Trust is a key component in delivering quality and respectful care within health care systems. However, a growing lack of confidence in health care, particularly among specific subgroups of the population in the United States, could further widen health disparities. In this essay, we explore one approach to building trust and reaching diverse communities to promote health: engaging community‐based organizations (CBOs) as trusted community messengers. We present case studies of partnerships in health promotion, community education, (...) and outreach that showcase how CBOs’ programs build and leverage trust in health care systems through their workforce, services, and engagement with the community. (shrink)

Mobile applications and socio-sexual networking websites are used by outreach workers to respond synchronously to questions and provide information, resources, and referrals on sexual health and STI/HIV prevention, testing, and care to gay, bisexual and other men who have sex with men. This exploratory study examined ethical issues identified by online outreach workers who conduct online sexual health outreach for GB2M. Semi-structured individual interviews were conducted between November 2013 and April 2014 with online providers and (...) managers to explore the benefits, challenges, and ethical implications of delivering online outreach services in Ontario, Canada. Interviews were digitally recorded and transcribed verbatim. Thematic analyses were conducted, and member-checking, analyses by multiple coders, and peer debriefing supported validity and reliability. Four themes emerged on the ethical queries of providing online sexual health outreach for GB2M: managing personal and professional boundaries with clients; disclosing personal or identifiable information to clients; maintaining client confidentiality and anonymity; and security and data storage measures of online information. Participants illustrated familiarity with potential ethical challenges, and discussed ways in which they seek to mitigate and prevent ethical conflict. Implications of this analysis for outreach workers, researchers, bioethicists, and policy-makers are to: understand ethical complexities associated with online HIV prevention and outreach for GB2M; foster dialogue to recognize and address potential ethical conflict; and identify competencies and skills to mitigate risk and promote responsive and accessible online HIV outreach. (shrink)

Cuba currently has more than 38,000 health workers providing emergency relief, long-term community-based care and medical education to some of the most vulnerable communities in the world. This current outreach to 76 countries positions Cuba as a leader in global health outreach. This has been well documented and praised by many scholars and policy makers alike. While many acknowledge the importance and impact of the Cuba’s global effort, there is very little understanding as to why Cuba (...) makes such a large global health commitment in the first place. I argue that solidarity is in fact a mixture of national pride, self-interest and humanistic outreach. Ultimately, it is a calculated effort to overcome current structures of inequity and exploitation on a global scale by expanding new opportunities for health professionals dedicated to providing care in marginalized communities. (shrink)

In ‘Ethics of sharing medical knowledge with the community: is the physician responsible for medical outreach during a pandemic?’ Strous and Karni note that the revised physician’s pledge in the World Medical Association Declaration of Geneva obligates individual physicians to share medical knowledge, which they interpret to mean a requirement to share knowledge publicly and through outreach. In the context of the COVID-19 pandemic, Strous and Karni defend a form of medical paternalism insofar as the individual physician must (...) reach out to communities who may not want, or know to seek out, medical advice, for reasons of public health and health equity. Strous and Karni offer a novel defence of why physicians ought to intervene even in insular communities, and they offer suggestions for how this could be done in culturally sensitive ways. Yet their view rests on an unfounded interpretation of the Geneva Declaration language. More problematically, their paper confuses shared and collective responsibility, misattributing the scope of individual physician obligations in potentially harmful ways. In response, this reply delineates between shared and collective responsibility, and suggests that to defend the obligation of medical outreach Strous and Karni propose, it is better conceptualised as a collective responsibility of the medical profession, rather than a shared responsibility of individual physicians. This interpretation rejects paternalism on the part of individual providers in favour of a more sensitive and collaborative practice of knowledge sharing between physicians and communities, and in the service of collective responsibility. (shrink)

The paper identifies common barriers and challenges to Pre-Exposure Prophylaxis (PrEP) uptake and offers considerations for state and local public health departments to address barriers and retool infrastructure to increase access to PrEP to new users. Authors identify synergistic opportunities with federal agencies and funders to advance PrEP-related HIV prevention efforts, that prioritize strategies and investments to provide PrEP to people who could benefit from the intervention but are unaware of PrEP or struggle to access it. Barriers discussed and (...) examined include financing strategies to reduce financial burden of PrEP medication, expanding PrEP access and outreach beyond clinical settings, and increasing the network and reach of the provider community to serve people we oppress through policy choices and discourses of racial and socioeconomic inferiority. (shrink)

A recent update to the Geneva Declaration’s ‘Physician Pledge’ involves the ethical requirement of physicians to share medical knowledge for the benefit of patients and healthcare. With the spread of COVID-19, pockets exist in every country with different viral expressions. In the Chareidi religious community, for example, rates of COVID-19 transmission and dissemination are above average compared with other communities within the same countries. While viral spread in densely populated communities is common during pandemics, several reasons have been suggested to (...) explain the blatant flouting of public health regulations. It is easy to fault the Chareidi population for their proliferation of COVID-19, partly due to their avoidance of social media and internet aversion. However, the question remains: who is to blame for their community crisis? The ethical argument suggests that from a public health perspective, the physician needs to reach out and share medical knowledge with the community. The public’s best interests are critical in a pandemic and should supersede any considerations of cultural differences. By all indications, therefore, the physician has an ethical obligation to promote population healthcare and share medical knowledge based on ethical concepts of beneficence, non-maleficence, utilitarian ethics as well as social, procedural and distributive justice. This includes the ethical duty to reduce health disparities and convey the message that individual responsibility for health has repercussions within the context of broader social accountability. Creative channels are clearly demanded for this ethical challenge, including measured medical paternalism with appropriate cultural sensitivity in physician community outreach. (shrink)

BackgroundAs hospitals have grown more complex, the ethical concerns they confront have grown correspondingly complicated. Many hospitals have consequently developed health care ethics programs (HCEPs) that include far more than ethics consultation services alone. Yet systematic research on these programs is lacking.MethodsBased on a national, cross-sectional survey of a stratified sample of 600 US hospitals, we report on the prevalence, scope, activities, staffing, workload, financial compensation, and greatest challenges facing HCEPs.ResultsAmong 372 hospitals whose informants responded to an online survey, (...) 97% of hospitals have HCEPs. Their scope includes clinical ethics functions in virtually all hospitals, but includes other functions in far fewer hospitals: ethical leadership (35.7%), regulatory compliance (29.0%), business ethics (26.2%), and research ethics (12.6%). HCEPs are responsible for providing ongoing ethics education to various target audiences including all staff (77.0%), nurses (59.9%), staff physicians (49.0%), hospital leadership (44.2%), medical residents (20.3%) and the community/general public (18.4%). HCEPs staff are most commonly involved in policy work through review of existing policies but are less often involved in development of new policies. HCEPs have an ethics representative in executive leadership in 80.5% of hospitals, have representation on other hospital committees in 40.7%, are actively engaged in community outreach in 22.6%, and lead large-scale ethics quality improvement initiatives in 17.7%. In general, major teaching hospitals and urban hospitals have the most highly integrated ethics programs with the broadest scope and greatest number of activities. Larger hospitals, academically affiliated hospitals, and urban hospitals have significantly more individuals performing HCEP work and significantly more individuals receiving financial compensation specifically for that work. Overall, the most common greatest challenge facing HCEPs is resource shortages, whereas underutilization is the most common greatest challenge for hospitals with fewer than 100 beds. Respondents’ strategies for managing challenges include staff training and additional funds.ConclusionsWhile this study must be cautiously interpreted due to its limitations, the findings may be useful for understanding the characteristics of HCEPs in US hospitals and the factors associated with these characteristics. This information may contribute to exploring ways to strengthen HCEPs. (shrink)

Responses to public health emergencies can entail difficult decisions about restricting individual liberties to prevent the spread of disease. The quintessential example is quarantine. While isolating sick patients tends not to provoke much concern, quarantine of healthy people who only might be infected often is controversial. In fact, as the experience with severe acute respiratory syndrome (SARS) shows, the vast majority of those placed under quarantine typically don't become ill. Efforts to enforce involuntary quarantine through military or police powers (...) also can backfire, stoking both panic and disease spread. Yet quarantine is part of a limited arsenal of options when effective treatment or prophylaxis is not available, and some evidence suggests it can be effective, especially when it is voluntary, home-based and accompanied by extensive outreach, communication and education efforts. Even assuming that quarantine is medically effective, however, it still must be ethically justified because it creates harms for many of those affected. Moreover, ethical principles of reciprocity, transparency, non-discrimination and accountability should guide any implementation of quarantine. (shrink)

Background Bioethical debates about privacy, big data, and public health surveillance have not sufficiently engaged the perspectives of those being surveilled. The data justice framework suggests that big data applications have the potential to create disproportionate harm for socially marginalized groups. Using examples from our research on HIV surveillance for individuals incarcerated in jails, we analyze ethical issues in deploying big data in public health surveillance. -/- Methods We conducted qualitative, semi-structured interviews with 24 people living with HIV (...) who had been previously incarcerated in county jails about their perspectives on and experiences with HIV surveillance, as part of a larger study to characterize ethical considerations in leveraging big data techniques to enhance continuity of care for incarcerated people living with HIV. -/- Results Most participants expressed support for the state health department tracking HIV testing results and viral load data. Several viewed HIV surveillance as a violation of privacy, and several had actively avoided contact from state public health outreach workers. Participants were most likely to express reservations about surveillance when they viewed the state’s motives as self-interested. Perspectives highlight the mistrust that structurally vulnerable people may have in the state’s capacity to act as an agent of welfare. Findings suggest that adopting a nuanced, context-sensitive view on surveillance is essential. -/- Conclusions Establishing trustworthiness through interpersonal interactions with public health personnel is important to reversing historical legacies of harm to racial minorities and structurally vulnerable groups. Empowering stakeholders to participate in the design and implementation of data infrastructure and governance is critical for advancing a data justice agenda, and can offset privacy concerns. The next steps in advancing the data justice framework in public health surveillance will be to innovate ways to represent the voices of structurally vulnerable groups in the design and governance of big data initiatives. (shrink)

This article investigates the ways in which discourses and experiences of health and healing have shaped the development of contemporary dance in France. It confronts the problem of how to situate contemporary dance in relation to other dance genres and suggests Robert Desjarlais’ concept of the ‘aesthetic of experience’ as a helpful framework for understanding the ways in which technique and virtuosity operate differently in contemporary dance than in other dance forms. The article is ethnographic and historical and attempts (...) to create a dialogue between dance studies and medical anthropology. The ethnographic and historical material has three parts. First, I offer an analysis of the cultural idiom of illness as blocageand argue that contemporary dancers in Aix-en-Provence experience their work as a form of healing or dÈblocage. Next, I show how two historical and political events in France led to the promotion of dance as a means of social reform: (1) the Situationist art movement of the 1960s and its idea of ‘awakening’ society through public art; and (2) the renovation of the French Ministry of Culture in 1982 and its subsequent promotion of contemporary dance in state-funded community outreach projects in the 1980s. Finally, drawing on rich narratives from fieldwork interviews, I define awareness, expression and presence as the primary technical elements of contemporary dance in Aix-en-Provence, France, in 2002, and explain their relationship to the notion of ‘dance as l'intervention’ that has grown out of the historical context of contemporary dance in France. (shrink)

Recent studies show that returning global health trainees often report having felt inadequately prepared to deal with ethical dilemmas they encountered during outreach clinical work. While global health training guidelines emphasize the importance of developing ethical and cultural competencies before embarking on fieldwork, their practical implementation is often lacking and consists mainly of recommendations regarding professional behavior and discussions of case studies. Evidence suggests that one of the most effective ways to teach certain skills in global (...) class='Hi'>health, including ethical and cultural competencies, is through service learning. This approach combines community service with experiential learning. Unfortunately, this approach to global health ethics training is often unattainable due to a lack of supervision and resources available at host locations. This often means that trainees enter global health initiatives unprepared to deal with ethical dilemmas, which has the potential for adverse consequences for patients and host institutions, thus contributing to growing concerns about exploitation and “medical tourism.” From an educational perspective, exposure alone to such ethical dilemmas does not contribute to learning, due to lack of proper guidance. We propose that the tension between the benefits of service learning on the one hand and the respect for patients’ rights and well-being on the other could be resolved by the application of a simulation-based approach to global health ethics education. (shrink)

This article tells the empirical story of women from seven villages of Kwale, the most southeastern county in the Coast Province of Kenya that borders with Tanzania—Lunga Lunga, Godo, Perani, Umoja, Maasailand, Mpakani and Jirani—as they searched for community health, equity, gender equality and peace on their own terms. This article shows that creative health initiatives can be successfully used as mechanisms for peace building. Since 2010, the Nikumbuke-Health by All Means projects from the University of Madison-Wisconsin (...) in the United States, have trained 57 health promoters and 32 female actors on disease prevention and health promotion that have outreached approximately 120,000 inhabitants around the county enhancing unity in diversity, and breaking down the walls of ethnic hostilities and prejudice. Because of its low cost and high effectivity, the United Nations awarded N-HbAM[1] the 2013 Public Service Award as a model of best practice in gender, community development and sustainable wellbeing. [1] In 2013, at the time of the UNPS Award the projects were still called Nikumbuke-Health by Motorbike. The name was changed in 2018 as the projects broadened in scope and geographical location. (shrink)

BackgroundStreet-connected children and youth in low- and middle-income countries have multiple vulnerabilities in relation to participation in research. These require additional considerations that are responsive to their needs and the social, cultural, and economic context, while upholding core ethical principles of respect for persons, beneficence, and justice. The objective of this paper is to describe processes and outcomes of adapting ethical guidelines for SCCY’s specific vulnerabilities in LMIC.MethodsAs part of three interrelated research projects in western Kenya, we created procedures to (...) address SCCY’s vulnerabilities related to research participation within the local context. These consisted of identifying ethical considerations and solutions in relation to community engagement, equitable recruitment, informed consent, vulnerability to coercion, and responsibility to report.ResultsSubstantial community engagement provided input on SCCY’s participation in research, recruitment, and consent processes. We designed an assent process to support SCCY to make an informed decision regarding their participation in the research that respected their autonomy and their right to dissent, while safeguarding them in situations where their capacity to make an informed decision was diminished. To address issues related to coercion and access to care, we worked to reduce the unequal power dynamic through street outreach, and provided access to care regardless of research participation.ConclusionsAlthough a vulnerable population, the specific vulnerabilities of SCCY can to some extent be managed using innovative procedures. Engaging SCCY in ethical research is a matter of justice and will assist in reducing inequities and advancing their health and human dignity. (shrink)

A bottom-up approach grounded in micro-level understanding of the thinking, feeling, behavioral, and social aspects of living with low income and associated low literacy can lead to greater understanding and improvement of interactions in the health arena. This paper draws on what we have learned about marketplace interactions in subsistence economies to inform innovations in medical education, design and delivery of healthcare for lowincome patients, outreach education, and future micro-level research at the human-healthcare interface.

Task shifting is increasingly used to address human resource shortages impacting HIV service delivery in low- and middle-income countries. By shifting basic tasks from higher- to lower-trained cadres, such as Community Health Workers, task shifting can reduce overhead costs, improve community outreach, and provide efficient scale-up of essential treatments like antiretroviral therapies. Although there is rich evidence outlining positive outcomes that CHWs bring into HIV programs, important questions remain over their place in service delivery. These challenges often reflect (...) concerns over whether CHWs can mitigate HIV through a means that does not overlook the ethical and practical constraints that undergird their work. Ethical and practical guidance thus needs to become the cornerstone of CHW deployment. This paper analyzes such challenges through the lens of Ethical Principlism. We examined papers identifying substantive and ethical challenges impacting CHWs as they provide HIV services in low- and middle-income contexts. To do this, we analyzed papers written in English and published from year 2000 or later. These articles were identified using MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar databases. In total, 465 articles were identified, 78 of which met our inclusion criteria. Article reference lists and grey literature were also examined. CHWs experience specific challenges while carrying out their duties, such as conducting emotionally- and physically-demanding tasks with often inadequate training, supervision and compensation. CHWs have also been poorly integrated into health systems, which not only impacts quality of care, but can hinder their prospects for promotion and lead to CHW disempowerment. As we argue, these challenges can be addressed if a set of ethical principles is prioritized, which specifically entail the principles of respect for persons, justice, beneficence, proportionality and cultural humility. CHWs play a crucial role in HIV service delivery, yet the ethical challenges that can accompany their work cannot be overlooked. By prioritizing ethical principles, policymakers and program implementers can better ensure that CHWs are combatting HIV through a means that does not exploit or take their critical role within service delivery for granted. (shrink)

A model frequently used to implement community‐based research involves engaging local community health workers who are trusted members of the community and familiar with local customs, language, and culture. In Spanish‐speaking communities, the CHWs are also known as promotores de salud (“health promoters”). Depending on the study design and nature of the research, promotores facilitate research through community outreach, instrument design, participant recruitment, intervention delivery, data collection, and other research‐related tasks. In 2000, the National Institutes of (...) class='Hi'>Health published a regulation requiring training of “key personnel” named on NIH‐supported research involving human subjects. Regardless of whether promotores are technically designated as key personnel on a particular study, they may benefit from training in research ethics. Unfortunately, the educational programs designed for academic researchers in response to the NIH mandate were poorly aligned with the needs of promotores and not suited for learning about human research ethics applied to the community health setting. For example, many promotores in our California‐Mexico border region are monolingual Spanish speakers who have no formal academic research training. Therefore, we set out to develop a training alternative appropriate to our local CHWs. In this essay, we provide overviews of the relevant instructional design principles and our formative research process, including examples of key findings. (shrink)

The Tobacco Control Legal Consortium is a national “network” designed to tap expertise about tobacco control legislation and to leverage existing resources. Based at the William Mitchell College of Law in St. Paul, Minnesota, the Consortium supports local counsel with research, strategic advice, sample materials and pleadings, and amicus briefs. The Consortium’s priorities are to support capacity nationally, to offer education, and to perform outreach activities to a variety of audiences.The Consortium seeks to advance policy change by making legal (...) expertise more readily available to the tobacco control community. Legal issues are inevitably involved in policy change. The Consortium does not provide legal representation, but conducts analysis and research. They publish on important and emerging legal issues as well as on specific cases, assist in the development of legislation, and train public health practitioners and policy makers on recurring legal issues. (shrink)

The Tobacco Control Legal Consortium is a national “network” designed to tap expertise about tobacco control legislation and to leverage existing resources. Based at the William Mitchell College of Law in St. Paul, Minnesota, the Consortium supports local counsel with research, strategic advice, sample materials and pleadings, and amicus briefs. The Consortium’s priorities are to support capacity nationally, to offer education, and to perform outreach activities to a variety of audiences.The Consortium seeks to advance policy change by making legal (...) expertise more readily available to the tobacco control community. Legal issues are inevitably involved in policy change. The Consortium does not provide legal representation, but conducts analysis and research. They publish on important and emerging legal issues as well as on specific cases, assist in the development of legislation, and train public health practitioners and policy makers on recurring legal issues. (shrink)

In the Netherlands, Forensic Flexible Assertive Community Treatment is used as a specialized form of outpatient intensive treatment. This outreaching type of treatment is aimed at patients with severe and long lasting psychiatric problems that are at risk of engaging in criminal behavior. In addition, these patients often suffer from addiction and experience problems in different areas of their life. The aim of this exploratory study was to gain more insight into the characteristics of the ForFACT patient population. More knowledge (...) about these patients may enhance the effectiveness of ForFACT and therefore reduce the risk of recidivism. Data on 132 ForFACT patients were gathered by studying electronic patient records, criminal records, and by conducting semi-structured interviews with practitioners and patients. Additionally, as part of a cognitive screening, two screening instruments were conducted to gain insight into intelligence and possible mild cognitive impairments. This article gives a broad description of the ForFACT patient population, including demographic data and context variables, diagnostics, recidivism risk and offense history, and aspects related to care. Furthermore, several recommendations are given to further improve ForFACT. Based on the results it can be concluded that the ForFACT patient population shows a high degree of diversity in complex care needs and responsivity issues. Therefore, this article highlights the necessity for ForFACT to collaborate with other mental health institutions, as well as probation officers, and forensic or criminal justice institutions. Moreover, it is important to continually check the inclusion and exclusion criteria when admitting patients to ForFACT, and to examine whether ForFACT is still the most adequate care for patients or if they need to be referred. In addition, the results emphasize the importance of cognitive screening for forensic outpatients. Finally, this study zooms in on the interface between forensic psychiatric care and general mental health care. (shrink)

Critics of mass culture often identify 1950s-style status competition as one of the central forces driving consumerism. Thomas Frank has challenged this view, arguing that countercultural rebellion now provides the primary source of consumerism in our society, and that ‘cool’ has become its central ideological expression. This paper provides a rearticulation and defense of Frank's thesis, first identifying consumerism as a type of collective action problem, then showing how the ‘hip consumer’ is one who adopts a free-rider strategy in this (...) context. (shrink)

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

Short-term international medical outreach experiences are becoming more popular among medical students. As the popularity of these trips grows, participants, scholars, and institutions have become more aware of the potential pitfalls of such experiences. Loyola University Chicago Stritch School of Medicine has an approximately 20-year international service immersion program that has sent more than 1,400 participants to more than 30 countries. Recently, ISI programming has been adjusted to provide students more formal sessions exploring the ethics of the ISI trips. (...) Students are required to attend both pre- and post-trip educational sessions covering a wide range of relevant global health topics as well as participating in in-country reflections and post-trip debriefings. This recent adjustment has evolved further to become the foundation for the SSOM’s four-year Global Health Honors program that not only encourages an ethical foundation for the student’s ISI experience but also hopes to provide a foundation for students as they look toward a future career in global health. (shrink)

During the coronavirus disease 2019 (COVID‐19) pandemic, bioethical analyses often emphasized population health and societal benefit. Hospital policies frequently focused on reducing risk of transmitting SARS‐CoV‐2 by restricting visitors; requiring protective equipment; and screening staff, patients and visitors. While restrictions can be burdensome, they are often justified as essential measures to protect the whole population against a virus with high rates of transmission, morbidity and mortality. Yet communities are not monolithic, and the impacts of these restrictions affect different groups (...) differently. An ophthalmological unit outreach program in Ethiopia serves to illustrate. Pre‐operative screening policies were designed to protect as many patients as possible but had adverse impacts on underserved communities. As this case study demonstrates, creating hospital policies that truly serve the good of the society may require a more holistic review of impacts on inequitably positioned communities. (shrink)

In the early 1970s, a World Health Organization‐initiated and United States‐funded project released lab‐reared mosquitoes outside New Delhi in the first large‐scale field trials of the genetic control of mosquitoes. Despite partnering with the Indian Council of Medical Research and investing significantly in outreach to local communities at the release sites, the project was embroiled in controversy and became an object of vehement debate within the Indian parliament and diplomatic contretemps between the United States and India. This early (...) episode of genetic control research demonstrates how a scientific collaboration was entangled in geopolitics and shaped by the legacy of colonialism. This historical case study has implications for public deliberation in the present, pointing to the challenges of shared decision‐making in the context of structural inequality, the way that a backdrop of military interest in a technology can impede trust, and the long‐term consequences of projects that foster mistrust. (shrink)

The Department of Health and Human Services, Office for Civil Rights enforces Section 504 of the 1973 Rehabilitation Act and Title II of the Americans with Disabilities Act. OCR works through complaint investigations and compliance reviews, as well as outreach, technical assistance, and public education to promote voluntary compliance. In the Olmstead decision of June 1999, the Supreme Court held that the ADA’s “integration regulation” requires state and local government to administer services, programs, and activities in the most (...) integrated setting appropriate to the needs of qualified individuals with disabilities. The decision changed the focus from whether a right to more integrated services exists, to under what circumstances and how services will be provided. The New Freedom Initiative announced by President Bush in February 2001 is a broadbased initiative to remove barriers to community living for people with disabilities and promote swift implementation of the Olmstead decision. (shrink)

We propose 4 equity-advancing operational improvements to eligibility and sign-up processes at mass vaccination sites: (1) preregistration using existing information, (2) eligibility rules that recognize the greater burden of COVID-19 in underserved neighborhoods, (3) appointment assignment that prioritizes those with disadvantage, and (4) socioculturally informed outreach to lottery selectees.

Dantis, Trudy As a 'definite community of Christian faithful', every parish is called to embody the presence of the church in the wider community. It does this by being a place of living communion and participation that is wholly mission-oriented, an environment conducive to hearing God's word and growing in the Christian life, and one that is engaged in dialogue, proclamation, outreach, worship and celebration. In doing so, a parish becomes 'salt' and 'light' for the community it is located (...) in. Parish vitality can therefore be likened to the 'saltiness' or 'luminosity' of a parish community. It is imperative for every parish community to grow in health and strength if it is to be an effective source of evangelisation and an authentic witness of the Gospel. As Wittberg notes, 'To the extent that their communal "salt" loses its flavor, parishes - are worse than irrelevant, because they no longer image God'. (shrink)

Background: Giving money as a direct incentive for patients in exchange for depot medication has proved beneficial in some clinical cases in assertive outreach . However, ethical concerns around this practice have been raised, and will be analysed in more detail here.Method: Ethical concern voiced in a survey of all AO teams in England were analysed regarding their content. These were grouped into categories.Results: 53 of 70 team managers mentioned concerns, many of them serious and expressing a negative attitude (...) towards giving money for depot adherence. Four broad categories of ethical concern following Christensen’s concept were distinguished: valid consent and refusal , psychiatric paternalism , resource allocation , organisational relationships , with a residual category others and unspecified .Discussion: The main concerns identified are discussed on the background of existing ethical theories in healthcare and the specific problems of community mental health and AO. Points for practice are derived from this discussion. A way forward is outlined that includes informed consent and an operational policy in the use of incentives, further randomised controlled trials and qualitative studies, and continuing discussions with all stakeholders, especially service users. (shrink)

Environmental disasters like Bhopal have a way of calling attention to environmental and corporate ethical issues. This paper discusses these issues in terms of a livable environment as an inalienable right and of corporate responsibility as an philosophical and social psychological disposition that enables corporations to respect that right. The corporate conscience is compared to the individual conscience and analyzed according to the moral development theories of Lawrence Kohlberg. Its moral development is recognized as problematic from the cited performance records (...) of some leading multinational corporations and from the anti-environmental lobbying efforts of the chemical industry itself. Outreach programs in environmental health associated with research projects in corporate ethics are suggested to develop the corporate conscience for preserving environmental integrity through corporate responsibility. (shrink)

Humanity’s self-ordained mandate to subdue and dominate nature is part of the cognitive foundation of the modern world—a perspective that remains deeply ingrained in science and technology. Marine biology has not been immune to this anthropocentric bias. But this needs to change, and the gaps between basic scientific disciplines and the global conservation imperatives of our time need to be bridged. In the face of a looming ecological and climate crisis, marine biologists must upgrade their values and professional standards and (...) help foster the radical transformation needed to avert a climate and ecological breakdown. To prevent some of the damage, they must cross the imaginary line that separates science from science-based activism and consciously pursue the health and durability of human and natural communities. To this end, they can (1) develop compelling narratives that engage human society, with emphasis on care for the wild living world; (2) move beyond marine conservation on paper and avoid self-serving complaisance; (3) advocate constructive changes in market and human behaviour, not only by documenting damage but also by clarifying how the extraction, production and consumption system can be steered away from practices that harm nature; (4) push for systemic change in politics through individual and collective efforts, supporting environmental activism and those who demand biosphere-saving policies; and (5) endorse a more ecocentric and holistic world vision, relinquishing contempt for spiritual wisdom and liaising with (or at least not dismissing) spiritual traditions that encourage equality, self-restraint and environmental sustainability. (shrink)

The outbreak of the coronavirus disease 2019 (COVID-19) since November 2019 has increased the challenges of human existence. Before the pandemic there were the issues of insecurity, religious and racial bigotry, climate change, poverty and so forth, which to a large extent have affected humanity negatively. The lockdown, which was introduced as a measure to curb the spread of the virus, exacerbated the anguish of the already tense world. Suddenly, the government proscribed gatherings of people in large numbers, thereby suspending (...) economic, cultural and social activities. The continued increase of the COVID-19 cases necessitated the shutdown of worship centres. It was the first time churches would be shut down in Nigeria. The incident provoked concerns and interests in public discourse and intellectual circles. Therefore, this study examines the effects of COVID-19 on churches, using a historical approach and basically depending on secondary sources from available literature and Internet sources of information. The findings show that it was the lockdown that affected the churches most, rather than the virus. The suspension of corporate worship, sacramental rites, evangelistic outreaches and pastoral visits posed a significant challenge to the churches, affecting members’ psychology and leading to a decline in church revenue and an increase in charity services. The study therefore recommends that churches be digitalised and house fellowships be revitalised. Contribution: Regardless of the impact the lockdown had on the churches, it conscientised them about the proper use of their personnel and material resources. Nowadays, churches do ministry differently, adapting to changing circumstances and harnessing divergent Christian concepts of faith and divine healing by combining science and faith in health-related theologies. (shrink)