Health Ethics Perspective Research Articles

Determination of Caesarean Section (SC) Delivery

There is a trend of increasing SC procedures in a number of hospitals, both in private hospitals and goverment hospitals, even though the clinical risk to mothers who give birth through SC surgery is greater than the risk of normal (vaginal) birth. Psychological risks cannot be avoided because the pain after SC surgery is longer and there are risks to the baby. The risk of adverse post-SC consequences needs to be studied further from a health ethics perspective, starting from the doctor's decision-making process in carrying out SC surgery. This research method is analytical using a cross-sectional approach (V. Wiratna Sujarweni, 2020). Time and Place of Research: Research was conducted from June-August 2023. This research was conducted at the Palembang Muhammadiyah Hospital in 2023. The number of types of birth with SC was 70 respondents and normal delivery was 26 respondents. The results of statistical tests showed that there was a significant relationship between maternal age, PEB/eclampsia, premature rupture of membranes (KPD), and gravida status, with SC delivery. From the research results it can be concluded that the type of delivery, maternal age, PEB/eclampsia, premature rupture of membranes (KPD), and gravida status, are factors that cause respondents to undergo SC delivery

Public Health Ethics Issues Arising in Relation to the COVID-19 Mask Debate in Japan

Abstract Debates concerning mask wearing continue in Japan. Here we critically examine the reasons for relaxing these regulations from a public health ethics perspective. We focus on three issues: government responsibility, political motivation, and cultural orientation, also discussing how these issues might have broader application in other parts of the world.

Children and COVID-19 Vaccine: A Public Health Ethics Perspective

As COVID-19 cases were in rise all over the world and the World Health Organization declared a pandemic, there was an increasing focus on availability of new vaccines and drugs against the virus. Meanwhile, we already have several vaccines in COVID-19 vaccination programmes across the globe. During the process of development and clinical trials of the vaccines, several questions were popped up by multiple stakeholders about child vaccination against COVID-19. Most of the queries focused on safety of COVID-19 vaccines, the clinical trial process, priority criteria of getting a vaccine, why and why not children be included in the vaccination programme. In adult population of the country, COVID-19 vaccination programme is being carried out in an unequalled state; the focus is now on paeditric population, as some countries have already started to vaccinate children. At the time of writing this paper when Government of Bangladesh has not yet decided to vaccinate children in the country but initiatives has been taken by health department for above 12 years children vaccination. However, this paper aims to discuss potential ethical dilemmas related to COVID-19 vaccination in children especially in low-resource settings and dig into effective strategies to implement COVID-19 vaccination programme properly in the field of public health.
 Bangladesh Med J. 2021 Sept; 50(3): 44-48

Regulation of genetically engineered (GE) mosquitoes as a public health tool: a public health ethics analysis

BackgroundIn recent years, genetically engineered (GE) mosquitoes have been proposed as a public health measure against the high incidence of mosquito-borne diseases among the poor in regions of the global South. While uncertainties as well as risks for humans and ecosystems are entailed by the open-release of GE mosquitoes, a powerful global health governance non-state organization is funding the development of and advocating the use of those bio-technologies as public health tools.In August 2016, the US Food and Drug Agency (FDA) approved the uncaged field trial of a GE Aedes aegypti mosquito in Key Haven, Florida. The FDA’s decision was based on its assessment of the risks of the proposed experimental public health research project. The FDA is considered a global regulatory standard setter. So, its approval of the uncaged field trial could be used by proponents of GE mosquitoes to urge countries in the global South to permit the use of those bio-technologies.MethodFrom a public health ethics perspective, this paper evaluates the FDA’s 2016 risk assessment of the proposed uncaged field trial of the GE mosquito to determine whether it qualified as a realistic risk evaluation.ResultsThe FDA’s risk assessment of the proposed uncaged field trial did not proximate the conditions under which the GE mosquitoes would be used in regions of the global South where there is a high prevalence of mosquito-borne diseases.ConclusionGiven that health and disease have political-economic determinants, whether a risk assessment of a product is realistic or not particularly matters with respect to interventions meant for public health problems that disproportionately impact socio-economically marginalized populations. If ineffective public health interventions are adopted based on risk evaluations that do not closely mirror the conditions under which those products would actually be used, there could be public health and ethical costs for those populations.

The Ethics of Stigma in Medical Male Circumcision Initiatives Involving Adolescents in Sub-Saharan Africa.

Ongoing global efforts to circumcise adolescent and adult males to reduce their risk of acquiring HIV constitute the largest public health prevention initiative, using surgical means, in human history. Voluntary medical male circumcision (VMMC) programs in Africa have significantly altered social norms related to male circumcision among previously non-circumcising groups and groups that have practiced traditional (non-medical) circumcision. One consequence of this change is the stigmatization of males who, for whatever reason, remain uncircumcised. This paper discusses the ethics of stigma with regard to uncircumcised adolescent males in global VMMC programs, particularly in certain recruitment, demand creation and social norm interventions. Grounded in our own experiences gained while conducting HIV-related ethics research with adolescents in Kenya, we argue that use of explicit or implicit stigma to increase the number of VMMC volunteers is unethical from a public health ethics perspective, particularly in campaigns that leverage social norms of masculinity. Ongoing global efforts to circumcise adolescent and adult males to reduce their risk of acquiring HIV constitute the largest public health prevention initiative, using surgical means, in human history. VMMC programs in Africa have significantly altered social norms related to male circumcision among previously non-circumcising groups and groups that have practiced traditional (non-medical) circumcision. One consequence of this change is the stigmatization of males who, for whatever reason, remain uncircumcised. This paper discusses the ethics of stigma with regard to uncircumcised adolescent males in global VMMC programs, particularly in certain recruitment, demand creation and social norm interventions. Grounded in our own experiences gained while conducting HIV-related ethics research with adolescents in Kenya, we argue that use of explicit or implicit stigma to increase the number of VMMC volunteers is unethical from a public health ethics perspective, particularly in campaigns that leverage social norms of masculinity.

COVID-19 Lockdowns: a Public Mental Health Ethics Perspective.

States all over the world have reacted to COVID-19 with quarantines of entire cities, provinces, and even nations. Previous studies and preliminary evidence from current lockdowns suggest that emergency measures protecting the public’s physical health by dislocating individuals, families, and social networks could well be causing a devastating public health crisis of mental ill-health in the months and years to come. This article is the first to take a public mental health ethics perspective in examining these lockdowns, the lodestar of which is the right to mental health, rooted in the concept of human dignity. Even the strictest lockdowns are not necessarily unethical but are prone to damage mental health disproportionately, with vulnerable and disadvantaged populations being at particular risk.

Ethical Implementation of Immunity Passports During the COVID-19 Pandemic.

A number of countries are planning the use of “immunity passports” as a way to ease restrictive measures and allow infected and recovered people to return to work during the COVID-19 pandemic. This paper brings together key scientific uncertainties regarding the use of serological tests to assure immune status and a public health ethics perspective to inform key considerations in the ethical implementation of immunity passport policies. Ill-conceived policies have the potential to cause severe unintended harms that could result in greater inequity, the stigmatization of certain sectors of society, and heightened risks and unequal treatment of individuals due to erroneous test results. Immunity passports could, however, be used to achieve collective benefits and benefits for specific populations besides facilitating economic recovery. We conclude that sector-based policies that prioritize access to testing based on societal need are likely to be fairer and logistically more feasible, while minimizing stigma and reducing incentives for fraud. Clear guidelines need to be set out for which sectors of society should be prioritized for testing, and rigorous mechanisms should be in place to validate test results and identify cases of reinfection.

Justice in control of methicillin-resistant Staphylococcus aureus transmission: a fair question to ask?

Active surveillance cultures and contact precautions is a strategy to control the transmission of methicillin-resistant Staphylococcus aureus (MRSA) within healthcare facilities. Whether to implement this strategy to routinely screen and isolate inpatients with MRSA in non-outbreak (endemic) settings, or to remove it and use standard infection control precautions only is scientifically and ethically controversial, in view of the potential adverse effects of contact precautions on patients. To support the use of standard precautions only, it has been argued that active surveillance to identify patients who are asymptomatically colonised with MRSA to place them in contact precautions is unjust or unfair to these patients in various ways. This paper will unpack and examine four distinct arguments, which are advanced from a medical ethics or quality improvement ethical framework, for why this is so. Our analysis shows that while these arguments highlight the injustice of current practices, they do not provide strong ethical reasons for justifying the removal of active surveillance and contact precautions to control MRSA transmission and infection. An implication of our arguments is that the ethical frame for evaluating prevention and control strategies for MRSA, a multi-drug resistant bacteria, should shift from healthcare to primarily public health. From a public health ethics perspective, whether a strategy is unjust, or how ethically significant its lack of fairness is, depends on assessing the evidence for its public health effectiveness and necessity in a given setting, and the extent of the harms and burdens patients with MRSA bear when they are on contact precautions, which remain matters of scientific debate or uncertainty. As an ethical consideration in the debate, the chief normative implication of justice is to provide us further reasons to revise current active surveillance-contact precautions practices, and for the need for research and interventions to minimise their potential adverse effects on patients.

The value of harm reduction for injection drug use: A clinical and public health ethics analysis

The US is facing dual public health crises related to opioid overdose deaths and HIV. Injection drug use is fueling both of these epidemics. The War on Drugs has failed to stem injection drug use and has contributed to mass incarceration, poverty, and racial disparities. Harm reduction is an alternative approach that seeks to decrease direct and indirect harms associated with drug use without necessarily decreasing drug consumption. Although overwhelming evidence demonstrates that harm reduction is effective in mitigating harms associated with drug use and is cost-effective in providing these benefits, harm reduction remains controversial and the ethical implications of harm reduction modalities have not been well explored.This paper analyzes harm reduction for injection drug use using the core principles of autonomy, nonmaleficence, beneficence, and justice from both clinical ethics and public health ethics perspectives. This framework is applied to harm reduction modalities currently in use in the US, including opioid maintenance therapy, needle and syringe exchange programs, and opioid overdose education and naloxone distribution. Harm reduction interventions employed outside of the US, including safer injection facilities, heroin-assisted treatment, and decriminalization/legalization are then discussed. This analysis concludes that harm reduction is ethically sound and should be an integral aspect of our nation's healthcare system for combating the opioid crisis. From a clinical ethics perspective, harm reduction promotes the autonomy of, prevents harms to, advances the well-being of, and upholds justice for persons who use drugs. From a public health ethics perspective, harm reduction advances health equity, addresses racial disparities, and serves vulnerable, disadvantaged populations in a cost-effective manner.

Digital Humanitarians: How Big Data Is Changing the Face of Humanitarian Response

This is a review of Patrick Meier’s 2015 book, Digital Humanitarians: How Big Data Is Changing the Face of Humanitarian Response. The book explores the role of technologies such as high-resolution satellite imagery, online social media, drones, and artificial intelligence in humanitarian responses during disasters such as the 2010 Haiti earthquake. In this analysis, the book is examined using a humanitarian health ethics perspective.

Health of Migrants: Approaches from a Public Health Ethics Perspective

Health of Migrants: Approaches from a Public Health Ethics Perspective

Ethical considerations in biobanks: how a public health ethics perspective sheds new light on old controversies.

Biobanks, collections of biospecimens with or without linked medical data, have increased dramatically in number in the last two decades. Their potential power to identify the underlying mechanisms of both rare and common disease has catalyzed their proliferation in the academic, medical, and private sectors. Despite demonstrated public support of biobanks, some within the academic, governmental, and public realms have also expressed cautions associated with the ethical, legal, and social (ELSI) implications of biobanks. These issues include concerns related to the privacy and confidentiality of data; return of results and incidental findings to participants; data sharing and secondary use of samples; informed consent mechanisms; ownership of specimens; and benefit sharing (i.e., the distribution of financial or other assets that result from the research). Such apprehensions become amplified as more researchers seek to pursue national and cross-border collaborations between biobanks. This paper provides an overview of two of the most contentious topics in biobank literature - informed consent and return of individual research results or incidental findings - and explores how a public health ethics lens may help to shed new light on how these issues may be best approached and managed. Doing so also demonstrates the important role that genetic counselors can play in the ongoing discussion of ethically appropriate biobank recruitment and management strategies, as well as identifies important areas of ongoing empirical research on these unresolved topics.

Pharmacovigilance and Public Health Ethics

Traditionally, bioethics has focused on the obligations of healthcare professionals and the rights of individual patients as well as participants in clinical research. However, in recent years, this center of attention has been questioned and a new “Public Health Ethics” has emerged. It argues that when dealing with ethical issues related to research or interventions, the health of groups and populations should be considered and not only that of individuals. This article reviews the background to the current debate on Public Health Ethics as well as some ethical theories and principles guiding its development. Following a discussion of issues in pharmacovigilance with an ethical dimension, the article explores the potential implications of the emergence of a Public Health Ethics perspective for regulatory pharmacovigilance as a public health activity. In summary it appears that this new perspective may offer a new take on ethical issues in pharmacovigilance and provide guidance as to when public health paternalism is justified or when the public good should take precedence over rights of individuals.

Professional ethics between the individual and society

Invited commentary on ‘Physical therapy and a public health ethics perspective’, Dawson A and Sim J.In their article ‘Physical therapy and a public health ethics perspective’,1 Dawson and Sim argue...

What Does Public Health Ethics Tell (Or Not Tell) Us About Intervening in Non-Communicable Diseases?

Obesity has been described as pandemic and a public health crisis. It has been argued that concerted research efforts are needed to enhance our understanding and develop effective interventions for the complex and multiple dimensions of the health challenges posed by obesity. This would provide a secure evidence base in order to justify clinical interventions and public policy. This paper critically examines these claims through the examination of models of public health and public health ethics. I argue that the concept of an effective public health intervention is unclear and underdeveloped and, as a consequence, normative frameworks reliant on meeting the effectiveness criterion may miss morally salient dimensions of the problems. I conclude by arguing for the need to consider both an ecological model of public health and inclusion of a critical public health ethics perspective for an adequate account of the public health challenges posed by obesity.

Physical therapy and a public health ethics perspective

Physical therapists have recently broadened their professional activity into the sphere of community and public health. Work on the ethics of physical therapy, however, has focussed largely on issues that arise within the traditional therapist–patient dyad. This paper explores the place of a public health ethics perspective within physical therapy, and considers the way in which the values and principles that have customarily informed ethical debate in physical therapy may need to be reconsidered and applied in different ways. Initially, the nature of public health, and by extension of public health ethics, is considered, and a distinction between ‘narrow’ and ‘broad’ definitions of public health is drawn. The current and potential role of physical therapy in public health is briefly discussed, and three specific areas are then explored: priority setting, autonomy in relation to health promotion, and involvement in the political sphere. It is argued that engagement with issues such as these requires a different approach to ethical decision making, and also a reappraisal of the boundaries of the professional role.