification and the political potential of sexuality. (shrink)

This paper addresses the recent rise of the use of alternative medicine in Western countries and it offers a novel explanation of that phenomenon in terms of cognitive and economic factors related to the free-market and patient-centric approach to medicine that is currently in place in those countries, in contrast to some alternative explanations of this phenomenon. Moreover, the paper addresses this troubling trend in terms of the serious harms associated with the use of alternative medical modalities. The explanatory theory (...) defended here is then predicated on the idea that an extreme patient-centric model of medical practice that treats largely ignorant patients as consumers of medical products and services endowed with an essentially unrestricted power of freedom to choose treatments predictably leads serious and avoidable harms. Some important moral and epistemological consequences of this model are then articulated and corrective measures are suggested. (shrink)

In recent years, genetically engineered (GE) mosquitoes have been proposed as a public health measure against the high incidence of mosquito-borne diseases among the poor in regions of the global South. While uncertainties as well as risks for humans and ecosystems are entailed by the open-release of GE mosquitoes, a powerful global health governance non-state organization is funding the development of and advocating the use of those bio-technologies as public health tools. In August 2016, the US Food and Drug Agency (...) (FDA) approved the uncaged field trial of a GE Aedes aegypti mosquito in Key Haven, Florida. The FDA’s decision was based on its assessment of the risks of the proposed experimental public health research project. The FDA is considered a global regulatory standard setter. So, its approval of the uncaged field trial could be used by proponents of GE mosquitoes to urge countries in the global South to permit the use of those bio-technologies. -/- From a public health ethics perspective, this paper evaluates the FDA’s 2016 risk assessment of the proposed uncaged field trial of the GE mosquito to determine whether it qualified as a realistic risk evaluation. -/- The FDA’s risk assessment of the proposed uncaged field trial did not proximate the conditions under which the GE mosquitoes would be used in regions of the global South where there is a high prevalence of mosquito-borne diseases. -/- Given that health and disease have political-economic determinants, whether a risk assessment of a product is realistic or not particularly matters with respect to interventions meant for public health problems that disproportionately impact socio-economically marginalized populations. If ineffective public health interventions are adopted based on risk evaluations that do not closely mirror the conditions under which those products would actually be used, there could be public health and ethical costs for those populations. (shrink)

ABSTRACT In this article, I indicate how the naturalized and individualized conception of disability that prevails in philosophy informs the indifference of philosophers to the predictable COVID-19 tragedy that has unfolded in nursing homes, supported living centers, psychiatric institutions, and other institutions in which elders and younger disabled people are placed. I maintain that, insofar as feminist and other discourses represent these institutions as sites of care and love, they enact structural gaslighting. I argue, therefore, that philosophers must engage in (...) conceptual engineering with respect to how disability and these institutions are understood and represented. To substantiate my argument, I trace the sequence of catastrophic events that have occurred in nursing homes in Canada and in the Canadian province of Ontario in particular during the pandemic, tying these events to other past and current eugenic practices produced in the Canadian context. The crux of the article is that the COVID-19 pandemic has thrown into vivid relief the carceral character of nursing homes and other congregate settings in which elders and younger disabled people are confined. -/- KEYWORDS carceral, conceptual engineering, nursing home-industrial-complex, philosophy of disability, structural gaslighting. (shrink)

On 26 January 2021, while announcing that the country had reached the mark of 100,000 deaths within 28 days of COVID-19, UK Prime Minister Boris Johnson said that he took “full responsibility for everything that the Government has done” as part of British efforts to tackle the pandemic. The force of this statement was undermined, however, by what followed: -/- What I can tell you is that we truly did everything we could, and continue to do everything that we can, (...) to minimise loss of life and to minimise suffering... -/- Taking these sentiments together, it was hard to avoid the conclusion that the government took responsibility only for doing everything right. Such an admission of responsibility, accommodating no admission of error or wrongdoing, is not really about responsibility at all. Indeed, the UK’s pandemic response has been marked from its earliest days by a shifting of focus from institutional responsibility to personal responsibility for individual UK residents. -/- This paper explores the relationship between these two sites of responsibility—the institutional and the personal—in the context of the sort of pandemic that is ongoing as we write. Section 2 offers some initial definitions and discussions of key terms. Section 3 outlines how these two ideas interact in principle during such emergencies. Section 4 turns to the ‘non-ideal’ implications for personal responsibility of failures of institutional responsibility. While our focus is on the specific context with which we are most familiar, the UK governmental approach, where appropriate we also include examples from other states. (shrink)

COVID-19 vaccination of children has begun in various high-income countries with regulatory approval and general public support, but largely without careful ethical consideration. This trend is expected to extend to other COVID-19 vaccines and lower ages as clinical trials progress. This paper provides an ethical analysis of COVID-19 vaccination of healthy children. Specifically, we argue that it is currently unclear whether routine COVID-19 vaccination of healthy children is ethically justified in most contexts, given the minimal direct benefit that COVID-19 vaccination (...) provides to children, the potential for rare risks to outweigh these benefits and undermine vaccine confidence, and substantial evidence that COVID-19 vaccination confers adequate protection to risk groups, such as older adults, without the need to vaccinate healthy children. We conclude that child COVID-19 vaccination in wealthy communities before adults in poor communities worldwide is ethically unacceptable and consider how policy deliberations might evolve in light of future developments. (shrink)

How could the initial, drastic decisions to implement “lockdowns” to control the spread of COVID-19 infections be justifiable, when they were made on the basis of such uncertain evidence? We defend the imposition of lockdowns in some countries by first, and focusing on the UK, looking at the evidence that undergirded the decision, second, arguing that this provided us with sufficient grounds to restrict liberty given the circumstances, and third, defending the use of poorly-empirically-constrained epidemiological models as tools that can (...) legitimately guide public policy. (shrink)

What position on dualism does medicine require? Our understanding of that ques- tion has been dictated by holism, as defined by the biopsychosocial model, since the late twentieth century. Unfortunately, holism was characterized at the start with con- fused definitions of ‘dualism’ and ‘reductionism’, and that problem has led to a deep, unrecognized conceptual split in the medical professions. Some insist that holism is a nonreductionist approach that aligns with some form of dualism, while others insist it’s a reductionist view (...) that sets out to eradicate dualism. It’s important to consider each version. Nonreductive holism is philosophically consistent and clinically unprob- lematic. Reductive holism, however, is conceptually incoherent—yet it is the basis for the common idea that the boundary between medical and mental health disorders must be vague. When we trace that idea through to its implementation in medical practice, we find evidence that it compromises the safety of patient care in the large portion of cases where clinicians grapple with diagnosis at the boundary between psychiatry and medicine. Having established that medicine must embrace some form of nonreduc- tionism, I argue that Chalmers’ naturalistic dualism is a stronger prima facie candidate than the nonreductive alternatives. Regardless of which form of nonreductionism we prefer, some philosophical corrections are needed to give medicine a safe and coherent foundation. (shrink)

The COVID-19 pandemic has coincided with the proliferation of ethical guidance documents to assist public health authorities, health care providers, practitioners and staff with responding to ethical challenges posed by the pandemic. Like ethical guidelines relating to infectious disease that have preceded them, what unites many COVID-19 guidance documents is their dependency on an under-developed approach to bioethical principlism, a normative framework that attempts to guide actions based on a list of prima facie, unranked ethical principles. By situating them in (...) relation to the key philosophical debates concerning bioethical principlism, we aim to explore the limits and limitations of pandemic ethical guidance documents as, specifically, ethics documents – documents that fulfil the functions of ethics as a fundamentally normative discipline. This means not only determining whether such ethical guidance documents can, in principle, provide adequate action guidance and action justification, but also, more importantly where pandemics are concerned, determining whether they support consistent decision making and transparent processes of justification. Having highlighted the problems with merely furnishing ethical guidelines with substantive ethical content in terms of principles and values, we argue that organizations that develop these documents should, instead, focus on the procedural dimensions of action guidance and action justification, which extend to questions regarding the make-up of the committees, panels and groups that develop such guidelines, the public transparency of justifications for specific pandemic-related advice or interventions and the development of explicit procedures for transparent and consistent decision making. (shrink)

Traditional medical practices and relationships are changing given the widespread adoption of AI-driven technologies across the various domains of health and healthcare. In many cases, these new technologies are not specific to the field of healthcare. Still, they are existent, ubiquitous, and commercially available systems upskilled to integrate these novel care practices. Given the widespread adoption, coupled with the dramatic changes in practices, new ethical and social issues emerge due to how these systems nudge users into making decisions and changing (...) behaviours. This article discusses how these AI-driven systems pose particular ethical challenges with regards to nudging. To confront these issues, the value sensitive design approach is adopted as a principled methodology that designers can adopt to design these systems to avoid harming and contribute to the social good. The AI for Social Good factors are adopted as the norms constraining maleficence. In contrast, higher-order values specific to AI, such as those from the EU High-Level Expert Group on AI and the United Nations Sustainable Development Goals, are adopted as the values to be promoted as much as possible in design. The use case of Amazon Alexa's Healthcare Skills is used to illustrate this design approach. It provides an exemplar of how designers and engineers can begin to orientate their design programs of these technologies towards the social good. (shrink)

In a recent article, Ethan Bradley and Mark Navin (2021) argue that vaccine refusal is not akin to free riding. Here, I defend one connection between vaccine refusal and free riding and suggest that, when viewed in conjunction with their other arguments, this might constitute a reason to mandate Covid-19 vaccination.

Despite having a set of well-intended tobacco control policies since 2003, the production and consumption of tobacco in Bangladesh have increased. This paper explains why the tobacco control policies in Bangladesh failed to deliver their intended outcomes. Using a combined framework of political economy and policy implementation analysis, this study examines the information collected from primary and secondary sources. Based on the findings, the paper argues that the game of interests among the stakeholders have made the state institutions inactive and (...) ineffective. Lack of political commitment and politics of interests have failed the implementation and skewed the outcome. (shrink)

The development of artificial womb technology is proceeding rapidly and will present important ethical and theological challenges for Christians. While there has been extensive secular discourse on artificial wombs in recent years, there has been little Christian engagement with this topic. There are broadly two primary uses of artificial womb technology—ectogestation as a form of enhanced neonatal care, where some of the gestation period takes place in an artificial womb, and ectogenesis, where the entire gestation period is within an artificial (...) womb. Ectogestation for the latter weeks or months of pregnancy could be possible within a decade or so, while ectogenesis for humans is far more speculative. Ectogestation is likely to significantly decrease maternal and neonatal morbidity and mortality, and so there is a strong case for supporting its development. Ectogenesis, however, may bring a number of challenges, including the commodification of children, and the pathologizing of pregnancy and childbirth. Its long-term effects on those who are created through this process are also unknown. In the event that it becomes ubiquitous, we may also find the central theological significance of pregnancy and birth diminished. The dilemma for Christians is that the development of ectogestation seems likely to normalise the use of artificial gestation, and, in time, pave the way for ectogenesis. (shrink)

The COVID-19 pandemic has led to intense conversations about ventilator allocation and reallocation during a crisis standard of care. Multiple voices in the media and multiple state guidelines mention reallocation as a possibility. Drawing upon a range of neuroscientific, phenomenological, ethical, and sociopolitical considerations, the authors argue that taking away someone’s personal ventilator is a direct assault on their bodily and social integrity. They conclude that personal ventilators should not be part of reallocation pools and that triage protocols should be (...) immediately clarified to explicitly state that personal ventilators will be protected in all cases. (shrink)

Pro-life advocates commonly argue that fetuses have the moral status of persons, and an accompanying right to life, a view most pro-choice advocates deny. A difficulty for this pro-life position has been Judith Jarvis Thomson’s violinist analogy, in which she argues that even if the fetus is a person, abortion is often permissible because a pregnant woman is not obliged to continue to offer her body as life support. Here, we outline the moral theories underlying public health ethics, and examine (...) the COVID-19 pandemic as an example of public health considerations overriding individual rights. We argue that if fetuses are regarded as persons, then abortion is of such prevalence in society that it also constitutes a significant public health crisis. We show that on public health considerations, we are justified in overriding individual rights to bodily autonomy by prohibiting abortion. We conclude that in a society that values public health, abortion can only be tolerated if fetuses are not regarded as persons. (shrink)

At the beginning of the COVID-19 pandemic, high hopes were placed on digital contact tracing. Digital contact tracing apps can now be downloaded in many countries, but as further waves of COVID-19 tear through much of the northern hemisphere, these apps are playing a less important role in interrupting chains of infection than anticipated. We argue that one of the reasons for this is that most countries have opted for decentralised apps, which cannot provide a means of rapidly informing users (...) of likely infections while avoiding too many false positive reports. Centralised apps, in contrast, have the potential to do this. But policy making was influenced by public debates about the right app configuration, which have tended to focus heavily on privacy, and are driven by the assumption that decentralised apps are “privacy preserving by design”. We show that both types of apps are in fact vulnerable to privacy breaches, and, drawing on principles from safety engineering and risk analysis, compare the risks of centralised and decentralised systems along two dimensions, namely the probability of possible breaches and their severity. We conclude that a centralised app may in fact minimise overall ethical risk, and contend that we must reassess our approach to digital contact tracing, and should, more generally, be cautious about a myopic focus on privacy when conducting ethical assessments of data technologies. (shrink)

As many Western countries emerged from initial periods of lockdown in spring 2020, they had brought COVID-19 infection rates down significantly. This was followed, however, with more drastic second and third waves of viral spread, which many of these same countries are struggling to bring under control, even with the implementation of further periods of lockdown. Could this have been prevented by policymakers? We revisit two strategies that were focus of much discussion during the early stages of the pandemic, and (...) which were implemented in several Western countries, albeit in a weakened form. These strategies both proceed by targeting certain segments of the population, while allowing others to go about their lives unhindered. The first suggests selectively isolating those that would most likely suffer severe adverse effects if infected – in particular the elderly. The second involves identifying and quarantining those who are likely to be infected through a contact tracing app that would centrally store users’ information. We suggest that both strategies showed promise in preventing the need for further lockdowns, albeit in a significantly more stringent form than anything that was implemented in Western countries. We then proceed to an ethical evaluation of these more stringent policies. We contend that selective isolation strategies face severe ethical problems due to its discriminatory nature, while the ethical issues with a more aggressive contact tracing regime can be mitigated. This analysis has implications for how to respond effectively and ethically to future pandemics, and perhaps contains lessons on how to successfully emerge from our current predicament. (shrink)

Drawing on the SAGE minutes and other documents, I consider the wider lessons for norms of scientific advising that can be learned from the UK’s initial response to coronavirus in the period January-March 2020, when an initial strategy that planned to avoid total suppression of transmission was abruptly replaced by an aggressive suppression strategy. I introduce a distinction between “normatively light advice”, in which no specific policy option is recommended, and “normatively heavy advice” that does make an explicit recommendation. I (...) argue that, although scientific advisers should avoid normatively heavy advice in normal times in order to facilitate democratic accountability, this norm can be permissibly overridden in situations of grave emergency. SAGE’s major mistake in early 2020 was not that of endorsing a particular strategy, nor that of being insufficiently precautionary, but that of relying too heavily on a specific set of “reasonable worst-case” planning assumptions. I formulate some proposals that assign a more circumscribed role to “worst-case” thinking in emergency planning. In an epilogue, I consider what the implications of my proposals would have been for the UK’s response to the “second wave” of late 2020. (shrink)

BackgroundViral pandemics present a range of ethical challenges for policy makers, not the least among which are difficult decisions about how to allocate scarce healthcare resources. One important question is whether healthcare workers should receive priority access to a vaccine in the event that an effective vaccine becomes available. This question is especially relevant in the coronavirus pandemic with governments and health authorities currently facing questions of distribution of COVID-19 vaccines.Main textIn this article, we critically evaluate the most common ethical (...) arguments for granting healthcare workers priority access to a vaccine. We review the existing literature on this topic, and analyse both deontological and utilitarian arguments in favour of HCW prioritisation. For illustrative purposes, we focus in particular on the distribution of a COVID-19 vaccine. We also explore some practical complexities attendant on arguments in favour of HCW prioritisation.ConclusionsWe argue that there are deontological and utilitarian cases for prioritising HCWs. Indeed, the widely held view that we should prioritise HCWs represents an example of ethical convergence. Complexities arise, however, when considering who should be included in the category of HCW, and who else should receive priority in addition to HCWs. (shrink)

Volume 20, Issue 7, July 2020, Page 180-182.

A short reflection on respects in which philosophers are particularly, if not uniquely, well positioned to address certain ethical and epistemological controversies pertaining to the coronavirus.

Commentary about the role of AI in bioethics for the 10th anniversary issue of AJOB: Empirical Bioethics.

Iris Marion Young’s classic paper on the phenomenology of pregnancy chronicles the alienating tendencies of technology-ridden maternal care, as the mother’s subjective knowledge of the pregnancy gets overridden by the objective knowledge provided by medical personnel and technological apparatuses. Following Fredrik Svenaeus, the authors argue that maternal care is not necessarily alienating by looking specifically at the proper attention paid by sonographers in maternal care when performing ultrasound examinations. Using Martin Heidegger’s philosophy as a theoretical lens, the authors argue that (...) sonographers who cultivate technical mastery, build patient rapport, explain the process and significance of the ultrasound, and understand the patient’s world are able to provide excellent patient care. The authors utilize Hans-Georg Gadamer’s hermeneutics to show how sonographers can frame the ultrasound in a way that acknowledges both the subjective knowledge of the mother and the objective data obtained by the sonographer through the use of technology. Ultimately, the authors argue that the common practice of framing the ultrasound as the chance to “meet the baby” is inappropriate, as it exacerbates the tendency to regard objective knowledge as the only legitimate knowledge in medical contexts. They recommend a more balanced approach that elicits a fusion of horizons between the patient’s subjective knowledge and the objective data that is obtained by the sonographer via the ultrasound, thus respecting and bolstering patient autonomy. (shrink)

We can say that it is necessary for every human being to walk towards the comprehension of the contingent and limited reality of the human person, starting with those whose work involves dealing with patients, as well as those who dedicate themselves to bioethical reflection, and even the patients themselves. In this way, at the time when these people face a situation of pain and suffering, they will be able to assume it with integrity and strength, always choosing to protect (...) the valuable gift of human life, and not simply looking for it. to make the pain disappear as it may, tearing it up at the root, often ending up with a human life, be it at the moment of conception, as an embryo, with disabilities, sick or aging. -/- Podemos decir que es necesario que todo ser humano camine hacia la comprensión de la realidad contingente y limitada de la persona humana, empezando por aquellos cuyo trabajo involucra el trato con pacientes, así como quienes se dedican a la reflexión bioética, e incluso los mismos pacientes. De esta manera, en el momento en que estas personas se enfrenten a una situación de dolor y sufrimiento, podrán asumirla con entere-za y fortaleza, optando siempre por proteger el valioso don de la vida humana, y no simplemente buscando hacer desaparecer el dolor a como dé lugar, arrancándolo de raíz, muchas veces terminando con una vida huma-na, sea en el momento de la concepción, como embrión, con discapacidades, enferma o envejecida. (shrink)

Brummett and Salter propose a useful and timely taxonomy of clinical ethics expertise (2019). As the field becomes further “professionalized” this taxonomy is important, and the core of it is right. It needs some refinement around the edges, however. In their conclusion, Brummett and Salter rightly point out that there is a significant difference between the ethicist whose recommendations are procedure- and process-heavy, consensus-driven, and dialogical and the authoritarian ethicist whose recommendations flow from “private moral views” (Brummett and Salter, 2019). (...) This admission doesn’t go far enough. Brummett and Salter’s taxonomy fails to capture the notion that offering recommendations whose normative force is moral is different in kind from recommendations whose normative force is non-moral, such as those recommendations that are free of moral content or justified by convention. The difference is in kind, not scale. I argue further that clinical ethics expertise, if possible, consists at least in offering recommendations whose normative force is moral. These two claims imply that the taxonomy fails to cut clinical ethics expertise at the joints: the ethicist who offers justified non-moral normative recommendations is a different kind of ethicist from the one who offers justified moral normative recommendations, yet both are categorized as clinical ethics experts. I finish by offering a refinement of the taxonomy that more precisely categorizes clinical ethicists. (shrink)

Conscientious objection in healthcare has come under heavy criticism on two grounds recently, particularly regarding abortion provision. First, critics claim conscientious objection involves a refusal to provide a legal and beneficial procedure requested by a patient, denying them access to healthcare. Second, they argue the exercise of conscientious objection is based on unverifiable personal beliefs. These characteristics, it is claimed, disqualify conscientious objection in healthcare. Here, we defend conscientious objection in the context of abortion provision. We show that abortion has (...) a dubitable claim to be medically beneficial, is rarely clinically indicated, and that conscientious objections should be accepted in these circumstances. We also show that reliance on personal beliefs is difficult to avoid if any form of objection is to be permitted, even if it is based on criteria such as the principles and values of the profession or the scope of professional practice. (shrink)

Animal-derived constituents are frequently used in anaesthesia and surgery, and patients are seldom informed of this. This is problematic for a growing minority of patients who may have religious or secular concerns about their use in their care. It is not currently common practice to inform patients about the use of animal-derived constituents, yet what little empirical data does exist indicates that many patients want the opportunity to give their informed consent. First, we review the nature and scale of the (...) problem by looking at the groups who may have concerns about the use of animal-derived constituents in their care. We then summarise some of the products used in anaesthesia and surgery that can contain such constituents, such as anaesthetic drugs, surgical implants and dressings. Finally, we explore the problem of animal-derived constituents and consent using Beauchamp and Childress’ four principles approach, examining issues of autonomy, beneficence, nonmaleficence and justice. Disclosing the use of animal-derived constituents in anaesthesia and surgery is warranted under Beauchamp and Childress’ four principles approach to the problem. Although there exist systemic and practical challenges to implementing this in practice, the ethical case for doing so is strong. The Montgomery ruling presents additional legal reason for disclosure because it entails that patients must be made aware of risks associated with their treatment that they attach significance to. (shrink)

Medical billing has become so intertwined with patient care, that in order to be truly committed to the physician's telos of managing a patient's medical suffering, it is imperative that physician ought to reexamine many of the ethical considerations about billing.

This article will explore and summarise the four main ethical theories that have relevance for healthcare assistants. These are utilitarianism, deontology, virtue ethics, and principlism. Understanding different ethical theories can have a number of significant benefits, which have the potential to shape and inform the care of patients, challenge bad practice and lead staff to become better informed about areas of moral disagreement.

Two chapters -- "Common Arguments about Abortion" and "Better (Philosophical) Arguments About Abortion" -- in one file, from the open access textbook "Introduction to Ethics: An Open Educational Resource" edited by Noah Levin. -/- Adults, children and babies are arguably wrong to kill, fundamentally, because we are conscious, aware and have feelings. Since early fetuses entirely lack these characteristics, we argue that they are not inherently wrong to kill and so most abortions are not morally wrong, since most abortions are (...) done early in pregnancy before consciousness and feeling develop in the fetus. Furthermore, since the right to life is not the right to someone else’s body, fetuses might not have the right to the pregnant woman’s body, and so she has the right to not allow the fetus use of her body; this further justifies abortion, at least, until technology allows for the removal of fetuses to other wombs. Since morally permissible actions should be legal, abortions should be legal. -/- In the course of arguing for these claims, we: -/- discuss how to best define abortion; dismiss many common “question-begging” arguments that merely assume their conclusion, instead of giving genuine reasons for them; refute some often-heard “everyday arguments” about abortion; explain why some influential philosophical arguments against abortion are unsuccessful; provide some positive arguments that at least early abortions are not wrong; briefly discuss the ethics and legality of later abortions, and more. -/- Little of this discussion should be taken as absolute “proof” of anything, as this is merely a reasoned introduction to the issues: much more needs to be discussed, always. (shrink)

Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to today’s severity criteria in (...) Norway and Sweden. The Scandinavian perspective on severity might be conducive to the international discussion, given its long-standing use as a priority setting criterion, despite having reached rather different conclusions so far. We then argue that severity can be viewed as a multidimensional concept, drawing on accounts of need, urgency, fairness, duty to save lives, and human dignity. Such concerns will often be relative to local mores, and the weighting placed on the various dimensions cannot be expected to be fixed. Thirdly, we present what we think are the most pertinent questions to answer about severity in order to facilitate decision making in the coming years of increased scarcity, and to further the understanding of underlying assumptions and values that go into these decisions. We conclude that severity is poorly understood, and that the topic needs substantial further inquiry; thus we hope this article may set a challenging and important research agenda. (shrink)

In a rigorous systematic review, Dukhanin and colleagues categorize metrics and evaluative tools of the engagement of patient, public, consumer, and community in decision-making in healthcare institutions and systems. The review itself is ably done and the categorizations lead to a useful understanding of the necessary elements of engagement, and a suite of measures relevant to implementing engagement in systems. Nevertheless, the question remains whether the engagement of patient representatives in institutional or systemic deliberations will lead to improved clinical outcomes (...) or increased engagement of individual patients themselves in care. Attention to the conceptual foundations of patient engagement would help make this systematic review relevant to the clinical care of patients. (shrink)

Individual health assessments (IHAs) for asymptomatic individuals provide a challenge to traditional distinctions between patient care and non-medical practice. They may involve undue radiation exposure, lead to false positives, and involve high out-of-pocket costs for recipients. A recent paper (Journal of the American College of Radiology 13(12): 1447–1457.e1, 2016) has criticised the use of IHAs and argued that recipients should be classified as ‘presenters’, not ‘patients’, to distinguish it from regular medical care. I critique this classificatory move, on two grounds: (...) one, it is conceptually suspect. Two, it obviates the medical ethics framework for IHAs, potentially exposing recipients of IHAs to lower standards of oversight and protection. Responsible regulation of IHAs will be easier to ethically justify if those seeking IHAs are considered patients and not merely presenters. (shrink)

Feminist phenomenology has contributed significantly to understanding the negative impact of the objectification of women’s bodies. The celebration of thin bodies as beautiful and the demonization of fat bodies as unattractive is a common component of that discussion. However, when one turns toward the correlation of fat and poor health, a feminist phenomenological approach is less obvious. In this paper, previous phenomenological work on the objectification of women is paralleled to the contemporary encouragement to discipline one’s body in order to (...) pursue better health. Similar ideologies of free choice in the face of bodily habits run through discussions of health and beauty. The paper uses the work of Merleau-Ponty and Beauvoir as well as the contemporary feminist phenomenologists Diaprose, Bartky, Bordo, Young, Grosz, and Carel to explore how women are constrained by health testing and health normalization. It argues that despite the apparent benefits of a focus on modifying health habits, feminists have good reason to be wary of the good health imperative. (shrink)

An abundance of data unequivocally shows that exercise can be an effective tool in the fight against obesity and its associated co-morbidities. Indeed, physical activity can be more effective than widely-used pharmaceutical interventions. Whilst metformin reduces the incidence of diabetes by 31% (as compared with a placebo) in both men and women across different racial and ethnic groups, lifestyle intervention (including exercise) reduces the incidence by 58%. In this context, it is notable that a group of prominent medics and exercise (...) scientists recently sent a well-publicised letter to the General Medical Council and Medical Schools Council calling for the introduction of evidence-based lifestyle education into all medical curricula. The letter warns that there is a lack of understanding of the impact that exercise and nutrition can have on physical health amongst doctors. In the absence of an educational overhaul, the signatories warn that the government is likely to fail to reach its goal of preventing tens of thousands of premature deaths from heart disease and cancer by 2020. Whilst we agree with the need to address this apparent lack of understanding, we argue that the ethical justification of doing so is not limited to this broadly beneficence-based justification. There is also a justification grounded in the duty of non-maleficence, that is, the duty to avoid unreasonably harming patients. This duty requires that doctors refrain from (i) preventing patients from undergoing beneficial treatment without good reason, (ii) exposing patients to unreasonable risks and (iii) reducing the therapeutic effect of an effective medical intervention. This requires an understanding of the physical impact of exercise. (shrink)

Respect for autonomy and beneficence are frequently regarded as the two essential principles of medical ethics, and the potential for these two principles to come into conflict is often emphasised as a fundamental problem. On the one hand, we have the value of beneficence, the driving force of medicine, which demands that medical professionals act to protect or promote the wellbeing of patients or research subjects. On the other, we have a principle of respect for autonomy, which demands that we (...) respect the self-regarding decisions of individuals. As well as routinely coming into opposition with the demands of beneficence in medicine, the principle of respect for autonomy in medical ethics is often seen as providing protection against beneficial coercion (i.e. paternalism) in medicine. However, these two values are not as straightforwardly opposed as they may appear on the surface. In fact, the way that we understand autonomy can lead us to implicitly sanction a great deal of paternalistic action, or can smuggle in paternalistic elements under the guise of respect for autonomy. -/- This paper is dedicated to outlining three ways in which the principle of respect for autonomy, depending on how we understand the concept of autonomy, can sanction or smuggle in paternalistic elements. As the specific relationship between respect for autonomy and beneficence will depend on how we conceive of autonomy, I begin by outlining two dominant conceptions of autonomy, both of which have great influence in medical ethics. I then turn to the three ways in which how we understand or employ autonomy can increase or support paternalism: firstly, when we equate respect for autonomy with respect for persons; secondly, when our judgements about what qualifies as an autonomous action contain intersubjective elements; and thirdly, when we expect autonomy to play an instrumental role, that is, when we expect people, when they are acting autonomously, to act in a way that promotes or protects their own wellbeing. I then provide a proposal for how we might work to avoid this. I will suggest that it may be impossible to fully separate paternalistic elements out from judgements about autonomy. Instead, we are better off looking at why we are motivated to use judgements about autonomy as a means of restricting the actions of patients or research subjects. I will argue that this is a result of discomfort about speaking directly about our beneficent motivations in medical ethics. Perhaps we can reduce the incentive to smuggle in these beneficent motivations under the guise of autonomy by talking directly about beneficent motivations in medicine. This will also force us to recognise paternalistic motivations in medicine when they appear, and to justify paternalism where it occurs. (shrink)

Over the past 25 years, several new “medicines” have come screeching onto health care’s various platforms, including narrative medicine, personalized medicine, precision medicine and person-centred medicine. Philosopher Miriam Solomon calls the first three of these movements different “ways of knowing” or “methods,” and argues that they are each a response to shortcomings of methods that came before them. They should also be understood as reactions to the current dominant model of medicine. In this article, I will describe our dominant model, (...) which I call “the new medical model.” I will argue that several towering problems in modern medicine can be traced to its philosophical foundations, which calls for philosophical analysis. (shrink)

Our reluctance to demystify grief is a sign of the distinctive obligation and discomfort that people feel towards those who have died. These feelings, however, are instructive about the nature of grief. As a vehicle of a living person’s relation to the dead, grief is mysterious—and we are rightly reluctant to take that mystery away. But grief is not to be avoided by philosophy on that account. I defend a less Romantic view of grief, in which a grieving person’s experience (...) of “normal” grief: 1) is felt to require an objectively recognized loss; 2) is felt to be dedicated to that lost object; 3) seems to most people to be something that she ought to feel; and 4) probably ought not to be medicalized, nor consequently medicated. This view of grief affords an understanding and appreciation of this rather special and important emotion without reducing its mystery. (shrink)

A growing range of brain-computer interface (BCI) technologies is being employed for purposes of therapy and human augmentation. While much thought has been given to the ethical implications of such technologies at the ‘macro’ level of social policy and ‘micro’ level of individual users, little attention has been given to the unique ethical issues that arise during the process of incorporating BCIs into eHealth ecosystems. In this text a conceptual framework is developed that enables the operators of eHealth ecosystems to (...) manage the ethical components of such processes in a more comprehensive and systematic way than has previously been possible. The framework’s first axis defines five ethical dimensions that must be successfully addressed by eHealth ecosystems: 1) beneficence; 2) consent; 3) privacy; 4) equity; and 5) liability. The second axis describes five stages of the systems development life cycle (SDLC) process whereby new technology is incorporated into an eHealth ecosystem: 1) analysis and planning; 2) design, development, and acquisition; 3) integration and activation; 4) operation and maintenance; and 5) disposal. Known ethical issues relating to the deployment of BCIs are mapped onto this matrix in order to demonstrate how it can be employed by the managers of eHealth ecosystems as a tool for fulfilling ethical requirements established by regulatory standards or stakeholders’ expectations. Beyond its immediate application in the case of BCIs, we suggest that this framework may also be utilized beneficially when incorporating other innovative forms of information and communications technology (ICT) into eHealth ecosystems. (shrink)

This article takes Heidegger's design distinctions for human being [Dasein] including affectivity, understanding, and speech, and, using these distinctions, generates a Heideggerian definition of empathy [Einfuehlung]. This article distinguishes empathic receptivity, empathic understanding, empathic interpretation, and empathic speech (or responsiveness). It also looks at characteristic breakdowns.