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Enhancing Global Health Impact—Beyond the Basic Minimum, Metrics and Ethical Consumption 增强全球健康影响——超越基本最低限度、衡量标准和道德消费
IF 2.1 3区 哲学 Q1 Nursing Pub Date : 2022-09-02 DOI: 10.1093/phe/phac013
Nicole Hassoun
How should we measure medicines’ global health impact to set targets, monitor performance and improve health around the world? Can such a metric provide a philosophically well-grounded basis for an ethical consumption campaign that will create incentives for pharmaceutical companies and other agents to expand (equitable) access to essential medicines? And if such metrics exist, how should we think about our individual obligations to support ethical consumption campaigns on this basis? This paper reflects on these questions in light of Tim Campbell’s, Yukiko Asada’s, and Andreas Albertsen’s worries about the answers I provide in Global Health Impact: Extending Access on Essential Medicines. I explain how reflecting on treatments consequences for individuals’ ability to live minimally well supports the creation of the Global Health Impact (GHI) index (https://global-health-impact.org/). I also consider how the index might be modified to better support efforts to promote everyone’s human rights. Finally, I argue that individuals should often promote positive change through GHI and other ethical consumption campaigns.
我们应该如何衡量药物对全球健康的影响,以制定目标、监测表现并改善世界各地的健康?这样一个指标能否为道德消费运动提供一个哲学上有根据的基础,从而激励制药公司和其他代理商扩大(公平)获得基本药物的机会?如果存在这样的指标,我们应该如何思考我们在这个基础上支持道德消费运动的个人义务?鉴于Tim Campbell、Yukiko Asada和Andreas Albertsen对我在《全球健康影响:扩大基本药物的获取》中提供的答案的担忧,本文对这些问题进行了反思。我解释了反思治疗对个人最低生活水平的影响如何支持全球健康影响(GHI)指数的创建(https://global-health-impact.org/)。我还考虑如何修改该指数,以更好地支持促进每个人人权的努力。最后,我认为个人应该经常通过GHI和其他道德消费活动来促进积极的变革。
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引用次数: 0
Better Mechanisms Are Needed to Oversee HREC Reviews. 需要更好的机制来监督HREC审查。
IF 2.1 3区 哲学 Q1 Nursing Pub Date : 2022-07-01 DOI: 10.1093/phe/phac010
Lisa Eckstein, Rebekah McWhirter, Cameron Stewart

Hawe et al. raise concerns about Human Research Ethics Committees (HRECs) taking a risk-averse and litigation-sensitive approach to ethical review of research proposals. HRECs are tasked with reviewing proposals for compliance with the National Statement on Ethical Conduct in Human Research for the purpose of promoting the welfare of participants. While these guidelines intentionally include a significant degree of discretion in HREC decision making, there is also evidence that HRECs sometimes request changes that go beyond the guidance provided by the National Statement. When HRECs request changes outside their remit, inconsistencies between individual HRECs become more common, contributing to delays in ethical review and reducing the quality of HREC decision making. Improvements to the HREC regulatory system are needed to promote transparency and accountability.

Hawe等人对人类研究伦理委员会(HRECs)采取规避风险和对诉讼敏感的方法对研究提案进行伦理审查表示担忧。HRECs的任务是审查符合《国家人类研究道德行为声明》的建议,以促进参与者的福利。虽然这些指导方针有意在hrecc的决策中包含很大程度的自由裁量权,但也有证据表明,HRECs有时会要求进行超出国家声明指导范围的更改。当HRECs要求在其职权范围之外进行变更时,单个HRECs之间的不一致变得更加普遍,从而导致伦理审查的延误,降低了hrecc决策的质量。需要改进HREC监管体系,以提高透明度和问责制。
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引用次数: 1
Personal Responsibility for Health: Exploring Together with Lay Persons. 个人健康责任:与外行人共同探讨。
IF 2.1 3区 哲学 Q1 Nursing Pub Date : 2022-07-01 DOI: 10.1093/phe/phac009
Yukiko Asada, Marion Brown, Mary McNally, Andrea Murphy, Robin Urquhart, Grace Warner

Emerging parallel to long-standing, academic and policy inquiries on personal responsibility for health is the empirical assessment of lay persons' views. Yet, previous studies rarely explored personal responsibility for health among lay persons as dynamic societal values. We sought to explore lay persons' views on personal responsibility for health using the Fairness Dialogues, a method for lay persons to deliberate equity issues in health and health care through a small group dialogue using a hypothetical scenario. We conducted two 2-h Fairness Dialogues sessions (n = 15 in total) in Nova Scotia, Canada. We analyzed data using thematic analysis. Our analysis showed that personal choice played an important role in participants' thinking about health. Underlying the concept of personal choice was considerations of freedom and societal debt. In participants' minds, personal and social responsibilities co-existed and they were unwilling to determine health care priority based on personal responsibility. The Fairness Dialogues is a promising deliberative method to explore lay persons' views as dynamic values to be developed through group dialogues as opposed to static, already-formed values waiting to be elicited.

与对个人健康责任的长期学术和政策调查同时出现的是对非专业人士观点的经验评估。然而,以往的研究很少将非专业人士的个人健康责任作为动态的社会价值来探讨。我们试图通过公平对话来探索非专业人士对个人健康责任的看法,这是一种非专业人士通过使用假设场景的小组对话来审议健康和医疗保健中的公平问题的方法。我们在加拿大新斯科舍省进行了两次2小时的公平对话(共15次)。我们使用主题分析来分析数据。我们的分析表明,个人选择在参与者对健康的看法中起着重要作用。个人选择概念的基础是对自由和社会债务的考虑。在参与者心目中,个人责任和社会责任并存,他们不愿意根据个人责任来确定医疗保健的优先次序。公平对话是一种很有前途的协商方法,它探索外行人的观点,将其作为动态的价值观,通过群体对话来发展,而不是静态的、已经形成的价值观,等待被激发出来。
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引用次数: 0
Building an Opt-Out Model for Service-Level Consent in the Context of New Data Regulations. 在新数据法规的背景下建立服务级同意的选择退出模型。
IF 2.1 3区 哲学 Q1 Nursing Pub Date : 2022-07-01 DOI: 10.1093/phe/phab030
A R Howarth, C S Estcourt, R E Ashcroft, J A Cassell

The General Data Protection Regulation (GDPR) was introduced in 2018 to harmonize data privacy and security laws across the European Union (EU). It applies to any organization collecting personal data in the EU. To date, service-level consent has been used as a proportionate approach for clinical trials, which implement low-risk, routine, service-wide interventions for which individual consent is considered inappropriate. In the context of public health research, GDPR now requires that individuals have the option to choose whether their data may be used for research, which presents a challenge when consent has been given by the clinical service and not by individual service users. We report here on development of a pragmatic opt-out solution to this consent paradox in the context of a partner notification intervention trial in sexual health clinics in the UK. Our approach supports the individual's right to withhold their data from trial analysis while routinely offering the same care to all patients.

《通用数据保护条例》(GDPR)于2018年出台,旨在协调整个欧盟(EU)的数据隐私和安全法律。它适用于在欧盟收集个人数据的任何组织。迄今为止,服务水平的同意已被用作临床试验的比例方法,这些临床试验实施低风险、常规、全服务范围的干预措施,个人同意被认为是不合适的。在公共卫生研究的背景下,GDPR现在要求个人有权选择是否将其数据用于研究,这在临床服务而不是个人服务用户同意的情况下提出了挑战。我们在这里报告在英国性健康诊所的合作伙伴通知干预试验的背景下,这种同意悖论的务实选择退出解决方案的发展。我们的方法支持个人对试验分析保留数据的权利,同时为所有患者提供常规的相同护理。
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引用次数: 2
COVID-19 Vaccination Passports: Are They a Threat to Equality? COVID-19 疫苗接种护照:它们对平等构成威胁吗?
IF 1.4 3区 哲学 Q2 ETHICS Pub Date : 2022-04-29 eCollection Date: 2022-04-01 DOI: 10.1093/phe/phac006
Kristin Voigt

In several countries, governments have implemented so-called 'COVID passport' schemes, which restrict access to venues such as bars or sports events to those who are vaccinated against COVID-19 and/or exempt vaccinated individuals from public health measures such as curfews or quarantine requirements. These schemes have been the subject of a heated debate. Concerns about inequality have played an important role in the opposition to such schemes. This article highlights that determining how COVID passports affect equality requires a much more nuanced analysis than is typically assumed. I identify a range of broadly egalitarian considerations that could be affected by the introduction of COVID passport schemes. While these schemes could undermine certain aspects of equality, I argue that they could also be used to promote equality. The magnitude and severity of these different effects, both promoting and undermining equality, depend on how precisely these schemes are framed and the local context in which they are implemented.

在一些国家,政府实施了所谓的 "COVID 护照 "计划,规定只有接种过 COVID-19 疫苗的人才能进入酒吧或体育赛事等场所,并且/或者接种过疫苗的人不受公共卫生措施(如宵禁或检疫要求)的限制。这些计划一直是激烈辩论的主题。对不平等的担忧在反对这些计划的过程中发挥了重要作用。本文强调,要确定 COVID 护照如何影响平等,需要进行比通常假设的更为细致的分析。我指出了一系列可能受到 COVID 护照计划影响的广泛的平等主义考虑因素。虽然这些计划可能会破坏某些方面的平等,但我认为它们也可以用来促进平等。这些促进和破坏平等的不同影响的程度和严重性,取决于如何精确地制定这些计划以及实施这些计划的当地环境。
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引用次数: 0
In Defense of Vaccine Mandates: An Argument from Consent Rights. 为疫苗强制接种辩护:从同意权论证。
IF 1.4 3区 哲学 Q2 ETHICS Pub Date : 2022-04-15 eCollection Date: 2022-04-01 DOI: 10.1093/phe/phac005
Daniel A Wilkenfeld, Christa M Johnson

This article will focus on the ethical issues of vaccine mandates and stake claim to the relatively extreme position that outright requirements for people to receive the vaccine are ethically correct at both the governmental and institutional levels. One novel strategy employed here will be to argue that deontological considerations pertaining to consent rights cut as much in favor of mandating vaccines as against them. The presumption seems to be that arguments from consent speak semi-definitively against forcing people to inject something into their bodies, and so any argument in favor of mandates must produce different and overriding logical and ethical considerations. Our central claim will be that the same logic that might seem to prohibit vaccine mandates as violations of consent actually supports such mandates when viewed from the perspective of the potential bystander who might otherwise be exposed to COVID-19.

本文将重点讨论强制接种疫苗的伦理问题,并主张一种相对极端的立场,即在政府和机构层面,直接要求人们接种疫苗在伦理上是正确的。本文采用的一个新颖策略是论证与同意权相关的义务论因素对强制接种疫苗的支持与反对程度相当。我们的假定似乎是,同意权的论点半确定地反对强迫人们向体内注射某些东西,因此任何支持强制的论点都必须产生不同的、压倒一切的逻辑和伦理考虑。我们的核心主张是,从可能接触到 COVID-19 的潜在旁观者的角度来看,同样的逻辑看似禁止违反同意原则的疫苗强制接种,实际上却支持这种强制接种。
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引用次数: 0
Public Reason and Public Health: Can Anti-smoking Policies Be Justified According to a Public Reason Account of Justification? 公共理性与公共健康:根据公共理性的正当性解释,禁烟政策是否合理?
IF 2.1 3区 哲学 Q1 Nursing Pub Date : 2022-04-09 DOI: 10.1093/phe/phac007
M. Nielsen
Public reason demands that policies are justified to all reasonable citizens. Public health aims at protecting or improving aggregated health outcomes. Since health is not an uncontroversial value, an insurmountable chasm between public reason and public health seems to preclude any viable synthesis between the two outlooks. For any given public health policy, some reasonable citizen seems to have a reason to support ‘no policy’ over ‘some policy’, meaning that the policy cannot be justified to all. The paper first spells out what exactly this conflict is about. Then, using smoking as a case, the paper outlines a model of reconciliation between public reason and public health that should give us some optimism if we want to have public health policies that are compatible with treating citizens as free and equal in the public reason sense.
公共理性要求政策对所有理性的公民都是合理的。公共卫生旨在保护或改善总体健康结果。既然健康不是一种毫无争议的价值,公共理性和公共健康之间不可逾越的鸿沟似乎排除了将这两种观点进行任何可行的综合。对于任何给定的公共卫生政策,一些理性的公民似乎有理由支持“没有政策”而不是“有政策”,这意味着该政策不可能对所有人都合理。这篇论文首先阐述了这种冲突到底是关于什么的。然后,以吸烟为例,本文概述了公共理性与公共健康之间的和解模式,如果我们希望公共卫生政策与在公共理性意义上将公民视为自由和平等的政策相兼容,这应该会给我们带来一些乐观。
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引用次数: 2
Response: Collective Moral Agents and Their Collective-Level Virtues 回应:集体道德主体及其集体层面的美德
IF 2.1 3区 哲学 Q1 Nursing Pub Date : 2022-04-01 DOI: 10.1093/phe/phac008
K. MacKay
Abstract In this short piece, I attempt to respond to some of the challenges raised by Jessica Nihlén Fahlquist and Karen Meagher in their commentaries on my paper, ‘Public Health Virtue Ethics’. While these authors have made many insightful and challenging remarks, I mostly focus on two questions here: first, about the nature of collectives as moral agents, in response to Nihlén Fahlquist, and second, about the concept of a collective-level virtue, in response to Meagher.
在这篇短文中,我试图回应Jessica nihl n Fahlquist和Karen Meagher对我的论文“公共卫生美德伦理”的评论中提出的一些挑战。虽然这些作者发表了许多富有洞察力和挑战性的言论,但我在这里主要关注两个问题:第一,关于集体作为道德行为体的本质,回应nihl Fahlquist;第二,关于集体层面美德的概念,回应Meagher。
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引用次数: 0
OUP accepted manuscript OUP接受稿件
IF 2.1 3区 哲学 Q1 Nursing Pub Date : 2022-01-01 DOI: 10.1093/phe/phac002
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引用次数: 2
Pandemic ethics and status quo risk 流行病伦理和现状风险
IF 2.1 3区 哲学 Q1 Nursing Pub Date : 2022-01-01 DOI: 10.1093/phe/phab031
R. Chappell
Conservative assumptions in medical ethics risk immense harms during a pandemic. Public health institutions and public discourse alike have repeatedly privileged inaction over aggressive medical interventions to address the pandemic, perversely increasing population-wide risks while claiming to be guided by 'caution'. This puzzling disconnect between rhetoric and reality is suggestive of an underlying philosophical confusion. In this paper, I argue that we have been misled by status quo bias-exaggerating the moral significance of the risks inherent in medical interventions, while systematically neglecting the (objectively greater) risks inherent in the status quo prospect of an out-of-control pandemic. By coming to appreciate the possibility and significance of status quo risk, we will be better prepared to respond appropriately when the next pandemic strikes.
在大流行期间,医学伦理的保守假设可能带来巨大危害。公共卫生机构和公共话语都一再倾向于不采取行动,而不是积极的医疗干预措施来应对大流行,这反而增加了全民风险,同时声称以“谨慎”为指导。修辞与现实之间的这种令人困惑的脱节暗示了一种潜在的哲学困惑。在本文中,我认为我们已经被现状偏见所误导——夸大了医疗干预中固有风险的道德意义,而系统地忽视了(客观上更大的)流行病失控的现状前景所固有的风险。通过认识到现状风险的可能性和重要性,我们将更好地做好准备,在下一次大流行来袭时作出适当的反应。
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引用次数: 0
期刊
Public Health Ethics
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