In the face of environmental crises such as climate change, pollution and biodiversity loss—which all adversely impact on health—Gils-Schmidt and Salloch explore whether physicians can be justified in taking climate issues into account in clinical care.1 While their approach centres on the ‘climate-sensitive’ decisions, physicians can carry out on the micro-level of clinical decision-making, they encourage further discussions on how climate-related issues can be included across different levels of decision-making in healthcare. We propose a list of tasks and a model (...) to assist with navigating the range of factors and structural elements an environmentally sensitive ethics must address. Stephen Gardiner’s notion of a perfect moral storm is central to understanding these issues.2 Gardiner describes how a perfect moral storm occurs in the centre of three overlapping conditions for human action and policymaking in the face of climate change. This storm is driven by: (1) a lack of interest among current generations to meet global needs and accommodate the well-being of future generations, (2) a lack of ecological concerns for other parts of nature than humans and (3) weak ethical and political theories and institutions shaping policy decisions on issues with severe implications across borders and generations. Moreover, these conditions are embedded in the existing, complex world of ethically unjustified power imbalances and social injustice. The growing awareness of healthcare’s climate footprint has amplified and accelerated global, grassroots action to make healthcare more environmentally friendly. This includes incorporating environmental impacts into quality improvement methodologies, building communities of practice to explore how to make …. (shrink)

When weighing up which inhaler to prescribe, a doctor may prioritise a patient’s preferences over the expected harms from the associated carbon emissions. Parker argues that this is wrong.1 Doctors have a pro-tanto duty to switch from a high-carbon metered-dose inhaler (MDI) to a low-carbon dry-powdered inhaler (DPI)—even though this provides no direct patient benefit—unless switching would undermine trust or significantly worsen a patient’s health. He goes on to state that even if DPIs are more expensive for the National Health (...) Service (NHS) then this is justified so long as it does not ‘significantly threaten’ the NHS’ ability to protect and promote health. This may appear to be a radical proposal, challenging the ethical principles of autonomy, health entitlements and justly distributed resources. However, we will claim that it is only radical in so far as one perceives (A) patient autonomy and healthcare entitlements as existing within a vacuum, unrelated to other foundational ethics concerns and (B) the health consequences of a given healthcare budget are limited solely to the designated recipients rather than all affected parties. Here, we test the claim that our responsibility for promoting patient autonomy …. (shrink)

While the concepts of race and ethnicity have been abused historically, they are potentially invaluable in epidemiology and public health. Epidemiology relies upon variables that help differentiate populations by health status, thereby refining public health and health care policy, and offering insights for medical science. Race and ethnicity are powerful tools for doing this. The prerequisite for their responsible use is a society committed to reducing inequalities and inequities in health status. When this condition is met, it is irresponsible not (...) to utilize these concepts. (shrink)

This article explores Gypsy Travellers' changing views on their children's education. It highlights the positive means some schools use to encourage greater involvement of Gypsy Traveller parents. It argues that current educational policy needs to be re-developed to incorporate more effective and affirmative responses to interrupted and nomadic learning. It draws heavily on interviews with Gypsy Traveller families in an effort to give 'voice' to an under-represented community.

Used wisely the concepts of race and ethnicity in research have great potential, but used unwisely they can do immense damage. We need to consider the potential issues that might require a change of emphasis or application of ethics in a multi-ethnic society. Doing no harm (non-maleficence) is the most important ethical pillar in the ethnicity and health field. Ethnic differences can be used in damaging ways. Without the ethic of beneficence in place it is better not to draw attention (...) to ethnic differences. Respect is the pre-condition for autonomy. Autonomy of ethnic minority populations to live in their own traditional way is not easy to achieve in multi-ethnic societies. There are difficult issues in multi-ethnic societies that require great sensitivity to create a sense of fairness and justice. Justice is the core value that underpins equity. There is a deep paradox – to promote equality, we may need to treat people and groups unequally. Ethical codes need to be modified to emphasize the importance of including ethnic minority populations in research and not bypassing them, as has been happening. It is correct, for example, that potential research participants' personal details are guarded. If such a person, however, does not read it may be unethical to send written information about a project. It may be more ethical to tele phone or even call at the doorstep of such a person. The history of racism in research is worrying, not least the fear that it might return. We need a governing code of conduct. Ethical research can help ethnic minority groups to move from the shadows of society and participate in a vibrant, healthy, multi-ethnic society. (shrink)

This article examines the impact of education on South Asian women's participation in traditional practices of `arranged marriages' and dowries. It is based upon research carried out by the author in East London. Sixty in-depth interviews were conducted with South Asian women, as well as participant observation of living with a South Asian community for a period of six months. The article explores which women participate in `arranged marriages' and receive dowries and which do not. The data indicate that women (...) with high levels of education are rejecting certain aspects of their traditions. However, women who continue the practices of `arranged marriages' and dowries have lower levels of education. They feel the continuation of such practices are part of their own South Asian identity in British society. The research demonstrates that women's level of education affects their participation in traditional South Asian practices. For some British-born South Asian women a process of redefinition is taking place. Their identities are shifting, complex and multifaceted and take on new meanings as they choose whether or not to participate in South Asian traditions. (shrink)

The Norwegian Oil Fund (‘Government Pension Fund – Global’) is worth over NOK 10.6 trillion (USD 1.15 USD trillion)1 making it the largest sovereign wealth fund in the world (Norges Bank Investment...

This paper examines understandings of community and safety for Gypsy, Roma and Traveller (GRT) groups in schools in a metropolitan borough. One school in particular was identified as being the 'Gypsy school' and was attended by the majority of GRT children in the borough. The school was recognised as a model of 'good practice' reflecting its holistic approach towards the GRT community but it was also successful for wider reasons. A picture of the intersection of different communities emerged from interview (...) accounts in which a GRT community with strong local attachments, socially negotiated and maintained, figured very strongly. The GRT community was also identified as sharing racist attitudes towards other non-white immigrants. This article examines children's perspectives of their engagement with the education process and how the strong GRT community played an important part in their understandings of safety and belonging. (shrink)

A national emphasis in Britain on community cohesion and citizenship has highlighted the need to explore understandings of difference within and between communities, particularly in school contexts. This paper reports on the first phase of a larger project exploring pupils' understandings and experiences of identity and diversity within secondary schools. Questionnaires were collected from 51 Year 8 pupils in two urban and ethnically diverse secondary schools in England. The findings suggest that pupils have a complex range of views about identity, (...) diversity and Britishness. (shrink)