Universal Basic Income, Poverty, and Social Justice: A Moral and Economic Imperative for Social Workers.

Modern technology threatens to dramatically alter the U.S. labor economy, but the crumbling social safety net may be insufficient for affected workers. Some advocates propose to address these converging problems through universal basic income (UBI). Authors conducted a preliminary review of social work perspectives on the topic of UBI. They found very little relevant literature, especially among American scholars. Existent social work literature frames UBI as an alternative to the neoliberal welfare state and mass unemployment. Social workers also contribute a critical social justice orientation to UBI scholarship in other disciplines. Grounded in the NASW Code of Ethics, authors argue that it is imperative for American social workers to seriously consider UBI as an answer to growing inequality and the unique expertise that social workers offer as allies of marginalized populations.

Are Patients' and Communities' Poverty Exploited to Give Health Professions Students Learning Experiences?

In clinical settings, exploitation of patients who live in poverty can be exacerbated when health professions students' educational goals are overemphasized relative to patients' and communities' needs. Continuity of care relies on health system infrastructure and its capacity to keep patients engaged. Achieving just health care delivery in domestic and international settings requires balancing students', patients', and communities' interests. This article examines how students' interests in learning should be considered relative to patients' and communities' interests in receiving quality care.

Are Medicaid Closed Formularies Unethical?

State Medicaid programs have proposed closed formularies to limit spending on drugs. Closed formularies can be justified when they enable spending on other socially valuable aims. However, it is still necessary to justify guidelines informing formulary design, which can be done through a process of decision making that includes the public. This article examines criticisms that Medicaid closed formularies limit deliberation about decisions that affect drug access and unfairly disadvantage poor patients. Although unfairness to poor patients is a risk, it is not a problem unique to Medicaid, since private insurance programs have also implemented closed formularies.

How to conduct good quality research on violence against children with disabilities: key ethical, measurement, and research principles.

BACKGROUND: Approximately one billion children experience violence every year. Violence against children is an urgent global public health concern and violation of children's rights. It is also a risk factor for serious negative health and social outcomes and is therefore addressed within the Sustainable Development Goals (SDGs). Children with disabilities, who make up one in 20 children worldwide, are particularly vulnerable to violence although good quality data are lacking on causes and means of prevention of violence against children with disabilities. Key challenges exist in the measurement of disability and violence, which in part explains the dearth in evidence. IMPROVING RESEARCH ON VIOLENCE AGAINST CHILDREN WITH DISABILITIES: This paper provides guidance on how to conduct good quality, ethical, and inclusive research on violence against children with disabilities, particularly in low-income settings. The lack of an international agreed 'gold standard' frustrates efforts to measure violence across settings and time. Careful consideration must be given to the design of survey tools. Qualitative and participatory research methods also offer important opportunities to explore children's subjective understanding and experiences of violence. Challenges also exist around the measurement of disability. Disability may be measured by asking directly about disability, through self-reported functioning, or through the presence of impairments or health conditions. These approaches have strengths and limitations and should build on what children are able to do and include appropriate adaptations for specific impairments where necessary. Ethical research also requires adherence to ethical guidelines and approvals, obtaining informed consent, appropriate child protection responses, and careful consideration of interviewer-related issues including their selection, training, and welfare. Key methodological gaps remain - how to include children with severe communication challenges in research; how to respond in instances of weak child protection systems; designing sampling procedures that adequately represent children with disabilities in large-scale violence surveys; and determining how best to ask about violence safely in large-scale surveys and monitoring data. This paper further advocates for the dissemination of research results in inclusive and accessible formats. CONCLUSION: With careful planning, challenges in collecting data on disability and violence can be overcome to generate evidence in this neglected area.

Social Work Is a Human Rights Profession.

As defined by the International Federation of Social Workers, social work is a human rights profession. This is explicitly stated in the professional codes of ethics in many nations. However, the most recent version of the Code of Ethics of the National Association of Social Workers continues to exclude any mention of human rights, fitting in with the history of U.S. exceptionalism on this subject. Social workers around the world have a long history of working for the achievement of human rights, including an explicit grounding of practice in human rights principles: human dignity, nondiscrimination, participation, transparency, and accountability. Utilizing these principles, U.S. social workers can move from the deficit model of the needs-based approach to competently contextualizing individual issues in their larger human rights framework. In this way, social work can address larger social problems and make way for the concurrent achievement of human rights. This article explains these principles and provides a case example of how to apply them in practice.

Bedside Rationing Under Resource Constraints-A National Survey of Ethiopian Physicians' Use of Criteria for Priority Setting.

In low-income settings resource constraints force clinicians to make harsh choices. We examine the criteria Ethiopian physicians use in their bedside rationing decisions through a national survey at 49 public hospitals in Ethiopia. Substantial variation in weight given to different criteria were reported by the 587 participating physicians (response rate 91.7%). Young age, primary prevention, or the patient being the family's economic provider increased likelihood of offering treatment to a patient, while small expected benefit or low chance of success diminished likelihood. More than 50% of responding physicians were indifferent to patient's position in society, unhealthy behavior, and residence, while they varied widely in weight they gave to patient's poverty, ability to work, and old age. While the majority of Ethiopian physicians reported allocation of resources that was compatible with national priorities, more contested criteria were also frequently reported. This might affect distributional justice and equity in health care access.

Greening the poor: the trap of moralization.

This article uses ethnographic data to engage a critical reflection on the tension between individual responsibility for the environment and inequality. While research has shown that the majority of sustainable consumers are middle and upper class, educated and white individuals, the study explores how the ethical injunction to ecological sustainability is being introduced to lower-income neighbourhoods in France. It draws on the observation of a national programme which aims at supporting inhabitants of public housing estates in the process of greening their lifestyle in order to fight climate change and fuel poverty. The paper analyses how environmental responsibilization is specific in that it calls upon a responsibility towards others, towards the common good. Using the Foucauldian concept of 'subjectivation', it describes and analyses the moral work implied by such behaviour change programmes. It demonstrates that a negative representation of poor households and a moral framing of the responsibility for the environment lead to a moralization of their lifestyle under the heading of 'eco-friendly behaviours'. A paradoxical result of such endeavours is that the social group with the least impactful lifestyle on the environment is the one which is moralized in the most intrusive and resolute manner. The article shows, however, that the tenants manage to resist the normalizing discourse on sustainable living, for reasons which are not anti-environmentalist. This piece thus provides interesting results for sustainability studies as well as for the sociology of the regulation of underprivileged neighbourhoods.

How Should Clinicians Respond When Different Standards of Care Are Applied to Undocumented Patients?

A challenge in caring for patients in resource-poor settings is the ethical discomfort and discouragement clinicians might experience when they're unable to provide optimal care due to lack of resources. This case, in which a resident is faced with rationalizing substandard care for certain classes of patients, probably represents the top of a slippery slope. This article argues that physicians should identify and advocate for optimal care for each patient. Moreover, physicians should advocate to improve the health system that allows for substandard care. Physicians should disclose to patients all available evaluation and treatment options, even those that seem cost prohibitive or unrealistic for some other reason. Transparency and objectivity in the patient-clinician relationship require good communication skills and are central to avoiding harm.

Newborn health benefits or financial risk protection? An ethical analysis of a real-life dilemma in a setting without universal health coverage.

INTRODUCTION: High healthcare costs make illness precarious for both patients and their families' economic situation. Despite the recent focus on the interconnection between health and financial risk at the systemic level, the ethical conflict between concerns for potential health benefits and financial risk protection at the household level in a low-income setting is less understood. METHODS: Using a seven-step ethical analysis, we examine a real-life dilemma faced by families and health workers at the micro level in Ethiopia and analyse the acceptability of limiting treatment for an ill newborn to protect against financial risk. We assess available evidence and ethical issues at stake and discuss the dilemma with respect to three priority setting criteria: health maximisation, priority to the worse-off and financial risk protection. RESULTS: Giving priority to health maximisation and extra priority to the worse-off suggests, in this particular case, that limiting treatment is not acceptable even if the total well-being gain from reduced financial risk is taken into account. Our conclusion depends on the facts of the case and the relative weight assigned to these criteria. However, there are problematic aspects with the premise of this dilemma. The most affected parties-the newborn, family members and health worker-cannot make free choices about whether to limit treatment or not, and we thereby accept deprivations of people's substantive freedoms. CONCLUSION: In settings where healthcare is financed largely out-of-pocket, families and health workers face tragic trade-offs. As countries move towards universal health coverage, financial risk protection for high-priority services is necessary to promote fairness, improve health and reduce poverty.

The potential exploitation of research participants in high income countries who lack access to health care.

There are millions of individuals living in North America and the European Union who lack access to healthcare services. When these individuals participate in research, they are at increased risk of being exposed to the risks and burdens of clinical trials without realizing the benefits that result from them. The mechanisms that have been proposed to ensure that research participants in low- and middle-income countries are not exploited are unlikely to protect participants in high-income countries. The present manuscript argues that one way to address concerns about exploitation in high-income countries would be to require sponsors to provide targeted benefits such as medical treatment during the trial, or the study drug after the trial. The latter could be achieved through extension studies, expanded access programs, or named-patient programs. Sponsors also might provide non-medical benefits, such as education or social support. Ethical and regulatory guidance should be revised to ensure that research participants in high-income countries who lack access to healthcare services receive sufficient benefits.

The Ethics of Introducing GMOs into sub-Saharan Africa: Considerations from the sub-Saharan African Theory of Ubuntu.

A growing number of countries in sub-Saharan Africa are considering legalizing the growth of genetically modified organisms (GMOs). Furthermore, several projects are underway to develop transgenic crops tailored to the region. Given the contentious nature of GMOs and prevalent anti-GMO sentiments in Africa, a robust ethical analysis examining the concerns arising from the development, adoption, and regulation of GMOs in sub-Saharan Africa is warranted. To date, ethical analyses of GMOs in the global context have drawn predominantly on Western philosophy, dealing with Africa primarily on a material level. Yet, a growing number of scholars are articulating and engaging with ethical theories that draw upon sub-Saharan African value systems. One such theory, Ubuntu, is a well-studied sub-Saharan African communitarian morality. I propose that a robust ethical analysis of Africa's agricultural future necessitates engaging with African moral theory. I articulate how Ubuntu may lead to a novel and constructive understanding of the ethical considerations for introducing GMOs into sub-Saharan Africa. However, rather than reaching a definitive prescription, which would require significant engagement with local communities, I consider some of Ubuntu's broader implications for conceptualizing risk and engaging with local communities when evaluating GMOs. I conclude by reflecting on the implications of using local moral theory in bioethics by considering how one might negotiate between universalism and particularism in the global context. Rather than advocating for a form of ethical relativism, I suggest that local moral theories shed light on salient ethical considerations that are otherwise overlooked.

Universal health care and equity: evidence of maternal health based on an analysis of demographic and household survey data.

INTRODUCTION: The drive toward universal health coverage (UHC) is central to the post 2015 agenda, and is incorporated as a target in the new Sustainable Development Goals. However, it is recognised that an equity dimension needs to be included when progress to this goal is monitored. WHO have developed a monitoring framework which proposes a target of 80% coverage for all populations regardless of income and place of residence by 2030, and this paper examines the feasibility of this target in relation to antenatal care and skilled care at delivery. METHODOLOGY: We analyse the coverage gap between the poorest and richest groups within the population for antenatal care and presence of a skilled attendant at birth for countries grouped by overall coverage of each maternal health service. Average annual rates of improvement needed for each grouping (disaggregated by wealth quintile and urban/rural residence) to reach the goal are also calculated, alongside rates of progress over the past decades for comparative purposes. FINDINGS: Marked inequities are seen in all groups except in countries where overall coverage is high. As the monitoring framework has an absolute target countries with currently very low coverage are required to make rapid and sustained progress, in particular for the poorest and those living in rural areas. The rate of past progress will need to be accelerated markedly in most countries if the target is to be achieved, although several countries have demonstrated the rate of progress required is feasible both for the population as a whole and for the poorest. CONCLUSIONS: For countries with currently low coverage the target of 80% essential coverage for all populations will be challenging. Lessons should be drawn from countries who have achieved rapid and equitable progress in the past.

Ethical Dilemmas Relating to the Management of a Newborn with Down Syndrome and Severe Congenital Heart Disease in a Resource-Poor Setting.

Decision-making regarding treatment for newborns with disabilities in resource-poor settings is a difficult process that can put parents and caregivers in conflict. Despite several guidelines that have helped to clarify some of the medical decision-making in Ghana, there is still no clear consensus on the specific moral criteria to be used. This article presents the case of a mother who expressed her wish that her child with Down syndrome should not have been resuscitated at birth. It explores the ethical issues at stake in both her misgivings about the resuscitation and her unwillingness to consider surgical repair of an atrioventricular (AV) canal defect. Knowing that children born with Down syndrome are able to pursue life's goals, should our treatment of complete AV canal defect in such children be considered morally obligatory, even in resource-poor settings like Ghana?

Dilemmas for international mobilization around child abuse and neglect.

The goal of this commentary is to articulate some issues and dilemmas raised by various efforts to mobilize international action around child abuse and neglect (CAN). We will start by proposing a typology of international mobilization strategies, noting that initiatives to promote CAN programming in new settings have tended to emphasize one of three vectors: governments, professionals, or international NGOs. There are pros and cons to each emphasis, which we discuss. We also review the debates around some of the following dilemmas: Should low-income countries be a top priority for CAN mobilization? Are there cultural and institutional capacities that need to be present in a country in order for CAN programs to work or be ethical? Are some CAN programs more likely to be internationally transferable than others and why so? Has the field adequately considered whether non-CAN programming (e.g., family planning) might actually be more effective at preventing maltreatment than CAN programming? Does the field give adequate acknowledgment that policies and practices emanating from high-resourced and Western countries may not always be the best to disseminate? Are we relying too much on a model of program transplantation over a model of local cultivation? Should we aim for modest rather than ambitious accomplishments in international mobilization? How much emphasis should be placed on the priority dissemination of evidence-based programming? We conclude with some suggestions in the service of clarifying these dilemmas and making some of these decisions more evidence based.

Youth mental health interventions via mobile phones: a scoping review.

Mobile phone technologies have been hailed as a promising means for delivering mental health interventions to youth and adolescents, the age group with high cell phone penetration and with the onset of 75% of all lifetime mental disorders. Despite the growing evidence in physical health and adult mental health, however, little information is available about how mobile phones are implemented to deliver mental health services to the younger population. The purpose of this scoping study was to map the current state of knowledge regarding mobile mental health (mMental Health) for young people (age 13-24 years), identify gaps, and consider implications for future research. Seventeen articles that met the inclusion criteria provided evidence for mobile phones as a way to engage youth in therapeutic activities. The flexibility, interactivity, and spontaneous nature of mobile communications were also considered advantageous in encouraging persistent and continual access to care outside clinical settings. Four gaps in current knowledge were identified: the scarcity of studies conducted in low and middle income countries, the absence of information about the real-life feasibility of mobile tools, the need to address the issue of technical and health literacy of both young users and health professionals, and the need for critical discussion regarding diverse ethical issues associated with mobile phone use. We suggest that mMental Health researchers and clinicians should carefully consider the ethical issues related to patient-practitioner relationship, best practices, and the logic of self-surveillance.