Felicitas Holzer

Applied philosophers have often defined ‘exploitation’ as a narrow, transaction-specific concept, ignoring its broader social or structural context. On this view, structural injustices are treated as irrelevant to explaining why exploitation is morally wrongful. This paper argues that this approach overlooks how background injustices frequently enable and shape exploitative transactions, making it easier for one party to take unfair advantage of another. While structural injustice is not itself the wrong-making feature of exploitation, it can causally influence how often exploitative transactions occur. In recognizing this causal role, I further contend that the remediation of background injustices is one important factor in determining who is responsible for addressing instances of exploitation.

The equitable distribution of vaccines has emerged as a major issue in pandemic treaty negotiations following the COVID-19 pandemic. Failures in global procurement and distribution have been attributed to ineffective allocation mechanisms and a general lack of cooperation. More than four years after the onset of the pandemic, this article presents a perspective on how to achieve a more equitable global allocation of medical supplies for future pandemics, drawing on the distinction between “ideal” and “non-ideal” schemes of cooperation. We will consider two perspectives: first, improving solutions under current, non-ideal circumstances where non-cooperation dominates in the short and medium term, given the challenges of an uncooperative international landscape; and second, implementing long-term policies that aim at ideal proposals, assuming an increased level of cooperation in the future. This evaluation will address the past successes and shortcomings of the COVAX facility, and also the negotiations on a pandemic treaty led by the World Health Organizations, to better address future pandemics. We will discuss key issues that ought to be of central concern when moving towards more cooperative solutions in the future.

El objetivo del presente artículo es el de Contribuir al conocimiento y reflexión sobre las experiencias que enfrenta el personal médico en situaciones críticas. Se llevaron a cabo once entrevistas a médicos en diversas regiones del país, utilizando un guion elaborado a partir de una revisión de la literatura en artículos académicos y medios de comunicación en línea. Con los datos recopilados, se construyó una matriz y se realizó un análisis temático. Se identificaron cinco conjuntos de temas: (i) Información general de los médicos y motivos para trabajar en zonas críticas; (ii) efectos de la violencia y la pandemia por COVID-19 en la prestación de servicios de salud; (iii) Recursos en salud; (iv) La ambivalencia del triaje: alivio ante la escasez, pero descontento moral hacia los médicos y (v) Gobernanza y políticas públicas. Como conclusiones se puede decir que la interacción de dos situaciones críticas, la violencia y la pandemia de COVID-19, plantea desafíos éticos que requieren una reflexión profunda.

Saving as many lives as possible while ensuring equity for vulnerable groups through access to triage resources has been the dominant position since the onset of the COVID-19 pandemic in 2020. However, the exact relationship between the principles of social justice and efficiency remains a controversial and unresolved issue. In this paper, we aim to systematically distinguish between different models of this relationship and show that conceptualizing social justice as a ‘moral side-constraint’ or adopting a ‘balancing approach’ that attempt to reconcile social justice with efficiency inevitably lead to significant moral costs that require further justification. Based on this discussion, we propose a novel “threshold model” for trading-off moral costs. According to this model, the structural impact of triage must be considered in order to determine whether one opts for triage with the primary aim of efficiency or social justice. This contextualization further explains why, in some societies and circumstances, social justice can rightly be seen as the primary concern, while in other societies and circumstances, efficiency can be defended as the primary concern.

Mexico's pandemic management and the absence of measures have been harshly criticized as being disproportionate. This paper examines whether the proportionality principle was properly applied to Mexico's COVID-19 response and outlines three reasons against such an endeavor, namely (i) the content of “proportionate measures” remained insufficiently well defined, (ii) there were yet fundamental rights conflicts to resolve, and (iii) the situation was moreover characterized by epistemic uncertainty.

La violencia en México, específicamente en algunos estados de la República mexicana en donde la población se enfrenta a situaciones de peligro, tiene como una de tantas consecuencias la ausencia de personal médico que se desempeñe como profesional y proporcione servicios de salud en estas zonas rurales. En este sentido, es de considerar que la asignación de recursos humanos en salud es fundamental para el funcionamiento de un sistema eficiente y observar las causas por las que médicos que desde el servicio social hasta el desempeño de su especialidad no consideran trabajar en lugares en donde se sienten vulnerables. En este proceso, es importante visibilizar los cuestionamientos éticos que pueden surgir por lo que este trabajo pretende dar importancia al tema de la exposición de circunstancias, hechos y cifras dentro de esta problemática y plantear las cuestiones normativas pertinentes dentro de este contexto.

Equal access to vaccines has been one of the key ethical challenges during the COVID-19 pandemic. Most scholars consider the massive purchase and hoarding of vaccines by high-income countries, especially at the beginning of the pandemic, to be unjust towards the vulnerable living in low-income countries. A recent proposal by Andreas Albertsen of a vaccine tax has been put forward to remedy this problem. Under such a scheme, high-income countries would pay a contribution, conceptualised as a vaccine tax, dedicated to buying vaccines and distributing them to low and middle-income countries. Proceeding from this proposal, we critically assess the feasibility of a vaccine tax and suggest how to conceptualise and implement a vaccine tax in practice. We present our ‘VaxTax model’ and explore its comparative advantages and disadvantages while considering other possible measures to address the global vaccine access problem, also in view of future pandemics and disease outbreaks.

What has the past reaction to the COVID-19 pandemic taught us? We have seen that many low and middle-income countries (LMICs) still lack access to vaccines, and it seems little progress has been made in the last few months and year. This article discusses whether the current strategies, most notably, vaccine donations by the international community and the COVID-19 global access facility COVAX, offer meaningful solutions to tackle the problem. At the centre of our analysis, we compare the concepts of “donations” and “charity” with “vaccine equity” and the “empowerment” of poorer countries. We suggest that the achievement of fair global vaccine production requires that our global approach is supportive of the idea of empowerment. We, therefore, need structural reforms, which would most importantly include capacity building, to positively impact this goal and to take the interests of the global poor seriously.

The term “innovation” or “innovative care” has recently gained attention in the context of the use of novel and not yet fully validated medical interventions and technologies. Most notably, there have been various incidences of medical activities insufficiently validated for its regular use in healthcare that fall into this category, such as stem cell treatments, genome sequencing for diagnostic purposes, or novel reproductive technologies. Latin American countries are among the places where new and non-validated medical activities take place, notably due to a lack of clear regulations and the poor support of authorities of existent legal and ethical guidelines, which is driven by “hidden battles” on the moral status of certain interventions. The increasing importance of innovative care underlines the importance of developing a general framework for these practices. Therefore, the present chapter scrutinizes this nascent field of inquiry in Latin America and offers a conceptual framework for innovation as well as its ethical justification. As we will argue, an important use of the term “innovation” or “innovative care” is best interpreted as “new non-validated practice” and not as a research activity. Then, we will defend that responsible innovation understood as responsible new non-validated practice is ethically permissible and poses an acceptable medical option if done in exceptional circumstances—where no reasonable alternatives can be provided to an individual patient—and following special ethical principles. Finally, we focus on the peculiarities and specific difficulties the concept of new non-validated practice poses to the Latin American context. We will conclude the chapter by some remarks and recommendations we draw from our analysis for individual patients, doctors, and societies in Latin America.

The ‘socially valuable knowledge’ principle has been widely acknowledged as one of the most important guiding principles for biomedical research involving human subjects. The principle states that the potential of producing socially valuable knowledge is a necessary requirement, although not sufficient, for the ethical conduct of research projects. This is due to the assumption that the social value of knowledge avoids exploitation of research subjects and justifies the use of health resources. However, more recently, several authors have started interrogating the validity of SVK in research and offered various lines of argument against the SVK principle as a necessary constraint to research. In this article, I will reconstruct the main arguments of this discussion between defenders and debunkers of the SVK principle and offer a third way to consider the social value of knowledge in research studies. I will argue that the social value of knowledge can be supported by an independent justification. This justification of the SVK principle addresses the rationality and common interest of researchers. Thus, I will introduce the SVK principle as a safeguarding principle for public trust based on a conceptual framework by Alex John London. My approach justifies keeping the principle as a precautionary and rational requirement for human health research that all rational stakeholders can agree upon.