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Silva DS, Cook VJ, Johnston JC, Gardy J. Ethical challenges in the treatment of non-refugee migrants with tuberculosis in Canada. J Public Health (Oxf) 2021; 43:e701-e705. [PMID: 33316055 PMCID: PMC8677445 DOI: 10.1093/pubmed/fdaa222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/18/2020] [Accepted: 11/07/2020] [Indexed: 11/14/2022] Open
Abstract
While attention to the ethical issues that migrants face in accessing tuberculosis care has increased in the last few years, most of the attention has focused on challenges that refugees face when emigrating. Less attention has been given to ethical challenges that arise in the context of providing tuberculosis treatment and care to non-refugee migrants in high-income countries (HIC), particularly those that do not face immediate danger or violence. In this paper, we analyze some of the ethical challenges associated with treating migrants with tuberculosis in the Canadian context. In particular, we will discuss (i) inter- and intra-jurisdictional issues that challenge quotidian public health governance structures, and (ii) the ethical imperative for the Canadian government and its provinces to clearly differentiate access to healthcare from a person's immigration status to help overcome power imbalances that may exist between public health workers and their clients. The arguments presented herein could potentially apply to other HIC with some form of universal health coverage.
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Affiliation(s)
- Diego S Silva
- Sydney Health Ethics, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, NSW 2050, Australia
| | - Victoria J Cook
- TB Services, Clinical Prevention Services, BCCDC, Vancouver, BC V5Z 4R4, Canada
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - James C Johnston
- TB Services, Clinical Prevention Services, BCCDC, Vancouver, BC V5Z 4R4, Canada
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Jennifer Gardy
- Surveillance, Data, and Epidemiology, Bill and Melinda Gates Foundation, Seattle, WA 98109, USA
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Burgoon ML, Miller PA, Hoover-Hankerson B, Strand N, Ross H. Patient Attitudes Toward Spoken Surveys in a Low-Income Urban Surgical Clinic. Am Surg 2020; 87:999-1004. [PMID: 33295190 DOI: 10.1177/0003134820960054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diverse groups in urban settings demonstrate poor participation in health care and low levels of literacy. It is possible the method of health information delivery (eg, spoken vs. written) in these settings could impact health care related communication and understanding, though little is known on this topic. The objective of this study was to uncover the advantages and disadvantages of spoken survey administration in a low-income urban setting. The data for this study were collected via spoken survey with eighty patients in 9 surgery clinics at Temple University Hospital (TUH) in North Philadelphia. Survey responses were coded into various groups until categories and relationships among them emerged to produce themes relevant in demonstrating the advantages and disadvantages of spoken survey. 69% (55) of respondents preferred a spoken survey format. Of the 55 patients who preferred the spoken format, 33% (18) possessed some level of college education and 47% (26) had finished high school. Of the 23 patients who primarily spoke Spanish or another language at home, 78% (18) preferred a spoken interview format. Overall, 53% (42) of patients experienced at least 1 instance of poor understanding throughout the survey. Patients were better able to understand questions in a spoken survey compared to written ones that they had completed in the past due to the opportunity for surveyors to explain questions when needed. It is possible that question explanation is necessary in low-income urban settings due to low-literacy levels or improved feelings of survey intimacy and efficiency.
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Affiliation(s)
- Montgomry L Burgoon
- Lewis Katz School of Medicine, 12314Temple University, Philadelphia, PA, USA
| | - Parker A Miller
- Lewis Katz School of Medicine, 12314Temple University, Philadelphia, PA, USA
| | | | - Nicolle Strand
- Department of Urban Bioethics, Lewis Katz School of Medicine, 12314Temple University, Philadelphia, PA, USA
| | - Howard Ross
- Department of Colorectal Surgery, 25139Temple University Hospital, Philadelphia, PA, USA
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Eckenwiler LA. A Global Ecological Ethic for Human Health Resources. JOURNAL OF BIOETHICAL INQUIRY 2020; 17:575-580. [PMID: 33169247 PMCID: PMC7651803 DOI: 10.1007/s11673-020-10039-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/26/2020] [Indexed: 06/11/2023]
Abstract
COVID 19 has highlighted with lethal force the need to re-imagine and re-design the provisioning of human resources for health, starting from the reality of our radical interdependence and concern for global health and justice. Starting from the structured health injustice suffered by migrant workers during the pandemic and its impact on the health of others in both destination and source countries, I argue here for re-structuring the system for educating and distributing care workers around what I call a global ecological ethic. Rather than rely on a system that privileges nationalism, that is unjust, and that sustains and even worsens injustice, including health injustice, and that has profound consequences for global health, a global ecological ethic would have us see health as interdependent and aim at "ethical place-making" across health ecosystems to enable people everywhere to have the capability to be healthy.
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Hossain F. Global responsibility vs. individual dreams: addressing ethical dilemmas created by the migration of healthcare practitioners. Glob Bioeth 2020; 31:81-89. [PMID: 33029070 PMCID: PMC7473311 DOI: 10.1080/11287462.2020.1773054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The migration of health care professionals from developing to developed countries is a trend. This migration benefits the destination countries but is quite often devastating to healthcare systems within the home countries. Skilled practitioners from developing countries forego opportunities in their homelands to migrate to developed countries. This leaves a vacuum of talent, weakening the health systems in the ‘home’ countries. Methods This piece analyzes the consequence of such migration through the lens of the four principles of Universal Declaration of Bioethics and Human rights (UDBHR): equality, justice and equity, solidarity and cooperation, and sharing of benefits. Results In the light of moral imagination and moral reflection, we can understand one another as global citizens. Policymakers must develop guides to restore balance and ensure equitable healthcare worldwide. Incorporating ethics education in medical schools and hospitals, implementing temporary migration visas, and helping home countries offer attractive compensation can address this concern. Conclusions Health is a universal human right; the well-being of all must be addressed without overly limiting the rights of practitioners to build the lives they imagine. On the other hand, practitioners should consider themselves global citizens and consider their ethical obligations when considering their migration.
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Affiliation(s)
- Fahmida Hossain
- Center for Healthcare Ethics, Duquesne University, Pittsburgh, PA, USA
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Lederman Z. Family for Life and Death: Family Presence during Resuscitation. INTERNATIONAL JOURNAL OF FEMINIST APPROACHES TO BIOETHICS 2019. [DOI: 10.3138/ijfab.12.2.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The dilemma of whether to allow relatives to see or even touch their loved one while she undergoes cardiopulmonary resuscitation (CPR) has been discussed for roughly four decades. However, Family Presence During Adult Resuscitation (FPDR) is still not widely implemented. In this paper, I espouse relational autonomy to make a case for a clinical approach of family-centered care and FPDR. In recent years, family-centered care (FCC) has gained increasing support. I argue that relational autonomy provides a conceptual framework for both FCC and FPDR. In turn, FCC provides a plausible clinical approach to justify FPDR, while the empirical evidence that supports FPDR provides a useful example to justify FCC.
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Tankwanchi ABS. Oppression, liberation, wellbeing, and ecology: organizing metaphors for understanding health workforce migration and other social determinants of health. Global Health 2018; 14:81. [PMID: 30092811 PMCID: PMC6085714 DOI: 10.1186/s12992-018-0397-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/11/2018] [Indexed: 11/10/2022] Open
Abstract
Background The Commission on Social Determinants of Health (CSDH) identifies the maldistribution of power, money, and resources as main drivers of health inequities. The CSDH further observes that tackling these drivers effectively requires interventions to focus at local, national, and global levels. Consistent with the CSDH’s observation, this paper describes the eco-psychopolitical validity (EPV) paradigm, a multilevel and transdisciplinary model for research and action, thus far insufficiently tapped, but with the potential to systematize the exploration of the social determinants of health. Results Using the physician migration from Sub-Saharan Africa (SSA) to the United States as illustration, this paper articulates how the EPV model can be applied to the systematic analysis of a complex social problem with health inequity implications. To help explore potential determinants of physician migration, a comprehensive coding matrix is developed; with the organizing metaphors of the EPV model–namely oppression, liberation, and wellbeing–serving as analytical categories. Through the lens of the EPV model, migrating physicians are revealed as both ecological subjects enmeshed in a vast web of transnational processes linking source and destination countries, and potential change agents pursuing liberation and wellbeing. While migration may expand the opportunities of émigré physicians, it is argued that, the pursuit of wellbeing by way of migration cannot fully materialize abroad without some efforts to return home, physically or socially. Conclusion Clarifying the relationship between various social determinants of health and health inequities at different levels of analysis is a more complex but essential endeavor to knowledge generation than using a one-dimensional frame. With its roots in interdisciplinary thinking and its emphasis on both individual and contextual factors, the EPV paradigm holds promise as a model for examining the social determinants of health.
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Affiliation(s)
- Akhenaten Benjamin Siankam Tankwanchi
- DST/NRF SARChi Programme on the Health Workforce, School of Public Health, Faculty of Health Sciences, University of the Witswatersrand, Johannesburg, South Africa.
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Lederman Z, Shepp E, Lederman S. Is Israel Its Brother’s Keeper? Responsibility and Solidarity in the Israeli–Palestinian Conflict. Public Health Ethics 2017. [DOI: 10.1093/phe/phx004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zohar Lederman
- The Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore
| | - Emily Shepp
- Health Policy and Administration, University of Illinois at Chicago, School of Public Health
| | - Shmuel Lederman
- Department of History, Philosophy and Judaic Studies, The Open University of Israel
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Prainsack B, Buyx A. Thinking ethical and regulatory frameworks in medicine from the perspective of solidarity on both sides of the Atlantic. THEORETICAL MEDICINE AND BIOETHICS 2016; 37:489-501. [PMID: 27933474 PMCID: PMC5167769 DOI: 10.1007/s11017-016-9390-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This article provides a concise overview of the history of scholarship on solidarity in Europe and North America. While recent decades have seen an increase in conceptual and scholarly interest in solidarity in North America and other parts of the Anglo-Saxon world, the concept is much more strongly anchored in Europe. Continental European politics in particular have given rise to two of the most influential traditions of solidarity, namely, socialism and Christian ethics. Solidarity has also guided important public instruments and institutions in Europe (e.g., welfare, healthcare, etc.). Despite the much stronger affinity of continental European societies to solidaristic thinking, we argue that solidarity has much to offer for addressing societal challenges on both sides of the Atlantic and beyond. After proposing a working definition of solidarity that highlights its utility for guiding policy and practice, we give an example of how a solidarity-based perspective can shape instruments for the governance of data use.
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Affiliation(s)
- Barbara Prainsack
- Department of Global Health & Social Medicine, King’s College London, Strand Campus, 2.10 East Wing, King’s Building, London, WC2R 2LS UK
| | - Alena Buyx
- Institute of Experimental Medicine, Christian-Albrechts-Universität zu Kiel, Arnold-Heller-Str. 3, Haus 28, 24105 Kiel, Germany
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Abstract
For much of the 20th century, vulnerability to deprivations of health has often been defined by geographical and economic factors. Those in wealthy, usually ‘Northern’ and ‘Western’, parts of the world have benefited from infrastructures, and accidents of geography and climate, which insulate them from many serious threats to health. Conversely, poorer people are typically exposed to more threats to health, and have lesser access to the infrastructures needed to safeguard them against the worst consequences of such exposure. However, in recent years the increasingly globalized nature of the world’s economy, society and culture, combined with anthropogenic climate change and the evolution of antibiotic resistance, has begun to shift the boundaries that previously defined the categories of person threatened by many exogenous threats to health. In doing so, these factors expose both new and forgotten similarities between persons, and highlight the need for global cooperative responses to the existential threats posed by climate change and the evolution of antimicrobial resistance. In this article, we argue that these emerging health threats, in demonstrating the similarities that exist between even distant persons, provides a catalyst for global solidarity, which justifies, and provides motivation for, the establishment of solidaristic, cooperative global health infrastructures.
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Barth M, Jugert P, Wutzler M, Fritsche I. Absolute moral standards and global identity as independent predictors of collective action against global injustice. EUROPEAN JOURNAL OF SOCIAL PSYCHOLOGY 2016. [DOI: 10.1002/ejsp.2160] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Markus Barth
- Department of Psychology; University of Leipzig; Leipzig Germany
| | - Philipp Jugert
- Department of Psychology; University of Leipzig; Leipzig Germany
| | - Markus Wutzler
- Department of Psychology; University of Leipzig; Leipzig Germany
| | - Immo Fritsche
- Department of Psychology; University of Leipzig; Leipzig Germany
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Abstract
Desde as últimas décadas do século passado vem sendo construído o campo da saúde global, enfocando questões de saúde supraterritoriais, que extrapolam as fronteiras nacionais, assim como seus determinantes e suas possíveis soluções. Este ensaio objetiva refletir sobre os valores éticos envolvidos na saúde global: justiça social, equidade e solidariedade. Procedeu-se à revisão de artigos científicos e documentos de agências multilaterais. Identificou-se a defesa da saúde global como um bem universal público, analisando os valores da justiça e da equidade com enfoque na alocação e distribuição de recursos, com tendência a priorizar os mais desfavorecidos. São apresentados conceitos de solidariedade, buscando compreender se há a responsabilidade moral de ser solidário com pessoas de outros países, o que justificaria a cooperação internacional na saúde.
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Illingworth P, Parmet WE. The Right to Health: Why It Should Apply to Immigrants. Public Health Ethics 2015. [DOI: 10.1093/phe/phv007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Eckenwiler L. Care worker migration, global health equity, and ethical place-making. WOMENS STUDIES INTERNATIONAL FORUM 2014. [DOI: 10.1016/j.wsif.2014.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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