This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law (...) and medicine, truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)

Advances in DNA sequencing technology open new possibilities for public health genomics, especially in the form of general population preventive genomic sequencing. Such screening programs would sit at the intersection of public health and preventive health care, and thereby at once invite and resist the use of clinical ethics and public health ethics frameworks. Despite their differences, these ethics frameworks traditionally share a central concern for individual rights. We examine two putative individual rights—the right not (...) to know, and the child’s right to an open future—frequently invoked in discussions of predictive genetic testing, in order to explore their potential contribution to evaluating this new practice. Ultimately, we conclude that traditional clinical and public health ethics frameworks, and these two rights in particular, should be complemented by a social justice perspective in order adequately to characterize the ethical dimensions of general population PGS programs. (shrink)

The ethics of organizations has received much attention in recent years. This raises the question of whether the ethics of organizations has also improved. In 1999, 2004, and 2008, a survey was conducted of 12,196 U.S. managers and employees. The results show that the ethical culture of organizations improved in the period between 1999 and 2004. Between 2004 and 2008 unethical behavior and its consequences declined and the scope of ethics programs expanded while ethical culture showed (...) no significant improvement during the same period. The article concludes with a discussion of the implications of these findings for future research and practice. (shrink)

Reproductive genetic carrier screening is increasingly being offered more widely, including to people with no family history or otherwise elevated chance of having a baby with a genetic condition. There are valid reasons to reject a prevention-focused public health ethics approach to such screening programs. Rejecting the prevention paradigm in this context has led to an emphasis on more individually-focused values of freedom of choice and fostering reproductive autonomy in RCS. We argue, however, that population-wide RCS has (...) sufficient features in common with other public health screening programs that it becomes important also to attend to its public health implications. Not doing so constitutes a failure to address the social conditions that significantly affect people’s capacity to exercise their reproductive autonomy. We discuss how a public health ethics approach to RCS is broader in focus than prevention. We also show that additional values inherent to ethical public health—such as equity and solidarity—are essential to underpin and inform the aims and implementation of reproductive carrier screening programs. (shrink)

"An important contribution to contemporary jurisprudential debate and to legal thought more generally, Just Interpretations is far ahead of currently available work."--Peter Goodrich, author of Oedipus Lex "I was struck repeatedly by the clarity of expression throughout the book. Rosenfeld's description and criticism of the recent work of leading thinkers distinguishes his work within the legal theory genre. Furthermore, his own theory is quite original and provocative."--Aviam Soifer, author of Law and the Company We Keep.

The clinical encounter between providers and patients is insufficient: most factors influencing health outcomes occur outside the clinic. Community Health Needs Assessments address this insufficiency via collaboration between hospitals and the communities they serve to address systemic sociological-economic variables impacting health outcomes. Considering this, why are Health Care Ethics Consultation services limited to the clinical setting? We can cultivate better ethics outcomes by addressing systemic sociological-economic factors that cause recurring ethics issues in the hospital. In this article, (...) I argue for the need for a Community Ethics Needs Assessment. CENA is a novel concept; thus, this article is exploratory. I argue for the necessity of a CENA and, more importantly, outline what methodology a CENA would use to both identify and address an ethics need. (shrink)

Effective community engagement is an important legal, ethical, and practical prerequisite for conducting field trials of genetically modified mosquitoes, because these studies can substantially impact communities and it is usually not possible to obtain informed consent from each community member. Researchers who are planning to conduct field trials should develop a robust community engagement strategy that meets widely recognized standards for seeking approval from the affected population, such as timeliness, consent, information sharing, transparency, understanding, responsiveness, mutual understanding, inclusiveness, and (...) respectfulness. Additional research is needed on the effectiveness of different methods of engaging communities in field trials of genetically modified mosquitoes and how to respond to public opposition to genetically modified organisms. For research programs involving the genetic modification of disease vectors to move forward, they must have public acceptance and support, which cannot be achieved without effective community engagement. (shrink)

In 1856, the State of Ohio began an enumeration of its population to count and identify people with disabilities. This paper examines the ethical role of the accounting profession in this project, which supported the transatlantic eugenics movement and its genocidal attempts to eliminate disabled persons from the population. We use a theoretical approach based on Levinas who argued that the self is generated through engagement with the Other, and that this engagement presupposes a responsibility to and for (...) the Other. We show that successive waves of legislation relied on State and County auditors along with Township clerks and assessors to conduct the mechanics of the enumeration of the population, which focused on the identification, categorization, and counting of the disabled people of the State. We argue that the accounting-based technologies of enumeration and reporting objectify the enumerated persons and deny the auditor’s pre-existing ethical obligation to this new Other. We show how the financial expertise and structures of the State were engaged in the execution of this mandate, which remained in place for over a century and supported a program of institutionalization. We consider the ramifications of this for our understanding of the ethical role of public sector accounting in the United States over this period, which has been under-explored. (shrink)

This chapter contains sections titled: The Malthusian Warning “Population Control” and its Critics “Leveling Off”: The Demographic Transition The Ethics of Population Programs Optimal Population Size: Fewer with More, or More with Less? A Thought‐Experiment About a Solution to the Population Problem References.

One of the main objectives of an ethics program is to improve the ethical culture of an organization. To date, empirical research treats at least one of these concepts as a one-dimensional construct. This paper demonstrates that by conceptualizing both constructs as multi-dimensional, a more in-depth understanding of the relationship between the two concepts can be achieved. Through the employment of the Corporate Ethical Virtues Model, eight dimensions of ethical culture are distinguished. Nine components of an ethics program (...) are identified. To assess the relationship between ethics programs and ethical culture, a survey was conducted of 4,056 members of the U. S. working population. The results show that the relationships between the components of an ethics program and the dimensions of ethical culture differ in strength, nature, and significance. Implications for research and practice are discussed. (shrink)

Purpose This study aims to examine the long-term effects of an Israeli digital literacy government program for disadvantaged populations, as they are perceived by participants of the program one year after completing the course. Design/methodology/approach Participants in the program were interviewed about the effects of participating in the program, their experiences and satisfaction, in retrospect, a year after they completed the program. Findings The main reasons for joining the program included cognitive motivations, mainly interest to become familiar with internet applications, (...) followed by employment aspiration. Positive benefits from participation included accumulated knowledge, confidence in using technology, empowerment and enhanced sense of self-efficacy. Interviewees also reported that as they could not practice or communicate with instructors once they completed the program, a significant portion of the accumulated gains faded. Social implications Social and practical implications: Digital technologies constitute key infrastructure to facilitate public participation, as well as for gaining social, political and economic capital. Therefore, there is a significant social value in reducing digital inequality by increasing digital literacy of disadvantaged populations, i.e. citizens with low socioeconomic status and low digital literacy. This study sheds light on the benefits gained from such programs, as perceived by past participants. Originality/value While previous studies evaluating digital literacy programs focus on specific technical improvements and short-term gains, this study investigates the long-term effects and shortcomings of the program as perceived by participants. (shrink)

Population policy has taken two divergent trajectories. In the developing part of the world, controlling population growth has been a major tune of the debate more than a half-century ago. In the more developed part of the world, an inverse pattern results in the discussion over the facilitation of population growth. The ethical debates on population policy have primarily focused on the former and ignored the latter. This paper proposes a more comprehensive account that justifies states’ (...) population policy interventions. We first consider the reasons that support pro-natalist policies to enhance fertility rates and argue that these policies are ethically problematic. We then establish an ethics of population policy grounded on account of self-sustaining the body politic, which consists of four criteria: survival, replacement, accountability, and solidarity. We discuss the implications of this account regarding birth-control and pro-natalist policies, as well as non-procreative policies such as immigration, adoption, and unintended baby-saving strategies. (shrink)

The vulnerability of participants in Substance Abuse and Mental Health Services Administration (SAMHSA) programs is a consequence of the illnesses that they are experiencing; ethical guarantees must be in place that ensure the dignity of the persons involved in such programs. Dignity is more than an individual concern; it has individual, institutional, and societal dimensions. An ethical framework is proposed that involves the interrelated vulnerabilities and needs of individuals and communities and our societal response to them. Among the (...) issues given particular attention are individual and community stigmatization, target population involvement in program planning, balance with regard to confidentiality and privacy, the place of proportionality grounded in a rich sense of community as a guiding ethical principle, and guidelines for SAMHSA programs. (shrink)

This paper considers the morally relevant ways in which population-based research is a distinct type of human subjects research that have unique moral considerations relevant for public health practitioners and researchers. By defining population-based research, the authors distinguish it from public health practice and then consider, in more detail, the ways in which population-based research differs from clinical human subjects research. Based upon the distinctions between these types of research and practice, they identify five important issues that (...) arise in the design and conduct of certain kinds of population-based research. The authors hope that public health practitioners find these distinctions useful in determining when their work may actually be population-based research and that public health researchers use them to identify the areas where ethical issues in their research may arise. (shrink)

Multiple scholars and institutions have asked what distinguishes public health research from public health practice. Most often, they ask in order to have a clear definition of what one does in various public health settings to assess oversight and/or regulation of human subjects research. More importantly, however, whether something is considered public health research or public health practice has real ethical implications in terms of the general moral considerations at stake and the obligations of public health researchers/practitioners to the populations (...) they serve or study.Numerous examples in recent history of research ethics, including the Kennedy Krieger Lead Abatement Study and EPA’s Children’s Environmental Exposure Research Study, suggest that an exploration of the ethics of public health, or more generally population-based research, may be warranted. Although we acknowledge that there are important ethical issues to consider in the implementation of public health practice, we leave that discussion for other authors. (shrink)

Targeting high-risk populations for public health interventions is a classic tool of public health promotion programs. This practice becomes thornier when racial groups are identified as the at-risk populations. I present the particular ethical and epistemic challenges that arise when there are low-risk subpopulations within racial groups that have been identified as high-risk for a particular health concern. I focus on two examples. The black immigrant population does not have the same hypertension risk as US-born African Americans. Similarly, (...) Finnish descendants have a far lower rate of cystic fibrosis than other Caucasians. In both cases the exceptional nature of these subpopulations has been largely ignored by the designers of important public health efforts, including the recent US government dietary recommendations. I argue that amending the publicly-disseminated risk information to acknowledge these exceptions would be desirable for several reasons. First, recognizing low-risk subpopulations would allow more efficient use of limited resources. Communicating this valuable information to the subpopulations would also promote truth-telling. Finally, presenting a more nuanced empirically-supported representation of which groups are at known risk of diseases (not focusing on mere racial categories) would combat harmful biological race essentialist views held by the public. (shrink)

Ethics instruction within an interdisciplinary core program involving a diverse student community representing many major fields of study presents unique challenges. Those challenges are in some ways compounded in the context of a religiously affiliated university whose spiritual and ethical commitments are grounded in the Judeo-Christian tradition even as its student population reflects increasing religious diversity. The authors present one method of addressing these challenges in hopes of inspiring broader discussions of how to teach ethics across the (...) curriculum to students from many backgrounds and with myriad academic and professional goals. (shrink)

Ethics in Public Health and Population Health.

Originally applied on domestic and lab animals, assisted reproduction technologies (ARTs) have also found application in conservation breeding programs, where they can make the genetic management of populations more efficient, and increase the number of individuals per generation. However, their application in wildlife conservation opens up new ethical scenarios that have not yet been fully explored. This study presents a frame for the ethical analysis of the application of ART procedures in conservation based on the Ethical Matrix (EM), and (...) discusses a specific case study—ovum pick-up (OPU) procedures performed in the current conservation efforts for the northern white rhinoceros (Ceratotherium simum cottoni)—providing a template for the assessment of ART procedures in projects involving other endangered species. (shrink)

This is a review of contemporary philosophical discussions of population policies. The focus is on normative justification, and the main question is whether population policies can be ethically justified. Although few analytical philosophers have directly addressed this question – it has been discussed more in other academic fields – many arguments and considerations can be placed in the analytical philosophical discourse. This article offers a comprehensive review and analysis of ethically relevant aspects of population policies evaluated on (...) the basis of the main ethical theories. This analysis is preceded by a brief historical contextualisation of when and how population policies became ethically contentious and how this relates to philosophical debates in environmental ethics, population ethics and political philosophy. The article also includes a conceptual analysis of population policies in which the empirical intricacies around individual fertility decisions are sorted out and the different ways in which they can be affected are categorised in a taxonomy which highlight the most relevant ethical aspects of population policies. The ethical analysis shows that while population policies can be justified on the basis of most ethical theories, it all depends on what prior assumptions are made about what is at stake. (shrink)

Observations from the Point of View of the Relationship between Economy and EthicsThe main goal of this review is not to discuss the different lectures one by one in order of appearance. In my opinion, it will be much more interesting to analyze the symposium thematically. First, I will discuss the way in which the problem of external debt as such has been presented. Secondly, I will focus on the different points of view from which the problem has been discussed. (...) Finally, I will reflect on the different arguments that have been formulated.The problem of external debt as such was presented by Prof. Garcia . He provided a detailed factual analysis of the problem, well illustrated and presented in its different aspects. Via official figures he showed the implications of external debt for the Third World countries as well as for the First World countries. What are the economic implications for both parties? For HIPC countries, the amount of total debt is situated between 200 and 300 percent of their annual export value and between 3 and 6 times their total annual GNP. For First World countries on the other hand, the cost of debt cancellation is equal to 1/6 of the UK military budget, to one-year's expenditure on cinema in the USA, or to one-year's expenditure on chocolate in the UK.On the social level he points to the following: nowadays, payments by the southern countries, corresponding to the external debt, are four times the official development aid sent by the northern countries. As a result of these payments, public expenditure on basic goods and services for the poorest population of the world is dramatically reduced. From a political point of view this means that the poorest and most excluded people of the world are paying the price for contracted loans about which they did not have anything to say. These were decisions made by the elites and most of the time guided by bad management or even by corruption. The poorest people have never benefited from these decisions, but at present they are undergoing the consequences of the debt. Garcia also shows that the problem of external debt in the South is not a matter of private, commercial affairs, but a matter of the public sector and of social justice. This means that debts are an issue of international politics and debt reduction a matter of international political willingness. (shrink)

The nascent for-profit psychedelic industry has begun to engage in corporate practices like funding scientific research and research programs. There is substantial evidence that such practices from other industries like tobacco, alcohol, pharmaceuticals and food create conflicts of interest and can negatively influence population health. However, in a context of funding pressures, low publicly funded success rates and precarious academic labor, there is limited ethics guidance for researchers working at the intersection of clinical practice and population (...) health as to how they should approach potential financial sponsorship from for-profit entities, such as the psychedelic industry. This article reports on a reflective exercise among a group of clinician scientists working in psychedelic science, where we applied Adams’ (2016) PERIL (Purpose, Extent, Relevant harm, Identifiers, Link) ethical decision-making framework to a fictionalized case of corporate psychedelic financial sponsorship. Our analysis suggests financial relationships with the corporate psychedelic sector may create varying degrees of risk to a research program’s purpose, autonomy and integrity. We argue that the commercial determinants of health provide a useful framework for understanding the ethics of industry-healthcare entanglements and can provide an important population health ethics lens to examine nascent industries such as psychedelics, and work toward potential solutions. (shrink)

Like all community-based public health campaigns, proposals to use genetic information to improve the health and welfare of communities, whether the old eugenic sterilization campaigns or the routinized population screening programs of today's ‘public health genetics’, can involve asking affected individuals to make special sacrifices or assume special responsibilities on behalf of the community's welfare. Moreover, unlike public health interventions that restrict individual liberties in order to prevent health problems which all community members risk more or less equally, (...) genetic prevention strategies always require sacrifices on the part of the community who face the genetic risks in question on behalf of those who do not. The irony of ‘community genetics’ is that most human communities are much too heterogeneous to face universal gene pool disasters. (shrink)

Tuberculosis, caused by bacteria, usually affects the lung. Being airborne, TB has been one of the world’s deadliest communicable diseases. In spite of being curable and preventable, the disease has always been a continuous threat to human population. Moreover, there are cases of multidrug resistant, extremely drug resistant as well as HIV associated forms. Recognizing this grave threat, the World Health Organization urged every country to have a national program for tuberculosis prevention and control. After incidences of involuntary detentions (...) of people with suspected TB in some places, WHO also recommended that national TB prevention programs should incorporate ethical considerations in them. Specifically, it prescribed that human rights and social justice issues should be given due considerations. Studies suggest that India, following the international recommendations, has rolled down a national program to prevent and control TB cases in the country. However, neither is there much consideration of ethics in it, nor there is any pronounced effort to include social justice issues. The present paper investigates how the inclusion of elements from social justice theory can actually help India’s TB program to address the issue of equitable protection. Specifically, it shows how insights from JP Ruger’s ‘Health Capability Paradigm’ can help India’s TB strategies to render equitable protection by addressing health inequities. (shrink)

This paper addresses whether universal, general education programs are enough to satisfy basic criteria of human rights, or whether comprehensive family planning programs, in conjunction with universal education programs, might also be morally required. Even before the Reagan administration instituted the ‘global gag rule’ at the 1984 conference in Mexico City, prohibiting funding to nongovernmental organizations that included providing information about abortion as a possible method of family planning, the moral acceptability of family planning programs has (...) been called into question. This paper makes a moral argument for family planning by appealing to both data and to theory: data about the efficacy of universal and comprehensive family planning education programs at reducing fertility and infant mortality, and theory about what is required for the establishment of autonomy. It reasons that universal educational programs are insufficient for the promotion of autonomy, and therefore argues on substantive autonomy grounds for comprehensive family planning programs in addition to universal education programs. (shrink)

Recent decades have seen an unprecedented proliferation of surveillance programs by government agencies. This development has been driven both by technological progress, which has made large scale surveillance operations relatively cheap and easy, and by the threat of terrorism, organized crime and pandemics, which supplies a ready justification for surveillance. For a long time, mass surveillance programs have been associated with autocratic regimes, most notoriously with the German Democratic Republic and the Stasi, its secret police. A more recent (...) case in point is the efforts of the People’s Republic of China to set up a comprehensive surveillance system that assigns citizens a score reflecting their social and political conformity. But the current rise of state mass surveillance is mostly attributable to the new readiness of liberal democracies to monitor their populations. The vast surveillance system uncovered by whistleblower Edward Snowden is maintained and supported by a group of established liberal democracies, including the United States, the United Kingdom, Canada, and many others. While surveillance programs of authoritarian regimes, installed to monitor and quash political dissidents, are uncontroversially unjust, surveillance operations carried out by liberal democracies possess at least some prima facie legitimacy. They are set up with the stated objective of protecting citizens against terrorism, organized crime and pandemics, which few would deny is the duty of any state. Still, the expansion of large-scale surveillance by democratic governments has widely been perceived as objectionable or at least problematic on account of its harmful effects on both individuals and liberal society at large. (shrink)

The majority of deaths due to tobacco in the twenty-first century will occur in the developing world, where over 80% of current tobacco users live. In November 2010 guidelines were adopted for implementing Article 14 of the World Health Organization’s Framework Convention on Tobacco Control (FCTC). The guidelines call on all countries to promote tobacco treatment programs. Nevertheless, some experts argue for a strict focus, at least in developing countries, on population-based measures such as taxes and indoor air (...) laws, which they consider more cost-effective than individual treatment. In this article we defend tobacco dependence treatment in developing countries. First, these experts understate the comparative cost-effectiveness of individual treatment programs. Second, they overlook numerous ethical considerations beyond cost-effectiveness that support individual tobacco treatment in developing countries. We conclude that the strict population-based focus in developing country tobacco control advocated by some experts is misplaced. In general, developing nations should combine population-based measures and individual tobacco treatment programs. (shrink)

United States public health experts have long expressed concern about the prevalence of the human immunodeficiency virus among injection drug users. The United States has the largest reported IDU population in the world: 1.1 to 1.5 million. Recent estimates from the Centers for Disease Control and Prevention suggest that 50 percent of incident HIV infections occur among IDUs, with additional infections occurring among their sex partners and offspring. More than 33 percent of new AIDS cases occur in IDUs, their (...) sexual partners, and their children. Almost one half of all women diagnosed with AIDS in the United States are IDUS. Many of the remaining infected women were infected as a result of sex with a male IDU.While public health agencies, legislators, community leaders, and religious groups have engaged in vigorous debate over the merits of needle exchange programs as an intervention to reduce HIV transmission, the programs, some legal and some illegal, have been implemented in fifty-five cities across the country. (shrink)

United States public health experts have long expressed concern about the prevalence of the human immunodeficiency virus among injection drug users. The United States has the largest reported IDU population in the world: 1.1 to 1.5 million. Recent estimates from the Centers for Disease Control and Prevention suggest that 50 percent of incident HIV infections occur among IDUs, with additional infections occurring among their sex partners and offspring. More than 33 percent of new AIDS cases occur in IDUs, their (...) sexual partners, and their children. Almost one half of all women diagnosed with AIDS in the United States are IDUS. Many of the remaining infected women were infected as a result of sex with a male IDU.While public health agencies, legislators, community leaders, and religious groups have engaged in vigorous debate over the merits of needle exchange programs as an intervention to reduce HIV transmission, the programs, some legal and some illegal, have been implemented in fifty-five cities across the country. (shrink)

Future population growth is uncertain and matters for climate policy: higher growth entails more emissions and means more people will be vulnerable to climate-related impacts. We show that how future population is valued importantly determines mitigation decisions. Using the Dynamic Integrated Climate-Economy model, we explore two approaches to valuing population: a discounted version of total utilitarianism (TU), which considers total wellbeing and is standard in social cost of carbon dioxide (SCC) models, and of average utilitarianism (AU), which (...) ignores population size and sums only each time period’s discounted average wellbeing. Under both approaches, as population increases the SCC increases, but optimal peak temperature decreases. The effect is larger under TU, because it responds to the fact that a larger population means climate change hurts more people: for example, in 2025, assuming the United Nations (UN)-high rather than UN-low population scenario entails an increase in the SCC of 85% under TU vs. 5% under AU. The difference in the SCC between the two population scenarios under TU is comparable to commonly debated decisions regarding time discounting. Additionally, we estimate the avoided mitigation costs implied by plausible reductions in population growth, finding that large near-term savings ($billions annually) occur under TU; savings under AU emerge in the more distant future. These savings are larger than spending shortfalls for human development policies that may lower fertility. Finally, we show that whether lowering population growth entails overall improvements in wellbeing—rather than merely cost savings—again depends on the ethical approach to valuing population. (shrink)

The goals and tasks of neuroethics formulated by Farahany and Ramos (2020) link epistemological and methodological issues with ethical and social values. The authors refer simultaneously to the social significance and scientific reliability of the BRAIN Initiative. They openly argue that neuroethics should not only examine neuroscientific research in terms of “a rigorous, reproducible, and representative neuroscience research process” as well as “explore the unique nature of the study of the human brain through accurate and representative models of its function (...) and dysfunction”, but also its responsibilities or social consequences. In our commentary, we would like to concentrate on problem selection, which is shortly noticed by Farahany and Ramos, and by BRAIN Initiative’s Neuroethics Report itself. The document raises an important issue related to problem selection, which is strengthening or perpetuating existing prejudices and biases by choosing a research subject: “scientists are prompted to consider how the questions they choose to study in the laboratory might amplify existing biases.” This leads to several further problems: what constitutes bias?; how biases may be embedded in the selection of research programs?; is it possible to conduct completely unbiased research?; who should be a gatekeeper in the case of research that may amplify biases? We try to notice possible answers to these questions in the context of the research on differences (e.g., cognitive, medical, behavioral) between human populations. (shrink)

An orthodox view in marketing ethics is that it is morally impermissible to market goods to specially vulnerable populations in ways that take advantage of their vulnerabilities. In his signature article “Marketing and the Vulnerable,” Brenkert (Bus Ethics Q Ruffin Ser 1:7–20, 1998) provided the first substantive defense of this position, one which has become a well-established view in marketing ethics. In what follows, we throw new light on marketing to the vulnerable by critically evaluating key components (...) of Brenkert’s general arguments. Specifically, we contend that Brenkert has failed to offer us any persuasive reasons to think that it is immoral to market to the vulnerable in ways that take advantage of their vulnerability. Although Brenkert does highlight the fact that the specially vulnerable are at greater risk of being harmed by already immoral marketing practices (e.g., deception, manipulation), he fails to establish that the specially vulnerable are a unique moral category of market clients or that there are special moral standards that apply to them. Moreover, even if Brenkert’s position were theoretically defensible, the practical implications of his position are far less tenable than he suggests. If our criticisms are sound, then Brenkert and others who endorse his position are seriously mistaken regarding how one can permissibly market products to vulnerable populations, and, in addition, they have improperly categorized certain morally permissible marketing practices as being immoral. (shrink)

ABSTRACT The rapid increase in human population is one of the underlying factors driving the ecological crisis. Despite efforts on the part of educators to raise awareness of environmental issues, the ecological impact of a burgeoning population – and the ethical implications of having children – remains an unbroachable topic. Nevertheless, the increase in human numbers is central to questions of sustainability: How can a species expect to survive in a finite terrestrial environment without limits to its (...) class='Hi'>population? Since most of the world’s ecological impact can be traced to capitalist-industrial- consumer societies in over-developed nations, the middle and upper classes in rich countries must weigh the ecological consequences of their family-planning decisions. In this paper, I argue that educational programs that are concerned with environmental ethics should have students examine the assumptions and implications of having children. I consider the risks associated with this proposal and respond to a series of possible objections. This paper does not advocate coercive measures for population control, but rather enjoins a pedagogical responsibility to view having children as an act with ecological consequences, an act that must be subject to careful examination. (shrink)

Through qualitative surveys, a team of law students, law professors, physicians, and residents explored the perceptions of neurology residents towards referral to appropriate legal resources in an academic training program. Respondents reported feeling uncomfortable screening their patients for health-harming legal needs, which many attributed to a lack of training in this area. These findings indicate that neurology residents would benefit from training on screening for social factors that may be impacting their patients’ health.

This paper examines the ethical implications of the Clean Development Mechanism, the United Nation’s climate change initiative that provides incentives to countries and firms in developed countries to motivate investments in greenhouse gas reduction projects in developing countries. Using the tenets of agency theory, we present a solid waste management project in El Salvador as an illustrative example of how the CDM can produce a disproportionately high social cost for the most marginalized populations in the developing world. We suggest that (...) the UN needs to reformulate the CDM so that it more effectively aligns the divergent goals of multiple actors and upholds the UN’s principles for sustainable development, including ethical firm-level behavior. By providing incentives for environmental, economic, and social value creation, the CDM would not only promote ethical norms for profit-seeking firms that participate in the program but also reinforce the UN’s twin pro-poor and environmental objectives. (shrink)

Advances in technology have made it possible for us to take actions that affect the numbers and identities of humans and other animals that will live in the future. Effective and inexpensive birth control, child allowances, genetic screening, safe abortion, in vitro fertilization, the education of young women, sterilization programs, environmental degradation and war all have these effects. Although it is true that a good deal of effort has been devoted to the practical side of population policy, moral (...) theory has not dealt adequately with the new possibilities. The dilemma faced by moral theory is that traditional theories cannot answer moral questions involving the creation of people. Two related problems arise. The first concerns numbers: how many people should there be? The second asks what sort of people should live and what their levels of well-being should be. Conventional social-contract theories, including the work of Rawls (1971), are restricted to situations with a fixed number of individuals. Sumner (1978) attempts to extend a Rawlsian veil-of-ignorance approach to possible people but is aware of the difficulties involved. The main problem is that possible people must be thought to benefit when they move from non-existence to existence, a view that we reject (see Section 1, Heyd, 1992, Chapter 1; McMahan, 1996a; Parfit, 1984, Appendix G). Rights-based and duty-based theories suffer from a similar problem; there must be a person who has the right or a person to whom the duty is owed (see McMahan, 1981). (shrink)

The first Ethics Bowl competition was established in the 1990s by Dr. Robert Ladenson of the Illinois Institute of Technology to help students reason through ethical challenges they will face in their personal and professional lives, and help them develop responsibilities as citizens of a democracy. Since then, the Ethics Bowl format and its pedagogical goals have been adapted to many other academic disciplines and a variety of student and professional populations. Our aim was to quantify the growth (...) of the Ethics Bowl concept by enumerating and describing extant Ethics Bowl programs, outlining both pedagogical goals and operational aspects. Using respondent-driven sampling, we identified 20 Ethics Bowl programs across the globe, reaching tens of thousands of participants annually, and an additional two programs preparing to launch in the near future. We conclude by making recommendations for pedagogical and operational dimensions of the programs. (shrink)

Consider Phoebe and Daphne. Phoebe has credences in 1 million propositions. Daphne, on the other hand, has credences in all of these propositions, but she's also got credences in 999 million other propositions. Phoebe's credences are all very accurate. Each of Daphne's credences, in contrast, are not very accurate at all; each is a little more accurate than it is inaccurate, but not by much. Whose doxastic state is better, Phoebe's or Daphne's? It is clear that this question is analogous (...) to a question that has exercised ethicists over the past thirty years. How do we weigh a population consisting of some number of exceptionally happy and satisfied individuals against another population consisting of a much greater number of people whose lives are only just worth living? This is the question that occasions population ethics. In this paper, I go in search of the correct population ethics for credal states. (shrink)

Existing ethics guidelines, influential literature and policies on ethical research generally focus on real-time data collection from humans. They enforce individual rights and liberties, thereby lowering need for aggregate protections. Although dependable, emerging public health research paradigms like research using public health data raise new challenges to their application. Unlike traditional research, RUPD is population-based, aligned to public health activities, and often reliant on pre-collected longitudinal data. These characteristics, when considered in relation to the generally lower protective ethico-legal (...) frameworks of the Global South, including Africa, highlight ethical gaps. Health and demographic surveillance systems are examples of public health programs that accommodate RUPD in these contexts. We set out to explore the perspectives of professionals with a working knowledge of these systems to determine practical ways of appropriating the foundational principles of health research to advance the ever growing opportunities in RUPD. We present their perspectives and in relation to the literature and our ethical analysis, make context relevant recommendations. We further argue for the development of a framework founded on the discussions and recommendations as a minimum base for achieving optimal ethics for optimal RUPD in the Global South. (shrink)

This paper evaluates the content of the syllabi of postgraduate courses on public health ethics within accredited schools and programs of public health in the United States in order to gain an awareness of the topics addressed within these courses. Methods: Data was gathered via the analysis of syllabi of courses on PHE. In 2012, information was requested by e-mail from the 48 schools and 86 PH programs accredited by the U.S. Council on Education for Public Health (...) for 2012. The “Epidemiology and PHE Syllabi” project of the University of Miami also was consulted. A table of topics was drawn up in order to carry out content analysis of the documents. Results: Data was obtained from 25 schools and 36 accredited programs ; 36 syllabi were gathered and 75 different topics were found. Of these, 38 topics were addressed in six or more syllabi and can be grouped as follows: foundations of PHE; autonomy and its limits; infectious disease control; justice; research ethics; health education and promotion; environmental and occupational health; screening; genetics; privacy and confidentiality; and community-based practice and vulnerable populations. Conclusions: The analyzed syllabi show high variability in curricular content. The debate with regard to whether a core curriculum on PHE should be established is ongoing. The results of this work might be of interest for schools and programs of PH in other countries or regions of the world in order to develop or ameliorate their own PHE syllabi. (shrink)

Male to male unprotected anal sex is the main route of HIV transmission in Australia. The Australian Study of Health and Relationships, a large, representative population survey of sexual health behaviors, found that six percent of males in the general population have engaged in homosexual activity. These findings were consistent with studies in Europeand North America. Condoms have been shown to reduce the transmission of HIV in the community. Barriers to the use of condoms include access,stigma,and cost? Nevertheless, (...) increased condom use has been reported among homosexual males, sex workers and injecting drug users although recent declines in condom use among homosexuals has presented new challenges in HIV prevention.The prevalence of male to male sexual activity may be higher in prison than in the general population. Sexual activity in prison can be consensual and non-consensual involving both homosexual / bisexual and heterosexual men. (shrink)

Male to male unprotected anal sex is the main route of HIV transmission in Australia. The Australian Study of Health and Relationships, a large, representative population survey of sexual health behaviors, found that six percent of males in the general population have engaged in homosexual activity. These findings were consistent with studies in Europeand North America. Condoms have been shown to reduce the transmission of HIV in the community. Barriers to the use of condoms include access,stigma,and cost? Nevertheless, (...) increased condom use has been reported among homosexual males, sex workers and injecting drug users although recent declines in condom use among homosexuals has presented new challenges in HIV prevention.The prevalence of male to male sexual activity may be higher in prison than in the general population. Sexual activity in prison can be consensual and non-consensual involving both homosexual / bisexual and heterosexual men. (shrink)

When applied in population-level contexts, such as schools or business, mindfulness-based interventions (MBIs) find themselves in a crossfire between two different kinds of criticisms. On one side, some worry that MBIs’ normative commitments might be “too thick,” worrying that MBIs might come with a particular conception of the good, and significant ethical and religious commitments. On the other side, some worry that contemporary MBIs are ethically “too thin,” as they shed too many of their original Buddhist ethical and soteriological (...) goals. In this chapter, it is argued that contemporary MBIs should remain normatively thin, as that makes them more suitable for population-level contexts. Against “thickness worries,” it is argued that MBIs are compatible with liberal respect for autonomy, as the benefits are often autonomy-enhancing, which makes MBIs potentially valuable across a broad range of conceptions of the good. The second line of argument is developed through a discussion of MBIs in schools. (shrink)

BackgroundTo help inform the development of more accessible, acceptable, and effective ethics consultation (EC) training programs, we conducted an EC training needs assessment, exploring ethics practitioners’ opinions on: the relative importance of various EC practitioner competencies; the potential market for EC training (that is, how many individuals would benefit and how much individuals and hospitals would be willing to pay); and the preferred content, format, and characteristics of EC training.MethodsAs part of a multipart study, we surveyed “best (...) informants” who self-identified as the person most actively involved in EC or healthcare ethics in a random sample of 600 U.S. general hospitals, stratified for bed size.ResultsThe competency that was ranked most important for a lead or solo ethics consultant was knowledge of ethics, while common sense was ranked least important. The median estimated number of individuals at each hospital who would benefit from EC training was six at the basic level, three at the advanced level, and two for EC management training. In 19.1 percent of hospitals, respondents thought their hospital would not be willing to pay anything for EC training within the next two years. Respondents thought potential trainees would be likely to participate in EC training on multiple different topics. Opinions varied widely on preferred formats. Most respondents thought it very important to be able to interact with instructors and with other trainees, practice EC skills, receive a certificate for completing EC training, and complete EC training during work hours.ConclusionsThese findings provide U.S. population data that may be useful to healthcare educators and bioethics leaders in their efforts to develop EC training programs and products that match trainees’ preferences and needs. (shrink)

Higher education institutions have a responsibility to promote the development of students' ethical and citizenship competencies, especially in contexts of major social inequality. Graduates, who constitute a very small percentage of the population in México, are the best qualified to conceive of creative alternatives to resolve its demanding social challenges. But this cannot be done if trained professionals and specialists remain indifferent to their communities and merely seek to satisfy their personal interests. Higher education institutions should have an active (...) role to play in the consolidation of democracy in México, providing society with technically and professionally well prepared individuals who are also ethical and competent citizens. This article sketches a 10-year program focusing on the development of the ethical and citizenship competencies of higher education students being implemented in a private university. Evidence from the first phase of assessment of ethical competencies is cited and discussed. (shrink)

In industries populated by small and medium enterprises, managers' good intentions frequently incur barriers to superior environmental performance (Tilley, Bus Strategy Environ 8:238-248, 1999). During the period when the U.S. wine industry was beginning to promote voluntary adoption of sound environmental practices, we examined managers' attitudes, norms, and perceptions of stakeholder pressures to assess their intentions to implement environmental management programs (EMP). We found that managers within the simple structures of these small and medium firms are responsive to attitudes, (...) norms, and pressures from internal stakeholders and that voluntarily established EMP increased the success of firms' implementation of energy conservation and recycling practices. Applications of our findings to future research on small and medium enterprises as well as direct practical applications of our results are discussed. (shrink)

Multidrug resistant organisms are a public health threat that have reduced the effectiveness of many available antibiotics. Antimicrobial stewardship programs have been tasked with reducing antibiotic use and therefore the emergence of MDROs. While fecal microbiota transplant has been proposed as therapy to reduce patient colonization of MDROs, this will require additional evidence to support an expansion of the current clinical indication for FMT. This article discusses the evidence and ethics of the expanded utilization of FMT by ASPs (...) for reasons other than severe recurrent or refractory Clostridioides difficile infection. (shrink)

Population ethics is widely considered to be exceptionally important and exceptionally difficult. One key source of difficulty is the conflict between certain moral intuitions and analytical results identifying requirements for rational (in the sense of complete and transitive) social choice over possible populations. One prominent such intuition is the Asymmetry, which jointly proposes that the fact that a possible child’s quality of life would be bad is a normative reason not to create the child, but the fact that (...) a child’s quality of life would be good is not a reason to create the child. This paper reports a set of questionnaire experiments about the Asymmetry in the spirit of economists’ empirical social choice. Few survey respondents show support for the Asymmetry; instead respondents report that expectations of a good quality of life are relevant. Each experiment shows evidence (among at least some participants) of dual-process moral reasoning, in which cognitive reflection is statistically associated with reporting expected good quality of life to be normatively relevant. The paper discusses possible implications of these results for the economics of population-sensitive social welfare and for the conflict between moral mathematics and population intuition. (shrink)