Reflection on Global Public Health Ethics from the Perspective of Community / 中国医学伦理学

The global spread of COVID -19 indicates that cultivating public health awareness and constructing the concept of human health community has become an urgent need and a long-term plan in the current social situation. In the post-epidemic period, only by adhering to the concept of human health community, strengthening the cooperation among individuals, families, communities, institutions, urban and rural areas, countries and so on, weaving closely and consolidating the "net bottom" of grass-roots prevention and control from point to area, and establishing the mechanism of group prevention, group control and joint prevention and control, can we thoroughly curb the spread of the epidemic in the world. Under the development concept and value orientation of human health community, the individual is not only a booster of public health, but also a component of public health, and also a beneficiary of public health. The realization of public health is inseparable from the practice of each individual. Under the guidance of the concept of human health community and the awareness of individual health first responsibility, all citizens need to shape health promotion behaviors that fit the individual’s own situation, promote the health maintenance atmosphere consciously followed by the whole society, create a healthy ecological environment accessible to everyone, and let all citizens share the good results of public health management, so as to achieve the good vision of human health community.

Ethical Consideration of Chinese Ancient Disasters and Diseases: Centered on the Basic Principles of Public Health Ethics / 中国医学伦理学

The ethical problems in the prevention and control of public disasters and epidemics have attracted more and more attention. Briefly combed the disaster and epidemic events in ancient China. From the view of the several basic principles of public health ethics, this paper took four aspects of the distribution of medical and health resources for epidemic diseases, the isolation prevention and control, the skeleton convergence and the protection of public health conditions as examples, to dialectically treat the measures taken by ancient people to deal with disasters and epidemics and explore some enlightenment of public health ethics in ancient Chinese disasters and epidemics. The measures of epidemic prevention and disaster resistance in ancient China have their own formation and development process. Although the historical limitations are insurmountable, interpreting it by using the basic principles of public health ethics will help us understand the development process of epidemic prevention and control, promote the development of medical archaeology, and provide some reference for the construction of public health undertakings today.

Ethics in infectious diseases: latent challenges. Part I / Ética en enfermedades infecciosas: retos latentes. Parte I

Abstract Infectious diseases socially imply individual and community medical problems. Therefore, they require actions aimed at social processes that affect the well-being of the individuals without losing sight of social groups. Faced with this panorama, we ask ourselves: is there a direct relationship between ethics and infectious diseases? To elucidate an answer, let us remember the peak period of the COVID-19 pandemic when guidelines based on ethical principles were issued to facilitate medical decisions on allocating scarce resources in periods of maximum demand. In those moments, since there was no inclusive component of society, the decisions made produced massive criticism. The reactions demonstrated the need to analyze in detail the criteria that had been considered correct. Consequently, we affirm that bioethical principles are transcendental in medical decisions and must be examined, not only for the individual but also with a view to public health. Moreover, the acquired immunodeficiency syndrome (AIDS) epidemic has lived with us for decades, and it continues to show its tragic face in the form of new cases, chronic illnesses, and deaths. Joint United Nations Programme on HIV/AIDS brings us closer to a complex reality where the fight against disease and global health are interrelated with other problems, such as the need to reduce inequality, for which human rights, gender equality, social protection, and the development of research projects, where the ethics committees in research in community processes are constituents.

Resumen Las enfermedades infecciosas implican problemas médicos individuales y comunitarios, por lo que requieren acciones dirigidas a procesos sociales que incidan en el bienestar de los individuos, sin perder de vista a los grupos sociales. Nos preguntamos: ¿existe relación directa entre la ética y las enfermedades infecciosas? Para dilucidar una respuesta, recordemos el periodo más álgido de la pandemia por COVID-19, cuando se emitieron guías fundamentadas en principios éticos para facilitar las decisiones médicas en la asignación de recursos escasos en periodos de máxima demanda. Al no haber un componente inclusivo con la sociedad, las decisiones que se tomaron produjeron críticas masivas, que demostraron la necesidad de analizar a detalle los criterios que se habían considerado correctos. En consecuencia, afirmamos que los principios bioéticos son trascendentales en las decisiones médicas y deben ser examinados, no solo frente al individuo, sino de cara a la salud pública (bien común e individualidad). Por otra parte, la epidemia del SIDA (síndrome de inmunodeficiencia adquirida) convive con nosotros desde hace décadas. ONUSIDA (Programa Conjunto de las Naciones Unidas sobre el VIH/SIDA) nos acerca una realidad compleja, como es que la lucha contra la enfermedad y por la salud global se interrelaciona con otros problemas como la necesidad de reducer la desigualdad, por los derechos humanos, la igualdad de género, la protección social y el desarrollo de proyectos de investigación, donde los comités de Ética en investigación en procesos comunitarios son constituyentes.

Study on Strategies to Deal with Ethical Dilemmas in Public Health Emergencies / 中国医学伦理学

Public health emergencies not only bring great challenges to the conventional public health system, but also face some ethical dilemmas in the governance process. For example, the compulsory isolation measures affect the normal lives of some citizens, the normal medical treatment of non-epidemic patients may be constrained by complex governance environments, and the relationship between patient privacy protection and the public’s right to know needs to be deeply considered and balanced. To respond the ethical dilemmas in public health emergencies, it is necessary to explore more effective new ideas and methods under ethical concepts, combine with ethical needs in the governance of public health emergencies, comprehensively improve governance capabilities starting from the basic principles and behavioral standards of governance, with a view to providing more effective ethical support for the governance of public health emergencies.

Ethical Dilemma of "Virus Sovereignty" / 中国医学伦理学

The concept of "virus sovereignty" proposed by Indonesia in 2007 challenges the international tradition of virus sharing. In the context of the global outbreak of coronavirus disease 2019, the issue of virus sharing has become an important topic in the reform of the global health governance mechanisms. Virus sharing is an important guarantee of dealing with major global infectious diseases. However, the emergence of the concept of "virus sovereignty" shows that there are defects in the operation of virus sharing mechanism in the international community. The "virus sovereignty" problem is an ethical issue essentially, involving asymmetric interests hindering unity and cooperation, intellectual property rights expansion challenging the principle of solidarity, and excessive self-defense amplifying utility risks. "Community of common health for mankind" provides a constructive and feasible option to solve the dilemma of "virus sovereignty".

Research on Ethical Issues in the Prevention and Control of Major Infectious Diseases / 中国医学伦理学

Major infectious diseases have the characteristics of sudden, group and harmfulness. Isolation is widely used in the field of infectious disease prevention and control as an emergency management tool to control the source of infection and protect susceptible populations in emergencies. However, while it has achieved good results, there are also objective ethical disputes between personal freedom and public health, personal privacy and public knowledge. This paper fully discusses the ethical problems exposed in the implementation stage of isolation, follows the ethical principles of minimum infringement, utility and respect, and puts forward suggestions to strengthen the ethical decision-making ability of grassroots personnel, improve the operation procedures of isolation, and give more humanistic care to the isolated population. On the premise of the unity of public interest and individual rights and interests, we hope to promote the benign interaction between individuals and the public, properly solve the practical problems existing in the disposal of major infectious diseases, and give full play to the optimal function of public policy objectives.

Preparation of a Questionnaire on Medical Students’ Cognition Level of Public Health Ethics / 中国医学伦理学

【Objective:】 To construct a questionnaire on medical students’ cognition level of public health ethics, and to provide a scientific and objective evaluation tool for understanding the cognitive level of medical students on public health ethics. 【Methods:】 Based on the literature review and focus group discussion, the initial questionnaire was constructed. The Delphi method was used to conduct three rounds of correspondence with 12 experts, and the final questionnaire was drafted. And exploratory factor analysis and internal consistency were used to evaluate the questionnaire. 【Results:】 In the three rounds of correspondence, the enthusiasms of experts were all 100%, the authority coefficients were all 0.84, the coefficients of variation were 0~0.32, 0~0.26, 0~0.12, respectively, and the coordination coefficients were 0.206, 0.163, and 0.250, respectively (all P<0.05). The analysis of the items showed that the critical ratio values and related coefficients of the questionnaire items were statistically different. The structural validity analysis showed that the cumulative variance contribution rate of the extracted two common factors was 61.015%. The intrinsic consistency reliability analysis showed that the questionnaire Cronbach’s coefficient was 0.956. Finally, the questionnaire of 26 items was formed, including two dimensions: knowledge of public health ethics and application of public health ethics. 【Conclusion:】 The questionnaire on medical students’ cognition level of public health ethics is reliable and has good reliability and validity, and can be used as a tool for medical students’ public health ethics cognition level.

Capacity building of community health workers: One size does not fit both rural and urban settings

The Accredited Social Health Activist (ASHA) programme in India is the world's largest all-female Community Health Workers (CHWs) programme. ASHAs are supposed to bridge the gap between community and health services by functioning as healthcare catalysts, service providers, and community-level health activists. This paper discusses the ethical challenges posed by using the same template for capacity building of ASHAs in rural and urban contexts, without accounting for the differences. Urban heterogeneity and rapidly growing urbanisation demand special attention for crucial programme activities like the capacity-building of ASHAs. When the relevant literature like policy and programme documents, training modules, and implementation guidelines were analysed, it was evident that the simple transplantation of rural models to urban contexts would not be a useful strategy. The recommended areas for improvement are the urban-specific customisation of ASHAs’ roles, the consideration of urban heterogeneity in the training content and pedagogy, utilising the advantages of the urban set-up, ensuring supportive supervision mechanisms for ASHAs, strengthening overall inter-sectoral convergence and community processes in urban areas.

Does India’s Menstrual Hygiene Management Scheme exclude the disabled?

The Menstrual Hygiene Scheme of the Government of India wishes to generate awareness among adolescent girls, and provide them with hygienic and affordable sanitary napkins. The scheme has been criticised for many reasons by various reviewers. However, we draw attention to a hitherto unaddressed gap that the scheme has effectively overlooked, the menstrual hygiene needs of disabled adolescent girls, and has thereby denied them their right to health and healthcare. This exacerbates health disparities, and raises questions of public health ethics. We conclude with recommendations on how to redress the situation and make the scheme more inclusive.

A theoretical framework for ethical decision-making during public health emergencies / Un marco teórico para la toma de decisiones éticas durante emergencias de salud pública / Um referencial teórico para tomada de decisão ética durante emergências de saúde pública

Abstract: The new theoretical ethical framework is a general frame or tool for ethical agents, developed to guide ethical reasoning during public health emergency preparedness and response. The TEF is based on the assumption that no existing ethical discourse in medical ethics alone is sufficient to address ethical issues of a PHE. The solutions suggested by existing approaches are limited in practicability and effectiveness, because they cannot address root problems and interplay among ethical problems. The reason for this insufficiency rests on the argument that ethical problems of PHEs have causal and reciprocal relationships, and any ethical decision-making framework should provide a wide enough perspective to consider relevant ethical norms and theories to suggest practical, implementable, coherent solutions compatible with the communal values and cultural norms. The TEF we suggest for PHEs embraces a holistic and integrated ethical perspective that enables us to comprehend that ethical problems that arise in various settings caused by PHE phenomena are in relationship with each other instead of addressing them as a standalone problem. The TEF provides decision-makers to achieve a coherent web of considered judgements compatible with ethical values and principles in various settings. This type of conceptualization offers a wide perspective to see causal and relational relationships among problems and produce outcomes that would not be possible by eclectic approaches.

Resumen: El nuevo Marco Ético Teórico (MET) es una estructura general o herramienta para eticistas, desarrollada para guiar el razonamiento ético durante la preparación y respuesta a emergencias de salud pública (ESP). Supone que no existe un discurso ético en la ética médica que por sí solo sea suficiente para abordar temas éticos de ESP. Las soluciones sugeridas de aproximaciones existentes son limitadas en la práctica y en la efectividad, debido a que no pueden abordar problemas de raíz sin considerar las interacciones entre los problemas éticos. Esta insuficiencia es porque los problemas éticos de ESP tiene relaciones causales y recíprocas, y cualquier estructura de toma de decisiones éticas debería proporcionar una perspectiva suficientemente amplia como para considerar normas éticas y teorías relevantes, y sugerir soluciones prácticas que sean coherentes y compatibles con valores comunes y normas culturales. El MET que sugerimos para ESP abarca una perspectiva ética integral e integrada, que posibilita la comprensión de que los problemas éticos que surgen en varías situaciones causadas por fenómenos ESP se hallan en relación entre ellos, en vez de abordarlos como un problema aislado. El MET proporciona a los que toman decisiones el lograr una red coherente de juicios compatibles con los valores y principios éticos en varias situaciones. Este tipo de conceptualización ofrece una amplia perspectiva para ver relaciones causales y relacionales entre problemas y producir resultados que no serían posibles mediante aproximaciones eclécticas.

Resumo: O novo referencial ético teórico (NT: TEF, sigla em inglês) é um referencial geral ou instrumento para agentes éticos, desenvolvido para guiar o raciocínio ético durante o preparo e resposta a emergências de saúde pública (NT: PHE, sigla em inglês). O TEF é baseado na suposição de que nenhum discurso ético existente em ética médica sozinho é suficiente para abordar aspectos éticos de uma PHE. As soluções sugeridas pelas abordagens existentes são limitadas em praticabilidade e efetividade, porque elas não podem abordar problemas fundamentais e inter-relacionar problemas éticos. A razão para essa insuficiência repousa no argumento de que problemas éticos de PHEs têm relações causais e recíprocas, e qualquer referencial para tomada de decisão ética deve propiciar uma perspectiva ampla o suficiente para considerar normas e teorias éticas relevantes para sugerir soluções práticas, implementáveis e coerentes, compatíveis com valores comunitários e normas culturais. A TEF que sugerimos para PHEs abarca uma perspectiva ética holística e integrada que nos permite compreender que os problemas éticos que surgem em diversos ambientes causados pelo fenômeno da PHE estão em relação entre si, ao invés de abordá-los como um problema isolado. O TFE propicia a tomadores de decisões alcançar uma rede de julgamentos considerados compatíveis com valores e princípios éticos em ambientes diversos. Esse tipo de conceitualização oferece uma perspectiva ampla para observar relações causais e relacionais entre problemas e produzir desfechos que não seriam possíveis por abordagens ecléticas.

Ethical issues for e-cigarette control policies in Australia

Although tobacco smoking in Australia is at a historical low, electronic cigarette (e-cigarette) use, especially among the youth is increasing. Policies around e-cigarette control in Australia are currently evolving, even during the pandemic, thus demonstrating its priority status. The current article discusses ethical issues for e-cigarette control policies in Australia using a public health ethics framework. The article is structured using the domains of the WHO-MPOWER framework of tobacco control to enable a comprehensive coverage of all elements of e-cigarette control policies in Australia. It highlights several ethical issues, from different stakeholder perspectives, and indicates moral and ethical tensions in different public health actions that might be considered in framing policies around e-cigarette control. Keywords: Electronic nicotine delivery systems, e-cigarettes, Australia,, smoke-free policy, public health ethics

Review of Health Ethics Research and Exploration of Its Contemporary Values / 中国医学伦理学

The research on health ethics has gone through three stages: the discussion of concepts, the all-round theoretical extension and become the spiritual power of healthy China. The paper mainly discussed the theoretical support and practical guidance provided by health ethics as a category of ethics for the development of public health undertakings in various eras, and its concept had gradually penetrated into many fields such as economy, politics, society, ecology and culture. Under the guidance of the Healthy China strategy, health ethics plays an important role in maintaining individual health, solving social public health problems, building a healthy China and constructing a community of human health.

Involuntary Hospitalization System: An Ethical Analysis Based on Mental Health Law of the People’s Republic of China / 中国医学伦理学

Involuntary hospitalization system is a controversial issue in international mental health legislation. During the legislation and implementation process of Mental Health Law of the People’s Republic of China, the substantive and procedural elements of the involuntary hospitalization system have always been under dispute and discussion. These disputes have profound ethical implications, highlighting the phenomenon of the coexistence of "insufficient" and "excessive" regarding China’s involuntary hospitalization system in protecting individual autonomy. From the perspective of public health ethics, the values of respect, justice, and care can provide ethical guidance for improving the involuntary hospitalization system and promoting the construction of mental health law.

Tendencia de la cesárea: una reflexión desde la ética / Cesarean section trend: a reflection from ethics / Tendência à cesárea: uma reflexão a partir da ética

Resumen: Las estadísticas mundiales muestran una tendencia al alza en las tasas de cesáreas que superan el 15% recomendado por la OPS/OMS. Esta cirugía se ha convertido en la más frecuente en los países de ingresos medios y altos. Algunos estudios sugieren que no todas estas cesáreas estarían justificadas. Al respecto se plantean algunas reflexiones sobre los dilemas éticos que se pueden observar desde varias posiciones teóricas, como el consecuencialismo, el kantianismo, la ética de la virtud y la teoría feminista. A su vez, estos dilemas están inmersos en múltiples factores individuales, sociales y culturales, entre otros. Desde la salud pública se debe revisar el parámetro actual definido como "rango aceptable" de cesáreas, ya que puede ser demasiado bajo. Igualmente se recomienda la aplicación de medidas para fortalecer en los pacientes el deseo de un parto normal, cuando sea posible, a través de información y educación oportuna durante la atención prenatal. Las decisiones del profesional de la salud y de las mujeres deben estar respaldadas por la mejor información disponible.

Abstract: World statistics show an upward trend in Cesarean section rates that exceed the 15% recommended by PAHO / WHO. This surgery has become the most common in high- and middle-income countries. Some studies suggest that not all these caesarean sections would be justified. In this regard, some reflections are made on the ethical dilemmas that can be observed from various theoretical positions such as consequentialism, Kantianism, the ethics of virtue and feminist theory. In turn, these dilemmas are immersed in multiple individuals, social and cultural factors, among others. From Public Health, the current parameter defined as the "acceptable range" of Caesarean sections should be reviewed as it may be too low. It is also recommended that measures be applied to strengthen patients' desire for a normal delivery whenever possible through timely information and education during prenatal care. The decisions of the health professional and women must be supported by the best information available.

Resumo: As estatísticas mundiais mostram uma tendência de alta nas taxas de cesáreas que superam em 15% o recomendado pela OPAS/OMS. Esta cirurgia se converteu na mais frequente em países de renda média e alta. Alguns estudos sugerem que não todas estas cesáreas seriam justificadas. A esse respeito se colocam algumas reflexões sobre os dilemas éticos que se podem observar desde várias posiciones teóricas, como o consequencialismo, o kantianismo, a ética da virtude e a teoria feminista. Por sua vez, estes dilemas estão imersos em múltiplos fatores individuais, sociais e culturais, entre outros. Deve-se revisar, a partir da saúde pública, o parâmetro atual definido como "faixa aceitável" de cesáreas, já que pode ser demasiado baixo. Igualmente se recomenda a aplicação de medidas para fortalecer nas pacientes o desejo de um parto normal, quando possível, através de informação e educação oportuna durante a assistência pré-natal. As decisões do profissional da saúde e das mulheres devem estar respaldadas pela melhor informação disponível.

Research Content and Ethical Thinking of Public Health Ethics / 中国医学伦理学

This article outlines the arising, the research content, the related ethical issues and the future de-velopment of public health ethics. The related ethical issues contains the ethical issues of disease prevention and control, the ethical issues in group unit, the ethical issues in public health policy-making, the ethical issues un-der the influence of biological science, and ethics review issues related with the thinking methoods namely moderate diversity, avoiding the socialism and in a relationship. The last, the article points out the human subjects in bio-medical researches.

On the Ethical Issues of Public Health in Responding to Pandemic Influenza / 中国医学伦理学

A pandemic influenza is an epidemic that outbreaks worldwide.Not only medical issues but also ethical issues of public health should be solved in the process of responding to pandemic influenza.It is vital to study ethical issues of public health posed in responding to pandemic influenza and discuss how to solve them ethically,which can provide a basis for formulating relevant policies and laws,and also can provide ethical evidences for evaluating whether the responding act is effective and can be justified ethically.

Ethic Decisions on Public Health / 中国医学伦理学

Ethic decisions on public health are of great significance.Through analysis on the present problems in public health,the paper puts forward the thinking and the counter-measures of ethic decisions on public health.

Ethical Thinking on the Tobacco Epidemic and Public Health / 中国医学伦理学

The tobacco epidemic is a problem with serious consequence for public health in the whole world. Reducing the tobacco harm and protecting public health have become a crucial topic for ethics. This paper, firstly, presents some facts related to the tobacco epidemic. Based on these facts, then, it analyzes the issue from ethical perspectives. And finally, it discusses the moral responsibilities for reducing the tobacco epidemic.