Public Health

Cross Post: Western Pharma Companies Should Supply Only Essential Medicines to Russia

Written by Alex Polyakov, The University of Melbourne and Julian Savulescu, University of Oxford

In response to Russia’s invasion of Ukraine and overwhelming destruction of property and loss of innocent lives, a number of western companies – from McDonalds to Apple – stopped or severely limited their activities in the Russian Federation.

One glaring exception appears to be the majority of western pharmaceutical companies that continue to supply medicines and equipment.

There is growing political and consumer pressure on these companies to take steps to join the concerted efforts designed to pressure the
Russian government to stop the war in Ukraine. Continue reading

Exercise, Population Health and Paternalism

Written by Rebecca Brown

 

The NHS is emphatic in its confidence that exercise is highly beneficial for health. From their page on the “Benefits of exercise” come statements like:

“Step right up! It’s the miracle cure we’ve all been waiting for”

“This is no snake oil. Whatever your age, there’s strong scientific evidence that being physically active can help you lead a healthier and happier life”

“Given the overwhelming evidence, it seems obvious that we should all be physically active. It’s essential if you want to live a healthy and fulfilling life into old age”.

Setting aside any queries about the causal direction of the relationship between exercise and good health, or the precise effect size of the benefits exercise offers, it at least seems that the NHS is convinced that it is a remarkably potent health promotion tool. Continue reading

Are Public Health Institutions Honest?

By Rebecca Brown

The COVID-19 pandemic has highlighted various cracks in the function of our public institutions. One notable concern is the way in which scientific – including health – information is communicated to the public. Communication can serve different purposes. In the context of COVID-19, communication has been essential: describing the nature of the novel coronavirus, the risks it posed to health, the measures likely to reduce its spread. Some of this communication was aimed at changing people’s behaviour in order to control the infection. For instance, people were told to wash their hands regularly, for at least 20 seconds, and to avoid touching their face. Much of this information was uncertain. Emerging data on COVID-19 presented ever-changing estimates for infection and case fatality rates.

There are particular demands that are made of health communication. It needs to reach a wide audience, delivering often quite technical, uncertain information to people with varying degrees of health literacy. It needs to encourage behaviours likely to promote individual and public health and avoid causing unnecessary panic and alarm. It must also, one might argue, avoid misleading people about the facts as they are best understood. This last point suggests that health communication should adhere to the demands of honesty. 

Continue reading

Paying for the Flu Vaccine

By Ben Davies

As I do every winter, I recently booked an appointment for a flu vaccine. I get it for free in the UK. If I didn’t have asthma, I’d still get vaccinated, but it would cost me between £9 and £14.99. That is both an ethical error on the part of the government, and may be a pragmatic one too.

Continue reading

Oxford Uehiro Centre Goes DefaultVeg

By Katrien Devolder

“Britons have cut their meat consumption by 17% over the past decade but will need to double these efforts if they are to meet targets for healthy diets and sustainable food production set out in the national food strategy earlier this year”. So began an article in The Guardian last Friday.[1] The article was reporting the guidance of the National food strategy[2]—commissioned by the UK government, but developed by an independent team in 2021—which recommends that meat consumption is cut by 30% within a decade. Many scientific studies have concluded that we (i.e., richer countries) need to be even more ambitious than that, especially if we want to halt the climate crisis.[3]

Continue reading

Special St Cross Seminar summary of Maureen Kelley’s: Fighting Diseases of Poverty Through Research: Deadly dilemmas, moral distress and misplaced responsibilities

Written By Tess Johnson

You can find the video recording of Maureen Kelley’s seminar here, and the podcast here.

Lately, we have heard much in the media about disease transmission in conditions of poverty, given the crisis-point COVID-19 spread and mortality that India is experiencing. Yet, much of the conversation is centred on the ‘proximal’—or more direct—causes of morbidity and mortality, rather than the ‘structural determinants’—or underlying, systemic conditions that lead to disease vulnerability in a population. As a result, much global health research is focussed on infectious disease treatment and prevention, rather than responses to the complex political, economic and social needs that underly disease in vulnerable communities. This can result not only in less efficient and effective research, but also moral distress for researchers, and a disconnect between research goals and the responsibility that researchers feel for addressing a community’s immediate needs.

In her Special St Cross Seminar last week, Maureen Kelley introduced her audience to these problems in global health research. Professor Kelley outlined, first, empirical findings evidencing this problem, a result of research she recently performed with the Ethox Centre’s REACH team, in collaboration with global health research teams around the world. Second, she linked this empirical work to theory on moral distress and researchers’ and institutions’ responsibilities toward participating communities in low and middle-income countries (LMICs). Continue reading

Pandemic Ethics: Key Workers Have a Stronger Claim to Compensation and Hazard Pay for Working During The COVID-19 Pandemic Than The Armed Forces Do When on Deployment

By Doug McConnell and Dominic Wilkinson

Post originally appeared on the Journal of Medical Ethics Blog

 

While the general public enjoy the relative safety of social distancing, key workers are at a higher risk of both contracting COVID-19 and transmitting it to their families. This is especially the case for ‘frontline’ workers who are frequently exposed to the virus and may not have access to adequate personal protective equipment (PPE). Tragically, many key workers have died of COVID-19 around the world already, including over 100 in the UK.

Although it is relatively rare for key workers to die from COVID-19, the risk of death is obviously much greater than one would usually expect in these roles and key workers clearly have good reason to be anxious. For ‘frontline’ workers, the distress is compounded by working in harrowing conditions where so many are dying alone. Furthermore, frontline workers have to take on the burdens of ensuring they do not transmit infections to their families, by moving in with patients, living in hotels, or maintaining rigorous social distancing in their own homes.

These atypical costs, risks, and burdens suggest that key workers are owed compensation in addition to their usual pay and a few instances of nationally coordinated applause. Continue reading

Maximising Ventilators: Some Ethical Complications

Written by Joshua Parker and Ben Davies

One of the impending tragedies of the COVID-19 pandemic is a grave mismatch between the supply of ventilators and the numbers needing them. This situation, as seen in Italy, is predicted to be mirrored here in the UK. Coronavirus can cause acute respiratory distress syndrome for which the management is mechanical ventilation on the ICU. This represents these patients’ only chance at survival. Part of the response to the incoming tsunami of patients requiring ventilation is to produce more ventilators. This is a reasonable way to try to lessen the mismatch between supply and demand. However, producing more ventilators cannot be the solution in isolation. As a complex piece of medical equipment, ventilators need trained staff to operate them and provide the additional care ventilated patients require. There has been a significant push to attempt to ensure enough ventilator trained staff as possible. Both staff and ventilator shortages present significant issues; yet it is shortages of ventilators that account for the bulk of ethical discussion so far. It is therefore worth exploring some of the ethical problems that might arise should there be plenty of ventilators, but not enough staff.

Continue reading

The Perfect Protocol? Ethics Guidelines in a Pandemic

Written by Joshua Parker and Ben Davies

One question occupying politicians and healthcare workers in the middle of this global pandemic is whether there will be enough ventilators when COVID-19 reaches its peak. As cases in the UK continue to increase, so too will demand for ventilators; Italy has reported overwhelming demand for the equipment and the need to ration access, and the UK will likely face similar dilemmas. Indeed, one UK consultant has predicted a scenario of having 8 patients for every one ventilator. Aside from anything else, this would be truly awful for the healthcare professionals having to make such decisions and live with the consequences.

Ethics is an inescapable part of medical practice, and healthcare professionals face numerous ethical decisions throughout their careers. But ethics is challenging, often involving great uncertainty and ambiguity. Medics often lack the time to sort through the morass that is ethics.  Many therefore prefer heuristics, toolboxes and a handful of principles to simplify, speed up and streamline their ethics.

Continue reading

Video Interview: Alberto Giubilini on the Ethics of Vaccination

Why do some people refuse to have their child vaccinated? Are there any good reasons not to vaccinate one’s child? Why should one have one’s child vaccinated if this doesn’t make a difference to whether the community is protected? Why is vaccinating one’s child an ethical issue? In this interview with Dr Katrien Devolder, Dr Alberto Giubilini (Philosophy, Oxford) discusses these and other questions, which he addresses in his new book ‘The Ethics of Vaccination’ (downloadable for free).

Authors

Affiliations