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  1.  71
    Passport to freedom? Immunity passports for COVID-19.Rebecca C. H. Brown, Julian Savulescu, Bridget Williams & Dominic Wilkinson - 2020 - Journal of Medical Ethics 46 (10):652-659.
    The COVID-19 pandemic has led a number of countries to introduce restrictive ‘lockdown’ policies on their citizens in order to control infection spread. Immunity passports have been proposed as a way of easing the harms of such policies, and could be used in conjunction with other strategies for infection control. These passports would permit those who test positive for COVID-19 antibodies to return to some of their normal behaviours, such as travelling more freely and returning to work. The introduction of (...)
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  2.  40
    The unnaturalistic fallacy: COVID-19 vaccine mandates should not discriminate against natural immunity.Jonathan Pugh, Julian Savulescu, Rebecca C. H. Brown & Dominic Wilkinson - 2022 - Journal of Medical Ethics 48 (6):371-377.
    COVID-19 vaccine requirements have generated significant debate. Here, we argue that, on the evidence available, such policies should have recognised proof of natural immunity as a sufficient basis for exemption to vaccination requirements. We begin by distinguishing our argument from two implausible claims about natural immunity: natural immunity is superior to ‘artificial’ vaccine-induced immunity simply because it is ‘natural’ and it is better to acquire immunity through natural infection than via vaccination. We then briefly survey the evidence base for the (...)
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  3.  41
    Responsibility in healthcare across time and agents.Rebecca C. H. Brown & Julian Savulescu - 2019 - Journal of Medical Ethics 45 (10):636-644.
    It is unclear whether someone’s responsibility for developing a disease or maintaining his or her health should affect what healthcare he or she receives. While this dispute continues, we suggest that, if responsibility is to play a role in healthcare, the concept must be rethought in order to reflect the sense in which many health-related behaviours occur repeatedly over time and are the product of more than one agent. Most philosophical accounts of responsibility are synchronic and individualistic; we indicate here (...)
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  4.  62
    Against Moral Responsibilisation of Health: Prudential Responsibility and Health Promotion.Rebecca C. H. Brown, Hannah Maslen & Julian Savulescu - 2019 - Public Health Ethics 12 (2):114-129.
    In this article, we outline a novel approach to understanding the role of responsibility in health promotion. Efforts to tackle chronic disease have led to an emphasis on personal responsibility and the identification of ways in which people can ‘take responsibility’ for their health by avoiding risk factors such as smoking and over-eating. We argue that the extent to which agents can be considered responsible for their health-related behaviour is limited, and as such, state health promotion which assumes certain forms (...)
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  5.  60
    Moral responsibility for (un)healthy behaviour.Rebecca C. H. Brown - 2013 - Journal of Medical Ethics 39 (11):695-698.
    Combatting chronic, lifestyle-related disease has become a healthcare priority in the developed world. The role personal responsibility should play in healthcare provision has growing pertinence given the growing significance of individual lifestyle choices for health. Media reporting focussing on the ‘bad behaviour’ of individuals suffering lifestyle-related disease, and policies aimed at encouraging ‘responsibilisation’ in healthcare highlight the importance of understanding the scope of responsibility ascriptions in this context. Research into the social determinants of health and psychological mechanisms of health behaviour (...)
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  6.  21
    Broad Medical Uncertainty and the ethical obligation for openness.Rebecca C. H. Brown, Mícheál de Barra & Brian D. Earp - 2022 - Synthese 200 (2):1-29.
    This paper argues that there exists a collective epistemic state of ‘Broad Medical Uncertainty’ regarding the effectiveness of many medical interventions. We outline the features of BMU, and describe some of the main contributing factors. These include flaws in medical research methodologies, bias in publication practices, financial and other conflicts of interest, and features of how evidence is translated into practice. These result in a significant degree of uncertainty regarding the effectiveness of many medical treatments and unduly optimistic beliefs about (...)
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  7.  37
    Resisting Moralisation in Health Promotion.Rebecca C. H. Brown - 2018 - Ethical Theory and Moral Practice 21 (4):997-1011.
    Health promotion efforts are commonly directed towards encouraging people to discard ‘unhealthy’ and adopt ‘healthy’ behaviours in order to tackle chronic disease. Typical targets for behaviour change interventions include diet, physical activity, smoking and alcohol consumption, sometimes described as ‘lifestyle behaviours.’ In this paper, I discuss how efforts to raise awareness of the impact of lifestyles on health, in seeking to communicate the need for people to change their behaviour, can contribute to a climate of ‘healthism’ and promote the moralisation (...)
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  8.  46
    Reframing the Debate Around State Responses to Infertility: Considering the Harms of Subfertility and Involuntary Childlessness.Rebecca C. H. Brown, Wendy A. Rogers, Vikki A. Entwistle & Siladitya Bhattacharya - 2016 - Public Health Ethics 9 (3):290-300.
    Many countries are experiencing increasing levels of demand for access to assisted reproductive technologies. Policies regarding who can access ART and with what support from a collective purse are highly contested, raising questions about what state responses are justified. Whilst much of this debate has focused on the status of infertility as a disease, we argue that this is something of a distraction, since disease framing does not provide the far-reaching, robust justification for state support that proponents of ART seem (...)
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  9.  16
    Irresponsibly Infertile? Obesity, Efficiency, and Exclusion from Treatment.Rebecca C. H. Brown - 2019 - Health Care Analysis 27 (2):61-76.
    Many countries tightly ration access to publicly funded fertility treatments such as in vitro fertilisation. One basis for excluding people from access to IVF is their body mass index. In this paper, I consider a number of potential justifications for such a policy, based on claims about effectiveness and cost-efficiency, and reject these as unsupported by available evidence. I consider an alternative justification: that those whose subfertility results from avoidable behaviours for which they are responsible are less deserving of treatment. (...)
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  10.  17
    ‘Maternal request’ caesarean sections and medical necessity.Rebecca C. H. Brown & Andrea Mulligan - 2023 - Clinical Ethics 18 (3):312-320.
    Currently, many women who are expecting to give birth have no option but to attempt vaginal delivery, since access to elective planned caesarean sections (PCS) in the absence of what is deemed to constitute ‘clinical need’ is variable. In this paper, we argue that PCS should be routinely offered to women who are expecting to give birth, and that the risks and benefits of PCS as compared with planned vaginal delivery should be discussed with them. Currently, discussions of elective PCS (...)
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  11.  20
    Deferring to Expertise whilst Maintaining Autonomy.Rebecca C. H. Brown - forthcoming - Episteme:1-20.
    This paper will consider the extent to which patients' dependence on clinical expertise when making medical decisions threatens patient autonomy. I start by discussing whether or not dependence on experts is prima facie troubling for autonomy and suggest that it is not. I then go on to consider doctors' and other healthcare professionals' status as ‘medical experts’ of the relevant sort and highlight a number of ways in which their expertise is likely to be deficient. I then consider how this (...)
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  12.  12
    Response to Commentaries on ‘Responsibility in Healthcare Across Time and Agents’.Rebecca C. H. Brown & Julian Savulescu - 2019 - Journal of Medical Ethics 45 (10):652-653.
    Let us first thank the four commentators who have taken the time to read and thoughtfully reflect on our paper. In that paper, we discuss how responsibility concepts must be sensitive to the temporal and social aspects of health-related behaviour, if responsibility is to play a role in health policy. This ‘if’ is a big one, and Hanna Pickard rightly challenges our position of neutrality with regard to whether or not responsibility should be incorporated into health policy.1 Pickard proposes that (...)
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  13.  23
    Social values and the corruption argument against financial incentives for healthy behaviour.Rebecca C. H. Brown - 2017 - Journal of Medical Ethics 43 (3):140-144.
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  14.  13
    “More effective” is not necessarily “better”: Some ethical considerations when influencing individual behaviour.Rebecca C. H. Brown - 2023 - Behavioral and Brain Sciences 46:e151.
    Chater & Loewenstein make a persuasive case for focusing behavioural research and policy making on s- rather than i-interventions. This commentary highlights some conceptual and ethical issues that need to be addressed before such reform can be embraced. These include the need to adjudicate between different conceptions of “effectiveness,” and accounting for reasonable differences between how people weight different values.
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  15.  14
    A Taxonomy of Non-honesty in Public Health Communication.Rebecca C. H. Brown & Mícheál de Barra - 2023 - Public Health Ethics 16 (1):86-101.
    This paper discusses the ethics of public health communication. We argue that a number of commonplace tools of public health communication risk qualifying as non-honest and question whether or not using such tools is ethically justified. First, we introduce the concept of honesty and suggest some reasons for thinking it is morally desirable. We then describe a number of common ways in which public health communication presents information about health-promoting interventions. These include the omission of information about the magnitude of (...)
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  16.  10
    Disclosure and consent: ensuring the ethical provision of information regarding childbirth.Kelly Irvine, Rebecca C. H. Brown & Julian Savulescu - forthcoming - Journal of Medical Ethics.
    Ethical medical care of pregnant women in Australia should include the real provision of information regarding the risks and benefits of vaginal birth. Routinely obtaining consent for the different ways in which childbirth is commonly intervened on and the assistance involved (such as midwife-led care or a planned caesarean section) and providing sufficient information for women to evaluate the harms and benefits of the care on offer, would not only enable the empowerment of women but would align with the current (...)
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  17.  7
    Correction to: Broad Medical Uncertainty and the ethical obligation for openness.Rebecca C. H. Brown, Mícheál de Barra & Brian D. Earp - 2023 - Synthese 201 (5):1-1.
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  18.  19
    Prospective Intention-Based Lifestyle Contracts: mHealth Technology and Responsibility in Healthcare.Emily Feng-Gu, Jim Everett, Rebecca C. H. Brown, Hannah Maslen, Justin Oakley & Julian Savulescu - 2021 - Health Care Analysis 29 (3):189-212.
    As the rising costs of lifestyle-related diseases place increasing strain on public healthcare systems, the individual’s role in disease may be proposed as a healthcare rationing criterion. Literature thus far has largely focused on retrospective responsibility in healthcare. The concept of prospective responsibility, in the form of a lifestyle contract, warrants further investigation. The responsibilisation in healthcare debate also needs to take into account innovative developments in mobile health technology, such as wearable biometric devices and mobile apps, which may change (...)
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  19.  13
    Proportionality, wrongs and equipoise for natural immunity exemptions: response to commentators.Jonathan Pugh, Julian Savulescu, Rebecca C. H. Brown & Dominic Wilkinson - 2022 - Journal of Medical Ethics 48 (11):881-883.
    We would like to thank each of the commentators on our feature article for their thoughtful engagement with our arguments. All the commentaries raise important questions about our proposed justification for natural immunity exemptions to COVID-19 vaccine mandates. Thankfully, for some of the points raised, we can simply signal our agreement. For instance, Reiss is correct to highlight that our article did not address the important US-centric considerations she helpfully raises and fruitfully discusses. We also agree with Williams about the (...)
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