Health Care Rights

In this paper, I raise some doubts about Nicole Hassoun's account of the obligations of states, pharmaceutical firms, and consumers with regard to global health, presented in Global Health Impact. I argue that it is not necessarily the case, as Hassoun claims, that if states are just, and therefore satisfy all of their obligations, then consumers will not have strong moral reasons, and perhaps obligations, to make consumption choices that are informed by principles and requirements of justice. This is because (...) there may be justice-based limits on what states can permissibly and feasibly do both to promote access to existing drugs for all of those who need them, and to promote research and development for new drugs that could treat diseases that primarily affect the global poor. One important upshot of my argument is that there can be reasons for organizations like the Global Health Impact Organization to exist, and to do the kind of work that Hassoun argues is potentially valuable in our deeply unjust world, even in much less unjust worlds in which states and firms largely, or even entirely, comply with their obligations. (shrink)

The importance of medical confidentiality is obvious to anyone who has ever been a patient, and protecting private information about patients is one of the key responsibilities of healthcare professionals. However, maintaining the confidentiality of patients who are incarcerated in prisons poses several ethical challenges. In this chapter we explain the importance of confidentiality in general, and the dilemmas that sometimes face doctors with regard to it, before describing some of the specific difficulties faced by prison doctors. Although healthcare professionals (...) working in prisons have the same duty to respect confidentiality as those working in the wider community, the conflicts of interest caused by their dual loyalty to prisoners and to prison authorities can make it very difficult to strike the right balance between respecting confidentiality and protecting prisoners and third parties. We illustrate some of the dilemmas facing prison doctors with a series of case discussions before providing suggestions for resolving these difficult situations. Ideally, a combination of great ethical and legal sensitivity on the part of healthcare professionals and general respect for prisoners’ rights on the part of other prison staff enables most issues to be resolved without the need to compromise patients’ confidentiality. (shrink)

In this article, I confront Flanigan’s recent attempt to show, not merely that women have a right to commit prenatal injury, but also that women who act on this right are praiseworthy and should not be criticized for this injury. I show that Flanigan’s arguments do not work, and I establish presumptive grounds against any such right, namely: prenatal injury, by definition, involves intentional or negligent harm and, as such, may be subsumed under a wider class of actions that are (...) presumptively wrong. (shrink)

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

A dogma accepted in many ethical, religious, and legal frameworks is that the reasons behind conscientious objection (CO) in healthcare cannot be evaluated or judged by any institution because conscience is individual and autonomous. This paper shows that the background view is mistaken: the requirement to reveal and explain the reasons for conscientious objection in healthcare is ethically justified and legally desirable. Referring to real healthcare cases and legal regulations, the paper argues that these reasons should be evaluated either ex (...) ante or ex post, and defends novel conceptual claims that have not been analyzed in the debates on CO. First, a moral threshold requirement: CO is only justified if the reasons behind a refusal are of a moral nature and meet a certain threshold of moral importance. Second, the rarely discussed conceptual similarities between CO in healthcare and the legal regulations concerning military refusals that place the burden of proof on conscientious objectors. The paper concludes that conscientious objection in healthcare can only be accommodated in some cases of destroying or killing human organisms. (shrink)

Background: The funding of health care is a major challenge to governments all across the world; the UK presents a useful and illustrative case. -/- Methodology: In this article I explain why the manner in which the provision of health care in the UK is organized is fundamentally incoherent and continuing to ignore this incoherence is bound to lead to ever-greater problems. -/- Discussion: Our society must decide on its priorities; herein I do not wish to argue what these ought (...) to be, but, rather more modestly, to emphasise the system's inconsistencies. -/- Perspectives: A reorganization of the system is needed to ensure a modicum of consistency. (shrink)

Despite having essential health needs regarding sexual and reproductive health services (SRHS), young people (e.g., adolescents) in many countries show low use of such services. The World Health Organization advocates fostering young people’s autonomy to access health services to address this global health problem. However, there are gaps in the literature to understand how young people’s autonomy can be fostered to access SRHS. In 2019–2020, we conducted semi-structured interviews with 45 young people aged 14–23 years old in Colombia to explore (...) how they might wish to have their autonomy fostered in accessing SRHS. Research in different cultural contexts has shown that young people generally do not wish to discuss sex with their parents. By contrast, most of our participants expressed a strong wish for the ability to talk openly with their parents about their sexual and reproductive health. One of the main complaints of these young people was that their parents lacked the necessary knowledge to help them make informed decisions related to their sexual and reproductive health (e.g., choosing a contraceptive option). As a potential solution, participants were enthusiastic about initiatives that could provide parents with comprehensive sex education to assist young people in making informed choices for their sexual and reproductive health, including how to access SRHS. (shrink)

The COVID-19 pandemic has helped to clarify the fair and equitable allocation of scarce medical resources, both within and among countries. The ethical allocation of such resources entails a three-step process: (1) elucidating the fundamental ethical values for allocation, (2) using these values to delineate priority tiers for scarce resources, and (3) implementing the prioritisation to faithfully realise the fundamental values. Myriad reports and assessments have elucidated five core substantive values for ethical allocation: maximising benefits and minimising harms, mitigating unfair (...) disadvantage, equal moral concern, reciprocity, and instrumental value. These values are universal. None of the values are sufficient alone, and their relative weight and application will vary by context. In addition, there are procedural principles such as transparency, engagement, and evidence-responsiveness. Prioritising instrumental value and minimising harms during the COVID-19 pandemic led to widespread agreement on priority tiers to include health-care workers, first responders, people living in congregate housing, and people with an increased risk of death, such as older adults and individuals with medical conditions. However, the pandemic also revealed problems with the implementation of these values and priority tiers, such as allocation on the basis of population rather than COVID-19 burden, and passive allocation that exacerbated disparities by requiring recipients to spend time booking and travelling to appointments. This ethical framework should be the starting point for the allocation of scarce medical resources in future pandemics and other public health conditions. For instance, allocation of the new malaria vaccine among sub-Saharan African countries should be based not on reciprocity to countries that participated in research, but on maximally reducing serious illness and deaths, especially among infants and children. (shrink)

In this paper, I distinguish two conceptions of solidarity, which I call solidarity as beneficence and solidarity as mutual advantage. I argue that only the latter is capable of providing a complete foundation for national universal health care programs. On the mutual advantage account, the rationale for universal insurance is parallel to the rationale for a labor union’s “closed shop” policy. In both cases, mandatory participation is necessary in order to stop individuals free-riding on an ongoing system of mutually advantageous (...) cooperation. (shrink)

Much of the discussion of the role of emerging technologies associated with AI, machine learning, digital simulacra, and relevant ethical considerations such as those discussed in the target article, take a relatively narrow and episodic view of a person’s healthcare needs. There is much speculation about diagnostic, treatment, and predictive applications but relatively little consideration of how such technologies might be used to address a person’s lived experience of illness and ongoing care needs. This is likely due to the greater (...) weight or priority given to acute care needs and the role of medical treatment in care provision, but it may also reflect the limitations of current technologies and our limited vision of their potential application. Such limitations are not surprising given that we are still grappling with the complexities and nuances of achieving the ethical and humanistic ideals of care, namely, care that addresses the hermeneutical, relational, contextual, temporal, and agential dimensions of a person’s health and wellbeing. (shrink)

Definition of the problem The umbrella term “explicability” refers to the reduction of opacity of artificial intelligence (AI) systems. These efforts are challenging for medical AI applications because higher accuracy often comes at the cost of increased opacity. This entails ethical tensions because physicians and patients desire to trace how results are produced without compromising the performance of AI systems. The centrality of explicability within the informed consent process for medical AI systems compels an ethical reflection on the trade-offs. Which (...) levels of explicability are needed to obtain informed consent when utilizing medical AI? Arguments We proceed in five steps: First, we map the terms commonly associated with explicability as described in the ethics and computer science literature, i.e., disclosure, intelligibility, interpretability, and explainability. Second, we conduct a conceptual analysis of the ethical requirements for explicability when it comes to informed consent. Third, we distinguish hurdles for explicability in terms of epistemic and explanatory opacity. Fourth, this then allows to conclude the level of explicability physicians must reach and what patients can expect. In a final step, we show how the identified levels of explicability can technically be met from the perspective of computer science. Throughout our work, we take diagnostic AI systems in radiology as an example. Conclusion We determined four levels of explicability that need to be distinguished for ethically defensible informed consent processes and showed how developers of medical AI can technically meet these requirements. (shrink)

We explain libertarian thought about family and children, including controversial issues in need of serious attention. To begin our discussion of marriage, we distinguish between procedural and substantive contractarian approaches to marriage, each endorsed by various libertarians. Advocates of both approaches agree that it is a contract that makes a marriage, not a license, but disagree about whether there are moral limits to the substance of the contract with only advocates of the substantive approach accepting such. Either approach, though, offers (...) advantages over the current licensing system, so we discuss paths from that to a contractarian system. We also discuss the concept of marriage itself, the ages of consent for marriage, sexual activity, and reproduction, as well as how marriages can be dissolved, and coercion that sometimes occurs in marriage. We then turn to children. We first discuss reproductive freedom and then discuss the moral relationship between children and parents, especially considering stewardship, propertarian, and best interests approaches (we also touch on anti-natalism). One of the biggest issues facing parents is how to properly raise and educate children; we discuss this in depth and consider the sort of schooling that should be offered in a free society. Since children lack the requisite ability to consent, they cannot choose their education; how to respond to this is of the utmost importance for libertarians. As we note, the same issue of consent looms large for many forms medical treatment of children. (shrink)

In 2020, the world faced a new pandemic. The corona infection hit an unprepared world, and there were no medicines and no vaccines against it. Research to develop vaccines started immediately and in a remarkably short time several vaccines became available. However, despite initiatives for global equitable access to COVID-19 vaccines, vaccines have so far become accessible only to a minor part of the world population. In this article, I discuss the global distribution of COVID-19 vaccines from an ethical point (...) of view. I reflect on what ethical principles should guide the global distribution of vaccines and what global justice and international solidarity imply for vaccine distribution and I analyse the reasons for states to prioritize their own citizens. My focus is on ethical reasons for and against ‘vaccine nationalism’ and ‘vaccine cosmopolitanism.’ My point of departure is the appeal for international solidarity from several world leaders, arguing that ‘Where you live should not determine whether you live’. I discuss the COVAX initiative to enable a global vaccination and the proposal from India and South Africa to the World Trade Organization to temporarily waive patent rights for vaccines. In the final section, I argue for global vaccine sufficientarianism, which is a modified version of vaccine cosmopolitanism. (shrink)

ABSTRACT What kind of basic minimum do we owe to others? This paper defends a new procedure for answering this question. It argues that its minimally good life account has some advantages over the main alternatives and that neither the first-, nor third-, person perspective can help us to arrive at an adequate account. Rather, it employs the second-person perspective of free, reasonable, care. There might be other conditions for distributive justice, and morality certainly requires more than helping everyone to (...) secure a basic minimum. Still, if the minimally good life account is correct, and we owe everyone a basic minimum, we must ensure that everyone lives well enough. (shrink)

We live in tragic times. Millions are sheltering in place to avoid exacerbating the Coronavirus (COVID-19) pandemic. How should we respond to such tragedies? This paper argues that the human right to health can help us do so because it inspires human rights advocates, claimants, and those with responsibility for fulfilling the right to try hard to satisfy its claims. That is, the right should, and often does, give rise to what I call_ the virtue of creative resolve_. This resolve (...) embodies a fundamental commitment to finding creative solutions to what appear to be tragic dilemmas. Contra critics, we should not reject the right even if it cannot tell us how to ration scarce health resources. Rather, the right gives us a response to apparent tragedy in motivating us to search for ways of fulfilling everyone’s basic health needs. (shrink)

The pelvic exam is used to assess the health of female reproductive organs and so involves digital penetration by a physician. However, it is common practice for medical students to acquire experience in administering pelvic exams by performing them on unconscious patients without prior authorization. In this article, we argue that such unauthorized pelvic exams (UPEs) are sexual assault. Our argument is simple: in any other circumstance, unauthorized digital penetration amounts to sexual assault. Since there are no morally significant differences (...) between UPEs and other instances of digital penetration, UPEs are sexual assault. So, insofar as one is against sexual assault, one should be against UPEs. (shrink)

Pyrrho and colleagues (2022) argue that the loss of health privacy can damage democratic values by increasing social polarization, removing individual choice, and limiting self-determination. As a remedy, the authors propose a data-regulation regime that prohibits companies from using such data for discriminatory purposes. Our commentary addresses three issues. First, we point out an additional problematic dimension of excessive health privacy loss, namely, the potential racialization of groups and individuals that it may likely contribute to. Second, we note that, in (...) our view, the authors’ argument for more regulation rests on an invidious comparison between the realistically described status quo and the idealized picture of the imagined regulatory regime that the authors briefly propose. Third, we argue that, despite existing regulations, both private and government actors frequently use private data in ways that lead to ethically problematic outcomes, especially when it comes to racialized communities. (shrink)

Dans notre société de plus en plus digitalisée, avons-nous vraiment le choix d’adopter ou non les technologies? Comment cette digitalisation impacte-t-elle les personnes âgées en particulier et son écosystème? Quels sont les enjeux éthiques soulevés par cette digitalisation? Ce texte vise à amener des éléments de réflexions en lien avec ces enjeux selon le point de vue de divers experts des domaines de la technologie, du vieillissement et de la bioéthique. Ces experts se sont rencontrés lors d’un symposium ayant eu (...) lieu à Angers, France, en octobre 2019. Le texte est un compte-rendu des échanges et points de vue de ces experts, ainsi que des discussions ouvertes qu’ils ont eues avec l’assistance, portant sur les principaux enjeux soulevés par cette digitalisation selon la perspective des personnes âgées, des proches-aidants, des soignants, de la société et de la recherche. (shrink)

Should we allocate costly health care to patients diagnosed with disorders of consciousness (DoC), such as patients diagnosed as being in a vegetative state or minimally conscious state? Peterson, Aas, and Wasserman (2021) argue that we should in their paper “What justifies the allocation of health care resources to patients with disorders of consciousness?” Their key insight is that the expected benefits to this patient population helps to justify such allocations. However, their insight is attached to a consequentialist framework aimed (...) at maximizing aggregate social welfare. An alleged virtue of their framework over Braddock’s (2017) approach is their agnosticism about the moral status and rights of DoC patients. In this commentary, however, we argue that their agnosticism is the biggest problem with their approach: failing to treat DoC patients as persons with rights runs the moral risk of violating their rights, which is more serious than the risk of failing to maximize social utility. A better approach that reduces moral risk would incorporate Braddock’s (2017) precautionary presumption of personhood. We should stand in solidarity with DoC patients and treat them as persons with dignity and rights. (shrink)

There is an ongoing increase in the use of mobile health technologies that patients can use to monitor health-related outcomes and behaviours. While the dominant narrative around mHealth focuses on patient empowerment, there is potential for mHealth to fit into a growing push for patients to take personal responsibility for their health. I call the first of these uses ‘medical monitoring’, and the second ‘personal health surveillance’. After outlining two problems which the use of mHealth might seem to enable us (...) to overcome—fairness of burdens and reliance on self-reporting—I note that these problems would only really be solved by unacceptably comprehensive forms of personal health surveillance which applies to all of us at all times. A more plausible model is to use personal health surveillance as a last resort for patients who would otherwise independently qualify for responsibility-based penalties. However, I note that there are still a number of ethical and practical problems that such a policy would need to overcome. The prospects of mHealth enabling a fair, genuinely cost-saving policy of patient responsibility are slim. (shrink)

Rigorous evaluations of the effects of vertical public health enterprises on the health systems of low-income countries usefully identify the public health and ethical costs of those initiatives. They reveal that such narrowly focused public health ventures undermine the efforts of those countries to establish and maintain adequately resourced and well-developed national health systems, including comprehensive primary care programs. This paper argues that the scope of assessments of vertical public health ventures should be broadened to include gender as an additional (...) axis of analysis. When members of socio-economically marginalized populations are sick with conditions that are not covered by fragmented and inadequate public health programs or disease-specific vertical public health schemes, their untreated illnesses add to the gendered familial caregiving responsibilities of the female members of their households. Those women and girls have to perform their ‘normal’ familial care work, work outside the home for pay, and take care of the unwell family members for whom the household cannot afford treatment. Given that women and girls from low-income households already shoulder a disproportionate amount of care work for their families, their health and life prospects are further affected by the amplification of their caregiving responsibilities. This paper argues that analyses of the impact of vertical public health initiatives should also track this gendered consequence of those enterprises because it is a crucial public health and ethical matter. (shrink)

The development of new methods in the field of prenatal testing leads to an expansion of information that needs to be provided to expectant mothers. The aim of this research is to explore opinions and attitudes of gynecologists in Germany, Poland and Russia towards access to prenatal testing and diagnostics in these countries. Semi-structured interviews were conducted with n = 18 gynecologists in Germany, Poland and Russia. The interviews were analyzed using the methods of content analysis and thematic analysis. Visible (...) in all three countries is a connection of prenatal medicine with the politically and socially contentious issue of pregnancy termination. Respondents in Poland and Russia concentrated on the topic of inadequate resources. Quality of information for expectant mothers is an important point in all three countries. Only in Germany was the issue of language barriers in communication raised. With regard to non-invasive prenatal testing (NIPT) respondents in Germany focused on the ethical issues of routinization of testing; in Poland and Russia they concentrated on fair access to NIPT. Challenges in all three countries arise from structural factors such as imprecise and prohibitive regulations, lack of resources or organization of healthcare services. These should be addressed on a political and medico-ethical level. (shrink)

The COVID-19 pandemic has forced clinicians, policy-makers and the public to wrestle with stark choices about who should receive potentially life-saving interventions such as ventilators, ICU beds and dialysis machines if demand overwhelms capacity. Many allocation schemes face the question of whether to consider age. We offer two underdiscussed arguments for prioritising younger patients in allocation policies, which are grounded in prudence and fairness rather than purely in maximising benefits: prioritising one’s younger self for lifesaving treatments is prudent from an (...) individual perspective, and prioritising younger patients works to narrow health disparities by giving priority to patients at risk of dying earlier in life, who are more likely to be subject to systemic disadvantage. We then identify some confusions in recent arguments against considering age. (shrink)

New technologies such as smart sensors improve rehabilitation processes and thereby increase older adults’ capabilities to participate in social life, leading to direct physical and mental health benefits. Wearable smart sensors for home use have the additional advantage of monitoring day-to-day activities and thereby identifying rehabilitation progress and needs. However, identifying and selecting rehabilitation priorities is ethically challenging because physicians, therapists, and caregivers may impose their own personal values leading to paternalism. Therefore, we develop a discussion template consisting of a (...) series of adaptable questions for the patient–physician encounter based on the capability approach. The goal is to improve geriatric rehabilitation and thereby increase participation in social life and well-being. To achieve this goal, we first analyzed what is considered important for participation on basis of the capability approach, human rights, and ethics of care. Second, we conducted an ethical analysis of each of the four identified dimensions of participation: political, economic, socio-cultural, and care. To improve compliance with rehabilitation measures, health professionals must align rehabilitation measures in an open dialogue with the patient’s aspiration for participation in each dimension. A discussion template based on the capability approach allows for a proactive approach in patient information and stimulates a critical assessment of treatment alternatives while reducing the risk of imposing personal values. (shrink)

As governments around the world imposed lockdowns or stay-at-home measures, people began to feel the stress as time dragged on. There were already reports on some individuals committing suicide. How do governments respond to such a phenomenon? Our main focus is the Philippine government and how it responded to the COVID-19 pandemic. In this paper, we argue that the problem with COVID-19 went forth just dealing with physical health. First, people suffer not just from being infected but the psychological stress (...) of possibly getting the virus and the toll of the government lockdown or quarantine. Second, the Philippine Bayanihan ‘We Heal As One Act’ lacks focus on mental health issues while the government's response seemed to focus on security issues. Third, there are countries around the world that have acted effectively in protecting people’s mental health. Lastly, we propose appropriate measures to help address the people's mental health while still in the pandemic and for a future one. (shrink)

The complex history of pandemics has created a diversified array of anti-epidemic responses, which have allowed structures of authority to express their power in multiple ways. In this paper, by considering theories applicable to cases ranging from Europe to Asia, from the 11th to the 18th century, we conduct a comparative analysis capable of identifying common traits and radical differences, aiming to show how such deployment of power was not always commensurate with the medical theories of the age, and with (...) the gravity of the epidemiological situation. Specifically, we analyse how Western European States, in their process of formation, employed the concept of ‘public health’ to create the grounds for an unprecedented exercise of power over the private sphere. Furthermore, we compare this attitude with the discrimination of the minority known as burakumin in Japan, which was destined to undertake any ‘dirty’ or ‘impure’ occupation, to preserve the immunity of the community. In other words, we examine how structures of power have exploited states of exception to implement control measures beyond the needs of the situation through an increasingly hypertrophic apparatus of security; and ways in which political authorities have not aligned with medical or philosophical authorities of their times, for opportunistic reasons that benefited their own social, religious, or racial group. (shrink)

Nicole Hassoun here makes a philosophical argument for health, and access to essential medicines, as essential human rights, and she proposes the Global Health Impact system as a way to ensure those rights. She reports how life-saving medicines are inaccessible and costly for the global poor, and that rather than focusing on treatments for critical, deadly global health problems, pharmaceutical companies instead invest in more profitable drugs. To address this problem, Hassoun's proposal will rate pharmaceutical companies based on their medicines' (...) impact on the improvement of global health, and will reward highly-rated medicines with a Global Health Impact label. (shrink)

This chapter defends a legal human right to tobacco control. Building on existing work, the chapter argues that the legal case for such a right is strong. Existing international human rights treaties, chiefly the International Covenant on Economic, Social and Cultural Rights, recognize a human right to health alongside several other rights that speak for covering tobacco control under human rights law. Drawing on Allen Buchanan’s pluralistic justificatory framework for human rights, the chapter argues that the philosophical case is strong (...) too. Tobacco is among the deadliest public health threats worldwide and its health impacts so severe that humans should have a claim against their governments to protect them against the harms of tobacco. Human rights law is a promising avenue to strengthen this claim. The chapter then defends a human right to tobacco control against several philosophical worries. For example, is strong tobacco control compatible with personal freedom? Is it compatible with personal consent? Would human rights legislation facilitate power relations that unduly restrict national and individual self-determination? This chapter argues that concerns with freedom of choice, consent and power relations do not speak against tobacco control. Conversely, a concern with power relations speaks for a human right to tobacco control as it could lessen the power asymmetries between tobacco companies and vulnerable populations, such as children, smokers of lower socio-economic status and citizens in low-income countries with weaker governance structures. (shrink)

The English cases of Charlie Gard and Alfie Evans involved a conflict between the desires of their parents to preserve their children’s lives and judgments of their medical teams in pursuit of clinically appropriate therapy. The treatment the children required was clearly extraordinary, including a wide array of advanced life-sustaining technological support. The cases exemplify a clash of worldviews rooted in different philosophies of life and medical care. The article highlights the differing perspectives on parental authority in medical care in (...) England, Canada, and the United States. Furthermore, it proposes a solution that accommodates for both reasonable parental desires and professional medical opinion. This is achieved by looking at concepts of extraordinary therapy, best interest, reasonable parenthood and medical objections. (shrink)

Florence Ashley has argued that requiring patients with gender dysphoria to undergo an assessment and referral from a mental health professional before undergoing hormone replacement therapy is unethical and may represent an unconscious hostility towards transgender people. We respond, first, by showing that Ashley has conflated the self-reporting of symptoms with self-diagnosis, and that this is not consistent with the standard model of informed consent to medical treatment. Second, we note that the model of informed consent involved in cosmetic surgery (...) resembles the model Ashley defends, and that psychological assessment and referral is recognised as an important aspect of such a model. Third, we suggest that the increased prevalence of psychiatric morbidity in the transgender population arguably supports the requirement of assessment and referral from a mental health professional prior to undergoing HRT. (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)

Increased awareness of the importance of mental health for global health has led to a number of new initiatives, including influential policy instruments issued by the World Health Organization (WHO) and the United Nations (UN). This policy brief describes two WHO instruments, the Mental Health Action Plan for 2013–2020 (World Health Organization, 2013) and the Mental Health Atlas (World Health Organization, 2015), and presents a comparative analysis with the Sustainable Development Goals (SDGs) of the UN’s 2030 Agenda for Sustainable Development (...) (United Nations, 2015). The WHO’s Action Plan calls for several specific objectives and targets, with a focus on improving global mental health governance and service coverage. In contrast, the UN’s SDGs include only one goal specific to mental health, with a single indicator tracking suicide mortality rates. The discrepancy between the WHO and UN frameworks suggests a need for increased policy coherence. Improved global health governance can provide the basis for ensuring and accelerating progress in global mental health. (shrink)

John Lizza says that to define death well, we must go beyond biological considerations. Death is the absence of life in an entity that was once alive. Biology is the study of life. Therefore, the definition of death should not involve non-biological concerns.

In the ongoing ‘brain death’ controversy, there has been a constant push for the use of the ‘higher brain’ formulation as the criterion for the determination of death on the grounds that brain-dead individuals are no longer human beings because of their irreversible loss of consciousness and mental functions. This essay demonstrates that such a position flows from a Lockean view of human persons. Compared to the ‘consciousness-related definition of death,’ the substance view is superior, especially because it provides a (...) holistic vision of the human person, and coheres with the perennial axiom about the ‘whole and parts.’. (shrink)

Health Care Ethics Health care ethics is the field of applied ethics that is concerned with the vast array of moral decision-making situations that arise in the practice of medicine in addition to the procedures and the policies that are designed to guide such practice. Of all of the aspects of the human body, and … Continue reading Health Care Ethics →.

In the effort to address the persistent organ shortage it is sometimes suggested that we should incentivize people to sign up as organ donors. One way of doing so is to give priority in the allocation of organs to those who are themselves registered as donors. Israel introduced such a scheme recently and the preliminary reports indicate increased donation rates. How should we evaluate such initiatives from an ethical perspective? Luck egalitarianism, a responsibility-sensitive approach to distributive justice, provides one possible (...) justification: Those who decide against being organ donors limit the health care resources available to others. As such, a priority rule can be justified by a luck egalitarian approach to distributive justice. Furthermore, a priority rule inspired by luck egalitarianism is well equipped to avoid prominent criticisms of such a procurement system. Luck egalitarianism provides us with reaons to exempt people who are not responsible for their inability to donate from receiving lower priority, provide sufficient information about donation, and mitigate social and natural circumstances affecting people’s choice to donate. (shrink)

BACKGROUND: Little is known about how hospitalized patients share decisions with physicians. METHODS: We conducted an observational study of patient-doctor communication on an inpatient medicine service among 18 hospitalized patients and 9 physicians. A research assistant (RA) approached newly hospitalized patients and their physicians before morning rounds and obtained consent. The RA audio recorded morning rounds, and then separately interviewed both patient and physician. Coding was done using integrated analysis. RESULTS: Most patients were white (61%) and half were female. Most (...) physicians were male (66%) and of Southeast Asian descent (66%). All physicians explained the plan of care to the patients; most believed that their patient understood. However, many patients did not. Physicians rarely asked the patient for their opinion. In all those cases, the decision had been made previously by the doctors. No decisions were made with the patient. Patients sometimes disagreed. CONCLUSIONS: Shared decision-making may not be the norm in hospital care. Although physicians do explain treatment plans, many hospitalized patients do not understand enough to share in decisions. When patients do assert their opinion, it can result in conflict. PRACTICE IMPLICATIONS: Some hospitalized patients are interested in discussing treatment. Improving hospital communication can foster patient autonomy. (shrink)

The paper discusses the possibility that the benefits of pharmacogenomics will not be distributed equally and will create orphan populations. I argue that since these inequalities are not substantially different from those produced by ‘traditional’ drugs and are not generated with the intention to discriminate, their production needs not be unethical. Still, the final result is going against deep-seated moral feelings and intuitions, as well as broadly accepted principles of just distribution of health outcomes and healthcare. I thus propose two (...) provisos that would prevent the most offensive outcomes and moderate the scope of the produced inequalities. The first proviso rejects pharmacogenomics innovations that worsen existing group inequalities and aggravate the disadvantage of communities with a history of discrimination. The second proviso requires that there is a strategy in place to even out as much as possible the distribution of benefits in the future and that a system of compensations is in place for pharmacogenomic orphans. Given that only one moral problem generated by pharmacogenomics has been tackled, the list of provisos might be expanded when other issues are considered. (shrink)

Too often, the right to healthcare has been considered an illusory right that is not even a legal right, but merely an aspirational norm that cannot be adjudicated before the court. In modern human rights law, considering individual and social rights as interdependent and indivisible, such an approach is untenable. Both legal doctrine and recent case law from domestic and international courts have elaborated and confirmed the specific obligations under the right to healthcare, countering the general complaint of “shrouded vagueness”. (...) Landmark cases have even provided a functional remedy to enforce individual healthcare claims successfully. This paper will examine the revised legal status and content of such a right to healthcare from a European perspective. (shrink)

Human rights are high priority norms that empower right holders to demand the benefits protected by their rights. This is no less true of socioeconomic human rights than civil and political human rights. I argue that realizing human socioeconomic rights requires that they be enacted into state law in such a way that individual right holders have the power to bring legal action in defense of their rights. Contrary to Thomas Pogge, it is not enough for states simply to provide (...) the benefits required by human rights. Unfortunately, limited resources mean that successful litigation by right holders threatens to disempower other right holders by distorting a fair distribution of limited resources, since those with the resources to litigate can command a disproportionate and unjust share of limited resources. Using the human right to health as an example, I argue that an important part of the solution requires specifying different aspects of the content of the right to health and adopting appropriately strong standards of judicial review. (shrink)

Private health insurance is a domain of mutually conflicting models of healthcare systems. Most European healthcare systems are built upon the principles of solidarity and equality, and are provided by public entities. But the private health insurance market can threaten these values, limiting solidarity, equality and universality for the sake of cost effectiveness, consumer choice and market competition. The aim of this article is to analyse these risks and present mechanisms for their mitigation, which would allow the construction of effective (...) and socially acceptable models, or private-public partnerships, in this domain. (shrink)

We consider an ethical dilemma in global health: is it ethically acceptable to provide some patients cheaper treatments that are less effective or more toxic than the treatments other patients receive? We argue that it is ethical to consider local resource constraints when deciding what interventions to provide. The provision of cheaper, less effective health care is frequently the most effective way of promoting health and realizing the ethical values of utility, equality, and priority to the worst off.

In recent years, there has been increasing recognition of both the philosophical questions engendered by the idea of a human right to health and the potential of philosophical analysis to help in the formulation of better policy. In this article, I attempt to locate recent work on the moral right to health in a number of historically established conceptions, with the aim of providing a map of the conceptual landscape as to the claims expressed by such a right.

In recent years, there has been increasing recognition of both the philosophical questions engendered by the idea of a human right to health and the potential of philosophical analysis to help in the formulation of better policy. In this article, I attempt to locate recent work on the moral right to health in a number of historically established conceptions, with the aim of providing a map of the conceptual landscape as to the claims expressed by such a right.

As health policy-makers around the world seek to make progress towards universal health coverage, they must navigate between two important ethical imperatives: to set national spending priorities fairly and efficiently; and to safeguard the right to health. These imperatives can conflict, leading some to conclude that rights-based approaches present a disruptive influence on health policy, hindering states’ efforts to set priorities fairly and efficiently. Here, we challenge this perception. We argue first that these points of tension stem largely from inadequate (...) interpretations of the aims of priority setting as well as the right to health. We then discuss various ways in which the right to health complements traditional concerns of priority setting and vice versa. Finally, we set out a three-step process by which policy-makers may navigate the ethical and legal considerations at play. (shrink)

Over the last decade, personalized medicine has become a buzz word, which covers a broad spectrum of meanings and generates many different opinions. The purpose of this article is to achieve a better understanding of the reasons why personalized medicine gives rise to such conflicting opinions. We show that a major issue of personalized medicine is the gap existing between its claims and its reality. We then present and analyze different possible reasons for this gap. We propose an hypothesis inspired (...) by the Windelband’s distinction between nomothetic and idiographic methodology. We argue that the fuzzy situation of personalized medicine results from a mix between idiographic claims and nomothetic methodological procedures. Hence we suggest that the current quandary about personalized medicine cannot be solved without getting involved in a discussion about the complex epistemological and methodological status of medicine. To conclude, we show that the Gadamer’s view of medicine as a dialogical process can be fruitfully used and reveals that personalization is not a theoretical task, but a practical one, which takes place within the clinical encounter. (shrink)

This review aims to identify (1) sources of knowledge and (2) important themes of the ethical debate related to surgical alteration of facial features in East Asians. This article integrates narrative and systematic review methods. In March 2014, we searched databases including PubMed, Philosopher’s Index, Web of Science, Sociological Abstracts, and Communication Abstracts using key terms “cosmetic surgery,” “ethnic*,” “ethics,” “Asia*,” and “Western*.” The study included all types of papers written in English that discuss the debate on rhinoplasty and blepharoplasty (...) in East Asians. No limit was put on date of publication. Combining both narrative and systematic review methods, a total of 31 articles were critically appraised on their contribution to ethical reflection founded on the debates regarding the surgical alteration of Asian features. Sources of knowledge were drawn from four main disciplines, including the humanities, medicine or surgery, communications, and economics. Focusing on cosmetic surgery perceived as a westernising practice, the key debate themes included authenticity of identity, interpersonal relationships and socio-economic utility in the context of Asian culture. The study shows how cosmetic surgery of ethnic features plays an important role in understanding female identity in the Asian context. Based on the debate themes authenticity of identity, interpersonal relationships, and socio-economic utility, this article argues that identity should be understood as less individualistic and more as relational and transformational in the Asian context. In addition, this article also proposes to consider cosmetic surgery of Asian features as an interplay of cultural imperialism and cultural nationalism, which can both be a source of social pressure to modify one’s appearance. (shrink)

This polemical note looks at the ethical issue of providing artificial nutrition and hydration to patients with advanced dementia from the perspective of an Aristotelian and naturalist ethics. I argue that this issue may be considered in terms of the Aristotelian notion of eudaimonia, well-being. I present a number of facts about the conditions of human life that contribute to eudaimonia. In addition, I present a number of facts about advanced dementia as well as clarify the goals of medicine. From (...) these facts, I argue that we are not ethically obligated to provide ANH to this class of patients. (shrink)