Johri, Mira, Ryoa Chung, et. al.. Global health and national borders: the ethics of foreign aid in a time of financial crisis.
2012, Globalization and Health 8:19
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Added by: Simon Fokt, Contributed by: Mira JohriAbstract:
BACKGROUND: The governments and citizens of the developed nations are increasingly called upon to contribute financially to health initiatives outside their borders. Although international development assistance for health has grown rapidly over the last two decades, austerity measures related to the 2008 and 2011 global financial crises may impact negatively on aid expenditures. The competition between national priorities and foreign aid commitments raises important ethical questions for donor nations. This paper aims to foster individual reflection and public debate on donor responsibilities for global health. METHODS: We undertook a critical review of contemporary accounts of justice. We selected theories that: (i) articulate important and widely held moral intuitions; (ii) have had extensive impact on debates about global justice; (iii) represent diverse approaches to moral reasoning; and (iv) present distinct stances on the normative importance of national borders. Due to space limitations we limit the discussion to four frameworks. RESULTS: Consequentialist, relational, human rights, and social contract approaches were considered. Responsibilities to provide international assistance were seen as significant by all four theories and place limits on the scope of acceptable national autonomy. Among the range of potential aid foci, interventions for health enjoyed consistent prominence. The four theories concur that there are important ethical responsibilities to support initiatives to improve the health of the worst off worldwide, but offer different rationales for intervention and suggest different implicit limits on responsibilities. CONCLUSIONS: Despite significant theoretical disagreements, four influential accounts of justice offer important reasons to support many current initiatives to promote global health. Ethical argumentation can complement pragmatic reasons to support global health interventions and provide an important foundation to strengthen collective action.
Comment : Designed for researchers, students, and practitioners in global health, this text offers an introduction to four important contemporary accounts of global justice and traces the implications of each position concerning responsibilities for health of people who live outside one’s own country. The text was written to empower each reader to develop her own position on responsibilities for global health. It is useful as a basis for classroom discussion and debate on contemporary challenges such as global health governance, aid, and distribution of scarce resources such as access to Covid-19 diagnostics, vaccines, and therapeutics.Kittay, Eva Feder. When Caring Is Just and Justice is Caring: Justice and Mental Retardation2001, Public Culture 13(3): 557-580-
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Added by: Jamie Robertson
Summary: In this paper, Kittay advances a conception of justice that 'begins with an acknowledgement of dependency and seeks to organise society so that our well-being is not inversely related to our need for care or to care' (576). Her motivation for advancing this view is that ideals of citizenship in liberal society, including independence and productivity, perpetuate the victimisation, social exclusion, or stigmatisation of people with mental retardation and their carers. This is because liberal definitions of personhood do not provide resources for responding in a morally adequate way to the mutual dependence of people with mental retardation and their carers/advocates. People with mental retardation are inescapably dependent because of their central need for attentive care. And, carers' work is so deeply other-directed that they also do not fit the liberal model of the rationally self-interested actor. Thus, both carers and their charges are vulnerable and need to be advocated for so that they can be seen as having important entitlements to public resources and claims to justice. To this end, Kittay proposes a conception of personhood that is based on relationships. Although those with mental retardation are inherently dependent, they still count as persons because they are able to participate in relationships. This makes them entitled to the satisfactions that make life worth living. To achieve the twin goal of achieving justice for familial or paid carers, Kittay advances a new principle of justice, doulia, which calls for larger society to support those who care for the inexorably dependent. Kittay takes her relational conception of personhood and her principle of doulia to ensure that appropriate forms of social organization exist to support all those who become dependent. She claims her view is needed because principles of charity and beneficence are not adequate since they are consistent with the continued stigmatization of mental retardation and care work, and ground only low-priority social obligations.Comment : This paper, with it's helpful discussions of the elements of the liberal tradition with which Kittay specifically takes issue and the inadequacies of the Americans with Disabilities Act, would be an appropriate reading for courses about the philosophy of disability or about liberal political theory.Kuhse, Helga. The Sanctity-of-Life Doctrine in Medicine: A Critique1987, Oxford University Press.-
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Added by: Clotilde Torregrossa, Contributed by: Simon Fokt
Publisher's Note: According to the "sanctity-of-life" view, all human lives are equally valuable and inviolable, and it would be wrong to base life-and-death medical decisions on the quality of the patient's life. Examining the ideas and assumptions behind the sanctity-of-life view, Kuhse argues against the traditional view that allowing someone to die is morally different from killing, and shows that quality-of-life judgments are ubiquitous. Refuting the sanctity-of-life view, she provides a sketch of a quality-of-life ethics based on the belief that there is a profound difference between merely being alive and life being in the patient's interest.Kuhse, Hoyt, Singer, Peter. Should the Baby Live? The Problem of Handicapped Infants1985, Oxford University Press.-
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Added by: Clotilde Torregrossa, Contributed by: Simon Fokt
Publisher's Note: Few subjects have generated so many newspaper headlines and such heated controversy as the treatment, or non-treatment, of handicapped newborns. In 1982, the case of Baby Doe, a child born with Down's syndrome, stirred up a national debate in the United States, while in Britain a year earlier, Dr. Leonard Arthur stood trial for his decision to allow a baby with Down's syndrome to die. Government intervention and these recent legal battles accentuate the need for a reassessment of the complex issues involved. This volume--by two authorities on medical ethics--presents a philosophical analysis of the subject based on particular case studies. Addressing the doctrine of the absolute sanctity of life, Singer and Kuhse examine some actual cases where decisions have been reached; consider the criteria for making these decisions; investigate the differences between killing and letting die; compare Western attitudes and practices with those of other cultures; and conclude by proposing a decision-making framework that offers a rational alternative to the polemics and confusion generated by this highly controversial topic.Lepora, Chiara. Individual Complicity: The Tortured Patient2013, In Chiara Lepora & Robert Goodin (eds.), On complicity and compromise. Oxford: Oxford University Press.-
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Added by: Clotilde Torregrossa, Contributed by: Simon Fokt
Abstract: Medical complicity in torture is prohibited by international law and codes of professional ethics. But in the many countries in which torture is common, doctors frequently are expected to assist unethical acts that they are unable to prevent. Sometimes these doctors face a dilemma: they are asked to provide diagnoses or treatments that respond to genuine health needs but that also make further torture more likely or more effective. The duty to avoid complicity in torture then comes into conflict with the doctor's duty to care for patients. Sometimes the right thing for a doctor to do requires complicity in torture. Whether this is the case depends on: the expected consequences of the doctor's actions; the wishes of the patient; and the extent of the doctor's complicity with wrongdoing. Medical associations can support physicians who face this dilemma while maintaining a commitment to clear principles denouncing torture.Levenbook, Barbara Baum. That Makes It Worse1980, The Monist 63 (2):228-245.-
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Added by: Chris Blake-Turner, Contributed by: Barbara Baum Levenbook
Abstract: Essays on excusing conditions and their correlates, mitigating conditions, usually begin with the assumption that there is general agreement on what the standard excuses are, and on where they are inapplicable. This assumption is justified; criminal law and the history of discussions of excuses have produced accord, though now and then doubts are expressed about particulars. Essays on excuses typically aim not so much to convince one that such-and-such are the general types of excuses but, rather, to show how they work and what their operation reveals about the nature of voluntary acts, full responsibility, etc.Comment : In a course on moral reasoningLiao, Shen-yi, Vanessa Carbonell. Materialized Oppression in Medical Tools and Technologies2023, American Journal of Bioethics 23(4), pp. 9-23-
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Added by: Maria Jimena Clavel VazquezAbstract:
It is well-known that racism is encoded into the social practices and institutions of medicine. Less well-known is that racism is encoded into the material artifacts of medicine. We argue that many medical devices are not merely biased, but materialize oppression. An oppressive device exhibits a harmful bias that reflects and perpetuates unjust power relations. Using pulse oximeters and spirometers as case studies, we show how medical devices can materialize oppression along various axes of social difference, including race, gender, class, and ability. Our account uses political philosophy and cognitive science to give a theoretical basis for understanding materialized oppression, explaining how artifacts encode and carry oppressive ideas from the past to the present and future. Oppressive medical devices present a moral aggregation problem. To remedy this problem, we suggest redundantly layered solutions that are coordinated to disrupt reciprocal causal connections between the attitudes, practices, and artifacts of oppressive systems.Comment : available in this BlueprintO'Neill, Onora. Some limits of informed consent2003, Journal of Medical Ethics 29 (1):4-7-
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Added by: Simon Fokt
Abstract: Many accounts of informed consent in medical ethics claim that it is valuable because it supports individual autonomy. Unfortunately there are many distinct conceptions of individual autonomy, and their ethical importance varies. A better reason for taking informed consent seriously is that it provides assurance that patients and others are neither deceived nor coerced. Present debates about the relative importance of generic and specific consent (particularly in the use of human tissues for research and in secondary studies) do not address this issue squarely. Consent is a propositional attitude, so intransitive: complete, wholly specific consent is an illusion. Since the point of consent procedures is to limit deception and coercion, they should be designed to give patients and others control over the amount of information they receive and opportunity to rescind consent already given.Comment : A great introductory text offering a short overview of the problems related to consent. The point regarding the intransitivity of consent is likely to inspire interesting discussions. As the paper is quite short, it can easily be used in conjunction with other texts.O'Neill, Onora. Autonomy and Trust in Bioethics2002, Cambridge University Press.-
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Added by: Chris Howard, Contributed by: Simon Fokt
Publisher's Note: Onora O'Neill suggests that the conceptions of individual autonomy (so widely relied on in bioethics) are philosophically and ethically inadequate; they undermine rather than support relationships based on trust. Her arguments are illustrated by issues raised by such practices as the use of genetic information by the police, research using human tissues, new reproductive technologies, and media practices for reporting on science, medicine, and technology. The study appeals to a wide range of readers in ethics, bioethics, and related disciplines.Comment : Parts of this book are an excellent supplement to units on autonomy and informed consent in an intermediate-advanced level medical ethics course. In particular, chapters 1, 2, and 4 would be excellent additions to a unit on autonomy, and chapter 7 would be a similarly excellent addition to a unit on informed consent.Rhodes, Rosamond. The professional responsibilities of medicine2007, In Rosamond Rhodes, Leslie Francis & Anita Silvers (eds.), The Blackwell Guide to Medical Ethics. Blackwell.-
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Added by: Clotilde Torregrossa, Contributed by: Simon Fokt
Publisher's Note: The Blackwell Guide to Medical Ethics is a guide to the complex literature written on the increasingly dense topic of ethics in relation to the new technologies of medicine. Examines the key ethical issues and debates which have resulted from the rapid advances in biomedical technology Brings together the leading scholars from a wide range of disciplines, including philosophy, medicine, theology and law, to discuss these issues Tackles such topics as ending life, patient choice, selling body parts, resourcing and confidentiality Organized with a coherent structure that differentiates between the decisions of individuals and those of social policyCan’t find it?Contribute the texts you think should be here and we’ll add them soon!
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