Against commercial-assisted suicide.

The idea of commercial-assisted suicide lives a marginal existence in the bioethical literature, despite its significant presence in popular culture. The practice of commercial-assisted suicide (CAS) is defined as suicide assistance performed for a financial reward through a contractual agreement between a customer and a service-provider, who does not necessarily need to be a medical professional. While CAS does indeed offer some potential solutions regarding the moral controversies surrounding physician-assisted suicide (PAS), I defend the idea that adopting it as policy ultimately proves morally indefensible and practically inefficient. This is due to the fact that the commodification of a given good necessarily implies the creation of a market of said good; as such, what I propose in this paper is a moral and practical evaluation of a market of CAS. In order to do so, I first examine the arguments in favor of CAS as put forward by Roland Kipke, who argues that any liberal defense of PAS necessarily implies a defense of CAS. In the first section, I argue against this idea using the liberal values of autonomy and equality of opportunity. In the second section of the paper, I argue that a market of CAS would be gravely dysfunctional due to one particular characteristic of death, namely, that is not compensable ex post. I conclude by arguing that while the practice of CAS may not prove morally problematic, the inevitable market that it will create should it be legalized most certainly will.

Commodification of biomaterials and data when funding is contingent to transfer in biobank research.

It is common practice for biobanks and biobank researchers to seek funding from agencies that are independent of the biobank that often stipulate conditions requiring researchers to grant access and share biomaterials and data as part of the agreement, in particular, in international collaborative health research. As yet, to the author's knowledge, there has been no study conducted to examine whether these conditions could result in the commercialization of biomaterials and data and whether such practice is considered ethical. This paper therefore seeks to answer the question of whether such sharing of biomaterials and data for biobank research in exchange for funding from sponsors and funders in collaborative health research is ethically justified. The central idea of this paper is based on an argument against commodification of the body and its parts, which includes biomaterials and data and holds that it is ethically wrong to commodify humans and their body parts. The arguments against commodification of biomaterials and data explored are the Kantian approach argument as it relates to interference of commodification with human dignity which is linked to a diminished sense of personhood, an argument against commodification that is based on a dilution of altruism and lastly the communitarian approach anti-commodification argument which emphasizes a social responsibility to the common good. Arguments in support of commodification based on liberal individualism and consequentialism are also discussed.

Offering more without offering compensation: non-compensating benefits for living kidney donors.

While different positions on the permissibility of organ markets enjoy support, there is widespread agreement that some benefits to living organ donors are acceptable and do not raise the same moral concerns associated with organ markets, such as exploitation and commodification. We argue on the basis of two distinctions that some benefit packages offered to donors can defensibly surpass conventional reimbursement while stopping short of controversial cash payouts. The first distinction is between benefits that defray the costs of donating an organ and benefits that incentivize donation by offering something in excess of defraying. The second distinction is between benefits that compensate donors and benefits that are non-compensating. We argue that non-compensating benefits are innocent of moral concerns typically associated with controversial cash payouts, and thus may be a morally promising avenue for increasing rates of kidney donation to address the tragic results of undersupply.

Blood and plasma donors during the COVID-19 pandemic: arguments against financial stimulation.

During the COVID-19 pandemic, blood and convalescent plasma donors are dearly needed. There is a need to modify donor recruitment strategies in order to stimulate these donors. Financial stimulants though, cannot be possibly used. This paper will analyze, from an ethical perspective, the possible consequences regarding the blood and plasma donor system by a simple shift of attention from the voluntary unpaid donor to the paid one or the blood seller.

From undergraduate to postgraduate uses of the dead human body: consequential ethical shift.

The dependence of surgical training programmes on the supply of bodies by for-profit organisations places them at serious ethical risk. These risks, with their commodification of the bodies used in the programme, are outlined. It is concluded that this is not a satisfactory model for the trainees' subsequent interaction with living patients and that a code of practice is required.

Reconstructing feminist perspectives of women's bodies using a globalized view: The changing surrogacy market in Japan.

This paper aims to evoke an alternative viewpoint on surrogacy, moving beyond popular Western feminist beliefs on the practice, by introducing the history and current context of East Asian surrogacy. To elaborate a different cultural perspective on surrogacy, this paper first introduces the East Asian history of contract pregnancy systems, prior to the emergence of the American invention of 'modern' surrogacy practice. Then, it examines Japanese mass media portrayals of cross-border surrogacy in which white women have become 'convenient' entities. The results of the analysis show how Japanese culture has adopted a rhetoric about the use of white women as convenient surrogate mothers in the global commercial surrogacy market. An essential aspect of surrogacy is the premise that a woman's reproductive function should be accessible to others. Past discussions among feminists have neglected this important point. Moreover, they share the assumption that white surrogacy clients are exploiters, who take advantage of women of colour as surrogate mothers. The current situation in Asia flips this perspective-with white women regarded as easier targets for exploitation by wealthy people of colour. For Asian clients, Westerners can be easily regarded as 'others' whom they can use for their reproductive needs. In today's globalized era, the surrogacy industry is no longer for affluent Westerners only. Considering this change, it is crucial to discuss surrogacy issues by reconstructing feminist perspectives with a globalized view, to help protect women's bodies, regardless of nationality, ethnicity, skin colour, or religion.

Construction of nursing knowledge in commodified contexts: A discussion paper.

This original article outlines a theoretical path and posterior critical analysis regarding two relevant matters in modern nursing: patterns of knowing in nursing and commodification contexts in contemporary health systems. The aim of our manuscript is to examine the development of basic and contextual nursing knowledge in commodified contexts. For this purpose, we outline a discussion and reflexive dialogue based on a literature search and our clinical experience. To lay the foundation for an informed discussion, we conducted a literature search and selected relevant articles in English, Spanish, and Portuguese that included contents on patterns of knowing, commodification, and nursing published from 1978 to 2017. Globalization, commodification, and austerity measures seem to have negative effects on nursing. Work conditions are worsening, deteriorating nurse-patient relationships, and limiting reflection on practice. Nurses must develop knowledge to challenge and participate in institutional organization and public health policies. Development of nursing knowledge may be difficult to achieve in commodified environments. Consequently, therapeutic care relationships, healthcare services, and nurses' own health are compromised. However, by obtaining organizational, sociopolitical, and emancipatory knowledge, nurses can use strategies to adapt to or resist commodified contexts while constructing basic knowledge.

Regulating the international surrogacy market:the ethics of commercial surrogacy in the Netherlands and India.

It is unclear what proper remuneration for surrogacy is, since countries disagree and both commercial and altruistic surrogacy have ethical drawbacks. In the presence of cross-border surrogacy, these ethical drawbacks are exacerbated. In this article, we explore what would be ethical remuneration for surrogacy, and suggest regulations for how to ensure this in the international context. A normative ethical analysis of commercial surrogacy is conducted. Various arguments against commercial surrogacy are explored, such as exploitation and commodification of surrogates, reproductive capacities, and the child. We argue that, although commodification and exploitation can occur, these problems are not specific to surrogacy but should be understood in the broader context of an unequal world. Moreover, at least some of these arguments are based on symbolic rhetoric or they lack knowledge of real-world experiences. In line with this critique we argue that commercial surrogacy can be justified, but how and under what circumstances depends on the context. Surrogates should be paid a sufficient amount and regulations should be in order. In this article, the Netherlands and India (where commercial surrogacy was legal until 2015) are case examples of contexts that differ in many respects. In both contexts, surrogacy can be seen as a legitimate form of work, which requires the same wage and safety standards as other forms of labor. Payments for surrogacy need to be high enough to avoid exploitation by underpayment, which can be established by the mechanisms of either minimum wage (in high income countries such as the Netherlands), or Fair-Trade guidelines (in lower-middle income countries such as India). An international treaty governing commercial surrogacy should be in place, and local professional bodies to protect the interests of surrogates should be required. Commercial surrogacy should be permitted across the globe, which would also reduce the need for intended parents to seek surrogacy services abroad.

Intimate partner violence, HIV and sexually transmitted infections in fishing, trading and agrarian communities in Rakai, Uganda.

BACKGROUND: Intimate partner violence (IPV), HIV and sexually transmitted infections (STI) can contribute to disparities in population health, depending on the individual, social and environmental factors characterizing a setting. To better understand the place-based determinants and patterns of these key interrelated public health problems in Uganda, we compared risk factors for IPV, HIV and STI in fishing, trading and agrarian communities in Rakai, Uganda by gender. METHOD: This study used cross-sectional data collected from 14,464 sexually active men (n = 6531) and women (n = 7933) as part of the Rakai Community Cohort Study, a population-based open cohort study of men and women aged 15-49 years. We used multilevel modified poisson regression models, which incorporated random intercepts for community and households. Factors associated with IPV, HIV and STI were assessed separately for men and women in fishing, trading and agrarian communities. RESULTS: A larger proportion of participants in the fishing communities than those in trading and agrarian communities were HIV positive, engaged in HIV risk behaviors, had STI symptoms and reported perpetration of or victimization by IPV. Female gender was a shared correlate of IPV, HIV and STI in the fishing communities. Engagement in multiple sexual relationships or partner's engagement in multiple relationships were shared correlates of IPV, and HIV in agrarian communities and IPV and STI in trading communities. CONCLUSION: Programs should target factors at multiple levels to reduce risk for syndemic conditions of HIV, STI and IPV in Rakai, Uganda particularly among men and women in fishing communities.

The patient-doctor relationship in the transnational healthcare context.

Moving away from paternalism to more equal forms of interaction in the patient-doctor relationship has been seen in positive light by policymakers, patients' rights advocates and scholars alike. Nonetheless, against the background of commercialisation and consumerism, empirical research showcases how reduced asymmetries bring in tensions and friction between patients and doctors (Greenfield et al. 2012). This paper contributes to the discussion through the examination of the patient-doctor relationship in the niche setting of private transnational healthcare markets which involve patients travelling overseas for care and where commodification, consumerism and care go hand-in-hand. It is geographically focused on two large cities in South-Eastern Europe as settings where health care is provided to foreign patients - Athens and Istanbul - and empirically draws on qualitative interviews with doctors who run small/medium practices. The findings highlight that, despite excessive consumerism, power asymmetries are not mitigated but patient vulnerability shapes the patient-doctor relationship. In the transnational context, the patient faces an additional source of vulnerability: a condition of foreignness. As such, the findings stress that one relationship model (the consumerist) does not, per se, replace an older one (e.g. the Parsonian). Instead, the consumer-provider dimension co-exists with the client-expert, patient-doctor and, finally, host-guest relation.

Beyond health: medicines, food supplements, energetics and the commodification of self-performance in Maputo.

With an increasing range of products in global and local markets, more options are available for individuals to enhance their image and their (cognitive, social and physical) performance. These 'performance consumptions' relate to ideals of well-being and improvement, and are based on constructed desires, expectations and needs that go beyond the (often blurred) dichotomy of health and illness. Drawing from mixed-methods research in Maputo, Mozambique, this paper discusses individuals' use of medicines and other substances - pharmaceuticals, food supplements, traditional herbs, cosmetics and energy drinks - for managing different aspects of their everyday lives. Through an overview of the main consumption practices, we explore the underlying purposes and strategies of users, and the perceived legitimacy and risks involved when using a variety of products accessible through formal and informal exchange channels. From tiredness to sexual and aesthetic management, we show how the body becomes the locus of experimentation and investment to perform in accordance with socially expected roles, individual aspirations and everyday tasks. With insights from individuals' accounts in Maputo, we aim to add to discussions on pharmaceuticalisation of body management by showing how the emergence of new performance consumptions is articulated with the reconfiguration of more 'traditional' consumption practices.

The commercialization of the biomedical sciences: (mis)understanding bias.

The growing commercialization of scientific research has raised important concerns about industry bias. According to some evidence, so-called industry bias can affect the integrity of the science as well as the direction of the research agenda. I argue that conceptualizing industry's influence in scientific research in terms of bias is unhelpful. Insofar as industry sponsorship negatively affects the integrity of the research, it does so through biasing mechanisms that can affect any research independently of the source of funding. Talk about industry bias thus offers no insight into the particular epistemic shortcomings at stake. If the concern is with the negative effects that industry funding can have on the research agenda, conceptualizing this influence as bias obscures the ways in which such impact is problematic and limits our ability to offer solutions that can successfully address the concerns raised by the growing role of private funding in science.

How to produce 'marketable and profitable results for the company': from viral interference to Roferon A.

This paper looks at the commodification of interferon, marketed by Hoffmann La Roche (short: Roche) as Roferon A in 1986, as a case study that helps us understand the role of pharmaceutical industry in cancer research, the impact of molecular biology on cancer therapy, and the relationships between biotech start-ups and established pharmaceutical firms. Drawing extensively on materials from the Roche company archives, the paper traces interferon's trajectory from observed phenomenon (viral interference) to product (Roferon A). Roche embraced molecular biology in the late 1960s to prepare for the moment when the patents on some of its bestselling drugs were going to expire. The company funded two basic science institutes to gain direct access to talents and scientific leads. These investments, I argue, were crucial for Roche's success with recombinant interferon, along with more mundane, technical and regulatory know-how held at Roche's Nutley base. The paper analyses in some detail the development process following the initial success of cloning the interferon gene in collaboration with Genentech. It looks at the factors necessary to scale up the production sufficiently for clinical trials. Using Alfred Chandler's concept of 'organizational capabilities', I argue that the process is better described as 'mobilisation' than as 'translation'.

Commodification of care and its effects on maternal health in the Noun division (West Region - Cameroon).

BACKGROUND: Since the mid-1980s, there has been a gradual ethical drift in the provision of maternal care in African health facilities in general, and in Cameroon in particular, despite government efforts. In fact, in Cameroon, an increasing number of caregivers are reportedly not providing compassionate care in maternity services. Consequently, many women, particularly the financially vulnerable, experience numerous difficulties in accessing these health services. In this article, we highlight the unequal access to care in public maternity services in Cameroon in general and the Noun Division in particular. METHODS: For this study, in addition to documentary review, two qualitative data collection techniques were used: direct observation and individual interviews. Following the field work, the observation data were categorized and analyzed to assess their relevance and significance in relation to the topics listed in the observation checklist. Interviews were recorded using a dictaphone; they were subsequently transcribed and the data categorized and coded. After this stage, an analysis grid was constructed for content analysis of the transcripts, to study the frequency of topics addressed during the interviews, as well as divergences and convergences among the respondents. RESULTS: The results of this data analysis showed that money has become the driving force in service provision. As such, it is the patient's economic capital that counts. Considered "clients", pregnant women without sufficient financial resources wait long hours in corridors; some die in pain under the indifferent gaze of the professionals who are supposed to take care of them. In sharp contrast, the findings revealed that financially privileged patients are able to bribe caregivers to attract their favour and obtain prompt, careful, and effective care. CONCLUSION: These ethical abuses observed in the Noun public health facilities drive women to use, from the beginning of their pregnancies to the delivery, only healthcare delivered by traditional health attendants.

Public Trust in Physicians-Health Care Commodification as a Possible Deteriorating Factor: Cross-sectional Analysis of 23 Countries.

Trust in physicians has declined, and surveys of public opinion show a poor level of public trust in physicians. Commodification of health care has been speculated as a plausible driving force. We used cross-national data of 23 countries from the International Social Survey Programme 2011 to quantify health care commodification and study its role in the trust that patients generally place in physicians. A modified health care index was used to quantify health care commodification. There were 34 968 respondents. A question about the level of general trust in physicians and a 4-item "general trust in physicians" scale were used as our major and minor outcomes. The results were that compared with those in the reference countries, the respondents in the health care-commodified countries were approximately half as likely to trust physicians (odds ratio: 0.47, 95% confidence interval [CI]: 0.31-0.72) and scored 1.13 (95% CI: 1.89-0.37) less on the general trust scale. However, trust in physicians in the health care-decommodified countries did not differ from that in the reference countries. In conclusion, health care commodification may play a meaningful role in the deterioration of public trust in physicians.

Governance Options to Enhance Ecosystem Services in Cocoa, Soy, Tropical Timber and Palm Oil Value Chains.

Dutch policies have advocated sustainable commodity value chains, which have implications for the landscapes from which these commodities originate. This study examines governance and policy options for sustainability in terms of how ecosystem services are addressed in cocoa, soy, tropical timber and palm oil value chains with Dutch links. A range of policies addressing ecosystem services were identified, from market governance (certification, payments for ecosystem services) to multi-actor platforms (roundtables) and public governance (policies and regulations). An analysis of policy narratives and interviews identified if and how ecosystem services are addressed within value chains and policies; how the concept has been incorporated into value chain governance; and which governance options are available. The Dutch government was found to take a steering but indirect role in all the cases, primarily through supporting, financing, facilitating and partnering policies. Interventions mainly from end-of-chain stakeholders located in processing and consumption countries resulted in new market governance, notably voluntary sustainability standards. These have been successful in creating awareness of some ecosystem services and bringing stakeholders together. However, they have not fully addressed all ecosystem services or stakeholders, thus failing to increase the sustainability of value chains or of the landscapes of origin. We argue that chains sourced in tropical landscapes may be governed more effectively for sustainability if voluntary, market policy tools and governance arrangements have more integrated goals that take account of sourcing landscapes and impacts along the entire value chain. Given the international nature of these commodities. These findings have significance for debates on public-private approaches to value chain and landscape governance.

Beyond Fair Benefits: Reconsidering Exploitation Arguments Against Organ Markets.

One common objection to establishing regulated live donor organ markets is that such markets would be exploitative. Perhaps surprisingly, exploitation arguments against organ markets have been widely rejected in the philosophical literature on the subject. It is often argued that concerns about exploitation should be addressed by increasing the price paid to organ sellers, not by banning the trade outright. I argue that this analysis rests on a particular conception of exploitation (which I refer to as 'fair benefits' exploitation), and outline two additional ways that the charge of exploitation can be understood (which I discuss in terms of 'fair process' exploitation and complicity in injustice). I argue that while increasing payments to organ sellers may mitigate or eliminate fair benefits exploitation, such measures will not necessarily address fair process exploitation or complicity in injustice. I further argue that each of these three forms of wrongdoing is relevant to the ethics of paid living organ donation, as well as the design of public policy more generally.

Consumer-driven and commercialised practice in dentistry: an ethical and professional problem?

The rise and persistence of a commercial model of healthcare and the potential shift towards the commodification of dental services, provided to consumers, should provoke thought about the nature and purpose of dentistry and whether this paradigm is cause for concern. Within this article, whether dentistry is a commodity and the legitimacy of dentistry as a business is explored and assessed. Dentistry is perceived to be a commodity, dependent upon the context of how services are to be provided and the interpretation of the patient-professional relationship. Commercially-focused practices threaten the fiduciary nature of the interaction between consumer and provider. The solution to managing commercial elements within dentistry is not through rejection of the new paradigm of the consumer of dental services, but in the rejection of competitive practices, coercive advertising and the erosion of professional values and duty. Consumerism may bring empowerment to those accessing dental services. However, if the patient-practitioner relationship is reduced to a mere transaction in the name of enhanced consumer participation, this empowerment is but a myth.

The Body as Gift, Commodity, or Something in Between: Ethical Implications of Advanced Kidney Donation.

An innovative program recently initiated at the University of California, Los Angeles (UCLA) Medical Center allows people to donate a kidney in exchange for a voucher that a loved one can redeem for a kidney if and when needed. As a relatively new practice, the ethical implications of advanced kidney donation have not yet been widely discussed. This paper reflects on some of the bioethical issues at stake in this new donation program, as well as some broader philosophical issues related to the meaning and moral salience of commodification. I first consider whether the literature on commercial markets in organs--a longstanding topic of bioethical debate--can meaningfully inform ethical analysis of kidney voucher programs. Specifically, I consider whether and to what extent common objections to the exchange of kidneys for cash also apply to the exchange of kidneys for "kidney vouchers." Second, I argue that the contrast between the ethical issues raised by these two practices highlights the need to understand commodification as existing on a continuum, with different degrees of commodification giving rise to different ethical issues. Doing so can help sharpen our understanding of commodification as a moral concept, as well as its relevance to broader debates about the moral limits of markets.