In the development of a rights-based approach to global health governance, international organizations have looked to human rights under international law as a basis for public health. Operationalizing human rights law through global health policy, the World Health Organization has faced obstacles in efforts to mainstream human rights across the WHO Secretariat. Without centralized human rights leadership in an increasingly fragmented global health policy landscape, regional health offices have sought to advance human rights (...) in health governance and support states in realizing a rights-based approach to health. Examining the efforts of the Pan American Health Organization, this article explores the evolution of human rights in PAHO policy, assesses the mainstreaming of human rights in the Pan American Sanitary Bureau, and analyzes the future of the rights-based approach through regional health governance. (shrink)

In 2010, historian Susan Reverby made public her discovery of the now notorious U.S.–Guatemalan S.T.D. experiments. More than 1300 Guatemalans had been intentionally exposed to syphilis, gonorrhea, and/or canchroid in nonconsensual experiments funded by Johns Hopkins, the Rockefeller Foundation, Bristol Myers-Squibb, and Mead Johnson and carried out by the U.S.P.H.S and Guatemalan health officials in collaboration with the Pan American Health Organization in 1946–48. The purpose of the experiments was to help develop more effective means of (...) preventing and diagnosing STDs. Subjects included prisoners, sex workers, military personnel, and psychiatric patients. The experiments included exposure to STDs through... (shrink)

RESUMEN La sexualidad es parte de la personalidad, la manera de expresarla y vivirla es diferente en cada persona, en tanto, la adolescencia, como etapa del ciclo vital humano, se caracteriza por cambios biológicos, sicológicos y sociales. Se realizó una revisión bibliográfica para profundizar en el estudio de la sexualidad en la adolescencia y las acciones educativas como alternativa de la educación sexual. Se ejecutó una búsqueda en la literatura digital de artículos de investigaciones originales en las bases de datos (...) SciELO Cuba, SciELO Regional, ScienceDirect, ClinicalKey, Cumed, Lilacs, así como los sitios web Organización Panamericana de la Salud, Organización Mundial de la Salud, Fondo de Población de las Naciones Unidas de Cuba, Fondo de las Naciones Unidas. Se concluye que las acciones educativas sobre sexualidad en la adolescencia permitirán a los jóvenes tomar decisiones fundamentadas sobre su sexualidad y su salud, prepararse para la vida y mantener una conducta sexual responsable. ABSTRACT Sexuality is part of personality, the way to express it and live it is different in everyone. Meanwhile, adolescence, as a stage of humans' life, is characterized by biological, psychological and social changes. In order to deepen on the study of sexuality in adolescence and on educational actions as alternatives of sexual education, a bibliographic review was carried out. It was made a digital literature search of articles from original researches in SciELO Cuba, SciELO Regional, ScienceDirect, ClinicalKey, Cumed, Lilacs, as well as the Pan-American Health Organization, the World Health Organization, the United Nations Fund for Population Activities, and the United Nations Fund websites. It was reached the conclusion that educational actions about sexuality in adolescence will allow young people to make conscious decisions about their sexuality and health, prepare for life and maintain a responsible sexual behavior. (shrink)

Zika virus was recognised in 2016 as an important vector-borne cause of congenital malformations and Guillain-Barré syndrome, during a major epidemic in Latin America, centred in Northeastern Brazil. The WHO and Pan American Health Organisation, with partner agencies, initiated a coordinated global response including public health intervention and urgent scientific research, as well as ethical analysis as a vital element of policy design. In this paper, we summarise the major ethical issues raised during the Zika epidemic, highlighting (...) the PAHO ethics guidance and the role of ethics in emergency responses, before turning to ethical issues that are yet to be resolved. Zika raises traditional bioethical issues related to reproduction, prenatal diagnosis of serious malformations and unjust disparities in health outcomes. But the epidemic has also highlighted important issues of growing interest in public health ethics, such as the international spread of infectious disease; the central importance of reproductive healthcare in preventing maternal and neonatal morbidity and mortality; diagnostic and reporting biases; vector control and the links between vectors, climate change, and disparities in the global burden of disease. Finally, there are controversies regarding Zika vaccine research and eventual deployment. Zika virus was a neglected disease for over 50 years before the outbreak in Brazil. As it continues to spread, public health agencies should promote gender equity and disease control efforts in Latin America, while preparing for the possibility of a global epidemic. (shrink)

This paper examines the role that population vulnerabilities play in insurance coverage for a representative sample of Latinos and Asians in the United States. Using data from the National Latino and Asian American Study (NLAAS), these analyses compare coverage differences among and within ethnic subgroups, across states and regions, among types of occupations, and among those with or without English language proficiency. Extensive differences exist in coverage between Latinos and Asians, with Latinos more likely to be uninsured. Potential explanations (...) include the type of occupations available to Latinos and Asians, reforms in immigration laws, length of time in the United States, and regional differences in safety-net coverage. Policy implications are discussed. (shrink)

Health Maintenance Organization (HMO) administrators have been accused of engaging in selective marketing. That is, through such strategies as tailoring the benefits package of the program or advertising in styles or in media that do not appeal to certain undesirable audiences, the administrator can minimize the percentage of persons in the HMO who are heavy users of health care services.By means of analyzing what insurance is (philosophically) and what it means for something to be a free market (...) commodity, the author argues that, as long as American society chooses to regard health insurance as a commodity or service of the free market, the use of such strategies is within the moral rights of health administrators. (shrink)

Amid undulating conceptions of the role and prowess of federalism emerges its central constitutional role: protecting American liberties against unwarranted governmental intrusions. To the extent that federalism is used as a guise for withdrawing fundamental rights to abortion by the U.S. Supreme Court in Dobbs v. Jackson Women’s Health Organization, individual rights are sacrificed in contravention of constitutional structural norms.

This study examines the relative effects of three policy levers on health coverage and costs in plans aimed at covering all Americans. Specifically, using microsimulation analysis and hypothetical proposals, it assesses how the generosity of financial assistance, an employer mandate, and an individual mandate affect the level of uninsurance, distribution of coverage, and federal costs, holding delivery system and benefits constant. The results suggest that only an individual mandate would cover all the uninsured; neither an employer mandate nor generous (...) subsidies alone would be sufficient. The distribution of coverage would be least disrupted by an employer mandate, while 7.3% of people could lose employer coverage with generous subsidies and a voluntary purchasing pool. Federal costs would be highest under a combined individual and employer mandate since there would be costs to minimize disruption. Although less generous subsidies coupled with an individual mandate could yield universal coverage at a low federal cost, doing so would require large, new payments by individuals. Other key trade-offs are discussed. (shrink)

The U.S. Centers for Disease Control and Prevention (CDC 2015) estimates that 35 percent of American adults are obese, while 69 percent are overweight. The CDC also estimates that nearly one in every five children in the United States is obese. The National Bureau of Economic Research estimates that medical treatments of obesity cost US$168.4 billion a year, or 16.5 percent of national spending on medical care (Cawley and Meyerhoefer 2010). Public Health England (n.d.) estimates that 25 percent (...) of the adult population in England is considered obese, while 62 percent of adults are overweight. The World Health Organization (WHO) estimates that in North America, large portions of Central and South America, most of Europe, Russia, and Australia, 60 percent of the population is overweight. The United States and the United Arab Emirates have the highest obesity rates, according to the WHO, at 32.6 and 33.8 percent, respectively. The rest of North America, those large portions of Central and South America, Europe, Russia, and Australia exhibit rates over 20 percent (WHO n.d.). (shrink)

I would like to extend my appreciation to the planning committee of this outstanding conference, the Centers for Disease Control and Prevention and the American Society of Law, Medicine & Ethics for allowing me to have this great opportunity to share my experience in teaching and studying medical and public health law and ethics with my U.S. colleagues. This morning, USA Today is reporting that Brundtland, the Director General of the World Health Organization, finally declared that (...) the aggressive control measures have stopped SARS. I think it is a special achievement on her part as she departs the WHO in less than two weeks. The new Director General of the WHO, JW Lee, is a close friend of mine. (shrink)

Many symptoms of possession described by exorcists correspond to the symptoms of psychiatric disorders. Before helping a person who feels that they are possessed by an evil spirit, one should answer this question: when is therapy necessary, and when is an exorcism required? The article points out that psychiatrists have different attitudes to theological explanations of possession and exorcism. According to the author, it is best to adopt a complementary attitude, such as leaves room for the thought that there exist (...) two causes for the symptoms of possession - the natural and the supernatural one. This may then furnish a common approach for medicine, psychology and religion. The article presents the theological criteria for determining possession by an evil spirit, and the psychological criteria for diagnosing pathological possession, as given by the World Health Organisation and the American Psychiatric Association. The author discusses similarities and differences between the theological criteria for diagnosing demonic possession and the criteria involved in a medical diagnosis. On the basis of both psychological and theological criteria, it is possible to recognize psychopathological states and demonic possession in multidimensional terms. This allows the author to distinguish four situations: health, psychopathological possession, demonic possession of a mentally healthy person, and coexistence of demonic possession with psychiatric disorders. Practical experience shows that the largest number of patients seeking help in health centres belongs to the fourth group, which is why there is a need for close cooperation between exorcists and psychologists or psychiatrists. (shrink)

Imagine that an American physician volunteered to treat wounded children through the Ministry of Health in Gaza, controlled by Hamas. Or that a Palestinian nurse attending to injured fighters in Gaza spoke out against the firing of rockets into Israel, was threatened with arrest, and sought asylum in the United States. Under U.S. law, the doctor could be subject to prosecution, and the nurse could be denied asylum—in the first case, because she provided medical care under the direction (...) or control of a designated terrorist organization; in the second, because he knowingly provided care to a member of a terrorist organization. The question of whether a terrorist is entitled to medical care, though largely theoretical, has generated considerable discussion, with near unanimity that there is no moral basis to refuse to treat. But whether a health professional can be punished for providing medical care either to terrorists or under the auspices of a terrorist organization has received little attention from either a moral or legal perspective, although such situations arise throughout the world. (shrink)

This paper presents the foundation upon which the contemporary knowledge of body integrity dysphoria (BID) is built. According to the World Health Organisation’s International Classification of Diseases, 11th edition (ICD-11), the main feature of BID is an intense and persistent desire to become physically disabled in a significant way. Three putative aetiologies that are considered to explain the insurgence of the condition are discussed: neurological, psychological and postmodern theories. The concept of bodily representation within the medical context is highlighted, (...) with the concept of dysphoria, which was brought to the fore with the introduction of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), and the ICD-11. Contemporary issues of “justice” are addressed to identify ethically relevant distinctions between BID and sex reassignment surgery. It is argued that there is no ethically relevant difference between the BID actor’s desire for invasive surgical intervention and the wish of gender dysphoric individuals to undergo sex reassignment surgery procedures. Some BID actors self-mutilate, and this presents medical professionals with difficult choices regarding whether or not to intervene in order to satisfy the BID patient’s desire. Both abstention and intervention may lead to severe ethical complications for doctors and patients despite the positive outcomes in terms of quality of life for BID individuals who manage to undergo such procedures. (shrink)

United States Atomic Energy Commission (USAEC) and UN agencies utilized techniques of power and negotiation to implement radiation exposure regulations. USAEC affiliated scientists’ expertise was cultivated while establishing a radiation protection regime based on classified experiments. World Health Organization (WHO) leadership sought to manifest a human right to health, including a right to protection from radiation contamination. The careers of a few technical experts and interagency UN correspondence shows how American risk models of radiation regulation traveled (...) and ultimately inhibited WHO attempts to frame radiation as a public health threat. The USAEC and the International Atomic Energy Agency (IAEA) navigated WHO’s way of perceiving radiation with technical experts and bureaucratic and legislative means. This paper shows the underpinning at the UN of competing models of radiation regulation, one state centric and the other, an individual right to health. This narrative provides insights into the nature of the UN’s current conceptualization of radiation regulation and argues for further research into UN, radiation, and human rights history. (shrink)

HALLETT C and WAGNER L. Nursing Inquiry 2011; 18: 359–368 Promoting the health of Europeans in a rapidly changing world: a historical study of the implementation of World Health Organisation policies by the Nursing and Midwifery Unit, European Regional Office, 1970–2003The World Health Organisation (WHO) was inaugurated in 1948. Formed in a period of post‐war devastation, WHO aimed to develop and meet goals that would rebuild the health of shattered populations. The historical study reported here examined (...) the work of the Nursing and Midwifery Unit (NMU) of WHO’s European Regional Office during the later part of the twentieth century. The study examined archive sources lodged at the NMU archive. The sources included manuscripts relating to important NMU initiatives, reports and papers published by WHO, and a range of secondary sources. The study identified three main driving forces in the work of the NMU of the European Regional Office of WHO. One of the strongest of these was a drive to develop and promote the nursing profession within the countries of the European Region. The second was the promulgation and implementation of the positive public health strategies of WHO, particularly its ‘38 Targets for Health for All by the Year 2000’. The third focussed on securing equity across the European continent and on promoting the development of the nursing professions in poorer and less‐developed countries. The study concludes that the nursing professions in European states grew in strength and influence, and that the health of populations improved throughout the continent between 1970 and 2003. It discusses the extent to which the role of the NMU in these advances may have been significant. (shrink)

The International Classification of Functioning, Disability and Health provides a classification of human bodily functions, which, while exhibiting non-conformance to many formal ontological principles, provides an insight into which basic functions such a classification should include. Its evaluation is an important first step towards such an adequate ontology of this domain. Presented at the 13th Annual North American WHO Collaborating Center Conference on the ICF, 2007.

Health care reforms, in particular the expansion of public and/or private health care benefit coverage to some or all population groups, is becoming an increasingly hot topic for discussion—and in some cases for action—at all levels of government. With almost 16% of Americans estimated to be uninsured for at least part of the year, opinion polls show health care near the top of the general public’s list of concerns. Little wonder that presidential candidates for the 2008 election (...) are incorporating ‘‘universal health care coverage’’ proposals in their campaign platforms. Will ‘‘cradle-to-grave’’ coverage for all become a reality or will they just experience cradle-to-grave debates over this issue? That is essentially one of the questions posed in the following discussion on the role of nonprofit health care organizations in promoting, and operating under, universal health care coverage. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Asian American Christian Ethics: Voices, Methods, Issues eds. by Grace Y. Kao and Ilsup AhnAlex MikulichAsian American Christian Ethics: Voices, Methods, Issues Edited by Grace Y. Kao and Ilsup Ahn WACO, TX: BAYLOR UNIVERSITY PRESS, 2015. 355 PP. $44.95This volume opens new horizons in Christian ethics. Editors Grace Y. Kao and Ilsup Ahn suggest two ways of conceptualizing Asian American Christian ethics. They describe the (...) first as "agency- or advocacy-centered" and the second as "bringing Western and Asian philosophical, theological, and cultural traditions together in critical dialogue and for selective retrieval for Asian American Christian ethics" (11). While the contributors to this book rightfully develop agency and advocacy-centered approaches within complex histories of colonialism and oppression, they also emulate Michael Walzer's "connected critic" who is not naïvely or uncritically "neutral" or dispassionate. The contributors appropriately use co-critical approaches that make possible "new and creative 'traditioning'" that does not uncritically reinscribe some "purer" Asian past or "undefiled by Western contact" (15).Nearly every chapter unpacks the deeply problematic term "Asian American" that was originally employed by activists who sought a new identity as "self-determining subjects rather than as 'oriental objects' in the United States" (4). But the term obfuscates multiple diversities within richly divergent national, geographical, colonial, and cultural histories and traditions.Hoon Choi explores the complexity of gender and sexual identities through a richly textured intersectional approach, examines how these identities become intertwined in double and triple binds, and reinterprets Christ as the fullness of humanity against Western hegemony and Eastern sexism. Choi's vibrant reinterpretation of Jesus Christ is complemented by a wise and compassionate pastoral approach.Sharon M. Tan calls for a reinterpretation both of Christian and Asian traditions of marriage, family, and parenting that will "entail a bicultural approach to life" and "creative new ways of retelling their stories and imagining their futures" (42). Tan underscores the difficulty of describing a Pan-Asian approach to marriage, family, and parenting by exploring the complexities of "Tiger Mothers," multigenerational households, the "special case of refugees," transnational families, and biculturality and adaptation.Hannah Ka deconstructs a wide range of Christian approaches to environmental ethics and reinterprets Sallie McFague's Body of God ecological theology through a distinctive Asian American approach. Drawing on beautiful and challenging stories from her own family as well as Confucian and Taoist [End Page 215] thought, Ka suggests a reinterpretation both of existential and functional indebtedness between human beings and all living things. She contends that "humans cannot survive even a day without … all other inorganic and organic existents on earth, while [other existents] can flourish without humans. The life of the human species is not merely interdependent with, but utterly indebted to, all the other existents on earth, rendering humans more vulnerable than others" (221).These are only a few examples of how this volume exemplifies clear, cogent, and constructive Christian ethics. Chapters by Ilsup Ahn ("Virtue Ethics"), Keun-Joo Christine Pae ("Peace and War"), Christina A. Astorga ("Wealth and Prosperity"), Ki Joo (KC) Choi ("Racial Identity and Solidarity"), SueJeanne Koh ("Health Care"), Hak Joon Lee ("Immigration"), Irene Oh ("Education and Labor"), and Jonathan Tran ("Cosmetic Surgery") all expand the horizons of contemporary ethics. I highly recommend this text for scholars to engage new horizons of Christian ethics and to use for a wide variety of upper level undergraduate and graduate courses in Christian ethics as well as constructive and pastoral theology.Alex MikulichLoyola University New OrleansCopyright © 2017 Society of Christian Ethics... (shrink)

Epidemiology is a core science of public health, focusing on research related to the distribution and determinants of both positive and adverse health states and events and on application of knowledge gained to improve public health. The American College of Epidemiology (ACE) is a professional organization devoted to the professional practice of epidemiology. As part of that commitment, and in response to concerns for more explicit attention to core values and duties of epidemiologists in light (...) of emerging issues and increased scrutiny of epidemiology, the College developed, adopted, and published a set of Ethics Guidelines. The structure of the ACE ethics guidelines is in four parts: (1) a brief statement of core values and duties of epidemiologists, coupled with the virtues important to professional practice; (2) concise statements of key duties and obligations; (3) exposition of the duties and obligations with more applications; and (4) a brief summary and conclusion. The Guidelines have been published on the ACE website and in the official College journal Annals of Epidemiology. The guidelines contain (and maintain) core elements that define the discipline of epidemiology and its fundamental duties, but they are also intended to be dynamic and evolving, responsive to a changing professional and social environment. (shrink)

Using interviews with activists and Lisa Sowle Cahill's concept of participatory discourse, this article examines how the Greater Boston Interfaith Organization (GBIO) built solidarity for the 2006 Massachusetts health care reform law. The analysis explores the morally formative connections between GBIO's activist strategies and its public liturgy for reform. The solidarity generated through this interfaith coalition's activities and religious arguments contrasts with two standard types of policy discourse, economics and liberalism. Arguments for health care reform based on (...) economic efficiency or positive rights are hampered by the lack of solidarity in U.S. political culture. GBIO's congregation-based organizing offers a performative model of public argumentation for religious groups committed to achieving affordable, quality health care for all Americans. (shrink)

The first meeting of the Global Forum for Bioethics in Research was initiated by the Fogarty International Centre of the National Institutes of Health and sponsored by the World Health Organisation, the Pan American Health Organisation and the NIH. Held in Bethesda on November 7-10,1999, the intent was to bring together individuals involved in medical research in low- and middle-income nations to share views with each other and with organisations that support clinical research. Approximately 120 persons (...) from 34 countries participated, including individuals from developing countries, pharmaceutical organisations, and communities where medical research is under way.The participants addressed the partnerships required between research sponsors and investigators involved in clinical trials in developing countries and the long-term needs for international multicentred training programs. (shrink)

This article comes out of a series of discussions among a diverse group of chief executive officers (CEOs) and other leaders of nonprofit hospitals, long-term care facilities, health maintenance organizations, and other insurance providers, including several nonprofit Blue Cross Blue Shield (BCBS) plans. The group has met several times over the past year around a shared concern: the current challenges to nonprofit health care organizations and the future role for nonprofits in the re-visioning and creation of an (...) class='Hi'>American health care system that is characterized by universal access, patient-centered quality, and national affordability. (shrink)

The United States has pursued policies of urban upheaval that have undermined social organization, dispersed people, particularly African Americans, and increased rates of disease and disorder. Healthcare institutions have been, and can be, a part of this problem or a part of the solution. This essay addresses two tools that healthcare providers can use to repair the urban ecosystem—perspective and solidarity. Perspective addresses both our ability to envision solutions and our ability to see in the space in which we (...) move. Solidarity is our ability to appreciate our fellowship with other people, a mindset that is at the heart of medical practice. These two tools lay the foundation for structurally competent healthcare providers to act in a restorative manner to create a health-giving built environment. (shrink)

The American Academy of Pediatrics recently released a policy statement and technical report on circumcision, in both of which the organisation suggests that the health benefits conferred by the surgical removal of the foreskin in infancy definitively outweigh the risks and complications associated with the procedure. While these new documents do not positively recommend neonatal circumcision, they do paradoxically conclude that its purported benefits ‘justify access to this procedure for families who choose it,’ claiming that whenever and for (...) whatever reason it is performed, it should be covered by government health insurance. The policy statement and technical report suffer from several troubling deficiencies, ultimately undermining their credibility. These deficiencies include the exclusion of important topics and discussions, an incomplete and apparently partisan excursion through the medical literature, improper analysis of the available information, poorly documented and often inaccurate presentation of relevant findings, and conclusions that are not supported by the evidence given. (shrink)

The World Health Organization states that depression is the leading cause of disability worldwide, and predicts that by 2030 the epidemic of depression raging across the world will be the single biggest contributor to the overall burden of disease of all health conditions. Yet this gloomy picture masks a number of paradoxes concerning the diagnosis and cultural interpretation of depression that appear to challenge the claimed prevalence rates on which it is based. This book's essays by some (...) of the world's leading researchers and scholars on depression explores these anomalies in detail from multidisciplinary and multicultural perspectives, and in doing so reshapes the debate on the nature of depression that is currently under way in the US and abroad. At the book's core is the exploration from the multiple perspectives of a key dilemma: is the epidemic of depression real or is it just apparent? In particular, could it be the result of criteria laid down in the official American classification system of mental disorders, the DSM, interacting with cultural changes to reshape our view of melancholy, pathologizing what were formerly normal symptoms of grief or intense sadness? The debate over the DSM's conception of depression has an international relevance, with the WHO's upcoming revisions to its International Classification of Diseases requiring coordination with the DSM. This collection of perspectives has an unprecedented international dimension, as scholars from Europe and around the world join US academics to explore a central and controversial element of contemporary psychiatric diagnosis - and one that has enormous practical implications for the future of mental health care and how we view our emotions. The book's accessible essays will make it useful to scholars, practitioners, and students across a wide range of disciplines. (shrink)

The presence of nanotechnologies grew and spread throughout Latin America during the first decade of the 21st century. Science and Technology policies have played an important role in the performance of these new technologies. Various international institutions, such as the World Bank, the Organization for Economic Co-operation and Development, and the Organization of American States promoted similar Science and Technology policies, and included nanotechnology as a priority area. This article shows the role of these Science and Technology (...) policies in the promotion of specific objectives and the gap that was left due to the failure to incorporate an examination of the potential risks to health and environment, not to mention other labor-related effects. The omission of matters relevant to workers and consumers by these institutions led to a distancing from organized civil society. (shrink)

This Article considers the conditions under which administrative agencies - particularly those with public health-related missions - may obtain partial autonomy from external interests or politicians. In the process, it critiques the proposition that administrative agencies in advanced industrialized countries such as the United States are routinely “captured” by external economic interests. Through case studies and the application of relevant theory from law and the study of political organization, the Article describes how agencies can produce a measure of (...) autonomy by forging coalitions of stakeholders both internal and external to the agency, and considers how partial autonomy may be modeled as a strategic process involving decisions under uncertainty. The Article then investigates how American publichealth agencies such as the Food and Drug Administration, the Food Safety Inspection Service, and the Centers for Disease Control have been able to use their partial autonomy to develop significant health policy innovations. Although agencies are by no means guaranteed even a partial degree of autonomy, they are nonetheless capable of affecting their political and legal environment, with consequences not only for public-health policy but also for the legitimacy of the nation-state. (shrink)

The American College of Nurse-Midwives, American Society for Pain Management Nursing, American Academy of Pediatrics, and other largely US-based medical organizations have argued that at least some forms of non-therapeutic child genital cutting, including routine penile circumcision, are ethically permissible even when performed on non-consenting minors. In support of this view, these organizations have at times appealed to potential health benefits that may follow from removing sexually sensitive, non-diseased tissue from the genitals of such minors. We (...) argue that these appeals to “health benefits” as a way of justifying medically unnecessary child genital cutting practices may have unintended consequences. For example, it may create a “loophole” through which certain forms of female genital cutting—or female genital “mutilation” as it is defined by the World Health Organization—could potentially be legitimized. Moreover, by comparing current dominant Western attitudes toward female genital “mutilation” and so-called intersex genital “normalization” surgeries (i.e. surgeries on children with certain differences of sex development), we show that the concept of health invoked in each case is inconsistent and culturally biased. It is time for Western healthcare organizations—including the American College of Nurse-Midwives, American Society for Pain Management Nursing, American Academy of Pediatrics, and World Health Organization—to adopt a more consistent concept of health and a unified ethical stance when it comes to child genital cutting practices. (shrink)

Many journalism organizations have published codes of ethics in recent years. The Association of Newspaper Editors, for example, lists 47 different codes on its website. But an organization of health care journalists felt that none of those codes addressed the unique challenges of covering complex health care topics. The Association of Health Care Journalists (AHCJ) is an independent, non-profit organization dedicated to advancing public understanding of health care issues. Its mission is to improve the (...) quality, accuracy and visibility of health care reporting, writing and editing. AHCJ has written a statement of principles for its 750 members. In it, AHCJ states some of the unique challenges faced by journalists covering health care, and offers suggestions on how to face those challenges. Bioethicists are invited to comment on the statement, and to help generate continued discussion of the issues addressed therein. (shrink)

The notions of subjectivity, affect, emotion, and moral feelings today impregnate the whole of society, and they are becoming increasingly perceptible in the area of scientific knowledge as well.1 This preoccupation with emotions developed initially in the wake of the advent of a more permissive society in the 1970s, and then with changes in the organization of capitalism, where flexible work has replaced the Taylorist and Fordist models of divided labor, and also with the crisis of the social welfare (...) system in the 1980s. In both Europe and North America, mental suffering and mental health problems have gradually come to occupy a prominent position in daily life in developed societies. Indeed, a vast and varied.. (shrink)

Between December 14 and 20, 1965, the World Health Organization Scientific Group on Haemoglobinopathies and Allied Disorders metatthe Geneva agency's headquarters. The group comprised eight well-known physicians including Tulio Arends, a leading Latin American human geneticist from the Venezuelan Institute for Scientific Investigations. Others came from North America, Northern and Southern Europe, the Middle East and South East Asia, an array that reflected the delicate geopolitical equilibriums of postwar international health programs, but also the development of (...) highly specialized biomedical research around the globe. They elected Herman Lehmann, from the Abnormal Haemoglobin Research Unit of the Medical Research... (shrink)

Individual researchers may interpret responsible conduct of research (RCR) in various ways, especially given the diversity of research personnel in modern science. Therefore, understanding individuals’ RCR-related misconceptions is important, as it can help RCR instructors customize their lessons to target learners’ incorrect and incomplete ideas. In this vein, this study aimed to explore whether Taiwanese and American graduate students differ in their perceptions and misconceptions regarding RCR-related concepts and, if so, to determine these differences. A diagnostic assessment, the Revised (...) RCR Reasoning Test (rev-RCRRT), was developed to pursue the intended goal. The rev-RCRRT is a two-tier test capable of diagnosing whether a student’s justifications of ethical acceptance in relation to specific RCR-related concepts are based on incorrect or incomplete ideas of RCR. The current results indicated that, first, participating graduate students’ test performances dropped drastically between the first- and second-tier items, suggesting that they were able to judge the ethical acceptability of given RCR-specific scenarios but lacked the advanced knowledge required to explain their judgments. Second, in general, American students achieved significantly better scores on the rev-RCRRT than Taiwanese students. Third, the two groups held different RCR-related misconceptions centered around various RCR topics. Specifically, Taiwanese students’ misconceptions involved concepts related to authorship, piecemeal publication, and human-subject protection. However, American students sometimes misjudged the issues regarding duplicate submissions and publication and the reproducibility of research and replication of ideas. In summary, through a cross-national comparative method, this study not only suggests that graduate students from different national backgrounds interpret RCR differently but also provides substantial evidence for the employment of a two-tier test approach in RCR-specific contexts. The implications of the current findings for future research and the utility of using two-tier tests in RCR instruction are also discussed in this article. (shrink)

This article considers challenges facing the pro-life movement after Dobbs v. Jackson Women’s Health Organization (2022). It identifies four questions the movement must face: (1) whether to adopt a combative or conciliatory rhetorical stance; (2) how to prioritize new legislative goals; (3) how to define the limits of acceptable compromise; and (4) how to respond to Americans with ambivalent attitudes toward abortion. The article argues that each of these issues could precipitate serious division in the pro-life movement that (...) will impact likelihood of future success. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 14.4 (2004) 411-425 [Access article in PDF] Vulnerability, Vulnerable Populations, and Policy Mary C. Ruof "Special justification is required for inviting vulnerable individuals to serve as research subjects and, if they are selected, the means of protecting their rights and welfare must be strictly applied."Guideline 13: Research Involving Vulnerable Persons International Ethical Guidelines for Biomedical Research Involving Human Subjects Council for International Organizations of (...) Medical Sciences (CIOMS) and World Health Organization (WHO) Geneva, Switzerland, 2002 Within medical research and healthcare certain groups are afforded special protections and services because of their designation as vulnerable. The vulnerable require special justification to participate in human subject research in order to eliminate potential human rights abuses. The Nuremberg Code of 1947 was written in response to the extreme human subject abuses that occurred under the Nazi regime, and, although the intent of the 1947 Code was to protect human rights, rigid voluntary consent requirements deprived some individuals of the right to participate in clinical trials. Recent human research guidelines, such as the CIOMS/WHO guidelines referenced above and the guidelines referenced in Section V of this Scope Note, attempt to balance both protection from abuse in research and access to new, experimental treatments for the vulnerable.Although various protective guidelines stipulate special protections for vulnerable populations, the concept of vulnerability and consequently the criteria designating vulnerable populations remain vague. Precisely who are the vulnerable? The word "vulnerability" stems from the Latin vulnerare, "to wound." (Oxford Encyclopedic English Dictionary 1995). In clinical research, the term [End Page 411] vulnerable generally is applied to individuals who are unable to give informed consent or who are susceptible to coercion. The Common Rule (45 CFR 46, Subpart A) includes as vulnerable research subjects: children, prisoners, pregnant women, and persons who are handicapped, mentally disabled, economically disadvantaged, or educationally disadvantaged. Although the Common Rule specifies certain vulnerable categories, the guidelines were not intended to be exclusive, leaving open the interpretation of vulnerability.In medical research and health policy, vulnerability is an abstract concept that has concrete effects both for those labeled vulnerable and for those not. Clinical researchers, healthcare workers, ethical reviewers, and policymakers must be able to identify vulnerable subjects to establish how healthcare resources will be allocated and who will qualify for special protections and socialized benefits. Attempts to quantify vulnerability in clear, measurable ways have met little if any consensus. As Alexander Morawa (II, 2003, p. 150) states, "There is no single approach to definition of vulnerability. In fact, there is no purposeful categorisation at all."Difficulties in defining vulnerability have prompted discourse surrounding its utility as a qualifying factor in the allocation of health resources and its appropriateness as a guiding principle in bioethics. Some of the authors cited in this Scope Note argue against the labeling and categorization of vulnerable individuals and populations. "Labeling individuals as 'vulnerable' risks viewing vulnerable individuals as 'others' worthy of pity, a view rarely appreciated" (III, Danis and Patrick 2002, p. 320). The categories of vulnerable groups listed under the Common Rule have been the source of controversy, "for example, many find the suggestion that pregnant women are vulnerable to be quite sexist" (IV, DeBruin 2001, p. 7). Instead of creating categories of vulnerable populations, would it not be better to derive an account of just treatment from a just social policy at large that encompasses human vulnerabilities (II, Brock 2002, p. 283).For some of the authors listed here, the concept of vulnerability is essential to bioethics. Robert Goodin (I, 1985, p. 107) writes that the vulnerability of other human beings is the source of our special responsibilities to them. In contrast to the four American principles of biomedical ethics—autonomy, nonmaleficence, beneficence, and justice—the four principles of European bioethics and biolaw include vulnerability along with autonomy, dignity, and integrity. According to, Jacob Dahl Rendtorff and Peter Kemp (I, 2000, p. 274) "the principle of vulnerability is ontologically prior to the other [European] principles, it expresses better than all of the other ethical principles... the finitude of the human condition."Some of the... (shrink)

This study examined factors including health-related anxiety, preexisting misinformation beliefs, and repeated exposure contributing to individuals’ acceptance of health misinformation. Through a large-scale online survey, this study found that health-related anxiety was positively associated with health misinformation acceptance. Preexisting misinformation beliefs, as well as repeated exposure to health misinformation, were both positively associated with health misinformation acceptance. The results also showed that demographic variables were significantly associated with health misinformation acceptance. In general, females (...) accepted more health misinformation compared to males. Participants’ age was negatively associated with health misinformation acceptance. Participants’ education level and income were both negatively associated with their acceptance of health misinformation. (shrink)