The Online Journal of Health Ethics is a multidisciplinary journal, which seeks to publish original research findings in the field of Public Health ranging from General Practice Nursing to behavioral health or public health and policy. The purpose of this journal is to provide a forum for the expression of ethics related to health in a scholarly format. Works to be considered for publication include, but are not limited to, article reviews, poems, letters to editors, book reviews, commentaries, short stories, full length articles, and case studies from authors in Nursing, Public Health and Policy, Nutrition, Social Work, and other disciplines that work with or are committed to improving the lives of individuals from a holistic worldview.


The library contains articles of the Online Journal of Health Ethics as of 1(2004) to current.

Recent Submissions

  • Health Inequality as a Socially Created Complex System

    Battle-Fisher, Michele (The Aquila Digital Community, 2021-12-01)
    Brought to light by COVID-19, and the Black Lives Matter and Twitter #BlackBioethics movements, bioethics as a discipline has not intentionally accounted for distributive justice in its scholarship. Modern society exhibits gross disparities that affect marginalized populations who suffer amid social, financial, physical and emotional stressors. While marginalized groups that are underserved are not monoliths, disparity persists in disadvantaged communities regardless of social and economic strata. Disparity is the epitome of injustice. The overemphasis on proximal determinants demonstrates ill placed overemphasis on personal culpability whilst ignoring systemic factors that result in structural injustice. The sciences of complexity and systems thinking move healthcare beyond historically ingrained heuristics that more often than not entrench disparities meant to be reversed. This paper sets out the argument that the application of complexity and systems as a groundwork for culturally inclusive bioethics by framing health disparities as structurally and morally complex.
  • "I Felt What was Happening in Our Country [USA] with Race was So Much Scarier than the [COVID-19] Virus.” Black Lives Matter Protesters’ Beliefs and Practices During the COVID-19 Pandemic

    Arana-Chicas, Evelyn; Jones, Brooke D.; Cartujano-Barrera, Francisco; Cupertino, Ana Paula (The Aquila Digital Community, 2021-12-01)
    This study describes the COVID-19 prevention practices and beliefs of Black Lives Matter protesters in the U.S. Participants completed a survey on following COVID-19 guidelines and answered interview questions. Twenty participants were enrolled. Mean age was 29 and most were female (80%) and black (75%). Participants almost always wore their masks (75%) and washed their hands (85%) while protesting. Most reported rarely social distancing (55%) and not being concerned about COVID-19 (55%). Themes included: 1) Fighting for social justice, 2) Protesting is more important than COVID-19, 3) Unable to social distance, 4) Masks mostly worn, 5) Protests sparked global movement, and 6) Increasing awareness of injustices. Our results suggest that protestors understand the importance of preventing the spread of COVID-19 and follow guidelines, but there are suggestions that some protestors do not consistently adhere to these guidelines. Results may contribute to policies that control the spread of COVID-19.
  • An Ethical Comparison of the COVID-19 National Disease Control Performance of China, Canada and the U.S. in the First Year of the Pandemic

    Gellert, George A; Gellert, Gabriel L. (The Aquila Digital Community, 2021-12-01)
    Objective: First year government pandemic control performance is compared in China, Canada and the USA to understand the ethical bases of different population outcomes achieved. Methods: Comparative analysis of ethical underpinnings and implications of pandemic performance includes degree of authoritarian power deployed to mitigate disease spread; benefits of single payer health care; impact of socioeconomic, racial/ethnic and health care inequities; anti-government sentiment/distrust; national leadership engagement; and science denial. Results: National COVID-19 response efforts vary according to the extent to which they leveraged autocratic tactics, from China whose highly autocratic first year pandemic performance was emulated, through liberal democracies like Canada where ethical compromises were largely avoided, to the USA where federal government abandonment of public health ethics produced one of the deadliest pandemic first year performances. Conclusions: Examining the ethics of pandemic disease control practices can lessen risk of repeated pandemic performance failures, and associated avoidable morbidity/mortality in future pandemics.
  • Agency and Health Policies

    Lopez Barreda, Rodrigo (The Aquila Digital Community, 2021-12-01)
    In the current medical ethics literature, the concept of agency is receiving growing attention. Nevertheless, many of those definitions are narrow in scope. This article intends to provide a deeper understanding of this concept, allowing for its use in clinical practice and public health policies. First, it revises the current concept of agency and some of its shortcomings. Then, the article presents two philosophical accounts of agency, identifying three relevant features, namely time-extended organised planfulness, endorsement of their own actions, and identification with the activity. Lastly, the article depicts how those features may help in the application of agency to the analysis of health issues by means of a number of examples at the individual and collective levels. When analysing health issues, the health status is a key component, but the process that brought about the outcome must be examined; agency informs about this procedural dimension.
  • Is There a Doctor in the House? Medical Ethics and the Doctoral Honorific

    Pike, Kenneth R.; Moore, M. Scott (The Aquila Digital Community, 2021-12-01)
    The proliferation of professional doctorates has reinvigorated debate over the use of the doctoral honorific. Doctorate holders are often addressed as “doctor” in academic contexts, but idiomatic American English associates “doctor” with physicians—licensed clinicians with doctoral degrees in medicine. The possibility of patient confusion has historically justified proscription of the doctoral honorific by others, including nurses, but recently such proscriptions have been withdrawn. An examination of history, language, and ethical reasoning leads us to conclude that, in the context of patient interaction, clinicians should eschew the doctoral honorific entirely. We think it appropriate for professionals to rely on training-pathway titles as part of their professional duty to inform. In particular, we argue that licensed clinicians with doctoral degrees in medicine should embrace the title of “physician.”
  • A Call for Liberty and Justice for All: Unraveling the Complexities in 2021

    Davis, Dr. Sheila P. (The Aquila Digital Community, 2021-12-01)
    This Preface summarizes the articles in this issue. Seven articles are presented with center on liberty and justice for all populations discussed.
  • Including a Chaplain and Culturally Sensitive Notary in End-of-Life and Earlier Difficult Healthcare Issues

    Stonestreet, John (The Aquila Digital Community, 2021-12-01)
    Would patients and families benefit from a Doctor Body Cam? Linked from, this article explores innovations providing accountability for ethical communication surrounding major healthcare decisions. One of the greatest challenges physicians face is living up to their own ideals, let alone others’ expectations, for high-stakes doctor-patient/family communication, especially at the end of life. From emotional strains to time limitations, a multiplicity of factors obfuscates the pursuit of excellence in this vital endeavor. Evidence suggests that, like nearly every other sector of healthcare and society, African American patients and families are most likely to get the short end of the physician communication stick. Drawing on the current literature, this piece makes a compelling case for the inclusion of third-party specialists to take some of the communication load off of overworked physicians in end-of-life discussions and earlier difficult healthcare issues. A more team-oriented approach to the interdisciplinary art of patient/family-provider health communication surrounding complex issues and treatment decisions may be a win-win for everyone involved.
  • Sexual Minority Rights Are Not Just for the West: Health and Safety Considerations in Africa

    Stewart, Robert Scott, Ph.D.; van Reenen, Dionne, Ph.D.; Watuwa, Richard, Ph.D. (The Aquila Digital Community, 2021-12-01)
    In a recent article, C.O. Akpan argues that it is “unnatural for a man to sleep with a man as with a woman, and the idea of marriage in this sense is an abomination” (“The morality of same-sex marriage: How not to globalize a cultural anomie,” Online Journal of Health Ethics, 13(1), 2017, p. 9). Arguments in favor of same sex marriage, he claims, are “driven and motivated by the human right fad” (p. 9) that is inappropriate for African countries. We argue that the specific arguments Akpan employs against the morality of homosexuality and same-sex marriage are flawed. Our paper also presents evidence that human rights are not simply a fad, nor are they of concern and appropriate only to the West. Finally, we examine the case in South Africa, the only African nation to include LGBTQ+ rights in its constitution. In particular, we show that by doing so, South Africa has increased the health and safety not only the LGBTQ+ community, but of the nation’s citizens at large.
  • Abbey and George

    Gunn, Jennie A (The Aquila Digital Community, 2020-10-27)
    Abbey and George discuss their beliefs regarding abortion in a light hearted manner. Both are aborted fetuses. Abbey was aborted by induction, and George by spontaneous. The pros and cons of abortion, the effects, and the use of fetal cells in research are presented in play format. Abbey is a devout Christian, and George is an atheist. The play allows the reader to hear both sides of the topic.
  • Winners and Losers in the American Political Debates of the Nation’s Health: An Ethical and Moral Dilemma

    Davis, Dr. Sheila P. (The Aquila Digital Community, 2020-10-19)
    The third and final issue of the Online Journal of Health Ethics for 2020 presents two poignant articles that are rankled with current health ethics and moral issues as the world races to a resolve for the COVID pandemic. There appears to be no easy, quick-fix solutions to the pandemic that has claimed over 1.11 million lives worldwide in this first wave. The Gellert article addresses his view of the U.S. government’s political response and the Gunn article presents an ethical perspective of the emerging promised vaccine to halt the virus.
  • An Epidemiological View of the 2020 U.S. Presidential Election: COVID-19 and the Ethics of Science Denial

    Gellert, George A., MD, MPH, MPA (The Aquila Digital Community, 2020-10-19)
    COVID-19 is exploiting U.S. political and cultural polarization in the first presidential election to be driven by epidemiology and public health. Medical science is on the ballot as Americans’ views on economic re-opening fracture according to party affiliation. The difference between pro aggressive versus incremental re-opening, mask wearing and social distancing is rooted in respect for, or denial of, the science of epidemiological pandemic disease control. Political leaders at multiple levels, and in particular the president, have politicized the wearing of face masks and so intentionally obscured and misinformed the public regarding the objectively and scientifically proven value of these protective measures. The presidential election rests at a fundamental level upon an individual choice of whether to accept or “believe” value-neutral, evidence-based science or an unethical decision to be swayed by political disinformation. The persistent and highly dysfunctional political and cultural polarization of the U.S. is now enabling and reinforcing the ethics of science denial, while driving the nation’s public health fate and near- to medium-term economic outcomes. However, mask wearing, social distance and sheltering are not political expressions, and the right to freedom of expression does not include behaviors that produce or could produce serious, and in the case of this pandemic, deadly impact on other citizens. One does not have the right to forms of political or other expression that kill or make ill other individuals.
  • Open letter to all readers, reviewers, and authors

    Davis, Dr. Sheila P. (The Aquila Digital Community, 2020-10-27)
    Open Letter for all Readers, Reviewers, and Authors of the Online Journal of Health Ethics
  • What's the flap about coronavirus?

    Dhara, V. Ramana (The Aquila Digital Community, 2020-01-01)
    This is a haiku about the vectors, modes of transmission and spread of SARS, MERS, and SARS-CoV-2
  • Patient advocacy: A tool for resolving ethical issues for patients that use the emergency department for chronic care management

    Baskin, LaWanda (The Aquila Digital Community, 2020-01-01)
    The current state of scientific knowledge on using the emergency department (ED) for chronic care management indicates that using the ED for chronic care management creates health disparities and burdens healthcare systems. Ethical concerns also arise because patients use the ED for chronic care management. This article discusses health literacy, self-care behaviors, and social support and the presence of patient suffering, nonmaleficence, and beneficence in patients who seek care for chronic care management in the ED. Patient advocacy as a tool to lessen these ethical issues is further discussed. Eighty-six participants were used in a cross-sectional correlational predictive study. Findings indicated that predictive relationships exist between health literacy, social support, and self-care behaviors and using the ED for chronic care management in the sample population. Key implications from this research are the need for patient advocacy to improve health literacy, self-care behaviors, and social support among patients with chronic conditions.
  • Summer 2020 Ethical Issues

    Davis, Dr. Sheila P. (The Aquila Digital Community, 2020-01-01)
    Summer 2020 Ethical Issues in the Online Journal of Health Ethics
  • The George Floyd of healthcare

    Davis, PhD, FNP-c, FAAN, LSM-BC, Sheila P.; Davis, MD, Gary (The Aquila Digital Community, 2020-01-01)
    Authors explore the infamous murder of an unarmed black man, George Floyd, and juxtaposition it to systemic racial practices in healthcare as documented by the Institute of Medicine Report: Unequal Treatment. The current COVID-19 pandemic is presented as a situation which has the potential to ignite unresolved discriminatory healthcare practices. Proposed are policies which could possibly mitigate this phenomenon.
  • Tuskegee syphilis study not America's only medical scandal: Chester M. Southam, MD, Henrietta Lacks, and the Sloan-Kettering research scandal

    Vernon, Leonard F (The Aquila Digital Community, 2020-01-01)
    The words “human medical experimentation” conjure up visions of Nazi medicine, which has come to exemplify the worst evils in the history of humankind. Places like Auschwitz and Dachau, where human life was cheap and test subjects plentiful were used as laboratories. In 2010 the US government apologized to Guatemala for allowing U.S. doctors to infect Guatemalan prisoners and mental patients with syphilis 65 years earlier, while acknowledging dozens of similar experiments in the United States. These included studies that often involved making healthy people sick. such as in the Tuskegee syphilis study. These experiments were often life threatening and took place with the direct approval and/or supervision of some of the country’s most prestigious research institutions and some of the leading medical researchers. Among these was the prestigious cancer research center in New York City, Sloan Kettering Hospital and its director of cancer research Chester Southam, MD.
  • Presumed consent and priority allocation systems for organ donation legislation in the United States: Making the moral case

    Shapiro, Anna K.; DePergola, Peter A., II (The Aquila Digital Community, 2020-01-01)
    In recent decades, developed nations, such as the United States, have seen the gap between the demand and the supply of transplantable organs widen, despite national campaigns intended to promote donor registration. This organ shortage crisis has deprived thousands of a basic quality of life and has caused a substantial increase in the cost of alternative medical care such as dialysis. In an attempt to address the shortage, some countries have instituted explicit “opt-out” and “priority allocation” policies that operate under the principle of presumed consent and offer higher priority on transplantation lists to registered donors. This paper seeks to justify such legislation, exploring the ethical implications and highlighting the potential benefits of an opt-out and priority allocation organ donation system. It argues that such policies should be made a legislative priority in order to strengthen the national organ donation system of the United States.
  • Allocation of resources and health professionals’ burden during the COVID-19 pandemic: Reflections on advanced directives, informed consent and social perception in Mexico

    Herrera-Ferrá, Karen; Souza-García, Leonardo; Muñoz-Torres, Antonio (The Aquila Digital Community, 2020-01-01)
    One of the main problems in the COVID-19 pandemic is the insufficient availability of resources. This deficiency has resulted in emotional and moral burdens of health professionals. Decisions are having to be made as to who will live and who will die. Moreover, given the global impact of this pandemic, negative impacts are heightened in low and middle-income countries such as Mexico. Authors focus on two issues related to, but not exclusive, to the Mexican healthcare system in an attempt to partially address scarce resources and health professionals’ burden. First, is the empowerment of patients’ autonomy through the incorporation of advanced directives (i.e. non-resuscitate order, the use of intensive care unit and/or ventilator) within informed consent. And, second, the socio-cultural perception of risk as relevant for public engagement on protective behavioral patterns. We argue that addressing these issues could possibly lessen the burden of healthcare professionals, and bring about greater autonomy among the public.
  • Dedication

    Sheila P. Davis (The Aquila Digital Community, 2020-04-10)
    This issue is dedicated to all those involved in the battle with COVID-19.

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