Public Health, Misc

When faced with an urgent and credible threat of grave harm, we should take proportionate precautions. This maxim captures the core commitments of the “precautionary principle”. But what is it for a precaution to be “proportionate”? I construct an account of proportionality (the “ARCANE” account) that consists of five fundamental conditions (absolute rights compatibility, reasonable compensation, consistency, adequacy and non- excessiveness) and a tie-breaker (efficiency). I apply this account to two examples from the COVID-19 pandemic (border closures and school closures), (...) arguing that my account captures the key questions on which it is both feasible and important to integrate expert input with democratic input. I close by considering how we might try to manage the risk of future pandemics in a proportionate way. (shrink)

Healthcare systems across the globe are struggling with increasing costs and worsening outcomes. This presents those responsible for overseeing healthcare with a challenge. Increasingly, policymakers, politicians, clinical entrepreneurs and computer and data scientists argue that a key part of the solution will be ‘Artificial Intelligence’ (AI) – particularly Machine Learning (ML). This argument stems not from the belief that all healthcare needs will soon be taken care of by “robot doctors.” Instead, it is an argument that rests on the classic (...) counterfactual definition of AI as an umbrella term for a range of techniques that can be used to make machines complete tasks in a way that would be considered intelligent were they to be completed by a human. Automation of this nature could offer great opportunities for the improvement of healthcare services and ultimately patients’ health by significantly improving human clinical capabilities in diagnosis, drug discovery, epidemiology, personalised medicine, and operational efficiency. However, if these AI solutions are to be embedded in clinical practice, then at least three issues need to be considered: the technical possibilities and limitations; the ethical, regulatory and legal framework; and the governance framework. In this article, we report on the results of a systematic analysis designed to provide a clear overview of the second of these elements: the ethical, regulatory and legal framework. We find that ethical issues arise at six levels of abstraction (individual, interpersonal, group, institutional, sectoral, and societal) and can be categorised as epistemic, normative, or overarching. We conclude by stressing how important it is that the ethical challenges raised by implementing AI in healthcare settings are tackled proactively rather than reactively and map the key considerations for policymakers to each of the ethical concerns highlighted. (shrink)

In exploring the intra-active, relational and material connections between humans and non- humans, proponents of posthumanism advocate a questioning of the ‘human’ beyond its traditional anthropocentric conceptualization. By referring specifically to controversial developments in mHealth applications, this paper critically diverges from posthuman accounts of human/non-human assemblages. Indeed, we argue that, rather than ‘dissolving’ the human subject, the power of assemblages lie in their capacity to highlight the antagonisms and contradictions that inherently affirm the importance of the subject. In outlining this (...) claim, we propose a turn from the posthuman to the inhuman as a way of understanding the contemporary landscape of (digital) health. (shrink)

It is well known that prisoners’ human rights are often violated. In this chapter we examine whether guidelines can be effective in preventing such violations and in helping physicians resolve the significant conflicts of interest that they often face in trying to protect prisoners’ rights. We begin by explaining the role of clinical and ethical guidelines outside prisons, in the context of healthcare for non-incarcerated prisoners, and then the specific role of such guidelines within prisons, where the main concerns are (...) ensuring respect for the principle of equivalence of care, and for a prisoner patient’s autonomy in health care decisions. After reviewing and analysing various national and international guidelines, we review the literature and assess whether the good practices set out in these guidelines actually translate into changes in professional behaviour and consequent benefits for prisoners. It emerges that physicians both outside and within prisons tend to be insufficiently familiar with the relevant guidelines, and that they too infrequently use the guidance to make decisions, preferring instead to use personal codes of conduct. Guidelines designed specifically for the prison context are important to ensure equivalence of care and should be better known by health care personnel and other professional groups working in prison. Further guidelines should be developed that describe challenging situations and provide concrete guidance as to how to deal with them. (shrink)

In the recent literature across philosophy, medicine and public health policy, many influential arguments have been put forward to support the use of randomization procedures to allocate scarce life-saving resources. In this paper, I provide a systematic categorization and a critical evaluation of these arguments. I shall argue that those arguments justify using randomization procedures to allocate scarce life-saving resources in fewer cases than their proponents maintain and that the relevant decision makers should typically allocate scarce life-saving resources directly to (...) the individuals with the strongest claims to these resources rather than use randomization procedures to allocate such resources. (shrink)

It is usually appropriate for adults to make significant decisions, such as about what kinds of medical treatment to undergo, for themselves. But sometimes impairments are suffered - either temporary or permanent - which render an individual unable to make such decisions. The Mental Capacity Act 2005 sets out the conditions under which it is appropriate to regard an individual as lacking the capacity to make a particular decision (and when provisions should be made for a decision on their behalf). (...) -/- To what extent does having capacity require the endorsement of certain values? Drawing on Owens et al (2009), I assess the extent to which understanding relevant information and weighing it in coming to a decision requires certain evaluative commitments. With reference to literature on anorexia nervosa and decisions informed by religious beliefs, I argue that it is difficult to avoid the conclusion that the conditions for capacity are value-laden, and that if this is so it is important to open discussion about which patterns of distorted valuing undermine capacity, and why. (shrink)

Background -/- Innovative neurosurgical treatments present a number of known risks, the natures and probabilities of which can be adequately communicated to patients via the standard procedures governing obtaining informed consent. However, due to their novelty, these treatments also come with unknown risks, which require an augmented approach to obtaining informed consent. -/- Objective -/- This paper aims to discuss and provide concrete procedural guidance on the ethical issues raised by serious unexpected complications of novel deep brain stimulation treatments. -/- (...) Approach -/- We illustrate our analysis using a case study of the unexpected development of recurrent stereotyped events in patients following the use of deep brain stimulation (DBS) to treat severe chronic pain. Examining these unexpected complications in light of medical ethical principles, we argue that serious complications of novel DBS treatments do not necessarily make it unethical to offer the intervention to eligible patients. However, the difficulty the clinician faces in determining whether the intervention is in the patient's best interests generates reasons to take extra steps to promote the autonomous decision making of these patients. -/- Conclusion and recommendations -/- We conclude with clinical recommendations, including details of an augmented consent process for novel DBS treatment. (shrink)

Organ shortage constitutes an unsolved problem for every country that offers transplantation as a therapeutic option. Besides the largely implemented donation model and the eventually implemented market model, a theorized automatic organ procurement model has raised a rich debate in the legal, medical and bioethical community, since it could show a higher potential to solve organ shortage. In this paper, we study the main arguments for and against this model. We show how, in the light of empirical data extracted from (...) countries with a universal health care system, its implementation could lead to a positive impact on organ procurement rates. Three factors are envisioned as fundamental in the comprehension and a possible regulation of the automatic organ procurement model: the lack of recognition of the conscientious objection, the preservation of the right to choose end of life conditions, and the need to avoid incentives for families or healthcare professionals. (shrink)

Medicines and medical devices containing animal-derived ingredients are frequently used on patients without their informed consent, despite a significant proportion of patients wanting to know if an animal-derived product is going to be used in their care. Here, I outline three arguments for why this practice is wrong. Firstly, I argue that using animal-derived medical products on patients without their informed consent undermines respect for their autonomy. Secondly, it risks causing non-trivial psychological harm. Thirdly, it is morally inconsistent to respect (...) patients' dietary preferences and then use animal-derived medicines or medical devices on them without their informed consent. I then address several anticipated objections, and conclude that the continued failure to address this issue is an ethical blind spot that warrants applying the principles of respect for autonomy and informed consent consistently. (shrink)

In the beginning of the COVID pandemic, researchers and bioethicists called for human challenge trials to hasten the development of a vaccine for COVID. However, the fact that we lacked a specific, highly effective treatment for COVID led many to argue that a COVID challenge trial would be unethical and we ought to pursue traditional phase III testing instead. These ethical objections to challenge trials may have slowed the progress of a COVID vaccine, so it is important to evaluate their (...) merit. One common way of doing so is to make an analogy to other social practices that are relevantly similar and which we currently sanction. We submit that non-directed live organ donation (NDLOD) is a promising analogy. After arguing that the risks to volunteers for each activity appear similar, we explore potential disanalogies that would undermine the comparison. We note that there are differences in both the kind and certainty of benefit secured by NDLOD compared to challenge trials. We conclude these differences are insufficient to make NDLOD permissible and challenge trials impermissible. Ultimately, if we think the risks associated with NDLOD are ethically permissible, then we should think the same of the risks associated with COVID challenge trials. (shrink)

In the ongoing pandemic, death statistics influence people’s feelings and government policy. But when does COVID-19 qualify as the cause of death? As philosophers of medicine interested in conceptual clarification, we address the question by analyzing the World Health Organization’s rules for the certification of death. We show that for COVID-19, WHO rules take into account both facts and values.

The debate for and against making e-cigarettes available to smokers is to a large extent empirical. We do not know the long-term health effects of vaping and we do not know how smokers will respond to e-cigarettes over time. In addition to these empirical uncertainties, however, there are difficult moral issues to consider. One such issue is that many smokers in some sense choose to smoke. Though smoking is addictive and though many start young, it does not seem impossible to (...) plan for and implement cessation. Yet many choose not to do so and we arguably have some reason to respect this choice. I propose that liberal opposition to strict tobacco control, based on respect for choice, is mitigated when e-cigarettes are available, since they are such a close substitute. Making e-cigarettes available to smokers might therefore not only enable switching in practice, but may make tougher tobacco control more justified. Another moral issue is that making e-cigarettes widely available might induce many people to vape, who would otherwise have neither vaped nor smoked. If this is so, the price of using e-cigarettes to accelerate smoking cessation may be a long-term vaping epidemic. Since vaping is less harmful than smoking, both individuals and society will have less reason to end this epidemic and so it may endure longer than the smoking epidemic would otherwise have done. This raises further questions around the weighing of reduced harm to current smokers against increased harm to future vapers. (shrink)

Consistent and well-designed frameworks for ethical oversight enable socially valuable research while forestalling harmful or poorly designed studies. I suggest some alterations that might strengthen the valuable checklist Rattani & Hyder propose for the ethical review of health policy and systems research (HPSR), or prompt future work in the area.

Opioid treatment agreements are written agreements between physicians and patients enumerating the risks associated with opioid medications along with the requirements that patients must meet to receive these medications on an ongoing basis. The choice to use such agreements goes beyond the standard informed consent process, and has a distinctive symbolic significance. Specifically, it suggests that physicians regard it as important to hold their patients accountable for adhering to various protocols regarding the use of their opioid medications. After laying out (...) a taxonomy of accountability relationships between physicians and patients, I argue that opioid treatment agreements are only justifiable for physicians to use in their provision of care if they improve public health outcomes, which has yet to be demonstrated. (shrink)

Models not only represent but may also influence their targets in important ways. While models’ abilities to influence outcomes has been studied in the context of economic models, often under the label ‘performativity’, we argue that this phenomenon also pertains to epidemiological models, such as those used for forecasting the trajectory of the Covid-19 pandemic. After identifying three ways in which a model by the Covid-19 Response Team at Imperial College London may have influenced scientific advice, policy, and individual responses, (...) we consider the implications of epidemiological models’ performative capacities. We argue, first, that performativity may impair models’ ability to successfully predict the course of an epidemic; but second, that it may provide an additional sense in which these models can be successful, namely by changing the course of an epidemic. (shrink)

Nyansa nye sika na w'akyekyere asie.. One critical factor that has contributed to the spread of the virus COVID-19 and resulting illnesses and deaths is both the conceptual and the ethical confusion between the prioritization of individual rights over social duties. The adherence to the belief in the priority of rights over duties has motivated some individuals to refrain from social distancing and, as a result, has placed themselves and other individuals at serious risk to health and life. My argument (...) is that the ethical enjoinder of social duty possesses priority over the ethical value of individual rights especially in times of global crisis. I demonstrate this point by arguing that the concept of individual right is derivative from the concept of social duty and through the argument that the concept of social duty is more efficacious in addressing global threats to human life than is the concept of individual rights. What is needed is an in-depth revision of the moral ordering of rights and duties and a vision of the human being as inherently other directed with duties toward others. I shall examine two specific ethical systems, that of Confucian and African, Akan moral philosophy that exemplify such a revision of the moral order. (shrink)

Common mental health disorders are rising globally, creating a strain on public healthcare systems. This has led to a renewed interest in the role that digital technologies may have for improving mental health outcomes. One result of this interest is the development and use of artificial intelligence for assessing, diagnosing, and treating mental health issues, which we refer to as ‘digital psychiatry’. This article focuses on the increasing use of digital psychiatry outside of clinical settings, in the following sectors: education, (...) employment, financial services, social media, and the digital well-being industry. We analyse the ethical risks of deploying digital psychiatry in these sectors, emphasising key problems and opportunities for public health, and offer recommendations for protecting and promoting public health and well-being in information societies. (shrink)

One branch of bioethics assumes that mainly agents of the state are responsible for public health. Following Susan Sherwin’s relational ethics, we suggest moving away from a “state-centered” approach toward a more thoroughly relational approach. Indeed, certain agents must be reconstituted in and through shifting relations with others, complicating discussions of responsibility for public health. Drawing on two case studies—the health politics and activism of the Black Panther Party and the work of the Common Ground Collective in post-Katrina New Orleans—we (...) argue for the need to attend more carefully to the limitations of states and state-driven public health programs. (shrink)

Christine Clavien and Samia Hurst (henceforth C-H) make at least three valuable contributions to the literature on responsibility and healthcare. They offer an admirably clear and workable set of criteria for determining a patient's degree of responsibility for her health condition; they deploy those criteria to cast doubt on the view that patients with lifestyle-related conditions are typically significantly responsible for their conditions; and they outline several practical difficulties that would be raised by any attempt to introduce responsibility-sensitive healthcare funding. (...) I am sympathetic to the general thrust of their argument, share—at least tentatively—their policy conclusions, and was persuaded by much of the detail of their argument. However, I do have three critical comments. (shrink)

Would compulsory treatment or vaccination for Covid-19 be justified? In England, there would be significant legal barriers to it. However, we offer a conditional ethical argument in favour of allowing compulsory treatment and vaccination, drawing on an ethical comparison with external constraints—such as quarantine, isolation and ‘lockdown’—that have already been authorised to control the pandemic. We argue that, if the permissive English approach to external constraints for Covid-19 has been justified, then there is a case for a similarly permissive approach (...) to compulsory medical interventions. (shrink)

Comme tous les autres projets humains, les politiques de santé publique sont souvent affectées par des imperfections et des erreurs. Cependant, elles sont mieux ancrées dans les résultats de la recherche scientifique que d’autres actions humaines en général, et politiques gouvernementales en particulier. D’une manière générale, les données sur lesquelles reposent les politiques de santé publique remplissent les conditions suivantes : méthodes de recherche rigoureuses, tests indépendants et précis, reproductibilité des résultats, mesure du taux d’erreur, capacité à écarter des hypothèses (...) rivales et un degré d’acceptation satisfaisant au sein de la communauté scientifique. Les politiques de santé publique comprennent des campagnes de vaccination de la population, en particulier des enfants. Ces actions de vaccination sont considérées comme sûres et efficaces par les institutions publiques, les organisations de santé, les médecins et les chercheurs en santé. Malgré cela, un nombre croissant de parents choisit de ne pas vacciner leurs enfants. Les fausse nouvelles sur les vaccins publiées dans les médias, en particulier dans les nouveaux médias, par les influenceurs, ont contribué certainement à cette tendance. Ces influenceurs sont insuffisamment qualifiés ou totalement non qualifiés pour commenter l’innocuité et l’efficacité des vaccins dans les médias. Par conséquent, ils ne peuvent pas produire des données fiables et des opinions qualifiées, c’est-à-dire des informations indépendantes, précises, pertinentes, fiables et complètes. Cependant, ces influenceurs parviennent à influencer, dans une large mesure, le comportement des parents en matière de vaccination. La stratégie de lutte contre les fausses nouvelles en publiant des preuves contraires est évidemment nécessaire, mais pas suffisante parce que beaucoup de fausses infos sur les vaccins fonctionnent comme des mythes. Etant fixées d’une manière partiellement irrationnelle, les mythes anti-vaccination ne peuvent être démystifiés seulement avec les dernières preuves scientifiques. C’est pourquoi il est nécessaire d’envisager des stratégies de relations publiques capables d’influencer des opinions collectives irrationnelles. (shrink)

This essay frames systemic patterns of mental abuse against women of color and Indigenous women on Turtle Island (North America) in terms of larger design-of-distribution strategies in settler colonial societies, as these societies use various forms of social power to distribute, reproduce, and automate social inequalities (including public health precarities and mortality disadvantages) that skew socio-economic gain continuously toward white settler populations and their descendants. It departs from traditional studies in gender-based violence research that frame mental abuses such as gaslighting--commonly (...) understood as mental manipulation through lying or deceit--stochastically, as chance-driven interpersonal phenomena. Building on structural analyses of knowledge in political epistemology (Dotson 2012, Berenstain 2016), political theory (Davis and Ernst 2017), and Indigenous social theory (Tuck and Yang 2012), I develop the notion of cultural gaslighting to refer to the social and historical infrastructural support mechanisms that disproportionately produce abusive mental ambients in settler colonial cultures in order to further the ends of cultural genocide and dispossession. I conclude by proposing a social epidemiological account of gaslighting that a) highlights the public health harms of abusive ambients for minority populations, b) illuminates the hidden rules of social structure in settler colonial societies, and c) amplifies the corresponding need for structural reparations. (shrink)

This chapter explores the question of whether or not individual agents are under a moral obligation to reduce their ‘antimicrobial footprint’. An agent’s antimicrobial footprint measures the extent to which her actions are causally linked to the use of antibiotics. As such, it is not necessarily a measure of her contribution to antimicrobial resistance. Talking about people’s antimicrobial footprint in a way we talk about our carbon footprint may be helpful for drawing attention to the global effects of individual behaviour (...) and for highlighting that our choices can collectively make a real difference. But can we be morally obligated to make a contribution to resolving a collective action problem when our individual contributions by themselves make no discernible difference? I will focus on two lines of argument in favour of such obligations: whether a failure to reduce one’s antimicrobial footprint is unfair and whether it constitutes wrongdoing because it is harmful. I conclude by suggesting that the argument from collective harm is ultimately more successful. (shrink)

Public health scholars and public health officials increasingly worry about health-related misinformation online, and they are searching for ways to mitigate it. Some have suggested that the tools of digital influence are themselves a possible answer: we can use targeted, automated digital messaging to counter health-related misinformation and promote accurate information. In this commentary, I raise a number of ethical questions prompted by such proposals—and familiar from the ethics of influence and ethics of AI—highlighting hidden costs of targeted digital messaging (...) that ought to be weighed against the health benefits they promise. (shrink)

In various responses to the COVID-19 pandemic, we can observe insufficient sensitivity towards the needs and circumstances of poorer citizens. Particularly in a context of high inequality, policy makers need to engage with the wider public in debates and consultations to gain better insights in the realities of the worst-off within their jurisdiction. When consultations involve members of traditionally underrepresented groups, these are not only more inclusive, which is in itself an ethical aim, but pool ideas and observations from a (...) much more diverse array of inhabitants. Inclusivity increases the odds to identify a larger range of weak spots for health security and to design health interventions that are less burdensome on those worst-off. (shrink)

Context In response to outbreaks of vaccine‐preventable disease and increasing rates of vaccine refusal, some political communities have recently implemented coercive childhood immunization programs, or they have made existing childhood immunization programs more coercive. Many other political communities possess coercive vaccination policies, and others are considering developing them. Scholars and policymakers generally refer to coercive immunization policies as “vaccine mandates.” However, mandatory vaccination is not a unitary concept. Rather, coercive childhood immunization policies are complex, context‐specific instruments. Their legally and morally (...) significant features often differ, and they are imposed by political communities in varying circumstances and upon diverse populations. Methods In this paper, we introduce a taxonomy for classifying real‐world and theoretical mandatory childhood vaccination policies, according to their scope (which vaccines to require), sanctions and severity (which kind of penalty to impose on vaccine refusers, and how much of that penalty to impose), and selectivity (how to enforce or exempt people from vaccine mandates). Findings A full understanding of the operation of a vaccine mandate policy (real or potential) requires attention to the separate components of that policy. However, we can synthesize information about a policy's scope, sanctions, severity, and selectivity to identify a further attribute—salience —which identifies the magnitude of the burdens the state imposes on those who are not vaccinated. Conclusion Our taxonomy provides a framework for forensic examination of current and potential mandatory vaccination policies, by focusing attention on those features of vaccine mandates that are most relevant for comparative judgments. (shrink)

In a recent article in this journal, Steve Clarke (2017) identifies two different bases for conscience-based refusals in healthcare: (1) all-things-considered moral judgments, and (2) the dictates of conscience. He argues that these two bases have distinct roles in justifying conscientious objection. However, accepting that there are these two bases, I argue that both are not able to justify conscientious objection. In particular, I argue that the second basis of the dictates of conscience cannot justify conscience-based refusal in a healthcare (...) context. Even if someone objects in a healthcare context on the basis of the dictates of her conscience, and even if we can explain why she objects with reference to the dictates of her conscience, her objection will only be justified if she makes a judgment. (shrink)

Janet Malek (91–102, 2019) argues that a “clinical ethics consultant’s religious worldview has no place in developing ethical recommendations or communicating about them with patients, surrogates, and clinicians.” She offers five types of arguments in support of this thesis: arguments from consensus, clarity, availability, consistency, and autonomy. This essay shows that there are serious problems for each of Malek’s arguments. None of them is sufficient to motivate her thesis. Thus, if it is true that the religious worldview of clinical ethics (...) consultants should play no role whatsoever in their work as consultants, this claim will need to be defended on some other ground. (shrink)

Authors present a practical approach to developing health care trainees' native ability as moral agents to become responsible health care practitioners. Highly recommended. Full text available free online.

Antimicrobial resistance (AMR) is a global public health disaster driven largely by antibiotic use in human health care. Doctors considering whether to prescribe antibiotics face an ethical conflict between upholding individual patient health and advancing public health aims. Existing literature mainly examines whether patients awaiting consultations desire or expect to receive antibiotic prescriptions, but does not report views of the wider public regarding conditions under which doctors should prescribe antibiotics. It also does not explore the ethical significance of public views (...) or their sensitivity to awareness of AMR risks or the standpoint (self-interested or impartial) taken by participants. Methods: An online survey was conducted with a sample of the U.S. public (n = 158). Participants were asked to indicate what relative priority should be given to individual patients and society-at-large from various standpoints and in various contexts, including antibiotic prescription. Results: Of the participants, 50.3% thought that doctors should generally prioritize individual patients over society, whereas 32.0% prioritized society over individual patients. When asked in the context of AMR, 39.2% prioritized individuals whereas 45.5% prioritized society. Participants were significantly less willing to prioritize society over individuals when they themselves were the patient, both in general (p = .001) and in relation to AMR specifically (p = .006). Conclusions: Participants’ attitudes were more oriented to society and sensitive to collective responsibility when informed about the social costs of antibiotic use and when considered from a third-person rather than first-person perspective. That is, as participants came closer to taking the perspective of an informed and impartial “ideal observer,” their support for prioritizing society increased. Our findings suggest that, insofar as antibiotic policies and practices should be informed by attitudes that are impartial and well-informed, there is significant support for prioritizing society. (shrink)

While many public health threats are now widely appreciated by the public, the risks from asbestos exposure remain poorly understood, even in high-risk groups. This article makes the case that asbestos exposure is an important, ongoing global health threat, and argues for greater policy efforts to raise awareness of this threat. It also proposes the extension of asbestos bans to developing countries and increased public subsidies for asbestos testing and abatement.

Many parents are hesitant about, or face motivational barriers to, vaccinating their children. In this paper, we propose a type of vaccination policy that could be implemented either in addition to coercive vaccination or as an alternative to it in order to increase paediatric vaccination uptake in a non-coercive way. We propose the use of vaccination nudges that exploit the very same decision biases that often undermine vaccination uptake. In particular, we propose a policy under which children would be vaccinated (...) at school or day-care by default, without requiring parental authorization, but with parents retaining the right to opt their children out of vaccination. We show that such a policy is likely to be effective, at least in cases in which non-vaccination is due to practical obstacles, rather than to strong beliefs about vaccines, ethically acceptable and less controversial than some alternatives because it is not coercive and affects individual autonomy only in a morally unproblematic way, and likely to receive support from the UK public, on the basis of original empirical research we have conducted on the lay public. (shrink)

Children’s preferences about medical treatment—like the preferences of other patients—hold moral weight in decision-making that is independent of considerations of autonomy or best interests. In light of this understanding of the moral value of patient preferences, the American Academy of Pediatrics could strengthen the ethical foundation for its formal guidance on pediatric assent.

In recent years, hospitals, clinics, and professional organizations have with increasing frequency pledged their commitment to “patient-and family-centered care”. The movement toward PFCC is especially pronounced in pediatrics, where the American Academy of Pediatrics has a long-held, explicit commitment to PFCC. However, the unified movement toward PFCC obscures differing conceptions of its purpose. First, patient-centered care, as opposed to provider- or disease-centered care, focuses on increasing patient involvement in care to accomplish two related, but distinct objectives: improving health outcomes and (...) better respecting patients’ wishes. The Institute of... (shrink)

In the United States, roughly 1 out of 4 births takes place at a hospital certified as Baby-Friendly. This paper offers a multi-disciplinary perspective on the Baby-Friendly Hospital Initiative (BFHI), including empirical, normative, and historical perspectives. Our analysis is novel in that we trace how medical practices of “quality improvement,” which initially appear to have little to do with breastfeeding, may have shaped the BFHI. Ultimately, we demonstrate that a rich understanding of the BFHI can be obtained by tracing how (...) norms of gender/motherhood interact with, and are supplemented by, other normative, historical, and institutional realities. We conclude with suggestions for practical revisions to the BFHI. (shrink)