Selected Topics - Ethics

• Australian Association of Professional and Applied Ethics
  The AAPAE s a dedicated to raising awareness and encouraging debate on issues of professional and applied ethics

Events

• School of Public Health and Community Medicine, UNSW - Upcoming Events

Global policies and related documents

• Approaches to Comprehensive National Policies on Ageing: Government - NGO Cooperation United Nations Economic and Social Commission for Asia and the Pacific, 2004

Reports, guidelines and projects

• Bioethical Implications of Globalization: An International Consortium Project of the European Commission
  Published in PLOS Medicine, this article outlines the Bioethical Implications of Globalization (BIG) project, a 42 months provisional project that aims to anticipate the major reasons for bioethical concern surrounding globalisation, to forecast future scenarios and to formulate new policy options in this field. The project’s purpose is both to raise short-term, tactical considerations and to provide a longer-term, strategic perspective.
• Bulletin of the World Health Organization Volume 86, Number 8, August 2008
  This month’s special theme is ethics and public health. In the first editorial, Carl H Coleman et al. discuss the key issues in public-health ethics and how WHO incorporates ethics into its mission. In the second, John Krebs presents the ethical dilemma involved in balancing individual rights with government intervention. In the third, Cristina P Pinheiro questions the ethics of drug donations and proposes alternative aid solutions. Articles: ‘The contribution of ethics to public health’ by Carl H Coleman et al.; ‘The importance of public-health ethics’ by John Krebs; ‘Drug donations: what lies beneath’ by Cristina P Pinheiro; ‘Using human rights to improve maternal and neonatal health: history, connections and a proposed practical approach’ by Sofia Gruskin et al.; ‘Herbal medicine research and global health: an ethical analysis’ by Jon C Tilburt & Ted J Kaptchu; ‘Denaturalizing scarcity: a strategy of enquiry for public-health ethics’ by Ted Schrecker; ‘Integrating ethics, health policy and health systems in low- and middle-income countries: case studies from Malaysia and Pakistan’ by Adnan A Hyder et al.; ‘Demographic and health surveillance: longitudinal ethical considerations’ by Margaret Carrel & Stuart Rennie; ‘Ethical analysis to improve decision-making on health technologies’ by Samuli I Saarni et al.; ‘A personalist approach to public-health ethics’ by Carlo Petrini & Sabina Gainotti; ‘National bioethical legislation and guidelines for biomedical research in the Islamic Republic of Iran’ by Farzaneh Zahedi & Bagher Larijani; ‘Health-sector responses to intimate partner violence in low- and middle-income settings: a review of current models, challenges and opportunities’ by Manuela Colombini et al.; ‘Emerging norms for the control of emerging epidemics’ by Christopher W McDougall et al.; ‘The burden of surgical conditions and access to surgical care in low- and middle-income countries’ by Doruk Ozgediz et al.; and ‘Access to medicines versus access to treatment: the case of type 1 diabetes’ by David Beran et al.
• Environmental Ethics and Public Policy Program
  Part of the Center for the Study of Values in Public life at the Harvard Divinity School , this program examines the issue of environmental ethics through seminars, courses and subject bibliographies.
• Establishing Bioethics Committees - Guide No.1
  This UNESCO publication is intended to provide a number of suggestions after having reviewed the efforts of many Member States that have already established Bioethics Committees at the national, regional, or local levels. The need to reflect on the moral dimension of advances in science and technology, as well as the desire to enhance the public’s health has, in many areas of the world, led to the establishment of various forms of Bioethics Committees, four of which are described and discussed in this Guide.
• Ethical Choices in Long-Term Care: What does Justice require?
  This PDF document published by WHO examines the ethical issues associated with providing long-term care to people with some sort of limitation. It recognises that all people including those with disabilities have the right to function as fully as their condition permits, regardless of their starting place.
• Ethical issues in epidemiological research and public health practice
  "A rich and growing body of literature has emerged on ethics in epidemiologic research and public health practice. Recent articles have included conceptual frameworks of public health ethics and overviews of historical developments in the field. Several important topics in public health ethics have also been highlighted. Attention to ethical issues can facilitate the effective planning, implementation, and growth of a variety of public health programs and research activities. ...Published in Emerging Themes in Epidemiology 3:16, 2006 this article by Steven S Coughlin provides an overview of ethical issues in epidemiologic research and public health practice for readers who do not necessarily have an in-depth knowledge of public health ethics."
• Ethics and governance of global health inequalities
  Research Aim: To study why global health inequalities are morally troubling, why efforts to reduce them are morally justified, how they should be measured and evaluated; how much priority disadvantaged groups should receive; and to delineate roles and responsibilities of national and international actors and institutions. Discussion and conclusions: Duties and obligations of international and state actors in reducing global health inequalities are outlined. The ethical principles endorsed include the intrinsic value of health to well-being and equal respect for all human life, the importance of health for individual and collective agency, the concept of a shortfall from the health status of a reference group, and the need for a disproportionate effort to help disadvantaged groups. This approach does not seek to find ways in which global and national actors address global health inequalities by virtue of their self-interest, national interest, collective security or humanitarian assistance. It endorses the more robust concept of "human flourishing" and the desire to live in a world where all people have the capability to be healthy. Unlike cosmopolitan theory, this approach places the role of the nation-state in the forefront with primary, though not sole, moral responsibility. Rather, shared health governance is essential for delivering health equity on a global scale.
• Ethics, Development and Disaster
  Text of keynote address delivered by Nobel Laureate Amartya Sen at the Ethics and Development Day of the Inter-American Development Bank on January 11, 2005 as part of the Inter-American Initiative on Social Capital, Ethics and Development.
• Ethics in Public Health Research: Anthrax Vaccine and Public Health Policy
  The Centers for Disease Control and Prevention has classified Bacillus anthracis, the causative organism of anthrax, as a category A potential bioterrorism agent. There are critical shortcomings in the US anthrax vaccine program. Rather than depending on the private sector, the government must assume direct production of anthrax vaccine. The development of a capacity capable of preemptive immunization of the public against anthrax should be considered. [publication summary] [American Journal of Public Health, November 2007, Vol 97, No. 11, pp.1945-1951]
• Global Pharmaceutical Development and Access: Critical Issues of Ethics and Equity
  The article presents global data on access to pharmaceuticals and discusses underlying barriers. Two are highly visible: pricing policies and intellectual property rights; two are less recognized: the regulatory environment and scientific and technological capacities. Two ongoing transitions influence and even distort the problem of universal access to medications: the epidemiologic transition to an increasing burden of chronic non-communicable diseases; and the growing role of biotechnology products (especially immunobiologicals) in the pharmacopeia. Examples from Cuba and Brazil are used to explore what can and should be done to address commercial, regulatory, and technological aspects of assuring universal access to medications. [author abstract] [MEDICC Review Vol. 13, No 3, PP.16-22, July 2011]
• Health Capability: Conceptualization and Operationalization
  Current theoretical approaches to bioethics and public health ethics propose varied justifications as the basis for health care and public health, yet none captures a fundamental reality: people seek good health and the ability to pursue it. Existing models do not effectively address these twin goals. The approach I espouse captures both of these orientations through a concept here called health capability. Conceptually, health capability illuminates the conditions that affect health and one’s ability to make health choices. By respecting the health consequences individuals face and their health agency, health capability offers promise for finding a balance between paternalism and autonomy. I offer a conceptual model of health capability and present a health capability profile to identify and address health capability gaps. [author abstract] [Am J Public Health, 2010; 100: 41–49]
• Is There a Global Bioethics? End-of-Life in Thailand and the Case for Local Difference
  Over the past decade, several scholars have advocated for international standards in medical ethics and human rights. Others have countered that such standards risk ignoring important cultural differences in the way people conceptualize medical decision-making. This essay, published in PLoS Medicine Vol.2, Iss. 10, 2006 explores possible answers to these questions, ultimately arguing that Western bioethics is insufficient to solve the problems that arise in the practice of allopathic medicine in non-Western contexts.
• Pandethics
  This paper explains the ethical importance of infectious diseases, and reviews four major ethical issues associated with pandemic influenza: the obligation of individuals to avoid infecting others, healthcare workers' 'duty to treat', allocation of scarce resources, and coercive social distancing measures. In each case, ways in which the ethical issues turn on both philosophical and empirical questions are highlighted. The paper concludes that ethicists should play a greater role in identifying ethically important empirical questions, and that scientists should take the ethical as well as the scientific importance of such questions into consideration when choosing research projects. [publication summary] [Public Health 123 (2009): 255–259]
• Patients’ Informed Consent in Dental Practice in Bulgaria
  Introduction: Patients’ informed consent is a legal regulation and a moral principle, determined by legislation in Bulgaria and the European Union. It represents patients’ rights to take part in the clinical decisions concerning their treatment. The authors report research showing informed consent’s more important aspects related to daily relationships between dentists and patients. Aims: The main aims of this study were to investigate the use of patients’ informed consent and the extent to which it is provided in Bulgarian dentists’ practice. Methods: A questionnaire, which included questions on various aspects of the use of informed consent, was used to collect data from a convenience sample of 102 dentists working in the Medical University of Sofia, Faculty of Dental Medicine and the Military Medical Academy, Sofia, Bulgaria. Completed questionnaires were returned anonymously. Results: Eighty dentists completed the questionnaire. Seventy-eight (97.5%) replied that they thought informed consent was necessary. Seventy (87.5%) dentists reported that they took informed consent for all types of treatment. Of the remainder, 10 reported taking informed consent prior to surgical interventions, eight before orthodontic treatment and seven before prosthetic treatment. However, only 64 (80%) respondents reported that they always obtained informed consent from their patients. Thirty-seven (46.25%) dentists responded that they obtained the oral form of informed consent, 30 (37.5%) that they obtained written informed consent, and 13 (16.25%) that they obtained both forms. Surgical treatment was the most frequent case in which the written form was obtained. Almost all participants (70; 87.5%) reported that they should always take informed consent when they treated children. Forty-one (51.25%) reported that they obtained informed consent from all patients but 21 (26.25%) did not obtain it when treating colleagues, 29 (36.25%) from relatives, 15 (18.75%) from friends, and 10 (12.5%) from long-time patients. Conclusions: From the current survey, it can be concluded that the dentists as staff members of leading training and healthcare facilities may well have demonstrated greater awareness about questions concerning patients’ informed consent than most other Bulgarian dentists. Informed consent plays a major role in the daily practice of the majority but many are not using written consent as a routine procedure. However, even though almost 100% of the dentists thought that it is necessary to get informed consent, only 80% of them obtained it in practice. [author abstract] [OHDM, Vol. 10, No. 2, pp.80-87 - June, 2011]
• Program on Legal and Ethical Issues in Correctional Health
  This program at the University of Texas focuses on the complex legal and ethical issues involved in the delivery of health care in correctional facilities, such as prisons, jails and juvenile detention facilities.
• Public health and ethics: An overview
  This article illustrates the ethical principles of medical care in the context of public health interventions. Emphases were made to describe the contemporary domain of public health in Sudan and to highlight several points that might help in conducting ethically sound interventions. It describes the main characteristics of public health interventions in our country in detail: performance of public health interventions in healthy people and their intrusive nature, the paternalistic temperament within which they are performed, lack of modern public health legislative code, and lack of evidence based interventions. It also examines several arguments that shape the moral and ethical bases for public health interventions. It arguse [sic] that public health interventions must meet four requirements to be ethically sound: (1) political acceptance, (2) public justification and community participation, (3) equity and justice, and; (4) confidentiality. [publication abstract] [Sudanese Journal of Public Health: July 2007, Vol.2 (3) 146-151]
• Public health: ethical issues
  "In this Report the authors consider some of the ethical issues that arise from efforts to improve health at the population level, and we examine the roles and responsibilities of the different parties involved. Although some might see personal behaviour as the primary factor determining the health of the population, we consider that to be too simplistic. Individual behaviour certainly plays a role, but health is influenced by many factors, such as clean air, the built and work environment, socio-economic and genetic background, and access to healthcare. Industries such as those producing, selling and marketing food, drink and tobacco also play an important role, and the impact of almost all these factors is influenced directly or indirectly by government policy." A short guide is also available.
• Reporting of euthanasia and physician-assisted suicide in the Netherlands: descriptive study
  Background: An important principle underlying the Dutch Euthanasia Act is physicians' responsibility to alleviate patients' suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians to report euthanasia to a review committee. We studied which arguments Dutch physicians use to substantiate their adherence to the criteria and which aspects attract review committees' attention. Methods: We examined 158 files of reported euthanasia and physician-assisted suicide cases that were approved by the review committees. We studied the physicians' reports and the verdicts of the review committees by using a checklist. Results: Physicians reported that the patient's request had been well-considered because the patient was clear-headed (65%) and/or had repeated the request several times (23%). Unbearable suffering was often substantiated with physical symptoms (62%), function loss (33%), dependency (28%) or deterioration (15%). In 35%, physicians reported that there had been alternatives to relieve patients' suffering which were refused by the majority. The nature of the relationship with the consultant was sometimes unclear: the consultant was reported to have been an unknown colleague (39%), a known colleague (21%), otherwise (25%), or not clearly specified in the report (24%). Review committees relatively often scrutinized the consultation (41%) and the patient's (unbearable) suffering (32%); they had few questions about possible alternatives (1%). Conclusion: Dutch physicians substantiate their adherence to the criteria in a variable way with an emphasis on physical symptoms. The information they provide is in most cases sufficient to enable adequate review. Review committees' control seems to focus on (unbearable) suffering and on procedural issues. [author abstract] [BMC Medical Ethics 2009, 10:18]
• Shared Principles of Ethics for Infant and Young Child Nutrition in the Developing World
  Background: The defining event in the area of infant feeding is the aggressive marketing of infant formula in the developing world by transnational companies in the 1970s. This practice shattered the trust of the global health community in the private sector, culminated in a global boycott of Nestle products and has extended to distrust of all commercial efforts to improve infant and young child nutrition. The lack of trust is a key barrier along the critical path to optimal infant and young child nutrition in the developing world. Discussion: To begin to bridge this gap in trust, we developed a set of shared principles based on the following ideals: Integrity; Solidarity; Justice; Equality; Partnership, cooperation, coordination, and communication; Responsible Activity; Sustainability; Transparency; Private enterprise and scale-up; and Fair trading and consumer choice. We hope these principles can serve as a platform on which various parties in the in the infant and young child nutrition arena, can begin a process of authentic trust-building that will ultimately result in coordinated efforts amongst parties. Summary: A set of shared principles of ethics for infant and young child nutrition in the developing world could catalyze the scale-up of low cost, high quality, complementary foods for infants and young children, and eventually contribute to the eradication of infant and child malnutrition in the developing world. [author abstract] [BMC Public Health 10: 321, 2010]
• The Declaration of Helsinki and public health
  This paper "looks back on a ground-breaking contribution to public health, reproduces an extract of the original text and adds a commentary on its significance from a modern perspective. … John R Williams looks at the Declaration of Helsinki and how it has evolved over time. The original declaration is reproduced here in full with permission of the World Medical Association." [Bulletin of the World Health Organization, August 2008, 86 (8): 650-652]
• The Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the United States
  "The Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the United States (the Code) reflects the mutual recognition of stakeholder interests relevant to the recruitment of foreign educated nurses (FENs) to the United States. It is based on an acknowledgement of the rights of individuals to migrate, as well as an understanding that the legitimate interests and responsibilities of nurses, source countries, and employers in the destination country may conflict. It affirms that a careful balancing of those individual and collective interests offers the best course for maximizing the benefits and reducing the potential harm to all parties. While the Code acknowledges the interests of these three primary stakeholder groups, its subscribers are the organizations that recruit and employ foreign educated nurses, e.g., third party recruiting firms, staffing agencies, hospitals, long-term care organizations and health systems."
• Whose hands on your genes?
  This discussion document on the storage, protection and the use of personal genetic information was published by the UK Human Genetics Commission in 2000.
• Virulent Epidemics and the Scope of Healthcare Workers' Duty of Care
  This article published in Emerging Infectious Diseases Vol.12, No.8; August 2006 critically examines the concept of duty of care as it relates to health care workers in epidemic situations.

Educational resources

• Bioethics Resources on the Web
  This website from the National Institutes of Health (USA) contains a broad collage of annotated web links dealing with Bioethics issues.
• Growth House
  An international gateway to resources for life-threatening illness and end of life issues.
• Genethics
  This site administered by Bryn Williams-Jones, a fellow in Ethics and Research Associate at Cardiff University, serves as a "clearing house for information on the social, ethical and policy issues associated with genetic and genomic knowledge and technology" .
• Human Genome Project Information- Ethical, Legal and Social Issues
  This site examines the social, ethical and legal issues surrounding the availability of human genetic information associated with the Human Genome Project.
• International Communication Forum in Human Molecular Genetics
  This page provides a forum for scientists, physicians and other genetics professionals worldwide to communicate the latest information in human molecular genetics.
• National Human Genome Research Institute Information Kit
  This multimedia education kit, first launched in 2001 by the Human Genome Project, is aimed at high school students and the general public. It includes a project timeline, essays on the legal and ethical implications of the project as well as a 3D computer-animated video illustrating the basic components and principles of molecular biology and a 15-minute video documentary, 'The Secrets of Our Lives', that weaves together conversations with HGP leaders to trace the development of the project and to address its scientific and societal impact.

Organisations and Networks

UN and multinational

• UNESCO, International Bioethics Committee
  UNESCO's Bioethics programme serves as an intellectual forum to examine the social, cultural, legal and ethical implications of stem cell research, genetic testing, cloning and other breakthroughs in the life sciences and to formulate bioethics policy in response.

Government

• Human Genome Research
  This US Department of Energy site provides an overview of the Human Genome Project and its vast implications for agriculture, medicine etc.,

Non Government

• American Society for Bioethics and Humanities (ASBH)
  A professional society of individuals, organizations, and institutions interested in bioethics and humanities
• American Society of Law, Medicine & Ethics (ASLME)
  The aim of this society is to provide high-quality scholarship, debate, and critical thought to the community of professionals at the intersection of law, health care, policy, and ethics.
• Center for Bioethics
  An interdisciplinary, interprofessional unit of the University of Pennsylvania Health System in Philadelphia. The Center's mission is to advance scholarly and public understanding of ethical, legal, social and public policy issues in health care.
• Center for Clinical Ethics and Humanities in Health Care
  Located at State University of New York at Buffalo, provides resources on bio-ethics including the database BIOETHICS
• Center for Health Ethics and Law
  Located at the West Virginia University (USA), the Center is affiliated with the professional schools of Dentistry, Medicine, Nursing and Pharmacy of the Robert C. Byrd Health Sciences Center.
• Centre for Professional Ethics
  The Centre is a research and teaching institution at the University of Central Lancashire in Preston. Its focus is applied philosophy, particularly in bioethics and environmental ethics.
• Council for Responsible Genetics
  A non-profit organization based in the USA
• Eubios Ethics Institute
  A non-profit group based in Japan that aims to stimulate the international discussion of ethical issues and technology development. It aims at an integrated and cross cultural approach to bioethics and at building up an international network.
• Global Lawyers and Physicians: Working Together for Human Rights
  A non-profit , non-governmental organisation focusing on health and human rights issues.
• Human Genome Organization (HUGO)
  An international organisation of scientists involved in human genetics
• Indigenous Peoples' Council on Biocolonialism
  The IPCB is organized to assist indigenous peoples in the protection of their genetic resources, indigenous knowledge, cultural and human rights from the negative effects of biotechnology.
• International Association of Bioethics
  The International Association of Bioethics aims to link all those working in bioethics and related fields facilitating mutual contact and encouraging the discussion of cross-cultural aspects in bioethics.
• International Center for Genetic Engineering and Biotechnology (ICGEB)
  ICGEB is an international organisation established to promote the safe use of biotechnology world wide with special regard to the needs of the developing world. ICGEB aims to be a research and training Centre of Excellence for its member states.
• John Dosseter Centre for Bioethics
  A joint project of the Faculties of Medicine and Nursing (University of Alberta) and the Capital Health Authority (University of Alberta Hospital Site) an interdisciplinarian, non-sectarian project encompassing medicine, nursing, dentistry, law, philosophy and theology.
• National Human Genome Research Institute (NHGRI)
  The leading coordinating body of the Human Genome Project
• Nordic Committee on Bioethics
  "The Committee sets out to promote Nordic collaboration and the exchange of information between researchers, scientists, parliamentarians and opinion formers on ethical aspects of biotechnology research, development and adaptation."
• HudsonAlpha Genome Sequencing Center (formerly the Stanford Human Genome Center)
  "The HudsonAlpha Genome Sequencing Center... is a not-for-profit research group, located at the HudsonAlpha Institute for Biotechnology, focusing on the generation of high quality plant and fungal genomic resources for the scientific community. We specialize in eukaryotic whole genome sequence, assembly, and analysis together with improvement or finishing of complex eukaryotic genomes."
• The (Alberta) Provincial Health Ethics Network, Alberta
  The mission of PHEN is to facilitate examination, discussion and decision-making with respect to ethical issues in health care in the Province of Alberta and to provide a linkage for Albertans needing health ethics assistance and to those interested and involved in health care ethics.
• University of Pittsburgh Center for Biosecurity
  The Center works to prevent the development and use of biological weapons, to catalyse advances in science and governance that diminish the power of biological weapons as agents of mass lethality, and to lessen the illness, death and civil disruption that would result if prevention efforts fail.

Academic Institutions with particular focus in this area

• Albert Einstein College of Medicine Training Program in Research Ethics
  This is a training program in international research ethics, with the aim of contributing to capacity building in research ethics in Latin America and fostering ongoing collaborations in the Americas
• Course on Ethical Issues in International Health Research
  Offered by the School of Public Health, Harvard University
• Phoebe R Berman Bioethics Institute
• School of Public Health and Community Medicine, UNSW

Key Conferences, conference and workshop reports

Conference reports

Journals, Newsletters, Forums

• American Journal of Bioethics
  
• Public Health Ethics
  Public Health Ethics (PHE) is a peer-reviewed international journal with a focus on the systematic analysis of the moral problems that arise in public health and preventive medicine. PHE combines theoretical and practical work from many different fields, notably philosophy, law, and politics, but also epidemiology and the medical sciences.

Bibliographies, Libraries

Public health bookshops

• EthicsWeb Bookstore
  A Comprehensive Canada based online bookstore dedicated to all aspects of ethical thought and practice
• Public Health bookshop