Larry Temkin draws on the work of Angus Deaton to argue that countries with poor governance sometimes rely on charitable giving and foreign aid in ways that enable them to avoid relying on their own citizens; this can cause them to be unresponsive to their citizens’ needs and thus prevent the long-term alleviation of poverty and other social problems. I argue that the implications of this “lack of government responsiveness argument” (or LOGRA) are both broader and narrower than they (...) might first appear. I explore how LOGRA applies more broadly to certain types of charitable giving in developed countries, with a focus on medical crowdfunding. I then highlight how LOGRA does not apply to charitable giving aimed at alleviating the suffering of the absolutely politically marginalized, or those especially vulnerable people to whom governments are never responsive. (shrink)

If medical complicity is understood as compliance with a directive to act against the professional's best medical judgment, the question arises whether it can ever be justified. This paper will trace the contours of what would legitimate a directive to act against a professional's best medical judgment (and in possible contravention of her oath) using Joseph Raz's service conception of authority. The service conception is useful for basing the legitimacy of authoritative directives on the ability of the (...) putative authority to enable subjects to comply better with reasons that already apply to them. Hence, the service conception bases the legitimacy of practical authority on a certain kind of greater knowledge or expertise. This helps to focus the conundrum regarding complicity on the clash of expertise between the medical expert and the governing body tasked with coordinating behaviour and otherwise devising rules for the social good. The ethical dilemma presented by a hypothetically legitimate directive to act against a professional's best medical judgment also serves to highlight the moral dimension of one's duty to obey a legitimate authority. (shrink)

Physicians in Islamic countries might be requested to participate in the Islamic legal code of qiṣāṣ, in which the victim or family has the right to an eye-for-an-eye retaliation. Qiṣāṣ is only used as a punishment in the case of murder or intentional physical injury. In situations such as throwing acid, the national legal system of some Islamic countries asks for assistance from physicians, because the punishment should be identical to the crime. The perpetrator could not be punished without a (...) physician’s participation, because there is no way to guarantee that the sentence would be carried out without inflicting more injury than the initial victim had suffered. By examining two cases of acid throwing, this paper discusses issues related to physicians’ participation in qiṣāṣ from the perspective of medical ethics and Islamic Shari’a law. From the standpoint of medical ethics, physicians’ participation in qiṣāṣ is not appropriate. First, qiṣāṣ is in sharp contrast to the Hippocratic Oath and other codes of medical ethics. Second, by physicians’ participation in qiṣāṣ, medical practices are being used improperly to carry out government mandates. Third, physician participation in activities that cause intentional harm to people destroys the trust between patients and physicians and may adversely affect the patient–physician relationship more generally. From the standpoint of Shari’a, there is no consensus among Muslim scholars whether qiṣāṣ should be performed on every occasion. We argue that disallowing physician involvement in qiṣāṣ is necessary from the perspectives of both medical ethics and Shari’a law. (shrink)

Most people are completely oblivious to the danger that their medical data undergoes as soon as it goes out into the burgeoning world of big data. Medical data is financially valuable, and your sensitive data may be shared or sold by doctors, hospitals, clinical laboratories, and pharmacies—without your knowledge or consent. Medical data can also be found in your browsing history, the smartphone applications you use, data from wearables, your shopping list, and more. At best, data about (...) your health might end up in the hands of researchers on whose good will we depend to avoid abuses of power.2 Most likely, it will end up with data brokers who might sell it to a future employer, or an insurance company, or the government. At worst, your medical data may end up in the hands of criminals eager to commit extortion or identity theft. In addition to data harms related to exposure and discrimination, the collection of sensitive data by powerful corporations risks the creation of data monopolies that can dominate and condition access to health care. -/- This chapter aims to explore the challenge that big data brings to medical privacy. Section I offers a brief overview of the role of privacy in medical settings. I define privacy as having one’s personal information and one’s personal sensorial space (what I call autotopos) unaccessed. Section II discusses how the challenge of big data differs from other risks to medical privacy. Section III is about what can be done to minimise those risks. I argue that the most effective way of protecting people from suffering unfair medical consequences is by having a public universal healthcare system in which coverage is not influenced by personal data (e.g., genetic predisposition, exercise habits, eating habits, etc.). (shrink)

In this paper, I defend a version of the medical model of disability, which defines disability as an enduring biological dysfunction that causes its bearer a significant degree of impairment. We should accept the medical model, I argue, because it succeeds in capturing our judgments about what conditions do and do not qualify as disabilities, because it offers a compelling explanation for what makes a condition count as a disability, and because it justifies why the federal government should (...) spend hundreds of billions of dollars, annually, on aid and accommodations for disabled people. After responding to a pair of objections Elizabeth Barnes has raised against the medical model, I contrast it with Guy Kahane and Julian Savulescu's welfarist account of disability, and with Barnes's own mere-difference view. Both of these accounts face serious challenges, although elements of Barnes's view can—and, in my opinion, should—be adopted by proponents of the medical model. (shrink)

The European Medical Information Framework project, funded through the IMI programme, has designed and implemented a federated platform to connect health data from a variety of sources across Europe, to facilitate large scale clinical and life sciences research. It enables approved users to analyse securely multiple, diverse, data via a single portal, thereby mediating research opportunities across a large quantity of research data. EMIF developed a code of practice to ensure the privacy protection of data subjects, protect the interests (...) of data sharing parties, comply with legislation and various organisational policies on data protection, uphold best practices in the protection of personal privacy and information governance, and eventually promote these best practices more widely. EMIF convened an Ethics Advisory Board, to provide feedback on its approach, platform, and the EcoP. The most important challenges the ECoP team faced were: how to define, control and monitor the purposes for which federated health data are used; the kinds of organisation that should be permitted to conduct permitted research; and how to monitor this. This manuscript explores those issues, offering the combined insights of the EAB and EMIF core ECoP team. For some issues, a consensus on how to approach them is proposed. For other issues, a singular approach may be premature but the challenges are summarised to help the community to debate the topic further. Arguably, the issues and their analyses have application beyond EMIF, to many research infrastructures connected to health data sources. (shrink)

We present the details of a methodology for quality assurance in large medical terminologies and describe three algorithms that can help terminology developers and users to identify potential mistakes. The methodology is based in part on linguistic criteria and in part on logical and ontological principles governing sound classifications. We conclude by outlining the results of applying the methodology in the form of a taxonomy different types of errors and potential errors detected in SNOMED-CT.

Reflection is widely acknowledged to play a crucial role in enhancing the competence of medical professionals. Developed countries have given importance to implementing reflective practices for professional development. In developing countries, reflective practices are not given much importance as a tool for professional growth. This article aims to uncover the existing practices of reflection and the challenges faced by medical professionals working at a government hospital in Nepal. It also promotes the practice of reflection to improve daily professional (...) practice. This article aims to uncover the existing practices of reflection and the challenges faced by medical professionals working at a government hospital in Nepal. This qualitative study utilized Narrative Inquiry as the research method and conducted semi-structured, in-depth interviews with two medical professionals selected through purposive sampling followed by content analysis of the collected data. The study was based on the theories of social constructivism and transformative learning. After analyzing the data, three significant themes emerged: empathizing through reflection, change in practice through reflection, and barriers to reflective practices. The study identified several barriers to reflective practices, including a negative attitude, sociocultural contexts, and a lack of support from the medical community. It is crucial to encourage self-reflection for medical professionals to enhance their professional growth and promote lifelong learning. This study provides valuable insights into the significance of reflective practices in the professional development of medical personnel, particularly in developing countries. (shrink)

Considerations of autonomy and independence, properly understood, support strictly egalitarian provision of necessary medical treatment. If the financially better-off can purchase access to necessary medical treatments that the financially less well-off cannot purchase without help, then their discretionary power to give or to withhold monetary gifts indirectly gives them the power to make life-and-death or sickness-and-health decisions for others. To prevent private citizens from having this objectionable form of power, government must ensure that citizens’ finances do not affect (...) their access to medical treatments that significantly prolong life, relieve suffering, or cure or mitigate disabilities. Government should ensure this even if doing so involves leveling down and even if it is unclear whether egalitarian provision of necessary treatment would provide better care to the poor than a less egalitarian health care system would. (shrink)

Background and Aim: Global trends and national policies have made internationalization and paying attention to the international markets of higher education inevitable on the one hand and becoming a legal requirement of Iranian medical sciences universities on the other hand. Therefore, the main goal of this article was to show, by examining the experience of international marketing of higher education in Tehran University of Medical Sciences, what are the futures of international marketing of higher education in medical (...) sciences? Materials and methods: in this documented data and the views, knowledge and lived experiences of the beneficiaries of the University of Medical Sciences were the basis of the study, and in the following, the methods of documentary studies, trend analysis, brainstorming, expert panel, theme analysis and scenario planning were used. Results: The most important achievement of this article is that among the challenges facing the international marketing of higher education in the University of Medical Sciences, two driving forces have the highest importance and uncertainty in shaping the future of this issue, including: sustainable security and cultural development. Conclusion: The normalization of political and economic relations with the world along with appropriate cultural development inside and outside the university and acceptance of cultural, racial, religious, intellectual, ethnic and gender differences strengthens the marketing process of higher education. In such a situation, the risk of investing in providing international higher education will be reduced. Therefore, the most expensive and the most important uncertainty facing the country's universities in international marketing is the attitude and approach of science and technology governance to the relations and structure governing the international system. (shrink)

: This article critically examines the constitution of impairment in prenatal testing and screening practices and various discourses that surround these technologies. While technologies to test and screen prenatally are claimed to enhance women's capacity to be self-determining, make informed reproductive choices, and, in effect, wrest control of their bodies from a patriarchal medical establishment, I contend that this emerging relation between pregnant women and reproductive technologies is a new strategy of a form of power that began to emerge (...) in the late eighteenth century. Indeed, my argument is that the constitution of prenatal impairment, by and through these practices and procedures, is a widening form of modern government that increasingly limits the field of possible conduct in response to pregnancy. Hence, the government of impairment in utero is inextricably intertwined with the government of the maternal body. (shrink)

This article is an effort to understand how healing of body was used by the Christian missionaries as an important tool for evangelisation with special reference to the Welsh Christian missionaries in North Cachar Hills from 1905 to 1961. The Welsh missionaries opened their mission in this Hill on 1905 with multiple endeavours such as opening schools, churches and dispensaries. North Cachar Hills was a sub division of Cachar district during the colonial period and was inhabited mainly by different indigenous (...) peoples such as the Dimasas, Zeme Nagas, Angami Nagas, old and new Kukis, Khasis, Karbis, etc. The missionaries regarded the local people as ‘heathen’ which means physically and morally ill and their traditional practices of appeasing the evil spirits for their ailments as a primitive act. Moreover the missionaries were not free from euro centrism and regarded their ideas and practices as superior than the traditional beliefs and practices of the natives. It is the intention of the article to highlight the strategy of the colonial administrator as well as the missionaries in operating humanitarian works such as ‘healing the heathens’. This article will also highlight the traditional treatment of illness and the medical measures taken by the colonial government and the responses of the local people on such measures. (shrink)

The objective of this article is to shed light on some challenging questions regarding public health and medical ethics that the Turkish healthcare system has recently been forced to confront. In recent years, terrorists in eastern Turkey have launched increasingly destructive attacks, including numerous attempts to undermine the social order by targeting not only government agencies but also the healthcare system. In this study, 54 terrorist incidents specifically targeting the Turkish healthcare system and healthcare professionals were analyzed and divided (...) into 6 categories according to the type of attack. Each category was evaluated in terms of the relevant ethical issues, with regard to both public health and medical ethics. This study shows that terrorist activity may lead to numerous breaches of public health and clinical ethics rules. Therefore, healthcare policy must involve special precautions to minimize breaches of public health and medical ethics in the face of terrorist attacks. (shrink)

The first case of COVID-19 in Iran was officially reported by the Iranian Government in February 19, 2020. In order to control and prevent the infection, the Government closed all the universities and requested the people to stay at home. Consequently, Tehran University of Medical Sciences (TUMS), like other universities, cancelled all the face-to-face classes in different Schools, and since the exact date for the resolution of this calamity could not be determined, TUMS decided to proceed the education flow (...) through the available Learning Management System (LMS). As one of the departments of the university, TUMS Department of Foreign Languages devised a plan and prepared itself for the new situation. This paper is a narrative account of the transition. Through reading this narration as a case of educational solution in the preset particular situation, language professors can adopt and implement efficient strategies and approaches in their educational settings. (shrink)

This letter was submitted to the Senate Standing Committee on Legal and Constitutional Affairs, Government of Canada, on 29th January, 2021, as final debate over Bill C-7 was being undertaken in the Senate regarding MAiD and the strong opposition to the legislation expressed across the Canadian disability community. It draws on our individual and joint work on eugenics, well-being, and disability.

Due to the Coronavirus Disease-2019 (COVID-19) lockdown implemented by the government, we had to transform our classes into the online sphere. The most commonly used methods of online teaching in Government Medical College, Thrissur were, live online lectures, PowerPoint presentations with narrations, prerecorded videos and assignments. Aim: To assess the logistical aspects, merit and demerits of different online teaching-learning methods among phase-1 medical student in a tertiary care teaching hospital during COVID-19 lockdown Materials and Methods: This cross-sectional study (...) was conducted from July 2020 to September 2020, among phase-1 MBBS students of Government Medical College, Thrissur, Kerala, India. Data was collected from 161 students through a questionnaire consisting of two parts. The first part dealt with logistical aspects, like net connectivity, gadget, expenditure, financial burden, residence and eye strain with online teaching learning methods. The second part dealt with the merits and demerits of each type of teaching learning methods, according to the students. All statistical data was analysed using the Statistical Package for the Social Sciences (SPSS) software version 16. Qualitative data was expressed as a percentage. Results: A total of 97.5% population of students was able to frequently access the online classes. Online learning strained the eyes of 47.8% of students. Mobile phones were used by 92.5% of students for attending online classes internet connectivity was mainly through 4G (71.4%) followed by Wi-Fi (19.9%) connections. Their most preferred method of online learning was online live lectures (35.4%) followed by PowerPoint presentations with narrations (33.5%). Blended learning (online and traditional together) was best preferred method of learning (46.6%). Conclusion: Live online lectures and blended learning were preferred by the majority of students. Thus, the online classes can be continued along with the traditional teaching in future. (shrink)

WHO in 2019 established the Advisory Committee on Developing Global Standards for Governance and Oversight of Human Genome Editing, which has recently published a Draft Governance Framework on Human Genome Editing. Although the Draft Framework is a good point of departure, there are four areas of concern: first, it does not sufficiently address issues related to establishing safety and efficacy. Second, issues that are a source of tension between global standard setting and state sovereignty need to be addressed (...) in a more nuanced fashion. Third, it fails to meaningfully engage with the extent to which the conceptualisation of human dignity may justifiably vary between jurisdictions. Fourth, the meaning of harm to the interests of a future person requires clarity. Provided these four areas of concern can be addressed, the future of the global governance of human genome editing may hold promise. (shrink)

The objective of this article is to shed light on some challenging questions regarding public health and medical ethics that the Turkish healthcare system has recently been forced to confront. In recent years, terrorists in eastern Turkey have launched increasingly destructive attacks, including numerous attempts to undermine the social order by targeting not only government agencies but also the healthcare system. In this study, 54 terrorist incidents specifically targeting the Turkish healthcare system and healthcare professionals were analyzed and divided (...) into 6 categories according to the type of attack. Each category was evaluated in terms of the relevant ethical issues, with regard to both public health and medical ethics. This study shows that terrorist activity may lead to numerous breaches of public health and clinical ethics rules. Therefore, healthcare policy must involve special precautions to minimize breaches of public health and medical ethics in the face of terrorist attacks. (shrink)

Since March of 2020, the world has been brought to its knees by unscientific and unethical mandates. These mandates have destroyed the world economy and the lives of countless innocent individuals. The “cure” that has been offered by medical bureaucrats and politicians has been more deadly than the disease (COVID-19). The imposition of ludicrous lockdowns, mask-wearing, coerced vaccination, and vaccine passports have not only proved to be ineffective, but also much more harmful than SARS-CoV-2 and all its variants. COVID-19 (...) has a recovery rate of close to 99% for most of the world’s population, however, despite this, institutions and power-hungry individuals have trampled upon our civil liberties and ignored our inalienable human rights. It is precisely as Thomas Paine famously stated: “The greatest tyrannies are always perpetrated in the name of the noblest causes.” -/- Many lives have been gratuitously lost because of the administration of deadly medical treatments, and the rejection of effective treatments that follow genuine science. In the process, informed consent has been disparaged and desecrated. For over two years, we were instructed to “trust the science,” but the “science” advocated by medical bureaucrats and greedy politicians was the reason why the world was turned upside-down. In the face of these crimes against humanity, justice will only be brought by real courts and real judges, but this will require the awakening of a critical mass. This book serves as an instrument for this awakening. (shrink)

The results of a recent survey of Nigerian women might give pause to opponents of female genital mutilation (FGM). One could well argue that if these Nigerian women themselves favour FGM, then it is ironically paternalistic to oppose it. Should Western feminists actually support FGM if it is what women in the South want? I argue in this commentary that such an argument rests on shaky statistical, psychological, medical, political and philosophical grounds. We should go on opposing female genital (...) mutilation with all our power. (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)

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)

Algorithmic governmentality is a new form of political governance interconnected with technology and computation. By coining the term “algorithmic governmentality,” Antoinette Rouvroy argues that this mode of governance reduces everything to data, and people are no longer individuals but dividuals (able to be divided) or readable data profiles. Implementing the concept of algorithmic governmentality, the current study analyses Project Itoh’s award-winning novel Harmony in terms of such relevant concepts as “subjectivity,” “infra-individuality” and “control,” as suggested by Rouvroy and (...) colleagues. The analysis further draws on Foucault’s ideas of “governmentality” and “neoliberalism” and Deleuze’s concepts of “dividuality” and “society of control.” In Itoh’s fictional world, the entire society is subject to the new medical government, which replaced the chaotic world with a perfect but harrowing benevolent society, eradicating disease, suicide and crime. As elucidated in this paper, despite the dominant controlling government, there is a hope for humans to regain and reestablish their subjectivity and give meaning to their own personality by defying the nihilistic computational system. (shrink)

Glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, and dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists, such as tirzepatide, have been found to be effective for treating obesity and diabetes, significantly reducing weight and the risk or predicted risk of adverse cardiovascular events. There is a global shortage of these medications that could last several years and raises questions about how limited supplies should be allocated. We propose a fair-allocation framework that enables evaluation of the ethics of current (...) practices and could guide governments, professional societies, and physicians in allocation decisions. (shrink)

Consent governs innumerable everyday social interactions, including sex, medical exams, the use of property, and economic transactions. Yet little is known about how ordinary people reason about the validity of consent. Across the domains of sex, medicine, and police entry, Study 1 showed that when agents lack autonomous decision-making capacities, participants are less likely to view their consent as valid; however, failing to exercise this capacity and deciding in a nonautonomous way did not reduce consent judgments. Study 2 found (...) that specific and concrete incapacities reduced judgments of valid consent, but failing to exercise these specific capacities did not, even when the consenter makes an irrational and inauthentic decision. Finally, Study 3 showed that the effect of autonomy on judgments of valid consent carries important downstream consequences for moral reasoning about the rights and obligations of third parties, even when the consented-to action is morally wrong. Overall, these findings suggest that laypeople embrace a normative, domain-general concept of valid consent that depends consistently on the possession of autonomous capacities, but not on the exercise of these capacities. Autonomous decisions and autonomous capacities thus play divergent roles in moral reasoning about consent interactions: while the former appears relevant for assessing the wrongfulness of consented-to acts, the latter plays a role in whether consent is regarded as authoritative and therefore as transforming moral rights. (shrink)

Introduction: The Kenyan government has put a spirited reform to ensure all Kenyans get universal healthcare. This has led to restructuring of several entities among them the health insurance industry. This is geared at alleviating the burden of catastrophic expenditure on health from the poor Kenyans. However, insurance uptake remains at less than a quarter of the population with many Kenyans still paying for healthcare out-of-pocket. These out-of-pocket payers often don’t afford the ever-increasing cost of healthcare in Kenya. This study (...) looked at how doctors deal with patients given their modality of payment. Methodology: This was an online based survey that was distributed to Kenyan doctors via email by Kenya Medical Association. The survey sought information from the respondents on how they dealt with patients given their modality of payment. In addition, respondents were asked to provide an example of a case they had dealt with that touched on each payment modality. Results: Respondents gave their experiences where insurance had influenced their clinical decisions. Codes developed from the prose were; “inability to pay”, “harmful to the patient”, “changed the prescription” among others Health insurance played a crucial role whenever respondents made decisions. Top on the list of things that the majority indicated would be considered is insurance status and/or their ability of patients to pay for the services. Conclusion: Respondents are stuck in a limbo; striving to give the best care to patients but limited by the patients’ inability to pay. In explaining their experiences, respondents explain a situation where they intend to offer the best, but patients cannot afford. This especially so for those without health insurance who end up either not getting services or at the very best, get inferior services. (shrink)

Governments standardly deploy a distinction between goods and services in assessing economic health and tracking national income statistics, of which medical goods and services carry significant importance. In what follows we draw on Basic Formal Ontology (BFO) to introduce a third kind of entity called patterns, which help capture the various ways in which goods and services are intertwined and help also to show how many services generate a new kind of non-goods-related products. Patterns are an overlooked yet essential (...) features of many economic sectors including medicine. Studying patterns offers new insights into various components of economic analysis, including outcomes-oriented evaluations of medical services and the value of human capital in the medical sphere. (shrink)

As opposed to a ‘one size fits all’ approach, precision medicine uses relevant biological, medical, behavioural and environmental information about a person to further personalize their healthcare. This could mean better prediction of someone’s disease risk and more effective diagnosis and treatment if they have a condition. Big data allows for far more precision and tailoring than was ever before possible by linking together diverse datasets to reveal hitherto-unknown correlations and causal pathways. But it also raises ethical issues relating (...) to the balancing of interests, viability of anonymization, familial and group implications, as well as genetic discrimination. This article analyses these issues in light of the values of public benefit, justice, harm minimization, transparency, engagement and reflexivity and applies the deliberative balancing approach found in theEthical Framework for Big Data in Health and Research to a case study on clinical genomic data sharing. Please refer to that article for an explanation of how this framework is to be used, including a full explanation of the key values involved and the balancing approach used in the case study at the end. Our discussion is meant to be of use to those involved in the practice as well as governance and oversight of precision medicine to address ethical concerns that arise in a coherent and systematic manner. (shrink)

Most medical research and a substantial amount of non-medical research, especially that involving human participants, is governed by some kind of research ethics committee (REC) following the recommendations of the Declaration of Helsinki for the protection of human participants. The role of RECs is usually seen as twofold: firstly, to make some kind of calculation of the risks and benefits of the proposed research, and secondly, to ensure that participants give informed consent. The extent to which the role (...) of the REC includes the former is not uncontroversial. Indeed, the most prevalent debate on the role of RECs sees liberals and strong paternalists arguing over the importance of informed consent given by competent agents versus the significance of making benevolent decisions on behalf of others. On the one hand, liberals argue for the rights of competent adults to decide for themselves the kinds and extents of risks to which they wish to expose themselves. On the other hand, proponents of strong paternalism raise concerns about the likelihood of participants being able to truly understand the complex data involved in research. They support a role for RECs in which they exercise duties of benevolence towards patients and participants by limiting the extent to which they can be exposed to significant, permanent and irreversible harms. In this paper, we will argue that when it comes to decisions about risk it is neither possible nor desirable for RECs to adopt either role. (shrink)

An abundance of data unequivocally shows that exercise can be an effective tool in the fight against obesity and its associated co-morbidities. Indeed, physical activity can be more effective than widely-used pharmaceutical interventions. Whilst metformin reduces the incidence of diabetes by 31% (as compared with a placebo) in both men and women across different racial and ethnic groups, lifestyle intervention (including exercise) reduces the incidence by 58%. In this context, it is notable that a group of prominent medics and exercise (...) scientists recently sent a well-publicised letter to the General Medical Council and Medical Schools Council calling for the introduction of evidence-based lifestyle education into all medical curricula. The letter warns that there is a lack of understanding of the impact that exercise and nutrition can have on physical health amongst doctors. In the absence of an educational overhaul, the signatories warn that the government is likely to fail to reach its goal of preventing tens of thousands of premature deaths from heart disease and cancer by 2020. Whilst we agree with the need to address this apparent lack of understanding, we argue that the ethical justification of doing so is not limited to this broadly beneficence-based justification. There is also a justification grounded in the duty of non-maleficence, that is, the duty to avoid unreasonably harming patients. This duty requires that doctors refrain from (i) preventing patients from undergoing beneficial treatment without good reason, (ii) exposing patients to unreasonable risks and (iii) reducing the therapeutic effect of an effective medical intervention. This requires an understanding of the physical impact of exercise. (shrink)

The U.S. FDA has issued emergency use authorizations for monoclonal antibodies for non-hospitalized patients with mild or moderate COVID-19 disease and for individuals exposed to COVID-19 as post-exposure prophylaxis. One EUA for an oral antiviral drug, molnupiravir, has also been recommended by FDA’s Antimicrobial Drugs Advisory Committee, and others appear likely in the near future. Due to increased demand because of the Delta variant, the federal government resumed control over the supply and asked states to ration doses. As future variants (...) with increased infectivity and/or severity emerge, further rationing may be required. We identify relevant ethical principles and priority groups for access to therapies based on an integrated approach to population health and medical factors. Using priority categories to allocate scarce therapies effectively operationalizes important ethical values. This strategy is preferable to the current approach of categorical rules based on vaccination, immunocompromise status, or older age, or the ad hoc consideration of clinical risk factors. (shrink)

This study steps beyond the traditional arguments of feminism and examines homebirth from a libertarian perspective. It addresses the debate over homebirth and midwifery, which includes the use of direct-entry midwives as well as the philosophical implications of individual autonomy expressed through consumer choice. Furthermore, this paper demonstrates that the medical establishment gains economic and political control primarily through medical licensing, and uses the state to undermine personal freedom as it advances a government-enforced monopoly on birth. At the (...) same time, empirical studies have established a substantial record of high safety and low medical complication rates for homebirth as compared to hospital births. Ultimately, the state’s restriction on medical choices is incompatible with the nonaggression principle and voluntarism, and therefore, with libertarianism. (shrink)

This topic focuses on the problems that arise in providing medical care to the population during armed conflict or martial law. Under such conditions, hospitals, clinics, and other healthcare facilities have to work in challenging circumstances with limited resources and reduced security for medical personnel. This topic explores such issues as how martial law affects the work of medical institutions, what problems arise in providing medical care to the population in war, how war affects the health (...) of the people, and what consequences it may have in the long term. Research in this area will help to understand how to organize better and prepare medical facilities to work in war conditions and ensure high-quality medical care to the population in emergencies. The methods used to write this article were analysis, synthesis, generalization, explanation, and data qualification. The primary and fundamental sources for writing an article may vary depending on the topic, but generally, the following sources can be recommended. Academic studies: these can be scholarly articles, monographs, dissertations, conference papers, and other materials related to the topic of your article. These sources can help you find information about the latest research in the field and allow you to see the approaches and methodologies used in the studies. Official sources: These can be legal documents, reports, regulations, guidelines, and other materials issued by government agencies, ministries, and other departments. These sources can help you understand the rules and regulations governing your article's topic. Expert reviews: these can be interviews with experts in the field, articles, and other materials written by well-known specialists. These sources can help you understand the views and opinions of well-known experts on the issues related to your paper. (shrink)

1. How do human organizations, as designed by humans, govern polities? -/- Current web-site analyses indicate that the medical-sites register the heaviest use. Humans are concerned with their health in a variety of iterations. If you will, it is the choice of the marketplace. But, humans must tend to the business of life. The humans live in communities, which necessarily choose definitions for their polities. Polities cannot exist without explicitly appointed and generally known socio-legal laws. In defining those rules, (...) societies decide how they are going to be organized and ruled---either consciously or by default---and how the common functions of the community are going to be financed. (shrink)

This project has been supported by the Australian Government through the Australian Research Council (project number CS170100008); the Department of Industry, Innovation and Science; and the Department of Prime Minister and Cabinet. ACOLA collaborates with the Australian Academy of Health and Medical Sciences and the New Zealand Royal Society Te Apārangi to deliver the interdisciplinary Horizon Scanning reports to government. The aims of the project which produced this report are: 1. Examine the transformative role that artificial intelligence may play (...) in different sectors of the economy, including the opportunities, risks and challenges that advancement presents. 2. Examine the ethical, legal and social considerations and frameworks required to enable and support broad development and uptake of artificial intelligence. 3. Assess the future education, skills and infrastructure requirements to manage workforce transition and support thriving and internationally competitive artificial intelligence industries. (shrink)

According to one influential view, requirements to elicit consent for medical interventions and other interactions gain their rationale from the respect we owe to each other as autonomous, or self-governing, rational agents. Yet the popular presumption that consent has a central role to play in legitimate intervention extends beyond the domain of cases where autonomous agency is present to cases where far from fully autonomous agents make choices that, as likely as not, are going to be against their own (...) best interest. The question how we should understand the rationale for eliciting consent in this range of ‘non-ideal’ cases is comparatively ill understood. In this paper, I explore the prospects of accounting for consent requirements in such ‘non-ideal’ cases by appealing to a set of agency-based interests; including an interest in playing a meaningful part in joint decisions affecting ourselves and others. (shrink)

The COVID-19 pandemic has been overwhelming public health-care systems around the world. With demand exceeding the availability of medical resources in several regions, hospitals have been forced to invoke triage. To ensure that this difficult task proceeds in a fair and organised manner, governments scrambled experts to draft triage guidelines under enormous time pressure. Although there are similarities between the documents, they vary considerably in how much weight their respective authors place on the different criteria that they propose. Since (...) most of the recommendations do not come with ethical justifications, analysing them requires that one traces back these criteria to their underlying theories of distributive justice. In the literature, COVID-19 triage has been portrayed as a value conflict solely between utilitarian and egalitarian elements. While these two accounts are indeed the main antipodes, I shall show that in fact all four classic theories of distributive justice are involved: utilitarianism, egalitarianism, libertarianism, and communitarianism. Detecting these in the documents and classifying the suggested criteria accordingly enables one to understand the balancing between the different approaches to distributive justice—which is crucial for both managing the current pandemic and in preparation for the next global health crisis. (shrink)

The costs of the COVID-19 pandemic are yet to be calculated, but they include the loss of millions of lives and the destruction of countless livelihoods. What is certain is that the SARS-CoV-2 virus has changed the way we live for the foreseeable future. It has forced many to live in ways they would have previously thought impossible. As well as challenging scientists and medical professionals to address urgent value conflicts in the short term, COVID-19 has raised slower-burning value (...) questions for corporations, public institutions, governments, and policymakers. In simple terms, the pandemic has brought what we care about into sharp relief, both collectively and individually. Whether this revaluation of our values will last beyond the current pandemic is unknown. Once COVID-19 has been tamed, will the desire to return to our previous lives be irresistible? Or will living under pandemic conditions have taught us something that will be incorporated into how we design our future lives and technologies? These are hard questions for the ethics of technology, which this volume aims to explore and address. (shrink)

The highly contagious 2019 novel coronavirus disease (COVID-19) outbreak has not only impacted health systems, economies, and governments, it has also rapidly grown into a global health crisis, which is now threatening the lives of millions of people globally. While, on one hand, medical institutions are critically attempting to find a cure, on the other hand, governments have introduced striking measures and policies to curtail the rapid spread of the disease. Although COVID-19 has achieved pandemic status and is predominantly (...) viewed as a biomedical issue, it is argued that it should also be treated as a psychological crisis. This paper also reviews the literature to examine and comment on the detrimental effects of isolation, which has been enforced as one of the primary preventative measures to manage the spread of COVID-19. This paper further outlines key recommendations that should be addressed across different levels to buffer against the known adverse effects of isolation, which is especially relevant for the current COVID-19 situation, where a large proportion of the global population is isolated, confined, and/or quarantined. (shrink)

Overall, there’s a rich literature on free speech and hate speech. However, there’s been comparatively less discussion on hate speech that brings in empirical psychological and medical evidence on the possible health harms hate speech can have for minorities. I introduce and piece together a set of pre-existing scientific data that’s new to the philosophical literature to help sufficiently establish an argument that governments should ban hate speech. Given the adverse effects hate speech can have on one’s mental and (...) physical health, hate speech causes harm at many times. Since it causes such harm and leads to overridingly negative consequences, the government ought to regulate such speech. (shrink)

A ‘should’ question normally signals work for an ethicist but this ethicist’s task is complicated by the normative dimension of all the chapters in this volume. Each author was asked to come up with three recommendations from their own subject area – ’should’ statements deriving from the ‘is’ analysis that they present. If those prescriptions cover the relevant topics, what more is there for an ethicist to do? I have had a personal interest in obstetricians’ relationship with ‘older women’ since (...) being classified as an ‘elderly primigravida’ at the superannuated age of 26 years. Apart from that, however, what original contribution can I make? The convenors of the 56th RCOG Study Group gave me plentiful suggestions – perhaps a little too plentiful: How should the RCOG approach its constituencies, medical ethics, regulation and its relationship to government and the rest of the medical profession, i.e. the NHS and the market, vested interests, individuals or consumers, families, the unborn, doctors, drug companies, surrogacy, the unborn, trafficking, global adoption, law, research? I have to admit this was just too much for me. Instead, I want to argue for what may seem a self-evidently simple point. The RCOG describes its mission as ‘setting standards to improve women’s health’ – presumably all women. In the 6 years that I have served on the RCOG Ethics Committee, however, we have almost always been concerned with that minority of the female population who are of reproductive age. (shrink)

As individuals we often face complex issues about which we must weigh evidence and come to conclusions. Corporations also have to make decisions on the basis of strong and compelling arguments. Legal practitioners, compelled by arguments for or against a proposition and underpinned by the weight of evidence, are often required to make judgments that affect the lives of others. Medical doctors face similar decisions. Governments make purchasing decisions—for example, for expensive military equipment—or decisions in the areas of public (...) or foreign policy. These issues involve many arguments on all sides of difficult debates. These issues involve understanding the arguments of others and being able to make objections and provide rebuttals to objections. Students in universities deal with arguments all the time. A major purpose of a university education—regardless of subject matter—is to teach students how to read, understand, and respond to complex arguments. The ability to do this makes for highly employable, adaptable, and reflectively critical individuals. We often call the skill of marshaling arguments and assessing them “critical thinking.” All universities claim to instill the skill of critical thinking in their graduates and routinely note this in their advertising and promotional documents. This short paper outlines one way this skill can be taught. (shrink)

I. EXECUTIVE SUMMARY The MRCT Center Post-trial Responsibilities: Continued Access to an Investigational Medicine Framework outlines a case-based, principled, stakeholder approach to evaluate and guide ethical responsibilities to provide continued access to an investigational medicine at the conclusion of a patient’s participation in a clinical trial. The Post-trial Responsibilities (PTR) Framework includes this Guidance Document as well as the accompanying Toolkit. A 41-member international multi-stakeholder Workgroup convened by the Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and Harvard University (...) (MRCT Center) developed this Guidance and Toolkit. Project Motivation A number of international organizations have discussed the responsibilities stakeholders have to provide continued access to investigational medicines. The World Medical Association, for example, addressed post-trial access to medicines in Paragraph 34 of the Declaration of Helsinki (WMA, 2013): “In advance of a clinical trial, sponsors, researchers and host country governments should make provisions for post-trial access for all participants who still need an intervention identified as beneficial in the trial. This information must also be disclosed to participants during the informed consent process.” This paragraph and other international guidance documents converge on several consensus points: • Post-trial access (hereafter referred to as “continued access” in this Framework [for terminology clarification – see definitions]) is the responsibility of sponsors, researchers, and host country governments; • The plan for continued access should be determined before the trial begins, and before any individual gives their informed consent; • The protocol should delineate continued access plans; and • The plan should be transparent to potential participants and explained during the informed consent process. -/- However, there is no guidance on how to fulfill these responsibilities (i.e., linking specific responsibilities with specific stakeholders, conditions, and duration). To fill this gap, the MRCT Center convened a working group in September of 2014 to develop a framework to guide stakeholders with identified responsibilities. This resultant Framework sets forth applicable principles, approaches, recommendations and ethical rationales for PTR regarding continued access to investigational medicines for research participants. (shrink)

Due to the outbreak of COVID-19 many families experience the threat of the COVID-19. This study aims to explore the lived experiences, challenges, and coping mechanisms of COVID-19 Family Survivors. The study employed the Interpretative Phenomenological Analysis with ten (10) participants. Based on the findings, the following conclusions were drawn: (1) Most of the participants consulted health professionals for their medications and advised herbal medicines in boosting their immune system. (2) Family survivors had to make adaptations to their daily routines (...) and established stringent health standards in their homes, such as separating the parents' and children's rooms, using disposable utensils, and ensuring that every surface of their homes was clean. (3) They were able to meet their necessities due to the generosity of their neighbors. These people were helped financially by their employers, neighbors, churchmates, and loved ones. Similarly, the government offered a different forum for the COVID-19 Family survivors to receive help and assistance. (4) Despite the hardships they faced, COVID-19 family survivors did not lose hope that they would be cured of COVID-19. These people tried their hardest to maintain their health by eating good meals, sleeping early, obtaining enough sunlight in the morning, and carefully selecting the vitamins they took. (5) Finally, despite the difficult battle against COVID19, these individuals grew resilient by building their spiritual lives, exercising their faith, and being brave for the sake of their loved ones. (shrink)

This paper is a study about Philadelphia’s comprehensive user engagement sites (CUESs) as the authors address and examine issues related to the upcoming implementation of a CUES while seeking solutions for its disputed questions and plans. Beginning with the federal drug schedules, the authors visit some of the medical and public health issues vis-à-vis safe injection facilities (SIFs). Insite, a successful Canadian SIF, has been thoroughly researched as it represents a paradigm for which a Philadelphia CUES can expand upon. (...) Also, the existing criticisms against SIFs are revisited while critically unpackaged and responded to in favor of the establishment. In the main section, the authors propose the layout and services of the upcoming CUES, much of which would be in congruent to Vancouver’s Insite. On the other hand, the CUES would be distinct from Insite, as the authors emphasize, in that it will offer an information center run by individuals in recovery and place additional emphasis on early education for young healthcare professionals by providing them a platform to work at the site. The paper will also briefly investigate the implementation of a CUES site under an ethical scope of the Harm Reduction Theory. Lastly, the authors recommend some strategic plans that the Philadelphia City government may consider employing at this crucial stage. (shrink)

This paper explores the relation between victims’ stories and normativity. As a contribution to understanding how the stories of those who have been abused or oppressed can advance moral understanding, catalyze moral innovation, and guide social change, this paper focuses on narrative as a variegated form of representation and asks whether personal narratives of victimization play any distinctive role in human rights discourse. In view of the fact that a number of prominent students of narrative build normativity into their accounts, (...) it might seem obvious that there is a connection between victims’ stories and moral insight. However, the category of victims’ stories spans an enormous variety of texts – private diaries, memoirs written for publication, interviews with journalists or social scientists, depositions prepared by human rights workers, stories shared with like-minded activists or with support groups, stories told to medical professionals, and testimony in courts, truth commissions and asylum hearings, to mention just some of the possibilities. The different contexts of elicitation and the different rules governing expression in these sites should make us wary of ready generalizations about the nature of victims’ narratives. Moreover, I doubt that existing explications of the way in which norms figure in narratives yield satisfactory theories of the contribution victims’ stories can make to discovering and defending just policies and practices. I consider two of the most prominent accounts of the relation between narrative and normativity. For different reasons, the account Anthony Amsterdam and Jerome Bruner present in their work on narrative and law and the account Hayden White presents in his work on narrative and history fail to appreciate the capacity of victims’ stories of abuse to advance understanding of and increase respect for human rights. In defense of the value of victims’ stories, I propose an account of the relation between normativity and a salient type of victim’s narrative that seems especially resistant to integration into human rights discourse. -/- . (shrink)

Objective: This main aim of the study is to explore COVID-19 pandemic problems from the perspective of public health-clinical care ethics through online mediareports in Turkey. Method: This research was designed as a descriptive and qualitative study that assesses COVID-19 through online media reports on critics between the periods of March 11, 2020 and April 2 2020 as a quantitative as number of reports and qualitative study, across Turkey. Reports were from Turkish Medical Association websites which included newspaper reports. (...) Study data were presented as statistically and qualitative data case and headlines. No ethical or ofTicial permission was sought as the study was conducted through open access internet news sites. Results: This online reports analysis retrieved about 6723 articles about the COVID-19. According to study data, information about COVID-19 were themed as follows: general deTiciencies in taking action and isolation, lack of isolation, passengers and transport vehicles not quarantined ; insufTicient diagnostic tests, decision to test after healthcare professionals become infected, lack of equipment, lack of evaluation outbreak countries [Table 2]. Conclusion and Suggestions: COVID-19 is a pandemic and is a global public health problem that concerns every individual and needs to be handled carefully. This requires a multi-faceted preparation and education. In this context, healthcare professionals should be well trained in this aspect and have all the necessary equipment throughout the process. Additionally, it should work systematically with the cooperation of all health organizations, the Ministry of Health, local governments and of course the media, in order to inform society, fairly distribute the resources and to implement the safety measures effectively. BrieTly, lack of transparency, insufTicient information, limited resources, lack of public health protection measures such as partial quarantine decision, partial implementation of the scientiTic board's re c ommenda ti on s fo r e c on omi c rea s on s, and contradiction of the explanations are revealed as serious ethical problems. (shrink)

Introduction In 2013, Dr. J. Muizelaar and Dr. R. Schrot, two neurosurgeons at the University of California Davis Medical Center (UCDMC), were found guilty of research misconduct due to failure to comply with institutional policies as well as Food and Drug Administration (FDA) regulations governing human subjects research. At issue here, however, is the difference between research and innovative therapy in the clinical setting of patient care where clinical judgment is reasonably to be privileged. Methods The UCDMC investigative document (...) is reviewed along with standard literature on clinical ethics and clinical data about glioblastoma multiforme (GBM) cancer. Results In this paper I argue that, by tendentiously focusing on policies, regulations, and procedures governing human subjects research, the UCDMC investigation failed to account for the centrality of clinical judgment and clinical ethics pertinent to judicious review of this matter, especially given the unique clinical context of terminally ill patients having exhausted standard care treatment options for glioblastoma multiforme (GBM) cancer. Conclusions The UCDMC investigation raises serious problems for clinicians who are engaged in innovative therapy in the clinical setting, requiring a regulatory framework separate from the normal Institutional Review Board (IRB) process. (shrink)

Although vaccines are considered an efficient public health tool by medical experts, in different countries, people’s confidence in them has been decreasing. COVID-19 has elevated medical scientists’ and practitioners’ social reputation, and it may have reduced global vaccination hesitancy. Still, this alone will not altogether remove the existent frictions that prevent people from complying with vaccination schedules. This paper will review the common causes behind vaccination hesitancy. It will also explore different types of public policy interventions that health (...) experts in governments and institutions employ to fight vaccine hesitancy and non-compliance. The main objective of this article is to argue that, considering the nature of the issue (vaccine hesitancy and its causes), among the various possibilities, policies based on behavioral insights can provide an effective instrument to remove those frictions. Among them, special attention will be devoted to nudges which promise efficiency while avoiding some of the ethical and political costs of other interventions, thanks to their libertarian paternalistic frame. The article concludes by suggesting that public health policymakers should consider the libertarian paternalistic approach of nudges when deploying interventions that aim at changing people’s attitudes and behavior. (shrink)

Within the next parliamentary term, the German government is expected to replace the current Embryo Protection Act with a new Human Reproductive Technology Act. Before introducing new legislation, policy makers may want to survey public attitudes towards novel applications of reproductive technology. In order to assess opinions and concerns about preconception sex selection for non-medical reasons, a social survey has been conducted in Germany. As a representative sample of the German population, 1005 men and women 18 years and older (...) were asked whether or not preconception sex selection should be made available. Of the respondents, 32% held that sex selection should be strictly prohibited, be it for medical or non-medical reasons, and 54% accepted the use of preconception sex selection for medical purposes. Only a minority of 11% approved of the use of preconception sex selection for non-medical reasons. The widespread opposition to a freely available service for non-medical sex selection is based on several claims: 87% of respondents hold that 'children are a gift and deserve to be loved regardless of any characteristics such as beauty, intelligence or sex'; 79% argue that choosing the sex of children is 'playing God'; 76% are opposed because it is seen as 'unnatural'; 49% are afraid that it is 'skewing the natural sex ratio'; and 40% consider it to be 'sexist'. (shrink)