Pub Date : 2024-06-01Epub Date: 2024-07-11DOI: 10.1007/s40592-024-00198-y
Isabella Holmes, Rosalind McDougall
Stimulated by development of reproductive technologies, many current bioethical accounts of parenthood focus on defining parenthood at or around birth. They tend to exclude from their scope some parent-child relationships that develop later in a child's life. In reality, a parent-child relationship can emerge or dissolve over time: the parents of person A as an adolescent or adult may be different to her parents when she is a young child. To address this aspect of parenthood, we propose a new 'mutuality account' of parenthood, grounded in the concept of ontological security. We argue that in most cases a parent-child relationship exists if there is mutual ontological security between the parent and child. We suggest that this mutual ontological security is constituted and sustained by shared frameworks of reality and cohesive personal narratives. Our intention is to broaden the conceptual understanding of parenthood, to include parent-child relationships that do not fall neatly into current bioethical accounts, and to argue against the notion that objective physiological, causal, or social ties are necessary to 'make' a parent.
在生殖技术发展的推动下,目前许多关于父母身份的生物伦理论述都侧重于界定出生时或出生前后的父母身份。它们往往将儿童生命后期发展起来的一些亲子关系排除在外。在现实生活中,亲子关系会随着时间的推移而出现或消解:青少年或成年人 A 的父母可能不同于她年幼时的父母。针对亲子关系的这一方面,我们提出了一种新的亲子关系 "相互性解释",其基础是本体安全概念。我们认为,在大多数情况下,如果父母与子女之间存在本体论上的相互安全感,亲子关系就会存在。我们认为,这种相互的本体论安全感是由共同的现实框架和有凝聚力的个人叙事构成和维持的。我们的目的是拓宽对亲子关系的概念性理解,将那些不完全属于当前生命伦理学范畴的亲子关系纳入其中,并反对客观的生理、因果或社会关系是 "造就 "父母的必要条件这一观点。
{"title":"The mutuality account of parenthood: a subjective approach to parent-child relationships.","authors":"Isabella Holmes, Rosalind McDougall","doi":"10.1007/s40592-024-00198-y","DOIUrl":"10.1007/s40592-024-00198-y","url":null,"abstract":"<p><p>Stimulated by development of reproductive technologies, many current bioethical accounts of parenthood focus on defining parenthood at or around birth. They tend to exclude from their scope some parent-child relationships that develop later in a child's life. In reality, a parent-child relationship can emerge or dissolve over time: the parents of person A as an adolescent or adult may be different to her parents when she is a young child. To address this aspect of parenthood, we propose a new 'mutuality account' of parenthood, grounded in the concept of ontological security. We argue that in most cases a parent-child relationship exists if there is mutual ontological security between the parent and child. We suggest that this mutual ontological security is constituted and sustained by shared frameworks of reality and cohesive personal narratives. Our intention is to broaden the conceptual understanding of parenthood, to include parent-child relationships that do not fall neatly into current bioethical accounts, and to argue against the notion that objective physiological, causal, or social ties are necessary to 'make' a parent.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2024-07-30DOI: 10.1007/s40592-024-00204-3
David B Resnik
The COVID-19 pandemic has highlighted the importance of biosafety in the biomedical sciences. While it is often assumed that biosafety is a purely technical matter that has little to do with philosophy or the humanities, biosafety raises important ethical issues that have not been adequately examined in the scientific or bioethics literature. This article reviews some pivotal events in the history of biosafety and biosecurity and explores three different biosafety topics that generate significant ethical concerns, i.e., risk assessment, risk management, and risk distribution. The article also discusses the role of democratic governance in the oversight of biosafety and offers some suggestions for incorporating bioethics into biosafety practice, education, and policy.
{"title":"Biosafety, biosecurity, and bioethics.","authors":"David B Resnik","doi":"10.1007/s40592-024-00204-3","DOIUrl":"10.1007/s40592-024-00204-3","url":null,"abstract":"<p><p>The COVID-19 pandemic has highlighted the importance of biosafety in the biomedical sciences. While it is often assumed that biosafety is a purely technical matter that has little to do with philosophy or the humanities, biosafety raises important ethical issues that have not been adequately examined in the scientific or bioethics literature. This article reviews some pivotal events in the history of biosafety and biosecurity and explores three different biosafety topics that generate significant ethical concerns, i.e., risk assessment, risk management, and risk distribution. The article also discusses the role of democratic governance in the oversight of biosafety and offers some suggestions for incorporating bioethics into biosafety practice, education, and policy.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2024-02-29DOI: 10.1007/s40592-023-00186-8
Ben Davies, Joshua Parker
Healthcare practitioners have access to a range of ethical guidance. However, the normative role of this guidance in ethical decision-making is underexplored. This paper considers two ways that healthcare practitioners could approach ethics guidance. We first outline the idea of deference to ethics guidance, showing how an attitude of deference raises three key problems: moral value; moral understanding; and moral error. Drawing on philosophical literature, we then advocate an alternative framing of ethics guidance as a form of moral testimony by colleagues and suggest that a more promising attitude to ethics guidance is to approach it in the spirit of 'critical engagement' rather than deference.
{"title":"Deference or critical engagement: how should healthcare practitioners use clinical ethics guidance?","authors":"Ben Davies, Joshua Parker","doi":"10.1007/s40592-023-00186-8","DOIUrl":"10.1007/s40592-023-00186-8","url":null,"abstract":"<p><p>Healthcare practitioners have access to a range of ethical guidance. However, the normative role of this guidance in ethical decision-making is underexplored. This paper considers two ways that healthcare practitioners could approach ethics guidance. We first outline the idea of deference to ethics guidance, showing how an attitude of deference raises three key problems: moral value; moral understanding; and moral error. Drawing on philosophical literature, we then advocate an alternative framing of ethics guidance as a form of moral testimony by colleagues and suggest that a more promising attitude to ethics guidance is to approach it in the spirit of 'critical engagement' rather than deference.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11369004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139991456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2024-07-13DOI: 10.1007/s40592-024-00199-x
Wayne X Shandera
COVID-19 presents a variety of ethical challenges in a set of arenas, arenas not always considered in past pandemics. These challenges include issues related to autonomy, distributive ethics, and the establishment of policies of equity and justice. Methods are a literature review based on regular editing of an online textbook during the COVID-19 outbreak and a literature review using key ethical terms. Patients are confronted with new issues related to autonomy. Providers need to expand their concepts of ethical issues to include decisions based on proportionality and public health ethics. The public health sector needs to assess the beneficence of alternative modes of disease control. The research community needs to redefine the concept of informed consent in emergent conditions. All elements of the medical spectrum-physicians, scientists, and the community-at-large including the pharmaceutical industry-need to consider the multifaceted methods for preventing future pandemics. This will require giving particular emphasis to public health funding and ending the documented discrimination that exists in the provision of proven therapies. The developing world is especially at risk for most of the ethical issues, especially those related to equity and justice. The ethical issues associated with the COVID-19 outbreak are not unique but provide a diverse set of issues that apply to patients, providers, social groups, and investigators. The further study of such issues can help with preventing future outbreaks.
{"title":"COVID-19 ethics: unique aspects and a review as of early 2024.","authors":"Wayne X Shandera","doi":"10.1007/s40592-024-00199-x","DOIUrl":"10.1007/s40592-024-00199-x","url":null,"abstract":"<p><p>COVID-19 presents a variety of ethical challenges in a set of arenas, arenas not always considered in past pandemics. These challenges include issues related to autonomy, distributive ethics, and the establishment of policies of equity and justice. Methods are a literature review based on regular editing of an online textbook during the COVID-19 outbreak and a literature review using key ethical terms. Patients are confronted with new issues related to autonomy. Providers need to expand their concepts of ethical issues to include decisions based on proportionality and public health ethics. The public health sector needs to assess the beneficence of alternative modes of disease control. The research community needs to redefine the concept of informed consent in emergent conditions. All elements of the medical spectrum-physicians, scientists, and the community-at-large including the pharmaceutical industry-need to consider the multifaceted methods for preventing future pandemics. This will require giving particular emphasis to public health funding and ending the documented discrimination that exists in the provision of proven therapies. The developing world is especially at risk for most of the ethical issues, especially those related to equity and justice. The ethical issues associated with the COVID-19 outbreak are not unique but provide a diverse set of issues that apply to patients, providers, social groups, and investigators. The further study of such issues can help with preventing future outbreaks.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141604337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2024-03-02DOI: 10.1007/s40592-024-00188-0
Hnin Si Oo, Pascal Borry
Contact investigation is an evidence-based intervention of multidrug-resistant tuberculosis (MDR-TB) to protect public health by interrupting the chain of transmission. In pursuit of contact investigation, patients' MDR-TB status has to be disclosed to third parties (to the minimum necessary) for tracing the contacts. Nevertheless, disclosure to third parties often unintentionally leads the MDR-TB patients suffered from social discrimination and stigma. For this reason, patients are less inclined to reveal their MDR-TB status and becomes a significant issue in contact investigation. This issue certainly turns into a negative impact on the public interest. Tension between keeping MDR-TB status confidential and safeguarding public health arises in relation to this issue. Regarding MDR-TB management, patient compliance with treatment and contact investigation are equally important. Patients might fail to comply with anti-TB therapy and be reluctant to seek healthcare due to disclosure concerns. In order to have treatment adherence, MDRTB patients should not live through social discrimination and stigma arising from disclosure and TB team has a duty to support them as a mean of reciprocity. However, implementation of contact investigation as a public health policy can still be challenging even with promising reciprocal support to the patients because MDR-TB patients are living in different contexts and situations. There can be no straight forward settlement but an appropriate justification for each distinct context is needed to strike a balance between individual confidentiality and public interest.
{"title":"Contact investigation in multidrug-resistant tuberculosis: ethical challenges.","authors":"Hnin Si Oo, Pascal Borry","doi":"10.1007/s40592-024-00188-0","DOIUrl":"10.1007/s40592-024-00188-0","url":null,"abstract":"<p><p>Contact investigation is an evidence-based intervention of multidrug-resistant tuberculosis (MDR-TB) to protect public health by interrupting the chain of transmission. In pursuit of contact investigation, patients' MDR-TB status has to be disclosed to third parties (to the minimum necessary) for tracing the contacts. Nevertheless, disclosure to third parties often unintentionally leads the MDR-TB patients suffered from social discrimination and stigma. For this reason, patients are less inclined to reveal their MDR-TB status and becomes a significant issue in contact investigation. This issue certainly turns into a negative impact on the public interest. Tension between keeping MDR-TB status confidential and safeguarding public health arises in relation to this issue. Regarding MDR-TB management, patient compliance with treatment and contact investigation are equally important. Patients might fail to comply with anti-TB therapy and be reluctant to seek healthcare due to disclosure concerns. In order to have treatment adherence, MDRTB patients should not live through social discrimination and stigma arising from disclosure and TB team has a duty to support them as a mean of reciprocity. However, implementation of contact investigation as a public health policy can still be challenging even with promising reciprocal support to the patients because MDR-TB patients are living in different contexts and situations. There can be no straight forward settlement but an appropriate justification for each distinct context is needed to strike a balance between individual confidentiality and public interest.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140013404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-18DOI: 10.1007/s40592-024-00196-0
Lucie White
The COVID pandemic was an exceptional public health situation - which brought with it unprecedented restrictions across the global populace. But what was it about this pandemic which caused us to implement such drastic restrictions on liberty? Much of the ethical debate on restrictive measures such as lockdowns and vaccine requirements focused on the potential harm that individuals cause to other individuals by the risk of infection. I will suggest that this may come from a reliance on J.S. Mill's harm principle as providing the ultimate justification for coercion - i.e., the well-accepted principle that state coercion is justified in order to prevent the imposition of unacceptable risk of harm to others. Though there have been attempts, in the wider public health ethics literature, to use the harm principle as a basis for restricting contribution to collective harms, I will suggest that these attempts cannot rely on the harm principle alone. I will then turn to the ways in which an individual-based line of reasoning does not capture a distinctive sort of harm posed by the COVID pandemic (and others like it): the potential failure of healthcare systems. I will draw out three ways in which a focus on the harm that an individual poses to another individual fails to capture the full scope of harm wrought by the collapse of healthcare systems. First, it can't adequately capture the cumulative and "looping effects" of the harm caused by strained healthcare systems. Second, it fails to capture the widespread ripple effects the failure of a central societal institution can have on other institutions. And third, the failure of a healthcare system can impose "psychic costs", affecting the moral character of all members of society, reducing trust in institutions, and potentially posing an existential threat to the fabric of society. Finally, I will sketch some implications of the recognition of this distinctive sort of harm for the justification of coercive public health measures.
{"title":"Justification for coercion in a public health crisis: not just a matter of individual harm.","authors":"Lucie White","doi":"10.1007/s40592-024-00196-0","DOIUrl":"https://doi.org/10.1007/s40592-024-00196-0","url":null,"abstract":"<p><p>The COVID pandemic was an exceptional public health situation - which brought with it unprecedented restrictions across the global populace. But what was it about this pandemic which caused us to implement such drastic restrictions on liberty? Much of the ethical debate on restrictive measures such as lockdowns and vaccine requirements focused on the potential harm that individuals cause to other individuals by the risk of infection. I will suggest that this may come from a reliance on J.S. Mill's harm principle as providing the ultimate justification for coercion - i.e., the well-accepted principle that state coercion is justified in order to prevent the imposition of unacceptable risk of harm to others. Though there have been attempts, in the wider public health ethics literature, to use the harm principle as a basis for restricting contribution to collective harms, I will suggest that these attempts cannot rely on the harm principle alone. I will then turn to the ways in which an individual-based line of reasoning does not capture a distinctive sort of harm posed by the COVID pandemic (and others like it): the potential failure of healthcare systems. I will draw out three ways in which a focus on the harm that an individual poses to another individual fails to capture the full scope of harm wrought by the collapse of healthcare systems. First, it can't adequately capture the cumulative and \"looping effects\" of the harm caused by strained healthcare systems. Second, it fails to capture the widespread ripple effects the failure of a central societal institution can have on other institutions. And third, the failure of a healthcare system can impose \"psychic costs\", affecting the moral character of all members of society, reducing trust in institutions, and potentially posing an existential threat to the fabric of society. Finally, I will sketch some implications of the recognition of this distinctive sort of harm for the justification of coercive public health measures.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140956559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Research on gender and antimicrobial resistance (AMR) beyond women's biological susceptibility is limited. A gender and equity lens in AMR research is necessary to promote gender equality and support the effectiveness, uptake, and sustainability of real-world AMR solutions. We argue that it is an ethical and social justice imperative to include gender and related intersectional issues in AMR research and implementation. An intersectional exploration of the interplay between people's diverse identities and experiences, including their gender, socio-economic status, race, disability, age, and sexuality, may help us understand how these factors reinforce AMR risk and vulnerability and ensure that interventions to reduce the risk of AMR do not impact unevenly. This paper reports on the findings of a systematic scoping review on the interlinkages between AMR, gender and other socio-behavioural characteristics to identify priority knowledge gaps in human and animal health in LMICs. The review focused on peer-reviewed and grey literature published between 2017 and 2022. Three overarching themes were gendered division of caregiving roles and responsibilities, gender power relations in decision-making, and interactions between gender norms and health-seeking behaviours. Research that fails to account for gender and its intersections with other lines of disadvantage, such as race, class and ability, risks being irrelevant and will have little impact on the continued and dangerous spread of AMR. We provide recommendations for integrating an intersectional gender lens in AMR research, policy and practice.
除了女性的生理易感性之外,有关性别和抗菌药物耐药性(AMR)的研究还很有限。AMR 研究中的性别和公平视角对于促进性别平等和支持现实世界中 AMR 解决方案的有效性、吸收和可持续性是必要的。我们认为,在 AMR 研究和实施中纳入性别和相关交叉问题是伦理和社会正义的当务之急。对人们的不同身份和经历(包括性别、社会经济地位、种族、残疾、年龄和性取向)之间的相互作用进行交叉探讨,有助于我们了解这些因素是如何强化 AMR 风险和脆弱性的,并确保降低 AMR 风险的干预措施不会产生不均衡的影响。本文报告了一项关于 AMR、性别和其他社会行为特征之间相互联系的系统性范围审查结果,以确定低收入国家人类和动物健康方面的优先知识缺口。综述重点关注 2017 年至 2022 年间发表的同行评审文献和灰色文献。三个首要主题是:护理角色和责任的性别分工、决策中的性别权力关系以及性别规范与寻求健康行为之间的相互作用。如果研究未能考虑性别因素及其与种族、阶级和能力等其他不利因素的交叉关系,就有可能失去意义,对急性呼吸道感染的持续和危险蔓延影响甚微。我们建议在 AMR 研究、政策和实践中纳入性别交叉视角。
{"title":"Gender and equity considerations in AMR research: a systematic scoping review.","authors":"Ingrid Lynch, Lorenza Fluks, Lenore Manderson, Nazeema Isaacs, Roshin Essop, Ravikanya Praphasawat, Lyn Middleton, Bhensri Naemiratch","doi":"10.1007/s40592-024-00194-2","DOIUrl":"https://doi.org/10.1007/s40592-024-00194-2","url":null,"abstract":"<p><p>Research on gender and antimicrobial resistance (AMR) beyond women's biological susceptibility is limited. A gender and equity lens in AMR research is necessary to promote gender equality and support the effectiveness, uptake, and sustainability of real-world AMR solutions. We argue that it is an ethical and social justice imperative to include gender and related intersectional issues in AMR research and implementation. An intersectional exploration of the interplay between people's diverse identities and experiences, including their gender, socio-economic status, race, disability, age, and sexuality, may help us understand how these factors reinforce AMR risk and vulnerability and ensure that interventions to reduce the risk of AMR do not impact unevenly. This paper reports on the findings of a systematic scoping review on the interlinkages between AMR, gender and other socio-behavioural characteristics to identify priority knowledge gaps in human and animal health in LMICs. The review focused on peer-reviewed and grey literature published between 2017 and 2022. Three overarching themes were gendered division of caregiving roles and responsibilities, gender power relations in decision-making, and interactions between gender norms and health-seeking behaviours. Research that fails to account for gender and its intersections with other lines of disadvantage, such as race, class and ability, risks being irrelevant and will have little impact on the continued and dangerous spread of AMR. We provide recommendations for integrating an intersectional gender lens in AMR research, policy and practice.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-13DOI: 10.1007/s40592-024-00190-6
Antoinette Lundahl
{"title":"Suicide-preventive compulsory admission is not a proportionate measure – time for clinicians to recognise the associated risks","authors":"Antoinette Lundahl","doi":"10.1007/s40592-024-00190-6","DOIUrl":"https://doi.org/10.1007/s40592-024-00190-6","url":null,"abstract":"","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140707726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-13DOI: 10.1007/s40592-024-00187-1
Maxwell J Smith
In his 2000 book, From Chaos to Coercion: Detention and the Control of Tuberculosis, Richard Coker makes a number of important observations and arguments regarding the use of coercive public health measures in response to infectious disease threats. In particular, Coker argues that we have a tendency to neglect public health threats and then demand immediate action, which can leave policymakers with fewer effective options and may require (or may be perceived as requiring) more aggressive, coercive measures to achieve public health goals. While Coker makes a convincing case as to why we should find it ethically problematic when governments find themselves in this position and resort to coercion, left outstanding is the question of whether this should preclude governments and health authorities from using coercion if and when they do find themselves in this position. In this paper, I argue that, while we should consider it ethically objectionable when governments resort to coercion because they have neglected a public health threat, its causes, and other possible responses to that threat, this should not then necessarily rule out the use of coercion in such circumstances; that there are ethically objectionable antecedents for why coercion is being considered should not necessarily or automatically cause us to think coercion in such cases cannot be justified. I address an objection to this argument and draw several conclusions about how governments' use of coercion in public health should be evaluated.
理查德-科克尔(Richard Coker)在 2000 年出版的《从混乱到强制》(From Chaos to Coercion:理查德-科克尔(Richard Coker)在其 2000 年出版的《从混乱到强制:拘留与结核病控制》一书中,就使用强制公共卫生措施应对传染病威胁提出了许多重要的看法和论点。特别是,科克尔认为,我们往往忽视公共卫生威胁,然后要求立即采取行动,这可能使政策制定者的有效选择更少,可能需要(或被认为需要)采取更激进的强制措施来实现公共卫生目标。科克尔提出了一个令人信服的理由,说明为什么当政府发现自己处于这种境地并诉诸强制手段时,我们应该认为这在伦理上是有问题的,但悬而未决的问题是,如果政府和卫生当局发现自己处于这种境地时,是否应该排除使用强制手段的可能性。在本文中,我将论证,当政府因为忽视公共卫生威胁、其原因以及其他可能的应对措施而诉诸强制手段时,我们应该认为这在伦理上是令人反感的,但这并不一定就排除了在这种情况下使用强制手段的可能性;为什么要考虑使用强制手段,这在伦理上是令人反感的,但这并不一定或自动导致我们认为在这种情况下使用强制手段是不合理的。我对这一论点提出了反对意见,并就如何评价政府在公共卫生领域使用强制手段得出了几点结论。
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Pub Date : 2023-12-21DOI: 10.1007/s40592-023-00185-9
B V E Hyde
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