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3.
Health Hum Rights ; 21(1): 7-18, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31239610

RESUMO

Global health is an interdisciplinary field engaged with implementation of the human right to health, yet ethical dimensions of the on-the-ground realities of this work have been underexplored. Fieldwork in global health produces knowledge through both primary research and the lessons of practical program implementation. Much of this essential knowledge, which often documents health disparities and other human rights abuses, arises from work in dangerous contexts. Work in such environments entails risk to all participants in the global health enterprise, both local and foreign, but affects them differently. The risks of ethical fieldwork must be considered not only for the well-being of project participants and fieldworkers but also in light of how they shape and constrain global health research and program implementation. Drawing on case examples from the authors' fieldwork, this article marks an effort to begin disentangling the realities of risks in the field and the responsibility borne by the fieldworker to undertake ethical action, recognizing that decisions are often made without established protocols or the immediate availability of guidance from colleagues. We call for further engagement within global health on ethical issues distinctive to the complex and dangerous places in which the promise of a right to health is enacted in the real world.


Assuntos
Saúde Global/ética , Direitos Humanos , Gestão de Riscos , Humanos , Pesquisa
6.
BMC Med ; 17(1): 84, 2019 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-31030670

RESUMO

BACKGROUND: It is critically important to conduct research on stigmatized conditions, to include marginalized groups that experience stigma, and to develop interventions to reduce stigma. However, such research is ethically challenging. Though superficial reference is frequently made to these widely acknowledged challenges, few publications have focused on ethical issues in research on stigmatized groups or conditions. In fact, a brief literature review found only two such publications. MAIN TEXT: At a recent Science of Stigma Reduction workshop comprising 60 stigma researchers from the USA and low and middle-income countries, the need for more robust and critical discussion of the ethics of the research was highlighted. In this paper we describe, illustrate through cases, and critically examine key ethical challenges that are more likely to arise because a research study focuses on health-related stigma or involves stigmatized groups or conditions. We examine the ethics of this research from two perspectives. First, through the lens of overprotection, where we discuss how the perception of stigma can impede ethical research, disrespect research participants, and narrow the research questions. Second, through the lens of research risks, where we consider how research with stigmatized populations can unintentionally result in harms. Research-related harms to participants include potential breaches of confidentiality and the exacerbation of stigma. Potential harms also extend to third parties, including families and populations who may be affected by the dissemination of research results. CONCLUSIONS: Research with stigmatized populations and on stigmatized conditions should not be impeded by unnecessary or inappropriate protective measures. Nevertheless, it may entail different and greater risks than other health research. Investigators and research ethics committees must be particularly attentive to these risks and how to manage them.


Assuntos
Comitês de Ética em Pesquisa/ética , Saúde Global/ética , Estigma Social , Humanos , Projetos de Pesquisa
8.
World J Surg ; 43(6): 1466-1473, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30850871

RESUMO

The rapid growth of global pediatric surgery beyond direct care delivery into research, education, and advocacy necessitates re-evaluation of the traditional ethical paradigms which have governed our partnerships in low- and middle-income countries (LMIC). Within this paper, we consider current and emerging ethical challenges and discuss principles to consider in order to promote autonomous systems for pediatric surgical care in LMIC.


Assuntos
Saúde Global/ética , Pediatria/ética , Especialidades Cirúrgicas/ética , Criança , Assistência à Saúde/ética , Países em Desenvolvimento , Humanos , Missões Médicas
9.
Nurs Outlook ; 67(3): 244-251, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30739734

RESUMO

BACKGROUND: Fundamental nursing responsibilities include health promotion, disease prevention, and alleviation of suffering both locally and internationally. PURPOSE: To examine the state of knowledge and provide clarity on the concept of social justice in global health. METHOD: Using a modified Walker and Avant approach, literature was synthesized based upon discipline, including: nursing, public health, social work, philosophy, international law, international development studies, and religious studies. A theoretical definition, antecedents, defining attributes, and consequences were identified along with gaps in current knowledge and understanding. A model case was followed by direction for further concept development. FINDINGS: Social justice in global health nursing is a fundamental human right to be protected and a moral obligation demonstrated by action. It results in change that improves the health of individuals and populations both locally and globally by recognizing and confronting injustice, oppression, and inequity while promoting participation, opportunity, justice, equity, and helping relationships. DISCUSSION: Nursing must bring its unique perspective to policies and practices pertinent to issues of inequity. As the largest group of health care providers globally, nursing has the responsibility and political potential to mediate change and address factors integral to ensuring social justice in global health.


Assuntos
Assistência à Saúde/ética , Assistência à Saúde/organização & administração , Saúde Global/ética , Cuidados de Enfermagem/ética , Cuidados de Enfermagem/organização & administração , Enfermagem em Saúde Pública/ética , Enfermagem em Saúde Pública/organização & administração , Justiça Social/ética , Humanos
10.
Am J Trop Med Hyg ; 100(1_Suppl): 42-47, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30430980

RESUMO

Addressing ethical issues through mentorship is key to encouraging scientific integrity and increasing research capacity. Across the global health arena, mentorship requires helping mentees understand and negotiate the regulatory aspects of research-which can substantially differ even between countries with similar resources. Mentorship support spans across the research framework from obtaining ethical approval and ensuring scientific integrity, to determining authorship and disseminating study results-providing multiple opportunities to model ethical behavior for mentees. The power imbalances between the global north and south in accessing funding resources produce further challenges in setting the research agenda and for ensuring equity in the dissemination of research findings. Gender further complicates the aspiration for equity; the proportion of women in high administrative or research positions remains low. This study explores four specific mentoring case scenarios commonly encountered in the global health research field in low- and middle-income institutions.


Assuntos
Pesquisa Biomédica/ética , Saúde Global/ética , Tutoria/ética , Mentores/educação , Ensino/ética , Autoria , Pesquisa Biomédica/educação , Comparação Transcultural , Países em Desenvolvimento/economia , Comitês de Ética em Pesquisa/ética , Saúde Global/educação , Guias como Assunto , Humanos , Tutoria/economia , Tutoria/métodos , Plágio , Competência Profissional , Ensino/organização & administração
11.
Am J Trop Med Hyg ; 100(1_Suppl): 48-53, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30430981

RESUMO

Capacity building in low- and middle-income country (LMIC) institutions hinges on the delivery of effective mentorship. This study presents an overview of mentorship toolkits applicable to LMIC institutions identified through a scoping review. A scoping review approach was used to 1) map the extent, range, and nature of mentorship resources and tools available and 2) to identify knowledge gaps in the current literature. To identify toolkits, we collected and analyzed data provided online that met the following criteria: written in English and from organizations and individuals involved in global health mentoring. We searched electronic databases, including PubMed, Web of Science, and Google Scholar, and Google search engine. Once toolkits were identified, we extracted the available tools and mapped them to pre-identified global health competencies. Only three of the 18 identified toolkits were developed specifically for the LMIC context. Most toolkits focused on individual mentor-mentee relationships. Most focused on the domains of communication and professional development. Fewer toolkits focused on ethics, overcoming resource limitations, and fostering institutional change. No toolkits discussed strategies for group mentoring or how to adapt existing tools to a local context. There is a paucity of mentoring resources specifically designed for LMIC settings. We identified several toolkits that focus on aspects of individual mentor-mentee relationships that could be adapted to local contexts. Future work should focus on adaptation and the development of tools to support institutional change and capacity building for mentoring.


Assuntos
Pesquisa Biomédica/educação , Educação/organização & administração , Saúde Global/educação , Tutoria/métodos , Mentores/educação , Ensino/organização & administração , África , Ásia , Pesquisa Biomédica/ética , Comparação Transcultural , Países em Desenvolvimento/economia , Educação/economia , Saúde Global/ética , Guias como Assunto , Humanos , Tutoria/economia , Competência Profissional , América do Sul , Ensino/ética , Estados Unidos
12.
J Pediatr Surg ; 54(2): 234-238, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30503026

RESUMO

This article describes the Global Surgery Symposium held within the 65th British Association of Paediatric Surgeons (BAPS) Annual Congress in 2018. Global surgery is a rapidly expanding and developing field and is of particular importance in paediatrics since children account for up to 50% of the population in low- and middle-income countries (LMICs). It is estimated that up to a third of childhood deaths in LMICs are the result of a surgical condition, and congenital anomalies have risen to become the 5th leading cause of death in children less than 5-years of age globally. Trainees in high-income countries (HICs) are increasingly interested in global surgery engagement through clinical placements, research, or education, or a combination of these. There is considerable controversy regarding the ethics, practicalities, usefulness, safety, and sustainability of these initiatives. In addition, there is debate as to whether such placements should occur within the paediatric surgery training pathway. LEVEL OF EVIDENCE: 5 (Expert Opinion).


Assuntos
Países Desenvolvidos , Países em Desenvolvimento , Bolsas de Estudo/ética , Pediatria/educação , Especialidades Cirúrgicas/educação , Saúde Global/educação , Saúde Global/ética , Humanos
15.
BMC Med Ethics ; 19(1): 94, 2018 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-30522485

RESUMO

BACKGROUND: Thus far, little work in bioethics has specifically focused on global health research priority-setting. Yet features of global health research priority-setting raise ethical considerations and concerns related to health justice. For example, such processes are often exclusively disease-driven, meaning they rely heavily on burden of disease considerations. They, therefore, tend to undervalue non-biomedical research topics, which have been identified as essential to helping reduce health disparities. In recognition of these ethical concerns and the limited scholarship and dialogue addressing them, we convened an international workshop in September 2015. The workshop aimed to initiate discussion on the appropriate relationship between global and national levels of health research priority-setting and to begin exploring what might be ethically required for priority-setting at each of those levels. MAIN TEXT: This paper comprises our reflections following the workshop. Its main objective is to launch a research agenda for the ethics of global health research priority-setting. We identify three domains of global health research priority-setting-scope, underlying values and substantive requirements, and procedural considerations. For each domain, specific research questions are highlighted and why they need to be explored is explained. Some preliminary thoughts and normative arguments as to how the research questions might be answered are also offered. For example, we provide initial ideas about the appropriate relationship between different priority-setting levels and what values and substantive considerations should guide or underpin global health research priority-setting as a matter of justice. CONCLUSION: We anticipate that framing a new research agenda for the ethics of global health research priority-setting will spur ethicists, researchers, and policymakers to refocus their efforts on developing more rigorous and ethically sound approaches to priority-setting.


Assuntos
Pesquisa Biomédica/ética , Saúde Global/ética , Pesquisa , Ética em Pesquisa , Humanos , Justiça Social/ética
16.
Bioethics ; 32(9): 562-568, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30450599

RESUMO

Drawing on a conception of people as 'ecological subjects', creatures situated in specific social relations, locations, and material environments, I want to emphasize the importance of place and place-making for basing, demonstrating, and forging future solidarity. Solidarity, as I will define it here, involves reaching out through moral imagination and responsive action across social and/or geographic distance and asymmetry to assist other people who are vulnerable, and to advance justice. Contained in the practice of solidarity are two core 'enacted commitments', first, to engaging our moral imaginations and recognizing others in need and, second, to responsive action. Recognizing the suffering of displacement and responding through place-making should follow from even the most simplistic understanding of people as 'implaced'. Recognition, furthermore, that places are created and sustained, transformed, or neglected in ways that foster or perpetuate inequities, including health inequities, generates responsibilities concerning place-making. Place-based interventions, on either count, should be principal and, indeed, prioritized ways of showing solidarity for the vulnerable and promoting justice. Where solidaristic relations do not prevail, place-making can catalyze and nurture them, and over time advance justice. On the moral landscapes of bioethics, the terrain where care and health are or should be at the center of attention, an ethic of place and place-making for those who have been displaced - patients, the elderly, urban populations, and asylum-seekers, for instance - expresses and has rich potential for nurturing bonds of solidarity.


Assuntos
Bioética , Saúde Global/ética , Acesso aos Serviços de Saúde/ética , Justiça Social/ética , Responsabilidade Social , Disparidades nos Níveis de Saúde , Humanos , Cooperação Internacional , Seguridade Social/ética
17.
AMA J Ethics ; 20(10): E979-986, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30346926

RESUMO

The United Nation's Sustainable Development Goals (SDGs) mark an important moment for the world to improve human capital through nutrition and health goal setting. While the Millennium Development Goals contributed to the reduction in the number of undernourished people, the agenda remains unfinished. We are at a crucial crossroads with malnutrition burdens and hunger not decreasing as fast as they should and sometimes increasing. There is a moral imperative to act on the SDGs for nutrition, and health systems and professionals working in those systems have significant roles to play in fulfilling the objectives set out by the goals-that is, in ensuring that all citizens have a chance to achieve their own development.


Assuntos
Saúde Global/ética , Desnutrição/prevenção & controle , Estado Nutricional , Conservação dos Recursos Naturais , Humanos , Responsabilidade Social , Organização Mundial da Saúde
18.
Bioethics ; 32(9): 553-561, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30264873

RESUMO

Many working in bioethics today are engaging in forms of normative interpretation concerning the meaningful contexts of relational agency and institutional structures of power. Using the framework of relational bioethics, this article focuses on two significant social practices that are significant for health policy and public health: the practices of solidarity and the practices of care. The main argument is that the affirming recognition of, and caring attention paid to, persons as moral subjects can politically motivate a society in three respects. The recognition of solidarity and the attention of care can prompt progressive change toward a democratic willingness: (a) to provide for equal respect for rights and dignity; (b) to provide the social resources and services needed for just health and well-being; and (c) to focus its creativity and wealth on the actualization of potential flourishing of each and all. Solidarity is discussed as a morally developmental stance that moves from standing up for another, standing up with another, and standing up as another. Care is discussed as a morally developmental stance that moves from the attentive rehabilitation of another, attentive companionship with and for another, and attentive commitment to another.


Assuntos
Saúde Global/ética , Acesso aos Serviços de Saúde/ética , Justiça Social/ética , Responsabilidade Social , Bioética , Disparidades nos Níveis de Saúde , Ciências Humanas/ética , Humanos , Cooperação Internacional , Saúde Pública , Seguridade Social/ética
19.
Nurs Outlook ; 66(5): 473-481, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30205904

RESUMO

BACKGROUND: Nurses are among the many U.S. health professionals engaged in international learning or service experiences and often travel to low-resource countries lacking guidance for ethical practice, respect for host partners, or collaborative work in different health systems. PURPOSE: The aim of this study is to develop evidence-based principles or guidelines for ethical global health nursing practice. METHODS: A three-round Delphi study was conducted. Global health nurse experts participated in Round 1 focus group, followed by nurses with global health expertise ranking global health nursing statements in Rounds 2 and 3. DISCUSSION: Findings led to 10 Ethical Principles for Global Health Nursing Practice and 30 statements for Ethical Guidelines in Global Health Nursing. These Ten principles address beneficence, nonmaleficence, dignity, respect, autonomy, social justice, and professional practice. The 30 guidelines offer more specific actions nurses must consider when working in global settings.


Assuntos
Saúde Global/ética , Processo de Enfermagem/tendências , Conferências de Consenso como Assunto , Técnica Delfos , Ética em Enfermagem , Grupos Focais , Humanos , América do Norte , Pesquisa Qualitativa , Inquéritos e Questionários
20.
Cuad. bioét ; 29(96): 193-201, mayo-ago. 2018.
Artigo em Inglês | IBECS | ID: ibc-175373

RESUMO

The notions of "human capital" and "self-entrepreneurship" are by now widespread. The present work takes a critical look at their pervasive acceptance and stresses the self-exploitation to which they give rise. The concept of self-entrepreneurship needs to take into account, in fact, the nature of a revolution in temporal phenomenology. This revolution not only blurs the distinction between time dedicated to life and time dedicated to one's profession. It means that time spent on whatever is traditionally irrelevant to work is potentially time robbed from successful self-entrepreneurship. An analysis is made, lastly, of the relationship between body and "bio-labor", recognizable in the emergence of new forms of manual labor. Emblematic, in this sense, is gestational surrogacy. This provides an opportunity to rediscover the pregnancy of M. Foucault's biopolitical interpretation of neoliberalism as opposed to the more recent category of "psychopolitics" defined by B.C. Han. In the current scenario, indeed, the body maintains a role that remains as central as it is paradoxical, on account of its configuration as an "entrepreneurial resource"


Las nociones de "capital humano" y "auto-emprendimiento" actualmente tienen gran difusión. El presente trabajo revisa críticamente su aceptación generalizada y enfatiza la auto-explotación a la que dan lugar. El concepto de auto-emprendimiento debe tener en cuenta, de hecho, la naturaleza de una revolución fenomenológica de lo temporal. Esta revolución no solo oscurece la distinción entre el tiempo dedicado a la vida y aquel dedicado a la profesión. Significa, a su vez, que el tiempo que se gasta en lo que tradicionalmente es irrelevante para el trabajo es potencialmente sustraído al tiempo de un autoemprendimiento exitoso. Por último, se realiza un análisis de la relación entre el cuerpo y la "bio-labor", reconocible en el surgimiento de nuevas formas de trabajo manual. Emblemática, en este sentido, es la subrogación gestacional. Esto brinda la oportunidad de redescubrir el embarazo en la interpretación biopolítica del neoliberalismo de M. Foucault como oposición a la categoría más reciente de "psicopolítica" definida por B.C. Han. En el escenario actual, de hecho, el cuerpo mantiene un papel que permanece tanto central como paradójico, debido a su configuración como "recurso empresarial"


Assuntos
Humanos , Contrato de Risco , Saúde Global/ética , Antropologia , Capitalismo , Política
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