Volume 20, Issue 10, October 2020, Page W1-W3.

November 2009’s announcement of the USPSTF’s recommendations for screening for breast cancer raised a firestorm of objections. Chief among them were that the panel had insufficiently valued patients’ lives or allowed cost considerations to influence recommendations. The publicity about the recommendations, however, often either simplified the actual content of the recommendations or bypassed significant methodological issues, which a philosophical examination of both the science behind screening recommendations and their import reveals. In this article, I discuss two of the leading ethical (...) considerations at issue in screening recommendations: respect for patient autonomy and beneficence and then turn to the most significant methodological issues raised by cancer screening: the potential biases that may infect a trial of screening effectiveness, the problem of base rates in communicating risk, and the trade-offs involved in a judgment of screening effectiveness. These issues reach more broadly, into the use of “evidence-based” medicine generally, and have important implications for informed consent. (shrink)

Preventing War and Promoting Peace: A Guide for Health Professionals is an interdisciplinary study of how pervasive militarism creates a propensity for war through the influence of academia, economic policy, the defense industry, and the news media. Comprising contributions by academics and practitioners from the fields of public health, medicine, nursing, law, sociology, psychology, political science, and peace and conflict studies, as well as representatives from organizations active in war prevention, the book emphasizes the underlying preventable causes of war, particularly (...) militarism, and focuses on the methods health professionals can use to prevent war. Preventing War and Promoting Peace provides hard-hitting facts about the devastating health effects of war and a broad perspective on war and health, presenting a new paradigm for the proactive engagement of health professions in the prevention of war and the promotion of peace. (shrink)

The target article by Laacke et al. focuses on the specific context of identifying people in social media with a high risk of depression by using artificial intelligence technologies. I...

The concept of minimal risk has been used to regulate and limit participation by adolescents in clinical trials. It can be understood as setting an absolute standard of what risks are considered minimal or it can be interpreted as relative to the actual risks faced by members of the host community for the trial. While commentators have almost universally opposed a relative interpretation of the environmental risks faced by potential adolescent trial participants, we argue that the ethical concerns against the (...) relative standard may not be as convincing as these commentators believe. Our aim is to present the case for a relative standard of environmental risk in order to open a debate on this subject. We conclude by discussing how a relative standard of environmental risk could be defended in the specific case of an HIV vaccine trial among adolescents in South Africa. (shrink)

Patients should not always receive hard data about the risks and benefits of a medical intervention. That information should always be available to patients who expressly ask for it, but it should be part of standard disclosure only sometimes, and only for some patients. And even then, we need to think about how to offer it.

Kolbe and de Melo-Martin (2023) describe fatal problems in current definitions and measurement of moral distress and injury (MD/I) in medical professionals, which impede development of genuine atte...

One of six commentaries on “Obesity: Chasing an Elusive Epidemic,” by Daniel Callahan, from the January‐February 2013 issue.

The Kimberley Process Certification Scheme is an innovation in global governance that combines a voluntary industry-led certification system with an inter-state import/export control regime. States, industry, and activists speedily negotiated it in large part due to the concentrated structure of the industry, and the complementary nature of emerging norms regarding both corporate behavior and international intervention in civil conflicts. The potential strength of the Kimberley Process lies in its state-led border controls, but these are being undermined by weak national governments. (...) This effort may not provide an effective model for regulating other "conflict commodities" because of the unique character of the diamond market. (shrink)

Volume 20, Issue 10, October 2020, Page 47-49.

This paper offers an historical perspective to the discussion of the relationship between Christianity and nonhuman-human animal relationships by examining the animal protection movement in English society as it first took root in the nineteenth century. The paper argues that the Christian beliefs of many in the movement, especially the evangelical outlook of their faith, in a considerable way affected the character as well as the aims and scope of the emergent British animal welfare movement - although the church authorities (...) did not take an active part in the discussion and betterment of the conditions of animals. An explicitly Christian discourse, important in creating and sustaining the important philanthropic tradition in Britain, mobilized the movement. The paper also traces the gradual decrease of the centrality of the movement's Christian elements later in the century when evolutionary ideas as well as other developments in society shed alternative light on the relationship between human and nonhuman animals and brought about different trends in the movement. This paper sees Christianity not as a static and defining source of influence but as a rich tradition containing diverse elements that people drew upon and used to create meanings for them. The paper implicitly suggests that both a religion's doctrines in theory and the outcome of a complex interaction with the changing society in which the religion is practiced determine its potential to influence animal-human relationships. (shrink)

One of the distinguishing features of the ‘narrative turn’ in bioethics has been the question of authorship. For bioethicists and clinicians worried about the distorting and diminishing effects of an increasingly objective, dualistic, and value-free medicine, narrative has played a leading role in establishing the importance of patients’ stories to the therapeutic endeavor while calling attention to the inadequacies of biomedicine. Narrative is seen as a way of ceding patients the moral authority to tell their stories, while at the same (...) time recognizing the value of patients’ stories to clinical practice. Because illness is an embodied and, therefore, deeply personal experience, stories... (shrink)

The growing importance of researching online activities, such as cyber-deviance and cyber-crime, as well as the use of online tools (e.g. questionnaires, games, and other interactive tools) has created new ethical and legal challenges for researchers, which can be even more complicated when researching adolescents. In this article, we highlight the risks emerging from the current European legal and ethical landscape when researching potentially vulnerable groups, with a special focus on online research. It is not always clear how to differentiate (...) research ethics consent from consent for data processing activities: when can an adolescent independently consent to research, or when is parental consent needed? Additional problems emerge when parents do not consent to research activities, but their adolescent children do. A serious ethical challenge can arise when the parents do not communicate with researchers, but the adolescent wishes to participate, especially when weak parental oversight is coupled with research on sensitive topics. We offer some guidance on what to keep in mind when conducting online research with adolescents and highlight possible ways that these issues can be dealt with in pan-European projects. (shrink)

This paper examines the role of clinical practitioners and clinical researchers internationally in establishing the utility of harm-reduction approaches to substance use. It thus illustrates the potential for clinicians to play a pivotal role in health promoting structural interventions based on harm-reduction goals and public health models. Popular media images of drug use as uniformly damaging, and abstinence as the only acceptable goal of treatment, threaten to distort clinical care away from a basis in evidence, which shows that some ways (...) of using drugs are far more harmful than others and that punitive approaches and insistence on total abstinence as the only goal of treatment often increases the harms of drug use rather than reducing drug use. Therefore the leadership and scientific authority of clinicians who understand the health impact of harm-reduction strategies is needed. Through a review of harm-reduction interventions in Canada, the United Kingdom, the United States, Australia, Switzerland, and the Netherlands, we identify three ways that clinicians have helped to achieve a paradigm shift from punitive approaches to harm-reduction principles in clinical care and in drug policy: through clinical research to provide data establishing the effectiveness and feasibility of harm-reduction approaches, by developing innovative clinical programmes that employ harm reduction, and thereby changing the standard of care to include routine use of these evidence-based approaches in their practices. We argue that through promotion of harm-reduction goals and methods, clinicians have unique opportunities to improve the health outcomes of vulnerable populations. (shrink)

This paper examines the role of clinical practitioners and clinical researchers internationally in establishing the utility of harm-reduction approaches to substance use. It thus illustrates the potential for clinicians to play a pivotal role in health promoting structural interventions based on harm-reduction goals and public health models. Popular media images of drug use as uniformly damaging, and abstinence as the only acceptable goal of treatment, threaten to distort clinical care away from a basis in evidence, which shows that some ways (...) of using drugs are far more harmful than others and that punitive approaches and insistence on total abstinence as the only goal of treatment often increases the harms of drug use rather than reducing drug use. Therefore the leadership and scientific authority of clinicians who understand the health impact of harm-reduction strategies is needed. Through a review of harm-reduction interventions in Canada, the United Kingdom, the United States, Australia, Switzerland, and the Netherlands, we identify three ways that clinicians have helped to achieve a paradigm shift from punitive approaches to harm-reduction principles in clinical care and in drug policy: through clinical research to provide data establishing the effectiveness and feasibility of harm-reduction approaches, by developing innovative clinical programmes that employ harm reduction, and thereby changing the standard of care to include routine use of these evidence-based approaches in their practices. We argue that through promotion of harm-reduction goals and methods, clinicians have unique opportunities to improve the health outcomes of vulnerable populations. (shrink)

Recent observations associate naturally occurring trace levels of Lithium in ground water with significantly lower suicide rates. It has been suggested that adding trace Lithium to drinking water could be a safe and effective way to reduce suicide. This article discusses the many ethical implications of such population-wide Lithium medication. It compares this policy to more targeted solutions that introduce trace amounts of Lithium to groups at higher risk of suicide or lower risk of adverse effects. The question of mass (...) treatment with Lithium recalls other choices in public health between population-wide and more targeted interventions. The framework we propose could be relevant to some of these other dilemmas. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page 17-19, June 2011.

“Active intervention” with suicidal callers to telephone crisis lines involves breaking confidentiality by dispatching emergency services, typically the police, to a suicidal person without that person’s consent and sometimes without his or her knowledge. In this paper I am concerned with the issue of whether active intervention is ethically justified from a feminist bioethical perspective, and if so, under what conditions.