This review summarizes the discussions held during the 3rd Bioethics Café in 2019, which focused on the theme: “The citizen as public health actor: challenges and opportunities”. Three panelists – Yan Kestens, Allison Marchildon and Karine Lefeuvre – enriched this meeting with their expertise in public health and ethics. This exchange highlighted the value of citizen participation in public health and the importance of nuancing its understanding and application. It is a priority to consider the (...) relationships between the various stakeholders, the contextual factors that can affect this process and the ethical strategies that can be used to strengthen “good” citizen participation. This meeting was part of a series of Bioethics Cafés held in Montreal and Quebec City on the subject of ethics, health and data. (shrink)

Open any standard bioethics textbook, and therein can be found a host of subjects ranging from the abortion rights controversy to the morality of xenographic tissue transplantation. Just as there is a wide scope to the subject matter of bioethics, its practitioners come from a multitude of disciplines, including law, medicine, nursing, theology, philosophy, sociology, and anthropology. And yet, despite a rich variety of investigators and methods, bioethicists overlook numerous subjects that deserve to be addressed. In particular, they (...) neglect issues of public health, preventive medicine, and social medicine. Although topics such as physician-assisted suicide, prenatal genetic testing, and the ethics of new reproductive technologies constitute the contemporary canon of bioethics and deserve sustained analysis, these subjects are not so significant that they should eclipse other issues. For example, gun control policies, the regulation of food additives. immunization programs, prenatal care, leave programs enabling employees to care for dying relatives, the provision of nutrition and medical care to the homeless, and the use of emergency rooms by the most impoverished citizens are all topics neglected by bioethicists. (shrink)

This text is a review of a Bioethics Café in June 2019 that focused on the protection of genetic information and the ownership of such data, but also on the impact of genetic tests offered to the public. Topics such as privacy, the ownership of genetic information, its uses and the benefits and risks of genetic testing were addressed and treated from a variety of ethical perspectives.

The COVID-19 pandemic brought about at least two normative challenges on unprecedented scale for liberal democracies. One concerned prioritization decisions when health care resources were constrained. The other, which arguably led to lasting damage to social cohesion and citizens’ trust in government and government public health institutions, concerned policies introduced with the aim of reducing the spread of SARS-CoV2, some of which turned out to be mistaken. I discuss in this essay a few examples of misguided, liberty-limiting public (...) health policies and describe how public health and public health ethics principlism provided cover for such policies. Citizens had reasons to be concerned about the duration of such liberty-infringing policies, the absence of predictable government policies, and the absence of transparent justifications for the policies that were implemented. (shrink)

Is solidarity in bioethics or public health ethics necessary? If so, why? Is there room for a principle of obligatory solidarity in bioethics or in public health ethics? In the first part of this paper, I assess the meaning of the value of solidarity in ethics. In the second part, I propose insights into the republican interpretation of solidarity, or, more correctly, “civic” solidarity. This is crucial to be able to distinguish between different sources of, and (...) justifications for, solidarity, some legitimate and some not legitimate. In the third part of the paper, I apply the republican concept of civic solidarity to the field of bioethics and public health ethics. This is intended to show how civic republicanism can correct both liberal deficiencies and communitarian excesses in bioethics. Civic solidarity is essential to finding this middle way. It is a key concept, considering the challenges that we face as citizens, health professionals and patients. Finally, the paper concludes with a summary and a plan for further research in this area. (shrink)

The COVID‐19 pandemic has infected millions around the world. Governments initially responded by requiring businesses to close and citizens to self‐isolate, as well as funding vaccine research and implementing a range of technologies to monitor and limit the spread of the disease. This article considers the use of smartphone metadata and Bluetooth applications for public health surveillance purposes in relation to COVID‐19. It undertakes ethical analysis of these measures, particularly in relation to collective moral responsibility, considering whether citizens ought, (...) or should be compelled, to comply with government measures. (shrink)

In this essay I argue that the same considerations that justify the strong commitment to anti-paternalism that has been affirmed in bioethics over the past half century, also calls for anti-paternalistic public health policies. First, I frame the puzzle—why are citizens morally entitled to make unhealthy and medically inadvisable decisions as patients but not as consumers? I then briefly sketch the reasons why bioethicists typically reject paternalism. Next, I argue that those same reasons tell against paternalism in (...) class='Hi'>public health ethics as well. Patients do not waive their rights to make medically inadvisable decisions when they leave their physician’s care. James Wilson disagrees. After I sketch Wilson’s arguments for paternalism in public health policy, I then argue, contra Wilson, that public health paternalism is wrong for the same reason that medical paternalism is wrong, and that the prevalence of paternalism in public policy does not mean that paternalism is morally permissible. I discuss the state’s authority to enforce paternalistic policies and I sketch an anti-paternalist vision for health policymakers. To close, I consider several objections. (shrink)

Partly in response to rising rates of obesity, many governments have published healthy eating advice. Focusing on health advice related to the consumption of animal products (APs), I argue that the individualistic paradigm that prevails must be replaced by a radically new approach that emphasizes the duty of all human beings to restrict their negative “Global Health Impacts” (GHIs). If they take human rights seriously, many governments from nations with relatively large negative GHIs—including the Australian example provided here—must develop strategies (...) to reduce their citizens’ negative GHIs. As the negative GHIs associated with the consumption of many APs are excessive, it is my view that many governments ought to adopt a qualified ban on the consumption of APs. (shrink)

The United Nations Educational, Scientific, and Cultural Organization's (UNESCO) Universal Declaration on Bioethics and Human Rights announces a significant array of welfare entitlements—to personal health and health care, medicine, nutrition, water, improved living conditions, environmental protection, and so forth—as well as corresponding governmental duties to provide for such public health measures, though the simple expedient of announcing that such entitlements are “basic human rights.” The Universal Declaration provides no argument for the legitimacy of the sweeping governmental authority, taxation, (...) and regulation to create and impose such “rights.” As this paper explores that some action promotes a purported good, such as “health,” does not thereby make the action morally permissible. Just as there are moral limits on legitimate personal actions, there are also moral limits on legitimate governmental actions to promote purported goods, including health. A core question of any governmental regulation, therefore, is whether it is a legitimate application of moral political authority or an unauthorized act of state coercion. Pace UNESCO's wide-ranging assertions, this paper argues that promoting health only falls within the legitimate authority of governments in very narrowly defined circumstances. As the paper critically explores, at stake are foundational moral and political questions concerning the limits of governmental authority to intervene in the consensual interaction of persons. Imposing such duties on others, including citizens of a state through regulatory activity and taxation, must be justified, nonarbitrary, and demonstrably within the limits of moral political authority. UNESCO's assertions do not meet this burden of proof. (shrink)

The aim of this article is twofold. First is to demonstrate that most values that underpin public health policy are a source of reasonable disagreement amongst citizens to whom said policy applies....

For graduate students and junior researchers alike, organising a science café may seem a simple and relatively harmless academic activity. However, organising such an event, especially when it aims to share complex and sophisticated thinking with the general public, can raise challenges from conception to completion. In this text, we share our reflections on the challenges and other lessons learned by the members of the organising team of a bioethics café funded by the Canadian Institutes of (...) Health Research, in the hope that our experience can be of use to others in organising similar events. (shrink)

Patient and citizen participation is now regarded as central to the promotion of sustainable health and health care. Involvement efforts create and encounter many diverse ethical challenges that have the potential to enhance or undermine their success. This article examines different expressions of patient and citizen participation and the support health ethics offers. It is contended that despite its prominence and the link between patient empowerment and autonomy, traditional bioethics is insufficient to guide participation efforts. In addition, the turn (...) to a “social paradigm” of ethics in examinations of biotechnologies and public health does not provide an account of values that is commensurable with the pervasive autonomy paradigm. This exacerbates rather than eases tensions for patients and citizens endeavoring to engage with health. Citizen and patient participation must have a significant influence on the way we do health ethics if its potential is to be fulfilled. (shrink)

Risk and crisis communication (RCC) is a current ethical issue subject to controversy, mainly due to the tension between individual liberty (a core component of fairness) and effectiveness. In this paper we propose a consistent definition of the RCC process in public health emergencies (PHERCC), which comprises six key elements: evidence, initiator, channel, publics, message, and feedback. Based on these elements and on a detailed analysis of their role in PHERCC, we present an ethical framework to help design, govern (...) and evaluate PHERCC strategies. The framework aims to facilitate RCC, incorporating effectiveness, autonomy, and fairness. It comprises five operational ethical principles: openness, transparency, inclusivity, understandability, and privacy. The resulting matrix helps understanding the interplay between the PHERCC process and the principles of the framework. The paper includes suggestions and recommendations for the implementation of the PHERCC matrix. (shrink)

Often celebrated as a model of development in Africa, Botswana nonetheless endured a severe HIV epidemic. This article describes the singularity of the Botswana experience in facing AIDS and creating the widest possible access to antiretroviral medications for its citizens. Through exploration of different sets of actors and the construction of their ethics of treatment, it is possible to examine how free and universal access was created within the national antiretroviral program. This article underscores the importance of the site and (...) the local dynamics in the advent of an ethics of access to treatment for Botswana citizens. At the intersection of national citizenship, pharmaceutical philanthropy, and biomedical collaborations, Botswana is an exemplary case (one of the first and unique in its kind) of global health programs for access to drugs in which patients' rights are tied to science and pharmaceutical development. As such it also bears some limitations and concerns over its sustainability. (shrink)

Citizen science models of public participation in scientific research represent a growing area of opportunity for health and biomedical research, as well as new impetus for more collaborative forms of engagement in large-scale research. However, this also surfaces a variety of ethical issues that both fall outside of and build upon the standard human subjects concerns in bioethics. This article provides background on citizen science, examples of current projects in the field, and discussion of established and emerging ethical (...) issues for citizen science in health and biomedical research. (shrink)

Breastfeeding and human milk are the normative standards for infant feeding and nutrition. Given the documented short- and long-term medical and neurodevelopment advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice.In a letter sent out to 2600 hospitals across the country they [Public Citizen] demand that healthcare facilities “immediately discontinue the distribution of commercial infant formula manufacturer discharge bags,” claiming it undermines women’s success at breastfeeding. What they failed to (...) explain is why a woman’s decision regarding her own tits is anyone’s fucking business but her own.Clearly, policies to promote breast-feeding.. (shrink)

Welfare-friendly outdoor poultry husbandry systems are associated with potentially higher public health risks for certain hazards, which results in a dilemma: whether to choose a system that improves chicken welfare or a system that reduces these public health risks. We studied the views of citizens and poultry farmers on judging the dilemma, relevant moral convictions and moral arguments in a practical context. By means of an online questionnaire, citizens (n = 2259) and poultry farmers (n = 100) judged (...) three practical cases, which illustrate the dilemma of improving chicken welfare or reducing public health risks for Campylobacter, avian influenza and dioxin. Furthermore, they scored the importance of moral arguments and to what extend they agreed with moral convictions related to humans and chickens. Citizens were more likely than farmers to choose a system that benefits chicken welfare at the expense of public health. These different judgments could be explained by differing moral convictions and valuations of moral arguments. Judgments of citizens and farmers were associated with moral arguments and convictions, predominantly with those regarding the value of chickens and naturalness. Citizens agreed stronger with moral convictions regarding the intrinsic value of chickens and regarding naturalness than farmers did, while farmers agreed stronger with conviction regarding fairness. We argue that opinions of citizens and farmers are context-dependent, which may explain the differences between these groups. It implies that opinions of different stakeholder groups should be considered in order to achieve successful innovations in poultry husbandry, which are supported by society. (shrink)

Welfare-friendly outdoor poultry husbandry systems are associated with potentially higher public health risks for certain hazards, which results in a dilemma: whether to choose a system that improves chicken welfare or a system that reduces these public health risks. We studied the views of citizens and poultry farmers on judging the dilemma, relevant moral convictions and moral arguments in a practical context. By means of an online questionnaire, citizens and poultry farmers judged three practical cases, which illustrate the (...) dilemma of improving chicken welfare or reducing public health risks for Campylobacter, avian influenza and dioxin. Furthermore, they scored the importance of moral arguments and to what extend they agreed with moral convictions related to humans and chickens. Citizens were more likely than farmers to choose a system that benefits chicken welfare at the expense of public health. These different judgments could be explained by differing moral convictions and valuations of moral arguments. Judgments of citizens and farmers were associated with moral arguments and convictions, predominantly with those regarding the value of chickens and naturalness. Citizens agreed stronger with moral convictions regarding the intrinsic value of chickens and regarding naturalness than farmers did, while farmers agreed stronger with conviction regarding fairness. We argue that opinions of citizens and farmers are context-dependent, which may explain the differences between these groups. It implies that opinions of different stakeholder groups should be considered in order to achieve successful innovations in poultry husbandry, which are supported by society. (shrink)

We believe that most bioethies committees as well as individual ethics consultants have major shortcomings in that they are unlikely to be open to serving the widest number of citizens who may need their services when facing bioethical dilemmas. The HDCC serves as a community resource, is open to all citizens, is free standing, and provides a wide variety of perspectives which can assist patients, their families, and healthcare providers to explore a range of values and options.The HDCC serves as (...) a model for communities that seek to establish a bioethics resource. Further, the HDCC model permits the further exploration of ways in which important healthcare issues can be faced. AHD believes, in keeping with its mission, that the creation of the HDCC can increase the public's awareness of and involvement in healthcare issues. As B. Jennings reminds us,The mission of community health decisions projects is to stimulate a well-informed conversation where many voices are heard and all reasonable perspectives given due consideration. They not only inform, but also enable responsible civic participation and thoughtful health care decisionmaking (6).The HDCC model can serve to bring discussions on bioethical dilemmas out of secrecy into safer, yet more open, community fora. (shrink)

This unique textbook utilizes an integrated, case-based approach to explore how the domains of bioethics, public health and the social sciences impact individual patients and populations. It provides a structured framework suitable for both educators (including course directors and others engaged in curricular design) and for medical and health professions students to use in classroom settings across a range of clinical areas and allied health professions and for independent study. The textbook opens with an introduction, describing the intersection (...) of ethics and public health in clinical practice and the six key themes that inform the book's core learning objectives, followed by a guide to using the book. It then presents 22 case studies that address a broad spectrum of patient populations, clinical settings, and disease pathologies. Each pair of cases shares a core concept in bioethics or public health, from community perspectives and end-of-life care to medical mistakes and stigma and marginalization. They engage learners in rigorous clinical and ethical reasoning by prompting readers to make choices based on available information and then providing additional information to challenge assumptions, simulating clinical decision-making. In addition to providing a unique, detailed clinical scenario, each case is presented in a consistent format, which includes learning objectives, questions and responses for self-directed learning, questions and responses for group discussion, references, and suggested further reading. All cases integrate the six themes of patient- and family-centered care; evidence-based practice; structural competency; biases in decision-making; cultural humility and awareness of the culture of medicine; and justice, social responsibility and advocacy. The final section discusses some challenges to evaluating courses and learning encounters that adopt the cases and includes a model framework for learner assessment. (shrink)

Metaphors used to describe new technologies mediate public understanding of the innovations. Analyzing the linguistic, rhetorical, and affective aspects of these metaphors opens the range of issues available for bioethical scrutiny and increases public accountability. This article shows how such a multidisciplinary approach can be useful by looking at a set of texts about one issue, the use of a newly developed technique for genetic modification, CRISPRcas9.

Nonhuman primates represent an important reservoir for the transmission of new infectious diseases to humans. While several working groups and international agencies have grappled with the ethics of xenotransplantation, the Nuffield Council on Bioethics have recently published a comprehensive and far-reaching series of recommendations that, while not eliminating the infectious disease risks, have nonetheless detailed the major points for concern and have developed a rational approach to minimizing these risks. This report should serve as the blueprint from which to (...) proceed with xenotransplantation. (shrink)

Conduct that satisfies certain bioethical doctrines may come into conflict with the needs and ethics of public health. The growth of antibiotic resistance in bacteria and the spread of HIV both contribute to the difficulty of controlling infectious disease. These two sets of priorities need to be reconciled and this is likely to require a reassessment of prevailing ethical doctrines in the face of the needs of public health.

Courses on bioethics and the law traditionally have focused their coverage on ethical issues arising from individual patients’ encounters with the medical care system, but the course also provides an excellent opportunity to expose students to ethical issues arising at the intersection of medical care and public health. The following materials were assembled for use near the end of a semester-long law school course in Bioethics & Law. I taught the course relying heavily on problems contained in (...) Barry R. Furrow et al., Bioethics: Health Care Law and Ethics, 7th ed., which was the primary text for the course. (shrink)

This paper argues that bioethics as a field should broaden its scope to include the ethics of war, focusing on war’s public health effects. The “Introduction” section describes the bioethics literature on war, which emphasizes clinical and research topics while omitting public health. The section, “War as a public health crisis” demonstrates the need for a public health ethics approach by framing war as a public health crisis. The section, “Bioethics principles for (...) war and public health” proposes six bioethics principles for war that address its public health dimensions: health justice, accountability, dignified lives, public health sustainability, nonmaleficence, and public health maximization. The section, “Justifying and applying bioethical principles” shows how these principles inform ethical analysis, including just war theory and military ethics. The section, “From principles to practice” envisions ways in which bioethicists can promote these principles in practice through research, teaching, and service. The “Conclusion” section urges bioethicists to engage with war as a public health crisis, including calling attention to war’s impact on civilians, especially women, children, and other vulnerable groups. (shrink)

This chapter provides an overview of public health in AfricaAfrica in four main sections. One section explores challenges and promises to public health posed by the size and diversity of Africa. The second section explores the challenges and promises of Africa’s infrastructure. The third section explores existing crises like the HIVHIV/AIDSAIDS pandemic and emerging crises like food insecurity. However, in the fourth section, I suggest that Africa’s biggest public health challenges are rooted in stigma and fear.

Author Information: Paul Tubig PhD Philosophy Student, University of Washington - Seattle ptubig@uw.edu Submission Title: The Place of Health in the Liberal Theory of Justice: The purpose of this paper is to articulate the relationship between health and justice. Ethical claims, such as the World Health Organization’s assertion that health is a fundamental human right or that global health inequalities are normative inequities, require a conceptual analysis of the meaning and value of health within a particular framework of justice. Working (...) from the liberal conception of justice as developed by John Rawls, I will argue that the political significance of health is derived from the Rawlsian democratic conception of persons. In developing this thesis, I will first argue against the traditional biomedical approach of defining health within the political context and instead, advocate a conception of health that comprises of a normative dimension to derive moral rights and responsibilities. I will then argue that the most reasonable conception of health as a public value is derived from Rawls’ democratic conception of persons. By understanding the public identity of citizens as persons who possess a specific set of moral powers and highest order moral interests to develop and exercise these powers, we can derive the political significance of health as a necessary background condition to serve these interests. Therefore, structural arrangements should promote public health to the extent that the two moral powers are developed and sustained. Key Words: Justice, Health, Rawls, Liberalism, Healthcare Justice, Political Bioethics. (shrink)

It is clear that corruption as the abuse of power is an enormous bioethical issue in the public health sector in SA, but as a challenge, it has not elicited much discussion from a global bioethical perspective. The Universal Declaration of Bioethics and Human Rights on corruption considers three matters. First, the existence of corruption as a problem of power is recognised in the health environment and condemned. Second, corruption is indicated as an immoral phenomenon that harms the (...) interests of the patient, ignores vulnerable people and neglects social responsibility. Third, it can be concluded that the UDBHR expresses the opinion that corruption has to be combated by a process of ethical decision-making, the use of ethics committees and ethics education. (shrink)

This essay examines the development of a liberation bioethics in Latin America with its focus on public health equity from the experience and knowledge of those who are at the margins, the poor and historically oppressed groups. An encounter between bioethics and liberation theology contributed to form a Latin American bioethics marked by a double aspect: bioethical scholarly focus on public health equity and social activism for universal healthcare coverage. Liberation theology has a role in (...) this bioethics oriented to public health, and Pope Francis offers a new contribution for this perspective at the same time that he brings it to a global discussion. Considering the exchange between liberation theology and bioethics and Francis’s insights, this essay offers a new perspective grounded in the Brazilian experiment and the Catholic social tradition to dialogue with US bioethical accounts by challenging the Western epistemological framework of bioethical studies in the Global North. (shrink)

Can Rawlsian public reason sufficiently justify public policies that regulate or restrain controversial medical and technological interventions in bioethics (and the broader social world), such as abortion, physician aid-in-dying, CRISPER-cas9 gene editing of embryos, surrogate mothers, pre-implantation genetic diagnosis of eight-cell embryos, and so on? The first part of this essay briefly explicates the central concepts that define Rawlsian political liberalism. The latter half of this essay then demonstrates how a commitment to Rawlsian public reason can (...) ameliorate (not completely resolve) many of the policy disagreements related to bioethically controversial medical interventions today. The goal of public reason is to reduce the size of the disagreement by eliminating features of the disagreement that violate the norms of public reason. The norms of public reason are those norms that are politically necessary to preserve the liberal, pluralistic, democratic character of this society. What remains is reasonable disagreement to be addressed through normal democratic deliberative processes. Specific issues addressed from a public reason perspective include personal responsibility for excessive health costs, the utility of a metaphysical definition of death for organ transplantation, and the moral status of excess embryos generated through IVF and/or their use in medical research. (shrink)

While bioethicist Arthur Caplan claims that “The Nazi analogy is equivalent to dropping a nuclear bomb in ethical battles about science and medicine”, we claim that such total exclusion of this analogy is equally problematic. Our analysis builds on Roberto Esposito’s conceptualization of immunitas and communitas as key elements of biopolitics. Within public health theories and practices there is an inherent tension between exclusion (immunitas) and inclusion (communitas) forces. Taking the immunitas logic to the extreme, as National Socialist medicine (...) did in the name of securing the German race, is a constant danger that needs to be taken seriously into consideration when discussing public health policies. The tension between the silencing of the Holocaust in bioethical debates on one side, and the persistent use of National Socialist medicine metaphors, on the other hand, is the focus of this paper. By delving into the meanings and the implications of this two‐edged discourse, we argue that comparing post‐war bioethics with pre‐war medical practices from a biopolitical perspective has the potential to depict a more nuanced account of continuities and discontinuities in bioethics. (shrink)

ABSTRACT Research ethics is the most developed aspect of bioethics in Africa. Most African countries have set up Institutional Review Boards (IRBs) to provide guidelines for research and to comply with international norms. However, bioethics has not been responsive to local needs and values in the rest of the continent. A new direction is needed in African bioethics. This new direction promotes the development of a locally‐grounded bioethics, shaped by a dynamic understanding of local cultures and (...) informed by structural and institutional problems that impact the public's health, as well as cognisant of the salient contribution of social sciences and social epidemiology which can bring a lasting impact on African local communities. In today's post‐Structural Adjustment Africa, where healthcare has been liberalized and its cost increased, a bioethics agenda that focuses essentially on disease management and clinical work remains blind in the face of a structural marginalization of the masses of poor. Instead, the multidimensional public health crisis, with which most African countries are confronted, calls for a bioethics agenda that focuses primarily, but not exclusively, on health promotion and advocacy. Such an approach to bioethics reckons with the macro‐determinants of health and well‐being and places clinical and research ethics in the broader context of population's health. The same approach underscores the need to become political, not only by addressing health policymaking processes and procedures, but also by becoming an advocacy forum that includes other constituencies equipped with the potentialities to impact the population's health. (shrink)

Contemporary biomedical ethics and environmental ethics share a common ancestry in Aldo Leopold's and Van Rensselaer Potter's initial broad visions of a connected biosphere. Over the past five decades, the two fields have become strangers. Public health ethics, a new subfield of bioethics, emerged from the belly of contemporary biomedical ethics and has evolved over the past 25 years. It has moved from its traditional concern with the tension between individual autonomy and community health to a wider focus (...) on social justice and solidarity. Public health has a broad focus that includes individual, community, and environmental health. Public health ethics attends to these broad commitments reflected in the increasing concern with the connectedness of health of individuals to the health of populations, to the health of animals, to the health of the environment; it is well situated to reconnect all three “fields” of ethics to promote a healthier planet. (shrink)

I whole-heartedly endorse Ismaili M'hmandi’s efforts to move away from the narrowest of liberal justificatory grounds for public health policy. I worry, however, that the liberal perfectioni...

In this commentary, I describe an ecostructural approach to health ethics, which is grounded in a conception of people as ecological subjects and privileges place in supporting health and health justice. This approach sees people as dwelling in health ecosystems that can support or undermine health, and it situates us in social norms and processes, with a particular concern for structural health injustice. In patient care, an ecostructural approach can be operationalized by attending to conditions in the sites where birthing, (...) healing, and dying take place and by critiquing their economic structures. For public health, relationships between people, animals, land, the built environment, and climate demand attention, as do racist norms and economic processes that thwart health justice. For global health, an ecostructural approach might envision a revolution in governance that challenges nationalism, in which health systems treat citizens while depending on human resources supplied through structures that sustain health injustice. (shrink)

This paper aims to search the question ‘whether the ethical issues of infectious disease, which has been so long considered as a problem in the discipline of bioethics, can be brought under the purview of public health ethics’. To explore the problem I begin with a brief description of the evolution of bioethics. I elaborate the six reasons of neglecting the discussion of infectious diseases in early bioethics as highlighted by Selgelid (2005). Then I analyse the (...) view of Bayer and Fairchild (2004) that how infectious diseases by its own ethical questions, make the shift from the autonomy-centred bioethics to common welfare focused public health ethics. However, I would like to conclude that although the ethical discussion of infectious diseases makes a moral shift from the discipline of bioethics to public health ethics, the latter should not always be solely guided by the principle of beneficence to avoid harm for the sake of community welfare. Public health ethics needs to be guided by the balance of the four biomedical principals, such as beneficence, nonmaleficence, autonomy, and justice. (shrink)

At its core, public health introduces tensions between individuals' autonomy and the need to account for the perspectives and needs of communities and populations. It further raises social justice issues, including fair allocation of limited resources. This article examines and elaborates on these tensions and their resolutions using specific public health examples. Experiences in the 1980s and 1990s with HIV/AIDS provide a particularly rich collection of issues that brought ethical issues in public health to the public's (...) attention, and in so doing challenged previously held assumptions about the appropriate consideration of individual rights in the context of population health objectives. Lastly, the article examines some of the ethical challenges arising in public health applications of recent science and technology advances, specifically the emerging area of public health genomics and the large scale collection and analysis of health information. (shrink)

Sanitary engineering is burdened by several challenges that attract bioethical attention: there are many ambiguities regarding the definition of the profession; its methodology seems to be a combination of several approaches from different sciences; and it often appears to be an amalgam of different disciplines. We argue that the bioethical perspective helps to show that these features can be taken as a stimulating challenge. Moreover, bioethics may illuminate how these features can become an asset to sanitary engineering in light (...) of the growing need for holistic approaches. First, we present a bioethical analysis of the aforementioned features as a useful way to clarify and strengthen the identity of the profession. Second, we argue that professional ethics have received the least attention, but are crucial to giving the profession stronger independence and professional identity and to creating a unique worldview at the crossroads of environmental and public health ethics. Finally, we propose a general framework of sound professional ethics of sanitary engineering as a necessary step towards rethinking the core values of the profession, clearly articulating a genuine professional ethic, and reforming educational politics related to professional education. (shrink)

Introduction: Public health ethics addresses moral dilemmas arising from balancing individual healthcare needs with societal interests. Ethical considerations in public health during pandemics and disasters aim to reduce mortality rates and minimize social injustice through fair principles. Objective: This paper analyzes public health ethics and ethical values in allocating resources during mass casualty incidents. The intersection of public health ethics, applied bioethics, and ethics of social consequences (through non-utilitarian consequentialism) guides addressing serious public health (...) challenges in catastrophic scenarios. The application of the given interaction is significant for professional medical ethics. Methodology: The paper employs inductive, deductive, and normative methods of bioethics and the methodology of ethics of social consequences. Conclusion: The paradigmatic disparity between the bioethics of pandemics and disaster bioethics lies in the fluid application of bioethical principles and the accentuation of utilitarian demands depending on the severity and scale of mass casualty incidents. Applied bioethics in crisis situations respects the approaches of public health ethics and attempts to increase positive social outcomes. The application of (scarce) resource allocation criteria and triage of patients is derived from ethical decisions beneficial to public health and lege artis approaches of medical bioethics. The paper presents professional and ethical criteria for medically inappropriate treatment within the framework of patient triage; we approach crisis ethics from the perspective of maximization of benefit. Age is not an exclusion criterion of acute healthcare provision in crisis situations. Ethics of social consequences as a form of non-utilitarian consequentialism allowing for social consequences bridges public health ethics and applied bioethics. (shrink)

Functional foods are a challenge tofood health policies, since they questioncentral ideas in the way that food healthpolicies have been developed over the lastdecades. Driven by market actors instead ofpublic authorities and focusing on the role ofsingle foods and single constituents in foodsfor health, they contrast traditional wisdombehind nutrition policies that emphasize therole of the diet as a whole for health.Sociological literature about food in everydaylife shows that technical rationality co-existswith other food related rationalities, such aspractical and economic rationalities, socialand (...) relational rationalities, and symbolicrationalities that influence citizens' ordinaryeating habits. An examination of lay views onexpert knowledge about food and health showthat skepticism exists with respect to thebasis of and balance of expert advice. Critical points with respect to how functionalfoods may influence routines in the populationswith relevance for public health include thefact, that they promote a way of thinking offood and health that is in conflict withwell-established practical ways of ensuring abalanced diet. (shrink)

The prevalence of obesity, metabolic syndrome, and the associated long-term chronic diseases (cardiovascular disease, type II diabetes, cancer, Alzheimer’s disease, depression) have reached epidemic levels in the United States and Western nations. In response to this public health calamity, the author of this paper presents and defends a novel bioethical argument: the consistency argument for outlawing SSBs (sugar-sweetened beverages) for child consumption (the “consistency argument”). This argument’s radical conclusion states that the government is justified in outlawing SSBs consumption for (...) child consumption. The reasoning is as follows: if one accepts that the physical harm caused by chronic alcohol consumption justifies the government outlawing alcoholic beverages for child consumption, and there is strong evidence that comparable physical harms result from chronic SSBs consumption, then, _mutatis mutandis_, the government is also justified in outlawing child consumption of SSBs. To support this argument, the author provides extensive evidence based on epidemiological observational studies, interventional studies, controlled trials, large meta-analyses, and the pathophysiology and biological mechanisms of action behind SSBs and chronic disease. Chronic consumption of large doses of SSBs and alcoholic beverages both drive the same diseases: obesity and insulin resistance, cardiovascular disease, hypertension, and cancer. Chronic SSB consumption carries the additional risk of Alzheimer’s disease, dementia, and depression. The author concludes this paper by considering prominent objections to the consistency argument, and then demonstrating that each objection is unsound. (shrink)

This book examines the relevance of modern medicine and healthcare in shaping the lives of elderly persons and ageing societies. Combining individual and social dimensions, Planning Later Life discusses the ethical, social, and political consequences of increasing life expectancies and demographic change in the context of biomedicine and public health. By focusing on the field of biomedicine and healthcare, the authors engage readers in a dialogue on the ethical and social implications of recent trends in dementia research and care, (...) advance healthcare planning, or the rise of anti-ageing medicine and prevention. Bringing together the largely separated debates of individualist bioethics on the one hand, and public health ethics on the other, the volume deliberately considers the entanglements of envisioning, evaluating, and controlling individual and societal futures. The process of devising and exploring the various positive and negative visions and strategies related to later life is rarely reflected systematically from a philosophical, sociological, and ethical point of view. As such, this book will be crucial to those working and studying in the life sciences, the humanities, and the social sciences, particularly in the areas of bioethics, social work, gerontology and aging studies, healthcare and social service, sociology, social policy, and geography and population studies. (shrink)

American healthcare -- Bioterror and bioart -- State of emergency -- Licensed to torture -- Hunger strikes -- War -- Cancer -- Drug dealing -- Toxic tinkering -- Abortion -- Culture of death -- Patient safety -- Global health -- Statue of security -- Pandemic fear -- Bioidentifiers -- Genetic genocide.

Many health care organizations made public commitments to become antiracist in the wake of George Floyd's murder. These actions raise questions about the appropriateness of health care's engagement in racial justice and social justice movements generally. We argue that health care organizations can be usefully thought of as having two roles: a functional role to care for the sick and a meta‐role as an organizational citizen. Fulfilling the role of citizen may require participating in the pursuit of social justice, (...) including efforts to achieve racial equity. The demands of these two roles will need to be balanced, but the role of organizational citizen has been largely ignored and merits serious attention. (shrink)

In 1997 President Clinton apologized to the survivors of the U.S. Public Health Service Syphilis Study. Since then, two of his recommendations have received little attention. First, he emphasized the need to remember the shameful past so we can build a better future for racial'ethnic minority populations. Second, he directed the creation in partnership with higher education to prepare training materials that would instruct biomedical researchers on the application of ethical principles to research with racial/ethnic minority populations. This article (...) proposes the inclusion of these issues in the implementation of the Affordable Care Act. It asks, What is the right or good thing to do? What are our obligations to one another? Two challenges are examined: (a) Conducting research with African Americans without knowledge of bioethics specific to this population, and (b) the ethical dilemma of conducting research that does not adequately take into account the diversity within the Black population that is a contributing factor in health disparities. Training and policy recommendations responsive to President Clinton's Apology are presented. (shrink)

Much of the ethical discourse concerning the coronavirus pandemic has focused on the allocation of scarce resources, be it potentially beneficial new treatments, ventilators, intensive care beds, or oxygen. Somewhat ironically, the more important ethical issues may lie elsewhere, just as the more important medical issues do not concern intensive care or treatment for COVID‐19 patients, but rather the diversion towards these modes of care at the expense of non‐Covid patients and treatment. In this article I explore how ethicists can (...) and should prioritize which ethical issues to deal with, and develop a method of triage for identification and prioritization of ethical issues both in the next public health emergency and in bioethics more widely. (shrink)