Public Health Ethics最新文献

英文中文

From Self-Management to Shared-Management: A Relational Approach for Equitable Chronic Care 从自我管理到共享管理：公平慢性病护理的关系方法

IF 2.1 3区哲学 Q2 ETHICS

Public Health Ethics

Pub Date : 2024-08-22 DOI: 10.1093/phe/phae007

Francisca Stutzin Donoso

Life with chronic disease and chronic care is hard and people who live in disadvantage may lack the freedom to prioritise their care because of increased competing demands. This paper proposes that shifting the goals of chronic care from self-management support to a shared-management approach can help improve wellbeing and health outcomes across social groups. This work draws on a qualitative exploration of the lived experience of chronic disease and an applied ethical analysis of the reproduction of disadvantages within chronic care. The qualitative results further specify respectful and collaborative patient-healthcare professional relationships; autonomy-supportive interventions; and continuity of care to face the complexity of chronicity in a phenomenological sense—a paradoxical experience of long duration that comprises the disease’s presence in the absence of its manifestation. The ethical analysis draws on performativity; autonomy and decision-making; and responsibility, which constitute the theoretical foundation for shared-management. This approach contributes to advance current normative thinking for health justice and outlines practical steps for its clinical implementation in the delivery of chronic care.

患有慢性疾病和长期护理的人生活艰辛，而生活在弱势群体中的人可能会因为更多相互竞争的需求而无法自由地优先考虑他们的护理。本文提出，将慢性病护理的目标从自我管理支持转向共同管理方法，有助于改善不同社会群体的福祉和健康状况。这项工作借鉴了对慢性病生活体验的定性探索，以及对慢性病护理中的不利因素再现进行的应用伦理分析。定性结果进一步明确了患者与医疗保健专业人员之间相互尊重、相互协作的关系；支持自主性的干预措施；以及从现象学意义上面对慢性病复杂性的连续性护理--一种由疾病存在而疾病不存在的长期矛盾体验。伦理分析借鉴了表演性、自主和决策以及责任，这些构成了共同管理的理论基础。这种方法有助于推进当前的健康正义规范思想，并概述了在提供慢性病护理的临床实施中的实际步骤。

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引用次数: 0

The Application of Australian Rights Protections to the Use of Hepatitis C Notification Data to Engage People ‘Lost to Follow Up’ 澳大利亚权利保护措施在使用丙型肝炎通知数据吸引 "失去随访 "者方面的应用

IF 2.1 3区哲学 Q2 ETHICS

Public Health Ethics

Pub Date : 2024-05-18 DOI: 10.1093/phe/phae006

Freya Saich, Shelley Walker, Margaret Hellard, Mark Stoové, Kate Seear

Hepatitis C is a global public health threat, affecting 56 million people worldwide. The World Health Organization has committed to eliminating hepatitis C by 2030. Although new treatments have revolutionised the treatment and care of people with hepatitis C, treatment uptake has slowed in recent years, drawing attention to the need for innovative approaches to reach elimination targets. One approach involves using existing notifiable disease data to contact people previously diagnosed with hepatitis C. Within these disease surveillance systems, however, competing tensions exist, including protecting individual rights to privacy and autonomy, and broader public health goals. We explore these issues using hepatitis C and Australia’s legislative and regulatory frameworks as a case study. We examine emerging uses of notification data to contact people not yet treated, and describe some of the ethical dilemmas associated with the use and non-use of this data and the protections that exist to preserve individual rights and public health. We reveal weaknesses in rights protections and processes under Australian public health and human rights legislation and argue for consultation with and involvement of affected communities in policy and intervention design before notification data is used to increase hepatitis C treatment coverage.

丙型肝炎是一种全球性的公共健康威胁，影响着全球 5600 万人。世界卫生组织承诺到 2030 年消灭丙型肝炎。虽然新的治疗方法彻底改变了丙型肝炎患者的治疗和护理，但近年来治疗接受率有所放缓，这使人们注意到需要采用创新方法来实现消除丙型肝炎的目标。然而，在这些疾病监测系统中存在着相互竞争的矛盾，包括保护个人隐私和自主权以及更广泛的公共卫生目标。我们以丙型肝炎和澳大利亚的立法与监管框架为案例，探讨了这些问题。我们研究了新出现的使用通知数据来联系尚未接受治疗者的情况，并描述了与使用和不使用这些数据相关的一些道德困境，以及为维护个人权利和公共健康而存在的保护措施。我们揭示了澳大利亚公共卫生和人权立法在权利保护和程序方面的薄弱环节，并主张在使用通知数据提高丙型肝炎治疗覆盖率之前，应与受影响社区进行协商并让其参与政策和干预措施的设计。

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引用次数: 0

Time to Treat the Climate and Nature Crisis as One Indivisible Global Health Emergency. 是时候将气候和自然危机视为一个不可分割的全球健康紧急情况了。

IF 1.4 3区哲学 Q2 ETHICS

Public Health Ethics

Pub Date : 2024-03-23 eCollection Date: 2024-04-01 DOI: 10.1093/phe/phad022

Kamran Abbasi, Parveen Ali, Virginia Barbour, Thomas Benfield, Kirsten Bibbins-Domingo, Stephen Hancocks, Richard Horton, Laurie Laybourn-Langton, Robert Mash, Peush Sahni, Wadeia Mohammad Sharief, Paul Yonga, Chris Zielinski

引用次数: 0

Psychedelics in PERIL: The Commercial Determinants of Health, Financial Entanglements and Population Health Ethics Psychedelics in PERIL：健康的商业决定因素、金融纠葛与人口健康伦理

IF 2.1 3区哲学 Q2 ETHICS

Public Health Ethics

Pub Date : 2024-03-02 DOI: 10.1093/phe/phae002

Daniel Buchman, Daniel Rosenbaum

The nascent for-profit psychedelic industry has begun to engage in corporate practices like funding scientific research and research programs. There is substantial evidence that such practices from other industries like tobacco, alcohol, pharmaceuticals and food create conflicts of interest and can negatively influence population health. However, in a context of funding pressures, low publicly funded success rates and precarious academic labor, there is limited ethics guidance for researchers working at the intersection of clinical practice and population health as to how they should approach potential financial sponsorship from for-profit entities, such as the psychedelic industry. This article reports on a reflective exercise among a group of clinician scientists working in psychedelic science, where we applied Adams’ (2016) PERIL (Purpose, Extent, Relevant harm, Identifiers, Link) ethical decision-making framework to a fictionalized case of corporate psychedelic financial sponsorship. Our analysis suggests financial relationships with the corporate psychedelic sector may create varying degrees of risk to a research program’s purpose, autonomy and integrity. We argue that the commercial determinants of health provide a useful framework for understanding the ethics of industry-healthcare entanglements and can provide an important population health ethics lens to examine nascent industries such as psychedelics, and work toward potential solutions.

新生的以营利为目的的迷幻药行业已经开始参与企业行为，如资助科学研究和研究项目。有大量证据表明，烟草、酒精、药品和食品等其他行业的此类做法会造成利益冲突，并对人口健康产生负面影响。然而，在资金压力大、公共资助成功率低、学术劳动岌岌可危的背景下，对于从事临床实践与人口健康交叉领域工作的研究人员来说，他们应该如何对待来自迷幻药行业等营利性实体的潜在经济赞助，目前的伦理指导还很有限。本文报告了一组从事迷幻剂科学研究的临床科学家的反思活动，我们将亚当斯（2016 年）的 PERIL（目的、范围、相关危害、标识符、联系）伦理决策框架应用于一个虚构的企业迷幻剂财务赞助案例。我们的分析表明，与企业迷幻药部门的财务关系可能会给研究项目的目的、自主性和完整性带来不同程度的风险。我们认为，健康的商业决定因素为理解产业与医疗保健之间的伦理纠葛提供了一个有用的框架，可以为研究迷幻药等新兴产业提供一个重要的人口健康伦理视角，并努力寻找潜在的解决方案。

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引用次数: 0

The Liberalism of Fear and Public Health Ethics 恐惧的自由主义与公共卫生伦理

IF 2.1 3区哲学 Q2 ETHICS

Public Health Ethics

Pub Date : 2024-02-27 DOI: 10.1093/phe/phae001

Alvin Chen

This article argues that the liberalism of fear provides a useful theoretical framework for public health ethics in two fronts. First, it helps reconcile the tension between public health interventions and liberal politics. Second, it reinforces the existing justifications for public health interventions in liberal political culture. The article discusses this in the context of political emotions in the COVID-19 pandemic. Fear plays a central role in the experiences of pandemic politics, and such fear is extended to the concern that post-pandemic government would normalize emergency politics and threaten the political culture of liberal democracy. The article proposes that the liberalism of fear provides a theoretical solution not only to alleviate such fear, but also to reconcile the long-established tension between liberal politics and public health intervention. This is particularly so if the liberalism of fear’s characteristic of political realism is taken into account. The article makes two points about this, and discusses their pragmatic implications in the case of compulsory vaccination.

本文认为，恐惧自由主义在两个方面为公共卫生伦理提供了有用的理论框架。首先，它有助于调和公共卫生干预与自由主义政治之间的矛盾。其次，它强化了自由主义政治文化中现有的公共卫生干预理由。文章以 COVID-19 大流行中的政治情绪为背景对此进行了讨论。恐惧在大流行病政治经历中扮演着核心角色，这种恐惧延伸到了对大流行病后政府将使应急政治正常化并威胁自由民主政治文化的担忧。文章提出，恐惧的自由主义不仅为减轻这种恐惧提供了理论解决方案，而且还调和了自由主义政治与公共卫生干预之间长期存在的紧张关系。如果考虑到恐惧自由主义的政治现实主义特征，这一点尤为重要。文章就此提出了两个观点，并讨论了它们在强制疫苗接种中的实际意义。

引用次数: 0

Reciprocity, Fairness and the Financial Burden of Undertaking COVID-19 Hotel Quarantine in Australia. 互惠、公平与澳大利亚 COVID-19 酒店检疫的财政负担。

IF 1.4 3区哲学 Q2 ETHICS

Public Health Ethics

Pub Date : 2023-12-20 eCollection Date: 2024-04-01 DOI: 10.1093/phe/phad027

Kari Pahlman, Jane Williams, Diego S Silva, Louis Taffs, Bridget Haire

In late March 2020 in response to the COVID-19 pandemic, Australia introduced mandatory 14-day supervised quarantine at hotels and other designated facilities for all international arrivals. From July 2020, most states and territories introduced a fixed charge for quarantine of up to $3220 per adult. The introduction of the fee was rationalised on the basis that Australians had been allowed sufficient time to return and there was a need to recover some of the cost associated with administering the program. Drawing on an empirical study of 58 returned Australian citizens and residents quarantined between March 2020 and January 2021, this paper aims to explore how people experienced paying for hotel quarantine, particularly with respect to fairness and relatedly, the principle of reciprocity. Reciprocity requires that the state has an obligation to assist individuals in discharging their duty to comply with public health measures and avoid disproportionate burdens accruing to populations or individuals. Though participants had varying opinions on whether they thought it fair to be charged for their quarantine, for many, the fee constituted a significant burden and source of stress. Given the undertaking of quarantine is primarily for the benefit of the public good, we argue the financial cost imposed on individuals does not meet the demands of reciprocity. It is imperative that future quarantine and isolation arrangements consider seriously the need to minimise burdens of individuals subject to such measures, and that fees do not become a new norm in public health and infectious disease control.

为应对 COVID-19 大流行，澳大利亚于 2020 年 3 月下旬开始在酒店和其他指定设施对所有国际入境者实施为期 14 天的强制监督检疫。从 2020 年 7 月起，大多数州和地区开始对每名成人收取高达 3220 澳元的固定检疫费。收费合理化的依据是，澳大利亚人已经有足够的时间回国，而且有必要收回与管理该计划相关的部分成本。本文通过对 2020 年 3 月至 2021 年 1 月期间被隔离的 58 名回国澳大利亚公民和居民进行实证研究，旨在探讨人们如何体验酒店隔离费用，尤其是在公平性和相关的互惠原则方面。互惠原则要求国家有义务协助个人履行遵守公共卫生措施的义务，避免给人群或个人带来过重的负担。尽管与会者对检疫收费是否公平有不同的看法，但对许多人来说，收费是一个沉重的负担，也是压力的来源。鉴于进行检疫主要是为了公共利益，我们认为强加给个人的经济成本并不符合互惠的要求。当务之急是，未来的检疫和隔离安排应认真考虑尽量减轻受此类措施影响的个人负担的必要性，而且收费不应成为公共卫生和传染病控制的新规范。

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引用次数: 0

How to Design Consent for Health Data Research? An Analysis of Arguments of Solidarity 如何为健康数据研究设计同意书？团结论点分析

IF 2.1 3区哲学 Q2 ETHICS

Public Health Ethics

Pub Date : 2023-12-12 DOI: 10.1093/phe/phad025

Svenja Wiertz

The article discusses the impact different concepts of solidarity can have on debates on models of consent for non-interventional research. It introduces three concepts of solidarity that have been referenced in bioethical debates: a purely descriptive concept, a concept that claims some derivative value for most but not all practices of solidarity, as well as a clearly normative concept where solidarity is tied to justice and taken to ground moral duties. It shows that regarding the rivalling models of study-specific consent, tiered consent and broad consent, the first two concepts can be taken to favour tiered consent while only normative solidarity supports a model of broad consent—or an argument to allow non-interventional research without requiring consent at all. As normative solidarity is tied to considerations of justice, however, the argument appears less straightforward than one might expect: It presupposes that the research contributes to overcoming existing social injustices.

文章讨论了不同的团结概念对非干预性研究同意模式辩论的影响。文章介绍了生物伦理辩论中提到的三种团结概念：一种纯粹描述性的概念，一种声称大多数团结实践（而非所有团结实践）具有某种衍生价值的概念，以及一种明确的规范性概念，在这种概念中，团结与正义联系在一起，并被视为道德义务的基础。它表明，在针对特定研究的同意、分层同意和广泛同意这几种相互对立的模式中，前两种概念都可以被视为有利于分层同意，而只有规范性团结支持广泛同意的模式--或者说支持允许进行非干预性研究而无需征得同意的论点。然而，由于规范团结与正义的考虑相联系，这一论点似乎没有人们想象的那么直截了当：它预先假定研究有助于克服现有的社会不公正现象。

引用次数: 0

Ageism Without Anticipation-Blindness 没有预期的老龄化--盲目性

IF 2.1 3区哲学 Q2 ETHICS

Public Health Ethics

Pub Date : 2023-12-09 DOI: 10.1093/phe/phad023

Martin Marchman Andersen, Lasse Nielsen

Ageism is the view that it is of greater moral value to allocate health care resources to younger people than to older people. In medical ethics, it is well-known that standard interpretations of distributive principles such as utilitarianism and egalitarianism imply some form of ageism. At times, ethicists argue as if practical complications are the only or main reason for not abiding to ageism. In this article, we argue that inferences to ageism from such distributive principles tend to commit what we call the anticipation-blindness fallacy: A much too narrow focus on life quality benefits of health care treatments inclines us to overlook the importance of life quality benefits of health care safety, that is the mere trust in and expectation of being treated and cared for as one grows old. This is a key omission because health safety has value for a much larger population and for much longer time. Taking health safety into account therefore has important implications as for how ageist we ought to be.

老龄歧视是一种观点，认为将医疗资源分配给年轻人比分配给老年人更具道德价值。在医学伦理学中，众所周知，对功利主义和平等主义等分配原则的标准解释意味着某种形式的年龄歧视。有时，伦理学家会争辩说，似乎实际问题是不遵守年龄歧视的唯一或主要原因。在本文中，我们认为，从这种分配原则推断出老龄歧视，往往会犯我们所说的 "预期盲目 "谬误：过于狭隘地关注医疗保健治疗对生命质量的益处，使我们倾向于忽视医疗保健安全对生命质量益处的重要性，即仅仅是对年老时得到治疗和护理的信任和期望。这是一个关键的疏忽，因为医疗安全对更多的人和更长的时间都有价值。因此，将医疗安全纳入考虑范围对于我们应该如何对待老龄问题具有重要意义。

引用次数: 0

Understanding Pandemic Solidarity: Mutual Support During the First COVID-19 Lockdown in the United Kingdom 了解大流行病的团结：英国第一次 COVID-19 封锁期间的相互支持

IF 2.1 3区哲学 Q2 ETHICS

Public Health Ethics

Pub Date : 2023-12-09 DOI: 10.1093/phe/phad024

Stephanie Johnson, Stephen Roberts, Sarah Hayes, Amelia Fiske, Federica Lucivero, Stuart McLennan, Amicia Phillips, Gabrielle Samuel, Barbara Prainsack

Throughout the COVID-19 pandemic, the concept of solidarity has been invoked frequently. Much interest has centred around how citizens and communities support one another during times of uncertainty. Yet, empirical research which accounts and understands citizen’s views on pandemic solidarity, or their actual practices has remained limited. Drawing upon the analysis of data from 35 qualitative interviews, this article investigates how residents in England and Scotland enacted, understood, or criticised (the lack of) solidarity during the first national lockdown in the United Kingdom in April 2020—at a time when media celebrated solidarity as being at an all-time high. It finds that although solidarity was practiced by some people, the perceived lack of solidarity was just as pronounced. We conclude that despite frequent mobilisations of solidarity by policy makers and other public actors, actual practices of solidarity are poorly understood—despite the importance of solidarity for public health and policy.

在 COVID-19 大流行的整个过程中，团结的概念经常被引用。人们的兴趣主要集中在公民和社区如何在不确定时期相互支持。然而，能够说明和理解公民对大流行病团结的看法或他们的实际做法的实证研究仍然有限。本文通过对 35 个定性访谈的数据分析，调查了英格兰和苏格兰的居民在 2020 年 4 月英国首次全国封锁期间是如何实施、理解或批评（缺乏）团结的--当时媒体将团结推向了前所未有的高潮。研究发现，尽管一些人践行了团结精神，但人们对缺乏团结精神的看法也同样明显。我们的结论是，尽管政策制定者和其他公共参与者经常动员人们团结一致，但人们对团结一致的实际做法了解甚少，尽管团结一致对公共卫生和政策非常重要。

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Confucian Welfarism: Intellectual Origins of Solidarity for Health and Welfare Systems 儒家福利主义:健康和福利制度团结的思想起源

3区哲学 Q2 ETHICS

Public Health Ethics

Pub Date : 2023-11-06 DOI: 10.1093/phe/phad021

Ming-Jui Yeh

Abstract Solidarity is presumed to underpin the redistributive health and welfare systems in modern democracies; however, it is often considered a Western—or more specifically, European—concept. While health and welfare systems have been transplanted successfully to many non-Western developed countries, whether the solidarity necessary for such systems exists or is intellectually available remains under debate. Using an East Asian country with the Confucian tradition as an illustrative case, I first argue that the Confucian tradition has special theoretical and sociological importance for health and welfare solidarity. Then, through investigating the classic Confucian writings, I propose transformed interpretations of the essential concepts of Confucian thought, namely filial piety, benevolent governance and the mandate of heaven. With these interpretations, the differentiated family-based solidarity and the people-rooted thought in Confucianism could be reimagined to fit with the modern liberal-democratic political regime and welfare arrangements. I call this model Confucian welfarism, which I argue could form the intellectual origins of solidarity for people who believe in or have an affinity to Confucian ethos.

团结被认为是现代民主国家再分配健康和福利制度的基础;然而，它通常被认为是西方的概念，或者更具体地说，是欧洲的概念。虽然保健和福利制度已成功地移植到许多非西方发达国家，但这种制度所必需的团结是否存在或是否在智力上可用仍在辩论中。以一个具有儒家传统的东亚国家为例，我首先论证了儒家传统对健康和福利团结具有特殊的理论和社会学意义。然后，通过对经典儒家著作的考察，我对儒家思想的基本概念，即孝道、仁政和天命，提出了转变的解释。在此基础上，儒家思想中以家庭为基础的差异化团结和以人为本的思想可以被重新构想，以适应现代自由民主的政治制度和福利安排。我把这种模式称为儒家福利主义，我认为它可以为那些相信或认同儒家精神的人形成团结的思想根源。

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