This book presents the first critical examination of the overlapping ethical, sociocultural, and policy-related issues surrounding disasters, global bioethics, and public health ethics. These issues are elucidated under the conceptual rubric: Public health disasters. The book defines PHDs as public health issues with devastating social consequences, the attendant public health impacts of natural or man-made disasters, and latent or low prevalence public health issues with the potential to rapidly acquire pandemic capacities. This notion is illustrated (...) using Ebola and pandemic influenza outbreaks, atypical drug-resistant tuberculosis, and the health emergencies of earthquakes as focal points. Drawing on an approach that reckons with microbial, existential, and anthropological realities; the book develops a relational-based global ethical framework that can help address the local, anthropological, ecological, and transnational dynamics of the ethical issues engendered by public health disasters. The book also charts some of the critical roles that relevant local and transnational stakeholders may play in translating the proposed global ethical framework from the sphere of concept to the arena of action. This title is of immense benefit to bioethics scholars, public and global health policy experts, as well as graduate students working in the area of global health, public health ethics, and disaster bioethics. (shrink)

Concepts and Cases in Nursing Ethics maps the ethical landscape of contemporary nursing. The book is the product of a collaboration between philosopher-ethicist Michael Yeo, nurse-ethicist Anne Moorhouse, and six representatives of various areas of professional nursing. It thus combines philosophical and ethical analysis with nursing knowledge and experience in a manner that is both understandable and relevant. The book is organized around six main concepts in nursing ethics: beneficence, autonomy, confidentiality, truth-telling, justice, and integrity. A chapter is devoted (...) to the elucidation of each of these concepts. In each chapter, historical background and conceptual analysis are supplemented by case studies that exemplify issues and show how the concept applies in nursing practice. In this new edition, the materials in each chapter have been updated to reflect recent developments in nursing and more generally in health care. In addition, a totally new chapter on ethical theory has been added. Complete with bibliographies and study questions for further analysis of cases, this book is ideally suited for textbook use. It will help both practitioners and students to deal better with the clinical problems and issues that are encountered in the field. However, it's simple prose and clear exposition of complex issues will make Concepts and Cases in Nursing Ethics attractive to anyone concerned about health care. (shrink)

_A portion of the revenue from this book’s sales will be donated to Doctors Without Borders to assist the humanitarian work of nurses, doctors, and other health care providers in the fight against COVID-19 and beyond._ _Concepts and Cases in Nursing Ethics_ is an introduction to contemporary ethical issues in health care, designed especially for Canadian audiences. The book is organized around six key concepts: beneficence, autonomy, truth-telling, confidentiality, justice, and integrity. Each of these concepts is explained and (...) discussed with reference to professional and legal norms. The discussion is then supplemented by case studies that exemplify the relevant concepts and show how each applies in health care and nursing practice. This new fourth edition includes an added chapter on end-of-life issues, and it is revised throughout to reflect the latest developments on topics such as global health ethics, cultural competence, social media, and palliative sedation, as well as ethical issues relating to COVID-19. (shrink)

Concepts and Cases in Nursing Ethics is an introduction to contemporary ethical issues in health care, designed especially for Canadian audiences. The book is organized around six key concepts: beneficence, autonomy, truth-telling, confidentiality, justice, and integrity. Each of these concepts is explained and discussed with reference to professional and legal norms. The discussion is then supplemented by case studies that exemplify the relevant concepts and show how each applies in health care and nursing practice. This new fourth edition (...) includes an added chapter on end-of-life issues, and it is revised throughout to reflect the latest developments on topics such as global health ethics, cultural competence, social media, and palliative sedation. (shrink)

Funding broadly connotes the notion of an institution and/or institutions making money and other resources available to individual researchers and organizations to accomplish specific projects. Whi...

The publication of DSM-5 has been accompanied by a fair amount of controversy. Amongst DSM’s most vocal ‘insider’ critics has been Thomas Insel, Director of the US National Institute of Mental Health. Insel has publicly criticised DSM’s adherence to a symptom-based classification of mental disorder, and used the weight of the NIMH to back a rival research strategy aimed at a more biology-based diagnostic classification. This strategy is part of Insel’s vision of a future, more preventative psychiatry in which (...) mental disorders are not only understood as biological disorders of the brain, but also as neurodevelopmental disorders. This paper examines the interest and merit of Insel’s views of mental and neurodevelopmental disorder for the philosophy of psychopathology, with a special focus of his neurodevelopmental model of schizophrenia. Pitman’s ‘moderate materialism’ will be used both as a philosophical lens through which to examine Insel’s position, as well as an example of a philosophical framework that may require updating and revision in the light of moves towards a neurodevelopmental conception of mental disorder. (shrink)

Chapter 1 Who this book is for and who it is not for1 There are already too many books offering solutions to the problems of the health service. ...

One of the central characteristics of public health disasters is the rapid overlapping of different needs and priorities that require making critical choices that inevitably elicit conflicti...

This book contains original essays that look at contagious/infectious disease pandemics and the ethical public policy and administration these have entailed. In particular, the pandemics of the 1918 flu pandemic, HIV in the 1990s, SARS in 2003, Ebola from 2014–2016 and the novel COVID-19 in 2020 are highlighted. The contributions in this work offer the reader insights in these and several other recent pandemics that present differently—either via contagion or mortality rate—and how each should be addressed by countries of various (...) sorts. This book is a must for the ongoing debate on how we should treat public health crises, such as the one we have all just encountered in the novel COVID-19 pandemic. (shrink)

Realizing the benefits of translating psychiatric genomics research into mental health care is not straightforward. The translation process gives rise to ethical challenges that are distinctive from challenges posed within psychiatric genomics research itself, or that form part of the delivery of clinical psychiatric genetics services. This article outlines and considers three distinct ethical concerns posed by the process of translating genomic research into frontline psychiatric practice and policy making. First, the genetic essentialism that is commonly associated with the (...) genomics revolution in health care might inadvertently exacerbate stigma towards people with mental disorders. Secondly, the promises of genomic medicine advance a narrative of individual empowerment. This narrative could promote a fatalism towards patients' biology in ways that function in practice to undermine patients' agency and autonomy, or, alternatively, a heightened sense of subjective genetic responsibility could become embedded within mental health services that leads to psychosocial therapeutic approaches and the clinician-patient therapeutic alliance being undermined. Finally, adopting a genomics-focused approach to public mental health risks shifting attention away from the complex causal relationships between inequitable socio-economic, political, and cultural structures and negative mental health outcomes. The article concludes by outlining a number of potential pathways for future ethics research that emphasizes the importance of examining appropriate translation mechanisms, the complementarity between genetic and psychosocial models of mental disorder, the implications of genomic information for the clinician-patient relationship, and funding priorities and resource allocation decision making in mental health. (shrink)

In this paper we discuss ethical implications of the use of mobile phone apps in the control of the COVID-19 pandemic. Contact tracing is a well-established feature of public health practice during infectious disease outbreaks and epidemics. However, the high proportion of pre-symptomatic transmission in COVID-19 means that standard contact tracing methods are too slow to stop the progression of infection through the population. To address this problem, many countries around the world have deployed or are developing mobile phone (...) apps capable of supporting instantaneous contact tracing. Informed by the on-going mapping of ‘proximity events’ these apps are intended both to inform public health policy and to provide alerts to individuals who have been in contact with a person with the infection. The proposed use of mobile phone data for ‘intelligent physical distancing’ in such contexts raises a number of important ethical questions. In our paper, we outline some ethical considerations that need to be addressed in any deployment of this kind of approach as part of a multidimensional public health response. We also, briefly, explore the implications for its use in future infectious disease outbreaks. (shrink)

Sue Sherwin was among the first feminist bioethicists to insist that bioethics needed to become much more richly contextual and relational than traditional approaches to the discipline were ready to acknowledge. Targeting clinical bioethics and its central notion of patient autonomy, feminist bioethics focused on how broader social inequalities were likely to manifest themselves within clinical encounters among patients, family members, and healthcare professionals. The general idea was that by attending to how more general social inequalities might be affecting clinical (...) encounters, an explicitly feminist bioethics could play a crucial role in developing institutional pathways for empowering patients to make more... (shrink)

Ethical decision making measures are widely applied as the principal dependent variable used in studies of research integrity. However, evidence bearing on the internal and external validity of these measures is not available. In this study, ethical decision making measures were administered to 102 graduate students in the biological, health, and social sciences, along with measures examining exposure to ethical breaches and the severity of punishments recommended. The ethical decision making measure was found to be related to exposure to (...) ethical events and the severity of punishments awarded. The implications of these findings for the application of ethical decision making measures are discussed. (shrink)

Centre for Applied Philosophy and Public Ethics, The Australian National University, LPO Box 8260, ANU, Canberra ACT 2601, Australia. Email: michael.selgelid{at}anu.edu.au ' + u + '@ ' + d + ' '/ /- ->. Home page: http: //www.cappe.edu.au/staff/michael-selgelid.htmThis article advocates the development of a moderate pluralist theory of political philosophy that recognizes that utility, liberty and equality are legitimate, independent social values and that none should have absolute priority over the others. Inter alia, such a theory would provide (...) a principled means for striking a balance, or making trade-offs, between these values in cases of conflict. Recent developments in public health ethics have made progress in thinking about how to make trade-offs between liberty and utility in particular. While public health ethicists often claim that the least restrictive alternative should be used to achieve the public health goal in question, I argue that a plausible but under-recognized idea is that the least restrictive alternative might sometimes involve improvement of global health via redistributive taxation—i.e., rather than coercive social distancing measures. I conclude by demonstrating that the proportionality principle leaves open the question of when exactly utility outweighs liberty or vice versa—and I argue that, rather than speaking about the morality of liberty-infringing public health interventions in categorical/binary terms, it would be more fruitful and realistic to think and speak about the degree to which a liberty-infringing public health intervention is morally appropriate. CiteULike Connotea Del.icio.us What's this? (shrink)

Bioethics, Volume 36, Issue 2, Page 194-200, February 2022.

The term “normal” is culturally ubiquitous and conceptually vague. Interestingly, it appears to be a descriptive-normative-hybrid which, unnoticedly, bridges the gap between the descriptive and the normative. People’s beliefs about normality are descriptive and prescriptive and depend on both an average and an ideal. Besides, the term has generally garnered popularity in medicine. However, if medicine heavily relies on the normal, then it should point out how it relates to the concept of health or to statistics, and what, after (...) all, normal means. Most importantly, the normativity of the normal needs to be addressed. Since the apparently neutral label “normal” can exclude, stigmatize, and marginalize people who are defined in contrast to it as abnormal, health professionals should think twice before using the term with patients. The present critical perspective advocates against using the term “normal,” as long as no understanding of a person’s individual normality has been attained. It advocates for the right to autonomously determine one’s own normality. For health professionals I do not see worthwhile benefits of subscribing to the concept of “normality” and imposing it on their patients. But I do see many risks. (shrink)

Spinoza rejects fundamental tenets of received morality, including the notions of Providence and free will. Yet he retains rich theories of good and evil, virtue, perfection, and freedom. Building interconnected readings of Spinoza's accounts of imagination, error, and desire, Michael LeBuffe defends a comprehensive interpretation of Spinoza's enlightened vision of human excellence. Spinoza holds that what is fundamental to human morality is the fact that we find things to be good or evil, not what we take those designations to (...) mean. When we come to understand the conditions under which we act-that is, when we come to understand the sorts of beings that we are and the ways in which we interact with things in the world-then we can recast traditional moral notions in ways that help us to attain more of what we find to be valuable.For Spinoza, we find value in greater activity. Two hazards impede the search for value. First, we need to know and acquire the means to be good. In this respect, Spinoza's theory is a great deal like Hobbes's: we strive to be active, and in order to do so we need food, security, health, and other necessary components of a decent life. There is another hazard, however, that is more subtle. On Spinoza's theory of the passions, we can misjudge our own natures and fail to understand the sorts of beings that we really are. So we can misjudge what is good and might even seek ends that are evil. Spinoza's account of human nature is thus much deeper and darker than Hobbes's: we are not well known to ourselves, and the self-knowledge that is the foundation of virtue and freedom is elusive and fragile. (shrink)

In order to understand the lived experiences of physicians in clinical practice, we interviewed eleven expert, respected clinicians using a phenomenological interpretative methodology. We identified the essence of clinical practice as engagement. Engagement accounts for the daily routine of clinical work, as well as the necessity for the clinician to sometimes trespass common boundaries or limits. Personally engaged in the clinical situation, the clinician is able to create a space/time bubble within which the clinical encounter can unfold. Engagement provides an (...) account of clinical practice as a unitary lived experience. This stands in stark contrast to the prevailing notion, referred to as a dual discourse, that describes medicine as the addition of humanism to science. Drawing on Aristotle’s notion of phronesis and Sartre’s definition of the situation, we illustrate how this novel perspective entwines clinical practice, the person of the clinician, and the clinician’s situation. (shrink)

In this chapter, I consider the prospects for deploying the concept of public reason in settling practical bioethical questions, focusing in particular on entitlements to healthcare. I begin by tracing the origins of the concept of public reason to the aspirations of the liberal political theorist to find a justification for the authority of government, which reconciles a basic belief in the autonomy of the individual with the legitimacy of the coercive institutions that create and govern the public sphere. I (...) then consider how the concept of public reason may be used in order to justify a universal entitlement to healthcare, paying particular attention to the work of Norman Daniels. Finally, I briefly consider the objection that an entitlement to healthcare grounded on such terms is insufficiently robust, because it downplays the values that healthcare encodes. I conclude by reflecting on whether the concept of public reason can be stretched to include a more robust conception of the value of health. (shrink)

Viral modernity is a concept based upon the nature of viruses, the ancient and critical role they play in evolution and culture, and the basic application to understanding the role of information and forms of bioinformation in the social world. The concept draws a close association between viral biology on the one hand, and information science on the other – it is an illustration and prime example of bioinformationalism that brings together two of the most powerful forces that now drive (...) cultural evolution. The concept of viral modernity applies to viral technologies, codes and ecosystems in information, publishing, education and emerging knowledge systems. This paper traces the relationship between epidemics, quarantine, and public health management and outlines elements of viral-digital philosophy based on the fusion of living and technological systems. We discuss Covid-19 as a ‘bioinformationalist’ response that represents historically unprecedented level of sharing information from the sequencing of the genome to testing for a vaccination. Finally, we look at the US response to Covid-19 through the lens of infodemics and post-truth. The paper is followed by three open reviews, which further refine its conclusions as they relate to philosophy and the notion of the virus as Pharmakon. (shrink)

Machine generated contents note: Chapter 1. Environmental Problems and Society Part I: The Material Chapter 2. Consumption and Materialism Chapter 3. Money and Machines Chapter 4. Population and Development Chapter 5. Body and Health Part II: The Ideal Chapter 6. The Ideology of Environmental Domination Chapter 7. The Ideology of Environmental Concern Chapter 8. The Human Nature of Nature Chapter 9. The Rationality of Risk Part III: The Practical Chapter 10. Mobilizing the Ecological Society Chapter 11. Governing the Ecological (...) Society . (shrink)

It is not a question here of demanding or strenuous work. In that sense of the word, we can work hard in almost any office and at almost any job. I can work hard writing this book, and sometimes do. A task or a cause that seems to us worth the hard work it entails is clearly a good thing. For all our natural laziness, we go looking for it. But hard has another sense--as in "hard winter" and "hard heart" (...) --where it means harsh, unpleasant, cruel, difficult to endure. Thus the account in Exodus of Israel's oppression, "And the Egyptians embittered their lives with hard labor" (1:14). Here the word describes jobs that are like prison sentences, work that people don't look for and wouldn't choose if they had even minimally attractive alternatives. This kind of work is a negative good, and it commonly carries other negative goods in its train: poverty, insecurity, ill health, physical danger, dishonor and degradation. And yet it is socially necessary work; it needs to be done, and that means that someone must be found to do it. (shrink)

One branch of bioethics assumes that mainly agents of the state are responsible for public health. Following Susan Sherwin’s relational ethics, we suggest moving away from a “state-centered” approach toward a more thoroughly relational approach. Indeed, certain agents must be reconstituted in and through shifting relations with others, complicating discussions of responsibility for public health. Drawing on two case studies—the health politics and activism of the Black Panther Party and the work of the Common Ground Collective in (...) post-Katrina New Orleans—we argue for the need to attend more carefully to the limitations of states and state-driven public health programs. (shrink)

Although Responsible Conduct of Research training is common in the sciences, the effectiveness of RCR training is open to question. Three key factors appear to be particularly important in ensuring the effectiveness of ethics education programs: educational efforts should be tied to day-to-day practices in the field, educational efforts should provide strategies for working through the ethical problems people are likely to encounter in day-to-day practice, and educational efforts should be embedded in a broader program of on-going career development efforts. (...) This article discusses a complex qualitative approach to RCR training development, based on a sensemaking model, which strives to address the afore-mentioned training concerns. Ethnographic observations and prior RCR training served the purpose of collecting information specific to a multi-disciplinary and multi-university research center with the goal of identifying metacognitive reasoning strategies that would facilitate ethical decision-making. The extensive qualitative analyses resulted in the identification of nine metacognitive reasoning strategies on which future RCR training will be developed. The implications of the findings for RCR training in the sciences are discussed. (shrink)

On February 2,2004,U.S. District Judge Federico Moreno issued the final order and judgment authorizing a settlement between the HMO CIGNA Healthcare and the physicians who treated patients covered by CIGNA, ending the companys involvement in the larger class action In re Managed Care Litigation, which stil includes eight other HMOs. The settlement, estimated by plaintiffs experts to be worth 1.3 billion, mandates changes in the companys business and disclosure practices, establishes a non-profit foundation dedicated to the promotion of high quality (...) health care, and guarantees at least 70 million in payments to the physicians. Similar in scope to the settlement approved between the physician class and Aetna Healthcare in October 2003,the settlement could potentially set a new standard for transparency and physician involvement in billing practices; however, much depends on the outcome of the remainder of the class action, which is set to go to trial later this year. (shrink)

Attendance at 12-step programs has become part of the orthodoxy of treating clients with substance abuse disorders. However, concerns have been raised about the assumptions on which 12-step programs are based. I argue that antirepresentationalism is the moral principle that underpins such concerns. After clarifying the principle of antirepresentationalism, I explore strategies for reconciling antirepresentationalism with 12-step programs. However, all the strategies I try fail. Consequently, I adopt an alternative way of thinking about antirepresentationalism that leaves mental health professionals (...) free to refer clients to 12-step programs. However, such referrals can continue only at the cost of accepting objectionable assumptions about motivation, spirituality and human agency. Therefore, it might well be time to find an alternative to 12-step programs. (shrink)

Public Health Policy and Ethics brings together philosophers and practitioners to address the foundations and principles upon which public health policy may be advanced. What is the basis that justifies public health in the first place? Why should individuals be disadvantaged for the sake of the group? How do policy concerns and clinical practice work together and work against each other? Can the boundaries of public health be extended to include social ills that are amenable to (...) group-dynamic solutions? These are some of the crucial questions that form the core of this volume of original essays sure to cause practitioners to engage in a critical re-evaluation of the role of ethics in public health policy. This volume is unique because of its philosophical approach. It develops a theoretical basis for public health and then examines cutting-edge issues of practice that include social and political issues of public health. In this way the book extends the usual purview of public health. Public Health Policy and Ethics is of interest to those working in public health policy, ethics and social philosophy. It may be used as a textbook for courses on public health policy and ethics, medical ethics, social philosophy and applied or public philosophy. (shrink)

Next SectionMaking threats and offers to patients is a strategy used in community mental healthcare to increase treatment adherence. In this paper, an ethical analysis of these types of proposal is presented. It is argued (1) that the primary ethical consideration is to identify the professional duties of care held by those working in community mental health because the nature of these duties will enable a threat to be differentiated from an offer, (2) that threatening to act in a (...) way that would equate with a failure to uphold the requirements of these duties is wrong, irrespective of the benefit accrued through treatment adherence and (3) that making offers to patients raises a number of secondary ethical considerations that need to be judged on their own merit in the context of individual patient care. The paper concludes by considering the implications of these arguments, setting out a pathway designed to assist community mental healthcare practitioners to determine whether making a specific proposal to a patient is right or wrong. (shrink)

Medicine at the Crossroads is a collection of essays based a column originally published in the Waco-Tribune Herald by renowned cardiologist Dr. Michael Attas of Baylor University. It touches on three perspectives - the physician, the patient, and the healthcare system - and addresses some of the most pressing questions in medicine today.

This volume explores the focus of interest in community and the emerging theoretical opposition between communitarianism and liberalism, including the practical, theoretical and ethical issues that relate to community in the healthcare professions.

A recurrent challenge in applied ethics concerns the development of principles that are both suitably general to cover various cases and sufficiently exact to guide behavior in particular instances. In business ethics, two central approaches—stockholder and stakeholder—often fail by one or the other requirement. The author argues that the failure is precipitated by their reliance upon “universal” theory, which views the justification of principles as both independent of their context of application and universally appropriate to all contexts. The author develops (...) a contextual interpretation of “constructivism” as an alternative approach, and argues that this alternative meets the above challenge. (shrink)

The evidence is overwhelming that members of particularly wealthy and industry-owning segments of Western societies have much larger carbon footprints than most other humans, and thereby contribute far more than their “fair share” to the enormous problem of climate change. Nonetheless, in this paper we shall counsel against a strategy focused primarily on blaming and shaming and propose, instead, a change in the ethical conversation about climate change. We recommend a shift in the ethical framework from a focus on the (...) role of individual agents and a conversation about guilt; in its place, we propose a relational approach to public health ethics that is centered around the idea of relational solidarity. We begin by briefly reviewing the most common—and woefully inadequate—approach in the West to reducing emissions and responding to the health-related impacts of climate change. We then go on to propose a relational approach to public health ethics as an alternative ethical framework that better fits the moral problems associated with climate change and holds promise for a more meaningful response. (shrink)

Proponents of vaccine mandates typically claim that everyone who can be vaccinated has a moral or ethical obligation to do so for the sake of those who cannot be vaccinated, or in the interest of public health. I evaluate several previously undertheorised premises implicit to the ‘obligation to vaccinate’ type of arguments and show that the general conclusion is false: there is neither a moral obligation to vaccinate nor a sound ethical basis to mandate vaccination under any circumstances, even (...) for hypothetical vaccines that are medically risk-free. Agent autonomy with respect to self-constitution has absolute normative priority over reduction or elimination of the associated risks to life. In practical terms, mandatory vaccination amounts to discrimination against healthy, innate biological characteristics, which goes against the established ethical norms and is also defeasible a priori. (shrink)

Last year saw the 20th anniversary edition of JECP, and in the introduction to the philosophy section of that landmark edition, we posed the question: apart from ethics, what is the role of philosophy ‘at the bedside’? The purpose of this question was not to downplay the significance of ethics to clinical practice. Rather, we raised it as part of a broader argument to the effect that ethical questions – about what we should do in any given situation – are (...) embedded within whole understandings of the situation, inseparable from our beliefs about what is the case, what it is that we feel we can claim to know, as well as the meaning we ascribe to different aspects of the situation or to our perception of it. Philosophy concerns fundamental questions: it is a discipline requiring us to examine the underlying assumptions we bring with us to our thinking about practical problems. Traditional academic philosophers divide their discipline into distinct areas that typically include logic: questions about meaning, truth and validity; ontology: questions about the nature of reality, what exists; epistemology: concerning knowledge; and ethics: how we should live and practice, the nature of value. Any credible attempt to analyse clinical reasoning will require us to think carefully about these types of question and the relationships between them, as they influence our thinking about specific situations and problems. So, the answers to the question we posed, about the role of philosophy at the bedside, are numerous and diverse, and that diversity is illustrated in the contributions to this thematic edition. (shrink)