RSS 1.0Online Journal of Health Ethics
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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.
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The Globethics library contains articles of the Online Journal of Health Ethics as of 1(2004) to current.
Recent Submissions
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Examining the ethics behind ICU admission during the COVID-19 PandemicDuring the COVID-19 pandemic surge, the demand for ICU beds far exceeds its supply in the hospitals. The healthcare team had to confront themselves with an ethical dilemma of distributing the limited beds to patients who required ICU admission and therefore needed to prioritize. This paper examines various ethical theories and principles that were used during the pandemic in assigning patients to ICU beds and proposes an algorithm to aid in decision making for ICU bed assignment in order to achieve a fair allocation of this scarce resource.
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Late Have I Loved Thee: Reintroducing the Journal of Health Ethics Twenty Years LaterThe Editor-in-Chief provides an overview of Volume 20, Issue 1.
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Ethical Requirements for Achieving Fairness in Radiology Machine Learning: An Intersectionality and Social Embeddedness ApproachRadiodiagnostics by machine-learning (ML) systems is often perceived as objective and fair. It may, however, exhibit bias towards certain patient sub-groups. The typical reasons for this are the selection of disease features for ML systems to screen, that ML systems learn from human clinical judgements, which are often biased, and that fairness in ML is often inappropriately conceptualized as “equality”. ML systems with such parameters fail to accurately diagnose and address patients’ actual health needs and how they depend on patients’ social identities (i.e. intersectionality) and broader social conditions (i.e. embeddedness). This paper explores the ethical obligations to ensure fairness of ML systems precisely in light of patients’ intersectionality and the social embeddedness of their health. The paper proposes a set of interventions to tackle these issues. It recommended a paradigm shift in the development of ML systems that enables them to screen both endogenous disease causes and the health effects of patients’ relevant underlying (e.g. socioeconomic) circumstances. The paper proposes a framework of ethical requirements for instituting this shift and further ensuring fairness. The requirements center patients’ intersectionality and the social embeddedness of their health most notably through (i) integrating in ML systems adequate measurable medical indicators of the health impact of patients’ circumstances, (ii) ethically sourced, diverse, representative and correct patient data concerning relevant disease features and medical indicators, and (iii) iterative socially sensitive co-exploration and co-design of datasets and ML systems involving all relevant stakeholders.
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Exploring ChatGPT’s Clinical Ethics Ability: A pilot studyBackground: Artificial Intelligence (AI), particularly public models like ChatGPT, has revolutionized the generation of human-like thought processes and text. Across healthcare, the integration of AI in decision-making processes is increasingly pervasive. However, the application of AI in ethical decision-making remains relatively unexplored. Methods: Ethics consultation notes from a tertiary academic medical center were de-identified. We trained ChatGPT using three separate ‘chats’ with one, two, or five unique notes and asked it to produce an ethical analysis/discussion and recommendations for a test case. We conducted this same series again but gave ChatGPT only the ethical analysis/discussion and recommendation sections from the training notes to learn from. Two independent raters scored ChatGPT’s ethics consultation documentation using the validated Ethics Consult Quality Assessment Tool (ECQAT). Results: When trained with full notes ChatGPT’s ECQAT overall holistic rating score for each ‘chat’ was 2.5 for one note, 1.5 for two, and 2.5 for five. When trained using only the ethical analysis/discussion and recommendation sections, ChatGPT scored 3 for one note, 2 for two, and 1 for five. Conclusion: ChatGPT's variable performance, influenced by training data, highlights its poor baseline ability and the need for targeted training. While initial improvement was observed with example consultations, complexity and scale affected performance adversely. The findings emphasize the importance of human oversight, as ChatGPT alone is unable to match human expertise. ChatGPT does exhibit potential for substantial improvement with better training and further research is needed to successfully make use of this powerful and widely accessible tool.
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Ethical and Legal Questions with Street MedicineThe homeless problem has been worsening in the U.S. for many years. Homeless residents have many health issues. Yet their healthcare needs are difficult to be met. To address this problem, the federal government and state governments are encouraging the implementation of Street Medicine programs by providing funding and changing regulations. However, due to the unique characteristics of this population, there are many ethical and legal issues related to delivering care to them. These issues have not been well discussed. This paper attempts to highlight the ethical and legal issues in Street Medicine. The goal is to call the attention of all the stakeholders to these issues so that meaningful discussions can begin.
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Advances in Biomedical Research and Treatments: What is Acceptable?This study investigated the technology acceptance (TA) of twenty-first century biomedical treatments by adults in the United States. A new TA instrument was created, using five distinct levels: (1) Healing and Prevention, (2) Replacement Organs, (3) Enhancements-Medical, (4) Enhancements-Discretionary, and (5) Transhumans. An on-line survey produced 353 usable responses, which showed distinct patterns for each of five biomedical treatment levels. There was clear support for Levels 1–3, but very strong opposition to Levels 4–5. The TA finding draws the line between which human interventions are acceptable versus others that should be prohibited through public policies and medical guidelines.
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COVID Remains 2023Editor's introduction to Vol. 19, Issue 1 of the Journal of Health Ethics
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A Framework for Personal Respiratory EthicsThe 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.
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Why the West Should Help China Reduce Unrecognized and Preventable COVID-19 DeathsIn 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.
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Ethical Considerations Surrounding Vaccine Development During A Public Health CrisisEpidemics 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.
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Why Do the Police Reject Counseling? An Examination of Necessary Changes to Police Subculture.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.
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Theory Building as Integrated Reflection: Understanding Physician Reflection Through Human Communication Research, Medical Education, and EthicsGrounded 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.
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Applying lessons learned: nursing facility administrators’ operational and ethical challenges during COVID-19Operational 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.
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Ethical and Moral Imperatives of 2022Editor's introduction to the Journal of Health Ethics vol. 18, no. 2
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Discussing the Injustice of the COVID-19 Vaccine Pass Imposed on Medical Consultation in Public Hospitals in Hong KongThe 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.
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A Doctor's Sabbatical on a Pirate ShipThis is a fantasy poem about a doctor and his adventures with piracy on the high seas.
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Community Based Rehabilitation Programs for Resettled Muslim Women RefugeesAccording 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
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Ethical implications of COVID-19 surveillance in Karnataka using Nancy Kass FrameworkNumerous 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.
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Reciprocity and Priority Allocation System for Organ Transplant: An Ethical AnalysisHow 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.
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Ethical considerations of telehealth: Access, inequity, trust, and overuseIn 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.