scholarly journals Adopting an ethical approach to migration health policy, practice and research

2021 ◽  
Vol 6 (7) ◽  
pp. e006425
Author(s):  
Kristine Husøy Onarheim ◽  
Kolitha Wickramage ◽  
David Ingleby ◽  
Supriya Subramani ◽  
Ingrid Miljeteig
Keyword(s):  
Decision Making ◽  
Health Policy ◽  
Policy Making ◽  
Ethical Issues ◽  
Health Workers ◽  
Decision Makers ◽  
Ethical Challenges ◽  
Ethical Frameworks ◽  
Ethical Approach ◽  
Trade Offs

Migration health is affected by decision making at levels ranging from global to local, both within and beyond the health sector. These decisions impact seeking, entitlements, service delivery, policy making and knowledge production on migration health. It is key that ethical challenges faced by decision makers are recognised and addressed in research and data, clinical practice and policy making on migration health. An ethical approach can provide methods to identify ethical issues, frameworks for systematising information and suggesting ethically acceptable solutions, and guidance on procedural concerns and legitimate decision making processes. By unpacking dilemmas, conflicts of interests and values at stake, an ethical approach is relevant for all who make decisions about migration health policy and practice. Adopting an ethical approach to migration health benefits governments, organisations, policy makers, health workers, data managers, researchers and migrants themselves. First, it highlights the inherent normative questions and trade-offs at stake in migration health. Second, it assists decision makers in deciding what is the ethically justifiable thing to do through an ‘all things considered’ approach. Third, ethical frameworks and technical guidance set normative and practical standards for decision makers facing ethical questions – from ‘bedside rationing’ to collection of big data or in policy making – that can ensure that migrants’ interests are considered. Fourth, there is a need for greater transparency and accountability in decision making, as well as meaningful participation of migrant groups. An ethical approach connects to public health, economic and human rights arguments and highlights the urgent need to mainstream concerns for migrants in global and national health responses.

scholarly journals Good education policy making: Data-informed but values-driven

2018 ◽  
Vol 100 (4) ◽  
pp. 36-39
Author(s):  
Harry Brighouse ◽  
Helen Ladd ◽  
Susanna Loeb ◽  
Adam Swift
Keyword(s):  
Decision Making ◽  
Interpersonal Relationships ◽  
Policy Making ◽  
Decision Makers ◽  
Democratic Process ◽  
Good Education ◽  
Trade Offs ◽  
Education Decision ◽  
Data Informed ◽  
Careful Thought

In this article, based on their book Educational Goods: Values, Evidence and Decision Making, Harry Brighouse, Helen Ladd, Susanna Loeb, and Adam Swift encourage education decision makers to give careful thought to the values that underlie the data they collect and use to inform policy. Rather than basing decisions entirely on what improves academic achievement, the authors call for attention to a wider array of values, which they call educational goods. These include the capacities to function in the labor market, to participate effectively in the democratic process, to make autonomous judgments about key life decisions such as occupation or religion, to develop healthy interpersonal relationships, to seek personal fulfilment, and to treat others with respect and dignity. Thinking in terms of these values can broaden the conversation about education priorities and bring clarity to decisions involving trade-offs and conflicting aims.

Pandemic Disease, Public Health, and Ethics

2019 ◽  
pp. 796-811 ◽  
Author(s):  
Maxwell Smith ◽  
Ross Upshur
Keyword(s):  
Public Health ◽  
Ethical Issues ◽  
Ethical Challenges ◽  
Pandemic Preparedness ◽  
Scarce Resources ◽  
Ethical Frameworks ◽  
Health Measures ◽  
Care Workers ◽  
The Face ◽  
Conducting Research

Infectious disease pandemics raise significant and novel ethical challenges to the organization and practice of public health. This chapter provides an overview of the salient ethical issues involved in preparing for and responding to pandemic disease, including those arising from deploying restrictive public health measures to contain and curb the spread of disease (e.g., isolation and quarantine), setting priorities for the allocation of scarce resources, health care workers’ duty to care in the face of heightened risk of infection, conducting research during pandemics, and the global governance of preventing and responding to pandemic disease. It also outlines ethical guidance from prominent ethical frameworks that have been developed to address these ethical issues and concludes by discussing some pressing challenges that must be addressed if ethical reflection is to make a meaningful difference in pandemic preparedness and response.

The Ethics of AI in Biomedical Research, Patient Care, and Public Health

2020 ◽  
pp. 702-718 ◽  
Author(s):  
Alessandro Blasimme ◽  
Effy Vayena
Keyword(s):  
Public Health ◽  
Patient Care ◽  
Biomedical Research ◽  
Disease Surveillance ◽  
Ethical Issues ◽  
Ethical Review ◽  
Ethical Challenges ◽  
Healthcare Provision ◽  
Social Scientists ◽  
Ethical Frameworks

This chapter explores ethical issues raised by the use of artificial intelligence (AI) in the domain of biomedical research, healthcare provision, and public health. The litany of ethical challenges that AI in medicine raises cannot be addressed sufficiently by current regulatory and ethical frameworks. The chapter then advances the systemic oversight approach as a governance blueprint, which is based on six principles offering guidance as to the desirable features of oversight structures and processes in the domain of data-intense biomedicine: adaptivity, flexibility, inclusiveness, reflexivity, responsiveness, and monitoring (AFIRRM). In the research domain, ethical review committees will have to incorporate reflexive assessment of the scientific and social merits of AI-driven research and, as a consequence, will have to open their ranks to new professional figures such as social scientists. In the domain of patient care, clinical validation is a crucial issue. Hospitals could equip themselves with “clinical AI oversight bodies” charged with the task of advising clinical administrators. Meanwhile, in the public health sphere, the new level of granularity enabled by AI in disease surveillance or health promotion will have to be negotiated at the level of targeted communities.

scholarly journals Using Deliberative Democracy for Better Urban Decision-Making through Integrative Thinking

Urban Science ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 3
Author(s):  
Janette Hartz-Karp ◽  
Dora Marinova
Keyword(s):  
Decision Making ◽  
Case Studies ◽  
Deliberative Democracy ◽  
Decision Makers ◽  
Capital City ◽  
City Region ◽  
Multiple Sources ◽  
Trade Offs ◽  
Urban Issues ◽  
Sustainability Challenges

This article expands the evidence about integrative thinking by analyzing two case studies that applied the collaborative decision-making method of deliberative democracy which encourages representative, deliberative and influential public participation. The four-year case studies took place in Western Australia, (1) in the capital city Perth and surrounds, and (2) in the city-region of Greater Geraldton. Both aimed at resolving complex and wicked urban sustainability challenges as they arose. The analysis suggests that a new way of thinking, namely integrative thinking, emerged during the deliberations to produce operative outcomes for decision-makers. Building on theory and research demonstrating that deliberative designs lead to improved reasoning about complex issues, the two case studies show that through discourse based on deliberative norms, participants developed different mindsets, remaining open-minded, intuitive and representative of ordinary people’s basic common sense. This spontaneous appearance of integrative thinking enabled sound decision-making about complex and wicked sustainability-related urban issues. In both case studies, the participants exhibited all characteristics of integrative thinking to produce outcomes for decision-makers: salience—grasping the problems’ multiple aspects; causality—identifying multiple sources of impacts; sequencing—keeping the whole in view while focusing on specific aspects; and resolution—discovering novel ways that avoided bad choice trade-offs.

scholarly journals Social network-based ethical analysis of COVID-19 vaccine supply policy in three Central Asian countries              

2021 ◽  
Author(s):  
Timur Aripov ◽  
Daniel Wikler ◽  
Damin Asadov ◽  
Zhangir Tulekov ◽  
Totugul Murzabekova ◽  
...  
Keyword(s):  
Ethical Issues ◽  
Vaccine Coverage ◽  
Scientific Data ◽  
Efficacy And Safety ◽  
Asian Countries ◽  
Ethical Frameworks ◽  
Trade Offs ◽  
Central Asian ◽  
Wide Range ◽  
Central Asian Countries

Abstract Abstract Background In the pandemic time, many low- and middle-income countries are experiencing restricted access to COVID-19 vaccines. An access to imported vaccines or ways to produce them locally becomes the principal source of hope. But developing a strategy for success in obtaining and allocating vaccines is not easy task. The governments in those countries have faced difficult decision whether to accept or reject offers of vaccine diplomacy, weighing price and availability of COVID-19 vaccines against concerns over their efficacy and safety. Our aim was to analyze public opinion regarding the governmental strategies to obtain COVID-19 vaccines in three Central Asian countries, focusing particularly on possible ethical issues. Methods We searched opinions expressed either in Russian or in the respective national languages. We provided data of the debate within three countries, drawn from social media postings and other sources. The opinion data was not restricted by source and time. This allowed to collect a wide range of possible opinions that could be expressed regarding COVID-19 vaccine supply and public’s participation in vaccine trials. We recognized ethical issues and possible questions concerning different ethical frameworks. We also considered additional information or scientific data, in the process of reasoning. Results As a result, public views on their respective government policies on COVID-19 vaccine supply ranged from strongly negative to slightly positive. We extracted most important issues from public debates, for our analysis. The first issue involved trade-offs between quantity, speed, price, freedom, efficacy and safety in the vaccines. The second set of issues arouse in connection with the request to site a randomized trial in one of countries (Uzbekistan). After considering additional evidences, we weighed individual with public risks and benefits to make specific judgements concerning every issue. Conclusions We believe that our analysis would be a helpful example of solving ethical issues that can rise concerning COVID-19 vaccine supply round the world. The public view can be highly critical, helping to spot such issues. An ignoring this view can lead to major problems, which in turn, can become a serious obstacle for the vaccine coverage and epidemics’ control in the countries and regions.

scholarly journals Evaluating underpinning, complexity and implications of ethical situations in humanitarian operations: qualitative study through the lens of career humanitarian workers

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e039463
Author(s):  
Ramin Asgary ◽  
Katharine Lawrence
Keyword(s):  
Decision Making ◽  
Social Constructivism ◽  
Moral Distress ◽  
Unintended Consequences ◽  
Aid Effectiveness ◽  
International Agency ◽  
Negative Consequences ◽  
Ethical Challenges ◽  
Ethical Frameworks ◽  
Humanitarian Operations

IntroductionData regarding underpinning and implications of ethical challenges faced by humanitarian workers and their organisations in humanitarian operations are limited.MethodsWe conducted comprehensive, semistructured interviews with 44 experienced humanitarian aid workers, from the field to headquarters, to evaluate and describe ethical conditions in humanitarian situations.Results61% were female; average age was 41.8 years; 500 collective years of humanitarian experience (11.8 average) working with diverse major international non-governmental organisations. Important themes included; allocation schemes and integrity of the humanitarian industry, including resource allocation and fair access to and use of services; staff or organisational competencies and aid quality; humanitarian process and unintended consequences; corruption, diversion, complicity and competing interests, and intentions versus outcomes; professionalism and interpersonal and institutional responses; and exposure to extreme inequities and emotional and moral distress. Related concepts included broader industry context and allocations; decision-making, values, roles and sustainability; resource misuse at programme, government and international agency levels; aid effectiveness and utility versus futility, and negative consequences. Multiple contributing, confounding and contradictory factors were identified, including context complexity and multiple decision-making levels; limited input from beneficiaries of aid; different or competing social constructs, values or sociocultural differences; and shortcomings, impracticality, or competing philosophical theories or ethical frameworks.ConclusionsEthical situations are overarching and often present themselves outside the exclusive scope of moral reasoning, philosophical views, professional codes, ethical or legal frameworks, humanitarian principles or social constructivism. This study helped identify a common instinct to uphold fairness and justice as an underlying drive to maintain humanity through proximity, solidarity, transparency and accountability.

scholarly journals Cancer During Pregnancy: How to Handle the Bioethical Dilemmas?—A Scoping Review With Paradigmatic Cases-Based Analysis

2020 ◽  
Vol 10 ◽  
Author(s):  
Diogo Alpuim Costa ◽  
José Guilherme Nobre ◽  
Susana Baptista de Almeida ◽  
Marisa Horta Ferreira ◽  
Inês Gonçalves ◽  
...  
Keyword(s):  
Decision Making ◽  
Pregnant Woman ◽  
Scoping Review ◽  
Ethical Issues ◽  
Case Reports ◽  
Grey Literature ◽  
Real Life ◽  
Published Data ◽  
Ethical Frameworks ◽  
Theoretical Approaches

Ethical issues that arise during the care of a pregnant woman with cancer are challenging to physicians, policymakers, lawyers, and the bioethics community. The main purpose of this scoping review is to summarize existing literature regarding the bioethical dilemmas when a conflict arises in the maternal-fetus dyad, like the one related to cancer and pregnancy outcomes. Moreover, we illustrate the decision-making process of real-life case reports. Published data were searched through the PubMed and Google Scholar databases, as well as in grey literature, using appropriate controlled keywords in English and Portuguese. After identification, screening, eligibility and data extraction from the articles, a total of 50 was selected. There are several established ethical frameworks for conflict resolution and decision-making. Pragmatic theoretical approaches include case-based analysis, the ethics of care, feminist theory, and traditional ethical principlism that scrutinizes the framework of autonomy, justice, beneficence, and non-maleficence. In addition, society and practitioner values could mediate this complex ethical interplay. The physician must balance autonomy and beneficence-based obligations to the pregnant woman with cancer, along with beneficence-based obligations to the fetus. Ethical challenges have received less attention in the literature, particularly before the third trimester of pregnancy. Best, unbiased and balanced information must be granted both to the patient and to the family, regarding the benefits and harms for the woman herself as well as for the fetal outcome. Based on a previously validated method for analyzing and working up clinical ethical problems, we suggest an adaptation of an algorithm for biomedical decision-making in cancer during pregnancy, including recommendations that can facilitate counseling and help reduce the suffering of the patient and her family.

scholarly journals Balancing health worker well-being and duty to care: an ethical approach to staff safety in COVID-19 and beyond

2020 ◽  
pp. medethics-2020-106557 ◽  
Author(s):  
Rosalind J McDougall ◽  
Lynn Gillam ◽  
Danielle Ko ◽  
Isabella Holmes ◽  
Clare Delany
Keyword(s):  
Decision Making ◽  
Clinical Work ◽  
Well Being ◽  
Decision Makers ◽  
Ethical Challenges ◽  
Healthcare Staff ◽  
Front Line ◽  
Specific Setting ◽  
Healthcare Work ◽  
Staff Protection

The COVID-19 pandemic has highlighted the risks that can be involved in healthcare work. In this paper, we explore the issue of staff safety in clinical work using the example of personal protective equipment (PPE) in the COVID-19 crisis. We articulate some of the specific ethical challenges around PPE currently being faced by front-line clinicians, and develop an approach to staff safety that involves balancing duty to care and personal well-being. We describe each of these values, and present a decision-making framework that integrates the two. The aim of the framework is to guide the process of balancing these two values when staff safety is at stake, by facilitating ethical reflection and/or decision-making that is systematic, specific and transparent. It provides a structure for individual reflection, collaborative staff discussion, and decision-making by those responsible for teams, departments and other groups of healthcare staff. Overall the framework guides the decision maker to characterise the degree of risk to staff, articulate feasible options for staff protection in that specific setting and identify the option that ensures any decrease in patient care is proportionate to the increase in staff well-being. It applies specifically to issues of PPE in COVID-19, and also has potential to assist decision makers in other situations involving protection of healthcare staff.

Ethical issues in social marketing

2017 ◽  
Author(s):  
Lynne Eagle ◽  
Stephan Dahl ◽  
David Low
Keyword(s):  
Social Marketing ◽  
Financial Incentives ◽  
Potential Role ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Code Of Ethics ◽  
Ethical Challenges ◽  
Ethical Frameworks

Many social marketers assume that because they are focusing on positive behaviour change they may expect fewer ethical issues arising from their work than conventional, commercial marketing. However, such a view is sadly too simplistic. This chapter focuses on the ethical issues facing social marketing. It argues that social marketers face an even greater potential for ethical issues and gives examples of these by focusing on targeting, stigmatization, victim blaming, coercion, and the use of financial incentives, among others. Recognizing the manifold potential for ethical challenges, and the lack of a decisive manner in which to resolve them easily, it then discusses ethical frameworks which can aid social marketers in formulating a response to potential issues and arriving at a considered decision. The chapter concludes by discussing the potential role of a professional code of ethics, and how this can aid future ethical decision-making.

scholarly journals ‘Nothing to do with the science’: How an elite sociotechnical imaginary cements policy resistance to public perspectives on science and technology through the machinery of government

2019 ◽  
Vol 50 (4) ◽  
pp. 589-608 ◽  
Author(s):  
Melanie Smallman
Keyword(s):  
Decision Making ◽  
Policy Making ◽  
Ethical Issues ◽  
Science And Technology ◽  
Problem Solver ◽  
Common Criticism ◽  
Social And Ethical Issues ◽  
Public Perspectives ◽  
Scientific Decision

That policymakers adopt technoscientific viewpoints and lack reflexivity is a common criticism of scientific decision-making, particularly in response to moves to democratize science. Drawing on interviews with UK-based national policymakers, I argue that an elite sociotechnical imaginary of ‘science to the rescue’ shapes how public perspectives are heard and distinguishes what is considered to be legitimate expertise. The machinery of policy-making has become shaped around this imaginary – particularly its focus on science as a problem-solver and on social and ethical issues as ‘nothing to do with the science’ – and this gives this viewpoint its power, persistence and endurance. With this imaginary at the heart of policy-making machinery, regardless of the perspectives of the policymakers, alternative views of science are either forced to take the form of the elite imaginary in order to be processed, or they simply cannot be accounted for within the policy-making processes. In this way, the elite sociotechnical imaginary (and technoscientific viewpoint) is enacted, but also elicited and perpetuated, without the need for policymakers to engage with or even be aware of the imaginary underpinning their actions.

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