Beyond Trade-Offs: Autonomy, Effectiveness, Fairness, and Normativity in Risk and Crisis Communication

This paper addresses the critiques based on trade-offs and normativity presented in response to our target article proposing the Public Health Emergency Risk and Crisis Communication (PHERCC) framework. These critiques highlight the ethical dilemmas in crisis communication, particularly the balance between promoting public autonomy through transparent information and the potential stigmatization of specific population groups, as illustrated by the discussion of the mpox outbreak among men who have sex with men. This critique underscores the inherent tension between communication effectiveness and autonomy versus fairness and equity. In response, our paper reiterates the adaptability of the PHERCC framework, emphasizing its capacity to tailor messages to diverse audiences, thereby reducing potential stigmatization and misinformation. Through community engagement and feedback integration, the PHERCC framework aims to optimize the effectiveness of communication strategies while addressing ethical concerns. Furthermore, by involving affected communities in the communication strategy from the onset, the framework seeks to minimize ethical trade-offs and enhance the acceptance and effectiveness of public health messages.

The PHERCC Matrix. An Ethical Framework for Planning, Governing, and Evaluating Risk and Crisis Communication in the Context of Public Health Emergencies

Risk and crisis communication (RCC) is a current ethical issue subject to controversy, mainly due to the tension between individual liberty (a core component of fairness) and effectiveness. In this paper we propose a consistent definition of the RCC process in public health emergencies (PHERCC), which comprises six key elements: evidence, initiator, channel, publics, message, and feedback. Based on these elements and on a detailed analysis of their role in PHERCC, we present an ethical framework to help design, govern and evaluate PHERCC strategies. The framework aims to facilitate RCC, incorporating effectiveness, autonomy, and fairness. It comprises five operational ethical principles: openness, transparency, inclusivity, understandability, and privacy. The resulting matrix helps understanding the interplay between the PHERCC process and the principles of the framework. The paper includes suggestions and recommendations for the implementation of the PHERCC matrix.

The Ethics of Population Policy for the Two Worlds of Population Conditions

Population policy has taken two divergent trajectories. In the developing part of the world, controlling population growth has been a major tune of the debate more than a half-century ago. In the more developed part of the world, an inverse pattern results in the discussion over the facilitation of population growth. The ethical debates on population policy have primarily focused on the former and ignored the latter. This paper proposes a more comprehensive account that justifies states' population policy interventions. We first consider the reasons that support pro-natalist policies to enhance fertility rates and argue that these policies are ethically problematic. We then establish an ethics of population policy grounded on account of self-sustaining the body politic, which consists of four criteria: survival, replacement, accountability, and solidarity. We discuss the implications of this account regarding birth-control and pro-natalist policies, as well as non-procreative policies such as immigration, adoption, and unintended baby-saving strategies.

Social Distance Warriors Should Not Be Regarded as Moral Exemplars in a Pandemic Nor as Paragons of Politeness: A Response to Shaw

In a recent article, Shaw contrasts his own supposed good behaviour, as that of a self-proclaimed "social distance warrior" with the alleged rude behaviour of one of his relatives, Jack, at social events in the former's house in Scotland in the early stages of the COVID-19 pandemic. He does so to illustrate and support his claims that it was wrong and rude to fail to comply with the governmental advice regarding social distancing because we had a responsibility "to minimize risk" and not wrong nor rude to challenge and cajole those people who failed to do so. This article shows that his claims are contestable. It suggests that his own behaviour was no better than Jack's.

Ethics and non-evidence based therapies: Portuguese perspective in a global setting

A contemporary serious lack of scientific knowledge by the general public and many decision-makers is now quite perceptible, both globally and in Portugal. Living in a science-driven technological world filled with scientific illiteracy is dangerous and a path toward disaster. Recent years brought a fairly strong global movement promoting the so-called "alternative therapy" that also affected Portugal. I propose an evidence-based ethics reflection and argumentation, both encompassing the global and the specific Portuguese reality. I debate the specific arguments used in favour of alternative therapies, demonstrating the inherent fallacies of thought, deliberate manipulation of words and concepts, and the dire consequences for global and local health politics by following this line of biased reasoning.

A Scalar Approach to Vaccination Ethics

Should people get vaccinated for the sake of others? What could ground-and limit-the normative claim that people ought to do so? In this paper, we propose a reasons-based consequentialist account of vaccination for the benefit of others. We outline eight harm-based and probabilistic factors that, we argue, give people moral reasons to get vaccinated. Instead of understanding other-directed vaccination in terms of binary moral duties (i.e., where people either have or do not have a moral duty to get vaccinated), we develop a scalar approach according to which people can have stronger or weaker moral reasons to get vaccinated in view of the moral good of vaccination. One advantage of our approach is that it can capture why a person might have strong moral reasons to get vaccinated with Vaccine A, but only weak moral reasons to get vaccinated with Vaccine B. We discuss theoretical strengths of our approach and provide a case study of vaccination against COVID-19 to demonstrate its practical significance.

[Changes in the routine work and moral distress in psychiatric care during the COVID-19 pandemic : A survey among physicians active in inpatient care in Germany]

BACKGROUND

During the COVID-19 pandemic a number of ethical challenges have arisen in the healthcare system. A psychological response to moral challenges is termed moral distress (MD).

OBJECTIVE

Identification of causes of MD in inpatient psychiatric care in the context of the COVID-19 pandemic in Germany.

MATERIAL AND METHODS

A survey was conducted using a self-administered non-validated online questionnaire as part of a cross-sectional study, in which 26 items about the experience of MD were examined and open questions about the handling of the pandemic and its effects on everyday work were posed. Physicians who worked in inpatient psychiatric care during the COVID-19 pandemic in Germany were surveyed anonymously with a convenience sample. The data acquisition took place between 17 November 2020 and 6 May 2021.

RESULTS

A total of 141 participants were included. They indicated multiple pandemic-related changes in their daily work partly resulting in MD.

CONCLUSION

MD is a neglected potential burden of inpatient psychiatric care under pandemic conditions (and beyond), which requires further research and an adequate handling. These results include implications for decision makers in crisis teams as well as a need for support services such as clinical ethics consultation services.

Ethical Preparedness for Health Policymaking and Implementation During Public Health Emergencies: The Role of Rapid Ethical Assessment

Scholars have called for ethical preparedness for public health practice and research to address the challenges of special ethical considerations under time and resource pressure during emergencies like the COVID-19 pandemic. We propose the idea of a rapid ethical assessment (REA) that aims to provide ethical justifications and policy recommendations for a specific public health policy, which is necessary for the ethical legitimacy of health policymaking and implementation. We suggest that an REA task force be established and incorporated into the administrative procedure to perform an REA in the early, middle, and terminal stages of a policy proposed by the health authority and to determine to what extent the tradeoffs between values and priorities required by the policy are ethically acceptable. The REA task force's role is consultative, with the final decisionmaking power and political responsibilities falling on the health authority. The REA task force should adopt 4 substantial ethical principles: utilitarianism, equity, human rights, and solidarity. The REA task force would consist of a multidisciplinary team of experts and a group of representatives from those who would be affected by the proposed policy. The REA task force would operate with a 5-step procedure of (1) convening, (2) investigation, (3) determination, (4) reporting and communication, and (5) decision and reassessment. We use 2 real incidents in Taiwan to demonstrate how the REA task force could work to enhance the ethical acceptance of a policy.

Mandatory COVID-19 vaccination for healthcare workers: The experience of chaplains evaluating religious accommodation requests from coworkers

Mandatory COVID-19 vaccination requirements for healthcare workers in the United States, instituted at the height of the pandemic to protect vulnerable patients and preserve the infrastructure of healthcare, nonetheless met with resistance by some members of the work force. As unprecedented numbers of employees sought religious accommodations, chaplain leaders were recruited by institutional leadership to adjudicate these requests, either alone or as part of a committee. This study reports results of a survey conducted from 6/1/2022 to 7/15/2022 with U.S. healthcare chaplains (n = 76) who were involved in the evaluation of coworker requests for religious exemption to the COVID-19 vaccine anytime during the pandemic until they accessed the survey. Chaplains were recruited online through national chaplaincy and ethics organizations. A mixed methods design facilitates integration of statistically significant associations with chaplains' in-depth reflections on their experience. Surveying the religious experts on the review committee affords a rare look into how the tension between the free exercise of religion in the workplace and the obligation to protect the public played out during the pandemic. The study further addresses a gap in research literature on the experience of chaplains during the pandemic and identifies unique features of moral injury experienced by a subset of healthcare providers. Chaplains largely perceived their involvement as promoting an ethical, informed process of review. Although all chaplains found this role stressful, high levels of meaning were protective against distress. Sources of distress identified included: ethical concern that granting exemptions would lead to the spread of the virus; inconsistencies in the review process; and, repeated exposure to coworkers' misunderstanding and political use of religious teachings. Featuring prominently in comments from chaplains was the difficulty navigating requests in the context of anti-science, anti-vaccine, and politically charged public discourse.

No Need for Parental Involvement in the Vaccination Choice of Adolescents

Parental decision making is necessary for contracting medical interventions that require personal risk-benefit evaluation, and for overseeing matters of education. In the nineteenth century, exemptions from obligatory vaccination were granted for religious and conscientious reasons. Then and today, religion and moral values play marginal roles in vaccine hesitancy and denialism. Rather, the key values invoked by vaccine hesitants and denialists are liberty and pluralism. Neither is compatible with limiting adolescents' choice. Because vaccination does not require assessment of personal medical risks, because it does not need to occur within the sphere of the doctor-patient relationship, and because the risk involved is within the range of their daily activities, adolescents have the right to free access to vaccination without legal requirement of parental involvement. Drawing on the development of Common Law, and on the development of respect for personal conscience in the history of ideas, this paper does not promote an argument that grants public health an overriding moral power. Rather, this paper rejects the presumption that vaccination of adolescents might involve a conflict between parental authority and public health. Free access to vaccination is compatible with the law and ethics of adolescents' evolving autonomy in relation to healthcare.

Balancing burdens of infection control: Norwegian district medical officers' ethical challenges during the COVID-19 pandemic

BACKGROUND

In several countries, district medical officers (DMOs) are public health experts with duties including infection control measures. The Norwegian DMOs have been key actors in the local handling of the COVID-19 pandemic.

METHODS

The aim of the study was to explore the ethical challenges experienced by Norwegian DMOs during the COVID-19 pandemic, and how the DMOs have handled these challenges. 15 in-depth individual research interviews were performed and analyzed with a manifest approach.

RESULTS

Norwegian DMOs have had to handle a large range of significant ethical problems during the COVID-19 pandemic. Often, a common denominator has been the need to balance burdens of the contagion control measures for different individuals and groups. In another large set of issues, the challenge was to achieve a balance between safety understood as effective contagion prevention on the one hand, and freedom, autonomy and quality of life for the same individuals on the other.

CONCLUSIONS

The DMOs have a central role in the municipality's handling of the pandemic, and they wield significant influence. Thus, there is a need for support in decision-making, both from national authorities and regulations, and from discussions with colleagues.

The Right to Protest During a Pandemic: Using Public Health Ethics to Bridge the Divide Between Public Health Goals and Human Rights

Public protest continued to represent a prominent form of social activism in democratic societies during the COVID-19 pandemic. In Australia, a lack of specific legislation articulating protest rights has meant that, in the context of pandemic restrictions, such events have been treated as illegal mass gatherings. Numerous large protests in major cities have, indeed, stirred significant public debate regarding rights of assembly during COVID-19 outbreaks. The ethics of infringing on protest rights continues to be controversial, with opinion divided as to whether public health goals or human rights should take precedence. This paper applies public health ethical theory to an in-depth analysis of arguments on both sides of the debate. Using the Nuffield Council on Bioethics framework as a backdrop, proportionality and necessity of restrictions are understood as key concepts that are common to both public health and human rights perspectives. The analysis presented here finds a middle-ground between the prevailing arguments on opposing sides and is further able to rationalize the use of protest itself as an important element of a mature public health ethics response to restrictive policy. Thus, this paper aims to influence public health policy and legislation regarding protest rights during public health emergencies.

The Ethical Significance of Post-Vaccination COVID-19 Transmission Dynamics

The potential for vaccines to prevent the spread of infectious diseases is crucial for vaccination policy and ethics. In this paper, I discuss recent evidence that the current COVID-19 vaccines have only a modest and short-lived effect on reducing SARS-CoV-2 transmission and argue that this has at least four important ethical implications. First, getting vaccinated against COVID-19 should be seen primarily as a self-protective choice for individuals. Second, moral condemnation of unvaccinated people for causing direct harm to others is unjustified. Third, the case for a harm-based moral obligation to get vaccinated against COVID-19 is weak. Finally, and perhaps most significantly, coercive COVID-19 vaccination policies (e.g., measures that exclude unvaccinated people from society) cannot be directly justified by the harm principle.

[Mobile health technologies, social justice and population-based vulnerabilities : A public health ethics perspective on mHealth using the example of type 2 diabetes mellitus]

Mobile health technologies (mHealth) promote the trend towards personal responsibility and self-management. By using the example of type 2 diabetes mellitus (T2DM), the article aims to deepen the discussion on mHealth, personal responsibility and justice-which has so far only been rudimentary-from a public health ethical perspective. It shows that in the field of T2DM, mHealth can on the one hand improve social health justice, but on the other hand can also exacerbate social health injustices. From a justice-focused, public health ethical perspective on T2DM mHealth, it is necessary to better understand whether and how vulnerable population groups are considered in mHealth development and implementation, how these groups experience the use of the technology, what social-epidemiological impacts the increasing use of mHealth can have, which health inequalities in the area of T2DM are unfair, to what extent personal responsibility should be placed in the hands of the users, and where the limits of personal responsibility lie. Considering social diversity and the social determinants of health is an ongoing process and must permeate all phases of mHealth development and implementation.

Ethics in infectious diseases: latent challenges. Part I

Infectious diseases socially imply individual and community medical problems. Therefore, they require actions aimed at social processes that affect the well-being of the individuals without losing sight of social groups. Faced with this panorama, we ask ourselves: is there a direct relationship between ethics and infectious diseases? To elucidate an answer, let us remember the peak period of the COVID-19 pandemic when guidelines based on ethical principles were issued to facilitate medical decisions on allocating scarce resources in periods of maximum demand. In those moments, since there was no inclusive component of society, the decisions made produced massive criticism. The reactions demonstrated the need to analyze in detail the criteria that had been considered correct. Consequently, we affirm that bioethical principles are transcendental in medical decisions and must be examined, not only for the individual but also with a view to public health. Moreover, the acquired immunodeficiency syndrome (AIDS) epidemic has lived with us for decades, and it continues to show its tragic face in the form of new cases, chronic illnesses, and deaths. Joint United Nations Programme on HIV/AIDS brings us closer to a complex reality where the fight against disease and global health are interrelated with other problems, such as the need to reduce inequality, for which human rights, gender equality, social protection, and the development of research projects, where the ethics committees in research in community processes are constituents.

Digital Covid Certificates as Immunity Passports: An Analysis of Their Main Ethical, Legal, and Social Issues

Digital COVID certificates are a novel public health policy to tackle the COVID-19 pandemic. These immunity certificates aim to incentivize vaccination and to deny international travel or access to essential spaces to those who are unable to prove that they are not infectious. In this article, we start by describing immunity certificates and highlighting their differences from vaccination certificates. Then, we focus on the ethical, legal, and social issues involved in their use, namely autonomy and consent, data protection, equity, and international mobility from a global fairness perspective. The main conclusion of our analysis is that digital COVID certificates are only acceptable if they meet certain conditions: that they should not process personal data beyond what is strictly necessary for the aimed goals, that equal access to them should be guaranteed, and that they should not restrict people's autonomy to access places where contagion is unlikely. We conclude that, if such conditions are guaranteed, digital COVID certificates could contribute to mitigating some of the most severe socioeconomic consequences of the pandemic.

Moralization and Mismoralization in Public Health

Moralization is a social-psychological process through which morally neutral issues take on moral significance. Often linked to health and disease, moralization may sometimes lead to good outcomes; yet moralization is often detrimental to individuals and to society as a whole. It is therefore important to be able to identify when moralization is inappropriate. In this paper, we offer a systematic normative approach to the evaluation of moralization. We introduce and develop the concept of 'mismoralization', which is when moralization is metaethically unjustified. In order to identify mismoralization, we argue that one must engage in metaethical analysis of moralization processes while paying close attention to the relevant facts. We briefly discuss one historical example (tuberculosis) and two contemporary cases related to COVID-19 (infection and vaccination status) that we contend to have been mismoralized in public health. We propose a remedy of de-moralization that begins by identifying mismoralization and that proceeds by neutralizing inapt moral content. De-moralization calls for epistemic and moral humility. It should lead us to pull away from our tendency to moralize-as individuals and as social groups-whenever and wherever moralization is unjustified.

Treating Workers as Essential Too: An Ethical Framework for Public Health Interventions to Prevent and Control COVID-19 Infections among Meat-processing Facility Workers and Their Communities in the United States

Meat is a multi-billion-dollar industry that relies on people performing risky physical work inside meat-processing facilities over long shifts in close proximity. These workers are socially disempowered, and many are members of groups beset by historic and ongoing structural discrimination. The combination of working conditions and worker characteristics facilitate the spread of SARS-CoV-2, the virus that causes COVID-19. Workers have been expected to put their health and lives at risk during the pandemic because of government and industry pressures to keep this "essential industry" producing. Numerous interventions can significantly reduce the risks to workers and their communities; however, the industry's implementation has been sporadic and inconsistent. With a focus on the U.S. context, this paper offers an ethical framework for infection prevention and control recommendations grounded in public health values of health and safety, interdependence and solidarity, and health equity and justice, with particular attention to considerations of reciprocity, equitable burden sharing, harm reduction, and health promotion. Meat-processing workers are owed an approach that protects their health relative to the risks of harms to them, their families, and their communities. Sacrifices from businesses benefitting financially from essential industry status are ethically warranted and should acknowledge the risks assumed by workers in the context of existing structural inequities.

The genetic technologies questionnaire: lay judgments about genetic technologies align with ethical theory, are coherent, and predict behaviour

Background

Policy regulations of ethically controversial genetic technologies should, on the one hand, be based on ethical principles. On the other hand, they should be socially acceptable to ensure implementation. In addition, they should align with ethical theory. Yet to date we lack a reliable and valid scale to measure the relevant ethical judgements in laypeople. We target this lacuna.

Methods

We developed a scale based on ethical principles to elicit lay judgments: the Genetic Technologies Questionnaire (GTQ). In two pilot studies and a pre-registered main study, we validated the scale in a representative sample of the US population.

Results

The final version of the scale contains 20 items but remains highly reliable even when reduced to five. It also predicts behaviour; for example, ethical judgments as measured by the GTQ predicted hypothetical donations and grocery shopping. In addition, the GTQ may be of interest to policymakers and ethicists because it reveals coherent and ethically justified judgments in laypeople. For instance, the GTQ indicates that ethical judgments are sensitive to possible benefits and harms (in line with utilitarian ethics), but also to ethical principles such as the value of consent-autonomy.

Conclusions

The GTQ can be recommended for research in both experimental psychology and applied ethics, as well as a tool for ethically and empirically informed policymaking.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12910-022-00792-x.

Vaccination in the 19th century in Italy and the role of the catholic church in public health: a historical overview

Using the case of the vaccine against smallpox as an example, this article explores how the attitude and the politics of the Vatican State towards vaccination changed between the 18th and 19th century. Despite some notable exceptions, the Catholic Church became progressively involved in supporting vaccination in Italy, exerting its temporal and spiritual authority to develop healthcare policies and to convince a population that still considered the vaccine as potentially harmful. The brief historical overview on vaccine and vaccination shows that during the XIX century the Catholic church and in particular, the political decision of the Pope, engaged temporal and spiritual power, high authority and persuasive influence to encourage the population, more than anyone the hesitant people, to get vaccine against smallpox. Although with the due differences determined by the path of time and by the scientific, educational and social advances of modern-day, this view from the past can provide us, with actual COVID pandemic, a reason of deep thinking and also how to face the present COVID-19 pandemic and to prepare for forcoming future. Actually, it shows us how the terrible smallpox epidemic was handled and finally overcome, thanks to vaccination.

Strategic planning, components and evolution in zoonotic diseases frameworks: one health approach and public health ethics

Zoonotic diseases are seen as a major public health concern. Routes of the rapid transmission of zoonotic diseases and the economic damage they cause to communities are all reasons why health institutions and systems need to pay more attention to these diseases. Strategic planning is one of the important tasks of policymakers in every organization and system. It is a very reliable and useful tool for leading all kinds of organizations, including health organizations. Countries with clear policy plans have succeeded in controlling and reducing zoonotic diseases. Such countries used appropriate strategic planning and pursued annual goals to control and prevent diseases. Three important steps (strategy development, strategy implementation and strategy evaluation) should be considered in developing a strategic planning for controlling and prevention of zoonotic diseases. Health systems need to develop strategic planning in order to upgrade their capabilities in combating zoonotic diseases. These programs must be flexible, in line with the one health approach, based on the current needs, and aligned with the new challenges faced with health systems. The strategic planning is directly related to national and international policies, organizational goals and missions, dynamism, degree of complexity, and organizational structure of each country's health system.

Contested solidarity and vulnerability in social media-based public responses to COVID-19 policies of mobility restrictions in Singapore: a qualitative analysis of temporal evolution

BACKGROUND

Mobility restriction is the most effective measure to control the spread of infectious disease at its early stage, especially if a cure and vaccine are not available. When control of the coronavirus disease 2019 (COVID-19) required strong precautionary measures, lockdowns were necessarily implemented in countries around the globe. Public health risk communication about the justification and scope of a lockdown was challenging as it involved a conflict between solidarity and individual liberty and a trade-off between various values across groups with different socioeconomic statuses. In the study, we examined public responses to the government-announced "circuit breaker" (a local term for lockdown) at four-time points in Singapore: (1) entry, (2) extension, (3) exit of lockdown 'phase 1' and (4) entry of lockdown 'phase 2'.

METHODS

We randomly collected 100 comments from the relevant articles on new organisations' Facebook and Instagram pages and conducted preliminary coding. Later, additional random 20 comments were collected to check the data saturation. Content analysis was focused on identifying themes that emerged from the responses across the four-time points.

RESULTS

At the entry, public support for the lockdown was prevalent; yet most responses were abstract with uncertainty. At six weeks of lockdown, initial public responses with uncertainty turned into salient narratives of their lived experiences and hardship with lockdown and unmasking of societal weaknesses caused by COVID-19. At the entry to phase 2, responses were centred on social-economic impact, disparity, and lockdown burnout with the contested notion of continuing solidarity. A temporal pattern was seen in the rationalisation of the lockdown experience from trust, anxiety, attribution of pandemic and lockdown, blaming of non-compliant behaviours, and confusion.

CONCLUSIONS

The findings indicated a temporal evolution of public responses from solidarity, attribution of the sustained pandemic, increasing ambiguity towards strong precautionary measures, concerns about economic hardship and mental well-being to worsened social vulnerability, where the government's restrictive policies were questioned with anxiety and confusion. Public health risk communication in response to COVID-19 should be transparent and address health equity and social justice to enhance individual and collective responsibility in protecting the public from the pandemic.

Risk, Responsibility, Rudeness, and Rules: The Loneliness of the Social Distance Warrior

We have a responsibility to obey COVID-19 rules, in order to minimize risk. Yet it is still seen as rude to challenge people who do not respect those rules, when in fact the opposite is true; it is rude to increase risk to others. In this paper I analyse the relationship between risk, responsibility, and rudeness by analysing the evolution of the main governmental slogans and rules and explore the complex relationship between simplicity, safety, and perceived fairness of these rules, and how these features in turn influence the extent to which we act responsibly. I begin by exploring the relationship between rudeness and risk in our interactions about coronavirus, before going on to analyse the importance of clear rules in minimizing tension between us, illustrating the argument with various slogans including "stay at home," "stay alert," and the now infamous "rule of six," which is actually at least three different rules. Ultimately, we are faced with a paradox: people annoyed about complex/unfair rules are less likely to obey them, even if that means rules will apply for longer and even though it was noncompliance with earlier simpler rules that means new rules are necessary. And if rules make less or no sense it is harder to try to get people to follow them in your own capacity as a citizen; it is hard to police rules that are seen as arbitrary or unfair.

Face mask uptake in the absence of mandates during the COVID-19 pandemic: a qualitative interview study with Swiss residents

Background

In the COVID-19 pandemic, Switzerland introduced broad nationwide face mask mandates only by October 2020, later than other Western European countries. This study aims to assess the underlying values and considerations of individuals to wear face masks in the absence of face mask mandates in the COVID-19 pandemic in German-speaking Switzerland.

Methods

As part of the “Solidarity in times of a pandemic” (SolPan) research commons, we interviewed 31 participants living in the German-speaking part of Switzerland in April 2020 and 25 of them again in October 2020. Qualitative inductive thematic analysis was applied for data analysis and interpretation. Public health ethics principles guided the interpretation and organization of findings.

Results

Five themes were identified: Trust and governmental policy; perceived benefits of mask-wearing; perceived risks of mask-wearing; social exclusion and prejudice; and decision-making in the absence of mandates. In light of increasing infection rates in October 2020, many participants started to consider the benefits higher than the risks and were willing to accept face mask mandates in that context, despite earlier reservations.

Conclusions

The absence of face mask mandates underline individual autonomy but may also suppress personal responsibility due to social influence. Face masks are only temporarily acceptable in liberal Western societies and face mask mandates should be enforced only when epidemiologically necessary.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12215-4.

Artificial Intelligence: the future of medicine, or an overhyped and dangerous idea?

INTRODUCTION

Contemporary discourse on Artificial Intelligence (AI) in medicine is oft-sensationalised to the point of bearing no resemblance to its everyday impact and potential - either to proselytise it as a saviour or to condemn its perilous, amoral and sprawling reach.This report aims to unravel the paucity of understanding underpinning this hyperbolic duality, whilst addressing the potential clearly defining its ethical use poses to the semi-public healthcare models in Ireland and Europe.

DISCUSSION

The report contrasts the challenge of regulating the breakneck development of AI, with healthcare's necessity for stringent quality control in ethical technological development to ensure patients' well-being.Physical, practical and philosophical approaches to Artificial Intelligence in medicine are explored through Beauchamp and Childress' principles of delivering care with beneficence, non maleficence, justice and autonomy. AI is scrutinised under Kantian deontological, Benthamite utilitarian and Rawlsian perspectives on health justice. Actor Network theory is used to explain sociotechnical interactions governing human stakeholders developing ethical AI.These analyses operate firstly to define AI concisely, then ground it in its contemporary and future functions in healthcare. They highlight the importance of aligning medical AI with accepted ethical standards as a necessity of its integrated use across healthcare.

CONCLUSION

This report concludes that balanced assessment of AI's role in healthcare requires improvement in three areas: improving clarity in definition of AI and its extant remit in medicine; aligning contemporary discourse on AI use with contemporary objective ethical, legal and system frameworks; and clearly identifying for dismissal a number of logical fallacies deliberately sensationalising AI's potential.

Lessons from Israel's COVID-19 Green Pass program

As of the beginning of March 2021, Israeli law requires the presentation of a Green Pass as a precondition for entering certain businesses and public spheres. Entitlement for a Green Pass is granted to Israelis who have been vaccinated with two doses of COVID-19 vaccine, who have recovered from COVID-19, or who are participating in a clinical trial for vaccine development in Israel. The Green Pass is essential for retaining immune individuals' freedom of movement and for promoting the public interest in reopening the economic, educational, and cultural spheres of activity. Nonetheless, and as the Green Pass imposes restrictions on the movement of individuals who had not been vaccinated or who had not recovered, it is not consonant with solidarity and trust building. Implementing the Green Pass provision while advancing its effectiveness on the one hand, and safeguarding equality, proportionality, and fairness on the other hand may imbue this measure with ethical legitimacy despite involving a potential breach of trust and solidarity.

Avoiding Cultural Imperialism in the Human Right to Health

As political instruments, human rights can be challenged in two important ways: first, by undermining the claim to universality by appealing to a kind of cultural relativism, and second, by accusing human rights of unjustifiably imposing values that are not genuinely universal (which I dub the problem of parochialism). The human right to health is no exception. If a human right to health is to be a useful instrument in mobilizing action for global health justice, then we need to take seriously the ways that health intersects with culture. Universal applicability is essential to both the legitimacy and efficacy of human rights. But without cultural sensitivity, additional injustices and imperialistic harms may be perpetuated. There are two goals within this paper-(1) to show that cultural imperialism is a moral and practical hazard, both in general and for the human right to health in particular and (2) to articulate a way of thinking about the human right to health that can minimize these hazards and arm it with moral credibility and political weight.

Emotion and COVID-19: Toward an Equitable Pandemic Response

This article discusses the ways in which healthcare professionals can use emotion as part of developing an ethical response to the COVID-19 pandemic. Affect theory, a growing approach to inquiry in the social sciences and humanities that appraises the historical and cultural contexts of emotions as expressed through art and politics, offers a frame for clinicians and researchers to consider ethical questions that surround the reopening of the United States economy in the wake of COVID-19. This article uses affect theory to describe how healthcare workers' emotions are useful for formulating a reopening plan grounded in collective action and a duty to do no harm.

Infection control for third-party benefit: lessons from criminal justice

This article considers what can be learned regarding the ethical acceptability of intrusive interventions intended to halt the spread of infectious disease (‘Infection Control’ measures) from existing ethical discussion of intrusive interventions used to prevent criminal conduct (‘Crime Control’ measures). The main body of the article identifies and briefly describes six objections that have been advanced against Crime Control, and considers how these might apply to Infection Control. The final section then draws out some more general lessons from the foregoing analysis for the ethical acceptability of different kinds of Infection Control.

Screening for multi-drug-resistant Gram-negative bacteria: what is effective and justifiable?

Effectiveness is a key criterion in assessing the justification of antibiotic resistance interventions. Depending on an intervention’s effectiveness, burdens and costs will be more or less justified, which is especially important for large scale population-level interventions with high running costs and pronounced risks to individuals in terms of wellbeing, integrity and autonomy. In this paper, we assess the case of routine hospital screening for multi-drug-resistant Gram-negative bacteria (MDRGN) from this perspective. Utilizing a comparison to screening programs for Methicillin-Resistant Staphylococcus aureus (MRSA) we argue that current screening programmes for MDRGN in low endemic settings should be reconsidered, as its effectiveness is in doubt, while general downsides to screening programs remain. To accomplish justifiable antibiotic stewardship, MDRGN screening should not be viewed as a separate measure, but rather as part of a comprehensive approach. The program should be redesigned to focus on those at risk of developing symptomatic infections with MDRGN rather than merely detecting those colonised.

COVID-19: Against a Lockdown Approach

Governments around the world have faced the challenge of how to respond to the recent outbreak of a novel coronavirus disease (COVID-19). Some have reacted by greatly restricting the freedom of citizens, while others have opted for less drastic policies. In this paper, I draw a parallel with vaccination ethics to conceptualize two distinct approaches to COVID-19 that I call altruistic and lockdown. Given that the individual measures necessary to limit the spread of the virus can in principle be achieved voluntarily as well as through enforcement, the question arises of how much freedom governments ought to give citizens to adopt the required measures. I argue that an altruistic approach is preferable on moral grounds: it preserves important citizen freedoms, avoids a number of potential injustices, and gives people a much-needed sense of meaning in precarious times.

COVID-19 Pandemic, Transparency, and "Polidemic" in the Republic of Korea

This article examines the development of the Republic of Korea's strategy to prevent the spread of COVID-19 with particular focus on ethical issues and the problem of politicization of public communication. Using prominent examples of stakeholders who have acted and expressed themselves in highly contradictory ways on the topic of the pandemic, we provide an analysis of how the public health policy discourse has entered into the realm of politicization and elaborate on the danger that this phenomenon poses in terms of rational debate and appropriate policy measures geared toward the public's safety. Considering the role that the Republic of Korea have had in global media coverage of quarantine policies and epidemic prevention, we believe that our study makes a significant contribution to the literature because it provides a new perspective and insights into the forces at work within and around a prevention strategy that has both been lauded and seen as highly controversial.

Taking stock of the availability and functions of National Ethics Committees worldwide

Background

National Ethics Committees (NECs) offer important oversight and guidance functions and facilitate public debate on bioethical issues. In an increasingly globalized world where technological advances, multi-national research collaborations, and pandemics are creating ethical dilemmas that transcend national borders, coordination and the joining of efforts among NECs are key. The purpose of this study is to take stock of the current NEC landscape, their varying roles and missions, and the range of bioethical topics on which they deliberated since their inception.

Methods

Data on the availability, functions, and ethical deliberations (publications) of NECs globally were gathered through a systematic search of NEC websites and through contacts known to the authors. The search was conducted in English, French, and Spanish. The data abstraction was done in Excel and included the NEC’s country, region, functions, and deliberations on bioethical issues. Deliberation topics were classified into thematic categories through an iterative process of regrouping to arrive at the main set of themes.

Results

124 NECs in 100 countries were identified. 44% of the NECs are in Europe and 47% are in high-income countries. Out of the 1108 retrieved publications, 40% were on bioethics in the context of research, followed by the clinic (28%) and public health issues (22%). The top five topics of these publications were: research ethics (124; 9%), genetics and genomics (62; 6%), organ transplantation (58; 5%), assisted reproductive technology (49; 4%), and end of life (36; 3%).

Conclusion

Our study makes an important contribution to understanding the current interests and functions of NECs and the range of their bioethics deliberations. By making the data publicly available through this publication, it allows users to conduct tailored analyses and queries based on their interests, and to seek and strengthen collaboration and exchange. It also makes the case for the fruitfulness of developing and maintaining a global repository of current and new deliberations to more effectively advance this field for the greater good of humanity, research, and public health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12910-021-00614-6.

A Public Health Ethics Case for Mitigating Zoonotic Disease Risk in Food Production

This article argues that governments in countries that currently permit intensive animal agriculture - especially but not exclusively high-income countries - are, in principle, morally justified in taking steps to restrict or even eliminate intensive animal agriculture to protect public health from the risk of zoonotic pandemics. Unlike many extant arguments for restricting, curtailing, or even eliminating intensive animal agriculture which focus on environmental harms, animal welfare, or the link between animal source food (ASF) consumption and noncommunicable disease, the argument in this article appeals to the value of protecting populations from future global health emergencies and their broad social, economic, and health impacts, taking the SARS-CoV-2 virus as a particularly salient example. The article begins by identifying how intensive animal agriculture contributes to the outbreak (and risk of future outbreaks) of zoonotic diseases. Next, we explore three specific policy options: 1. Incentivizing plant-based and cell-based ASF alternatives through government subsidies; 2. Disincentivizing intensive ASF production through the adoption of a “zoonotic tax”; and 3. Eliminating intensive ASF production through a total ban. We argue that all three of these measures are permissible, although we remain agnostic as to whether these measures are obligatory. We argue for this conclusion on the grounds that each measure is justified by the same sorts of considerations that justify other widely accepted public health interventions, and each is compatible with a variety of theories of justice. We then address potential objections. Finally, we discuss how our novel argument relates to extant ethical arguments in favor or curtailing ASF production and consumption.

Priority allocation of pandemic influenza vaccines in Australia - Recommendations of 3 community juries

BACKGROUND

Pandemic planning has historically been oriented to respond to an influenza virus, with vaccination strategy being a key focus. As the current COVID-19 pandemic plays out, the Australian government is closely monitoring progress towards development of SARS-CoV2 vaccines as a definitive intervention. However, as in any pandemic, initial supply will likely be exceeded by demand due to limited manufacturing output.

METHODS

We convened community juries in three Australian locations in 2019 to assess public acceptability and perceived legitimacy of influenza pandemic vaccination distribution strategies. Preparatory work included literature reviews on pandemic vaccine allocation strategies and on vaccine allocation ethics, and simulation modelling studies. We assumed vaccine would be provided to predefined priority groups. Jurors were then asked to recommend one of two strategies for distributing remaining early doses of vaccine: directly vaccinate people at higher risk of adverse outcomes from influenza; or indirectly protect the general population by vaccinating primary school students, who are most likely to spread infection.

RESULTS

Thirty-four participants of diverse backgrounds and ages were recruited through random digit dialling and topic-blinded social media advertising. Juries heard evidence and arguments supporting different vaccine distribution strategies, and questioned expert presenters. All three community juries supported prioritising school children for influenza vaccination (aiming for indirect protection), one by 10-2 majority and two by consensus. Justifications included that indirect protection benefits more people and is likely to be more publicly acceptable.

CONCLUSIONS

In the context of an influenza pandemic, informed citizens were not opposed to prioritising groups at higher risks of adverse outcomes, but if resources and epidemiological conditions allow, achieving population benefits should be a strategic priority. These insights may inform future SARS-CoV-2 vaccination strategies.

Pregnant women & vaccines against emerging epidemic threats: Ethics guidance for preparedness, research, and response

Zika virus, influenza, and Ebola have called attention to the ways in which infectious disease outbreaks can severely - and at times uniquely - affect the health interests of pregnant women and their offspring. These examples also highlight the critical need to proactively consider pregnant women and their offspring in vaccine research and response efforts to combat emerging and re-emerging infectious diseases. Historically, pregnant women and their offspring have been largely excluded from research agendas and investment strategies for vaccines against epidemic threats, which in turn can lead to exclusion from future vaccine campaigns amidst outbreaks. This state of affairs is profoundly unjust to pregnant women and their offspring, and deeply problematic from the standpoint of public health. To ensure that the needs of pregnant women and their offspring are fairly addressed, new approaches to public health preparedness, vaccine research and development, and vaccine delivery are required. This Guidance offers 22 concrete recommendations that provide a roadmap for the ethically responsible, socially just, and respectful inclusion of the interests of pregnant women in the development and deployment of vaccines against emerging pathogens. The Guidance was developed by the Pregnancy Research Ethics for Vaccines, Epidemics, and New Technologies (PREVENT) Working Group - a multidisciplinary, international team of 17 experts specializing in bioethics, maternal immunization, maternal-fetal medicine, obstetrics, pediatrics, philosophy, public health, and vaccine research and policy - in consultation with a variety of external experts and stakeholders.

[Efficiency is not enough. Ethical analysis and recommendations for the allocation of scarce resources in a pandemic situation]

OBJECTIVE

To develop a support tool to decision-making in the framework of the COVID-19 pandemic.

METHOD

Different ethical recommendations that emerged in Spain on prioritizing scarce health resources in the COVID-19 pandemic first wave were searched; it was conducted a narrative review of theoretical models on distribution in pandemics to define an ethical foundation. Finally, recommendations are drawn to be applied in different healthcare settings.

RESULTS

Three principles are identified; strict equality, equity and efficiency, which are substantiated in specific distribution criteria.

CONCLUSIONS

A model for the distribution of scarce health resources in a pandemic situation is proposed, starting with a decision-making procedure and adapting the distribution criteria to different healthcare scenarios: primary care settings, nursing homes and hospitals.

In defence of a single body of clinical and public health, medical ethics

BACKGROUND

Since some form of dual clinical/public health practice is desirable, this paper explains why their ethics should be combined to influence medical practice and explores a way to achieve that.

MAIN TEXT

In our attempt to merge clinical and public health ethics, we empirically compared the individual and collective health consequences of two illustrative lists of medical and public health ethical tenets and discussed their reciprocal relevance to praxis. The studied codes share four principles, namely, 1. respect for individual/collective rights and the patient's autonomy; 2. cultural respect and treatment that upholds the patient's dignity; 3. honestly informed consent; and 4. confidentiality of information. However, they also shed light on the strengths and deficiencies of each other's tenets. Designing a combined clinical and public health code requires fleshing out three similar principles, namely, beneficence, medical and public health engagement in favour of health equality, and community and individual participation; and adopting three stand-alone principles, namely, professional excellence, non-maleficence, and scientific excellence. Finally, we suggest that eco-biopsychosocial and patient-centred care delivery and dual clinical/public health practice should become a doctor's moral obligation. We propose to call ethics based on non-maleficence, beneficence, autonomy, and justice - the values upon which, according to Pellegrino and Thomasma, the others are grounded and that physicians and ethicists use to resolve ethical dilemmas - "neo-Hippocratic". The neo- prefix is justified by the adjunct of a distributive dimension (justice) to traditional Hippocratic ethics.

CONCLUSION

Ethical codes ought to be constantly updated. The above values do not escape the rule. We have formulated them to feed discussions in health services and medical associations. Not only are these values fragmentary and in progress, but they have no universal ambition: they are applicable to the dilemmas of modern Western medicine only, not Ayurvedic or Shamanic medicine, because each professional culture has its own philosophical rationale. Efforts to combine clinical and public health ethics whilst resolving medical dilemmas can reasonably be expected to call upon the physician's professional identity because they are intellectual challenges to be associated with case management.

Justice, Well-Being, and Civic Duty in the Age of a Pandemic: Why we all Need to Do our bit

This article presents an argument related to justice obligations during a pandemic and explores implications of the argument. A just society responds to a serious threat to the well-being of its people such as a viral pandemic to mitigate the impact of the pandemic on the well-being of its members. This creates identifiable societal obligations which are discharged by the institutions and individuals within society that are situated to do so. There are therefore identifiable obligations resting on various societal institutions, such as government, churches, schools, and corporate institutions, as well as obligations resting on individuals. Should an institution or individual fail to act in ways consistent with these social obligations, they perpetrate an injustice on society and its members.

COVID-19 and the ethics of quarantine: a lesson from the Eyam plague

The recent outbreak of the SARS-CoV-2 coronavirus is posing many different challenges to local communities, directly affected by the pandemic, and to the global community, trying to find how to respond to this threat in a larger scale. The history of the Eyam Plague, read in light of Ross Upshur's Four Principles for the Justification of Public Health Intervention, and of the Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights, could provide useful guidance in navigating the complex ethical issues that arise when quarantine measures need to be put in place.

Learning Lessons from COVID-19 Requires Recognizing Moral Failures

The most powerful lesson learned from the 2013-2016 outbreak of Ebola in West Africa was that we do not learn our lessons. A common sentiment at the time was that Ebola served as a "wake-up call"-an alarm which signalled that an outbreak of that magnitude should never have occurred and that we are ill-prepared globally to prevent and respond to them when they do. Pledges were made that we must learn from the outbreak before we were faced with another. Nearly five years later the world is in the grips of a pandemic of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19). It is therefore of no surprise that we are now yet again hearing that the COVID-19 pandemic serves as the "wake-up call" we need and that there are many lessons to be learned to better prepare us for future outbreaks. Will anything be different this time around? We argue that nothing will fundamentally change unless we truly understand and appreciate the nature of the lessons we should learn from these outbreaks. Our past failures must be understood as moral failures that offer moral lessons. Unless we appreciate that we have a defect in our collective moral attitude toward remediating the conditions that precipitate the emergence of outbreaks, we will never truly learn.

Humiliating Whistle-Blowers: Li Wenliang, the Response to Covid-19, and the Call for a Decent Society

The ethical experience and lessons of China's and the world's response to COVID-19 will be debated for many years to come. But one feature of the Chinese authoritarian response that should not be overlooked is its practice of silencing and humiliating the whistle-blowers who told the truth about the epidemic. In this article, we document the humiliation of Dr Li Wenliang (1986-2020), the most prominent whistle-blower in the Chinese COVID-19 epidemic. Engaging with the thought of Israeli philosopher Avishai Margalit, who argues that humiliation constitutes an injury to a person's self-respect, we discuss his contention that a decent society is one that abolishes conditions which constitute a justification for its dependents to consider themselves humiliated. We explore the ways that institutions humiliate whistle-blowers in Western countries as well as in China.

Applying a Precautionary Approach to Mobile Contact Tracing for COVID-19: The Value of Reversibility

The COVID-19 pandemic presents unprecedented challenges to public health decision-making. Specifically, the lack of evidence and the urgency with which a response is called for, raise the ethical challenge of assessing how much (and what kind of) evidence is required for the justification of interventions in response to the various threats we face. Here we discuss the intervention of introducing technology that aims to trace and alert contacts of infected persons-contact tracing (CT) technology. Determining whether such an intervention is proportional is complicated by complex trade-offs and feedback loops. We suggest that the resulting uncertainties necessitate a precautionary approach. On the one hand, precautionary reasons support CT technology as a means to contribute to the prevention of harms caused by alternative interventions, or COVID-19 itself. On the other hand, however, both the extent to which such technology itself present risks of serious harm, as well as its effectiveness, remain unclear. We therefore argue that a precautionary approach should put reversibility of CT technology at the forefront. We outline several practical implications.

A general approach to compensation for losses incurred due to public health interventions in the infectious disease context

This paper develops a general approach to how society should compensate for losses that individuals incur due to public health interventions aimed at controlling the spread of infectious diseases. The paper falls in three parts. The first part provides an initial introduction to the issues and briefly outlines five different kinds of public health interventions that will be used as test cases. They are all directed at individuals and aimed at controlling the spread of infectious diseases (1) isolation, (2) quarantine, (3) recommended voluntary social distancing, (4) changes in health care provision for asymptomatic carriers of multi-resistant microorganisms, and (5) vaccination. The interventions will be briefly described including the various risks, burdens and harms individuals who are subject to these interventions may incur. The second part briefly surveys current compensation mechanisms as far as any exist and argue that even where they exist they are clearly insufficient and do not provide adequate compensation. The third part will then develop a general framework for compensation for losses incurred due to public health interventions in the infectious disease context. This is the major analytical and constructive part of the paper. It first analyses pragmatic and ethical arguments supporting the existence of an obligation on the part of the state to compensate for such losses, and then considers whether this obligation can be defeated by (1) resource considerations, or (2) issues relating to personal responsibility.

Synergistic Disparities and Public Health Mitigation of COVID-19 in the Rural United States

Public health emergencies expose social injustice and health disparities, resulting in calls to address their structural causes once the acute crisis has passed. The COVID-19 pandemic is highlighting and exacerbating global, national, and regional disparities in relation to the benefits and burdens of undertaking critical basic public health mitigation measures such as physical distancing. In the United States, attempts to address the COVID-19 pandemic are complicated by striking racial, economic, and geographic inequities. These synergistic inequities exist in both urban and rural areas but take on a particular character and impact in areas of rural poverty. Rural areas face a diverse set of structural challenges, including inadequate public health, clinical, and other infrastructure and economic precarity, hampering the ability of communities and individuals to implement mitigation measures. Public health ethics demands that personnel address both the tactical, real-time adjustment of typical mitigation tools to improve their effectiveness among the rural poor as well as the strategic, longer-term structural causes of health and social injustice that continue to disadvantage this population.

It Didn't Have to be This Way: Reflections on the Ethical Justification of the Running Ban in Northern Italy in Response to the 2020 COVID-19 Outbreak

In this paper I discuss the ethical justifiability of the limitation of freedom of movement, in particular of the ban on running outdoors, enforced in Italy as a response to the COVID-19 outbreak in the spring of 2020. I argue that through the lens of public health ethics literature, the ban on running falls short of the criterion of proportionality that public health ethics scholars and international guidelines for the ethical management of infectious disease outbreak recommend for any measure that restricts essential individual freedoms, such as the freedom of movement. The public health ethics framework, however, falls short of explaining the widespread public support that the running ban has had in Italy. I discuss possible factors which could explain the public support for the ban in Italy. Finally, I raise the question of what societal implications the abandonment of the public health ethics framework based on proportionality might have. I conclude that if it is the case, as the history of pandemics teaches us, we will experience further waves of COVID-19 outbreaks, it becomes very important to raise these questions now, with an eye towards informing public health policies for the management of future COVID-19 outbreaks. This discussion should not become politicized along the lines of liberal pro-lockdown/conservative anti-lockdown. Instead, we should reflect on the trade-offs of lockdown policies according to a pluralist framework, in which COVID-19 related deaths are not the only possible value to pursue.

Collateral Paternalism and Liberal Critiques of Public Health Policy: Diminishing Theoretical Demandingness and Accommodating the Devil in the Detail

Critical literatures, and public discourses, on public health policies and practices often present fixated concerns with paternalism. In this paper, rather than focus on the question of whether and why intended instances of paternalistic policy might be justified, we look to the wider, real-world socio-political contexts against which normative evaluations of public health must take place. We explain how evaluative critiques of public health policy and practice must be sensitive to the nuance and complexity of policy contexts. This includes sensitivity to the 'imperfect' reach and application of policy, leading to collateral effects including collateral paternalism. We argue that theoretical critiques must temper their demandingness to real-world applicability, allowing for the detail of social and policy contexts, including harm reduction: apparent knock-down objections of paternalism cannot hold if they are limited to an abstract or artificially-isolated evaluation of the reach of a public health intervention.

A qualitative study of big data and the opioid epidemic: recommendations for data governance

BACKGROUND

The opioid epidemic has enabled rapid and unsurpassed use of big data on people with opioid use disorder to design initiatives to battle the public health crisis, generally without adequate input from impacted communities. Efforts informed by big data are saving lives, yielding significant benefits. Uses of big data may also undermine public trust in government and cause other unintended harms.

OBJECTIVES

We aimed to identify concerns and recommendations regarding how to use big data on opioid use in ethical ways.

METHODS

We conducted focus groups and interviews in 2019 with 39 big data stakeholders (gatekeepers, researchers, patient advocates) who had interest in or knowledge of the Public Health Data Warehouse maintained by the Massachusetts Department of Public Health.

RESULTS

Concerns regarding big data on opioid use are rooted in potential privacy infringements due to linkage of previously distinct data systems, increased profiling and surveillance capabilities, limitless lifespan, and lack of explicit informed consent. Also problematic is the inability of affected groups to control how big data are used, the potential of big data to increase stigmatization and discrimination of those affected despite data anonymization, and uses that ignore or perpetuate biases. Participants support big data processes that protect and respect patients and society, ensure justice, and foster patient and public trust in public institutions. Recommendations for ethical big data governance offer ways to narrow the big data divide (e.g., prioritize health equity, set off-limits topics/methods, recognize blind spots), enact shared data governance (e.g., establish community advisory boards), cultivate public trust and earn social license for big data uses (e.g., institute safeguards and other stewardship responsibilities, engage the public, communicate the greater good), and refocus ethical approaches.

CONCLUSIONS

Using big data to address the opioid epidemic poses ethical concerns which, if unaddressed, may undermine its benefits. Findings can inform guidelines on how to conduct ethical big data governance and in ways that protect and respect patients and society, ensure justice, and foster patient and public trust in public institutions.

Face masks in the general healthy population. Scientific and ethical issues

In most European countries, facemasks use is recommended or mandatory in enclosed spaces where physical distancing is not possible. In Spain, this measure was first extended to open public spaces and later made mandatory regardless of whether or not the interpersonal safety distance can be kept. At present, there is no evidence on the effectiveness of universal masking of healthy people in the community to prevent infection with respiratory viruses, including SARS-CoV-2. The mandatory use of masks poses some ethical questions. Firstly, it entails a paternalistic action. Secondly, application of the principle of precaution becomes questionable when there is no clear benefit-risk relationship. Thirdly, compulsoriness can interfere with equity of public health actions. Fourthly, it can result in social stigma and discrimination against those who do not wear one, even though they well may have good reasons for doing so. Lastly, this measure may generate confusion in the population, along with an altered perception of the risk. The World Health Organization recommends its use in public places with a high potential risk of transmission and where other prevention measures, such as physical distancing, are not possible. Mandatory use of masks in public open spaces, regardless of the risk of transmission or of whether or not the interpersonal safety distance can be kept, is an intrusive measure that restricts individual freedoms, and would not appear to be justified on the basis of available scientific evidence. What we need are recommendations explaining where, when, how and what type of mask to wear.

COVID-19 Lockdowns: a Public Mental Health Ethics Perspective

States all over the world have reacted to COVID-19 with quarantines of entire cities, provinces, and even nations. Previous studies and preliminary evidence from current lockdowns suggest that emergency measures protecting the public’s physical health by dislocating individuals, families, and social networks could well be causing a devastating public health crisis of mental ill-health in the months and years to come. This article is the first to take a public mental health ethics perspective in examining these lockdowns, the lodestar of which is the right to mental health, rooted in the concept of human dignity. Even the strictest lockdowns are not necessarily unethical but are prone to damage mental health disproportionately, with vulnerable and disadvantaged populations being at particular risk.