With an eye ultimately to answering the question of how business can alleviate poverty completely, the paper examines existing arguments about the approach of business to poverty reduction with the case of people with disabilities living in poverty in Vietnam. The paper suggests that business should take the knowledge and potential of poor people into consideration in its interfaces with different types of poor people: consumers, workers, property owners, etc. Furthermore, investigating how business can (...) help reduce poverty while still earning a profit and ensuring customer satisfaction limits research on business approach to poverty, since it assumes that business will have some “not-for-profit” purposes. The findings point out that businesses with “not-for-profit” purposes serve as a promising area for further exploration and research of business approach to poverty alleviation. (shrink)

Background Increase in global health research undertaken in resource poor settings in the last decade though a positive development has raised ethical concerns relating to potential for exploitation. Some of the suggested strategies to address these concerns include calls for providing universal standards of care, reasonable availability of proven interventions and more recently, promoting the overall social value of research especially in clinical research. Promoting the social value of research has been closely associated with providing fair benefits to (...) various stakeholders involved in research. The debate over what constitutes fair benefits; whether those that addresses micro level issues of justice or those focusing on the key determinants of health at the macro level has continued. This debate has however not benefited from empirical work on what stakeholders consider fair benefits. This study explores practical experiences of stakeholders involved in global health research in Kenya, over what benefits are fair within a developing world context. Methods and results We conducted in-depth interviews with key informants drawn from within the broader health research system in Kenya including researchers from the mainstream health research institutions, networks and universities, teaching hospitals, policy makers, institutional review boards, civil society organisations and community representative groups. The range of benefits articulated by stakeholders addresses both micro and macro level concerns for justice by for instance, seeking to engage with interests of those facilitating research, and the broader systemic issues that make resource poor settings vulnerable to exploitation. We interpret these views to suggest a need for global health research to engage with current crises that face people in these settings as well as the broader systemic issues that produce them. Conclusion Global health research should provide benefits that address both the micro and macro level issues of justice in order to forestall exploitation. Embracing the two is however challenging in terms of how the various competing interests/needs should be balanced ethically, especially in the absence of structures to guide the process. This challenge should point to the need for greater dialogue to facilitate value clarification among stakeholders. (shrink)

Ruth Macklin argued that dignity is nothing more than respect for persons or their autonomy. During the COVID-19 pandemic, difficult decisions are being made about the allocation of scarce resources. Respect for autonomy cannot justify rationing decisions. Justice can be invoked to justify rationing. However, this leaves an uncomfortable tension between the principles. Dignity is not a useless concept because it is able to account for why we respect autonomy and for why it can be legitimate to override autonomy (...) in times of critical care resource shortages. Dignity affirms the worth of the human individual as a meaning-making embodied subject, who is always in relationship to others, the world, time, and transcendence, and who realizes their dignity through their moral behaviour. Such an understanding means people should be helped to make morally right decisions about their own treatment, which may include forgoing potentially beneficial treatment for the good of others. Respect for dignity does not require fulfilling the morally wrong choices of one who insists on treatment at the expense of others. Dignity also protects the discretion of clinicians to make decisions appropriate to their competence by prohibiting the application of broad-based criteria such as age. (shrink)

CRISPR‐Cas technology accelerates development of fast, accurate, and portable diagnostic tools, typified by recent applications in COVID‐19 diagnosis. Parasitic helminths cause devastating diseases afflicting 1.5 billion people globally, representing a significant public health and economic burden, especially in developing countries. Currently available diagnostic tests for worm infection are neither sufficiently sensitive nor field‐friendly for use in low‐endemic or resource‐poor settings, leading to underestimation of true prevalence rates. Mass drug administration programs are unsustainable long‐term, and diagnostic tools – required (...) to be rapid, specific, sensitive, cost‐effective, and user‐friendly without specialized equipment and expertise – are urgently needed for rapid mapping of helminthic diseases and monitoring control programs. We describe the key features of the CRISPR‐Cas12/13 system and emphasise its potential for the development of effective tools for the diagnosis of parasitic and other neglected tropical diseases (NTDs), a key recommendation of the NTDs 2021–2030 roadmap released by the World Health Organization. (shrink)

Stereotypes sometimes lead us to make poor judgements of other people, but they also have the potential to facilitate quick, efficient, and accurate judgements. How can we discern whether any individual act of stereotyping will have the positive or negative effect? How Stereotypes Deceive Us addresses this question. It identifies various factors that determine whether or not the application of a stereotype to an individual in a specific context will facilitate or impede correct judgements and perceptions of (...) the individual. It challenges the thought that stereotyping only and always impedes correct judgement when the stereotypes that are applied are inaccurate, failing to reflect social realities. It argues instead that stereotypes that reflect social realities can lead to misperceptions and misjudgements, and that inaccurate but egalitarian social attitudes can therefore facilitate correct judgements and accurate perceptions. The arguments presented in this book have important implications for those who might engage in stereotyping and those who are at risk of being stereotyped. They have implications for those who work in healthcare and those who have mental health conditions. How Stereotypes Deceive Us provides a new conceptual framework-evaluative dispositionalism-that captures the epistemic faults of stereotypes and stereotyping, providing conceptual resources that can be used to improve our own thinking by avoiding the pitfalls of stereotyping, and to challenge other people's stereotyping where it is likely to lead to misperception and misjudgement. (shrink)

Humans have always played a crucial role in the evolutionary dynamics of agricultural biodiversity and thus there is a strong relationship between these resources and human cultures. These agricultural resources have long been treated as a global public good, and constitute the livelihoods of millions of predominantly poor people. At the same time, agricultural biodiversity is under serious threat in many parts of the world despite extensive conservation efforts. Ethical considerations regarding the collecting, research, and use (...) of agricultural biodiversity are currently topics of great concern. For example, easy access to genetic resources for breeding purposes is important, but international agreements and legal frameworks are necessary to ensure adequate recognition of the contributions of local communities and traditional farmers in creating and nurturing these resources. Here, we assess ethical principles in the context of existing codes of conduct that are relevant for agro-biodiversity researchers. We aim to create awareness among scientists and policy makers who are concerned with agro-biodiversity research and its potential impact on local communities. We encourage a serious assessment of the ethical principles presented here and hope to facilitate an integration of these principles into the reader’s personal ethical framework. Key ethical principles considered here include the importance of obtaining prior informed consent, equity, and the inalienability of rights of local communities and farmers. (shrink)

The provision of health care service in resource-poor settings is associated with a broad set of ethical issues. Devakumar's case discusses the ethical issues related to the inability to treat in a cholera clinic patients who do not have cholera. This paper gives a closer look on the context in which Devakumar's case took place. It also analyses the potential local and organizational factors that gives rise to ethical dilemmas and aggravate them. It also proposes a framework to (...) help in the proactive handling of the factors that leads to ethical dilemmas and resolving the ethical issues as they appear. It adopts the four principles of autonomy, beneficence, non-maleficence and justice as universal and prima facie principles, but with the inclusion of a local understanding of what of each of these principles means. It is based on a collaborative approach that involves the beneficiaries and other partners in the field to help share information and resources, as well as adopting the provision of a wider service to the whole community. This is done by asking three basic questions: (a) who are the relevant stakeholders? (b) what ought to be the ethical principles in place? and (c) how should we take, implement and follow the decision about service provision? (shrink)

Development is concerned with the fulfillment of people's needs and wants. Most governments, corporations and international organizations use an economic model of development to make decisions about the fulfillment of people's needs and wants. As world problems mount in severity and the carrying capacity of the earth is approached, the costs, consequences and dangers of using the economic model of development are great. A new model of development is required to tackle problems as difficult and demanding as the (...) environmental crisis, rapid consumption of the world's renewable and non?renewable resources, the gap between rich and poor nations and rich and poor people, and the potential collapse of the global eco?system. The model that is proposed is the cultural model of development. Based on a holistic and equitable rather than dualistic and partisan approach to development, the cultural model makes it possible to take the natural environment fully and forcefully into account in all developmental planning and decision?making, as well as to focus attention on the whole rather than a part of the whole. This necessitates new understandings and measurements of production, productivity, living standards and indicators of developmental performance. It also necessitates significant changes in the policies and practices of international organizations, governments, corporations and citizens. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Liberation and SpiritualityRoger HaightThese reflections on liberation and spirituality respond to a precise question. There is no better way to begin than in stating it clearly. People committed to action in behalf of liberation need a spirituality. What spirituality does Christianity offer them? The issue is not why Christian spirituality needs to be attentive to the demands of the poor and other victims of discrimination. The reasons (...) why Christian spirituality must be liberationist have been made convincingly over the past forty-five years. It should be taken for granted that Christians are to be concerned with liberation. A slightly different issue is at stake in the question of what spirituality, present in Christianity, is summoned forth when people who are dedicated to the project of liberation turn to Christianity and ask about its spiritual resources. This question comes from a different audience, one made up of those who are not sure that Christianity or religion generally has anything to offer to the commitment to human liberation. In addressing that question the goal is to respond with some clear convictions about what Christianity has to offer and how it may affect the lives of liberationists.Because this has to be done in a short space, the response will appear more like an outline than an argument. But both those familiar with Christianity and those less so will be able to understand the basic elements of the spirituality that is proffered. The presentation moves forward in three parts. The first explores the language of liberation and spirituality. The second and substantive part brings forward four classic witnesses to Christian spirituality and allows each to highlight a particular element of an integral Christian spirituality. And the third emphasizes the dimensions of ultimacy and finality.liberation and spiritualityThe words “liberation” and “spirituality” are familiar to everyone, but they do not bear the same meaning in everyone’s usage. The discussion, then, has to begin with a brief definition of the meaning of these terms as they are used here. These definitions [End Page 135] do not have to be developed at length. What follows simply stipulates aspects of these terms that are crucial for the logic of the position presented here.The term “liberation” is used very broadly because human repression takes many forms. In these reflections “liberation” refers to the process of attaining or assisting others to attain freedom from various obstacles to human flourishing. There can be no doubt that since the nineteenth century social oppression has provided a focal point for understanding liberation. Humanity in the West has gradually become more and more conscious of social and historical conditioning of individual human beings. We have learned that societies are human constructions; that they favor some and neglect, marginalize, and positively subjugate others; that no society has to be the way it is; that it can be changed; that some people encourage and others resist change; and that human beings can have a less or more conscious role in the process. We have the potential to be agents of social liberation. But other forms of liberation need not be excluded from the concept. It does not make any sense to neglect some forms of repressed human freedom in favor of others, even though some forms of human deprivation are more serious than others.One problem with such an open view of liberation is that it seems to give every liberationist concern an equal voice. It may even open a door to competitive interests. It is one thing to say that every human diminishment requires attention, but in a limited economy of human energy, time, and resources we cannot, either as individuals or societies, attend to all problems with equal vigor at the same time. We need some criteria for measuring importance. To this question a scale of values offered by Bernard Lonergan has some relevance. He begins to rank from below in an ascending scale the needs and values that lie open to human commitment.1 The denial of any basic human requirement like food and shelter calls out for liberation. But a scale of values measures relative importance of various human needs and opportunities for freedom’s development... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Hope for Common Ground: Mediating the Personal and the Political in a Divided Church by Julie Hanlon RubioBrian StiltnerHope for Common Ground: Mediating the Personal and the Political in a Divided Church Julie Hanlon Rubio washington, dc: georgetown university press, 2016. 264 pp. $89.95 / $29.95Julie Hanlon Rubio wrote Hope for Common Ground to address divisions over ethical and political issues within the Catholic Church. Rubio writes in (...) a spirit of hope, affirming that it is possible for Catholics to find common ground by drawing on resources within their tradition and within themselves. She proposes that "the potential for seeing and developing common ground is particularly strong if we focus on what can be done in the 'local' sphere—that is, in the space between" the personal and the political (xvii). Localized focus is recommended by the Catholic principle of subsidiarity, which means working on social problems from the bottom up through the small- and medium-sized [End Page 195] groups that matter greatly for people's well-being, such as families, churches, and neighborhoods.Rubio's project is vital because civic spaces have become so fraught. Although this book was published early in 2016, these words are even more apt in 2017: "In both popular and academic Catholic circles, politics has become a very uncomfortable space. … Catholics are more divided than at any point in their history, and in this they mirror society rather than providing an alternative to it" (xiv–xv). If Catholic Christians, claiming a common life and common Lord, are as divided as society itself, they testify poorly to their values. By contrast, if they redirect some of their energies from the personal and the political to the local, then "instead of fighting each other, Catholics can participate more, agree on more, and, consequently, build up more" (229).Part 1 of the book draws on Church tradition and ethics texts to articulate a vision of what it means to be a faithful citizen. Divisions within the Catholic community are shaped in part by interpretations of Church teaching that discourage Catholics from thinking they should cooperate with others who think differently. In recent years, the American bishops have pushed Catholic citizens to consider some political issues, such as abortion and gay marriage, as more important than others. Rubio aims to right such imbalances by showing that Catholic teaching supports pluralism, appreciates the pragmatic side of politics, and holds a nuanced account of how people can act conscientiously in an imperfect world. She offers "a social ethic for ordinary Christians" (58), equally focused on faithfulness and effectiveness.The payoff in part 2 of the book is excellent. Rubio enters the culture-war debates over the family, poverty, abortion, and end-of-life care; elsewhere she briefly but insightfully examines white privilege, sweatshop clothing, and police violence. In each of these cases, Rubio describes the current divide, provides background analysis that cuts through misconceptions and slanted data, and suggests ways that Catholics can find common ground and build up the common good in church and society. Here is one small example of the kind of applications she makes: "A Catholic Charities center in my city included a conversation on advance directives in the agenda for a weekly meeting of mothers in a poor neighborhood. Though the instruction was quite simple, it gave the women a chance to talk about their faith, experiences, fears, and hopes in relation to death and dying. … These women are now better equipped than many for the tough conversations that are surely ahead" (218).Rubio practices what she preaches, exhibiting a conversational tone and capacious vision throughout. While focused on Catholic sources and issues, Hope for Common Ground is by no means narrow. Not only other Christians but also all [End Page 196] people have to face the social issues discussed here, and it matters to all citizens how religious communities are addressing them. Therefore, this book is a great launching point for honest conversations in college courses, while scholars in the field will do well to engage with Rubio's theory of local action. The book deserves a wide readership within and outside Catholic circles.Brian StiltnerSacred... (shrink)

The first United Nations Millennium Development Goal calls for a distinct reduction of worldwide poverty. It is now widely accepted that the private sector is a crucial partner in achieving this ambitious target. Building on this insight, the ‹Bottom of the Pyramid’ concept provides a framework that highlights the untapped opportunities with the ‹poorest of the poor’, while at the same time acknowledging the abilities and resources of private enterprises for poverty alleviation. This article connects the idea of (...) business with the poor to sustainable development and especially to the notions of inter- and intragenerational justice. These principles of justice can be linked with the ‹Bottom of the Pyramid’ approach directly through the Rawlsian principles to foster holistic thinking. On this basis, the article offers a normative-ethical reasoning of corporations’ possible responsibilities for the poorest of the poor. Today’s state of worldwide inequalities is likely to generate future tensions between the privileged western world and the uncounted mass of poor (let alone the ethical dubiousness of this status). However, it is at the same time problematic if not even impossible to improve the situation of the poor by simply copying the resource intensive western way of living to the ‹Bottom of the Pyramid’ due to the limited carrying capacity of the earth. After highlighting possible moral dilemmas which may occur through such a potential trade off, this article concludes with an outlook on how the concepts ‹Bottom of the Pyramid’ and sustainable development could be combined. (shrink)

Why do American Black people generally have worse health than American White people? To answer this question, “Black Health” dispels any notion that Black people have inferior bodies that are inherently susceptible to disease. This is simply false racial science that has been used to abuse Black people since our African ancestors were brought to America on slave ships. A genuine investigation into the status of Black people’s health requires us to acknowledge that race has (...) always been a powerful social category. Race largely predetermines individuals’ social and political power and access to resources needed for health and wellbeing. And as a group, Black people have been intentionally denied this power and access. Systemic racism, oppression, and White supremacy in American institutions have largely been the perpetrators of differing social power and access to resources for Black people. It is these systemic inequities that create the social conditions needed for poor health outcomes for Black people to persist. An examination of social inequities reveals that it is no accident that Black people have poorer health than White people, instead in America, almost every institution has been designed to withhold what Black people need for proper health and wellbeing. Black Health provides a succinct discussion of Black people’s health, including the social, political, and at times cultural determinants of their health. This book examines the ways that Black people’s multiple identities—social, cultural, and political—intersect with anti-Black institutions, such as housing and health care to determine their poor outcomes in pregnancy, pain management, sleep, and cardiovascular disease. (shrink)

This book explores the implications of knowing our place in the universe and recognising our hybridity. It is a series of self-reflections and essays drawing on many diverse ways of knowing. The book examines the complex ethical challenges of closing the wide gap in living standards between rich and poor people/communities. The notion of an ecological citizen is presented with a focus on protecting current and future generations. The idea is to track the distribution and redistribution of (...) class='Hi'>resources in the interests of social and environmental justice. The central argument looks for ways to hold the powerful to account so as to enable virtuous living by the majority to be demonstrated in what the author calls a "planetary passport" - a careful use of resources and a way to provide safe passage to those in need of safe habitat. The book argues that nation states need to find ways to control the super-rich through the governance process and to enhance a sense of shared ecological citizenship and responsibility for biodiversity. The fundamental approach is collaborative research. Planetary Passport: Representation, Accountability and Re-Generation is comprised of six chapters. Chapter 1 begins by making a case for a paradigm shift away from business as usual and the pursuit of profit at the expense of the social and environmental fabric of life. The aim is to explore alternatives and to discuss some ways of achieving wellbeing whilst the focus is on human rights, discrimination and outlining the notion of a planetary passport. Chapter 2 makes a specific link between people and the planet as a basis for understanding the nature of hybridity and interconnectedness and the implications for ethics. Chapter 3 focuses on building this planetary passport for social and environmental justice in order to enable people with complex needs to consider the consequences of either continuing to live the same way as before or making changes to the way that they live. Meanwhile Chapter 4 does the same as the previous chapter, but explores the political context of consumption and short term profit Chapter 5 examines the challenges and opportunities that come from explorations within a cross-cultural learning community. This includes a look at co-creation and co-determination. Finally Chapter 6 ends with a look to the future and a potential new framework for people and the planet through a planetary passport.. (shrink)

Background Informed consent is a universally accepted precondition for scientific researches involving human participants. However, various factors influence the process of obtaining authentic informed consent, and researchers particularly working in resource-poor countries often face considerable difficulties in implementing the universally recommended procedures for obtaining informed consent. We have conducted this Rapid Ethical Assessment to accommodate the local cultural norms and to understand the relevant ethical issues in the Silti community before the conduct of a cluster-randomized controlled trial. Methods This (...) REA was conducted in two purposively selected Woredas/Districts and Worabe Town administration of Silti Zone. Data were collected using in-depth interviews and focus group discussions. Purposive and convenient sampling techniques were used to select respondents. Five in-depth interviews and 15 Focus Group Discussions were conducted in the Amharic language. The collected data was transcribed, translated, and analyzed using a thematic approach. Result Most of the community members never heard about research and therapeutic misconception was common. In the area, the permission of people working in the formal and informal community administration is essential before approaching individuals. The male head of the household should also be involved in the decision before individual household members participate in research. Furthermore, sensitizing the community using public and religious gatherings was suggested before individual recruitment. In the consent process, delivering selected information particularly the purpose and benefits of the research was emphasized and the tendency of preferring verbal consent was documented despite the willingness of the individuals to sign on the consent form. Local health workers were identified as appropriate personnel to communicate information and the procedures of the research were found to be acceptable. However, the value of small incentives was suggested to motivate potential participants. Finally, involving all concerned stakeholders and respecting the cultural norm of the community was emphasized. Conclusion Through REA, we understand the research awareness of the community, their expectation, and the cultural norms relevant to the ethical conduct of research. It enabled us to devise culturally sensitive and scientifically sound strategies to secure authentic informed consent. The process of conducting REA was found to be feasible, quick, and efficient. (shrink)

Fundamental aspects of human use of the environment can be explained by game theory. Game theory explains aggregate behaviour of the human species driven by perceived costs and benefits. In the 'game' of global environmental protection and conservation, the stakes are the living conditions of all species including the human race, and the playing field is our planet. The question is can we control humanity's hitherto endless appetite for resources before we irreparably harm the global ecosystem and cause extinction (...) of even more species? The central problem is that some proportion of the individuals or groups will behave selfishly. The inducement for using more than a fair share, or 'cheating', increases as that resource becomes rarer, thus the benefits of cheating increase. In addition, the total number of people is increasing, so the proportion of cheaters must decrease to even keep total resource use constant. Cost benefit analysis of the effect of regulation and incentives on potential cheaters may provide a rational approach to controlling environmental problems. While it is debatable that environmental values are constant across cultures, communal use of resources seems to follow global rules. Cooperative use and punishment of those who use more than their share appear to be ubiquitous in human societies. Schemes for controlling human impact on the global environment must take into consideration basic behaviours including development of social norms and the positive feedback created because resources become more valuable with increasing rarity leading to more incentive for consumption. (shrink)

An enduring concern for educational policy in many affluent countries is the endemic nature of educational inequalities that are predominately located in poor urban contexts. Given the inabilities of school reform per se to deal with these inequalities, the paper focuses on issues of scarcity and spatial processes that are implicated in the formation of young people's educational identities – identities that then mediate the conversion of educational resources into educational attainments or achievements.

Forest tenure reforms are occurring in many developing countries around the world. These reforms typically include devolution of forest lands to local people and communities, which has attracted a great deal of attention and interest. While the nature and level of devolution vary by country, all have potentially important implications for resource allocation, local ecosystem services, livelihoods and climate change. This book helps students, researchers and professionals to understand the importance and implications of these reforms for local environmental quality, (...) climate change, and the livelihoods of villagers, who are often poor. It is shown that local forest management can often be more successful than top-down management of common pool forest resources. The relationship of local forest tenure reform to the important climate change initiative REDD+ is also considered. The work includes a number of generic chapters and also detailed case studies from China, Ethiopia, Kenya, Nepal, Tanzania and Uganda. Using specific examples and a wide variety of disciplinary perspectives, including quantitative and qualitative analytical methods, the book provides an authoritative and critical picture of local forest reforms in light of the key challenges humanity faces today. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Black Health: The Social, Political, and Cultural Determinants of Black People's Health by Keisha RayChioma Dibia (bio)Black Health: The Social, Political, and Cultural Determinants of Black People's Health by Keisha Ray New York: Oxford University Press, 2023Prior to the COVID-19 pandemic, bioethics had engaged only sparingly with the concept of racism. In 2016, Danis and colleagues published an article exhorting bioethicists to engage more meaningfully with (...) the concept of racism—given its impact on health and well being—and to consider strategies for combating it within and outside clinical settings (Danis et al. 2016, 5). While this paper generated considerable debate regarding how far bioethics ought to go in its engagement with racism (Baker 2016, 16; Weddle 2016, 32; Fuller 2016, 29), the focus of the field of bioethics quickly turned to more traditional subjects of bioethical inquiry, including ethical issues arising in doctor-patient relationships and new reproductive technologies. However, since the COVID-19 pandemic and the murder of George Floyd during that time, racism has received greater attention in the bioethics literature and Keisha Ray's Black Health arrives just in time to urge us to ensure that the current focus on the impact of racism on the health of racially minoritized people is not short-lived (Ray 2023, 21; BBC News 2020).The overarching argument in Ray's Black Health is that Black people's poor health does not arise from innate biological deficiencies but stems from their experience of racism at the structural, institutional, and interpersonal levels. Ray stresses that far from being solely a feature of America's past, racism [End Page 105] continues to taint Black people's relationship with the healthcare system and other societal institutions. In each chapter, Ray focuses on a specific racial disparity in health to illustrate how racism limits Black people's access to the social determinants of health and thereby contributes to their poor health. To set the context for this discussion, Ray provides an introductory chapter where she unpacks key terms including "racism," "racial disparities," and "the social determinants of health." In this chapter, Ray also clearly outlines the structure of the text and provides a summary of each chapter. This chapter provides the blueprint for the rest of the book, as in it, Ray provides a clear statement of the style, content, and purpose of Black Health.The first racial disparity that Ray considers is Black birthing mortality, and in chapter 1, Ray traces this to the history of slavery and eugenic policies which have shaped the relationship between physicians and Black women. As Ray explains, since Black people were forcibly brought to the United States, the government has sought to control Black women's reproductive lives and has often relied on physicians to effect control. She demonstrates how harmful stereotypes about Black women, including their so-called hardiness, originated in medical literature and have been used to deny pregnant Black women humane care. According to Ray, "[c]linicians' attitude and behaviors towards Black pregnant people still reflect an enslaved and slave-owner mentality, and this has great consequences for the survival of Black pregnant people." (32) By highlighting the birthing experiences of Serena Williams and Shalon Irving, Ray dispels the assumption that wealth or academic qualifications are a panacea for Black birthing mortality and shows how racism can be deadly for all Black pregnant women, irrespective of socioeconomic status. Ray also considers how income and housing inequities affect Black pregnant women and the cumulative effect of weathering on their health as well as that of their unborn children. This chapter most clearly shows how interpersonal, institutional, and structural racism operate and intersect to render pregnancy and childbirth a potentially dangerous experience for Black women.Next, Ray turns to racial disparities in clinical pain management and continues to explore the impact of historically racist beliefs and false stereotypes on the care of Black people. However, in this second chapter, Ray delves more deeply into the role of medical literature—both historical and contemporary sources—in perpetuating false assumptions about the Black body. She demonstrates how the historical portrayal of the Black body as not only less than human... (shrink)

Avon Longitudinal Study of Parents and Children is a birth cohort study within which the Project to Enhance ALSPAC through Record Linkage was established to enrich the ALSPAC resource through linkage between ALSPAC participants and routine sources of health and social data. PEARL incorporated qualitative research to seek the views of young people about data linkage, including their opinions about appropriate safeguards and research governance. In this paper we focus on views expressed about the purpose and composition of research (...) ethics committees. Digitally recorded interviews were conducted with 48 participants aged 17–19 years. Participants were asked about whether medical research should be monitored and controlled, their knowledge of research ethics committees, who should sit on these committees and what their role should be. Interview recordings were fully transcribed and anonymised. Thematic analysis was undertaken, assisted by the Framework approach to data management. The majority of interviewees had little or no specific knowledge of ethics committees. Once given basic information about research ethics committees, only three respondents suggested there was no need for such bodies to scrutinise research. The key tasks of ethics committees were identified as monitoring the research process and protecting research participants. The difficulty of balancing the potential to inhibit research against the need to protect research participants was acknowledged. The importance of relevant research and professional expertise was identified but it was also considered important to represent wider public opinion, and to counter the bias potentially associated with self-selection possibly through a selection process similar to ‘jury duty’. There is a need for more education and public awareness about the role and composition of research ethics committees. Despite an initial lack of knowledge, interviewees were able to contribute their ideas and balance the rights of individuals with the wider benefits from research. The suggestion that public opinion should be represented through random selection similar to jury duty may be worth pursuing in the light of the need to ensure diversity of opinion and establish trust amongst the general public about the use of ‘big data’ for the wider public good. (shrink)

An enduring concern for educational policy in many affluent countries is the endemic nature of educational inequalities that are predominately located in poor urban contexts. Given the inabilities of school reform per se to deal with these inequalities, the paper focuses on issues of scarcity and spatial processes that are implicated in the formation of young people's educational identities - identities that then mediate the conversion of educational resources into educational attainments or achievements.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Just Sustainability: Technology, Ecology, and Resource Extraction eds. by Christiana Z. Peppard and Andrea ViciniTallessyn Zawn Grenfell-LeeJust Sustainability: Technology, Ecology, and Resource Extraction Edited by Christiana Z. Peppard and Andrea Vicini maryknoll, ny: orbis, 2015. 304 pp. $42.00Just Sustainability offers a detailed journey through various Catholic contextual understandings of what ecological sustainability means today in light of the demands of justice. In the first section of the book, (...) called "Locations" (11–53), the contributors put concepts of sustainability into dialog with concerns of socioeconomic, gender, and racial justice from contexts as diverse as Europe, East Asia, India, Africa, and North America. The various locations share common themes, such as the importance of deep meanings of the term "sustainability," the priority of education and advocacy, the resource and energy challenges behind structures of injustice, and the primary role of economics. Yet distinctive emphases emerge from the diverse contexts as well. Examples include the [End Page 200] need for humility instead of the ironic arrogance of nuclear energy in Japan, the widespread challenges of corruption in Africa and Mexico, and the problem of the agriculture lobby in the United States.The second section, "Structures" (57–156), steps back from specific cultural contexts and explores various systemic approaches to the challenge of just sustainability. Using Catholic social teachings, the authors again often speak from diverse global contexts, but with reference specifically to economic and societal systems such as politics, measurements of well-being, urban planning, food and agriculture, and health care. In this section the authors speak of which structures have worked and which have failed to build just and sustainable societies. For example, in the Philippines, more accountability through transparency and regular reporting helped impact energy efficiency. In Kenya and Chad, the authors highlight the need for reliable social systems of access, communication, collaboration, and government in order to counter corruption and build sustainable programs to address HIV, hunger, employment, and food sovereignty. Several authors also describe the positive impact of more democratic and egalitarian participatory structures that involve the people most affected by ecological decisions and policies.The last section, "Theological Stances and Sustainable Relations" (159–268), delves more deeply into Catholic theological resources to provide both a foundation as well as specific practices of just sustainability. The authors wrestle with theocentric, biocentric, and anthropocentric concepts of humanity and the imago Dei, the Eucharist as a potentially powerful way to connect ideas of inequity, the promise of ecofeminist theologies in elevating the wisdom of local peoples to build just sustainability practices, and virtue ethics and Catholic social teachings to foster ecological conversion and build solidarity, hope, and efficacy.The book sets itself a challenging task, to provide a coherent picture of Catholic approaches to building just sustainability while presenting a spectrum of not only diverse cultural and geographical contexts but also diverse theologies. In the end, the book reveals the ways in which Catholic laity and leaders are creatively responding to the challenge of just sustainability across much of the globe by using a combination of ecclesial, theological, and social scientific resources. The book would have benefited from a concluding essay to tie together some of the salient themes from the numerous, somewhat disparate essays, and a chapter from South America would have strengthened the global orientation of the collection. Nonetheless, the reader is left with a more holistic understanding of the difficult task of just sustainability as well as the wealth of work toward this goal from many parts of the Earth. [End Page 201]Tallessyn Zawn Grenfell-LeeBoston University School of TheologyCopyright © 2018 Society of Christian Ethics... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Black Health: The Social, Political, and Cultural Determinants of Black People's Health by Keisha RayChioma Dibia (bio)Black Health: The Social, Political, and Cultural Determinants of Black People's Health by Keisha Ray New York: Oxford University Press, 2023Prior to the COVID-19 pandemic, bioethics had engaged only sparingly with the concept of racism. In 2016, Danis and colleagues published an article exhorting bioethicists to engage more meaningfully with (...) the concept of racism—given its impact on health and well being—and to consider strategies for combating it within and outside clinical settings (Danis et al. 2016, 5). While this paper generated considerable debate regarding how far bioethics ought to go in its engagement with racism (Baker 2016, 16; Weddle 2016, 32; Fuller 2016, 29), the focus of the field of bioethics quickly turned to more traditional subjects of bioethical inquiry, including ethical issues arising in doctor-patient relationships and new reproductive technologies. However, since the COVID-19 pandemic and the murder of George Floyd during that time, racism has received greater attention in the bioethics literature and Keisha Ray's Black Health arrives just in time to urge us to ensure that the current focus on the impact of racism on the health of racially minoritized people is not short-lived (Ray 2023, 21; BBC News 2020).The overarching argument in Ray's Black Health is that Black people's poor health does not arise from innate biological deficiencies but stems from their experience of racism at the structural, institutional, and interpersonal levels. Ray stresses that far from being solely a feature of America's past, racism [End Page 105] continues to taint Black people's relationship with the healthcare system and other societal institutions. In each chapter, Ray focuses on a specific racial disparity in health to illustrate how racism limits Black people's access to the social determinants of health and thereby contributes to their poor health. To set the context for this discussion, Ray provides an introductory chapter where she unpacks key terms including "racism," "racial disparities," and "the social determinants of health." In this chapter, Ray also clearly outlines the structure of the text and provides a summary of each chapter. This chapter provides the blueprint for the rest of the book, as in it, Ray provides a clear statement of the style, content, and purpose of Black Health.The first racial disparity that Ray considers is Black birthing mortality, and in chapter 1, Ray traces this to the history of slavery and eugenic policies which have shaped the relationship between physicians and Black women. As Ray explains, since Black people were forcibly brought to the United States, the government has sought to control Black women's reproductive lives and has often relied on physicians to effect control. She demonstrates how harmful stereotypes about Black women, including their so-called hardiness, originated in medical literature and have been used to deny pregnant Black women humane care. According to Ray, "[c]linicians' attitude and behaviors towards Black pregnant people still reflect an enslaved and slave-owner mentality, and this has great consequences for the survival of Black pregnant people." (32) By highlighting the birthing experiences of Serena Williams and Shalon Irving, Ray dispels the assumption that wealth or academic qualifications are a panacea for Black birthing mortality and shows how racism can be deadly for all Black pregnant women, irrespective of socioeconomic status. Ray also considers how income and housing inequities affect Black pregnant women and the cumulative effect of weathering on their health as well as that of their unborn children. This chapter most clearly shows how interpersonal, institutional, and structural racism operate and intersect to render pregnancy and childbirth a potentially dangerous experience for Black women.Next, Ray turns to racial disparities in clinical pain management and continues to explore the impact of historically racist beliefs and false stereotypes on the care of Black people. However, in this second chapter, Ray delves more deeply into the role of medical literature—both historical and contemporary sources—in perpetuating false assumptions about the Black body. She demonstrates how the historical portrayal of the Black body as not only less than human... (shrink)

In response to the many changes currently going on in health care, this book offers the combined insight and wisdom of a stellar group of scholars and professionals with extensive experience in the health care field. The book opens with a look at people's actual experience of health care today, from four different perspectives. It then addresses foundational questions, including the nature of medicine, nursing, and justice. Surveyed next are the changing economics of health care as well as the (...) impact of these changes on such areas as mental health care, long-term care, health care for minorities, and legal malpractice. The closing section of the book assesses from a Christian perspective available constructive alternatives, including creative funding strategies with special attention to the needs of poor persons, physician unions, and the use of "alternative medicine" therapies. (shrink)

In this article, we describe an ontology aimed at the representation of the relevant entities and relations in the philosophical world. We will guide the reader through our modeling choices, so to highlight the ontology’s practical purpose: to enable an annotation of philosophical resources which is capable of supporting pedagogical navigation mechanisms. The ontology covers all the aspects of philosophy, thus including characterizations of entities such as people, events, documents, and ideas. In particular, here we will present a (...) detailed exposition of the entities belonging to the idea branch of the ontology, for they have a crucial role in the world of philosophy. Moreover, as an example of the type of applications made possible by the ontology we will introduce PhiloSurfical, a prototype tool we created to navigate contextually a classic work in twentieth century philosophy, Wittgenstein’s Tractatus Logico-Philosophicus. We discuss the potential usage of such navigation mechanisms in educational and scholarly contexts, which aim to enhance the learning process through the serendipitous discovery of relevant resources. (shrink)

Thanks to mounting discussion about projected technologies’ possibly altering the species mentally and physically, philosophical investigation of what human beings are proceeds robustly. Many thinkers contend that whatever we are has little to do with how we should behave. Yet, tampering with what the human being is may tread upon human rights to be whatever one is. Rights given in widely recognized documents such as the U.N. Declaration of the Rights of Indigenous Peoples assume what humans are and need depends (...) upon ontological assumptions about human existence. Godman turns to human ontology—just what kind of beings humans are (from an angle distinct from the other two books) and how these play into rights. She is concerned with how well the social sciences accord with what we are. Gunkel homes in on a more specific moral topic than Godman's general concern with identity’s role in rights: automata moral status and rights. He enjoins us to inquire into what human rights are before we take on the new technologies’ challenge to it. Schneider’s Artificial You, while not explicitly about rights, poses a rights quandary. Certain individuals with reputable resources and practical backing explicitly seek to evolve the species as they see fit. The urgency among these works concerns how we need a sharper idea of what we are, how we should act and be treated, and how our rights fare among potential human improvements. (shrink)

Old age is often described from the perspective of losses, deficits, and risks. This chapter rejects such a way of thinking. It focuses on the potentials of older adults. The main aim of this chapter is to describe different resources that can be interpreted as positive contributions of older people and the ageing population in society and the economy. Notions of the human capital, the social capital, the cultural capital, and the symbolic capital of older people will (...) be briefly discussed and compared. (shrink)

Genomics is increasingly becoming an integral component of health research and clinical care. The perceived difficulties associated with genetic research involving Aboriginal and Torres Strait Islander people mean that they have largely been excluded as research participants. This limits the applicability of research findings for Aboriginal and Torres Strait Islander patients. Emergent use of genomic technologies and personalised medicine therefore risk contributing to an increase in existing health disparities unless urgent action is taken. To allow the potential benefits (...) of genomics to be more equitably distributed, and minimise potential harms, we recommend five actions: ensure diversity of participants by implementing appropriate protocols at the study design stage; target diseases that disproportionately affect disadvantaged groups; prioritise capacity building to promote Indigenous leadership across research professions; develop resources for consenting patients or participants from different cultural and linguistic backgrounds; and integrate awareness of issues relating to Indigenous people into the governance structures, formal reviews, data collection protocols and analytical pipelines of health services and research projects. (shrink)

Intrigued by the so-called “rebellion of the poor,” this paper traces back the current South African concern with popular protest to its reconfiguration during the last years of the apartheid order. Focusing on the discourse around grassroots resistance in the mid- to late-1980s, I begin by showing how, in juxtaposition to an ideal notion of civil society, popular mobilization had been largely delegitimized and the emancipatory politics of ungovernability recast as antidemocratic by the first few years of the post-apartheid (...) regime. In deploying particular notions of violence and culture, this discursive shift, I suggest, fed into reconstructing the ungovernable subject as the racial other of the new South Africa’s citizenry. The second part of the paper mobilizes Foucault’s genealogy of liberalism to draw parallels between this process and the liberal effort to resolve the potentially conflicting principles of governing the economic subject and the subject of rights within the realm of civil society. Finally, via the postcolonial critique of liberal notions of civility and their rootedness in racial thinking, I suggest that civil society secures the governability of the population through rendering the potentially disruptive freedom of the people as the excess freedom of the racialized other. (shrink)

Studying the most ethical way to allocate scarce medical resources has been of interest within the last year, due to shortages associated with the COVID-19 pandemic. This study aimed to establish differences between what healthcare providers (HCP) and laypeople consider to be the most ethical way to prioritise the distribution of scarce resources. Healthcare providers ( n = 100) and laypeople ( n = 102) were asked to rank ethical principles from most to least ethical for the allocation (...) of ICU beds in a COVID-19 outbreak, COVID-19 vaccinations and organ transplantation, and the rankings from each scenario across the two groups were compared. Results indicated that HCPs preferred utilitarian principles informed by medical knowledge, such as ‘prognosis’, whereas laypeople preferred less situation-specific and prioritarian principles, such as ‘sickest first’, replicating pre-pandemic findings. Laypeople showed increased in-group agreement when ranking principles, potentially due to the collective experience of the pandemic. Demographic variables such as older age, identifying as Black, Asian or minority ethnic and greater experience with COVID-19, were also associated with a preference for ‘prognosis’. (shrink)

Digital medicine—a drug delivered with an ingestion sensor and related data collection system—has potential clinical value, especially for people whose lives are made more disorganized by poverty-related stress. It would be unjust if poor people were effectively barred from this treatment modality. Yet, unless a concerted effort is made to enable access through provision of smartphones to those who cannot afford them, this injustice will aggravate the digital divide in clinical care.

Stewardship is potentially a usefulconcept in modernizing management philosophies. Use ofthe term has increased markedly in recent years, yetthe term is used loosely and rarely defined in landmanagement literature. The connections between thispractical usage and the ethical basis of stewardshipare currently poorly developed. The followingdefinition is proposed: ``Stewardship is theresponsible use (including conservation) of naturalresources in a way that takes full and balancedaccount of the interests of society, futuregenerations, and other species, as well as of privateneeds, and accepts significant answerability (...) tosociety.'''' A religious interpretation would require thephrase ``and ultimately to God'''' to be added.Stewardship has both secular and religiousinterpretations and it will be desirable to developboth of these aspects in parallel. A task forphilosophers is to establish whether the ethical basisof stewardship is sufficient to address environmentalconcerns or whether it is necessary to embrace widerethical approaches. Stewardship occupies similarground to several other concepts of use and managementof resources, particularly sustainability. It canbuild on sustainability by encouraging a broader viewof who and what should benefit from managementactivity. In particular, it focuses attention on therole of managers in providing public benefit and onenvisaging other species as a form of ``stakeholder'''' inmanagement decisions. Stewardship is applicable acrossthe widest range of fields of resource use and alsohas relevance to aspects of land tenure and propertyrights. Application of stewardship will require someadjustments in the roles of private managers/ownersvis-à-vis government. It might providemanagers with an expanded role and, importantly, amore positive image, both of themselves and in theeyes of the public. Stewardship could alsobe developed in a way that has relevance to citizensin general (as opposed to managers and owners ofresources), through their interactions with naturalresources as consumers. (shrink)

The United Network for Organ Sharing (UNOS) waiting list was designed as a just and equitable system through which the limited number of organs is allocated to the millions of Americans in need of a transplant. People have trusted the system because of the belief that everyone on the list has an equal opportunity to receive an organ and also that allocation is blind to matters of financial standing, celebrity or political power. Recent events have revealed that certain practices (...) and policies have the potential to be exploited. The policies addressed in this paper enable those on the list with the proper resources to gain an advantage over other less fortunate members, creating a system that benefits not the individual most in medical need, but the one with the best resources. These policies are not only unethical but threaten the balance and success of the entire UNOS system. This paper proposes one possible solution, which seeks to balance the concepts of justice and utility. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:What inspires action in Global Health?Daniel Palazuelos"Why do all of you want to go to the middle of nowhere and take care of the sickest people even though you won't have half the tools necessary to make the slightest difference?" he asks.I'm sitting in the Intensive Care Unit workroom enjoying one of those rare, calm moments during residency when this question suddenly breaks my peace. A co-resident, my (...) friend from Latin America, makes this inquiry without even looking up, as he clicks nonchalantly through some Internet pages. I look at him and try to understand him within his context; he was born and raised in [End Page E6] what is traditionally considered a "resource-poor setting," but through talent, hard work, luck and privilege he was accepted into one of the best residency programs in one of the best U.S. hospitals. Unprepared, I give some anemic responses about social responsibility and global citizenship.He looks at his screen and clicks on a couple of links. Suddenly, he turns to me and exclaims, "I get it! You guys are going because then you can put your PWAB on your CV!" I give him a blank look.He stands and goes over to the dry erase board to write: "PWAB—Picture With an African Baby."I'm amused for a moment, and then suddenly hurt. What does this mean? Is he questioning our intentions, our moral resolve? I look over to his computer and see that he's been flipping through the "Global Health Residency" pages of all the local residency programs, or the Facebook pages of colleagues who have recently returned from work abroad. My hurt morphs into incredulity—all the pages have a picture of a beaming, healthy doctor holding a beautiful, newly happy, previously sick, African baby. And then, the code bell goes off, and the admissions start. Reflection time is over.Years later, now that I have become a junior faculty member within the same residency program, I divide my year between global health projects in rural Mexico and Guatemala, the classrooms of a U.S. medical school, and the patient rooms of a teaching hospital. The number of undergraduate and medical students who approach me because they want advice about how to work in global health is staggering; their emails fill my inbox and their faces grace my office hours. External observers have even compared the unprecedented rise of this type of interest to "a veritable tsunami," and we often take for granted that this is because the field is "inspiring" (Mallampati & Heintz, 201, p. 22). We still don't know, however, what all this inspiration becomes once it touches down on-site. For many students, the experience with talented mentors on-site opens up for them a life-long career that aims to address the greatest challenges of our day. The PWAB, however, implies that for an important number of other students, global health is becoming a social capital commodity: an edu-vacation, something to make your mother proud, win a mate, maybe even just another mandatory rotation needed to spice up the application for a career in a highly competitive subspecialty.If students are the future of this field, then the way that global health educators like myself manage this issue may ultimately determine the objectives and scope of countless potential projects hoping to help the billions of people barely surviving abject poverty. I have a career in global health that is more than a hobby because of the clear vision and strong leadership of my mentors and our university (Farmer, 2011). When I was hired as faculty, they worked with me to find the right full-time equivalent (FTE) split so that I could both make a living as an attending, and also still have time to teach, think, research, and manage a project abroad pro bono. But it's from this point that my question begins: once the students are inspired, and the investment made, what inspires good, sustained, pragmatic action in global health?A big part of the answer to this question will depend on how we define global health. Global health is growing, but... (shrink)

The debate concerning whether to legalize and regulate the global market in human organs is hindered by a lack of adequate bioethical language. The author argues that the preferential option for the poor, a theological category, can provide the grounding for an inductive moral epistemology adequate for reforming the use of culturally Western bioethical language. He proposes that the traditional, Western concept of bioethical coercion ought to be modified and expanded because the conditions of the market system, as viewed (...) from the perspective of organ vendors systemically deprived of access to sufficient resources, are sufficiently exploitative as to diminish the possibility of these vendors giving informed consent. Moreover, empirical studies conducted by professionals in medicine, sociology, psychiatry, economics, and medical anthropology continue to contribute support to the growing interdisciplinary consensus that functionally coercive structural factors exert the most significant influence upon a vendor's decision to sell an organ within any market, regardless of legality or degree of regulation. Therefore any proposal to legalize and regulate the organ market remains patently unethical because doing so would likely function to constrain further the agency of poor potential vendors. (shrink)

We investigate the growing use of information and communication technology in Nigeria and its potential as a tool to combat the HIV/AIDS epidemic through information management. Potential applications include data gathering for research and disease tracking, knowledge sharing, and dissemination of information on research findings, prevention methods, available care and support, and patient rights. The research is based on 1450 responses to a widely distributed questionnaire.

We investigate the growing use of information and communication technology in Nigeria and its potential as a tool to combat the HIV/AIDS epidemic through information management. Potential applications include data gathering for research and disease tracking, knowledge sharing, and dissemination of information on research findings, prevention methods, available care and support, and patient rights. The research is based on 1450 responses to a widely distributed questionnaire.

Base-of-the-pyramid business models aim to achieve profitability and poverty reduction by including poor people into corporate value chains. This goal duality creates tensions. Actors’ responses to these tensions are influenced by their cognitive frames of the phenomena building the tension. Applying a cognitive perspective, I investigate how corporate actors with different frames of poverty respond proactively or defensively to the poverty–profitability tension by adapting business model elements. I find that proactive and defensive responses differ for actors holding different (...) cognitive frames of poverty. The responses have consequences for the poverty impact potential of BOP business models. (shrink)

Each decade since 1979, the Healthy People initiative establishes the national prevention agenda and provides the foundation for disease prevention and health promotion policies and programs. Law and policy have been included in Healthy People objectives from the start, but not integrated into the overall initiative as well as possible to potentially leverage change to meet Healthy People targets and goals. This article provides background on the Healthy People initiative and its use among various stakeholder groups, (...) describes the work of a project aiming to better integrate law and policy into this initiative, and discusses the development of Healthy People 2030 — the next iteration of health goals for the nation. Lessons from the preliminary stages of developing Healthy People by the HHS Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 and a Federal Interagency Workgroup will be included. Efforts by the Committee focused on the role of law and policy as determinants of health and valuable resources around health equity are also shared. Finally, the article discusses ways that law and policy can potentially be tools to help meet Healthy People targets and to attain national health goals. (shrink)

By a potential person I shall mean an entity which is not now a person but which is capable of developing into a person, given certain biologically and/or technologically possible conditions. This is admittedly a narrower sense than some would attach to the term ‘potential'. After all, people of the twenty-fifth century, if such there will be, are in some sense potential people now, even though the specific biological entities from which they will develop, i.e. (...) the particular gametes or concepti, do not yet exist. For there do exist, in the reproductive capacities of people now living and in the earth's resources, conditions adequate to produce these future people eventually, provided of course that various possible catastrophes are avoided. Indeed, in some sense of ‘potential’ there have been countless billions of potential people from the beginning of time. But I am concerned not with such remote potentialities but with currently existing entities that are capable of developing into people. (shrink)

Increasingly, commissioners and providers of services for people with intellectual disabilities are turning to assistive technology and telecare as a potential solution to the problem of the increased demand for services, brought about by an expanding population of people with intellectual disabilities in the context of relatively static or diminishing resources. While there are numerous potential benefits of assistive technology and telecare, both for service providers and service users, there are also a number of ethical (...) issues. The aim of this paper is to raise these issues and to set them within the ethical framework proposed by Beauchamp and Childress. There is a need for a wider debate as a first step in the development of strategies to address the issues raised in the paper. (shrink)

Bank Street College of Education professor Salvatore Vascellaro is a leading advocate of taking children and teachers into a wider world as the key to improving our struggling schools. Combining practical and theoretical guidance, Out of the Classroom and into the World visits a rich variety of classrooms transformed by innovative field trip curricula--showing how students’ hearts and minds are opened as they discover how a suspension bridge works, what connects them to the people and places of their neighborhood, (...) and as they come to understand the ecosystem of a river by following it to its source. Vascellaro shows, equally, that what teachers can offer children is fueled by their own engagement with the world, and he offers stunning examples of teachers awakened by their direct experiences with the social issues plaguing American society--from the flood-torn areas of New Orleans to the mining areas of West Virginia. Based on the core principles of progressive pedagogy, and the wisdom gained from Vascellaro’s experience as a teacher, school administrator, and teacher educator, Out of the Classroom and into the World is a direct retort to test scores and standards as adequate measures of teaching and learning--an inspiring call and major new resource for anyone interested in reinvigorating America’s classrooms. (shrink)

Bank Street College of Education professor Salvatore Vascellaro is a leading advocate of taking children and teachers into a wider world as the key to improving our struggling schools. Combining practical and theoretical guidance, Out of the Classroom and into the World visits a rich variety of classrooms transformed by innovative field trip curricula--showing how students’ hearts and minds are opened as they discover how a suspension bridge works, what connects them to the people and places of their neighborhood, (...) and as they come to understand the ecosystem of a river by following it to its source. Vascellaro shows, equally, that what teachers can offer children is fueled by their own engagement with the world, and he offers stunning examples of teachers awakened by their direct experiences with the social issues plaguing American society--from the flood-torn areas of New Orleans to the mining areas of West Virginia. Based on the core principles of progressive pedagogy, and the wisdom gained from Vascellaro’s experience as a teacher, school administrator, and teacher educator, Out of the Classroom and into the World is a direct retort to test scores and standards as adequate measures of teaching and learning--an inspiring call and major new resource for anyone interested in reinvigorating America’s classrooms. (shrink)

BackgroundCarefully planned research is critical to developing policies and interventions that counter physical, psychological and social challenges faced by young people living with HIV/aids, without increasing burdens. Such studies, however, must navigate a ‘vulnerability paradox’, since including potentially vulnerable groups also risks unintentionally worsening their situation. Through embedded social science research, linked to a cohort study involving Adolescents Living with HIV/aids (ALH) in Kenya, we develop an account of researchers’ responsibilities towards young people, incorporating concepts of vulnerability, resilience, (...) and agency as ‘interacting layers’.MethodsUsing a qualitative, iterative approach across three linked data collection phases including interviews, group discussions, observations and a participatory workshop, we explored stakeholders’ perspectives on vulnerability and resilience of young people living with HIV/aids, in relation to home and community, school, health care and health research participation. A total of 62 policy, provider, research, and community-based stakeholders were involved, including 27 ALH participating in a longitudinal cohort study. Data analysis drew on a Framework Analysis approach; ethical analysis adapts Luna’s layered account of vulnerability.ResultsALH experienced forms of vulnerability and resilience in their daily lives in which socioeconomic context, institutional policies, organisational systems and interpersonal relations were key, interrelated influences. Anticipated and experienced forms of stigma and discrimination in schools, health clinics and communities were linked to actions undermining ART adherence, worsening physical and mental health, and poor educational outcomes, indicating cascading forms of vulnerability, resulting in worsened vulnerabilities. Positive inputs within and across sectors could build resilience, improve outcomes, and support positive research experiences.ConclusionsThe most serious forms of vulnerability faced by ALH in the cohort study were related to structural, inter-sectoral influences, unrelated to study participation and underscored by constraints to their agency. Vulnerabilities, including cascading forms, were potentially responsive to policy-based and interpersonal actions. Stakeholder engagement supported cohort design and implementation, building privacy, stakeholder understanding, interpersonal relations and ancillary care policies. Structural forms of vulnerability underscore researchers’ responsibilities to work within multi-sectoral partnerships to plan and implement studies involving ALH, share findings in a timely way and contribute to policies addressing known causes of vulnerabilities. (shrink)

The core idea of libertarianism, considered as a basic moral theory, is that people have certain negative rights and that those rights determine morally right action. Libertarianism is supposed to provide robust explanations to some of our intuitions, such as that it is wrong to steal, kill, rape or enslave other people. However, its exclusive focus on negative rights (i.e., rights to non-interference) makes it incapable of explaining some other intuitions, such as that the utterly rich should help (...) the utterly poor. Although libertarianism can explain why we should never do bad to others, it cannot explain why we should sometimes do good to others. For this reason, libertarianism is not satisfactory as it stands. A natural suggestion, therefore, is that we should either abandon libertarianism in favor of some of its better faring rivals, or revise the theory in order to get rid of the features that make it unsatisfactory. This paper proposes a new libertarian theory of morality: a theory that endorses a utilitarian proviso for use of external resources. I call this theory mid-libertarianism. The basic idea of mid-libertarianism is that individuals are free to do as they want as long as they do not violate the rights of others, given that they maximize utility whenever they use external resources. The paper is divided into four main sections. In this frst section, I introduce mid-libertarianism as a normative ethical theory. In the second main section, I put forward the key arguments for mid-libertarianism, which are, roughly, that it maintains the main explanatory powers of existing versions of libertarianism, while it avoids some of the most severe problems that these theories face. In the third section, I answer some potential objections to midlibertarianism. In the fourth section, I conclude that mid-libertarianism deserves to be taken seriously as a new contender in the normative ethics debate. (shrink)

The COVID‐19 pandemic has raised important universal public health challenges. Conceiving ethical responses to these challenges is a public health imperative but must take context into account. This is particularly important in sub‐Saharan Africa (SSA). In this paper, we examine how some of the ethical recommendations offered so far in high‐income countries might appear from a SSA perspective. We also reflect on some of the key ethical challenges raised by the COVID‐19 pandemic in low‐income countries suffering from chronic shortages in (...) health care resources, and chronic high morbidity and mortality from non‐COVID‐19 causes. A parallel is drawn between the distribution of severity of COVID‐19 disease and the classic “Fortune at the bottom of the pyramid” model that is relevant in SSA. Focusing allocation of resources during COVID‐19 on the ‘thick’ part of the pyramid in Low‐to‐Middle Income Countries (LMICs) could be ethically justified on utilitarian and social justice grounds, since it prioritizes a large number of persons who have been economically and socially marginalized. During the pandemic, importing allocation frameworks focused on the apex of the pyramid from the global north may therefore not always be appropriate. In a post‐COVID‐19 world, we need to think strategically about how health care systems can be financed and structured to ensure broad access to adequate health care for all who need it. The root problems underlying health inequity, exposed by COVID‐19, must be addressed, not just to prepare for the next pandemic, but to care for people in resource poor settings in non‐pandemic times. (shrink)

BackgroundPromoting the social value of global health research undertaken in resource poor settings has become a key concern in global research ethics. The consideration for benefit sharing, which concerns the elucidation of what if anything, is owed to participants, their communities and host nations that take part in such research, and the obligations of researchers involved, is one of the main strategies used for promoting social value of research. In the last decade however, there has been intense debate within (...) academic bioethics literature seeking to define the benefits, the beneficiaries, and the scope of obligations for providing these benefits. Although this debate may be indicative of willingness at the international level to engage with the responsibilities of researchers involved in global health research, it remains unclear which forms of benefits or beneficiaries should be considered. International and local research ethics guidelines are reviewed here to delineate the guidance they provide.MethodsWe reviewed documents selected from the international compilation of research ethics guidelines by the Office for Human Research Protections under the US Department of Health and Human Services.ResultsAccess to interventions being researched, the provision of unavailable health care, capacity building for individuals and institutions, support to health care systems and access to medical and public health interventions proven effective, are the commonly recommended forms of benefits. The beneficiaries are volunteers, disease or illness affected communities and the population in general. Interestingly however, there is a divide between "global opinion" and the views of particular countries within resource poor settings as made explicit by differences in emphasis regarding the potential benefits and the beneficiaries.ConclusionAlthough in theory benefit sharing is widely accepted as one of the means for promoting the social value of international collaborative health research, there is less agreement amongst major guidelines on the specific responsibilities of researchers over what is ethical in promoting the social value of research. Lack of consensus might have practical implications for efforts aimed at enhancing the social value of global health research undertaken in resource poor settings. Further developments in global research ethics require more reflection, paying attention to the practical realities of implementing the ethical principles in real world context. (shrink)

The theory and practice of liberalism has historically justified the dispossession of non-European peoples through the ideological deployment of individual rights—private property being the most prominent. Rather than discarding rights language altogether owing to its colonialist background, the theological option for the poor in the postconciliar Church of Latin America establishes a criterion of authenticity that contributes to its prophetic renewal. The methodological turn toward the poor evident in the liberation theology of Ignacio Ellacuría can wrest rights from (...) its crippling association with political, economic, and cultural forms of liberal domination as seen in the Americas. Latin American theologians provide historical and constructive resources for demythologizing the sacred right to private property in liberalism’s neocolonial present and historical past, as typified by John Locke. Specifically, the theme of integral liberation outlines the material, social, and transcendent dimensions of justice for the dispossessed as an ecclesial alternative to liberal individualism. (shrink)

In its expansion to genomic, epidemiological and biomedical research, citizen science has been promoted as contributing to the democratisation of medical research and healthcare. At the same time, it has been criticised for reinforcing patterns of exclusion in health and biomedicine, and sometimes even creating new ones. Although citizen science has the potential to make biomedical research more inclusive, the benefits of current citizen science initiatives are not equally accessible for all people—in particular those who are resource-poor, (...) located outside of traditional networks of healthcare services, or members of minorities and marginalised groups. In view of growing public investments in participatory research endeavours, we argue that it should be considered more explicitly if, and how, citizen science could help make research more inclusive, contribute to the public good, and possibly even lead to better and more equitable healthcare. Reflecting on emerging ethical concerns for scientific conduct and best medical practice, we propose a set of relevant considerations for researchers, practitioners, bioethicists, funders and participants who seek to advance ethical practices of citizen-led health initiatives, and address profound differences in position, privilege and power in research. (shrink)

I suggest that the diagnosis that an individual self-diagnoses with can be influenced by levels of public awareness. Accurate diagnosis requires consideration of multiple diagnoses. Sometimes, different diagnoses can overlap with one another and can only be differentiated in subtle and nuanced ways, but particular diagnoses vary considerably in levels of public awareness. As such, an individual may meet the diagnostic criteria for one diagnosis but self-diagnoses with a different diagnosis because it is better known. I then outline a (...) class='Hi'>potential negative consequence of this. Psychiatric diagnoses can grant access to what I call social resources, namely, political advocacy, campaigning for support, participating in scientific research, building diagnostic cultures, and opportunity for social interactions with people who have the same diagnosis. The strength of the social resources for a particular diagnosis can be made stronger when more people have that diagnosis. As such, inaccurate self-diagnosis can result in the social resources for one diagnosis being strengthened whilst not being strengthened in relation to another diagnosis in comparison to accurate diagnosis. This shows how inaccurate self-diagnosis can alter the distribution of social resources. We need to consider whether this is unfair to people who are diagnosed with less well-known conditions. (shrink)