An excellent critical analysis and scientific assessment of the nature and actual level of risk leading environmental health hazards pose to the public. Issues such as radiation from nuclear testing, radon in the home, and the connection between electromagnetic fields and cancer, environmental factors and asthma, pesticides and breast cancer and leukemia clusters around nuclear plants are discussed and how scientists assess these risks is illuminated.

Environmental health research produces scientific knowledge about environmental hazards crucial for public health and environmental justice movements that seek to prevent or reduce exposure to these hazards. The environment in environmental health research is conceptualized as the range of possible social, biological, chemical, and/or physical hazards or risks to human health, some of which merit study due to factors such as their probability and severity, the feasibility of their remediation, and injustice in their distribution. This (...) paper explores the ethics of identifying the relevant environment for environmental health research, as judgments involved in defining an environmental hazard or risk, judgments of that hazard or risk's probability, severity, and/ or injustice, as well as the feasibility of its remediation, all ought to appeal to non-epistemic as well as epistemic values. I illustrate by discussing the case of environmental lead, a housing-related hazard that remains unjustly distributed by race and class and is particularly dangerous to children. Examining a controversy in environmental health research ethics where researchers tested multiple levels of lead abatement in lead-contaminated households, I argue that the broader perspective on the ethics of environmental health research provided in the first part of this paper may have helped prevent this controversy. (shrink)

Using the example of air pollution, I criticize a restricted utilitarian view of environmental risks. It is likely that damage to health due to environmental pollution in Western countries is relatively modest in quantitative terms (especially when considering cancer and comparing such damage to the effects of some life-style exposures). However, a strictly quantitative approach, which ranks priorities according to the burden of disease attributable to single causes, is questionable because it does not consider such aspects as inequalities (...) in the distribution of risks. Secondly, the ability of epidemiological research to identify some health effects is limited. Third, the environment has symbolic and aesthetic components that overcome a strict evaluation of damage based on the impairment of human health. It is not acceptable that priorities be set just balancing the burden of disease caused by pollution in the environment against economic constraints. As an example of a computation that inherently includes economic analysis, I refer to the proposal of an estimator of mortality in coal mining, i.e., a rate which puts deaths in the numerator and tons of coal extracted in the denominator. According to this estimator, mortality due to accidents decreased from 1.15 to 0.42 in the period 1950–1970 in the United States, for each million tons of coal extracted. However, considering the steep decline in the workforce in the same period, the traditional mortality rate (deaths over persons-time) actually increased. The proposal of a measure of mortality based on the amount of coal extracted is just one example of the attempts to influence decisions by including an economic element (productivity) in risk assessment. This paper has three purposes: One, to describe empirical research concerning the health effects of environmental pollutants; two, to discuss the scientific principles and methods used in the identification of environmental hazards; and three, to critically discuss some of the ethical principles which are applied in medicine and in the assessment and management of risk. (shrink)

Discussions of socioeconomic liability and compensation must necessarily start from an understanding of the socioeconomic, legal, and scientific basis for identifying, assessing, managing, and apportioning blame for hazards related to innovations. Public discussions about the nature of the liability challenge related to genetically modified (GM) crops and other modified organisms have focused less on direct, traditional health, public safety, technical, or environmental failures (e.g., innovations that generate hazards directly for users or indirectly to bystanders) and more on socioeconomic (...) concerns, such as comingled product that offends product quality standards. This article examines the theoretical and legal underpinnings of the current risk analysis framework used in most Organization for Economic Cooperation and Development countries and uses it to assess two areas of significant controversy—the release of herbicide-tolerant canola and flax varieties in Western Canada. The article offers lessons for the management of liabilities arising from the introduction of GM crops. (shrink)

PurposeAlthough an increasing body of literature suggests a relationship between brain irradiation and deterioration of neurocognitive function, it remains as the standard therapeutic and prophylactic modality in patients with brain tumors. This review was aimed to abstract and evaluate the prediction models for radiation-induced neurocognitive decline in patients with primary or secondary brain tumors.MethodsMEDLINE was searched on October 31, 2021 for publications containing relevant truncation and MeSH terms related to “radiotherapy,” “brain,” “prediction model,” and “neurocognitive impairments.” Risk of bias (...) was assessed using the Prediction model Risk Of Bias ASsessment Tool.ResultsOf 3,580 studies reviewed, 23 prediction models were identified. Age, tumor location, education level, baseline neurocognitive score, and radiation dose to the hippocampus were the most common predictors in the models. The Hopkins verbal learning and the trail making tests were the most frequent outcome assessment tools. All studies used regression as machine learning method. All models were judged to have a high risk of bias mainly due to issues in the analysis.ConclusionExisting models have limited quality and are at high risk of bias. Following recommendations are outlined in this review to improve future models: developing cognitive assessment instruments taking into account the peculiar traits of the different brain tumors and radiation modalities; adherence to model development and validation guidelines; careful choice of candidate predictors according to the literature and domain expert consensus; and considering radiation dose to brain substructures as they can provide important information on specific neurocognitive impairments. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context (...) of a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS l. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[1] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[2] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. ll. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[3] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[4] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[5] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[6] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[7] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[8] In democratic societies, one must take into consideration community morals and values.[9] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[10] lll. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[11] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[12] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[13] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[14] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. lV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[15] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[16] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[17] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[18] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[19] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[20] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[21] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. Vl. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[22] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[23] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[24] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. Vll. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [1] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [2] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [3] Moss, p. 1295-1298. [4] Moss, p. 1296. [5] Moss, p. 1295-1298. [6] Moss, p. 1295-1298. [7] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [8] Cohen, p. 1299-1301. [9] Moss, p. 1297. [10] Cohen, p. 1300. [11] Cappelen, p. 478-480. [12] Cappalen, p. 478-480. [13] Cappelen, p.479. [14] Cappelen, p. 479. [15] Cappelen, p. 479 [16] Cohen, p. 1301. [17] Cappelen, p. 478. [18] Cohen, p. 1299-1301. [19] Cohen, p. 1301. [20] Cappelen, p. 476-480. [21] Cappelen, p. 476-480. [22] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [23] Kawachi, p. 18-33. [24] Kawachi, p. 18-33. (shrink)

Every year, the number of tourists in the Chernobyl Exclusion Zone is increasing. The most numerous visitors are journalists who come to perform theirofficial duties. At the same time, researchers have not yet shown interest in such an interesting and important tourist phenomenon. The purpose of this article is to de- scribe a new phenomenon of media tourism in the Chernobyl Exclusion Zone and its features. The study was conducted with a help of a qualitative case study analysis method. (...) The websites of the state and private enterprises and mass media publications based on the results of trips to the territory for 2013-2017 were analyzed. As a result, the specific features of journalists who visit the Chernobyl Exclusion Zone were identified. Such journalists mainly have confidence in the absence of a threat to health (55%), developed empathy (45%) and imagination of thinking (45%). Consequently, the tragedy of history and the gloomy appearance of the territory, the suffering of local residents make it attractive to journalists. In addition, due to personal interest, the voluntary travel motive (61,5%) prevails over conditional forced travel (38,5%). At the same time, the attention of journalists to the territory is attracted due to the activities of tourists. The authors describe the so-called «compensation effect», when the reduction of tourists' attention to the territory is balanced by an increase in the attention of the mass media. The presence of risk explains the predominance of men among journalists in the Chernobyl Exclusion Zone (54%). For example, women can better assess the risk due to greater vulnerability. The peculiarity of journalists' work in the Chernobyl Exclusion Zone is the risk of radiation exposure and ethical controversy. The study shows that journalists' inherent positive world perception and profound sense of professional duty can successfully overcome these obstacles. The results of the study can be used by the following researchers to identify ways and strategies for promoting media tourism in the Chernobyl Exclusion Zone. The benefit of this study is to draw attention to a new unexplored tourist phenomenon. Mass media have a great influence on the formation of a positive attitude towards the territory and attracting the attention of tourists. Taking into account the specific features of media tourism will help to attract more tourists and improve the quality of rendering service to journalists. (shrink)

First concerns about the use of nanosilver were raised almost a decade ago, but assessing the risks has been extremely challenging scientifically, and regulation to protect environmental and human health remains controversial. In order to understand the known risks and issues associated with the use of nanosilver, we carried out a DPSIR analysis and analysed drivers, pressures, state, impacts and potential policy responses. We found that most concerns relate to the potential development of multi-resistant bacteria and (...) the environmental impacts of nanosilver. From the DPSIR analysis, we found that new legislation for nanomaterials in general and nanosilver-specific changes in the current European chemical, biocide and medical legislation were the optimal policy responses, along with limiting the overall use of nanosilver. In order to qualify the identified potential policy responses, we carried out a stakeholder analysis, in order to explore possibilities for reaching consensus amongst stakeholders. Through the stakeholder analysis, the interests, views, power and influence of the identified stakeholders were mapped. Overall, the policy options identified in the DPSIR analysis were deemed not to be implementable, as industry and NGOs seem to have fundamentally conflicting views and interests. The use of the combination of DPSIR and stakeholder analysis proved valuable for use in cases of complexity, as they compensate for each other’s limitations and open up for a discussion what can be done to reduce risks. (shrink)

Previous research has identified several factors (such as remuneration, workload, negative perceptions of criminal defendants) which may lead to a barrister not acting in the defendant's best interests, when advising on plea or engaging in plea bargaining. This article applies aspects of the principal – agent problem to the relationship between defence barristers and defendants in England and Wales in order to analyse the extent to which incentives can align the interests of the agent (the barrister) with those of the (...) principal (the defendant) in order to prevent moral hazard caused by the agent's competing interests. Coercive, material and moral incentives are considered, and the role of the solicitor and the significance of the barrister's reputation are also discussed. It is argued that none of the forms of incentive which would traditionally reduce the risk of moral hazard do so to any great extent in the barrister – defendant relationship, and that this is due in part to the complexity of the overlapping principal – agent dynamics within which the barrister – defendant relationship lies. (shrink)

After WWII, global concerns about the uses of nuclear energy and radiation sources in agriculture, medicine, and industry brought about calls for radiation protection. At the beginning of the 1960s radiation protection involved the identification and measurement of all sources of radiation to which a population was exposed, and the evaluation and assessment of populations in terms of the biological hazard their exposure posed. Mexico was not an exception to this international trend. This paper goes back to the origins of (...) the first studies on the effects of radiation and on radioprotective compounds in the Genetics and Radiobiology Program of the National Commission of Nuclear Energy founded in 1960, at a time when the effects of radiation on living beings and radiation protection demanded the attention of highly localized groups of scientists and the creation of international as well as national institutions, and its connection to dosimetry and radiation protection until the 1990s. This historical reconstruction examines the circulation of knowledge, scientists, and their material and cognitive resources, to show that radiobiology, with dosimetry and radiation protection as cases in point, not only were carried out with high international standards in parallel with international agencies, but also reflected local material needs, including the standardization of new experimental techniques. (shrink)

Blue-collar workers throughout the world generally face higher levels of pollution than the public and are unable to control many health risks that employers impose on them. Economists tend to justify these risky workplaces on the grounds of the compensating wage differential (CWD). The CWD, or hazard-pay premium, is the alleged increment in wages, all things being equal, that workers in hazardous environments receive. According to this theory, employees trade safety for money on the job market, even though (...) they realize some of them will bear the health consequences of their employment in a risky occupational environment. To determine whether the CWD or hazard-pay premium succeeds in justifying alleged environmental injustices in the workplace, this essay (1) surveys the general theory behind the “compensating wage differential”; (2) presents and evaluates the “welfare argument” for the CWD; (3) offers several reasons for rejecting the CWD, as a proposed rationale for allowing apparent environmental injustice in the workplace; and (4) applies the welfare argument to an empirical case, that of US nuclear workers. The essay concludes that this argument fails to provide a justification for the apparent environmental injustice faced by the 600,000 US workers who have labored in government nuclear-weapons plants and laboratories. (shrink)

Regardless of unpredictable and contingent geopolitical events such as last year’s surprising rejection of the European Constitution in France and the Netherlands, this coming year will certainly witness a large surge in patriotism. The Winter Olympics in February, and the World Cup in the summer, both promise to whip national sentiments into a fever pitch. One other thing is certain, though: journals of philosophy and ethics will continue to debate the virtues of cosmopolitanism, as this number of Ethical Perspectives does (...) through its contributions below.Why is this? Why do philosophers and academics hold on to this idea of cosmopolitanism, an idea utterly lacking in the convictions of the general public? Is it perhaps because the first cosmopolitans were in fact philosophers? The first to identify himself as a cosmopolitan was Diogenes the Cynic, and Plato’s dialogues paint many of the Sophists in cosmopolitan hues. Although people generally support the idea of internationalism as far as it promotes trade, travel, and football tournaments, once it begins to meddle in internal affairs, as it does with outsourcing and transnational constitutions, they tend to fall back upon the patria. They killed Socrates for corrupting the youth of Athens, not the youth of the world.Whether it is the service and manufacturing industries of Asia and India ‘stealing’ American jobs, or widespread fears of Brussels’ legendary bureaucrats, the non-academic public consistently turns from its tepid embrace of cosmopolitanism to patriotism whenever threatened. Are we too quick to label this as self-interest or even selfishness? Or is there something else at work in the debate between cosmopolitanism and patriotism? Some approaches to cosmopolitanism are certainly guilty of an absolute removal of difference, of wishing away the nation state, of replacing it with an international body based on purely universal principles, and of wiping away the competencies of nations on many levels. The call for the world state can come across as an appeal for an anodyne and internationalist homogeneity based on a clinical morality that, for all its sensitivity, runs roughshod over the well-engrained cultural, legal, and social beliefs of many peoples.Clearly, this is what many Europeans fear, and to a large degree, Americans as well in their dislike for the International Court of Justice. Even the economic hegemony of outsourcing removes national power, and replaces it with pure economic rationality.Our contributors below do not advocate these reductions, although some may point to them. Key to each contribution below is sensitivity to the world as it is, to its need for difference even in the face of an ever-increasing globalisation that sometimes is connected with cosmopolitanism. Yet, every proponent of cosmopolitanism must sketch how it is possible in practice. Of course, an obvious problem is how to dwell consequently as a cosmopolitan. Not many contemporary cosmopolitans would be prepared to follow Diogenes’ commitment to rootlessness: living in exile after having been included in a forgery conviction aimed at his father, the ascetic Diogenes called a barrel his home. Such was his drive to live a levelled life that he cast away his only bowl upon seeing a poor peasant boy drinking from cupped hands. Today’s cosmopolitan leads a much more prosaic life, and hence the problem with cosmopolitanism begins as something mundane. Does not a cosmopolitan still pay national taxes? Does not a cosmopolitan still need a national passport and second country visas? But, the questions quickly turn ontological: how can one shed oneself of one’s nationality, of one’s belonging, as if it is just an accident of one’s own constitution, instead of as an important property of one’s own constitution? In other words, belonging is important: a citizen of the world still values citizenship. Clearly, the absolute cosmopolitan reduction is an absurdity: one is always rooted, in some sense. Even cosmopolitanism is rooted in a specific Western mindset, and is no self-evident preference of human existence.As Rudi Visker’s contribution so clearly shows through an investigation of the narcissism of minor differences, these questions revolve around the question of confrontation with alterity. What I am, in no small way plays off what I am not. I cannot be everything, if I am something. Freud’s analysis of minor differences reveals that members of a group identify with that group on the basis these minor differences. What is self-evident to a particular culture marks that culture off from another culture, a culture that by definition does not share the same set of the self-evident. To be a foreigner, as any ex-patriot can attest, is to stand outside of the self-evident, whether this means interpreting gestures, understanding commercial practices, or, as Freud would have it, staying on the correct side of national taboos. There is thus a dialectic of inner and outer, a dialectic which refuses a reduction of one to the other. As Visker puts it, recognising the stranger within oneself is quite different than recognising the stranger outside of oneself, and to confuse these as being the same is not only to misunderstand the very issue at stake, it is also a dangerous trivialisation of difference.But clearly, there is something viable and laudable in the idea of cosmopolitanism, since it stresses the universal moral community of humanity. Cosmopolitanism is an attempt to see all human subjects as subject to the same moral law. Indeed, the sort of federation to which cosmopolitanism leads, at least in a modified Kantian expression as Bert van Roermund tells us, even gives us good grounds to recognise the legitimacy and moral equivalence of states. Importantly, the international legal order does not draw its power from any supranational force, but from the choice of independent national actors to recognise it. Hence, this cosmopolitan order depends on nationhood, and good standing within this order depends on the degree to which a country decides to participate. Again, the universal here depends on well-rooted particularity, a particularity able to choose for the universal.What do we do, then, with outlaw nations, those nations that are hostile to the choice for the universal? Through a clear reading of Hegel, Paul Cobben proposes that the metric for a state’s legality is the measure to which it permits the moral freedom of its citizens to bloom. A free person requires a free legal order; only in such can a person obtain the full measure of human rights due. States that do not permit this blooming are illegitimate; they contradict the nature of the human person, and citizens dwelling under the yoke of these have the right to ask for outside assistance in removing this illegitimate power above them. However, for this plea to be met, two conditions must obtain: the oppressed people must have the wherewithal to form a political order after the removal of the illegitimate state, and the action must be grounded in the principles and support of a legal community, which in essence would be a world federation of states. In fact, it is morally incumbent upon all legal states to aim at such a world federation, upon pain of contradiction.Our duty to others does not end with the politically oppressed; the economically oppressed also lay a moral claim upon us. So, as Toon Vandevelde asks in his contribution, what about the global poor? The poor are hungry and in need of shelter and a future, but to address these issues at the level of rights is in a way heartless: what good does it do to legislate that everyone has the right to food, when this right can never be called upon, or enforced, in any meaningful sense? Moreover, approaches that demand non-prioritised generosity not only ignore the fundamental economic fact of scarcity, they also run the risk of creating the moral hazard of dependence on charity. The true cosmopolitan approach is the recognition of our common humanity and of our concomitant duty to help others as far as this help does not endanger us. This duty is compounded by the marginalisation of the poor through globalisation, a globalisation that they did not ask for. The extent of our help is indeterminate, but its direction is clear: it must aim to integrate those poor who wish it within our international systems, and so to ease their own transitions from poverty.Both Gil Anidjar and Maria Bonnafous-Boucher continue this theme of economy, but each from a highly specific viewpoint. Indeed, their contributions are perhaps somewhat darker, delving into an aspect of the unspoken underneath the choice for the universal. Anidjar begins with the relation between religion and economy within the interplay of Judaism and Christianity, whereas Bonnafous-Boucher focuses on the development of political economy through a Foucaultian lens. Although highly distinct contributions, both share the insight that the economy is now the central theme of our power structures, and that economy, isolated from questions of morality or justice, must likewise play a decisive role within the structure of cosmopolitanism, or, at minimum, the political unity of peoples. For, national government long ago ceded to a promiscuous mix of governance, and religion to economy. This nexus enthrones governance as an economic rationale stripped of all other trappings, and inscribes any possible cosmopolitanism within a framework of an aggressive capitalism, a kind of economic theology, a kind of hegemony in which state boundaries are essentially liquefied. Capital, after all, knows no boundaries. (shrink)

This paper argues that common social narratives about unhealthy eaters can cause significant damage to agency. I identify and analyze a narrative that combines a “control model” of eating agency with the healthist assumption that health is the ultimate end of eating. I argue that this narrative produces and enables four types of damage to the agency of those identified as unhealthy eaters. Due to uncertainty about what counts as healthy eating and various forms of prejudice, the (...) unhealthy eater label and its harms to agency are more likely to stick to some people than others and may reinforce patterns of oppression. I argue that fat people are especially vulnerable to this identification and the damage it can do. I then consider possible “counterstories” about unhealthy eaters, alternative narratives that might be less damaging to agency than the control narrative. I identify one promising counterstory but suggest that it may be limited when it comes to repairing damage to the agency of fat people. Overall, this paper illustrates some of the complex ways that healthism about eating affects agency, and emphasizes the ethical importance of the ways we think about and discuss eating and eaters. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Deep Listening and Virtuous Friendship:Spiritual Care in the Context of Religious MultiplicityDuane R. BidwellA monk asked Zen master Yunmen: “What is the teaching of the Buddha’s entire lifetime?” Yunmen answered:“An appropriate response.”1In a pivotal scene from the 1988 film A Fish Called Wanda, con artist Wanda Gershwitz is fed up—finally—with her partner, Otto West. When his jealousy and ersatz intellectualism repeatedly jeopardize their attempts to steal $20 million in (...) diamonds, Wanda yells: “Now let me correct you on a few things, okay? Aristotle was not Belgian. The central message of Buddhism is not ‘Every Man for Himself.’ And the London Underground is not a political movement. Those are all mistakes, Otto, I looked them up.”2 It’s a funny moment, of course. But Otto’s (mis)understanding of Gautama’s teaching demonstrates a challenge in translating a spiritual-religious tradition from one cultural setting to another. Too often, and usually without intention, we are like Otto; we colonize and domesticate unfamiliar ideas, assimilating them into our existing worldview instead of experiencing and accommodating their challenging differences. Otto’s facile appropriation of Buddhism confirms rather than confronts his pre-critical, individualistic, and perhaps Darwinist worldview. A Buddhist caregiver might say that Otto was not “listening deeply” to the myriad voices that shaped his perspective.Similar hazards face someone writing about deep listening in relation to religious multiplicity.3 Deep listening, as a caring practice, “belongs” to the emerging field of Buddhist contemplative care,4 in which it has a technical (although perhaps undertheorized) usage richly informed by Buddhist thought and practice. But when I reflect as a pastoral theologian and spiritual caregiver trained in the Christian traditions of cura animarum, the cure or care of souls, deep listening can become unmoored from its origins. Someone marinated in the discourses and practices of Christian care can easily and perhaps unintentionally conflate deep listening with classic Christian [End Page 3] concepts of care such as the ministry of presence, the practice of unconditional positive regard,5 and the giving of oneself to God for the sake of the care seeker. Although I identify as a Buddhist Christian, habitual Christian views shape my thinking the way a canyon or streambed shapes the flow of water; unless I am attentive to the ways that Buddhist thought and practice seek fissures and carve new channels through the sediment of Christian spiritual care, I risk appropriating or erasing the practices that Buddhist caregivers call deep listening.Mindful of these waters, I want to immerse myself and readers in a particular question: In the context of spiritual care, what happens at the confluence of deep listening and a practitioner’s multiple religious voices? In responding to this question I have three aims: to describe deep listening, to provide a theoretical and experiential account of deep listening in the context of religious multiplicity, and to suggest an image from the Pāli canon that can help practitioners engage religious multiplicity in ways that minimize harm, increase compassion, and realize wisdom. A particular moment in spiritually integrative psychotherapy serves as a touchstone for my reflection; thus, I begin where the canyon creates a slender and fast-moving channel for deep listening: psychotherapy with Julie.6violence, karma, and compassionAt twenty-seven years of age, Julie was a soft-spoken, biracial graduate student who radiated mindful presence. She identifies as Asian American, and with her shaved head and tendency to wear dark colors and dramatic scarves, she might seem a typical LA hipster to other passengers on the commuter train she rode to and from our appointments. One year before our psychotherapeutic work, Julie had been beaten and raped by a boyfriend; subsequent thoughts of suicide led to a brief hospitalization. At that time she was assigned diagnoses of bipolar II and post-traumatic stress disorders. Daily, she swallowed a powerful mood stabilizer; monthly, she visited a psychiatrist. The symptoms of bipolar disorder, substance abuse, addiction, schizophrenia, depression, and suicide were present in her extended family. Julie sought counseling because of tension between what she called her “Buddhist identity” and the mental health diagnoses assigned to her. She said she... (shrink)

Examining legal ethics within the framework of modern practice, this book identifies two important ethical issues that all lawyers confront: the difference between the role of lawyers and the role of judges in pursuing justice, and the conflicting responsibilities lawyers have to their clients and to the legal system more broadly. In addressing these issues, Legal Ethics provides an explanation of the duties and dilemmas common to practicing lawyers in modern legal systems throughout the world. The authors focus their (...) class='Hi'>analysis on lawyers in independent practice in modern capitalist constitutional regimes, including the United States, Japan, Europe, and Latin America, as well as the emerging legal systems in China and the former Soviet bloc, to develop connections between the legal profession and political systems based on the rule of law. They find that although ethical tension is inherent in the legal practice of all these societies, the legal profession is essential to stable political institutions. (shrink)

Research has demonstrated that policing is a stressful occupation and has a negative impact on police officers’ mental and physical health, performance, and interactions with citizens. Mental health at the workplace has become a concern due to the costs of depression, anxiety, burnout, and even suicide, which is high among police officers.To ameliorate occupational health, it is crucial therefore to identify stress and burnout levels on a regular basis. However, the instruments frequently used to measure stress have (...) not valorized the specificity of policing tasks. This study aims: i) conducting a literature review, to identify questionnaires used to assess occupational stress and burnout among police officers; ii) to analyze the psychometric characteristics of a Portuguese version of Operational Police Stress Questionnaire (PSQ-Op); and, using the PSQ-op and other questionnaires, iii) to identify operational stress, burnout, and distress levels among Portuguese police officers. The literature review identified 108 studies, which use a multiplicity of questionnaires to measure burnout or occupational stress among police officers, but few studies use specific police stress questionnaires. Sample sizes were mostly below 500 participants and studies were mainly developed in the last decade in the USA and Brazil, but also in another 24 countries, showing the extent of the interest in this topic. This study applied to 2057 police officers from National Portuguese Police, a force policing urban centers, the PSQ-Op, as well the Spanish Burnout Inventory and the Kessler Psychological Distress Scale.The results show that the psychometric properties of the Portuguese version of PSQ-Op are adequate. Factorial analysis revealed two dimensions defined as social and work issues, which were associated with measures of distress and burnout.Fit indices suggested a second-order solution called operational police stress. Overall, and considering the scale range of each questionnaire, the results showed moderate values of operational stress, distress, and burnout. However, considering their cut-off points, 85% of the sample presented high operational stress levels, 11% critical values for burnout, and 28% high distress levels, with 55% of the sample at risk of psychological disorder. These results reinforce the need to prevent stress and to invest in police officers’ occupational health. (shrink)

Background Though artificial intelligence holds great value for healthcare, it may also amplify health inequalities through risks of bias. In this paper, we explore bias risks in targeted medicines manufacturing. Targeted medicines manufacturing refers to the act of making medicines targeted to individual patients or to subpopulations of patients within a general group, which can be achieved, for example, by means of cell and gene therapies. These manufacturing processes are increasingly reliant on digitalised systems which can be (...) controlled by artificial intelligence algorithms. Whether and how bias might turn up in the process, however, is uncertain due to the novelty of the development. Methods Examining stakeholder views across bioethics, precision medicine, and artificial intelligence, we document a range of opinions from eleven semi-structured interviews about the possibility of bias in AI-driven targeted therapies manufacturing. Result Findings show that bias can emerge in upstream (research and development) and downstream (medicine production) processes when manufacturing targeted medicines. However, interviewees emphasized that downstream processes, particularly those not relying on patient or population data, may have lower bias risks. The study also identified a spectrum of bias meanings ranging from negative and ambivalent to positive and productive. Notably, some participants highlighted the potential for certain biases to have productive moral value in correcting health inequalities. This idea of “corrective bias” problematizes the conventional understanding of bias as primarily a negative concept defined by systematic error or unfair outcomes and suggests potential value in capitalizing on biases to help address health inequalities. Our analysis also indicates, however, that the concept of “corrective bias” requires further critical reflection before they can be used to this end. (shrink)

Objective: To determine the usefulness of Q methodology to locate and describe shared subjective influences on clinical decision making among participant physicians using hypothetical cases containing common ethical issues. Design: Qualitative study using by-person factor analysis of subjective Q sort data matrix. Setting: University medical center. Participants: Convenience sample of internal medicine attending physicians and house staff (n = 35) at one midwestern academic health sciences center. Interventions: Presented with four hypothetical cases involving urgent decision making near the (...) end of life, participants selected one of three specific clinical actions offered for each case. Immediately afterward and while considering their decision, each respondent sorted twenty-five subjective self-referent items in terms of the influence of each statement on their decision-making process. By-person factor analysis, where participants are defined as variates, yielded information about the attitudinal background the physicians brought to their consideration of each hypothetical case. We performed a second-order factor analysis on all of the subjective viewpoints to determine if a smaller core of shared attitudes existed across some or all of the four case vignettes. Factor scores for each item and post-sort comments from interviews conducted individually with each respondent guided the interpretation of ethical perspective used by these respondents in making clinical decisions about the cases. Measurements and Main Results: Second-order factor analysis on seventeen viewpoints used by physicians in the four hypothetical urgent decision cases revealed three moderately correlated (r 2 < 40%) subjective core attitudinal guides used broadly among all the cases and among sixteen of the seventeen original factors. Across all the cases, our participants were guided in general by: (1) patient-focused beneficence, (2) a patient- and surrogate-focused perspective that includes risk avoidance, and (3) best interest of the patient guided by ethical values. Economic impact on the physician, expediency in resolution of the situation, and the expense of medical treatment were not found to be influential determinants in this study. Conclusions: Q sorting and by-person factor analysis are useful qualitative methodological tools to study the complex structure of subjective attitudes that influence physicians in making medical decisions. This study revealed the subjective viewpoints used by our physician participants as they made ethically challenging treatment decisions. The three second-order factors identified here are grounded in current bioethical values as well as the personal traits of physicians. The participants' decision methods appear to resemble casuistry more than principle-based decision making. Generalizability of results will require further studies. (shrink)

Background: The rapid spread of COVID-19 infection has led countries across the globe to take various measures to contain the outbreak, including the closure of Universities. Forcing University students to stay at home has created enormous stress and uncertainty in their daily life.Objective: This study aimed to assess the perceived stress and coping strategies among undergraduate health science students of Jimma University amid the COVID-19 outbreak.Materials and methods: An online cross-sectional survey was conducted involving 337 undergraduate health science (...) students from August to September 5, 2020. The perceived stress scale -10 and Brief-COPE scale were used to assess the level of stress and coping strategies, respectively. Statistical Package for Social Science Version 22 was employed for data analysis. Logistic regression was conducted to identify predictors of high perceived stress.Results: The overall mean [±standard deviation ] age of the participants was 22.88 years. The mean PSS score was 22.16, and high perceived stress was reported in 121 participants. The overall mean coping score was 72.34, and approach coping was the predominantly used strategy for coping with stress. Personal perception of being stressed by the daily number of COVID-19 cases/deaths in Ethiopia, rare online talk/chat with friends, presence of confusion due to the inconsistent strategies developed by the health/government authorities in view of the scientific recommendations, perception of self/family members being at risk of getting sick, decreased household income following the COVID-19 pandemic, practicing denial, self-blame, planning, and religion as means of coping with stress were associated with high perceived stress.Conclusion: Over one-third of the participants had a high level of perceived stress, and the majority of them were practicing effective means of coping with stress. The authors recommend that the hosting University in collaboration with the concerned bodies develop innovative strategies to improve the psychological well-being of the students. (shrink)

Post-market pharmaceutical surveillance or ‘pharmacovigilance’ relies on the reporting of suspected adverse drug reactions to regulatory databases. Recently, more ‘active’ methods that directly involve patients in identifying and reporting suspected adverse drug reactions have been suggested. This is different than traditional ‘passive’ methods, e.g., using databases without contacting patients directly. Though there are benefits to active pharmacovigilance, it is not without its potential risks. Here I highlight one of those risks – the nocebo effect. Nocebo effects are (...) harms that are thought to arise by conditioning or negative expectation. If a patient engaged in active pharmacovigilance is improperly motivated to seek out and report suspected adverse drug reactions, nocebo harms can occur. Not only is this a bioethical concern about harm, but it is also an epistemic or data-quality problem. Since nocebo effects are not due to the pharmacological properties of the drugs under investigation, nocebo effects reported as suspected adverse drug reactions constitute false positives in these databases. (shrink)

Background: Risks to healthcare workers have escalated during the pandemic and they are likely to experience a greater level of stress. This cross-sectional study investigated mental distress among healthcare workers during the early phase of Coronavirus disease-2019 outbreak in India.Method: 140 healthcare workers of a tertiary care hospital in India were assessed for perceived stress and insomnia. A factor analysis with principal component method reduced these questions to four components which were categorized as insomnia, stress-related anxiety, stress-related irritability, (...) and stress-related hopelessness. Further statistical analyses were done on these factor scores to identify the predictors and investigate the differences between the different categories of healthcare workers.Result: Doctors had the highest level of anxiety among the healthcare workers. Both doctors and nurses perceived a greater level of irritability than the other HCWs. Compared to doctors and nurses, other HCWs were more likely to experience insomnia. Lower age, higher education, female gender, and urban habitat were associated with greater perception of anxiety. Older age, being quarantined, and single marital status were the significant predictors of irritability. Female gender, single marital-status, and higher number of medical ailments contributed to perceived hopelessness. Quarantine significantly predicted insomnia.Conclusion: Different categories of healthcare workers are experiencing varied mental health problems owing to their heterogeneous socio-demographic backgrounds. Tailored and personalized care, as well as policies, might help in alleviating their problems. Further research is warranted to explore the psychological distress and remedies among these frontline workers during and after the ongoing pandemic crisis. (shrink)

Research on applying signature character strengths demonstrated positive effects on well-being, health and work behavior. Future health care professionals represent a group at risk for impaired well-being due to high study demands. This study investigates potential long-term protective effects on well-being. In total, 504 medical students participated in a longitudinal online study, with at least 96 providing complete data at all three time points. Data on individual signature character strengths and their applicability, thriving, work engagement, burnout, mental (...) and physical health were collected. Longitudinal relations of signature character strengths’ applicability and well-being, mental and physical health were tested with cross-lagged panel analyses. Moreover, indirect longitudinal mediation effects via work engagement and emotional exhaustion were considered. Cross-lagged panel analyses demonstrated significant positive effects of thriving on signature character strengths’ applicability at later time points indicating that higher levels of well-being might be mandatory first to have access to one’s own signature character strengths in a naturalistic setting. Disentangling thriving, the effect was only significant for psychological well-being. Across all three time points, significant indirect effects via work engagement on the relation of the applicability of signature character strengths and well-being were identified, whereas significant indirect effects on mental and physical health were only evident at t2 and t3. A longitudinal mediation analysis via work engagement revealed a significant indirect effect. These results call for further research as previous studies showed that the applicability of signature character strengths affected well-being, not vice versa. The ‘broaden-and-build’ theory and the assumption of well-being in a “top-down” model could possibly explain these novel results. (shrink)

The medical model of childbearing assumes that a pregnancy always has the potential to turn into a risky procedure. In order to advocate humanized birth in high risk pregnancy, an important step involves the enlightenment of the professional’s preconceptions on humanized birth in such a situation. The goal of this paper is to identify the professionals’ perception of the potential obstacles and facilitating factors for the implementation of humanized care in high risk pregnancies. Twenty-one midwives, obstetricians, and (...) class='Hi'>health administrator professionals from the clinical and academic fields were interviewed in nine different sites in Japan from June through August 2008. The interviews were audio taped, and transcribed with the participants’ consent. Data was subsequently analyzed using content analysis qualitative methods. Professionals concurred with the concept that humanized birth is a changing and promising process, and can often bring normality to the midst of a high obstetric risk situation. No practice guidelines can be theoretically defined for humanized birth in a high risk pregnancy, as there is no conflict between humanized birth and medical intervention in such a situation. Barriers encountered in providing humanized birth in a high risk pregnancy include factors such as: the pressure of being responsible for the safety of the mother and the fetus, lack of the women’s active involvement in the decision making process and the heavy burden of responsibility on the physician’s shoulders, potential legal issues, and finally, the lack of midwifery authority in providing care at high risk pregnancy. The factors that facilitate humanized birth in a high risk include: the sharing of decision making and other various responsibilities between the physicians and the women; being caring; stress management, and the fact that the evolution of a better relationship and communication between the health professional and the patient will lead to a stress-free environment for both. Humanized birth in a high risk pregnancy is something that goes beyond just curing women of their illnesses. It can be considered as a token of caring, and continued support, which positively consolidates the doctor-patient relationship. As yet, it has not been described as a practiced guideline, due to its ever-changing complexities. (shrink)

In the past decade, electronic cigarettes emerged as a possible harm-reduction instrument in nicotine consumption, sparking extensive research interest. While comparisons between e-cigarettes and traditional tobacco products have been conducted, the long-term health consequences of e-cigarette utilization remain unclear. This research conducted a study analyzing publications to investigate patterns of research in the domain of e-cigarettes and e-liquids usage and its health risk by utilizing the Scopus database, Biblioshiny, and VOS viewer to identify the trends in this (...) subject and providing insight into the current state of research in this area. Three types of analysis—performance analysis, ranking analysis, and scientific mapping—were conducted using a dataset comprising 212 research papers obtained from the Scopus database. This analysis includes a visual representation of document types, author keywords, international collaborations, and yearly scientific output. This research also identified the most significant authors and affiliations, as well as scientific production by country. Word clouds and network visualizations show the most relevant words and their relationships in research. Furthermore, this research also provides a general overview of the potential harm-reduction tool as well as the future impact of e-cigarettes on health risks. (shrink)

IntroductionHigh healthcare costs make illness precarious for both patients and their families’ economic situation. Despite the recent focus on the interconnection between health and financial risk at the systemic level, the ethical conflict between concerns for potential health benefits and financial risk protection at the household level in a low-income setting is less understood.MethodsUsing a seven-step ethical analysis, we examine a real-life dilemma faced by families and health workers at the micro level in Ethiopia (...) and analyse the acceptability of limiting treatment for an ill newborn to protect against financial risk. We assess available evidence and ethical issues at stake and discuss the dilemma with respect to three priority setting criteria: health maximisation, priority to the worse-off and financial risk protection.ResultsGiving priority to health maximisation and extra priority to the worse-off suggests, in this particular case, that limiting treatment is not acceptable even if the total well-being gain from reduced financial risk is taken into account. Our conclusion depends on the facts of the case and the relative weight assigned to these criteria. However, there are problematic aspects with the premise of this dilemma. The most affected parties—the newborn, family members and health worker—cannot make free choices about whether to limit treatment or not, and we thereby accept deprivations of people’s substantive freedoms.ConclusionIn settings where healthcare is financed largely out-of-pocket, families and health workers face tragic trade-offs. As countries move towards universal health coverage, financial risk protection for high-priority services is necessary to promote fairness, improve health and reduce poverty. (shrink)

Background As health education robots may potentially become a significant support force in nursing practice in the future, it is imperative to adhere to the European Union’s concept of “Responsible Research and Innovation” (RRI) and deeply reflect on the ethical risks hidden in the process of intelligent robotic health education. Aim This study explores the perceptions of professional nursing professionals regarding the potential ethical risks associated with the clinical practice of intelligent robotic health education. Research (...) design This study adopts a descriptive phenomenological approach, employing Colaizzi’s seven-step method for data analysis. Participants and research context We conducted semi-structured interviews with 17 nursing professionals from tertiary comprehensive hospitals in China. Ethical considerations This study has been approved by the Ethics Committee of the Second Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Second Chinese Medicine Hospital. Findings Nursing personnel, adhering to the principles of RRI and the concept of “person-centered” care, have critically reflected on the potential ethical risks inherent in robotic health education. This reflection has primarily identified six themes: (a) threats to human dignity, (b) concerns about patient safety, (c) apprehensions about privacy disclosure, (d) worries about implicit burdens, (e) concerns about responsibility attribution, and (f) expectations for social support. Conclusions This study focuses on health education robots, which are perceived to have minimal ethical risks, and provides rich and detailed insights into the ethical risks associated with robotic health education. Even seemingly safe health education robots elicit significant concerns among professionals regarding their safety and ethics in clinical practice. As we move forward, it is essential to remain attentive to the potential negative impacts of robots and actively address them. (shrink)

Historically, recordkeeping has been an essential task for health professionals. Today, this mandatory task increasingly takes place as digital documentation. This study critically examines problem constructions in practical documents on digital documentation strategies in Danish municipal healthcare and how these problem constructions imply particular solutions. A document analysis based on the approach presented in Bacchi's “What's the problem represented to be?” was applied. Forty practical documents in the form of guidelines, strategies, and quality control documents were included. The (...) analysis uncovered three problem representations: lack of coherence between health services in a complex healthcare system, lack of assessable data for management and political prioritization, and inefficiency in the healthcare system. The proposed solution is a digitalized and standardized practice that transforms recordkeeping in the municipalities. However, municipal healthcare is at risk of being fragmented due to digital documentation's focus on the organizational management of health with task‐oriented practices supplied by an anonymous health professional. We find that digital documentation functions as an organizational micromanagement approach that assigns the health professional a subject position as an employee acting according to the organization's framework rather than the profession's normative framework. (shrink)

Introduction: Mental health nursing is dependent on nurses’ ability to engage in therapeutic relationships with patients. The ability to manage professional boundaries is equally important, but less explored. This study aims to address the following research questions: How do nurses define their professional, personal, and private roles? What are nurses’ experiences with professional boundaries? What are the implications of nurses’ understanding of these boundaries? Background: Nurse–patient relationships are characterized by asymmetrical power dynamics, which places the responsibility of delineating professional (...) boundaries on the nurse. While ethical codes offer guidance, nurses must identify appropriate boundaries in a dynamic process that relies on the clinical context. Research design: This study used critical discursive psychological analysis to examine data from participant observations, individual interviews, and focus group discussions. Participants and research context: We included 16 nurses working in mental health care in this study, comprising 12 in specialist mental health care and 4 in community mental health care. Ethical considerations: The study was registered with Norwegian Social Science Data Services. Results: Nurses defined professionalism as being an educated caregiver who prioritizes patients’ needs. Professionalism involves personal engagement, while some personal matters remain private. However, nurses experienced challenges in maintaining professional boundaries, facing dilemmas due to the subjective nature of boundaries and patients’ unpredictable responses. Conclusions: While nurses prioritize patients’ needs and best interests, this study demonstrated that personal engagement is considered part of professionalism. However, nurses encounter complex dilemmas in setting professional boundaries. Additionally, these boundaries can either emphasize or de-emphasize the power differential in nurse-patient relationships. (shrink)

Loneliness has been reframed from a ‘social problem of old age’ into a major public health problem. This transformation has been generated by findings from observational studies of a relationship between loneliness and a range of negative health outcomes including dementia. From a public health perspective, key to evaluating the relationship between loneliness and dementia is examining how studies define and measure loneliness, the exposure variable, and dementia the outcome. If we are not consistently measuring these then (...) building a body of evidence for the negative health outcomes of loneliness is problematic. Three key criteria had to meet for studies to be included in our analysis. To test the proposition that loneliness is a cause of dementia we only included longitudinal studies. For inclusion studies had to measure loneliness at baseline, have samples free of dementia and assess dementia at follow up. We identified 11 papers published between 2000 and 2018 that meet these criteria. These studies included seven different countries and only one was specifically focused upon dementia: all other studies were cohort studies focused upon ageing and health and wellbeing. There was extensive heterogeneity in how studies measured loneliness and dementia and in the use of co-variates. Loneliness was measured by either self-rating scales or scales. Dementia was assessed by clinical tests, diagnostic/screening tools, cognitive function tests, and self-reported doctor diagnosis. Substantial variation in loneliness prevalence and dementia incidence. Six studies did not report a statistically significant relationship between loneliness and dementia. Significant excess risk of dementia among those who were lonely ranged from 15% to 64%. None of these studies are directly comparable as four different loneliness and dementia measures were used. We suggest that the evidence to support a relationship between loneliness and dementia is inconclusive largely because of methodological limitations of existing studies. If we wish to develop this evidence base, then using a consistent set of loneliness and dementia outcome measures in major longitudinal studies would be of benefit. (shrink)

Recent evidence of intergenerational epigenetic programming of disease risk broadens the scope of public health preventive interventions to future generations, i.e. non existing people. Due to the transmission of epigenetic predispositions, lifestyles such as smoking or unhealthy diet might affect the health of populations across several generations. While public policy for the health of future generations can be justified through impersonal considerations, such as maximizing aggregate well-being, in this article we explore whether there are (...) rights-based obligations supervening on intergenerational epigenetic programming despite the non-identity argument, which challenges this rationale in case of policies that affect the number and identity of future people. We propose that rights based obligations grounded in the interests of non-existing people might fall upon existing people when generations overlap. In particular, if environmental exposure in F0 will affect the health of F2 through epigenetic programming, then F1 might face increased costs to address F2's condition in the future: this might generate obligations upon F0 from various distributive principles, such as the principle of equal opportunity for well being. (shrink)

Risk communication has been generally categorized as a warning act, which is performed in order to prevent or minimize risk. On the other side, risk analysis has also underscored the role played by information in reducing uncertainty about risk. In both approaches the safety aspects related to the protection of the right to health are on focus. However, it seems that there are cases where a risk cannot possibly be avoided or uncertainty reduced, (...) this is for instance valid for the declaration of side effects associated with pharmaceutical products or when a decision about drug approval or retirement must be delivered on the available evidence. In these cases, risk communication seems to accomplish other tasks than preventing risk or reducing uncertainty. The present paper analyzes the legal instruments which have been developed in order to control and manage the risks related to drugs – such as the notion of “development risk” or “residual risk” – and relates them to different kinds of uncertainty. These are conceptualized as epistemic, ecological, metric, ethical, and stochastic, depending on their nature. By referring to this taxonomy, different functions of pharmaceutical risk communication are identified and connected with the legal tools of uncertainty management. The purpose is to distinguish the different functions of risk communication and make explicit their different legal nature and implications. (shrink)

For at least the past three decades, injuries have been recognized as an important public health problem in the United States. In 2001, there were approximately 157,000 deaths due to injuries in the US. There were also almost 30 million non-fatal injury incidents.Injuries have been defined as: “…any unintentional or intentional damage to the body resulting from acute exposure to thermal, mechanical, electrical, or chemical energy or from the absence of such essentials as heat or oxygen”. Within public (...) class='Hi'>health, the field of injury prevention and control is dedicated to reducing the burden of injuries on the lives of people around the world.Injury prevention seeks to reduce injuries by: 1) identifying risk factors, 2) designing interventions to address the risk factors, 3) implementing those interventions, 4) evaluating their effectiveness, and 5) replicating those that work. As with many other public health problems, interventions can target factors associated with the human or host, vehicle or vector, and the physical or social environment. (shrink)

Global Cellular Health Screening Market Size research report offers in-depth assessment of revenue growth, market definition, segmentation, industry potential, influential trends for understanding the future outlook and current prospects for the market. -/- Get a Sample Copy of the Report at – -/- Also, the growing importance of healthy life expectancy (HALE) and the use of home diagnostic tests are remarkably increasing globally. As a result, there is increasing demand for cellular health screening kits and services due to (...) greater patient awareness. Moreover, home diagnostic tests are convenient for patients because it helps to save time and cost associated with visiting hospitals and clinics. -/- Drivers & Restraints -/- The growing awareness for personalized medicine across the world due to the emergence of new disease conditions increased the rate of clinical studies conducted in countries such as the U.S., the U.K., and China. This led to the adoption of cellular health screening tests for an overview of health at a cellular level. -/- This study provides information about the sales and revenue during the historic and forecasted period of (2024 to 2030). Understanding the segments helps in identifying the importance of different factors that aid market growth. Estimations about the CAGR value for specific forecast period, market drivers, market restraints, and competitive strategies are assessed in this Cellular Health Screening Market report. -/- This report focuses on Cellular Health Screening Market volume and value at the global level, regional level and company level. From a global perspective, this report represents overall Cellular Health Screening Market market size by analysing historical data and future prospect. Regionally, this report focuses on several key regions: North America, Europe, Asia-Pacific, Latin America and Middle East and Africa. -/- Competitive Strategic Window: -/- The Competitive Strategic Window analyses the competitive landscape in terms of markets, applications, and geographies to help the vendor define an alignment or fit between their capabilities and opportunities for future growth prospects. It describes the optimal or favorable fit for the vendors to adopt successive merger and acquisition strategies, geography expansion, research & development, and new product introduction strategies to execute further business expansion and growth during a forecast period. -/- An Overview of the Impact of COVID-19 on this Market: -/- The advancement of COVID-19 has conveyed the world to a stop. We fathom that this prosperity crisis amazingly influences associations across ventures. Nevertheless, everything fortunate or unfortunate should reach a conclusion. There are a couple of organizations that are fighting and some are thriving. By and large, essentially every region is relied upon to be impacted by the pandemic. -/- We are advancing incessant endeavors to help your business support and create during COVID-19 pandemics. Considering our experience and expertise, we will offer you an impact examination of Covid episode across ventures to help you with preparing for what's to come. -/- Key players covered in the global Cellular Health Screening Market research report: -/- . (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Calling Obesity a Disease Is A Terrible DecisionMoose FinklesteinFactsThe medical world struggles to see the difference between health and body weight. It is still mostly combined with the strong belief that there is no way a fat person can be fit and healthy. Despite repeated studies and work to show differently, this prejudice remains. This has become part of what I call “Everyone Knows” pseudoscience, where data that (...) have no scientific basis become “fact” due to constant repetition.Obesity is already the cause of great stigma in our society. Fat people are considered “ugly,” fat jokes are acceptable in everyday life, and being called ‘fat’ is, to many, as big an insult as a racial slur. Fat prejudice can approach the levels of racial prejudice (Puhl, Andreyevea & Brownell, 2008). Fat children are bullied, sometimes to the point of suicide. Some studies have found children as young as five trying to diet for being fat, no matter their actual weight. Fat people are more likely to be unemployed or underemployed, and there are prejudicial beliefs that fat workers are more problematic, despite research saying otherwise (Roehling, Roehling, & Odland, 2008).Obesity is seen by the masses as something people choose. However, science disagrees. There has long been a link between depression and obesity. Mental health is tightly tied to obesity, where those who experience weight discrimination are more likely to gain weight, although unhealthy behaviours such as binge eating and exercise avoidance are sometimes seen as a coping mechanism (Sutin & Teracciano, 2013).It has been reported in a number of journals that 90–95% of the people who lose weight regain the weight within 10 years (Mann et al., 2007; Miller, 1999). “Everyone Knows” claims that this is because people go back to bad habits. Science, however, says that there are complex ways the body wants to regain the weight (Sumithran & Proietto, 2013; Sumithran et al., 2011). Worse, dieting may contribute to obesity. Adolescent girls who diet are at 324% greater risk for obesity than those who do not diet (Stice, Cameron, R. P., Killen, J. D., Hayward, C. & Taylor, C. B. 1999). Weight loss dieting may cause other health problems as well, such as immune system problems (Shade ED, et al. 2004).In the medical world, doctors are encouraged to talk to patients about their weight. Every fat person has heard, “What are we going to do about your weight?” The “we” is supposed encourage the patient to feel that the doctor is on the patient’s side in their battle. Yet what many patients hear is, “I don’t see you as a patient, I see you as fat.” Science says that the higher a patient’s BMI the less respect a doctor has for the patient (Huzinga, Cooper, Bleich, Clark, & Beach, 2009).Horror stories about fat people trying to get decent health care are everywhere. For a good example, see Bruce Taylor Seeman’s piece, “The Perils of Obesity May Include the Doctor” (2006). [End Page E1] There are many blogs and stories on the internet about the way patients are not just shamed for their weight, but actively bullied by medical professionals. One blog, The Well Rounded Mama (wellroundedmama.blogspot.com), discusses the bias of doctors against pregnant fat women, who are told things like, “You cannot have a healthy baby when you are this fat” and encouraged to abort. Tales from people told that their weight is the cause for everything and anything can be found on sites like First Do No Harm (fathealth.wordpress.com). Reading blogs by medical professionals can show the disdain they have for fat people. In one, an emergency room nurse declared that all fat diabetics have poor control, based solely on perceptions from her job. Comments were mostly other nurses agreeing with how “disgusting” fat people are to have to deal with. However, Yale University’s Rudd Center for Food Policy & Obesity not only recognizes the problem but aims to help medical professionals eliminate the bias.If obesity becomes a disease, weight loss surgery (WLS) becomes a bigger gold mine. Medical insurance will be more likely to cover weight loss surgery. WLS is an ever-changing target: there... (shrink)

The aim of the article is to present the results of bibliometric analyzes of scientific papers on the quality management of medical services published in 2001–2017 and indexed in the Scopus database. The analysis uses basic techniques of bibliometric analysis with the technical support of VOSviewer software. The publication proposes an original procedure for analyzing the literature on the subject. The results of the study allowed to determine the trends in the number of publications from 2010 to 2017. (...) At the same time, an analysis of areas of science was presented, in which issues related to the management of the quality of medical services were analyzed, as well as citation of main authors and research centers. The whole analysis concerning the topic of quality management of medical services and bibliometric analysis of scientific works on the concepts and interrelations studied has identified the main six clusters that related to the management of quality of medical services ranging from broadly understood changes in healthcare organizations, internal quality management factors, development issues and education, regulation and standardization of the concept of quality improvement, and technological aspects of quality management in medical services. It seems, therefore, that the conducted studies can be considered as a specific guide for those interested in risk and uncertainty, despite the fact that they are not free of restrictions, for example, due to the narrowing of the time or criteria concerning the types of documents examined. In this context, the analyzes carried out give a wide range of opportunities to propose new research ideas on the above issues in contemporary organizations. (shrink)

When scientists consider the interaction of science and value judgments, debates often occur. When public policy grows out of science, disagreements between scientists can become even more spirited. This paper examines the case of nutrition policy in the United States, which has been both at the interface between agriculture and medicine and the object of serious discord concerned with the strength and validity of the scientific evidence and the responsibility for action. The development of indirect intervention policies, designed to educate (...) and inform the public on diet and health, is traced as a practical demonstration of the effects of involvements of nutritional scientists of different disciplines and philosophic bents. Controversies centered mainly on the issues of diet and coronary heart disease and of diet and cancer in nutritional guidelines for Americans and the recommended dietary allowances. But the arguments turned on a complex web of values and interests as well as scientific questions. A remarkable turnaround by animal agriculture and its scientific support occurred, changing from a defensive, rightist stance to one that appears to recognize a moral responsibility to the public health. The convincing point was likely the changing market. Nutritional scientists, however, remained divided on the issue of whether a public health strategy keyed to public education should replace a strategy to identify persons of high risk and modify the risk by treatment. Our analysis suggests that the tension between libertarian and utilitarian social values of scientists is at least as important as disagreements relative to validity and strengths of the scientific evidence. (shrink)

BackgroundOccupational burnout is a mental health problem that among nurses may lead not only to physical and psychological complications, but also to a decrease in the quality of patient care. Considering the stressful nature of surgery, operating room nurses may be at a greater risk. Therefore, the present study aimed to identifying factors associated with the occupational burnout from the perspective of operating room nurses.Materials and methodsThis qualitative study was conducted in Iran in 2021 using conventional content (...) analysis. Sampling was performed using purposeful sampling method with maximum variation. In order to collect data, individual, semi-structured interviews were performed with 18 operating room nurses. Interviews continued until data saturation. Data were recorded, transcribed and analyzed using steps proposed by Graneheim and Lundman. Data management was performed using MAXQDA-2020 software. Four criteria provided by Guba and Lincoln were used to improve the study’s trustworthiness and rigor.ResultsA main theme, 4 categories and 15 subcategories were extracted from the data. The main theme is “gradual burnout due to job tension” and categories and subcategories include organizational factors, interpersonal factors, Occupational nature factors as well as individual factors.ConclusionNumerous factors associated with burnout in operating room nurses, which may put the personnel under more pressure. According to these factors, nursing managers and operating room nurses can consider effective strategies to prevent or coping with burnout. (shrink)

Two right-to-die organisations offer assisted suicide in Switzerland. The specific legal situation allows assistance to Swiss and foreign citizens. Both organisations require a report of the person’s health status before considering assistance. This qualitative study explored these reports filed to legal authorities after the deaths of individuals in the area of Zurich. Health status reports in the legal medical dossiers of the deceased were analysed using content analysis and Grounded Theory. From 421 cases of assisted suicide (2001–2004), (...) 350 reports on health status were filed. Many cases contained diagnosis lists only. Other reports had more elaborate reports revealing that some physicians were aware about the patient’s death wish and the intention to solicit assisted suicide. Physicians’ attitudes ranged from neutral to rather depreciative. Few physicians openly referred the patient to the organisations and supported the patient’s request by highlighting a history of suffering as well as reporting understanding and agreement with the patient’s wish to hasten death. In the health status reports five categories could be identified. Some files revealed that physicians were aware of the death wish. The knowledge and recognition of the patient’s death wish varied from no apparent awareness to strongly supportive. This variety might be due to difficulties to discuss the death wish with patients, but might also reflect the challenge to avoid legal prosecution in the country of origin. To require comparable health status reports as requirements for the right-to-die organisations might be difficult to pursue. (shrink)

Interweaving hazards in environmental crises can be framed as a wicked problem as well as an opportunity for the interdisciplinary contribution of philosophical analysis on risk. Due to nonlinear mechanisms and contextual variations, this shows the importance of inquiring about contrasting assessments of vulnerability and the demand for comprehensive collective actions in coping with climate risks. The article examines how to address overlapping ecological and social risks, focusing on decision-making in the context of local energy transition (...) projects through the lens of collective epistemic responsibility. By analyzing disciplinary accounts and exploring the links between assessment and decision-making further research directions for collective risk prevention strategies will be outlined, and some implications for interdisciplinary investigation on risk and expertise will be sketched. (shrink)

Over the past years, one of the most contentious topics in policy debates on genetics has been the use of genetic testing in insurance. In the rush to confront concerns about potential abuses of genetic information, most countries throughout Europe and the US have enacted genetics-specific legislation for insurance. Drawing on current debates on the pros and cons of a genetics-specific legislative approach, this article offers empirical insight into how such legislation works out in insurance practice. To this end, ethnographic (...) fieldwork was done in the underwriting departments of Belgian insurance companies. Belgium was one of the first European countries introducing genetics-specific legislation in insurance. Although this approach does not allow us to speak in terms of ‘ the causal effects of the law’, it enables us to point to some developments in insurance practice that are quite different than the law’s original intentions. It will not only become clear that the Belgian genetics-specific legislation does not offer adequate solutions to the underlying issues it was intended for. We will also show that, while the legislation’s focus has been on the inadmissibility of genetic discrimination, at the same time differences are made in the insurance appraisal within the group of the asymptomatic ill. In other words, by giving exclusive legal protection to the group of genetic risks, other non-genetic risk groups are unintendedly being under-protected. From a policy point of view, studying genetics-specific legislation is especially valuable because it forces us to return to first principles: Which risks deserve our legal protection in insurance? Who do we declare our solidarity with? (shrink)

Concerns about the risks of unmitigated greenhouse gas emissions are growing. At the same time, confidence that international policy agreements will succeed in considerably lowering anthropogenic greenhouse gas emissions is declining. Perhaps as a result, various geoengineering solutions are gaining attention and credibility as a way to manage climate change. Serious consideration is currently being given to proposals to cool the planet through solar-radiation management. Here we analyze how the unique and nontrivial risks of geoengineering strategies pose fundamental (...) questions at the interface between science and ethics. To illustrate the importance of integrated ethical and scientific analysis, we define key open questions and outline a coupled scientific-ethical research agenda to analyze solar-radiation management geoengineering proposals. We identify nine key fields of coupled research including whether solar-radiation management can be tested, how quickly learning could occur, normative decisions embedded in how different climate trajectories are valued, and justice issues regarding distribution of the harms and benefits of geoengineering. To ensure that ethical analyses are coupled with scientific analyses of this form of geoengineering, we advocate that funding agencies recognize the essential nature of this coupled research by establishing an Ethical, Legal, and Social Implications program for solar-radiation management. (shrink)

Government-sponsored school lunch programs have garnered attention from activists and policymakers for their potential to promote public health, sustainable diets, and food sovereignty. However, across country contexts, these programs often fall far short of their transformative potential. It is vital, then, to identify policies and organizing strategies that enable school lunch programs to be redesigned at the national scale. In this article, we use document analysis of historical newspapers and government data to examine the motivating factors and underlying (...) conditions that allowed South Korea’s universal free, eco-friendly school lunch program to become a tool for advancing social justice and ecological goals at the national scale. We analyze the socio-historical evolution and current status of the Korean school lunch program, combining the multi-level perspective with insights from environmental sociology and critical food studies, in order to shed light on the factors that enabled the program to become an innovative niche and articulate the opportunities and challenges it now faces. We identify the state-sponsored creation of what we call “precautionary infrastructure” as a key anchoring mechanism between the school food niche and agri-food regime. Precautionary infrastructure includes new supply chains, certification standards, and sourcing policies that provide a stable market for eco-friendly farms and small-scale producers, while minimizing the environmental health risks of school lunch by delivering organic and pesticide-free ingredients to on-site kitchens that serve free lunches to all students. This analysis offers insight into how public school-lunch programs can become protected niches that help drive sustainability transitions within agri-food systems. (shrink)

Cost-effectiveness analysis for health interventions is traditionally conducted in a risk-neutral way, insensitive to risk attitudes in the population, which are potentially non-neutral. While the standard outcome metric of quality-adjusted life years (QALYs) aims to be deferential to people's valuations of health states, cost-effectiveness analysis of risky interventions using the QALY metric is not similarly deferential to people's risk attitudes. I argue that there is no good justification for this practice. Non-neutral attitudes to (...) risk, especially where they concern individually life-changing interventions need not be irrational, and so imposing neutrality is not justifiable as a way of debiasing preferences. Many common justifications for deference to health state preferences extend to risk attitudes. But even if reasons for deference do not extend, imposition of risk neutrality as opposed to any other rationally permissible risk attitude is under-motivated as default practice. Thus, either methods for measuring risk attitudes separately and incorporating them into cost-effectiveness analysis should be used more widely or a richer set of information should be presented to political decision-makers and the public to enable them to decide how to take into account the individual risks faced by members of the population, on top of aggregate effects on population health. (shrink)

This work sought to carry out a comparative analysis of in vitro fertilization (IVF) vis-à-vis St. Thomas Aquinas’ Natural Law Theory. Both of them emanated from problem of infertility. IVF makes use of artificial insemination for fertilization which is quite contrary to the natural process of sexual reproduction. This work makes use of analytic method to analyse comparatively in vitro fertilization and St. Thomas Aquinas’ Natural Law Theory. Thus, this work conceives that IVF is one of the assisted reproductive (...) technologies in the scientific exploration of genetic engineering and bio-technology which emanated to tackle the problem of genetic inheritance outside marriage. It contravenes the coital or natural reproduction which conforms to St. Thomas Aquinas’ second precept of natural law. Again, IVF is artificial as such it is pruned to many complications. There is no adequate information given by the medical practitioners or providers of this service on the health hazards or risks involve in IVF. In addition, in vitro fertilization makes provision for donor gamete and surrogate motherhood which may have many negative implications both for the couples, off-spring, gestation mother, and society at large. (shrink)

BackgroundThe West African Ebola virus epidemic from 2014 to 2016 is unprecedented in its scale, surpassing all previous and subsequent Ebola outbreaks since 1976. This epidemic provoked a humanitarian emergency that extended to different spheres of life, making visible ethical challenges in addition to medical, economic, and social ones. The present article aims to identify and differentiate the scope of ethical issues associated with the Ebola epidemic.MethodsAn online media analysis was performed on articles published from March 2014 to September (...) 2015 in ten preselected academic journals (scientific press) and two online newspapers (lay press). Two methodological approaches were combined: a systematic literature search and a qualitative content analysis. An additional keyword search was conducted on the PubMed database for the period after the end of the Ebola epidemic (2016-2020) to obtain an overview of research dealing with medical ethics due to the epidemic and to compare these results with the identified ethical challenges.ResultsA total of 389 articles dealing with the subject fields “Ebola epidemic” and “ethics” were researched. For qualitative content analysis, the time span with the highest article density was selected and a total of 64 articles were included (15 scientific articles, 49 popular articles). Five core ethical challenges of the Ebola epidemic emerged: 1. Responsibility and Accountability, 2. Spillover Effects, 3. Research and Development, 4. Health Communication, and 5. Resource Allocation. Articles in academic journals were dominated by the discussion of normative aspects in the area of “research and development”, while newspaper articles focused on aspects of “responsibility and accountability”.ConclusionAn ethical discussion of the Ebola epidemic requires an examination of as many of the ethical dimensions involved as possible. The presented investigation of the two types of media with regard to the Ebola epidemic offers this possibility of a more comprehensive insight into this diversity as a basis for ethical discussions. (shrink)

For lesbian, gay, bisexual, transgender, and queer youth, identity development is one of the most critical developmental task. LGBTQ youth are shown to be at risk for a variety of risk factors including depression and suicidal ideation and attempts due to how their identities are appraised in heteronormative societies. However, most LGBTQ educational psychology research have highlighted protective factors that are primarily relevant to support LGBTQ white-youth. One of the major developmental theories, Erikson’s stages of psychosocial development, has (...) identified adolescence as the period where identity development occurs. However, through an intersectional lens, identity development appears to encompass more than adolescence but also emerging adulthood, a developmental stage not accounted for by Erikson’s stages of psychosocial development. The primary goal of this study is to seek to understand and question Erikson’s stages of psychosocial development through an intersectional lens of an autoethnography of my LGBTQ experiences. An autoethnographic approach [diary entries, conversations, interview, social media websites and blogs, and drawing ] is used to understand my LGBTQ-person of color experiences of “coming out” or self-disclosure during my adolescence through emerging adulthood. Data was collected on April 2020 and spanned from 2006 through 2020 to account for the developmental period of adolescence and emerging adulthood. Thematic analysis revealed four themes across the two developmental periods: confusion and conflict between my gay and ethnic identity as a closeted adolescent, my first “coming out” as a gay adolescent and “it got better,” frustration arising from the internal conflict between my gay and POC identity as an emerging adult, and frustration arising from external experiences with the flaws of LGBTQ community inclusivity. Results reflected a continuous theme of identity exploration and struggle through both adolescence and emerging adulthood, highlighting the need for future research to replicate similar experiences from other intersectional individuals during emerging adulthood stage, a developmental stage that is considered in between Erikson’s adolescent and young adulthood developmental stage. (shrink)

Endocrine-disrupting chemicals have been identified as posing risks to reproductive health and may have intergenerational effects. However, responses to the potential harms they pose frequently rely on medicalised understandings of the body and normative gender identities. This article develops an intersectional feminist framework of intergenerational justice in response to the potential risks posed by endocrine-disrupting chemicals. We examine critiques of endocrine disruptors from feminist, critical disability and queer standpoints, and explore issues of race and class in exposures. (...) We argue that responding to the risks posed by endocrine disruptors such as brominated flame retardants (BFRs) and phthalates requires developing a theory of intergenerational justice that recognises relationality and transcorporeality, and that also recognises harm in terms of suffering, not in terms of difference. (shrink)

BackgroundHealth screening is undertaken to identify individuals who are deemed at higher risk of disease for further diagnostic testing so that they may possibly benefit from interventions to modify the natural course of disease. In Singapore, screening tests are widely available in the form of a package, which bundles multiple tests in one session and commonly includes non-recommended tests. There are various ethical issues associated with such testing as they may not be clinically appropriate and can result in more (...) harm than benefit. This article describes the practice of health screening packages, identifies the ethical issues arising from such packages and discusses the implications of these ethical issues on policy and practice of screening in Singapore.MethodsA content analysis of the websites of providers offering general health screening packages to individuals was conducted. A total of 14 health screening package providers were analysed for how packages were conducted and promoted, how clinically appropriate screening tests were, and the price range and composition of screening packages. A normative ethical analysis based on the four principles approach of beneficence, non-maleficence, autonomy and justice in biomedical ethics was used.ResultsTwelve of the 14 providers included non-recommended tests such as tumour markers, treadmill stress tests and MRI scans in their general health screening packages. Package prices ranged from S$26 to S$10,561, with providers charging higher when more tests were included. Health screening packages were broadly conducted in three stages: the offer and selection of a health screening package; medical assessment and performance of screening tests; a post-screening review. While material provided by all providers was factual, there was no information on the potential risks or harms of screening.ConclusionSeveral ethical issues were identified that should be addressed with regard to health screening packages in Singapore. A key issue was the information gap between providers and patients, which may result in patients undergoing inappropriate testing that may be more harmful than beneficial. Health screening packages can stimulate unnecessary demand for healthcare and contribute to an inequitable distribution of healthcare resources. (shrink)

The stigmatisation of the gecekondu in post-1945 Turkey is a common theme in the literature. However, these studies have drawn little connection with health issues, even though these are known to be important in the mechanisms of stigmatisation. Policies for tuberculosis (TB) control—then Turkey's “number one health issue”—have tended to focus on individual and biological factors, to the detriment of social or environmental ones that could contribute to making TB a matter of politics and not only of policies. (...) A close study of the practices of the numerous TB-control actors nevertheless reveals an entanglement of the social, the environmental, and the medical questions. Through the emblematic but unknown case study of the TB-control pilot area created in Zeytinburnu in 1961, this article studies discourses, but also graphic representations, portraying the gecekondu as unhealthy, revealing an underlying environmental conception of TB among Turkish public health actors. The choice of Istanbul's biggest gecekondu neighbourhood to be a pilot area originated from a common conception of the gecekondu areas as pathogenic, but also contributed to reinforcing this vision and adding it to the very definition of the gecekondu. It thus participated in the stigmatisation of these areas and their inhabitants, even if some of the study's conclusions undermined the common vision of the gecekondu as populated by poor, rural migrants. However, the pilot project was also conceived as a way to integrate the inhabitants into the modern city. The “pilot” character of the area, if characteristic of the vocabulary of the 1960s, which were also the time of the attempt to “socialise the health services” in Turkey, is questionable. The project displayed a desire to know and control this specific territory rather than a genuine promotion of broader environmental changes to be replicated on a national scale. (shrink)