AESP: Axe Éthique et Santé Publique

Social Policy & Administration; 08/01/2013
(AN 88005248)
SocINDEX with Full Text

Social Policy & Administration; 08/01/2013
(AN 88005245)
SocINDEX with Full Text

Related Articles

Access to assisted reproductive technologies in France: the emergence of the patients' voice.

Med Health Care Philos. 2013 Feb;16(1):55-68

Authors: Fournier V, Berthiau D, d'Haussy J, Bataille P

Abstract
Is there any ethical justification for limiting the reproductive autonomy and not make assisted reproductive technologies available to certain prospective parents? We present and discuss the results of an interdisciplinary clinical ethics study concerning access to assisted reproductive technologies (ART) in situations which are considered as ethically problematic in France (overage or sick parents, surrogate motherhood). The study focused on the arguments that people in these situations put forward when requesting access to ART. It shows that requester's arguments are based on sound ethical values, and that their legitimacy is at least as strong as that of those used by doctors to question access to ART. Results reveal that the three implicit normative arguments that founded the law in 1994, which are still in force after the bioethics law revision in July 2011-the welfare of the child, the illegitimacy of a "right to a child," and the defense of the so called "social order"-are challenged on several grounds by requesters as reasons for limiting their reproductive autonomy. Although these results are limited to exceptional situations, they are of special interest insofar as they give voice to the requesters' own ethical concerns in the ongoing political debate over access to ART.

PMID: 22466867 [PubMed - indexed for MEDLINE]

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Expected ethical competencies of public health professionals and graduate curricula in accredited schools of public health in North America.

Am J Public Health. 2013 May;103(5):938-42

Authors: Lee LM, Wright B, Semaan S

Abstract
OBJECTIVES: We assessed expected ethics competencies of public health professionals in codes and competencies, reviewed ethics instruction at schools of public health, and recommended ways to bridge the gap between them.
METHODS: We reviewed the code of ethics and 3 sets of competencies, separating ethics-related competencies into 3 domains: professional, research, and public health. We reviewed ethics course requirements in 2010-2011 on the Internet sites of 46 graduate schools of public health and categorized courses as required, not required, or undetermined.
RESULTS: Half of schools (n = 23) required an ethics course for graduation (master's or doctoral level), 21 did not, and 2 had no information. Sixteen of 23 required courses were 3-credit courses. Course content varied from 1 ethics topic to many topics addressing multiple ethics domains.
CONCLUSIONS: Consistent ethics education and competency evaluation can be accomplished through a combination of a required course addressing the 3 domains, integration of ethics topics in other courses, and "booster" trainings. Enhancing ethics competence of public health professionals is important to address the ethical questions that arise in public health research, surveillance, practice, and policy.

PMID: 22994177 [PubMed - indexed for MEDLINE]

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California's historic effort to reduce the stigma of mental illness: the Mental Health Services Act.

Am J Public Health. 2013 May;103(5):786-94

Authors: Clark W, Welch SN, Berry SH, Collentine AM, Collins R, Lebron D, Shearer AL

Abstract
In a historic effort to reduce the stigma of mental illness, California voters approved the Mental Health Services Act in 2004. The law funds a comprehensive statewide prevention initiative that places stigma and discrimination reduction at its center, with 25 projects providing interventions at the institutional, societal, and individual levels. Stakeholders selected specific strategies from the research-based California Strategic Plan on Reducing Stigma and Discrimination. Strategies range from social marketing to increase public knowledge to capacity building at the local level, including training that emphasizes participation by consumers of mental health services and cultural competence. Collectively, these strategies aim to foster permanent change in the public perception of mental illness and in the individual experience of stigma. We examined the context, planning, programming, and evaluation of this effort.

PMID: 23488486 [PubMed - indexed for MEDLINE]

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Virtue in medicine reconsidered: individual health and global health.

Perspect Biol Med. 2013;56(1):126-47

Authors: Benatar S, Upshur R

Abstract
One hundred years after the Flexner Report recommended major changes to medical education, an international panel has released a vision of medical education for the 21st century. Two major features of this detailed report that were not adequately articulated or developed were (1) the values that underpin care of individual patients and how these could be sustained and promoted, and (2) the values required to promote global health at a time when health disparities are widening. After reviewing the timeless scientific and humanistic foundations of clinical medicine that are essential for the care of individuals, we consider the role of virtue both in relation to individual patient care and in promoting an ethical framework for population health within a cosmopolitan global health perspective, and suggest that many organs of society should contribute to promoting such progress.

PMID: 23748531 [PubMed - in process]

Vulnerability in Research Ethics: a Way Forward.

Bioethics. 2013 May 30;

Authors: Lange MM, Rogers W, Dodds S

Abstract
Several foundational documents of bioethics mention the special obligation researchers have to vulnerable research participants. However, the treatment of vulnerability offered by these documents often relies on enumeration of vulnerable groups rather than an analysis of the features that make such groups vulnerable. Recent attempts in the scholarly literature to lend philosophical weight to the concept of vulnerability are offered by Luna and Hurst. Luna suggests that vulnerability is irreducibly contextual and that Institutional Review Boards (Research Ethics Committees) can only identify vulnerable participants by carefully examining the details of the proposed research. Hurst, in contrast, defines the vulnerable as those especially at risk of incurring the wrongs to which all research ethics participants are exposed. We offer a more substantive conception of vulnerability than Luna but one that gives rise to a different rubric of responsibilities from Hurst's. While we understand vulnerability to be an ontological condition of human existence, in the context of research ethics, we take the vulnerable to be research subjects who are especially prone to harm or exploitation. Our analysis rests on developing a typology of sources of vulnerability and showing how distinct sources generate distinct obligations on the part of the researcher. Our account emphasizes that the researcher's first obligation is not to make the research participant even more vulnerable than they already are. To illustrate our framework, we consider two cases: that of a vulnerable population involved in international research and that of a domestic population of people with diminished capacity.

PMID: 23718774 [PubMed - as supplied by publisher]

Public Health Genomics; 05/01/2013
With the human genome project running from 1989 until its completion in 2003, and the incredible advances in sequencing technology and in bioinformatics during the last decade, there has been a shift towards an increase focus on studying common complex disorders which develop due to the interplay of many different genes as well as environmental factors. Although some susceptibility genes have been identified in some populations for disorders such as cancer, diabetes and cardiovascular diseases, the integration of this information into the health care system has proven to be much more problematic than for single gene disorders. Furthermore, with the 1000$ genome supposedly just around the corner, and whole genome sequencing gradually being integrated into research protocols as well as in the clinical context, there is a strong push for the uptake of additional genomic testing. Indeed, the advent of public health genomics, wherein genomics would be integrated in all aspects of health care and public health, should be taken seriously. Although laudable, these advances also bring with them a slew of ethical and social issues that challenge the normative frameworks used in clinical genetics until now. With this in mind, we highlight herein 5 principles that are used as a primer to discuss the ethical introduction of genome-based information and genome-based technologies into public health. Copyright © 2013 S. Karger AG, Basel
(AN 87774061)
Health Policy Reference Center

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Ethical Tradeoffs in Trial Design: Case Study of an HPV Vaccine Trial in HIV-Infected Adolescent Girls in Lower Income Settings.

Dev World Bioeth. 2013 May 31;

Authors: Lindsey JC, Shah SK, Siberry GK, Jean-Philippe P, Levin MJ

Abstract
The Declaration of Helsinki and the Council of the International Organization of Medical Sciences provide guidance on standards of care and prevention in clinical trials. In the current and increasingly challenging research environment, the ethical status of a trial design depends not only on protection of participants, but also on social value, feasibility, and scientific validity. Using the example of a study assessing efficacy of a vaccine to prevent human papilloma virus in HIV-1 infected adolescent girls in low resource countries without access to the vaccine, we compare several trial designs which rank lower on some criteria and higher on others, giving rise to difficult trade-offs. This case demonstrates the need for developing more nuanced guidance documents to help researchers balance these often conflicting criteria.

PMID: 23725055 [PubMed - as supplied by publisher]

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Moderate eugenics and human enhancement.

Med Health Care Philos. 2013 Jun 1;

Authors: Selgelid MJ

Abstract
Though the reputation of eugenics has been tarnished by history, eugenics per se is not necessarily a bad thing. Many advocate a liberal new eugenics-where individuals are free to choose whether or not to employ genetic technologies for reproductive purposes. Though genetic interventions aimed at the prevention of severe genetic disorders may be morally and socially acceptable, reproductive liberty in the context of enhancement may conflict with equality. Enhancement could also have adverse effects on utility. The enhancement debate requires a shift in focus. What the equality and/or utility costs of enhancement will be is an empirical question. Rather than philosophical speculation, more social science research is needed to address it. Philosophers, meanwhile, should address head-on the question of how to strike a balance between liberty, equality, and utility in the context of genetics.

PMID: 23728949 [PubMed - as supplied by publisher]

Related Articles

Best practices in policy approaches to obesity prevention.

J Health Care Poor Underserved. 2013;24(2 Suppl):168-92

Authors: Fox AM, Horowitz CR

Abstract
The rapidly rising rate of obesity has prompted a variety of policy responses at national, regional, and local levels. Yet, many have expressed concern that these policy responses have a limited evidence base, are overly paternalistic, and have the potential to increase rather than shrink obesity-related disparities. The purpose of this article is to evaluate obesity policies in terms of the adequacy of evidence for action and along two ethical dimensions: their potential effect on liberty and equity. To evaluate evidence, we engage in a systematic review of reviews and rate policies in terms of the sufficiency of evidence of effectiveness at combating obesity. We then apply a libertarian-paternalist framework to assess policies in terms of their impact on liberty and inverse-equity theory to assess impact on disparities. This article provides a framework to assist decision-makers in assessing best practices in obesity using a more multi-faceted set of dimensions.

PMID: 23727973 [PubMed - in process]

The New Genetics and Informed Consent: Differentiating Choice to Preserve Autonomy.

Bioethics. 2013 May 30;

Authors: Bunnik EM, de Jong A, Nijsingh N, de Wert GM

Abstract
The advent of new genetic and genomic technologies may cause friction with the principle of respect for autonomy and demands a rethinking of traditional interpretations of the concept of informed consent. Technologies such as whole-genome sequencing and micro-array based analysis enable genome-wide testing for many heterogeneous abnormalities and predispositions simultaneously. This may challenge the feasibility of providing adequate pre-test information and achieving autonomous decision-making. At a symposium held at the 11th World Congress of Bioethics in June 2012 (Rotterdam), organized by the International Association of Bioethics, these challenges were presented for three different areas in which these so-called 'new genetics' technologies are increasingly being applied: newborn screening, prenatal screening strategies and commercial personal genome testing. In this article, we build upon the existing ethical framework for a responsible set-up of testing and screening offers and reinterpret some of its criteria in the light of the new genetics. As we will argue, the scope of a responsible testing or screening offer should align with the purpose(s) of testing and with the principle of respect for autonomy for all stakeholders involved, including (future) children. Informed consent is a prerequisite but requires a new approach. We present preliminary and general directions for an individualized or differentiated set-up of the testing offer and for the informed consent process. With this article we wish to contribute to the formation of new ideas on how to tackle the issues of autonomy and informed consent for (public) healthcare and direct-to-consumer applications of the new genetics.

PMID: 23718722 [PubMed - as supplied by publisher]

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Shared decision making in cancer screening and treatment decisions for American Indian and Alaska native communities: can we ethically calibrate interventions to patients' values?

J Cancer Educ. 2012 Dec;27(4):790-2

Authors: Nowakowski KE, Tilburt JC, Kaur JS

Abstract
Shared decision making has been advocated as a key ethical strategy to improve quality of care and cancer control, especially in relation to screening and treatment decisions at various stages of the cancer continuum. Recent research on cancer in American Indian/Alaska Native (AI/AN) communities has highlighted significant disparities, raising questions about how best to implement prevention and screening programs in often fragmented and underfunded Indian health, tribal and urban systems. Incorporating shared decision making initiatives routinely may provide opportunities to address the complex choices AI/AN patients face.

PMID: 23055128 [PubMed - in process]

Critical Public Health, Volume 0, Issue 0, Page 1-13, Ahead of Print.

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Ethics and Smoking Cessation: Should the Medical Treatment Be a "Freewill" Choice or a Mandatory Issue for Hospitalized COPD Patients?

Chest. 2012 Oct 1;142(4_MeetingAbstracts):1089A

Authors: Tilea L, Postolache P, Lica F, Ciobanu M

Abstract
SESSION TYPE: Tobacco Cessation and Prevention PostersPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PMPURPOSE: To identify the results of respecting the free-choice of COPD-related hospitalized patients regarding the method for smoking cessationMETHODS: All smokers hospitalized for COPD exacerbation in a Pneumology hospital received the same intensive counseling, consisting in motivational and behavioral counseling, specific education regarding smoking-related influences on COPD, the role of medication for cessation. It was emphasized the opportunity to start medication during hospitalization and to continue after discharge, free-of-charge. After one day, the patients were asked if they wish to follow the medical treatment for smoking cessation with varenicline or if they want to quit "cold turkey". The treatment was initiated after all the possible drug interactions were evaluated. The smoker status was determined by CO measurement. A final evaluation was made at discharge. Evaluations at 3, 6 and 12 months will follow.RESULTS: In the first 2 months of our study, 56 smokers with COPD-related exacerbations were admitted. 35 out of 56 patients (62,5%) considered sufficient the specific counseling for smoking cessation, while 21 patients (37,5%) expressed their wish to start medical treatment. From the 21 patients receiving medication, only one discontinued medication due to complications of COPD, meaning that 95.2% were non-smokers at discharge. From the 35 patients receiving only specific counseling, 19 (representing 54.3%) were non-smokers at discharge. This means that almost a third (30.3%) of all COPD patients were still smokers at discharge.CONCLUSIONS: Despite their precarious physical and psychological status, intensive psychological counseling and free-of-charge, efficient treatment, almost one third of patients hospitalized for COPD exacerbation are reluctant to choose the evidence-based recommendation for quitting smoking and continue to smoke.CLINICAL IMPLICATIONS: Taking into account the evidences about the effects of smoking on the evolution and prognosis of COPD, the efficacy of the medication for smoking cessation, these preliminary results could contribute to give an answer to the ethical issue: should we or should we not introduce the treatment for tobacco addiction in the regular treatment of COPD exacerbation, regardless the opinion of the patient.DISCLOSURE: The following authors have nothing to disclose: Lavinia Tilea, Florentina Lica, Magdalena CiobanuNo Product/Research Disclosure InformationNational Institute of Pneumology "Marius Nasta", Bucharest, Romania.

PMID: 23699871 [PubMed - as supplied by publisher]

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[Public health program planning through the capabilities lens.]

Rev Epidemiol Sante Publique. 2013 May 15;

Authors: Breton E, Sherlaw W

Abstract
As a theory of distributive justice, Amartya Sen's theory of capabilities questions the choices and decisions associated with the development and planning of public health programs. In this paper, the authors describe Sen's approach and explore its implications for public health by applying it to the case of tobacco control programs. Based on the tobacco control objectives set by the WHO and on the MPOWER package of measures, they notice that the translation of the objectives in capabilities call for a greater attention to the conditions of living of the different population groups. It also put into doubt the measures restricting access to tobacco products that do not account for their differing impacts on adults. The authors conclude that this ethical perspective is likely to be controversial as it may rank freedom as a value that overrides health.

PMID: 23684105 [PubMed - as supplied by publisher]

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