In the field of bioethics, scholars have begun to consider carefully the impact of structural issues on global population health, including socioeconomic and political factors influencing the disproportionate burden of disease throughout the world. Human rights and social justice are key considerations for both population health and biomedical research. In this paper, I will briefly explore approaches to human rights in bioethics and review guidelines for ethical conduct in international health research, focusing specifically on health research conducted in resource-poor settings. (...) I will demonstrate the potential for addressing human rights considerations in international health research with special attention to the importance of collaborative partnerships, capacity building, and respect for cultural traditions. Strengthening professional knowledge about international research ethics increases awareness of ethical concerns associated with study design and informed consent among researchers working in resource-poor settings. But this is not enough. Technological and financial resources are also necessary to build capacity for local communities to ensure that research results are integrated into existing health systems. Problematic issues surrounding the application of ethical guidelines in resource-poor settings are embedded in social history, cultural context, and the global political economy. Resolving the moral complexities requires a commitment to engaged dialogue and action among investigators, funding agencies, policy makers, governmental institutions, and private industry. (shrink)

Development is entrenched within a Western, hegemonic framework. This can lead one to wonder if development ethics is, in fact, possible. Too many decisions are made and too many policies dominate an international development agenda that are guided by economic forces and national self-interests. Although development ethics has attempted to break through this situation, it has not had the impact that is needed. The current practice of ethics in development is too weak to have the impact needed to generate truly (...) desirable change. In this paper, I offer some reflections and argue for a strong ethical approach in development. (shrink)

Problem: Medical student mistreatment, as well as patient and staff mistreatment by all levels of medical trainees and faculty, is still prevalent in U.S. clinical training. Largely missing in interventions to reduce mistreatment is acknowledgement of the abuse of power produced by the hierarchical structure in which medicine is practiced. Approach: Beginning in 2001, Yale School of Medicine has held annual “Power Day” workshops for third year medical students and advanced practice nursing students, to define and analyse power dynamics within (...) the medical hierarchy and hidden curriculum using literature, guest speakers, and small groups. During rotations, medical students write narratives about the use of power witnessed in the wards. In response to student and small group leader feedback, workshop organizers have developed additional activities related to examining and changing the use of power in clinical teams. Outcome: Emerging narrative themes included the potential impact of small acts and students feeling “mute” and “complicit” in morally distressing situations. Small groups provided safe spaces for advice, support, and professional identity formation. By 2005, students recognized residents that used power positively with Power Day awards and alumni served as keynote speakers on the use of power in medicine. By 2010, departments including OB/GYN, surgery, psychiatry, and paediatrics, had added weekly team Power Hour discussions. Next Steps: The authors highlight barriers, benefits, and lessons learned. Barriers include the notion of clinical irrelevance and resistance to the word “power” due to perceived accusation of abuse. Benefits include promoting open dialogue about power, fostering inter-professional collaboration, rewarding positive role modelling by residents and faculty, and creating a network of trainee empowerment and leadership. Furthermore, faculty have started to ask that issues of power be addressed in a more transparent way at their level of the hierarchy as well. (shrink)

Medicine increasingly envisions health promotion in terms of reducing risk as determined by quantitative risk factors, such as blood pressure, blood lipids, or genetic variants. This essay argues that this vision of health care as risk reduction is dangerous for Christian bioethics, since risk can be infinitely reduced leading to a self-defeating spiral of iatrogenic effects. Moreover, it endangers character because this vision of health is connected to a reductionist vision of the body and an understanding of individual risk that (...) undermines the more communal virtue of solidarity. The essay concludes by discussing how recent Thomistic analyses in favor of physical enhancements illustrate some of the problems that envisioning health care in terms of risk reduction holds for Christian bioethics. (shrink)

Agro-ecological innovations aim at promoting sustainable agricultural practices that have long term benefits. However, farmers rarely adopt beneficial innovations in agro-ecology despite expressing an understanding of the benefits and a desire to do so. It has been argued that the farmers lack sufficient knowledge to implement complex innovations. We believe that in many cases such knowledge is necessary, but is ultimately insufficient for complex innovation adoption. We argue that in addition to knowledge and a desire to adopt an innovation, many (...) farmers require a collaborative relation with an ally. We call this method the Alliance Approach to innovation. This approach is modeled after the therapeutic Alliance Approach at work in cognitive and behavioral sciences. We argue that using the Alliance Approach will not only prove effective in helping farmers adopt complex agro-ecology innovations, but also a better fit for the human centered development of capability approach human development, as it is likely to enhance both the well-being and agency of the farmers. (shrink)

Although the field of surgical ethics focuses primarily on informed consent, surgical decision‐making, and research ethics, some surgeons have started to consider ethical questions regarding justice and solidarity with poor and minoritized populations. To date, those calling for social justice in surgical care have emphasized increased diversity within the ranks of the surgical profession. This article, in contrast, foregrounds the agency of those most affected by injustice by bringing to bear an ethic of accompaniment. The ethic of accompaniment is born (...) from a theological tradition that has motivated work to improve health outcomes in those at the margins through its emphasis on listening, solidarity against systemic drivers of disease, and proximity to individuals and communities. Through a review of surgical ethics and exploration of a central patient case, we argue for applying an ethic of accompaniment to the care of surgical patients and their communities. (shrink)

There is a proven connection between an individual's social condition and his/her life expectancy and likelihood of contracting diseases. Indeed, a large body of scientific evidence shows that social inequalities, in particular, are the main “cause” of harm to health. The interpretation provided by the theory of specific determinants, according to which health inequalities are caused by lifestyles and a propensity for unhealthy behaviors, has contributed greatly to focusing scholars’ attention on social contexts, believed to influence an individual's inclination/exposure to (...) risk, and therefore, health inequalities. Nevertheless, the theory of the social determinants of health provides a very rigid representation of the factors responsible for health, which are placed in categories with varying levels of centrality. In short, the theory sets out a hierarchy that goes from the general to the particular, with the more external layers influencing the internal layers, but not vice versa. Reciprocal influences among the factors are excluded, as are interactions among the processes that put subjects at risk or protect them. The adopted explicative model is linear, reductionist, and based on a cause-and-effect relationship. However, today we know that interactions between the body, individual, and society are difficult to reconcile with a deterministic view of social inequalities in health; hence, there appears to be an urgent need to formulate hypotheses and develop approaches based on complex strategies regarding the construction of reality. This article sets out a pathway that, starting from the theory of the social determinants of health, goes on to show the necessity of a socio-constructivist approach supported by information and communication technologies. Moreover, it outlines the preconditions of a culture – and communication-based intervention model that can aid institutions in making choices in the field of social architecture that can reduce health inequalities. (shrink)

In Vermont, approximately 1000–1200 migrant workers from Latin America are helping to sustain the state’s dairy industry. These dairy workers, the majority of whom are from Mexico and Guatemala, experience significant mental health impacts stemming from a combination of stressors due to leaving their home of origin and challenges related to working in rural Vermont. This article employs a framework of structural violence and structural vulnerability to situate the lived experiences and health concerns of migrant farmworkers in Vermont’s dairy industry. (...) It presents two case studies of applied projects that have been utilized to address these health concerns, a gardening project called Huertas that addresses issues of food insecurity and barriers in access to fresh and culturally familiar produce, and a participatory comics project called El Viaje Más Caro that aims to address mental health concerns through engaged storytelling and comics production. The authors of this article have designed and carried out these projects with the goal of interrupting the forms of structural violence and structural vulnerability that negatively impact the wellbeing of farmworkers in the state’s dairy industry. This article describes the successes and limitations of these projects with the hope they can be adapted and replicated for other farmworker communities facing similar health barriers. (shrink)

Abstract:This article examines the relationship between philosophy and culture in global bioethics. First, it studies what is meant by the term “global” in global bioethics. Second, the author introduces four different types, or recognizable trends, in philosophical inquiry in bioethics today. The main argument is that, in order to make better sense of the complexity of the ethical questions and challenges we face today across the globe, we need to embrace the universal nature of self-critical and analytical philosophical analysis and (...) argumentation, rather than using seemingly philosophical approaches to give unjustified normative emphasis on different cultural approaches to bioethics. (shrink)

Randomized experiments, as developed by Esther Duflo and Abhijit Banerjee at the Abdul Latif Jameel Poverty Action Lab, offer a novel, evidence-based approach to fighting poverty. This approach is original, in that it imports the methodology of clinical trials for application in development economics. This paper examines the analogy between J-PAL’s field experiments in development economics and randomized controlled trials in medicine. RCTs and randomized field experiments are commonly treated as identical, but such treatment neglects some of the major distinguishing (...) features that make each experiment specifically apt for use in its respective field. The central claim of this paper is that the analogy between medicine and development economics is incomplete because the central dimensions of RCTs are not simply different but altogether lacking in J-PAL’s approach. This weakens both the political and the theoretical power of such experiments in development economics. (shrink)