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Schuff Zimmerman MM, Maclean SJ, DeringAnderson AM, Alexander ED, Maeda BTY, Tran ATQ, Hoff KL, Majid SJ, Stukenholtz KL, Hansen HL. Discussion of an approach to starting a JEDI inventory in a College of Pharmacy. Curr Pharm Teach Learn 2024; 16:244-254. [PMID: 38423845 DOI: 10.1016/j.cptl.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/05/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
Problem description\The University of Nebraska College of Pharmacy is interested in conducting and learning from an inventory of Justice, Equity, Diversity, and Inclusion (JEDI) within the college. QUALITY IMPROVEMENT METHODS An extensive literature review was undertaken to define the terms included in JEDI and to craft a listing of ideal inventory components. RESULTS OF CQI INQUIRY The terms used in JEDI were defined and a list of 148 ideal inventory components was created. This list is further segmented by the JEDI components themselves and by five assessment factors including: representation, curriculum & education, policies & procedures, support & resources, and college climate. INTERPRETATION AND DISCUSSION The attempt to create an ideal listing of JEDI inventory components resulted in an unusably large number of potential items. This occurred intentionally to allow the next steps in the longitudinal creation of a workable, quantifiable, and evaluative JEDI inventory process. Describing these preliminary efforts are important in the ultimate acceptance of the results of the JEDI inventory. CONCLUSION Deliberate and extensive listing of initial aspirations for a JEDI inventory of a College of Pharmacy or any institution allows for sufficient input and breadth to help assure that no significant factor is overlooked as the process is refined.
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Affiliation(s)
- Meghan M Schuff Zimmerman
- University of Nebraska College of Pharmacy, 986145 Medical Center, Omaha, NE 68198-6145, United States of America.
| | - Skyler J Maclean
- University of Nebraska College of Pharmacy, 986145 Medical Center, Omaha, NE 68198-6145, United States of America.
| | - Allison M DeringAnderson
- Department of Pharmacy Practice & Science, 986145 Medical Center, PDD 2055, Omaha, NE 68198-6145, United States of America.
| | - Emma D Alexander
- University of Nebraska College of Pharmacy, 986145 Medical Center, Omaha, NE 68198-6145, United States of America.
| | - Brooke Taylor Y Maeda
- University of Nebraska College of Pharmacy, 986145 Medical Center, Omaha, NE 68198-6145, United States of America.
| | - Anh T Q Tran
- University of Nebraska College of Pharmacy, 986145 Medical Center, Omaha, NE 68198-6145, United States of America.
| | - Karen L Hoff
- University of Nebraska College of Pharmacy, 986145 Medical Center, Omaha, NE 68198-6145, United States of America.
| | - Sonoor J Majid
- University of Nebraska College of Pharmacy, 986145 Medical Center, Omaha, NE 68198-6145, United States of America.
| | - Kaitlyn L Stukenholtz
- University of Nebraska College of Pharmacy, 986145 Medical Center, Omaha, NE 68198-6145, United States of America.
| | - Hannah L Hansen
- University of Nebraska College of Pharmacy, 986145 Medical Center, Omaha, NE 68198-6145, United States of America.
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Mitchell LK, Chopp D. Medical-Legal Partnerships Reinvigorate Systems Lawyering Using an Upstream Approach. J Law Med Ethics 2024; 51:810-816. [PMID: 38477281 PMCID: PMC10937177 DOI: 10.1017/jme.2023.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
The upstream framework presented in public health and medicine considers health problems from a preventive perspective, seeking to understand and address the root causes of poor health. Medical-legal partnerships (MLPs) have demonstrated the value of this upstream framework in the practice of law and engage in upstream lawyering by utilizing systemic advocacy to address root causes of injustices and health inequities. This article explores upstreaming and its use by MLPs in reframing legal practice.
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Affiliation(s)
| | - Debra Chopp
- UNIVERSITY OF MICHIGAN LAW SCHOOL, ANN ARBOR, MI, USA
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Charlton V, DiStefano M. An empirical ethics study of the coherence of NICE technology appraisal policy and its implications for moral justification. BMC Med Ethics 2024; 25:28. [PMID: 38448909 PMCID: PMC10918908 DOI: 10.1186/s12910-024-01016-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND As the UK's main healthcare priority-setter, the National Institute for Health and Care Excellence (NICE) has good reason to want to demonstrate that its decisions are morally justified. In doing so, it has tended to rely on the moral plausibility of its principle of cost-effectiveness and the assertion that it has adopted a fair procedure. But neither approach provides wholly satisfactory grounds for morally defending NICE's decisions. In this study we adopt a complementary approach, based on the proposition that a priority-setter's claim to moral justification can be assessed, in part, based on the coherence of its approach and that the reliability of any such claim is undermined by the presence of dissonance within its moral system. This study is the first to empirically assess the coherence of NICE's formal approach and in doing so to generate evidence-based conclusions about the extent to which this approach is morally justified. METHODS The study is grounded in the theory, methods and standards of empirical bioethics. Twenty NICE policy documents were coded to identify and classify the normative commitments contained within NICE technology appraisal policy as of 31 December 2021. Coherence was systematically assessed by attempting to bring these commitments into narrow reflective equilibrium (NRE) and by identifying sources of dissonance. FINDINGS Much of NICE policy rests on coherent values that provide a strong foundation for morally justified decision-making. However, NICE's formal approach also contains several instances of dissonance which undermine coherence and prevent NRE from being fully established. Dissonance arises primarily from four sources: i) NICE's specification of the principle of cost-effectiveness; ii) its approach to prioritising the needs of particular groups; iii) its conception of reasonableness in the context of uncertainty, and iv) its concern for innovation as an independent value. CONCLUSION At the time of analysis, the level of coherence across NICE policy provides reason to question the extent to which its formal approach to technology appraisal is morally justified. Some thoughts are offered on why, given these findings, NICE has been able to maintain its legitimacy as a healthcare priority-setter and on what could be done to enhance coherence.
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Affiliation(s)
- Victoria Charlton
- Department of Global Health and Social Medicine, King's College London, London, UK.
| | - Michael DiStefano
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, USA
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Kurniawan A, Hamdani J, Chusida A, Utomo H, Rizky BN, Prakoeswa BFWR, Yuniar AR, Salazar-Gamarra R, Alias A, Yusof MYPM, Marya A. Exploring the feasibility of smartphone cameras for 3D modelling of bite patterns in forensic dental identification. Leg Med (Tokyo) 2024; 67:102399. [PMID: 38219704 DOI: 10.1016/j.legalmed.2024.102399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 12/02/2023] [Accepted: 01/07/2024] [Indexed: 01/16/2024]
Abstract
The field of bitemark analysis involves examining physical alterations in a medium resulting from contact with teeth and other oral structures. Various techniques, such as 2D and 3D imaging, have been developed in recent decades to ensure precise analysis of bitemarks. This study assessed the precision of using a smartphone camera to generate 3D models of bitemark patterns. A 3D model of the bite mark pattern was created using 3Shape TRIOSTM and a smartphone camera combined with monoscopic photogrammetry. The mesiodistal dimensions of the anterior teeth were measured using Rapidform Explorer and OrtogOnBlender, and the collected data were analyzed using IBM® SPSS® Statistics version 23.0. The mean mesiodistal dimension of the anterior teeth, as measured on the 3D model from 3Shape TRIOSTM and smartphone cameras, was found to be 6.95 ± 0.7667 mm and 6.94 ± 0.7639 mm, respectively. Statistical analysis revealed no significant difference between the two measurement methods, p > 0.05. The outcomes derived from this study unequivocally illustrate that a smartphone camera possessing the specific parameters detailed in this study can create a 3D representation of bite patterns with an accuracy level on par with the outputs of a 3D intraoral camera. These findings underscore the promising trajectory of merging smartphone cameras and monoscopic photogrammetry techniques, positioning them as a budget-friendly avenue for 3D bitemark analysis. Notably, the monoscopic photogrammetry methodology assumes substantial significance within forensic odontology due to its capacity for precise 3D reconstructions and the preservation of critical measurement data.
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Affiliation(s)
- Arofi Kurniawan
- Department of Forensic Odontology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia.
| | - Janice Hamdani
- Department of Forensic Odontology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - An'nisaa Chusida
- Department of Forensic Odontology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Haryono Utomo
- Department of Forensic Odontology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Beta Novia Rizky
- Department of Forensic Odontology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Azra Rahma Yuniar
- Department of Forensic Odontology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Rodrigo Salazar-Gamarra
- Faculty of Sciences of Life and Health, School of Dentistry, Digital Dentistry Lab, Universidad Científica del Sur, Lima, Peru
| | - Aspalilah Alias
- Department of Forensic Odontology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Basic Sciences and Oral Biology, Faculty of Dentistry, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Mohd Yusmiaidil Putera Mohd Yusof
- Department of Forensic Odontology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia; Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM) and Faculty of Dentistry, Universiti Teknologi MARA, Selangor, Malaysia
| | - Anand Marya
- Department Department of Orthodontics, Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia; Center for Transdisciplinary Research, Saveetha Dental College, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai, India
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Chang KF, Lin CT, Bin YQ. Harmony with nature: Disentanglement the influence of ecological perception and adaptation on sustainable development and circular economy goals in country. Heliyon 2024; 10:e26034. [PMID: 38370265 PMCID: PMC10874742 DOI: 10.1016/j.heliyon.2024.e26034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 02/20/2024] Open
Abstract
From the perspective of ecosystem attributes, this research was conducted to explore the impact of people's adaptation and response to their perception of environmental risks on their preference for sustainable development strategies and the realization of a circular economy based on Social Judgment Theory and the Value-Belief-Norm (VBN) theory. To achieve the goal, three substudies were conducted using questionnaire surveys-the first substudy aimed to examine the influence of ecological attributes on environmental risk perception (ERP). The second substudy attempted to understand the intricate connection between ERP and justice, while the third study explored the relationship between justice and SDS (sustainable development strategies) and CEG (realization of a circular economy). The results indicate the following: (1) The first substudy reveals that ecological attributes impact environmental risk perception (ERP), with different environmental values exerting distinct influences. (2) The second substudy suggests that ERP facilitates the realization of social, environmental, and ecological justice, but people's preference for a specific economic growth strategy will affect their tendency to realize justice. (3) The third substudy shows that sustainability strategies (i.e., sustainable production, consumption, and use) mediate the relationship between justice and circular economy goals (CEG). Among the three strategies, sustainable use plays the most significant mediating role. The research outcomes underscore the importance of prioritizing sustainable use in future research in theory and practice.
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Affiliation(s)
- Kuei-Feng Chang
- Management College, Guangdong Polytechnic Normal University, PR China
| | - Cheng-To Lin
- International College, Renmin University of China, Beijing, PR China
| | - Ye-Qi Bin
- School of Management, Guangzhou University, Guangzhou, PR China
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6
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Buckey TM, Feldman SF, Apter AJ. An Ethical Framework for Allergy and Immunology. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00174-0. [PMID: 38395255 DOI: 10.1016/j.jaip.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Ethical dilemmas routinely occur in the clinical practice of allergy and immunology. These ethical questions stem from the range of conditions and the different populations cared for by Allergists/Immunologists. Hence, medical ethics is not an esoteric concept, but a practical skill physicians exercise regularly. Moreover, an ethics-centered approach may improve patient safety and outcomes. This article will describe key principles of bioethics and illustrate an ethical framework that physicians can use in their conversations with patients. Utilization of this ethical framework is demonstrated through applying it to four unique clinical scenarios encountered by Allergists/Immunologists from different practice settings. The ethical framework for allergy and immunology is a technique to navigate ethically complex decisions that arise in routine clinical practice.
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Affiliation(s)
- Timothy M Buckey
- Section of Allergy and Immunology, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Scott F Feldman
- Section of Allergy and Immunology, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrea J Apter
- Section of Allergy and Immunology, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kouada R, Annabi K, Mosbahi A, Masmoudi T, Ben Dhiab M. L’accès aux soins des migrants en Tunisie en 2023-2024: Situation actuelle et enjeux éthiques. Tunis Med 2024; 102:65-69. [PMID: 38567469 DOI: 10.62438/tunismed.v102i2.4617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/27/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Transformed progressively into a transit country towards Europe but also as a host, Tunisia has seen a diversification of migratory movements since the 2011 revolution, as well as the profiles of migrants who face multiple difficulties that can have an impact on their health. AIM This update aimed to expose the situation of migrants in Tunisia regarding access to healthcare, and to raise the ethical issues that result from it. RESULTS Providing care to vulnerable individuals, especially migrants, compels us to reevaluate our practices and question ourselves. Ethical questioning is constant to determine how to do well and not harm. The reflection on this more humane "social medicine" comprehending the patient in its entirety, is only in its beginnings. The critical health status of the poorest populations and their extreme vulnerability do not only call for adapted and specific care measures but also a more comprehensive questioning of social ties and the place that our society grants to the weakest and excluded. CONCLUSION Migration must be considered as a central issue of the ethics of the health of a population in order to provide quality care without prejudice.
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Affiliation(s)
- Rihem Kouada
- Department of forensic medicine, Farhat Hached university hospital, Sousse, Tunisia
| | - Khaled Annabi
- Department of forensic medicine, Farhat Hached university hospital, Sousse, Tunisia
| | - Amal Mosbahi
- Department of forensic medicine, Farhat Hached university hospital, Sousse, Tunisia
| | - Tasnim Masmoudi
- Department of forensic medicine, Farhat Hached university hospital, Sousse, Tunisia
| | - Mohamed Ben Dhiab
- Department of forensic medicine, Farhat Hached university hospital, Sousse, Tunisia
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Yang Q, Hoffman M, Krueger F. The science of justice: The neuropsychology of social punishment. Neurosci Biobehav Rev 2024; 157:105525. [PMID: 38158000 DOI: 10.1016/j.neubiorev.2023.105525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
The social punishment (SP) of norm violations has received much attention across multiple disciplines. However, current models of SP fail to consider the role of motivational processes, and none can explain the observed behavioral and neuropsychological differences between the two recognized forms of SP: second-party punishment (2PP) and third-party punishment (3PP). After reviewing the literature giving rise to the current models of SP, we propose a unified model of SP which integrates general psychological descriptions of decision-making as a confluence of affect, cognition, and motivation, with evidence that SP is driven by two main factors: the amount of harm (assessed primarily in the salience network) and the norm violator's intention (assessed primarily in the default-mode and central-executive networks). We posit that motivational differences between 2PP and 3PP, articulated in mesocorticolimbic pathways, impact final SP by differentially impacting the assessments of harm and intention done in these domain-general large-scale networks. This new model will lead to a better understanding of SP, which might even improve forensic, procedural, and substantive legal practices.
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Affiliation(s)
- Qun Yang
- Department of Psychology, Jing Hengyi School of Education, Hangzhou Normal University, Hangzhou, China.
| | - Morris Hoffman
- Second Judicial District (ret.), State of Colorado, Denver, CO, USA.
| | - Frank Krueger
- School of Systems Biology, George Mason University, Fairfax, VA, USA.
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Han J, Xu Z, Ma Y. Ethical Reflection on the "QR code Dilemma" Faced by Older People During COVID-19 in China. J Bioeth Inq 2024:10.1007/s11673-023-10317-9. [PMID: 38294677 DOI: 10.1007/s11673-023-10317-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/11/2023] [Indexed: 02/01/2024]
Abstract
The widespread application of QR code technology is best represented by the health codes used in China's pandemic prevention and control. This technology has enhanced the country's ability to manage the pandemic by achieving higher efficiency and accuracy. Unfortunately, a certain segment of the older population has encountered difficulties in adapting and maintaining their daily activities. This indicates the limitations of QR code technology in achieving social isolation. This article argues that for a more comprehensive pandemic prevention and control policy system to be established, managing the implementation of this very technology should be done in a more humane fashion, i.e. under the guidance of three moral principles: benevolence, justice, and non-maleficence. By doing so, implementation of QR code technology is done in a way that is not only conducive to COVID-19 prevention and control but also mitigate marginalization of the older people. In the post-pandemic era, the socialization of digital technology will accelerate. Therefore, in the field of public health, we should direct attention not only to the fair distribution of resources but also to the issue of identity that arises due to digital divide.
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Affiliation(s)
- J Han
- Department of Philosophy, Xiamen University, Xiamen, Fu Jian Province, People's Republic of China
| | - Z Xu
- Department of Philosophy, Xiamen University, Xiamen, Fu Jian Province, People's Republic of China.
| | - Y Ma
- Centre for Bioethics, School of Medicine, Xiamen University, Xiamen, Fu Jian Province, People's Republic of China
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Moore CB, Dolan DD, Yarmolinsky R, Cho MK, Soo-Jin-Lee S. The ELSI Virtual Forum, 30 Years of the Genome: Integrating and Applying ELSI Research. J Law Med Ethics 2023; 51:661-671. [PMID: 38088602 DOI: 10.1017/jme.2023.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
This paper reports our analysis of the ELSI Virtual Forum: 30 Years of the Genome: Integrating and Applying ELSI Research, an online meeting of scholars focused on the ethical, legal, and social implications (ELSI) of genetics and genomics.
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11
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Rice BM. Using nursing science to advance policy and practice in the context of social and structural determinants of health. Nurs Outlook 2023; 71:102060. [PMID: 37852871 PMCID: PMC10843015 DOI: 10.1016/j.outlook.2023.102060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/17/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Social and structural determinants of health play a large role in health inequities. PURPOSE To highlight how nursing science can be used to advance policy and practice in the context of social and structural determinants of health. METHODS This paper reports on the author's keynote presentation from the 2022 State of The Science Conference on Social and Structural Determinants of Health presented by the Council for the Advancement of Nursing Science. Key concepts are overviewed and defined, followed by examples of two community-engaged research projects with findings that inform practice and policy. The author concludes with individual-, social- and structural-level recommendations as a clarion call for nurses to use research to eliminate health inequities and promote justice for all. CONCLUSION What we know is, in part, only as good as what we do with that knowledge. When lives are at stake, gone are the days of knowing something and failing to act on that knowledge.
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Affiliation(s)
- Bridgette M Rice
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA.
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12
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Hofmann B. Addressing the paradox: Health expansion threatening sustainable healthcare. Eur J Intern Med 2023; 117:3-7. [PMID: 37735001 DOI: 10.1016/j.ejim.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/28/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
We need to address the paradox that health expansion threatens sustainable healthcare as anti-aging drugs are on the trail from trial to the market and come together with health enhancement measures changing demography and the health of populations. This poses global, social, and professional problems, and challenges clinical medicine as well as health policy. To handle the emerging challenges, we need to address four crucial issues: (1) injustice (access), (2) sustainability, (3) basic human rights, and (4) eugenics. To do so we need to differentiate between health improvements and health enhancements and reinforce medicine's strongest moral appeal: to reduce suffering.
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Affiliation(s)
- Bjørn Hofmann
- Centre of Medical Ethics, Faculty of Medicine, University of Oslo, PO Box 1130, Blindern, Oslo N-0318, Norway; Institute for the Health Sciences at the Norwegian, University of Science and Technology in Gjøvik, Norway.
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Rheeder AL. The Ethical Assessment of the Stay-At-Home Order in South Africa in Light of The Universal Declaration of Bioethics And Human Rights (UNESCO). J Bioeth Inq 2023:10.1007/s11673-023-10304-0. [PMID: 37882951 DOI: 10.1007/s11673-023-10304-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 08/30/2023] [Indexed: 10/27/2023]
Abstract
The South African government announced the much-discussed stay-at-home order between March 27 and April 30, 2020, during what was known as lockdown level 5, which meant that citizens were not allowed to leave their homes. The objective of this study is to assess the stay-at-home order against the global principles of the UDBHR. It is deducible that, in reference to the UDBHR, the government possessed the right to curtail individual liberty, thereby not infringing on Article 5 of the UDBHR and therefore, in this context, passes the test of the UDBHR. However, it remains uncertain at present whether the limitation of freedom imposed by the South African stay-at-home order was successful in controlling the spread of COVID-19 and protecting individuals from harm. Initial investigations also indicate that individuals who are particularly vulnerable may not have received equitable treatment in accordance with the principle outlined in Article 10, therefore, it can be cautiously and modestly argued that the stay-at-home order does not withstand scrutiny when assessed against the UDBHR. Given the continued discussion about the efficacy of limiting freedom to control the spread of COVID-19, and the growing conviction that the advancement of justice is being called into question, the notion of least restriction ought to be considered seriously. Ten Have (2022) is correct in asserting that global bioethics should also seriously consider other principles beyond an almost exclusive focus on limiting individual freedom. The preliminary conclusion is that the potential implementation of the stay-at-home order in the future must be seriously reconsidered.
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Affiliation(s)
- A L Rheeder
- Faculty of Theology, North-West University, Potchefstroom Campus, Private Bag X 6001, Potchefstroom, 2520, South Africa.
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Bahador RS, Dastyar N, Ahmadidarrehsima S, Rafati S, Rafati F. The patients' lived experiences with equitable nursing care. Nurs Ethics 2023:9697330231209293. [PMID: 37867260 DOI: 10.1177/09697330231209293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Equitable care is a fundamental value in the nursing profession. Healthcare workers have both a moral and professional duty to ensure that they do not discriminate. AIM This study aimed to explore how patients perceive equitable nursing care. RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT This descriptive phenomenological qualitative research study used purposeful sampling to select 17 patients from various departments of a general hospital in southern Iran. The participants were then interviewed using a semi-structured in-depth interview format, which aimed to delve into their experiences with equitable nursing care. The collected data were analyzed using Colaizzi's seven-step method and MAXQDA20 software. ETHICAL CONSIDERATIONS Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Ethics Committee of Jiroft University of Medical Sciences. FINDINGS The data analysis of the study identified three main themes and six subthemes that were related to the experiences of patients with equitable nursing care. The first theme, equitable care, encompassed subthemes such as nurses' dedicated efforts to facilitate patient recovery and adherence to ethical behavior. The second theme, unconscious causes of inequitable nursing care, included subthemes such as unintentional discrimination stemming from organizational constraints and unconscious biases resulting from a lack of knowledge and skills. The third theme, discriminatory care, comprised subthemes such as deliberate discrimination based on personal traits and selective discrimination. CONCLUSION The study findings indicate that achieving equitable nursing care requires a multifaceted approach. This includes effective hospital management, organizational reforms, and regulatory enhancements. Additionally, it is crucial to pay close attention to the needs of patients, enhance nurses' theoretical and practical skills in providing equitable care, fostering a culture of equality within healthcare settings, and consider the personality dimensions and moral characteristics of nurses.
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Affiliation(s)
- Raziyeh Sadat Bahador
- Department of Nursing, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Neda Dastyar
- Department of Nursing, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Sudabeh Ahmadidarrehsima
- Department of Nursing, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Shideh Rafati
- Social Factors in Health Promotion Research Center, Hormozgan Health Research Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Foozieh Rafati
- Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
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15
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Tong S, Samet JM, Steffen W, Kinney PL, Frumkin H. Solidarity for the Anthropocene. Environ Res 2023; 235:116716. [PMID: 37481056 DOI: 10.1016/j.envres.2023.116716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/24/2023]
Abstract
Social solidarity is essential to large-scale collective action, but the need for solidarity has received little attention from scholars of Earth Systems, sustainability and public health. Now, the need for solidarity requires recognition. We have entered a new planetary epoch - the Anthropocene - in which human-induced global changes are occurring at an unprecedented scale. There are multiple health crises facing humanity - widening inequity, climate change, biodiversity loss, diminishing resources, persistent poverty, armed conflict, large-scale migration, and others. These global challenges are so far-reaching, and call for such extensive, large-scale action, that solidarity is a sine qua non for tackling these challenges. However, the heightened need for solidarity has received little attention in the context of the Anthropocene and, in particular, how it can be created and nurtured has been overlooked. In this commentary, we explore the concept of solidarity from inter-species, intra-generational and inter-generational perspectives. We also propose strategies to enhance solidarity in the Anthropocene.
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Affiliation(s)
- Shilu Tong
- National Institute of Environmental Health, China CDC, Beijing, China; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
| | | | - Will Steffen
- The Australian National University, Canberra, Australia
| | - Patrick L Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, USA
| | - Howard Frumkin
- School of Public Health, University of Washington, Seattle, USA; Trust for Public Land, Seattle, USA
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16
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Lamph G, Nowland R, Boland P, Pearson J, Connell C, Jones V, Wildbore E, L Christian D, Harris C, Ramsden J, Gardner K, Graham-Kevan N, McKeown M. Relational practice in health, education, criminal justice, and social care: a scoping review. Syst Rev 2023; 12:194. [PMID: 37833785 PMCID: PMC10571424 DOI: 10.1186/s13643-023-02344-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/04/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Establishing and maintaining relationships and ways of connecting and being with others is an important component of health and wellbeing. Harnessing the relational within caring, supportive, educational, or carceral settings as a systems response has been referred to as relational practice. Practitioners, people with lived experience, academics and policy makers, do not yet share a well-defined common understanding of relational practice. Consequently, there is potential for interdisciplinary and interagency miscommunication, as well as the risk of policy and practice being increasingly disconnected. Comprehensive reviews are needed to support the development of a coherent shared understanding of relational practice. METHOD This study uses a scoping review design providing a scope and synthesis of extant literature relating to relational practice focussing on organisational and systemic practice. The review aimed to map how relational practice is used, defined and understood across health, criminal justice, education and social work, noting any impacts and benefits reported. Searches were conducted on 8 bibliographic databases on 27 October 2021. English language articles were included that involve/discuss practice and/or intervention/s that prioritise interpersonal relationships in service provision, in both external (organisational contexts) and internal (how this is received by workers and service users) aspects. RESULTS A total of 8010 relevant articles were identified, of which 158 met the eligibility criteria and were included in the synthesis. Most were opinion-based or theoretical argument papers (n = 61, 38.60%), with 6 (3.80%) critical or narrative reviews. A further 27 (17.09%) were categorised as case studies, focussing on explaining relational practice being used in an organisation or a specific intervention and its components, rather than conducting an evaluation or examination of the effectiveness of the service, with only 11 including any empirical data. Of the included empirical studies, 45 were qualitative, 6 were quantitative, and 9 mixed methods studies. There were differences in the use of terminology and definitions of relational practice within and across sectors. CONCLUSION Although there may be implicit knowledge of what relational practice is the research field lacks coherent and comprehensive models. Despite definitional ambiguities, a number of benefits are attributed to relational practices. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021295958.
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Affiliation(s)
- Gary Lamph
- School of Nursing and Midwifery, Edge Hill University, Lancashire Ormskirk, UK
| | - Rebecca Nowland
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK.
| | - Paul Boland
- IMPlementation and Capacity Building Team (IMPaCT), Applied Health Research Hub (AHRh), University of Central Lancashire, Preston, UK
| | - Jayn Pearson
- Criminal Justice Partnership, University of Central Lancashire, Preston, UK
| | - Catriona Connell
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Vanessa Jones
- School of Psychology and Counselling, The Open University, Milton Keynes, UK
| | | | - Danielle L Christian
- IMPlementation and Capacity Building Team (IMPaCT), Applied Health Research Hub (AHRh), University of Central Lancashire, Preston, UK
| | - Catherine Harris
- Health Technology Assessment Unit, University of Central Lancashire, Preston, UK
| | | | - Kathryn Gardner
- School of Psychology and Humanities, University of Central Lancashire, Preston, UK
| | - Nicola Graham-Kevan
- School of Psychology and Humanities, University of Central Lancashire, Preston, UK
| | - Mick McKeown
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
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17
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Tsunematsu K, Asai A, Kadooka Y. Moral conflicts from the justice and care perspectives of japanese nurses: a qualitative content analysis. BMC Med Ethics 2023; 24:79. [PMID: 37794440 PMCID: PMC10552434 DOI: 10.1186/s12910-023-00960-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 09/22/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Healthcare professionals use the ethics of justice and care to construct moral reasoning. These ethics are conflicting in nature; different value systems and orders of justice and care are applied to the cause of actual moral conflict. We aim to clarify the structure and factors of healthcare professionals' moral conflicts through the lens of justice and care to obtain suggestions for conflict resolutions. METHOD Semi-structured interviews about experiences of moral conflict were conducted with Japanese nurses recruited using the snowball sampling method. Interviews were conducted based on the real-life moral conflict and choice interview. Interviews were recorded and transcribed verbatim, then analyzed based on the interpretive method of data analysis. Verbatim transcripts were read four times, first to get an overall sense of the conflict, then to understand the person's thoughts and actions that explain the conflict, and third and fourth to identify perspectives of justice and care, respectively. Each moral perspective was classified into categories according to Chally's taxonomy. RESULTS Among 31 responses, 2 that did not mention moral conflict were excluded, leaving 29 responses that were analyzed. These responses were classified into six cases with conflict between both justice and care perspectives or within one perspective, and into two cases without conflict between perspectives. The "rules" category of justice and the "welfare of others" category of care were included in many cases of conflict between two perspectives, and they frequently occurred in each perspective. CONCLUSIONS The nurses in this study suggest that they make moral judgments based on moral values that are intertwined with justice and care perspectives complex manner.Organizational, professional, and patient-related factors influenced conflicts between justice and care. Additionally, multiple overlapping loyalties created conflicts within justice perspectives, and multifaceted aspects of care-provider's responsibility and patient need created conflicts within care. Decision-making biased towards one perspective can be distorted. It is important to consider ethical issues from both perspectives to resolve conflicts, especially the effective use of the ethics of care is recommended.
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Affiliation(s)
- Kayoko Tsunematsu
- Department of Bioethics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 8608556, Japan.
| | - Atsushi Asai
- Department of Medical Ethics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Yasuhiro Kadooka
- Department of Bioethics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 8608556, Japan
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18
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Rahman MF, Falzon D, Robinson SA, Kuhl L, Westoby R, Omukuti J, Schipper ELF, McNamara KE, Resurrección BP, Mfitumukiza D, Nadiruzzaman M. Locally led adaptation: Promise, pitfalls, and possibilities. Ambio 2023; 52:1543-1557. [PMID: 37286919 PMCID: PMC10460758 DOI: 10.1007/s13280-023-01884-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/30/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023]
Abstract
Locally led adaptation (LLA) has recently gained importance against top-down planning practices that often exclude the lived realities and priorities of local communities and create injustices at the local level. The promise of LLA is that adaptation would be defined, prioritised, designed, monitored, and evaluated by local communities themselves, enabling a shift in power to local stakeholders, resulting in more effective adaptation interventions. Critical reflections on the intersections of power and justice in LLA are, however, lacking. This article offers a nuanced understanding of the power and justice considerations required to make LLA useful for local communities and institutions, and to resolve the tensions between LLA and other development priorities. It also contributes to a further refinement of LLA methodologies and practices to better realise its promises. Ultimately, we argue that the utility of the LLA framing in promoting climate justice and empowering local actors needs to be tested empirically.
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Affiliation(s)
- M. Feisal Rahman
- Living Deltas Hub, Department of Geography and Environmental Sciences, Northumbria University, Newcastle-Upon-Tyne, UK
| | - Danielle Falzon
- Department of Sociology, Rutgers University, New Brunswick, NJ 08901 USA
| | - Stacy-ann Robinson
- Environmental Studies Department, Colby College, Waterville, ME 04901 USA
- Perry World House, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Laura Kuhl
- School of Public Policy and Urban Affairs, and International Affairs Program, Northeastern University, Boston, MA 02115 USA
| | - Ross Westoby
- Griffith Institute for Tourism, Griffith University, Brisbane, QLD 4111 Australia
| | - Jessica Omukuti
- Institute for Science, Innovation and Society (InSIS), University of Oxford, Oxford, UK
- Department of Anthropology, University of Oxford, Oxford, UK
| | - E. Lisa F. Schipper
- Department of Geography, University of Bonn, Meckenheimer Allee 166, 53115 Bonn, Germany
| | - Karen E. McNamara
- School of Earth and Environmental Sciences, The University of Queensland, Brisbane, QLD 4072 Australia
| | | | - David Mfitumukiza
- Department of Geography, Geoinformatics, and Climate Sciences, College of Agricultural and Environmental Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Md. Nadiruzzaman
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Social Sciences, Maastricht University, Universiteitssingel 60, 6229 ER Maastricht, Netherlands
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19
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Garrafa V. [Bioethics and the right of access to health care.]. Salud Colect 2023; 19:e4491. [PMID: 37992289 DOI: 10.18294/sc.2023.4491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/24/2023] [Indexed: 11/24/2023] Open
Abstract
Access to health care is a universal human right and therefore should not be treated as a commodity only accessible to people with the economic means to acquire it. This study adopts a theoretical framework based on UNESCO's Universal Declaration on Bioethics and Human Rights. The discussion first explores the rationale for choosing human rights as a foundation for such an endeavor. Secondly, the notion of equity is presented as an indispensable principle that should be incorporated into such discussions, reinforcing the understanding that unequal people and populations must be treated in a differentiated and compensatory manner, with the aim of seeking true equality based on the humanitarian recognition of every individual's rights, accounting for their needs and differences. Thirdly, the text seeks to address the complex problem of prioritizing the allocation of scarce resources in order to ensure access to health care for as many people as possible. In summary, this article intends to demonstrate that access to health care for all people, regardless of their income level, should be considered to be a universal human right. Beyond the obligations of governments and the private sector to support inclusive programs, there is also a need to acknowledge social movements' legitimate struggles for achieving better living conditions and health outcomes for all people, without exception.
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Affiliation(s)
- Volnei Garrafa
- Doctor en Ciencias, Posdoctorado en Bioética. Profesor Emérito, Centro Internacional de Bioética e Humanidades, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasilia, Brasil
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20
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Oppenheimer D, Rego F, Nunes R. The search for the principle of justice for infertile couples: characterization of the brazilian population and bioethical discussion. BMC Med Ethics 2023; 24:69. [PMID: 37667304 PMCID: PMC10476313 DOI: 10.1186/s12910-023-00947-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Infertility is an increasingly prevalent disease in society and is considered by the World Health Organization to be a public health problem. An important ethical issue arises from the clarification of reproductive rights in a fair and equal way. The objective of this study was to deepen and update the knowledge and discussion about the difficulty of accessing infertility treatments in Brazil. METHODS A cross-sectional observational study was carried out through the application of an online questionnaire that collected the socioeconomic characteristics of couples and identify how barriers to infertility care affect the most vulnerable populations. We included couples who sought medical assistance to achieve pregnancy at two clinics in the states of São Paulo and Minas Gerais. RESULTS A total of 201 questionnaires were analyzed. Most couples self-declared as white and the average age of wives was 36 years and husbands 38 years. 65% (65%) of couples would proceed with the treatment in a different city to which they lived, 37% evaluated as having easy access to a medical specialist only after indication, and more than half of the participating have thought about giving up the treatment due to some difficulty in accessing it. 39% of participants sought more than one medical service to find better reception, 42% of couples sought more than one medical service to define where it would be better financially, and 67.2% referred to the high cost of treatments, that is, financial issues, as a great difficulty in accessing medical services and/or treatment. Although 72.6% of couples considered having a good quality of life, 54.2% admitted that infertility and the search for treatment generated anxiety/stress in the couple's life. CONCLUSION There is a need for public education on reproductive health and for policymakers to raise awareness of the importance of the difficulty that many couples face in seeking treatment to become pregnant, especially in countries with less financial resources. Indeed, it is commonly accepted that there is a universal human right to access healthcare of appropriate quality as a matter of justice. Discussion of access to reproductive technologies should be considered taking into account the longstanding ethical debate regarding fertility, fecundity, and infertility, as well as reproductive care.
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Affiliation(s)
- Drauzio Oppenheimer
- Faculdade de Medicina de Itajubá, Av. Rennó Junior, 368, São Vicente, Itajubá, CEP 37502-138, MG, Brasil.
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - Francisca Rego
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Rui Nunes
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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21
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Knox JBL, Svendsen MN. The fertility of moral ambiguity in precision medicine. Med Health Care Philos 2023; 26:465-476. [PMID: 37280471 PMCID: PMC10243698 DOI: 10.1007/s11019-023-10160-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/08/2023]
Abstract
Although precision medicine cuts across a large spectrum of professions, interdisciplinary and cross-sectorial moral deliberation has yet to be widely enacted, let alone formalized in this field. In a recent research project on precision medicine, we designed a dialogical forum (i.e. 'the Ethics Laboratory') giving interdisciplinary and cross-sectorial stakeholders an opportunity to discuss their moral conundrums in concert. We organized and carried out four Ethics Laboratories. In this article, we use Simone de Beauvoir's concept of moral ambiguity as a lens to frame the participants' experience with fluid moral boundaries. By framing our approach through this concept we are able to elucidate irremediable moral issues that are collectively underexplored in the practice of precision medicine. Moral ambiguity accentuates an open and free space where different types of perspectives converge and can inform each other. Based on our study, we identified two dilemmas, or thematic interfaces, in the interdisciplinary moral deliberations which unfolded in the Ethics Laboratories: (1) the dilemma between the individual and the collective good; and (2) the dilemma between care and choice. Through our investigation of these dilemmas, we show how Beauvoir's concept of moral ambiquity not only serves as a fertile catalyst for greater moral awareness but, furthermore, how the concept can become an indispensable part of the practices of and the discourse about precision medicine.
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Affiliation(s)
- Jeanette Bresson Ladegaard Knox
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building, 1014 Copenhagen, Denmark
- University Hospital of Copenhagen, Copenhagen, Denmark
| | - Mette Nordahl Svendsen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building, 1014 Copenhagen, Denmark
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22
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Brummett A, Crutchfield P. The pain lottery. Ann Palliat Med 2023; 12:919-924. [PMID: 37164967 DOI: 10.21037/apm-22-1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/14/2023] [Indexed: 05/12/2023]
Abstract
Moral challenges with addiction and overdosing have resulted from the abundance of opioids, but the coronavirus disease of 2019 has prompted reflection on ethical issues that could arise from a shortage. Driven by a duty to plan, some jurisdictions have formed committees to see if standard allocation considerations extend to cover a shortage of opioid pain medication. The problem, we argue, is that the standard allocation protocols do not apply to a shortage of opioids because prognosis only has limited relevance and the moral disvalue of pain is not dependent upon a patient's status as a frontline worker, age, or residence in a disadvantaged community. While the use of lotteries in allocation schemes has been deemphasized in standard allocation schema, we argue for and outline the details of a tiered lottery that first prioritizes opioids needed for emergent procedures and then moves on to allocate opioids based on the severity of a patient's pain. Additionally, we argue that some deception, in the form of withholding information from patients about the implementation and details of a pain lottery, is ethically permissible to address the unique moral tension between transparency and beneficence that arises for the treatment of pain in conditions of opioid scarcity.
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Affiliation(s)
- Abram Brummett
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Parker Crutchfield
- Medical Ethics, Humanities, and Law, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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23
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Zakout GA. Practicing equitable principles in cancer clinical research: Has the EU got it right? J Cancer Policy 2023; 37:100435. [PMID: 37507086 DOI: 10.1016/j.jcpo.2023.100435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023]
Abstract
Clinical trials are a fundamental part of cancer research as they establish the efficacy and safety of new cancer treatments for everyone. The lack of sociodemographic diversity among cancer clinical trial participants leaves a vacuum in scientific knowledge, which can distort credible evidence from being accessible and represents a major barrier to advancing cancer care for the entire patient population. It can also cause avoidable harm to the public, undermine patients trust and result in wasteful allocation of healthcare resources. It is therefore imperative that there is representation of all population groups who may use these new cancer treatments in clinical trial settings. Europeans are disproportionately affected by cancer with cancer mortality rates being substantially affected by inequities in socioeconomic education status. General and political recognition of cancer injustices in the EU have further increased given the contemptuously unequal impacts of the legal and policy responses to it. While innovative advances in cancer research have bridged much of these critical gaps particularly in the last few decades more work needs to be done to circumvent implications of cancer health disparities. To reduce cancer health disparities, systemic and individual-level barriers to cancer clinical trial participation must be addressed through effective and ethically rigorous EU health laws and policies.
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Affiliation(s)
- Ghada A Zakout
- Erasmus University Rotterdam, Erasmus School of Law, Burg. Oudlaan 50, 3062 PA Rotterdam, Netherlands.
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24
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Bladt T, Vorup-Jensen T, Ebbesen M. Principles for Just Prioritization of Expensive Biological Therapies in the Danish Healthcare System. J Bioeth Inq 2023; 20:523-542. [PMID: 37733175 PMCID: PMC10624754 DOI: 10.1007/s11673-023-10283-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 02/18/2023] [Indexed: 09/22/2023]
Abstract
The Danish healthcare system must meet the need for easy and equal access to healthcare for every citizen. However, investigations have shown unfair prioritization of cancer patients and unfair prioritization of resources for expensive medicines over care. What is needed are principles for proper prioritization. This article investigates whether American ethicists Tom Beauchamp and James Childress's principle of justice may be helpful as a conceptual framework for reflections on prioritization of expensive biological therapies in the Danish healthcare system. We present an empirical study exploring the principles for prioritizing new expensive biological therapies. This study includes qualitative interviews with key Danish stakeholders experienced in antibody therapy and prioritizing resources for expensive medicines. Beauchamp and Childress's model only covers government-funded primary and acute healthcare. Based on the interviews, this study indicates that to be helpful in a Danish context this model should include equal access for citizens to government-funded primary and acute healthcare, costly medicine, and other scarce treatments. We conclude that slightly modified, Beauchamp and Childress's principle of justice might be useful as a conceptual framework for reflections on the prioritization of expensive biological therapies in the Danish healthcare system.
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Affiliation(s)
- Tara Bladt
- Danish College of Pharmacy Technicians, Hillerød, Denmark
| | | | - Mette Ebbesen
- Techno-Anthropology & Participation, Department of Planning, Aalborg University, Rendsburggade 14, DK- 9000, Aalborg, Denmark.
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25
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Schulz S, Harzheim L, Hübner C, Lorke M, Jünger S, Woopen C. Patient-centered empirical research on ethically relevant psychosocial and cultural aspects of cochlear, glaucoma and cardiovascular implants - a scoping review. BMC Med Ethics 2023; 24:68. [PMID: 37641094 PMCID: PMC10464431 DOI: 10.1186/s12910-023-00945-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The significance of medical implants goes beyond technical functioning and reaches into everyday life, with consequences for individuals as well as society. Ethical aspects associated with the everyday use of implants are relevant for individuals' lifeworlds and need to be considered in implant care and in the course of technical developments. METHODS This scoping review aimed to provide a synthesis of the existing evidence regarding ethically relevant psychosocial and cultural aspects in cochlear, glaucoma and cardiovascular implants in patient-centered empirical research. Systematic literature searches were conducted in EBSCOhost, Philpapers, PsycNET, Pubmed, Web of Science and BELIT databases. Eligible studies were articles in German or English language published since 2000 dealing with ethically relevant aspects of cochlear, glaucoma and passive cardiovascular implants based on empirical findings from the perspective of (prospective) implant-wearers and their significant others. Following a descriptive-analytical approach, a data extraction form was developed and relevant data were extracted accordingly. We combined a basic numerical analysis of study characteristics with a thematically organized narrative synthesis of the data. RESULTS Sixty-nine studies were included in the present analysis. Fifty were in the field of cochlear implants, sixteen in the field of passive cardiovascular implants and three in the field of glaucoma implants. Implant-related aspects were mainly found in connection with autonomy, freedom, identity, participation and justice, whereas little to no data was found with regards to ethical principles of privacy, safety or sustainability. CONCLUSIONS Empirical research on ethical aspects of implant use in everyday life is highly relevant, but marked by ambiguity and unclarity in the operationalization of ethical terms and contextualization. A transparent orientation framework for the exploration and acknowledgment of ethical aspects in "lived experiences" may contribute to the improvement of individual care, healthcare programs and research quality in this area. Ethics-sensitive care requires creating awareness for cultural and identity-related issues, promoting health literacy to strengthen patient autonomy as well as adjusting healthcare programs accordingly. More consideration needs to be given to sustainability issues in implant development and care according to an approach of ethics-by-design.
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Affiliation(s)
- Sabine Schulz
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES), University of Cologne and University Hospital of Cologne, Universitätsstraße 91, 50931, Cologne, Germany.
| | - Laura Harzheim
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES), University of Cologne and University Hospital of Cologne, Universitätsstraße 91, 50931, Cologne, Germany
| | - Constanze Hübner
- Center for Life Ethics, University of Bonn, 53113, Bonn, Germany
| | - Mariya Lorke
- Faculty of Engineering and Mathematics, University of Applied Sciences and Arts (HSBI), 33619, Bielefeld, Germany
| | - Saskia Jünger
- Department of Community Health, University of Applied Health Sciences Bochum, Gesundheitscampus 6-8, 44801, Bochum, Germany
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26
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Thakral S, Ghosh M, Setia P, Sharma G. Therapeutic artifact: Case series. J Forensic Leg Med 2023; 98:102577. [PMID: 37557007 DOI: 10.1016/j.jflm.2023.102577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/24/2023] [Accepted: 08/05/2023] [Indexed: 08/11/2023]
Abstract
Artifacts are pervasive in every realm of biological science, and this includes the field of medicine. Unless explicitly recognized by scientific experts, artifacts can be found and may influence research and findings in the medical domain, just as they do in other branches of biological science. Therapeutic artifacts are changes that occur in the body as a result of medical interventions. These artifacts can sometimes pose challenges in forensic investigations, as they may be misinterpreted or mistaken for signs of trauma or foul play. This case series presents three cases illustrating different types of treatment artifacts encountered in forensic medicine. These three cases highlight the importance of considering medical interventions and therapies when interpreting autopsy findings. It is crucial for forensic experts to have a comprehensive understanding of therapeutic artifacts to accurately differentiate them from genuine injuries or pathologies. By recognizing and properly interpreting these artifacts, forensic investigations can be conducted with increased accuracy and ensure that justice is served.
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Affiliation(s)
- Sahil Thakral
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
| | - Mithun Ghosh
- Department of Forensic Medicine and Toxicology, LLRM, Meerut, Uttar Pradesh, India.
| | - Puneet Setia
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India.
| | - Gaurav Sharma
- Department of Forensic Medicine and Toxicology, S.N. Medical College, Agra, Uttar Pradesh, India.
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Primavesi R, Patocka C, Burcheri A, Coutin A, Morizio A, Ali A, Pandya A, Gagné A, Johnston B, Thoma B, LeBlanc C, Fovet F, Gallinger J, Mohadeb J, Ragheb M, Dong S, Smith S, Oyedokun T, Newmarch T, Knight V, McColl T. Call to action: equity, diversity, and inclusion in emergency medicine resident physician selection. CAN J EMERG MED 2023; 25:550-557. [PMID: 37368231 DOI: 10.1007/s43678-023-00528-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 05/17/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES This call to action seeks to improve emergency care in Canada for equity-deserving communities, enabled by equitable representation among emergency physicians nationally. Specifically, this work describes current resident selection processes and makes recommendations to enhance the equity, diversity, and inclusion (EDI) of resident physician selection in Canadian emergency medicine (EM) residency programs. METHODS A diverse panel of EM residency program directors, attending and resident physicians, medical students, and community representatives met monthly from September 2021 to May 2022 via videoconference to coordinate a scoping literature review, two surveys, and structured interviews. This work informed the development of recommendations for incorporating EDI into Canadian EM resident physician selection. At the 2022 Canadian Association of Emergency Physicians (CAEP) Academic Symposium, these recommendations were presented to symposium attendees composed of national EM community leaders, members, and learners. Attendees were divided into small working groups to discuss the recommendations and address three conversation-facilitating questions. RESULTS Symposium feedback informed a final set of eight recommendations to promote EDI practices during the resident selection process that address recruitment, retention, mitigating inequities and biases, and education. Each recommendation is accompanied by specific, actionable sub-items to guide programs toward a more equitable selection process. The small working groups also described perceived barriers to the implementation of these recommendations and outlined strategies for success that are incorporated into the recommendations. CONCLUSION We call on Canadian EM training programs to implement these eight recommendations to strengthen EDI practices in EM resident physician selection and, in doing so, help to improve the care that patients from equity-deserving groups receive in Canada's emergency departments (EDs).
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Affiliation(s)
- Robert Primavesi
- Montreal General Hospital, McGill University, Montreal, QC, Canada.
| | | | | | | | | | - Amir Ali
- University of Toronto, Toronto, ON, Canada
| | | | - Austin Gagné
- Montreal General Hospital, McGill University, Montreal, QC, Canada
| | | | - Brent Thoma
- University of Saskatchewan, Saskatoon, SK, Canada
| | | | | | - John Gallinger
- Canadian Resident Matching Service (CaRMS), Ottawa, ON, Canada
| | | | | | - Sandy Dong
- University of Alberta, Edmonton, AB, Canada
| | - Sheila Smith
- University of Saskatchewan, Saskatoon, SK, Canada
| | | | | | - Vanessa Knight
- Montreal General Hospital, McGill University, Montreal, QC, Canada
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Wang Y, Harris PL, Pei M, Su Y. Do Bad People Deserve Empathy? Selective Empathy Based on Targets' Moral Characteristics. Affect Sci 2023; 4:413-428. [PMID: 37304566 PMCID: PMC10247634 DOI: 10.1007/s42761-022-00165-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 11/14/2022] [Indexed: 06/13/2023]
Abstract
The relation between empathy and morality is a widely discussed topic. However, previous discussions mainly focused on whether and how empathy influences moral cognition and moral behaviors, with limited attention to the reverse influence of morality on empathy. This review summarized how morality influences empathy by drawing together a number of hitherto scattered studies illustrating the influence of targets' moral characteristics on empathy. To explain why empathy is morally selective, we discuss its ultimate cause, to increase survival rates, and five proximate causes based on similarity, affective bonds, the appraisal of deservingness, dehumanization, and potential group membership. To explain how empathy becomes morally selective, we consider three different pathways (automatic, regulative, and mixed) based on previous findings. Finally, we discuss future directions, including the reverse influence of selective empathy on moral cognition, the moral selectivity of positive empathy, and the role of selective empathy in selective helping and third-party punishment.
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Affiliation(s)
- Yiyi Wang
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, 5 Yiheyuan Road, Haidian District, 100871 Beijing, People’s Republic of China
| | - Paul L. Harris
- Harvard Graduate School of Education, Harvard University, Cambridge, MA USA
| | - Meng Pei
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, 5 Yiheyuan Road, Haidian District, 100871 Beijing, People’s Republic of China
| | - Yanjie Su
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, 5 Yiheyuan Road, Haidian District, 100871 Beijing, People’s Republic of China
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Bjelac J, Shaker M, Greenhawt M, Kodish E. Viewing Pediatric Food Oral Immunotherapy Through an Ethical Lens-A Narrative Systematic Review. J Allergy Clin Immunol Pract 2023; 11:1914-1925. [PMID: 36965706 DOI: 10.1016/j.jaip.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/31/2023] [Accepted: 03/11/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND Food allergy remains a common problem and a lifelong condition for many children. In recent years, food allergy management has increasingly involved conversations about food oral immunotherapy (OIT). Although ethical considerations of autonomy, beneficence, nonmaleficence, and justice implicitly inform these conversations, applying these principles can be complex, particularly in young children. Families of young children assume a role of surrogate decision-maker and must balance immediate risks with the hope of longer-term benefits. OBJECTIVE To explore implementation of OIT in children through an ethical lens. METHODS To evaluate OIT through an ethical lens, we conducted a literature search to explore currently published frameworks in this area. RESULTS Evaluation of the harm principle, the basic interest principle, and the best interest principle of parental decision-making can be informative. Shared decision-making continues to be central to the process of engaging with patient-family units to individualize the best care, at the right time, and minimize decisional discord. Although OIT is well-positioned to promote health and well-being, challenges to equity, sustainability, and organizational support must be considered to improve access for appropriate patients. CONCLUSIONS Whereas approaches to food OIT may be tailored to the individual context of each patient-family unit, ethical principles must guide decisions to initiate and continue therapy. Traditional ethical principles of autonomy, beneficence, nonmaleficence, and justice remain cornerstones when considering the ethical context of OIT.
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Affiliation(s)
- Jaclyn Bjelac
- Food Allergy Center of Excellence, Center for Pediatric Allergy and Immunology, Cleveland Clinic, Cleveland, Ohio.
| | - Marcus Shaker
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Matthew Greenhawt
- Section of Allergy/Immunology, Food Challenge and Research Unit, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo
| | - Eric Kodish
- Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
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Galappaththi EK, Perera CD, Dharmasiri IP, Ford JD, Kodithuwakku SS, Chicmana-Zapata V, Zavaleta-Cortijo C, Pickering K, van Bavel B, Hyams K, Arotoma-Rojas I, Akugre FA, Nkalubo J, Namanya DB, Mensah A, Hangula MM. Policy responses to COVID-19 in Sri Lanka and the consideration of Indigenous Peoples. Environ Sci Policy 2023; 144:110-123. [PMID: 36949900 PMCID: PMC10011033 DOI: 10.1016/j.envsci.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/23/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
COVID-19 has had uneven impacts on health and well-being, with Indigenous communities in the Global South facing some of the highest risks. Focusing on the experience of Sri Lanka, this study identifies key policy responses to COVID-19, documents how they evolved over two years of the pandemic, and examines if and how government responses have addressed issues pertaining to Indigenous Peoples. Drawing upon an analysis of policy documents (n = 110) and interviews with policymakers (n = 20), we characterize seven key policy responses implemented by the Sri Lankan government: i) testing for and identifying COVID-19; ii) quarantine procedures; iii) provisional clinical treatments; iv) handling other diseases during COVID-19; v) movement; vi) guidelines to be adhered to by the general public; and vii) health and vaccination. The nature of these responses changed as the pandemic progressed. There is no evidence that policy development or implementation incorporated the voices and needs of Indigenous Peoples.
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Affiliation(s)
- Eranga K Galappaththi
- Department of Geography, Virginia Polytechnic Institute and State University, Blacksburg, United States
| | - Chrishma D Perera
- Department of Geography, Virginia Polytechnic Institute and State University, Blacksburg, United States
- University of Colombo, Colombo, Sri Lanka
| | - Indunil P Dharmasiri
- Department of Geography, Virginia Polytechnic Institute and State University, Blacksburg, United States
| | - James D Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, United Kingdom
| | - Sarath S Kodithuwakku
- Department of Agricultural Economics & Business Management, University of Peradeniya, Sri Lanka
| | - Victoria Chicmana-Zapata
- Unidad de Ciudadanía Intercultural y Salud Indígena (UCISI), Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carol Zavaleta-Cortijo
- Unidad de Ciudadanía Intercultural y Salud Indígena (UCISI), Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Bianca van Bavel
- Priestley International Centre for Climate, University of Leeds, Leeds, United Kingdom
| | - Keith Hyams
- Department of Politics and International Studies, University of Warwick, Coventry, UK
| | - Ingrid Arotoma-Rojas
- Priestley International Centre for Climate, University of Leeds, Leeds, United Kingdom
| | | | - Jonathan Nkalubo
- Uganda National Health Research Organization & Mulago National Referral Hospital, Uganda
| | - Didacus Bambaiha Namanya
- Ministry of Health-Uganda National Health Research Organisation, & Uganda Martyrs, University, Uganda
| | - Adelina Mensah
- Institute for Environment and Sanitation Studies, University of Ghana, Accra, Ghana
| | - Martha M Hangula
- Department of Animal Production, Agribusiness and Economics, University of Namibia, Namibia
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Hodge JG, Barraza L, Piatt JL, White EN. Midterm Maelstrom: Public Health Legal Impacts of Election 2022. J Law Med Ethics 2023; 51:208-212. [PMID: 37226743 DOI: 10.1017/jme.2023.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Among the morass of critical issues impacting the results of the midterm elections in 2022 were core public health issues related to health care access, justice, and reforms. Collectively, voters' communal health and safety concerns dominated outcomes in key races which may shape national, state, and local legal approaches to protecting the public's health in the modern era.
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Affiliation(s)
- James G Hodge
- SANDRA DAY O'CONNOR COLLEGE OF LAW, ARIZONA STATE UNIVERSITY, TEMPE, AZ, USA
| | - Leila Barraza
- UNIVERSITY OF ARIZONA COLLEGE OF PUBLIC HEALTH, UNIVERSITY OF ARIZONA, TUCSON, AZ, USA
| | - Jennifer L Piatt
- SANDRA DAY O'CONNOR COLLEGE OF LAW, ARIZONA STATE UNIVERSITY, TEMPE, AZ, USA
| | - Erica N White
- SANDRA DAY O'CONNOR COLLEGE OF LAW, ARIZONA STATE UNIVERSITY, TEMPE, AZ, USA
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Jalilian H, Amraei M, Javanshir E, Jamebozorgi K, Faraji-Khiavi F. Ethical considerations of the vaccine development process and vaccination: a scoping review. BMC Health Serv Res 2023; 23:255. [PMID: 36918888 PMCID: PMC10013982 DOI: 10.1186/s12913-023-09237-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/02/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Various vaccines have been developed and distributed worldwide to control and cope with COVID-19 disease. To ensure vaccines benefit the global community, the ethical principles of beneficence, justice, non-maleficence, and autonomy should be examined and adhered to in the process of development, distribution, and implementation. This study, therefore, aimed to examine ethical considerations of vaccine development and vaccination processes. METHODS A scoping review of the literature was conducted based on the Arkesy and O'Malley protocol to identify eligible studies published until November 2021. We searched Web of Science, PubMed, Scopus, and SciELO databases. The search was conducted using combinations of Medical Subject Heading (MeSH) search terms and keywords for Ethics, COVID-19, and vaccines in abstract, keywords, and title fields to retrieve potentially relevant publications. We included any study that reported one of the four principles of medical ethics: autonomy, justice, non-maleficence, and beneficence in the COVID-19 vaccine development and distribution and implementation of vaccinations. Letters, notes, protocols, and brief communications were excluded. In addition, we searched gray literature to include relevant studies (ProQuest database, conferences, and reports). Data were analyzed using framework analysis. RESULTS In total, 43 studies were included. Ethical considerations concluded two themes: (1) production and (2) distribution and vaccination. The production process consisted of 16 codes and 4 main Categories, distribution and vaccination process consisted of 12 codes and 4 main Categories. Moreover, the ethical considerations of special groups were divided into four main groups: health care workers (HCWs) (five codes), children and adolescents (five codes), the elderly (one code), and ethnic and racial minorities (three codes). CONCLUSION Due to the externalities of pandemics and the public and social benefits and harms of vaccination, it is not feasible to adhere to all four principles of medical ethics simultaneously and perfectly. This issue confronts individuals and policymakers with several moral dilemmas. It seems that decision-making based on the balance between social benefit and social harm is a better criterion in this regard, and the final decision should be made based on maximizing the public benefit and minimizing the public harm.
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Affiliation(s)
- Habib Jalilian
- Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahdi Amraei
- Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Elnaz Javanshir
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Farzad Faraji-Khiavi
- Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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O'Neil MM, Johnson RA, Córdova D, Pryor J, Pinals DA. A legal dispute resolution intervention for patients with substance use disorders: a study protocol for a randomized controlled trial. BMC Public Health 2023; 23:435. [PMID: 36879259 PMCID: PMC9990301 DOI: 10.1186/s12889-023-15296-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Substance use disorders (SUDs) represent major public health concerns and are linked to enhanced risk of legal consequences. Unresolved legal issues may prevent individuals with SUD from completing treatment. Interventions aimed at improving SUD treatment outcomes are limited. Filling that gap, this randomized controlled trial (RCT) tests the ability of a technology-assisted intervention to increase SUD treatment completion rates and improve post-treatment health, economic, justice-system, and housing outcomes. METHODS A randomized controlled trial with a two-year administrative follow-up period will be conducted. Eight hundred Medicaid eligible and uninsured adults receiving SUD treatment will be recruited at community-based non-profit health care clinics in Southeast, Michigan, USA. Using an algorithm embedded in a community-based case management system, we randomly assign all eligible adults to one of two groups. The treatment/intervention group will receive hands-on assistance with a technology aimed at resolving unaddressed legal issues and the control group receives no treatment. Upon enrollment into the intervention, both treatment (n = 400) and control groups (n = 400) retain traditional options to resolve unaddressed legal issues, such as hiring an attorney, but only the treatment group is targeted the technology and offered personalized assistance in navigating the online legal platform. To develop baseline and historical contexts for participants, we collect life course history reports from all participants and intend to link those in each group to administrative data sources. In addition to the randomized controlled trial (RCT), we used an exploratory sequential mixed methods and participatory-based design to develop, test, and administer our life course history instruments to all participants. The primary objective is to test whether targeting no-cost online legal resources to those experiencing SUD improves their long-term recovery and decreases negative health, economic, justice-system, and housing outcomes. DISCUSSION Findings from this RCT will improve our understanding of the acute socio-legal needs faced by those experiencing SUD and provide recommendations to help target resources toward the areas that best support long-term recovery. The public health impact includes making publicly available a deidentified, longitudinal dataset of uninsured and Medicaid eligible clients in treatment for SUD. Data include an overrepresentation of understudied groups including African American and American Indian Alaska Native persons documented to experience heightened risk for SUD-related premature mortality and justice-system involvement. Within these data, several intended outcome measures can inform the health policy landscape: (1) health, including substance use, disability, mental health diagnosis, and mortality; (2) financial health, including employment, earnings, public assistance receipt, and financial obligations to the state; (3) justice-system involvement, including civil and criminal legal system encounters; (4) housing, including homelessness, household composition, and homeownership. TRIAL REGISTRATION Retrospectively registered # NCT05665179 on December 27, 2022.
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Affiliation(s)
- Meghan M O'Neil
- Institute for Social Research, Population Studies Center, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, USA.
| | - Rebecca A Johnson
- Georgetown University, McCourt School of Public Policy, 37th and O Streets NW, Washington, DC, 20057, USA
| | - David Córdova
- School of Social Work, University of Michigan, 1080 S. University, Ann Arbor, MI, 48109, USA
| | - Jenna Pryor
- School of Social Work, University of Michigan, 1080 S. University, Ann Arbor, MI, 48109, USA
| | - Debra A Pinals
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
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Hosseinabadi-Farahani M, Fallahi-Khoshknab M, Arsalani N, Hosseini M, Mohammadi E. Culture of discrimination in healthcare: A grounded theory. Nurs Ethics 2023; 30:302-316. [PMID: 36476080 DOI: 10.1177/09697330221130608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Discrimination in health care is an international challenge and a serious obstacle to justice and equality in health. RESEARCH OBJECTIVE The purpose of this study was to design a grounded theory of discrimination in health care based on the experiences and perceptions of Iranian healthcare providers and patients. RESEARCH DESIGN This qualitative study was conducted using by the grounded theory method. PARTICIPANTS AND RESEARCH CONTEXT Data were collected through semi-structured interviews with 18 healthcare providers including 11 nurses, two physicians, two nurse's assistants, and three patients in two general hospitals in Tehran, Iran. Participants were selected through purposeful sampling and analyzed simultaneously using the Corbin and Strauss (2015) approach. ETHICAL CONSIDERATIONS The study was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Ethics code: IR.USWR.REC.1398.023). Also, after explaining the objectives of the study, all the participants completed and signed the written consent form. FINDINGS The "culture of discrimination" was the study's core category, reflecting the nature of discrimination in health care. The theory of "culture of discrimination in health care" is the result of five main categories: "individual social stimuli," "culture of discrimination," "unintentional discrimination," "conflict with discrimination," and "dissatisfaction with discriminatory behavior." These categories cover the underlying factors, strategies, and outcomes of the discrimination process in health care. DISCUSSION The results of the study showed that nurses and other health care providers experience unintentional discrimination. Unintentional discrimination refers to discriminatory behaviors and practices of health care providers. CONCLUSION The theory of culture of discrimination in health care can be used as a practical guide to describe and understand the role of health care providers, especially nurses. Further studies with a quantitative approach to applying this theory in medical settings are recommended.
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Affiliation(s)
| | - Masoud Fallahi-Khoshknab
- Department of Nursing, School of Rehabilitation, 48533University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Narges Arsalani
- Department of Nursing, Iranian Research Centre of Aging, 48533University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammadali Hosseini
- Department of Nursing, School of Rehabilitation, 48533University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Eesa Mohammadi
- Department of Nursing, Faculty of Medical Sciences, 41616Tarbiat Modares University, Tehran, Iran
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Taber P, Armin JS, Orozco G, Del Fiol G, Erdrich J, Kawamoto K, Israni ST. Artificial Intelligence and Cancer Control: Toward Prioritizing Justice, Equity, Diversity, and Inclusion (JEDI) in Emerging Decision Support Technologies. Curr Oncol Rep 2023; 25:387-424. [PMID: 36811808 DOI: 10.1007/s11912-023-01376-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 02/24/2023]
Abstract
PURPOSE FOR REVIEW This perspective piece has two goals: first, to describe issues related to artificial intelligence-based applications for cancer control as they may impact health inequities or disparities; and second, to report on a review of systematic reviews and meta-analyses of artificial intelligence-based tools for cancer control to ascertain the extent to which discussions of justice, equity, diversity, inclusion, or health disparities manifest in syntheses of the field's best evidence. RECENT FINDINGS We found that, while a significant proportion of existing syntheses of research on AI-based tools in cancer control use formal bias assessment tools, the fairness or equitability of models is not yet systematically analyzable across studies. Issues related to real-world use of AI-based tools for cancer control, such as workflow considerations, measures of usability and acceptance, or tool architecture, are more visible in the literature, but still addressed only in a minority of reviews. Artificial intelligence is poised to bring significant benefits to a wide range of applications in cancer control, but more thorough and standardized evaluations and reporting of model fairness are required to build the evidence base for AI-based tool design for cancer and to ensure that these emerging technologies promote equitable healthcare.
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Affiliation(s)
- Peter Taber
- Department of Biomedical Informatics, University of Utah School of Medicine, 421 Wakara Way, Salt Lake City, UT, 84108, USA.
| | - Julie S Armin
- Department of Family and Community Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah School of Medicine, 421 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Jennifer Erdrich
- Division of Surgical Oncology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah School of Medicine, 421 Wakara Way, Salt Lake City, UT, 84108, USA
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Ginapp C, Aminawung JA, Harper A, Puglisi LB. Exploring the Relationship between Debt and Health after Incarceration: a Survey Study. J Urban Health 2023; 100:181-189. [PMID: 36650355 PMCID: PMC9918653 DOI: 10.1007/s11524-022-00707-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/19/2023]
Abstract
Financial debt and incarceration are both independently associated with poor health, but there is limited research on the association between debt and health for those leaving incarceration. This exploratory study surveyed 75 people with a chronic health condition and recent incarceration to examine debt burden, financial well-being, and possible associations with self-reported health. Eighty-four percent of participants owed at least one debt, with non-legal debt being more common than legal debt. High financial stress was associated with poor self-reported health and the number of debts owed. Owing specific forms of debt was associated with poor health or high financial stress. Non-legal financial debt is common after incarceration, and related stress is associated with poor self-reported health. Future research is needed in larger populations in different geographical areas to further investigate the relationship and the impact debt may have on post-release poor health outcomes. Policy initiatives to address debt in the post-release population may improve health.
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Affiliation(s)
- Callie Ginapp
- Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06520-8056, USA.
| | - Jenerius A Aminawung
- Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06520-8056, USA
- SEICHE Center for Health and Justice, 300 George Street G05, New Haven, CT, 06520, USA
| | - Annie Harper
- Department of Psychiatry, Yale University School of Medicine, 319 Peck St., Erector Sq. Building #1, New Haven, CT, 06511, USA
| | - Lisa B Puglisi
- Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06520-8056, USA.
- SEICHE Center for Health and Justice, 300 George Street G05, New Haven, CT, 06520, USA.
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Myers PL, Chung KC. Role of Health Equity Research and Policy for Diverse Populations Requiring Hand Surgery Care. Hand Clin 2023; 39:17-24. [PMID: 36402522 DOI: 10.1016/j.hcl.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health equity requires allocation of resources to eliminate the systematic disparities in health, imposed on marginalized groups, which adversely impact outcomes. A socioecological approach is implemented to elucidate the role of health equity research and policy for underrepresented minority and socioeconomically disadvantaged populations. Through investigation of the individual, community, institution, and public policy, we investigate problems and propose solutions to ensure fair and just treatment of all patients requiring hand surgery.
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Affiliation(s)
- Paige L Myers
- Department of Surgery, Section of Plastic Surgery, University of Michigan, 2130 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Kevin C Chung
- Department of Surgery, Section of Plastic Surgery, University of Michigan, 2130 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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Pemberton D. Biographical lives and organ conscription. Theor Med Bioeth 2023; 44:75-93. [PMID: 36520353 DOI: 10.1007/s11017-022-09603-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 06/17/2023]
Abstract
According to 2021 data, the United States' opt-in system of posthumous organ donation results in seventeen Americans dying each day waiting for vital organs, while many good undonated organs go to the grave with the corpse. One of the most aggressive, and compelling, proposals to resolve this tragedy is postmortem organ conscription, also called routine salvaging or organ draft. This proposal entails postmortem retrieval of needed organs, regardless of the prior authorization or refusal of the deceased or his family. The argument of most proponents of conscription relies heavily upon a denial of the possibility of posthumous harms. While I also deny the possibility of posthumous harms, I argue this denial fails to acknowledge other serious wrongs that could be done to the deceased person and his corpse. While the person can no longer be harmed, his life, in a roughly biographical sense, can be damaged. Humans highly value life in this sense, often more than biological life. Respect for this sense of life also informs appropriate treatment of particular human corpses, which already have special value beyond mere resource. I will argue that conscription proponents fail to appropriately value lives and human corpses. This failure can lead to multiple wrongs, among them a wrongful exploitation of the vulnerability of a person's life and corpse and a disrespect of persons. While it is possible that some biographical lives could be made better, or at least less bad, by conscription, the judgments such decisions would require make conscription bad policy.
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Bonotti M, Borghini A, Piras N, Serini B. The Justice and Ontology of Gastrospaces. Ethical Theory Moral Pract 2023; 26:91-111. [PMID: 36721496 PMCID: PMC9880365 DOI: 10.1007/s10677-022-10357-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 06/18/2023]
Abstract
In this paper, we establish gastrospaces as a subject of philosophical inquiry and an item for policy agendas. We first explain their political value, as key sites where members of liberal democratic societies can develop the capacity for a sense of justice and the capacity to form, revise, and pursue a conception of the good. Integrating political philosophy with analytic ontology, we then unfold a theoretical framework for gastrospaces: first, we show the limits of the concept of "third place;" second, we lay out the foundations for an ontological model of gastrospaces; third, we introduce five features of gastrospaces that connect their ontology with their political value and with the realization of justice goals. We conclude by briefly illustrating three potential levels of intervention concerning the design, use, and modification of gastrospaces: institutions, keepers, and users.
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Lei X, Kaplan SA. The real-time and carry-over effects of in justice on performance and service quality in a ridesharing driver scenario. Curr Psychol 2023; 42:1-22. [PMID: 36684460 PMCID: PMC9838455 DOI: 10.1007/s12144-022-04215-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/11/2023]
Abstract
The nature of gig work and its growth have important implications for organizational justice theory. Aspects of gig work, including the transactional compensation arrangement, strict algorithmic rating system, and power asymmetry between drivers and customers, have implications for understanding how dimensions of distributive, informational, and interpersonal injustice manifest and impact job performance in the gig context. An understanding of this topic can inform justice theory more broadly and help explain inconsistent findings in the literature. Here, we report the results of two studies examining the unique effects of these respective dimensions of injustice on emotions and, ultimately, the driving performance and service quality in a ridesharing service context. In Study 1, we modeled the passenger-driver interaction of the ridesharing context using a driving simulator in a laboratory setting to differentiate the real-time and carry-over effects of specific dimensions of injustice. The results from 99 participants showed that perceptions of interpersonal injustice increased anger and unhappiness during the ride, in turn impairing driving and service performance. Antecedent-focused emotion regulation strategies (ERS) reduced felt unhappiness. Moreover, unexpectedly, perceived distributive injustice as caused by the customer rating had opposite (direct versus indirect) effects on service performance in the subsequent ride. Study 2 was an online simulation vignette scenario with 294 participants. The results replicated the findings of Study 1 and revealed two moderators of the unexpected distributive justice-performance relationship. Supplementary Information The online version contains supplementary material available at 10.1007/s12144-022-04215-3.
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Affiliation(s)
- Xue Lei
- School of Business, East China University of Science and Technology, No. 130 Meilong Road, Shanghai, 200237 China
- Department of Psychology, George Mason University, Fairfax, VA USA
| | - Seth A. Kaplan
- Department of Psychology, George Mason University, Fairfax, VA USA
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Lucas T, Yamin JB, Krohner S, Goetz SMM, Kopetz C, Lumley MA. Writing about justice and injustice: Complex effects on affect, performance, threat, and biological responses to acute social stress among african American women and men. Soc Sci Med 2023; 316:115019. [PMID: 35589454 DOI: 10.1016/j.socscimed.2022.115019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/26/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Brief, culturally-tailored, and scalable stress coping interventions are needed to address a broad range of stress-related health disparities, including among African Americans. In this study, we develop two brief justice writing interventions and demonstrate a methodological approach for evaluating how prompting African Americans to think about justice and injustice can alter responses to acute social stress. METHODS African American women and men were randomized to a neutral writing condition or one of two justice-based writing interventions, which prompted them to recall past experiences of personal justice - with (adjunctive injustice) or without (personal justice-only) recalling and writing about injustice. Participants then completed a modified Trier Social Stress Test, during which they received feedback on poor performance. We measured cognitive performance, affect, and perceived threat in response to task feedback. We also measured blood pressure and salivary cortisol stress responses. RESULTS Men experienced more positive emotion, performed better on the stressor task, and were less threatened by poor performance feedback in the personal justice-only condition. Men also had lower systolic blood pressure reactivity in the justice writing conditions compared to control. Women experienced less positive emotion, performed worse on the stressor task, and were more threatened by feedback in the personal justice-only condition. Women also had lower cortisol recovery after the stressor task in the adjunctive injustice condition. CONCLUSION Thinking about justice and injustice may alter performance, affect, threat, and biological responses to acute social stress. Still, gender differences highlight that justice thinking is likely to produce heterogeneous and complex stress coping responses among African Americans.
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Affiliation(s)
- Todd Lucas
- Division of Public Health, Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 200 East 1st Street, Flint, MI, 48502, USA; Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 Wilson Road, East Lansing, MI, 48824, USA.
| | - Jolin B Yamin
- Department of Psychology, Wayne State University, 5057 Woodward Ave, Detroit, MI, 48202, USA
| | - Shoshana Krohner
- Department of Psychology, Wayne State University, 5057 Woodward Ave, Detroit, MI, 48202, USA
| | - Stefan M M Goetz
- Peace Research Institute Oslo, Hausmanns Gate 3, Oslo, 0186, Norway
| | - Catalina Kopetz
- Department of Psychology, Wayne State University, 5057 Woodward Ave, Detroit, MI, 48202, USA
| | - Mark A Lumley
- Department of Psychology, Wayne State University, 5057 Woodward Ave, Detroit, MI, 48202, USA
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Hofstad T, Husum TL, Rugkåsa J, Hofmann BM. Geographical variation in compulsory hospitalisation - ethical challenges. BMC Health Serv Res 2022; 22:1507. [PMID: 36496384 PMCID: PMC9737766 DOI: 10.1186/s12913-022-08798-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 11/07/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Compulsory hospitalisation in mental health care restricts patients' liberty and is experienced as harmful by many. Such hospitalisations continue to be used due to their assumed benefit, despite limited scientific evidence. Observed geographical variation in compulsory hospitalisation raises concern that rates are higher and lower than necessary in some areas. METHODS/DISCUSSION We present a specific normative ethical analysis of how geographical variation in compulsory hospitalisation challenges four core principles of health care ethics. We then consider the theoretical possibility of a "right", or appropriate, level of compulsory hospitalisation, as a general norm for assessing the moral divergence, i.e., too little, or too much. Finally, we discuss implications of our analysis and how they can inform the future direction of mental health services.
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Affiliation(s)
- Tore Hofstad
- grid.5510.10000 0004 1936 8921Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - Tonje Lossius Husum
- grid.5510.10000 0004 1936 8921Centre for Medical Ethics, University of Oslo, Oslo, Norway ,grid.412414.60000 0000 9151 4445Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Jorun Rugkåsa
- grid.411279.80000 0000 9637 455XHealth Services Research Unit, Akershus University Hospital, Lørenskog, Norway ,grid.463530.70000 0004 7417 509XCentre for Care Research, University of South-Eastern Norway, Porsgrunn, Norway
| | - Bjørn Morten Hofmann
- grid.5510.10000 0004 1936 8921Centre for Medical Ethics, University of Oslo, Oslo, Norway ,grid.5947.f0000 0001 1516 2393Department of Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway
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Hofmann B. Ethical issues with geographical variations in the provision of health care services. BMC Med Ethics 2022; 23:127. [PMID: 36474244 PMCID: PMC9724375 DOI: 10.1186/s12910-022-00869-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/26/2022] [Indexed: 12/12/2022] Open
Abstract
Geographical variations are documented for a wide range of health care services. As many such variations cannot be explained by demographical or epidemiological differences, they are problematic with respect to distributive justice, quality of care, and health policy. Despite much attention, geographical variations prevail. One reason for this can be that the ethical issues of geographical variations are rarely addressed explicitly. Accordingly, the objective of this article is to analyse the ethical aspects of geographical variations in the provision of health services. Applying a principlist approach the article identifies and addresses four specific ethical issues: injustice, harm, lack of beneficence, and paternalism. Then it investigates the normative leap from the description of geographical variations to the prescription of right care. Lastly, the article argues that professional approaches such as developing guidelines, checklists, appropriateness criteria, and standards of care are important measures when addressing geographical variations, but that such efforts should be accompanied and supported by ethical analysis. Hence, geographical variations are not only a healthcare provision, management, or a policy making problem, but an ethical one. Addressing the ethical issues with geographical variations is key for handling this crucial problem in the provision of health services.
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Affiliation(s)
- Bjørn Hofmann
- grid.5947.f0000 0001 1516 2393Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU), PO Box 191, 2801 Gjøvik, Norway ,grid.5510.10000 0004 1936 8921The Centre for Medical Ethics, University of Oslo, PO Box 1130, 0318 Oslo, Norway
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Smith-Carrier T, Manion K. Bringing It All Together: Leveraging Social Movements and the Courts to Advance Substantive Human Rights and Climate Justice. Hum Rights Rev 2022; 23:551-574. [PMID: 36540202 PMCID: PMC9735170 DOI: 10.1007/s12142-022-00674-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 06/17/2023]
Abstract
Although significant literature and jurisprudence has amassed on rights-based climate litigation over recent years, less research and case law has emerged on poverty-related court cases and the fulfilment of economic, social, and cultural rights (ESCR) in Canada. Fewer still are studies exploring the interlinkages between these areas of inquiry. The purpose of this paper is to explore, using Canada as a case study, rights-based developments in climate litigation cases and how these could impact the innovative advancement of ESCR (e.g. to food, housing and water). Typically, issues of justiciability and standing emerge, impeding the realization of such rights. Given the grave threats we now face, climate cases and social movements must be brought together to better hold state actors accountable for their rights obligations. We implore the legal community to explore ways to traverse juridical obstacles to realize the interdependencies of human rights and protect the planet from calamitous climate change.
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Affiliation(s)
- Tracy Smith-Carrier
- School of Humanitarian Studies, Royal Roads University, 2005 Sooke Road, Victoria, BC V9B 5Y2 Canada
| | - Kathleen Manion
- School of Humanitarian Studies, Royal Roads University, 2005 Sooke Road, Victoria, BC V9B 5Y2 Canada
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Abstract
The Belmont Report continues to be held in high regard, and most bioethical analyses conducted in recent years have presumed that it affects United States federal regulations. However, the assessments of the report's creators are sharply divided. Understanding the historic reputation of this monumental report is thus crucial. We first recount the historical context surrounding the creation of this report. Subsequently, we review the process involved in developing ethical guidelines and describe the report's features. Additionally, we analyze the effect of unfolding events on the subsequent creation of federal regulations, especially on gene therapy clinical trials. Moreover, throughout this paper we evaluate the ethical principles outlined in this report and describe how they overlap with the issue of protecting socially vulnerable groups. Based on the analysis, we conclude that the features of the Belmont Report cannot be considered as having affected the basic sections of the federal regulations for ethical reviews that were made uniform in 1981. Nevertheless, regarding the regulations on gene therapy clinical trials-which were at first expected to be applicable to research involving children-in addition to implementing policies regarding the public review of protocols that passed ethical review, this report's principles are clearly reflected in the key notes that should have been referred to when the report was created.
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Affiliation(s)
- Hiroyuki Nagai
- Department of Biomedical Ethics, University of Tokyo Faculty of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Center for Technology Research and Innovation, BIPROGY Inc, 1-1-1 Toyosu, Koto-ku, Tokyo, 135-8650, Japan
| | - Eisuke Nakazawa
- Department of Biomedical Ethics, University of Tokyo Faculty of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Akira Akabayashi
- Department of Biomedical Ethics, University of Tokyo Faculty of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
- Division of Medical Ethics, New York University School of Medicine, 227 East 30th Street, New York, NY, 10016, USA.
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McCormack JC, Chu JTW, Marsh S, Bullen C. Knowledge, attitudes, and practices of fetal alcohol spectrum disorder in health, justice, and education professionals: A systematic review. Res Dev Disabil 2022; 131:104354. [PMID: 36375286 DOI: 10.1016/j.ridd.2022.104354] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 07/12/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND AIMS Fetal alcohol spectrum disorder (FASD) is one of the most common forms of developmental disability, and yet, anecdotally, is poorly understood by both the public and professionals across health, justice, education, and social services. This review aims to understand the knowledge, attitudes, and practices of professionals who work across a range of sectors - specifically health, education and justice - where they may encounter people with FASD, their families and caregivers. METHOD We conducted a systematic search for research using surveys or questionnaires to address knowledge, and attitudes of professionals in health, education, and justice with regards to FASD between 1990 and 2021. Our search consisted of electronic databases (APA PsychInfo, CINAHL, EMBASE, Medline, PubMed, and PAIS Index) and grey literature sources. RESULTS Our search yielded 971 results, of which 58 were relevant. The studies surveyed professionals from health (n = 35), education (n = 10), justice (n = 8), social services (n = 1), and multiple settings (n = 4). Most studies were conducted in North America. The areas surveyed included knowledge of FASD, attitudes towards people with FASD, experience with FASD, practices towards people with FASD, and education and training needs. CONCLUSIONS Knowledge, attitudes, and practices towards FASD have been surveyed extensively in healthcare professionals over the last 30 years, but less so with those working in justice and education sectors. Findings from surveys suggest that although most professionals had some knowledge of the effects of FASD, their knowledge of the specific criteria of Fetal Alcohol Syndrome (FAS) and FASD is poor across most professional groups, including most health professionals. Our review highlights the need to provide training and information across sectors ongoing surveillance to determine where gaps in knowledge are and what resources are needed. WHAT THIS PAPER ADDS This study is the first to systematically synthesize knowledge, attitudes, and practices toward FASD across different sectors. Poor knowledge and insufficient training were common. Knowledge, attitudes, and practices about FASD have been surveyed extensively in the healthcare setting, but surveys are more limited outside of this setting. Continuous surveillance is needed to identify and respond to knowledge gaps and changes in practice.
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Affiliation(s)
- Jessica C McCormack
- National Institute for Health Innovation, School of Population Health, The University of Auckland, New Zealand
| | - Joanna Ting Wai Chu
- National Institute for Health Innovation, School of Population Health, The University of Auckland, New Zealand.
| | - Samantha Marsh
- National Institute for Health Innovation, School of Population Health, The University of Auckland, New Zealand; Social and Community Health, School of Population Health, The University of Auckland, New Zealand
| | - Chris Bullen
- National Institute for Health Innovation, School of Population Health, The University of Auckland, New Zealand
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Scott PO, Catlett JL, Seah C, Leisman S. A Framework for Antiracist Curriculum Changes in Nephrology Education. Adv Chronic Kidney Dis 2022; 29:493-500. [PMID: 36371111 DOI: 10.1053/j.ackd.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/20/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022]
Abstract
Addressing persistent racial health disparities in cases of kidney disease will first require significant investment in examining how structural racism has influenced our clinical practice and medical education. Improving how we understand and articulate race is critical for achieving this goal. This work begins with ensuring that race's mention within nephrology literature and curricular materials for medical trainees is thoroughly rooted in evidence-based rationale-not to serve as a proxy for polygenic contributions, social determinants of health, or systemic health care barriers. While many institutions are increasingly recognizing the importance of instituting such changes on behalf of the systematically marginalized patient populations who are most affected by these disparities, there is a paucity of guidance on how to critically appraise and revise decades of pathophysiological and epidemiological findings through an antiracist lens. In this article, we propose an inquiry-based framework with case-study examples to help readers recognize improper use of race within nephrology, assess personal and institutional readiness to introduce changes to said content, and generate materials that center evidence-based findings and reject harmful misinterpretations of race.
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Affiliation(s)
| | | | - Carina Seah
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Staci Leisman
- Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medicine, Division of Nephrology, Mount Sinai Hospital, New York, NY.
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Faissner M, Hartmann KV, Marcinski-Michel I, Müller R, Weßel M. [Feminist perspectives in German-language medical ethics: a review and three hypotheses]. Ethik Med 2022; 34:669-686. [PMID: 36258779 PMCID: PMC9559163 DOI: 10.1007/s00481-022-00724-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/08/2022] [Indexed: 11/06/2022]
Abstract
Im internationalen Diskurs sind feministische Perspektiven auf die Medizinethik bereits etabliert. Demgegenüber scheinen diese bislang nur vereinzelt in den deutschsprachigen medizinethischen Diskurs eingebracht zu werden. In diesem Artikel untersuchen wir, welche feministischen Perspektiven im deutschsprachigen medizinethischen Diskurs vertreten sind, und schlagen weitere Ansätze für eine feministische Medizinethik vor. Zu diesem Zweck zeichnen wir mittels einer systematisierten Literaturrecherche feministische Perspektiven im deutschsprachigen medizinethischen Diskurs seit der Etablierung der Medizinethik als eigenständiger institutionalisierter Disziplin nach. Wir analysieren, welche Themen bereits innerhalb der Medizinethik aus einer feministischen Perspektive untersucht worden sind, und identifizieren Leerstellen. Basierend auf der Literaturrecherche, unseren eigenen Vorarbeiten sowie der Zusammenarbeit in der Arbeitsgruppe in der Akademie für Ethik in der Medizin „Feministische Perspektiven in der Bio- und Medizinethik“ stellen wir drei Thesen vor, die aus unserer Sicht einer Weiterentwicklung des deutschsprachigen medizinethischen Diskurses dienen können. Die erste These bezieht sich auf die Ziele feministischer Medizinethiken und besagt, dass diese (epistemische) Gerechtigkeit anstreben. Die zweite These stellt zentrale Eigenschaften von feministischen Medizinethiken als kritisch und kontext-sensibel heraus. In der dritten These diskutieren wir Intersektionalität und Postkolonialismus als theoretische Ansätze, die zu einer epistemisch gerechten, kritischen und kontext-sensiblen Medizinethik beitragen können. Wir argumentieren, dass feministische Perspektiven grundständig verankert werden sollten. Der Artikel schließt mit einem Ausblick auf die Arbeit der im letzten Jahr gegründeten Arbeitsgruppe in der Akademie für Ethik in der Medizin „Feministische Perspektiven in der Bio- und Medizinethik“.
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Affiliation(s)
- Mirjam Faissner
- Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum, Ruhr-Universität Bochum, Alexandrinenstraße 1–3, 44791 Bochum, Deutschland
| | - Kris Vera Hartmann
- Institut für Geschichte und Ethik der Medizin, Medizinische Fakultät, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland
| | - Isabella Marcinski-Michel
- Institut für Ethik und Geschichte der Medizin, Medizinische Fakultät, Georg-August-Universität Göttingen, Göttingen, Deutschland
| | - Regina Müller
- Institut für Philosophie, Universität Bremen, Bremen, Deutschland
| | - Merle Weßel
- Ethik in der Medizin, Department Versorgungsforschung, Fakultät VI Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
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Puyol Á. [The role of solidarity in a pandemic.]. Rev Esp Salud Publica 2022; 96:e202210072. [PMID: 36196631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/05/2022] [Indexed: 06/16/2023] Open
Abstract
Solidarity is part of the map of values and ethical principles of the COVID-19 pandemic that has devastated the world since the end of 2019. Solidarity has been behind the justification for public health measures such as confinement, quarantines, lockdowns, the mandatory use of masks, and the financing, distribution and inoculation of vaccines against the virus; it has also been used to economic compensation, intergenerational sacrifices, the importance of public health care and even mutual aid between citizens, institutions and countries to face the worst effects of the pandemic. However, solidarity has been used interchangeably as a descriptive and normative, motivational and justificatory, sentimental and political, moral and legal idea, thus increasing confusion about its meaning, use and scope. This article reviews the rhetorical use of solidarity during the pandemic, shows the contradictions derived from that use, and sheds light on the normative use it should have in order to more rigorously address responses to future pandemics.
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Affiliation(s)
- Ángel Puyol
- Universitat Autònoma de Barcelona. Barcelona. España
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50
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McDonald KE, Schwartz AE, Sabatello M. Eligibility criteria in NIH-funded clinical trials: Can adults with intellectual disability get in? Disabil Health J 2022; 15:101368. [PMID: 36123292 DOI: 10.1016/j.dhjo.2022.101368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/04/2022] [Accepted: 08/14/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although scientific breakthroughs can promote health equity, there is concern that adults with intellectual disability, a health disparities population, may be excluded from clinical trials. OBJECTIVE To determine the extent to which adults with intellectual disability are subject to exclusion from National Institutes of Health (NIH)-funded clinical trials. METHODS We studied recent NIH-funded Phase 2/3, 3, and 4 clinical trials of United States-based working-age adults (>18 < 55 years of age) listed in ClinicalTrials.gov. We coded eligibility criteria for inclusion, direct exclusion, and indirect exclusion of adults with intellectual disability. RESULTS We rarely identified studies that directly include adults with intellectual disability. Most studies (74.6%) had eligibility criteria that directly and/or indirectly exclude adults with intellectual disability. Approximately one-third of studies had direct exclusion criteria based on cognitive impairment or diagnosis of intellectual disability. Nearly 65% of studies indirectly excluded adults with intellectual disability based on factors likely associated with intellectual disability (e.g., functional capacity, inability to read/write, and/or research staff discretion). CONCLUSIONS We found less exclusion based on diagnosis of intellectual disability than anticipated. Nonetheless, about three-fourths of studies had eligibility criteria which would likely lead to the direct and/or indirect exclusion of adults with intellectual disability. Our findings suggest substantial cause for concern that adults with intellectual disability experience widespread exclusion from NIH-funded clinical trials-exclusion that may lack appropriate justification and assessment. Consequently, this group is denied equal access to the potential benefits of scientific discovery. We provide recommendations for approaches to include adults with intellectual disability.
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Affiliation(s)
- Katherine E McDonald
- Department of Public Health, David B. Falk College of Sport and Human Dynamics, Syracuse University. 344 White Hall, Syracuse University, Syracuse, NY 13210, USA.
| | - Ariel E Schwartz
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, Mass General Brigham Institute of Health Professions, MA, USA.
| | - Maya Sabatello
- Department of Medicine, Center for Precision Medicine and Genomics, and Department of Medical Humanities and Ethics, Columbia University, NY, USA.
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