Adoptant une perspective populationnelle inspirée des « sciences de la santé de la population », cet article développe une critique de la manière dont la médecine personnalisée envisage l’individu et la population et défend l’idée qu’une approche conjointe de la santé de l’individu et de la santé de la population est une condition pour une médecine humaniste.

In this paper I use normative analysis to explore the curious and seemingly singular phenomenon whereby some dog owners deny the physical and moral facts about a situation where it is claimed their dog harmed or irritated others. I define these as epistemic and ethical denial, respectively, and offer a tentative exploration of their implications in terms of relational autonomy and responsible behaviour in public spaces.

COVID-19 deeply affects many spheres of life. Lockdown measures implemented worldwide have accentuated mental wellbeing changes in the population from the perspectives of space and social relations. These changes leave lasting imprints on individuals and communities. This article draws upon solidarity and care ethics in exploring their role in rebuilding mental wellbeing in the light of constraints arising from lockdown. The diversity of responses to physical and social isolation during the pandemic illuminates the distinctly relational nature of human beings, offering (...) the opportunity for care and solidarity to respond to mental wellbeing challenges in an inclusive and context-sensitive way. (shrink)

Vaccine hesitancy is a growing threat to public health. The reasons are complex but linked inextricably to a lack of trust in vaccines, expertise and traditional sources of authority. Efforts to increase immunization uptake in children in many countries that have seen a fall in vaccination rates are two-fold: addressing hesitancy by improving healthcare professional-parent exchange and information provision in the clinic; and, secondly, public health strategies that can override parental concerns and values with coercive measures such as mandatory and (...) presumptive vaccination. It is argued that such conflicting, parallel approaches seriously risk undermining trust that is crucial for sustaining herd immunity. Although public health strategies can be ethically justified in limiting freedoms, a parent-centered approach seldom acknowledges how it is impacted by contemporaneous coercive measures. In addition, the clinical encounter is not well suited to helping parents consider the public dimensions of vaccination, despite these being important for trust formation and informed decision-making. Efforts to address vaccine hesitancy require more consistent engagement of parental and citizen views. Along with evidence-based information, debates need to be informed by ethical support that equips parents and professionals to respond to the private and public dimensions of vaccination in a more even-handed, transparent manner. Efforts to address vaccine hesitancy need to avoid simple reliance on either parental values or coercive public policies. To do this effectively requires increasing citizen engagement on vaccination to help inform a parent-centered approach and legitimize public policy measures. In addition, cultivating a more ethically consistent strategy means moving beyond the current silos of health ethics - clinical and public health ethics. (shrink)

n this paper, I argue that political solidarity is important to justice. At its core, political solidarity is a relational concept. To be in a relation of political solidarity, is to be in a relation of connection or unity with one’s fellow citizens. I argue that fellow citizens can be said to stand in such a relation when they have attitudes of collective identification, mutual respect, mutual trust, and mutual support and loyalty toward one another. I argue that political solidarity, (...) so conceived, is an integral element of a theory of justice. I argue that there are distinctly social bases for political solidarity and that justice requires that we promote these. Furthermore, as an example of the sort of social and political arrangements that might encourage political solidarity, I discuss Canada’s response to the recent H1N1 pandemic and the failings of this response with respect to members of the Aboriginal community within Canada. I argue that ensuring that members of the Aboriginal community had equal access to the goods they needed to protect themselves against H1N1 infection would have promoted relations of political solidarity and, in turn, would have promoted justice more effectively. (shrink)

It is foundational to ethics and bioethics that individuals will have to make hard decisions, frequently in challenging circumstances. But the scenarios and standard modes of theorizing in bioethics may fail to address important ethical questions, in part because of a paradigmatic focus on individual rights and freedoms in the context of decision making. There is a growing conviction that theorists of ethics and bioethics must reframe our core units of analysis to attend to health in public, collective, relational terms.1 (...) This would involve a move from an approach that focuses primarily on the relation between doctors and patients or between researchers and research subjects to something very different— something .. (shrink)

Stigmatization and sharming of healthcare workers in Japan during the coronavirus 2019 pandemic reveal uniquely Japanese features. Seken, usually translated as ‘social appearance or appearance in the eyes of others,’ is a deep undercurrent woven into the fabric of Japanese life. It has led to providers who become ill with the SARS-CoV-2 virus feeling ashamed, while concealing their conditions from coworkers and public health officials. It also has led to healthcare providers being perceived as polluted and their children being told (...) they were not welcome in schools. Although such experiences are not isolated to Japan and have appeared in other parts of the world, the cultural forces driving them in Japan are unique. Overcoming stigmatization and shaming of Japanese healthcare providers will require concerted efforts to understand cultural barriers and to view such practices as raising human rights issues affecting the safety and well-being of all. (shrink)

For over 100 years, the field of contemporary public health has existed to improve the health of communities and populations. As public health practitioners conduct their work – be it focused on preventing transmission of infectious diseases, or prevention of injury, or prevention of and cures for chronic conditions – ethical dimensions arise. Borrowing heavily from the ethical tools developed for research ethics and bioethics, the nascent field of public health ethics soon began to feel the limits of the clinical (...) model and began creating different frameworks to guide its ethical challenges. Several public health ethics frameworks have been introduced since the late 1990s, ranging from extensions of principle-based models to human rights and social justice perspectives to those based on political philosophy. None has coalesced as the framework of choice in the discipline of public health. This paper examines several of the most-known frameworks of public health ethics for their common theoretical underpinnings and values, and suggests next steps toward the formulation of a single framework. (shrink)

Public health involves the use of power to change institutions and redistribute resources and deliberately to shape individual thought and behavior. This requires normative legitimation and demands ethical critique. This article explores concepts that are vital to public health ethics, but have been relatively neglected. These are membership, solidarity and the concept of place. The article argues that the practice of public health should recognize the equal rights of membership in communities of health justice. Public health should also rely on (...) a sense of obligation and mutual aid in a world of shared vulnerability and reciprocal recognition. Finally, public health achieves its goals not merely—and perhaps not most fundamentally—through information and altering the logical ratiocination of individuals or groups, but rather through the reformation of sense and sensibility. (shrink)

While the effects of COVID-19 are being felt globally, the pandemic disproportionately affects lower- and middle-income countries (LMICs) by exacerbating existing global health disparities. In this article, we illustrate how intersecting upstream social determinants of global health form a disparity pathway that compromises LMICs’ ability to respond to the pandemic. We consider pre-existing disease burden and baseline susceptibility, limited disease prevention resources, and unequal access to basic and specialized health care, essential drugs, and clinical trials. Recognizing that ongoing and underlying (...) disparity issues will require long-term correction efforts, this pathway approach is nonetheless helpful to inform ethical responses to this global pandemic. It can facilitate international cooperation during the pandemic to reduce the disparate burdens among different regions without imposing significant burden on any particular contributor. The pathway approach allows international stakeholders in various social positions to respond to different components of the pathway based on their respective strengths and resources to help break the cycle of global health inequity. Guided by the ethical principles of relational and pragmatic solidarity, we argue for a coordinated global division of labor such that different stakeholders can collaborate to foster equitable healthcare access during this pandemic. (shrink)

In the biomedical and behavioral sciences, it is widely recognized that researchers conducting studies involving human participants must respect the autonomy of research subjects. There is significant debate in the clinical research ethics and bioethics literatures about what it means for an individual to be autonomous. According to proponents of the Liberal Conception of Autonomy, an autonomous person is an agent who has interests and opinions and the capacity to deliberate about them. In contrast, proponents of the Relational Conception of (...) Autonomy argue that because humans are social creatures, autonomy is a relational concept and ought to be recognized as such by medical professionals. In this article, I argue that the LCA/RCA debate is flawed, and that the notion of freedom as non-domination, rather than autonomy, ought to be adopted for biomedical research ethics policies regarding informed consent and research agenda-setting. I then argue that this view of freedom should also be adopted... (shrink)

This study is a contribution to Chinese-Western dialogue of bioethics but perhaps the first one of its kind. From a Chinese-Western comparative ethical perspective, this work brings Chinese ethical theories, especially Confucian ethics, into a contemporary context of the epidemic of HIV/AIDS, and to see how the deeply-rooted thoughts of Confucius interact, compete, or integrate with concepts from Western ethical traditions. An underlying belief is that some ideas in Confucian ethics are important and insightful beyond their cultural and historical origins (...) in China and other Confucianism influenced societies.Methodologically, this thesis employs two approaches, conceptual normative analysis combined with critical interpretation. The ‘interpretive’ approach I employ, as an important methodology supplementing my normative analysis, not only deals with Chinese ancient texts, but also explains specific beliefs and practices in China.With a critical eye, this thesis carefully examines a number of key topics in the ethics of AIDS in China from a cross-cultural perspective. Topics including: views on personhood and the vulnerability of People Living with HIV/AIDS; prioritising and balancing the role of ‘harm reduction’ and the role of ‘eradication of deviant behaviour’ in AIDS policy in China; rights-based opt-out approach and duty-based family-centred approach in HIV testing and Biobanking; blood donation; moral responsibility and personal responsibility for health; and the popular rhetoric of ‘innocent infection’ versus ‘guilty infection’ in AIDS. My overall aim in this work is to present a cross-cultural bioethics study through the investigation of some ethical issues in AIDS in China from a Chinese-Western comparative perspective and also attempt to suggest a humane and effective policy for HIV/AIDS which I believe is appropriate to both traditions. I believe this work has contributed to our knowledge in three related but independent areas: the control of the epidemic of HIV/AIDS in China; medical ethics in China; and to both the methods and the utility of cross-cultural study of bioethics between China and the West. (shrink)

Many legal scholars well recognize that, in some instances, support for a law or policy may be primarily because of its expressive function, i.e. the statements it makes about underlying values. In these cases, the expressive content of a law or policy may actually overshadow its central purpose. Examples of this phenomenon, according to Cass Sunstein, include, for example, regulations against hate speech in the USA. He suggests that achieving the consequence (prohibiting hateful speech against certain groups) may not be (...) the real focus (central purpose) of the law. Rather, the real focus is on the social meaning of these regulations—that bigotry is unacceptable in a liberal society. In this way, a particular law or policy can operate on many levels—while aiming to achieve a particular objective or behavior, it can also be a valuable tool for achieving other important social goals through its expressive function. This article applies this insight to the realm of public health policy, with particular attention to the case of pandemic planning, and suggests that public health policy and its overall goals may be well-served by deliberate regard for, and appropriate utilization of, the expressive function. (shrink)

In this paper, we explore the role of reciprocity in the employment of restrictive measures in contexts of contagion. Reciprocity should be understood as a substantive value that governs the use, level and extent of restrictive measures. We also argue that independent of the role reciprocity plays in the legitimisation the use of restrictive measures, reciprocity can also motivate support and compliance with legitimate restrictive measures. The importance of reciprocity has implications for how restrictive measures should be undertaken when preparing (...) and evaluating public health responses to contagion. (shrink)

The portrayal of novel neurotechnologies in Steven Spielberg’s Minority Report serves to inoculate viewers from important moral considerations that are displaced by the film’s somewhat singular emphasis on the question of how to reintroduce freedom of choice into an otherwise technology driven world. This sets up a crisis mentality and presents a false dilemma regarding the appropriate use, and regulation, of neurotechnologies. On the one hand, it seems that centralized power is required to both control and effectively implement such technologies (...) and, on the other hand, individual heroic resistance is required to protect citizens from the invasions of personal privacy and state control made possible through neurotechnologies. While Minority Report, as a dystopic vision of emergent neurotechnologies, engages surface ethical issues it risks cheapening them through its rather simplistic, dichotomous analysis. Most conspicuously absent from this approach is a sense of the social matrices that work to circumscribe or augment expressions of human freedom, privacy, control and power that are all implicated in our engagement with novel neurotechnologies. Were Minority Report unique in this respect it would have little interest, but we think this type of cheapening of ethical discourse about novel technologies is common. Because science fiction film informs the social imaginary in which ethical considerations and ultimately policy decisions take place, such cheapening risks subverting pervasive and tangible ethical issues by focusing on the sensationalistic and simplistic. (shrink)

The experiences of working-class people and those from communities of color seeking abortions in the United States before and during COVID-19 call for feminist, relational pandemic ethics. Françoise Baylis and colleagues argue for public health ethics that emphasize relational personhood, relational autonomy, social justice, and solidarity. COVID-19 abortion bans in the United States require vigilance against powerful actors who abuse these values—particularly that of solidarity—to further their political, religious, and/or economic agendas in harmful ways. Thus, efforts to promote solidarity during (...) a pandemic must attend to social injustice and systemic oppression and provide resources to vulnerable people. (shrink)

This paper draws on findings from qualitative interviews with queer and trans patients and with physicians providing care to queer and trans patients in Halifax, Nova Scotia, Canada, to explore how routine practices of health care can perpetuate or challenge the marginalization of queers. One of the most common “measures” of improved cultural competence in health care practice is self-reported increases in confidence and comfort, though it seems unlikely that an increase in physician comfort levels with queer and trans patients (...) will necessarily mean better health care for queers. More attention to current felt discomfort in patient–provider encounters is required. Policies and practices that avoid discomfort at all costs are not always helpful for care, and experiences of shared discomfort in queer health contexts are not always harmful. (shrink)

Health has been a focal point in sustainable development policies. Seventeen new goals of sustainable development contribute directly or indirectly to people’s health. Particular emphasis should be laid on health, along with saving lives of poor people. This can be done by effectively creating healthier society for individuals around the world. Sustainable development goals perceive significance value—that is to concentrate on the needs of hindered groups, children, women, and the poorest of poor to attain sustainable development of human ambitions and (...) to confirm a healthier life for all. This paper analyses the issues of public health and sustainable development from an ethical point of view. As ethics deals with what is good or bad, right or wrong, the paper examines the normative aspects of sustainable development with respect to public health. (shrink)

In this paper, I summarize the medical evidence regarding the auditory and non-auditory effects of noise and analyse the ethics of noise and personal autonomy in the social environment using a variety of case studies. Key to this discussion is the fact that, contrary to the traditional definition of noise, sound can be noise without being annoying, as the evidence shows that some sounds can harm without being perceived. Ultimately, I develop a theory of ‘noisy autonomy’ with which to guide (...) us in discussing the public health ethics of noise and other sounds. (shrink)

In this article, we present an ethics framework for health practice in humanitarian and development work: the ethics of engaged presence. The ethics of engaged presence framework aims to articulate in a systematic fashion approaches and orientations that support the engagement of expatriate health care professionals in ways that align with diverse obligations and responsibilities, and promote respectful and effective action and relationships. Drawn from a range of sources, the framework provides a vocabulary and narrative structure for examining the moral (...) dimensions of providing development or humanitarian health assistance to individuals and communities, and working with and alongside local and international actors. The elements also help minimize or avoid certain miscalculations and harms. Emphasis is placed on the shared humanity of those who provide and those who receive assistance, acknowledgement of limits and risks related to the contributions of expatriate health care professionals, and the importance of providing skillful and relevant assistance. These elements articulate a moral posture for expatriate health care professionals that contributes to orienting the practice of clinicians in ways that reflect respect, humility, and solidarity. Health care professionals whose understanding and actions are consistent with the ethics of engaged presence will be oriented toward introspection and reflective practice and toward developing, sustaining and promoting collaborative partnerships. (shrink)

In this paper, I attend to a current strand in bioethics that forwards solidarity as a promising direction for bioethics theory and health-promoting practices. Drawing on resources from social and political philosophy, I argue that we can gain useful insight in bioethics if we understand solidarity as a political relation grounded not on shared social location but rather on shared visions for the sorts of worlds in which collective health and dignity proliferate. I consider what traction this conception of solidarity (...) might give for thinking about social justice issues in the context of political movements for “reproductive justice.”. (shrink)

Philosophical arguments stemming from the public health ethics arena suggest that public health interventions ought to be subject to normative inquiry that considers relational values, including concepts such as solidarity, reciprocity and health equity. As yet, however, the extent to which ‘public’ values influence the ‘autonomous’ decisions of the public remains largely unexplored. Drawing on interviews with 50 men in Vancouver, Canada, this study employs a critical discourse analysis to examine participants’ decisions and motivations to voluntarily access HIV testing and/or (...) to accept a routine HIV test offer. Within a sub-set of interviews, a transactional discourse emerged in which the decision to test features an arrangement of ‘giving and receiving’. Discourses related to notions of solidarity emphasize considerations of justice and positions testing as a ‘public’ act. Lastly, ‘individualistic’ discourses focused on individual-level considerations, with less concern for the broader public ‘good’. These findings underscore how normative dimensions pertaining to men’s decisions to test are dialectically interrelated with the broader social and structural influences on individual and collective health-related behaviour, thereby suggesting a need to advance an explicit empirical-normative research agenda related to population and public health intervention research. (shrink)