Involuntary psychiatric commitment for suicide prevention and physician aid-in-dying (PAD) in terminal illness combine to create a moral dilemma. If PAD in terminal illness is permissible, it should also be permissible for some who suffer from nonterminal psychiatric illness: suffering provides much of the justification for PAD, and the suffering in mental illness can be as severe as in physical illness. But involuntary psychiatric commitment to prevent suicide suggests that the suffering of persons with mental illness does not justify (...) ending their own lives, ruling out PAD. Since both practices have compelling underlying justifications, the most reasonable accommodation might seem to be to allow PAD for persons with mental illness whose suffering is severe enough to justify self-killing, but prohibit PAD for persons whose suffering is less severe. This compromise, however, would require the articulation of standards by which persons’ mental as well as physical suffering could be evaluated. Doing so would present a serious philosophical challenge. (shrink)

Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research (...) evidence will be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world. (shrink)

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

The near-miss has been considered an important factor of reinforcement in gambling behavior, and previous research has focused more on its industry-related causes and effects and less on the gaming phenomenon itself. The near-miss has usually been associated with the games of slots and scratch cards, due to the special characteristics of these games, which include the possibility of pre-manipulation of award symbols in order to increase the frequency of these “engineered” near-misses. In this paper, we argue that starting from (...) an elementary mathematical description of the classical (by pure chance) near-miss, generalizable to any game, and focusing equally on the epistemology of its constitutive concepts and their mathematical description, we can identify more precisely the fallacious elements of the near-miss cognitive effects and the inadequate perception and representation of the observational-intentional “I was that close.” This approach further suggests a strategy of using non-standard mathematical knowledge of an epistemological type in problem-gambling prevention and cognitive therapies. (shrink)

: This essay provides a critical analysis of rape prevention since the 1980s. I argue that we must challenge rape prevention's habitual reinforcement of the notion that fear is a woman's best line of defense. I suggest changes that must be made in the anti-rape movement if we are to move past fear. Ultimately, I raise the question of what, if not vague threats and scare tactics, constitutes prevention.

Ethics guidance increasingly recognises that researchers and sponsors have obligations to consider provisions for post-trial access to interventions that are found to be beneficial in research. Yet, there is little information regarding whether and how such plans can actually be implemented. Understanding practical experiences of developing and implementing these plans is critical to both optimising their implementation and informing conceptual work related to PTA. This viewpoint is informed by experiences with developing and implementing PTA plans for six large-scale multicentre HIV (...) prevention trials supported by the HIV Prevention Trials Network. These experiences suggest that planning and implementing PTA often involve challenges of planning under uncertainty and confronting practical barriers to accessing healthcare systems. Even in relatively favourable circumstances where a tested intervention medication is approved and available in the local healthcare system, system-level barriers can threaten the viability of PTA plans. The aggregate experience across these HIV prevention trials suggests that simply referring participants to local healthcare systems for PTA will not necessarily result in continued access to beneficial interventions for trial participants. Serious commitments to PTA will require additional efforts to learn from future approaches, measuring the success of PTA plans with dedicated follow-up and further developing normative guidance to help research stakeholders navigate the complex practical challenges of realising PTA. (shrink)

In this response to Jonny Anomaly’s ‘Is Obesity a Public Health Problem?’ I argue, contra the author that public health actually increases individuals’ abilities to choose actions that further their health goals, specifically in the case of obesity. The intractability of obesity as an individual medical problem combined with the health benefits of modest (5–10 per cent of body weight) weight loss suggest that public health measures helping people make small changes in eating habits improve population health. I argue that (...) such measures are available to public health via behavioral economic research and policy proposals from libertarian paternalists. I respond to author’s claim that obesity does not constitute a public health problem because: (i) it is not an epidemic and (ii) obesity reduction is not a public good. I argue that epidemic status is not required for classification as a public health problem, but that obesity does have the status of an epidemic. I also point out flaws in author’s reasoning about obesity, public health and social costs. I conclude by suggesting that public health, in partnership with stakeholders and other areas of government, is poised to help create conditions for modest weight loss and increased population health overall. (shrink)

In this article, I challenge the risk assessment approach to the ethics of pre-exposure prophylaxis (PrEP) as HIV prevention among men who have sex with men (MSM). Traditional risk assessment focuses on the medical risks and benefits of using medical technologies, but this emphasizes certain risks and benefits over others. The medical risks of using PrEP are presently being overblown and its social and political risks are being overlooked. By recontextualizing risk within the history of HIV and considering the (...) lived experiences of MSM with sex, HIV, and HIV prevention, we can broaden the present risk assessment framework to include all of the relevant risks involved in using PrEP. We can also better situate risk as one of several moral concepts, including trust and solidarity, which move us towards a more nuanced analysis of the social and political effects of PrEP on the relationships and communities of MSM. (shrink)

In order to demedicalize the ethics of pre-exposure prophylaxis as HIV prevention, I consider the social effects on men who have sex with men. The Centers for Disease Control and Prevention considers MSM to be the highest risk group for contracting HIV in the USA. The ethics of using PrEP as HIV prevention among MSM, however, has both a medical dimension and a social dimension. While the medical dimension of the ethics of PrEP includes concerns about side (...) effects, drug resistance and distribution, the social dimension of the ethics of PrEP includes concerns about stigmatization, sexual and romantic relationships and sexual freedom. The medical concerns of the ethics of PrEP may take precedence over the social concerns, but there is a growing body of literature that already addresses the medical concerns. Much less attention has been given to the social concerns of the ethics of PrEP, and in this article, I aim to fill this gap in the literature. Therefore, I focus on the often-overlooked social dimension of the ethics of PrEP to help understand the connection between the risks, relationships and communities of MSM using PrEP as HIV prevention. (shrink)

In many regions around the world, those at highest risk for acquiring HIV are young adults and adolescents. Young men who have sex with men in the USA are the group at greatest risk for HIV acquisition, particularly if they are part of a racial or ethnic minority group.1 Adolescent girls and young women have the highest incidence rates of any demographic subgroup in sub-Saharan Africa.2 To reverse the global AIDS pandemic’s toll on these high-risk groups, it is important to (...) deploy the most effective HIV prevention tools to young MSM in the USA, to adolescent girls and young women in sub-Saharan Africa, and to any other adolescents and young adults at high risk for HIV as products are proven to be safe and efficacious. Although prevention interventions with proven efficacy, such as oral pre-exposure prophylaxis, are available,3–8 they have not been sufficient to stem the tide and an expanded prevention toolkit is urgently needed to serve these populations. The field of HIV prevention continues to identify promising leads in the development of new biomedical prevention products, either delivering antiviral drug topically or systemically. The dapivirine ring has been shown to provide modest protection and is currently being tested in open label studies while injectable cabotegravir is being tested in a large efficacy trial for preventing HIV acquisition. Advances in the field of HIV prevention mean that scientists and regulators must plan for how they will bring prevention tools to populations at high risk for HIV as they conduct efficacy and effectiveness trials. For instance, safety data from younger age groups can also be used in combination with efficacy data from adult studies, where appropriate, as bridging studies to expand labelling to younger ages. If these …. (shrink)

Getting consumers to adopt infection prevention measures is important for society to overcome the coronavirus pandemic. This research adopts a moral decoupling perspective to examine how consumers in Germany respond to perceived transgressions of COVID-19 infection prevention regulations. Focusing on two nonpharmaceutical measures (mask wearing, social distancing) as well as a pharmaceutical one (vaccination), two empirical studies indicate that transgression relevance influences intention to adopt the measure (in parallel) through judgment of performance and judgment of morality. Type of (...) transgression moderates the effect of transgression relevance on morality, but not on performance. In addition, effects weaken as a person’s fear of infection increases. Effects are robust, though, when controlling for moral decoupling and moral delegation (Study 1), and additionally for psychological reactance and political orientation (Study 2). Implications for research and practice evolve around new insights into how to get consumers to adopt infection prevention measures more effectively. (shrink)

HIV infection and AIDS create many dilemmas in Chinese AIDS/HIV prevention policy. A strategy of clinical tolerance is proposed to address these dilemmas. The immediate purpose of the strategy of clinical tolerance is to win the cooperation of members of stigmatized groups at high risk for contracting HIV infection and AIDS, which occurs as a result of acts done in private and thus beyond the reach of regulation. The strategy of clinical tolerance differs from both tolerance as liberal tolerance (...) and tolerance as a moral ideal of tolerance. A strategy of clinical tolerance does not ask the government, health worker, health official or the public to change either laws or the disapproval of prostitution, homosexuality and drug use. A strategy of clinical tolerance asks, instead, that we weigh what we may regard as the wrong involved in prostitution, homosexuality, and drug use against the greater evil of an HIV/AIDS epidemic. A strategy of clinical tolerance offers the most effective and practical way to confront a growing and significant public health problem in China. (shrink)

The ability of adolescents to access safe and effective new products for HIV prevention and treatment is optimised by adolescent licensure at the same time these products are approved and marketed for adults. Many adolescent product development programmes for HIV prevention or treatment products may proceed simultaneously with adult phase III development programmes. Appropriately implemented, this strategy is not expected to delay licensure as information regarding product efficacy can often be extrapolated from adults to adolescents, and pharmacokinetic properties (...) of drugs in adolescents are expected to be similar to those in adults. Finally, adolescents enrolled in therapeutic HIV prevention and treatment research can be considered adults, based on US Food and Drug Administration regulations and the appropriate application of state law. The FDA permits local jurisdictions to apply state and local HIV/sexually transmitted infection minor treatment laws so that adolescents who are HIV-positive or at risk of contracting HIV may be enrolled in therapeutic or prevention trials without obtaining parental permission. (shrink)

BackgroundIn many Western countries like Germany, the social integration of children with an immigrant background has become an urgent social tasks. The probability of them living in high-risk environments and being disadvantaged regarding health and education-related variables is still relatively higher. Yet, promoting language acquisition is not the only relevant factor for their social integration, but also the support of earlier developmental processes associated with adequate early parenting in their first months of life. The Emotional Availability Scales measure the quality (...) of caregiver-child-interactions as an indicator of the quality of their relationship and thus of such early parenting, focusing on mutual and emotional aspects of their interaction.MethodThis pilot study examined in a randomized controlled trial the effects of the prevention project First Steps regarding the hypothesis that the Emotional Availability improved to a greater extent in “difficult-to-reach” immigrant mother-child dyads in a psychoanalytically oriented early intervention compared to a usual care intervention offered by paraprofessionals with an immigrant background. A sample of N = 118 immigrant women in Germany from 37 different countries and their children was compared with regard to the parental EA-dimensions sensitivity, structuring, non-intrusiveness and non-hostility and the child dimensions responsiveness to and involvement of the caregiver in the pre-post RCT design.Results and ConclusionDifferent from what was expected, repeated ANOVAs revealed no significant pre-post group differences for the parental dimensions. For the child dimensions the effect of time of measurement was highly significant, which can be interpreted as mostly natural developmental effects. Still, on the level of simple main effects for each intervention, only in the FIRST STEPS groups child responsiveness significantly improved. When controlled for confounding variables, a significant interaction effect for maternal sensitivity in favor of the FIRST STEPS intervention was found. The systematic group differences indicate that the more extensive and professional intervention, focusing on the individual needs of the participants, is more suitable to support the quality of the mother-child-relationship amongst immigrant mother-child dyads than usual care. The results are discussed taking into account the context of the maternal migration process and potential maternal traumatization.Clinical Trial Registration[https://clinicaltrials.gov], identifier [DRKS00004632]. (shrink)

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)

The two significant zoonotic bacterial infections that have remained a concern due to the complex dynamics involved in transmission and global prevalence are anthrax and brucellosis. The present paper attempts to address some of the most important zoonotic pathogens, highlighting their epidemiology, clinical manifestations, diagnosis, treatment, and prevention strategies. Anthrax is largely transmitted through direct contact with the infected animals or their products resulting in cutaneous, inhalational, and gastrointestinal forms, all with specific clinical outcomes and approaches for treatment. Similarly, (...) the genus Brucella primarily transmits brucellosis to humans by occupational exposure and consumption of contaminated animal products. Its presentation may be acute, chronic, or in relapse. Diagnosis is made by a combination of serological, molecular, and culture-based techniques, while the treatment focuses on antimicrobial regimens specific to the pathogen. However, this increases the problem of antimicrobial resistance, which makes their effective management challenging, necessitating an integrated approach. Mitigating risks through biosecurity measures, vaccination, public health education, and a One Health approach that includes human, animal, and environmental health, all facilitate prevention and control of an outbreak. Advanced surveillance and diagnostic technologies further support the prompt interventions to contain outbreaks. It then goes on to highlight the importance of interdisciplinarity for decreasing the global burden of zoonotic bacterial diseases. (shrink)

RESUMEN Las investigaciones en el campo de la teoría de la comunicación apuntan a que en la actualidad el proceso es, desde lo social, una vía para el logro de las relaciones interpersonales y posee sus potencialidades estratégicas para la construcción social y cultural del hombre. Se realizó una revisión bibliográfica para el acercamiento inicial al estudio de las temáticas de la comunicación social en salud y la prevención de enfermedades en la comunidad. Por ello el objetivo del presente trabajo (...) estriba en establecer los fundamentos teóricos que sustentan el estudio de las relaciones entre la comunicación en salud y la concreción del trabajo preventivo desde la comunidad. Se defiende que la comunicación social en salud promueve el diálogo y el intercambio de información y es un componente imprescindible de todos los servicios de salud. ABSTRACT Research on the theoretical basis of communication point to the fact that nowadays, the process is, from a social point of view, a means of achieving interpersonal relationships and it has strategic potential toward men’s social and cultural construction. A bibliographic review was carried out in order to approach the study of subject matters related to social communication in health and disease prevention in the community. Therefore, this paper aims at stablishing the theoretical basis that support the study of the relationship between communication in health and the implementation of precautionary work from the community. It is defended that social communication in health promotes dialogue and information exchange and it is an essential element in all health services. (shrink)

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

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)

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 article aims to review the program of professional training of teachers for the prevention of adrenaline addiction in adolescents and its effectiveness. The task of the work is to determine the strategy that will ensure the effectiveness of professional training of teachers for the prevention of adrenaline addiction in adolescents in the course of experimental work. In the process of studying the problem, the work of researchers in the selected scientific field is considered. As a result of (...) the work done, the strategy and plan of the teacher's professional training program were determined for the organization of effective professional training for preventive activities aimed at the adrenaline addiction of adolescents. (shrink)

Background and aim Healthcare professionals are regularly exposed to moral challenges in patient care potentially compromising quality of care and safety of patients. Preventive clinical ethics support aims to identify and address moral problems in patient care at an early stage of their development. This study investigates the occurrence, risk factors, early indicators, decision parameters, consequences and preventive measures of moral problems. Method Semi-structured expert interviews were conducted with 20 interprofessional healthcare professionals from 2 university hospitals in Basel, Switzerland. A (...) Likert scale questionnaire was completed by the interviewees and analysed using descriptive and inferential statistics. Results Healthcare professionals are frequently exposed to a variety of moral problems, such as end-of-life decisions, resource allocation and assessing the patient's will or decisional capacity. Thirty-four different risk factors for moral problems are identified, e.g. patient vulnerability, divergent values or world views, inadequate resources or poor ethical climate. Twenty-one early indicators are recognised such as disagreement between healthcare professionals, patients and relatives, emotional disturbances, gut feeling or conflict of conscience. A variety of preventive measures are suggested and presented in a preventive clinical ethics support process model. The most helpful measures are early ethical conversations with colleagues, early team-internal ethical case discussions and an ethics-trained contact person on the ward. Ethics training, kerbside consultations, proactive ethics consultations, ethics screening and rounds are also considered helpful. Conclusions Clinical ethics support services should not only offer reactive and complex, but also proactive and low-threshold support for healthcare professionals, patients and relatives. (shrink)

Male partner involvement in the prevention of mother-to-child transmission of human immunodeficiency virus is considered as one of the priority interventions in reducing paediatric HIV. However, there is neither a standard definition nor measurement for MPI in PMTCT. The study explored meanings of MPI in PMTCT programmes in Zimbabwe. Eight focus group discussions were conducted with men and women aged 18 years and above. Seven key informants from health institutions and organisations providing PMTCT services were interviewed. Eight in-depth interviews (...) were conducted with pregnant women at two public health facilities. Thematic analysis was used for data analysis. Five major themes were identified which facilitated our understanding of MPI. Male partner involvement was referred to as participation of male partners in HIV couple counselling and testing. Acceptance of condom use during pregnancy and breastfeeding was deemed vital as this prevents HIV transmission. Male partners were expected to have knowledge of administering antiretroviral drugs to an HIV-exposed child. Provision of financial support was another form of male involvement commonly expected during antenatal and postnatal periods. Faithfulness in marriage was a major theme that was highlighted, especially by respondents in marital relationships. Male partner presence in PMTCT community educational sessions was also considered. However, the provision of male-oriented educational programmes was identified as poor. The study suggested a definition for MPI in PMTCT in Zimbabwe. The merit of this definition was that it took a holistic approach to include activities beyond antenatal activities and HIV testing. Future research should explore how public health institutions could create male-oriented health services within PMTCT programmes, as this has the potential of increasing men’s involvement in PMTCT of HIV.Contribution: This article contributed to the knowledge on how world views, which is shaped by culture and religion, influenced the formation of meanings on MPI PMTCT programmes. (shrink)

Research has shown that suicide rate in Australia is on the rise and that most people who die by suicide are not in contact with mental health services. They most likely communicate their suicidal thoughts to family members or close friends, whose responses may sound unhelpful and/or dismissive, thus reinforcing suicidal ideation. This national emergency has been tackled via a social media campaign, #YouCan Talk, launched by a government-supported digital platform, BeyondBlue. This article adopts a multimodal discourse analysis approach to (...) investigate how peer support is encouraged and articulated in the context of mental health discourse for suicide prevention. The two case studies selected for analysis from the BeyondBlue platform are the #YouCanTalk social media campaign, designed to teach carers to identify severe depression and effectively respond to suicide warning signs and a sample of posts from a thread for peer support in a monitored online forum devoted to help carers who seek peer advice. Unlike previous research, the article focuses on how pronouns and verbs index interpersonal relations in a systemic-functional perspective as well as other multimodal resources, such as visuals, layout and hyperlinking, to understand how identities are entextualised by both professional health providers and peer carers in digital platforms that address mental health issues. (shrink)