The ethics of providing health care in resource-poor environments is a complex topic. It implies two related questions: What can we do with the resources on hand? Of all the things we can do, which ones should we do? “Resource-poor” environments are situations in which clinicians, organizations, or healthcare systems have the knowledge and skills, but not the means, to carry out highly effective and beneficial interventions. Determinants of a population’s health often rely less on disease (...) and injury management than on recognizing and meeting their basic needs. Many of the world’s people with the greatest health problems live in fragile contexts and remote areas. Their access to food, safe water, personal safety, improved sanitation facilities, and health care remains elusive, with availability often based on socioeconomic status, gender, ethnicity, or geography. Of course, ethical international healthcare work also requires an understanding of the illnesses and injuries that most frequently plague the population. To function ethically and to know both what can and what should be done with available resources, individuals and organizations involved in international healthcare must be experienced, adaptable, culturally sensitive, inspired, situationally aware, beneficent, courageous, honest, and fair. (shrink)

The ethics of providing health care in resource-poor environments is a complex topic. It implies two related questions: What can we do with the resources on hand? Of all the things we can do, which ones should we do? “Resource-poor” environments are situations in which clinicians, organizations, or healthcare systems have the knowledge and skills, but not the means, to carry out highly effective and beneficial interventions. Determinants of a population’s health often rely less on disease (...) and injury management than on recognizing and meeting their basic needs. Many of the world’s people with the greatest health problems live in fragile contexts and remote areas. Their access to food, safe water, personal safety, improved sanitation facilities, and health care remains elusive, with availability often based on socioeconomic status, gender, ethnicity, or geography. Of course, ethical international healthcare work also requires an understanding of the illnesses and injuries that most frequently plague the population. To function ethically and to know both what can and what should be done with available resources, individuals and organizations involved in international healthcare must be experienced, adaptable, culturally sensitive, inspired, situationally aware, beneficent, courageous, honest, and fair. (shrink)

The Global Code of Conduct for Research in Resource-Poor Settings (GCC) aims to stop the export of unethical research practices from higher to lower income settings. Launched in 2018, the GCC was immediately adopted by European Commission funding streams for application in research that is situated in lower and lower-middle income countries. Other institutions soon followed suit. This article reports on the application of the GCC in two of the first UK-funded projects to implement this new code, one (...) situated in India and one in Pakistan. Through systematic ethics evaluation of both projects, the practical application of the GCC in real-world environments was tested. The findings of this ethics evaluation suggest that while there are challenges for implementation, application of the GCC can promote equity in international research collaborations. (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)

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)

It is widely acknowledged that the HIV and AIDS pandemic is a global emergency and that cheap, effective treatment should be provided for as many people as possible worldwide. But there are many challenges to rolling out antiretroviral treatment in resource-poor settings. These include the cost of drugs, sustaining their supply and distribution, the complexity of treatment regimens, selection of patients for treatment, shortage of medical and nursing personnel, inadequacy of healthcare facilities, the need for uninterrupted, lifelong treatment, (...) and monitoring for drug resistance. Great efforts, nationally and internationally, are required to meet these challenges. (shrink)

Many countries have not considered palliative care a public health problem. With limited resources, disease-oriented therapies and prevention measures take priority. In this paper, I intend to describe the moral framework for considering palliative care as a public health priority in resource-poor countries. A distributive theory of justice for health care should consider integrative palliative care as morally required as it contributes to improving normal functioning and preserving opportunities for the individual. For patients requiring terminal care , we (...) are guided less by principles of justice and more by the duty to relieve suffering and society's commitment to protecting the professional's obligation to uphold principles of beneficence, compassion and non-abandonment. A fair deliberation process is necessary to allow these strong moral commitments to serve as reasons when setting priorities in resource poor countries. (shrink)

In this era of globalization, as the health problems of poor countries and rich countries become increasingly intertwined, medical research is being conducted at the international level. For example, a research study may be sponsored by a developed country and conducted in a resource-poor country to address health problems faced by both nations. The globalization of medical research is, in effect, quickly outpacing the development of internationally accepted ethical guidelines for the conduct of research. For many medical (...) researchers working in resource-poor countries, ethical decision-making is like sailing in the days before modern navigation; one is never quite sure where one is, or in what direction one is headed. Our aim in this article is to fix a few navigational points on an ethical compass to guide biomedical researchers from developed countries working in resource-poor countries.Just as one of the principles underlying the Hippocratic Oath is “First, do no harm,” a principle underlying medical research ethics may be “First, do not exploit.”. (shrink)

This review considers ethical challenges to research design and informed consent in biomedical and behavioral studies conducted in resource-poor settings. A review of the literature explores relevant social, cultural, and ethical issues in the conduct of biomedical and social health research in developing countries. Ten case vignettes illustrate ethical challenges that arise in international research with culturally diverse populations. Recommendations for researchers and policy-makers concerned about ethical practices in multinational studies conducted in resource-poor settings are also (...) listed. (shrink)

Decision-making regarding treatment for newborns with disabilities in resource-poor settings is a difficult process that can put parents and caregivers in conflict. Despite several guidelines that have helped to clarify some of the medical decision-making in Ghana, there is still no clear consensus on the specific moral criteria to be used. This article presents the case of a mother who expressed her wish that her child with Down syndrome should not have been resuscitated at birth. It explores the (...) ethical issues at stake in both her misgivings about the resuscitation and her unwillingness to consider surgical repair of an atrioventricular (AV) canal defect. Knowing that children born with Down syndrome are able to pursue life’s goals, should our treatment of complete AV canal defect in such children be considered morally obligatory, even in resource-poor settings like Ghana? (shrink)

Healthy Volunteers (HVs) who participate in clinical trials are a vulnerable group that deserves specific protection. We assessed the number and types of studies that involve HVs around the world and outline the methodological barriers to their analysis. We found that tens of thousands of HVs are involved every year in clinical trials in a large variety of countries and that the overwhelming majority of studies are not “first-in-human” but pharmacokinetic studies. The two cornerstones for both ethical and safe participation (...) of HVs in clinical trials are properly obtained informed consent, and a minimization of exposure to risk, in particular by avoiding concealed participation in multiple trials. To minimize the risk of exploitation of HVs and their exposure to risk, we propose ways to ensure genuine informed consent, and advocate setting up national Healthy Volunteer volunteer registries as established in France and the U.K. (shrink)

Applying bioethical principles can be difficult in resource-poor environments, particularly for Western doctors unfamiliar with these limitations. The challenges become even greater when clinicians must make rapid critical decisions. As the following case in Zambia illustrates, the Rapid Ethical Decisionmaking Model, long used in emergency medicine, is a useful tool in such circumstances.

A conceptual framework influenced bythe concept of moral ecology is developed andused to analyze the transition fromtechnological (green revolution) to ecological(organic) rice farming by resource poor farmersfrom the Philippine island of Bohol. This MoralEcology Framework (MEF) focuses on theepistemology of the two farming systems and howthis influences management principles andpractice. The orienting concepts of systemic understanding, exchange betweensociety and the environment, local versusextra-local exchange and scope areintegral to this analysis. The case studydemonstrates how the ostracism of nature underthe (...) green revolution coupled with itsinflexible production options affected thesustainability of some local rice farmingsystems. Whereas the transition to organicfarming and the concomitant incorporation ofecological processes and more flexibleproduction options has allowed local farmers toenhance the sustainability of their farmingsystems by altering the exchange processeswithin the socio-ecological system. (shrink)

In this era of globalization, as the health problems of poor countries and rich countries become increasingly intertwined, medical research is being conducted at the international level. For example, a research study may be sponsored by a developed country and conducted in a resource-poor country to address health problems faced by both nations. The globalization of medical research is, in effect, quickly outpacing the development of internationally accepted ethical guidelines for the conduct of research. For many medical (...) researchers working in resource-poor countries, ethical decision-making is like sailing in the days before modern navigation; one is never quite sure where one is, or in what direction one is headed. Our aim in this article is to fix a few navigational points on an ethical compass to guide biomedical researchers from developed countries working in resource-poor countries.Just as one of the principles underlying the Hippocratic Oath is “First, do no harm,” a principle underlying medical research ethics may be “First, do not exploit.”. (shrink)

Ethics dumping is a global phenomenon involving the ‘off-shoring’of research. Research that would be prohibited, severely restrictedor regarded as highly patronizing in high-income regions is instead conducted inresource-poor settings. Twenty-eight case studies of ethics dumping were examined through inductive thematic analysis to reveal predisposing factors from the perspective of researchers from high-income regions. Six categories were agreed and further illuminated: Patronizing conduct, unfair distribution of benefits and/or burdens, culturally inappropriate conduct, double standards, lack of due diligence and lack of (...) transparency. The ultimate aim of the paper is to deepen understanding of thesehighly unethical practicesamongst academics who stand against poverty, leading to theirfurther reduction. (shrink)

Through its adoption of the biomedical model of disease which promotes medical individualism and its reliance on the individual-based anthropology, mainstream bioethics has predominantly focused on respect for autonomy in the clinical setting and respect for person in the research site, emphasizing self-determination and freedom of choice. However, the emphasis on the individual has often led to moral vacuum, exaggeration of human agency, and a thin (liberal?) conception of justice. Applied to resource-poor countries and communities within developed countries, (...) autonomy-based bioethics fails to address the root causes of diseases and public health crises with which individuals or communities are confronted. A sociological explanation of disease causation is needed to broaden principles of biomedical ethics and provides a renewed understanding of disease, freedom, medical practice, patient-physician relationship, risk and benefit of research and treatment, research priorities, and health policy. (shrink)

BackgroundHealthcare ethics is neglected in clinical practice in LMICs such as Nepal. The main objective of this study was to assess the current status of knowledge, attitude and practice of healthcare ethics among resident doctors and ward nurses in a tertiary teaching hospital in Nepal.MethodsThis was a cross sectional study conducted among resident doctors and ward nurses in the largest tertiary care teaching hospital of Nepal during January- February 2016 with a self-administered questionnaire. A Cramer’s V value was assessed to (...) ascertain the strength of the differences in the variables between doctors and nurses. Association of variables were determined by Chi square and statistical significance was considered if p value was less than 0.05.ResultsOur study demonstrated that a significant proportion of the doctors and nurses were unaware of major documents of healthcare ethics: Hippocratic Oath, Nuremberg code and Helsinki Declaration. A high percentage of respondents said that their major source of information on healthcare ethics were lectures, books, and journals. Attitude of doctors and nurses were significantly different in 9 out of 22 questions pertaining to different aspects of healthcare ethics. More nurses had agreement than doctors on the tested statements pertaining to different aspects of healthcare ethics except for need of integration of medical ethics in ungraduate curricula,paternalistic attitude of doctor was disagreed more by doctors. Notably, only few doctors stood in support of physician-assisted dying.ConclusionsSignificant proportion of doctors and nurses were unaware of three major documents on healthcare ethics which are the core principles in clinical practice. Provided that a high percentage of respondents had motivation for learning medical ethics and asked for inclusion of medical ethics in the curriculum, it is imperative to avail information on medical ethics through subscription of journals and books on ethics in medical libraries in addition to lectures and training at workplace on medical ethics which can significantly improve the current paucity of knowledge on medical ethics. (shrink)

The effectiveness of antiretroviral regimes (ARVs) to reduce risk of HIV transmission from mother to child and as post-exposure prophylaxis has been known for almost two decades. Recent research indicates ARVs can also reduce the risk of HIV transmission via sexual intercourse in two other ways. With pre-exposure prophylaxis (PrEP), ARVs are used to reduce risk of HIV acquisition among persons who are HIV negative and significantly exposed to the virus. With treatment as prevention (TasP), ARVs are used to reduce (...) risk of HIV transmission from persons who are already HIV positive. The development of these new prevention strategies raises a rationing problem: given the chronic shortage of ARVs for HIV-infected persons in need of treatment, is it ethically justified to allocate ARVs for PrEP and/or TasP? This article examines the intuitively appealing view that allocation of ARVs for treatment should be the highest priority, the use of ARVs for TasP should be a secondary priority, and that utilizing ARVs for PrEP would be unethical. I will argue that selective, evidence-based allocation of ARVs for prevention in certain cases could be ethically justified even when there is insufficient anti-retroviral access for all those needing it for treatment. (shrink)

The HIV/AIDS epidemic has placed increasing demands on limited paediatric intensive care services in developing countries. The decision to admit HIV infected children with Pneumocystis carinii pneumonia into the paediatric intensive care unit has to be made on the best available evidence of outcome and the ethical principles guiding appropriate use of scarce resources. The difficulty in confirming the diagnosis of HIV infection and PCP in infancy, issues around HIV counselling, and the variance in the outcome of HIV infected children (...) with PCP admitted to the PICU in African studies compound this process. Pragmatic decision making will require evaluation of at least three ethical questions: are there clinical and moral reasons for admitting HIV positive children with PCP to the PICU, should more resources be committed to caring for HIV children who require the PICU, and how can we morally choose candidates for the PICU? Those working in the PICU in HIV endemic regions need to make difficult personal decisions on effective triage of admissions of HIV infected children with PCP based on individual case presentation, availability of resources, and applicable ethical principles. (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.

Healthcare ethics is neglected in clinical practice in LMICs such as Nepal. The main objective of this study was to assess the current status of knowledge, attitude and practi...

Technologies and services provided to resource-poor farmers need to be relevant and compatible with the context in which they operate. This paper examines the contribution of extension services to the food security of resource-poor farmers in a rural village in South Africa. It considers these in terms of the local context and the production of African vegetables in household food plots. A mixture of participatory, qualitative and quantitative research tools, including a household survey, is used to (...) argue that local production practices contribute more to food security requirements than the extension services. This is because of the ability of African vegetables to grow relatively well in semi-arid areas where other exotic plants do not, their ability to provide at least two foodstuffs during their life cycle, and the ability of either the fruit or the leaves, or both, to be dried and stored for consumption in the winter months. These crops can make a significant contribution in terms of household food security, but a number of social and agroecological factors are constraining their production and placing their availability under threat. Despite this, the extension services remain focused on certain activities within vegetable garden projects, even when these are not meeting their proposed purpose—food security by means of cash-crop production. The paper concludes that social and agroecological constraints could be improved if the extension services were changed. This could include the use of context specific and low-cost technologies to ensure that these crops are able to increase their contribution to household food security for resource-poor farmers in semi-arid areas. (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)

Purpose ‐ The purpose of this paper is to explore the "resource curse" problem as a counter-example of creative performance and innovation by examining reliance on capital and physical resources, showing the gap between expectations and ex-post actual performance that became clearer under conditions of economic turmoil. Design/methodology/approach ‐ The analysis uses logistic regressions with dichotomous response and predictor variables on structured tables of count data, representing firm performance as an outcome of capital resources, physical resources and innovation where (...) appropriate. Findings ‐ Key findings relevant to economic and business practice follow. First, a typical characteristic of successful Vietnamese firms in the transition period is their reliance on either capital resources or physical asset endowments. Second, poor performers exhibit evidence of over-reliance on both capital and physical assets. Third, firms that relied on both types of resources tended to downplay creative performance. Some evidence suggests that firms face more acute problem caused by the law of diminishing returns in troubled times. Fourth, the "innovation factor" has not been tapped as a source of economic growth. Research limitations/implications ‐ This study has some limitations. The size of the survey sample is approximately 150 firms, while the potential sample of > 300 should be possible in the future. When the size increases, the research could be expanded to include further variables that will help investigate more deeply into the related issues and business implications. With regard to the implications of the study, the absence of innovations has made the notion of "resource curse" identical to "destructive creation" implemented by ex-ante resource-rich firms, and worsened the problem of resource misallocation in transition turmoil. The Vietnamese corporate sector's addiction to resources may contribute to economic deterioration, through a downward spiral of lower efficiency leading to consumption of more resources. Practical implications ‐ Insights obtained from this study could save transition economies' resources which have almost always been considered sine qua non before any critical major policymaking, while this is not necessarily true, and in many cases, even counterproductive. Originality/value ‐ Original data set on Vietnam stock market are collected, processed, prepared and used by the authors. Original design by the authors for regression equations with dichotomous predictor variables: dependence on endowed physical assets, reliance on capital resources and significant signs of creative performance/innovations. Original idea of viewing "resource curse" as absence of innovation and due to uncreative "destructive creation" of poor-performing commercial operations by resource-rich firms is used in the paper. We have searched the literature in business research and found that the empirical results have not been previously reported. (shrink)

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)

Inequality is an effect of much concern for economists and policy makers. Inequality gives rise to poverty, a phenomenon still troubling the world economy, characterized by a gap wherein the standard deviation between the rich and the poor is too high. Various factors are attributed to the growing inequality, but one which is often overlooked is misallocation of knowledge resources. In this paper, we reinforce the concept of knowledge as being a capital resource. Following this, by using a (...) simple model, we attempt to explain inequality borne out of its heterogeneous allocation and its discrete nature of distribution as a capital resource. The effect being that, lack of access to quality education for those who need it most creates a phenomenon which we call Knowledge Resource Inequality (KRI). (shrink)

The current statist order assumes that states have a right to make rules involving the transfer and/or extraction of natural resources within the territory. Cosmopolitan theories of global justice have questioned whether the state is justified in its control over natural resources, typically by pointing out that having resources is a matter of good luck, and this unfairness should be addressed. This paper argues that self-determination does generate a right over resources, which others should not interfere with. It does not (...) entail, however, that there is no obligation on rich countries to redistribute to poor countries. Indeed, in some rare instances, it might be necessary for a particular political community to use its resources, but the presumption is that the collectively self-determining group should have the right to decide that. (shrink)

In their paper, ‘When are thought experiments poor ones?’ (Peijnenburg and Atkinson 2003), Jeanne Peijnenburg and David Atkinson argue that most, if not all, philosophical thought experiments are “poor” ones with “disastrous consequences” and that they share the property of being poor with some (but not all) scientific thought experiments. Noting that unlike philosophy, the sciences have the resources to avoid the disastrous consequences, Peijnenburg and Atkinson come to the conclusion that the use of thought experiments in (...) science is in general more successful than in philosophy and that instead of concocting more “recherché” thought experiments, philosophy should try to be more empirical. (shrink)

Global poverty measurement is important. It is used to allocate scarce resources, evaluate progress, and assess existing projects, policies, and institutional designs. But given the diversity of ways in which poverty is conceived, how can we settle on a conception and measure that can be used for interpersonal and inter-temporal global comparison? -/- This book lays out the key contemporary debates in poverty measurement, and provides a new analytical framework for thinking about poverty conception and measurement. Rather than trying to (...) find some essential meaning of poverty, the author recommends explicitly reflecting on the purposes served by the concept and the values that do and should inform our conceptions and measures. -/- After reviewing the strengths and weaknesses of five competing conceptions of poverty and their corresponding measures, the book concludes with specific recommendations for the future. Poverty measurement should be developed through a process of public reason that gives weight to the voices of those individuals who are most marginalized and deprived. The author suggests new values, desiderata, and candidate indicators that should be used in a pro-poor poverty measure. (shrink)

In their paper, 'When are thought experiments poor ones?' (Peijnenburg and Atkinson, 2003, Journal of General Philosophy of Science 34, 305-322), Jeanne Peijnenburg and David Atkinson argue that most, if not all, philosophical thought experiments are "poor" ones with "disastrous consequences" and that they share the property of being poor with some (but not all) scientific thought experiments. Noting that unlike philosophy, the sciences have the resources to avoid the disastrous consequences, Peijnenburg and Atkinson come to the (...) conclusion that the use of thought experiments in science is in general more successful than in philosophy and that instead of concocting more "recherché" thought experiments, philosophy should try to be more empirical. In this comment I will argue that Peijnenburg's and Atkinson's view on thought experiments is based on a misleading characterization of both, the dialectical situation in philosophy as well as the history of physics. By giving an adequate account of what the Discussion in contemporary philosophy is about, we will arrive at a considerably different evaluation of philosophical thought experiments. (shrink)

In their paper, ‘When are thought experiments poor ones?’ (Peijnenburg and David Atkinson, 2003, Journal of General Philosophy of Science 34, 305-322.), Jeanne Peijnenburg and David Atkinson argue that most, if not all, philosophical thought experiments are “poor” ones with “disastrous consequences” and that they share the property of being poor with some (but not all) scientific thought experiments. Noting that unlike philosophy, the sciences have the resources to avoid the disastrous consequences, Peijnenburg and Atkinson come to (...) the conclusion that the use of thought experiments in science is in general more successful than in philosophy and that instead of concocting more “recherché” thought experiments, philosophy should try to be more empirical. In this comment I will argue that Peijnenburg’s and Atkinson’s view on thought experiments is based on a misleading characterization of both, the dialectical situation in philosophy as well as the history of physics. By giving an adequate account of what the discussion in contemporary philosophy is about, we will arrive at a considerably different evaluation of philosophical thought experiments. For I am convinced that we now find ourselves at an altogether decisive turning point in philosophy, and that we are objectively justified in considering that an end has come to the fruitless conflict of systems. We are already at the present time, in my opinion, in possession of methods which make any such conflict in principle unnecessary. What is now required is their resolute application. (Schlick, ‘The Turning Point in Philosophy’, 1930/1959, p. 54). (shrink)

One of the most interesting questions raised in Cecile Fabre’s Cosmopolitan War concerns war for the sake of resources. Fabre argues that it is sometimes permissible to go to war for the sake of resources that the poor are entitled to. I agree with this, but I think it is true only in very restricted circumstances. I consider a number of arguments in favour of resource wars, showing many of them to fail. The most promising argument, I suggest, (...) is that those who possess resources that have unjustly been secured are complicit in posing future threats by contributing to a market for unjustly secured resources. Whilst this argument has some promise, even it, I suggest, is in no way decisive. (shrink)

With a global commitment to scaling up AIDS care and treatment in resource-poor settings for some of the most HIV-affected countries in Africa, availability of antiretroviral treatment is no longer the principal obstacle to expanding access to treatment. A shortage of trained healthcare personnel to initiate treatment and manage patients represents a more challenging barrier to offering life-saving treatment to all patients in need. Physician-centered treatment policies accentuate this challenge. Despite evidence that task shifting for nurse-centered AIDS patient (...) care is effective and can alleviate severe physician shortages that currently obstruct treatment scale-up, political commitment and policy action to support task shifting models of care has been slow to absent. In this paper we review the evidence in support of task shifting for AIDS treatment in Africa and argue that continued policy inaction amounts to unwarranted healthcare rationing and as such is ethically untenable. (shrink)

An idea is a public good. The use of an idea by one person does not hinder others to benefit from the same idea. However in order to generate new life-saving ideas, e.g. inventions in the life sciences, a huge amount of human and material resources are needed. Powerful, but highly criticized tools to speed up the rate of innovation are exclusive rights, most prominently the use of patents and plant breeders’ rights. Exclusive rights leave by nature a number of (...) people empty-handed, with starvation, stuntedness, prevalence of disease and death as preventable and quotidian consequences. To stimulate a human rights compatible use of exclusive rights a wide range of moral frameworks have been developed to condemn current praxes. Most prominent in the debate are theories building on (1) utilitarian calculations of weighing benefits with Peter Singer as a prominent advocate, (2) Pogge’s vindication of compensatory duties for institutional harms, (3) a comprehensive analysis on how the current innovation incentive system fails to secure human rights and human capabilities and lastly (4) showing how the status quo nurtures misrecognition. With help of those theories modest targets as well as a thorough restructure of the innovation incentive system can be justified. Those theories have the mammoth task of restraining well-established ideas supporting the permissibility of a reckless use of property rights that are deeply anchored in the property law discourse. Life sciences raise a range of special problems when justifying pro-poor innovation. Healthy people living in a society with a good sanitary infrastructure need far less resources to tackle health problems than people in places with a poor infrastructure. Patents that involve gene sequences (or part thereof) make inventing around impossible, making the seeking of licenses mandatory for investigators wanting to make follow-up research with the molecule. Speedy sharing of data concerning public health hazards or threats to food security are vital to maintain living standards. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Introduction:Developing Health Care in Severely Resource-Constrained SettingsPaul Farmer and Sadath SayeedThis symposium of Narrative Inquiry in Bioethics catalogues the experiences of health care providers working in resource-poor settings, with stories written by those on the frontlines of global health. Two commentaries by esteemed scholars Renee Fox and Byron and Mary-Jo Good accompany the narratives, helping situate the lived experiences of global health practitioners within the frameworks (...) of sociology and medical anthropology respectively.The burgeoning interest in global health among students, health science trainees, clinical practitioners, social entrepreneurs, philanthropists, and government officials is often linked with substantial moral claims. People working in global health often start with the rhetorical premise that each and every human being, regardless of economic, social, or political circumstances that lie beyond his or her control, deserves equal access to quality health care services. This is a bold position at risk of trivialization, in part because the sentiment is so commonplace among global health equity activists.Despite this relatively recent global outpouring of solidarity and concern, billions of poor people still lack access to basic health services. All too often, interventions that perpetuate existing trade practices and market economics are promoted, usually to the detriment of the poor. As our good friend and colleague Arthur Kleinman warns:The irrelevance of ethics can be seen when considering universal ethical formulations of justice and equity that do not begin with the local moral conditions of poor people, those experiencing the systematic injustice of higher disease rates and fewer health-care resources because of their positioning at the bottom of local social structures of power.(1999, p.72)If we are serious about reducing health disparities globally, we must be prepared to mobilize resources in Africa just as we would in the United States or in Europe. If we fetishize cost-effective (read: low-cost) interventions for the poor, we must ask whether we use the same metrics in other situations. In other words, we must always strive to address the fundamental structural and social causes of health inequity.We believe that global health must avoid the "iron cage of rationality," to use sociologist Max Weber's words. One unanticipated consequence of the growth of global health as a field is that the "audit culture"—which encourages accountability and effectiveness—can at times reinforce power differentials between donors (whether government agencies or multilateral foundations) and their intended beneficiaries. Agendas are often set not by community members but by global health leaders who rarely demonstrate sustained commitments to a local community. [End Page 73]As the guest editors of this issue, we hope to recapture the soul of global health work through the art of storytelling. Narratives, even when presented as raw and unrefined as many within this issue, remind us of the immense challenges—both programmatic and moral—involved in this work. The profound scarcity of resources available to health providers in poor countries forces ethical questions on doctors, nurses, pharmacists, social workers, and other health care workers, who make difficult choices every day about what to do with the few resources they have. These are the ethical dilemmas of mortal dramas at their most dire. Global health work demands of its practitioners an alternate mode of audit than academic methodologies can provide. Narratives return us to the basic human commitments that led many of us to this work, and they remind us to use words like equality and justice meaningfully.The narratives that follow offer unmitigated perspectives on the working lives of global health practitioners. They highlight the translation of the moral and programmatic challenges of health care delivery into real choices: for example, between a visiting surgeon's desire to treat a patient and his capacity (or really incapacity) to provide follow-up care. They acknowledge the necessity of interdisciplinary cooperation in resource-constrained settings, as well as the difficulties in collaborating across cultures and continents. Most importantly, they make the claim that a newborn in distress in a tent in Port-au-Prince merits the same resources and attention as one in Boston, and that his or her death merits the same indignation. They demonstrate the radical solidarity inherent in the... (shrink)

The Totonac homegarden is a traditionally designed agroecosystem mixing different elements, such as cultivated and wild plants, and livestock. Our objective was to understand the role and importance of homegardens as a strategy for subsistence and natural resources management. Anthropological fieldwork was carried out in Coxquihui, Veracruz, Mexico, a Totonac community. Conventional sampling using a questionnaire yielded a sample of 40 individuals, each representing a family group. Personal interviews, life stories, observations, and field transects enriched survey information. Fieldwork permitted identification (...) of four types of Totonac homegardens: backyards, cropping fields, acahuales or fallow fields, and fences or field edges. Each of these gardens yields an array of products and services important for several cultural roles and natural resource management aims. Totonacs see land as the dominant and most critical resource. A great deal of terrain is steeply sloped and soils are poor. Homegardens play a key role in a production system that minimizes these site limitations, striking a balance between resource maintenance and subsistence needs. Their functions are ecological, to foster a multistrata vegetation cover, and a continuous supply of organic matter to the soil; economic, serving as living storehouses where diverse products (food, timber, firewood, forage, animals, ceremonial supplies, medicinal products), are kept through the annual cycle; and social, performing various social roles such as growing medicinal, ritual, and edible plants, thus supporting beliefs and culture continuity. Studies like this contribute to a better understanding of Totonac culture and native ecology, and give ideas for a better land management. (shrink)

Objective To compare the perspectives of medical students in the preclinical and clinical phases of medical training on the issue of rationing scarce medical resources in times of crisis. Methods Questionnaire-based cross-sectional study. Results A total of 201 participants took part in the study, with 100 participants in the preclinical phase group, and 101 in the clinical phase group. A multivariable analysis found that just 14.9% (n = 34) of the clinical phase students were willing to give a short-supplied blood (...) unit to the first-arrived patient to the emergency department when more patients are expected compared to 63.9% in the preclinical group (n = 62) ( p < 0.001, OR = 0.75 95% CI: 0.029−0.192). Seventy-four percent (n = 74) of the clinical phase students were found to be willing to remove a patient from a respirator to allocate it to an ill child compared to 35.7% (n = 35) in the preclinical phase group ( p < 0.001, OR = 4.168 95% CI: 1.931−8.998). Of the clinical phase group, 46.6% (n = 41) were willing to allocate a short supplied flu medicine to a patient with poor prognosis compared to 57.7% (n = 56) in the preclinical phase group ( p = 0.04, OR = 0.457 95% CI: 0.216−0.966). Conclusion Clinical exposure during training may affect the way medical students make ethical decisions, independent of age, sex, as well as marital and parental status. (shrink)

Hennie Lötter, in his book Poverty, Ethics, and Justice, contends that we have a moral obligation to eradicate global poverty, but does so under the assumption that eradicating poverty is possible under current political and economic policy. Roughly 1.8 billion people (the consuming class) currently consume the majority of the world’s economic production. About 5.2 billion poor people (the non-consuming class) would like to consume at similar levels. Is it possible for the non-consuming class to approach levels of material (...) welfare similar to that of the consuming class? What would be the impact on the global environment if the billions of the non-consuming class started to consume at a reasonable standard? The answers to these questions are rather bleak for the cause of eradicating poverty: discussions on global poverty like Lötter’s fail to cohere with data on the environment and regarding resources constraints. Without radical transformation of current economic and political philosophy, the assumption that the eradication of poverty is possible is a false assumption. (shrink)

Hennie Lötter, in his book Poverty, Ethics, and Justice, contends that we have a moral obligation to eradicate global poverty, but does so under the assumption that eradicating poverty is possible under current political and economic policy. Roughly 1.8 billion people currently consume the majority of the world’s economic production. About 5.2 billion poor people would like to consume at similar levels. Is it possible for the non-consuming class to approach levels of material welfare similar to that of the (...) consuming class? What would be the impact on the global environment if the billions of the non-consuming class started to consume at a reasonable standard? The answers to these questions are rather bleak for the cause of eradicating poverty: discussions on global poverty like Lötter’s fail to cohere with data on the environment and regarding resources constraints. Without radical transformation of current economic and political philosophy, the assumption that the eradication of poverty is possible is a false assumption. (shrink)

Two of the greatest challenges facing humanity are environmental degradation and the persistence of poverty. Both can be met by instituting a Global Resources Dividend (GRD) that would slow pollution and natural-resource depletion while collecting funds to avert poverty worldwide. Unlike Hillel Steiner's Global Fund, which is presented as a fully just regime governing the use of planetary resources, the GRD is meant as merely a modest but widely acceptable and therefore realistic step toward justice. Paula Casal has set (...) forth various ways in which this step might be improved upon. Solid counter-arguments can be given to her criticisms and suggestions. But to specify the best (effective and realizable) design of an appropriate global institutional mechanism with some confidence, economists, political scientists, jurists, environmental scientists, and activists would need to be drawn in to help think through the immense empirical and political complexities posed by this urgent task. (shrink)

Contrary to much Kant interpretation, this article argues that Kant's moral philosophy, including his account of charity, is irrelevant to justifying the state's right to redistribute material resources to secure the rights of dependents (the poor, children, and the impaired). The article also rejects the popular view that Kant either does not or cannot justify anything remotely similar to the liberal welfare state. A closer look at Kant's account of dependency relations in “The Doctrine of Right” reveals an argumentative (...) structure sufficient for a public institutional protection of dependents and evidence that Kant identifies concerns of economic justice as lying at the heart of the state's legitimacy. (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.

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.

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)

North Sumatra and West Java in Indonesia, the Andes of Bolivia and Peru, Western Province, the Coast and Machakos in Kenya, were Small Ruminant Collaborative Research Support Program (SR-CRSP) sites in which the role of small ruminants was studied and where technological interventions were designed. In all cases the target groups were poor rural households that could maintain sheep, goats, or South American camelids. The objective was to increase the welfare of families through the use of small ruminant technologies. (...) Access to and control of resources, and intrahousehold dynamics were analyzed to understand if, how, and when, technological interventions help achieve this objective. The way in which the studied villages integrate into the market, the specific role that livestock and other productive enterprises play in the household economy, the risks faced by families in rural areas condition the role of livestock and other resource management technologies. As an asset, small and large stock are gendered, but this is qualified by the alternatives that household members have. Small ruminants under the domain of women, either through production or marketing, are shown to contribute to in-kind consumption or, as liquid assets, to household welfare purchases, in the case of Andean agropastoral households and households in Kenya. Women are also managers of the grazing areas, which are often fallow fields. The research experiences show the relationship between gender, resource management, and the ability to build livestock assets and security, in different houehold production systems. (shrink)

Should we grant a fresh start to those who come to regret their past lifestyle choices? A negative response to this question can be located in the luck egalitarian literature. As a responsibility-sensitive theory of justice, luck egalitarianism considers it just that people’s relative positions reflect their past choices, including those they regret. In a recent article, Vansteenkiste, Devooght and Schokkaert argue against the luck egalitarian view, maintaining instead that those who regret their past choices in health are disadvantaged in (...) a relevant way and should receive compensation. Employing the ideal that people should be made equal as measured by equivalent resources, they purport to show the fairness of such an arrangement through a hypothetical scenario. Relaxing the implicit assumptions of this scenario brings forth several unattractive consequences of the fresh-start idea. The main problem is that in striving to ensure that people’s past choices do not affect their own opportunities, the authors must accept that these choices put heavy strains on the opportunities available to other people. Furthermore, the luck egalitarian position is more compelling than they admit. (shrink)