1
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Wittrock J. A human right to pleasure? Sexuality, autonomy and egalitarian strategies. J Med Ethics 2024; 50:263-267. [PMID: 37277174 PMCID: PMC10958316 DOI: 10.1136/jme-2023-109011] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/19/2023] [Indexed: 06/07/2023]
Abstract
A growing focus on pleasure in human rights discourse has been used to address patterns of sexual exclusion, often when addressing the problems of people with disabilities (PWD). As convincingly argued by Liberman, however, not all PWD suffer from sexual exclusion, and not all who suffer from sexual exclusion are PWD. Danaher and Liberman have thus argued in various ways for a broader range of measures, addressing sexual exclusion. This article builds on previous research and offers a conceptual framework for addressing sexual pleasure and exclusion in terms of human rights. It argues that human rights aim to safeguard autonomy, which is interpreted as multidimensional. It, thus, divides autonomy into the four dimensions of liberty (freedom from threat and coercion), opportunity (options to choose between), capacity (what an agent is capable of doing) and authenticity (the extent to which choices are genuine). Furthermore, it distinguishes between distinct egalitarian strategies, which offer different problems and possibilities, and may be combined. Thus, there is direct egalitarian distribution, indirect egalitarian distribution, baseline or threshold strategies and general promotion strategies. By way of conclusion, the importance of sexual authenticity as the ultimate aim of sexual rights is emphasised.
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Affiliation(s)
- Jon Wittrock
- Global Political Studies, Malmö Universitet, Malmö, Sweden
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2
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Muyskens KL. Medical Pluralism as a Matter of Justice. J Med Humanit 2024; 45:95-111. [PMID: 37434074 DOI: 10.1007/s10912-023-09809-x] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/13/2023]
Abstract
Culture, health, and medicine intersect in various ways-and not always without friction. This paper examines how liberal multicultural states ought to interact with diverse communities which hold different health-related or medical beliefs and practices. The debate is fierce within the fields of medicine and bioethics as to how traditional medicines ought to be regarded. What this debate often misses is the relationship that medical traditions have with cultural identity and the value that these traditions can have beyond the confines of the clinical setting. This paper will attempt to bring some clarity to the discussion. In so doing, it will delve into some controversial areas: (1) the debate around whether liberal states ought to embrace multiculturalism, (2) the existence and nature of group-differentiated rights, (3) the question of whether healthcare systems ought to embrace medical pluralism, and (4) what this would entail for policymakers, clinicians, and patients. Ultimately, I argue that liberal democratic states with multicultural populations ought to recognize medical pluralism as a matter of respecting group-differentiated and individual human rights.
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3
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Jubany-Roig P, Massó Guijarro E. [Breastfeeding behind bars: Experiences of incarcerated mothers in the Spanish penitentiary system]. Salud Colect 2024; 20:e4665. [PMID: 38427347 DOI: 10.18294/sc.2024.4665] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024] Open
Abstract
This research aims to analyze the breastfeeding experiences of incarcerated mothers in the prisons of the Spanish penitentiary system. Additionally, it explores whether these mothers have perceived practices related to obstetric violence during pregnancy, childbirth, and the postpartum period. An exploratory-descriptive study was conducted using a qualitative approach and a critical ethnographic method. Fieldwork, including participant observation and semi-structured interviews, was carried out between December 2021 and April 2022. The study involved 30 adult women from Africa, Europe, Eastern Europe, and Latin America, all serving sentences with their infants in Mother Units located in the Spanish cities of Alicante, Barcelona, Madrid, and Seville. The main findings highlight the need for penitentiary policies with a gender and feminist perspective. These policies should aim to eliminate severe inequalities and discriminations faced by incarcerated women while protecting the basic rights of both mothers and infants.
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Affiliation(s)
- Pilar Jubany-Roig
- Psicóloga. Investigadora predoctoral, Programa de Doctorado en Filosofía, Universidad de Granada, España
| | - Ester Massó Guijarro
- Doctora en Filosofía y Antropología. Profesora titular de Filosofía Moral, Universidad de Granada, España
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4
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Wicks E. The role of the right to life in respect of deaths caused by negligence in the healthcare context. Med Law Rev 2024; 32:81-100. [PMID: 38007608 PMCID: PMC10896627 DOI: 10.1093/medlaw/fwad037] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
This article investigates the question of whether a death caused by negligence in the healthcare context is capable of violating the right to life under Article 2 of the European Convention on Human Rights. This provision imposes extensive positive obligations upon Contracting States, including an operational duty to take reasonable steps to save a life that they know, or ought to know, is at risk. This article addresses the question of exactly when such an operational duty arises, with particular focus on the healthcare context in which deaths caused by medical negligence have not traditionally been regarded as amounting to violations of the right to life. This article argues that two key factors in determining the existence of an operational duty to save life are the assumption of responsibility and nature of risk. It also argues for the need to take surrounding circumstances into account and for an increased use of the right to life in holding public bodies to account for deaths caused by negligence in the healthcare context.
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Affiliation(s)
- Elizabeth Wicks
- Centre for Rights and Equality in Health Law (CREHL) and Leicester Law School, University of Leicester, Leicester, UK
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5
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Bozzo A. Abortion and the basis of equality: a reply to Miller. J Med Ethics 2024; 50:207-208. [PMID: 36858812 DOI: 10.1136/jme-2023-108960] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
Miller has recently argued that the standard liberal and moderate positions on abortion are incapable of grounding the claim that 'all non-disabled adult humans are equal'. The reason, he claims, is such accounts base the intrinsic moral worth of a human being on some property (or set of properties) which comes in degrees. In contrast, he argues that moral equality must reside in some binary property, such as the property of being human. In this paper, I offer three criticisms of Miller's position.
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Affiliation(s)
- Alexander Bozzo
- Humanities, University of Wisconsin-Green Bay, Green Bay, Wisconsin, USA
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6
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Miller C. Human equality and the impermissibility of abortion: a response to Bozzo. J Med Ethics 2024; 50:209-211. [PMID: 37979974 DOI: 10.1136/jme-2023-109501] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/16/2023] [Indexed: 11/20/2023]
Abstract
I have recently offered a defence of human equality, and consequently an argument against abortion. This has been objected to by Bozzo, on the grounds that my account of human equality is unclear and could be grounded in utilitarian or Kantian ethics, that my account struggles to ground the permissibility of therapeutic abortions, and that my proposed foundation for human equality itself is parasitic on a scalar property which generates the same difficulties I am attempting to solve. I provide an account of human equality which cannot easily be grounded in utilitarianism or Kantianism, offer a variety of defences of therapeutic abortion consistent with treating the mother and child equally, and show that even if the value of humanness is ultimately grounded in a scalar quality, my argument succeeds.
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Affiliation(s)
- Calum Miller
- Blackfriars Hall, University of Oxford, Oxford, UK
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7
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Liblik SA, Rocha da Cunha T, Liblik CSDFK, Biscioni DN, Girardi DR. [Ethics in the use of psychedelics: The definition of illicit drugs from the perspective of critical bioethics]. Salud Colect 2024; 20:e4630. [PMID: 38381110 DOI: 10.18294/sc.2024.4630] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 02/05/2024] [Indexed: 02/22/2024] Open
Abstract
This essay, situated in the field of bioethics, examines the prohibition of psychedelic use, exploring arguments surrounding the growing evidence of their therapeutic potential and their millennia-long history of cultural and spiritual uses. It initially discusses the historical context of psychedelics and the various terms used to describe them. The essay problematizes the definition of "drugs," highlighting the lack of objective criteria for distinguishing between legal and illicit substances. Drawing on concepts and theoretical frameworks of critical bioethics, it analyzes how the prohibitionist moral discourse is sustained more by political and economic interests than by scientific justifications, leading to stigmatization and vulnerability. The essay advocates for the end of the prohibition of psychedelics based on ethical arguments, emphasizing their importance in reducing individual and collective suffering. The work contributes to a deeper reflection on this socially controversial topic, integrating interdisciplinary knowledge.
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Affiliation(s)
- Sergio Alexandre Liblik
- Magíster en Bioética. Profesor, Pontifícia Universidade Católica do Paraná, Curitiba, Brasil
| | - Thiago Rocha da Cunha
- Doctor en Bioética. Profesor, Programa de Pós-grado em Bioética, Pontifícia Universidade Católica do Paraná, Curitiba, Brasil
| | - Carmem Silvia da Fonseca Kummer Liblik
- Doctora en Históra. Investigadora, Grupo de Pesquisa CNPq/PUCPR Bioética, Saúde Global e Direitos Humanos, Pontifícia Universidade Católica do Paraná, Curitiba, Brasil
| | - Diego Nicolás Biscioni
- Magíster en Salud Pública. Profesor, Departarmento de Salud y Actividad Física, Universidad Nacional de Avellaneda, Avellaneda, Argentina
| | - Dennys Robson Girardi
- Magíster en Tecnología en Salud. Doctorando em Direito Empresarial e Cidadania, Centro Universitário Curitiba, Curitiba, Brasil
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8
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Wang H. Single women's access to egg freezing in mainland China: an ethicolegal analysis. J Med Ethics 2023; 50:50-56. [PMID: 37147115 DOI: 10.1136/jme-2023-108915] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/12/2023] [Indexed: 05/07/2023]
Abstract
In the name of safeguarding public interests and ethical principles, China's National Health Commission bans unmarried women from using assisted reproductive technology (ART), including egg freezing. Supported by local governments, the ban has restricted single women's reproductive rights nationwide. Although some courts bypassed the ban to allow widowed single women to use ART, they have not adopted a position in favour of single women's reproductive autonomy, but quite the contrary. Faced with calls to relax the ban and allow single women to freeze eggs electively, the National Health Commission refused to amend their policy, partly to protect women's well-being paternalistically and partly to implement the central government's policies to boost the birthrate and maintain traditional family structures. While the government's concerns about elective egg freezing are not entirely unfounded, they have failed to demonstrate that banning single women's egg freezing is a suitable, necessary and proportionate means to safeguard societal interests and ethical principles. The authority's assumptions that women cannot make rational decisions for their health even with adequate informed consent procedures, that banning egg freezing by single women promotes a culture of having children 'at a proper age', and that egg freezing by single women offends China's public moralities have not been substantiated.
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Affiliation(s)
- Hao Wang
- Shen Junru Law School, Hangzhou Normal University, Hangzhou, Zhejiang, China
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9
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Cea Madrid JC. Mad activisms in mental health: a integrative review. Salud Colect 2023; 19:e4627. [PMID: 38055370 DOI: 10.18294/sc.2023.4627] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023] Open
Abstract
The following text presents the results of a integrative review whose purpose was to identify and analyze the production of academic literature on mad activism in the field of mental health and its link with the notions of disability and neurodiversity. From searches conducted in May 2023 in the Web of Science, Scopus, and PubMed databases, 52 articles were selected, and thematic content analysis strategies were applied. The results account for various articulations between the concepts addressed, establishing a critical look at the biomedical model in mental health. In the forms of mad activism, the human rights approach, the fight against stigma and its influence on the reform processes of the mental health system become relevant. On the other hand, a framework of social justice, identity policies and practices of mutual support from the community are established. As a whole, they emphasize methodological innovations and an intersectional perspective on the production of knowledge. It is concluded that it is possible to situate madness as a field of constitution of a political actor and epistemic subject. Based on this, possible lines of research on mad activisms in Latin America are formulated.
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Affiliation(s)
- Juan Carlos Cea Madrid
- Psicólogo. Magíster en psicología, mención psicología comunitaria. Estudiante de Doctorado en Psicología. Universidad de Chile, Santiago, Chile.
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Steinert T. Using coercion in mental disorders or risking the patient's death? An analysis of the protocols of a clinical ethics committee and a derived decision algorithm. J Med Ethics 2023:jme-2023-109578. [PMID: 38050143 DOI: 10.1136/jme-2023-109578] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/12/2023] [Indexed: 12/06/2023]
Abstract
While principle-based ethics is well known and widely accepted in psychiatry, much less is known about how decisions are made in clinical practice, which case scenarios exist, and which challenges exist for decision-making. Protocols of the central ethics committee responsible for four psychiatric hospitals over 7 years (N=17) were analysed. While four cases concerned suicide risk in the case of intended hospital discharge, the vast majority (N=13) concerned questions of whether the responsible physician should or should not initiate the use of coercion in patients lacking mental capacity. The committee's recommendations were non-uniform. Forced feeding and electroconvulsive therapy were endorsed in each one case. In two cases of intermittent loss of capacity due to heavy drinking or intermittent severe suicidal ideation, a self-binding contract was recommended and the use of coercion was considered as justified for a very limited period. In all other cases, most of which involved involuntary treatment, the use of coercion was not endorsed. Without exception, the recommendations were accepted with relief by the physicians and their treatment teams, who feared liability in the event of harm to the patient. Eventually, a model of a decision algorithm was derived from the ethical arguments in the protocols.
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Affiliation(s)
- Tilman Steinert
- Centers for Psychiatry Suedwuerttemberg, Ravensburg, Germany
- Ulm University, Ulm, Germany
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Towns C, Ballantyne A. Blowing the whistle on mixed gender hospital rooms in Australia and New Zealand: a human rights issue. J Med Ethics 2023:jme-2023-109080. [PMID: 37783477 DOI: 10.1136/jme-2023-109080] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/28/2023] [Indexed: 10/04/2023]
Abstract
The practice of placing men and women in the same hospital room (mixed gender rooms) has been prohibited in the UK National Health Service for over a decade. However, recent research demonstrates that the practice is common and increasing in a major New Zealand public hospital. Reports and complaints show that the practice also occurs in Australia. We argue that mixed gender rooms violate the fundamental human rights of personal security and dignity. The high rates of cognitive impairment, sensory impairment and frailty in hospital wards exacerbates the risk for these violations and subsequent harm. We argue for the adoption of specific national policies prohibiting mixed gender rooms and public reporting of breaches. Importantly, these guidelines can be adopted without compromising the rights of gender minorities. In the long term, hospitals should be built with single occupancy rooms.
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Affiliation(s)
- Cindy Towns
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Angela Ballantyne
- Primary Health Care and General Practice, Otago University, Wellington, New Zealand
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12
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Garrafa V. [Bioethics and the right of access to health care.]. Salud Colect 2023; 19:e4491. [PMID: 37992289 DOI: 10.18294/sc.2023.4491] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/24/2023] [Indexed: 11/24/2023] Open
Abstract
Access to health care is a universal human right and therefore should not be treated as a commodity only accessible to people with the economic means to acquire it. This study adopts a theoretical framework based on UNESCO's Universal Declaration on Bioethics and Human Rights. The discussion first explores the rationale for choosing human rights as a foundation for such an endeavor. Secondly, the notion of equity is presented as an indispensable principle that should be incorporated into such discussions, reinforcing the understanding that unequal people and populations must be treated in a differentiated and compensatory manner, with the aim of seeking true equality based on the humanitarian recognition of every individual's rights, accounting for their needs and differences. Thirdly, the text seeks to address the complex problem of prioritizing the allocation of scarce resources in order to ensure access to health care for as many people as possible. In summary, this article intends to demonstrate that access to health care for all people, regardless of their income level, should be considered to be a universal human right. Beyond the obligations of governments and the private sector to support inclusive programs, there is also a need to acknowledge social movements' legitimate struggles for achieving better living conditions and health outcomes for all people, without exception.
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Affiliation(s)
- Volnei Garrafa
- Doctor en Ciencias, Posdoctorado en Bioética. Profesor Emérito, Centro Internacional de Bioética e Humanidades, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasilia, Brasil
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13
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Kumar-Hazard B, Dahlen HG. Setting a human rights and legal framework around 'the ethics of consent during labour and birth: episiotomies'. J Med Ethics 2023; 49:634-635. [PMID: 37620137 DOI: 10.1136/jme-2023-109251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Bashi Kumar-Hazard
- Law, University of Sydney SCIL, Sydney, New South Wales, Australia
- Human Rights in Childbirth, (NGO), San Francisco, California, USA
| | - Hannah Grace Dahlen
- Midwifery, University of Western Sydney, Penrith South, New South Wales, Australia
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14
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Nyberg R, McCredden J, Hardell L. The European Union assessments of radiofrequency radiation health risks - another hard nut to crack (Review). Rev Environ Health 2023; 0:reveh-2023-0046. [PMID: 37609829 DOI: 10.1515/reveh-2023-0046] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/30/2023] [Indexed: 08/24/2023]
Abstract
In 2017 an article was published on the unwillingness of the WHO to acknowledge the health effects associated with the use of wireless phones. It was thus stated that the WHO is 'A Hard Nut to Crack'. Since then, there has been no progress, and history seems to be repeating in that the European Union (EU) is following in the blind man's footsteps created by the WHO. Despite increasing evidence of serious negative effects from radiofrequency radiation on human health and the environment, the EU has not acknowledged that there are any risks. Since September 2017, seven appeals by scientists and medical doctors have been sent to the EU requesting a halt to the roll-out of the fifth generation of wireless communication (5G). The millimeter waves (MMW) and complex waveforms of 5G contribute massively harmful additions to existing planetary electromagnetic pollution. Fundamental rights and EU primary law make it mandatory for the EU to protect the population, especially children, from all kinds of harmful health effects of wireless technology. However, several experts associated with the WHO and the EU have conflicts of interest due to their ties to industry. The subsequent prioritizing of economic interests is resulting in human and planetary health being compromised. Experts must make an unbiased evaluation with no conflicts of interest. The seven appeals to the EU have included requests for immediate protective action, which have been ignored. On the issue of wireless radiation and the health of citizens, the EU seems to be another hard nut to crack.
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Affiliation(s)
- Rainer Nyberg
- Åbo Akademi University Faculty of Education and Welfare Studies, Vasa, Finland
| | - Julie McCredden
- Oceania Radiofrequency Scientific Advisory Association, Brisbane, QLD, Australia
| | - Lennart Hardell
- The Environment and Cancer Research Foundation, Orebro, Sweden
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Miller C. Subhumans, human flourishing and abortion: a reply to Räsänen. J Med Ethics 2023:jme-2023-109461. [PMID: 37607806 DOI: 10.1136/jme-2023-109461] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/24/2023]
Abstract
In a recent article, I argued that all humans are morally equal, and that this generates an argument against abortion. Here, I defend my argument against two objections from Räsänen: that it is possible to ground equal human value in the ability to flourish in a particular kind of way, and that being human is not, in fact, a binary property in the way needed for the argument to work. I show that this proposed criterion for grounding human value falls prey to my original argument, and that Räsänen's attempt to conceive of subhuman entities fails.
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Affiliation(s)
- Calum Miller
- Blackfriars Hall, University of Oxford, Oxford, UK
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16
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Horák F, Dienstbier J. Dark side of the principles of non-discrimination and proportionality: the case of mandatory vaccination. J Med Ethics 2023:jme-2023-108998. [PMID: 37586831 DOI: 10.1136/jme-2023-108998] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023]
Abstract
Deciding the conflict between various rights and interests, especially in medical ethics where health and lives are in question, has significant challenges, and to obtain appropriate outcomes, it is necessary to properly apply the principles of non-discrimination and proportionality. Using the example of mandatory vaccination policies, we show that this task becomes even more difficult when these principles lead us to counterintuitive and paradoxical results. Although the general purpose of these principles is to ensure that decisions and policies seek the highest and broadest possible enjoyment of rights for all (ie, the least restrictive solution), they achieve the complete opposite when applied to mandatory vaccination policies. To highlight and explain these paradoxical results, we present a typology of fifteen hypothetical mandatory vaccination policies containing various degrees of restriction and apply well-established non-discrimination and proportionality tests from constitutional law to each. We argue that mandatory vaccination policies exhibit two characteristics, namely the non-linear relationship between their general purposes and specific goals and the involvement of life and health, suggesting that more restrictive policies should prevail even though less restrictive policies might fail these tests. Using clearly structured and rigorous methodology from constitutional law, the proposed approach delivers a fresh view on the core ethical principles of non-discrimination and proportionality and a potentially useful tool in helping resolve also other challenges encountered in medical ethics beyond mandatory vaccination policies.
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Affiliation(s)
- Filip Horák
- Constitutional Law, Charles University Faculty of Law, Praha, Czech Republic
| | - Jakub Dienstbier
- Constitutional Law, Charles University Faculty of Law, Praha, Czech Republic
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Zóttola L. [The praxe: a disciplinary apparatus for entering into the world of Academia in Portugal]. Salud Colect 2023; 19:e4537. [PMID: 37988564 DOI: 10.18294/sc.2023.4537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/13/2023] [Indexed: 11/23/2023] Open
Affiliation(s)
- Lía Zóttola
- Doctora en Psicología. Profesora Asociada Regular, Universidad Nacional de Santiago del Estero, Santiago del Estero, Argentina
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Abstract
An Ethics Committee (EC) is an independent body composed of members with expertise in both scientific and nonscientific arenas which functions to ensure the protection of human rights and the well-being of research subjects based on six basic principles of autonomy, justice, beneficence, nonmaleficence, confidentiality, and honesty. MEDLINE, Scopus, and Directory of Open Access Journals were searched for studies relevant to this topic. This review is focused on the types of research articles that need EC approval, the submission process, and exemptions. It further highlights the constitution of ECs, their duties, the review process, and the assessment of the risk-benefit of the proposed research including privacy issues. It's pertinent for academicians and researchers to abide by the rules and regulations put forth by ECs for upholding of human rights and protecting research subjects primarily, as well as avoiding other issues like retraction of publications. Despite various issues of cost, backlogs, lack of expertise, lesser representation of laypersons, need for multiple approvals for multisite projects, conflicts of interest, and monitoring of ongoing research for the continued safety of participants, the ECs form the central force in regulating research and participant safety. Data safety and monitoring boards complement the ECs for carrying out continuous monitoring for better protection of research subjects. The establishment of ECs has ensured safe study designs, the safety of human subjects along with the protection of researchers from before the initiation until the completion of a study.
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Affiliation(s)
- Pankti Mehta
- Department of Clinical Immunology and Rheumatology, King George's Medical University, Lucknow, India.
| | - Olena Zimba
- Department of Clinical Rheumatology and Immunology, University Hospital in Krakow, Krakow, Poland
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Armen Yuri Gasparyan
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, UK
| | - Birzhan Seiil
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Marlen Yessirkepov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
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Mussell R, Brannan S, English V, Harrison CA, Sheather JC. Ethics briefing. J Med Ethics 2023; 49:449-450. [PMID: 37217287 DOI: 10.1136/jme-2023-109145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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DiStefano MJ, Karim SA, Krubiner CB, Hofman KJ. Integrating Health Technology Assessment and the Right to Health in South Africa: A Qualitative Content Analysis of Substantive Values in Landmark Judicial Decisions. J Law Med Ethics 2023; 51:131-149. [PMID: 37226744 DOI: 10.1017/jme.2023.48] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The World Health Assembly has encouraged WHO member-states to establish capacity in health technology assessment (HTA) as a support for achieving universal health coverage (UHC). Simultaneously, the WHO has stated that UHC is "a practical expression of the concern for health equity and the right to health." This has prompted questions about potential tensions between priority-setting efforts and the right to health on the road to UHC. South Africa (SA) is an ideal setting in which to explore how the priority-setting work of an HTA body may be integrated with an existing rights framework.
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Affiliation(s)
- Michael J DiStefano
- SKAGGS SCHOOL OF PHARMACY AND PHARMACEUTICAL SCIENCES, UNIVERSITY OF COLORADO, AURORA, CO, USA
| | - Safura Abdool Karim
- SCHOOL OF PUBLIC HEALTH, UNIVERSITY OF WESTERN CAPE, CAPE TOWN, SOUTH AFRICA
| | | | - Karen J Hofman
- UNIVERSITY OF THE WITWATERSRAND SCHOOL OF PUBLIC HEALTH, JOHANNESBURG, SOUTH AFRICA
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21
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Shikako K, Lencucha R, Hunt M, Jodoin S, Elsabbagh M, Hudon A, Cogburn D, Chandra A, Gignac-Eddy A, Ananthamoorthy N, Martens R. How Did Governments Address the Needs of People With Disabilities During the COVID-19 Pandemic? An Analysis of 14 Countries' Policies Based on the UN Convention on the Rights of Persons With Disabilities. Int J Health Policy Manag 2023; 12:7111. [PMID: 37579394 PMCID: PMC10425656 DOI: 10.34172/ijhpm.2023.7111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/28/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND People with disabilities have experienced heightened social risks in the context of the pandemic, resulting in higher rates of infection and mortality. They have also borne elevated burdens associated with public health measures. The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) obliges its 184 state parties to eliminate discrimination and ensure equality and inclusion for persons with disabilities, including protection and safety in situations of emergency. It remains unclear to what extent national COVID-19 policies have aligned with these commitments under the UNCRPD. Our objective in this exploratory study was to assess alignment between the UNCRPD indicators and COVID-19 policies from 14 countries with the goal of informing policy development that is inclusive of persons with disabilities and responsive to rights under the UNCRPD. METHODS We identified COVID-19 policy documents from 14 purposively selected countries. Country selection considered diversity based on geographic regions and national income levels, with restriction to those countries that had ratified the UNCRPD and had English or French as an official language. We used a computational text mining approach and developed a complex multilevel dictionary or categorization model based on the UNCRPD Bridging the Gap indicators proposed by the Office of the High Commissioner on Human Rights (OHCHR). This dictionary was used to assess the extent to which indicators across the entirety of the UNCRPD were represented in the selected policies. We analyzed frequency of associations with UNCRPD, as well as conducting 'key word in context' analyses to identify themes. RESULTS We identified 764 COVID-19 national policy documents from the period of January 2020 to June 2021. When analyzed in relation to the Articles of the UNCRPD, the most frequently identified were Articles 11 (risk and humanitarian emergencies), 23 (home and family), 24 (education), and 19 (community living). Six countries produced 27 policies that were specifically focused on disability. Common themes within these documents included continuation of services, intersectionality and equity, and disability considerations in regulations and public health measures. CONCLUSION Analyzing country policies in light of the UNCRPD offers important insights about how these policies do and do not align with states' commitments. As new policies are developed and existing ones revised, more comprehensive approaches to addressing the rights of persons with disabilities are urgently needed.
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Affiliation(s)
- Keiko Shikako
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Center for Interdisciplinaire Research in Rehabilitation of the Greater Montreal (CRIR), Montreal, QC, Canada
| | - Raphael Lencucha
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Center for Interdisciplinaire Research in Rehabilitation of the Greater Montreal (CRIR), Montreal, QC, Canada
| | - Matthew Hunt
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Center for Interdisciplinaire Research in Rehabilitation of the Greater Montreal (CRIR), Montreal, QC, Canada
| | | | - Mayada Elsabbagh
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Anne Hudon
- School of Rehabiltiation, University of Montreal, Montreal, QC, Canada
| | - Derrick Cogburn
- School of International Service and Kogod School of Business, American University, Washington, DC, USA
- Institute on Disability and Public Policy (IDPP), American University, Washington, DC, USA
| | - Ananya Chandra
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Center for Interdisciplinaire Research in Rehabilitation of the Greater Montreal (CRIR), Montreal, QC, Canada
| | | | | | - Rachel Martens
- Kids Brain Health Network, CanChild, Calgary, AB, Canada
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22
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Cortes Lopes D, Bento Loyens D. [Prevention of Female Genital Mutilation in Travel Medicine]. ACTA MEDICA PORT 2023; 36:376. [PMID: 37130574 DOI: 10.20344/amp.19788] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/17/2023] [Indexed: 05/04/2023]
Affiliation(s)
- Diogo Cortes Lopes
- Unidade de Saúde Pública António Luz. Agrupamento de Centros de Saúde da Amadora. Amadora. Portugal
| | - Dinis Bento Loyens
- Unidade de Saúde Pública António Luz. Agrupamento de Centros de Saúde da Amadora. Amadora. Portugal
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23
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Longo M, Lorubbio V. Ecosystem Vulnerability. New Semantics for International Law. Int J Semiot Law 2023; 36:1-18. [PMID: 37362074 PMCID: PMC10140698 DOI: 10.1007/s11196-023-09998-7] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2023] [Indexed: 06/28/2023]
Abstract
The effects of climate change and increasing environmental pollution have clearly shown the vulnerability of individuals, local communities, and the natural environment, even in the Western context. However, despite such unquestionable data, International Law is still struggling to find adequate, unambiguous, effective solutions to the issue. Even the 'human right to a healthy environment', recognised by the UN General Assembly in 2022, is permeated by an anthropocentric idea of the world, which prevents it from fully dealing with ecosystem issues so as to protect any living and non-living being. The paper starts by exploring the historical relevance of the concept of limit and the lack of boundaries in contemporary society, aiming to show that new semantics are needed, in order to overcome contemporary extractivism. An analysis of international legislation and jurisprudence will investigate the role that the concept of ecosystem vulnerability might play in the implementation of both human rights and the rights of nature.
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Affiliation(s)
- Mariano Longo
- Department of Human and Social Sciences, University of Salento, Lecce, Italy
| | - Vincenzo Lorubbio
- Department of Human and Social Sciences, University of Salento, Lecce, Italy
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24
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Omigbodun OO, Ryan GK, Fasoranti B, Chibanda D, Esliker R, Sefasi A, Kakuma R, Shakespeare T, Eaton J. Reprioritising global mental health: psychoses in sub-Saharan Africa. Int J Ment Health Syst 2023; 17:6. [PMID: 36978186 PMCID: PMC10043866 DOI: 10.1186/s13033-023-00574-x] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
Arthur Kleinman's 2009 Lancet commentary described global mental health as a "moral failure of humanity", asserting that priorities should be based not on the epidemiological and utilitarian economic arguments that tend to favour common mental health conditions like mild to moderate depression and anxiety, but rather on the human rights of those in the most vulnerable situations and the suffering that they experience. Yet more than a decade later, people with severe mental health conditions like psychoses are still being left behind. Here, we add to Kleinman's appeal a critical review of the literature on psychoses in sub-Saharan Africa, highlighting contradictions between local evidence and global narratives surrounding the burden of disease, the outcomes of schizophrenia, and the economic costs of mental health conditions. We identify numerous instances where the lack of regionally representative data and other methodological shortcomings undermine the conclusions of international research carried out to inform decision-making. Our findings point to the need not only for more research on psychoses in sub-Saharan Africa, but also for more representation and leadership in the conduct of research and in international priority-setting more broadly-especially by people with lived experience from diverse backgrounds. This paper aims to encourage debate about how this chronically under-resourced field, as part of wider conversations in global mental health, can be reprioritised.
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Affiliation(s)
- O O Omigbodun
- Department of Psychiatry and Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, 200212, Oyo State, Nigeria
| | - G K Ryan
- Department of Population Health, London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, Keppel Street, London, WC1E 7HT, UK.
| | - B Fasoranti
- Department of Psychiatry and Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, 200212, Oyo State, Nigeria
| | - D Chibanda
- Department of Population Health, London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, Keppel Street, London, WC1E 7HT, UK
- Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - R Esliker
- Mental Health Department, University of Makeni, Lunsar-Makeni Highway, Makeni, Sierra Leone
| | - A Sefasi
- Department of Mental Health, Kamuzu University of Health Sciences, P/Bag 360, Blantyre, Malawi
| | - R Kakuma
- Department of Population Health, London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, Keppel Street, London, WC1E 7HT, UK
| | - T Shakespeare
- Department of Population Health, London School of Hygiene and Tropical Medicine, International Centre for Evidence in Disability, Keppel Street, London, WC1E 7HT, UK
| | - J Eaton
- Department of Population Health, London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, Keppel Street, London, WC1E 7HT, UK
- CBM Global Disability Inclusion, Dr.-Werner-Freyberg-Straβe 7, 69514, Laudenbach, Germany
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25
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Affiliation(s)
- Morgan Carpenter
- Health Ethics, The University of Sydney, Sydney, New South Wales, Australia
| | - Katharine B Dalke
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Brian D Earp
- Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
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26
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Sotelo-Monroy GE, Villaseñor-Robledo C, Peñaloza-Solano G, Tafoya-Ramos F. [Controversies between mental health and disability standards in Mexico]. Rev Med Inst Mex Seguro Soc 2023; 61:204-211. [PMID: 37200620 PMCID: PMC10395880] [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] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Indexed: 05/20/2023]
Abstract
There are controversies between the practice of psychiatry, current international standards and mental disorders or conditions with disabilities, framed in social care models. The objective of this work is to provide evidence and analyze the main gaps in mental health such as: the invisibility of some people with disabilities for the design of policies, legislation, or public programs; the predominance of the medical model, in which the substitution of decision-making in informed consent prevails, which violates the rights of legal personality, equality, freedom, security and respect for personal integrity, among others. This analysis highlights the importance of: a) integrating the legal provisions on health and disability to international standards, and complying with the Human Rights framework of the Political Constitution of the United States of Mexico, especially the pro personae principle and to the conforming interpretation clause; b) reform the General Health Law in matters of mental health and general health, in order to change the paradigm of asylum care to move towards that of community care with a focus on primary health care, adjacent to the services of the National System of Health; c) prohibit the institutionalization of people with mental disorders, as well as coercive measures as containment measures, and instead train and encourage verbal de-escalation techniques.
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Affiliation(s)
- Gabriel Eugenio Sotelo-Monroy
- Secretaría de Salud, Servicios de Atención Psiquiátrica, Dirección de Gestión de Servicios. Ciudad de México, México
| | - Clarisa Villaseñor-Robledo
- Secretaría de Salud, Servicios de Atención Psiquiátrica, Dirección de Gestión de Servicios. Ciudad de México, México
| | - Guillermo Peñaloza-Solano
- Secretaría de Salud, Servicios de Atención Psiquiátrica, Dirección de Gestión de Servicios. Ciudad de México, México
| | - Fabiola Tafoya-Ramos
- Secretaría de Salud, Servicios de Atención Psiquiátrica, Dirección de Gestión de Servicios. Ciudad de México, México
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Abstract
This article discusses the human rights of residents in care homes in England who were affected by restrictions that were imposed during the first months of the COVID-19 pandemic in order to safeguard health and life at a time of public health emergency. It focuses on the potentially adversarial relationship between the need to protect the health of these residents and the possible adverse interferences with their human rights in the initial phase of the pandemic. The scope and application of these rights to the healthcare context is not straightforward due to the exigencies of the pandemic. Consideration is given to whether their rights, as protected by the European Convention on Human Rights (ECHR) and the United Nations Convention on the Rights of Persons with Disabilities (CRPD) are vindicated or breached by the actions taken in the context of the COVID-19 pandemic. The article questions whether the restrictions that were applied were justified, given the limitations that exist within some ECHR Articles. It deliberates upon what can be done to ensure that relevant bodies and care homes, themselves, are better enabled to respond to a public health emergency in an individualistic, rights-based manner, based upon both principlism and pragmatism.
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28
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Knoedler L, Oezdemir B, Moog P, Prantl L, Broer PN, Knoedler C, Rieger UM, Perl M, von Isenburg S, Gassner UM, Obed D, Haug V, Panayi AC, Knoedler S. Thinking like a Lawyer- Human Rights and Their Association with the Plastic Surgeon of Today. Aesthetic Plast Surg 2023; 47:490-497. [PMID: 35922668 PMCID: PMC9944724 DOI: 10.1007/s00266-022-02990-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/11/2022] [Indexed: 11/24/2022]
Abstract
Plastic surgeons are trained to perform a wide repertoire of surgeries-ranging from standard local procedures to highly specialized operations. Therefore, plastic surgeons treat a plethora of clinical presentations and address multiple patient needs. Their daily workflow is increasingly entwined with legal topics. The concrete legal interpretation falls within the remit of legal experts. However, by understanding the legal basics of selected surgical procedures, plastic surgeons may generate synergies in patient care and clinical practice. The legal situation is to be elucidated based on the German Basic Law (GBL) and the European Convention on Human Rights (ECHR). LEVEL OF EVIDENCE V: "This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ."
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Affiliation(s)
- Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Berkin Oezdemir
- Faculty of Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Philipp Moog
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - P Niclas Broer
- Department of Plastic, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
| | - Christoph Knoedler
- Faculty of Applied Social and Health Sciences, Regensburg University of Applied Sciences, Regensburg, Germany
| | - Ulrich M Rieger
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Academic Teaching Hospital of the J.W. Goethe University, Frankfurt am Main, Germany
| | - Markus Perl
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | | | | | - Doha Obed
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
- Department of Surgery, Division of Plastic Surgery, Brigham and Womens Hospital, Harvard Medical School, Boston, USA
| | - Valentin Haug
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
- Department of Surgery, Division of Plastic Surgery, Brigham and Womens Hospital, Harvard Medical School, Boston, USA
| | - Adriana C Panayi
- Department of Surgery, Division of Plastic Surgery, Brigham and Womens Hospital, Harvard Medical School, Boston, USA
| | - Samuel Knoedler
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
- Department of Surgery, Division of Plastic Surgery, Brigham and Womens Hospital, Harvard Medical School, Boston, USA.
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29
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Barsky BA, Stein MA. The United Nations convention on the rights of persons with disabilities, neuroscience, and criminal legal capacity. J Law Biosci 2023; 10:lsad010. [PMID: 37214222 PMCID: PMC10198698 DOI: 10.1093/jlb/lsad010] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/18/2023] [Accepted: 04/22/2023] [Indexed: 05/24/2023]
Abstract
The United Nations Convention on the Rights of Persons with Disabilities requires states parties to 'recognize that persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life.' This mandate has sparked debate about the interpretation of legal capacity, including within the criminal context as applied to the retrogressively named 'insanity defense.' Yet, under-examined are two questions: First, what defenses should defendants with psychosocial disabilities be able to invoke during criminal prosecutions? Second, what kind of evidence is consistent with, on the one hand, determining a defendant's decision-making capacity to establish culpability and, on the other hand, the right to equal recognition before the law? Developments in neuroscience offer a unique prism to grapple with these issues. We argue that neuroscientific evidence of impaired decision-making, insofar as it presents valid and interpretable diagnostic information, can be a useful tool for influencing judicial decision-making and outcomes in criminal court. In doing so, we oppose the argument espoused by significant members of the global disability rights community that bioscientific evidence of psychosocial disability should be inadmissible to negate criminal responsibility. Such a position risks more defendants being punished harshly, sentenced to death, and placed in solitary confinement.
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Borges LC, Zeferino de Menezes H, Crosbie E. More Pain, More Gain! The Delivery of COVID-19 Vaccines and the Pharmaceutical Industry's Role in Widening the Access Gap. Int J Health Policy Manag 2022; 11:3101-3113. [PMID: 36028975 PMCID: PMC10105197 DOI: 10.34172/ijhpm.2022.6942] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 08/01/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND An effective response to the coronavirus disease 2019 (COVID-19) pandemic entails a comprehensive strategy that ensures equitable access to all COVID-19-fighting technologies. To achieve this goal, the international community has acknowledged immunization as a public good. However, a trend of grossly unequal dose distribution emerged, owing, among other factors, to pharmaceutical companies' profit-driven actions, jeopardizing the mechanisms built to increase vaccine access. The contradiction between public health interests and corporate discretion in determining vaccine dose distribution poses critical concerns about the health risks associated with lengthening the duration of the pandemic and the eventual liability of companies for violations of human rights. METHODS To evaluate the risks posed to the COVID-19 immunization program, data on vaccine allocation and delivery, vaccine dose application, immunized populations, and the volume of Advanced Purchase Agreements (APAs) between countries and pharmaceutical companies were compiled and assessed. A descriptive analysis was then conducted to analyze the role of pharmaceutical companies in providing equitable access to COVID-19 vaccines. RESULTS When the data is broken down by income (as of June 2021), it shows that high-income countries (HICs) have already crossed the COVID-19 Vaccine Global Access (COVAX) 20% immunization threshold. However, countries of all other income levels have yet to achieve this mark for fully vaccinated people. Upper-middle-income countries (UMICs) have approximately 3%, low- and middle-income countries (LMICs) have approximately 2% and low-income countries (LICs) have less than 0.1% of fully vaccinated people per hundred. The supply shortage is expected to last until the second half of 2021. CONCLUSION As a result of the COVAX failure, a health gap emerged with countries living in a pre-immunization period for an extended time. The existing conflict between the international response to tackle COVID-19 and corporate profit-driven behavior contributed to prolonging pandemic, especially in Africa. Accordingly, there is a need to approve an international treaty that targets the activities of all actors, including the pharmaceutical companies, in protecting human rights and the right to health realms.
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Affiliation(s)
| | | | - Eric Crosbie
- School of Public Health, University of Nevada Reno, Reno, NV, USA
- Ozmen Institute for Global Studies, University of Nevada Reno, Reno, NV, USA
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31
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Mussell R, Harrison CA, Sheather JC, Brannan S, English V. Ethics briefing. J Med Ethics 2022; 48:1083-1084. [PMID: 36442974 DOI: 10.1136/jme-2022-108714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Abstract
Social inequalities and human rights are inevitably linked to children's and adolescents' healthy development. Children who experience structural and interpersonal inequalities in access to resources and opportunities based on their gender, race, ethnicity, or other group categories are denied the right to fair treatment. We assert that investigating the psychological perspectives that children hold regarding inequalities and human rights is necessary for creating fair and just societies. We take a constructivist approach to this topic which seeks to understand how individuals interpret and evaluate observed and experienced inequalities. Even young children think about these issues. Yet, throughout development, individuals must often weigh multiple, potentially conflicting considerations when interpreting, evaluating, and responding to social inequalities and rights violations. In these complex contexts, children and adolescents are neither fully "moral" nor fully "prejudiced." Rather, critical questions for research in this area concern when, why, and for whom young people reject inequalities and support rights, and, by contrast, when, why, and for whom they accept that inequalities and rights violations should be allowed to persist. This paper provides a brief overview of how different conceptions of social inequalities and rights are intrinsically linked together.
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Buse K, Mialon M, Jones A. Thinking Politically About UN Political Declarations: A Recipe for Healthier Commitments-Free of Commercial Interests Comment on "Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases". Int J Health Policy Manag 2022; 11:1208-1211. [PMID: 34634885 PMCID: PMC9808168 DOI: 10.34172/ijhpm.2021.92] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/20/2021] [Indexed: 01/12/2023] Open
Abstract
As evidence mounts that corporate actor engagement in United Nations (UN) policy-making processes leads to weaker and shallower public health commitments, greater attention is being paid to how to minimise undue interference and manage conflicts of interest (CoI). While we welcome efforts to develop normative guidance on managing such conflicts, we argue that there is the need to go further. In particular, we propose that an index be developed that would assess the health impacts of individual corporate actors, and those actors who fail to achieve a set benchmark would not have engagement privileges. We further propose the establishment of an independent panel of experts to advise on corporate actor engagement as well as on ambiguous and potentially health-harming commitments in text under negotiation in the UN. Recognising that the implementation of such measures will be contested, we recommend a number of practical steps to make their implementation more politically palatable.
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Affiliation(s)
- Kent Buse
- Healthier Societies Program, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Mélissa Mialon
- Trinity Business School, Trinity College Dublin, Dublin, Ireland
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Moats NA. Did U.S. Governments Violate Individual Human Rights? A Thomistic Response to COVID-19 Government Mandates. New Blackfriars 2022; 103:NBFR12754. [PMID: 35942254 PMCID: PMC9347823 DOI: 10.1111/nbfr.12754] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 04/04/2022] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
In response to the COVID-19 pandemic, some Americans have claimed that U.S. governments have superseded their jurisdiction and violated individuals' human rights in the use of government mandates. Many citizens and politicians have also claimed that governments are utilizing the pandemic as a smoke screen to take individual rights away from citizens to gain further power. In light of such claims, I provide a Thomistic response to argue that state and local political authorities' use of public health mandates were other-regarding in seeking to protect the common good in an unprecedented health crisis. Further, I argue that the characterization of individual rights atomized from community has led to an improper understanding of political authorities, individual rights, and our duties to our communities. Rejecting the reductive, skeptical, individualistic, and atomistic views that many Americans have engendered, I provide a Thomistic political orientation that more adequately helps us think about political authorities' and citizens' responsibilities within our political communities.
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35
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Davies M, Brannan S, English V, Harrison CA, Reidinger C, Sheather JC. Ethics briefing. J Med Ethics 2022; 48:427-428. [PMID: 35606011 DOI: 10.1136/medethics-2022-108354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Martin Davies
- Medical Ethics and Human Rights, British Medical Association, London, UK
| | - Sophie Brannan
- Medical Ethics and Human Rights, British Medical Association, London, UK
| | - Veronica English
- Medical Ethics and Human Rights, British Medical Association, London, UK
| | | | - Carrie Reidinger
- Medical Ethics and Human Rights, British Medical Association, London, UK
| | - Julian C Sheather
- Medical Ethics and Human Rights, British Medical Association, London, UK
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Hemachandra D, Riordan D, Sabir A, Keightley P. Criminal and financial penalties for clinicians in the ACT Mental Health Act weigh more heavily on senior doctors. Australas Psychiatry 2022; 30:179-184. [PMID: 34192472 DOI: 10.1177/10398562211025015] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We sought to assess the attitudes of ACT public psychiatry doctors towards the financial and criminal penalties in the ACT Mental Health Act 2015. METHOD Baseline attitude was surveyed with an 11-item 5-point Likert scale. Education was then provided about the offences outlined in the Act and the associated penalties. The same initial survey was then repeated. Primary outcomes were changes in attitude pre- and post- information, and secondarily data was explored for differences related to gender and seniority. RESULTS Forty-nine percent of 89 eligible public mental health system doctors responded. The majority of the survey respondents were female (59%). Provision of information resulted in a significant improvement in understanding of liabilities (2.80 (SD 1.14) versus 3.58 (SD 0.93), t(39) = 4.06, p < 0.001). Gender had no significant impact on scores. Senior staff were less legally secure and less satisfied with the Mental Health Act pre-information being provided. With regards to notification penalties, with education, junior staff became more secure and seniors less so. CONCLUSIONS Information provision improves understanding of the penalties under the Mental Health Act 2015. Having a senior role predicts lower satisfaction with the penalties in the Act.
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Affiliation(s)
| | - Denise Riordan
- Senior Staff Specialist Psychiatrist, Acting Director of Clinical Services, Clinical Director of the Child and Adolescent Mental Health Service, Canberra Health Services, ACT, Australia.,Honorary Senior Lecturer, Australian National University Australia
| | - Azra Sabir
- Staff Specialist Psychiatrist, Deputy Clinical Director Adult Community Mental Health Services, Canberra Health Services, ACT, Australia
| | - Philip Keightley
- Senior Staff Specialist Psychiatrist, Director of Psychiatry Training, Canberra Health Services, ACT, Australia.,Clinical Lecturer, Australian National University Medical School, Garran, ACT, Australia
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Abstract
This article focuses on the implications of the IMF's surcharges policies, jointly with its de facto preferred creditor status, on the right to sustainable development of sovereign borrowers. The article argues that, while surcharges are not effective in limiting access to IMF credit, they inequitably distribute the IMF's operating costs, are disproportionate, pro-cyclical, very costly for developing countries, and non-transparent. Furthermore, if surcharges are theoretically a way to protect the IMF from potential risks of default, the article questions the IMF's de facto preferred creditor status, as it precisely denies the possibility of granting debt relief in case of insolvency, ultimately affecting the right to development of -mainly- middle-income borrowing countries.
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38
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Aneja K, Ginsbach K, Gottschalk K, Halabi S, Nardi F. COVID-19 Law Lab: Building Strong Legal Evidence. J Law Med Ethics 2022; 50:385-389. [PMID: 35894579 DOI: 10.1017/jme.2022.67] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The COVID-19 Law Lab platform enables quantitative representation of epidemic law and policies in a given country for multiple years, enabling governments and researchers to compare countries, and learn about the impacts and drivers of policy choices. The Law Lab initiative is designed to address the urgent need for quality legal information to support the study of how law and policy can be used to effectively manage this, and future, pandemic(s).
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Affiliation(s)
- Kashish Aneja
- O'NEIL INSTITUTE FOR NATIONAL AND GLOBAL HEALTH LAW, GEORGETOWN UNIVERSITY, WASHINGTON, DC, USA
- SUPREME COURT OF INDIA, NEW DELHI, INDIA
| | - Katherine Ginsbach
- O'NEIL INSTITUTE FOR NATIONAL AND GLOBAL HEALTH LAW, GEORGETOWN UNIVERSITY, WASHINGTON, DC, USA
| | - Katie Gottschalk
- O'NEIL INSTITUTE FOR NATIONAL AND GLOBAL HEALTH LAW, GEORGETOWN UNIVERSITY, WASHINGTON, DC, USA
| | - Sam Halabi
- O'NEIL INSTITUTE FOR NATIONAL AND GLOBAL HEALTH LAW, GEORGETOWN UNIVERSITY, WASHINGTON, DC, USA
- COLORODO SCHOOL OF PUBLIC HEALTH, COLORADO STATE UNIVERSITY, AURORA, COLORADO, USA
| | - Francesca Nardi
- O'NEIL INSTITUTE FOR NATIONAL AND GLOBAL HEALTH LAW, GEORGETOWN UNIVERSITY, WASHINGTON, DC, USA
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39
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O'Connor AM, Seunik M, Radi B, Matthyse L, Gable L, Huffstetler HE, Meier BM. Transcending the Gender Binary under International Law: Advancing Health-Related Human Rights for Trans* Populations. J Law Med Ethics 2022; 50:409-424. [PMID: 36398651 PMCID: PMC9679587 DOI: 10.1017/jme.2022.84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Despite a recent wave in global recognition of the rights of transgender and gender-diverse populations, referred to in this text by the umbrella label of trans*, international law continues to presume a cisgender binary definition of gender - dismissing the lived realities of trans* individuals throughout the world. This gap in international legal recognition and protection has fundamental implications for health, where trans* persons have been and continue to be subjected to widespread discrimination in health care, longstanding neglect of health needs, and significant violations of bodily autonomy.
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Affiliation(s)
| | | | - Blas Radi
- UNIVERSITY OF BUENOS AIRES, BUENOS AIRES, ARGENTINA
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40
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Hobson C, Papadopoulou N. Regulating Risk and Autonomy in Assisted Suicide: Conway V Secretary of State for Justice. Med Law Rev 2021; 29:128-142. [PMID: 33914070 DOI: 10.1093/medlaw/fwaa016] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Noel Conway appealed against the dismissal of his claim in the High Court, that section 2(1) Suicide Act 1961 is incompatible with his Article 8(1) ECHR right to respect for private and family life. Mr Conway's appeal concerned three main issues: first, the correct way the court should respond to Parliament's decision not to amend section 2(1) Suicide Act; secondly, the way the Divisional Court addressed Mr Conway's alternative scheme; and thirdly, the weight to be placed upon personal autonomy. The Court of Appeal held that Parliament is better placed for determining the purported legal rights relating to assisted suicide. The court also concludes that there is evidence for the potential of indirect coercion or undue influence if assisted suicide is permitted. The comment draws out the court's basic presumption in analysing the efficacy of Mr Conway's alternative scheme to protect the weak and vulnerable. The comment also argues the level of acceptable risk used by the court in assessing Mr Conway's scheme-a 100% success rate-is overly-cautious and inconsistent. Finally, the comment goes on to show that courts still have problems, in end-of-life cases, in understanding how ethical principles operate in determining true propositions of law.
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Affiliation(s)
- Clark Hobson
- Lecturer, School of Law, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - Nataly Papadopoulou
- Lecturer, School of Law, Queen Mary University of London, Mile End Road, London, E1 4NS, UK
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41
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Onocko-Campos R, Davidson L, Desviat M. Mental health and human rights: Challenges for health services and communities. Salud Colect 2021; 17:e3488. [PMID: 34105324 DOI: 10.18294/sc.2021.3488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/24/2021] [Indexed: 11/24/2022] Open
Abstract
The care of people with mental health problems requires health system and service reforms to build up proper mental health care. The challenges of the present moment continue to be immense. The viral pandemic that we are experiencing has exposed the fragility of our health and social services and certified the inequality and precariousness of the living conditions of many people. The collection of articles published in the journal Salud Colectiva as part of the open call for papers "Mental health and human rights: challenges for health services and communities," includes articles from Spain, Brazil, Mexico, and Chile. These papers present conceptual experiences and reflections on community action plans and programs, contributing toward better knowledge and development of mental health in the region.
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42
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Nocete Navarro L, López de Loma Osorio V, Bravo Ortiz MF, Fernández Liria A. [Mental health and human rights: The experience of professionals in training with the use of mechanical restraints in Madrid, Spain]. Salud Colect 2021; 17:e3045. [PMID: 33822542 DOI: 10.18294/sc.2021.3045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/28/2020] [Indexed: 11/24/2022] Open
Abstract
Mechanical restraint is a coercive procedure in psychiatry, which despite being permitted in Spain, raises significant ethical conflicts. Several studies argue that non-clinical factors - such as professionals' experiences and contextual influences - may play a more important role than clinical factors (diagnosis or symptoms) in determining how these measures are employed. The aim of this study is to understand how the experiences of mental health professionals in training relate to the use of mechanical restraints in Madrid's mental health network. Qualitative phenomenological research was conducted through focus groups in 2017. Interviews were transcribed for discussion and thematic analysis with Atlas.ti. Descriptive results suggest that these measures generate emotional distress and conflict with their role as caregivers. Our findings shed light on different factors related to their experiences and contexts that are important in understanding the use of mechanical restraint, as well as the contradictions of care in clinical practice.
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43
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Llort Suárez A, Clua-García R. [Public policies for people who use drugs: Strategies for the elimination of stigma and the promotion of human rights]. Salud Colect 2021; 17:e3041. [PMID: 33822543 DOI: 10.18294/sc.2021.3041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/24/2020] [Indexed: 11/24/2022] Open
Abstract
This paper aims to provide theoretically informed practical proposals for the improvement of current drug policies, which are based on a biological model of disease and the criminalization of people who use drugs. First, we present alternatives to a biologically-oriented scientific conception centered around neuroscientific postulates, which support the idea that the etiology of addiction materializes in the brain, in favor of models based on the social sciences where context plays a relevant role in the description and management approaches regarding different uses of psychoactive substances. Second, epistemological models and proposals are offered from a practical perspective to sustain or implement policies and programs in accordance with a more sustainable approach based on the elimination of stigma and the promotion of political participation of people who use drugs. In short, drug policies based on human rights.
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44
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Porsdam Mann S, Treit PV, Geyer PE, Omenn GS, Mann M. Ethical principles, opportunities and constraints in clinical proteomics. Mol Cell Proteomics 2021:mcp.RA120.002435. [PMID: 33397710 DOI: 10.1074/mcp.ra120.002435] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 11/06/2022] Open
Abstract
Recent advances in MS-based proteomics have vastly increased the quality and scope of biological information that can be derived from human samples. These advances have rendered current workflows increasingly applicable in biomedical and clinical contexts. As proteomics is poised to take an important role in the clinic, associated ethical responsibilities increase in tandem with the impact on the health, privacy, and well-being of individuals. Here we conducted and report a systematic literature review of ethical issues in clinical proteomics. We add our perspectives from a background of bioethics, the results of our accompanying paper extracting individual-sensitive results from patient samples, and the literature addressing similar issues in genomics. The spectrum of potential issues ranges from patient re-identification to incidental findings of clinical significance. The latter can be divided into actionable and unactionable findings. Some of these have the potential to be employed in discriminatory or privacy-infringing ways. However, incidental findings may also have great positive potential. A plasma proteome profile, for instance, could inform on the general health or disease status of an individual regardless of the narrow diagnostic question that prompted it. We suggest that early discussion of ethical issues in clinical proteomics is important to ensure that eventual regulations reflect the considered judgment of the community as well as to anticipate opportunities and problems that may arise as the technology matures further.
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Affiliation(s)
| | | | - Philipp Emanuel Geyer
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Germany
| | - Gilbert S Omenn
- Center for Computational Med. & Bioinformatic, University of Michigan, United States
| | - Matthias Mann
- Dept. Proteomics and Signal Transduction, Max-Planck Institute of Biochemistry, Germany
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45
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Cohen IG, Giannini T, Adashi EY. Pharmaceutical Companies, Human Rights, and the Alien Tort Statute. J Law Med Ethics 2021; 49:500-502. [PMID: 34665093 DOI: 10.1017/jme.2021.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
On January 3, 2019, U.S. District Judge Theodore D. Chuang of the U.S. District Court of the District of Maryland took a crucial first step in redressing one of the worst human subjects research ethics violations in U.S. history.
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46
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de Mesquita JB, Kapilashrami A, Meier BM. Strengthening Human Rights in Global Health Law: Lessons from the COVID-19 Response. J Law Med Ethics 2021; 49:328-331. [PMID: 34924043 DOI: 10.1017/jme.2021.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
While human rights law has evolved to provide guidance to governments in realizing human rights in public health emergencies, the COVID-19 pandemic has challenged the foundations of human rights in global health governance. Public health responses to the pandemic have undermined international human rights obligations to realize (1) the rights to health and life, (2) human rights that underlie public health, and (3) international assistance and cooperation. As governments prepare for revisions of global health law, new opportunities are presented to harmonize global health law and human rights law, strengthening rights-based governance to respond to future threats.
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47
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Chopra S, Pradhan A, Dixon E, Radnofsky ML, Ganesh K, Lazar A. Designing for and with People with Dementia using a Human Rights-Based Approach. Ext Abstr Hum Factors Computing Syst 2021; 44:1-8. [PMID: 34423336 PMCID: PMC8375512] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
User-centered design is typically framed around meeting the preferences and needs of populations involved in the design process. However, when designing technology for people with disabilities, in particular dementia, there is also a moral imperative to ensure that human rights of this segment of the population are consciously integrated into the process and respectfully included in the product. We introduce a human rights-based user-centered design process which is informed by the United Nations Convention on the Rights of Persons with Disabilities (CRPD). We conducted two editions of a three-day-long design workshop during which undergraduate students and dementia advocates came together to design technology for people with dementia. This case study demonstrates our novel approach to user-centered design that centers human rights through different stages of the workshop and actively involves people with dementia in the design process.
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Affiliation(s)
- Shaan Chopra
- College of Information Studies, University of Maryland, College Park, MD, U.S
| | - Alisha Pradhan
- College of Information Studies, University of Maryland, College Park, MD, U.S
| | - Emma Dixon
- College of Information Studies, University of Maryland, College Park, MD, U.S
| | - Mary L. Radnofsky
- Advocate for the Human Rights of People with Dementia, Alexandria, VA, U.S
| | - Kausalya Ganesh
- College of Information Studies, University of Maryland, College Park, MD, U.S
| | - Amanda Lazar
- College of Information Studies, University of Maryland, College Park, MD, U.S
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48
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Carreño A, Blukacz A, Cabieses B, Jazanovich D. ["No one seems ready to hear what I've seen:" Mental health care for refugees and asylum seekers in Chile]. Salud Colect 2020; 16:e3035. [PMID: 33374087 DOI: 10.18294/sc.2020.3035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/24/2020] [Indexed: 11/24/2022] Open
Abstract
This article analyzes the results of a descriptive, qualitative study carried out in 2018 on the mental healthcare needs of Latin American refugees and asylum seekers in Chile, through the perspectives of refugees and asylum applicants (n=8), healthcare professionals responsible for delivery of care (n=4), and members of civil society organisations involved in this area (n=2). Our findings indicate that despite Chile's commitment to international treaties in this regard, little has been achieved in safeguarding the right to access to mental health care, understood as part of the universal right to health care access. This article documents barriers to mental health care access for migrants applying for asylum and refugee status. Post-migration stress factors may also increase the risk of emotional disorders within this group of people. Mental healthcare providers and teams are often not equipped with the tools to deal with the psychological consequences arising from the situations of violence and persecution associated with forced migration. Our study discusses the need to strengthen the link between mental health care - as a fundamental human right - and the right to international protection.
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49
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Bernard R, Bowsher G, Sullivan R. COVID-19 and the Rise of Participatory SIGINT: An Examination of the Rise in Government Surveillance Through Mobile Applications. Am J Public Health 2020; 110:1780-1785. [PMID: 33058704 DOI: 10.2105/ajph.2020.305912] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The COVID-19 pandemic has triggered a significant growth in government surveillance techniques globally, primarily through the use of cell phone applications. However, although these applications can have actionable effects on public health efforts to control pandemics, the participatory or voluntary nature of these measures is obscuring the relationship between health information and traditional government surveillance techniques, potentially preventing effective oversight. Public health measures have traditionally been resistant to the integration of government-led intelligence techniques, such as signals intelligence (SIGINT), because of ethical and legal issues arising from the nature of surveillance techniques.We explore this rise of participatory SIGINT and its nature as an extension of biosurveillance through 3 drivers: the rise of surveillance capitalism, the exploitation of a public health crisis to obscure state of exception politics with a moral imperative, and the historically enduring nature of emergency-implemented surveillance measures.We conclude that although mobile applications may indeed be useful in containing pandemics, they should be subject to similar oversight and regulation as other government intelligence collection techniques.
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Affiliation(s)
- Rose Bernard
- All authors are with the Conflict and Health Research Group, Kings College London, London, UK
| | - Gemma Bowsher
- All authors are with the Conflict and Health Research Group, Kings College London, London, UK
| | - Richard Sullivan
- All authors are with the Conflict and Health Research Group, Kings College London, London, UK
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50
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Abstract
With 1 in 3 women affected, accounting for one billion women worldwide, Violence Against Women (VAW) constitutes one of the widest reaching human rights violations globally. Although the forms they take may vary, these abuses are not confined to a single social class, geographic region, or culture. Existing studies have yet to describe the full burden of abuse that asylum-seeking women endure throughout their lifetimes. We describe a novel coding tool that classifies types of abuse, identifies abuse perpetrators, and estimates how long and how often each abuse was experienced. The authors used this tool to describe and categorize the abuses endured by 85 cisgender, adult women seeking asylum in the United States who presented to the Weill Cornell Center for Human Rights for forensic medical evaluations from 2013 to 2017. We reviewed a total of 180 legal and forensic medical affidavits that were written in support of the applicants' asylum claims. Using the coding tool, we identified each abuse, classified every perpetrator, and, whenever possible, estimated how long and how frequently each abuse was endured. Interpretations of the raw data contained in this article and a discussion of their significance can be found in our associated publication: "Gender-Based Violence experienced by Women Seeking Asylum in the United State: A Lifetime of Multiple Traumas Inflicted by Multiple Perpetrators" [1]. The coding instrument described herein characterizes VAW by classifying the narrative data that are included in interviews, focus groups, medical records, and the like. Our coding instrument is the first of its kind to describe all types and severities of violence endured by women, classify the perpetrators of that violence, and delineate the timeline of violence over each individual's life. We hope that this holistic approach to classifying and describing VAW will enable other research groups to examine untested or unrealized associations between victims, perpetrators, and abuses. Ultimately, obtaining more complete data will empower us to advocate more effectively and to design more comprehensive care for victims of VAW.
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Affiliation(s)
| | - Andrew R. Milewski
- Weill Cornell Center for Human Rights, Weill Cornell Medicine, OB/GYN, 1300 York Ave, New York 10065, NY, United States
| | - Joseph Shin
- Division of General Internal Medicine at Weill Cornell Medicine, New York, NY, USA
| | - Deborah Ottenheimer
- Weill Cornell Center for Human Rights, Weill Cornell Medicine, OB/GYN, 1300 York Ave, New York 10065, NY, United States
- The Nest Community Health Center, Harlem United/Upper Room Aids Ministry, United States
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