Do we have stronger duties to assist in emergencies than in nonemergencies? According to Peter Singer and Peter Unger, we do not. Emergency situations, they suggest, merely serve to make more salient the very extensive duties to assist that we always have. This view, while theoretically simple, appears to imply that we must radically revise common-sense emergency norms. Resisting that implication, theorists like Frances Kamm, Jeremy Waldron, and Larry Temkin suggest that emergencies are indeed normatively exceptional. While their (...) approach is more in line with common-sense, however, it is theoretically less simple, and it is has proven difficult to justify the exception. In this paper we propose a model of emergencies that we call the Informal-Insurance Model, and explain how this can be used to combine theoretical simplicity with common-sense emergency norms. (shrink)

In this book Tom Sorell argues that emergencies can justify types of action that would normally be regarded as wrong. Beginning with the ethics of emergencies facing individuals, he explores the range of effective and legitimate private emergency response and its relation to public institutions, such as national governments. He develops a theory of the response of governments to public emergencies which indicates the possibility of a democratic politics that is liberal but that takes seriously threats to (...) life and limb from public disorder, crime or terrorism. Informed by Hobbes, Schmitt and Walzer, but substantially different from them, the book widens the justification for recourse to normally forbidden measures, without resorting to illiberal politics. This book will interest students of politics, philosophy, international relations and law. (shrink)

This article examines how emerging technologies – particularly artificial intelligence – disrupt the moral and institutional foundations of contemporary military practice. While strategic documents from the United States, NATO, and other major actors anticipate profound institutional transformation driven by AI, their treatment of ethics largely confines itself to legal compliance and technical safeguards, leaving the ethical role of military leadership in managing disruptive change underexamined. Drawing on Seumas Miller’s distinction between social institutions that are merely instrumental to collective goods and (...) those whose defining ends are constitutive of such goods, the article argues that the military belongs to the latter category. Because the military’s core function – defending the sovereignty of a polity – is itself morally significant, technological disruption of its organizational structures simultaneously constitutes ethical disruption. The article thus reconceives change management during periods of technological transition as calling for a specific kind of military prudence, a practical wisdom exercised within and through the institution’s role-mediated ethical practices. By analyzing three concrete modes of techno-moral disruption, the article shows how AI may reshape ethical standards, redistribute professional knowledge, and alter organizational ethos, and why navigating these transformations responsibly is a central task of military virtue. (shrink)

Although there are problems with applying the unexpurgated Hobbes to the demands of modern terrorism and civil war, a toned-down but recognizable version of the theory does lend itself to these kinds of violent challenges to state power. Sober Hobbesianism is my term for the toned-down theory. According to me, this form of Hobbesianism gives security great weight while at the same time limiting the legal repression that is sometimes proposed in the name of security during emergencies. Instead of (...) tracing war to simple difference of opinion, and common or garden self-love, sober Hobbesianism traces war to disagreements in which there are fundamentalist attachments to a point of view or way of life or a person or place. A fundamentalist attachment is an attachment to something one would rather die or kill for than not have. Sober Hobbesianism criminalizes certain expressions of fundamentalist attachments and limits pretexts both for violence and for departures from a normal legal order that simulates some of the features of a liberal order. (shrink)

Many believe that in?supreme emergencies? collectives are granted what I elsewhere call?special permissions?, permissions to carry out self-defensive acts which would otherwise be morally forbidden. However, there appears to be a continuum between non-emergency, emergency and supreme-emergency situations, which gives rise to the following problem: If special permissions are granted in supreme emergencies, they should apply, mutatis mutandis, to less extreme cases too. If, to save itself from wholesale massacre, a collective is allowed to kill thousands of noncombatants (...) on the side of the aggressor, then to save itself from a less murderous campaign, a collective should be allowed to kill several hundreds of noncombatants, and so on. But this conclusion seems to undermine the most fundamental ideas of just war theory. The purpose of the paper is to discuss possible solutions to this problem. I contend that a contractarian view of the war convention offers the most attractive solution, though, at the end of the day, I am not sure that it will work. (shrink)

Responses to public health emergencies can entail difficult decisions about restricting individual liberties to prevent the spread of disease. The quintessential example is quarantine. While isolating sick patients tends not to provoke much concern, quarantine of healthy people who only might be infected often is controversial. In fact, as the experience with severe acute respiratory syndrome (SARS) shows, the vast majority of those placed under quarantine typically don't become ill. Efforts to enforce involuntary quarantine through military or police powers (...) also can backfire, stoking both panic and disease spread. Yet quarantine is part of a limited arsenal of options when effective treatment or prophylaxis is not available, and some evidence suggests it can be effective, especially when it is voluntary, home-based and accompanied by extensive outreach, communication and education efforts. Even assuming that quarantine is medically effective, however, it still must be ethically justified because it creates harms for many of those affected. Moreover, ethical principles of reciprocity, transparency, non-discrimination and accountability should guide any implementation of quarantine. (shrink)

This study investigated the relationships among undergraduate students’ awareness, perception, and preparedness to use artificial intelligence (AI) tools for decision- making during health emergencies in two Nigerian public universities (N = 4,632). A cross-sectional correlational design was adopted for the study. Data were collected using an online questionnaire with valid and reliable psychometric properties (α ≥ 0.90). One-sample t-tests revealed that undergraduates reported high levels of awareness (t = 55.97, < 0.001) and perception (t = 86.92, p < 0.001) (...) regarding AI use.p Although their preparedness to use AI for decision-making during health emergencies was statistically significant (t = − 34.08, p < 0.001), the mean score was comparatively lower than the baseline value of 2.50, indicating a significantly low level of preparedness. Simple linear regression analyses revealed that AI awareness significantly predicted perception and preparedness. Perception also significantly predicted preparedness. Both awareness and perception jointly accounted for 9.6% of the variance in preparedness (F(2, 4629) = 247.08, p < 0.001). Relatively, awareness remained a significant predictor of preparedness (β = 0.304, p < 0.001) even after controlling for perception. In contrast, perception became insignificant in predicting readiness when awareness was controlled for. Random forest regression (RFR) was used to test predictive accuracy and assess non-linear patterns. The results showed that awareness and perception explained 26% (training set) and 25% (test set) of the variance in undergraduates’ readiness. RFR results solidified the importance of AI awareness as the top predictor (100% predictive importance) over perception (78% predictive importance). These findings suggest that foundationalknowledge is associated with increasing readiness to adopt AI during health emergencies. Therefore, educational interventions should focus on enhancing AI awareness to improve students’ preparedness higher institutions of learning. Keywords. (shrink)

Despite Kant's explicit statement that every murderer must suffer death, there are at least four situations to be found in Kant's work in which the killing of a human being should not lead to the death penalty: when too many murderers are involved; when a mother kills her illegitimate child; when one duellist kills the other; when one person pushes another off a plank in order to save his life. This paper discusses these situation and concentrates on the last situation (...) - Kant's interpretation of the plank of Carneades – with an eye to what they learn us about Kant understanding of the law. Does Kant acknowledge a legal vacuum? In order to come to a conclusion, Kant's 'solution' of the plank is compared with those suggested by other authors, such as Cicero, Pufendorf and Lon Fuller in his famous 'speluncean explorers' case. (shrink)

In this article, I seek to make sense of the oft-invoked idea of 'public emergency' and of some of its (supposedly) radical moral implications. I challenge controversial claims by Tom Sorell, Michael Walzer, and Giorgio Agamben, and argue for a more discriminating understanding of the category and its moral force.

What characterizes emergency today is the proliferation of the term. Any event or situation supposedly has the potential to become an emergency. Emergencies may happen anywhere and at any time. They are not contained within one functional sector or one domain of life. The substantive focus of the articles collected in this special issue reflects this proliferation: they explore ways of governing in, by and through emergencies across different types of emergencies and different domains of life. In (...) response to this proliferation, the issue opens up critical work on the politics of emergency beyond the ‘state of exception’ as dominant paradigm. Emergency is treated as a problem for government that calls for the invention of new techniques or the redeployment of existing techniques. Through this shift in emphasis, the articles in this issue disclose relations between modalities of power and emergency life that differ from the ‘lightening flash’ of a sovereign decision on the exception taken from outside of life, or the capacity to ‘mould’ an always-already emergent life from within life. (shrink)

The three primary ethical challenges in preparing for public health emergencies - addressing questions of rationing, restrictions and responsibilities - all entail confronting uncertainty. But the third, considering whether people and institutions will live up to their responsibilities in a crisis, is perhaps the hardest to predict and therefore plan for. The quintessential example of a responsibility during a public health emergency is that of health care professionals' obligation to continue caring for patients during epidemics. Historically, this 'duty to (...) treat' has sometimes gone unrecognized or ignored, but it has also famously been adhered to, including during the recent SARS epidemic. And non-crisis examples of health professionals working in the face of personal risk are very common. The duty to treat should be circumscribed by several considerations, including the levels or risk and benefit at issue, the degree of public reliance on health professional action, and the nature of the individual health professional's acceptance of greater than usual risk. Examining the professional duty to treat and the legitimate questions it raises can provide insight into other actors' responsibilities. Public health ethics as well as professional ethics can help frame answers to some key questions: How strong are ethical responsibilities during crises? To whom do they apply? Should they be more explicit - and hence more circumscribed - or less explicit and hence largely aspirational? And how can public health policies encourage responsible actions? (shrink)

This article addresses an important, overlooked regulatory challenge during global health emergencies. It provides novel insights into how, and why, best practice can support decision makers in interpreting and implementing key guidance on conducting research during GHEs. The ability to conduct research before, during and after such events is crucial. The recent West-African Ebola outbreaks and the Zika virus have highlighted considerable room for improvement in meeting the imperative to research and rapidly develop effective therapies. A means of effectively (...) capturing these experiences and folding them into future decision-making is lacking; the need for effective practical translational measures remains. The challenge for the research community lies in extracting meaningful action-guiding content from pre-existing guidelines—which draw upon practical examples of guidelines ‘in action’—that assist in determining how to act in a particular situation. Insights are provided into the role of best practice as a means to do so; such examples can provide invaluable support to decision makers in interpreting high-level guidance; overarching guidelines retain their necessary level of generality and flexibility, whilst corresponding best practice examples—which incorporate important lessons learned—illustrate how such guidelines can be interpreted at a practical level. (shrink)

There are three broad ethical issues related to handling public health emergencies. They are the three R's - rationing, restrictions and responsibilities. Recently, a severe shortage of annual influenza vaccine in the US, combined with the threat of pandemic flu, has provided an opportunity for policy makers to think about rationing in very concrete terms. Some lessons from annual flu vaccination likely will apply to pandemic vaccine distribution, but many preparatory decisions must be based on very rough estimates. What (...) ethical principles should guide rationing decisions, what data should inform these decisions, how to revise decisions as new data emerge, and how to implement rationing decisions on the ground are all important considerations. In addition, ethicists might be able to help policy makers think through the importance of international cooperation in surmounting global rationing dilemmas and to accept the inevitable responsibilities of government in making and implementing rationing decisions. (shrink)

The article examines the distinction between the state of emergency and the normal state and an inherent undecidability at the base of the distinction. We argue that states of emergency arise from strategic sovereign decisions to divide visible from invisible, enemy from ally, underground economy from above-ground, illegitimate war from legitimate war. The capacity to so divide is manifested, for instance, in the technology of air raid sirens in a way that indicates the momentum of the technicity that covertly underlies (...) sovereign power. The article, furthermore, shows how the distinction between the visible and the invisible can serve as a mystification, perpetuating the state of emergency by disguising the intrinsic connection between the two domains. (shrink)

Volume 20, Issue 7, July 2020, Page 101-103.

This essay comments on the sense of disquiet philosophers, especially newer philosophers, can feel when discussing sensitive topics with non-philosophers, and the role philosophy teachers have in providing support to students who are undergoing substantial personal transformation.

This second installment in a chronologically arranged, three-part sequence continues the author's examination of Anglo-American literati who, in the later nineteenth and twentieth centuries, turned — in acts of combined xenophilia and xenophobia — to Russian literature and literary theory in order to escape the dominant influence of avant-garde movements in France. These Anglophone writers found in Russian exemplars a responsible, morally rigorous, and pragmatic, yet philosophically sophisticated, alternative to what they described as the amoral, superficial, and pretentious aestheticism of (...) French literary culture. Part 2 treats the poetry and criticism of the English “Movement” poet Donald Davie in light of his turn, in 1958, toward the example of Boris Pasternak as a way of escaping the influence of French Symbolist poetics and the post-Symbolist poetics of anglophone modernism. Although Davie understood that Pasternak was as much a modernist as T. S. Eliot or Ezra Pound, he also argued that the Russian's poetry, unlike theirs, sought, on explicitly moral grounds, to maintain conventional syntax and purity of diction, with the result that Pasternak's verse communicates with the reader more as prose than as music does. (shrink)

Life threatening emergencies involving infants and children are inherently dramatic, tension-filled situations. It is no wonder, then, that depictions of such events can be found in literature by and about doctors. In many ways, too, such depictions can illuminate key aspects of such events, such as the physician's own anxiety and the tensions between the various people involved, better than the medical literature. Hence it is suggested that the study of literary depictions of pediatric emergencies might be a (...) useful adjunct for those, physicians and other health care providers, who are called upon to manage them. (shrink)

Thomas Hobbes might seem an unlikely source for a theory of emergency powers applicable to liberal democracies in our own day. He advocated the concentration of political, judicial, economic and military authority, and was in favour of great latitude for a monarch or assembly in the choice of means to security. His theory demands absolute submission to law on the part of citizens, with no constitutional limitations on what laws can require. 1 The same theory demands preventive measures against sedition, (...) and has a very expansive conception of seditious behavior. What is more, the concentration of power with wide discretion is supposed to be politics as usual. (shrink)

ABSTRACT Universities occupy a contested space regarding their responses to the climate and nature emergencies. They are criticised for their neoliberalism, marketisation and corporatism yet they provide education to the leaders of tomorrow who are essential for the transition to a sustainable world. In this paper, residential education is explored through a three-phase Rites of Passage framework based on teaching to transgress. Dependable and trustworthy literature sources were identified to develop strands of a pedagogical framework. Autoethnographic vignettes added further (...) novel strands based on insights into residential education from the authors’ lived experiences. Thus a residential education pedagogical web emerges to reimagine learning, teaching and research in higher education that deals directly with the climate and nature emergencies. We argue that more residential education centres should be developed to operate as semi-autonomous satellites of their parent universities because they can be more participatory, flexible and dynamic. (shrink)

What are emergencies and why do they matter? In this chapter (in its penultimate version), I seek to outline the morally significant features of the concept of emergency, and demonstrate how these features generate corresponding first- and second-order challenges and responsibilities for those in a position to do something about them. In section A, I contend that emergencies are situations in which there is a risk of serious harm and a need to react urgently if that harm is (...) to be averted or minimized. These conceptual features matter morally, since it is precisely to them that those who invoke emergencies to justify otherwise impermissible actions tend to appeal. The basic first-order challenge facing emergency responders is two-fold. It is, first, to identify how these features shape circumstances of action in ways that affect (or do not affect) which reasons for action and which corresponding courses of conduct are justifiably available to them. In situations when emergency responders are compelled to make authoritative determinations due to significant contestability and indeterminacies in the contours or materialization of the said features, their challenge is then also to make these determinations legitimately. In section B, I argue that second-order challenges having to do with the foreseeability of emergencies, the value(s) of exposure to them, and their preventability further compound the predicament of emergency responders. I conclude, in section C, by saying a few words about one last morally salient feature shared by many, though not all, emergencies considered in the chapter — namely, their public dimension. (shrink)

City of Chicago officials adopted a “racial equity” approach to mitigate the disproportionate racial impact of COVID-19, yet according to interviews with racially and socioeconomically marginalized Chicagoans, this approach failed to address core vulnerabilities associated with health, housing, mental health, and welfare. This article argues that COVID-19 represents and reifies the convergence of three sets of emergencies. First, federal and local governments governed through emergency, enacting temporally bounded governmental strategies that presumed scarcity, triaged care, and naturalized structural inequality by (...) delinking the effects of racism from its causes. This response was spectacular and anticipatory—designed to safeguard the status quo until “normalcy” could be restored. This approach exacerbated two existing endemic emergencies: (1) the slow emergencies racially marginalized populations have faced for decades due to neoliberal restructuring and fragmented care infrastructure and (2) the sacrifice of lower-income frontline workers to premature death to safeguard the economy and protect the middle class. (shrink)

Health researchers, research trainees, and ethics reviewers should be prepared for the special application of research ethics within complex humanitarian emergencies. This paper argues that as a precursor to published ethical guidelines for conducting research in complex emergencies, researchers and research ethics committees should observe the following primary ethical considerations: (1) the research is not at the expense of humanitarian action; (2) the research is justified in that it is needs-driven and relevant to the affected populations; and (3) (...) the research does not compromise the humanitarian principles of neutrality, impartiality and independence. These primary considerations are in harmony with the humanitarian goals of saving lives, alleviating suffering, and témoignage. Furthermore, there is an important role for research in supporting humanitarian action, and the extreme vulnerability of research participants in complex emergencies demands intense research ethics scrutiny. It is important to discern which ethical considerations are essential, and which are merely desirable, as excessive research ethics requirements may impede life-saving research. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Spirometer, Whale, Slave:Breathing Emergencies, c. 1850John Durham Peters (bio)Breath dramatically starts with a slap at birth and ceases with death and yet we typically ignore it until it is under duress. Unlike marine mammals such as whales and dolphins who can never fully automate breathing—they sleep one brain hemisphere at a time so as to keep conscious watch, like yogis, over their respiration—we humans are mostly somnambulists with (...) regard to breath. Unlike our briny cousins, we won't drown if we neglect our breath. Our relatively accommodating habitat at the fold of lithosphere and atmosphere enables a Lethe of oblivion, though many elements of our world are hostile to breath: water, fire, earth, extremes of height, heat, or cold. Nothing could be more fundamental for aerobic terrestrial creatures than breathing. So its routine cloaking in impercipience must somehow be functional and require a great deal of nervous expenditure. (It always takes a lot of work to make an infrastructure invisible.)Breathing is a good test case for the notion, common to many variants of critical theory, that nature for humans is always second nature: what would it mean to find culture, history, and politics in something that is so relentlessly universal and given? The intensity of the urge for drink, food, sex, or sleep pales compared to that of taking a breath withheld or expelling a breath too long held. Here, it seems, desire and need converge. Breathing morphs into awareness, art and artifice when threat, absence or curiosity rouse it from its slumber—when we swim, have a coughing fit, sing, or challenge someone to a breath-holding contest. Under the earth in a mine, high in the air on a mountain or airplane, ill with a respiratory disease, or in other extreme situations, we need techniques and technologies to breathe. Like everything supposedly natural, we can't leave breathing in peace. We mold breath in techniques of speech, song, and prayer and in technologies of diving, medicine, and air travel. A full accounting of such would form a full encyclopedia of human ingenuity.1 [End Page 85]With typical flamboyance, Peter Sloterdijk declared that the atmosphere first ceased to be taken for granted, i.e., became technical, a matter of art, on 22 April 1915, with the German deployment of poison gas in World War I. On a world-historical scale, he takes this weaponization of the environment as an "air-quake" that launched modern air-conditioning in its most literal sense of climatization (as French and German has it) and not just interior cooling (Sloterdijk 89-110 passim). We need a history of comparative breathing emergencies! Every era, like every life, has its encounters with the precarity of breathing, even if not as conveniently dated or climate-change prognostic as 22 April 1915. The urban concentration of human population starting a few thousand years ago, for instance, made people co-breathers (con-spirators) in new ways and thus more prone to the contagious respiratory illnesses that have long ravaged our species.I want to look at one such moment—one marked by a deadly global respiratory illness, new instruments for producing data, worries about radical alterations to the atmosphere, comparative interest in nonhuman forms of life, and the politicization of breathing. 1850, like 2020, was a moment when breath awoke from its autonomic quiet. The nineteenth century was the great age of tuberculosis, the tragic and romantic lung disease. It was a time of fog, smoke, and mud, of climate-changing volcanic eruptions and a year without a summer, and of a mysterious, brooding "storm-cloud" that John Ruskin complained of so bitterly. Medical instruments, the whaling industry, and struggles for the abolition of slavery all brought the lungs into the foreground.SpirometerThe nineteenth century was also the great age of instrumentation. Light and sound were only the two most famous dynamic processes to yield to new graphic methods of inscription such as photography and phonography. The spirometer was one of many devices designed to render visual data of physiological functions, such as the myograph, the flame manometer, sphygmomanometer, and the kymograph. Many of them are still in use. The invention... (shrink)

Rights theorists tend to take tempi pacifici for granted, but it is precisely in emergencies that rights are most difficult to protect and most in need of protection. Two remedies are: first, to be successful in emergencies and second, to establish a free government capable of handling emergencies. These remedies play no role in the thinking of the ACLU, which has increasingly come to define the public's understanding of rights. For the ACLU, a right is not a (...) right unless it can be carried to an extreme and used irresponsibly. A better liberal theory, with instruction from Machiavelli, will seek to combine our interest in security with our assertion of rights. (shrink)

Global health emergencies often lead to a proliferation of health-related research and resultant data, which is shared across borders to help control the outbreak of disease and support decision-making regarding public health interventions. However, efforts to share data can be hindered by diverse international ethical and legal frameworks. The frameworks aim to govern coordinated processing, sharing and transfer of health data across borders thus placing burdens on researchers who are willing or obligated to share data. In this paper, we (...) investigate ethical values and legal principles that can be applied to ensure a more streamlined approach in the governance of cross-border health data sharing during global health emergencies. A scoping review approach was used to better understand emerging evidence about issues related to the ethical and legal governance of cross-border health data sharing. We first highlight the challenges of sharing health data across borders. We then discuss how the challenges might be overcome through the application of ethical values and legal principles that have been identified in literature. This is followed by a proposal for possible ways of streamlining the governance of health data sharing from ethical and legal perspectives in a bid to better prepare for future global health emergencies and promote the responsible sharing of health data. (shrink)

Disasters and public health emergencies raise a variety of ethical dilemmas, often including those that require balancing the best interests of individuals against those of groups or communities. The on-going COVID-19 pandemic provides examples of these ethical conflicts, as do other recent outbreaks. Decisions and actions in this context must address different ethical issues, ranging from those directly related to autonomy, consent, privacy and confidentiality to those related to interventions and technologies, such as efficacy, effectiveness, safety and fair access. (...) This paper aims to identify ethical conflicts with complex resolutions involving aspects related to values, rights and needs of individuals and the collective, and to suggest how such challenges could lead to more positive experiences and outcomes when confronted in future emergencies. (shrink)

Risk and crisis communication (RCC) is a current ethical issue subject to controversy, mainly due to the tension between individual liberty (a core component of fairness) and effectiveness. In this paper we propose a consistent definition of the RCC process in public health emergencies (PHERCC), which comprises six key elements: evidence, initiator, channel, publics, message, and feedback. Based on these elements and on a detailed analysis of their role in PHERCC, we present an ethical framework to help design, govern (...) and evaluate PHERCC strategies. The framework aims to facilitate RCC, incorporating effectiveness, autonomy, and fairness. It comprises five operational ethical principles: openness, transparency, inclusivity, understandability, and privacy. The resulting matrix helps understanding the interplay between the PHERCC process and the principles of the framework. The paper includes suggestions and recommendations for the implementation of the PHERCC matrix. (shrink)

Widespread obesity poses a serious challenge to health outcomes in the developed world and is a growing problem in the developing world. There has been a raft of proposals to combat the challenge of obesity, including restrictions on the nature of food advertising, the content of prepared meals, and the size of sodas; taxes on saturated fat and on calories; and mandated “healthy-options” on restaurant menus. Many of these interventions seem to have a greater impact on rates of obesity than (...) does simply providing information about health risks and healthier lifestyles. The more interventionist policy options have, however, been implemented only slowly, in large part because of criticisms that they are unjustified infringements on the liberty of consumers. Food industry groups, free-market think tanks, and the popular press regard measures that incentivize or penalize particular food and lifestyle choices as unjustifiable state regulation of purely self-regarding behavior. To counteract the liberty-oriented position, those who favor a more interventionist role for the state have recently argued for labeling obesity as a public health emergency. By labeling obesity as a public health emergency, policy-makers could override concerns about individual liberty in order to pursue more interventionist policies designed to guide consumer choices toward healthier lifestyles. In this paper, we argue that, contrary to initial appearances, obesity possesses some of the morally relevant features of public health emergencies, though we do not argue that it actually constitutes one. (shrink)

BackgroundPublic health emergencies, such as the Covid-19 pandemic, put great pressure on healthcare workers (HCW) across the world, possibly increasing the risk of experiencing ethically challenging situations (ECS). Whereas experiencing ECS as a HCW in such situations is likely unavoidable, mitigation of their adverse effects (e.g., moral distress) is necessary to reduce the risk of long-term negative consequences. One possible route of mitigation of these effects is via work environmental factors.ObjectivesThe current study aimed to examine: [1] risk factors associated (...) with ECS among HCW [2], intensity of moral distress associated with ECS across various occupational factors (i.e., profession, degree of exposure to patients with Covid-19), and [3] the impact of work environmental factors on this association, in a sample of HCW during the pandemic.MethodsWe employed multiple logistic and linear regression to self-report data from 977 HCWs at four Norwegian hospitals responding to a survey at the fourth wave of the pandemic.ResultsAbout half of HCW in this study had experienced ECS during the pandemic, and levels of moral distress associated with such were higher than in previous studies using similar assessment methods. Younger age, female sex, geographical work area (mid-north of Norway), and profession (nurse) were all associated with higher odds (range of OR: 1.30–2.59) of experiencing ECS, as were direct contact with patients with Covid-19. Among those participants who reported that they had experienced ECS during the pandemic, moral distress levels when recalling those situations were moderate (Mean 5.7 on a 0–10 scale). Men reported somewhat lower intensity of moral distress (partial eta squared; ηp2 = 0.02). Reporting a manageable workload (ηp2 = 0.02), and greater opportunity to work according to best practice (ηp2 = 0.02), were associated with lower levels of moral distress.ConclusionsOur findings suggest that moral distress could potentially be mitigated on an organizational level, particularly by focusing on ensuring a manageable workload, and an ability to work according to best practice. To build sustainable healthcare systems robust enough to withstand future public health emergencies, healthcare organizations should implement measures to facilitate these aspects of HCWs’ work environment. (shrink)

Biobanking can promote valuable health research that may lead to significant societal benefits. However, collecting, storing and sharing human samples and data for research purposes present numerous ethical challenges. These challenges are exacerbated when the biobanking efforts aim to facilitate research on public health emergencies and include the sharing of samples and data between low/middle-income countries (LMICs) and high-income countries (HICs). In this article, we explore ethical challenges for COVID-19 biobanking, offering examples from two past infectious disease outbreaks in (...) LMICs where biobanking activities contributed to the perpetuation of global inequities. We focus on how the ethical imperative to promote the common good during public health emergencies can conflict with protecting the interests of biobank participants. We discuss how conducting biobank research under a waiver of informed consent during public health emergencies is ethically permissible, provided guidance is in place to prevent biopiracy and exploitation of vulnerable communities. We also highlight the need for biobank collaborations between LMICs and HICs to promote capacity building and benefit sharing. Finally, we offer guidance to promote the ethical oversight of biobanks and biobank research during the COVID-19 pandemic or other future public health emergencies. (shrink)

abstract Assume that some group, A, is under a serious threat from some other group, B. The only way group A can defend itself is by using lethal force against group B, but the standard conditions for using force in self‐defence are not met. Ought group A to avoid the use of force even if this means yielding to an aggressive, evil power? Most people would resist this conclusion, yet given the violation of essential conditions for self‐defence, this resistance is (...) hard to justify. The aim of this paper is to point to an interesting yet unnoticed move made by some philosophers to find a way out of this problem, a move which relies on construing the situation at hand as a tragic dilemma. I show the attractiveness of this solution and argue that in the end it fails. (shrink)

Background The COVID-19 pandemic forced governments, multilateral public health organisations and research institutions to undertake research quickly to inform their responses to the pandemic. Most COVID-19-related studies required swift approval, creating ethical and practical challenges for regulatory authorities and researchers. In this paper, we examine the landscape of ethics review processes in Africa during public health emergencies (PHEs). Methods We searched four electronic databases (Web of Science, PUBMED, MEDLINE Complete, and CINAHL) to identify articles describing ethics review processes during (...) public health emergencies and/or pandemics. We selected and reviewed those articles that were focused on Africa. We charted the data from the retrieved articles including the authors and year of publication, title, country and disease(s) reference, broad areas of (ethical) consideration, paper type, and approach. Results Of an initial 4536 records retrieved, we screened the titles and abstracts of 1491 articles, and identified 72 articles for full review. Nine articles were selected for inclusion. Of these nine articles, five referenced West African countries including Liberia, Guinea and Sierra Leone, and experiences linked to the Ebola virus disease. Two articles focused on South Africa and Kenya, while the other two articles discussed more general experiences and pitfalls of ethics review during PHEs in Africa more broadly. We found no articles published on ethics review processes in Africa before the 2014 Ebola outbreak, and only a few before the COVID-19 outbreak. Although guidelines on protocol review and approval processes for PHEs were more frequently discussed after the 2014 Ebola outbreak, these did not focus on Africa specifically. Conclusions There is a gap in the literature about ethics review processes and preparedness within Africa during PHEs. This paper underscores the importance of these processes to inform practices that facilitate timely, context-relevant research that adequately recognises and reinforces human dignity within the quest to advance scientific knowledge about diseases. This is important to improve fast responses to PHEs, reduce mortality and morbidity, and enhance the quality of care before, during, and after pandemics. (shrink)

My thesis in this paper is that liberals should adopt a very strong presumption in favor of the rule of law during a public health emergency and should only turn to rule by experts under very narrow, and extremely rare, conditions. In addition to defending this thesis, this paper offers a general framework for when liberals should permit violations of the rule of law in favor of rule of experts during public health emergencies. -/- The paper proceeds as follows. (...) In section I, I define some thorny theoretical issues about the rule of law that will clarify what, precisely, I mean by rule of law and rule of experts in public health. In section II, I advance several arguments in favor of the rule of law in public health. These arguments will be the following: (1) the democracy argument, (2) the autonomy argument, (3) the respect for rational planning argument, and (4) the precedent argument. These arguments are intended to establish the claim that liberals should endorse a very strong presumption in favor of not violating the rule of law during a public health emergency. In section III, I ask when this very strong presumption in favor of the rule of law may be overridden in favor of rule by experts. I outline a narrow set of conditions that must obtain for this to be the case. My own view is that these conditions very rarely, if ever, obtain in the real world. But, if the reader disagrees with me on this point, the general framework is still useful. (shrink)