Applied Ethics

Dialogamos con Cintia Rodríguez Garat, quien obtuvo el Primer Premio Bioética 2023 de la Fundación Jaime Roca por su trabajo “Resiliencia y salud pública de las mujeres mapuce ante el cambio climático. Un análisis desde una perspectiva intercultural, participativa y de derechos humanos”.

I review José Medina's The Epistemology of Protest: Silencing, Epistemic Activism, and the Communicative Life of Resistance, and raise some questions about the felicity, legitimacy and civility of protest.

The purpose of this paper is twofold: first, to provide a clarification of how ‘education in a postliberal world’ differs from the concept of ‘postliberal education;’ and second, to contribute to an understanding of the backlash against liberalism and liberal education in recent years. The paper is primarily conceptual and only secondarily descriptive in that it prioritizes the importance of clarifying the conceptual haze surrounding the notion of postliberalism and related terms (i.e. illiberalism, anti-liberalism); it is argued that this conceptualization (...) is necessary as these concepts have different educational implications in different political contexts. The paper outlines a number of broad dimensions that are important to explore in future research on the entanglement between postliberalism and education; it also discusses how the concept of postliberalism could be used fruitfully to account for changes in education in ways that take into consideration the recent critiques against liberalism and liberal education. (shrink)

Nel dibattito filosofico recente si è iniziato a guardare con sempre più interesse al potenziale giustificatorio delle spiegazioni genealogiche. Se la tradizione continentale da ha infatti messo l’accento sulle implicazioni critiche e destabilizzanti del metodo genealogico, la tradizione analitica ha mostrato che esso può anche offrire supporto ai propri oggetti d’indagine: norme di comportamento, pratiche, concetti e via dicendo.2 Secondo Matthieu Queloz, un resoconto genealogico ha un carattere giustificatorio quando riesce a identificare un rapporto strumentale necessario tra il concetto o (...) la pratica presa in oggetto e bisogni umani abbastanza fondamentali da poter essere riconosciuti come tali da tutti. Si pensi, ad esempio, al resoconto funzionalista con cui Williams spiega la virtù della veridicità in quanto indispensabile al soddisfacimento del basilare bisogno umano di raccolta e messa in comune di informazioni attendibili. La domanda che voglio affrontare riguarda le supposte capacità giustificatorie di questo tipo di spiegazioni. Fino a che punto esse modificano davvero – per usare un’espressione di Sellars – lo spazio delle ragioni? Sono del parere che la loro portata normativa e valutativa sia variabile e che prendere in esame alcuni casi limite aiuti a dimostrarlo. Più nello specifico, ritengo che in alcuni casi le ragioni offerte attraverso queste spiegazioni siano ragioni non tanto per giustificare il ricorso a certi concetti o pratiche, ma ragioni per scusare coloro che vi ricorrono. (shrink)

Der Begriff der Lebenswelt ist ein genuin philosophischer Begriff, der ursprünglich in der Phänomenologie beheimatet ist und inzwischen von vielen anderen Fachwissenschaften sowie Fachdidaktiken aufgegriffen wurde. Geht es nun um die digitale Dimension der Lebenswelt oder - je nach Definition - die digitale Durchdringung derselben, ist die Forschung dementsprechend interdisziplinär aufgestellt. Ein spezifisch philosophischer Zugang zur 'digitalen Lebenswelt' findet sich bis dato nur vereinzelt und soll mit diesem Band bewusst unternommen werden. Nach grundsätzlichen Überlegungen zum Begriff werden ausgewählte Phänomene unter (...) den Aspekten des 'Selbst' und der 'Gemeinschaft' genauer betrachtet (z.B. Leiblichkeit, VR/AR, Internetpornografie, Metaversum, Soziale Netzwerke und digitale Teilhabe). Der letzte Teil befasst sich mit Computerspielen als Bereich, der besonders viele Anknüpfungspunkte philosophischer und ethischer Diskussion bietet. (shrink)

The case of clinical trials for convalescent plasma during COVID-19 illustrates important lessons for realizing public sector approaches to biomedical research and development. These lessons, centering on mission, transparency, and spillover effects, can be translated to wider efforts to develop a “public option” for clinical trials.

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)

As a legal aid union president in New Haven, laboring within shouting distance of a different large research university, I recall how our membership rolled our eyes when Professors Greiner, Pattanayak, and Hennesy of Harvard published their study providing evidence, through a randomized control trial, that law clinic housing work made no difference for clients.1 Representing, as I was, “lawyers, secretaries, and paralegals who have dedicated their careers to serving poor clients in crisis,”2 the authors’ conclusion generated first shock, then (...) denial, and then an anxious realization that somebody’s job was to research and disseminate such conclusions. In a 2013 United States where there was one legal aid lawyer for every 8,893 people who qualified,3 where federal Legal Services Corporation funding had dropped 40% over ten years in real dollars,4 and in an America that spends as much on Halloween costumes for its pets as it does legal aid for the poor,5 the inquiry felt like a pile-on. It made no more sense to us than asking if a teacher is “good for students,” a nurse “good for the sick,” or a chef “good for the hungry.”6. (shrink)

This Paper argues that to protect at-risk communities — and all Americans — from the deadly effects of environmental racism, Congress must pass the Environmental Justice for All Act. The Act is intended to “restore, reaffirm, and reconcile environmental justice and civil rights.” It does so by restoring an individual’s right to sue in federal court for discrimination based on race, ethnicity, or national origin regardless of intent under the Civil Rights Act of 1964, strengthening the National Environmental Policy Act, (...) and providing economic incentives focused on environmental justice. (shrink)

Industry-funded religious liberty legal groups have sought to undermine healthcare policy and law while simultaneously attacking the rights of sexual and gender minorities. Whereas past scholarship has tracked religiously-affiliated healthcare providers’ growing political power and attendant transformations to legal doctrine, our account emphasizes the political donors and visionaries who have leveraged religious providers and the U.S. healthcare system’s delegated structure to transform social policy and bureaucratic agencies more generally.

U.S. law imposes strict recording and reporting requirements on all entities that manufacture and distribute controlled substances. As a result, the prescription opioid crisis has unfolded in a data-saturated environment. This article asks why the systematic documentation of opioid transactions failed to prevent or mitigate the crisis. Drawing on a recently disclosed trove of 1.4 million internal records from Mallinckrodt Pharmaceuticals, a leading manufacturer of prescription opioids, we highlight a phenomenon we propose to call data diversion, whereby data ostensibly generated (...) or collected for the purpose of regulating the distribution of controlled substances were repurposed by the industry for the opposite aim of increasing sales at all costs. Systematic data diversion, we argue, contributed substantially to the scale of drug diversion seen with opioids and should become a focus of policy intervention. (shrink)

Catholic hospitals and health systems have proliferated and succeeded in American healthcare; they now operate four of the largest health systems and serve nearly one in six hospital patients. Like other religious entities that Wuest and Last write about in this issue, in their article Church Against State, they have benefited by and supported the long reach of conservative efforts to undermine the administrative state.

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.

Following from sweeping law reforms across the global health landscape, there is a need to prepare the next generation to advance global health law to ensure justice for a healthier world. Educational programs across disciplines have increasingly incorporated the field of global health law, with new courses examining the law and policy frameworks that apply to the new set of public health threats, non-state actors, and regulatory instruments that structure global health. Such interdisciplinary training must be expanded throughout the world (...) to prepare future practitioners to strengthen global health law — ensuring a foundation for global health in legal studies and law and global health studies. Meeting this imperative for global health law teaching — establishing academic courses and textbooks on global legal responses to shared health threats — will be necessary to support students to address the global health challenges of the future. (shrink)

PrécisDespite significant scholarship, research, and funding dedicated to implementing criminal diversion programs over the past two decades, persons with serious mental illness and substance use disorders remain substantially overrepresented in United States jails and prisons. Why are so many U.S. adults with behavioral health problems incarcerated instead of receiving treatment and other support to recover in the community? In this paper, we explore this persistent problem within the context of “relentless unmet need” in U.S. behavioral health (Alegría et al., 2021).

Interventional clinical studies of convalescent plasma to treat COVID-19 were predominantly funded and led by public sector actors, including blood services operators. We aimed to analyze the processes of clinical studies of convalescent plasma to understand alternatives to pharmaceutical industry biopharmaceutical research and development, particularly where public sector actors play a dominant role. We conducted a qualitative, critical case study of purposively sampled prominent and impactful clinical studies of convalescent plasma during 2020-2021.

Medical legal partnerships address individual legal needs that can create impediments to health. Little is known about outcomes from medical legal partnerships and their relationship to access to justice. This paper reports outcomes from one medical legal partnership from the perspective of the client, with specific emphasis on impact on health and concepts related to access to justice. We suggest a conceptual model for incorporating medical legal partnerships into a broader framework about access to justice.

PrécisThe administration of Pre-Mortem Interventions (PMIs) to preserve the opportunity to donate, to assess the eligibility to donate, or to optimize the outcomes of donation and transplantation are controversial as they offer no direct medical benefit and include at least the possibility of harm to the still-living patient. In this article, we describe the legal analysis surrounding consent to PMIs, drawing on existing legal commentary and identifying key legal problems. We provide an overview of the approaches in several jurisdictions that (...) have chosen to explicitly address PMIs within codified law. We then provide, as an example, a detailed exploration of how PMIs are likely to be addressed in one jurisdiction where general medical consent law applies because there is no specific legislation addressing PMIs — the province of Ontario in Canada. (shrink)

Policies allowing some minors to consent to receive recommended vaccines are ethically defensible. However, a policy change at the federal level expanding minor consent for vaccinations nationwide risks triggering a political backlash. Such a move may be perceived as infringing on the rights of parents to make decisions about their children’s health care. In the current post-COVID environment of heightened anti-vaccination activism, changes to minor consent laws may be unadvisable, and policy makers should proceed with caution.

Women are the fastest-growing population of people who use drugs in the US. As a group, they are more likely than men to experience stigma, poverty, and negative mental health outcomes. This article discusses the unique needs of women drug users in the US and provides suggestions on how to leverage national attention — and federal funding — to make harm reduction services in the US more gender sensitive, and, as a result, more effective in reducing harm for women who (...) use drugs in this country. (shrink)

Physician-based transparency approaches have been advanced as a strategy for informing patients of the likely financial consequences of using services. The structure of health care pricing and insurance coverage, and the low uptake of existing tools, suggest these approaches are likely to be unwieldy and unsuccessful. They may also generate new ethical challenges.

Secondary use of clinical data in research or learning activities (SeConts) has the potential to improve patient care and biomedical knowledge. Given this potential, the ethical question arises whether physicians have a professional duty to support SeConts. To investigate this question, we analyze prominent international declarations on physicians’ professional ethics to determine whether they include duties that can be considered as good reasons for a physicians’ professional duty to support SeConts. Next, we examine these documents to identify professional duties that (...) might conflict with a potential duty of physicians to support SeConts. (shrink)

This commentary takes up a challenge posed by Franklin Miller in a 2022 essay in Bioethics Forum. Dr. Miller queried whether bioethicists could be useful in public health policy contexts and while he refrained from issuing an ultimate opinion, did identify several challenges to such utility. The current piece responds to the challenges Dr. Miller identifies and argues that with appropriate training, public health ethicists can be of service in virtually any context in which public health policies are deliberated and (...) decided. (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.

A deluge of state “anti-equity” legislative bills seek to reverse prevailing trends in diversity, equity, and inclusion; withdraw protections of LGBTQ+ communities; and deny access to gender-based care for trans minors and adults. While the political and constitutional fate of these acts is undetermined, profound impacts on patients and their providers are already affecting the delivery of health care and public health services.

The opioid epidemic demands the development, implementation, and evaluation of innovative, research-informed practices such as diversion programs. Aritürk et al. have articulated important bioethical considerations for implementing diversion programs in resource-constrained service environments. In this commentary, we expand and advance Aritürk et al.’s discussion by discussing existing resources that can be utilized to implement diversion programs that prevent or otherwise minimize the issues of autonomy, non-maleficence, beneficence, and justice identified by Aritürk et al.

More than twenty-five years after the first signs of potential harm, the US remains locked in the grip of an opioid epidemic, with more Americans dying from overdoses than ever before.1 Diversion of prescription opioids plays an important role in opioid-related harms. Much of the scientific and public health focus on diversion has been on end-users, given how commonly non-medical prescription opioid use occurs, as well as the proportion of individuals who report that their source of non-medical opioids was friends (...) or family. However, diversion of opioids, as well as their rampant oversupply, can be discerned higher up the supply chain, including among wholesalers, pharmacies and rogue prescribers whose behavior may trigger well-described “flags” warranting further evaluation and action. (shrink)