Catherine Myser

We identify the ways the policies of leading international bioethics journals limit the participation of researchers working in the resource-constrained settings of low- and middle-income countries in the development of the field of bioethics. Lack of access to essential scholarly resources makes it extremely difficult, if not impossible, for many LMIC bioethicists to learn from, meaningfully engage in, and further contribute to the global bioethics discourse. Underrepresentation of LMIC perspectives in leading journals sustains the hegemony of Western bioethics, limits the presentation of diverse moral visions of life, health, and medicine, and undermines aspirations to create a truly “global” bioethics. Limited attention to this problem indicates a lack of empathy and moral imagination on the part of bioethicists in high-income countries, raises questions about the ethics of bioethics, and highlights the urgent need to find ways to remedy this social injustice.

Examining the ethics of long-term, career involvement by physicians in global health work is vital, given growing professional interest and potential health implications for communities abroad. However, current literature remains heavily focused on ethical considerations of short-term global health training experiences. A literature review informed our development of an ethics framework centered on two perspectives: the practitioner perspective, further subdivided into extrinsic and intrinsic factors, and community perspectives, specifically that of the host community and the physician’s home community. Some physician factors included cultural/linguistic differences, power imbalances, and sustainable skills/competencies. Receiving community factors included resource limitations, standard of care disparities, and community autonomy. Home community factors focused on the opportunity cost of an unavailable physician who was trained and supported by the local community. Descriptive review permitted comparison with existing short-term literature, noting similarities and differences. Our framework provides a basis for further research and critical analysis of ethical implications of career-long physician global health work

Recent law and ethics literature has been inundated with recommendations of the "best interests" criterion as the appropriate guide for neonatal and maternal-fetal decision-making. Increasingly, however, its adequacy is being questioned. In Chapter 1, I survey the arguments of "best interests" defenders and critics and suggest one problem is that the "best interests" criterion has yet to be subjected to a systematic conceptual and ethical analysis. In Chapter 2, therefore, I conduct such an analysis to evaluate more systematically its appropriateness as a decision-making guide in neonatal and maternal-fetal medicine, concluding that the "best interests" criterion cannot assist us in seeing and addressing all that is at stake in neonatal and maternal-fetal decision-making because it excludes any consideration of the "interdependent" and other interests of family members. Therefore, I suggest that an ethical criterion or set of criteria which can explicitly consider and adequately balance the interests of infants or fetuses and family members would be a more helpful guide for neonatal and maternal-fetal decision-making. ;In Chapters 3-7, I attempt to move beyond the "best interests" criterion, drawing on fieldwork I conducted in the United States, Sweden, and India to point out some conceptual and normative gaps to be addressed in the development of a more adequate guide for neonatal and maternal-fetal decision-making. In Chapter 3, I describe this fieldwork and explain its purpose as illustrating the clinical ethical strategies employed in these countries to balance the interests of various parties in actual decision-making. In Chapters 4-6, I describe these strategies. Finally, in Chapter 7, I point out some conceptual and normative gaps in these decision-making strategies, noting that these gaps have also been unaddressed by the "best interests" critics reviewed in Chapters 1 and 2. I suggest that we must address these gaps to develop theoretical structures that will enable us to explicitly consider and adequately balance the "interdependent" and other interests of infants or fetuses, their family members, and even society in neonatal and maternal-fetal decision-making

Ethical reasoning and decision-making may be thought of as 'professional skills', and in this sense are as relevant to efficient clinical practice as the biomedical and clinical sciences are to the diagnosis of a patient's problem. Despite this, however, undergraduate medical programmes in ethics tend to focus on the teaching of bioethical theories, concepts and/or prominent ethical issues such as IVF and euthanasia, rather than the use of such ethics knowledge (theories, principles, concepts, rules) to clinical practice. Not surprisingly, many students and clinicians experience considerable difficulty in using what they know about ethics to help them make competent ethical decisions in their day-to-day clinical practice. This paper describes the development of a seminar programme for teaching senior medical students a more systematic approach to ethical reasoning and analysis and clinical decision-making

Who are the gatekeepers in bioethics? Does editorial bias or institutional racism exist in leading bioethics journals? We analyzed the composition of the editorial boards of 14 leading bioethics journals by country. Categorizing these countries according to their Human Development Index (HDI), we discovered that approximately 95 percent of editorial board members are based in (very) high-HDI countries, less than 4 percent are from medium-HDI countries, and fewer than 1.5 percent are from low-HDI countries. Eight out of 14 leading bioethics journals have no editorial board members from a medium- or low-HDI country. Eleven bioethics journals have no board members from low-HDI countries. This severe underrepresentation of bioethics scholars from developing countries on editorial boards suggests that bioethics may be affected by institutional racism, raising significant questions about the ethics of bioethics in a global context

I argue that there has been inadequate attention to and questioning of the dominance and normativity of whiteness in the cultural construction of bioethics in the United States. Therefore we risk reproducing white privilege and white supremacy in its theory, method, and practices. To make my argument, I define whiteness and trace its broader social and legal history in the United States. I then begin to mark whiteness in U.S. bioethics, recasting Renee Fox's sociological marking of its American-ness as an important initial marking of its whiteness/WASP ethos. Furthermore, I consider the attempts of social scientists to highlight sociocultural diversity as a corrective in U.S. bioethics. I argue that because they fail to problematize white dominance and normativity and the white-other dualism when they describe the standpoints of African-American, Asian-American, and Native-American others, their work merely inoculates difference and creates or maintains minoritized spaces. Accordingly, the dominant white center of mainstream U.S. bioethics must be problematized and displaced for diversity research to make a difference. In conclusion, I give several examples of how we might advance the recommended endeavor of exploring our own ethnicity, class, and other social positioning and norms operating in U.S. bioethics, briefly highlighting "white talk" as one challenge

How do bioethics gatekeepers located in wealthy nations treat bioethics workers from developing countries? Can the policies of leading international bioethics journals—based on a concern for profit that effectively restricts access for most researchers from developing countries—be ethically justified? We examined these policies focusing on the way they influence the ability of researchers in resource-poor countries to participate in the development of the field of bioethics. Eight of the fourteen leading bioethics journals are published by three transnational publishing houses, all of which are based in wealthy nations. None of these eight journals participates in the Health InterNetwork Access to Research Initiative of the World Health Organization, a program that provides free or very low-cost online access to the major journals by researchers in developing countries. Lack of access to these essential resources makes it extremely difficult, if not impossible, for bioethicists in developing countries to learn from, and engage in, the global bioethics dialogue. Thus, exclusionary practices of leading bioethics journals sustain the hegemony of Western bioethics, raising serious questions about professed aspirations to create a truly “global” bioethics. This phenomenon indicates lack of empathy and moral imagination of bioethicists in developed countries, raises serious questions about the ethics of bioethics, and highlights the urgent need for creative solutions to remedy this social injustice

Ethical reasoning and decision-making may be thought of as 9professional skills9, and in this sense are as relevant to efficient clinical practice as the biomedical and clinical sciences are to the diagnosis of a patient9s problem. Despite this, however, undergraduate medical programmes in ethics tend to focus on the teaching of bioethical theories, concepts and/or prominent ethical issues such as IVF and euthanasia, rather than the use of such ethics knowledge (theories, principles, concepts, rules) to clinical practice. Not surprisingly, many students and clinicians experience considerable difficulty in using what they know about ethics to help them make competent ethical decisions in their day-to-day clinical practice. This paper describes the development of a seminar programme for teaching senior medical students a more systematic approach to ethical reasoning and analysis and clinical decision-making.

Some claim that “global health is public health” but most regard global health as a new field, rapidly emerging mostly at North American academic institutions . The term was first incorporated into University of California, San Francisco’s Institute for Global Health in 1999 and UCSF also inaugurated the first North American master of science in global health in 2009. Global health is commonly acknowledged to have historical precedents in tropical medicine and international health. All three fields are regarded as having some overlapping and some distinctive features . One overlapping feature of all three is retaining traces of European and/or North American conquest, imperialism, and colonialism that create a legacy of ongoing ethical challenges for global health . One touted distinctive feature of global health is its ..

At the University of Newcastle, health law and ethics is taught and assessed in each year of the five-year curriculum. However, the critical question for assessment remains: 'Does teaching ethics have a measurable effect on the clinical activity of medical students who have had such courses?' Those responsible for teaching confront this question each year they sit down to construct their assessment tools. Should they assess what the student knows? Should they assess the student's moral reasoning, that is, what decisions the student makes, and, how these decisions are justified, or should they assess what the student actually does when dealing with patients in the clinical setting, and how he or she does it? From 1982 to 1991, assessment at Newcastle was primarily aimed at determining the quality of the students' ethics knowledge base. This paper describes the strengths and limitations of a purely knowledge-based method of evaluation and why in 1992, we are now attempting to redefine and assess, what we call 'clinical ethical competence' in terms of how students actually apply this knowledge base in a controlled clinical context