Anthropocene, climate change, public health ethics and non human animals
Dr. Fabiola Leyton | University of Barcelona | Spain
In the context of climate change today, the Anthropocene challenges the Ethics of Public Health. In this paper, I want to address how urgent and critical the shift from animal agriculture to plant-based diets has become.
Individual health responsibility must be supported by public health policies that take into account the food consequences in a context of climate change to promote the shift from animal agriculture to plant-based diets, through economic and tax incentives for the adoption of plant-based diets, subsidies for plant-based foods, among other public measures that have an impact on the private sphere.
Critical review of literature, reports and recommendations on climate change, public health, food ethics lead to the intersectional consideration of this complex problem that is a global concern.
It reflects on six intersectional areas that shape this problem: climate change, the sustainable development goals agenda and global food strategy, the threat of agriculture and livestock farming in the context of climate change, the individual and collective benefits of adopting plant-based diets, the threat of pandemics, and the responsibility and ethics of science; to set out some urgent proposals in relation to public health and the individual choices it shapes
More efforts are needed in order to intersectionally address the consequences of climate change in the Anthropocene era. This implies major shifts in public health ethics that integrate dietary changes towards the promotion of plant-based food consumption, away from animal agriculture and grounded in the social responsibility of science and technology.
From self-management to shared management in chronic care: an empirical ethics investigation into the lived experience of chronic disease in England
Dr. Francisca Stutzin | University of Cambridge | United Kingdom
This paper focuses on the problem of health outcomes inequalities for chronic diseases. It argues that 1) even within universal health coverage systems, there are significant health inequalities caused by differences in patients’ abilities to adhere to long-term treatments and that 2) inequalities in long-term treatment adherence are correlated with, and aggravate, existing health inequalities.
Long-term care largely focuses on patient self-management. This presupposes that patients can psychologically adjust to illness and systematically adhere to treatment. However, a significant proportion of patients struggle to fulfil these expectations. Thus, a qualitative empirical ethics study was conducted within the NHS England to better understand this double inequity.
Overall findings suggest that current views of adjustment and long-term treatment adherence ignore the dynamism and interdependence underlying the management of chronic disease. Drawing on first-person accounts of illness and adopting an interdisciplinary perspective this work describes adjustment to chronic disease as the ongoing effort towards balancing multiple demands to live lives people have reason to value.
Wellbeing is not always best promoted by maximising treatment adherence, so patients do not and should not always prioritise long-term treatment over competing concerns and projects. Still, it is morally problematic that structural injustice puts the disadvantaged in a position in which they are more likely to lack the freedom to prioritise treatment. This paper concludes that adopting a shared responsibility model for long-term care has the potential to ameliorate the cumulative effect of disadvantage and reduce health outcomes inequalities amongst people who live with chronic disease.
The moral implications of threatened solidarity
Prof. Dr. Marcel Verweij | Wageningen University | Netherlands
Solidarity is a peculiar moral value because unlike some other values like justice or autonomy, it appears primarily to have normative force within communities that do share a sense of solidarity. If such a shared concern is lacking, it is hard to see why people would or should have solidarity-related moral reasons to ‘stand together’ and protect members who are vulnerable. Obviously, in such a case we can still see and maintain forms of risk-solidarity as a matter of a rational or prudential insurance policy, but it is difficult to see how a richer moral idea of solidarity that would involve that people see a threat to some individuals also as a threat their community as having moral significance in a society where few people do endorse and share it.
In this presentation I will unpack this idea, and explore the moral significance of situations in which solidarity is threatened or eroded in a society. I will focus on two different threats to health solidarity. The first is about situations in which some individuals are unwilling to act in ways that can be considered as required by solidarity, notably vaccine refusal in the context of the covid19 pandemic. The second is about medical technological developments that can be highly beneficial for some patients but at very high financial costs that are burdening the solidaristic health (insurance) system, notably novel medicines. The analysis will (probably) offer reason to strengthen conceptual links between solidarity and justice.
Diverse Perception of Broad Consent between Thailand and Canada
Dr. Permyos Ruengsakulrach | Institute Board Review, Bangkok Hospital Headquarters, Bangkok Hospital Group, Bangkok, Thailand | Thailand
Introduction: Broad consent is a type of consent where a participant expresses his /her general consent that his/ her own information can be used in future research. The study objectives are to learn the community perspective and compare opinions on broad consent between Thai and Canadian.
Methods: The comparative Canadian data and questionnaire used in this study derived from the second author from BMC Med Ethics, 17(1), 48. 214. 211 Canadian patients from a renal clinic in a large urban hospital returned completed surveys. 214 Thai participants from 2 communities in Bangkok were asked to complete the translated, modified questionnaire from Canada. Comparisons of agreement were compared with Chi-square test.
Outcome: Thai participants were significant younger than Canadian (47.2 ± 13.7 vs 58.9 ± 17.3 yrs, P < 0.001) however did not differ by sex. Both Thai and Canadian agreed to consent to have their identifiable health information or biospecimens held in a research repository, data library or biobank and used as needed by researchers, 78.5/70.5 vs 74.8/.72.2 (P = 0.02 and 0.2), respectively. However Thai respondents expressed a need to know the identity of the person to whom their identifiable health information/biospecimen are being given before they would give consent in 79.9/76.6% compared with the Canadian 22.7/19.1% (P < 0.001, both).
Conclusion: Most Thai and Canadian participants agreed with the use of their information and specimens for research with broad consent. Thai participants wanted to know when their identifiable health information will be used for research more often than Canadian participants.
Harm Minimisation: what is it and when can it be ethically justified?
Prof. Angus Dawson | Sydney Health Ethics, The University of Sydney | Australia
Harm minimisation (HM) is a key aim of many actual or proposed public health policies (e.g. supply of clean needles/syringes for injecting drug users; drug testing at music festivals; promoting e-cigarettes over burning tobacco etc). In this talk I try and do two things. First, there is conceptual work to do. Can HM be clearly distinguished from related concepts such as harm reduction, harm prevention and harm avoidance etc? I will argue that it is important to be clear about what we are talking about. Second, assuming we have a clear concept of HM, where, if at all, is it justifiable to use it as a policy aim? I will argue that it would make no sense to have HM as an overall policy aim, as in at least some cases it is appropriate to weigh the chance of harms arising from a policy against other important considerations (such as benefits). It looks as though cases where HM is most plausible as a policy aim are where people are held to be going to act in a harmful way anyway, and we seek to minimise the chances of (preventable) harm arising from such acts. I will explore the nature of this justification in two ways. First, we should note that it takes the form of a conditional, where the antecedent involves an empirical claim which may be contested. Second, it might be argued that HM necessarily involves complicity in harms that it would be better to prevent.