Monash Bioethics Review最新文献

New Zealand and Malaysia have abandoned plans to introduce a generational smoking ban because of concerns that such a policy is incompatible with liberal democracy as it undermines autonomy. This paper challenges this claim by showing that smoking is not an autonomous act. Autonomy requires a deliberation of preferences, wills and inclinations. This does not occur in smokers because of three related factors: nicotine addiction, cognitive biases and psychosocial development in addiction. Nicotine addiction results in strong physical and psychological desires to seek pleasure and to avoid withdrawal. This is further potentiated by conditioned behaviour. Cognitive biases explain why smokers act in ways that are detrimental to their health. Psychosocial development explains how the brains of smokers are unable to make rational decisions. This combination renders smokers unable to reflect on their actions and thus act autonomously. This stance is compatible with Mill's view that actions that devalue autonomy cannot be considered autonomous. Defenders of liberalism should not be quick to dismiss a smoking ban and can instead foster autonomy by supporting it.

South Africa implemented a comprehensive response to COVID-19 comprising of several coercive public health measures. As in many countries, COVID-19 measures were subject to a number of legal challenges on the grounds that these measures infringed on individual rights and liberties. Here, courts were required to assess the extent to which these limitations were justifiable against the state's imperative to improve public health. Consequently, the acceptability of different justifications of coercive public health measures during the COVID-19 pandemic in South Africa may be understood and assessed through the lens of its jurisprudence. This paper seeks to outline the approach to allowing, or disallowing, coercive public health measures as adopted by the judiciary as arbiters of allowable human rights infringements and thus permitting or prohibiting the state from exercising coercive powers. Specifically, this analysis aims to identify the principles underpinning the decisions with an expressly ethical lens with a view to providing content for the operationalisation of justifications for coercive state action such as the harm principle, reciprocity, least restrictive means in relation to the promotion of public health and the limitation of individual liberty.

Vaccine mandates are diverse policy instruments that impact people differently. This paper explores how different types of mandates may generate distinct subjective experiences of constraint, compulsion, or power across populations. We identify and analyze five key aspects of mandate policies that influence these experiences - (1) the alignment between individual preferences and mandate requirements, (2) the relationship between parents' and children's interests, (3) the experienced severity of sanctions, (4) the availability of reasonable alternatives, and (5) the power that the enforcing authority actually applies to particular persons - which are crucial for assessing mandates' effectiveness, identifying which populations are most affected, anticipating public responses, and informing ethical justifications. We remain neutral about whether these experiences constitute coercion, but we emphasize that these experiences may have ethical significance regardless of how they are categorized. This paper provides a foundation for future normative work by clarifying some of the complex landscape of vaccine mandate policies and their impacts, without explicitly defending a particular theory of coercion or public health justice.

In this piece we examine three forms of coercive or otherwise involuntary care that can occur with patient consent. To do so, we examine: (1) uninformed consent, (2) contingency-based consent and (3) constrained-market consent, amongst female sterilization patients. While there is broad recognition that "coercion" in sterilization care can manifest beyond instances of overt force and clarity on what constitutes coercion within clinical care, this has not translated to accountability. The current practice of identifying coercion through discrete civil cases may facilitate a narrow understanding of its contemporary prevalence; one that does not align with definitions of coercion supported by international human rights entities. We use three acute, and widely recognized, examples-hysterectomies in ICE detention facilities, India's sterilization camp deaths and birth control quotas for Uyghur women-as an entry point to highlight less overt contemporary forms of coercive sterilization care, pairing each example with data that explores prevalence at a broader population level. These data suggest less visible forms of coercion may persist relatively unchallenged-raising the ethical case for a functional approach to the measurement of coercion. In turn, we argue the relevant question may not be "when is coercion ethically justified in public health," but rather, why is coercion already the status quo?

Bayanihan, commonly understood as the spirit of cooperation with the kapwa (shared identity), is often attributed as a distinctly Filipino trait that motivates altruistic and ethical actions. Despite this popular image, a lacuna exists in understanding how this concept applies to foreign migrants residing in the Philippines. In this paper, we aim to explore the identified gap and, in turn, propose a normative framework for migration health ethics grounded in the Filipino philosophical concepts of bayanihan and kapwa, arguing that these concepts offer an interesting alternative to the dominant theories and policies on migration. To accomplish this aim, we begin with a discussion of the conceptual foundation of migration health ethics. Afterwards, we situate bayanihan and kapwa, highlighting their ethical significance as well as their limitations and possible misuses. Finally, we propose how theseFilipino concepts can guide the development of an equitable and inclusive framework for migration health ethics in the Philippines.