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Bioethics in the public square: reflections on the how -- Campbell 38 (7): 439 -- Journal of Medical Ethics

Abstract

As bioethics gains more prominence in public policy debates, it is time to more fully reflect on the following: what is its role in the public square, and what limitations relate to and barriers impede its fulfilment of this role? I contend we should consider the how of bioethics (as a policy influencer) rather than simply focus on the who or what of bioethical enquiry. This is not to suggest considerations of latter categories are not important, only that too little attention has been paid to parallel or resulting policy involvement—involvement that will require specialised skills and knowledge that we can develop with a proactive (vs reactive) stance. Moreover, and equally critically, this how of public policy involvement will require more transparency regarding influences (eg, philosophical, ideological, cultural, socio-political) on what bioethicists bring to the table and what constituency base each represents—a humility as to the scope of one's role. In this vision, bioethics is not one single person or belief system for a policymaker to call to guide or give support to a position; rather, it offers tools—formed and utilised by a diverse disciplinary range of individuals—to help guide ethical analysis of biomedical endeavours, with the goal of infusion and diffusion of ethical enquiry and prioritisation in health policymaking, and greater humility among bioethicists who inform this discussion.

 

Copyright © 2012 by the BMJ Publishing Group Ltd & Institute of Medical Ethics. All rights reserved.

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Accueil | Axe Éthique et Santé des Populations

Accueil | Axe Éthique et Santé des Populations | Éthique et santé publique | Scoop.it
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Notre veille est maintenant disponible sur le site de l'Axe ESP du Réseau de recherche en santé des populations du Québec.

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Désy, Michel et France Filiatrault (2013) Dimension éthique de la stigmatisation en santé publique (outil d'aide à la réflexion), Institut national de santé publique du Québec.

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Stuart H, Arboleda-Flórez J. (2012) «A public health perspective on the stigmatization of mental illnesses» in Public Health Reviews, 2012;34

Stuart H, Arboleda-Flórez J.  (2012) «A public health perspective on the stigmatization of mental illnesses» in Public Health Reviews, 2012;34 | Éthique et santé publique | Scoop.it
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Base de connaissances: Inégalités sociales de santé

Base de connaissances: Inégalités sociales de santé | Éthique et santé publique | Scoop.it
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RÉFIPS/La Tribune sur les Inégalités Sociales de Santé

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Les politiques de quantification - Cairn.info

Les politiques de quantification - Cairn.info | Éthique et santé publique | Scoop.it
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Revue Française de Socio-Économie2010/1 (n° 5)
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L’entrepreneur et la coordination. Les limites paradoxales des approches autrichiennes - Cairn.info

L’entrepreneur et la coordination. Les limites paradoxales des approches autrichiennes - Cairn.info | Éthique et santé publique | Scoop.it
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Publication: Population and Public Health Ethics: Cases from Research, Policy, and Practice

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BMC Medical Ethics | Abstract | Procedure versus process: ethical paradigms and the conduct of qualitative research

Abstract (provisional)

Background

Research is fundamental to improving the quality of health care. The need for regulation of research is clear. However, the bureaucratic complexity of research governance has raised concerns that the regulatory mechanisms intended to protect participants now threaten to undermine or stifle the research enterprise, especially as this relates to sensitive topics and hard to reach groups.

Discussion

Much criticism of research governance has focused on long delays in obtaining ethical approvals, restrictions imposed on study conduct, and the inappropriateness of evaluating qualitative studies within the methodological and risk assessment frameworks applied to biomedical and clinical research. Less attention has been given to the different epistemologies underlying biomedical and qualitative investigation. The bioethical framework underpinning current regulatory structures is fundamentally at odds with the practice of emergent, negotiated micro-ethics required in qualitative research. The complex and shifting nature of real world settings delivers unanticipated ethical issues and (occasionally) genuine dilemmas which go beyond easy or formulaic 'procedural' resolution. This is not to say that qualitative studies are 'unethical' but that their ethical nature can only be safeguarded through the practice of 'micro-ethics' based on the judgement and integrity of researchers in the field.

Summary

This paper considers the implications of contrasting ethical paradigms for the conduct of qualitative research and the value of 'empirical ethics' as a means of liberating qualitative (and other) research from an outmoded and unduly restrictive research governance framework based on abstract prinicipalism, divorced from real world contexts and values.

 

© 2012 BioMed Central Ltd unless otherwise stated. Part of Springer Science+Business Media.

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American Public Health Association - Nonsmoker and “Nonnicotine” Hiring Policies: The Implications of Employment Restrictions for Tobacco Control

American Public Health Association - Nonsmoker and “Nonnicotine” Hiring Policies: The Implications of Employment Restrictions for Tobacco Control | Éthique et santé publique | Scoop.it

ABSTRACT

Smoking has been restricted in workplaces for some time. A number of organizations with health promotion or tobacco control goals have taken the further step of implementing employment restrictions. These restrictions apply to smokers and, in some cases, to anyone testing positive on cotinine tests, which also capture users of nicotine-replacement therapy and those exposed to secondhand smoke.

Such policies are defended as closely related to broader antismoking goals: first, only nonsmokers can be role models and advocates for tobacco control; second, nonsmoker and “nonnicotine” hiring policies help denormalize tobacco use, thus advancing a central aspect of tobacco control.

However, these arguments are problematic: not only can hiring restrictions come into conflict with broader antismoking goals, but they also raise significant problems of their own. (Am J Public Health. Published online ahead of print September 20, 2012: e1-e6. doi:10.2105/AJPH.2012.300745)

Read More: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.300745

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Furthering the sceptical case against virtue ethics in nursing ethics - Holland - 2012 - Nursing Philosophy - Wiley Online Library

Furthering the sceptical case against virtue ethics in nursing ethics - Holland - 2012 - Nursing Philosophy - Wiley Online Library | Éthique et santé publique | Scoop.it

Abstract

In a recent article in this journal I presented a sceptical argument about the current prominence of virtue ethics in nursing ethics. Daniel Putman has responded with a defence of the relevance of virtue in nursing. The present article continues this discussion by clarifying, defending, and expanding the sceptical argument. I start by emphasizing some features of the sceptical case, including assumptions about the nature of sceptical arguments, and about the character of both virtue ethics and nursing ethics. Then I respond to objections of Putman's such as that, according to virtue ethics, virtue is relevant to the whole of a human life, including one's behaviour in a professional context; and that eudaimonia should be central in explaining and motivating a nurse's decision to enter the profession. Having argued that these objections are not compelling, I go on to discuss an interesting recent attempt to reassert the role of virtue ethics in the ethics of professions, including nursing. This centres on whether role-specific obligations – e.g. the obligations that arise for a moral agent qua lawyer or mother – can be accommodated in a virtue ethics approach. Sean Cordell has argued that the difficulty of accommodating role-specific obligations results in an ‘institution-shaped gap’ in virtue ethics. He suggests a way of meeting this difficulty that appeals to the ergon of institutions. I endorse the negative point that role-specific obligations elude virtue ethics, but argue that the appeal to the ergon of institutions is unsuccessful. The upshot is further support for scepticism about the virtue ethics approach to nursing ethics. I end by gesturing to some of the advantages of a sceptical view of virtue ethics in nursing ethics.

 

Copyright © 1999–2012 John Wiley & Sons, Inc. All Rights Reserved.

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Heterogeneity of risk within racial groups, a challenge for public health programs.[Prev Med. 2012] - PubMed - NCBI

Abstract

Targeting high-risk populations for public health interventions is a classic tool of public health promotion programs. This practice becomes thornier when racial groups are identified as the at-risk populations. I present the particular ethical and epistemic challenges that arise when there are low-risk subpopulations within racial groups that have been identified as high-risk for a particular health concern. I focus on two examples. The black immigrant population does not have the same hypertension risk as US-born African Americans. Similarly, Finnish descendants have a far lower rate of cystic fibrosis than other Caucasians. In both cases the exceptional nature of these subpopulations has been largely ignored by the designers of important public health efforts, including the recent US government dietary recommendations. I argue that amending the publicly-disseminated risk information to acknowledge these exceptions would be desirable for several reasons. First, recognizing low-risk subpopulations would allow more efficient use of limited resources. Communicating this valuable information to the subpopulations would also promote truth-telling. Finally, presenting a more nuanced empirically-supported representation of which groups are at known risk of diseases (not focusing on mere racial categories) would combat harmful biological race essentialist views held by the public.

Copyright © 2012. Published by Elsevier Inc.

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‘Risking enchantment’: how are we to view the smoking person?

‘Risking enchantment’: how are we to view the smoking person? | Éthique et santé publique | Scoop.it

Abstract

The idea of the smoking person portrayed in public health has been criticised as being based on too narrow a view of human nature. This article discusses that view: that of a person with a stable core and epiphenomenal ‘behaviours’ that can be removed by rational persuasion or Pavlovian manipulation, and examines social scientific critiques of it. The social sciences explore the meanings smoking has for individuals and portray human identity as malleable, the result of ongoing interactions with human and non-human others. Aspects of smokers’ experience revealed in qualitative research – descriptions of cigarettes as ‘companions’ or ‘friends’, deep reliance, sensual pleasure – are sometimes difficult to articulate but can be given full voice in the context of the literary arts. We explore some examples of these sources and argue that a complete picture of smoking meanings is impossible without reference to them. We take a pragmatic approach, following the philosopher William James, who argued that emotional and spiritual experiences contribute to the truth of human existence as much as material explanations, to suggest that this understanding should be part of a critical but supportive engagement with public health research in order to develop more nuanced and humane approaches to smoking cessation.

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WHO European review of social determinants of health and the health divide. [Lancet. 2012] - PubMed - NCBI

Abstract

The European region has seen remarkable heath gains in those populations that have experienced progressive improvements in the conditions in which people are born, grow, live, and work. However, inequities, both between and within countries, persist. The review reported here, of inequities in health between and within countries across the 53 Member States of the WHO European region, was commissioned to support the development of the new health policy framework for Europe: Health 2020. Much more is understood now about the extent, and social causes, of these inequities, particularly since the publication in 2008 of the report of the Commission on Social Determinants of Health. The European review builds on the global evidence and recommends policies to ensure that progress can be made in reducing health inequities and the health divide across all countries, including those with low incomes. Action is needed-on the social determinants of health, across the life course, and in wider social and economic spheres-to achieve greater health equity and protect future generations.

Copyright © 2012 Elsevier Ltd. All rights reserved.

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Do Social Networking Sites Enhance the Attractiveness of Risky Health Behavior? Impression Management in Adolescents' Communication on Facebook and its Ethical Implications

Do Social Networking Sites Enhance the Attractiveness of Risky Health Behavior? Impression Management in Adolescents' Communication on Facebook and its Ethical Implications | Éthique et santé publique | Scoop.it
Social networking sites (SNS) are of increasing importance for adolescents’ social life.
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Aspects éthiques de la prise en compte des populations dans le processus d'évaluation d'impact sur la santé (2013)

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George Argyrou «Evidence Based Policy: Principles of Transparency and Accountability», in Australian Journal of Public Administration, Volume 71, Issue 4, pages 457–468, December 201 DOI: 10.1111/j...

George Argyrou «Evidence Based Policy: Principles of Transparency and Accountability», in Australian Journal of Public Administration, Volume 71, Issue 4, pages 457–468, December 201 DOI: 10.1111/j... | Éthique et santé publique | Scoop.it
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OECD Guidelines on Measuring Subjective Well-being - Books - OECD iLibrary

OECD Guidelines on Measuring Subjective Well-being - Books - OECD iLibrary | Éthique et santé publique | Scoop.it
Being able to measure people’s quality of life is fundamental when assessing the progress of societies. There is now widespread acknowledgement that meas
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Organisation pour la coopération et le développement économique (OCDE)Publication Date : 20 Mar 2013Pages : 290ISBN : 9789264191655 (PDF) ; 9789264191648 (print)DOI : 10.1787/9789264191655-en
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Summarizing Social Disparities in Health

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Yukiko ASADA, Y. YOSHDA et A.M. WHIPP, dans Milbank Quarterly, vol. 91, no 1, (2013).

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Prevention and Control of Meningococcal Disease

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Nous suspendons indéfiniment nos activités de curation sur Scoop.it. Notre veille sur l'éthique et la santé publique demeure toutefois toujours aussi active et pertinente! Ils vous est possible de continuer à nous suivre sur notre site web (http://cesp.inspq.qc.ca/veille-documentaire.aspx), en vous abonnant à notre fil RSS (http://feeds.feedburner.com/veilleESP?format=xml) ou encore en vous abonnant à nos alertes courriels : http://feedburner.google.com/fb/a/mailverify?uri=veilleESP&loc=fr_FR

 

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The comparative cost-effectiveness of an equity-focused approach to child survival, health, and nutrition: a modelling approach. [Lancet. 2012] - PubMed - NCBI

Abstract

Progress on child mortality and undernutrition has seen widening inequities and a concentration of child deaths and undernutrition in the most deprived communities, threatening the achievement of the Millennium Development Goals. Conversely, a series of recent process and technological innovations have provided effective and efficient options to reach the most deprived populations. These trends raise the possibility that the perceived trade-off between equity and efficiency no longer applies for child health-that prioritising services for the poorest and most marginalised is now more effective and cost effective than mainstream approaches. We tested this hypothesis with a mathematical-modelling approach by comparing the cost-effectiveness in terms of child deaths and stunting events averted between two approaches (from 2011-15 in 14 countries and one province): an equity-focused approach that prioritises the most deprived communities, and a mainstream approach that is representative of current strategies. We combined some existing models, notably the Marginal Budgeting for Bottlenecks Toolkit and the Lives Saved Tool, to do our analysis. We showed that, with the same level of investment, disproportionately higher effects are possible by prioritising the poorest and most marginalised populations, for averting both child mortality and stunting. Our results suggest that an equity-focused approach could result in sharper decreases in child mortality and stunting and higher cost-effectiveness than mainstream approaches, while reducing inequities in effective intervention coverage, health outcomes, and out-of-pocket spending between the most and least deprived groups and geographic areas within countries. Our findings should be interpreted with caution due to uncertainties around some of the model parameters and baseline data. Further research is needed to address some of these gaps in the evidence base. Strategies for improving child nutrition and survival, however, should account for an increasing prioritisation of the most deprived communities and the increased use of community-based interventions.

Copyright © 2012 Elsevier Ltd. All rights reserved.

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The fallacy of the equity-efficiency trade off: rethinking the efficient health system. [BMC Public Health. 2012] - PubMed - NCBI

Abstract

In the health systems literature one can see discussions about the trade off between the equity achievable by the system and its efficiency. Essentially it is argued that as greater health equity is achieved, so the level of efficiency will diminish. This argument is borrowed from economics literature on market efficiency. In the application of the economic argument to health, however, serious errors have been made, because it is quite reasonable to talk of both health equity being a desirable output of a health system, and the efficient production of that output. In this article we discuss notions of efficiency, and the equity-efficiency trade off, before considering the implications of this for health systems.

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Human rights consequences of mandatory HIV screening policy of newcomers to Canada

Human rights consequences of mandatory HIV screening policy of newcomers to Canada | Éthique et santé publique | Scoop.it
This paper focuses on the key human rights consequences of the HIV screening policy that applies to all permanent and some temporary resident applicants to Canada.
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The global financial crisis and health equity: toward a conceptual framework

The global financial crisis and health equity: toward a conceptual framework | Éthique et santé publique | Scoop.it

Abstract

In this article, we identify pathways that link the global financial crisis to health equity. We distinguish between direct and indirect channels of influence, and develop a conceptual model that builds on the literature analyzing the impacts of globalization on social determinants of health. The most pertinent direct pathways discussed are economic contraction, health budget cutbacks, rise in unemployment, and qualitative transformations of health systems. We also outline how other indirect channels of influence are likely to affect health equity, including cutbacks to welfare programs, labor market transformations, the emergence of an ideological climate conducive to austerity politics, and reductions in official development assistance. We conclude by suggesting that the current intensification of neoliberal policy implementation is likely to undermine health equity, and that a different path toward economic recovery is required to ensure equitable access to health care.

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Public health ethical perspectives on the values of the European Commission's White Paper "Together for Health". [Cent Eur J Public Health. 2012] - PubMed - NCBI

Abstract

BACKGROUND:

In 2007 the European Commission issued the White Paper: "Together for Health". Considered the EU Health Strategy for the years 2008-2013, it offers the cornerstones for setting priorities in EU health actions.

OBJECTIVES:

The public health framework offered in this strategy is explicitly built on shared values--including the overarching values of universality, access to good quality care, equity and solidarity that reacted to certain health care challenges within the EU. This article analyses the Health Strategy via its ethical scope and considers implications for future health policy making.

METHODS:

The Health Strategy and related documents are scrutinised to explore how the mentioned values are defined and enfolded. Additionally, scientific databases are searched for critical discussions of the value base of the Health Strategy. The results are discussed and reasoned from a public health ethical perspective.

RESULTS:

The Health Strategy is barely documented and discussed in the scientific literature. Furthermore, no attention was given to the value base of the Health Strategy. Our analysis shows that the mentioned values are particularly focussed on health care in general rather than on public health in particular. Besides this, the given values of the Health Strategy are redundant.

CONCLUSIONS:

An additional consideration of consequentialist public health ethics values would normatively strengthen a population-based health approach of EU health policy making.

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