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Garland A, Morain S, Sugarman J. Response to Open Peer Commentaries on "Do Clinicians Have a Duty to Participate in Pragmatic Clinical Trials?". Am J Bioeth 2023; 23:W1-W3. [PMID: 37668494 DOI: 10.1080/15265161.2023.2250277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
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Selin C, Lambert L, Morain S, Nelson JP, Barlevy D, Farooque M, Manley H, Scott CT. Researching the future: scenarios to explore the future of human genome editing. BMC Med Ethics 2023; 24:72. [PMID: 37735670 PMCID: PMC10512597 DOI: 10.1186/s12910-023-00951-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Forward-looking, democratically oriented governance is needed to ensure that human genome editing serves rather than undercuts public values. Scientific, policy, and ethics communities have recognized this necessity but have demonstrated limited understanding of how to fulfill it. The field of bioethics has long attempted to grapple with the unintended consequences of emerging technologies, but too often such foresight has lacked adequate scientific grounding, overemphasized regulation to the exclusion of examining underlying values, and failed to adequately engage the public. METHODS This research investigates the application of scenario planning, a tool developed in the high-stakes, uncertainty-ridden world of corporate strategy, for the equally high-stakes and uncertain world of the governance of emerging technologies. The scenario planning methodology is non-predictive, looking instead at a spread of plausible futures which diverge in their implications for different communities' needs, cares, and desires. RESULTS In this article we share how the scenario development process can further understandings of the complex and dynamic systems which generate and shape new biomedical technologies and provide opportunities to re-examine and re-think questions of governance, ethics and values. We detail the results of a year-long scenario planning study that engaged experts from the biological sciences, bioethics, social sciences, law, policy, private industry, and civic organizations to articulate alternative futures of human genome editing. CONCLUSIONS Through sharing and critiquing our methodological approach and results of this study, we advance understandings of anticipatory methods deployed in bioethics, demonstrating how this approach provides unique insights and helps to derive better research questions and policy strategies.
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Affiliation(s)
- Cynthia Selin
- School for the Future of Innovation in Society at Arizona State University, PO Box 876002, 85287-6002, Tempe, AZ, USA.
| | - Lauren Lambert
- School of Sustainability at Arizona State University, 4th floor, Walton Center for Planetary Health, 85281, Tempe, AZ, USA
| | - Stephanie Morain
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Ave, 21212, Baltimore, MD, USA
| | - John P Nelson
- School of Public Policy, Georgia Institute of Technology, 685 Cherry St., Suite 107, 30332, Atlanta, GA, USA
| | - Dorit Barlevy
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 310D, 77030, Houston, TX, USA
| | - Mahmud Farooque
- Consortium for Science, Policy and Outcomes, Arizona State University, 1800 I Street, 20006, Washington, DC, USA
| | - Haley Manley
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 310D, 77030, Houston, TX, USA
| | - Christopher T Scott
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 310D, 77030, Houston, TX, USA
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Abstract
Growing interest in embedded research approaches-where research is incorporated into clinical care-has spurred numerous studies to generate knowledge relevant to the real-world needs of patients and other stakeholders. However, it also has presented ethical challenges. An emerging challenge is how to understand the nature and extent of investigators' obligations to patient-subjects. Prior scholarship on investigator duties has generally been grounded upon the premise that research and clinical care are distinct activities, bearing distinct duties. Yet this premise-and its corresponding implications-are challenged when research and clinical care are deliberately integrated. After presenting three case studies from recent pragmatic clinical trials, we identify six differences between explanatory trials and embedded research that limit the application of existing scholarship for ascertaining investigator duties. We suggest that these limitations indicate a need to account for the implications of usual care and to move beyond a narrow focus on the investigator-subject dyad, one that better reflects the team- and institution-based nature of contemporary health systems.
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Califf RM, Faden R, Kass N, Morain S, Crane M. Challenges in the Ethics and Implementation of Learning Health Care Systems. Am J Bioeth 2023; 23:1-4. [PMID: 37450514 DOI: 10.1080/15265161.2023.2223033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
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Garland A, Morain S, Sugarman J. Do Clinicians Have a Duty to Participate in Pragmatic Clinical Trials? Am J Bioeth 2023; 23:22-32. [PMID: 36449269 PMCID: PMC10355327 DOI: 10.1080/15265161.2022.2146784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Clinicians have good moral and professional reasons to contribute to pragmatic clinical trials (PCTs). We argue that clinicians have a defeasible duty to participate in this research that takes place in usual care settings and does not involve substantive deviation from their ordinary care practices. However, a variety of countervailing reasons may excuse clinicians from this duty in particular cases. Yet because there is a moral default in favor of participating, clinicians who wish to opt out of this research must justify their refusal. Reasons to refuse include that the trial is badly designed in some way, that the trial activities will violate the clinician's conscience, or that the trial will impose excessive burdens on the clinician.
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Morain S, Kraft SA, Wilfond B, McGuire A, Dickert N, Garland A, Sugarman J. Toward Meeting the Obligation of Respect for Persons in Pragmatic Clinical Trials. Hastings Cent Rep 2022; 52:9-17. [PMID: 35763201 PMCID: PMC9704739 DOI: 10.1002/hast.1391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Research ethics oversight systems have traditionally emphasized the informed consent process as the primary means by which to demonstrate respect for prospective subjects. Yet how researchers can best fulfill the ethical obligations of respect for persons in pragmatic clinical trials (PCTs)-particularly those that may alter or waive informed consent-remains unknown. We propose eight dimensions of demonstrating respect in PCTs: (1) engaging patients and communities in research design and execution, (2) promoting transparency and open communication, (3) maximizing agency, (4) minimizing burdens and promoting accessibility, (5) protecting privacy and confidentiality, (6) valuing interpersonal interactions with clinicians and study team members, (7) providing compensation, and (8) maximizing social value. While what respect requires in the context of PCTs will vary based on the nature of the PCT in question, the breadth of these dimensions demonstrates that respect obligations extend beyond informed consent processes.
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Affiliation(s)
- Stephanie Morain
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Stephanie A. Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, WA
- University of Washington School of Medicine, Seattle, WA
| | - Benjamin Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, WA
- University of Washington School of Medicine, Seattle, WA
| | - Amy McGuire
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX
| | - Neal Dickert
- Emory University School of Medicine, Atlanta, GA
| | - Andrew Garland
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD
- Johns Hopkins School of Medicine, Baltimore, MD
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Shamshirsaz AA, Hessami K, Morain S, Afshar Y, Nassr AA, Arian SE, Asl NM, Aagaard K. Intention to Receive COVID-19 Vaccine during Pregnancy: A Systematic Review and Meta-analysis. Am J Perinatol 2022; 39:492-500. [PMID: 34670322 DOI: 10.1055/a-1674-6120] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This meta-analysis aimed to assess the level of intent to receive coronavirus disease 2019 (COVID-19) vaccination and demographical factors influencing vaccine uptake among pregnant individuals. STUDY DESIGN PubMed, Scopus, and archive/pre-print servers were searched up to May 22nd, 2021. Cross sectional surveys reporting the percentage of the pregnant individuals intending to get a COVID-19 vaccine were considered eligible for meta-analysis. This review was registered with PROSPERO (CRD42021254484). The primary outcome was to estimate the prevalence of COVID-19 vaccination intent among pregnant population. The secondary outcome was to evaluate the factors influencing the intention for vaccination. RESULTS Twelve studies sourcing data of 16,926 individuals who were identified as pregnant were eligible. The estimated intention for the receipt of COVID-19 vaccine among women who were pregnant was 47% (95% CI: 38-57%), with the lowest prevalence in Africa 19% (95% CI: 17-21%) and the highest in Oceania 48.0% (95% CI: 44.0-51.0%). Uptake of other vaccines (influenza and/or TdaP) during pregnancy was associated with higher rate of intent to receive the COVID-19 vaccine (OR = 3.03; 95% CI: 1.37-6.73; p = 0.006). CONCLUSION The intent to receive COVID-19 vaccine is relatively low among women who are pregnant and substantially varies based on the country of residence. In our meta-analysis, intent of women who were pregnant to receive the COVID-19 vaccine was significantly associated with the history of receiving influenza or TdaP vaccine during pregnancy. Given that in every country only a minority of gravidae have received the COVID-19 vaccine, despite known risks of maternal morbidity and mortality with no evidence of risks of vaccination, it highlights the importance of revised approaches at shared decision making and focused public health messaging by national and international advisories. KEY POINTS · The estimated global intention for COVID-19 vaccination among pregnant women was 47%.. · The lowest intention was in Africa and the highest in Oceania.. · These findings highlight the importance of public health messaging by by different agencies..
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Affiliation(s)
- Alireza A Shamshirsaz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Kamran Hessami
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Stephanie Morain
- Department of Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Ahmed A Nassr
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Sara E Arian
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Nazlisadat Meshinchi Asl
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Kjersti Aagaard
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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Nassr AA, Hessami K, Morain S, Afshar Y, Arian S, Mesh N, Aagaard KM, Shamshirsaz AA. Intention to receive COVID-19 vaccine during pregnancy: A systematic review and meta-analysis. Am J Obstet Gynecol 2022. [PMCID: PMC8696579 DOI: 10.1016/j.ajog.2021.11.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Leah R Fowler
- Health Law & Policy Institute, University of Houston Law Center, Houston, Texas;
| | | | - Stephanie Morain
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
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Morain S, Mathews D, Murphy Bollinger J, Sugarman J. Response to Open Peer Commentaries on "Ethics and Collateral Findings in Pragmatic Clinical Trials". Am J Bioeth 2020; 20:W9-W11. [PMID: 31896323 DOI: 10.1080/15265161.2019.1699615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Salerno J, Peters ES, Pinney SM, Morain S, Hlaing WM. Untangling the ethical intersection of epidemiology, human subjects research, and public health. Ann Epidemiol 2019; 34:1-5. [PMID: 31005553 PMCID: PMC7370238 DOI: 10.1016/j.annepidem.2019.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/08/2019] [Accepted: 03/15/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Members of the American College of Epidemiology (ACE) Ethics Committee identified current ethics and epidemiology topic areas to consider for further discussion, consultation, teaching opportunities, and conference presentation. This article reflects on the activities of the Committee at the ACE Annual Meeting in New Orleans, Louisiana, September 24-26, 2017. METHODS The overall aim for the Ethics Committee was to engage members of the College and other audiences and highlight the evolution of ethics and epidemiology since the inception of the original Ethics Guidelines published by the ACE Ethics and Standards of Practice Committee in 2000. The Ethics Committee organized a symposium session at the 2017 Annual Meeting of ACE on the ethics of human subjects research as it relates to specialized areas of epidemiology and the intersecting role of public health. This article presents a summary and further discussion of that symposium session. RESULTS Three topic areas were presented: an overview of ethics and epidemiology (E.S.P.), very high biomarker levels in environmental epidemiology research (S.M.P.), and the interface of epidemiology, human subjects research, and public health interventions (S.M.). This article begins by reviewing the foundations of epidemiology and public health and the well-known ethical principles of human subjects research. Then, it considers the ethical considerations in the use of population registry data in epidemiological research, environmental epidemiology, and epidemic surveillance and response. This article may form the basis of teaching of ethics principles related to epidemiology and public health and may serve as a companion piece to the original ACE Ethics Guidelines. CONCLUSIONS Researchers are increasingly faced with ethical considerations in diverse, nontraditional, and specialized areas of epidemiology and public health. This article illustrates these challenges with real-world examples of clinical and population registry data, the study of environmental biomarkers, and Zika virus epidemic; it also reviews relevant ethical principles underpinning these examples and identifies where gaps in knowledge may exist.
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Affiliation(s)
- Jennifer Salerno
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada.
| | - Edward S Peters
- Epidemiology Program, School of Public Health, Louisiana State University, New Orleans
| | - Susan M Pinney
- Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Stephanie Morain
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX
| | - WayWay M Hlaing
- Division of Epidemiology and Population Sciences, Department of Public Health Sciences, University of Miami, Miami, FL
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Abstract
Twenty-nine Americans die in alcohol-impaired driving crashes daily. The National Academies of Sciences, Engineering, and Medicine released a report that identified strategies to reduce alcohol-impaired driving deaths. One strategy suggests amending state laws to reduce the legal blood alcohol concentration (BAC) limit from 0.08 to 0.05. Although BAC 0.05 laws would likely reduce alcohol-related deaths, they are also controversial. Critics object to these laws because they restrict individual liberty and fail to consider that individuals value social drinking. We explored the ethical acceptability of BAC 0.05 laws. We made an ethical argument in support of BAC 0.05 laws, which include preventing harm to both drinking drivers and to others. We then considered and rejected liberty-based objections to BAC 0.05 laws. We concluded that BAC 0.05 laws are not only ethically defensible but desirable. States and Congress should work to promote them.
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Affiliation(s)
- Stephanie Morain
- Stephanie Morain is with the Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX. Emily Largent is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Emily Largent
- Stephanie Morain is with the Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX. Emily Largent is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Morain S, Schoen L, Marty M, Schwarz EB. Parental Leave, Lactation, and Childcare Policies at Top US Schools of Public Health. Am J Public Health 2019; 109:722-728. [PMID: 30896996 PMCID: PMC6459636 DOI: 10.2105/ajph.2019.304970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To describe policies related to parental leave, breastfeeding, and childcare for faculty and staff at top schools of public health in the United States. METHODS We identified the top 25 schools of public health from the US News and World Report rankings. We reviewed each institutional Web site to identify publicly available policies as of July 2018. RESULTS For birth mothers, 80% (20/25) of the schools provided paid childbearing leave to faculty (mean = 8.2 weeks), and 48% (12/25) provided paid childbearing leave for staff (mean = 5.0 weeks). For nonbirth parents, 68% (17/25) provided paid parental leave for faculty and 52% (13/25) for staff (range = 1-15 weeks). We found that 64% (16/25) of the schools had publicly available lactation policies, and 72% (18/25) of the schools had at least 1 university-run on-campus childcare center. CONCLUSIONS The majority of top US schools of public health provide paid leave to faculty birth mothers. However, most schools fall short of the 14 weeks recommended by the American Public Health Association.
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Affiliation(s)
- Stephanie Morain
- Stephanie Morain is with the Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX. At the time of the study, Lauren Schoen was a research assistant at the Center for Medical Ethics & Health Policy, Baylor College of Medicine. Makenna Marty is a medical student at California Northstate University, Elk Grove. Eleanor Bimla Schwarz is with the Department of General Internal Medicine at University of California Davis, Sacramento
| | - Lauren Schoen
- Stephanie Morain is with the Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX. At the time of the study, Lauren Schoen was a research assistant at the Center for Medical Ethics & Health Policy, Baylor College of Medicine. Makenna Marty is a medical student at California Northstate University, Elk Grove. Eleanor Bimla Schwarz is with the Department of General Internal Medicine at University of California Davis, Sacramento
| | - Makenna Marty
- Stephanie Morain is with the Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX. At the time of the study, Lauren Schoen was a research assistant at the Center for Medical Ethics & Health Policy, Baylor College of Medicine. Makenna Marty is a medical student at California Northstate University, Elk Grove. Eleanor Bimla Schwarz is with the Department of General Internal Medicine at University of California Davis, Sacramento
| | - Eleanor Bimla Schwarz
- Stephanie Morain is with the Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX. At the time of the study, Lauren Schoen was a research assistant at the Center for Medical Ethics & Health Policy, Baylor College of Medicine. Makenna Marty is a medical student at California Northstate University, Elk Grove. Eleanor Bimla Schwarz is with the Department of General Internal Medicine at University of California Davis, Sacramento
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Abstract
Eliminating formula giveaways ("banning the bag") has been embraced as a way to reduce the influence of formula marketing in hospitals and to increase breastfeeding rates among new mothers, but the policy raises ethical concerns in the mind of some, notably because it denies a useful benefit to mothers who have trouble affording formula. Hospital policies to promote breastfeeding, including banning the bag, should be sensitive to the economic and other costs associated with breastfeeding and should be consciously designed to make breastfeeding easier and not just to make formula feeding more difficult. We recommend that hospitals evaluate the negative impacts of banning the bag on their patient population in order to ensure that families are not being negatively affected.
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Affiliation(s)
- Stephanie Morain
- An assistant professor in the Center for Medical Ethics and Health Policy at Baylor College of Medicine in Houston
| | - Anne Barnhill
- A faculty member in the Berman Institute of Bioethics at Johns Hopkins University in Baltimore, and a philosopher and bioethicist
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Abraham E, Blanco C, Lee CC, Christian JB, Kass N, Larson EB, Mazumdar M, Morain S, Newton KM, Ommaya A, Patrick-Lake B, Platt R, Steiner J, Zirkle M, Lopez MH. Generating Knowledge from Best Care: Advancing the Continuously Learning Health System. NAM Perspect 2016. [DOI: 10.31478/201609b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Morain S. Evaluating the Legitimacy of Contemporary Legal Strategies for Obesity. Kennedy Inst Ethics J 2015; 25:369-393. [PMID: 26775878 DOI: 10.1353/ken.2015.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Contemporary legal strategies for obesity raise troubling questions regarding individual liberty and the legitimate scope of public health authority. This article argues that the predominant approach to assessing public health legitimacy--John Stuart Mill's "harm principle"--may be unsuitable for evaluating the legitimacy of legal strategies for obesity. The article proposes an alternative test for assessing the legitimate scope of public health authority: John Rawls's liberal principle of legitimacy. It outlines how Rawls's principle would evaluate obesity policies, and contrasts this evaluation to that of Mill. The alternative test avoids some of the limitations of the Millian approach, and may offer an improved mechanism for assessing the liberty effects of policies for obesity and other public health activities.
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Affiliation(s)
- Stephanie Morain
- Edmond J. Safra Center for Ethics, Harvard University, Cambridge, MA, USA
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Morain S, Mello MM. Survey Finds Public Support For Legal Interventions Directed At Health Behavior To Fight Noncommunicable Disease. Health Aff (Millwood) 2013; 32:486-96. [DOI: 10.1377/hlthaff.2012.0609] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Stephanie Morain
- Stephanie Morain is a doctoral candidate in the ethics track of the Interfaculty Initiative in Health Policy at Harvard University, in Cambridge, Massachusetts
| | - Michelle M. Mello
- Michelle M. Mello ( ) is a professor of law and public health in the Department of Health Policy and Management and director of the Program in Law and Public Health at the Harvard School of Public Health, in Boston, Massachusetts
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