34 found
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  1. The importance of getting the ethics right in a pandemic treaty.G. Owen Schaefer, Caesar A. Atuire, Sharon Kaur, Michael Parker, Govind Persad, Maxwell J. Smith, Ross Upshur & Ezekiel Emanuel - 2023 - The Lancet Infectious Diseases 23 (11):e489 - e496.
    The COVID-19 pandemic revealed numerous weaknesses in pandemic preparedness and response, including underfunding, inadequate surveillance, and inequitable distribution of countermeasures. To overcome these weaknesses for future pandemics, WHO released a zero draft of a pandemic treaty in February, 2023, and subsequently a revised bureau's text in May, 2023. COVID-19 made clear that pandemic prevention, preparedness, and response reflect choices and value judgements. These decisions are therefore not a purely scientific or technical exercise, but are fundamentally grounded in ethics. The latest (...)
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  2. Donation After Circulatory Death: Burying the Dead Donor Rule.David Rodríguez-Arias, Maxwell J. Smith & Neil M. Lazar - 2011 - American Journal of Bioethics 11 (8):36-43.
    Despite continuing controversies regarding the vital status of both brain-dead donors and individuals who undergo donation after circulatory death (DCD), respecting the dead donor rule (DDR) remains the standard moral framework for organ procurement. The DDR increases organ supply without jeopardizing trust in transplantation systems, reassuring society that donors will not experience harm during organ procurement. While the assumption that individuals cannot be harmed once they are dead is reasonable in the case of brain-dead protocols, we argue that the DDR (...)
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  3.  25
    Learning Lessons from COVID-19 Requires Recognizing Moral Failures.Maxwell J. Smith & Ross E. G. Upshur - 2020 - Journal of Bioethical Inquiry 17 (4):563-566.
    The most powerful lesson learned from the 2013-2016 outbreak of Ebola in West Africa was that we do not learn our lessons. A common sentiment at the time was that Ebola served as a “wake-up call”—an alarm which signalled that an outbreak of that magnitude should never have occurred and that we are ill-prepared globally to prevent and respond to them when they do. Pledges were made that we must learn from the outbreak before we were faced with another. Nearly (...)
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  4.  65
    Data Sharing During Pandemics: Reciprocity, Solidarity, and Limits to Obligations.Diego S. Silva & Maxwell J. Smith - 2023 - Journal of Bioethical Inquiry 20 (4):667-672.
    South Africa shared with the world the warning of a new strain of SARS-CoV2, Omicron, in November 2021. As a result, many high-income countries (HICs) instituted complete travel bans on persons leaving South Africa and other neighbouring countries. These bans were unnecessary from a scientific standpoint, and they ran counter to the International Health Regulations. In short, South Africa was penalized for sharing data. Data sharing during pandemics is commonly justified by appeals to solidarity. In this paper, we argue that (...)
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  5.  6
    The ethics of firing unvaccinated employees.Maxwell J. Smith - 2024 - Journal of Medical Ethics 50 (4):268-271.
    Some organisations make vaccination a condition of employment. This means prospective employees must demonstrate they have been vaccinated (eg, against measles) to be hired. But it also means organisations must decide whether _existing_ employees should be expected to meet newly introduced vaccination conditions (eg, against COVID-19). Unlike prospective employees who will not be _hired_ if they do not meet vaccination conditions, existing employees who fail to meet new vaccination conditions risk being _fired_. The latter seems worse than the former. Hence, (...)
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  6.  45
    Ebola and Learning Lessons from Moral Failures: Who Cares about Ethics?Maxwell J. Smith & Ross E. G. Upshur - 2015 - Public Health Ethics 8 (3):305-318.
    The exercise of identifying lessons in the aftermath of a major public health emergency is of immense importance for the improvement of global public health emergency preparedness and response. Despite the persistence of the Ebola Virus Disease outbreak in West Africa, it seems that the Ebola ‘lessons learned’ exercise is now in full swing. On our assessment, a significant shortcoming plagues recent articulations of lessons learned, particularly among those emerging from organizational reflections. In this article we argue that, despite not (...)
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  7.  20
    Systems thinking and ethics in public health: a necessary and mutually beneficial partnership.Cameron D. Norman, Maxwell J. Smith & Diego S. Silva - 2018 - Monash Bioethics Review 36 (1-4):54-67.
    Systems thinking has emerged as a means of conceptualizing and addressing complex public health problems, thereby challenging more commonplace understanding of problems and corresponding solutions as straightforward explanations of cause and effect. Systems thinking tries to address the complexity of problems through qualitative and quantitative modeling based on a variety of systems theories, each with their own assumptions and, more importantly, implicit and unexamined values. To date, however, there has been little engagement between systems scientists and those working in bioethics (...)
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  8.  25
    Allocating scarce unproven interventions during public health emergencies: Insights from the who meuri framework.Ignacio Mastroleo & Maxwell J. Smith - 2020 - American Journal of Bioethics 20 (9):41-44.
    Volume 20, Issue 9, September 2020, Page 41-44.
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  9.  24
    Key Ethical Concepts and Their Application to COVID-19 Research.Angus Dawson, Ezekiel J. Emanuel, Michael Parker, Maxwell J. Smith & Teck Chuan Voo - 2020 - Public Health Ethics 13 (2):127-132.
    During the WHO-GloPID COVID-19 Global Research and Innovation Forum meeting held in Geneva on the 11th and 12th of February 2020 a number of different ethical concepts were used. This paper briefly states what a number of these concepts mean and how they might be applied to discussions about research during the COVID-19 pandemic and related outbreaks. This paper does not seek to be exhaustive and other ethical concepts are, of course, relevant and important.
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  10.  34
    Ethics for pandemics beyond influenza: Ebola, drug-resistant tuberculosis, and anticipating future ethical challenges in pandemic preparedness and response.Maxwell J. Smith & Diego S. Silva - 2015 - Monash Bioethics Review 33 (2-3):130-147.
    The unprecedented outbreak of Ebola virus disease in West Africa has raised several novel ethical issues for global outbreak preparedness. It has also illustrated that familiar ethical issues in infectious disease management endure despite considerable efforts to understand and mitigate such issues in the wake of past outbreaks. To improve future global outbreak preparedness and response, we must examine these shortcomings and reflect upon the current state of ethical preparedness. To this end, we focus our efforts in this article on (...)
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  11.  61
    Health Equity in Public Health: Clarifying our Commitment.Maxwell J. Smith - 2015 - Public Health Ethics 8 (2):173-184.
    Health equity is increasingly identified as a principal goal to be achieved through public health policies and activities. However, what is to be measured in the assessment of health equity and how inequities in health ought to be redressed are among the pressing questions that must be answered if health equity is to serve as a meaningful and consistent ethical guide for measurement and intervention in public health. In this article I argue that the concept of health equity, in the (...)
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  12.  34
    Casting Light and Doubt on Uncontrolled DCDD Protocols.David Rodríguez-Arias, Iván Ortega-Deballon, Maxwell J. Smith & Stuart J. Youngner - 2013 - Hastings Center Report 43 (1):27-30.
    The ever‐increasing demand for organs led Spain, France, and other European countries to promote uncontrolled donation after circulatory determination of death (uDCDD). For the same reason, New York City has recently developed its own uDCDD protocol, which differs from European programs in some key ways. The New York protocol incorporates a series of technical and management improvements that address some practical problems identified in response to European uDCDD protocols. However, the more fundamental issue of whether uDCDD donors are dead when (...)
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  13.  77
    Correction to: Data Sharing During Pandemics: Reciprocity, Solidarity, and Limits to Obligations.Diego S. Silva & Maxwell J. Smith - 2023 - Journal of Bioethical Inquiry 20 (4):673-673.
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  14. “With Human Health It’s a Global Thing”: Canadian Perspectives on Ethics in the Global Governance of an Influenza Pandemic.Daniel Felipe Perez, Cécile Bensimon, Christopher W. McDougall, Maxwell J. Smith & Alison K. Thompson - 2015 - Journal of Bioethical Inquiry 12 (1):115-127.
    We live in an era where our health is linked to that of others across the globe, and nothing brings this home better than the specter of a pandemic. This paper explores the findings of town hall meetings associated with the Canadian Program of Research on Ethics in a Pandemic , in which focus groups met to discuss issues related to the global governance of an influenza pandemic. Two competing discourses were found to be at work: the first was based (...)
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  15.  20
    Ebola and Learning Lessons from Moral Failures: Who Cares about Ethics?: Table 1.Maxwell J. Smith & Ross E. G. Upshur - 2015 - Public Health Ethics:phv028.
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  16.  49
    Avoiding Violation of the Dead Donor Rule: The Costs to Patients.Maxwell J. Smith, David Rodríguez-Arias & Ivan Ortega - 2012 - American Journal of Bioethics 12 (6):15-17.
    The American Journal of Bioethics, Volume 12, Issue 6, Page 15-17, June 2012.
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  17.  64
    Response to Open Peer Commentaries on “Donation After Circulatory Death: Burying the Dead Donor Rule”.David Rodríguez-Arias, Maxwell J. Smith & Neil M. Lazar - 2011 - American Journal of Bioethics 11 (8):W4-W6.
    The American Journal of Bioethics, Volume 11, Issue 8, Page W4-W6, August 2011.
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  18.  9
    Cause for coercion: cause for concern?Maxwell J. Smith - forthcoming - Monash Bioethics Review:1-9.
    In his 2000 book, From Chaos to Coercion: Detention and the Control of Tuberculosis, Richard Coker makes a number of important observations and arguments regarding the use of coercive public health measures in response to infectious disease threats. In particular, Coker argues that we have a tendency to neglect public health threats and then demand immediate action, which can leave policymakers with fewer effective options and may require (or may be perceived as requiring) more aggressive, coercive measures to achieve public (...)
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  19.  5
    The intervention ladder and the ethical appraisal of systemic public health interventions.Maxwell J. Smith & Kayla Gauthier - forthcoming - Journal of Medical Ethics.
    The intervention ladder, developed by the Nuffield Council on Bioethics, is a framework intended to help evaluate the ethical acceptability and justification of public health interventions according to their intrusion on liberty.1 In their recent article, Paetkau2 argues ‘the ladder obscures potential interventions that operate on a systemic rather than individual level’ (p. 1) and that ‘it is crucial that systemic interventions not be left off the table when considering potential concrete interventions’ (p. 3), leading them to propose instead the (...)
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  20.  3
    Adapting and Adaptive Research.Maxwell J. Smith - 2023 - In Susan Bull, Michael Parker, Joseph Ali, Monique Jonas, Vasantha Muthuswamy, Carla Saenz, Maxwell J. Smith, Teck Chuan Voo, Katharine Wright & Jantina de Vries (eds.), Research Ethics in Epidemics and Pandemics: A Casebook. Springer Verlag. pp. 85-106.
    Research conducted during epidemics may warrant adaptations or adaptive designs owing to practical constraints, time pressures, uncertainty, the importance of flexibility, and the potential for research to detract from epidemic response. Adapting research entails choosing different research designs or methods if research goals, contexts or constraints justify or require a different approach. Adaptive research, by contrast, is a type of research that prospectively plans for modifications after research has been initiated, while maintaining the validity and integrity of the research. While (...)
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  21.  38
    A Vaping Matter: E‐cigarette Use in Health Care Organizations.Sally Bean & Maxwell J. Smith - 2015 - Hastings Center Report 45 (6):11-12.
    Although there is no federal legislation yet on e-cigarettes, the U.S. Food and Drug Administration proposed regulations in April 2014 that would prohibit sales of e-cigarettes to anyone under eighteen and require that they be approved by the FDA as a tobacco product and carry warning labels for consumers on their packaging. Only three U.S. states have extended the same restrictions placed on tobacco products to e-cigarettes; however, eighteen states have passed legislation enacting use restrictions on venues such as schools, (...)
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  22.  10
    Research Ethics in Epidemics and Pandemics: A Casebook.Susan Bull, Michael Parker, Joseph Ali, Monique Jonas, Vasantha Muthuswamy, Carla Saenz, Maxwell J. Smith, Teck Chuan Voo, Katharine Wright & Jantina de Vries (eds.) - 2023 - Springer Verlag.
    This open access casebook addresses complex and important ethical challenges arising when health-related research in conducted in the context of epidemics and pandemics. This book provides contextually-rich real-world case studies illustrating research ethics issues encountered by researchers, ethics reviewers and regulators around the globe during the COVID-19 pandemic. The accompanying commentaries outline relevant conceptual approaches and ethical considerations. These promote understanding and reflection on relevant ethical issues, ethical approaches and competing considerations in a manner supporting thoughtful evaluation of their implications (...)
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  23.  35
    An Ethical Justification for Expanding the Notion of Effectiveness in Vaccine Post-Market Monitoring: Insights from the HPV Vaccine in Canada.Ana Komparic, Maxwell J. Smith & Alison Thompson - 2016 - Public Health Ethics 9 (1):78-91.
    Health regulators must carefully monitor the real-world safety and effectiveness of marketed vaccines through post-market monitoring in order to protect the public’s health and promote those vaccines that best achieve public health goals. Yet, despite the fact that vaccines used in collective immunization programmes should be assessed in the context of a public health response, post-market effectiveness monitoring is often limited to assessing immunogenicity or limited programmatic features, rather than assessing effectiveness across populations. We argue that post-market monitoring ought to (...)
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  24.  2
    How “Ought” the Best Interests of Children be Considered in Medical Decision-making?Zoe Ritchie, Micaela Forte, Maxwell J. Smith & Jacob Shelley - unknown
    This summary reports on the design and proceedings of a collaborative case-based workshop and panel on how we ‘ought’ to consider the best interests of children in medical decision-making, presented virtually at the Canadian Bioethics Society - Société Canadienne de Bioéthique Workshop and Community Forum in May of 2023.
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  25.  17
    Is the Cure Worse than the Disease? The Ethics of Imposing Risk in Public Health.Diego S. Silva & Maxwell J. Smith - 2023 - Asian Bioethics Review 15 (1):19-35.
    Efforts to improve public health, both in the context of infectious diseases and non-communicable diseases, will often consist of measures that confer risk on some persons to bring about benefits to those same people or others. Still, it is unclear what exactly justifies implementing such measures that impose risk on some people and not others in the context of public health. Herein, we build on existing autonomy-based accounts of ethical risk imposition by arguing that considerations of imposing risk in public (...)
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  26.  17
    Conceptualizing the “Self” in Neuroethics: An Appeal to Philosophy of Mind.Maxwell J. Smith - 2010 - American Journal of Bioethics Neuroscience 1 (3):16-17.
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  27.  38
    Political legitimacy and research ethics.Maxwell J. Smith & Daniel Weinstock - 2018 - Bioethics 33 (3):312-318.
    In democratic theory, “legitimacy” refers to the set of conditions that must be in place in order for the claims to authority of somebody to be deemed appropriate, and for their claims to compliance to be warranted. Though criteria of legitimacy have been elaborated in the context of democratic states, there is no reason for them not to be drawn up, with appropriate amendments, for other kinds of authority structures. This paper examines the claims to authority made over researchers by (...)
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  28.  16
    Rights vs. Liberty.Maxwell J. Smith - 2011 - Hastings Center Report 41 (1):5-5.
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  29.  35
    Setting Health‐Care Priorities: What Ethical Theories Tell Us.Maxwell J. Smith - 2020 - Bioethics 34 (4):442-443.
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  30.  67
    Vulnerability: A Contentious and Fluid Term.Maxwell J. Smith, Carrie Bernard, Kate Rossiter, Sachin Sahni & Diego Silva - 2010 - Hastings Center Report 40 (1):5-6.
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  31.  25
    What’s on the Menu for an Equitable Approach to Nutrition Labelling in Restaurants?Maxwell J. Smith - 2015 - Public Health Ethics 8 (1):98-102.
    The primary aim of menu labelling should be understood as informing consumers such that they are better able to make informed food purchasing and consumption decisions; the extent to which consumers’ behaviours or, indeed, health outcomes, are affected may be contingent on several other factors and should therefore be considered more distal aims of what menu labelling intends to, or is able to, achieve. It is of importance to be clear about the nature and scope of menu labelling, including what (...)
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  32.  19
    Why we should not ‘just use age’ for COVID-19 vaccine prioritisation.Maxwell J. Smith - 2022 - Journal of Medical Ethics 48 (8):538-541.
    Older age is one of the greatest risk factors for severe outcomes from COVID-19. If we believe it is important to use limited supplies of COVID-19 vaccines to protect the most vulnerable and prevent deaths, then available doses should be allocated with significant priority to older adults. Yet, we should resist the conclusion that age should be the sole criterion for COVID-19 vaccine prioritisation or that no younger populations (eg, those under the age of 60) should be prioritised until all (...)
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  33.  14
    The not-so-tell-tale heart.D. R. Vailhen & Maxwell J. Smith - 2011 - Hastings Center Report 41 (2):7.
  34.  22
    “She was finally mine”: the moral experience of families in the context of trisomy 13 and 18– a scoping review with thematic analysis. [REVIEW]Maxwell J. Smith, Randi Zlotnik Shaul, Gail Teachman & Zoe Ritchie - 2024 - BMC Medical Ethics 25 (1):1-20.
    IntroductionThe value of a short life characterized by disability has been hotly debated in the literature on fetal and neonatal outcomes.MethodsWe conducted a scoping review to summarize the available empirical literature on the experiences of families in the context of trisomy 13 and 18 (T13/18) with subsequent thematic analysis of the 17 included articles.FindingsThemes constructed include (1) Pride as Resistance, (2) Negotiating Normalcy and (3) The Significance of Time.InterpretationOur thematic analysis was guided by the moral experience framework conceived by Hunt (...)
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