Public Health EthicsPub Date : 2024-10-14eCollection Date: 2024-11-01DOI: 10.1093/phe/phae009
Stuart Rennie, Sara Levintow, Adam Gilbertson, Winnie Kavulani Luseno
{"title":"Ethics of Mathematical Modeling in Public Health: The Case of Medical Male Circumcision for HIV Prevention in Africa.","authors":"Stuart Rennie, Sara Levintow, Adam Gilbertson, Winnie Kavulani Luseno","doi":"10.1093/phe/phae009","DOIUrl":"10.1093/phe/phae009","url":null,"abstract":"<p><p>Mathematical modelling has played an increasingly prominent role in public health responses, for example by offering estimates of how infectious disease incidence over time may be affected by the adoption of certain policies and interventions. In this paper, we call for greater research and reflection into the ethics of mathematical modeling in public health. First, we present some promising ways of framing the ethics of mathematical modeling that have been offered in the very few publications specifically devoted to this subject. Second, to draw out some issues that have not yet been sufficiently considered, we bring in the case of mathematical modeling in voluntary medical male circumcision (VMMC) initiatives for HIV prevention in Africa. We argue that greater attention should be paid to ethical considerations in mathematical modeling, particularly as its use is becoming more widespread and its potential impacts are becoming greater in the 'big data' era, as witnessed during the COVID-19 pandemic.</p>","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":"17 3","pages":"125-138"},"PeriodicalIF":1.4,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Public Health EthicsPub Date : 2024-08-29eCollection Date: 2024-11-01DOI: 10.1093/phe/phae008
Manisha Pahwa, Julia Abelson, Paul A Demers, Lisa Schwartz, Katrina Shen, Meredith Vanstone
{"title":"Ethical Dimensions of Population-Based Lung Cancer Screening in Canada: Key Informant Qualitative Description Study.","authors":"Manisha Pahwa, Julia Abelson, Paul A Demers, Lisa Schwartz, Katrina Shen, Meredith Vanstone","doi":"10.1093/phe/phae008","DOIUrl":"10.1093/phe/phae008","url":null,"abstract":"<p><p>Normative issues associated with the design and implementation of population-based lung cancer screening policies are underexamined. This study was an exposition of the ethical justification for screening and potential ethical issues and their solutions in Canadian jurisdictions. A qualitative description study was conducted. Key informants, defined as policymakers, scientists and clinicians who develop and implement lung cancer screening policies in Canada, were purposively sampled and interviewed using a semi-structured guide informed by population-based disease screening principles and ethical issues in cancer screening. Interview data were analyzed using qualitative content analysis. Fifteen key informants from seven provinces were interviewed. Virtually all justified screening by beneficence, describing that population benefits outweigh individual harms if high-risk people are screened in organized programs according to disease screening principles. Equity of screening access, stigma and lung cancer primary prevention were other ethical issues identified. Key informants prioritized beneficence over concerns for group-level justice issues when making decisions about whether to implement screening policies. This prioritization, though slight, may impede the implementation of screening policies in a way that effectively addresses justice issues, a goal likely to require justice theory and critical interpretation of disease screening principles.</p>","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":"17 3","pages":"139-153"},"PeriodicalIF":1.4,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"From Self-Management to Shared-Management: A Relational Approach for Equitable Chronic Care","authors":"Francisca Stutzin Donoso","doi":"10.1093/phe/phae007","DOIUrl":"https://doi.org/10.1093/phe/phae007","url":null,"abstract":"Life with chronic disease and chronic care is hard and people who live in disadvantage may lack the freedom to prioritise their care because of increased competing demands. This paper proposes that shifting the goals of chronic care from self-management support to a shared-management approach can help improve wellbeing and health outcomes across social groups. This work draws on a qualitative exploration of the lived experience of chronic disease and an applied ethical analysis of the reproduction of disadvantages within chronic care. The qualitative results further specify respectful and collaborative patient-healthcare professional relationships; autonomy-supportive interventions; and continuity of care to face the complexity of chronicity in a phenomenological sense—a paradoxical experience of long duration that comprises the disease’s presence in the absence of its manifestation. The ethical analysis draws on performativity; autonomy and decision-making; and responsibility, which constitute the theoretical foundation for shared-management. This approach contributes to advance current normative thinking for health justice and outlines practical steps for its clinical implementation in the delivery of chronic care.","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":"24 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Freya Saich, Shelley Walker, Margaret Hellard, Mark Stoové, Kate Seear
{"title":"The Application of Australian Rights Protections to the Use of Hepatitis C Notification Data to Engage People ‘Lost to Follow Up’","authors":"Freya Saich, Shelley Walker, Margaret Hellard, Mark Stoové, Kate Seear","doi":"10.1093/phe/phae006","DOIUrl":"https://doi.org/10.1093/phe/phae006","url":null,"abstract":"Hepatitis C is a global public health threat, affecting 56 million people worldwide. The World Health Organization has committed to eliminating hepatitis C by 2030. Although new treatments have revolutionised the treatment and care of people with hepatitis C, treatment uptake has slowed in recent years, drawing attention to the need for innovative approaches to reach elimination targets. One approach involves using existing notifiable disease data to contact people previously diagnosed with hepatitis C. Within these disease surveillance systems, however, competing tensions exist, including protecting individual rights to privacy and autonomy, and broader public health goals. We explore these issues using hepatitis C and Australia’s legislative and regulatory frameworks as a case study. We examine emerging uses of notification data to contact people not yet treated, and describe some of the ethical dilemmas associated with the use and non-use of this data and the protections that exist to preserve individual rights and public health. We reveal weaknesses in rights protections and processes under Australian public health and human rights legislation and argue for consultation with and involvement of affected communities in policy and intervention design before notification data is used to increase hepatitis C treatment coverage.","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":"210 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141063381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Public Health EthicsPub Date : 2024-03-23eCollection Date: 2024-04-01DOI: 10.1093/phe/phad022
Kamran Abbasi, Parveen Ali, Virginia Barbour, Thomas Benfield, Kirsten Bibbins-Domingo, Stephen Hancocks, Richard Horton, Laurie Laybourn-Langton, Robert Mash, Peush Sahni, Wadeia Mohammad Sharief, Paul Yonga, Chris Zielinski
{"title":"Time to Treat the Climate and Nature Crisis as One Indivisible Global Health Emergency.","authors":"Kamran Abbasi, Parveen Ali, Virginia Barbour, Thomas Benfield, Kirsten Bibbins-Domingo, Stephen Hancocks, Richard Horton, Laurie Laybourn-Langton, Robert Mash, Peush Sahni, Wadeia Mohammad Sharief, Paul Yonga, Chris Zielinski","doi":"10.1093/phe/phad022","DOIUrl":"10.1093/phe/phad022","url":null,"abstract":"","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":"17 1-2","pages":"1-4"},"PeriodicalIF":1.4,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11245690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Psychedelics in PERIL: The Commercial Determinants of Health, Financial Entanglements and Population Health Ethics","authors":"Daniel Buchman, Daniel Rosenbaum","doi":"10.1093/phe/phae002","DOIUrl":"https://doi.org/10.1093/phe/phae002","url":null,"abstract":"The nascent for-profit psychedelic industry has begun to engage in corporate practices like funding scientific research and research programs. There is substantial evidence that such practices from other industries like tobacco, alcohol, pharmaceuticals and food create conflicts of interest and can negatively influence population health. However, in a context of funding pressures, low publicly funded success rates and precarious academic labor, there is limited ethics guidance for researchers working at the intersection of clinical practice and population health as to how they should approach potential financial sponsorship from for-profit entities, such as the psychedelic industry. This article reports on a reflective exercise among a group of clinician scientists working in psychedelic science, where we applied Adams’ (2016) PERIL (Purpose, Extent, Relevant harm, Identifiers, Link) ethical decision-making framework to a fictionalized case of corporate psychedelic financial sponsorship. Our analysis suggests financial relationships with the corporate psychedelic sector may create varying degrees of risk to a research program’s purpose, autonomy and integrity. We argue that the commercial determinants of health provide a useful framework for understanding the ethics of industry-healthcare entanglements and can provide an important population health ethics lens to examine nascent industries such as psychedelics, and work toward potential solutions.","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":"20 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140017119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Liberalism of Fear and Public Health Ethics","authors":"Alvin Chen","doi":"10.1093/phe/phae001","DOIUrl":"https://doi.org/10.1093/phe/phae001","url":null,"abstract":"This article argues that the liberalism of fear provides a useful theoretical framework for public health ethics in two fronts. First, it helps reconcile the tension between public health interventions and liberal politics. Second, it reinforces the existing justifications for public health interventions in liberal political culture. The article discusses this in the context of political emotions in the COVID-19 pandemic. Fear plays a central role in the experiences of pandemic politics, and such fear is extended to the concern that post-pandemic government would normalize emergency politics and threaten the political culture of liberal democracy. The article proposes that the liberalism of fear provides a theoretical solution not only to alleviate such fear, but also to reconcile the long-established tension between liberal politics and public health intervention. This is particularly so if the liberalism of fear’s characteristic of political realism is taken into account. The article makes two points about this, and discusses their pragmatic implications in the case of compulsory vaccination.","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":"25 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140010346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Public Health EthicsPub Date : 2023-12-20eCollection Date: 2024-04-01DOI: 10.1093/phe/phad027
Kari Pahlman, Jane Williams, Diego S Silva, Louis Taffs, Bridget Haire
{"title":"Reciprocity, Fairness and the Financial Burden of Undertaking COVID-19 Hotel Quarantine in Australia.","authors":"Kari Pahlman, Jane Williams, Diego S Silva, Louis Taffs, Bridget Haire","doi":"10.1093/phe/phad027","DOIUrl":"10.1093/phe/phad027","url":null,"abstract":"<p><p>In late March 2020 in response to the COVID-19 pandemic, Australia introduced mandatory 14-day supervised quarantine at hotels and other designated facilities for all international arrivals. From July 2020, most states and territories introduced a fixed charge for quarantine of up to $3220 per adult. The introduction of the fee was rationalised on the basis that Australians had been allowed sufficient time to return and there was a need to recover some of the cost associated with administering the program. Drawing on an empirical study of 58 returned Australian citizens and residents quarantined between March 2020 and January 2021, this paper aims to explore how people experienced paying for hotel quarantine, particularly with respect to fairness and relatedly, the principle of reciprocity. Reciprocity requires that the state has an obligation to assist individuals in discharging their duty to comply with public health measures and avoid disproportionate burdens accruing to populations or individuals. Though participants had varying opinions on whether they thought it fair to be charged for their quarantine, for many, the fee constituted a significant burden and source of stress. Given the undertaking of quarantine is primarily for the benefit of the public good, we argue the financial cost imposed on individuals does not meet the demands of reciprocity. It is imperative that future quarantine and isolation arrangements consider seriously the need to minimise burdens of individuals subject to such measures, and that fees do not become a new norm in public health and infectious disease control.</p>","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":"17 1-2","pages":"67-79"},"PeriodicalIF":1.4,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11245694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"How to Design Consent for Health Data Research? An Analysis of Arguments of Solidarity","authors":"Svenja Wiertz","doi":"10.1093/phe/phad025","DOIUrl":"https://doi.org/10.1093/phe/phad025","url":null,"abstract":"The article discusses the impact different concepts of solidarity can have on debates on models of consent for non-interventional research. It introduces three concepts of solidarity that have been referenced in bioethical debates: a purely descriptive concept, a concept that claims some derivative value for most but not all practices of solidarity, as well as a clearly normative concept where solidarity is tied to justice and taken to ground moral duties. It shows that regarding the rivalling models of study-specific consent, tiered consent and broad consent, the first two concepts can be taken to favour tiered consent while only normative solidarity supports a model of broad consent—or an argument to allow non-interventional research without requiring consent at all. As normative solidarity is tied to considerations of justice, however, the argument appears less straightforward than one might expect: It presupposes that the research contributes to overcoming existing social injustices.","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":"12 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138580529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ageism Without Anticipation-Blindness","authors":"Martin Marchman Andersen, Lasse Nielsen","doi":"10.1093/phe/phad023","DOIUrl":"https://doi.org/10.1093/phe/phad023","url":null,"abstract":"Ageism is the view that it is of greater moral value to allocate health care resources to younger people than to older people. In medical ethics, it is well-known that standard interpretations of distributive principles such as utilitarianism and egalitarianism imply some form of ageism. At times, ethicists argue as if practical complications are the only or main reason for not abiding to ageism. In this article, we argue that inferences to ageism from such distributive principles tend to commit what we call the anticipation-blindness fallacy: A much too narrow focus on life quality benefits of health care treatments inclines us to overlook the importance of life quality benefits of health care safety, that is the mere trust in and expectation of being treated and cared for as one grows old. This is a key omission because health safety has value for a much larger population and for much longer time. Taking health safety into account therefore has important implications as for how ageist we ought to be.","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":"68 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138559918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}