Public Health Ethics Research Articles

Why ethical frameworks fail to deliver in a pandemic: Are proposed alternatives an improvement?

In the past decade, numerous ethical frameworks have been developed to support public health decision-making in challenging areas. Before the COVID-19 pandemic began, members of the authorship team were involved in research programmes, in which the development of ethical frameworks was planned, to guide (a) the use of new technologies for emerging infectious disease surveillance; and (b) the allocation of scarce supplies of pandemic influenza vaccine. However, as the pandemic evolved, significant practical challenges emerged that led to our questioning the value of these frameworks. We now believe that a normative instrument, such as a framework, cannot adequately or reliably provide the ethical guidance that needs to be incorporated into public health decision-making during natural disasters or infectious disease emergencies. Recently it has been suggested that there are potentially more dynamic, flexible, and effective ways to navigate decisions involving complex considerations entailed in policies and practices during a public health emergency. In this paper, we first outline the key functions of a public health ethics framework, before describing why we believe it would not be fit for purpose during a crisis. We end by considering whether proposed alternative methods to promote ethical public health decision-making goals have the potential to meet these objectives.

Closing Ventanas to open doors: an ethical approach to public health research in areas of high climate vulnerability

In the context of climate change, the complex relationship between humanity and nature is revealed. This context provides an excellent opportunity to understand the tensions, ethical, and philosophical aspects involved in health research in areas of high climatic vulnerability. To address this problem, the situation of the Concón, Quintero, and Puchuncaví area, one of the five environmental sacrifice zones established in Chile, is used as a case study. After years of studies on the harmful health effects of this industrial center and governmental inaction, the executive power decided to close the Codelco Ventanas Division Smelter. This closure allows us to reflect on the opportunities for developing ethical public health research in areas of high climate vulnerability, in addition to making clear the role of public health professionals under the principle of responsibility, using environmental, climate, and intergenerational justice

Public health ethics and punitive drug policy: Are new proposed sanctions for drug possession in the UK ethically justifiable?

Public health ethics and punitive drug policy: Are new proposed sanctions for drug possession in the UK ethically justifiable?

Rethinking the Ethics of the Covid-19 Pandemic Lockdowns.

Public health responses to the Covid-19 pandemic included various measures to mitigate the spread of the virus. Among these, the most restrictive was a broad category referred to as "lockdowns." We argue that the reasoning offered in favor of extended lockdowns-those lasting several months or longer-did not adequately account for a host of countervailing considerations, including the impact on mental illness, education, employment, and marginalized communities as well as health, educational, and economic inequities. Furthermore, justifications offered for extended lockdowns set aside a basic tenet of public health ethics: restrictions on liberty and autonomy should be the least intrusive means of achieving the desired end. Since it is now clear that extended lockdowns cause severe harm to many vulnerable populations, the burden of proof is on those who would advocate for them, and there must be a much higher bar to implement an extended lockdown, with high-quality evidence that the benefit would substantially exceed its harm.

P-384 Advanced paternal age: a mapping of the ethical issues

Abstract Study question What are the ethical issues raised by advanced paternal age? Summary answer Advanced paternal age is an ethically challenging phenomenon at the intersection of perinatal ethics, public health ethics, research ethics and policymaking. What is known already Although there is no clear indication on when begins advanced paternal age (APA), there is a tendency to consider 40 years old and over as a turning point in male reproduction. APA is now associated with several risks for male fertility, miscarriages, future child health and psychological development. Clinicians, scientists, social science researchers and ethicists have pointed several ethical issues raised by APA. For the moment, the scope of this discussion has not been fully assessed in a systematic way. Study design, size, duration To support a comprehensive evaluation of APA, we propose a mapping of the ethical issues of APA. Participants/materials, setting, methods First, we conducted a systematic literature review to identify ethical issues pointed by researchers and clinicians. Second, this first list of issues was discussed by a panel of experts (N = 23) through a web survey. The results from both data collections were triangulated by qualitative analysis into an integrated list of issues. Main results and the role of chance Six groups of issues emerged from data analysis. The first group relates to issues associated with the family project. In other words, how to balance the risks of APA with the benefits of the family project. The second group looks at the issues for healthcare professionals, i.e., how to support the family project while respecting the professional duty to protect their patients’ wellbeing. The third group refers to the gender justice issues and how APA generates inequities between gendered reproductive roles. The fourth group covers the public health dimension of APA and the justification to create intervention to respond to a collective and potentially intergenerational phenomenon. The fifth group is concerned about ways to develop sound and fair policies to respond to the challenges of APA. The sixth group encompasses research ethics issues on how to respectfully develop the field of research on APA. Limitations, reasons for caution APA is a burgeoning field of research, and it faces two principal limitations: (1) there is no clear understanding of the molecular mechanism of APA effect, and (2) data on the psychosocial dimension of APA is scarce. For these reasons, the ethical reflection is still speculative. Wider implications of the findings These findings offer a roadmap for future research on the ethics of APA. They provide a comprehensive understanding of issues that can be discussed during preconception counselling. At last, they suggest indications for the development of public health interventions or policies dedicated to address the most challenging aspects of APA. Trial registration number not applicable

Public Health Reports in 2022: Impact Factor Increase; COVID-19 Coverage; Authorship by State, Tribal, Local, and Territorial Agencies; and New Department on Public Health Ethics.

Public Health Reports in 2022: Impact Factor Increase; COVID-19 Coverage; Authorship by State, Tribal, Local, and Territorial Agencies; and New Department on Public Health Ethics.

Quantifying the impact of individual and collective compliance with infection control measures for ethical public health policy.

Infectious disease control measures often require collective compliance of large numbers of individuals to benefit public health. This raises ethical questions regarding the value of the public health benefit created by individual and collective compliance. Answering these requires estimating the extent to which individual actions prevent infection of others. We develop mathematical techniques enabling quantification of the impacts of individuals or groups complying with three public health measures: border quarantine, isolation of infected individuals, and prevention via vaccination/prophylaxis. The results suggest that (i) these interventions exhibit synergy: They become more effective on a per-individual basis as compliance increases, and (ii) there is often substantial "overdetermination" of transmission. If a susceptible person contacts multiple infectious individuals, an intervention preventing one transmission may not change the ultimate outcome (thus, risk imposed by some individuals may erode the benefits of others' compliance). These results have implications for public health policy during epidemics.

The Conflict Between Public Health And Civil Liberties: The Initial UK Government Policy Response to the Covid-19 Pandemic

This paper aims to illustrate the tension between public health and civil liberties through the case study of the UK government’s emergency response to the Covid-19 pandemic. In the area of public health, this tension is predominantly approached by reference to two theories: liberalism and communitarianism. This paper studies these positions and how they are manifested in evidence-based policymaking by combining a study of public health policy with a study of public health ethics. The studies help demonstrate the UK government’s framing of health policy relating to Covid-19 in terms of liberalism and communitarianism. The paper concludes that in the initial UK government response to Covid-19, the government discourse evoked communitarian values and framed its policies as being evidence-led and as prioritising public health. However, the policy measures themselves manifested liberal values: they had the underlying concern of not infringing excessively on civil liberties, and individuals were given autonomy of decision making within the measures that were taken. The article concluded that emergency times require a communitarian response based on preventative action. This article is the first to combine public health policy with public health ethics to demonstrate how values form a key part of decision making.

A public health ethics exploration of a novel mobile health application for public health surveillance

A public health ethics exploration of a novel mobile health application for public health surveillance

Public health ethics in the education and training of our public health workforce

Public health ethics in the education and training of our public health workforce

Chapitre 5. L’impact de la pandémie de COVID-19 sur l’évolution du paradigme éthique de la médecine clinique en Russie (« à la guerre comme à la guerre »)

The CОVID-19 pandemic became a catalyst for the transformation of the ideas of the existence of global ethics in favor of real moral pluralism, exposed the problem of abandoning the principles of personalized medicine in favor of public health ethics (collective ethics of civil society). The authors sequentially analyze the objective factors that influenced the change in the moral paradigm of the clinical medicine in Russia: the peculiarities of the course of infection, the lack of resources in the health-care sector, the inability to use advanced treatment methods in different groups of patients, the protection of medical workers, the provision of emergency and planned surgical interventions, and the prevention of further spread of infection. In addition, the moral consequences of the use of administrative measures to limit the spread of the pandemic are given: restriction of social contacts, the use of personal protective equipment, retraining of specialists, re-profiling of the bed fund, leveling problems of communication with colleagues, patients and students. Special attention is paid to the problem of “anti-vaxxers”, representing a significant part of society and hindering the implementation of the vaccination program of the population. We believe that active and passive protest against vaccinations lie not in a rational plane, but in an emotional one, in an immanent distrust of the state and its institutions. Thus arises a secondary ethical problem of the state’s responsibility for the life and health of every citizen, regardless of their beliefs. Contradictions in the moral principles of individual strata of the population (including groups like those who agree to get vaccinated, those who doubt, the indifferent ones, “active anti-vaccinators”) currently seem irreconcilable due to the state’s detachment from solving moral problems.Ethic divergence in the context of the pandemic has become real, stable and difficult to overcome, while the claims of a single, global, global bioethics are being questioned. The COVID-19 pandemic has formulated the ethical task of the 21st century, which will have to be the development of public policy and practice of clinical medicine in the context of serious moral contradictions and significant bioethical differences.

Vietnam and its international commitments and obligations of human rights: The case of the individual rights to life, liberty, and personal security in the time of COVID-19

The respect, protection, and fulfilment of human rights has always been one of the foremost priorities of countries. The primary responsibility of such belongs to the state as recognized in international and national legal regulations. Indeed, international and national law, especially international human rights law, recognizes that in certain circumstances such as emergency cases human rights can be limited, temporarily restricted, temporarily suspended, or, based on the three basic reasons: (1) public security and public order, (2) public health and social ethics, and (3) the rights and interests of others. These restrictions must be established by law and under the principles of the rule of law, democracy, openness, transparency, and accountability. The vulnerability of restricting human rights during emergencies, such as the prevention of COVID-19 for public health reasons during the recent widespread pandemic, shows need and urgency for the theory and practice of crisis management and the guarantee of human rights on a global, regional, and national scale. Therefore, this article contributes to the analysis and interpretation of the theoretical and practical basis for ensuring human rights in emergency situations through Vietnamese legal provisions and practices of the right to life in time of COVID-19.

Factors of influenza vaccine inoculation and non-inoculation behavior of community-dwelling residents in Japan: Suggestions for vaccine policy and public health ethics after COVID-19.

The aim of this study is to provide basic information that contributes to vaccine inoculation policy after COVID-19. We used the secondary data of the influenza vaccine inoculation behavior survey for community-dwelling adults conducted in 2011, before the COVID-19 pandemic, but after the 2009 novel influenza A (H1N1) pdm 09 pandemic. All factors such as socio-demographic characteristics, health-related behaviors, family environment, physical and social environment, and area of residence were adjusted, and factors related to vaccine inoculation behavior were analyzed. Those living with pregnant women had a significantly higher odds ratio of inoculation; this was self-evident in that those people considered infection to their family. Regarding the social environment, those aged 20-64years with a significantly higher adjusted odds ratio of inoculation were those with "at least five people with which they interacted in the neighborhood". This result can be interpreted in two ways relating to altruism in Japan. Finally, we indicated the importance of learning from the past, including the case of 2009.

What Type of Person Should I Be? About the Appeal to Virtues in Public Health Interventions.

In line with how ethics has developed for the last three centuries, public health ethics has been widely dominated by a deontological as well as a utilitarian approach. The latter is a version of consequentialism, which states that maximizing utility is the primary goal of the majority of individuals or group action, while, on the other hand, virtue ethics, or at least the appeal to virtues, has been largely marginalized. The aim of this article is twofold. Firstly, we aim to highlight the political and ethical nature of public health interventions, often interpreted and presented as mere scientific enterprises. Secondly, we try to highlight the need to integrate or at least recognize the value of appeal to virtues in public health measures. The analysis will reference the Italian COVID-19 vaccination program as a case study. Initially, we will explore the political and ethical nature of any public health measure, using the implementation of the COVID-19 vaccination program in Italy as an example. Subsequently, we will illustrate the deontological approach to ethics, the utilitarian one, and the virtues one, focusing on the dynamic of the agent's perspective. Lastly, we will briefly analyze both the Italian COVID-19 vaccination program and the communication campaign that promoted it.

Good death disrupted: Nurses' moral emotions navigating clinical and public health ethics during the first wave of COVID-19 pandemic.

To explore the moral emotions that frontline nurses navigated in endeavouring to ensure a 'good death' for hospital patients and care home residents during the first wave of the COVID-19 pandemic. Under normal circumstances, frontline staff are focused on clinical ethics, which foreground what is best for individuals and families. Public health crises such as a pandemic require staff to adapt rapidly to focus on what benefits communities, at times compromising individual well-being and autonomy. Visitor restrictions when people were dying provided vivid exemplars of this ethical shift and the moral emotions nurses encountered with the requirement to implement this change. Twenty-nine interviews were conducted with nurses in direct clinical care roles. Data were analysed thematically informed by the theoretical concepts of a good death and moral emotions. The data set highlighted that moral emotions such as sympathy, empathy, distress and guilt were integral to the decisions participants described in striving for a good palliative experience. Four themes were identified in the data analysis: nurses as gatekeepers; ethical tensions and rule bending; nurses as proxy family members; separation and sacrifice. Participants reflected on morally compromising situations and highlighted agency through emotionally satisfying workarounds and collegial deliberations that enabled them to believe that they were party to painful but morally justifiable decisions. Nurses are required to implement national policy changes that may disrupt notions of best practice and therefore be experienced as a moral wrong. In navigating the moral emotions accompanying this shift, nurses benefit from compassionate leadership and ethics education to support team cohesion enabling nurses to prevail. Twenty-nine frontline registered nurses participated in the qualitative interviews that inform this study. The study adhered to the Consolidated Criteria for Reporting Qualitative Research checklist.

Exercising Caution: A Case for Ethics Analysis in Physical Activity Promotion

Abstract Despite the important role of physical activity in population health and well-being, it has received less focus in public health ethics as compared to other modifiable lifestyle factors such as smoking and diet. However, when considering the current and potential role of physical activity within public health—including interventions and policies to encourage physical activity in schools and workplaces, changes to the built environment and the equity issues associated with access to physical activity—it is a ripe territory for ethical analysis. This paper makes a case for a more sustained focus on physical activity within public health ethics by reviewing two ethical issues within physical activity and public health: physical activity inequity as a structural injustice issue, and stigma in physical activity promotion. While the benefits of physical activity for every age group and demographic are numerous, ethics oversight is encouraged to ensure that these efforts do not impose unnecessary risks or stigmatize marginalized populations.

Collaboration and research imperatives for a growing right-to-die movement.

This commentary discusses key controversies surrounding assisted dying that have now evolved, creating further tensions and divisions among assisted dying organizations, adding to existing controversy based on ethical, political, and theological grounds-all shaping public health policy in Canada and elsewhere. The growing worldwide trend in the right-to-die movement is increasingly focusing on medical assistance in dying (MAID) with most service organizations (societies) devoted to a sanctioned, legislatively prescribed approach. While in consequence important changes have occurred in numerous countries and jurisdictions with successful challenges on the absolute prohibition to assisted dying, it is arguably the case that as many-if not more-people are still denied this controversial right to have a peaceful, reliable, and painless end of their own choosing. We examine implications of this for beneficiaries and service providers, while showing how a collaborative and strategic approach that includes all options to access a human right to determine our own end-of-life options can effectively address these tensions for the benefit of all right-to-die organizations, regardless of differences in their respective tasks, directions, and agendas, with each mutually reinforcing the work of the other. We conclude by stressing the essential need for collaboration in terms of furthering research to better understand challenges facing policymakers andbeneficiaries and potential liabilities for health professionals providing this service.

The Right to Protest During a Pandemic: Using Public Health Ethics to Bridge the Divide Between Public Health Goals and Human Rights

Public protest continued to represent a prominent form of social activism in democratic societies during the COVID-19 pandemic. In Australia, a lack of specific legislation articulating protest rights has meant that, in the context of pandemic restrictions, such events have been treated as illegal mass gatherings. Numerous large protests in major cities have, indeed, stirred significant public debate regarding rights of assembly during COVID-19 outbreaks. The ethics of infringing on protest rights continues to be controversial, with opinion divided as to whether public health goals or human rights should take precedence. This paper applies public health ethical theory to an in-depth analysis of arguments on both sides of the debate. Using the Nuffield Council on Bioethics framework as a backdrop, proportionality and necessity of restrictions are understood as key concepts that are common to both public health and human rights perspectives. The analysis presented here finds a middle-ground between the prevailing arguments on opposing sides and is further able to rationalize the use of protest itself as an important element of a mature public health ethics response to restrictive policy. Thus, this paper aims to influence public health policy and legislation regarding protest rights during public health emergencies.

Ethics Principles for Artificial Intelligence-Based Telemedicine for Public Health.

The use of artificial intelligence (AI) in the field of telemedicine has grown exponentially over the past decade, along with the adoption of AI-based telemedicine to support public health systems. Although AI-based telemedicine can open up novel opportunities for the delivery of clinical health and care and become a strong aid to public health systems worldwide, it also comes with ethical risks that should be detected, prevented, or mitigated for the responsible use of AI-based telemedicine in and for public health. However, despite the current proliferation of AI ethics frameworks, thus far, none have been developed for the design of AI-based telemedicine, especially for the adoption of AI-based telemedicine in and for public health. We aimed to fill this gap by mapping the most relevant AI ethics principles for AI-based telemedicine for public health and by showing the need to revise them via major ethical themes emerging from bioethics, medical ethics, and public health ethics toward the definition of a unified set of 6 AI ethics principles for the implementation of AI-based telemedicine. (Am J Public Health. 2023;113(5):577-584. https://doi.org/10.2105/AJPH.2023.307225).

The Ethical Framework with COVID-19 and Challenges of Bangladesh Government: A Critical Discussion

To control the spread of nCoV-2 (COVID-19), almost all countries are taking active non-therapeutic measures. COVID-19 has delivered to the fore the long-standing debates on ethics, public health ethics, and moral values. Human life is uncertain and threatened due to no medical invention generally to guard life against this dangerous virus by using social and community protection to be maintained as a safeguard. For affected individuals and fair dealings, ethics, ethical values, and morality are the sole force to dominate this case and are thought-about vital tools. Patients, their relatives, aid workers, policymakers, and the general public face ethical issues due to the pandemic. The foremost attentive ethical problems during this crisis area unit human rights, obligations for healthcare staff, and obligations of nations and intergovernmental organizations. Then, at that point, the test of moral qualities is a unit that has been addressed: the morals of segregation and social separation, the obligation of care of teammates with patients, and admittance to treatment when assets are restricted. This article will clarify the ethical framework and ethical values of the main tools in non-pharmacological and non-vaccine-related situations of this disease. It will provide a basic ethical framework to guide decision-makers at all levels in the preparation and response to COVID-19, with much attention paid to allocating scarce resources. Data was gathered and reviewed from secondary documents, observation, and previous studies such as articles and journals. Bangladesh, one of the foremost inhabited territories in this world, has an extreme challenge to implement mitigation measures for this extensive corruption and mismanagement problem. The findings of this study show that the various ethical aspects are the only power for managing COVID-19. An ethical framework that promotes trust-building and solidarity and guides decision-making can still be developed. This study will play a role in ethically combating this devastating COVID-19 pandemic and creating a model for the authority that will maintain ethical values in numerous segments of the department. This writing will also guide, by the notion of position, notions of trust, ethical behavior, and sensible decision-making and apply these ethical concerns to the present situations for the pandemic, and provide individuals ways to attach and facilitate every other.