We consider the implications for the ethical evaluation of research programs of two fundamental changes in the revised research ethical guideline of the Council for International Organizations of Medical Sciences. The first is the extension of scope that follows from exchanging “biomedical” for “health‐related” research, and the second is the new evaluative basis of “social value,” which implies new ethical requirements of research. We use the example of antibiotic resistance interventions to explore the need to consider the instances of (...) what we term the pragmatic risks of such interventions to evaluate the social value of certain kinds of health‐related research. These (pragmatic) risks severely threaten the social value of interventions in every area where human and social responses significantly impact on their effectiveness. Thus, the social value of health‐related research needed to demonstrate its effectiveness depends on the extent and successful management of such risks. Research designed to take into account the management of pragmatic risks also gives rise to similar types of risks, and the potential for social value in light of those risks needs to be considered in ethical reviews based on the new guidelines. We argue that, to handle this new expanded task, the international system of research ethical review addressed by the guidelines needs institutional development. (shrink)

While promoting population health has been the classic goal of public health practice and policy, in recent decades, new objectives in terms of autonomy and equality have been introduced. These different goals are analysed, and it is demonstrated how they may conflict severly in several ways, leaving serious unclarities both regarding the normative issue of what goal should be pursued by public health, what that implies in practical terms, and the descriptive issue of what goal that actually (...) is pursued in different contexts. A basic conflict of perspective is handled by integrating the ideas of public health striving for health-related autonomy and equality, resulting in a prioritarian oriented population approach to health-related autonomy. This integrated goal is demonstrated to constrain itself in several ways attractive from the point of view of the classic goal, but several serious problems remain. For this reason, a model where all of the three goals are integrated into one coherent structure where they can be assigned varying degrees of importance relative to the level of population health is described. It is argued that this model avoids the problems set out earlier, and is actually normatively preferable to the classic goal alone. It is furthermore argued that the model may be employed as a useful tool for descriptive ethics, as well as a vehicle for international harmonisation of public health policies. A number of practical implications regarding, e.g., the importance of respecting autonomy and the allocation of public health resources are noted, as are a battery of questions for further research. (shrink)

A new landscape of prenatal testing is presently developing, including new techniques for risk-reducing, non-invasive sampling of foetal DNA and drastically enhanced possibilities of what may be rapidly and precisely analysed, surrounded by a growing commercial genetic testing industry and a general trend of individualization in healthcare policies. This article applies a set of established ethical notions from past debates on PNT for analysing PNT screening-programmes in this new situation. While some basic challenges of PNT stay untouched, the new development (...) supports a radical individualization of how PNT screening is organized. This reformation is, at the same time, difficult to reconcile with responsible spending of resources in a publicly funded healthcare context. Thus, while the ethical imperative of individualization holds and applies to PNT, the new landscape of PNT provides reasons to start rolling back the type of mass-screening programmes currently established in many countries. Instead, more limited offers are suggested, based on considerations of severity of conditions and optimized to simultaneously serve reproductive autonomy and public health within an acceptable frame of priorities. The new landscape of PNT furthermore underscores the ethical importance of supporting and including people with disabilities. For the very same reason, no ban on what may be analysed using PNT in the new landscape should be applied, although private offers must, of course, conform to strict requirements of respecting reproductive autonomy and what that means in terms of counselling. (shrink)

This article examines the responsibilities of researchers who conduct exploratory research to provide a service to vulnerable respondents. The term “service” is used to denote the provision of a tangible benefit in relation to the research question that is apart from the altruistic research benefits. This article explores what this “service” could look like, who might be responsible for providing it, and the challenges associated with such a service. The article argues that not providing a tangible benefit to vulnerable research (...) participants is inconsistent with the principle of social justice that undergirds much of the rationale for conducting health disparities research. (shrink)

While health care goals are usually formulated in terms of the securing of good health for the population, the goal of public health is to an increasing extent, at least in Western countries, being formulated in terms of the provision of societal preconditions for securing of good health. This goal may be attained although no one enjoys good health as a result, namely if people choose not to make use of the preconditions provided. However, reaching (...) this goal may still seem desirable in that it promotes the autonomy of people with regard to health-related choices. In this presentation, I address the questions: 1) whether or not the promotion of autonomy may be supported as goal of public health on the basis of ethical theories dealing with autonomy, 2) whether this support is equally strong regardless of the economic, social and cultural conditions of different countries. I will argue that the first question may be answered affirmatively only if certain important revisions are made in the ethical theories in questions but that these revisions at the same time raise a number of very complicated issues in theory as well as in practice. Regarding the second question, I will claim that in so far as the goal of promoting autonomy may be morally justified, there are a number of reasons supporting the suggestion that this justification is much stronger in societal settings where reasonably high health and welfare levels are allready secured. (shrink)

In this paper it is argued that courts must, where appropriate, take into account the fact that National Health Service hospitals are under‐funded when they determine the standard of care owed by such hospitals and their professional staff to patients. Although this suggestion is inconsistent with the traditional view of the courts, its adoption would bring negligence cases into harmony with judicial review decisions. It would also cohere with a new understanding of accident causation within complex organisations, which suggests (...) that many of the injuries suffered by patients in under‐funded hospitals are the result of systemic failures that cannot necessarily be attributed to those who are the last actors in the causal chain leading to damage. (shrink)

Many cultural competency efforts in healthcare stress the importance of cultural diversity and difference. This emphasis is necessary and well justified. It has helped sensitize healthcare systems to the differences among people and their health-related attitudes, preferences, and behaviors. However, the emphasis on diversity and difference has, unfortunately, also detracted from serious consideration of the things that cultures have in common and the possibility that socioeconomic differences are today far more important than cultural ones in determining healthcare outcomes.

Why does equality matter, as a social and political value, and what does it require? Relational egalitarians argue that it does not require that people receive equal distributive shares of some good, but that they relate as equals. Christian Schemmel here provides the first comprehensive development of a liberal conception of relational equality, one which understands relations of non-domination and egalitarian norms of social status as stringent demands of social justice. He first argues that expressing respect for the freedom and (...) equality of individuals in social cooperation requires stringent protections against domination. Taking this as a starting point, he then develops a substantive, liberal conception of non-domination and argues that non-domination is a particularly important, but not the only, concern of social justice. From there, Schemmel develops an account of the wrongness of inegalitarian norms of social status which shows how status-induced foreclosure of important social opportunities is a social injustice in its own right, over and above the role of status inequality in enabling domination, and the threats it poses to individuals' self-respect. Finally, Schemmel articulates the core requirements of liberal relational egalitarianism for political, economic, and health justice: these amount to demands for far-reaching forms of equality in all three domains, which can rarely, if ever, be overridden by competing concerns. With expert rigor and creativity, Justice and Egalitarian Relations brings together scholarship in a variety of related topics, from social justice and liberalism to distributive and relational equality, social equality, neo-republicanism, and non-denomination. (shrink)

This paper presents a systematic account of ethical issues actualised in different areas, as well as at different levels and stages of health care, by introducing organisational and other procedures that embody a shift towards person centred care and shared decision-making (PCC/SDM). The analysis builds on general ethical theory and earlier work on aspects of PCC/SDM relevant from an ethics perspective. This account leads up to a number of theoretical as well as empirical and practice oriented issues that, in (...) view of broad advancements towards PCC/SDM, need to be considered by health care ethics researchers. Given a PCC/SDM-based reorientation of health care practice, such ethics research is essential from a quality assurance perspective. (shrink)

Antibiotic resistance, arising when bacteria develop defences against antibiotics, is creating a public health threat of massive proportions. This raises challenging questions for standard notions in bioethics when suitable policy is to be characterized and justified. We examine the particular proposal of expediting innovation of new antibiotics by cutting various forms of regulatory ‘red tape’ in the standard system for the clinical introduction of new drugs. We find strong principled reasons in favour of such a lowering of the ethical (...) standards of research and the clinical introduction of new antibiotic formulas. However, this support is undermined by pragmatic challenges owing to expected responses from stakeholders, creating uncertainty about which policies could actually be effectively implemented. We describe an underlying dilemma on how to rationally justify compromises between ideal ethical justification and pragmatic risks that needs to be further addressed in this light. We suggest a solution to this dilemma related to proposals of expediting antibiotic drug innovation. (shrink)

Public health is often distinguished from heaslth care in that it is said to serve more 'collective' goals, such as 'the common good' rather than the good of individual people. However, it is not clear what this good is supposed to be (although it is supposed to be 'common'). In regular health care we see in the West a gradual expansion of traditional goals exclusively in terms of length and quality of life to goals having to do more (...) with autonomy - the ability of people to control and direct their own lives. This has lead to a number of questions regarding how such an ethical ideal of promotion of autonomy may be construed, whether or not it really is an ideal, what practical consequences it has etc. (shrink)

The idea that there is such a thing as a human right to health has become pervasive. It has not only been acknowledged by a variety of international law documents and thus entered the political realm but is also defended in academic circles. Yet, despite its prominence the human right to health remains something of a mystery - especially with respect to its philosophical underpinnings. Addressing this unfortunate and intellectually dangerous insufficiency, this book critically assesses the stipulation that (...) health is a human right which - as international law holds - derives from the inherent dignity of the human person. Scrutinising the concepts underlying this stipulation, it shall conclude that such right cannot be upheld from a philosophical perspective. (shrink)

‘Researcher identity’ affects global health research in profound and complex ways. Anthropologists in particular have led the way in portraying the multiple, and sometimes tension-generating, identities that researchers ascribe to themselves, or have ascribed to them, in their places of research. However, the central importance of researcher identity in the ethical conduct of global health research has yet to be fully appreciated. The capacity of researchers to respond effectively to the ethical tensions surrounding their identities is hampered by (...) lack of conceptual clarity, as to the nature and scope of the issues involved. This paper strives to provide some clarification of these ethical tensions by considering researcher identity from the perspective of (1) Guillemin and Heggen's (2009) key distinction between procedural ethics and ethics in practice, and (2) our own distinction between perceptions of identity that are either symmetrical or asymmetrical, with the potential to shift research relationships toward greater or lesser ethical harmony. Discussion of these concepts is supported with ethnographic examples from relevant literature and from our own (United States (US) Government-funded) research in South Africa. A preliminary set of recommendations is provided in an effort to equip researchers with a greater sense of organization and control over the ethics of researcher identity. The paper concludes that the complex construction of researcher identity needs to be central among the ethical concerns of global health researchers, and that the conceptual tools discussed in the paper are a useful starting point for better organizing and acting on these ethical concerns. (shrink)

Purpose: We investigated the role of gender in abusive leadership practices, along with the effects of abusive leadership on employee health. We tested two hypotheses regarding the relationship between abusive leadership practices and subordinates’ health outcomes. Design: At two points of measurement, 663 participants in Germany rated their 158 direct team leaders on abusive supervision and stated their own levels of emotional exhaustion and somatic stress. To test our hypotheses, we used a mixed model approach. Findings: The results (...) show no gender differences between the ratings for female and male leaders regarding abusive supervision, but do confirm that the leaders’ gender did play a role in employees’ perceptions of abuse; perceived abusive supervision is more strongly related to increased emotional exhaustion and somatic stress when the leader is male. Limitations: The generalizability of the study is limited due to a majority of females in the sample. Practical implications: Organisations should review their policies and procedures to first identify abusive supervision, then to offer adequate support programs for both leaders and subordinates. Originality/value: The study integrates gender into research on leadership and health, shifting the focus from previous studies that investigated constructive to destructive leadership. A further strength of the study is the application of a multilevel design and two separate points of measurement. (shrink)

ZusammenfassungTrotz seiner großen Verbreitung in den Lebenswissenschaften wurde dem Aquarium bisher wenig wissenschafts- und technikhistorische Aufmerksamkeit zuteil. Dies ist nicht zuletzt durch den Umstand begründet, dass das Aquarium und seine Geschichte bisher größtenteils als außerwissenschaftlich aufgefasst wurden. Dabei spielen so unterschiedliche Kontexte wie Akklimatisierung, Amateurnaturkunde und bürgerliche Populärkultur eine wichtige Rolle. Gleichzeitig ist die Entwicklung des Aquariums aber auch eng mit der Geschichte der Lebenswissenschaften verbunden. Mit Blick auf die zweite Hälfte des 19. Jahrhunderts verstehe ich das Aquarium als techno-natural (...) assemblage, in der Technologie, Kultur und Natur zu einem künstlichen Naturraum verbunden sind. Seine Geschichte beginnt in der britischen Amateurnaturkunde und der französischen Akklimatisierungsbewegung. Im Deutschland des späten 19. Jahrhunderts entwickelte sich das Aquarium zu einem Massenphänomen. Gleichzeitig hielt es Einzug in die Lebenswissenschaften, wo es als Einfallstor, Instrument und Umwelt Verwendung fand. Wie sich zeigt, ist das Aquarium eine hochgradig konstruierte Technologie, die sich aus einer Verbindung unterschiedlicher Traditionen herausgebildet und das Leben in die Lebenswissenschaften gebracht hat. (shrink)

Die Zeitgeschichte der Prävention hat Konjunktur. An ihr lässt sich nämlich exemplarisch der Wandel von Konzepten, Organisation und Praxis des biopolitischen Regierens von Bevölkerung anhand des vorbeugenden gesellschaftlichen Umgangs mit Gesundheit und Krankheit beleuchten. Eine entscheidende Technologie ist hierbei die Gesundheitsaufklärung. Diese ist jedoch nach wie vor gerade im Hinblick auf ihre methodologischen Wandlungsprozesse sowie auf die Relationen zwischen internationalen Entwicklungen und nationalen Implementationen wenig erforscht. Auf Grundlage einer quantitativen sowie qualitativen Analyse dreier englischsprachiger Zeitschriften wird diese Lücke im Folgenden (...) ein Stück weit geschlossen. Es wird gezeigt, wie sich in den 1950er Jahren ein internationaler Fachdiskurs der Gesundheitserziehung etablierte und in diesem sich ein verwissenschaftlichendes Berufsfeld konstituierte. Darin wurde die Forderung deutlich, vom deutschen Modell einer anschaulichen Vermittlung medizinischen Wissens vor allem durch Ausstellungen abzukommen und sich auf die Integration sozialwissenschaftlicher Erkenntnisse und Methoden zu fokussieren. Aus der Perspektive der behavioural sciences wurden das Handeln und die Möglichkeit seiner Beeinflussung in Netze wechselseitiger Einflussfaktoren eingefügt: Nur Umfrageforschung zu Gesundheitseinstellungen und -motivationen sowie zur Wirkung der eigenen Aktivitäten schien es zu ermöglichen, den in der Gesundheitserziehung priorisierten Zweck zu erfüllen, Verhalten zu ändern. Über solch eine Zweck‑, Mittel- und Wissensbestimmung, die – gleichwohl unterschiedlich – sowohl in der Bundesrepublik als auch in der DDR rezipiert und institutionalisiert wurde, vergewisserten sich die Akteure im Diskurs, einer internationalen Profession der healtheducators anzugehören. Doch die Hoffnungen, „Rezepte für die Lenkung der Menschen“ zu finden, erfüllten sich auch mit mehr Forschung und der Implementation ihrer Ergebnisse nicht. (shrink)

Few studies have considered in detail the ethical issues surrounding research in which investigators ask community members to engage in research subject recruitment within their own communities. Peer-driven recruitment and its variants are useful for accessing and including certain populations in research, but also have the potential to undermine the ethical and scientific integrity of community-based research. This paper examines the ethical implications of utilizing community members as recruiters of human subjects in the context of PDR, as well as the (...) authors' experience with a variant of PDR in a research project in South Africa. The importance of situating PDR in a comprehensive community engagement process that is responsive to the constraints of science and local needs and interests is emphasized. The paper will have relevance to bioethicists, health researchers, and research regulators concerned about the appropriate use of peer-driven recruitment strategies in health research. (shrink)

For decades, Christiane Northrup has been helping women navigate their lives with grace and joy. This elegant, compact volume offers her trademark wisdom in a fresh form, filled with pointed reminders "to help you develop a deeper respect for, and connection to, your own body and its exquisite guidance system [to] create a vibrantly healthy body, mind, and spirit." Each beautifully designed black-and-white page carries a quote that touches on a topic of deep significance: everything from heart-listening to epigenetics to (...) the importance of knowing that your decisions about medical treatment are not irreversible. Examples include:You are an ever-renewing, ever-changing, ever-growing being, born with an inner guidance that helps you create and maintain vibrant health and happiness. / When faced with a dilemma, take a moment to sit with the issue. Don't rush to decide what to do. Intend to let Divine inspiration flow to you, and it will be so! The next time you get an ache or a pain, soften the area around it with compassion. Ask your body what it needs. Listen deeply for the answer. (shrink)

BackgroundWhile neighborhood safety and stranger danger have been mostly canonized to play a part in parents’ physical activity avoidance, less is known about the impact of parental stress and perceived risk on children’s PA avoidance and consequently on children’s level of PA and wellbeing. Understanding the contributors to children’s wellbeing during pandemic disease is the first critical step in contributing to children’s health during epidemic diseases.MethodsThis study employed 276 healthy children, aged 10–12 years, and their parents. Data were collected (...) in October and November 2020, about 9 months after the local closing of schools due to the coronavirus disease 2019 pandemic. Parents and children answered a separate set of questions. Besides the demographic information, the parents responded to questions on their stress level, perceived risk of COVID-19, and PA avoidance for children. Children responded to questions on their PA and wellbeing in the last week. Data were analyzed using SmartPLS and IBM SPSS 22.ResultsThe result of the study supported the four directional research hypotheses of the sequential study model. As hypothesized, parents’ stress and perceived risk levels of COVID-19 negatively affected children’s PA. The PA level was shown to predict children’s wellbeing and mental health. Housing type, parents’ job security, number of siblings, number of members living together in-home, and history of death or hospitalization of relatives or family members due to COVID-19 were found to be associated with parents’ stress and children’s mental health.ConclusionThis study sheds light on parents’ role in children’s wellbeing and mental health during the COVID-19 pandemic. Parents with higher stress and high restrictive behaviors might put their children at risk of mental disorders in the end. (shrink)

There is no cure or vaccine for HIV/AIDS. The only life-prolonging treatment available is antiretroviral (ARV) therapy. WHO estimates, however, that less than 5 percent of those who require treatment in developing countries currently enjoy access to these medicines. In Africa fewer than 50,000 people–less than 2 percent of the people in need–currently receive ARV therapy. These facts have elicited strongly divergent reactions, and views about the appropriate response to this crisis have varied widely.The intensity of the debate concerning access (...) to life-prolonging medicines for the treatment of HIV/AIDS, and the heated rhetoric with which they are often conducted, suggest that these disagreements may be rooted in deeper disagreements of value. It is not obvious, however, what disagreements of value are at stake in this debate. By analyzing the statements of scholars, public officials, activist organizations, and private sector representatives, each of whom may endorse very different policy recommendations on access to HIV/AIDS drugs, we have identified and created a typology of the different sources of disagreement in the debate. We conclude that the central disagreements concerning access to medicines arise from competing understandings of how responsibilities for bringing remedy to hardships should be allocated to different agents and institutions. A central lesson that emerges from our analysis is that thinking about “health equity” must extend beyond the explanation and justification of goals, values, and ideals, and engage more honestly with the difficult question of how responsibilities for bringing remedy to health crises should be allocated in complex social contexts. (shrink)

BackgroundValue sensitivity – the ability to recognize value-related issues when they arise in practice – is an indispensable competence for medical practitioners to enter decision-making processes related to ethical questions. However, the psychological competence of value sensitivity is seldom an explicit subject in the training of medical professionals. In this contribution, we outline the traditional concept of moral sensitivity in medicine and its revised form conceptualized as value sensitivity and we propose an instrument that measures value sensitivity.MethodsWe developed an instrument (...) for assessing the sensitivity for three value groups in a four step procedure: 1) value identification ; 2) value representation ; 3) vignette construction and quality evaluation ; and 4) instrument validation by comparing nursing professionals with hospital managers.ResultsWe find that nursing professionals recognize and ascribe importance to principle-related issues more than professionals from hospital management. The latter are more likely to recognize and ascribe importance to strategy-related issues.ConclusionsThese hypothesis-driven results demonstrate the discriminatory power of our newly developed instrument, which makes it useful not only for health care professionals in practice but for students and people working in the clinical context as well. (shrink)

The social shaping of technology (SST) approach to analysing technological development lends itself to an understanding of the relatively negotiated, heterogeneous, and local character of technologies, politicising the mediated nature of sociotechnical change. Here, conditions of actor engagement lie at the heart of analysing technology in social context—that is, the occasions, strategies, and scope of influence that are afforded different actors, by way of how particular problems come to be defined and resolved. In this paper we examine the framing of (...) a number of concrete technology assessments (TAs) from Denmark, from the realms of general TA and health technology assessment (HTA). Our examination of the TA initiatives is directed towards the relatively open-ended and consequently explorative and qualitative stance that SST takes in characterising the boundaries between the technical and the social. The paper goes on to discuss a possible place of ethical inquiry in TA, based on the understanding of technological development that SST affords. In the reflexive approach to addressing technology's relation to society, technology no longer maintains a universally reducible character in time or in social space. Through the possibility of analytically and practically opening up for otherwise seemingly locked actor-positions SST gives room for a more differentiated questioning and treatment of ethical issues in which technology may be implicated. (shrink)

Predictive interventions and practices are becoming a defining feature of medicine. The author points out that according to the inner logic and external supporters of modern medicine, participating in healthcare increasingly means participating in knowing, sharing, and using of predictive information. At the same time, the author addresses the issue that predictive information may also have problematic side effects like overdiagnosis, health-related anxiety, and worry as well as impacts on personal life plans. The question is raised: Should we resort (...) to stigmatization if doing so would increase participation in predictive interventions, and thereby save healthcare costs and reduce morbidity and premature death? The paper concludes that even if such a strategy cannot be ruled out in some forms and contexts, we ought to be very cautious about the dangers of shame and stigmatization. (shrink)

In the context of climate change and its accompanying impact on stress and mental health, we argue that positive psychology (PP) may benefit from an integration of spirituality to better support people’s wellbeing. Starting with an overview of climate change’s impact on wellbeing and health, we explore the paradoxical and complex relationship between humans and nature. Following which, we will briefly define spirituality and present an evocative metaphor of the wave to portray the evolution of the field of (...) PP. In our conclusive remarks, we argue that the field of PP has gradually become more open to integrate spirituality (since the first wave), as it evolves towards greater complexity (in its third wave). In addition to meaning, some spiritual perspectives potentially relevant to positive psychology facilitate an ecocentric view (i.e., eco-spiritualities) which allow for a better understanding of the paradoxical human-nature relationship, as we struggle to deal with the complex issues related to climate change. (shrink)

ABSTRACTThis paper analyses ethical issues in forensic psychiatric research on mentally disordered offenders, especially those detained in the psychiatric treatment system. The idea of a ‘dual role’ dilemma afflicting forensic psychiatry is more complicated than acknowledged. Our suggestion acknowledges the good of criminal law and crime prevention as a part that should be balanced against familiar research ethical considerations. Research aiming at improvements of criminal justice and treatment is a societal priority, and the total benefit of studies has to be (...) balanced against the risks for research subjects inferred by almost all systematic studies. Direct substantial risks must be balanced by health benefits, and normal informed consent requirements apply. When direct risks are slight, as in register‐based epidemiology, lack of consent may be counter‐balanced by special measures to protect integrity and the general benefit of better understanding of susceptibility, treatment and prevention. Special requirements on consent procedures in the forensic psychiatric context are suggested, and the issue of the relation between decision competence and legal accountability is found to be in need of further study. The major ethical hazard in forensic psychiatric research connects to the role of researchers as assessors and consultants in a society entertaining strong prejudices against mentally disordered offenders. (shrink)

Reducing disparities in health for racial and ethnic minorities has been a focus for US public health since the Heckler Report. Yet, a majority of racial and ethnic minorities in the US continue to have lower life expectancies and are more susceptible to poorer health outcomes compared to their white counterparts. Improvements in public health have been thwarted by ideological differences and structural restraints that necessitate an alternative method aimed at reorienting ethical discourse and guiding the (...) public health as an institution. Informed by a neo-Aristotelian concept of justice and the good life explicated through the Catholic social tradition, a new framework will enable public health to more wholly achieve its aim in the service of the populations that continue to be marginalized. (shrink)

During the COVID-19 crisis there have been many difficult decisions governments and other decision makers had to make. E.g. do we go for a total lock down or keep schools open? How many people and which people should be tested? Although there are many good models from e.g. epidemiologists on the spread of the virus under certain conditions, these models do not directly translate into the interventions that can be taken by government. Neither can these models contribute to understand the (...) economic and/or social consequences of the interventions. However, effective and sustainable solutions need to take into account this combination of factors. In this paper, we propose an agent-based social simulation tool, ASSOCC, that supports decision makers understand possible consequences of policy interventions, but exploring the combined social, health and economic consequences of these interventions. (shrink)

While other parts of medicine and health care seems traditionally to be primarily directed at preventing losses of bodily functions, repairing said functions in the case of such losses, or at least to provide ailment for unpleasant symptoms, sports medicine has allready from the beginning been involved with the project of enhancing bodily functions with regard to sports performance. First, when sports medicine involve itself in the traditional health care activity of prevention, therapy and ailment, the aim is (...) often very different from ordinary medical activities in that it tries to secure bodily functions far beyond what is required to reach what would normally be seen as a non-pathological state of a person. Second, sports medicine actively involves itself in the project of extending and enhancing human performance capacities through medical knowledge and technology. This raises several issues both with regard to medical ethics and the ethics of sports. For example, how should the goals of sports medicine be viewed from the perspective of rationing scarce health care resources? Should sports medicine be restricted by rules from the sports community as to which performance enhancing activities are tolerated in that sector? Or should sports medicine rather direct what is to be accepted within the world of sports? Both lines of reasoning are to be found in debates about, e.g., doping, controversial training methods and the potential use of gene technology in sports. The paper will address these issues and analyse them from a philosophical point of view. (shrink)

This book involves an in-depth analysis of the ethical, political and philosophical issues related to health-oriented screening programs.

The IOC and WADA have announced their ambition to develop control program in order to detect athletes' illegitimate use of genetic technology for enhancing performance. Although it is far from clear what such uses should be counted as illegitimate, as well as to what extent the idea of control programs for such things is a feasible idea, I will assume that such programs will concern so-called somatic genetic modifications that aims at altering the athlete's initial bodily biochemistry in a way (...) that may enhance performance without the presence of any medical reason for undertaking such modifications. This means that the envisioned control-program will have to make use of the method of genetic testing in order to detect the possible presence (or non-presence) of various genetic variants within the athlete. As a consequence of this, several ethical issues familiar within the field of genetic testing for health purposes are suddenly actualised within the area of doping control. These issues concern primarily how to handle and communicate the information about the athlete that is uncovered by such testing. However, due to the ways in which gene doping may be performed, in the case of atheletic control programs, issues of medical safety and the question of what hardships it is reasonable to require of athletes to endure also become paramount. As a consequence, one may ask whether or not sporting ethics will have to consider applying the rule of informed consent in connection to testing programs of the kind here discussed. (shrink)

This collection moves from COVID to Kairos, engaged with the legacy of Paul Tillich. Liminal spaces reflect ambiguous transitional moments in human consciousness and culture. In early 2020, cultures and states turned inward for protection, exacerbating intertwined health, political, racial justice, and economic crises. Tillich would have understood these overlapping challenges to be heralding a kairotic moment, reflecting simultaneous crises and opportunities. The collected essays reflect on the intersections of COVID and Kairos. Authors engage numerous ethical challenges precipitated by (...) the current Kairos moment, thinking through and with Tillich. Other essays offer reflections on our cultural moment, engaging topics from public health to video games to hate speech. Reflecting on the cultural moment, this collection offers unique insight into the Tillichian legacy for the present and future. (shrink)

The Swedish solution to the legal handling of professional conscientious refusal in healthcare is described. No legal right to conscientious refusal for any profession or class of professional tasks exists in Sweden, regardless of the religious or moral background of the objection. The background of this can be found in strong convictions about the importance of public service provision and related civic duties, and ideals about rule of law, equality and non-discrimination. Employee's requests to change work tasks are handled on (...) a case-by-case basis within the frames of labour law, ensuring full voluntariness, and also employer's privilege regarding the organisation and direction of work, and duties of public institutions to provide services. Two complicating aspects of this solution related to the inclusion of ‘alternative medical’ service providers in a national health service, and professional insistence on conscientious refusal rights to accept legalised assisted dying are discussed. The latter is found to undermine the pragmatic reasons behind recent attempts by prolife groups to challenge the Swedish solution related to legal abortion in courts. (shrink)

Sharing research data has great potential to benefit science and society. However, data sharing is still not common practice. Since public research funding agencies have a particular impact on research and researchers, the question arises: Are public funding agencies morally obligated to promote data sharing? We argue from a research ethics perspective that public funding agencies have several pro tanto obligations requiring them to promote data sharing. However, there are also pro tanto obligations that speak against promoting data sharing in (...) general as well as with regard to particular instruments of such promotion. We examine and weigh these obligations and conclude that all things considered funders ought to promote the sharing of data. Even the instrument of mandatory data sharing policies can be justified under certain conditions. (shrink)

Definition of the problemMedical and nursing care often takes place within complex organizational structures that comprise numerous facilities at numerous locations. We introduce an interactive ethical concept, designed in cooperation with the diaconal foundation BruderhausDiakonie Reutlingen and the International Centre for Ethics in Science, University of Tübingen, to address the particular needs of such organizations.ArgumentsTherefore we portray the interactive Nijmegen Model which combines an ethics committee located at the management level and situational ethical case deliberations on the ward in order (...) to bring together two indispensable ways of ethical reflection in organizations: “top-down”/“bottom-up”. We illustrate the challenges of implementing the said model into the organizational construction of the BruderhausDiakonie and how to address these by means of conception and implementation.ConclusionConsidering the implementational challenges that we encountered, the Nijmegen Model needs to be enhanced by introducing a link between the committee and the case deliberations. We delineate the basic elements and the requirements for such a position while reporting our initial practical experience with this model. (shrink)

With more than half of individuals incarcerated having serious mental health concerns, correctional settings offer excellent opportunities for epidemiological, prevention, and intervention research. However, due to unique ethical and structural challenges, these settings create risks and vulnerabilities for participants not typically encountered in research populations. We surveyed 1,224 researchers, Institutional Review Board members, and IRB prisoner representatives to assess their perceptions of risks and vulnerabilities associated with mental health research conducted in correctional settings. Highest ranked risks were related (...) to privacy, stigma, and confidentiality; lowest ranked risks were related to prisoners’ loss of privileges or becoming targets of violence due to having participated in research. Cognitive impairment, mental illness, lack of autonomy, and limited access to services emerged as the greatest sources of vulnerability; being male, being female, being older than age 60, being a minority, and being pregnant were the lowest ranked sources of vulnerability. Researchers with corrections experience perceived lower risks and vulnerabilities than all other groups, raising the question whether these researchers accurately appraise risk and vulnerability based on experience, or if their lower risk and vulnerability perceptions reflect potential bias due to their vested interests. By identifying areas of particular risk and vulnerability, this study provides important information for researchers and research reviewers alike. (shrink)

This paper analyses ethical issues in forensic psychiatric research on mentally disordered offenders, especially those detained in the psychiatric treatment system. The idea of a 'dual role' dilemma afflicting forensic psychiatry is more complicated than acknowledged. Our suggestion acknowledges the good of criminal law and crime prevention as a part that should be balanced against familiar research ethical considerations. Research aiming at improvements of criminal justice and treatment is a societal priority, and the total benefit of studies has to be (...) balanced against the risks for research subjects inferred by almost all systematic studies. Direct substantial risks must be balanced by health benefits, and normal informed consent requirements apply. When direct risks are slight, as in register-based epidemiology, lack of consent may be counter-balanced by special measures to protect integrity and the general benefit of better understanding of susceptibility, treatment and prevention. Special requirements on consent procedures in the forensic psychiatric context are suggested, and the issue of the relation between decision competence and legal accountability is found to be in need of further study. The major ethical hazard in forensic psychiatric research connects to the role of researchers as assessors and consultants in a society entertaining strong prejudices against mentally disordered offenders. (shrink)

Two essential periods may be identified in the early stages of the history of vitamin D-resistant rickets. The first was the period during which a very well known deficiency disease, rickets, acquired a scientific status: this required the development of unifying principles to confer upon the newly developing science of pathology a doctrine without which it would have been condemned to remain a collection of unrelated facts with very little practical application. One first such unifying principle was provided by the (...) notion of hygiene; while the blanket explanations provided by this notion alone were much too general to enable rickets to achieve scientific status, it did point out the need to look for specific external causes for the disease and to examine the life-style and dietary habits of the patients. The second phase of the conceptualization of the disease was the assumption of a specific cause — that is, using concepts developed in the area of infectious diseases. This was made possible by fundamental similarities between deficiency and infectious diseases, in spite of their apparent differences. Both types of illness have some of the characteristics of what Georges Canguilhem calls the ontological representation of disease as opposed to dysharmonic representations, which primarily concern the endocrine diseases. It is precisely this shift from one to the other manner of perceiving ill health that enabled the identification of the vitamin D-resistant rickets. Conceptualization of the notion of vitamin D resistancy required that the conditions causing the disease be looked for within the organism rather than outside it; this was thus the first time that endocrine concepts were applied to studying the physiology of vitamin D.The history of resistant rickets therefore represents an interesting model for understanding the growth of biomedical knowledge. It allows the development of a number of more general ideas on the question of the relationship between biology and medicine and on the thorny problem of specificity in medical thinking. As far as this topic is concerned it can be seen that there was an ongoing exchange between medical and biological thinking during the initial period up until 1937, and that one could deny any such specificity in medical thinking during this same period. Albright, for example, used human diseases as spontaneously produced models for experimental biology. It was also more feasible for an experimental biologist to administer toxic doses than for a clinician to do so.What, then, if any, is the place of the specificity of medical thinking in this history? The fact that medicine is characterized not only by it ccognitive content78 but also by its final aim, which is to restore health, makes it necessary to take factors other than objective knowledge into consideration. This is particularly evident in two aspects of medicine, therapeutics and nosology, and in approaching the notion of pathological individuality.Therapeutic activity has a largely empirical approach. Many drugs, such as cod-liver oil, were discovered empirically. Treatment often in the past, and still now, has proceeded by trial and error, upon no established theoretical basis. At this level the relationship between biology and medicine is roughly comparable to that between science and technology79 \3- that is, it is impossible to reduce either therapeutics or technical activities to the simple application of basic science. In this sense, the application of vitamin D to vitamin-resistant rickets is quite typical. Further-more, in the case studied here, the therapeutic activity heralds a definite breaking away from the medicatrix naturae of conventional medicine dating back to ancient times, and it embodies a new concept of the organism and of disease: no longer can the diseased organism be thought of as merely having a perturbed equilibrium requiring restoration by means of a natural style of medicine. On the contrary, vitamin D resistance is an obstacle that indicates profound biological dysfunction, to be rectified only by means of an extremely aggressive and therefore dangerous therapy. The therapy thus serves to reveal the severity of the dysfunction, thereby leading inevitably to conceptual innovation. This sheds light on the theoretical innovations of which the therapeutic activity is capable.Therapeutic activity is also influenced by notions of health and illness, normal and pathological states, none of which may be determined entirely objectively. For example, the term healing as used by Albright in the case of resistant rickets that he described may be discussed in this light.Nosology, or the classification of diseases, depends largely on the description of clinical syndromes, which are themselves mainly based on subjective elements (discomfort, disability, or the extent of a patient's suffering). The advent of pathological anatomy at the beginning of the nineteenth century disrupted classification by introducing the concept of localized anatomical lesions81-and, hence, an element of material objectivity \3- into nosology. Radiological examination further complicated matters by enabling the equivalent of an autopsy on living matter. Lastly, biological examination complicated nosology by showing that biological anomalies may exist in human beings without necessarily leading to a pathological condition. Medical thinking can choose to combine all these elements to describe a disease, but can also separate them and retain only a few, or a single one, according to requirements - as did Albright.The notion of biological and pathological individuality is fundamental to the development of medical thinking. Whatever its theoretical origin, medical thinking has since ancient times incorporated the idea that each individual reacts differently to the same treatment and his own specific pathological tendencies. I mentioned earlier that in the history of vitamin D-resistant rickets the notion of rachitic tendency reflected this type of thinking. After 1937, this history progressed by successively separating new individual entities, affecting smaller and smaller groups of individuals in each case. In other words, the need to understand and to define individual illness more closely required the development of new concepts and the construction of new individual categories of disease linking these concepts to older clinical, radiological, and biochemical elements. (shrink)

This research presents the results of a survey regarding scientific misconduct and questionable research practices elicited from a sample of 1215 management researchers. We find that misconduct is not encountered often by reviewers nor editors. Yet, there is a strong prevalence of misrepresentations. When it comes to potential methodological improvements, those that are skeptical about the empirical body of work being published see merit in replication studies. Yet, a sizeable majority of editors and authors eschew open data policies, which points (...) to hidden costs and limited incentives for data sharing in management research. (shrink)