Saving as many lives as possible while ensuring equity for vulnerable groups through access to triage resources has been the dominant position since the onset of the COVID-19 pandemic in 2020. However, the exact relationship between the principles of social justice and efficiency remains a controversial and unresolved issue. In this paper, we aim to systematically distinguish between different models of this relationship and show that conceptualizing social justice as a ‘moral side-constraint’ or adopting a ‘balancing approach’ that attempt to (...) reconcile social justice with efficiency inevitably lead to significant moral costs that require further justification. Based on this discussion, we propose a novel “threshold model” for trading-off moral costs. According to this model, the structural impact of triage must be considered in order to determine whether one opts for triage with the primary aim of efficiency or social justice. This contextualization further explains why, in some societies and circumstances, social justice can rightly be seen as the primary concern, while in other societies and circumstances, efficiency can be defended as the primary concern. (shrink)

This article provides ethical guidance on using race in health research as a variable or in defining the study population. To this end, a plain, non-exhaustive checklist is provided for researchers and research ethics committees, preceded by a brief introduction on the need for justification when using race as a variable or in defining a study population, the problem of exoticism, that distinctions pertain between race, ethnicity and ancestry, the problematic naming of races, and that race does not serve well (...) as a presumed biological construct in genetic research. (shrink)

Background: The experience of racism in healthcare is particularly challenging to address due to misunderstandings of the definition, the complex interplay of other potential discriminations and, at some level, the denial that it occurs. Limited studies have reported racism as an aspect of workplace violence toward nurses and nursing students from both patients and staff. Research aims: To understand nursing students’ experience of unethical behaviour, including racism during clinical placement, the perpetrators, impacts, advocating and reporting. Research design: An interpretive, qualitative (...) design was used, and 15 nursing students were interviewed using semi-structured interview guides. The interview recordings were transcribed and thematically analysed. Participants and research context: Nursing students voluntarily participated and completed the interviews for this study from one undergraduate nursing student cohort in metropolitan South Australia. Ethical considerations: This study received ethical approval from the University Social and Behavioural Research Ethics Committee. Findings/results: The two major themes with subthemes of the findings include (1) The multi-faceted student nurse experience of racism: sub themes – racism from patients to nurses, from nurses to nursing students’ and racism towards patients. (2) The pervasive influence and limited reporting of racism by nursing students: sub themes-feeling disempowered, and barriers to reporting racism. Conclusions: The findings of this study highlight the registered nurse students’ experience of racism in various forms within the clinical environment and the significant negative impact it has on RNS during placements. This evidence calls for systemic changes to create a more inclusive and supportive environment for all RNS. (shrink)

Racial bias and language discrimination are recognized in the health sector in countries such as Sri Lanka. This may extend to images used in health communication and educational literature. We analyzed the racial and ethnic representation in a sample of newspapers and websites related to health obtained over a period. Most of the human figures in health-related messages in newspapers had an overrepresentation of Caucasians. This trend was absent in websites where 73% of the images of Sri Lankans. The reasons (...) for this pattern could be due to the availability of image-quality photographs and exposure to a norm that is racially biased. For example, a majority of images in medical textbooks and prestigious journals are of white Caucasians. A predominance of such images could have two impacts. At an individual level, it would affect acquiring skills of visual diagnoses. At a societal level, it may reinforce a view that most forms of health-related knowledge are created in the West and could add to existing discrimination based on skin color (i.e., colorism). The latter is a known psychosocial stressor that contributes to psychological distress among socially disadvantaged populations and promotes behaviors adverse to health and residential segregation. These may contribute to poorer physical, mental, and infant health outcomes in dark-skinned individuals compared to lighter-skinned in the USA and Canada. Such discrimination within the health system would compromise basic human dignity, disempower patients, and violate the principle of autonomy. Sri Lankan media, the healthcare profession, and educationists need to recognize the relevance and importance of using images that appropriately reflect the realities of their own environment, its people, and patients. (shrink)

Les personnes racialisées subissent des dommages excessifs et évitables liés à la consommation de substances, ce qui soulève des questions sur la manière dont la justice doit être recherchée par le biais des politiques de santé. Cette étude de cas vise à montrer comment les perspectives bioéthiques peuvent contribuer à éclairer les approches de la justice raciale dans la prise de décision en matière de politique de santé publique concernant la consommation de substances psychoactives.