Public Health

This research focuses on transgender patients discrimination in Yogyakarta in accessing healthcare services. There are two questions on this research: what is the obstacle faced by the transgender-patients in accessing healthcare services? How is the analysis of biomedical ethics seeing this issue? The results on this research are despite the fact they were not being discriminated in the hospital, they did not get the health insurance by the government because of the administrative issue which can not accommodate their gender choice. (...) Therefore, this research seeks to understand the barriers of transgender patients in accessing healthcare services through the perspective of biomedical ethics of Tom L. Beauchamp and James Childress. The researcher concludes that the general rule on social benefits applied in society is still limited only to the specific genders. It is not in accordance with the two principles in biomedical ethics: the principle of justice states that the transgender who is physically harmed has right to get social benefits to remedy the effect of the disadvantages due to their natural property and to have more equal chance of life; and the principle of autonomy states that an autonomous decision of the transgender people to choose their gender is related to the individual rights although they have different view with others and as long as their action do not leave the disadvantage to others, it must be respected as a moral obligation. (shrink)

Bartha and DesRoches (Synthese 199(3–4):8701–8740, 2021) and Steel and Bartha (Risk Analysis 43(2):260–268, 2023) argue that we should understand the precautionary principle as the injunction to maximise lexical utilities. They show that the lexical utility model has important pragmatic advantages. Moreover, the model has the theoretical advantage of satisfying all axioms of expected utility theory except continuity. In this paper I raise a trilemma for any attempt at modelling the precautionary principle with lexical utilities: it permits choice cycles or leads (...) to paralysis or implies that the smallest value difference that is possible in a context has extreme axiological implications. (shrink)

The COVID-19 pandemic forced us to reconsider our interactions with the world around us, shifting how we navigate public and private spaces every day. Most people in the United States previously thought nothing of touching railings or doorknobs, going to school or work while ill, or attending crowded events. Along with new health interventions and institutional practices, daily behaviors aimed at infection control, such as routine hand washing and wearing face masks when symptomatic, protected our communities from COVID-19. Many new (...) interventions and practices are here to stay, but it is unclear which personal behaviors to protect against COVID-19 and other infectious diseases we should continue. Intuitively plausible ethical arguments support individuals taking reasonable measures to avoid causing or propagating harm to other members of the community. As such, by failing to adopt easily implementable preventive behaviors, we live ethically suboptimal lives and violate our social contract to one another. As the world transitions from epidemic to endemic COVID-19, applying the lessons learned from the pandemic is crucial to mitigating old and new infectious disease threats. Along with the role of public health agencies to organize and communicate about communicable diseases, clinicians and public health workers have critical roles in establishing social norms for behaviors that prevent the spread of infectious diseases, given their professional responsibilities and statuses as trusted authority figures. (shrink)

Cost-effectiveness analysis for health interventions is traditionally conducted in a risk-neutral way, insensitive to risk attitudes in the population, which are potentially non-neutral. While the standard outcome metric of quality-adjusted life years (QALYs) aims to be deferential to people's valuations of health states, cost-effectiveness analysis of risky interventions using the QALY metric is not similarly deferential to people's risk attitudes. I argue that there is no good justification for this practice. Non-neutral attitudes to risk, especially where they concern individually life-changing (...) interventions need not be irrational, and so imposing neutrality is not justifiable as a way of debiasing preferences. Many common justifications for deference to health state preferences extend to risk attitudes. But even if reasons for deference do not extend, imposition of risk neutrality as opposed to any other rationally permissible risk attitude is under-motivated as default practice. Thus, either methods for measuring risk attitudes separately and incorporating them into cost-effectiveness analysis should be used more widely or a richer set of information should be presented to political decision-makers and the public to enable them to decide how to take into account the individual risks faced by members of the population, on top of aggregate effects on population health. (shrink)

Disability Justice in Public Health Emergencies is the first book to highlight contributions from critical disability scholarship to the fields of public health ethics and disaster ethics. It takes up such contributions with the aim of charting a path forward for clinicians, bioethicists, public health experts, and anyone involved in emergency planning to better care for disabled people—and thereby for all people—in the future. Across 11 chapters, the contributors detail how existing public health emergency responses have failed and still fail (...) to address the multi-faceted needs of disabled people. They analyze complications in the context of epidemic and pandemic disease and emphasize that vulnerabilities imposed upon disabled people track and foster patterns of racial and class domination. -/- The central claim of the volume is that the ethical and political insights of disability theory and activism provide key resources for equitable disaster planning for all. The volume builds upon the existing efforts of disability communities to articulate emergency planning priorities and response measures that take into account the large body of qualitative and quantitative research on disabled people’s health, needs, and experiences. It is only by listening to disabled people’s voices that we will all fare better in future public health emergencies. (shrink)

Casgevy, the world’s first approved CRISPR-based cell therapy, has been priced at $2.2 million per patient. Although this hefty price tag was widely anticipated, the extremely high cost of this and other cell and gene therapies poses a major ethical issue in terms of equitable access and global health. In this Perspective, we argue that lowering the prices of future CRISPR therapies is an urgent ethical imperative. Although we focus on Casgevy as a case study, much of our analysis can (...) be extrapolated to the controversies over affordable access to other gene and cell therapies. First, we explain why this first-of-its-kind CRISPR therapy might be so expensive. We then analyze the ethical issues of equity and global health of early CRISPR treatments. Next, we discuss potential solutions to lower the prices of CRISPR gene therapies. We conclude that the approval of CRISPR transforms our obligations of justice and compels us to bring future gene therapies to the maximum possible number of patients with serious genetic diseases at affordable prices. (shrink)

This is a case study of an ethical dilemma concerning the appropriateness of encouraging care-staff, working within a dementia care home, to either wear a clinical uniform or not to wear a clinical uniform in practice. It is proposed that people living with dementia may sustain higher levels of wellbeing if care-staff wear clothes that are more akin to their care home environment, for example, wearing similar clothes to the residents or even wearing pyjamas and nightwear during a night shift. (...) The counter argument is that the practice may lead to greater levels of distress due to disorientation, increased potential for infection and inability to identify nurses when needed. (shrink)

Xenotransplant patient selection recommendations restrict clinical trial participation to seriously ill patients for whom alternative therapies are unavailable or who will likely die while waiting for an allotransplant. Despite a scholarly consensus that this is advisable, we propose to examine this restriction. We offer three lines of criticism: (1) The risk–benefit calculation may well be unfavorable for seriously ill patients and society; (2) the guidelines conflict with criteria for equitable patient selection; and (3) the selection of seriously ill patients may (...) compromise informed consent. We conclude by highlighting how the current guidance reveals a tension between the societal values of justice and beneficence. (shrink)

For Albert Camus, plague was both a fact of life and a powerful metaphor for the human condition. Camus engaged most explicitly and extensively with the subject of plague in his 1947 novel, The Plague (La peste), which chronicles an outbreak of what is presumably cholera in the French-Algerian city of Oran. I often thought of this novel—and what it might teach us—during the recent COVID-19 pandemic. In this article, I discuss seven important insights from The Plague about epidemics, public (...) health and morality. (shrink)

Was ist Wissen von morgen im Vergleich mit Wissen von heute? Die geschichtliche Erfahrung zeigt diesen Übergang als ein Prozess der Weiterentwicklung der Sprache, weil menschliches Wissen an die Sprache gekoppelt ist, und seine Inhalte zu begreifen nur in sprachlichen Formen möglich ist. Während alte Sprachen vergehen, entstehen neue Sprachen: in diesem Prozess der Erneuerung von sprachlichen Formen wird das Wissen gesammelt, geklärt, und weitergegeben, und das geschieht durch Auswahl der Worte, deren Gebrauchswert ständig geprüft wird.

Although digital breast tomosynthesis has higher sensitivity than digital mammography and at least as high specificity, digital mammography remains the most common method for conducting mammographic screening. At the same time, mammography systems are now delivered “DBT-ready” and can be used for either digital mammography or digital breast tomosynthesis. In this paper, we ask whether it is ethically permissible to use such equipment for digital mammography, given its lower sensitivity. We argue it is not, and that clinics are ethically required (...) to use their DBTready equipment to screen with digital breast tomosynthesis whenever this is practically possible. Our argument relies on a comparison between digital breast tomosynthesis and a hypothesized improvement in the image quality of digital mammography. (shrink)

I argue that harm reduction programs should be extended to include psychedelic drugs. I reach this conclusion by first defining harm reduction and discussing arguments in favor of harm reduction for drug use in general. I offer defenses of harm reduction for drug use on the basis of consequentialism, Kantianism/deontology, and virtue ethics. I then apply this reasoning to harm reduction for psychedelic drugs, while also arguing that these programs are easier to defend than harm reduction for other, harder drugs (...) and that these programs could be easily implemented. (shrink)

Recent efforts in a range of scientific fields have emphasised research and methods concerning individual differences and individualisation. This article brings together various scientific disciplines—ecology, evolution, and animal behaviour; medicine and psychiatry; public health and sport/exercise science; sociology; psychology; economics and management science—and presents their research on individualisation. We then clarify the concept of individualisation as it appears in the disciplinary casework by distinguishing three kinds of individualisation studied in and across these disciplines: Individualisation ONE as creating/changing individual differences (the (...) process that generates differences between individuals: intrapopulation or intraspecific variation/heterogeneity); Individualisation TWO as individualising applications (the tailoring or customising of something—information, treatment, a product or service, etc.—for an individual or specific group of individuals); and Individualisation THREE as social changes influencing autonomy, risk, and responsibilities (the process discussed under the rubric of sociological individualisation theory). Moreover, we analyse conceptual links between individualisation and individuality, and characterise different sorts of individuality that the disciplines study. This paper aims to promote interdisciplinary research concerning individualisation by establishing a common conceptual-theoretical basis, while leaving room for disciplinary differences. (shrink)

It is unknown to what extent medical researchers generalize study findings beyond their samples when their sample size, sample diversity, or knowledge of conditions that support external validity do not warrant it. It is also unknown to what extent medical researchers describe their results with precise quantifications or unquantified generalizations, i.e., generics, that can obscure variations between individuals. We therefore systematically reviewed all prospective studies (n = 533) published in the top four highest ranking medical journals, Lancet, New England Journal (...) of Medicine (NEJM), Journal of the American Medical Association (JAMA), and the British Medical Journal (BMJ), from January 2022 to May 2023. We additionally reviewed all NEJM Journal Watch clinical research summaries (n = 143) published during the same time. Of all research articles reporting prospective studies, 52.5% included generalizations beyond specific national study populations, with the numbers of articles with generics varying significantly between journals (JAMA = 12%; Lancet = 77%) (p < 0.001, V = 0.48). There was no evidence that articles containing broader generalizations or generics were correlated with larger or more nationally diverse samples. Moreover, only 10.2% of articles with generalizations beyond specific national populations reported external validity strengthening factors that could potentially support such extrapolations. There was no evidence that original research articles and NEJM Journal Watch summaries intended for practitioners differed in their use of broad generalizations, including generics. Finally, from the journal with the highest citation impact, articles containing broader conclusions were correlated with more citations. Since there was no evidence that studies with generalizations beyond specific national study populations or with generics were associated with larger, more nationally diverse samples, or with reports of population similarity that may permit extensions of conclusions, our findings suggest that the generalizations in many articles were insufficiently supported. Caution against overly broad generalizations in medical research is warranted. (shrink)

This paper combines considerations from ethics, medicine and public health policy to articulate and defend a systematic case for mask wearing mandates (MWM). The paper argues for two main claims of general interest in favour of MWM. First, MWM provide a more effective, just and fair way to tackle the ongoing COVID-19 pandemic than policy alternatives such as laissez-faire approaches, mask wearing recommendations and physical distancing measures. And second, the proffered objections against MWM may justify some exemptions for specific categories (...) of individuals, but do not cast doubt on the justifiability of these mandates. Hence, unless some novel decisive objections are put forward against MWM, governments should adopt MWM. (shrink)

The term ‘environment’ is not uniformly defined in the public health sciences, which causes crucial inconsistencies in research, health policy, and practice. As we shall indicate, this is somewhat entangled with diverging pathogenic and salutogenic perspectives (research and policy priorities) concerning environmental health. We emphasise two distinct concepts of environment in use by the World Health Organisation. One significant way these concepts differ concerns whether the social environment is included. Divergence on this matter has profound consequences for the understanding of (...) health and disease, for measures derived from that understanding targeting health promotion and disease prevention, and consequently, for epistemic structures and concept development in scientific practice. We hope to improve the given situation in public health by uncovering these differences and by developing a fruitful way of thinking about environment. Firstly, we side with the salutogenic conception of environment as a _health resource_ (as well as a source of health risks). Secondly, we subdivide the concept of environment into four _health-oriented environmental categories_ (viz., natural, built-material, socio-cultural, and psychosocial) and we link these with other theoretical notions proposed in the health sciences literature. Thirdly, we propose that in public health ‘environment’ should be understood as consisting of all extrinsic factors that influence or are influenced by the health, well-being, and development of an individual. Consequently, none of the four categories should be excluded from the concept of environment. We point out the practical relevance and fruitfulness of the conception of environment as a health source and frame this in causal terms, representing _individual health environments_ as causal networks. Throughout, we side with the view that for the design of human health-promoting settings, increased attention and consideration of environmental resources of salutogenic potential is particularly pressing. (shrink)

Andrea Bidoli argues that ectogestation could be seen as an emancipatory intervention for women. Specifically, she claims that ectogestation would create unique conditions to reevaluate one’s reproductive preference, address certain specific negative social implications of gestation and childbirth, and that it is unfair to hold ectogestation to a higher standard than other innovations such as modern contraceptives and non-medical egg freezing. In this commentary, I claim that Bidoli—like so many others—unjustly bypasses men and their reproductive desires. For a long time, (...) the discussion of the ethics of ectogenesis has focused on women and their reproductive liberation. However, since in many countries, an increasing number of men in reproductive age face difficulties in finding a partner and lack access to other forms of assisted reproduction, it is men who need ectogestation the most. (shrink)

The COVID pandemic was an exceptional public health situation – which brought with it unprecedented restrictions across the global populace. But what was it about this pandemic which caused us to implement such drastic restrictions on liberty? Much of the ethical debate on restrictive measures such as lockdowns and vaccine requirements focused on the potential harm that individuals cause to other individuals by the risk of infection. I will suggest that this may come from a reliance on J.S. Mill’s harm (...) principle as providing the ultimate justification for coercion – i.e., the well-accepted principle that state coercion is justified in order to prevent the imposition of unacceptable risk of harm to others. Though there have been attempts, in the wider public health ethics literature, to use the harm principle as a basis for restricting contribution to collective harms, I will suggest that these attempts cannot rely on the harm principle alone. I will then turn to the ways in which an individual-based line of reasoning does not capture a distinctive sort of harm posed by the COVID pandemic (and others like it): the potential failure of healthcare systems. I will draw out three ways in which a focus on the harm that an individual poses to another individual fails to capture the full scope of harm wrought by the collapse of healthcare systems. First, it can’t adequately capture the cumulative and “looping effects” of the harm caused by strained healthcare systems. Second, it fails to capture the widespread ripple effects the failure of a central societal institution can have on other institutions. And third, the failure of a healthcare system can impose “psychic costs”, affecting the moral character of all members of society, reducing trust in institutions, and potentially posing an existential threat to the fabric of society. Finally, I will sketch some implications of the recognition of this distinctive sort of harm for the justification of coercive public health measures. (shrink)

On 26 January 2021, while announcing that the country had reached the mark of 100,000 deaths within 28 days of COVID-19, UK Prime Minister Boris Johnson said that he took “full responsibility for everything that the Government has done” as part of British efforts to tackle the pandemic. The force of this statement was undermined, however, by what followed: -/- What I can tell you is that we truly did everything we could, and continue to do everything that we can, (...) to minimise loss of life and to minimise suffering... -/- Taking these sentiments together, it was hard to avoid the conclusion that the government took responsibility only for doing everything right. Such an admission of responsibility, accommodating no admission of error or wrongdoing, is not really about responsibility at all. Indeed, the UK’s pandemic response has been marked from its earliest days by a shifting of focus from institutional responsibility to personal responsibility for individual UK residents. -/- This paper explores the relationship between these two sites of responsibility—the institutional and the personal—in the context of the sort of pandemic that is ongoing as we write. Section 2 offers some initial definitions and discussions of key terms. Section 3 outlines how these two ideas interact in principle during such emergencies. Section 4 turns to the ‘non-ideal’ implications for personal responsibility of failures of institutional responsibility. While our focus is on the specific context with which we are most familiar, the UK governmental approach, where appropriate we also include examples from other states. (shrink)

Spitale, Germani, and Biller-Andorno’s (2024) PHERCC matrix sets out a useful and systematic framework for risk and crisis communication in public health emergencies. A problem in ensuring effective messaging is the extent to which the messaging environment is *quiet* or *noisy*: in other words, whether or not a message has to *compete with other messages* at the same time. I use the example of the UK’s experience during COVID-19, which was marked by tensions between the devolved regional governments—and consequently divergent (...) policy responses—which sowed confusion among the populace. More generally, if policymakers try to account for the needs of competing publics simultaneously (in order to meet the inclusivity and understandability principles), this may increase the noise problem and so actually undermine effective public health messaging. The issue of noisy messaging environments reveals a tradeoff between inclusivity and understandability versus effectiveness in risk and crisis communication. (shrink)

Bioethics: 50 Puzzles, Problems, and Thought Experiments collects 50 cases—both real and imaginary—that have been, or should be, of special interest and importance to philosophical bioethics. Cases are collected together under topical headings in a natural order for an introductory course in bioethics. Each case is described in a few pages, which includes bioethical context, a concise narrative of the case itself, and a discussion of its importance, both for broader philosophical issues and for practical problems in clinical ethics and (...) health policy. Each entry also contains a brief, annotated, list of suggested readings. In addition to the classic cases in bioethics, the book contains discussion of cases that involve several emerging bioethical issues: especially, issues around disability, social justice, and the practice of medicine in a diverse and globalized world. (shrink)

Authors: Joseph M. Eble, John A. Di Camillo, Peter J. Colosi. --- NEWS RELEASE For Immediate Release February 27, 2024 Contact: Joseph M. Eble, MD Corresponding author 919-667-5206 -/- The statement, Catholics United on Brain Death and Organ Donation: A Call to Action (HTML), was published on February 27, 2024. It was prepared by Joseph Eble, a physician and President of the Tulsa Guild of the Catholic Medical Association; John Di Camillo, an ethicist of The National Catholic Bioethics Center; and (...) Peter Colosi, a philosophy professor at Salve Regina University. -/- Catholic United explains that the criteria for brain death establish only partial loss of brain function. This is now abundantly clear based on scientific studies, a recent effort to lower the legal standard for death, and updated brain death guidelines issued in October 2023. -/- Catholics United bridges a divide among faithful Catholics about whether the concept of brain death aligns with Church teaching. Some Catholics hold that brain death represents true death when there is complete and irreversible cessation of all brain activity, often called whole brain death. Others hold that brain death does not represent true death. Since the existing criteria establish only partial loss of brain function, all the endorsers—whether they accept or reject whole brain death as true death—agree that “the current brain death criteria in widespread use do not provide moral (prudential) certainty of death.” -/- Catholics United calls on health care professionals and institutions to cease organ harvesting that relies on the inadequate criteria, noting that 70% of all donors are declared dead using brain death criteria. “Given the lack of moral certainty of death whenever the current brain death criteria are used,” the statement affirms, “a clear majority of vital organ donors can be presumed alive at the time of organ harvesting.” Since the Catholic Church forbids removing vital organs when this would kill the patient, “it is therefore wrong to remove organs from patients declared dead using these inadequate criteria.” . (shrink)

The ethical theories employed in health care today assume, in the main, a modern Western philosophical framework. Yet the diversity of cultural and religious assumptions regarding human nature, health and illness, life and death, and the status of the individual suggest that a cross-cultural study of health care ethics is needed. A Cross-Cultural Dialogue on Health Care Ethics provides this study. It shows that ethical questions can be resolved by examining the ethical principles present in each culture, critically assessing each (...) value, and identifying common values found within all traditions, It encourages the development of global awareness and sensitivity to and respect for the diversity of peoples and their values and will advance understanding as well as help to foster a greater balance and a fuller truth in consideration of the human condition and what makes for health and wholeness. (shrink)

This study examines the ethical and legal issues faced by girls/women requesting abortions who were victims of rape, aspects which have received little attention to date. This is a retrospective study using an approach and legal issues relating to incidents of unwanted pregnancy resulting from rape as reported in Turkish newspapers from 2010 to 2018. A total of 95 articles were discovered and categorized. These were then evaluated for content and analyzed in terms of the ethical issues related to the (...) cases. Of the articles,14 involved rape-related pregnancy cases. The six cases chosen for analysis in this study were carefully selected from newspaper reports between 2010-2018. The victims who requested abortions were between 9 and 26 weeks pregnant and aged 14-26 years old. Turkish courts approved only two of the victims' requests. The cases in this study were evaluated by the authorities solely on legal grounds. The stress experienced by victims of rape is exacerbated by compulsory pregnancy; the fact that these victims were not allowed to terminate their pregnancies resulted in their further punishment. Requests for abortions should be assessed not only in terms of legality but also based on medical and especially ethical issues. (shrink)

In this paper, we identify some key features of what makes something a disease, and consider whether these apply to pregnancy. We argue that there are some compelling grounds for regarding pregnancy as a disease. Like a disease, pregnancy affects the health of the pregnant person, causing a range of symptoms from discomfort to death. Like a disease, pregnancy can be treated medically. Like a disease, pregnancy is caused by a pathogen, an external organism invading the host’s body. Like a (...) disease, the risk of getting pregnant can be reduced by using prophylactic measures. We address the question of whether the ‘normality’ of pregnancy, its current necessity for human survival, or the value often attached to it are reasons to reject the view that pregnancy is a disease. We point out that applying theories of disease to the case of pregnancy, can in many cases illuminate inconsistencies and problems within these theories. Finally, we show that it is difficult to find one theory of disease that captures all paradigm cases of diseases, while convincingly excluding pregnancy. We conclude that there are both normative and pragmatic reasons to consider pregnancy a disease. (shrink)

Every year, hundreds of patients in England die whilst waiting for a kidney transplant, and this is evidence that the current system of altruistic-based donation is not sufficient to address the shortage of kidneys available for transplant. To address this problem, we propose a monopsony system whereby kidney donors can opt-in to receive financial compensation, whilst still preserving the right of individuals to donate without receiving any compensation. A monopsony system describes a market structure where there is only one ‘buyer’—in (...) this case the National Health Service. By doing so, several hundred lives could be saved each year in England, wait times for a kidney transplant could be significantly reduced, and it would lessen the burden on dialysis services. Furthermore, compensation would help alleviate the common disincentives to living kidney donation, such as its potential associated health and psychological costs, and it would also help to increase awareness of living kidney donation. The proposed system would also result in significant cost savings that could then be redirected towards preventing kidney disease and reducing health disparities. While concerns about exploitation, coercion, and the ‘crowding out’ of altruistic donors exist, we believe that careful implementation can mitigate these issues. Therefore, we recommend piloting financial compensation for living kidney donors at a transplant centre in England. (shrink)

This chapter examines whether high prices for gene therapies are justified and whether the problems associated with high prices can be solved by the "pay for performance" (P4P) reimbursement model. To this end, we first describe how prices for new drugs, including gene therapies, are set in Germany (section 2.). P4P is then presented as an example of a reimbursement model (section 3.). The subsequent ethical analysis (section 4.) first examines whether P4P models can sustainably guarantee the right to health (...) and healthcare for all people (section 4.1; cf. on the "sustainable right to health" already Alex, 2021). It is then shown that cost-benefit analyses for setting prices for new gene therapies must be viewed critically from an ethical perspective and pose a problem for equity of access and thus also for the sustainable guarantee of a right to health (section 4.2). The final question is whether P4P is compatible with the idea of human dignity (Article 1 I 1 of the German Basic Law) (section 4.3; cf. already König et al., 2020). -/- Alex, K. (2021): Ethical conceptualization of a sustainable right to health(care). In: Schildmann, J. et al. (eds.): Defining the value of medical interventions. Normative and empirical challenges. Kohlhammer, Stuttgart: 29-48. PMID: 36256802 König, J. et al. (2020): Am individuellen Therapieergebnis orientierte Erstattungsverfahren in der Onkologie: ethische Implikationen am Beispiel der CAR-T-Zelltherapie. In: Ethik Med 32: 85–92. doi: 10.1007/s00481-020-00565-3. (shrink)

Una vez que se desarrollen vacunas efectivas contra la enfermedad del coronavirus 2019 (COVID-19), estas serán escasas. Esto plantea la cuestión de cómo distribuirlas equitativamente entre países. La asignación de vacunas entre países plantea cuestiones complejas y controvertidas que involucran la opinión pública, la diplomacia, la economía, la salud pública y otras consideraciones. Sin embargo, muchos líderes nacionales, organizaciones internacionales y productores de vacunas reconocen que un factor central en esta toma de decisiones es la ética [1, 2]. No obstante, (...) se ha avanzado poco en la definición de lo que constituye una distribución internacional equitativa de vacunas. Muchos han respaldado la “distribución equitativa de la vacuna contra el COVID-19” sin describir un marco o sin ofrecer recomendaciones [3, 4]. Se han presentado dos propuestas sustantivas para la asignación internacional de una vacuna contra la COVID19, pero presentan graves fallas. Ofrecemos una propuesta más éticamente defendible y práctica para la distribución equitativa de la vacuna COVID19: el Modelo de la Prioridad Equitativa. El Modelo de la Prioridad Justa está orientado principalmente a tres grupos. Una es la alianza COVAX, encabezada por GAVI (por sus siglas en inglés), la Organización Mundial de la Salud (OMS) y la Coalición para Innovaciones en Preparación para Epidemias (CEPI por sus siglas en inglés), que tiene la intención de comprar vacunas para distribuirlas equitativamente entre países [5]. Un segundo grupo son los productores de vacunas. Afortunadamente, muchos productores se han comprometido públicamente con una distribución internacional de vacunas “amplia y equitativa” [2]. El último grupo son los gobiernos nacionales, algunos de los cuales también se han comprometido públicamente con una distribución equitativa [1]. Estos grupos necesitan un marco claro para reconciliar valores en competencia, uno que ellos y otros aceptarán legítimamente como ético y no solo como una afirmación de poder. El Modelo de la Prioridad Justa especifica lo que implica una distribución equitativa de vacunas, dando contenido a sus compromisos. Además, la aceptación de este marco ético común reducirá la duplicación y el desperdicio, lo que facilitará los esfuerzos por lograr una distribución equitativa. Eso, a su vez, promoverá la confianza de los productores en que las vacunas se asignarán de manera equitativa para beneficiar a las personas, lo que motivará un aumento en el suministro de vacunas para distribución internacional. (shrink)

Es probable que las vacunas contra COVID-19 sean escasas en los próximos años. Muchos países, desde la India hasta el Reino Unido, han adoptado el nacionalismo de las vacunas. ¿Cuáles son los límites éticos de este nacionalismo de vacunas? Ni el nacionalismo extremo ni el cosmopolitismo extremo son éticamente justificables. En cambio, proponemos el marco de prioridad justa para quienes residen en un país (PJR, por sus siglas en español), en el que los gobiernos pueden retener las dosis de la (...) vacuna COVID-19 para quienes residen en el país solo en la medida en que sean necesarias para mantener un nivel de mortalidad que no sea de crisis mientras están implementando intervenciones razonables de salud pública. En la práctica, un nivel de mortalidad sin crisis es el experimentado durante una mala temporada de gripe, el cual la sociedad considera un riesgo de fondo aceptable. Los gobiernos toman medidas para limitar la mortalidad por influenza, pero no existe una emergencia que incluya confinamientos severos. Este "estándar de riesgo de gripe" es una heurística no arbitraria y generalmente aceptada. La mortalidad por encima del estándar de riesgo de gripe justifica mayores intervenciones gubernamentales, incluida la retención de vacunas para quienes residen en un país por sobre la necesidad global. El nivel preciso de vacunación necesario para cumplir con el estándar de riesgo de influenza dependerá de factores empíricos relacionados con la pandemia. Esto vincula los principios éticos a los datos científicos que surgen de la emergencia. Por lo tanto, el marco PJR reconoce que los gobiernos deben priorizar la adquisición de vacunas para su país cuando sea necesario para reducir la mortalidad a niveles similares a los de la gripe sin crisis. Pero después de eso, un gobierno está obligado a hacer su parte para compartir vacunas para reducir los riesgos de mortalidad de las personas en otros países. Consideramos y rechazamos las objeciones al marco PJR basadas en que un país (1) haya desarrollado una vacuna, (2) haya aumentado los impuestos para pagar la investigación y compra de vacunas, (3) quiera eliminar las cargas económicas y sociales, y (4) sea ineficaz para combatir el COVID-19 a través de intervenciones de salud pública. (shrink)

Este número de acceso abierto tiene como objetivo resaltar los puntos de vista de los países latinoamericanos sobre la justicia en un contexto de pandemia y contribuir al diálogo entre estos y con la comunidad científica global. Explora los desafíos globales de la pandemia de COVID-19, las diferencias relevantes entre las medidas de salud pública y su impacto en los países de ingresos altos versus los países de ingresos bajos o medios, y cómo la injusticia global se profundizó debido a (...) la pandemia de COVID-19. También llama la atención sobre las experiencias, los resultados y las respuestas del norte global a la pandemia con respecto a poblaciones vulnerables y trayectorias de exposición que se reproducen en América Latina. (shrink)

This open-access issue aims to highlight views about justice in a pandemic context from Latin American countries and to contribute to the dialogue between them as well as with the global scientific community. It explores the global challenges of the COVID-19 pandemic, relevant differences between public health measures and their impact on high-income countries versus low- or middle-income countries, and how global injustice deepened because of the COVID-19 pandemic. It also draws attention to experiences, outcomes, and responses to the pandemic (...) from the global north regarding vulnerable populations and exposure paths that are also present in Latin America. (shrink)

Is it wrong to create a blind child, for example by in vitro fertilization, if you could create a sighted child instead? Intuitively many people believe it is wrong, but this belief is difficult to justify. When there is a possibility to create and select either ‘blind’ or ‘sighted’ embryos choosing a set of ‘blind’ embryos seems to harm no-one since choosing ‘sighted’ embryos would create a different child altogether. So when the parents choose ‘blind’ embryos, they give some specific (...) individual a life that is the only option for her. Because her life is worth living (as blind peoples’ lives are), the parents have not wronged the child by creating her. This is the reasoning behind the famous non-identity problem. I suggest that the non-identity problem is based on a misunderstanding. I claim that when choosing a ‘blind’ embryo, prospective parents harm ‘their child’, whoever she or he will be. Put another way: parents harm their child in the de dicto sense and that is morally wrong. (shrink)

Shared decision-making involves health professionals and patients/clients working together to achieve true person-centred health care. However, this goal is infrequently realized, and most barriers are unknown. Discussion between philosophers, clinicians, and researchers can assist in confronting the epistemic and moral basis of health care, with benefits to all. The aim of this paper is to describe what shared decision-making is, discuss its necessary conditions, and develop a definition that can be used in practice to support excellence in maternity care. Discussion (...) between the authors, with backgrounds in philosophy, clinical maternity care, health care management, and maternity care research, assisted the team to confront established norms in maternity care and challenge the epistemic and moral basis of decision-making for caesarean section. The team concluded that shared decision-making must start in pregnancy and continue throughout labour and birth, with equality in discourse facilitated by the clinician. Clinicians have a duty of care for the adequacy of women's knowledge, which can only be fulfilled when relevant knowledge is offered freely and when personal beliefs and biases that may impinge on decision-making (defeaters) are disclosed. Informed consent is not shared decision-making. Key barriers include existing cultural norms of “the doctor knows best” and “patient acquiescence” that prevent defeaters being acknowledged and discussed and can lead to legal challenges, overuse of medical intervention and, in some areas, obstetric violence. Shared decision-making in maternity care can thus be defined as an enquiry by clinician and expectant woman aimed at deciding upon a course of care or none, which takes the form of a dialogue within which the clinician fulfils their duty of care to the client's knowledge by making available their complete knowledge (based on all types of evidence) and expertise, including an exposition of any relevant and recognized potential defeaters. Research to develop measurement tools is required. (shrink)

In this paper, I consider an example of fast science produced in the early stages of the pandemic and the lasting effects of the study on public safety and trust in science. Due to pressures intrinsic to contemporary science and from the pandemic to produce research on COVID quickly, studies on COVID-19 that did not meet rigorous scientific standards were used to form public health policies and recommendations. I argue that the fast science produced for COVID-19, which caused many public (...) health policies and recommendations to change throughout the pandemic, confuses the publics and erodes their trust in science. (shrink)

This article applies the tools of experimental philosophy to the ongoing debate about both the theoretical viability and the practical import of partially aggregative moral theories in distributive ethics. We conduct a series of three experiments (N=383): First, we document the widespread occurrence of the intuitions that motivate this position. Our study then moves beyond establishing the existence of partially aggregative intuitions in two dimensions: First, we extend experimental work in such a way as to ascertain which amongst existing versions (...) of partial aggregation (localised vs. global) chimes more fully with moral common sense. Specifically, we document how, in tie-breaking cases, ‘irrelevant goods’ judgments (Kamm) are just as robust as the original aggregative/non-aggregative pair of judgments that constitute partial aggregation. Second, by pairing laypeople’s moral judgments in standard cases with their intuitions about the limits of permissible self-prioritisation, we investigate whether one prominent explanation of why irrelevant claims may not be aggregated (Voorhoeve’s ‘personal prerogative’ argument) can be said to underpin people’s intuitions about the (ir)relevance relation of claims in conflict cases. We close with a discussion of our findings’ practical and theoretical import and highlight avenues for future research. (shrink)

One of the lessons of the COVID-19 pandemic is that the lay public relies immensely on the knowledge of public health officials. At every phase of the pandemic, the testimony of public health officials has been crucial for guiding public policy and individual behavior. The reason is simple: public health officials know a lot more than you and I do about public health. As lay people, we rely on experts. This seems straightforward. But the COVID-19 pandemic has shown that public (...) health officials seem undecided as to what, precisely, their role is; are they providing the public information as it presents itself, or are they informing the public in a way that produces a desired or optimal outcome? In this article, I answer the following question: what are public health officials morally obligated to tell the public? As I see it, these are the main options: (1) public health officials should tell the full truth, regardless of outcome; or (2) they should tell partial truths or lies that are aimed to promote a socially optimal outcome. My answer to this question is that public health officials are only allowed to lie under very narrow and rare conditions. -/- . (shrink)

This article argues that non-consensual vaccination is morally impermissible, for the same reasons for which sexual assault is not permissible. Likewise, mandatory vaccination is morally akin to sexual harassment, and therefore is not to be allowed.

This chapter provides a high-level overview of key ethical issues raised by the use of surveillance technologies, such as digital contact tracing, disease surveillance, and vaccine passports, to combat the COVID-19 pandemic. To some extent, these issues are entirely familiar. I argue that they raise old questions in new form and with new urgency, at the intersection of information ethics, research ethics, and public health. Whenever we deal with data-driven technologies, we have to ask how they fare in relation to (...) important values like privacy, fairness, transparency, and accountability—values emphasized by information ethics scholars. Likewise, when such technologies put individuals at risk in order to drive scientific research and knowledge construction, we have to ask how they implicate values such as autonomy, beneficence and non-maleficence, and justice—values central to research ethics. And as researchers focusing on health information have long argued, when the data collected by these technologies pertain to individuals and public health, these ethical issues take on a special cast. -/- It is also true, however, that the pandemic has placed these questions in a new and revealing light. I highlight three insights from information ethics and research ethics that can help us navigate this difficult terrain. First, the value of privacy is instrumental, not absolute—there is nothing wrong with asking how to balance privacy against other important values. Second, privacy has both individual and social importance. Weighing privacy, on one hand, and public health, on the other, is not, therefore, a contest between individual and collective interests. Rather, it is an attempt to balance disparate public goods. Third, we ought to put these kinds of ethical decisions in the hands of third parties, rather than leaving them up to those who directly stand to benefit from them. In the case of pandemic surveillance technologies, this should mean more public, democratic oversight. (shrink)