This chapter explores two questions in detail: How should we determine the threshold for costs that individuals are asked to bear through insurance premiums or care-related out-of-pocket costs, including user fees and copayments? and What is an adequate relationship between costs and benefits? This chapter argues that preventing impoverishment is a morally more urgent priority than protecting households against income fluctuations, and that many health insurance plans may not adequately protect individuals from health care costs that threaten to (...) drop their financial status below a decent minimum. A design that places greater emphasis on preventing impoverishment and finances the achievement of that goal by reducing unnecessary subsidies to better-off households would better accord with a sufficientarian approach to health care. -/- . (shrink)

Antimicrobial resistance is a growing public health concern and is associated with the over- or inappropriate use of antimicrobials in both humans and agriculture. While there has been reco- gnition of this problem on the part of agricultural and public health authorities, there has none- theless been significant difficulty in translating policy recommendations into practical guidelines. In this paper, we examine the process of public health policy development in Quebec agriculture, with a focus on the (...) case of pork production and the role of food animal veterinarians in policy making. We argue that a tendency to employ strictly techno-scientific risk analyses of antimicro- bial use ignores the fundamental social, economic and political realities of key stakeholders and so limits the applicability of policy recommendations developed by government advisory groups. In particular, we suggest that veterinarians’ personal and professional interests, and their ethi- cal norms of practice, are key factors to both the problem of and the solution to the current over-reliance on antimicrobials in food production. (shrink)

Antimicrobial resistance is a growing public health concern and is associated with the over - or inappropriate use of antimicrobials in both humans and agriculture. While there has been recognition of this problem on the part of agricultural and public health authorities, there has nonetheless been significant difficulty in translating policy recommendations into practical guidelines. In this paper, we examine the process of public health policy development in Quebec agriculture, with a focus on the case (...) of pork production and the role of food animal veterinarians in policy making. We argue that a tendency to employ strictly techno- scientific risk analyses of antimicro- bial use ignores the fundamental social, economic and political realities of key stakeholders and so limits the applicability of policy recommendations developed by government advisory groups. In particular, we suggest that veterinarians’ personal and professional interests, and their ethical norms of practice, are key factors to both the problem of and the solution to the current over -reliance on antimicrobials in food production. (shrink)

The policy makers or lawyers may face the need of legal research for reasons. The congressmen may plan to make new laws to address the challenges of their constituent or to the interest of nation. The lawyers may need to serve their clients who like to know the legal issues involved, the strategies to deal with their loss and recovery, and prospect for winning the case if the dispute has gotten worse. The lawyers may practice in a solo business (...) or might work as an associate lawyer in the law firms. A senior lawyer or partner in some cases may like to exploit the junior work force about the problems or grievances from the potential clients. Since he needs to focus their attention on other matters, such as the business expansion of his law firm or more lucrative cases in need of career hands, he may tap the junior lawyer for the legal research, who could assist with the basis of his final legal opinion. The memorandum, opinion letter and brief would be such forms of professional communication for the lawyers and legal researchers. The congressman also can be supplemented with the aid of staffs in terms of his legal expertise and grasp of the issues standing for carrying their responsibility more effectively. For the lawyers and legal researchers, the structure of state and federal legal system is the kind of important variants to orient their work direction and basic frame for the most efficient and adequate scope of search and analysis. The paradigm change also is revolutionary to impact the general base of people. Decades ago, the research or researcher only related with the class of professionals, such as professors, lawyers, career officers and cadres of enterprises. They would enjoy insulation and exploit their research work as an entrance barrier from lay people. Their large shelves at home study or in the room or corner of office thrust an impression that he or she is learned and knowledgeable. This impliedly communicates his or her prestige of social or professional success. The books and articles seem to symbolize a kind of monopoly which bears to exclude unclassified or non-professional workers. The change is remarkable that every citizen could benefit from the on-line sources of information, which, of course, is generally true of professional knowledge. Now professors fear of plagiarism that students often are the kind of suspect. The legal research would turn on the help of digitization which revolutionizes to incur a new mode of research operation. About the query, the citizens and people can readily verify its truth or falsity with one clique within the personal computer. An enormous amount of information is currently flowing on the internet and on-line sources of reference, which shapes an informative and knowledgeable society. As the medical doctors warned decades ago, the precept is any most effective, “forbear from your intelligence or knowledge work for your health.” Many of them now spend long hours a day to satisfy their curiosity and intelligent search. He or she may be well awarded an academic degree if to recognize their hard work on his PC. Nevertheless, this information age does not always bring a positive progress, which arouses the kind of issues, say, right of privacy, on-line fraud. In some cases, this transformation may lead to an inferior attitude of researcher. My today’s experience is one of exotic case. I have received an e-mail from Google CEO stating that I have been selected as one of twelve winners from the pool of Google users. The award money is enormous which stalls me for some time. The authenticity and reliability have hit my head, and I utilized a verification service website managed by the team of lawyers. It costs five dollars and remaining 24 dollars would be processed upon the progress of interaction. I am waiting for an answer from the team. Then the research nowadays is not limited to the basic context of our subsistence, but influences in any depth into the professional lives. (shrink)

Community-based participatory research (CBPR) and community engaged research (CEnR) are key to promoting community and patient engagement in actionable evidence-based strategies to improve research for health equity. Rapid growth of CBPR/CEnR research projects have led to the broad adoption of partnering principles in community-academic partnerships and among some health and academic organizations. Yet, transformation of principles into best practices that foster trust, shared power, and equity outcomes still remain fragmented, are dependent on individuals with long term projects, or (...) are non-existent. This paper describes how we designed our Engage for Equity PLUS intervention that leverages the leadership and membership of champion teams (including community-engaged faculty, community partners and patient advocates) to improve organizational policies and practices to support equity based CBPR/CEnR. (shrink)

Background: Use of patients’ medical data for secondary purposes such as health research, audit, and service planning is well established in the UK. However, the governance environment, as well as public understanding about this work, have lagged behind. We aimed to systematically review the literature on UK and Irish public views of patient data used in research, critically analysing such views though an established biomedical ethics framework, to draw out potential strategies for future good practice guidance and inform ethical (...) and privacy debates. Methods: We searched three databases using terms such as patient, public, opinion, and electronic health records. Empirical studies were eligible for inclusion if they surveyed healthcare users, patients or the public in UK and Ireland and examined attitudes, opinions or beliefs about the use of patient data for medical research. Results were synthesised into broad themes using a framework analysis. Results: Out of 13,492 papers and reports screened, 20 papers or reports were eligible. While there was a widespread willingness to share patient data for research for the common good, this very rarely led to unqualified support. The public expressed two generalised concerns about the potential risks to their privacy. The first of these concerns related to a party’s competence in keeping data secure, while the second was associated with the motivation a party might have to use the data. Conclusions: The public evaluates trustworthiness of research organisations by assessing their competence in data-handling and motivation for accessing the data. Public attitudes around data-sharing exemplified several principles which are also widely accepted in biomedical ethics. This provides a framework for understanding public attitudes, which should be considered in the development in any guidance for regulators and data custodians. We propose four salient questions which decision makers should address when evaluating proposals for the secondary use of data. (shrink)

Globally, the population is ageing, which has serious consequences for businesses. The prosperity of companies is crucially dependent on the ability to effectively manage their employees, including older workers. Best practice in age management is defined as those measures that combat age barriers and/or promote age diversity. These measures may entail specific initiatives aimed at particular dimensions of age management; they may also include more general employment or human resources policies that help to create an environment in which individual employees (...) can achieve their potential without being disadvantaged by their age. Promoting early retirement is generally not encouraged. Companies now have to encourage longer working lives. Much needs to be done to ensure that work remains a positive experience for workers throughout their career trajectories, and it does not damage their health. It has been found by studies that health is significantly related to retirement timing, influences work performance, and health-related organisational policies can positively influence employee retention. The major contemporary challenges to health at work are those associated with the way work, and work organisations are designed and managed. This is especially true for older workers. A comprehensive and effective approach towards age management can be very beneficial for them. How should companies implement age management? Some possible ways are set out in this policy brief below, which focuses on best practices in age management regarding ergonomic aspects and health interventions for older workers at an organisational level. The intention is to discuss the current situation and to illustrate some organisational techniques in selected countries. This policy brief can serve as an inspiration for, among others, companies and policymakers. Recommendations for successful practice are included. In total, this policy brief covers 8 COST member countries to give a glimpse of the current situation of best practice in age management and show how companies in various states deal with ergonomic aspects, health interventions and the ageing of their labour force. (shrink)

Psychological well-being is a major global concern receiving more scholarly attention following the 2008 Great Recession, and it becomes even more relevant in the context of COVID-19 outbreak. In this study, we investigated the impact of economic uncertainty resulting from natural disasters, epidemics, and financial crisis on individuals' mental health. As unemployment rate exponentially increases, individuals are faced with health and economic concerns. Not all society members are affected to the same extent, and marginalized groups, such as those (...) suffering from chronic mental illnesses or low-income families cannot afford the downsizing, mass lay-offs and lack of access to public health services. Psychiatric profession is familiarized with the phenomenon of intolerance of uncertainty (IU), and we examine how this concept is associated with job uncertainty and social identity disturbance. Several studies have formally investigated the effects of IU, but to our knowledge, this is the first research integrating the psychological well-being, job uncertainty and identity disturbance caused by economic breakdown. Literature points to many reported cases of PTSD, anxiety, depression and suicidal tendencies following major social disasters. Yet, we have undertaken to analyze the subjective experiences underlying the self-harming behaviors in an attempt to fill the methodological gap by drawing insights from prominent psychological, sociological and economic theories. We find economic uncertainty to have a positive relation to job uncertainty and identity disturbance, and a negative relationship with psychological well-being. Psychological well-being depends on coherency between both abstract subjective and concrete objective identity, and when these perceptions are inconsistent, cognitive dissonance arises resulting in identity disturbance. We argue that stability is not associated with monetary advantage only, but also with a wide range of other benefits that are crucial for individuals' growth, satisfaction and sense of identity. Therefore, we propose the implementation of social support and public welfare policies to mitigate health risks during the turbulent socio-economic changes. (shrink)

Consistent and well-designed frameworks for ethical oversight enable socially valuable research while forestalling harmful or poorly designed studies. I suggest some alterations that might strengthen the valuable checklist Rattani & Hyder propose for the ethical review of health policy and systems research (HPSR), or prompt future work in the area.

Recently, there has been a concerted effort to shift bioethics’ traditional focus from clinical and research settings to more robustly engage with issues of justice and health equity. This broader bioethics agenda seeks to embed health related issues in wider institutional and cultural contexts and to help develop fair policies. In this paper, we argue that bioethicists who ascribe to the broader bioethics’ agenda could gain valuable insights from the interdisciplinary field of environmental justice and transportation justice, in (...) particular. We then proceed to demonstrate the importance of adopting an intersectional approach to transportation and health. The paper concludes with the argument that intersectional gender inequality is of particular importance when studying both health equity and the unequal distribution of burdens associated with transportation systems in local contexts. This essay is meant to be the beginning of a robust conversation concerning health equity, transportation justice, and intersectional distributions of both benefits and burdens. (shrink)

While there has been significant discussion in the health sciences and ethics literatures about problems associated with publication practices (e.g., ghost- and gift-authorship, conflicts of interest), there has been relatively little practical guidance developed to help researchers determine how they should fairly allocate credit for multi-authored publications. Fair allocation of credit requires that participating authors be acknowledged for their contribution and responsibilities, but it is not obvious what contributions should warrant authorship, nor who should be responsible for the quality (...) and content of the scientific research findings presented in a publication. In this paper, we review arguments presented in the ethics and health science literatures, and the policies or guidelines proposed by learned societies and journals, in order to explore the link between author contribution and responsibility in multi-author multidisciplinary health science publications. We then critically examine the various procedures used in the field to help researchers fairly allocate authorship. (shrink)

Local participation is always beneficial for sustainable action and environmental problems resulting from urban implementation due to the failure of social and institutional change necessary for a successful transformation of rural life to urban life ahead of the rapid movement of the population. Despite good legal practice and comprehensive guidelines, evidence suggests that Environmental Impact Assessment (EIA) or more broadly Environmental, Social and Health Impact Assessment (ESHIA) have not yet been found satisfactory in Nigeria, as the current system amounts (...) to duplication of efforts and cost. However, ESHIA has been developed and integrated to help manage project activities, facilities, and operations sustainably, so that both economic and ecological profits are accrued (sustainable development) or ensure that any development project does not result in excessive deterioration of and/or the irreversible adverse effect on any component of the environment – a recite for sustainable development. A literature review was done by using a variety of search engines including Research Gate, Google Scholar, Academia, Mendeley, SSRN search strategy to retrieve research publications, “grey literature” and expert working group reports. The thrust of this study is to evaluate the potential benefits of ESHIA as a tool for sustainable environmental development. The evaluation and implementation of EIA are one of the strengths of these tools. Indeed, EIA is the first and foremost management tool employed to help mitigate adverse, potential, and associated impacts of proposed major developments in our environment. EIA is a regulatory requirement that is efficiently used to improve performance, project design, enhancing decision-making, and facilitating policy programs in a sustainable environment. An evaluation of the EIA systems reveals several weaknesses of the EIA system. These include the inadequate capacity of EIA approval authorities, deficiencies in screening and scoping, poor EIA quality, insufficient public participation, and weak monitoring, and erratic government policies. Overall, most EIA study rarely meets the objectives of being a project planning tool to contribute to achieving sustainable development and mitigate the impact of the development project. The study recommends some directions for the future to ensure that entire content of the EIA are religiously implemented, review the existing EIA act, increase the expertise of EIA consultants, create a liaison office with an international organisation and with sister agency, ESHIA must enjoy Improved budgetary provision, time latitude, spatial contexts and methodological improvements for outcome measures to achieve results that are relevant to sustainable development by improving project design, enhancing decision making and facilitating policy programs. (shrink)

Several attempts have been made to apply the choice-sensitive theory of distributive justice, luck egalitarianism, in the context of health and healthcare. This article presents a framework for this discussion by highlighting different normative decisions to be made in such an application, some of the objections to which luck egalitarians must provide answers and some of the practical implications associated with applying such an approach in the real world. It is argued that luck egalitarians should address distributions of (...) class='Hi'>health rather than healthcare, endorse an integrationist theory that combines health concerns with general distributive concerns and be pluralist in their approach. It further suggests that choice-sensitive policies need not be the result of applying luck egalitarianism in this context. (shrink)

KEY POINTS In Canada, commercial data brokers collect deidentified patient data from pharmacies, private drug insurers, the federal government and medical clinics without patient consent. Although pharmaceutical companies are the data brokers’ primary customers, academics and nonprofit and public entities also use commercial data sets, given the absence of a coordinated public approach to collecting these data across Canada. Risks of commercialized patient data include loss of anonymity, surveillance and marketing, discrimination and violation of Indigenous data sovereignty. Coordinated infrastructure for (...) the collection and coordination of health data across Canada and updated privacy legislation would protect individuals and communities and enable appropriate data uses. (shrink)

Developing countries have seen rapid economic growth, but they have also faced unprecedented environmental challenges, including air pollution, water pollution, land pollution, waste pollution, etc. Take air pollution as an example. It is alarming that 99 percent of the world’s population breathes polluted air. Air pollution is deemed a “quiet killer”, giving rise to numerous consequences ranging from health and psychological impacts to economic and social costs. For example, air pollution annually causes roughly 7 million premature deaths and an (...) economic loss of USD 8.1 trillion, accounting for 6.1% of the global GDP. Furthermore, it is worth noting that the urban population is projected to exceed two-thirds of the total global population by 2050, as urbanization exacerbates the air pollution problem, creating even more air pollution challenges for humankind in the long run. Every new piece of information matters for scientific progress in air pollution assessment, policymaking, and public health protection. From this viewpoint, the goal/objective of this Special Issue (SI) of Urban Science is to keep communities, scholars, and policymakers informed on the research progress on air quality and human health. Specifically, this SI serves as a forum for advancing scientific understanding of environmental changes associated with air pollution and air quality, strategies and/or different measures that the public, particularly urban residents, can employ to lessen and/or mitigate unexpected impacts. I hope that the useful information and insightful findings presented by scholars in this SI can support or facilitate desirable urban environment policies that help, ultimately, increase human and societal wellbeing. (shrink)

Abstract The present paper examines the role of epistemic virtues in the formation of intellectual identity and its impact on improving our truth-seeking behaviors. A epistemic virtue is a special faculty or trait of a person whose operation makes that person a thinker, believer, learner, scholar, knower, cognizer, perceiver, etc., or causes his intellectual development and perfection, and improves his truth-seeking and knowledge-acquiring behaviours and places him on the path to attain understanding, perception and wisdom. Virtue epistemology is a set (...) of approaches in contemporary epistemology that regards knowledge as "a true belief arising from humans epistemic virtues." Virtue responsibilism and Virtue reliabilism are two important approaches to virtue epistemology that differ together in their attitude to the nature of epistemic virtue. Responsibilisms regards epistemic virtues as an acquired character traits that must be attained through practice and training with plenty of effort from the agent who possesses the will. In contrast, virtue reliabilisms considers epistemic virtues as reliable and innate cognitive faculties, and believes that this natural faculties has been placed in the human being from the very beginning and, if used in the appropriate condition and in a proper environment, is reliably truth-conducive. So virtue epistemology, which is distinguished from belief-based analytical epistemology by focusing on the cognitive character of the agent rather than the belief, regards epistemic virtues as the constructive factor of the epistemic agent and the condition of reaching the truth. From the two approaches of virtue reliabilism and virtue responsibilism, this paper focuses on the second approach and with using of the nine-fold virtues, that Jason Baehr posed, shows how to make epistemically good and thinker human by utilizing these virtues and avoiding the corresponding vices and through this, gained the truth in various epistemic areas. After explaining these virtues and their role in the two mentioned domains based on the virtue epistemology, the significance of this relationship in the view of Mulla Sadra as an example of Islamic philosophy is examined, For the reason that he sees knowledge as the produce of some factors that epistemic virtues is considered part of them. In the view of Sadra, epistemic virtues is the specific attributes and traits of reason faculty that their function causes man to be a very good and strong perciever, and their actual possesion or their gradual acquisition leads to the perfection of the soul and the dignity of human existence. In a new theory of soul-  Ph.D. Student of Islamic Philosophy and Theology, Qom University, Qom, Iran (Responsible author) [email protected]  Associate Professor of Islamic Philosophy and Theology, Qom University, Qom, Iran. [email protected]  Professor of Islamic Philosophy and Theology, Qom University, Qom, Iran. [email protected] 2/ Comparative Theology, Vol: 9, No: 19, Spring & Summer 2018 knowledge, he considers the journey of the soul from the outset as evolutionary journey, and, on the other hand, he considers all human activities directly as an activity of the soul (epistemic agent), which he performs through his own faculties. As a result, the soul is a increasing and evolving being, while at the same time acquiring knowledge is also from its own activities, and therefore the factors that make up the soul are also influential in its products. Now, as knowledge comes from soul exposure to the outside world, the more this soul is refined from pollutions and adorned to virtues, the better reflection from reality will be. Undoubtedly, the desire to engage in the process of truth-seeking and the responsible use of cognitive virtues and skills lead man to a desirable goal (recognition of truth) and forms his true intellectual identity. In the end, the paper suggests that because of the importance of epistemic virtues in the improvement of truth-seeking behaviors, educating and cultivating of these types of virtues should be part of the spoken and written course content of universities and schools, and must be proper critical thinking is institutionalized and strengthened in the spirit of community members. Educational resources contain a wide range of information that can deeply influence our epistemic behaviors and actions. Hence, it is necessary to include praised cognitive skills and epistemic virtues training in them. Teachers play an important role in educating and developing epistemic virtues as part of the formal curriculum content of educational centers, perhaps as part of critical thinking and logic courses. The formal education of epistemic virtues and the creation of opportunities for practicing and exercising them will be a good starting point for institutionalizing and developing admired cognitive skills among members of the community. In a society where individuals in their epistemic processes use their own cognitive virtues and organize their beliefs on their basis, the community itself and the social relations will also be virtuous, because the necessity of such an virtues is that individuals interact with their peers and In these interactions, rule virtue. Observing fairness towards others, intellectual humility, intellectual generosity, courage against miscreant and one who has weak arguments, observance of neutrality and other epistemic virtues, if it is to be found in societies as a habit and praised skill, then that society will be virtuous and its relations will be healthier and with the cultivating of those virtues, Intellectual and moral development will also become easier and more common. Intellectual virtues (or praised cognitive skills) should be taught to the community members, so that they display such characteristics when engaging in social activities, whean expressing opinions, when doing research, and so on. It is important to change our education policies, because the decay of praised cognitive skills leads to devastating consequences for intellectual identity and the truth-seeking and knowledgeacquiring behavior of the community members. (shrink)

While a plethora of studies has been conducted to examine stress and its impact on mental health in western countries, research is scarce investigating the relationship between student challenge stress and health illness in the context of Chinese colleges. No studies examined the moderating effect of self-efficacy on the relationship between challenge stress and health illness. This study attempted to investigate the relationships between these three variables among Chinese college students. Especially, this study focused on examining whether (...) self-efficacy moderated the effect of perceived challenge stress on students’ mental health. Also, the differences were tested between male and female students in terms of these three variables. A sample of 578 Chinese college students was recruited over an approximately 12-week period from 7 Chinese universities. An online survey link was distributed through WeChat. The SPSS version 26 software was used to analyze the data. Results showed that there is no significant difference between genders in terms of perceived challenge stress, self-efficacy, and students’ mental health. In addition, challenge stress was positively related to the students’ mental health (β = 0.35, p < 0.01) while there was a negative association between self-efficacy and mental health (β = -0.41, p < 0.01). Furthermore, self-efficacy plays a moderating role in the relationship between challenge stress and mental health (β = -0.11, p = 0.02). Students with low self-efficacy tend to experience more mental health issues. It is suggested that Chinese colleges and universities pay more attention to students with low self-efficacy, either through faculty/staff interventions or peer counseling. Professors consider reducing students’ academic stress to improve their mental health. (shrink)

Recent epidemiological reports of associations between socioeconomic status and epigenetic markers that predict vulnerability to diseases are bringing to light substantial biological effects of social inequalities. Here, we start the discussion of the moral consequences of these findings. We firstly highlight their explanatory importance in the context of the research program on the Developmental Origins of Health and Disease (DOHaD) and the social determinants of health. In the second section, we review some theories of the moral status of (...) health inequalities. Rather than a complete outline of the debate, we single out those theories that rest on the principle of equality of opportunity and analyze the consequences of DOHaD and epigenetics for these particular conceptions of justice. We argue that DOHaD and epigenetics reshape the conceptual distinction between natural and acquired traits on which these theories rely and might provide important policy tools to tackle unjust distributions of health. (shrink)

In the United States, prohibitionist policies are used as the primary approach to combat the negative effect of substance use on society. An extensive academic literature spanning the disciplines of economics, political science, and multiculturalism documents the great social costs of the United States’ “War on Drugs” both nationally and internationally. These costs come with at best marginal effect on substance abuse and other crimes linked to the drug trade. In many cases, there is a reason to believe that these (...) policies exacerbate the problems they aim to address. This article explores psychologists’ ethical commitments to social change concerning such drug policy, given the field of psychology’s expanding commitment to social justice. We examine arguments regarding the boundaries between psychologists’ personal and professional ethics with regard to political participation. Using drug prohibition as an exemplar, we suggest that many psychologists’ political actions and professional ethics may be misaligned. Ultimately, we conclude that the endorsement of prohibitionist drug policies is in direct conflict with the guiding ethical principles put forth by the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct. (shrink)

Type 1 diabetes (T1D) is a chronic illness that requires intensive lifelong management of blood glucose concentrations by means of external insulin administration. There have been substantial developments in the ways of measuring glucose levels, which is crucial to T1D self-management. Recently, continuous glucose monitoring (CGM) has allowed people with T1D to keep track of their blood glucose levels in near real-time. These devices have alarms that warn users about potentially dangerous blood glucose trends, which can often be shared with (...) ther people. CGM is consistently associated with improved glycemic control and reduced hypoglycemia and is currently recommended by doctors. However, due to the costs of CGM, only those who qualify for hospital provision or those who can personally afford it are able to use it, which excludes many people. In this paper, I argue that unequal access to CGM results in: (1) unjust health inequalities, (2) relational injustice, (3) injustice with regard to agency and autonomy, and (4) epistemic injustice. These considerations provide prima facie moral reasons why all people with T1D should have access to CGM technology. I discuss the specific case of CGM policy in the Netherlands, which currently only provides coverage for a small group of people with T1D, and argue that, especially with additional considerations of cost-effectiveness, the Dutch government ought to include CGM in basic health care insurance for all people with T1D. (shrink)

Background: Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims: We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical (...) support for gender diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH’s worldwide mission and scope. Method: This article employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results: The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion: We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound. (shrink)

This thesis under the title “Public Health Policy in Resource Allocation: the Role of Ubuntu Ethics in Redressing Resource Disparity between Public and Private Healthcare in South Africa” explores health care disparities pertaining to resource allocation between public and private sector. It is of relevance and importance in South Africa where 54% of the population live on less than US$3 per day. Although the government has instituted certain changes aimed at transforming the public health care system, (...) the resource allocation gap between the two persists and remains wide. The research gives special attention to the role that Ubuntu ethics can play in redressing the resource allocation disparities between public and private health care sectors in South Africa, pointing out the existing gap in financing, as well as human resource between public and private health care sectors, which leads to poor health outcomes in public sector. Therefore, the problem is the prevalent inequality of resource allocation between private and public health care sectors. The analysis of policy gaps, as well as evaluating the cause of disparities in the health system is the goal of this research. The study endeavours to redress the disparities within the context of Ubuntu ethical principles and proposes a change in public policy so as to enhance healthcare for the benefit of the people. The study is philosophical and ethical, so the methodology used is discursive in nature, majorly focusing on critically reviewing existing literature, that is, the philosophical resources on Ubuntu ethics and justice theories as well as a range of government resources inclusive of public health policy documents. Social determinants of health and their impact in a South African context are discussed with the implication that health is not merely freedom from disease and or incapacity, but rather being well mentally, physically and socially. The attainment of a healthy status goes beyond ability to access healthcare services, and incorporates social determinants including but not limited to conditions in which people have been born into, stay, establish career and grow old in. It also includes the arrangements put in place to deal with illness and determine health. Issues of revenue, literacy, communal safety networks, vocation and conditions under-which vocation is undertaken, lack of work and vocation insecurity, early stages of human development, gender, cultural group, dietary insecurity, housing communal exclusion and disability all come into the picture as factors that determine health. But there is also discussion of the socio-economic status as contributors to health inequity wherein alcohol abuse, sugar intake, and smoking are identified as behavioural factors that complicate public health. One outstanding feature of this research is that it establishes a link between Ubuntu and public health policy. The researcher establishes that Ubuntu ethics is appropriate for not only discussing public morality, but also for formulating public policy that is morally tenable for South Africa, especially for the public health sector. This thesis calls for an application of Ubuntu in a proper context in order to enhance societal well-being for the benefit of many, if not all. The research proposes the fundamental principle of Ubuntu ethics in which the good of the community is as important as the good of every member of the community. Since Ubuntu ethics does not merely seek to fulfil what benefits the majority, as would be the case in a utilitarian society, the researcher advocates for the building of consensus on the common good, which should be understood to imply not just what is good for everyone in the community, but also what is good for the continued well-being of the community as a single unit. In this regard, the research finds it important that deliberate effort be made to integrate Ubuntu ethics into policies, citing the example of the National Health Insurance (NHI). The good health of all the members of a community is an assurance of the well-being and continuity of the whole national community. The research concludes that public health policy should integrate Ubuntu ethical values such as community, sharing, care, solidarity, identity, harmony, respect, and dignity into policy documents and legislation. (shrink)

Effective stakeholder engagement and inclusive governance are essential for effective and equitable ocean management. However, few cross-national studies have been conducted to examine how stakeholders’ economic and cultural benefit perceptions influence their support level for policies focused on ocean preservation. The current study aims to fill this gap by employing the Bayesian Mindsponge Framework (BMF) analytics on a dataset of 709 stakeholders from 42 countries, a part of the MaCoBioS project funded by the European Commission H2020. We found that economic (...) and cultural benefit perceptions are generally negatively associated with the policy support level. Regarding economic aspects, stakeholders considering transportation and shipping, renewable energy generation, and oil and gas provision as the most crucial benefits their countries’ oceans provide tend to obtain less support for policies focusing on ocean preservation. Meanwhile, for cultural aspects, perceiving recreation and tourism, aesthetic pleasure, mental health and well-being support, and sense of identity provision as the most important benefits provided by the country’s ocean are negatively associated with the policy support level. The perceived economic, cultural, and environmental tradeoffs when supporting policies focused on ocean preservation were discussed. Recommendations for improving the effective management of multi-use marine space are also provided to reduce the perceived competing interests among stakeholders. (shrink)

This dissertation aimed to examine the consequence of health-induced poverty and two policy responses to address this issue among older adults in the United States and China. Specifically, Paper I investigates whether public transfers crowded out private transfers among rural and urban Chinese older families and if this dynamic would change when health care expenses were high. Paper II examines the effect of New Rural Cooperative Medical Insurance, a national health insurance program for rural residents in (...) China, on changing the incidence of health-induced poverty among middle-aged and older beneficiaries. Paper III tests the effects of closing the Medicare Part D donut hole (coverage gap) through the Affordable Care Act (ACA) on changing prescription drug cost-induced poverty. Overall, the findings obtained from these three papers provide empirical evidence that health-induced poverty is prevalent among older adults in both China and the United States and the current public transfers and health policies are either ineffective or insufficient to reduce health-induced poverty as intended. (shrink)

Dear Colleagues, -/- In this editorial, we would like to share with you important developments in the European Journal of Therapeutics (Eur J Ther). -/- First of all, as the editorial team, we would like you to know that we hold frequent meetings to benefit our esteemed colleagues and continue to work with great devotion in line with our goal of taking the journal further. We have previously shared with you that we have applied to many indexes. It is with (...) great pleasure that we would like to inform you that in the last few months, more of our index applications have been approved. -/- Index Copernicus, as a result of this application, the ICV 2022 value of our journal was determined to be 100 (approved 2023-10-31) [1] BASE (Bielefeld Academic Search Engine) (approved 2023-11-30) [2] Sherpa Romeo (approved 2023-09-27) [3] MIAR (approved 2023-10-16) [4] -/- All indexes in our journal are currently included on the journal web page [5]. -/- As the editorial team, we would like to inform you that we have determined a policy on this issue for our journal [6], taking into account the recommendations of important international ethics committees such as the Committee on Publication Ethics (COPE) [7] and the World Association of Medical Editors (WAME) [8], which have recently become a trendy topic of discussion about AI chatbots and academic studies prepared with the support of such tools. -/- As you know, when our journal was founded in 1990 [9], it was published in two yearly issues. It is an essential responsibility for us to carry our journal, which continued its publication life with three issues a year in 2009 [10] and four issues a year in 2014 [11]. With your valuable support, we would like to announce that we will increase our journal to 6 issues a year as of 2024 (February, April, June, August, October and December) with the rapidly growing progress of our journal. -/- Unfortunately, we cannot share the names of the referees who made significant contributions to our journal in 2023 due to the changes in the article submission interface during the year and the inaccessibility of some data in the previous interface. However, we would like to emphasize again that we are grateful to all of them for their valuable contributions. Moreover, to expand our journal's referee list, we would like to remind you that competent academics who volunteer in this regard can fill out the “Become a Reviewer for the European Journal of Therapeutics” form [12]. -/- Finally, we would like to point out that we have strengthened our editorial team with an academician competent in dentistry, Fatih Sari, DDS, PhD. -/- Fatih Sari, DDS, PhD, is a new Editorial Board Member of the Eur J Ther. Dr. Sari is an Associate Professor in the Department of Prosthodontics at the Gaziantep University Faculty of Dentistry. He is a Vice Dean of the Faculty of Dentistry and Head of Clinical Departments. Dr. Sari is a prosthodontist and a member of the Turkish Dental Association. He has experience in implant-supported fixed prostheses, Cad/Cam applications and dental materials. -/- We look forward to being able to offer you a large number of high-quality and valuable articles over the coming year. In addition, we would like to thank the readers, authors and reviewers of the Eur J Ther for their continuous support. -/- Sincerely yours,. (shrink)

Objective: To assess the relation between autocratisation—substantial decreases in democratic traits (free and fair elections, freedom of civil and political association, and freedom of expression)—and countries’ population health outcomes and progress toward universal health coverage (UHC). -/- Design: Synthetic control analysis. -/- Setting and country selection: Global sample of countries for all years from 1989 to 2019, split into two categories: 17 treatment countries that started autocratising during 2000 to 2010, and 119 control countries that never autocratised from (...) 1989 to 2019. The treatment countries comprised low and middle income nations and represent all world regions except North America and western Europe. A weighted combination of control countries was used to construct synthetic controls for each treatment country. This statistical method is especially well suited to population level studies when random assignment is infeasible and sufficiently similar comparators are not available. The method was originally developed in economics and political science to assess the impact of policies and events, and it is now increasingly used in epidemiology. -/- Main outcome measures: HIV-free life expectancy at age 5 years, UHC effective coverage index (0-100 point scale), and out-of-pocket spending on health per capita. All outcome variables are for the period 1989 to 2019. -/- Results: Autocratising countries underperformed for all three outcome variables in the 10 years after the onset of autocratisation, despite some improvements in life expectancy, UHC effective coverage index, and out-of-pocket spending on health. On average, HIV-free life expectancy at age 5 years increased by 2.2% (from 64.7 to 66.1 years) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by 3.5% (95% confidence interval 3.3% to 3.6%, P<0.001) (from 64.7 to 66.9 years) in the absence of autocratisation. On average, the UHC effective coverage index increased by 11.9% (from 42.5 to 47.6 points) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by 20.2% (95% confidence interval 19.6% to 21.2%, P<0.001) (from 42.5 to 51.1 points) in the absence of autocratisation. Finally, on average, out-of-pocket spending on health per capita increased by 10.0% (from $4.00 (£3.1; €3.4) to $4.4, log transformed) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by only 4.4% (95% confidence interval 3.9% to 4.6%, P<0.001) (from $4.0 to $4.2, log transformed) in the absence of autocratisation. -/- Conclusions: Autocratising countries had worse than estimated life expectancy, effective health service coverage, and levels of out-of-pocket spending on health. These results suggest that the noticeable increase in the number of countries that are experiencing democratic erosion in recent years is hindering population health gains and progress toward UHC. Global health institutions will need to adjust their policy recommendations and activities to obtain the best possible results in those countries with a diminishing democratic incentive to provide quality healthcare to populations. (shrink)

The rapidly declining biosphere integrity, representing one of the core planetary boundaries, is alarming. One of the most widely accepted measures to halt the rate of biodiversity loss is to maintain and expand protected areas that are effectively managed. However, it requires substantial finance derived from nature-based tourism, specifically visitors from urban areas. Using the Bayesian Mindsponge Framework (BMF) on 535 Vietnamese urban residents, the current study examined how their biodiversity loss perceptions can affect their willingness to pay for the (...) entrance fee and conservation in protected areas. We found that perceived environmental degradation, loss of economic growth, loss of nature-based recreation opportunity, and loss of knowledge as consequences of biodiversity loss has indirect effects on paying willingness through the mediation of the attitude towards conservation. Especially, the perceived knowledge loss also has a direct positive influence on the willingness to pay for the entrance fee and conservation. In contrast, perceived loss of health is negatively associated with the attitude towards conservation. Based on these findings, we suggest that building an eco-surplus culture among urban residents can be a promising way to generate more finance from nature-based tourism for conservation in protected areas and ease the domestic government's and international organizations' funding allocations problems. (shrink)

New York City has extensive public health regulations. Some regulations aim to reduce smoking, and they include high cigarette taxes and bans on smoking in public places such as bars, restaurants, public beaches, and public parks. Other regulations aim to combat obesity. They include regulations requiring display of calorie information on some restaurant menus and the elimination of transfats in much public cooking. One important issue is whether New York City officials -- including both public health officials and (...) other city officials -- have adequately explained the justification to the public. Explanation has practical importance; the public might not back controversial and restrictive regulations unless offered a good rationale. But explanation is also an official duty, since public officials should make their reasoning transparent to their constituents. This article argues that New York City has not adequately communicated the rationales for its regulations to the public. It then offers several suggestions for improving public communication. After laying out those suggestions, this article points out that even if communication were improved, New York City’s regulations would still raise difficult philosophical issues. Those issues are briefly discussed in the final sections. NOTE: this is a reprint of a conference presentation. (shrink)

“Proof of concept” is a phrase frequently used in descriptions of research sought in program announcements, in experimental studies, and in the marketing of new technologies. It is often coupled with either a short definition or none at all, its meaning assumed to be fully understood. This is problematic. As a phrase with potential implications for research and technology, its assumed meaning requires some analysis to avoid it becoming a descriptive category that refers to all things scientifically exciting. I provide (...) a short analysis of proof of concept research and offer an example of it within synthetic biology. I suggest that not only are there activities that circumscribe new epistemological categories but there are also associated normative ethical categories or principles linked to the research. I examine these and provide an outline for an alternative ethical account to describe these activities that I refer to as “extended agency ethics”. This view is used to explain how the type of research described as proof of concept also provides an attendant proof of principle that is the result of decision-making that extends across practitioners, their tools, techniques, and the problem solving activities of other research groups. (shrink)

Epistemic consequentialism is the view that epistemic goodness is more fundamental than epistemic rightness. This paper examines the relationship between epistemic consequentialism and theistic belief. I argue that, in an epistemic consequentialist framework, there is an epistemic reason to believe in God. Imagine having an unlimited amount of time to ask an omniscient being anything you wanted. The potential epistemic benefits would be enormous. Considerations like these point to an epistemic version of Pascal’s wager. I compare and contrast the epistemic (...) wager with the traditional wager, and argue that the epistemic wager has several notable advantages. (shrink)

A simple argument proposes a direct link between realism about quantum mechanics and one kind of metaphysical holism: if elementary quantum theory is at least approximately true, then there are entangled systems with intrinsic whole states for which the intrinsic properties and spatiotemporal arrangements of salient subsystem parts do not suffice. Initially, the proposal is compelling: we can find variations on such reasoning throughout influential discussions of entanglement. Upon further consideration, though, this simple argument proves a bit too simple. To (...) get such metaphysically robust consequences out, we need to put more than minimal realism in. This paper offers a diagnosis: our simple argument seems so compelling thanks to an equivocation. The predictions of textbook quantum theory already resonate with familiar holistic slogans; for realists, then, any underlying reality, conforming to such predictions, also counts as holistic in some sense or other, if only by association. Such associated holism, though, does not establish the sort of specific, robust supervenience failure claimed by our simple argument. While it may be natural to slide to this stronger conclusion, facilitating the slide is not minimal realism per se but an additional explanatory assumption about how and why reality behaves in accordance with our theory: roughly, quantum theory accurately captures patterns in the features and behaviors of physical reality because some underlying metaphysical structure constrains reality to exhibit these patterns. Along with the diagnosis comes a recommendation: we can and should understand one traditional disagreement about the metaphysics of entanglement as another manifestation of a familiar and more general conflict between reductive and non-reductive conceptions of metaphysical theorizing. Such reframing makes clearer what resources reductionists have for resisting the simple argument’s challenge from quantum holism. It also has an important moral for their opponents. Traditional focus on whole-part supervenience failure distracts from a root disagreement about metaphysical structure and its role in our theorizing. Non-reductionists fond of our simple argument would be better off tackling this root directly. (shrink)

In the wake of the advent of genome editing technology CRISPR-Cas9 (clustered regularly interspaced palindromic repeat (CRISPR)-associated protein 9), there has been a global debate around the implications of manipulating the human genome. While CRISPR-based germline gene editing is new, the debate about the ethics of gene editing is not – for several decades now, scholars have debated the ethics of making heritable changes to the human genome. The arguments that have been raised both for and against the use of (...) genetic technologies in human reproduction reiterate much of the arguments made in the pre-CRISPR debate. As such, it is instructive for South Africa to reflect on these arguments now, in considering our position on the regulation of the use of this novel biotechnology. There are two dominant schools of thought in this area, bioliberalism and bioconservatism. Bioconservatives raise concerns about the risks of genetic manipulation, and argue that it ought to be limited or prohibited to avert these risks to human health and human nature. Bioliberal scholars are more open to the prospect of genetic manipulation, because of its potential utility. In this article, I conclude that in liberal democracies such as our own, bioliberal arguments ought to be seriously considered when formulating policy on human genome editing because of the extent to which they resonate with our Constitutional values and human rights. I further suggest that there is a need for an enquiry into the relevance of African perspectives on the ethical questions that arise concerning germline genome editing. (shrink)

Patients with serious illnesses or injuries may decide to quit their medical treatment if they think paying the fees will put their families into destitution. Without treatment, it is likely that fatal outcomes will soon follow. We call this phenomenon “near-suicide”. This study attempted to explore this phenomenon by examining how the seriousness of the patient’s illness or injury and the subjective evaluation of the patient’s and family’s financial situation after paying treatment fees affect the final decision on the treatment (...) process. Bayesian Mindsponge Framework (BMF) analytics were employed to analyze a dataset of 1042 Vietnamese patients. We found that the more serious the illnesses or injuries of patients were, the more likely they were to choose to quit treatment if they perceived that paying the treatment fees heavily affected their families’ financial status. Particularly, only one in four patients with the most serious health issues who thought that continuing the treatment would push themselves and their families into destitution would decide to continue the treatment. Considering the information-filtering mechanism using subjective cost–benefit judgments, these patients likely chose the financial well-being and future of their family members over their individual suffering and inevitable death. Our study also demonstrates that mindsponge-based reasoning and BMF analytics can be effective in designing and processing health data for studying extreme psychosocial phenomena. Moreover, we suggest that policymakers implement and adjust their policies (e.g., health insurance) following scientific evidence to mitigate patients’ likelihood of making “near-suicide” decisions and improve social equality in the healthcare system. (shrink)

Patients with serious illnesses or injuries may decide to quit their medical treatment if they think paying the fees will put their families into destitution. Without treatment, it is likely that fatal outcomes will soon follow. We call this phenomenon “near-suicide”. This study attempted to explore this phenomenon by examining how the seriousness of the patient’s illness or injury and the subjective evaluation of the patient’s and family’s financial situation after paying treatment fees affect the final decision on the treatment (...) process. Bayesian Mindsponge Framework (BMF) analytics were employed to analyze a dataset of 1042 Vietnamese patients. We found that the more serious the illnesses or injuries of patients were, the more likely they were to choose to quit treatment if they perceived that paying the treatment fees heavily affected their families’ financial status. Particularly, only one in four patients with the most serious health issues who thought that continuing the treatment would push themselves and their families into destitution would decide to continue the treatment. Considering the information-filtering mechanism using subjective cost–benefit judgments, these patients likely chose the financial well-being and future of their family members over their individual suffering and inevitable death. Our study also demonstrates that mindsponge-based reasoning and BMF analytics can be effective in designing and processing health data for studying extreme psychosocial phenomena. Moreover, we suggest that policymakers implement and adjust their policies (e.g., health insurance) following scientific evidence to mitigate patients’ likelihood of making “near-suicide” decisions and improve social equality in the healthcare system. (shrink)

The value of health states is often understood to depend on their impact on the goodness of people's lives. As such, prominent health states metrics are grounded in particular conceptions of wellbeing – e.g. hedonism or preference satisfaction. In this paper, I consider how liberals committed to the public justification requirement – the requirement that public officials choose laws and policies that are justifiable to their citizens – should evaluate health states. Since the public justification requirement prohibits (...) public officials from appealing to controversial conceptions of the good life, liberals committed to this principle face a significant puzzle. (shrink)

This book provides a survey of the ethical aspects of health care resources distribution. It first distinguishes health from health care in an effort to clear up the ethical landscape. After this, still with the same purpose, it makes a distinction between problems of macro-allocation and micro-allocation. In the rest of the book two questions of macro-allocation are treated in some detail. First, several approaches – in particular: utilitarian, egalitarian, communitarian, and libertarian – to the question whether (...) we have a right to health care are assessed. Second, it is discussed how best, if we have such a right, health care resources are allocated given obvious budget constraints. Here again the major theories discussed are utilitarian, communitarian, and egalitarian. Although it is not the aim of the book to propose a new theory of the ethics of health care resource distribution, the critical approach throughout is broadly egalitarian in spirit. (shrink)

In this article we argue that the social value of health research should be conceptualized as a function of both the expected benefits of the research and the priority that the beneficiaries deserve. People deserve greater priority the worse off they are. This conception of social value can be applied for at least two important purposes: in health research priority setting when research funders, policy-makers, or researchers decide between alternative research projects; and in evaluating the ethics of (...) proposed research proposals when research ethics committees assess whether the social value of the research is sufficient to justify the risks and burdens to research participants and others. In assessing how far a proposed research project will advance the interests of people who are more disadvantaged, research priority setters and RECs should examine the diseases that the research targets and the type of research. Just as certain diseases impose a greater burden on people who are more disadvantaged, so certain types of intervention and forms of research are more likely to benefit people who are more disadvantaged. We outline which populations are likely to be representative of the global worst off and identify what types of health research, and which disease categories, are priorities for these populations. (shrink)

In bioethics, the predominant categorization of various types of influence has been a tripartite classification of rational persuasion (meaning influence by reason and argument), coercion (meaning influence by irresistible threats—or on a few accounts, offers), and manipulation (meaning everything in between). The standard ethical analysis in bioethics has been that rational persuasion is always permissible, and coercion is almost always impermissible save a few cases such as imminent threat to self or others. However, many forms of influence fall into the (...) broad middle terrain—and this terrain is in desperate need of conceptual refining and ethical analysis in light of recent interest in using principles from behavioral science to influence health decisions and behaviors. This paper aims to address the neglected space between rational persuasion and coercion in bioethics. First, I argue for conceptual revisions that include removing the “manipulation” label and relabeling this space “nonargumentative]influence,” with two subtypes: “reason-bypassing” and “reason-countering.” Second, I argue that bioethicists have made the mistake of relying heavily on the conceptual categories themselves for normative work and instead should assess the ethical permissibility of a particular instance of influence by asking several key ethical questions, which I elucidate, that relate to (1) the impact of the form of influence on autonomy and (2) the relationship between the influencer and the influenced. Finally, I apply my analysis to two examples of nonargumentative influence in health care and health policy: (1) governmental agencies such as the Food and Drug Administration (FDA) trying to influence the public to be healthier using nonargumentative measures such as vivid images on cigarette packages to make more salient the negative effects of smoking, and (2) a physician framing a surgery in terms of survival rates instead of mortality rates to influence her patient to consent to the surgery. (shrink)

The most recent versions of official psychiatric diagnostic guidelines include a new addition: Prolonged Grief Disorder (PGD). PGD is controversial due to concerns about harmful looping effects. Some opponents of PGD’s inclusion in the DSM worry that the diagnosis may pathologize normal human experiences and alienate grievers from their grief. This paper argues that these concerns are less troubling than they initially appear (in part because they assume an unhelpful, and conceptually optional, background understanding of health conditions as pathologies) (...) and calls attention to overlooked beneficial looping effects that might be achieved by medicalizing (some) experiences of grief. (shrink)

Summary Background Self-binding directives instruct clinicians to overrule treatment refusal during future severe episodes of illness. These directives are promoted as having potential to increase autonomy for individuals with severe episodic mental illness. Although lived experience is central to their creation, service users’ views on self-binding directives have not been investigated substantially. This study aimed to explore whether reasons for endorsement, ambivalence, or rejection given by service users with bipolar disorder can address concerns regarding self-binding directives, decision-making capacity, and human (...) rights. Methods This study used qualitative data from an internet-based survey distributed to the mailing list of the UK charity Bipolar UK, which contained multiple closed and open questions on advance decision-making in bipolar disorder. Quantitative analysis of a closed question about self-binding directives had already demonstrated endorsement amongst a very high proportion of participants with bipolar disorder who completed the survey. We conducted thematic analysis of responses from those participants who answered a subsequent open question about reasons for their view. Research was co-produced within a multi-disciplinary team, with clinical, legal, and ethical expertise, and lived experience of bipolar disorder. Ideas and methodologies associated with all these areas of expertise were used in the analysis of these reasons and to gain insight into the thoughts of individuals with bipolar disorder about self-binding directives and associated issues. Findings Between Oct 23 and Dec 5, 2017, 932 individuals with a self-reported clinical diagnosis of bipolar disorder completed the internet survey, with 565 (154 men; 400 women; 11 transgender or other) providing free text answers to the open question. A large majority of respondents endorsed self-binding directives, nearly all describing a determinate shift to types of distorted thinking and decision-making when unwell as their key justification. Responses indicating ambivalence were dominated by logistical concerns about the drafting and implementation of self-binding directives, while those who rejected self-binding directives also cited logistical concerns, validity of their thinking when unwell, and potential contravention of human rights. Interpretation This study is, to our knowledge, the first large study of reasons why mental health service users might endorse or reject the use of self-binding directives. The findings provide empirical support for introducing self-binding directives into mental health advance decision-making practice and policy and may help to address enduring ethical concerns surrounding possible implementation of the directive while a person retains decision-making capacity. The opinions expressed here in responses given by multiple service users with bipolar disorder challenge a prominent view within international disability rights debates that involuntary treatment and recognition of impaired mental capacity constitute inherent human rights violations. Funding The Wellcome Trust . (shrink)

In seeking to clarify the concept of conflict of interest (COI) in debates about physician–industry relationships, Howard Brody (2011) highlights the extent to which the prob- lem turns on a common pejorative understanding of COI. Whether it is the academic or public policy “pharmapologists” or “pharmascolds” talking about COI, there is often a straightforward and overly simplistic correlation made: that is, a conflict of interest—by definition—leads to fraudulent or corrupt behavior. The same type of reasoning is com- monly found (...) in discussions about COI outside the health sciences, most notably in news stories about the awarding of government contracts or the behaviour of corporate executives. The problem is that in focusing on dramatic failures to manage COI (e.g., around Vioxx), there is a tendency to strongly associate COI with extreme forms of financial and even criminal misconduct, leaving the public, policymakers, academics, and professionals with a skewed and limited understanding of the concept. (shrink)

In this paper, I sound a warning note about the medicalization of risk conditions such as high cholesterol, especially in a health care climate of resource scarcity.

Innovation is progressively needed in responding to global challenges. Moreover, the increasing complexity of challenges implies demand for the usage of multisectoral and policy mix approaches. Wicked problems can be tackled by "integrated innovation" that combines the coordinated implementation of social, technological, and health innovation co-created by entities of the public sector, the private sector, the non-governmental sector, and the informal sector. This Research Topic focuses on filling the knowledge gaps about the selected types of innovation. First, regarding (...) social innovation that can be understood as new strategies, concepts, products, services, and organizational forms that allow the satisfaction of human needs. Second, a technological innovation that refers to new or remarkably improved products, goods, or services in terms of their technical specifications, components, materials, software, design, or other functional features. Third, health innovation that focuses on novel or enhanced health policies, systems, products, technologies, services, and care delivery schemes to improve people’s health. Finally, this Research Topic highlights attempts to develop integrated innovation that can add value to social policy, health policy, and environmental policy by improving efficiency, effectiveness, quality, sustainability, safety, and affordability. (shrink)

William Smith’s recent article criticises the so-called orthodox approaches to the normative analysis of healthcare resource allocation, associated to the requirement that decision-makers should abide by strictly procedural principles of legitimacy defining a deliberative democratic process. Much of the appeal of Smith’s argument goes down to his awareness of real-world processes and, in particular, to the large gap he identifies between well-led democratic deliberation and the messiness of the process through which the intuitively legitimate Affordable Care Act was created. This (...) reply aims to demonstrate that the ACA provides no counterexample to orthodox views, seizing this opportunity to explore the specific space that the procedural principles populating orthodox accounts are meant to regulate. Neither general questions of healthcare justice concerning, for example, universal access nor, relatedly, the activity of elected politicians falls within the natural scope of application of such principles, revealing a much more complex picture of the interactions between justice and legitimacy as well as substantive and procedural considerations than acknowledged by Smith. In the end, orthodox accounts of healthcare resource allocation turn out to provide a precious fund of theoretical resources for the normative study of administrators, which might be useful well beyond bioethics and health policy. (shrink)

The implementation of actions for health is only possible by adequate policy development. There is a need to review the nature and development of policy in health political science gaze. Therefore, the present study aims to conduct a review on theory and researches to develop adequate policies in health care system. It provides a comprehensive review about the important theories with empirical research evidences for promoting health. The review analysis shows that it is important (...) to understand the theory and approach behind policy development to recognize the incremental nature of aspects involved in policy development. The health political science insights need to be embraced in the light of public health and promotion of health. The present study has provided deep understanding about the structuring and implementation of health policies in health care systems in the light of theory and research. (shrink)

The growing epidemic of allergy and allergy-induced asthma poses a significant challenge to population health. This article, written for a target audience of policy-makers in public health, aims to contribute to the development of policies to counter allergy morbidities by demonstrating how principles of social justice can guide public health initiatives in reducing allergy and asthma triggers. Following a discussion of why theories of social justice have utility in analyzing allergy, a step-wise policy assessment protocol (...) formulated on Rawlsian principles of social justice is presented. This protocol can serve as a tool to aid in prioritizing public health initiatives and identifying ethically problematic policies that necessitate reform. Criteria for policy assessment include: 1) whether a tentative public health intervention would provide equal health benefit to a range of allergy and asthma sufferers, 2) whether targeting initiatives towards particular societal groups is merited based on the notion of ‘worst-off status’ of certain population segments, and 3) whether targeted policies have the potential for stigmatization. The article concludes by analyzing three examples of policies used in reducing allergy and asthma triggers in order to convey the general thought process underlying the use of the assessment protocol, which public health officials could replicate as a guide in actual, region-specific policy development. (shrink)

Peter Fitzpatrick’s writings prove once and for all that it is possible for a law professor to write in beautiful English. His work also proves once and for all that the dominating tradition of Anglo-American legal philosophy and of law teaching has been barking up the wrong tree: namely, that the philosopher and professional law teachers can understand justice as nested in empty forms, better known as rules, doctrines, principles, policies, and other standards. The more rigorous our analysis or (...) decomposition of the forms, we have believed, the more closely do we access the identity of laws. Justice has been assumed to be a matter of intellectually accessing such analysed forms. Fitzpatrick’s articles and books embody an implicit critique of the analytic view of law and of justice. My entry point into this critique is his preoccupation with Jacques Derrida’s theory of laws as universals and with Derrida’s theory of justice as an inaccessible immediacy or presence in context-specific or concrete experienced events. Each event is experienced in an official’s decision. Such a decision represents what Derrida, Fitzpatrick, and Hegel call ‘individuality’. -/- Derrida’s theory of law presents a conundrum. Derrida misses the possibility that law may exist by virtue of its content rather than its form. Derrida misses this possibility because, heavily influenced by Kant (in Derrida’s theory of law), Derrida associates law with universals. This is so because Kant (and Derrida) are preoccupied with the identity of what counts as a law (lois) rather than with a law’s legitimacy. A universal cannot exist unless it is legitimate, and it is legitimate, I claim, by virtue of its content. In his association of law with universals, Derrida presupposes that legal knowledge exists with reference to a territorial-like boundary. The forms are represented or signified by signs (signifiers) within a boundary of the ultimate form (the state, the nation, or humanity). This ultimate form as a universal, like the discrete rules or forms, lacks socially contingent content. A boundary separates knowable universals from the unknowable world on the exteriority of the boundary. The unknowable world is constituted by concrete events experienced in context-specific circumstances. In his legal theory Derrida hones in upon the decision as the experienced event. In a decision, one is present or immediate with the event. Derrida considers such immediacy as justice. The immediacy, however, can only be represented as a sign (sometimes called a signifier). The sign, in turn, represents an empty signified or form, according to Derrida. Because the immediacy remains a representation rather than a presentation of the experienced event, laws as universals cannot be just. The rupture between the inaccessible immediacy of a decision on the one hand and the represented empty forms on the other is critical to Derrida’s theory of law. -/- I claim that this rupture permeates Derrida’s writings about law because Derrida possesses a territorial-like sense of legal knowledge. I shall argue to this effect as follows. In the first section I shall explain the importance of Fitzpatrick’s exposure of the vacuity of the foundation of the system or structure of universals. In the second section I shall flesh out two elements of Derrida’s legal theory: law as form and the ipseity or concrete event that the form excludes from law. This takes me to the third section, where I shall elaborate how Derrida’s legal theory presupposes knowledge as territorial. I shall argue in the final section that this very sense of territorial knowledge prevents justice from accessing law and law from accessing justice. I conclude with the hint of a very different sense of law, one that draws from experiential knowledge in contradistinction to territorial knowledge. (shrink)

Scientisationisagrowingtrendasindividualsworldwideharnessscientific tools and knowledge to solve problems. This phenomenon is evident in biomedical research, which has increased across sub-Saharan Africa, and when encountering bioethical issues arising during the course of such research. This research synthesis considers how the constructs of culture, actors, and resources in the region shape undergraduate bioethics education. Using a lens of sociological neo-institutionalism, taken-for-granted bioethical scripts, like informed consent and medical confidentiality, are evident in this education; however, actual implementation demonstrates the way they are often adapted (...) and contextualised, with implications for students and instructors, and ultimately patients and research participants. The education considered is that for undergraduates in health sciences and medicine because they are prominent actors in research and clinical practice across the region. In considering insights from this literature, the aim is to positively impact health across sub-Saharan Africa. (shrink)

This article will address the considerations that must be examined in the design of public policies and government programs to achieve an intercultural approach to the health of the Pu Mapuce Zomo (Mapuce women). In this sense, the proposed objective is to formulate three essential aspects that serve as a basis to promote adequate frameworks for public health policies oriented towards an intercultural approach. For this, methodologically, from a qualitative approach, the ethical, gender(s) and epistemic aspects that must (...) be considered in the configuration of health programs that favor the health care of indigenous women will be investigated. With this purpose, it begins by delimiting the unavoidable ethical-normative and gender approach to highlight the basic needs of Mapuce women. This approach seeks to establish a parameter about the obligations that States have in relation to the development of human capabilities. Finally, three aspects will be presented that the State must replicate in its health proposals to guarantee the construction of an intercultural approach to health, appropriate to the basic needs of Mapuce women in Argentina. (shrink)

Objectives The study aims to evaluate the impact of the Revised Health Insurance Law 2014 on the utilisation of outpatient and inpatient care services, healthcare services utilisation at different levels of providers, types of providers and types of visits across different entitlement groups. Design/setting Secondary data from two waves of the Vietnam Household Living Standard Survey (VHLSS) 2016, VHLSS 2014 were used. A cross-sectional study applying propensity score matching was conducted. Participants A total of 4900 individuals who reported using (...) healthcare services are analysed. Outcomes measure Numbers of outpatient and inpatient visits, frequency of healthcare service utilisation at commune health stations, district hospitals, provincial hospitals, public and private health facilities, number of visits at health facility for medical treatment and health checks per year. Results The result indicates that health insurance (HI) policy increased the number of outpatient visits for the enrolled between 0.87 and 1.29. The greatest impact was found on participants of heavily subsidised health insurance (HSHI) programmes with 1.29 visits per person per year. Similarly, an increase between 0.08 and 0.16 in the number of inpatient admissions was because of participation in HI. With regard to type of healthcare providers, the study found that participation in HI has the most effect on the use of healthcare services at district hospitals. However, the study demonstrated that the impacts of HI on the increase in the frequency of visiting commune health stations, number of visits at the provincial hospital for HSHI groups, and number of visits at health facilities for health check and consultation were sensitive to unobserved characteristics. Conclusion Our findings imply that policy-makers in Vietnam could continue expanding health insurance coverage to increase access to healthcare services for citizens, especially vulnerable groups. In addition, the government should draw more attention to primary healthcare level. (shrink)