Including more than 50'000 documents - as well as 500 doctoral theses - the Globethics Health Ethics collection is a unique online resource covering topics related to health ethics such as pharmaceuticals, health economics, health politics, access to medical care, environmental issues and bioethics.

Recent Submissions

  • Child-headed Households in South Africa: The Legal and Ethical Dilemmas when Children are the Primary Caregivers in a Therapeutic Relationship

    Andra le Roux-Kemp (17161918) (2013-01-01)
    Child-headed households (CHHs) have become a common and integral part of South African society. Millions of children have lost their parents and/or primary caregivers due to a variety of reasons of which the HIV/AIDS pandemic can be singled out as a major cause. It is therefore not uncommon today to have minors (under the age of 18 years) care for their younger siblings and/or ill parents or family. A child-headed household (CHH) refers to a living situation/arrangement where a child has taken charge of a household in terms of decision-making responsibilities as well as the responsibility to provide for the physical, social and emotional needs of others living with that particular child, in that household, and regardless of familial relationship. This paper is concerned with the legal and ethical dilemmas that arise in a therapeutic relationship where a minor is the primary caregiver of a patient unable to care for him-/herself. Where do a medical practitioner’s responsibilities lie in communicating important medical information about the patient’s condition to the patient’s minor caregiver? While the patient’s rights to privacy and confidentiality are important, the patient’s particular condition and medical care may also necessitate that certain information be disclosed to the minor caregiver. However, the minor caregiver may not always be a willing party to this collaborative therapeutic relationship and the ability of such a minor to consent to medical treatment on behalf of the patient, or take on responsibilities in terms of this therapeutic relationship can also be called into question. The various therapeutic approaches, roles, skills and conditions of this unique form of agency should therefore be given due consideration from both a legal and ethical point of view.
  • Postmortem Sperm Retrieval and Assisted Reproduction: Issues without Solutions?

    Nilesh K. Tumram; Rajesh V. Bardale (Naif University Publishing House, 2019-05-01)
    The issue of request for post-mortem sperm retrieval [PMSR] for reproductive purposes has gained momentum in the recent past in India and other countries. There are various methods for postmortem retrieval of sperm. Modern medicine has progressed to a stage where posthumous gamete retrieval with subsequent reproduction has become a possibility. However, very little has been discussed regarding guidelines orethical, social, and medical issues related to such a procedure. The procedure is a boon for families who might have become saddened by the untimely death of their son. The procedure can be useful for not only the spouse of married individuals but also to their parents. Also, such a procedure can be very helpful to the parents of their unmarried son, who was their sole support. However, there is no discussion of using such PMSR techniques in married as well as unmarried individuals if requested by close relatives. The present paper discusses the issues regarding PMSR in deceased individuals and the various issues that may arise.
  • Ethical Dilemma involving autonomy and COVID-19 testing

    Buowari DY (Nigerian Medical Association, Akwa Ibom State Branch, 2021-10-01)
    Background: In December 2019, an atypical form of pneumonia was discovered in Wuhan, China and it has spread to different parts of the world including Nigeria. Testing for the causative agent which is the severe acute respiratory distress syndrome coronavirus-2 is one of the strategies to contain the pandemic. For some reason, some patients with clinical symptoms suggestive of COVID-19 may refuse to be tested for the disease. Methodology: A review of studies conducted on COVID-19 testing and ethical dilemma associated with it was done using Google Scholar, PubMed and Cochrane reviews. Conclusion: Ethical dilemma exists in testing for COVID-19 as some patients may refuse testing even when it is necessary and they present with symptoms suggestive of COVID-19. The right to autonomy according to the principles of medical ethics is necessary for every medical consultation but may not be important in pandemics as the person becomes a health threat and harmful to the public.
  • The Distinction between Ordinary and Extraordinary Treatment: Can It Be Maintained?

    Emmerich, Nathan; Mallia, Pierre; Gordijn, Bert; Pistoia, Francesca; Kearns, Alan J.; Emmerich, Nathan; Gordijn, Bert (Springer, 2024-02-27)
    The distinction between ordinary and extraordinary treatment has a long history. Since it was first proposed and discussed in the medieval period, it has formed part of medical ethics, even as that discourse, and the landscape it comments on, has radically changed and developed. In this essay we briefly canvas the history of the debate on ordinary/extraordinary treatment and consider its relevance for professional medical practice in the present context.
  • Ethical, Legal, and Social Implications of Symptom Checker Apps in Primary Health Care (CHECK.APP): Protocol for an Interdisciplinary Mixed Methods Study

    Wetzel, Anna-Jasmin; Koch, Roland; Preiser, Christine; Müller, Regina; Klemmt, Malte; Ranisch, Robert; Ehni, Hans-Jörg; Wiesing, Urban; Rieger, Monika A.; Henking, Tanja (MISC, 2024-03-07)
    Background: Symptom checker apps (SCAs) are accessible tools that provide early symptom assessment for users. The ethical, legal, and social implications of SCAs and their impact on the patient-physician relationship, the health care providers, and the health care system have sparsely been examined. This study protocol describes an approach to investigate the possible impacts and implications of SCAs on different levels of health care provision. It considers the perspectives of the users, nonusers, general practitioners (GPs), and health care experts. Objective: We aim to assess a comprehensive overview of the use of SCAs and address problematic issues, if any. The primary outcomes of this study are empirically informed multi-perspective recommendations for different stakeholders on the ethical, legal, and social implications of SCAs. Methods: Quantitative and qualitative methods will be used in several overlapping and interconnected study phases. In study phase 1, a comprehensive literature review will be conducted to assess the ethical, legal, social, and systemic impacts of SCAs. Study phase 2 comprises a survey that will be analyzed with a logistic regression. It aims to assess the user degree of SCAs in Germany as well as the predictors for SCA usage. Study phase 3 will investigate self-observational diaries and user interviews, which will be analyzed as integrated cases to assess user perspectives, usage pattern, and arising problems. Study phase 4 will comprise GP interviews to assess their experiences, perspectives, self-image, and concepts and will be analyzed with the basic procedure by Kruse. Moreover, interviews with health care experts will be conducted in study phase 3 and will be analyzed by using the reflexive thematical analysis approach of Braun and Clark. Results: Study phase 1 will be completed in November 2021. We expect the results of study phase 2 in December 2021 and February 2022. In study phase 3, interviews are currently being conducted. The final study endpoint will be in February 2023. Conclusions: The possible ethical, legal, social, and systemic impacts of a widespread use of SCAs that affect stakeholders and stakeholder groups on different levels of health care will be identified. The proposed methodological approach provides a multifaceted and diverse empirical basis for a broad discussion on these implications. Trial Registration: German Clinical Trials Register (DRKS) DRKS00022465; https://tinyurl.com/yx53er67.
  • The relationship between managerial ethical profiles (MEP) and individual, organisational and external factors influencing the ethical decision-making of healthcare managers in Australia

    Wilson, M; Casali, Luca (Promaco Conventions Pty Ltd, 2008)
    Whether the community is looking for “scapegoats” to blame or seeking more radical and deeper causes, healthcare managers are in the firing line whenever there are woes in the healthcare sector. The public has a right to question whether ethics have much influence on the everyday decision making of healthcare managers. This paper reports on the findings of empirical research conducted on the influence of ethics and other factors on the decision making of 441 health care managers in Australia. Results from this study indicate that healthcare managers in Australia draw on a range of ethical frameworks in their everyday decision making, which in this study form the basis of five corresponding managerial ethical profiles: knights, guardian angels, duty-followers, defenders and chameleons. Results from the study also indicate that the range of individual, organisational and external factors influencing decision making can be grouped into three major clusters or functions. Crossreferencing these functions and other demographic data to the managerial ethics profiles provides further analytical insight in to the characteristics of the managerial ethical profiles. Summarizing, as they do, existing strengths and weaknesses in managerial ethical decision making, identifying these profiles not only can contribute to increasing organisational knowledge and self-awareness, but also has clear implications for the design and implementation of ethics education and training in large scale organisations such as health care systems.
  • Program proposal: challenging anti-fat bias, body dissatisfaction, and disordered eating among adolescents using health at every size and intuitive eating principles

    Calcaterra, Paulina (author); Riggs Skean, Karen (chair); Kelly, Shalonda (member); Rutgers University; Graduate School of Applied and Professional Psychology (2024)
    Adolescence is a critical period when individuals are at risk for experiencing distress about their body image and developing disordered eating behaviors. A growing body of research has identified the internalization of weight bias (also referred to as weight stigma, anti-fat bias, anti-fat attitudes) as a major factor contributing to disordered eating and body image difficulties. Weight bias refers to social attitudes that stigmatize fatness, marginalize fat people, and promote thinness as an ideal. Weight bias is buttressed by diet culture, which perpetuates myths that weight is individually controllable through restrictive dieting. Since the 1960s, researchers and advocates have demonstrated harmful physical and psychological consequences of weight stigma; they have also identified non-dieting, size inclusive paradigms (Health at Every Size (HAES), intuitive eating) that promote physical and psychological health without reinforcing anti-fat bias and diet culture. Programs incorporating these principles with adults have been proven to reduce body dissatisfaction and disordered eating while enhancing physical and psychological health and wellness. No primary prevention programs targeting adolescents have used HAES and intuitive eating interventions, and few interventions have demonstrated long-term efficacy at reducing disordered eating among adolescents. A new school-based curriculum is presented for adolescents aimed at preventing disordered eating and body image distress while increasing body acceptance and intuitive eating. Psychoeducation, social learning, media literacy skills, mindfulness skills, and practice implementing HAES and intuitive eating principles are the mechanisms of change that will promote these outcomes. The materials and content for an 8-session workshop series plus booster sessions are provided, including an overview of each session, presentation slides, and content for practice materials including homework assignments.
  • Revista Portuguesa de Medicina Geral e Familiar

    Associação Portuguesa de Medicina Geral e Familiar, 2024-03-10
  • Desperately seeking targets: the ethics of routine HIV testing in low-income countries

    Rennie Stuart; Behets Frieda (The World Health Organization, 2006-01-01)
    The human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) pandemic, and responses to it, have exposed clear political, social and economic inequities between and within nations. The most striking manifestations of this inequity is access to AIDS treatment. In affluent nations, antiretroviral treatment is becoming the standard of care for those with AIDS, while the same treatment is currently only available for a privileged few in most resource-poor countries. Patients without sufficient financial and social capital - i.e., most people with AIDS - die each day by the thousands. Recent AIDS treatment initiatives such as the UNAIDS and WHO "3 by 5" programme aim to rectify this symptom of global injustice. However, the success of these initiatives depends on the identification of people in need of treatment through a rapid and massive scale-up of HIV testing. In this paper, we briefly explore key ethical challenges raised by the acceleration of HIV testing in resource-poor countries, focusing on the 2004 policy of routine ("opt-out") HIV testing recommended by UNAIDS and WHO. We suggest that in settings marked by poverty, weak health-care and civil society infrastructures, gender inequalities, and persistent stigmatization of people with HIV/AIDS, opt-out HIV-testing policies may become disconnected from the human rights ideals that first motivated calls for universal access to AIDS treatment. We leave open the ethical question of whether opt-out policies should be implemented, but we recommend that whenever routine HIV-testing policies are introduced in resource-poor countries, that their effect on individuals and communities should be the subject of empirical research, human-rights monitoring and ethical scrutiny.
  • Surgical informed consent practices and influencing factors in sub-Saharan Africa: a scoping review of the literature

    Chiara Pittalis (7895276); Cherie Sackey (17911974); Paul Okeny (7899644); Bip Nandi (16738182); Jakub Gajewski (7895600) (2024-03-06)
    Introduction: Current international standards in consent to surgery practices are usually derived from health systems in Western countries, while little attention has been given to other contexts such as sub-Saharan Africa (SSA), despite this region facing the highest burdens of disease amenable to surgery globally. The aim of this study was to examine how the concept of informed consent for surgery is interpreted and applied in the context of SSA, and factors affecting current practices. Methods: A systematic search of Medline, Embase and African Journal OnLine databases as well as grey sources was executed in May 2023 to retrieve relevant literature published since 2010 in English language against a set of given criteria. The socioecological framework for health was used for organising and summarising the identified evidence. Results: A total of 27 papers were included in the review. Findings revealed that consent to surgery practices is generally substandard across SSA and the process is not adequate. Patients' understanding of informed consent is limited, likewise awareness of their rights to decision-making. A range of factors at the individual, interpersonal, institutional and system/societal levels affect the informed consent process. Conclusion: There is a need to find more culturally acceptable and ethical ways to include the participation of patients in the decision-making process for surgical treatment in the SSA and define standards more closely aligned with the local context.
  • Poverty, equity, human rights and health

    Braveman Paula; Gruskin Sofia (The World Health Organization, 2003-01-01)
    Those concerned with poverty and health have sometimes viewed equity and human rights as abstract concepts with little practical application, and links between health, equity and human rights have not been examined systematically. Examination of the concepts of poverty, equity, and human rights in relation to health and to each other demonstrates that they are closely linked conceptually and operationally and that each provides valuable, unique guidance for health institutions' work. Equity and human rights perspectives can contribute concretely to health institutions' efforts to tackle poverty and health, and focusing on poverty is essential to operationalizing those commitments. Both equity and human rights principles dictate the necessity to strive for equal opportunity for health for groups of people who have suffered marginalization or discrimination. Health institutions can deal with poverty and health within a framework encompassing equity and human rights concerns in five general ways: (1) institutionalizing the systematic and routine application of equity and human rights perspectives to all health sector actions; (2) strengthening and extending the public health functions, other than health care, that create the conditions necessary for health; (3) implementing equitable health care financing, which should help reduce poverty while increasing access for the poor; (4) ensuring that health services respond effectively to the major causes of preventable ill-health among the poor and disadvantaged; and (5) monitoring, advocating and taking action to address the potential health equity and human rights implications of policies in all sectors affecting health, not only the health sector.
  • When staff is underpaid: dealing with the individual coping strategies of health personnel

    Van Lerberghe Wim; Conceição Claudia; Van Damme Wim; Ferrinho Paulo (The World Health Organization, 2002-01-01)
    Health sector workers respond to inadequate salaries and working conditions by developing various individual "coping strategies" - some, but not all, of which are of a predatory nature. The paper reviews what is known about these practices and their potential consequences (competition for time, brain drain and conflicts of interest). By and large, governments have rarely been proactive in dealing with such problems, mainly because of their reluctance to address the issue openly. The effectiveness of many of these piecemeal reactions, particularly attempts to prohibit personnel from developing individual coping strategies, has been disappointing. The paper argues that a more proactive approach is required. Governments will need to recognize the dimension of the phenomenon and systematically assess the consequences of policy initiatives on the situation and behaviour of the individuals that make up their workforce.
  • The long-term effects of exogenous endocrine disrupters on the female reproductive system

    Tornheim, Keith; Lane, Sandra; Frazier, Gabrielle E. (2024-02-27)
    Endocrine disrupting chemicals (EDCs) of exogenous origin refer to compounds that disrupt the regular functioning of the endocrine system responsible for maintaining hormonal balance in the body. These disruptors are prevalent in our surroundings and are present in various consumer products, including cosmetics, plastics, and pesticides. The means of action vary depending on the specific chemical and target hormone receptor. EDCs can mimic, obstruct, alter hormone production, transport, and metabolize, leading to a range of health risks such as metabolic disorders, immune system dysfunction, and endocrine-related cancers, as well as reproductive abnormalities. Interference with the production, transport, and function of hormones responsible for the menstrual cycle and pregnancy, including estrogen, progesterone, and luteinizing hormone, leads to reproductive problems. EDCs also cause permanent alterations in the development of the female reproductive system during fetal and early childhood stages. Some of the most widely known EDCs include bisphenol-A (BPA), phthalates, and polychlorinated biphenyls (PCBs), which have been found in human tissue and fluids, such as urine and breast milk.
 Researchers continue to discover and analyze EDC prevalence and the effects on human health. While efforts have been made to reduce exposure to these compounds, they remain prevalent in the environment. There are lifestyle interventions that can help with the prevention and exposure to EDCs. Such interventions include healthier eating habits, avoiding the use of plastic containers containing EDCs, choosing safer personal care products, filtering drinking water, reducing exposure to air pollution, and supporting policies and regulations that promote the use of safer chemicals.
  • The legal implications of the administration of placebo to psychiatric patients

    Unknown Author (12488544) (2001-06-01)
    This paper concerns a practice that is sometimes encountered in the treatment of patients with mental illness: the use of placebo for purportedly therapeutic purposes. It will consider the lawfulness of that practice under domestic law; and suggest that previous attempts to perform such an analysis may be flawed. It will argue that existing statutory restrictions may apply to - andprohibit - therapeutic placebo administration, and will conclude with a brief analysis of the possible impact upon such administration of the Human Rights Act 1998.The word 'placebo' is here used in the sense of a pill, medicine, procedure etc., prescribed more for the psychological benefit to the patient of being given a prescription than for any physiological effect.' It does not describe the use of any similar substance in the testing of new drugs (nor, to acknowledge every facet of the formal definition, does it connote either vespers for the dead or an eighteenth century sycophant).Furthermore, it is assumed that the use of placebo is founded upon a clinical assessment that such is the preferable course, for to deny a patient substantive medication that might carry a therapeutic benefit would be to invite litigation, primarily, though by no means exclusively, under the domestic tort of negligence.
  • The Declaration of Istanbul on organ trafficking and transplant tourism

    Dominique Martin (13083387); Ahmed Nada (17835125) (2024-01-23)
    The Declaration of Istanbul on organ trafficking and transplant tourism
  • The concept of stewardship in health policy

    Richard B. Saltman; Odile Ferroussier-Davis
    There is widespread agreement that both the configuration and the application of state authority in the health sector should be realigned in the interest of achieving agreed policy objectives. The desired outcome is frequently characterized as a search for good governance serving the public interest. The present paper examines the proposal in The World Health Report 2000 that the concept of stewardship offers the appropriate basis for reconfiguration. We trace the development of stewardship from its initial religious formulation to more recent ecological and sociological permutations. Consideration is given to the potential of stewardship for encouraging state decision-making that is both normatively based and economically efficient. Various dilemmas that could impede or preclude such a shift in state behaviour are examined. We conclude that the concept of stewardship holds substantial promise if adequately developed and effectively implemented.
  • Ethical issues in health workforce development

    Cash Richard (The World Health Organization, 2005-01-01)
    Increasing the numbers of health workers and improving their skills requires that countries confront a number of ethical dilemmas. The ethical considerations in answering five important questions on enabling health workers to deal appropriately with the circumstances in which they must work are described. These include the problems of the standards of training and practice required in countries with differing levels of socioeconomic development and different priority diseases; how a society can be assured that health practitioners are properly trained; how a health system can support its workers; diversion of health workers and training institutions; and the teaching of ethical principles to student health workers. The ethics of setting standards for the skills and care provided by traditional health-care practitioners are also discussed.
  • An ethical engagement: creative practice research, the academy and professional codes of conduct

    Kate MacNeill (13588117); Barbara Bolt (18092185); Estelle Barrett (18092188); Megan McPherson (18092191); Marie Sierra (18092194); Sarah Miller (799078); Pia Ednie-Brown (18092197); Carole Wilson (18092200) (2021-01-01)
    This paper reports on the experiences of creative practice graduate researchers and academic staff as they seek to comply with the requirements of the Australian National Statement on the Ethical Conduct of Research Involving Humans. The research was conducted over a two-year period (2015 to 2017) as part of a wider project ‘iDARE – Developing New Approaches to Ethics and Research Integrity Training through Challenges Presented by Creative Practice Research’. The research identified the appreciation of ethics that the participants acquired through their experience of institutional research ethics procedures at their university. It also revealed a disjunction between the concepts of ethics acquired through meeting institutional research ethics requirements, the notion of ethics that many researchers adopt in their own professional creative practice and the contents of professional codes of conduct. A key finding of the research was that to prepare creative practice graduates for ethical decision-making in their professional lives, research ethics training in universities should be broadened to encompass a variety of contexts and enable researchers to develop skills in ethical know-how.
  • Ethical considerations of using artificial intelligence in healthcare

    Gaillard, Nathan (2023-12-04)
    This bachelor’s Thesis explores the necessity of frameworks in the use of artificial intelligence (AI) in healthcare settings, emphasizing the ethical implications and responsible implementation. The emergence of AI tools and the COVID-19 pandemic have raised significant ethical concerns related to bias, transparency, and accountability in healthcare.
 
 The research is composed of a comprehensive literature review focusing on the current use of AI as well as the status of ethical questions and solutions in medicine. It also includes qualitative interviews and a survey. This is made to gain a broad understanding of the topic from multiple perspectives. This approach allows us to align ethical guidelines with the values, needs and concerns of most people. This also fosters interdisciplinary dialogue.
 
 Key findings highlight the need for a universal ethical framework in using AI in healthcare. The necessity for transparency, informed consent, participatory design, adequate training for medical professionals, balance between technological prowess and human element, have all been identified during the study. These insights help decision-makers, researchers, healthcare professionals, as well as actors from other sectors who might be confronted with similar ethical questions, adopt safely AI technology.
 
 In conclusion, the thesis proposes a set of guidelines for the safe and ethical implementation and use of AI in healthcare. This serves as a tool for stakeholders to understand AI in the medical and pharmaceutical fields responsibly, considering the diverse viewpoints of the three main actors noted in the study: patients, medical professionals, and AI developers.
  • Ethical Challenges of Organ Transplantation: Current Debates and International Perspectives

    Hansen, Solveig Lena; Schicktanz, Silke (transcript VerlagDEUBielefeld, 2024-02-23)
    This collection features comprehensive overviews of the various ethical challenges in organ transplantation. International readings well-grounded in the latest developments in the life sciences are organized into systematic sections and engage with one another, offering complementary views. All core issues in the global ethical debate are covered: donating and procuring organs, allocating and receiving organs, as well as considering alternatives. Due to its systematic structure, the volume provides an excellent orientation for researchers, students, and practitioners alike to enable a deeper understanding of some of the most controversial issues in modern medicine.

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