Responses to public health emergencies can entail difficult decisions about restricting individual liberties to prevent the spread of disease. The quintessential example is quarantine. While isolating sick patients tends not to provoke much concern, quarantine of healthy people who only might be infected often is controversial. In fact, as the experience with severe acute respiratory syndrome (SARS) shows, the vast majority of those placed under quarantine typically don't become ill. Efforts to enforce involuntary quarantine through military or police powers (...) also can backfire, stoking both panic and disease spread. Yet quarantine is part of a limited arsenal of options when effective treatment or prophylaxis is not available, and some evidence suggests it can be effective, especially when it is voluntary, home-based and accompanied by extensive outreach, communication and education efforts. Even assuming that quarantine is medically effective, however, it still must be ethically justified because it creates harms for many of those affected. Moreover, ethical principles of reciprocity, transparency, non-discrimination and accountability should guide any implementation of quarantine. (shrink)

In this book Tom Sorell argues that emergencies can justify types of action that would normally be regarded as wrong. Beginning with the ethics of emergencies facing individuals, he explores the range of effective and legitimate private emergency response and its relation to public institutions, such as national governments. He develops a theory of the response of governments to public emergencies which indicates the possibility of a democratic politics that is liberal but that takes seriously threats to (...) life and limb from public disorder, crime or terrorism. Informed by Hobbes, Schmitt and Walzer, but substantially different from them, the book widens the justification for recourse to normally forbidden measures, without resorting to illiberal politics. This book will interest students of politics, philosophy, international relations and law. (shrink)

There are three broad ethical issues related to handling public health emergencies. They are the three R's - rationing, restrictions and responsibilities. Recently, a severe shortage of annual influenza vaccine in the US, combined with the threat of pandemic flu, has provided an opportunity for policy makers to think about rationing in very concrete terms. Some lessons from annual flu vaccination likely will apply to pandemic vaccine distribution, but many preparatory decisions must be based on very rough estimates. What (...) ethical principles should guide rationing decisions, what data should inform these decisions, how to revise decisions as new data emerge, and how to implement rationing decisions on the ground are all important considerations. In addition, ethicists might be able to help policy makers think through the importance of international cooperation in surmounting global rationing dilemmas and to accept the inevitable responsibilities of government in making and implementing rationing decisions. (shrink)

The three primary ethical challenges in preparing for public health emergencies - addressing questions of rationing, restrictions and responsibilities - all entail confronting uncertainty. But the third, considering whether people and institutions will live up to their responsibilities in a crisis, is perhaps the hardest to predict and therefore plan for. The quintessential example of a responsibility during a public health emergency is that of health care professionals' obligation to continue caring for patients during epidemics. Historically, this 'duty to (...) treat' has sometimes gone unrecognized or ignored, but it has also famously been adhered to, including during the recent SARS epidemic. And non-crisis examples of health professionals working in the face of personal risk are very common. The duty to treat should be circumscribed by several considerations, including the levels or risk and benefit at issue, the degree of public reliance on health professional action, and the nature of the individual health professional's acceptance of greater than usual risk. Examining the professional duty to treat and the legitimate questions it raises can provide insight into other actors' responsibilities. Public health ethics as well as professional ethics can help frame answers to some key questions: How strong are ethical responsibilities during crises? To whom do they apply? Should they be more explicit - and hence more circumscribed - or less explicit and hence largely aspirational? And how can public health policies encourage responsible actions? (shrink)

This article addresses an important, overlooked regulatory challenge during global health emergencies. It provides novel insights into how, and why, best practice can support decision makers in interpreting and implementing key guidance on conducting research during GHEs. The ability to conduct research before, during and after such events is crucial. The recent West-African Ebola outbreaks and the Zika virus have highlighted considerable room for improvement in meeting the imperative to research and rapidly develop effective therapies. A means of effectively (...) capturing these experiences and folding them into future decision-making is lacking; the need for effective practical translational measures remains. The challenge for the research community lies in extracting meaningful action-guiding content from pre-existing guidelines—which draw upon practical examples of guidelines ‘in action’—that assist in determining how to act in a particular situation. Insights are provided into the role of best practice as a means to do so; such examples can provide invaluable support to decision makers in interpreting high-level guidance; overarching guidelines retain their necessary level of generality and flexibility, whilst corresponding best practice examples—which incorporate important lessons learned—illustrate how such guidelines can be interpreted at a practical level. (shrink)

In this article, I seek to make sense of the oft-invoked idea of 'public emergency' and of some of its (supposedly) radical moral implications. I challenge controversial claims by Tom Sorell, Michael Walzer, and Giorgio Agamben, and argue for a more discriminating understanding of the category and its moral force.

Thomas Hobbes might seem an unlikely source for a theory of emergency powers applicable to liberal democracies in our own day. He advocated the concentration of political, judicial, economic and military authority, and was in favour of great latitude for a monarch or assembly in the choice of means to security. His theory demands absolute submission to law on the part of citizens, with no constitutional limitations on what laws can require. 1 The same theory demands preventive measures against sedition, (...) and has a very expansive conception of seditious behavior. What is more, the concentration of power with wide discretion is supposed to be politics as usual. (shrink)

Life threatening emergencies involving infants and children are inherently dramatic, tension-filled situations. It is no wonder, then, that depictions of such events can be found in literature by and about doctors. In many ways, too, such depictions can illuminate key aspects of such events, such as the physician's own anxiety and the tensions between the various people involved, better than the medical literature. Hence it is suggested that the study of literary depictions of pediatric emergencies might be a (...) useful adjunct for those, physicians and other health care providers, who are called upon to manage them. (shrink)

Rights theorists tend to take tempi pacifici for granted, but it is precisely in emergencies that rights are most difficult to protect and most in need of protection. Two remedies are: first, to be successful in emergencies and second, to establish a free government capable of handling emergencies. These remedies play no role in the thinking of the ACLU, which has increasingly come to define the public's understanding of rights. For the ACLU, a right is not a (...) right unless it can be carried to an extreme and used irresponsibly. A better liberal theory, with instruction from Machiavelli, will seek to combine our interest in security with our assertion of rights. (shrink)

This second installment in a chronologically arranged, three-part sequence continues the author's examination of Anglo-American literati who, in the later nineteenth and twentieth centuries, turned — in acts of combined xenophilia and xenophobia — to Russian literature and literary theory in order to escape the dominant influence of avant-garde movements in France. These Anglophone writers found in Russian exemplars a responsible, morally rigorous, and pragmatic, yet philosophically sophisticated, alternative to what they described as the amoral, superficial, and pretentious aestheticism of (...) French literary culture. Part 2 treats the poetry and criticism of the English “Movement” poet Donald Davie in light of his turn, in 1958, toward the example of Boris Pasternak as a way of escaping the influence of French Symbolist poetics and the post-Symbolist poetics of anglophone modernism. Although Davie understood that Pasternak was as much a modernist as T. S. Eliot or Ezra Pound, he also argued that the Russian's poetry, unlike theirs, sought, on explicitly moral grounds, to maintain conventional syntax and purity of diction, with the result that Pasternak's verse communicates with the reader more as prose than as music does. (shrink)

Global health emergencies often lead to a proliferation of health-related research and resultant data, which is shared across borders to help control the outbreak of disease and support decision-making regarding public health interventions. However, efforts to share data can be hindered by diverse international ethical and legal frameworks. The frameworks aim to govern coordinated processing, sharing and transfer of health data across borders thus placing burdens on researchers who are willing or obligated to share data. In this paper, we (...) investigate ethical values and legal principles that can be applied to ensure a more streamlined approach in the governance of cross-border health data sharing during global health emergencies. A scoping review approach was used to better understand emerging evidence about issues related to the ethical and legal governance of cross-border health data sharing. We first highlight the challenges of sharing health data across borders. We then discuss how the challenges might be overcome through the application of ethical values and legal principles that have been identified in literature. This is followed by a proposal for possible ways of streamlining the governance of health data sharing from ethical and legal perspectives in a bid to better prepare for future global health emergencies and promote the responsible sharing of health data. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Spirometer, Whale, Slave:Breathing Emergencies, c. 1850John Durham Peters (bio)Breath dramatically starts with a slap at birth and ceases with death and yet we typically ignore it until it is under duress. Unlike marine mammals such as whales and dolphins who can never fully automate breathing—they sleep one brain hemisphere at a time so as to keep conscious watch, like yogis, over their respiration—we humans are mostly somnambulists with (...) regard to breath. Unlike our briny cousins, we won't drown if we neglect our breath. Our relatively accommodating habitat at the fold of lithosphere and atmosphere enables a Lethe of oblivion, though many elements of our world are hostile to breath: water, fire, earth, extremes of height, heat, or cold. Nothing could be more fundamental for aerobic terrestrial creatures than breathing. So its routine cloaking in impercipience must somehow be functional and require a great deal of nervous expenditure. (It always takes a lot of work to make an infrastructure invisible.)Breathing is a good test case for the notion, common to many variants of critical theory, that nature for humans is always second nature: what would it mean to find culture, history, and politics in something that is so relentlessly universal and given? The intensity of the urge for drink, food, sex, or sleep pales compared to that of taking a breath withheld or expelling a breath too long held. Here, it seems, desire and need converge. Breathing morphs into awareness, art and artifice when threat, absence or curiosity rouse it from its slumber—when we swim, have a coughing fit, sing, or challenge someone to a breath-holding contest. Under the earth in a mine, high in the air on a mountain or airplane, ill with a respiratory disease, or in other extreme situations, we need techniques and technologies to breathe. Like everything supposedly natural, we can't leave breathing in peace. We mold breath in techniques of speech, song, and prayer and in technologies of diving, medicine, and air travel. A full accounting of such would form a full encyclopedia of human ingenuity.1 [End Page 85]With typical flamboyance, Peter Sloterdijk declared that the atmosphere first ceased to be taken for granted, i.e., became technical, a matter of art, on 22 April 1915, with the German deployment of poison gas in World War I. On a world-historical scale, he takes this weaponization of the environment as an "air-quake" that launched modern air-conditioning in its most literal sense of climatization (as French and German has it) and not just interior cooling (Sloterdijk 89-110 passim). We need a history of comparative breathing emergencies! Every era, like every life, has its encounters with the precarity of breathing, even if not as conveniently dated or climate-change prognostic as 22 April 1915. The urban concentration of human population starting a few thousand years ago, for instance, made people co-breathers (con-spirators) in new ways and thus more prone to the contagious respiratory illnesses that have long ravaged our species.I want to look at one such moment—one marked by a deadly global respiratory illness, new instruments for producing data, worries about radical alterations to the atmosphere, comparative interest in nonhuman forms of life, and the politicization of breathing. 1850, like 2020, was a moment when breath awoke from its autonomic quiet. The nineteenth century was the great age of tuberculosis, the tragic and romantic lung disease. It was a time of fog, smoke, and mud, of climate-changing volcanic eruptions and a year without a summer, and of a mysterious, brooding "storm-cloud" that John Ruskin complained of so bitterly. Medical instruments, the whaling industry, and struggles for the abolition of slavery all brought the lungs into the foreground.SpirometerThe nineteenth century was also the great age of instrumentation. Light and sound were only the two most famous dynamic processes to yield to new graphic methods of inscription such as photography and phonography. The spirometer was one of many devices designed to render visual data of physiological functions, such as the myograph, the flame manometer, sphygmomanometer, and the kymograph. Many of them are still in use. The invention... (shrink)

Biobanking can promote valuable health research that may lead to significant societal benefits. However, collecting, storing and sharing human samples and data for research purposes present numerous ethical challenges. These challenges are exacerbated when the biobanking efforts aim to facilitate research on public health emergencies and include the sharing of samples and data between low/middle-income countries (LMICs) and high-income countries (HICs). In this article, we explore ethical challenges for COVID-19 biobanking, offering examples from two past infectious disease outbreaks in (...) LMICs where biobanking activities contributed to the perpetuation of global inequities. We focus on how the ethical imperative to promote the common good during public health emergencies can conflict with protecting the interests of biobank participants. We discuss how conducting biobank research under a waiver of informed consent during public health emergencies is ethically permissible, provided guidance is in place to prevent biopiracy and exploitation of vulnerable communities. We also highlight the need for biobank collaborations between LMICs and HICs to promote capacity building and benefit sharing. Finally, we offer guidance to promote the ethical oversight of biobanks and biobank research during the COVID-19 pandemic or other future public health emergencies. (shrink)

Disasters and public health emergencies raise a variety of ethical dilemmas, often including those that require balancing the best interests of individuals against those of groups or communities. The on-going COVID-19 pandemic provides examples of these ethical conflicts, as do other recent outbreaks. Decisions and actions in this context must address different ethical issues, ranging from those directly related to autonomy, consent, privacy and confidentiality to those related to interventions and technologies, such as efficacy, effectiveness, safety and fair access. (...) This paper aims to identify ethical conflicts with complex resolutions involving aspects related to values, rights and needs of individuals and the collective, and to suggest how such challenges could lead to more positive experiences and outcomes when confronted in future emergencies. (shrink)

Making research data readily accessible during a public health emergency can have profound effects on our response capabilities. The moral milieu of this data sharing has not yet been adequately explored. This article explores the foundation and nature of a duty, if any, that researchers have to share data, specifically in the context of public health emergencies. There are three notable reasons that stand in opposition to a duty to share one’s data, relating to: (i) data property and ownership, (...) (ii) just distribution of benefits and burdens and (iii) the contemporary ethos of science. We argue each reason can be successfully met with corresponding rationale in favour of data sharing. Further support for data sharing has been echoed in policies of health agencies, funding bodies and academic institutions; in documents on the ethical conduct of biomedical research; and in discussions on the nature of public health. From this, we ascertain that sharing data is the morally sound default position. This article then highlights the key roles reciprocity and solidarity play in supporting the practice of data sharing. We conclude with recommendations to regard public health research data as a common-pool resource in order to build a framework for stable data sharing management. (shrink)

Widespread obesity poses a serious challenge to health outcomes in the developed world and is a growing problem in the developing world. There has been a raft of proposals to combat the challenge of obesity, including restrictions on the nature of food advertising, the content of prepared meals, and the size of sodas; taxes on saturated fat and on calories; and mandated “healthy-options” on restaurant menus. Many of these interventions seem to have a greater impact on rates of obesity than (...) does simply providing information about health risks and healthier lifestyles. The more interventionist policy options have, however, been implemented only slowly, in large part because of criticisms that they are unjustified infringements on the liberty of consumers. Food industry groups, free-market think tanks, and the popular press regard measures that incentivize or penalize particular food and lifestyle choices as unjustifiable state regulation of purely self-regarding behavior. To counteract the liberty-oriented position, those who favor a more interventionist role for the state have recently argued for labeling obesity as a public health emergency. By labeling obesity as a public health emergency, policy-makers could override concerns about individual liberty in order to pursue more interventionist policies designed to guide consumer choices toward healthier lifestyles. In this paper, we argue that, contrary to initial appearances, obesity possesses some of the morally relevant features of public health emergencies, though we do not argue that it actually constitutes one. (shrink)

Background The COVID-19 pandemic forced governments, multilateral public health organisations and research institutions to undertake research quickly to inform their responses to the pandemic. Most COVID-19-related studies required swift approval, creating ethical and practical challenges for regulatory authorities and researchers. In this paper, we examine the landscape of ethics review processes in Africa during public health emergencies (PHEs). Methods We searched four electronic databases (Web of Science, PUBMED, MEDLINE Complete, and CINAHL) to identify articles describing ethics review processes during (...) public health emergencies and/or pandemics. We selected and reviewed those articles that were focused on Africa. We charted the data from the retrieved articles including the authors and year of publication, title, country and disease(s) reference, broad areas of (ethical) consideration, paper type, and approach. Results Of an initial 4536 records retrieved, we screened the titles and abstracts of 1491 articles, and identified 72 articles for full review. Nine articles were selected for inclusion. Of these nine articles, five referenced West African countries including Liberia, Guinea and Sierra Leone, and experiences linked to the Ebola virus disease. Two articles focused on South Africa and Kenya, while the other two articles discussed more general experiences and pitfalls of ethics review during PHEs in Africa more broadly. We found no articles published on ethics review processes in Africa before the 2014 Ebola outbreak, and only a few before the COVID-19 outbreak. Although guidelines on protocol review and approval processes for PHEs were more frequently discussed after the 2014 Ebola outbreak, these did not focus on Africa specifically. Conclusions There is a gap in the literature about ethics review processes and preparedness within Africa during PHEs. This paper underscores the importance of these processes to inform practices that facilitate timely, context-relevant research that adequately recognises and reinforces human dignity within the quest to advance scientific knowledge about diseases. This is important to improve fast responses to PHEs, reduce mortality and morbidity, and enhance the quality of care before, during, and after pandemics. (shrink)

False information is always produced after the outbreak of major emergencies. Taking this into consideration, this paper discusses the behavior of multiple parties in relation to false information dissemination after major emergencies. First, a game model is constructed, using relevant knowledge of evolutionary game theory, between three parties: regulatory institutions, opinion leaders, and ordinary Internet users. Second, the model equations are solved, and the evolutionary stability strategies of each game party under different circumstances are analyzed. Third, a numerical (...) simulation is applied to the evolutionary trends under different strategy combinations with varying parameters. The results show that the probability of each game party making ideal decisions is positively correlated with the degree of punishment imposed by regulatory institutions on opinion leaders who release false information, the reward provided by regulatory institutions on opinion leaders who release positive information, the degree of participation and satisfaction gained by Internet users in adopting positive information, the richness of authentic content released by opinion leaders, and the psychological identification of Internet users with opinion leaders. Meanwhile, the probability of each game party making ideal decisions is negatively correlated with investigation and evidence collection costs borne by opinion leaders who release positive information, the additional income for opinion leaders who have false information adopted by Internet users, the costs of Internet users’ time and energy when they adopt information released by opinion leaders, and the costs of independently judging the accuracy of information by Internet users. (shrink)

The ongoing COVID-19 pandemic and resulting health and economic crisis has caused major disruptions in the functioning of food systems and revived the discussion on what forms balanced, effective and responsible crisis management. As part of its thought leadership and its social responsibility in times of crisis, WUR is uniquely placed to contribute to the scientific knowledge base and data collection mechanisms required for early recognition and rapid response. In addition, WUR takes on the challenge to generate timely insights into (...) the possible scenarios for the prevention of a crisis and during and after emergencies to enable our clients and stakeholders to make informed decisions. Lastly, WUR can provide a better understanding of the mechanisms of spillover, and tangible and practical tools to help reduce the risk of spillover events from occurring, prevent pathogen spread, or mitigate the impacts of a future pandemic. In its research institutes and university, WUR brings together expertise in human, animal, plant and environmental health, the global agri-food system, economics, social sciences, food safety and security, ethics, and policy. Here, in the knowledge that COVID-19 will not be the last pandemic, we present WUR’s ambition and capabilities towards an integrated global multi-stakeholder approach to the prevention and management of potentially pandemic diseases, across the four phases of crisis management; prevention, preparedness, response, and recovery and learning. (shrink)

Risk and crisis communication (RCC) is a current ethical issue subject to controversy, mainly due to the tension between individual liberty (a core component of fairness) and effectiveness. In this paper we propose a consistent definition of the RCC process in public health emergencies (PHERCC), which comprises six key elements: evidence, initiator, channel, publics, message, and feedback. Based on these elements and on a detailed analysis of their role in PHERCC, we present an ethical framework to help design, govern (...) and evaluate PHERCC strategies. The framework aims to facilitate RCC, incorporating effectiveness, autonomy, and fairness. It comprises five operational ethical principles: openness, transparency, inclusivity, understandability, and privacy. The resulting matrix helps understanding the interplay between the PHERCC process and the principles of the framework. The paper includes suggestions and recommendations for the implementation of the PHERCC matrix. (shrink)

I discuss the problem that Kant’s ethics seems to be incapable of capturing our strong intuition that emergencies create a context for actions that is very different from other cases of helping and from other opportunities to further obligatory ends. I argue that if we pay attention to how Kant grounds beneficence we see that distress and emergency function as constitutive concerns. They are vital to establishing the duty of beneficence in the first place, and they also guide the (...) application of duties to specific cases. Kant’s conception of imperfect duties to others, when understood correctly, offers a way to understand why emergencies are morally important, but also why other factors have a place in our moral reasoning. (shrink)

Public health emergencies, including infectious disease outbreaks and natural disasters, are issues faced by every community. To address these threats, it is critical for all jurisdictions to understand how law can be used to enhance public health preparedness, as well as improve coordination and collaboration across jurisdictions. As sovereign entities, Tribal governments have the authority to create their own laws and take the necessary steps to prepare for, respond to, and recover from disasters and emergencies. Legal preparedness is (...) a key component of public health preparedness. This article first explains legal preparedness and Tribal sovereignty and then describes the relationship between Tribal Nations, the US government, and states. Specific Tribal concerns with respect to emergency preparedness and the importance of coordination and collaboration across jurisdictions for emergency preparedness are discussed. Examples of collaborative efforts between Tribal and other governments to enhance legal preparedness are described. (shrink)

This manuscript summarizes the most common barriers to effective administrative preparedness and how to surmount them through the use of promising practices, strategies, and NACCHO developed resources focused on addressing unique jurisdictional requirements and needs.

Law plays a critical role in all stages of a public health emergency, including planning, response, and recovery. Public health emergencies introduce health concerns at the population level through, for example, the emergence of a novel infectious disease. In the United States, at the federal, state, and local levels, laws provide an infrastructure for public health emergency preparedness and response efforts: they grant the government the ability to officially declare an emergency, authorize responders to act, and facilitate interjurisdictional coordination. (...) Law is perhaps most visible during an emergency when the president or a state's governor issues a disaster declaration establishing the temporal and geographic parameters for the response and making financial and other resources available. This legal authority has increasingly been used during the last decade. (shrink)

Between 2013 and 2016, West Africa experienced the largest ever outbreak of Ebola Virus Disease. In the absence of registered treatments or vaccines to control this lethal disease, the World Health Organization coordinated and supported research to expedite identification of interventions that could control the outbreak and improve future control efforts. Consequently, the World Health Organization Research Ethics Review Committee was heavily involved in reviews and ethics discussions. It reviewed 24 new and 22 amended protocols for research studies including interventional (...) and observational studies. WHO-ERC provided the reviews within on average 6 working days. The WHO-ERC often could not provide immediate approval of protocols for reasons which were not Ebola Virus Disease specific but related to protocol inconsistencies, missing information and complex informed consents. WHO-ERC considerations on Ebola Virus Disease specific issues are presented. To accelerate study approval in future public health emergencies, we recommend: internally consistent and complete submissions with information documents in language participants are likely to understand, close collaboration between local and international researchers from research inception, generation of template agreements for data and sample sharing and use during the ongoing global consultations on bio-banks, formation of Joint Scientific Advisory and Data Safety Review Committees for all studies linked to a particular intervention or group of interventions, formation of a Joint Ethics Review Committee with representatives of the Ethics Committees of all institutions and countries involved to strengthen reviews through the different perspectives provided without the ‘opportunity costs’ for time to final approval of multiple, independent reviews, direct information exchange between the chairs of advisory, safety review and ethics committees, more Ethics Committee support for investigators than is standard and a global consultation on criteria for inclusion of pregnant women and children in interventional studies for conditions which put them at particularly high risk of mortality or other irreversible adverse outcomes under standard-of-care. (shrink)

John Taurek famously held the view that, when deciding whom to rescue, the numbers don’t count: we should instead give everyone the same chance of surviving. Surprisingly little engagement has taken place between the detailed and rich literature on whether the numbers count in rescue cases, and the practical question of whether certain facts about patients are eligible for consideration in real-world prioritisation, e.g., in emergency triage during a pandemic. I suggest that a position close to Taurek’s maps on to (...) real-world arguments by groups representing disabled individuals. Whereas Taurek is focused on equalising survival chances, some disability rights activists and scholars appear to argue in favour of equalising selection chances. I consider the philosophical promise of this approach by appealing to the idea of “opacity respect”, and suggest a sufficientarian alternative. (shrink)

The particular dynamics of public health emergencies urge scientists and Ethics Committee (EC) members to change and adapt their operating procedures to function effectively. Despite having previous pandemic experiences, ethics committees were unprepared to adapt to COVID-19 pandemic challenges. This survey aims to learn and thoroughly discuss the most salient issues for ECs during the COVID-19 pandemic. The results indicate that the main problems faced by ECs were lack of/insufficient regulations, lack of data/experience/knowledge, sloppy review, poor research design, and (...) poor adaptation to quarantine measures. Coping with factors that threaten the autonomy and independence of ECs, the ethical dilemma regarding maximizing common good versus protecting the rights and well-being of study participants, comprehending the change in the context of vulnerable populations, and redefining the role of ECs to strengthen trust in science and vaccine confidence were outstanding issues. (shrink)

In this paper I will argue that in emergency cases, physician autonomy is soci-etally constrained under Principle VI of the American Medical Association's “Principles of Medical Ethics”1 The issue will be seen to turn on whether the contextual use of “emergency” should be construed narrowly or broadly; I argue for a broadened rendering. Although a societal emergency is not defined here, I recommend that the condition of inner city healthcare presents a paradigm “patient” for such emergency care. I further urge (...) that because societal constraints on physician autonomy are ambiguous and only derived indirectly in the AMA document, further AMA comment on physician autonomy and societal responsibility would advance clarity on the profession's commitment to the public trust. (shrink)

Michael Walzer has argued that nations fighting a just war may be permitted indiscriminate attacks on enemy noncombatants if they are genuinely necessary to avoid an imminent and morally disastrous defeat. Critics often challenge this "supreme emergency" exemption from just war principles by arguing that it is inconsistent with his critiques of utilitarianism, realism, and sub-state terrorism. While morally troubling, I argue that Walzer's doctrine is both tightly cabined and consistent with his meta-ethical pluralism, his emphasis on the value of (...) political community, and his doubts about abstract philosophy's ability to answer pressing political questions. (shrink)

During an emergency, laws serve crucial functions, including clarifying responsibilities, authorizing critical interventions, and protecting vulnerable populations. However, provisions of existing laws designed for normal, non-emergency circumstances may sometimes hinder emergency response efforts, thereby potentially endangering the public's health rather than protecting it. Pursuant to declared states of emergency, disaster, or public health emergency, however, the legal landscape changes in several important ways. Interventions not legally permissible under non-emergency circumstances become available. One key example is authority to temporarily waive legal (...) provisions that may impede emergency response efforts, such as professional licensing requirements, facility capacity limitations, pharmaceutical pedigree obligations, and state contract restrictions, among other laws spanning a host of legal spheres.This article examines the structure and use of waiver authority in emergencies. It provides recent examples of waivers and analyzes potential application to a hypothetical emergency scenario. (shrink)

A typical discussion around health reform in the U.S. focuses on how the nation can most effectively and efficiently extend insurance coverage to the rising number of people who have none. Furthermore, discussions about health care reform typically are centered on times of normalcy, when the health care system is not overly taxed and there is the luxury of time to think about everyday matters of health and health care, including health care services needed to prevent illness, treat conditions, and (...) address individual emergencies. But in light of the lessons learned over the past decade, it is also essential to consider how any reformed health care system will react to and mitigate the consequences of a public health emergency. (shrink)

abstract Assume that some group, A, is under a serious threat from some other group, B. The only way group A can defend itself is by using lethal force against group B, but the standard conditions for using force in self‐defence are not met. Ought group A to avoid the use of force even if this means yielding to an aggressive, evil power? Most people would resist this conclusion, yet given the violation of essential conditions for self‐defence, this resistance is (...) hard to justify. The aim of this paper is to point to an interesting yet unnoticed move made by some philosophers to find a way out of this problem, a move which relies on construing the situation at hand as a tragic dilemma. I show the attractiveness of this solution and argue that in the end it fails. (shrink)

The risk and crisis communication process in public health emergencies (PHERCC, public health emergency risk and crisis communication) matrix, as proposed by Spitale, Germani, and Biller-Andorno (2...

Although Jonathan Herington, Angus Dawson, and Heather Draper offer valuable insights on how to conceptualize health hazards and understand their effects on populations, I resist the label “public health emergency” for obesity, and here is why. It is important—politically and pragmatically—to be judicious with words that have legal and real‐world consequences. Once a concept is stretched to encompass a broad swath of events, it loses its power. The broader the application of the term “public health emergency,” the more it loses (...) the core idea of an emergent event. Thus, framing a long‐simmering health hazard such as obesity as an emergency would mute the voices of public health authorities seeking a surge response to a truly emergent event, such as a rapidly spreading novel disease or a natural or man‐made disaster. (shrink)