In this review, I survey theoretical accounts of exploitation in business, chiefly through the example of low wage or sweatshop labor. This labor is associated with wages that fall below a living wage standard and include long working hours. Labor of this kind is often described as self-evidently exploitative and immoral (Van Natta 1995). But for those who defend sweatshop labor as the first rung on a ladder toward greater economic development, the charge that sweatshop labor is self-evidently exploitative fails (...) adequately to explain the nature of the alleged wrongdoing. While all sides might agree that poor working conditions are unfortunate and undesirable, defenders of sweatshop labor argue that they provide the best available employment alternative for some workers and the best chance at economic development for many low and middle income countries (LMICs). Some defenders of sweatshop labor even embrace the label of exploitation. <br><br>Unless there is a clear, widely understood account by which exploitation is a moral wrong, then charging a practice as exploitative will do little to advance debates over whether and why a practice is morally problematic. A considerable body of work has been developed applying a growing literature on exploitation to sweatshop labor. While many forms of moral wrong are associated with sweatshop labor, I will focus specifically on the worry that low wages allow relatively wealthy employers wrongfully to take advantage of or gain from relatively poor workers, especially in LMICs. In particular, I will focus on instances of alleged exploitation in employment relationships that are voluntary and mutually beneficial. I have two reasons for doing so. First, by restricting this review to voluntary and mutually beneficial instances of exploitation, I can isolate the moral wrong of exploitation from other moral wrongs, especially the wrongs of coercion and outright harms to workers. Second, the focus on mutually beneficial and voluntary relationships will allow for arguments that sweatshop labor is not only not exploitative, but is a morally praiseworthy means of helping to encourage economic growth in poor areas of the world and to provide jobs that pay better and are more stable than any existing alternatives.<br><br>In this review, I aim to accomplish three goals. First, I will provide an overview of the many different uses of the charge of exploitation in business practice through an examination of the uses of the term in the literature on sweatshop labor. While it is often not clear what kind of moral wrong is assumed to take place when the charge of exploitation is used, I will demonstrate that many distinct types of exploitation, connected to distinct moral wrongs, are used in the literature on sweatshop labor and elsewhere in business ethics. Specifically, I will identify two broad categories of exploitation—exploitation as unfairness and exploitation as the mere use of others—with subgroups under each main category of exploitation. Second, I will discuss which of these senses of exploitation are defensible as identifying clear moral wrongs that take place in the context of business and, specifically, sweatshop labor. As I will argue, not all uses of the charge of exploitation are capable of persuasively identifying clear moral wrongs. Moreover, there is not a single, clear type of exploitation that takes place in business but, rather, several distinct forms. Third, I will apply the lessons learned from my exploration of exploitation in sweatshop labor to other specific areas of business. As I will argue, there are multiple viable models of exploitation in the sweatshop literature that can illuminate exploitative practices of relatively well compensated employees, customers, suppliers, and entire communities. <br><br>While discussions of theories of exploitation tend to argue for a single, correct account of this moral wrong, my review of the literature on exploitation in sweatshop labor supports the conclusion that there are multiple defensible accounts of the moral wrong of exploitation. For this reason, those who would charge that a relationship is exploitative should specify the form of exploitation that they believe is taking place. (shrink)

Sweatshop labor is often cited as an example of the worst and most pervasive form of exploitation today, yet understanding what is meant by the charge has proven surprisingly difficult for philosophers. I develop an account of what I call “Needs Exploitation,” grounded in a specification of the duty of beneficence. In the case of sweatshop labor, I argue that employers face a duty to extend to employees a wage sufficient to meet their basic needs. This duty is limited by (...) the degree of the employees’ dependence on the employer for basic needs and a reasonability standard where the employer may remain within a range of well-being between deficiency and luxury. (shrink)

ABSTRACT:In this response, I reiterate my argument that price gouging undercuts the goal of equity in access to essential goods whereas Zwolinski emphasizes the importance of the efficient provision of essential goods above all other goals. I agree that the efficient provision of essential goods is important as I argue for the goal of equitable access to sufficient of the goods essential to living a minimally flourishing human life. However, efficiency is a means to this goal rather than the end (...) itself. Finally, I offer additional arguments against the non-worseness claim. (shrink)

Corroborating Testimony, Probability and Surprise’, Erik J. Olsson ascribes to L. Jonathan Cohen the claims that if two witnesses provide us with the same information, then the less probable the information is, the more confident we may be that the information is true (C), and the stronger the information is corroborated (C*). We question whether Cohen intends anything like claims (C) and (C*). Furthermore, he discusses the concurrence of witness reports within a context of independent witnesses, whereas the witnesses in (...) Olsson's model are not independent in the standard sense. We argue that there is much more than, in Olsson's words, ‘a grain of truth’ to claim (C), both on his own characterization as well as on Cohen's characterization of the witnesses. We present an analysis for independent witnesses in the contexts of decision-making under risk and decision-making under uncertainty and generalize the model for n witnesses. As to claim (C*), Olsson's argument is contingent on the choice of a particular measure of corroboration and is not robust in the face of alternative measures. Finally, we delimit the set of cases to which Olsson's model is applicable. 1 Claim (C) examined for Olsson's characterization of the relationship between the witnesses 2 Claim (C) examined for two or more independent witnesses 3 Robustness and multiple measures of corroboration 4 Discussion. (shrink)

The concept of minimal risk has been used to regulate and limit participation by adolescents in clinical trials. It can be understood as setting an absolute standard of what risks are considered minimal or it can be interpreted as relative to the actual risks faced by members of the host community for the trial. While commentators have almost universally opposed a relative interpretation of the environmental risks faced by potential adolescent trial participants, we argue that the ethical concerns against the (...) relative standard may not be as convincing as these commentators believe. Our aim is to present the case for a relative standard of environmental risk in order to open a debate on this subject. We conclude by discussing how a relative standard of environmental risk could be defended in the specific case of an HIV vaccine trial among adolescents in South Africa. (shrink)

In this response, I reiterate my argument that price gouging undercuts the goal of equity in access to essential goods whereas Zwolinski emphasizes the importance of the efficient provision of essential goods above all other goals. I agree that the efficient provision of essential goods is important as I argue for the goal of equitable access to sufficient of the goods essential to living a minimally flourishing human life. However, efficiency is a means to this goal rather than the end (...) itself. Finally, I offer additional arguments against the non-worseness claim. (shrink)

We often hear stories of people in terrible and seemingly intractable situations that are preyed upon by individuals offering empty promises of help. Frequently these cases are condemned as "exploiting the hope" of another. These accusations are made in a range of contexts, including human smuggling, the beauty industry, and unproven medical interventions. This concept is meant to do heavy lifting in public discourse, identifying a specific form of unethical conduct. However, it is poorly understood what is intended to be (...) wrong by exploiting hope, the range of activities that can accurately be captured under this concept, and what should be done about it. Thus, it is an ethical concept that is ripe for extended analysis and discussion. (shrink)

Is there anything peculiarly "photographic" about photography—something which sets it apart from all other ways of making pictures? If there is, how important is it to our understanding of photographs? Are photographs so unlike other sorts of pictures as to require unique methods of interpretation and standards of evaluation? These questions may sound artificial, made up especially for the purpose of theorizing. But they have in fact been asked and answered not only by critics and photographers but by laymen. Furthermore, (...) for most of this century the majority of critics and laymen alike have tended to answer these questions in the same way: that photographs and paintings differ in an important way and require different methods in interpretation precisely because photographs and paintings come into being in different ways. These answers are interesting because, even within the rather restricted classes of critics, photographers, and theorists, they are held in common by a wide variety of people who otherwise disagree strongly with each other—by people who think that photographs are inferior to paintings and people who believe they are superior; by people who think that photographs ought to be "objective" and those who believe they should be "subjective"; by those who believe that it is impossible for photographers to "create" anything and by those who believe that they should at least try. Joel Snyder teaches criticism and history of photography at the University of Chicago and is presently compiling a book of his own photographs. His contributions to Critical Inquiry include "Picturing Vision" and "Reflexions on Las Meninas: Paradox Lost", written with Ted Cohen in the Winter 1980 issue. Neil Walsh Allen produces educational audio-visual materials and has designed eight permanent exhibits on the history and applications of photography for the Smithsonian Institution. (shrink)

Many nations in the developing world invest scarce funding into training health workers. When these workers migrate to richer countries, particularly when this migration occurs before the source community can recoup the costs of training, the destination community realizes a net gain in resources by obtaining the workers' skills without having to pay for their training. This effect of health worker migration has frequently been condemned as 'poaching' or a case of theft. I assess the charge that the rich nations (...) of the world poach the resources of the developing world through the active recruitment of migrants. I argue that the charge of poaching is misguided in these cases. The misuse of the term poaching is particularly troubling as it distracts attention away from the many actual moral wrongs taking place through the process of health worker migration and objectifies health workers. (shrink)

Scholarship aiming to describe the wrongness of exploitation, especially when it is voluntary and mutually beneficial, has increased greatly in recent years. In this paper, I expand the scope of this discussion by highlighting a set of additional ethical concerns associated with many cases of mutually voluntary and beneficial exploitation. Specifically, I argue that the phenomenon of persons desperately seeking out and gratefully accepting exploitative interactions raises special moral concerns. The element of voluntariness is key to understanding how and why (...) some exploitative interactions are degrading to exploitees. When an exploitative offer does not allow the exploitee sufficient progress toward a decent minimum of human functioning, these offers can create what I call a 'demeaning choice', where the exploitee may either accept the status quo or accept an offer that improves the exploitee's insufficiently. In these cases, the exploitee's participation in the interaction contributes to its demeaning quality, creating a form of `surface endorsement' of the treatment that she receives. (shrink)

In the mid 1980s it was apparent that the need for organ donors exceeded those willing to donate. Some University of Pittsburgh Medical Center (UPMC) physicians initiated discussion of possible new organ donor categories including individuals pronounced dead by traditional cardiac criteria. However, they reached no conclusion and dropped the discussion. In the late 1980s and the early 1990s, four cases arose in which dying patients or their families requested organ donation following the elective removal of mechanical ventilation. Controversy surrounding (...) these cases precipitated open discussion of the use of organ donors pronounced dead on the basis of cardiac criteria. Prolonged deliberations by many committees in the absence of precedent ultimately resulted in what is, to our knowledge, the country's first policy for organ donation following elective removal of life support. The policy is intricate and conservative. Care was taken to include as many interested parties as possible in an effort to achieve representative and broad based support. This paper describes the development of the UPMC policy on non-heart-beating organ donation. (shrink)

I find it more than merely suggestive that we call many different kinds of pictures "realistic." As a category label, "realistic" is remarkably elastic. We cheerfully place into the category pictures that are made in strict accordance with the rules of linear perspective, pictures that are at slight variance with those rules but that nonetheless look perfectly "correct" , and pictures made in flagrant contravention of perspective geometry . We accept as realistic pictures that are made in strict accordance with (...) the rules of perspective construction that we could never judge as being similar to anything we might or could ever see . We accept as realistic pictures that are in sharp disagreement with what we now take to be the facts of vision . . . There is something charming and yet nasty about the belief in the special relation of picture to world. It is charming because it allows us to "enter" with ease into pictures and allows them to "extend" into our world. It allows us to think of pictures as "true to life," to use [Ernst] Gombrich's beguiling term, to look at a picture and ask questions of it, as if we were looking at the world through a window. It allows us to treat pictures as substitutes for the objects they represent and so, for example, to buy clothing from an illustrated catalogue, or to analyze architectural styles from pictures of buildings. In brief, it allows us to feel proximity to what is depicted and urges us to conclude that in certain important respects looking at a picture is equivalent to looking at what is pictured. Joel Snyder, associate professor of humanities and of art and design at the University of Chicago, teaches aesthetics, and theory and history of photography. A practicing photographer, he is currently completing a monograph on the photographer Timothy H. O'Sullivan. His contributions to Critical Inquiry include "Photography, Vision, and Representation" and "Reflexions on Las Meninas: Paradox Lost", written with Ted Cohen in the Winter 1980 issue. (shrink)

Crowdfunding websites allow users to post a public appeal for funding for a range of activities, including adoption, travel, research, participation in sports, and many others. One common form of crowdfunding is for expenses related to medical care. Medical crowdfunding appeals serve as a means of addressing gaps in medical and employment insurance, both in countries without universal health insurance, like the United States, and countries with universal coverage limited to essential medical needs, like Canada. For example, as of 2012, (...) the website Gofundme had been used to raise a total of 8.8 million dollars for seventy-six hundred campaigns, the majority of which were health related. This money can make an important difference in the lives of crowdfunding users, as the costs of unexpected or uninsured medical needs can be staggering. In this article, I offer an overview of the benefits of medical crowdfunding websites and the ethical concerns they raise. I argue that medical crowdfunding is a symptom and cause of, rather than a solution to, health system injustices and that policy-makers should work to address the injustices motivating the use of crowdfunding sites for essential medical services. Despite the sites’ ethical problems, individual users and donors need not refrain from using them, but they bear a political responsibility to address the inequities encouraged by these sites. I conclude by suggesting some responses to these concerns and future directions for research. (shrink)

Human subject trials of pharmaceuticals in low and middle income countries have been associated with the moral wrong of exploitation on two grounds. First, these trials may include a placebo control arm even when proven treatments for a condition are in use in other parts of the world. Second, the trial researchers or sponsors may fail to make a successful treatment developed through the trial available to either the trial participants or the host community following the trial.Many commentators have argued (...) that a single form of exploitation takes place during human subject research in LMICs. These commentators do not, however, agree as to what kind of moral wrong exploitation is or when exploitation is morally impermissible. In this paper, I have two primary goals. First, I will argue for a taxonomy of exploitation that identifies three distinct forms of exploitation. While each of these forms of exploitation has its critics, I will argue that they can each be developed into plausible accounts of exploitation tied to different vulnerabilities and different forms of wrongdoing. Second, I will argue that each of these forms of exploitation can coexist in single situations, including human subject trials of pharmaceuticals. This lesson is important, since different forms of exploitation in a single relationship can influence, among other things, whether the relationship is morally permissible. (shrink)

Judgment aggregation problems are language dependent in that they may be framed in different yet equivalent ways. We formalize this dependence via the notion of translation invariance, adopted from the philosophy of science, and we argue for the normative desirability of translation invariance. We characterize the class of translation invariant aggregation functions in the canonical judgment aggregation model, which requires collective judgments to be complete. Since there are reasonable translation invariant aggregation functions, our result can be viewed as a possibility (...) theorem. At the same time, we show that translation invariance does have certain normatively undesirable consequences (e.g. failure of anonymity). We present a way of circumventing them by moving to a more general model of judgment aggregation, one that allows for incomplete collective judgments. (shrink)

Despite legislation and public education, racism and sexism are alive and well. Though pre‐conceptive gender selection may enhance procreative liberty, this technology presents two disturbing questions. First, does sex selection represent underlying parental sexism? Second, by performing gender selection, do medical professionals perpetuate sexism? It will be maintained that pre‐conceptive sex selection is sexist as it reflects parental anticipation of stereotypical gender based behavior. Perhaps even more incriminating, sex selection forces parents to prefer one sex over another, to place a (...) value on gender. This emphasis on sex conflicts with societal goals which urge, and often legally require, individuals to ignore gender. We will assert that pre‐conceptive gender selection exemplifies sexism in its purest most blatant form as prior to conception, before parents can possibly know anything about their child, gender dominates the calculus of a child’s worth. We will also emphasize that physicians, by facilitating sex selection, legitimize the motivations of their patients and provide de facto support of sexism. In a similar vein, arguments against pre‐conceptive race selection will be made. (shrink)

Many people in desperate need of an organ will die on waiting lists for transplantation or face increased morbidity because of their wait. This circumstance is particularly troubling since many viable organs for transplantation go unused when individuals fail to participate in their local organ donation system. In this paper, I consider whether participating in organ transplantation should be considered a form of a rescue of others from the great harms caused by a shortage in transplantable organs. Specifically, I consider (...) whether cadaver organ transplantation is a case of an easy rescue. If so, participation in cadaver organ transplantation will be a duty rather than a supererogatory act.1 This question is important in illuminating individual duties to participate in organ transplantation. Moreover, as I will argue, it has repercussions for community-wide policies for enrolling individuals in transplantation schemes. -/- In the first section of this paper, I tie cadaver organ transplantation to the duty to rescue others from great harm when it is easy to do so. Given the number of persons who will die or be greatly harmed without transplanted organs, the transfer of organs upon death is seemingly similar to other, classical cases of easy rescue. In the second section, I consider objections to this proposal on the ground that cadaver organ transplantation is structurally dissimilar to classical rescue cases, especially given uncertainty over when and to whom organs will be transplanted, if they are transplanted at all. In the third section, I consider the objection that cadaver organ transplantation is a demanding, rather than easy, rescue. While I grant that cadaver organ transplantation will be demanding for some persons, I argue that there remain many cases where it will be an easy rescue. In the final section, I consider the policy implications of my argument. In particular, I argue that understanding cadaver organ transplantation as a duty should shift the debate over opt-out, opt-in, and mandatory choice procedures for participating in organ transplantation upon death. While different systems will be appropriate for different communities, understanding transplantation as a duty in some cases helps to justify an opt-out system. (shrink)

Medical tourism is a practice, whereby individuals travel across national borders with the intention of receiving medical care. Medical tourists are motivated to travel abroad by a number of factors, including the affordability of care abroad, access to treatments not available at home, and wait times for care at home. In this article, we share the findings of interviews conducted with 32 Canadian medical tourists with the aim of developing a better understanding of medical tourism, the ethical issues it raises (...) for public health within Canada and other source countries for medical tourists, and to identify research gaps and policy responses to this practice. While patient and academic perspectives overlap in several regards, we suggest areas in which academic consideration of the ethical issues raised by medical tourism can be informed by patient perspectives. (shrink)

Medical tourism (MT) can be conceptualized as the intentional pursuit of non-emergency surgical interventions by patients outside their nation of residence. Despite increasing popular interest in MT, the ethical issues associated with the practice have thus far been under-examined. MT has been associated with a range of both positive and negative effects for medical tourists' home and host countries, and for the medical tourists themselves. Absent from previous explorations of MT is a clear argument of how responsibility for the harms (...) of this practice should be assigned. This paper addresses this gap by describing both backward looking liability and forward looking political responsibility for stakeholders in MT. We use a political responsibility model to develop a decision-making process for individual medical tourists and conclude that more information on the effects of MT must be developed to help patients engage in ethical MT. (shrink)

Objections arise to the concept of artistic intention based upon the psychology of a period. Here too we experience trends or volitions which can only be explained by precisely those artistic creations which in their own turn demand an explanation on the basis of these trends and volitions. Thus "Gothic" man or the "primitive" from whose alleged existence we wish to explain a particular artistic product is in truth the hypostatized impression which has been culled from the works of art (...) themselves. Or it is a question of intentions and evaluations which have become conscious as they find their formulation in the contemporary theory of art or in contemporary art criticism. Thus these formulations, just like the individual theoretical statements of the artists themselves, can once more only be phenomena parallel to the artistic products of the epoch; they cannot already contain their interpretation. Here again this parallel phenomenon would, in its entirety, represent an extraordinarily interesting object of humanistic investigation, but it would be incapable of defining in detail a methodologically comprehensible volition. So, too, the view of art which accompanies a period's artistic output can express the artistic volition of the period in itself but cannot put a name to it for us. This view can be of eminent significance when we are seeking a logical explanation for the perception of tendencies dominating at a given time and thus also for the judgment of artistic volition at that time, which must also be interpreted.Erwin Panofsky, the renowned art historian, was professor at the Institute for Advanced Study, Princeton University, until his death in 1968. Among his many books and articles are Meaning in the Visual Arts, Early Netherlandish Painting, and Renaissance and Renascenes in Western Art. Kenneth Northcott is professor of German and comparative literature at the University of Chicago and the translator of Arnold Hauser's Sociology of Art . Joel Snyder is chairman of the committee on general studies in the humanities at the University of Chicago. (shrink)

Background: Medical tourism involves patients travelling internationally to receive medical services. This practice raises a range of ethical issues, including potential harms to the patient's home and destination country and risks to the patient's own health. Medical tourists often engage the services of a facilitator who may book travel and accommodation and link the patient with a hospital abroad. Facilitators have the potential to exacerbate or mitigate the ethical concerns associated with medical tourism, but their roles are poorly understood. -/- (...) Methods: 12 facilitators were interviewed from 10 Canadian medical tourism companies. -/- Results: Three themes were identified: facilitators' roles towards the patient, health system and medical tourism industry. Facilitators' roles towards the patient were typically described in terms of advocacy and the provision of information, but limited by facilitators' legal liability. Facilitators felt they played a positive role in the lives of their patients and the Canadian health system and served as catalysts for reform, although they noted an adversarial relationship with some Canadian physicians. Many facilitators described personally visiting medical tourism sites and forming personal relationships with surgeons abroad, but noted the need for greater regulation of their industry. -/- Conclusion: Facilitators play a substantial and evolving role in the practice of medical tourism and may be entering a period of professionalisation. Because of the key role of facilitators in determining the effects of medical tourism on patients and public health, this paper recommends a planned conversation between medical tourism stakeholders to define and shape facilitators' roles. (shrink)

Medical tourism is the practice of traveling across international borders with the intention of accessing medical care, paid for out-of-pocket. This practice has implications for preferential access to medical care for Canadians both through inbound and outbound medical tourism. In this paper, we identify four patterns of medical tourism with implications for preferential access to care by Canadians: Inbound medical tourism to Canada’s public hospitals; Inbound medical tourism to a First Nations reserve; Canadian patients opting to go abroad for medical (...) tourism; and Canadian patients traveling abroad with a Canadian surgeon. These patterns of medical tourism affect preferential access to health care by Canadians by circumventing domestic regulation of care, creating jurisdictional tensions over the provision of health care, and undermining solidarity with the Canadian health system. (shrink)

When successful solid organ transplantation was initiated almost 40 years ago, its current success rate was not anticipated. But continuous efforts were undertaken to overcome the two major obstacles to success: injury caused by interrupting nutrient supply to the organ and rejection of the implanted organ by normal host defense mechanisms. Solutions have resulted from technologic medical advances, but also from using organs from different sources. Each potential solution has raised ethical concerns and has variably resulted in societal acclaim, censure, (...) and apathy. Transplant surgery is now well accepted, and the list of transplant candidates has grown far quicker than the availability of organs. More than 30,000 patients were awaiting organs for transplantation at the end of March 1993. While most organs came from donors declared dead by brain criteria, the increasing shortage of donated organs has prompted a reexamination of prior restrictions of donor groups. Recently, organ procurement from donors with cardiac death has been reintroduced in the United States. This practice had been mostly abandoned by the U.S. and some, though not all, other countries. Transplantation has been more successful using organs procured from heart-beating, "brain dead" cadavers than organs from non-heart-beating cadavers. However, recent advances have led to success rates with organs from non-heart-beating donors that may portend large increases in organ donation and procurement from this source. (shrink)

Surely [John R.] Searle must rely on a stable, formal conception of the point of view. He sets Las Meninas on a par with the antimony of the liar and the paradoxes of set theory. But nothing is an antimony or a paradox just because it seems so or just because it is confusing or difficult, even if it seems so to everyone. To deserve such a description, a thing must be, so to speak, intrinsically intractable, not merely resistant when (...) looked at in a particular way. If a man says "I do not believe I am alive," that would be odd, and it would be hard to understand just what he means, and it may even be hard or impossible to believe that he is telling the truth; but there is no antimony. If a man says "I am lying," then we have a primitive version of the antimony of the liar. Given the meaning of this utterance—and nothing else—there is no way to get a grip on it. If what the man says is true, then it's false; if what he says is false, then it's true. Joel Snyder, a practicing photographer, is associate professor of humanities and of art and design at the University of Chicago. His contributions to Critical Inquiry include "Photography, Vision, and Representation," written with Neil Walsh Allen , and "Picturing Vision" . Ted Cohen, associate professor of philosophy at the University of Chicago, has written on language, aesthetics, and taste. His previous contribution to Critical Inquiry, "Metaphor and the Cultivation of Intimacy," appeared in the Autumn 1978 issue. (shrink)

BackgroundWhile ethicists have for many years called for human subject trial participants and, in some cases, local community members to benefit from participation in pharmaceutical and other intervention-based therapies, little is known about how these discussions are impacting the practice of research ethics boards that grant ethical approval to many of these studies.MethodsTelephone interviews were conducted with 23 REB members from across Canada, a major funder country for human subject research internationally. All interviews were digitally recorded and transcribed verbatim. After (...) coding, the data was analyzed to identify central themes and topics. Themes were identified, application of the themes was confirmed, and these themes were then used to populate the findings of this manuscript.ResultsOur analysis of the interviews identified two primary themes when considering what benefits are owed to research participants and their communities. 1) Most study participants felt that given that these studies are led by persons in the role of researcher rather than health care provider, they had a limited obligation to provide benefits to study participants. 2) These REB members were all working in Canada, a high income country where most residents enjoy high levels of access to health care. As a result of this context, the study participants tended to focus on ethical concerns including obtaining informed consent and avoiding undue inducement to participate in research rather than ensuring that study participants directly benefit from successful trials.ConclusionsResearch on REB members’ attitudes toward what benefits are owed to study participants and community members is needed in other countries in order to determine how context affects these attitudes. (shrink)

Numerous social, economic and academic pressures can have a negative impact on representations of biomedical research. We review several of the forces playing an increasingly pernicious role in how health and science information is interpreted, shared and used, drawing discussions towards the role of narrative. In turn, we explore how aspects of narrative are used in different social contexts and communication environments, and present creative responses that may help counter the negative trends. As traditional methods of communication have in many (...) ways failed the public, changes in approach are required, including the creative use of narratives. (shrink)

Medical crowdfunding has raised many ethical concerns, among them that it may undermine privacy, widen health inequities, and commodify health care. One motivation for medical crowdfunding has received particular attention among ethicists. Recent studies have shown that many individuals are using crowdfunding to finance access to scientifically unsupported medical treatments. Recently, GoFundMe prohibited campaigns for antivaccination groups on the grounds that they “promote misinformation about vaccines” and for treatment at a German clinic offering unproven cancer treatments due to “the need (...) to make sure people are equipped to make well‐informed decisions.” GoFundMe has not taken any additional actions to regulate the much larger presence of campaigns seeking to fund unproven medical interventions on the platform. In this article, we make the ethical case for intervention by GoFundMe and other crowdfunding platforms. (shrink)

I would like to thank all of the respondents to my article both for their expansions on the theme of health worker migration and for their criticisms of my argument against the use of the term ’poaching’ in the context of international health worker migration. In this response, I will clarify my argument in light of the worries raised primarily by Tache and Schillinger and Ari Zivotofsky and Naomi Zivotofsky.

Organ transplantation is an accepted therapy for major organ failure, but it depends on the availability of viable organs. Most organs transplanted in the U.S. come from either "brain-dead" or living related donors. Recently organ procurement from patients pronounced dead using cardiopulmonary criteria, so-called "non-heart-beating cadaver donors" (NHBCDs), has been reconsidered. In May 1992, the University of Pittsburgh Medical Center (UPMC) enacted a new, complicated policy for procuring organs from NHBCDs after the elective removal of life support. Seventeen months later (...) only one patient has become a NHBCD. This article describes her case and the results of interviews with the health care team and the patient's family. The case and interviews are discussed in relation to several of the ethical concerns previously raised about the policy, including potential conflicts of interest, the definition of cardiopulmonary death, and a possible net decrease in organ donation. The conclusion is reached that organ procurement from non-heart-beating cadavers is feasible and may be desirable both for the patient's family and the health care providers. (shrink)

Task shifting is increasingly used to address human resource shortages impacting HIV service delivery in low- and middle-income countries. By shifting basic tasks from higher- to lower-trained cadres, such as Community Health Workers, task shifting can reduce overhead costs, improve community outreach, and provide efficient scale-up of essential treatments like antiretroviral therapies. Although there is rich evidence outlining positive outcomes that CHWs bring into HIV programs, important questions remain over their place in service delivery. These challenges often reflect concerns over (...) whether CHWs can mitigate HIV through a means that does not overlook the ethical and practical constraints that undergird their work. Ethical and practical guidance thus needs to become the cornerstone of CHW deployment. This paper analyzes such challenges through the lens of Ethical Principlism. We examined papers identifying substantive and ethical challenges impacting CHWs as they provide HIV services in low- and middle-income contexts. To do this, we analyzed papers written in English and published from year 2000 or later. These articles were identified using MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar databases. In total, 465 articles were identified, 78 of which met our inclusion criteria. Article reference lists and grey literature were also examined. CHWs experience specific challenges while carrying out their duties, such as conducting emotionally- and physically-demanding tasks with often inadequate training, supervision and compensation. CHWs have also been poorly integrated into health systems, which not only impacts quality of care, but can hinder their prospects for promotion and lead to CHW disempowerment. As we argue, these challenges can be addressed if a set of ethical principles is prioritized, which specifically entail the principles of respect for persons, justice, beneficence, proportionality and cultural humility. CHWs play a crucial role in HIV service delivery, yet the ethical challenges that can accompany their work cannot be overlooked. By prioritizing ethical principles, policymakers and program implementers can better ensure that CHWs are combatting HIV through a means that does not exploit or take their critical role within service delivery for granted. (shrink)

Contemporary accounts of the concept of exploitation can be grouped into camps that tie the wrongness of taking advantage of another person to: (1) the unfair division of benefits resulting from an interaction; (2) excessive benefits resulting from structural injustice; and (3) a failure of respect for others’ humanity. In practice, accounts of exploitation that focus on the fairness of benefits resulting from individual transactions and, to a lesser degree, unjust social and economic institutions have dominated the applied ethics literature (...) using the concept of exploitation. However, fairness-based accounts of exploitation have a difficult time explaining a common dimension of purportedly exploitative cases in the press and academic literature—namely the absolute deprivation of and/or experience of injustice by victims of exploitation. In this paper, I argue that a respect-based account can explain how exploitation arises both from individual interactions and against a backdrop of injustice. Specifically, our connections with one another and social and economic institutions specify the duty of beneficence and political responsibility to promote just institutions. Exploitation takes place when people fail to act on these specified obligations in favor of their own benefit. (shrink)

In 1991, the University of Pittsburgh Medical Center implemented a policy that permitted the recovery of organs from cadavers pronounced dead using standardized cardiac criteria. This policy allowed families that had made a decision to forgo life sustaining treatment to then request organ donation. This entailed taking the patient to the operating room, discontinuing therapy, and after the patient is pronounced dead, procuring organs.

It is ironic that, with few exceptions, the now vast body of critical literature about Diego Velázquez’s Las Meninas fails to link knowledge to understanding—fails to relate the encyclopedic knowledge we have acquired of its numerous details to a convincing understanding of the painting as a whole. Las Meninas is imposing and monumental; yet a large portion of the literature devoted to it considers only its elements: aspects of its nominal subjects, their biographies, and their roles in the household of (...) the queen or the king. Niceties of court etiquette; concerns about clothing, and shoes , and the small cup of water offered to the Infanta Margarita .This increasingly intimate discussion of the painting’s details is not altogether beside the point; some of this information deserves to be integrated into descriptions of the painting as a whole. But a reader of these descriptive accounts soon begins to suspect they are offered in the hope that some new details might provoke an understanding of the entire painting, might prove to be the key to our comprehension of it. In fact, Las Meninas invites such analysis. Some nineteenth-century critics called it “photographic” in its naturalism , in the profusion of its detail, and in the alleged “snapshot” quality of its composition.1 The underlying motive of this understanding ought not to be dismissed, even thought the photography analogy is clearly grotesque, in terms both of history and visual sensibility. Although we know a great deal about the contention, in seventeenth-century Spanish art theory, that a major function of art is the perfecting of nature according to ideal standards, Las Meninas nonetheless is most commonly taken to be a pure spectacle memorializing an incidental moment, seemingly explicable solely in terms of what is apparent in it. 1. Gustav Waagen, paraphrased in Carl Justi, Diego Velazquez and His Times , p. 419; William Stirling-Maxwell, quoted in ibid. Joel Snyder is associate professor of humanities and of art and design and is chairman of the Committee on General Studies in the Humanities at the University of Chicago. He is currently working on a book about the foundations of perspective. His previous contributions to Critical Inquiry are “Photography, Vision, and Representation,” written with Neil Walsh Allen , “Picturing Vision” , and “Reflexions on Las Meninas: Paradox Lost,” written with Ted Cohen. (shrink)

(People do not understand how what is borne in different directions comes to be in agreement with itself; [for] a framework like that of the bow and the lyre turns back [on itself].).

Medical tourists, persons that travel across international borders with the intention to access non-emergency medical care, may not be adequately informed of safety and ethical concerns related to the practice of medical tourism. Researchers indicate that the sources of information frequently used by medical tourists during their decision-making process may be biased and/or lack comprehensive information regarding individual safety and treatment outcomes, as well as potential impacts of the medical tourism industry on third parties. This paper explores the feedback from (...) former Canadian medical tourists regarding the use of an information sheet to address this knowledge gap and raise awareness of the safety and ethical concerns related to medical tourism. (shrink)

The novel coronavirus and its disease, COVID-19, have revealed how many health systems are ill equipped to respond to a population’s health needs. While the Catholic Church has nearly two thousand years of robust engagement in health care, it has been lacking in the realm of global public health. The Catholic Church’s health care ministries have been preoccupied with responding to illness by offering immediate relief to medical suffering. It is necessary to complement the focus on interpersonal healing by transforming (...) the social structures that perpetuate patterns of illness. By drawing on their social teachings, Catholic health care ministries offer a unique contribution to global public health. This paper will develop four contributions for global public health and analyze them in light of the COVID-19 pandemic. (shrink)

BackgroundMedical tourism, the practice of persons intentionally travelling across international boundaries to access medical care, has drawn increasing attention from researchers, particularly in relation to potential ethical concerns of this practice. Researchers have expressed concern for potential negative impacts to individual safety, public health within both countries of origin for medical tourists and destination countries, and global health equity. However, these ethical concerns are not discussed within the sources of information commonly provided to medical tourists, and as such, medical tourists (...) may not be aware of these concerns when engaging in medical tourism. This paper describes the methodology utilized to develop an information sheet intended to be disseminated to Canadian medical tourists to encourage contemplation and further public discussion of the ethical concerns in medical tourism.MethodsThe methodology for developing the information sheet drew on an iterative process to consider stakeholder feedback on the content and use of the information sheet as it might inform prospective medical tourists’ decision making. This methodology includes a literature review as well as formative research with Canadian public health professionals and former medical tourists.ResultsThe final information sheet underwent numerous revisions throughout the formative research process according to feedback from medical tourism stakeholders. These revisions focused primarily on making the information sheet concise with points that encourage individuals considering travelling for medical tourism to do further research regarding their safety both within the destination country, while travelling, and once returning to Canada, and the potential impacts of their trip on third parties. This methodology may be replicated for the development of information sheets intending to communicate ethical concerns of other practices to providers or consumers of a certain service. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page W1-W3, June 2011.