Intergenerational Global Heath
(Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - February 25, 2015 Category: Medical Ethics Source Type: research

Essay: My Own Feet
Abstract A medical student reflection on humbling compassion through giving and receiving care in the context of global health. (Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - February 25, 2015 Category: Medical Ethics Source Type: research

Restricting Access to ART on the Basis of Criminal Record
This article reviews the legislation and identifies arguments that may be used to justify restricting access to ART for various reasons. The arguments reviewed include limitations of reproductive rights, inheriting undesirable genetic traits, distributive justice, and the welfare of the future child. We show that none of these arguments justifies restricting access to ART in the context of past criminal history. We show that a “presumption against treatment” is an unjustified infringement on reproductive freedom and that it creates various inconsistencies in current social, medical, and legal policy. We argue t...
Source: Journal of Bioethical Inquiry - February 21, 2015 Category: Medical Ethics Source Type: research

How Do We Thank Thee? Let Us (Try to) Count the Ways
(Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - February 21, 2015 Category: Medical Ethics Source Type: research

Ethical Aspects of the Glasgow Effect
(Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - February 21, 2015 Category: Medical Ethics Source Type: research

Health Care Sharing Ministries and Their Exemption From the Individual Mandate of the Affordable Care Act
Abstract The U.S. 2010 Patient Protection and Affordable Care Act (ACA) exempts members of health care sharing ministries (HCSMs) from the individual mandate to have minimum essential insurance coverage. Little is generally known about these religious organizations and even less critical attention has been brought to bear on them and their ACA exemption. Both deserve close scrutiny due to the exemption’s less than clear legislative justification, their potential influence on the ACA’s policy and ethical success, and their salience to current religious liberty debates surrounding the expansion of religi...
Source: Journal of Bioethical Inquiry - February 12, 2015 Category: Medical Ethics Source Type: research

“With Human Health It’s a Global Thing”: Canadian Perspectives on Ethics in the Global Governance of an Influenza Pandemic
Abstract We live in an era where our health is linked to that of others across the globe, and nothing brings this home better than the specter of a pandemic. This paper explores the findings of town hall meetings associated with the Canadian Program of Research on Ethics in a Pandemic (CanPREP), in which focus groups met to discuss issues related to the global governance of an influenza pandemic. Two competing discourses were found to be at work: the first was based upon an economic rationality and the second upon a humanitarian rationality. The implications for public support and the long-term sustainability of n...
Source: Journal of Bioethical Inquiry - February 12, 2015 Category: Medical Ethics Source Type: research

Why Do People Participate in Epidemiological Research?
Abstract Many assumptions are made about public willingness to participate in epidemiological research, yet few empirical studies have been conducted to ascertain whether such assumptions are correct. Our qualitative study of the public and of expert stakeholders leads us to suggest that people are generally prepared to participate in epidemiological research, particularly if it is conducted by a trusted public institution such as a government health department, charity, or university. However, there is widespread community distrust of research conducted or sponsored by pharmaceutical companies. Individuals are pr...
Source: Journal of Bioethical Inquiry - February 12, 2015 Category: Medical Ethics Source Type: research

Ethical Considerations of Physician Career Involvement in Global Health Work: A Framework
Abstract Examining the ethics of long-term, career involvement by physicians in global health work is vital, given growing professional interest and potential health implications for communities abroad. However, current literature remains heavily focused on ethical considerations of short-term global health training experiences. A literature review informed our development of an ethics framework centered on two perspectives: the practitioner perspective, further subdivided into extrinsic and intrinsic factors, and community perspectives, specifically that of the host community and the physician’s home commun...
Source: Journal of Bioethical Inquiry - February 12, 2015 Category: Medical Ethics Source Type: research

Conflicts in Learning to Care for Critically Ill Newborns: “It Makes Me Question My Own Morals”
Abstract Caring for critically ill and dying patients often triggers both professional and personal growth for physician trainees. In pediatrics, the neonatal intensive care unit (NICU) is among the most distressing settings for trainees. We used longitudinal narrative writing to gain insight into how physician trainees are challenged by and make sense of repetitive, ongoing conflicts experienced as part of caring for very sick and dying babies. The study took place in a 45-bed, university-based NICU in an urban setting in the United States. From November 2009 to June 2010 we enrolled pediatric residents and neona...
Source: Journal of Bioethical Inquiry - February 6, 2015 Category: Medical Ethics Source Type: research

Mutual Scorn Within the Abortion Debate: Some Parallels With Race Relations
Abstract By emphasizing the parallels between both racial vilification and the vilification that takes place when we discuss abortion in our society, I hope to provide a new perspective on the way the United States converses about this divisive issue. This perspective, in turn, can help us see how we can move forward from the stagnate polemics that have permeated the abortion debate in the United States for the past 40 years. (Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - February 5, 2015 Category: Medical Ethics Source Type: research

The Question of Autonomy in Maternal Health in Africa: A Rights-Based Consideration
This study applies a rights-based approach to maternal health and demonstrates how rights concerns are associated with negative outcomes in maternal health in Africa. The discussion is situated at the household level, which is the starting point in health care. The paper submits that beyond legal and political rights within the context of the state, rights-based issues manifest at the household level. Many of those rights issues, especially relating to women’s autonomy, are detrimental to maternal health in Africa. Therefore, a rights-based approach in the social construction of maternal health realities will contrib...
Source: Journal of Bioethical Inquiry - February 5, 2015 Category: Medical Ethics Source Type: research

Situating the Trovan Trial With the Use of Experimental Ebola Therapies Is Like Comparing an Apple With an Orange
(Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - February 5, 2015 Category: Medical Ethics Source Type: research

Content of Public Health Ethics Postgraduate Courses in the United States
Conclusions: The analyzed syllabi show high variability in curricular content. The debate with regard to whether a core curriculum on PHE should be established is ongoing. The results of this work might be of interest for schools and programs of PH in other countries or regions of the world in order to develop or ameliorate their own PHE syllabi. (Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - February 5, 2015 Category: Medical Ethics Source Type: research

Teaching Corner: “First Do No Harm”: Teaching Global Health Ethics to Medical Trainees Through Experiential Learning
Abstract Recent studies show that returning global health trainees often report having felt inadequately prepared to deal with ethical dilemmas they encountered during outreach clinical work. While global health training guidelines emphasize the importance of developing ethical and cultural competencies before embarking on fieldwork, their practical implementation is often lacking and consists mainly of recommendations regarding professional behavior and discussions of case studies. Evidence suggests that one of the most effective ways to teach certain skills in global health, including ethical and cultural compet...
Source: Journal of Bioethical Inquiry - February 4, 2015 Category: Medical Ethics Source Type: research

Making a Commitment to Ethics in Global Health Research Partnerships: A Practical Tool to Support Ethical Practice
Abstract Global health research partnerships have many benefits, including the development of research capacity and improving the production and use of evidence to improve global health equity. These partnerships also include many challenges, with power and resource differences often leading to inequitable and unethical partnership dynamics. Responding to these challenges and to important gaps in partnership scholarship, the Canadian Coalition for Global Health Research (CCGHR) conducted a three-year, multi-regional consultation to capture the research partnership experiences of stakeholders in South Asia, Latin A...
Source: Journal of Bioethical Inquiry - February 4, 2015 Category: Medical Ethics Source Type: research

Essay: Leaky Pipes
Abstract In the face of great tragedy, the desire to pinpoint blame can be instinctual as a remedy for alleviating one’s conscience in a system that causes great suffering. However, to remedy the system that causes such suffering requires a critical analysis of the factors that perpetuate inequitable power structures. This is the story of a journey that broadened my lens of analysis with which to critically evaluate the harmful structural and social determinants magnified in resource-limited settings (Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - February 4, 2015 Category: Medical Ethics Source Type: research

Essay: Freedom
Abstract This is a reflective essay written about the humanism evident in a cross-cultural patient–doctor encounter in an HIV clinic in Swaziland, Africa. (Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - February 4, 2015 Category: Medical Ethics Source Type: research

Untangling the Surrogacy Web and Exploring Legal Duties Following the Discharge of Mental Health Patients
(Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - February 4, 2015 Category: Medical Ethics Source Type: research

Essay: Dear Tenzin
Abstract Global health experiences during medical education can have a profound effect on physicians-in-training. This reflection was written to capture a meaningful moment during the author’s experience in medical school—one that made real the contrast between children from different social circumstances. Now a resident physician in pediatrics, the author carries with him the lessons learned from his time in rural India. (Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - February 4, 2015 Category: Medical Ethics Source Type: research

Essay: On Stars
Abstract This 2014 Consortium of Universities for Global Health essay examines the ethical dilemmas of working as a senior dental student at a free clinic in rural New England. (Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - February 4, 2015 Category: Medical Ethics Source Type: research

Teaching Corner: Child Family Health International
Abstract Child Family Health International (CFHI) is a U.S.-based nonprofit, nongovernmental organization (NGO) that has more than 25 global health education programs in seven countries annually serving more than 600 interprofessional undergraduate, graduate, and postgraduate participants in programs geared toward individual students and university partners. Recognized by Special Consultative Status with the United Nations Economic and Social Council (ECOSOC), CFHI utilizes an asset-based community engagement model to ensure that CFHI’s programs challenge, rather than reinforce, historical power im...
Source: Journal of Bioethical Inquiry - February 4, 2015 Category: Medical Ethics Source Type: research

Teaching Corner: Raising the Bar: Ethical Considerations of Medical Student Preparation for Short-Term Immersion Experiences
Abstract Short-term international medical outreach experiences are becoming more popular among medical students. As the popularity of these trips grows, participants, scholars, and institutions have become more aware of the potential pitfalls of such experiences. Loyola University Chicago Stritch School of Medicine (SSOM) has an approximately 20-year international service immersion (ISI) program that has sent more than 1,400 participants to more than 30 countries. Recently, ISI programming has been adjusted to provide students more formal sessions exploring the ethics of the ISI trips. Students are required to att...
Source: Journal of Bioethical Inquiry - February 4, 2015 Category: Medical Ethics Source Type: research

Essay: Break the Silence
Abstract The author recounts major personal and moral tensions that arose during an 11-month period living in Ghana and shares how she has since learned to reconcile those tensions. (Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - February 4, 2015 Category: Medical Ethics Source Type: research

Essay: The Thrill Is Back (With Some Gray Hairs)
Abstract This 2013 Consortium of Universities for Global Health essay examines the challenges, personal cost, and ethical dilemmas of working as a medical officer at a district hospital in South Africa and confronting health issues such as HIV/AIDS, tuberculosis, and childhood sexual abuse. (Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - February 4, 2015 Category: Medical Ethics Source Type: research

Developing Global Health Programming: A Guidebook for Medical and Professional Schools (Second Edition)
Abstract Developing Global Health Programming: A Guidebook for Medical and Professional Schools (2nd edition), edited by Jessica Evert, Paul Drain, and Thomas Hall, is reviewed. In spite of some editorial shortcomings, the book is a terrific aggregation of resources and reflections on the state of global health education that leaves readers with a multitude of useful and diverse tools, as well as directions about where to find additional ones. (Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - January 29, 2015 Category: Medical Ethics Source Type: research

The Political and Ethical Challenge of Multi-Drug Resistant Tuberculosis
This article critically examines current responses to multi-drug resistant tuberculosis (MDR-TB) and argues that bioethics needs to be willing to engage in a more radical critique of the problem than is currently offered. In particular, we need to focus not simply on market-driven models of innovation and anti-microbial solutions to emergent and re-emergent infections such as TB. The global community also needs to address poverty and the structural factors that entrench inequalities—thus moving beyond the orthodox medical/public health frame of reference. (Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - January 29, 2015 Category: Medical Ethics Source Type: research

Teaching Corner: The Prospective Case Study
Abstract Over the past decade, global health has emerged as one of the fastest growing academic programs in the United States. Ethics training is cited widely as an essential feature of U.S. global health programs, but generally it is not deeply integrated into the global health teaching and training curricula. A discussion about the pedagogy of teaching global health ethics is long overdue; to date, only a few papers specifically engage with pedagogy rather than competencies or content. This paper explores the value of case study pedagogy for a full-semester graduate course in global health ethics at an American ...
Source: Journal of Bioethical Inquiry - January 29, 2015 Category: Medical Ethics Source Type: research

Disaster Bioethics: Normative Issues When Nothing Is Normal
Abstract Disaster Bioethics: Normative Issues When Nothing Is Normal, edited by Dónal P. O’Mathúna, Bert Gordijn, and Mike Clarke, is reviewed. This volume is the second in a series addressing public health ethics and is comprised of 13 chapters contributed by individual authors and divided into two sections. Although this is not a monumental work, it is one of importance. It asks more questions than it answers, which is fitting in an emerging discipline. It will serve to shape and focus future research and debate. Not all contributions are of equal import, but each has something to ...
Source: Journal of Bioethical Inquiry - January 29, 2015 Category: Medical Ethics Source Type: research

Teaching Corner: An Undergraduate Medical Education Program Comprehensively Integrating Global Health and Global Health Ethics as Core Curricula
Abstract The Medical School for International Health (MSIH) was created in 1996 by the Faculty of Health Sciences at Ben-Gurion University of the Negev in affiliation with Columbia University’s Health Sciences division. It is accredited by the New York State Board of Education. Students complete the first three years of the program on the Ben-Gurion University campus in Be’er-Sheva, Israel, while fourth-year electives are completed mainly in the United States (at Columbia University Medical Center and affiliates as well as other institutions) along with a two-month global health elective at one of nume...
Source: Journal of Bioethical Inquiry - January 29, 2015 Category: Medical Ethics Source Type: research

Response to the Case of Short-Term International Development Work
(Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - January 29, 2015 Category: Medical Ethics Source Type: research

Helping or Hindering? Some Ethical Implications of Global Health Work
(Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - January 29, 2015 Category: Medical Ethics Source Type: research

Nonconsensual Clinical Trials: A Foreseeable Risk of Offshoring Under Global Corporatism
Abstract This paper explores the connection of offshoring and outsourcing to nonconsensual global pharmaceutical trials in low-income countries. After discussing reasons why the topic of nonconsensual offshored clinical trials may be overlooked in bioethics literature, I suggest that when pharmaceutical corporations offshore clinical trials today, nonconsensual experiments are often foreseeable and not simply the result of aberrant ethical conduct by a few individuals. Offshoring of clinical trials is structured so that experiments can be presented as health care in a unique form of outsourcing from the host count...
Source: Journal of Bioethical Inquiry - January 29, 2015 Category: Medical Ethics Source Type: research

Los Torturadores Medicos: Medical Collusion With Human Rights Abuses in Argentina, 1976–1983
This article reconstructs the narrative of the Proceso’s human rights abuses to argue that health professionals knowingly and often enthusiastically facilitated, oversaw, and participated in every phase of the “disappearance,” torture, and mass murder process. (Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - December 1, 2014 Category: Medical Ethics Source Type: research

Questions and Answers on the Belgian Model of Integral End-of-Life Care: Experiment? Prototype?
This article analyses domestic and foreign reactions to a 2008 report in the British Medical Journal on the complementary and, as argued, synergistic relationship between palliative care and euthanasia in Belgium. The earliest initiators of palliative care in Belgium in the late 1970s held the view that access to proper palliative care was a precondition for euthanasia to be acceptable and that euthanasia and palliative care could, and should, develop together. Advocates of euthanasia including author Jan Bernheim, independent from but together with British expatriates, were among the founders of what was probably the firs...
Source: Journal of Bioethical Inquiry - December 1, 2014 Category: Medical Ethics Source Type: research

Bioethics : The Basics
(Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - December 1, 2014 Category: Medical Ethics Source Type: research

Should Health Care Providers Be Forced to Apologise After Things Go Wrong?
Abstract The issue of apologising to patients harmed by adverse events has been a subject of interest and debate within medicine, politics, and the law since the early 1980s. Although apology serves several important social roles, including recognising the victims of harm, providing an opportunity for redress, and repairing relationships, compelled apologies ring hollow and ultimately undermine these goals. Apologies that stem from external authorities’ edicts rather than an offender’s own self-criticism and moral reflection are inauthentic and contribute to a “moral flabbiness” that stunt...
Source: Journal of Bioethical Inquiry - December 1, 2014 Category: Medical Ethics Source Type: research

Someone Is Watching You: The Ethics of Covert Observation to Explore Adult Behaviour at Children’s Sporting Events
Abstract Concerns have been expressed about adult behaviour at children’s sporting events in New Zealand. As a consequence, covert observation was identified as the optimal research method to be used in studies designed to record the nature and prevalence of adult sideline behaviour at children’s team sporting events. This paper explores whether the concerns raised by the ethics committee about the use of this controversial method, particularly in relation to the lack of informed consent, the use of deception, and researcher safety, were effectively managed. This is achieved by reflecting on the condu...
Source: Journal of Bioethical Inquiry - December 1, 2014 Category: Medical Ethics Source Type: research

Ebola, Ethics, and the Question of Culture
(Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - December 1, 2014 Category: Medical Ethics Source Type: research

Using the Ebola Outbreak as an Opportunity to Educate on Vaccine Utility
(Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - November 25, 2014 Category: Medical Ethics Source Type: research

“When Pirates Feast … Who Pays?” Condoms, Advertising, and the Visibility Paradox, 1920s and 1930s
Abstract For most of the 20th century, the condom in the United States was a cheap, useful, but largely unmentionable product. Federal and state statutes prohibited the advertising and open display of condoms, their distribution by mail and across state lines, and their sale for the purpose of birth control; in some states, even owning or using condoms was illegal. By the end of World War I, condoms were increasingly acceptable for the prevention of sexually transmitted disease, but their unique dual function—for disease prevention and contraception—created ongoing ambiguities for sellers, consumers, a...
Source: Journal of Bioethical Inquiry - November 24, 2014 Category: Medical Ethics Source Type: research

Art, (In)Visibility, and Ebola
(Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - November 23, 2014 Category: Medical Ethics Source Type: research

Collateral Damage: A Patient, a New Procedure, and the Learning Curve
This article is a review of the 2010 book Collateral Damage by Dan Walter. (Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - November 21, 2014 Category: Medical Ethics Source Type: research

The Moral Landscape: How Science Can Determine Human Values
Abstract In The Moral Landscape: How Science Can Determine Human Values, Sam Harris presents a case for basing moral principles on scientific investigation. He highlights some of the limits of traditional religious dogmas. Likewise, he critiques the excessive moral indecisiveness and ineptitude of some who hold a more liberal doctrine, calling this “moral relativism.” Harris also puts forward a thought-provoking argument as to how science can be used to create a superior moral framework. However, there are shortcomings with Harris’ argument, which fails to address the distinction between Hume&rsq...
Source: Journal of Bioethical Inquiry - November 18, 2014 Category: Medical Ethics Source Type: research

Disease, Communication, and the Ethics of (In) Visibility
Abstract As the recent Ebola outbreak demonstrates, visibility is central to the shaping of political, medical, and socioeconomic decisions. The symposium in this issue of the Journal of Bioethical Inquiry explores the uneasy relationship between the necessity of making diseases visible, the mechanisms of legal and visual censorship, and the overall ethics of viewing and spectatorship, including the effects of media visibility on the perception of particular “marked” bodies. Scholarship across the disciplines of communication, anthropology, gender studies, and visual studies, as well as a photographer&...
Source: Journal of Bioethical Inquiry - November 13, 2014 Category: Medical Ethics Source Type: research

Ethical Challenges Posed by the Ebola Virus Epidemic in West Africa
Abstract This paper examines how people in West Africa are reacting to the Ebola virus disease, an epidemic presently prevalent in the region. Certain lifestyle changes are suggested. Additionally, the heart of the paper focuses on the request by governments to be allowed access to experimental drugs, such as Zmapp and TKM-Ebola, for their infected populations. The author argues that granting such a request would circumvent research ethics procedures, which could potentially constitute significant risk to users of the drugs. The Pfizer Kano meningitis trial of 1996 is cited as an example to buttress how unapproved...
Source: Journal of Bioethical Inquiry - November 12, 2014 Category: Medical Ethics Source Type: research

The Liminal Body
Abstract If James has a latent tuberculosis infection (LTBI), he is at risk of developing active tuberculosis disease but he is not yet sick. LTBI is a liminal space between health and illness. Diagnosed with LTBI, James could be conceptualised as having a liminal body. Treatments for LTBI are available, but why would a person seek treatment for a disease he does not yet have? One thing is definite: James needs to be educated about the symptoms and severity of active tuberculosis disease. (Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - October 30, 2014 Category: Medical Ethics Source Type: research

Documenting Women’s Postoperative Bodies: Knowing Stephanie and “Remembering Stephanie” as Collaborative Cancer Narratives
Abstract Photographic representations of women living with or beyond breast cancer have gained prominence in recent decades. Postmillennial visual narratives are both documentary projects and dialogic sites of self-construction and reader-viewer witness. After a brief overview of 30 years of breast cancer photography, this essay analyzes a collaborative photo-documentary by Stephanie Byram and Charlee Brodsky, Knowing Stephanie (2003), and a memorial photographic essay by Brodsky written ten years after Byram’s death, “Remembering Stephanie” (2014). The ethics of representing women’s p...
Source: Journal of Bioethical Inquiry - October 22, 2014 Category: Medical Ethics Source Type: research

African Kaposi’s Sarcoma in the Light of Global AIDS: Antiblackness and Viral Visibility
Abstract Drawing on the theoretical frameworks of antiblackness and intersectionality and the concept of viral visibility, this essay attends to the considerable archive of research about endemic Kaposi’s sarcoma (KS) in sub-Saharan Africa accrued during the mid-20th century. This body of data was inexplicably overlooked in Western research into KS during the first decade of the AIDS epidemic, during which period European and Mediterranean KS cases were most often cited as precedents despite the volume of African data available. This paper returns to the research on KS conducted in Africa during the colonial...
Source: Journal of Bioethical Inquiry - October 11, 2014 Category: Medical Ethics Source Type: research

Ebola Virus in West Africa: Waiting for the Owl of Minerva
Abstract The evolving Ebola epidemic in West Africa is unprecedented in its size and scope, requiring the rapid mobilization of resources. It is too early to determine all of the ethical challenges associated with the outbreak, but these should be monitored closely. Two issues that can be discussed are (1) the decision to implement and evaluate unregistered agents to determine therapeutic or prophylactic safety and efficacy and (2) the justification behind this decision. In this paper, I argue that it is not compassionate use that justifies this decision and suggest three lines of reasoning to support the decision...
Source: Journal of Bioethical Inquiry - October 8, 2014 Category: Medical Ethics Source Type: research