PrécisFederally Qualified Health Centers (FQHCs) proved to be critical points of access for people of color and other underserved populations during the COVID-19 pandemic, administering 61% of their COVID-19 vaccinations to people of color, compared to the 40% rate for the overall United States’ vaccination effort. To better understand the approaches and outcomes of FQHCs in pandemic response, we conducted semi-structured interviews with FQHC health care providers and outreach workers and analyzed them using an inductive qualitative (...) methodology. (shrink)

Founded on a commitment to social justice and health equity, community health centers in the United States provide high‐quality primary care to underserved populations and address social drivers of health disparities. Through an examination of two books on the history of community health centers, Peace & Health: How a Group of Small‐Town Activists and College Students Set Out to Change Healthcare, by Charles Barber, and Community Health Centers: A Movement and the (...) People Who Made It Happen, by Bonnie Lefkowitz, this essay provides insight into what it takes to center social justice in community‐based health care organizations. As bioethics reorganizes itself around an emphasis on justice, scholars in bioethics have much to learn from colleagues in community health. (shrink)

With disparate rates of morbidity and mortality among minoritized communities, COVID-19 illuminated the need for equity-informed practices in public health. Pacia et al posit FQHCs as entities that addressed inequity when others failed. This commentary further situates how FQHCs address the public health crisis of institutional racism and related health inequities every day and presents a FQHC-led Ethics and Equity Framework and Workflow Checklist to guide ethical and equitable engagement with FQHCs.

In “Obligations of the Gift,” Lee argues that ethical thinking regarding return of genetic research results has been too narrowly focused on individual consent and participants’ “right to kn...

In lieu of an abstract, here is a brief excerpt of the content:Operating in a Contemporary Safety NetJason D. KeuneIt is summer, and I have just started my fourth year of general surgery residency, having just returned from two years in the lab. My “lab years” were spent as a Scholar–in–Residence of the American College of Surgeons. The scholarship that I engaged in included obtaining an MBA and a Graduate Certificate in Professional Ethics. The ethics component was self–designed with help (...) from an advisor, and was made up of graduate courses in political theory, healthcare financing law and bioethics. To say that I was reflective as I returned to the clinical rotations of the fourth year of residency would be understated.During this two–year period, I did not operate. I did do some clinical work during this time, but there wasn’t anyone in town willing to hire a partially–trained surgeon to do anything operative. I ended my third year of residency very happy with my technical skills, and was not sure just how these skills would survive a two–year hiatus. The challenge, as I thought of it then, would be to return to clinical rotations with this insecurity in mind and try to gain insight into just how rusty my skills were in a short period of time, and rectify them. I was in for a surprise.I felt a chill of trepidation when I discovered that the rotation that had been selected for me to return to was one in which I would be assigned to operate on and care for a low–income population of uninsured or underinsured patients with surgical problems—with minimal attending supervision. The patients were referred from the Federally Qualified Health Centers in town. The rotation had arisen from altruistic roots. The surgical service, provided at a large, academic urban hospital, was established when the city’s last remaining public hospital closed its doors for surgical patients. The service was an upright attempt to provide surgical continuity for this population. As I started the rotation and performed my first surgeries in two years with very minimal supervision, I realized that I would be participatory in what sums to a thoroughly unjust healthcare system. I would be caught in a swirl of humanitarian justice celebrated and a focus on a justice that seemed to fall short of a mark.The indigent hospital itself managed the clinic with a full complement of staff befitting a contemporary surgical clinic, albeit with a rather rudimentary computer system. The recordkeeping mechanism in our surgical office, however, was done without administrative assistance. We occupied a small room amongst the academic surgical offices at our home institution. The chief resident sat at a large [End Page 12] desk, the intern at a smaller desk, and the medical student had a chair and a laptop. The recordkeeping mechanism tracking who needed surgery, who had had surgery, and who needed follow–up on pathology was maintained by all members of the team. It involved one labyrinthine Excel spreadsheet, with multiple tabs, and a complex color–coordinated scheme of organization. The team would scan the entire thing on a daily basis to make sure nothing would be missed.When it came time to schedule a patient for the operating room, it was my responsibility as a chief resident to get an attending to “cover the case”, which amounted to finding an attending who agreed, at the bare minimum, to be present for the “critical portion” of the case. If the case was complex or very difficult, an attending surgeon would have to be sought who would scrub in and help perform the procedure. Not every attending would cover a charity case—the reasons why were not forthcoming. One surgeon would scrub every case he was asked to cover, stating that he felt every patient should have the same chance at the best treatment. Another would come to the room, but sit along the wall and review manuscripts as we operated, there to grant reassurance, and answer questions, but not, presumably, to direct the overall decision–making. All patients with breast cancer were seen, and operated on by one very dedicated breast surgeon with a humanitarian bent.I... (shrink)

Preparing for and responding to public health emergencies involving medical countermeasures raise often complex legal challenges and questions among response stakeholders at the local, state, and federal levels. This includes concerns about emergency legal authorities, liability, emergency use of regulated medical products, and regulations that might enhance or hinder public health response goals. In this article, lawyers from the U.S. Department of Health and Human Services’ Office of the General Counsel , Centers for Disease Control and (...) Prevention , and Food and Drug Administration discuss federal legal tools that are critical to enhancing MCM legal preparedness for public health emergencies, with an emphasis on the legal mechanisms that can be used to facilitate the emergency use of countermeasures. Specifically, the authors describe the Public Readiness and Emergency Preparedness Act and Emergency Use Authorization authority, outlining the conditions under which these tools can be utilized and providing examples of how they have supported both pre-event and intra-event activities. (shrink)

By 2014, each of the fifty states and the District of Columbia will have a new health insurance exchange, or marketplace, established under the Patient Protection and Affordable Care Act. These exchanges are the centerpiece of the reform law: they will be the main portals where people who do not have health insurance coverage through their jobs and small businesses will go, either in person or online, to find a health plan and to learn about and apply (...) for federal subsidies. The most immediate challenge facing all fifty‐one exchanges is fulfilling their most basic role: ensuring that all who are eligible to enroll in qualified health plans and to receive federal subsidies in fact enroll. (shrink)

As this nation embarks on new efforts to reform the U.S. health system, we face a critical unfinished agenda from the mid- 1960s: persistent racial, ethnic, and socioeconomic disparities in health and health care. Medicaid, Medicare, and Community Health Centers — public programs with very different legislative histories and financing mechanisms — were the first federally funded, nationwide efforts to improve health care access for low-income and elderly Americans. Members of racial and ethnic (...) minority groups also greatly benefited from these efforts because recipients of federal funds, such as Medicare, were required to comply with the newly passed Civil Rights Act of 1964, which barred racial discrimination. Unquestionably, government played a major role in the gains in health care access that have occurred in the last half century. Yet today all Americans do not have the same opportunities for health, access to care, or quality of care when they receive it. (shrink)

This article explores how structural failures in major federal environmental regulations —which set a foundation for environmental protections nationwide— have helped create many of the environmental injustices that people of color and low-income communities experience. It continues by examining how local governments have reinforced and compounded the failures in the federal environmental regulatory framework, particularly through local land use decisions. Although states play an important role in environmental policymaking, we propose that local governments are uniquely positioned to utilize a (...) class='Hi'>health justice approach to address environmental health inequities. This approach centers partnerships between frontline communities and local governments to develop just solutions that fill gaps within the federal environmental regulatory system and anticipate and mitigate the compounding effects of environmental health inequities. (shrink)

At the end of last year, President George Bush implemented a smallpox vaccination plan covering military operatives, health care workers, and “first-responders”. The program is administered by the federal Department of Health and Human Services in conjunction with the states and follows the smallpox vaccination guidelines established by the Centers for Disease Control and Prevention in September 2002. While inoculation is mandatory for military personnel, health care workers and first-responders are vaccinated on a voluntary basis. The (...) Administration had hoped that 450,000 health care workers would be inoculated within the first month of the program. Toward the end of February, however, only about 1 percent of the anticipated recipients had been inoculated. In Connecticut, which was the first state to begin the nonmilitary component of the program, only three people received vaccinations on the first day. (shrink)

The Management of Scientific Integrity within Academic Medical Centers discusses the impact scientific misconduct has in eight complex case studies. Authors look at multifaceted mixtures of improper behavior, poor communication, cultural issues, adverse medical/health issues, interpersonal problems and misunderstandings to illustrate the challenge of identifying and managing what went wrong and how current policies have led to the establishment of quasi legal processes within academic institutions. The book reviews the current global regulations and concludes with a section authored (...) by a US federal court judge who provides his perspective on the adequacy of current regulations and policies. (shrink)

The fight for public health primacy in U.S. emergency preparedness and response to COVID-19 centers on which level of government — federal or state — should “call the shots” to quell national emergencies?

I hated my outpatient primary care clinic during residency. Every Wednesday at noon, I scrambled to finish my inpatient work in the hospital, to raggedly see my patients, to sign out my unfinished errands to the covering residents, and to leave the children’s hospital, heading north up the dilapidated thoroughfare to the federally qualified health center where my residency clinic was held. The noise of the street, the honking of the cars, the shouts of the pedestrians, the (...) extremes of cold and of heat: after hiding in the sanctity of the university, the five-minute march up to clinic immersed me in the battlefield of the South Side of Chicago. The march prepared me for the chaos that awaited me in the... (shrink)

The National Institutes of Health is the largest biomedical research institution in the world. It has become one of the world's most highly respected research centers in part because of its efforts over the years to provide the research community with leadership in both the ethical and scientific parameters of research involving humans. As its 113th birthday approaches at the turn of the century, its great legacy is providing an environment to stimulate and nourish the diversity and creativity (...) of ideas, and thereby enable science to progress. This research must continue to be guided and tempered by consistent and critical federally-supported ethical analyses. (shrink)

Anthropogenic climate change is causing temperature rise in temperate zones resulting in climate conditions more similar to subtropical zones. As a result, rising temperatures increase the range of disease-carrying insects to new areas outside of subtropical zones, and increased precipitation causes flooding that is more hospitable for vector breeding. State governments, the federal government, and governmental agencies, like the Animal and Plant Health Inspection Service of USDA and the National Notifiable Disease Surveillance System of the U.S. Centers for (...) Disease Control and Prevention, lack a coordinated plan for vector-borne disease accompanying climate change. APHIS focuses its surveillance primarily on the effect of illness on agricultural production, while NNDSS focuses on the emergence of pathogens affecting human health. This article provides an analysis of the current framework of surveillance of, and response to, vector-borne infectious diseases, the impacts of climate change on the spread of vector-borne infectious diseases, and recommends changes to federal law to address these threats. (shrink)

Elimination of state laws that preempt local antismoking ordinances is a national health objective. However, the tobacco industry and its supporters have continued to pursue statelevel preemption of local tobacco control ordinances as part of an apparent strategy to avoid the difusion of grassroots antismoking initiatives. And, an increasing number of challenges to local ordinances by the tobacco industry and persons supported by the tobacco industry are being decided in state supreme courts and courts of appeals. The outcomes of (...) seemingly similar cases about the validity of local smoke-free air ordinances vary signifcantly by state. This paper examines the common and unique aspects of the decisions and the potential implications of court rulings on preemption for future state tobacco control eforts and achievement of national health objectives around the elimination of preemption. Using a search strategy developed for the Centers for Disease Control and Prevention's State Tobacco Activities Tracking and Evaluation System, cases where a state or federal appellate level court made a fnding on the validity of a local smoke-free air ordinance or regulation were identifed in 19 states. In contrast to previous studies, we found that cases in approximately half of states were decided for local governments. We also found that across the states, courts were considering similar factors in their decisions including the extent to which: the local government possessed the authority to pass the ordinance, the ordinance conficted with the state constitution, and state statutes preempt the ordinance. (shrink)

This article examines the regulation of Latina youth sexualities in the context of sexual and reproductive health care provision. In-depth interviews with health care providers working in two Latino-serving community health centers are analyzed for how they interpret and respond to the sexual and reproductive practices of their low-income Latina teen patients. The author finds that providers emphasize teenage pregnancy as a social problem among this population to the exclusion of other dimensions of youth sexualities and (...) encourage Latina girls’ adherence to a life course trajectory that conforms to middle-class, heteronormative ideals as a solution to this problem. By relying on such understandings, providers construct meanings of sexual citizenship that require participation in bourgeois heteronormativity. These findings suggest that Latino-serving community health centers, their providers, and their teen patients could benefit from questioning the assumptions that inform providers’ appraisals of Latina youth and developing a more inclusive approach to Latina youth sexualities beyond a discourse of pregnancy prevention. Such efforts could allow community health centers to actively participate in disrupting the structural inequalities that shape their young patients’ lives. (shrink)

There are now over 1.1 million people overseen by Immigration and Customs Enforcement (ICE), with about 33,000 detained in jails and federal detention centers around the country at any particular time. The average detention time is two months, but some are detained for much longer periods. Since its inception, one hundred and twenty one deaths and countless cases of medical neglect have occurred. Given its secrecy, and lack of accountability and oversight, it is not clear how many of these (...) deaths are the result of grossly inadequate medical care. ICE is a branch of a government agency in a democratic country, thus the citizens on whose behalf it allegedly operates have an obligation to ensure that it operates in conformity with the fundamental principles of justice on which this nation was founded. ICE is a young and rapidly growing bureaucracy with little oversight. It operates using a mix of federal, state, local and private centers, many of which are penal institutions. It has a history of serious abuse, and even when it operates in conformity with its penal standards, it inflicts additional harm onto vulnerable people, especially asylum seekers and parents of minor children. It thus requires our constant vigilance and concern. Our immigration policies and detention practices are deeply troubling, but until we elect to reform them, we have a special obligation to the vulnerable populations that we house in ICE detention. (shrink)

This paper is one of the four interrelated action agenda papers resulting from the National Summit on Public Health Legal Preparedness convened in June 2007 by the Centers for Disease Control and Prevention and multi-disciplinary partners. Each of the action agenda papers deals with one of the four core elements of public health legal preparedness: laws and legal authorities; competency in using those laws; coordination of law-based public health actions; and information. Options presented in this paper (...) are for consideration by policy makers and practitioners — in all jurisdictions and all relevant sectors and disciplines — with responsibilities for all-hazards emergency preparedness.Advancing and protecting the public's health depends upon the coordination of actions by many, diverse partners. For effective public health preparedness, there must be effective coordination of legal tools and law-based strategies across local, state, tribal, and federal jurisdictions, and also across sectors such as public health, health care, emergency management, education, law enforcement, community design, and academia. (shrink)

In the fall of 2001, the need for a vigorous and effective public health system became more apparent than it had been for many decades. With the advent of the first widescale bioterrorist attack on the United States, the government's obligation to respond and take steps to protect the public health became self-evident.Also obvious was the need for of an effective partnership between federal, state, and local officials. Local officials are almost always on the front lines of the (...) struggle against bioterrorism. They are the first to recognize a suspicious case and to provide testing and treatment for the affected population. At the same time, state officials are needed to support and coordinate local efforts, providing an expertise that may be lacking in many communities, especially smaller ones.But few would doubt that the federal government has a key role to play. The Centers for Disease Control and Prevention is expected to lead the epidemiological investigation and provide expertise on how to cope with diseases that remain unfamiliar to most physicians. (shrink)

In the fall of 2001, the need for a vigorous and effective public health system became more apparent than it had been for many decades. With the advent of the first widescale bioterrorist attack on the United States, the government's obligation to respond and take steps to protect the public health became self-evident.Also obvious was the need for of an effective partnership between federal, state, and local officials. Local officials are almost always on the front lines of the (...) struggle against bioterrorism. They are the first to recognize a suspicious case and to provide testing and treatment for the affected population. At the same time, state officials are needed to support and coordinate local efforts, providing an expertise that may be lacking in many communities, especially smaller ones.But few would doubt that the federal government has a key role to play. The Centers for Disease Control and Prevention is expected to lead the epidemiological investigation and provide expertise on how to cope with diseases that remain unfamiliar to most physicians. (shrink)

No one questions the importance of protecting human subjects of research, but over the past few years dissatisfaction has surfaced with the manner in which the protection is conferred by the federal regulatory system referred to as “The Common Rule. ” Some of the criticism surfaces in print. Some bubbles out anecdotally in conversations among researchers, with complaints about the review process being virtually inevitable whenever the topic arises. Like those in other disciplines that differ more or less dramatically from (...) the world of clinical medical research around which the Common Rule was conceptualized, public health researchers, particularly those working in official public health agencies, have experienced some tension and difficulty in adapting to the rules. The Centers For Disease Control and Prevention has adopted guidelines that require Common Rule review for “research” but not “practice” activities. (shrink)

This paper is one of the four interrelated action agenda papers resulting from the National Summit on Public Health Legal Preparedness convened in June 2007 by the Centers for Disease Control and Prevention and multi-disciplinary partners. Each of the action agenda papers deals with one of the four core elements of public health legal preparedness: laws and legal authorities; competency in using those laws; coordination of law-based public health actions; and information. Options presented in this paper (...) are for consideration by policy makers and practitioners — in all jurisdictions and all relevant sectors and disciplines — with responsibilities for all-hazards emergency preparedness.Advancing and protecting the public's health depends upon the coordination of actions by many, diverse partners. For effective public health preparedness, there must be effective coordination of legal tools and law-based strategies across local, state, tribal, and federal jurisdictions, and also across sectors such as public health, health care, emergency management, education, law enforcement, community design, and academia. (shrink)

No one questions the importance of protecting human subjects of research, but over the past few years dissatisfaction has surfaced with the manner in which the protection is conferred by the federal regulatory system referred to as “The Common Rule. ” Some of the criticism surfaces in print. Some bubbles out anecdotally in conversations among researchers, with complaints about the review process being virtually inevitable whenever the topic arises. Like those in other disciplines that differ more or less dramatically from (...) the world of clinical medical research around which the Common Rule was conceptualized, public health researchers, particularly those working in official public health agencies, have experienced some tension and difficulty in adapting to the rules. The Centers For Disease Control and Prevention has adopted guidelines that require Common Rule review for “research” but not “practice” activities. (shrink)

It is still remarkably difficult for public health officials charged with developing and implementing pandemic influenza preparedness plans at the community levelto obtain clear, concrete, and consistent guidance on how to construct plans that are both ethical and actionable. As of mid-2007, most of the federal and state pandemic plans filed with the Centers for Disease Control and Prevention, describing how public health officials will coordinate public agencies and private entities in the event of an outbreak, failed (...) to include ethical guidance for first responders responsible for providing essential services and making fair decisions during a public health emergency. (shrink)

Medical-legal partnerships — collaborative endeavors between health care clinicians and lawyers to more effectively address issues impacting health care — have proliferated over the past decade. The goal of this interdisciplinary approach is to improve the health outcomes and quality of life of patients and families, recognizing the many non-medical influences on health care and thus the value of an interdisciplinary team to enhance health. There are currently over 180 MLPs at over 200 hospitals and (...) health centers in the United States, with increasing federal interest and potential legislative support of this model.This article examines the unique, interrelated, and often similar ethical issues that confront the clinical and legal partners involved in MLPs. We contend that the ethical precepts of the clinical and legal professions should be seen as opportunities, not barriers, to further the interdisciplinary nature of MLPs. (shrink)

We analyzed whether institutions training physicians and advanced practice registered nurses have conflict of interest policies specific to pharmaceutical relationships and if present do such policies extend to students, other clinicians, personnel, sites, and curriculum. The 2014 Association of Academic Health Centers list of US members identified 65 eligible universities. A 10-item web-based survey was distributed to potential participants. Initial contact was to institutional Directors of Nursing Research, with sequential contacts if no response to Nursing Deans or Department (...) Chairs, Clinical Placement Coordinators, Institutional Research Board Directors, Bioethics Departments, and Legal Counsel. Contacts received 2 email reminders before initiating the next level of contact. Reminder postcards were sent to Dean or Department Chair non-responders. 20 institutions fully completed the survey, a 30% response. Most reported COIP for continuing education or industry funded speaking but 40.5% were "unsure" or "unclear" whether this included curriculum. 55.6% were "unsure" or "did not know" if preceptors were included. Website confirmation noted COIP most frequently covered research funding or trials or gifts and meals. Policies least frequently covered curriculum. 25% included all clinicians in their COIP. No institution covered clinical preceptors unless they were employees. Gaps exist in knowledge of COIP and their scope related to the education of nurse prescribers. While most policies cover research funding or trials in accordance with federal law, they are not explicit or known regarding their extension to nonphysician clinicians, curriculum, or preceptors. (shrink)

Critics of the gaps in our nation’s health insurance decry the absence of a health insurance “system” and the resulting “patchwork” of private and public insurance that leaves so many Americans unprotected. There is no question that these gaps are unconscionable; but they are also no accident. They are the result of policy and political choices with substantial consequences for those who remain uncovered. In my view, the fundamental political barrier to universal coverage is that our success in (...) insuring most of the nation’s population has “crowded out” our political capacity to insure the rest. This paper will explain how we arrived at the mix of private and public insurance we now have, how that mix impedes efforts to achieve universal coverage, and how “crowd-out” affects strategy for improving coverage in the future. (shrink)

Critics of the gaps in our nation’s health insurance decry the absence of a health insurance “system” and the resulting “patchwork” of private and public insurance that leaves so many Americans unprotected. There is no question that these gaps are unconscionable; but they are also no accident. They are the result of policy and political choices with substantial consequences for those who remain uncovered. In my view, the fundamental political barrier to universal coverage is that our success in (...) insuring most of the nation’s population has “crowded out” our political capacity to insure the rest. This paper will explain how we arrived at the mix of private and public insurance we now have, how that mix impedes efforts to achieve universal coverage, and how “crowd-out” affects strategy for improving coverage in the future. (shrink)

Federal and state budgetary constraints continually challenge Medicaid. The effects of benefit cuts are common: long waiting lists for community‐based services, skeletonized drug formularies with unstable access to long‐term prescriptions, no psychiatric therapy for people immobilized by depression, and no more than fourteen days of acute hospitalization. Reimbursements may be so low that providers cannot hire qualified staff and must reduce services, close facilities, or refuse to take Medicaid altogether. Misguided efficiency policies may afflict some groups of patients as (...) well. Decisions to narrow access rights to publicly funded health care promote the perception that more broadly inclusive programs would be unwisely and unfairly generous. They also risk characterizing disability rights as “special,” confined to a narrow class of people who charitably ought not to be expected to provide for themselves. In contrast, on a philosophical view we have been exploring—one that addresses problems of justice under circumstances of injustice by pursuing rather than reducing inclusion—efforts like these are unjust. (shrink)

To provide basic health care services in rural areas is one of the major challenges for developing countries like Bangladesh because of lack of infrastructures and unavailability of qualified medical doctors in the villages. Telemedicine viewed as a new way of offering health care services that has the potential to overcome this problem. Author is a member of extended group at Dhaka University (DU) which has been developing telemedicine equipment and data acquisition software to promote telemedicine practice (...) in Bangladesh. PC based ECG equipment, Digital stethoscope, Digital microscope, Digital X-ray view box and some other essential medical equipment was developed for telemedicine services. The data acquisition software establishes an easy and appropriate patients to doctor interaction through a trained operator in a remote center that involve management and arrangement of consultation of a chosen and agreeing doctor by a patient. Upon establishing audio-visual connection between patient and doctor relevant physiological data from different diagnostic instruments will be uploaded securely in a dedicated web server which can be viewed real time using unique patient/doctor ID and password. Recently the Telemedicine group of DU and a local NGO named SAMAMA with support from Service innovation fund (SIF) of Prime Minister Office (PMO) of Bangladesh took the initiative to establish eight rural telemedicine centers and one expert center for the field trial of telemedicine in Bangladesh. The aim of this paper is to examine the ethical challenges of such health care system and our effort to overcome those problem before starting the field trial. (shrink)

This paper challenges historically preconceived notions surrounding a minor’s ability to make medical decisions, arguing that federal health law should be reformed to allow minors with capacity as young as age 12 to consent to their own Centers for Diseases Control and Prevention (CDC)-approved COVID-19 vaccinations. This proposal aligns with and expands upon current exceptions to limitations on adolescent decision-making. This analysis reviews the historic and current anti-vaccination sentiment, examines legal precedence and rationale, outlines supporting ethical arguments regarding (...) adolescent decision-making, and offers rebuttals to anticipated ethical counterarguments. (shrink)

The United States Federal Government has repeatedly put the people of Vieques, Puerto Rico in harm’s way due to the injurious after-effects of air-to-ground weapons testing. Most of the harm happened during the Navy’s 70 years on the island. Yet, the harm continues today considering that aspects of the cleanup count as continued acts of environmental injustice, viewed within the context of the island’s colonial history. Usually, this harm deals with public health issues, but the remediation protocols do not (...) account for considerations such as cultural identity and heritage. This paper shows how the procedures for environmental remediation in Vieques qualify as a case of environmental injustice according to Robert M. Figueroa’s ‘environmental justice paradigm.’ The aim of employing this kind of approach is to pinpoint the underlying reasons why this is a case of environmental injustice. (shrink)

In an earlier edition of CambridgeQuarterly, in the section (CQ Vol 9, No 4), Larry Gottlieb sought advice on ethics committee assembly and policy implementation for a community mental health center. One concern mentioned is that staff members frequently encounter ethical issuesregarding the care of clients whose decisionmaking abilities are impaired by chronic mental illness and/or substance abuse. My response offers a suggestion for policy development and implementation, which may be integrated into guiding staff members of community mental (...) class='Hi'>health centers toward a model of care planning that is centered on clients' experiences of their treatments and on relationship-building among clients, community members, and mental health professionals. (shrink)

This article provides a critical analysis of the evolution and impact of hospital-sponsored women's health centers. Using original data gathered from interviews, participant observation, and content analysis of documents and brochures, the authors describe the development of four models of hospital-sponsored women's health centers and illustrate three specific mechanisms of the co-optation process. They show how many elements of feminist health care were used for the purpose of marketing and revenue production rather than for empowering (...) women and transforming the delivery of care. Following Stratigaki's notion of negative countereffect, the authors show how the key feminist concepts of women-centered care and empowerment ended up contradicting their original meaning and purpose. Rather than being the subject of care, women became the object of treatment and revenue production. (shrink)

In this essay, we suggest practical ways to shift the framing of crisis standards of care toward disability justice. We elaborate on the vision statement provided in the 2010 Institute of Medicine (National Academy of Medicine) “Summary of Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations,” which emphasizes fairness; equitable processes; community and provider engagement, education, and communication; and the rule of law. We argue that interpreting these elements through disability justice entails a commitment to both (...) distributive and recognitive justice. The disability rights movement's demand “Nothing about us, without us” requires substantive inclusion of disabled people in decision‐making related to their interests, including in crisis planning before, during, and after a pandemic like Covid‐19. (shrink)

Source: Author: Mohammad Sabahi Bidgoli, Ali Kebriaei, Sayed Gholamabas Moosavi Background and Aim: Patients' viewpoints are commonly used to assess quality of care in diverse healthcare organizations. This permits managerial decisions to be made based on knowledge rather than conjecture. The purpose of the current study is to investigate quality gap of family health care through measuring differences between clients’ perceptions and expectations at Kashan city health centers in Iran.Methodology: A cross-sectional design was applied in 2013. The (...) study sample was composed of 384 women clients of family health services randomly selected from Kashan city health centers. The SERVQUAL questionnaire was used for data collection. Service quality gap was measured by computing the difference between the rating respondents assign to expectations and perceptions statements. For pair wise comparison of the expectations and perceptions the Wilcoxon Signed Rank test was used. Internal consistency of the scale was confirmed with Cronbach's Alpha coefficients.Findings: In all dimensions of the services a significant (P ]]>. (shrink)

Many formerly incarcerated people have civil legal needs that can imperil their successful re-entry to society and, consequently, their health. We categorize these needs and assess their association with cardiovascular disease risk factors in a sample of recently released people. We find that having legal needs related to debt, public benefits, housing, or healthcare access is associated with psychosocial stress, but not uncontrolled high blood pressure or high cholesterol, in the first three months after release.

Dear Readers,Welcome to this issue of our beloved Bangladesh Journal of Bioethics! In this sweltering heat we are all seeking for some cool and comfort. We bring this issue of BJB on different ethical practices and bring up related questions. Are we respecting the rights of every human being when we are either doing research or practicing health service provision? What are the minimum norms and standards to be maintained or are we circumventing those? The issue looks into different (...) issues and provides us with indepth information, queries, fears and reservations.In the article on Knowledge, attitude and practice of medical ethics among medical intern students in a Medical College in Kathmandu, Ramesh P Aacharyaand Yagya L Shakya, report on a Knowledge Attitude and Practice survey of 46 medical undergraduate interns of Maharajgunj Medical Campus. The result of the survey is quite interesting. ‘Doctors know the best irrespective of patients’ opinion was agreed upon by 35 %, ‘Confidentiality cannot be kept in modern era and should be abandoned’ was strongly disagreed by 34.8% and disagreed by 60.9%. The Authors hope that the findings will assist the faculties to strengthen the teaching of medical ethics and guiding the interns for ethical professional conduct. In the article titled Organizational Justice and Employee’s Service Behavior in the Healthcare Organizations in Bangladesh is an agenda for Research, Md. Nuruzzaman and Md. Humayun Kabir Talukder present a conceptual framework and a set of hypotheses regarding the relationships among distributive justice, procedural justice, interactional justice, employee’s citizenship behaviour, role prescribed behaviour and counterproductive behavior in the healthcare organizations in Bangladesh. The authors state that the purpose is to assist the policy makers and service providers in identifying desirable and undesirable HRM practices in order to maintain optimum level of employee commitment for ensuring quality and efficient service delivery to the communities. Though the article is theoretical it may be useful for the policy makers and service providers. If an operational research could be carried out to test the hypothesis the practical utility of the concept could be tested in Bangladesh.Zoheb Rafique in the article Ethical Justification of Conducting Research Trials in Lower and Middle Income Countries Including Pakistan: The Responsibilities of Research Enterprises explores the ethical aspects of research sponsored by commercial agencies. He looks into the factors that influence selection of a study site for a sponsored trial particularly in traditional countries like Pakistan where cultural values add to the problem in assuring that research is conducted in an ethical manner. In this paper, the Author discusses the responsibilities of researchers and funders in low and middle income countries like Pakistan and the ethical justifications of doing research trials in developing countries. He concludes that research participants should be fully informed about the research trial and their participation and it is their right to know all risks and benefits so that they have the option of rejecting participation.The article on Ethical aspects of Dhaka University Tele-medicine System by Ahmed Raihan Abir provides and analysis of the tele- medicine system in Dhaka University. The Author is a member of an extended group at Dhaka University (DU) which has been developing telemedicine equipment and data acquisition software to promote telemedicine practice in Bangladesh. Recently the Telemedicine group of DU and a local NGO named SAMAMA with support from Service innovation fund (SIF) of the Prime Minister Office (PMO) of Bangladesh took the initiative to establish eight rural telemedicine centers and one expert center for the field trial of telemedicine in Bangladesh. The aim of this paper is to examine the ethical challenges of such health care system and the effort to overcome these problems before starting the field trial. The author looks into the details of Data confidentiality and security, Responsibilities of Doctor and Rural Technician, Quality of service and Implications of telemedicine in Bangladesh. He concludes that DU telemedicine project will essentially bring the services of qualified medical experts to the doorsteps of the common people throughout the country, even in the remote rural areas. Although a telemedicine cannot match a face to face consultation, DU tele-medicine system is much better than no consultation at all.Sifat Rahman in the article on Ethical Issues of Fair Subject Selection in Research provides an overview of the criterion for maintaining ethical standards for conducting research. The Author reviews the three fundamental conditions to be met for adhering to strict ethical standards which are: Respect for Persons by protecting the autonomy of people, treating them with courtesy and respect and obtaining informed consent.; Beneficence which incorporates the philosophy of "Do no harm" while maximizing benefits for the research project and minimizing risks to the research subjects; and Justice by ensuring that reasonable, non-exploitative, and well-considered procedures are administered fairly. Finally the Author concludes that Researchers must be truthful and conduct no deception.Dear Readers, as you can see from the above ethics and maintaining the values in research and services are of utmost importance in the improvement of the quality of life. Through our queries, questions and sense of respect for every living being can our endeavors to ensure ethics in all spheres of development be successful.Dear Readers, please keep on sending your articles, notes or thoughts to us. Your participation will make a difference in the quality of our lives.Best regardsTahera AhmedEditor. (shrink)

Institutional review boards are almost universally considered to be overworked and understaffed. They also require substantial commitments of time and resources from their members. Although some surveys report average IRB memberships of 15 people or more, federal regulations require only five. We present data on IRB meetings at eight of the top 25 academic medical centers in the United States funded by the National Institutes of Health. These data indicate substantial contributions from primary reviewers and chairs during protocol (...) discussions but little from other members, which implies that it may be possible for smaller IRBs to accomplish the same tasks with no reduction in the quality of review. (shrink)

In this paper, I apply Michel Foucault’s analysis of normalization to the 2006 announcement by the US and European Endocrinological Societies that variations on the term “hermaphrodite” and “intersex” would be replaced by the term, “Disorders of Sex Development” or DSD. I argue that the change should be understood as normalizing in a positive sense; rather than fighting for the demedicalization of conditions that have significant consequences for individuals’ health, this change can promote the transformation of the conceptualization of (...) intersex conditions from “disorders like no other” to “disorders like many others.” Understood in these terms, I conclude, medical attention to those with atypical anatomies should be recast from a preoccupation with “normal appearance” to the concern with human flourishing that is the proper object of medical attention. (shrink)

Photo ID 72893750 © Rawpixelimages|Dreamstime.com ABSTRACT Solidarity is a concept increasingly employed in bioethics whose application merits further clarity and explanation. Given how vital cooperation and community-level care are to mitigating communicable disease transmission, we use lessons from the COVID-19 pandemic to reveal how solidarity is a useful descriptive and analytical tool for public health scholars, practitioners, and policymakers. Drawing upon an influential framework of solidarity that highlights how solidarity arises from the ground up, we reveal how structural forces (...) can impact the cultivation of solidarity from the top down, particularly through ensuring robust access to important social determinants of health. Public health institutions can support solidarity movements among individuals and communities by adopting a lens of social justice when considering public health priorities and, in turn, promote health equity. INTRODUCTION Over the past two decades, scholars have invoked the concept of solidarity when assessing a wide range of topics in bioethics, from CRISPR-Cas9 technology to organ donation to structural racism.[1] However, the growing literature on solidarity has not fully examined the roles and responsibilities of institutions and governments in fostering solidarity, especially regarding public health measures that implicate entire populations. We argue that it remains unclear how public health institutions should engage with solidarity and how their engagement will affect public health and its ethics. We first take Prainsack and Buyx’ three-tiered framework as an analytical starting point.[2] We then explore how public health institutions can foster solidarity by carefully considering factors that may bolster it on an interpersonal, community, and national scale. We conclude that public health institutions should adopt a lens of social justice to promote solidarity at the interpersonal and community levels, thereby promoting equity in future public health efforts. BACKGROUND Calls for solidarity in bioethics raise longstanding normative questions about the nature and limits of our duties to one another and how to weigh autonomy over considerations of justice.[3] Though the term is diversely applied, Prainsack and Buyx propose a potentially unifying definition in the 2011 Nuffield Council report, “Solidarity: Reflections On An Emerging Concept in Bioethics.” The report defines solidarity as an activity involving “shared practices reflecting a collective commitment to carry financial, social, emotional, and or other ‘costs’ to assist others.” Their conceptualization also includes important features that distinguish solidarity from other values like empathy or altruism: solidarity emphasizes action rather than mere internal feeling and recognition of connection as motivation.[4] Bioethicists have since applied this conceptualization when analyzing issues in public and global health, given that population-level efforts need cooperation from individuals and communities. Prainsack and Buyx further note that solidarity is relevant in bioethics discourses about justice and equity, in support of providing aid to low- and middle-income countries, and as a value exemplified by European welfare states.[5] Other bioethicists have argued that promoting solidarity can contribute to community engagement, partnership with Tribal communities, and global health equity.[6] Most recently, scholars have applied solidarity as a lens to assess the COVID-19 pandemic, highlighting the pitfalls of national mitigation efforts and global disparities in disease outcomes.[7] I. Solidarity at Three Levels It seems impossible to foster solidarity in public health if we cannot identify it in general contexts. Prainsack and Buyx articulate three levels of solidarity: interpersonal solidarity, group solidarity, and legal or contractual codifications of solidarity.[8] They argue that each level inherently informs the one ‘above’ it in a unilateral direction. In other words, solidarity is fundamentally a bottom-up phenomenon. Solidarity among individuals influences group norms, which then have the potential to shape policy and institutional practice.[9] Within the Prainsack and Buyx framework, it would seem nonsensical to posit how solidarity might be expressed vertically or from the “top down.” It appears intuitively odd to imagine how a government entity might ‘be’ in solidarity with a person or group if solidarity requires some cognition about their condition per Prainsack and Buyx’ definition. Some have argued that solidarity does not seem like something that one can impose, as instances of it arise from agents recognizing and acting upon some bond rather than in response to a command. Indeed, people may be rightfully hesitant to engage in solidarity if the official messaging is overly paternalistic or coercive.[10] However, some authors have countered that governments can express solidarity through enacting structural and policy changes, though it is ambiguous how these actions are distinct from a justice-driven approach.[11] If a bottom-up approach is thus the most practical means of achieving policy that reflects solidarity, then it does not add much to public health. Institutions would be ineffective without the population’s initiation of the corresponding social norms. However, we find this conclusion overly pessimistic. Fostering a culture of solidarity to improve public health has potential merit. Prainsack and Buyx’ framework overlooks how public health actors can influence solidarity between individuals and across communities. To clarify, we agree with the view that solidarity is a bottom-up phenomenon. Solidarity may not be able to originate in a top-down fashion, but we suggest that public health institutions can take a more active role in providing the public with accurate information, promoting social justice, and intervening in the social determinants of health. II. The COVID-19 Pandemic as a Case Study Lessons learned from the ongoing COVID-19 pandemic support our argument. The pandemic deepened socioeconomic disparities in the US and hindered access to vital resources such as food, housing, and healthcare.[12] Prainsack recently noted: “[n]ext to the immediate health effects of the virus, poverty and grave inequalities have been the root causes of human suffering during the pandemic.”[13] Prior to the pandemic, many rural and low-income populations lacked reliable access to the internet and devices like laptops or smartphones. This continued lack of access restricts the flow of information and prevents people from accessing telemedicine services.[14] Preexisting social, political, and health inequities worsened health outcomes among many marginalized racial and ethnic groups. It is well-documented that communities of color, including Black, American Indian or Alaska Native, and Latinx populations, had greater COVID-related mortality and morbidity due to the effects of structural racism.[15] Although federal US agencies such as the Centers for Disease Control and Prevention enacted laws that provided safety nets (e.g., the Federal Eviction Moratorium), the majority of such programs have ended, leaving many with little assistance and the threat of further hardship.[16] These disparities are relevant because Prainsack, Buyx, and others note that solidarity arises from agents recognizing and acting on some perceived attainable collective goal(s). Income inequality and disparate access to food, education, and health care may lead people to consider public health goals unattainable. This could limit the desire to work toward those goals collectively.[17] The existing literature on collective action theory supports this intuition. It emphasizes that structural conditions, such as an absence of perceived hope for social change among a group, can lead to low ‘group efficacy’ and little willingness to cooperate, both within and across socioeconomic strata.[18] The pandemic spurred countless messages from public health agencies. The messaging did not recognize or attend to the different material realities and circumstances of the US population. How can people feel comfortable getting vaccinated if they deeply distrust the government, including public health institutions? How can people remain motivated to wear masks and distance themselves if they cannot afford basic necessities and work jobs without adequate pay and leave policies? We ask these questions to illustrate how socioeconomic disparities can marginalize people if they feel ignored, apathetic, or resentful of those better off or those in power whom they perceive to “not be doing enough.” This marginalization precludes the formation of solidarity. There are instances when a population has disparate access to resources and social capital, but solidarity may still emerge from a shared goal or vision for the future. For example, a heterogeneous population living in the same town may come together to protest an environmental injustice that impacts their water supply with the common goal of securing access to safe drinking water. However, many populations in the US failed to recognize shared goals of this kind during the COVID-19 pandemic. A significant minority of the US population was reluctant to acknowledge the severity of COVID-19 infection and thus refused to participate in efforts to mitigate its spread. Even between groups who shared the goal of slowing COVID-19 transmission, the methods were widely debated. Approximately 20 percent of the adult population eligible for vaccination remains unvaccinated.[19] Governmental bodies responsible for disseminating information, coordinating the allocation of resources, and establishing guidelines have a large role in mediating these disagreements and intervening in socioeconomic conditions that impact people's ability and willingness to engage in solidarity. III. Solidarity, Social Justice, and the Role of Public Health Institutions Adopting a lens of social justice provides further insights into how public health actors impact solidarity. Powers and Faden argue that the “foundational moral justification for the social institution of public health is social justice.”[20] Their theory of social justice has two aims. First, it ensures that everyone has a sufficient amount of the six core elements of well-being and that public health institutions are responsible for “adopting policies and creating environments” where all can flourish.[21] Second, public health institutions should distribute resources meant to promote well-being and focus on the “needs of those who are the most disadvantaged.”[22] Public health institutions should enact policies that address injustice. In doing so, public health institutions can seed the opportunity to build solidarity from the bottom up. Equipping individuals and communities with resources will foster cooperation and adherence to policies that require solidarity, such as masking and vaccination. This is consistent with arguments illustrating how institutions such as Tribal governments promote the conditions needed for their group, and especially its most vulnerable members, to flourish.[23] Addressing social determinants of health with a social justice lens will create the circumstances under which more individuals and groups can find common causes and foster solidarity. In the long run, such efforts may result in the establishment of values and practices from the bottom up. There are societal and public health preconditions required before institutions can expect their audience to act in solidarity with one another. Through their great influence over information and resources, public institutions do have the power to impact what values are most widespread. Furthermore, public health may foster trust and hope, which are important psychosocial factors that influence collective action,[24] if policies increase access to resources that promote well-being. Messaging efficacy also depends on the context of public trust, education, and whether the institutions meet one’s basic needs. Disparate messaging across different public institutions may confuse or disillusion individuals. To apply our theory of solidarity to the decision to vaccinate, a policy would be to foster conditions that facilitate access to vaccines and information about vaccine efficacy instead of imposing a top-down mandate without first eliciting public trust. IV. Counterargument Some argue that discordant public health messaging, ineffective government, and inadequate social programs can also bring people together under pressure and foster solidarity. One may argue that the most powerful motivators towards solidarity are strife and disparity, as evidenced throughout history. During the pandemic alone, political struggle and personal hardship inspired solidarity in the US, from individual neighbors helping each other to mutual aid groups forming across communities. We thus do not claim that solidarity is possible only when our government programs and public health institutions are most effective. We instead point out that solidarity can be further hindered when people feel alienated, hopeless, and pitted against each other. CONCLUSION Many competing conceptualizations of solidarity persist in the bioethics literature, and Prainsack and Buyx offer one compelling framework that public health ethicists continue to draw upon.[25] However, their framework fails to acknowledge how public health institutions impact interpersonal and group solidarity. Public health institutions can foster solidarity through actions other than mere messaging, invoking catchphrases like “we are all in this together.” Efforts to address socioeconomic preconditions and alleviate health disparities can cultivate group solidarity. As we saw during the pandemic, cooperation and solidarity go hand-in-hand with disease mitigation efforts; solidarity has clear intrinsic value.[26] As this relationship becomes more apparent, we will continue to see attempts from public health institutions to foster or invoke solidarity. Therefore, public health institutions would be remiss to ignore their role in addressing the social determinants of health. Adopting a social justice lens when planning public health interventions will clarify and strengthen their role in facilitating solidarity. Ultimately, if health disparities continue to persist or widen, it is very hard to imagine how group solidarity can ever be achieved. The widescale adoption of many public health measures needed to promote health and well-being would be conducive to solidarity. - Disclaimer: The opinions expressed are the authors’ and do not represent the views of the NIH, DHHS, or the U.S. government. Funding Disclosure: This work was supported in part by the Intramural Program of the National Institutes of Health Clinical Center. - [1] John J Mulvihill et al., “Ethical Issues of CRISPR Technology and Gene Editing through the Lens of Solidarity,” British Medical Bulletin 122 (2017): 17–29, https://doi.org/10.1093/bmb/ldx002; Ben Saunders, “Altruism or Solidarity? The Motives for Organ Donation and Two Proposals,” Bioethics 26, no. 7 (September 2012): 376–81, https://doi.org/10.1111/j.1467-8519.2012.01989.x; -Vanessa Y Hiratsuka, “SPECIAL REPORT: A Critical Moment in Bioethics: Reckoning with Anti-Black Racism through Intergenerational Dialogue A Call for Solidarity in Bioethics: Confronting Anti-Black Racism Together,” 2022, https://doi.org/10.1002/hast.1380. [2] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics London: Nuffield Council on Bioethics, 2011; Prainsack and Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach.” Bioethics 26, no. 7 (September 2012): 343–50. https://doi.org/10.1111/J.1467-8519.2012.01987.X. [3] Bob Simpson, “A ‘We’ Problem for Bioethics and the Social Sciences: A Response to Barbara Prainsack,” Science, Technology, & Human Values 43, no. 1 (January 12, 2018): 45–55, https://doi.org/10.1177/0162243917735899. [4] Barbara Prainsack and Alena Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics (London: Nuffield Council on Bioethics, 2011). [5] Barbara Prainsack and Alena Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach,” Bioethics 26, no. 7 (September 2012): 343–50, https://doi.org/10.1111/J.1467-8519.2012.01987.X. [6] Bridget Pratt, Phaik Yeong Cheah, and Vicki Marsh, “Solidarity and Community Engagement in Global Health Research,” The American Journal of Bioethics : AJOB 20, no. 5 (May 3, 2020): 43–56, https://doi.org/10.1080/15265161.2020.1745930; Sara Chandros Hull, F. Leah Nez (Diné), and Juliana M. Blome, “Solidarity as an Aspirational Basis for Partnership with Tribal Communities,” The American Journal of Bioethics 21, no. 10 (October 3, 2021): 14–17, https://doi.org/10.1080/15265161.2021.1965258; Mbih J. Tosam et al., “Global Health Inequalities and the Need for Solidarity: A View from the Global South,” Developing World Bioethics 18, no. 3 (September 1, 2018): 241–49, https://doi.org/10.1111/DEWB.12182. [7] Peter West-Oram, “Solidarity Is for Other People: Identifying Derelictions of Solidarity in Responses to COVID-19,” Journal of Medical Ethics 47, no. 2 (February 1, 2021): 65–68, https://doi.org/10.1136/MEDETHICS-2020-106522; Barbara Prainsack, “Solidarity in Times of Pandemics,” Democratic Theory 7, no. 2 (December 1, 2020): 124–33, https://doi.org/10.3167/DT.2020.070215; F. Marijn Stok et al., “Social Inequality and Solidarity in Times of COVID-19,” International Journal of Environmental Research and Public Health 18, no. 12 (June 2, 2021), https://doi.org/10.3390/IJERPH18126339; Ming Jui Yeh, “Solidarity in Pandemics, Mandatory Vaccination, and Public Health Ethics,” American Journal of Public Health 112, no. 2 (February 1, 2022): 255–61, https://doi.org/10.2105/AJPH.2021.306578; Barbara Prainsack, “Beyond Vaccination Mandates: Solidarity and Freedom During COVID-19.,” Am J Public Health 112, no. 2 (February 1, 2022): 232–33, https://doi.org/10.2105/AJPH.2021.306619. [8] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics London: Nuffield Council on Bioethics, 2011; Prainsack and Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach.” Bioethics 26, no. 7 (September 2012): 343–50. https://doi.org/10.1111/J.1467-8519.2012.01987.X. [9] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics London: Nuffield Council on Bioethics, 2011; Prainsack and Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach.” Bioethics 26, no. 7 (September 2012): 343–50. https://doi.org/10.1111/J.1467-8519.2012.01987.X. [10] Yeh, “Solidarity in Pandemics, Mandatory Vaccination, and Public Health Ethics”; Prainsack, “Beyond Vaccination Mandates: Solidarity and Freedom During COVID-19.” [11] Ho, Anita, and Iulia Dascalu. "Relational solidarity and COVID-19: an ethical approach to disrupt the global health disparity pathway." Global Bioethics 32, no. 1 (2021): 34-50; West-Oram, Peter. "Solidarity is for other people: identifying derelictions of solidarity in responses to COVID-19." Journal of Medical Ethics 47, no. 2 (2021): 65-68. [12] Monica Webb Hooper, Anna María Nápoles, and Eliseo J. Pérez-Stable, “COVID-19 and Racial/Ethnic Disparities,” JAMA 323, no. 24 (June 23, 2020): 2466, https://doi.org/10.1001/jama.2020.8598. [13] Prainsack, Barbara. “Beyond Vaccination Mandates: Solidarity and Freedom During COVID-19.” Am J Public Health 112, no. 2 (February 1, 2022): 232–33. https://doi.org/10.2105/AJPH.2021.306619. [14] Camille A Clare, “Telehealth and the Digital Divide as a Social Determinant of Health during the COVID-19 Pandemic,” Network Modeling Analysis in Health Informatics and Bioinformatics 10 (2021): 26, https://doi.org/10.1007/s13721-021-00300-y. [15] Patrick Nana-Sinkam et al., “Health Disparities and Equity in the Era of COVID-19,” Journal of Clinical and Translational Science 5, no. 1 (March 16, 2021): e99, https://doi.org/10.1017/cts.2021.23. [16] Kathryn M Leifheit et al., “Expiring Eviction Moratoriums and COVID-19 Incidence and Mortality,” American Journal of Epidemiology 190, no. 12 (December 1, 2021): 2503–10, https://doi.org/10.1093/aje/kwab196. [17] Barbara Prainsack, “Solidarity in Times of Pandemics,” Democratic Theory 7, no. 2 (December 1, 2020): 124–33, https://doi.org/10.3167/DT.2020.070215 [18] Maximilian Agostini and Martijn van Zomeren, “Toward a Comprehensive and Potentially Cross-Cultural Model of Why People Engage in Collective Action: A Quantitative Research Synthesis of Four Motivations and Structural Constraints.,” Psychological Bulletin 147, no. 7 (July 2021): 667–700, https://doi.org/10.1037/bul0000256. [19] Department of Health and Human Services (HHS) Centers for Disease Control and Prevention (HHS/CDC), “COVID Data Tracker,” 2023, https://covid.cdc.gov/covid-data-tracker. [20] Powers, Madison, and Ruth Faden. Social Justice: The Moral Foundation of Public Health and Health Policy. 1st editio. New York: Oxford Press, 2006, p. 9 and Chapter 4 [21] Powers and Faden, Social Justice: The Moral Foundation of Public Health and Health Policy; Madison Powers and Ruth Faden, Structural Injustice: Power, Advantage, and Human Rights (New York: Oxford University Press, 2019). [22] Powers, Madison, and Ruth Faden. Social Justice: The Moral Foundation of Public Health and Health Policy. 1st editio. New York: Oxford Press, 2006, p. 10 [23] Bobby Saunkeah et al., “Extending Research Protections to Tribal Communities,” The American Journal of Bioethics 21, no. 10 (October 3, 2021): 5–12, https://doi.org/10.1080/15265161.2020.1865477. [24] Agostini and van Zomeren, “Toward a Comprehensive and Potentially Cross-Cultural Model of Why People Engage in Collective Action: A Quantitative Research Synthesis of Four Motivations and Structural Constraints.” [25] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics. [26] Ruth Chadwick, “COVID‐19 and the Possibility of Solidarity,” Bioethics 34, no. 7 (September 8, 2020): 637–637, https://doi.org/10.1111/bioe.12813. (shrink)

In “Think Pragmatically: Investigators’ Obligations to Patient-Subjects When Research is Embedded in Care,” Morain and Largent 2023 persuasively argue that the prevailing ways of conceptualizing in...

Journal Name: Semiotica Issue: Ahead of print.

In lieu of an abstract, here is a brief excerpt of the content:A New Look at Animal-to-Human Organ TransplantationCharles R. McCarthy (bio)The acute shortage of organs available for transplantation into human beings combined with a new scientific understanding of the immune systems of both humans and animals make it probable that animal-to-human solid organ transplants (xenografts) may soon be attempted at a frequency rate unknown in the past. 1 Optimism about successful animal-to-human organ transplantation is greater than at any previous (...) time. The creation of a reliable supply of animal organs appears to be technically feasible. At least five major transplant centers in the United States are currently considering plans to pursue xenotransplantation. Although, at the time of this writing, no federal guidelines prohibit animal-to-human organ transplantation, the institutions considering such programs are awaiting deliberations on the subject by the Institute of Medicine (IOM), the Food and Drug Administration (FDA), and the Department of Health and Human Services (DHHS).The demand for organs suitable for transplantation into human beings greatly exceeds the supply. According to the United Network for Organ Sharing (UNOS 1996a), approximately 44,000 patients in the United states awaited organ transplantation at the end of 1995. In 1994, more than 3,000 patients died while on the transplant waiting list, and the demand for transplantable organs increases annually (UNOS 1996b). The figures do not include the hundreds or perhaps thousands of patients who could profit from a transplant, but who do not meet the requirements of the UNOS waiting list. Even if efforts to persuade persons to donate organs are redoubled, and even if the consent to donate organs should become a legal presumption, there is little prospect of developing a sufficient supply of transplantable human organs to meet the growing demand.As technical and biological barriers to successful animal-to-human xenografts are lowered, the prospect of raising dedicated colonies of animals, genetically altered to reduce the chances that human hosts will reject organs derived from them, is being seriously discussed. 2 Such colonies do not exist at the present time. [End Page 183] However, if new techniques for animal-to-human transplantation prove successful, it is likely that animal colonies will be established to provide a ready and predictable supply of organs for transplantation to humans. Some believe that commercial investment in colonies of purpose-bred animals to serve as a source of transplantable organs is close at hand (Leventhal 1994).New drugs and new combinations of existing drugs have improved the chances of successful medical outcomes for patients who receive solid organ transplants. It is now recognized that serial application of immunosuppressive drugs can reduce the likelihood of both short- and long-term organ rejection (Makowka 1994). Improved understanding of both human and animal immune systems, insights into histocompatibility, new agents to control graft-versus-host disease, animal breeding programs for the production of transgenic animals, and improved surgical techniques have opened, as never before, the possibility of successful transfer of organs from animals to humans. Some rate the chances of good patient outcomes (usually measured in terms of time of patient survival) as high, others make more conservative predictions, but virtually all experts believe that the chances for successful human patient outcomes resulting from xenotransplantation are improved. Because many patients face immanent death unless their organs can be replaced, there can be little doubt that many humans will readily consent to xenotransplantation.History Suggests CautionDespite the advances in immunosuppression, the frequency of failure in past animal-to-human xenograft attempts should temper the optimism of the transplant community. To date, all efforts to prolong human life by implanting solid organs from animals into human recipients have failed. The first attempts at animal-to-human xenotransplantation early in the twentieth century resulted in the early death of all recipients (Neuhof 1923). More sophisticated efforts at xenotransplantation occurred in the late 1960s and early 1970s, a period when anti-rejection drugs began to make allografts more feasible. Although one human recipient of a xenograft survived for nine months (with poor quality of life), most patients died within a matter of minutes, hours, or a few days following the transplantation of organs from chimpanzees or baboons (Starzl... (shrink)