Climate change harms health and damages and diminishes environmental resources. Gradually it will cause health systems to reduce services, standards of care, and opportunities to express patient autonomy. Prominent public health organizations are responding with preparedness, mitigation, and educational programs. The design and effectiveness of these programs, and of similar programs in other sectors, would be enhanced by greater understanding of the values and tradeoffs associated with activities and public policies that drive climate change. Bioethics could generate such understanding by (...) exposing the harms and benefits in different cultural, socioeconomic, and geographic contexts, and through interdisciplinary risk assessments. Climate change is a bioethics problem because it harms everyone and involves health, values, and responsibilities. This article initiates dialog about the responsibility of bioethics to promote transparency and understanding of the social values and conflicts associated with climate change, and the actions and public policies that allow climate change to worsen. (shrink)

One manifestation of climate change is the increasingly severe extreme weather that causes injury, illness and death through heat stress, air pollution, infectious disease and other means. Leading health organisations around the world are responding to the related water and food shortages and volatility of energy and agriculture prices that threaten health and health economics. Environmental and climate ethics highlight the associated challenges to human rights and distributive justice but rarely address health or encompass bioethical methods or analyses. Public health (...) ethics and its broader umbrella, bioethics, remain relatively silent on climate change. Meanwhile global population growth creates more people who aspire to Western lifestyles and unrestrained socioeconomic growth. Fulfilling these aspirations generates more emissions; worsens climate change; and undermines virtues and values that engender appreciation of, and protections for, natural resources. Greater understanding of how virtues and values are evolving in different contexts, and the associated consequences, might nudge the individual and collective priorities that inform public policy toward embracing stewardship and responsibility for environmental resources necessary to health. Instead of neglecting climate change and related policy, public health ethics and bioethics should explore these issues; bring transparency to the tradeoffs that permit emissions to continue at current rates; and offer deeper understanding about what is at stake and what it means to live a good life in today's world. (shrink)

Stakeholder consultation is part of the democratic process, embraces respect for persons, and is necessary for upholding the principle of justice. People are more likely to uphold standards they have participated in setting, so stakeholder consultation encourages adherence to societal and institutional standards as these evolve. Stakeholder consultation is also responsive to the call to “resocialize” ethics by contextualizing dilemmas and involving the destitute in choices about their healthcare. In resource-poor settings, such consultation promotes local “ownership” of, and leadership within, (...) development programs, which enhances effectiveness and sustainability. Stakeholder consultation is, therefore, a form of capacity building. To succeed, it must be responsive to regional, national, and individual constraints, including socioeconomic, cultural, and political ones. Several such constraints impact on the demand for, and availability of, palliative healthcare in the Caribbean. (shrink)

There is international recognition of the need for sustainable research ethics committees to provide ethical review of human subjects research in developing countries, but many developing countries do not have such committees . Theoretical and practical uncertainties encountered by an IRB on the Caribbean island of Grenada offer insight into ethical review of research in developing countries. Theoretical uncertainties include questions about whether means of ensuring confidentiality and obtaining informed consent will be effective in local settings, and whether deviations from (...) Western norms are justifiable. International guidelines are helpful in addressing these concerns, but are subject to interpretation. Guidelines are less helpful in practical areas like selecting members or chairs. They do not address what sort of procedures and paperwork will work in a developing country, or IRBs’ relationships to governments that have no mandate for them. Experiences presented here show that IRBs in developing countries can sustainably adhere to international standards. Sustainability requires knowledge, personal commitment, and an official mandate to uphold international standards. Capacity building must therefore focus on educational programs to make developing country leaders knowledgeable about the value of international guidelines to their nations. Such knowledge is needed before people will become motivated to promote, implement, and uphold the guidelines. People in developing countries must help design bridges to help their nations put international standards into practice. The structure of such bridges may, of necessity, vary in different settings. (shrink)

Guidelines for Institutional Review Boards (IRBs) or research ethics committees exist at national and international levels. These guidelines are based on ethical principles and establish an internationally acceptable standard for the review and conduct of medical research. Having attained a multinational consensus about what these fundamental guidelines should be, IRBs are left to interpret the guidelines and devise their own means of implementing them. Individual and community values bear on the interpretation of the guidelines so different IRBs attain different levels (...) of effectiveness. In the Caribbean and Pan American regions there are few IRBs. Obstacles to the establishment and function of IRBs are exacerbated in developing regions like these by differences in language, literacy, and local value systems; education, administrative expertise, facilities, and access to information are also limited. A regional IRB network might facilitate more uniform ethical review in developing countries, and simplify IRB procedures. (shrink)

There is international recognition of the need for sustainable research ethics committees to provide ethical review of human subjects.

CIOMS has been criticised for not adequately consulting stakeholders about its revised ethical guidelines regarding medical research.

This article presents empirical data on the limited availability of hospice and palliative care to the 6 million people of the English-speaking Caribbean. Ten of the 13 nations therein responded to a survey and reported employing a total of 6 hospice or palliative specialists, and having a total of 15 related facilities. The evolving socioeconomic and cultural context in these nations bears on the availability of such care, and on the willingness to report, assess, and prioritize pain, and to prescribe (...) opiates for pain. Socioeconomics and culture also impinge on what medications and modalities of care are routinely available for pain or other conditions and can challenge professionalism, empathy, and responsiveness to patients’ unrelieved pain. Although all respondents report having a protocol for pain management, hospice, or end-of-life care, their annual medical use of opiates is well below the global mean. The International Narcotics Control Board , which monitors such use, encourages Caribbean and other low- and middle-income countries to increase their use of opiates to treat pain, and to overcome both unfounded fears of addiction and overly restrictive interpretation of related laws and regulations. Contextual considerations like those described here are important to the success of policies and capacity-building programs aiming to increase access to hospice and palliation, and perhaps to improving other aspects of health and healthcare. Exploring and responding to the realities of socioeconomic and cultural conditions will enhance public and policy dialogue and improve the design of interventions to increase access to palliative and hospice care. Improving access to palliative and hospice care in the Caribbean demonstrates beneficence and helps to fulfill human rights conventions. (shrink)

An unlinked seroprevalence study of HIV and other viruses was conducted on pregnant women on the Caribbean island of Grenada in 1994. Investigators were from both the developed world and the Grenadian Ministry of Health . There was then no board on Grenada to protect research subjects or review ethical aspects of studies. Nurses from the MOH were asked to verbally inform their patients about the study, and request that patients become subjects of the study and give blood for screening. (...) If consent was given nurses took blood and administered a survey about each subjects' knowledge of HIV transmission routes. Nurses shared a spoken dialect and cultural heritage with prospective subjects and were probably more effective than foreign researchers at informing subjects. Informed consent was obtained with a simplified consent form supplemented by conversation with each prospective research subject. Facilitating discussion between people with common cultural backgrounds helps apply the Western approach to informed consent to communities in the developing world. Researchers must disclose all information to nurses or other mediators, and ensure that nurses disclose as much information as possible to prospective subjects. So modified, informed consent maintains respect for persons and becomes applicable and relevant to various cultures. (shrink)

To the Editor: Conflicts of interest pervade medicine with sometimes profound repercussions. The unethical recruitment of oocyte donors, for example, reported by Aaron Levine in “Self-Regulation, Compensation, and the Ethical Recruitment of Oocyte Donors” (Mar–Apr 2010) threatens medical professionalism, societal trust in medicine, and possibly the health of young women. Levine shows that in violation of fertility industry standards, donors with high SAT scores are often paid more than those with lower scores. Such payments are deceptive and ethically problematic because (...) neither intelligence nor SAT score is proven to be genetically transmitted. Moreover, some question the value of aptitude and intelligence tests .. (shrink)

An unlinked seroprevalence study of HIV and other viruses was conducted on pregnant women on the Caribbean island of Grenada in 1994. Investigators were from both the developed world and the Grenadian Ministry of Health . There was then no board on Grenada to protect research subjects or review ethical aspects of studies. Nurses from the MOH were asked to verbally inform their patients about the study, and request that patients become subjects of the study and give blood for screening. (...) If consent was given nurses took blood and administered a survey about each subjects' knowledge of HIV transmission routes. Nurses shared a spoken dialect and cultural heritage with prospective subjects and were probably more effective than foreign researchers at informing subjects. Informed consent was obtained with a simplified consent form supplemented by conversation with each prospective research subject. Facilitating discussion between people with common cultural backgrounds helps apply the Western approach to informed consent to communities in the developing world. Researchers must disclose all information to nurses or other mediators, and ensure that nurses disclose as much information as possible to prospective subjects. So modified, informed consent maintains respect for persons and becomes applicable and relevant to various cultures. (shrink)

Jecker et al. (2024) offer seven principles with which to guide conference organizers and assess how ethically a conference is organized. While focused on bioethics, these principles are relevant t...

Changes in earth's atmosphere, oceans, soil, weather patterns, and ecosystems are well documented by countless scientific disciplines. These manifestations of climate change harm public health. Given their goals and social responsibilities, influential health organizations recognize health impacts compounded by geography, social values, social determinants of health, health behaviors, and relationships between humans and environments primarily described in feminist ethics and environmental ethics. Health impacts are relevant to, but seldom addressed in bioethics, global health, public policy, or health or environmental policy. (...) This book is the first to describe cultural, geographic, and socioeconomic factors that influence the regional significance of these impacts and frame them for bioethics and policy analyses. (shrink)

ABSTRACT:Planet Earth and its growing human population are challenged by the health impacts of industrial policies that drive global emissions production and cause climate change. The health-care industry has capacity and responsibility to adopt environmentally sustainable policies and practices. Bioethicists have a responsibility to support environmental sustainability through their clinical, research, educational, and policy work. They communicate complex ideas to diverse stakeholders and can communicate similarly to improve understanding about emissions and the value of environmentally sustainable policy. A growing bioethics (...) literature addresses climate change in collaboration with human and veterinary medicine and other disciplines. Pursuing environmental sustainability with the vigor that made autonomy a norm would help to reduce global emissions production in health care and make it a role model for other industries. Making environmental sustainability a health-care norm would be as significant an accomplishment as doing so for individual autonomy. (shrink)

Health promotion involves social and environmental interventions designed to benefit and protect health. It often harmfully impacts the environment through air and water pollution, medical waste, g...

This paper examines pain and pain relief in the Caribbean, where pain is widely perceived as an unavoidable part of life, and where unnecessary suffering results from untreated and under treated pain. Barriers to pain relief in the Caribbean include patient and family attitudes, inadequate knowledge among health professionals and unduly restrictive regulations on the medical use of opioids. Similar barriers exist all over the world. This paper urges medical, nursing and public health professionals, and educators to examine attitudes towards (...) pain and pain relief and to work towards making effective pain relief and palliation more accessible. It recommends that i) health professionals and officials be better educated about pain, palliation and opioids, ii) regulatory restrictions be updated in light of clinical and scientific evidence, iii) opioid procurement policies be adjusted to facilitate increased medical use, iv) medical charts and records be modified to routinely elicit and document patients levels of pain, and v) educational campaigns be developed to inform the public that moderate and severe pain can be safely relieved at the end of life and other stages of life. The professional, respectful, and beneficent response to patients in pain is to provide rapid and aggressive pain relief or to urgently consult a pain or palliative specialist. When a health system hinders such efforts the ethical response is to identify, facilitate and advocate for overcoming barriers to improvement. (shrink)

Parsa-Parsi _et al_ bring attention to the World Medical Association (WMA) and transparency to its International Code of Medical Ethics (ICoME) revisions. 1 We value their report and the revised ICoME but explain here that the ICoME cannot reflect consensus among all WMA members, or the wider medical profession, given structural and epistemic injustices that restrain low-income and middle-income country (LMIC) physicians from participating in activities such as WMA revisions. Such injustices overlook experiences and contributions of those from LMICs and (...) marginalised groups, hindering their access to and influence within medicine. 2 They also undermine access to information about, and from, the WMA. Recruiting new members from, and better engaging members in, LMICs would strengthen the WMA and its influence across the medical profession, and better elevate environmental sustainability as a biomedical and bioethical concern. This would be beneficial because there is controversy among physicians, bioethicists and... (shrink)

Climate change has substantial impacts on public health and safety, disease risks and the provision of health care, with the poor being particularly disadvantaged. Management of the associated health risks and changing health service requirements requires adequate responses at local levels. Health-care providers are central to these responses. While climate change raises ethical questions about its causes, impacts and social justice, medicine and bioethics typically focus on individual patients and research participants rather than these broader issues. We broaden this focus (...) by examining awareness among health-care providers in the Caribbean region, where geographic and socioeconomic features pose particular vulnerabilities to climate change. In focus groups, Caribbean providers described rises in mosquito-borne, flood-related, heat-related, respiratory and mental illnesses, and attributed these to local impacts of climate change. Their discussions showed that the significance of these impacts differs in different Caribbean nations, raising policy and social justice questions. Bioethics and public health ethics are situated to frame, inform and initiate public and policy dialog about values and scientific evidence associated with climate change. We urge readers to initiate such dialog within their own institutions about the context-dependent nature of the burdens of climate change, and values and policies that permit it to worsen. (shrink)

A google scholar search for “global bioethics” returns citations situating ethical analyses within the evolving social and physical features of the global environment. Such work is consistent with...

Professions typically formulate codes of ethics. Medical students are exposed to various codes and often are expected to recite some.

Andocides is generally not considered one of the best orators. To point up his flawed style, scholars have discussed a notoriously vindictive and humorous section in Andocides 1: in 124ff. Andocides describes the profligate lifestyle of his prosecutor, Callias III the Ceryx, the son of Hipponicus II and dadouchos of the Eleusinian Mysteries.

This article outlines challenges to benefitting developing countries that are hosts of international research. In the context of existing guidance and frameworks for benefit‐sharing, it aims to provoke dialog about socioeconomic factors and other background conditions that influence what constitute benefits in a given host setting, and about the proportionality between benefits to hosts and benefits to sponsors and researchers. It argues that capacity‐building for critical thinking and negotiation in many developing country governments, institutions, and communities is a benefit because (...) it can help to overcome background conditions that impinge on equitable international research negotiations, partnerships, and benefits. Enhancing the capacity for both critical thinking and negotiation can, like other targets of capacity‐building, nurture respectful and trusting partnerships that benefit all stakeholders in international research. (shrink)

Professionalism is demonstrated through attitudes and behaviors. Medical education is concerned with teaching and evaluating it among students. It is often bioethicists who teach professionalism to medical students. Most bioethics curricula use lectures and group discussions to introduce principles and theories, but there is variation in number of credit and contact hours, placement in the curriculum and alongside which courses bioethics is placed), the extent of individual mentoring, and the emphasis placed on any particular philosophical approach. Bioethics curricula also vary (...) in whether and how explicitly and extensively they address topics, including professionalism, cultural competence, medical humanities, spirituality, death and dying, and community service, and in the number and topics of vignettes, controversies, assignments, and course activities. (shrink)

This paper examines pain and pain relief in the Caribbean, where pain is widely perceived as an unavoidable part of life, and where unnecessary suffering results from untreated and under treated pain. Barriers to pain relief in the Caribbean include patient and family attitudes, inadequate knowledge among health professionals and unduly restrictive regulations on the medical use of opioids. Similar barriers exist all over the world. This paper urges medical, nursing and public health professionals, and educators to examine attitudes towards (...) pain and pain relief and to work towards making effective pain relief and palliation more accessible. It recommends that i) health professionals and officials be better educated about pain, palliation and opioids, ii) regulatory restrictions be updated in light of clinical and scientific evidence, iii) opioid procurement policies be adjusted to facilitate increased medical use, iv) medical charts and records be modified to routinely elicit and document patients levels of pain, and v) educational campaigns be developed to inform the public that moderate and severe pain can be safely relieved at the end of life and other stages of life. The professional, respectful, and beneficent response to patients in pain is to provide rapid and aggressive pain relief or to urgently consult a pain or palliative specialist. When a health system hinders such efforts the ethical response is to identify, facilitate and advocate for overcoming barriers to improvement. (shrink)

Andocides is generally not considered one of the best orators. To point up his flawed style, scholars have discussed a notoriously vindictive and humorous section in Andocides 1: in 124ff. Andocides describes the profligate lifestyle of his prosecutor, Callias III the Ceryx, the son of Hipponicus II and dadouchos of the Eleusinian Mysteries.

With the publication recently of two valuable studies on Attic demes, we are now more fully aware of what we know, and do not know, of the deme. With Osborne's work, we now have some idea of the tendency of Athenians to own and maintain property in the deme of origin, but the role of marriage in consolidating property in that deme is more difficult to assess. In contrast to Osborne's focus on the ancestral deme, this brief study will concentrate (...) on the deme into which the woman married; such a deme will be termed the deme of marriage or the marital deme. The study will focus particularly on the families who contracted more than one alliance for their kinswomen into the same outside deme and will emphasize the importance of siblings in securing and maintaining these alliances in the marital deme. (shrink)

This article proposes a sensory studies methodology for the interpretation of museum objects. The proposed method unfolds in two phases: virtual encounter via an on-line catalog and actual exposure in the context of a handling workshop. In addition to exploring the écart between image and object, the “Sensing Art and Artifacts” exercise articulates a framework for arriving at a multisensory, cross-cultural, interactive understanding of aesthetic value. The case studies presented here involve four objects from the collection of the Hunterian Museum (...) as sensed and interpreted by scholars of psychology, philosophy, sociology, and anthropology. It is proposed that aesthetic judgment in the expanded (cross-cultural) sense contemplated here involves apprehending the museum object through multiple sensory modalities in place of the conventional Western fixation on visible form. (shrink)

Interruptions are often inevitable and occur many times in daily life (Ratwani & Trafton, 2010). Interruptions at work can disrupt progress on tasks and result in costly mistakes (Brumby, Cox, Back...

Two articles published in Bioethics recently have explored the ways that bioethics can contribute to the climate change debate. Cheryl Cox Macpherson argues that bioethicists can play an important role in the climate change debate by helping the public to better understand the values at stake and the trade-offs that must be made in individual and social choices, and Sean Valles claims that bioethicists can contribute to the debate by framing the issues in terms of the public health (...) impacts of climate change. While Macpherson and Valles make valid points concerning a potential role for bioethics in the climate change debate, it is important to recognize that much more than ethical analysis and reflection will be needed to significantly impact public attitudes and government policies. (shrink)

Cheryl Cox MacPherson recently argued, in an article for this journal, that ‘Climate Change is a Bioethics Problem’. This article elaborates on that position, particularly highlighting bioethicists' potential ability to help reframe the current climate change discourse to give more attention to its health risks. This reframing process is especially important because of the looming problem of climate change skepticism. Recent empirical evidence from science framing experiments indicates that the public reacts especially positively to climate change messages framed (...) in public health terms, and bioethicists are particularly well positioned to contribute their expertise to the process of carefully developing and communicating such messages. Additionally, as climate framing research and practice continue, it will be important for bioethicists to contribute to the creation of that project's nascent ethical standards. The discourse surrounding antibiotic resistance is posited as an example that can lend insight into how communicating a public health-framed message, including the participation of bioethicists, can help to override public skepticism about the findings of politically contentious scientific fields. (shrink)

In a prior issue of Developing World Bioethics, Cheryl Macpherson and Ruth Macklin critically engaged with an article of mine, where I articulated a moral theory grounded on indigenous values salient in the sub-Saharan region, and then applied it to four major issues in bioethics, comparing and contrasting its implications with those of the dominant Western moral theories, utilitarianism and Kantianism. In response to my essay, Macpherson and Macklin have posed questions about: whether philosophical justifications are something (...) with which bioethicists ought to be concerned; why something counts as ‘African’; how medicine is a moral enterprise; whether an individual right to informed consent is consistent with sub-Saharan values; and when thought experiments help to establish firm conclusions about moral status. These are important issues for the field, and I use this reply to take discussion of them a step or two farther, defending my initial article from Macpherson's and Macklin's critical questions and objections. (shrink)

An overview of the philosophy and psychology of hallucination and its relevance to the philosophy of perception.

If a benevolent and all-powerful God exists, how can there be so much suffering? Could God have created a better world? Or is evil the price we pay for freedom of the will?