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Éthique et santé publique
Une veille documentaire portant sur différents thèmes en éthique de la santé publique
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Nudges in Public Health: Paternalism Is Paramount

Nudges in Public Health: Paternalism Is Paramount | Éthique et santé publique | Scoop.it
(2012). Nudges in Public Health: Paternalism Is Paramount. The American Journal of Bioethics: Vol. 12, No. 2, pp. 16-17.
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Nudge Ethics: Just a Game of Billiards?

Nudge Ethics: Just a Game of Billiards? | Éthique et santé publique | Scoop.it
(2012). Nudge Ethics: Just a Game of Billiards? The American Journal of Bioethics: Vol. 12, No. 2, pp. 22-24.
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Value-Ladenness and Rationality in Health Communication

Value-Ladenness and Rationality in Health Communication | Éthique et santé publique | Scoop.it
(2012). Value-Ladenness and Rationality in Health Communication. The American Journal of Bioethics: Vol. 12, No. 2, pp. 20-22.
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Respect for cultural diversity in bioethics is an ethical imperative. [Med Health Care Philos. 2012] - PubMed - NCBI

Abstract

The field of bioethics continues to struggle with the problem of cultural diversity: can universal principles guide ethical decision making, regardless of the culture in which those decisions take place? Or should bioethical principles be derived from the moral traditions of local cultures? Ten Have and Gordijn (Medicine, Health Care and Philosophy 14:1-3, 2011) and Bracanovic (Medicine, Health Care and Philosophy 14:229-236, 2011) defend the universalist position, arguing that respect for cultural diversity in matters ethical will lead to a dangerous cultural relativity where vulnerable patients and research subjects will be harmed. We challenge the premises of moral universalism, showing how this approach imports and imposes moral notions of Western society and leads to harm in non-western cultures.

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Public Health versus Private Freedom? - The Guatemala Times

Public Health versus Private Freedom? - The Guatemala Times | Éthique et santé publique | Scoop.it
Public Health versus Private Freedom?The Guatemala Times

PRINCETON – In contrasting decisions last month, a United States Court of Appeals struck down a US Food and Drug Administration requirement that cigarettes be sold in packs with graphic health...

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What's the Point of Philosophical Bioethics? [Health Care Anal. 2012] - PubMed - NCBI

Abstract

Many people working in bioethics take pride in the subject's embrace of a wide range of disciplines. This invites questions of what in particular is added by each. In this paper, I focus on the role of philosophy within the field: what, if anything, is its unique contribution to bioethics? I sketch out a claim that philosophy is central to bioethics because of its particular analytic abilities, and defend its place within bioethics from a range of sceptical attacks.

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A universal preference for equality in health? Reasons to reconsider properties of applied social welfare functions. [Soc Sci Med. 2012] - PubMed - NCBI

Abstract

The literature on how to combine efficiency and equity considerations in the social valuation of health allocations has borrowed extensively from applied welfare economics, including the literature on inequality measurement. By so doing, it has adopted normative assumptions that have been applied for evaluating the allocation of welfare (or income) rather than the allocation of health, including the assumption of a monotonically declining social marginal value of welfare/income/health. At the same time, empirical studies that have elicited social preferences for allocation of health have reported results that are seemingly incompatible with this assumption. There are two ways of addressing this inconsistency; we may censor the stated preferences by arguing that they cannot be supported by normative arguments, or we may reject or modify the analytical framework in order to accommodate the stated preferences. We argue that the stated preferences can be supported by normative reasoning and therefore conclude that one should be cautious in applying the standard welfare economic framework to the allocation of health.

Copyright © 2012 Elsevier Ltd. All rights reserved.

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Infosuicide.org actualités: SANTE PUBLIQUE ET STIGMATISATION

L'anthropologue québécois Raymond Massé explique pourquoi l'absence de réflexion éthique sur les impacts des interventions de santé publique « n'est plus acceptable ». Il faut notamment former les intervenants quant ...
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Predictive genetic testing in minors for late-onset conditions: a chronological and analytical review of the ethical arguments -- Mand et al. 38 (9): 519 -- Journal of Medical Ethics

Abstract

Predictive genetic testing is now routinely offered to asymptomatic adults at risk for genetic disease. However, testing of minors at risk for adult-onset conditions, where no treatment or preventive intervention exists, has evoked greater controversy and inspired a debate spanning two decades. This review aims to provide a detailed longitudinal analysis and concludes by examining the debate's current status and prospects for the future. Fifty-three relevant theoretical papers published between 1990 and December 2010 were identified, and interpretative content analysis was employed to catalogue discrete arguments within these papers. Novel conclusions were drawn from this review. While the debate's first voices were raised in opposition of testing and their arguments have retained currency over many years, arguments in favour of testing, which appeared sporadically at first, have gained momentum more recently. Most arguments on both sides are testable empirical claims, so far untested, rather than abstract ethical or philosophical positions. The dispute, therein, lies not so much in whether minors should be permitted to access predictive genetic testing but whether these empirical claims on the relative benefits or harms of testing should be assessed.

 

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

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The Use of Persuasion in Public Health Communication: An Ethical Critique

Abstract

Public health communications often attempt to persuade their audience to adopt a particular belief or pursue a particular course of action. To a large extent, the ethical defensibility of persuasion appears to be assumed by public health practitioners; however, a handful of academic treatments have called into question the ethical defensibility of persuasive risk- and health communication. In addition, the widespread use of persuasive tactics in public health communications warrants a close look at their ethical status, irrespective of previous critiques. In this article, we review some ethical objections previously advanced against the use of persuasion in public health communications, and also consider some novel but potentially relevant objections. We conclude that persuasion is ethically problematic in some circumstances and attempt to clarify what these circumstances are. However, whereas persuasion may be ethically problematic in some circumstances, it need not be viewed as intrinsically problematic.

© The Author 2012. Published by Oxford University Press. Available online at www.phe.oxfordjournals.org

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Conditional Cash Transfer to Promote Institutional Deliveries in India: Toward a Sustainable Ethical Model to Achieve MDG 5A

Abstract

The Millennium Development Goal (MDG) 5 A states that the maternal mortality ratio has to be reduced to three-quarters between 1990 and 2015. The target for India is a maternal mortality ratio of 109/100,000 live births. The Janani Suraksha Yojna (JSY) (Maternal Protection Scheme) is a centrally sponsored conditional cash transfer scheme to promote institutional deliveries and thus ensure safe delivery and reduce maternal mortality. The JSY scheme and its various evaluations were reviewed. The Tannahill’s ethical framework was applied to the JSY and analyzed. Evaluations have shown that the JSY has significantly increased institutional deliveries. The public health system is not fully geared up for delivering good quality maternal health services. Thus encouraging women to go to them violates the principle of doing good. There are several barriers for availing the scheme. Procuring the certificates to meet eligibility can be difficult. The women do not have power over the cash incentive. There are large inequities in access to the JSY scheme based on socioeconomic status, caste and education. The accountability mechanisms for the scheme are weak at the grassroots level. Without an overall improvement in health system and awareness among women, the JSY cannot be said to empower the women in a sustainable way. In order, that the increases in institutional deliveries due to JSY are more than just a Hawthorne effect, which is a change in behavior just due to the fact that the population is being closely observed and intervened, there is a need to bridge the ethical gaps in the program to make it an empowering, sustainable, accountable and just one.

© The Author 2012. Published by Oxford University Press. Available online at www.phe.oxfordjournals.org

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The Public Interest, Public Goods, and Third-Party Access to UK Biobank

Abstract

In 2007, the Ethics and Governance Council of the UK Biobank commissioned a Report on ‘Concepts of Public Good and Pubic Interest in Access Policies’. This study considered the Biobank’s role as a ‘public good’ in respect to supporting and promoting health throughout society. However, the conditions under which access by third parties to UK Biobank are justified in the public interest have not been well considered. In this article, I propose to analyse the conditions that should allow such access. My argument develops UK Biobank’s function as a ‘public good’ and in terms of its responsibilities as a public health institution; both to protect the rights of the participants and in having a role in reinforcing public goals. Although these two tasks may conflict, it is possible that resolute opposition to some third-party access demands—if properly justified in terms of a public interest—will be damaging to, rather than protective of, participants’ rights. To illustrate my argument, I consider the appropriate response to an extraordinary public emergency, such as a serious criminal investigation or disaster response, in terms of an ethical access policy.

© The Author 2012. Published by Oxford University Press. Available online at www.phe.oxfordjournals.org

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Rawls and Religious Paternalism

Abstract

MacDougall has argued that Rawls’s liberal social theory suggests that parents who hold certain religious convictions can legitimately refuse blood transfusion on their children’s behalf. This paper argues that this is wrong for at least five reasons. First, MacDougall neglects the possibility that true freedom of conscience entails the right to choose one’s own religion rather than have it dictated by one’s parents. Second, he conveniently ignores the fact that children in such situations are much more likely to die than to survive without blood. Third, he relies on an ambiguous understanding of what is “rational” and treats children as mere extensions of their parents. Fourth, he neglects the fact that those in the original position would seek to protect themselves from persecution and enslavement and thus would not allow groups of children to be killed because of their parents’ beliefs. Finally, Rawls makes it clear that we should choose for children as we would choose for ourselves in the original position, with no particular conception of the good (such as that held by Jehovah’s Witnesses).

 

© The Author 2012. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

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Don't Call Me “Nudge”: The Ethical Obligation to Use Effective Interventions to Promote Public Health

Don't Call Me “Nudge”: The Ethical Obligation to Use Effective Interventions to Promote Public Health | Éthique et santé publique | Scoop.it
(2012). Don't Call Me “Nudge”: The Ethical Obligation to Use Effective Interventions to Promote Public Health. The American Journal of Bioethics: Vol. 12, No. 2, pp. 18-20.
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Seeking Better Health Care Outcomes: The Ethics of Using the “Nudge”

Seeking Better Health Care Outcomes: The Ethics of Using the “Nudge” | Éthique et santé publique | Scoop.it

Abstract

Policymakers, employers, insurance companies, researchers, and health care providers have developed an increasing interest in using principles from behavioral economics and psychology to persuade people to change their health-related behaviors, lifestyles, and habits. In this article, we examine how principles from behavioral economics and psychology are being used to nudge people (the public, patients, or health care providers) toward particular decisions or behaviors related to health or health care, and we identify the ethically relevant dimensions that should be considered for the utilization of each principle.

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Priorities for autism spectrum disorders risk communication and ethics

Abstract

Autism spectrum disorders are an issue of increasing public health significance. The incidence of autism spectrum disorders has been increasing in recent years, and they are associated with significant personal and financial impacts for affected persons and their families. In recent years, a large number of scientific studies have been undertaken, which investigate genetic and environmental risk factors for autism, with more studies underway. At present, much remains unknown regarding autism spectrum disorder risk factors, but the emerging picture of causation is in many cases complex, with multiple genes and gene–environment interactions being at play. The complexity and uncertainty surrounding autism spectrum disorder risk factors raise a number of questions regarding the ethical considerations that should be taken into account when undertaking autism spectrum disorder risk communication. At present, however, little has been written regarding autism spectrum disorder risk communication and ethics. This article summarizes the findings of a recent conference investigating ethical considerations and policy recommendations in autism spectrum disorder risk communication, which to the authors’ knowledge is the first of its kind. Here, the authors discuss a number of issues, including uncertainty; comprehension; inadvertent harm; justice; and the appropriate roles of clinicians, scientists, and the media in autism spectrum disorder risk communication.

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A realist-constructionist perspective on participatory research in health promotion. [Health Promot Int. 2012] - PubMed - NCBI

Abstract

Clarifying the contours of research in health promotion (HP) is an ongoing challenge. Research in this action-oriented field has traditionally been developed based on values such as participation and empowerment. Consequently, many forms of participatory research have emerged throughout the years, and participatory research has positioned itself as a core competency of HP and public health. This paper argues that participation as a normative stance guiding methodology, or as value, is a fragile posture upon which to position research practices. The argument is based on a realist-constructionist perspective of science and specifically uses Law and Latour's notion of inscription device and Callon's actor-network theory to suggest that participation is an epistemological necessity and that participatory research practices may be considered as inscription devices. These theoretical notions help clarify the consequences of participation on knowledge production. Finally, the article refers to Stengers's work to propose an ecology of research practices that defines obligations and exigencies for HP with respect to knowledge production and that are more consistent with the field's values of social justice and equity.

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JAMA Network | JAMA: The Journal of the American Medical Association | Ethical Challenges of Preexposure Prophylaxis for HIV

On July 16, 2012, emtricitabine/tenofovir (Truvada; Gilead Sciences) became the first drug approved by the US Food and Drug Administration (FDA) for preexposure prophylaxis (PrEP) of human immunodeficiency virus (HIV) for adults at high risk. Clinical trials have demonstrated that daily use of oral antiretroviral drugs can reduce the risk of HIV acquisition through sexual intercourse. With 50 000 new HIV infections per year in the United States1 and 2 million per year worldwide,2 PrEP could become a major component of “combination prevention” along with condoms, counseling, testing, and treatment.

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Responsibility, Paternalism and Alcohol Interlocks

Drink driving causes great suffering and material destruction. The alcohol interlock promises to eradicate this problem by technological design.
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The Ethics of Testing a Test: Randomized Trials of the Health Impact of Diagnostic Tests for Infectious Diseases. [Clin Infect Dis. 2012] - PubMed - NCBI

Abstract

In the last decade, many new rapid diagnostic tests for infectious diseases have been developed. In general, these new tests are developed with the intent to optimize feasibility and population health, not accuracy alone. However, unlike drugs or vaccines, diagnostic tests are evaluated and licensed on the basis of accuracy, not health impact (e.g., reduced morbidity or mortality). Thus, these tests are sometimes recommended or scaled-up for purposes of improving population health without randomized evidence that they do so. We highlight the importance of randomized trials to evaluate the health impact of novel diagnostics and note that such trials raise distinctive ethical challenges of equipoise, equity, and informed consent. We discuss the distinction between equipoise for patient-important outcomes versus diagnostic accuracy, the equity implications of evaluating health impact of diagnostics under routine conditions, and the importance of offering reasonable choices for informed consent in diagnostic trials.

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Ethical questions must be considered for electronic health records -- Spriggs et al. 38 (9): 535 -- Journal of Medical Ethics

Abstract

National electronic health record initiatives are in progress in many countries around the world but the debate about the ethical issues and how they are to be addressed remains overshadowed by other issues. The discourse to which all others are answerable is a technical discourse, even where matters of privacy and consent are concerned. Yet a focus on technical issues and a failure to think about ethics are cited as factors in the failure of the UK health record system. In this paper, while the prime concern is the Australian Personally Controlled Electronic Health Record (PCEHR), the discussion is relevant to and informed by the international context. The authors draw attention to ethical and conceptual issues that have implications for the success or failure of electronic health records systems. Important ethical issues to consider as Australia moves towards a PCEHR system include: issues of equity that arise in the context of personal control, who benefits and who should pay, what are the legitimate uses of PCEHRs, and how we should implement privacy. The authors identify specific questions that need addressing.

 

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

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Understanding Solidarity (With a Little Help from Your Friends)

Abstract

In this paper we respond to Angus Dawson’s and Marcel Verweij’s recent editorial on ‘Solidarity: A Moral Concept in need of Clarification’. While Dawson’s and Verweij’s call for a broader solidarity-based research agenda is highly timely, their critique of our Report on ‘Solidarity as an Emerging Concept in Bioethics’ (2011) is based on some mistaken assumptions and misinterpretations of our arguments. These are (1) a fundamental misunderstanding of the importance of practice in our conceptualisation of solidarity; (2) a misinterpreration of the normativity of our concept; and (3) a misrepresentation of our case study of public policy in the context of pandemics and in turn, of the relevance of our concept for policy-making. We correct each of these and in a final section we comment on the model of rational and constitutive solidarity put forward by Dawson and Verweij as an alternative to our conception of solidarity.

© The Author 2012. Published by Oxford University Press. Available online at www.phe.oxfordjournals.org

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Obesity: Towards a System of Libertarian Paternalistic Public Health Interventions

Abstract

This article draws on scientific explanations of obesity to motivate the creation of a system of paternalistic public health interventions into the obesity epidemic. Libertarian paternalists argue that paternalism is warranted in light of the cognitive limits of human decision-making abilities. There are further, specific biological limits on our capacity to choose and maintain a healthy diet. These biological facts strengthen the general motivation for libertarian paternalism. As a consequence, the creation of a system of paternalistic public health interventions into the obesity epidemic is warranted.

© The Author 2012. Published by Oxford University Press. Available online at www.phe.oxfordjournals.org

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Ethics of Artificial Water Fluoridation in Australia

Abstract

A recent decision by several Australian federal politicians to support a parliamentary review of artificial water fluoridation has an intensified debate on the public health intervention. While there is a majority agreement among Australian dentists and other health professionals that adequate enamel fluoride is essential for dental health, the ethics of artificial fluoridation of public water supplies as a contemporary vehicle for facilitating adequate supply of fluoride to teeth is highly contested. Opponents of artificial water fluoridation insist that there are many alternative sources of fluoride, that mandatory water fluoridation violates the ethical principle of autonomy and that water fluoridation is not only expensive and unnecessary but also may endanger health by causing fluorosis and, potentially, hypothyroidism and pathological bone fractures. In contrast, proponents of water fluoridation posit that mandatory water fluoridation facilitates health equity and that the benefits accruing to society from prevention of dental caries (beneficence principle) outweighs impairment of individual autonomy. This article utilizes Childress’ ‘justificatory conditions’ to evaluate the ethical appropriateness of artificial water fluoridation in Australia. The author concludes that there is insufficient ethical justification for artificial water fluoridation in Australia.

© The Author 2012. Published by Oxford University Press. Available online at www.phe.oxfordjournals.org

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