This chapter concerns the normativity of the concepts of paternalism and libertarian paternalism. The first concept is central in evaluating public health policy, but its meaning is controversial. The second concept is equally controversial and has received much attention recently. It may or may not shape the future evaluation of public health policy. In order to facilitate honest and fruitful debate, I consider three approaches to these concepts, in terms of their normativity. Concepts, I claim, may be considered nonnormative, normatively (...) charged, or normative in that they involve more complex relationships between values or duties. While the last approach is often best, other approaches may be appropriate depending on the context and purpose of discussion. The chapter’s conceptual investigation is illustrated by application to two public health policies: a tax on the consumption of fat and the encouragement of health-promoting food displays in restaurants and supermarkets. (shrink)

Background The field of bioethics has evolved over the past half-century, incorporating new domains of inquiry that signal developments in health research, clinical practice, public health in its broadest sense and more recently sensitivity to the interdependence of global health and the environment. These extensions of the reach of bioethics are a welcome response to the growth of global health as a field of vital interest and activity. Methods This paper provides a critical interpretive review of how the term “global (...) health ethics” has been used and defined in the literature to date to identify ethical issues that arise and need to be addressed when deliberating on and working to improve the discourse on ethical issues in health globally. Results Selected publications were analyzed by year of publication and geographical distribution, journal and field, level of engagement, and ethical framework. Of the literature selected, 151 articles were written by authors in high-income countries, as defined by the World Bank country classifications, 8 articles were written by authors in low- or middle-income countries, and 13 articles were collaborations between authors in HIC and LMIC. All of the articles selected except one from 1977 were published after 1998. Literature on global health ethics spiked considerably from the early 2000s, with the highest number in 2011. One hundred twenty-seven articles identified were published in academic journals, 1 document was an official training document, and 44 were chapters in published books. The dominant journals were the American Journal of Bioethics, Developing World Bioethics, and Bioethics. We coded the articles by level of engagement within the ethical domain at different levels: interpersonal, institutional, international, and structural. The ethical frameworks at use corresponded to four functional categories: those examining practical or narrowly applied ethical questions; those concerned with normative ethics; those examining an issue through a single philosophical tradition; and those comparing and contrasting insights from multiple ethical frameworks. Conclusions This critical interpretive review is intended to delineate the current contours and revitalize the conversation around the future charge of global health ethics scholarship. (shrink)

The most common response to the challenge of protecting health through law is to focus on protecting the rights of vulnerable individuals and to enhance their access to health care. Each one of us is vulnerable or potentially vulnerable because of the fragile, existential nature of the human condition. Catastrophic and unexpected events could instantaneously transform us from a state of total independence and potential vulnerability to one of extreme vulnerability and complete dependence. Some legal provisions have the potential to (...) provide a modicum of protection when we find ourselves in those situations. There are also legal provisions that contribute to beneficial social circumstances; for example, legislation enabling universal access to medical care, and operationalizing respect for the individual’s right to health care, as advocated for by other authors in this issue. (shrink)

Some claim that “global health is public health” but most regard global health as a new field, rapidly emerging mostly at North American academic institutions . The term was first incorporated into University of California, San Francisco’s Institute for Global Health in 1999 and UCSF also inaugurated the first North American master of science in global health in 2009. Global health is commonly acknowledged to have historical precedents in tropical medicine and international health. All three fields are regarded as having (...) some overlapping and some distinctive features . One overlapping feature of all three is retaining traces of European and/or North American conquest, imperialism, and colonialism that create a legacy of ongoing ethical challenges for global health . One touted distinctive feature of global health is its .. (shrink)

The COVID-19 pandemic is affecting countries across the globe. Only a globally coordinated response, however, will enable the containment of the virus. Responding to a request from policy makers for ethics input for a global resource pledging event as a starting point, this paper outlines normative and procedural principles to inform a coordinated global coronavirus response. Highlighting global connections and specific vulnerabilities from the pandemic, and proposing standards for reasonable and accountable decision-making, the ambition of the paper is two-fold: to (...) raise awareness for the justice dimensions in the global response, and to argue for moving health from the periphery to the centre of philosophical debates about social and global justice. (shrink)

In this paper I revisit previous critiques that I have made of much, though by no means all, bioethical discourse. These pertain to faithfulness to dualistic ontology, a taken-for-granted normative anthropocentrism, and the exclusion of a consideration of how political economy shapes the conditions for bioethical discourse (Twine Medicine, Health Care and Philosophy 8(3):285-295, 2005; International Journal of Sociology of Agriculture and Food 16(3):1-18, 2007, 2010). Part of my argument around bioethical dualist ontology is to critique the assumption of a (...) division between the “medical” (human) and “agricultural” (nonhuman) and to show various ways in which they are interrelated. I deepen this analysis with a focus on transnational pharmaceutical companies, with specific attention to their role in enhancing agricultural production through animal drug administration. I employ the topical case of antibiotics in order to speak to current debates in not only the interdisciplinary field of bioethics but also that of animal studies. More generally, the animal-industrial complex (Twine Journal for Critical Animal Studies 10(1):12-39, 2012) is underlined as a highly relevant bioethical object that deserves more conceptual and empirical attention. (shrink)

Over the past decade, global health has emerged as one of the fastest growing academic programs in the United States. Ethics training is cited widely as an essential feature of U.S. global health programs, but generally it is not deeply integrated into the global health teaching and training curricula. A discussion about the pedagogy of teaching global health ethics is long overdue; to date, only a few papers specifically engage with pedagogy rather than competencies or content. This paper explores the (...) value of case study pedagogy for a full-semester graduate course in global health ethics at an American university. I address some of the pedagogical challenges of teaching global health ethics through my innovative use of case study methodology—the “prospective case study”. (shrink)

The last decade has seen an explosion of interest in the health and welfare of marginalized communities around the world. In one striking indicator, public and private development assistance for health programs increased from $8.65 billion in 1998 to $21.79 billion in 2007 [1]. There has been emergent academic interest as well, with growing ranks of undergraduate and graduate students and professionals adopting the field as their specialty. Despite the burgeoning interest, however, much about the field remains unclear. Reimagining Global (...) Health is an important contribution to this budding field for two reasons: it proposes a cohesive introductory text for a field in desperate need of one, and it seeks to “reimagine” some key concepts in global health in an effort to provide a bold new direction for the field. Its stated aim is to move global health from a mere “collection of problems” into an identifiable discipline .As a textbook, the work succeeds admirably. The book .. (shrink)

This article examines two interrelated aspects of Mexican regional music response to the coronavirus crisis in the música huasteca community: the growth of interactive huapango livestreams as a preexisting but newly significant space for informal community gathering and cultural participation at the onset of the coronavirus pandemic, and the composition of original verses by son huasteco performers addressing the pandemic. Both the livestreams and the newly created coronavirus disease verses reflect critical improvisatory approaches to the pandemic in música huasteca. The (...) interactive livestreams signaled an ad hoc community infrastructure facilitated by social media and an emerging community space fostered by Do-It-Yourself activists. Improvised COVID-related verses presented resonant local and regional themes as a community response to a global crisis. Digital ethnography conducted since March 2020 revealed a regional burst of musical creativity coupled with DIY intentionality, a leveling of access to virtual community spaces, and enhanced digital intimacies established across a wide cultural diaspora in Mexico and the USA. These responses were musically, poetically, and organizationally improvisational, as was the overall outpouring of the son huasteco music inspired by the coronavirus outbreak. Son huasteco is a folk music tradition from the Huasteca, a geo-cultural region spanning the intersection of six states in central Mexico. This study examines a selection of musical responses by discussing improvisational examples in both Spanish and the indigenous language Nahuatl, and in the virtual musical communities of the Huasteca migrant diaspora in digital events such as “Encuentro Virtual de Tríos Huastecos,” the “Huapangos Sin Fronteras” festival and competition, and in the nightly gatherings on social media platforms developed during the pandemic to sustain the Huastecan cultural expression. These phenomena have served as vibrant points of transnational connection and identity in a time where physical gatherings were untenable. (shrink)