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

Recent Submissions

  • COVID Remains 2023

    Davis, Sheila P. (The Aquila Digital Community, 2023-01-01)
    Editor's introduction to Vol. 19, Issue 1 of the Journal of Health Ethics
  • A Framework for Personal Respiratory Ethics

    Goddard, Ian W (The Aquila Digital Community, 2023-07-01)
    The Covid-19 pandemic raises the need for an ethical framework that addresses the unique ethical challenges and questions arising from airborne infectious diseases. For example, are we ever ethically obliged to wear a face mask? If so, why and when? The Respiratory Ethics Framework (REF) herein proposes pathways to answers grounded in ethical norms and the moral principles of non-harm, beneficence and respect for personal autonomy. REF is a personal ethics wherein your ethical duty to increase your respiratory hygiene efforts—such as by donning a mask—is proportional to your estimation of an increase in the likelihood that your respiratory effluent poses a risk of harmful infection to others. REF includes illustrated decision models that instantiate a framework of proportionality between levels of risk, ethical duty and mitigation that shapes risk mitigation across domains.
  • Why the West Should Help China Reduce Unrecognized and Preventable COVID-19 Deaths

    Gellert, George A. (The Aquila Digital Community, 2023-07-01)
    In an era marked by a ruinous war between a democratic state and a totalitarian regime, political volatility, rightward looking isolationism and nationalism, and heightened competition and disputes between China and the West, it is perhaps difficult to discern why the West should supply China with COVID-19 vaccines and therapeutics, as well as epidemiological assistance in order to mitigate a potentially unrecognized COVID-19 crisis in that nation. This commentary considers three arguments against Western and international indifference to the plight of China as it transitions to COVID-19 endemicity.
  • Ethical Considerations Surrounding Vaccine Development During A Public Health Crisis

    Zaidi, Syed Arsalan Akhter; Saleem, Kainat; Bollam, Rahul; Zaidi, Bushra (The Aquila Digital Community, 2023-07-01)
    Epidemics and Pandemics have been plaguing mankind since many centuries, and are a cause of major healthcare expense in modern times. The novel coronavirus pandemic of 2019-2020 spread worldwide faster than many previous pandemics, including EBOLA in 2017. Although personal protective equipment, and social distancing slowed the outbreak, a vaccine is needed to ensure global immunization and to stop this deadly outbreak. Developing a vaccine in times of a public health crisis comes with a lot of ethical considerations, including overlooking proper informed consent, the issue of using placebo in control arm of trials, extended timelines of development of vaccines, randomized placebo control trial of secondary vaccine once the first vaccine is approved, and utilizing vulnerable population for trials. These issues are often overlooked due to the urgency of the situation, and the need of developing a cure/vaccine can lead to potential oversight of many regulations. We discuss some of these issues related to vaccine development in a pandemic situation in this commentary paper. We also discuss some of the arguments supporting a secondary vaccine development such as logistical/economic issue, better efficacy, and the conditions of Equipoise.
  • Why Do the Police Reject Counseling? An Examination of Necessary Changes to Police Subculture.

    Otu, Noel; Otu, Ntiense E. (The Aquila Digital Community, 2022-11-01)
    Abstract This paper reviews the concept of police subculture and examines its role in the management and acceptance of treatment for stress-related injury. In particular, we examine the impact of stigma that attaches to treatment within this subculture. The persistence of the dominant police subculture remains a significant obstacle to officers seeking treatment for stress-related illnesses. The subculture has historically resisted acknowledging the need for treatment in response to the occupational and/or organizational stress-related injury that results from frequent exposure to work-related trauma. Many police administrators are still embedded within and resist changes to the subculture, which results in an atmosphere that is unwelcoming to officers seeking or accepting treatment. This study draws on both qualitative and quantitative studies and modifies labeling theory to determine the sources of stigma involved in the police subculture. The paper reviews the reasons why officers refuse treatment, discusses the issue of stigmatization and labeling, and argues for the need to change police subculture, at least in part by ensuring that administrators support treatment and good health for officers. It is revealed that the stigmatization of officers who seek and receive treatment directly results in others’ refusal/rejection of it. The study recommends that departments address the subcultural processes of labeling and stigmatization associated with stress counseling at the individual, management, and organizational levels to bring about a shift in police subculture and improve the level of occupational health and safety for officers on the force.
  • Theory Building as Integrated Reflection: Understanding Physician Reflection Through Human Communication Research, Medical Education, and Ethics

    Vicini, Andrea; Duggan, Ashley P.; Shaughnessy, Allen F. (The Aquila Digital Community, 2022-11-01)
    Grounded in a presupposition that a single explanatory framework cannot fully account for the expansive learning processes that occur during medical residency, the article examines developing physicians’ reflective writing from three disciplinary lenses. The goal is to understand how the multi-dimensional nature of medical residency translates into assembling educational experiences and constructing meaning that cannot be fully explained through a single discipline. An interdisciplinary research team across medical education, communication, and ethics qualitatively analyzed reflective entries (N=756) completed by family medicine residents (N=33) across an academic year. Results provide evidence for moving toward an integrated thematic explanation across disciplines. The authors suggest that the integration of disciplinary explanations allows for comprehensive understanding of reflection as a cornerstone in the broader formation of the physician. Examples provide evidence for an integrated understanding of a fuller human experience by considering the three thematic explanations as co-occurring, reciprocal processes.
  • Applying lessons learned: nursing facility administrators’ operational and ethical challenges during COVID-19

    Wickersham, Mary Eleanor R (The Aquila Digital Community, 2022-11-01)
    Operational and ethical challenges for nursing homes across the United States during the COVID-19 pandemic were daunting, that experience perhaps only a forecast of future epidemics that nursing home administrators and operators may face. This article describes administrator-identified challenges and focuses on how nursing homes might learn from their experiences by increasing flexibility to meet evolving needs, improving quality assurance and disaster planning, using ethics policies and ethical decision-making processes to work through difficult decisions, and leading the way in creating new policies that will make nursing home care safer and more appropriate for patients with ever changing needs.
  • Ethical and Moral Imperatives of 2022

    Davis, Sheila P., PhD (The Aquila Digital Community, 2022-12-01)
    Editor's introduction to the Journal of Health Ethics vol. 18, no. 2
  • Discussing the Injustice of the COVID-19 Vaccine Pass Imposed on Medical Consultation in Public Hospitals in Hong Kong

    Cheng, Fung Kei (The Aquila Digital Community, 2022-11-01)
    The COVID-19 pandemic has devastated public health, economy and social life all over the world, especially wherever a vaccine pass scheme has been implemented. Many countries have begun to relax schedules to return to normal activities. In contrast, Hong Kong continues to tighten the utilisation of a vaccine pass for medical services in order to boost vaccination rates. Such a practice not only significantly challenges ethical and operative concerns but also threatens health equity and social justice for healthcare decision-makers and practitioners, consequently hurting public health and community well-being. This discussion analyses the various arguments, reviews vaccine hesitancy and suggests a holistic approach for solutions (aside from vaccination and medications) to strengthen individual immunity and therefore to deal with this disease more effectively, efficiently and ethically, including personal hygiene and lifestyle.
  • A Doctor's Sabbatical on a Pirate Ship

    Dhara, V. Ramana (The Aquila Digital Community, 2022-08-01)
    This is a fantasy poem about a doctor and his adventures with piracy on the high seas.
  • Community Based Rehabilitation Programs for Resettled Muslim Women Refugees

    Walton, Lori Maria, PhD, DPT, MScPT, MPH(s); Hakim, PhD, PT, NCS, Renee; Raigangar, PhD(c), MScPT, M.Ed., Veena; Schwartz, DPT, NCS, Jennifer; Ambia, MScPT, SJM Ummul; Zaaeed, DrPH, LMSW, Najah; Schbley, Bassima (The Aquila Digital Community, 2022-08-01)
    According to the 2021 report from the United Nations High Commissioner for Refugees, 82.4 million people were forcibly displaced because of violence, wars, or persecution and over 26.4 million are currently living with refugee status. Displacement and resettlement trauma are associated with chronic disease onset and poor cognitive, physical, and mental health outcomes for refugee populations. To mitigate some of the deleterious effects of resettlement trauma, we propose a community-based rehabilitation program (CBRP) framework that is culturally sensitive, trauma-informed and focused on the vulnerabilities of women. The purpose of this novel CBRP framework is to address health inequities among a vulnerable refugee population through program development, with a focus on: (1) active participation of the refugee community throughout all levels of program planning; (2) intersectional, gender-focused analysis of power and privilege within the community and host country aimed at reducing barriers and improving access to quality CBRP programs for women; (3) trauma-informed, team-oriented, resilience programming to improve cognitive, physical, and mental health outcomes and prevent chronic disease. This paper will also discuss the need for gender transformative interventions to address specific health inequities related to CBRP feasibility and access, cultural and social influences, acceptability, and related laws and policies. Key Words: Refugee Health, Muslim Women, Community-based Rehabilitation Programs, Physical Activity
  • Ethical implications of COVID-19 surveillance in Karnataka using Nancy Kass Framework

    Jain, Apurva; Arora, Lakshya (The Aquila Digital Community, 2022-08-01)
    Numerous public health hurdles, including pandemics such as COVID-19, have led to concerns about community health practices in relation, necessitating the application of an ethical perspective. International research ethics guidelines are only used in a restricted range of contexts of public health. As a result, a variety of frameworks have been established to assist ethical analysis of public health concerns. In this study, we have used the Nancy Kass framework for analyzing COVID-19 surveillance in Karnataka state of India, which is a six-step approach that can assist public health practitioners in evaluating the ethical consequences of interventions, policy initiatives, services, and so on. In order to supervise the compliance of home quarantine, the government of Karnataka mandated uploading selfies as a digital tracking surveillance measure for the COVID-19 outbreak. However, these measures raised several ethical questions, especially related to an individual’s privacy, confidentiality, autonomy, and liberty. An established state surveillance mechanism with includes enforced measures for data security along with the moral duty of an individual to protect the health of the community can probably balance the principles of ethics.
  • Reciprocity and Priority Allocation System for Organ Transplant: An Ethical Analysis

    Wong, Gordon; YU, Chong Ho (The Aquila Digital Community, 2022-08-01)
    How to increase the supply of organs donations for transplant is a critical issue in healthcare. Although recently xenotransplantation has received much publicity, it may be years before this becomes clinically viable. The Reciprocity and Priority Allocation (RPA) System currently used in Israel and a few other countries may be a reasonable approach to increase organ donation in the foreseeable future. For this approach to be accepted by the public, a robust analysis on its ethical implications is needed. This paper applies two formal ethics frameworks to analyze the implication of the RPA system.
  • Ethical considerations of telehealth: Access, inequity, trust, and overuse

    O'Reilly-Jacob, Monica; Vicini, Andrea; Duggan, Ashley P. (The Aquila Digital Community, 2022-08-01)
    In the U.S. healthcare system, telehealth is increasingly present and demands ethical assessment. On the one hand, telehealth increases access to healthcare services for some at-risk populations (e.g., people suffering from mental illness and addictions) and in specific contexts (e.g., rural). On the other hand, telehealth widens the digital divide and can lead to overuse of services. Furthermore, because it is still unclear how telehealth influences trust between patients and primary care clinicians, connecting relationship science and human communication research can inform critical reasoning. Finally, healthcare policy is advancing toward the wide adoption of telehealth. Hence, it is urgent to address these ethical issues and invest in further research.
  • 2022: Global Ethical Think Tank

    Davis, Sheila A, PhD (The Aquila Digital Community, 2022-01-01)
    Editor's introduction to Volume 18, Number 1 of the Journal of Health Ethics.
  • Financial Incentives and Healthcare: A Critique of Michael Sandel

    Peacock, Mark (The Aquila Digital Community, 2022-08-01)
    The use of financial incentives in healthcare calls for ethical examination. Michael Sandel's influential work represents such examination and is subject to critical analysis in this paper. Sandel focuses on monetary payments to persuade patients to lose weight, give up smoking etc. but also on the much-discussed case of giving drug addicts money in return for their consent to be sterilized. He offers two separate objections to financial incentives, one based on coercion, the other on corruption. I argue that Sandel's corruption objection to commodification is insufficient to ground the objection he has to financial incentives in healthcare. Whatever strength his corruption objection has comes from his coercion objection.
  • 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.

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