The ethics and value of contact tracing apps: International insights and implications for Scotland's COVID-19 response.

The COVID-19 pandemic has put health systems, economies and societies under unprecedented strain, calling for innovative approaches. Scotland's government, like those elsewhere, is facing difficult decisions about how to deploy digital technologies and data to help contain, control and manage the disease, while also respecting citizens' rights. This paper explores the ethical challenges presented by these methods, with particular emphasis on mobile apps associated with contact tracing. Drawing on UK and international experiences, it examines issues such as public trust, data privacy and technology design; how changing disease threats and contextual factors can affect the balance between public benefits and risks; and the importance of transparency, accountability and stakeholder participation for the trustworthiness and good-governance of digital systems and strategies. Analysis of recent technology debates, controversial programmes and emerging outcomes in comparable countries implementing contact tracing apps, reveals sociotechnical complexities and unexpected paradoxes that warrant further study and underlines the need for holistic, inclusive and adaptive strategies. The paper also considers the potential role of these apps as Scotland transitions to the 'new normal', outlines challenges and opportunities for public engagement, and poses a set of ethical questions to inform decision-making at multiple levels, from software design to institutional governance.

Pox Parties for Grannies? Chickenpox, Exogenous Boosting, and Harmful Injustices.

Some societies tolerate or encourage high levels of chickenpox infection among children to reduce rates of shingles among older adults. This tradeoff is unethical. The varicella zoster virus (VZV) causes both chickenpox and shingles. After people recover from chickenpox, VZV remains in their nerve cells. If their immune systems become unable to suppress the virus, they develop shingles. According to the Exogenous Boosting Hypothesis (EBH), a person's ability to keep VZV suppressed can be 'boosted' through exposure to active chickenpox infections. We argue that even if this hypothesis were true, immunization policies that discourage routine childhood varicella vaccination in order to prevent shingles for other people are unethical. Such policies harm children and treat them as mere means for the benefit of others, and are inconsistent with how parents should treat their children and physicians should treat their patients. These policies also seem incompatible with institutional transparency.

Navigating the Ethics of COVID-19 in Otolaryngology.

The COVID-19 pandemic has dramatically altered how otolaryngologists contemplate and assume their roles in health care delivery. The ethical implications of this pandemic upon our practice are formidable and distinct from other surgical fields. The salient ethical issues of public health stewardship and safety, distributive justice, and nonabandonment are distilled for the practicing otolaryngologist.

Surveillance and control of asymptomatic carriers of drug-resistant bacteria.

Drug-resistant bacterial infections constitute a major threat to global public health. Several key bacteria that are becoming increasingly resistant are among those that are ubiquitously carried by human beings and usually cause no symptoms (i.e. individuals are asymptomatic carriers) until and/or unless a precipitating event leads to symptomatic infection (and thus disease). Carriers of drug-resistant bacteria can also transmit resistant pathogens to others, thus putting the latter at risk of resistant infections. Accumulating evidence suggests that such transmission occurs not only in hospital settings but also in the general community, although considerably more data are needed to assess the extent of this problem. Asymptomatic carriage of drug-resistant bacteria raises important ethical questions regarding the appropriate public health response, including the degree to which it would be justified to impose burdens on asymptomatic carriers (and others) in order to prevent transmission. In this paper, we (i) summarize current evidence regarding the carriage of key drug-resistant bacteria, noting important knowledge gaps; and (ii) explore the particular implications of existing public health ethics frameworks for policy-making regarding asymptomatic carriers. Inter alia, we argue that the relative burdens imposed by public health measures on healthy carriers (as opposed to sick individuals) warrant careful consideration and should be proportionate to the expected public health benefits in terms of risks averted. We conclude that more surveillance and research regarding community transmission will be needed in order to clarify relevant risks and design proportionate policies, although extensive community surveillance itself would also require careful ethical consideration.

Prostitution as a Psychiatric Situation: Ethical Aspects.

This paper presents the morally controversial phenomenon of prostitution. As the basis for contemplating the prostitution issue the most important is revealing and understanding its primitive ethical root. For understanding its "soul", its essence, also important is comprehending sexual, "elementary thoughts" of mankind, through the relationship between prostitution and religious, social, political and spiritual life, and its nature as a reflection of the sexual-ethical concepts in different epochs and nations. We emphasize the connection between prostitution and psychiatry. Placing a special focus on importance of personality for deciding to become a prostitute, and by pulling it through a moral prism we define prostitution as a new medical situation. In favor of that, we stress the importance of the presence, position and role of psychiatrists within an indispensable multidisciplinary team, which is complementary despite its heterogeneousness, synergistically and simultaneously dealing with psychological, physical and social health-problems of women engaged in prostitution. We propose peer education as a way of promoting healthy and safer behaviors among the subculture of prostitutes, where we see another important role of psychiatrists in selecting/recruiting, training and motivating peer educators among them.

Separate goals, converging priorities: on the ethics of treatment as prevention.

Recent evidence confirming that the administration of antiretroviral drugs (ARVs) to HIV-infected persons may effectively reduce their risk of transmission has revived the discussion about priority setting in the fight against HIV/AIDS. The fact that the very same drugs can be used both for treatment purposes and for preventive purposes (Treatment as Prevention) has been seen as paradigm-shifting and taken to spark a new controversy: In a context of scarce resources, should the allocation of ARVs be prioritized based on the goal of providing treatment, or on the goal of preventing the spread of the HIV epidemic? Contributions to this discussion tend to assume that treatment and prevention constitute two divergent goals that entail conflicting priorities. We challenge that assumption on the basis of both conceptual and empirical examination. We argue that, as far as the provision of ARVs to HIV-infected persons is concerned, the goals of treatment and prevention do not entail conflicting priorities; to the contrary, they dictate converging strategies for the optimal allocation of ARVs. In light of the current evidence, the concept of Treatment as Prevention can indeed be seen as paradigm-shifting, yet in a novel way: Rather than extending the tension between the goals of treatment and prevention to the level of drug-allocation, it dissolves this tension by providing a rationale for a unified strategy for allocating ARVs.

Ethical and legal issues on HIV testing, policy and the practice of dentistry.

This paper is structured around the following: autonomy and consent, confidentiality, disclosure, knowledge of patient and provider HIV status, the right to choose whom to treat, testing for HIV and the importance of HIV policies in the workplace to guard against discrimination. The emergence of the HIV/AIDS pandemic has challenged traditional ethical values of the health care profession. These include the infectious nature of HIV, the social stigma of the disease and its ethical and legal dilemmas. This paper addresses some of the pertinent questions related to HIV infection and AIDS. The three broad principles of ethics, namely, autonomy, beneficence and justice, provide the basic framework on which this paper is based. Advances in the biotechnology of rapid oral fluid testing particularly in the detection of HIV antibodies from patients in the dental setting have raised additional ethical and legal considerations in the subsequent management of HIV infected patients to include disclosure of test results to the patient and proper referral to physicians or nurse practitioners. The oral health care worker must thus have a solid foundation in the application of bioethical principles. A clinical case scenario related to HIV testing in the dental setting is presented to illustrate how a lack of understanding and the wrongful application of ethical principles may lead to patient harm and legal liability. Given the increasing infection rate of HIV worldwide, polices must be upheld and revised as needed to protect healthcare providers, patients, and society generally against discrimination.

A decade of the United Kingdom sperm-washing program: untangling the transatlantic divide.

Fertility assistance to HIV-positive men is now accepted practice in many parts of the world. We analyze the legislative, ethical, and clinical factors that explain the differences across continents with the aim of opening up the debate within the United States on whether clinics can justify denying HIV-infected men the opportunity of parenting through a now well-established risk reduction method with a proved safety record.

Consent and informational responsibility.

The notion of "consent" is frequently referred to as "informed consent" to emphasise the informational component of a valid consent. This article considers aspects of that informational component. One misuse of the language of informed consent is highlighted. Attention is then directed to some features of the situation in which consent would not have been offered had certain information been disclosed. It is argued that whether or not such consent is treated as sufficiently informed must, from a moral point of view, take account of four conditions. When these are applied to the operation of consent in relation to criminal responsibility for HIV transmission, the approach in some recent cases is shown to be morally questionable.

Ethical considerations about reporting research results with potential for further stigmatization of undocumented immigrants.

A broad spectrum of infectious diseases is studied in vulnerable populations. However, ethical considerations of reporting research results that could increase stigmatization of socially marginalized and vulnerable populations are not often discussed in the medical literature, particularly not in the context of transmissible diseases. This article addresses ethical considerations that arose when one of us (J.M.A.) recently published the results of a study in Clinical Infectious Diseases that imply that undocumented persons are more likely to transmit tuberculosis than are documented foreign-born persons or persons born in the United States. These study results have the potential to further fuel the often fierce debate regarding undocumented immigrants in the United States. To our knowledge, such ethical considerations have not been discussed previously in the medical literature.