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513Three Case Studies in Making Fair Choices on the Path to Universal Health CoverageHealth and Human Rights 18 (2): 11-22. 2016.The goal of achieving Universal Health Coverage (UHC) can generally be realized only in stages. Moreover, resource, capacity and political constraints mean governments often face difficult trade-offs on the path to UHC. In a 2014 report, Making fair choices on the path to UHC, the WHO Consultative Group on Equity and Universal Health Coverage articulated principles for making such trade-offs in an equitable manner. We present three case studies which illustrate how these principles can guide pr…Read more
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479The world’s first COVID-19 human challenge trial using the D614G strain of SARS-CoV-2 is underway in the United Kingdom. The Wellcome Trust is funding challenge stock preparation of the Beta variant (B.1.351) for a follow-up human challenge trial, and researchers at Imperial College London are considering conducting that trial. However, little has been written thus far about the ethical justifiability of human challenge trials with SARS-CoV-2 variants of concern. While vaccine resistance as such…Read more
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14Future pandemics and the urge to ‘do something’Journal of Medical Ethics. forthcoming.Research with enhanced potential pandemic pathogens (ePPP) makes pathogens substantially more lethal, communicable, immunosuppressive or otherwise capable of triggering a pandemic. We briefly relay an existing argument that the benefits of ePPP research do not outweigh its risks and then consider why proponents of these arguments continue to confidently endorse them. We argue that these endorsements may well be the product of common cognitive biases—in which case they would provide no challenge …Read more
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On Prevalence and PrudenceIn Ben Davies, Gabriel De Marco, Neil Levy & Julian Savulescu (eds.), Responsibility and Healthcare, Oxford University Press Usa. pp. 103-125. 2024.John Roemer’s pragmatic proposal for luck-egalitarian planners normalizes risky choices for individuals’ social “types,” such that risk takers from types where the same risky behaviors are prevalent retain their just entitlements to societal redress, and ones from types where they are rare encounter just penalties. This chapter shows, however, that risky behaviors that are prevalent in one’s type do not always intuitively retain rights to redress, and that ones that are rare in one’s type do not…Read more
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1098Cómo tomar decisiones justas en el camino hacia la cobertura universal de saludPan-American Health Organization (PAHO). 2015.La cobertura universal de salud está en el centro de la acción actual para fortalecer los sistemas de salud y mejorar el nivel y la distribución de la salud y los servicios de salud. Este documento es el informe fi nal del Grupo Consultivo de la OMS sobre la Equidad y Cobertura Universal de Salud. Aquí se abordan los temas clave de la justicia (fairness) y la equidad que surgen en el camino hacia la cobertura universal de salud. Por lo tanto, el informe es pertinente para cada agente que infl uy…Read more
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1356Faire Des Choix Justes Pour Une Couverture Sanitaire UniverselleWorld Health Organization. 2015.This report from the WHO Consultative Group on Equity and Universal Health Coverage offers advice on how to make progress fairly towards universal health coverage.
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1556Making Fair Choices on the Path to Universal Health CoverageWorld Health Organisation. 2014.This report by the WHO Consultative Group on Equity and Universal Health Coverage addresses how countries can make fair progress towards the goal of universal coverage. It explains the relevant tradeoffs between different desirable ends and offers guidance on how to make these tradeoffs.
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56Making Fair Choices on the Path to Universal Health Coverage: Applying Principles to Difficult CasesHealth Systems and Reform 3 (4): 1-12. 2017.Progress towards Universal Health Coverage (UHC) requires making difficult trade-offs. In this journal, Dr. Margaret Chan, the WHO Director-General, has endorsed the principles for making such decisions put forward by the WHO Consultative Group on Equity and UHC. These principles include maximizing population health, priority for the worse off, and shielding people from health-related financial risks. But how should one apply these principles in particular cases and how should one adjudicate bet…Read more
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14When offering a patient beneficial treatment undermines public healthBioethics 37 (9): 846-853. 2023.Sometimes, offering someone beneficial care is likely to thwart the similar or more serious medical needs of more people. For example, when acute shortage is strongly predicted to persist, providing the long period on scarce intensive care that a certain COVID‐19 patient needs is sometimes projected to block several future COVID‐19 patients from receiving the shorter periods on intensive care that they will need. Expected utility is typically higher if the former is denied intensive care. A temp…Read more
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33Ethical and legal race‐responsive vaccine allocationBioethics 37 (8): 814-821. 2023.In many countries, the COVID‐19 pandemic varied starkly between different racial and ethnic groups. Before vaccines were approved, some considered assigning priority access to worse‐hit racial groups. That debate can inform rationing in future pandemics and in some of the many areas outside COVID‐19 that admit of racial health disparities. However, concerns were raised that “race‐responsive” prioritizations would be ruled unlawful for allegedly constituting wrongful discrimination. This legal ar…Read more
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4Pediatric Heart Surgery in Ghana: Three Ethical QuestionsJournal of Clinical Ethics 25 (4): 317-322. 2014.When a group of doctors and nurses from Boston, Massachusetts, provided evaluation and heart surgery to children in Ghana, they encountered three rationing dilemmas: (1) What portion of surgery slots should they reserve for the simplest, most cost-effective surgeries? (2) How much time should be reserved for especially simple, nonsurgical interventions? (3) How much time should be reserved to training local staff to perform such surgeries? This article investigates these three dilemmas.
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52Inequalities in HIV Care: Chances Versus OutcomesAmerican Journal of Bioethics 11 (12): 42-44. 2011.We analyse three moral dilemmas involving resource allocation in care for HIV-positive patients. Ole Norheim and Kjell Arne Johansson have argued that these cases reveal a tension between egalitarian concerns and concerns for better population health. We argue, by contrast, that these cases reveal a tension between, on the one hand, a concern for equal *chances*, and, on the other hand, both a concern for better health and an egalitarian concern for equal *outcomes*. We conclude that, in these c…Read more
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26Input and output in distributive theoryNoûs 57 (1): 3-25. 2023.Distributive theories evaluate distributions of goods based on candidate recipients’ characteristics, e.g. how well off candidates are, how deserving they are, and whether they fare below sufficiency. But such characteristics vary across possible worlds, so distributive theories may differ in terms of the world which for them settles candidates’ characteristics. This paper examines how distributive theories differ in terms of whether candidate recipients’ relevant characteristics are grounded in…Read more
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8All research that might result in a pandemic must undergo external reviewBioethics 37 (3): 223-225. 2023.
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Informed consentIn Peter Schaber & Andreas Müller (eds.), The Routledge Handbook of the Ethics of Consent, Routledge. 2018.
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27Paired Publication: A Way to Lower One Barrier between Philosophical Insight and BioethicsAmerican Journal of Bioethics 22 (12): 33-35. 2022.Blumenthal-Barby et al. (2022) are right. Philosophers should pay greater attention to bioethics and bioethicists should pay greater attention to insights from philosophy. This commentary extends t...
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17Do coronavirus vaccine challenge trials have a distinctive generalisability problem?Journal of Medical Ethics 48 (9): 586-589. 2022.Notwithstanding the success of conventional field trials for vaccines against COVID-19, human challenge trials that could obtain more information about these and about other vaccines and further strategies against it are about to start in the UK. One critique of COVID-19 HCTs is their distinct paucity of information on crucial population groups. For safety reasons, these HCTs will exclude candidate participants of advanced age or with comorbidities that worsen COVID-19, yet a vaccine should prot…Read more
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36Research ethics and public trust in vaccines: the case of COVID-19 challenge trialsJournal of Medical Ethics 50 (4): 278-284. 2024.Despite their clearly demonstrated safety and effectiveness, approved vaccines against COVID-19 are commonly mistrusted. Nations should find and implement effective ways to boost vaccine confidence. But the implications for ethical vaccine development are less straightforward than some have assumed. Opponents of COVID-19 vaccine challenge trials, in particular, made speculative or empirically implausible warnings on this matter, some of which, if applied consistently, would have ruled out most C…Read more
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20COVID-19 controlled human infection studies: worries about local community impact and demands for local engagementJournal of Medical Ethics 47 (8): 539-542. 2021.In spring, summer and autumn 2020, one abiding argument against controlled human infection studies of SARS-CoV-2 vaccines has been their impact on local communities. Leading scientists and bioethicists expressed concern about undue usage of local residents’ direly needed scarce resources at a time of great need and even about their unintended infection. They recommended either avoiding CHI trials or engaging local communities before conducting any CHIs. Similar recommendations were not made for …Read more
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14Symposium on risks to bystanders in clinical research: An introductionBioethics 34 (9): 879-882. 2020.
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27Inequalities in Health: Concepts, Measures, and Ethics (edited book)Oxford University Press. 2013.Which inequalities in longevity and health among individuals, groups, and nations are unfair? And what priority should health policy attach to narrowing them? These essays by philosophers, economists, epidemiologists, and physicians attempt to determine how health inequalities should be conceptualized, measured, ranked, and evaluated.
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25Is There an Ethical Upper Limit on Risks to Study Participants?Public Health Ethics 13 (2): 143-156. 2020.Are some risks to study participants too much, no matter how valuable the study is for society? This article answers in the negative.
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14Study bystanders and ethical treatment of study participants—A proof of conceptBioethics 34 (9): 941-947. 2020.The ethics of research on human subjects is often construed as a fine balance between the interests of patients in need of novel health interventions, and those of study participants who should remain safe in the process. But there is a third group in the mix. Some people belong to neither category, yet research can affect or jeopardize them. Call such people “bystanders.” This article shows that thinking about bystander protection can question whether there is an upper limit on the risks that s…Read more
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92Why continuing uncertainties are no reason to postpone challenge trials for coronavirus vaccinesJournal of Medical Ethics 46 (12): 808-812. 2020.To counter the pandemic caused by severe acute respiratory syndrome coronavirus 2, some have proposed accelerating SARS-CoV-2 vaccine development through controlled human infection trials. These trials would involve the deliberate exposure of relatively few young, healthy volunteers to SARS-CoV-2. We defend this proposal against the charge that there is still too much uncertainty surrounding the risks of COVID-19 to responsibly run such a trial.
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121Measuring the Global Burden of Disease: Philosophical Dimensions (edited book)Oup Usa. 2020.The Global Burden of Disease Study is one of the largest-scale research collaborations in global health, producing critical data for researchers, policy-makers, and health workers about more than 350 diseases, injuries, and risk factors. Such an undertaking is, of course, extremely complex from an empirical perspective. But it also raises complex ethical and philosophical questions. In this volume, a group of leading philosophers, economists, epidemiologists, and policy scholars identify and dis…Read more
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51Adding Lithium to Drinking Water for Suicide Prevention—The EthicsPublic Health Ethics 12 (3): 274-286. 2019.Recent observations associate naturally occurring trace levels of Lithium in ground water with significantly lower suicide rates. It has been suggested that adding trace Lithium to drinking water could be a safe and effective way to reduce suicide. This article discusses the many ethical implications of such population-wide Lithium medication. It compares this policy to more targeted solutions that introduce trace amounts of Lithium to groups at higher risk of suicide or lower risk of adverse ef…Read more
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32Non-Consequentialist UtilitarianismEthics and Economics 11 (2). 2014.Full Text / Article complet.
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38Dependence on Digital Medicine in Resource-Limited SettingsAmerican Journal of Bioethics 18 (9): 54-56. 2018.
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33Can Rationing through Inconvenience Be Ethical?Hastings Center Report 48 (1): 10-22. 2018.In this article, we provide a comprehensive analysis and a normative assessment of rationing through inconvenience as a form of rationing. By “rationing through inconvenience” in the health sphere, we refer to a nonfinancial burden that is either intended to cause or has the effect of causing patients or clinicians to choose an option for health-related consumption that is preferred by the health system for its fairness, efficiency, or other distributive desiderata beyond assisting the immediate…Read more
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Harvard UniversityRegular Faculty
Cambridge, Massachusetts, United States of America
Areas of Interest
Normative Ethics |
Social and Political Philosophy |
17th/18th Century Philosophy |