At the core of medicine is the idea to help fellow human beings by improving or even restoring their health. Let us call this the auxiliary stance of medicine—the motivation of medical intervention by reference to a moral obligation to guide our peers in their attempt to live a healthy and productive life. In parallel, the auxiliary stance is also central to public health, with a focus on prevention and health promotion. Taken together, we can view medicine (...) and public health as the two main human auxiliary endeavors to protect individuals and populations from health risks and help them to heal when sick. (shrink)

In this paper I attempt to show how an appeal to a particular kind of collective obligation - a collective obligation falling on an unstructured collective consisting of the world’s population as a whole – can be used to undermine recently influential objections to the idea that there is a human right to health which have been put forward by Gopal Sreenivasan and Onora O’Neill. -/- I take this result to be significant both for its own sake and because (...) it helps to answer a challenge often put to Those who argue for the existence of collective obligations: namely, to explain why the question of whether there are any such obligations might matter from a practical point of view. One way of introducing the objection is to focus on questions of agency. Here I'll argue both that there can be obligations on groups that are not themselves collective agents, and that these can play an important explanatory and clarifcatory role in accounting for obligations which fall on individuals. (shrink)

If health sciences are to be humanized, health professionals must first humanize themselves. This research deepens the paradigmatic aspects that enrich and form the basis of a compassionate attitude, a key element in this process of humanization. For this reason, emphasis has been placed on the sensitivity that is at the basis of a compassionate attitude. It is proposed that this sensitivity includes wonder as a starting point that allows one to connect with reality and to encounter the (...) reality of the human person, who in turn discovers that he is called to communion with another like himself. In this way, compassion is considered as a movement of the heart, and the particularities and consequences of this movement are identified in order to respond to objections to compassion, especially those of the German philosopher Friedrich Nietzsche. It is noted that his criticisms are directed against a compassion understood as pity, while compassion understood as a movement of the heart distances itself from falling into the sentimentalization of pity and helps to reaffirm the positive dimension of compassion. -/- Si se quiere humanizar las ciencias de la salud, han de comenzar a humanizarse los profesionales de la salud. Por esta razón, en esta investigación se profundiza en aspectos paradigmáticos que fundamentan y enriquecen el ser compasivo, considerado como un elemento clave en dicho proceso de humanización. Para ello, se ha puesto énfasis en la sensibilidad que se encuentra al fondo de la actitud compasiva. Se ha planteado que dicha sensibilidad involucra el asombro como punto de partida, que conecta con la realidad y que permite encontrarse con la realidad de la persona humana, que a su vez se descubre llamada a la comunión con el otro semejante a ella. De esta manera, se llega a considerar la compasión como un movimiento del corazón, y a partir de allí, se determinan las particularidades y consecuencias de este movimiento para responder a las objeciones que se le hacen a la compasión, principalmente las del filósofo alemán Friedrich Nietzsche. Se ha determinado que sus críticas están dirigidas a una compasión entendida como lástima, mientras que la compasión entendida como movimiento del corazón, se aleja de caer en la sentimentalización de la lástima y da luces para retomar la dimensión positiva que posee la compasión. (shrink)

Mental health is a global priority, and states and stakeholders are taking steps toward advancing a human right to mental health for all (APA, 2018). This is evidenced by international studies, initiatives, declarations, and domestic policy interventions. From a right-based perspective, mental health is not the mere absence of a psychiatric condition or psychosocial disability (WHO, 2022). It speaks of an environment in which individuals live a life of dignity. The application of human rights principles to mental (...) health allows us to incorporate novel ideas about the role of all stakeholders in fostering the security, freedom, justice, and dignity of individuals. With this point of view in mind, many states are revisiting their mental health laws and governance practices. (shrink)

There are a number of important links and similarities between public health and safety. In this extended essay, Gregg D. Caruso defends and expands his public health-quarantine model, which is a non-retributive alternative for addressing criminal behavior that draws on the public health framework and prioritizes prevention and social justice. In developing his account, he explores the relationship between public health and safety, focusing on how social inequalities and systemic injustices affect health outcomes and crime (...) rates, how poverty affects brain development, how offenders often have pre-existing medical conditions (especially mental health issues), how involvement in the criminal justice system itself can lead to or worsen health and cognitive problems, how treatment and rehabilitation methods can best be employed to reduce recidivism and reintegrate offenders back into society, and how a public health approach could be successfully applied within the criminal justice system. Caruso's approach draws on research from the health sciences, social sciences, public policy, law, psychiatry, medical ethics, neuroscience, and philosophy, and he delivers a set of ethically defensible and practically workable proposals for implementing the public health-quarantine model. The essay begins by discussing recent empirical findings in psychology, neuroscience, and the social sciences that provide us with an increased understanding of the social and neurological determinants of health and criminal behavior. It then turns to Caruso's public health-quarantine model and argues that the model provides the most justified, humane, and effective approach for addressing criminal behavior. Caruso concludes by proposing a capability approach to social justice grounded in six key features of human well-being. He argues that we cannot successfully address concerns over public health and safety without simultaneously addressing issues of social justice—including the social determinants of health (SDH) and the social determinants of criminal behavior (SDCB)—and he recommends eight general policy proposals consistent with his model. (shrink)

In our recent article, together with more than 60 of our colleagues, we outlined a proposal for drug policy reform consisting of four specific yet interrelated strategies: (1) de jure decriminalization of all psychoactive substances currently deemed illicit for personal use or possession (so-called “recreational” drugs), accompanied by harm reduction policies and initiatives akin to the Portugal model; (2) expunging criminal convictions for nonviolent offenses pertaining to the use or possession of small quantities of such drugs (and releasing those serving (...) time for these offenses), while delivering retroactive ameliorative relief; (3) the ultimate legalization and careful regulation of currently illicit drugs; and (4) the delivery of a new “Marshall Plan” focused on community-building initiatives, expanded harm reduction programs, and social and health care support efforts (Earp et al. 2021). We were gratified to see so many thoughtful commentaries on our proposal, and we respond to them in part in this reply. (shrink)

What is it to be mentally healthy? In the ongoing movement to promote mental health, to reduce stigma, and to establish parity between mental and physical health, there is a clear enthusiasm about this concept and a recognition of its value in human life. However, it is often unclear what mental health means in all these efforts and whether there is a single concept underlying them. Sometimes, the initiatives for the sake of mental health are aimed (...) just at reducing mental illness, thus implicitly identifying mental health with the absence of diagnosable psychiatric disease. More ambitiously, there are high-profile proposals to adopt a positive definition, identifying mental health with psychic or even overall well-being. We argue against both: a definition of mental health as mere absence of mental illness is too thin, too undemanding, and too closely linked to psychiatric value judgments, while the definition in terms of well-being is too demanding and potentially oppressive. As a compromise, we sketch out a middle position. On this view, mental health is a primary good, that is, the psychological preconditions of pursuing any conception of the good life, including well-being, without being identical to well-being. (shrink)

The definitions and conceptualizations of health, and the management of healthcare have been challenged by the current global scenarios (e.g., new diseases, new geographical distribution of diseases, effects of climate change on health, etc.) and by the ongoing scholarship in humanities and science. In this paper we question the mainstream definition of health adopted by the WHO—‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (WHO in Preamble (...) to the constitution of the World Health Organization as adopted by the international health conference, The World Health Organization, 1948)—and its role in providing tools to understand what health is in the contemporary context. More specifically, we argue that this context requires to take into account the role of the environment both in medical theory and in the healthcare practice. To do so, we analyse WHO documents dated 1984 and 1986 which define health as ‘coping with the environment’. We develop the idea of ‘coping with the environment’, by focusing on two cardinal concepts: adaptation in public health and adaptivity in philosophy of biology. We argue that the notions of adaptation and adaptivity can be of major benefit for the characterization of health, and have practical implications. We explore some of these implications by discussing two recent case studies of adaptivity in public health, which can be valuable to further develop adaptive strategies in the current pandemic scenario: community-centred care and microbiologically healthier buildings. (shrink)

The context of international health research involving human subjects, and this should appear obvious, is the human community. As such, basic questions of how human beings should be treated by other human beings, particularly in situations of unequal power – e.g., in the form of control, choice, or opportunity – lay at the foundations of related ethical discourse when ethics are discussed at all. I trace a narrative that follows upon a recent revision process of international guidelines for biomedical (...) research involving human subjects. I focus in particular upon the issue of a standard of care. In the second section, I draw upon philosophers John Rawls, Claudia Card, and Allen Buchanan to discuss concerns regarding the 'least advantaged members of society' in the context of global inequality. The paper includes reflections upon pedagogy in courses focused upon international health research involving human subjects. (shrink)

We must resist thoroughly reframing climate change as a health issue. For human health–centric ethical frameworks omit dimensions of value that we must duly consider. We need a new, an environmental, research ethic, one that we can use to more completely and impartially evaluate proposed research on mitigation and adaptation strategies.

This goal of this thesis in the philosophy of nature is to move us closer towards a true biological science of consciousness in which the evolutionary origin, function, and phylogenetic diversity of consciousness are moved from the field’s periphery of investigations to its very centre. Rather than applying theories of consciousness built top-down on the human case to other animals, I argue that we require an evolutionary bottomup approach that begins with the very origins of subjective experience in order to (...) make sense of the place of mind in nature. To achieve this goal, I introduce and defend the pathological complexity thesis as both a framework for the scientific investigation of consciousness and as a lifemind continuity thesis about the origins and function of consciousness. (shrink)

The EAT-Lancet Commission, consisting of 37 nutritionists, ecologists, and other experts from 16 countries, proposed safe operating space for food systems. This space helps to set ranges of food intake to ensure universal human health and a stable Earth system (not passing the planetary boundaries). Eventually, the Commission developed a 2,500-calorie-per-day eating plan for keeping the food systems in a safe operating space.

Taking into consideration the extremely harsh public health conditions faced by the majority of the world population, the Health Impact Fund (HIF) proposal seeks to make the intellectual property regimes more in line with human rights obligations. While prioritizing access to medicines and research on neglected diseases, the HIF makes many compromises in order to be conceived as politically feasible and to retain a compensation character that makes its implementation justified solely on basis of negative duties. Despite that (...) current global health realities make such steps reasonable, the paper looks up the negative effects on one overlooked human right: the right to participate in scientific advancement. (shrink)

One of the most frequently voiced criticisms of free will skepticism is that it is unable to adequately deal with criminal behavior and that the responses it would permit as justified are insufficient for acceptable social policy. This concern is fueled by two factors. The first is that one of the most prominent justifications for punishing criminals, retributivism, is incompatible with free will skepticism. The second concern is that alternative justifications that are not ruled out by the skeptical view per (...) se face significant independent moral objections (Pereboom 2014: 153). Despite these concerns, I maintain that free will skepticism leaves intact other ways to respond to criminal behavior—in particular incapacitation, rehabilitation, and alteration of relevant social conditions—and that these methods are both morally justifiable and sufficient for good social policy. The position I defend is similar to Derk Pereboom’s (2001, 2013, 2014), taking as its starting point his quarantine analogy, but it sets out to develop the quarantine model within a broader justificatory framework drawn from public health ethics. The resulting model—which I call the public health-quarantine model (Caruso 2016, 2017a)—provides a framework for justifying quarantine and criminal sanctions that is more humane than retributivism and preferable to other non-retributive alternatives. It also provides a broader approach to criminal behavior than Pereboom’s quarantine analogy does on its own since it prioritizes prevention and social justice. -/- In Section 1, I begin by (very) briefly summarizing my arguments against free will and basic desert moral responsibility. In Section 2, I then introduce and defend my public health-quarantine model, which is a non-retributive alternative to criminal punishment that prioritizes prevention and social justice. In Sections 3 and 4, I take up and respond to two general objections to the public health-quarantine model. Since objections by Michael Corrado (2016), John Lemos (2016), Saul Smilanksy (2011, 2017), and Victor Tadros (2017) have been addressed in detail elsewhere (see Pereboom 2017a; Pereboom and Caruso 2018), I will here focus on objections that have not yet been addressed. In particular, I will respond to concerns about proportionality, human dignity, and victims’ rights. I will argue that each of these concerns can be met and that in the end the public health-quarantine model offers a superior alternative to retributive punishment and other non-retributive accounts. (shrink)

African Traditional Religion and medicine are integral parts of life and culture of the Africans and have greatly influenced their conceptions about human health and wholeness. Their many realities that Africans have not been able to abandon, in spite of the allurements of western civilization, Christianity, Islam and the advances in the biomedical sciences. The aim of this paper is to highlight the meaning of health and wholeness as central issues of concern in African Traditional Religion and Medicine. (...) The misconception, abuse and derogatory attitudes even from some notable Africans towards alternative medicine, as well as the all need of integrating both the alternative and orthodox medicine to bring about total wholeness, serves as the research problem. This paper argued that the biopsycho-socio-ecological model of health and wholeness is fundamental to the African Traditional Religion and Medicine. This model brings together the different aspects of human life and treats the human person as an integral and harmonious whole in perpetual relationship with the sacred, the human community and the environment. This paper therefore recommends that first, Africa has to open to modern medical discoveries and practices and secondly, African Traditional Religion and Medicine concern should be mainstreamed into the medical practice in health care services in contemporary Nigeria. It finally conclude that the alternative medicine despite the arrays of it inadequacies, objections and misconceptions, the practice has come to stay. (shrink)

Environmental health research produces scientific knowledge about environmental hazards crucial for public health and environmental justice movements that seek to prevent or reduce exposure to these hazards. The environment in environmental health research is conceptualized as the range of possible social, biological, chemical, and/or physical hazards or risks to human health, some of which merit study due to factors such as their probability and severity, the feasibility of their remediation, and injustice in their distribution. This paper (...) explores the ethics of identifying the relevant environment for environmental health research, as judgments involved in defining an environmental hazard or risk, judgments of that hazard or risk's probability, severity, and/ or injustice, as well as the feasibility of its remediation, all ought to appeal to non-epistemic as well as epistemic values. I illustrate by discussing the case of environmental lead, a housing-related hazard that remains unjustly distributed by race and class and is particularly dangerous to children. Examining a controversy in environmental health research ethics where researchers tested multiple levels of lead abatement in lead-contaminated households, I argue that the broader perspective on the ethics of environmental health research provided in the first part of this paper may have helped prevent this controversy. (shrink)

ABSTRACT: BACKGROUND: The governments and citizens of the developed nations are increasingly called upon to contribute financially to health initiatives outside their borders. Although international development assistance for health has grown rapidly over the last two decades, austerity measures related to the 2008 and 2011 global financial crises may impact negatively on aid expenditures. The competition between national priorities and foreign aid commitments raises important ethical questions for donor nations. This paper aims to foster individual reflection and public (...) debate on donor responsibilities for global health. METHODS: We undertook a critical review of contemporary accounts of justice. We selected theories that: (i) articulate important and widely held moral intuitions; (ii) have had extensive impact on debates about global justice; (iii) represent diverse approaches to moral reasoning; and (iv) present distinct stances on the normative importance of national borders. Due to space limitations we limit the discussion to four frameworks. RESULTS: Consequentialist, relational, human rights, and social contract approaches were considered. Responsibilities to provide international assistance were seen as significant by all four theories and place limits on the scope of acceptable national autonomy. Among the range of potential aid foci, interventions for health enjoyed consistent prominence. The four theories concur that there are important ethical responsibilities to support initiatives to improve the health of the worst off worldwide, but offer different rationales for intervention and suggest different implicit limits on responsibilities. CONCLUSIONS: Despite significant theoretical disagreements, four influential accounts of justice offer important reasons to support many current initiatives to promote global health. Ethical argumentation can complement pragmatic reasons to support global health interventions and provide an important foundation to strengthen collective action. (shrink)

Since before we can remember, humanity aims to overcome its biological limitations; such a goal has certainly played a key role in the advent of technique. However, despite the benefits that technique may bring, the people who make use of it will inevitably be under risk of harm. Even though human technical wisdom consists in attaining the best result without compromising anybody’s safety, misuses are always a possibility in the horizon. Nowadays, technology can be used for more than just improving (...) human capacities, preserving and restoring health or promoting human well-being. It also enables us to overcome human limitations and reach way beyond our "natural design". That being said, what could possibly justify the fear for these new directions of biotechnology? Should medicine and health care change their traditional goals and begin searching for artificial improvements to wellness in human nature? In this paper, I will hereby present and briefly discuss the main topics of the contemporary issue of human enhancement: the therapy-enhancement distinction, the possibility of cognitive enhancements and better physical performances, the fight against senescence, the arguments for and against human eugenics, the search for perfection, the quest of moral enhancement, the problem of public priorities, and some questions on medical ethics. Then, finally, I will want to present some realist perspectives on the subject. (shrink)

In this four part essay I present a comprehensive model of health based on the generalized empirical method of Bernard Lonergan, which integrates the empirical method of natural science and the phenomenological method of historical and related human sciences in a way that is unique among contemporary thinkers. The GEM model, in turn, offers a unique framework - a higher viewpoint - for integrating the manifold viewpoints of clinical practice, the humanities (the drama and narrative of human living), (...) health science and health policy in a methodically dynamic and critically progressive fashion in order to address the many pressing problems of contemporary healthcare. (shrink)

In medical sciences, health is measured by reference to our species-typical anatomy and functional integrity – the objective standard of human health. Proponents of transhumanism are committed to biomedical enhancement of human beings by augmenting our species-typical anatomy and functional integrity. I argue that this normative impasse is not only a problem for the transhumanist movement, but also undermines the rationale for some common medical interventions.

The guiding premise from which this special report begins is the conviction and hope that justice is at the normative heart of medicine and that it is the perpetual task of bioethics to bring concerns of justice to bear on medical practice. On such an account, justice is medicine's lifeblood, that by which it contributes to life as opposed to diminishing it. It is in this larger, historical, intersectional, critical, and ethically minded context that we must approach pressing questions facing (...) medicine, including the question of the import and role of genomic knowledge for human life. The second premise is that, at least in principle, the knowledge generated by genomics can be a gift or a weight, or both at the same time. That is to say that, on the one hand, genomic knowledge is a gift, creating novel insights into the genetic drivers of disease and into the geographical paths of our ancestors. And on the other hand, it is a weight, creating new obligations, new forms of social classification, and new forms of surveillance. Because it is in many ways the “common sense” of the day that genomic knowledge is a gift, this special report, which contains nine essays, concentrates on the ways in which such knowledge can be a weight, a weight that has the potential to thwart—and historically has thwarted—medicine from genuinely advancing justice . (shrink)

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)

-/- This chapter evaluates the ethical issues that using cost-effectiveness considerations to set animal health priorities might present, and its conclusions are cautiously optimistic. While using cost-effectiveness calculations in animal health is not without ethical pitfalls, these calculations offer a pathway toward more rigorous priority-setting efforts that allow money spent on animal well-being to do more good. Although assessing quality of life for animals may be more challenging than in humans, implementing prioritization based on cost-effectiveness is less ethically (...) fraught. (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)

This book offers inter alia a systematic investigation of the actual argumentative strategy of Socratic conversation and explorations of Socratic and Platonic morality including an examination ofeudaimonia and the mental conception of health in the Republic as self-control, with a view to the relation of individual health/happiness to social order. The essays cover a period from 1968 to 2012. Some of them are now published for the first time. Self-motion in the later dialogues involves tripartition and tripartition in (...) turn involves embodiment. The Philebus psychology too anticipates Aristotle. The Forms of the Timaeus are patterns, but the two-world picture is abandoned: there is one world constituted by Forms and Place. The Epinomis is arguably genuine. More generally, denying that Plato develops, e.g. exegetically and psychologically, is absurd. There are too many contradictions in the Corpus. The dialogues are artistic wholes and the author's message must be interpreted accordingly: hence in a sense every character is Plato's mouthpiece. Aristotle's idea of the human good or quality of life as optimal mental activity according to the special human capabilities is the root of the modern selfactualization projects. Panaetius (free reason) and Posidonius (science) mark the end of the older Stoa's hard-core materialism and the beginning of a new more 'modern' era. -/- . (shrink)

Since the human genome was decoded, great emphasis has been placed on the unique, personal nature of the genome, along with the benefits that personalized medicine can bring to individuals and the importance of safeguarding genetic privacy. As a result, an equally important aspect of the human genome – its common nature – has been underappreciated and underrepresented in the ethics literature and policy dialogue surrounding genetics and genomics. This article will argue that, just as the personal nature of the (...) genome has been used to reinforce individual rights and justify important privacy protections, so too the common nature of the genome can be employed to support protections of the genome at a population level and policies designed to promote the public's wellbeing. In order for public health officials to have the authority to develop genetics policies for the sake of the public good, the genome must have not only a common, but also a public, dimension. This article contends that DNA carries a public dimension through the use of two conceptual frameworks: the common heritage framework and the common resource framework. Both frameworks establish a public interest in the human genome, but the CH framework can be used to justify policies aimed at preserving and protecting the genome, while the CR framework can be employed to justify policies for utilizing the genome for the public benefit. A variety of possible policy implications are discussed, with special attention paid to the use of large-scale genomics databases for public health research. (shrink)

The Republic of Ireland is introducing major human rights-based reform to its mental health laws. This paper outlines the new legal landscape in which psychologists must operate against the backdrop of present day effects of Ireland’s dark legacy of institutionalisation. A rights-based approach aims to positively transform mental health service delivery and we advocate for person-centred treatments as the ‘new normal’. We summarise the recent advocacy work undertaken by the Psychological Society of Ireland’s Special Interest Group in Human (...) Rights & Psychology. Finally, we present an innovative best practice case promoting future rights-based delivery via the Socio-Ecological Model of Health – Kyrie Farm. Keywords: UNCRPD; Assisted Decision Making Act 2015 (ADMA) in the Rep. of Ireland; The Socio-Ecological Model of Health. (shrink)

Defenders of evolutionary medicine claim that medical professionals and public health officials would do well to consider the role of evolutionary biology with respect to the teaching, research, and judgments pertaining to medical theory and practice. An integral part of their argument is that the human body should be understood as a bundle of evolutionary compromises. Such an appreciation, which includes a proper understanding of biological function and physiological homeostasis, would provide a crucial perspective regarding the understanding and securing (...) of human health needs currently lacking in the medical arena. (shrink)

The experience of Costa Rica highlights the potential for conflicts between the right to health and fair priority setting. For example, one study found that most favorable rulings by the Costa Rican constitutional court concerning claims for medications under the right to health were either for experimental treatments or for medicines that should have low priority based on health gain per unit of expenditure and severity of disease. In order to better align rulings with priority setting criteria, (...) in 2014, the court initiated a reform in its assessment of claims for medicine. This paper assesses this reform’s impact on the fairness of resource allocation. It finds three effects. First, a reduction in successful claims for experimental medication, which is beneficial. Second, an increase in the success rate of medication lawsuits, which is detrimental because most claims are for extremely cost-ineffective medications. Third, a decline in the number of claims for medicine, which is beneficial because it forestalls such low-priority spending. This paper estimates that, taking all three effects into account, the reform has had a modest net positive impact on overall resource allocation. However, it also argues that there is a need for further reforms to lower the number of claims to low-priority medicines that are granted. (shrink)

Despite the recent advances in information and communication technology that have increased our ability to store and circulate information, the task remains of ensuring that the right sorts of information reach the right sorts of people. In what follows we defend the thesis that efforts to develop efficient means for sharing information across healthcare systems and organizations would benefit from a careful analysis of human action in healthcare organizations, and that the communication of healthcare information and knowledge needs to rest (...) on a sound ontology of social interaction. We illustrate this thesis in relation to the HL7 RIM, which is one centrally important tool for communication in the healthcare domain. (shrink)

That there is a positive correlation between healthy populations and socio-economic and human development is not in dispute. It is in countries’ interests, therefore, to aim to have healthy, productive citizens. A strong, well-functioning public health care system would go some way to realising this. In sub-Saharan Africa, the issue of how to finance health care and make it accessible to the majority of citizens is an ongoing challenge. While the overall intention behind The Structural Adjustment Programmes (SAPs) (...) of the 1980s and 1990s was to assist development, the inadvertent result in many African countries that subscribed to SAPs was, in fact, the deepening of poverty and inequality. (shrink)

Rationale and objectives: Medical humanities are becoming increasingly recognized as positively impacting medical education and medical practice. However, the extent of medical humanities teaching in medical schools is largely unknown. We reviewed medical school curricula in Canada, the UK and the US. We also explored the relationship between medical school ranking and the inclusion of medical humanities in the curricula. -/- Methods: We searched the curriculum websites of all accredited medical schools in Canada, the UK and the (...) US to check which medical humanities topics were taught, and whether they were mandatory or optional. We then noted rankings both by Times Higher Education and U.S. News and World Report and calculated the average rank. We formally explored whether there was an association between average medical school ranking and medical humanities offerings using Spearman's correlation and inverse variance weighting meta-analysis. -/- Results: We identified 18 accredited medical school programmes in Canada, 41 in the UK, and 154 in the US. Of these, nine (56%) in Canada, 34 (73%) in the UK and 124 (80%) in the US offered at least one medical humanity that was not ethics. The most common medical humanities were medical humanities (unspecified), history, and literature (Canada); sociology and social medicine, medical humanities (unspecified), and art (UK); and medical humanities (unspecified), literature and history (US). Higher ranked medical schools appeared less likely to offer medical humanities. -/- Conclusions: The extent and content of medical humanities offerings at accredited medical schools in Canada, the UK and the US varies, and there appears to be an inverse relationship between medical school quality and medical humanities offerings. Our analysis was limited by the data provided on the Universities' websites. Given the potential for medical humanities to improve medical education and medical practice, opportunities to reduce this variation should be exploited. (shrink)

New biotechnologies have the potential to both dramatically improve human well-being and dramatically widen inequalities in well-being. This paper addresses a question that lies squarely on the fault line of these two claims: When as a matter of justice are societies obligated to include a new biotechnology in a national healthcare system? This question is approached from the standpoint of a twin aim theory of justice, in which social structures, including nation-states, have double-barreled theoretical objectives with regard to human well-being. (...) The first aim is to achieve a sufficient level of well-being in each of six core dimensions. In the special case of healthcare systems, this aim is focally but not exclusively attentive to achieving health sufficiency as one of the core dimensions. The second aim is to combat the emergence and persistence of densely woven patterns of systematic disadvantage that tend to undermine the achievement of a sufficient level of health and the other core elements of well-being of some persons and groups. Judgments about entitlements to health related resources, including new biotechnologies, are made in light of a threshold notion of health sufficiency. What is enough or sufficient health? The answer that is defended here is that sufficient health is enough health for a decent human life, understood as enough health to live a full life course without preventable, significant functional disability or decrement in health, or treatable pain or suffering. When a state must include a new biotechnology in its national healthcare system is also influenced by ancillary concerns about the connection between health and other core dimensions of well-being. What counts as a significant functional impairment or health decrement is thus explicated, in part, in relation to the theory’s sufficiency aim for the other essential dimensions of well-being, and thus for a decent life, overall. Those elements of health that play a critical role in the experience of sufficient reasoning, affiliation, security, respect and self determination are especially important; any loss of health function or capacity that threatens the individual’s prospects for sufficiency in these other dimensions, including the relational egalitiarian concerns they entail, constitutes a significant functional impairment. Within national borders, individuals are thus entitled to those health-related goods and services that are essential for a sufficiency of each of the dimensions of well-being; with regard to self determination and respect, what is sufficient by way of guaranteed access to specific goods and services is going to depend on the implications of such access for where an individual stands in relation to her co-nationals. The content of any entitlement to health-related goods and services is also necessarily dynamic. What can be done for health and the other core dimensions of well-being as a function of technological innovation and diffusion is in constant flux. The paper concludes by considering the implications of this analysis for the conditions under which states are obligated to include access in their healthcare systems to one biotechnology, deep brain stimulation. (shrink)

In this article, we address the relevance of J.S. Mill’s political philosophy for a framework of public health ethics. In contrast to some readings of Mill, we reject the view that in the formulation of public policies liberties of all kinds enjoy an equal presumption in their favor. We argue that Mill also rejects this view and discuss the distinction that Mill makes between three kinds of liberty interests: interests that are immune from state interference; interests that enjoy a (...) presumption in favor of liberty; and interests that enjoy no such presumption. We argue that what is of focal importance for Mill in protecting liberty is captured by the essential role that the value of self-determination plays in human well-being. Finally, we make the case for the plausibility of a more complex and nuanced Millian framework for public health ethics that would modify how the balancing of some liberty and public health interests should proceed by taking the thumb off the liberty end of the scale. Mill’s arguments and the legacy of liberalism support certain forms of state interference with marketplace liberties for the sake of public health objectives without any presumption in favor of liberty. (shrink)

Aims and Objectives. This article uses the concept of embodiment to demonstrate a conceptual approach to applied phenomenology. -/- Background. Traditionally, qualitative researchers and healthcare professionals have been taught phenomenological methods, such as the epoché, reduction, or bracketing. These methods are typically construed as a way of avoiding biases so that one may attend to the phenomena in an open and unprejudiced way. However, it has also been argued that qualitative researchers and healthcare professionals can benefit from phenomenology’s well-articulated theoretical (...) framework, which consists of core concepts, such as selfhood, empathy, temporality, spatiality, affectivity, and embodiment. -/- Design. This is a discursive article that demonstrates a conceptual approach to applied phenomenology. -/- Method. To outline and explain this approach to applied phenomenology, the Discussion section walks the reader through four stages of phenomenology, which progress incrementally from the most theoretical to the most practical. -/- Discussion. Part one introduces the philosophical concept of embodiment, which can be applied broadly to any human subject. Part two shows how philosophically trained phenomenologists use the concept of embodiment to describe general features of illness and disability. Part three illustrates how the phenomenological concept of embodiment can inform empirical qualitative studies and reflects on the challenges of integrating philosophy and qualitative research. Part four turns to phenomenology’s application in clinical practice and outlines a workshop model that guides clinicians through the process of using phenomenological concepts to better understand patient experience. -/- Conclusion and Relevance to Clinical Practice. A conceptual approach to applied phenomenology provides a valuable alternative to traditional methodological approaches. Phenomenological concepts provide a foundation for better understanding patient experience in both qualitative health research and clinical practice, and therefore provide resources for enhancing patient care. (shrink)

Background: Oral health of women is often neglected during pregnancy. We need to address this issue in a developing country’s perspective, as oral healthcare is not an integral part of antenatal protocols. -/- Objective: To evaluate the oral health status of pregnant women using the Oral Hygiene Index-Simplified (OHI-S) Score as well as explore oral hygiene practice by them and conduct a mini-assessment of their knowledge of oral health. -/- Methods: This cross-sectional, descriptive study was conducted using (...) data by using a semi-structured questionnaire among 170 pregnant women attending an antenatal center in Dhaka city, Bangladesh, from March to August 2018. A pre-tested semi-structured questionnaire containing OHI-S index was used for data collection. Dental mirror and probe were used for oral hygiene assessment. -/- Results: The mean age of the participants was 24.22±5.07 years. 140(82.4%) were found to use toothbrushes as a tooth-cleaning aid and 146(85.9%) used toothpaste as a tooth cleaning material. Among them, 132(94.3%) were found to brush at least once a day. The predominant health problems identified by clinical examination among those pregnant women were gum bleeding, mild to severe periodontitis, halitosis (bad breath), and loose teeth. The majority did not know the safe period of dental treatment and the consequences of having poor oral health during pregnancy. The overall oral hygiene status of the maximum pregnant women was ‘Fair’ (50.6%) (OHI-S score 0-1.2), while 39.4% had ‘Poor’ oral hygiene status (OHI-S score 1.3-3.0) and only 10% had ‘Good’ oral hygiene status (OHI-S score 3.1-6.9). -/- Conclusion: Pregnant women in Bangladesh suffer from various oral health issues during pregnancy; however, they exhibit that they do not address this issue due to a lack of awareness and other factors. Hence, it is crucial to plan and implement effective oral health programs for pregnant women all over the country. (shrink)

The question of what constitutes and facilitates mental health or psychological well-being has remained of great interest to martial artists and philosophers alike, and still endures to this day. Although important questions about well-being remain, it has recently been argued in the literature that a paradigmatic or prototypical case of human psychological well-being would characteristically consist of positive emotion, engagement, relationships, meaning, and accomplishment. Other scholarship has also recently suggested that martial arts practice may positively promote psychological well-being, although (...) recent studies on martial arts have not yet been reviewed and integrated under the PERMA framework from positive psychology to further explore and explicate this possibility. This article therefore contributes to the literature by reviewing recent work on psychological well-being and martial arts to determine whether there is substantive support for the claim that practicing martial arts can positively contribute to one flourishing with greater psychological well-being. (shrink)

Imagine you are the CEO of a hospital [. . .]. Decisions are constantly being made in your organization about how to spend the organization's money. The amount of money available to spend is never adequate to pay for everything you wish you could spend it on, therefore you must set spending priorities. There are two questions you need to be able to answer . . . How should we set priorities in this organization? How do we know when we (...) are doing it well? When people seek to achieve good public policy, the result will tend to be good public policy. In a collective choice process, public‐spirited individual participants produce good public policy by deliberating—talking with each other, listening to each other's arguments, and being willing to learn and change their minds based on such dialogue. –Steven Kelman (1992: 181) Public policy scholars agree that those persons (or agencies) vested with the authority to establish health care priorities should elicit public input before making rationing decisions. The two most common approaches are (i) consultation and (ii) deliberation. Though deliberation has obvious advantages over consultation, it falters in the face of the objection that ordinary citizens lack the cognitive resources for the extended, rigorous inquiry required of them in undertaking the priority‐setting task. To overcome this objection, I propose that deliberative forums for health care rationing should be designed so that they imitate the natural pattern of human experience. The experience of deliberation should encompass both prolonged periods of less‐demanding cognitive activity, in which citizens passively receive information, and briefer periods of more‐demanding cognitive activity, in which they engage in active problem‐solving. In arguing for this thesis, I rely on two theoretical sources and one practical case study, in the following order: (i) John Dewey's metaphysics of experience, (ii) cognitive science research on schemas and frames, and (iii) the Health Care Council in São Paulo, Brazil. (shrink)

In this paper, I challenge the argument that if we take health to be a meta-capability, we will be able to address the vulnerabilities that characterize human life. Instead, I argue that some vulnerabilities, like that attached to being a patient, can not be successfully addressed.

The alleged threats to human nature are at the root of many concerns about the use of nanotechnology to extend human health and capabilities. Bu the concept of human nature is illusory, selectively deployed, and does not impose any ethical constraint on human enhancement. Human nature is not only a meaningless concept, a product of our imperfect human cognition and a relic of the idea of a "soul," but, as it is deployed today against human enhancement technologies, it is (...) also a morally offensive, racist concept. The "human-racists" who deploy the concept of human nature are more inclusive than their forebears, but the make the same mistake of tying citizenship and value to biology. By setting aside the concept of human nature, we can affirm the value of the myriad aspects of human existence that we wish to preserve and extend using human enhancement technologies, including whatever genetic capacities and limits we may discover. Human enhancement technologies, such as those that may be enabled by nanotechnology and genetic engineering, enable us to define a new and more dynamic set of human capabilities, and to better achieve many moral virtues, regardless of whether they are part of "human nature" or not. (shrink)

The antipsychiatrists in the 1960's, specifically Thomas Szasz, have claimed that mental illness does not exist. This argument was based on a specific definition of physical disease that, Szasz argued, could not be applied to mental illness. Thus, by problematizing mental illness, the spotlight had turned to physical disease. Since then, philosophers of medicine have proposed definitions applying both to pathophysiological and psychopathological conditions. This paper analyzes prominent naturalist definitions which aim to provide value-free accounts of pathological conditions, as well (...) as normative accounts that propose value-laden accounts. The approaches surveyed differ not only in terms of value, but also in terms of their perspective. This perspective concerns whether the concept of health, illness or disease/disorder is emphasized. The emphasis on health or illness is holistic as it looks at the human being as a whole, while focus on disease or disorder is analytic as it considers part functions. I will here argue in favor of holism and will propose a definition of mental health based on Sartre's existential psychoanalysis of Gustave Flaubert. (shrink)

Dominant views about the nature of health and disease in bioethics and the philosophy of medicine have presumed the existence of a fixed, stable, individual organism as the bearer of health and disease states, and as such, the appropriate target of medical therapy and ethical concern. However, recent developments in microbial biology, neuroscience, the philosophy of cognitive science, and social and personality psychology (Ickes...

Upon Brexit & Trade War, the research took a supply-side analysis in macroeconomic paradigm for the purpose and cause of the actions. In the geopolitical competitions on crude oil resources between the allied powers & the Russian hegemony, the latter of which has effective control over P. R. China’s multilateral behaviors, the external research induced that trade war, either by complete information in intelligence or an unintended result, was a supply chain attack in prohibiting the antisatellite weapon supplies in the (...) Northern regions of mainland China in relation to Russia. Although no substantive change to international relations, the Trade War’s prohibitive effect on the high frequency trading in the monetary domain of CNY was observed, which had been the source of economic bubbles in the import-export control regime with centralized banking. The paper argues that by realism in economy & military strategy, trade war was ineffective in deterring the covert operations of the People’s Liberation Army by their territorial strategies and raises questions in humanitarianism in conflict situations. Moreover, with gross privacy breaches by mass surveillance in domain politics, totalitarianism with coercions, and counterfeit of drone strikes, traditional methods of threat elimination are rendered less pragmatic apart from the adversaries’ cyber security breaches. With the scientific approach, I offer an ecological paradigm with historic analysis of the Chinese military’s conducts in terms economics. The territorial methods of the PLA are contextualized into the ecological paradigm in regionalism & public administration. Electronic combats of the Chinese regime with the Great Firewall and Denial-of-Service attacks not only contribute to the diminishing natural freedoms of the population, but also transgress the fundamental right to health along with non-traditional nuclear threats to P.R.C. itself. (shrink)

The purpose of cultural competence education for medical professionals is to ensure respectful care and reduce health disparities. Yet as Berger and Miller (2021) show, the cultural competence framework is dated, confused, and self-defeating. They argue that the framework ignores the primary driver of health disparities—systemic racism—and is apt to exacerbate rather than mitigate bias and ethnocentrism. They propose replacing cultural competence with a framework that attends to two social aspects of structural inequality: health and social policy, (...) and institutional-system activity; and two psychological aspects of structural inequality: the clinical encounter, and the epistemic. -/- We agree with the structural approach. To that end, we think it would be fruitful to include attention to physical contributors to structural inequality, namely the material artifacts used in medicine. Devices, tools, and technologies can materialize biases, perpetuate oppression, and contribute to health disparities. Granted, not everything that interests philosophers can be squeezed into medical education. Nevertheless, there are compelling reasons for including the study of material artifacts in education designed to reduce health disparities. First, devices and tools often carry forward biases from the past, and keep biases hidden from plain sight. Second, by studying these artifacts, future clinicians can begin to see themselves as part of a larger sociotechnical system. Finally, as medicine becomes increasingly tech-laden, it’s important for clinicians to see how material artifacts (including algorithms) connect individuals to structures. This will help to undermine oversimplified narratives according to which objective tools and technologies can correct for the bias and subjectivity of flawed human beings. (shrink)

Since the 1960s, the focus of African Philosophy has predominantly been Afrocentric, and with an emphasis on racial issues, as a reaction to Eurocentrism. To hold an open intercultural dialogue on African Philosophy with African and other philosophers is, therefore, not-self-evident. This article will argue that intercultural dialogues or (in case of more than two participants) ‘polylogues’ can and should become a more central point of focus in the academic study of African Philosophy. The author will center on how three (...) renowned African(a) philosophers with a focus on the Akan people of Ghana have initiated intercultural dialogues for the enhancement of human wellbeing. These are Kwasi Wiredu, Kwame Gyekye and Kwame Anthony Appiah. What these philosophers have in common is their belief that all human beings are interdependent and that an emphatic, ethic orientation to one another and mutual communication helps to live together in social harmony, which enhances the wellbeing of mankind. Discussing these African philosophers’ insights into depth will pave the way for other scholars to explore the intercultural dialogue as a weak or non-centric and non-racial focused philosophical method and to enhance understanding of its relation to African(a) Philosophy and a Global Ethics of care. Keywords: Global Ethics, African(a) Philosophy, Akan, intercultural philosophical dialogue, human wellbeing. (shrink)

One of the most frequently voiced criticisms of free will skepticism is that it is unable to adequately deal with criminal behavior and that the responses it would permit as justified are insufficient for acceptable social policy. This concern is fueled by two factors. The first is that one of the most prominent justifications for punishing criminals, retributivism, is incompatible with free will skepticism. The second concern is that alternative justifications that are not ruled out by the skeptical view per (...) se face significant independent moral objections. Yet despite these concerns, I maintain that free will skepticism leaves intact other ways to respond to criminal behavior—in particular preventive detention, rehabilitation, and alteration of relevant social conditions—and that these methods are both morally justifiable and sufficient for good social policy. The position I defend is similar to Derk Pereboom’s, taking as its starting point his quarantine analogy, but it sets out to develop the quarantine model within a broader justificatory framework drawn from public health ethics. The resulting model—which I call the public health -quarantine model—provides a framework for justifying quarantine and criminal sanctions that is more humane than retributivism and preferable to other non-retributive alternatives. It also provides a broader approach to criminal behavior than Pereboom’s quarantine analogy does on its own. (shrink)

This chapter delves into the museological side of ‘the way forward’ to conservation for planetary health bioethics. Specifically, it highlights the crucial role that museums play – their curatorial or exhibition interventions, conservation operations, development policies, or practices – which present or represent the vital relationship between human and planetary health. While it is not new to stress the significance of museums’ link to the environment and environmental education, it is necessary to re-examine recent cases in light of (...) the rapid changes brought about by climate change and the constant call for sustainability. We thus offer a review of some recent literature that appraises the museum’s role in bioethically considering the health of our living planet. Learning this role taps into relatively new themes such as ecomuseums and architectural heritage, or critical eco-museology. (shrink)