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1.
Sociol Health Illn ; 44 Suppl 1: 1-21, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36515539

RESUMO

In this collection we develop the concept of "complicity" as a means to understand how medical sociologists might be allied in unexpected or uncomfortable ways with dominant structures of power. After giving examples of complicity from our own research, we introduce existing scholarship on complicity, describing it as a concept that comes coupled with a sense of responsibility and that is related to, yet distinct from, a range of other terms including reflexivity, collusion, guilt, and shame. We also discuss how complicity has been described to occur at the level of the institution, within theoretical frameworks, and during mundane moments that we face on a day-to-day basis. Building on this review, we hypothesise that medical sociology - where access to fieldsites is often hard won, where "researching up" in medical and scientific institutions is common, and where our own work frequently concerns matters central to medical institutions themselves - is a discipline wherein mundane complicity is likely. Following this gathering exercise, we introduce the interventions that comprise this collection: interventions from a diversity of sociologists of health and illness who, perhaps for the first time in written form, account for how complicities of various kinds came to shape their work and how, with varying levels of success, they have sought redress. We close by offering some insight into the process of developing this collection, celebrating its successes while also acknowledging that many gaps and complicities remain.


Assuntos
Cumplicidade , Política , Humanos
2.
JAMA ; 328(17): 1701-1702, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36318124

RESUMO

This Viewpoint discusses the exclusion of abortion care from many established medical sources (such as hospitals) and from coverage by many major payers and how the health care system should legitimize and ensure clinician training in safe abortion care.


Assuntos
Aborto Induzido , Cumplicidade , Acesso aos Serviços de Saúde , Feminino , Humanos , Gravidez , Aborto Induzido/ética , Acesso aos Serviços de Saúde/ética , Ética Médica
3.
J Immigr Minor Health ; 24(6): 1599-1601, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35930091

RESUMO

This year marks 30 years since Australia introduced its policy of mandatory, indefinite immigration detention. We provide an overview of these policies with a focus on the involvement of healthcare workers, both within centres and externally, protesting these policies. We discuss several lessons that can be learnt from Australia?s approach, namely that traditional approaches to health and healthcare have done little to address the suffering of those who are detained. We call for the healthcare community to consider their role in activism and in calling for the abolition of detention. These lessons sadly have increasing global relevance with several countries now seeking to emulate Australia?s cruelty.


Assuntos
Emigração e Imigração , Refugiados , Humanos , Austrália , Cumplicidade , Atenção à Saúde
4.
J Forensic Leg Med ; 89: 102358, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35580463

RESUMO

Involuntary sterilization is a violation of human rights and grounds for asylum in the United States. Forensic medical evaluations can be useful in documenting this form of persecution and supporting asylees' claims for immigration relief. We conducted a retrospective case analysis of the personal and medical affidavits of 14 asylum-seeking women from four Latin America countries who all reported they had been involuntarily sterilized. Sixty-four percent said that "consent" was coerced; the remainder were unaware of having been sterilized at the time of the procedure. In all cases, findings on hysterosalpingogram were consistent with sterilization, revealing that all 14 had undergone a tubal ligation. Eighty-six percent of the women had been sterilized at the time of childbirth. The healthcare providers involved in the 14 cases failed to obtain informed consent, misled patients about sterilization, engaged in discriminatory behavior, and/or breached patient confidentiality regarding their HIV-status. All 14 asylum cases were defensive; of the 7 cases (50%) that have been decided to date, 100% have been granted asylum.


Assuntos
Médicos , Refugiados , América Central , Cumplicidade , Feminino , Direitos Humanos , Humanos , México , Estudos Retrospectivos , Esterilização Involuntária , Estados Unidos
5.
Nature ; 604(7904): 40, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35383323
6.
J Med Ethics ; 48(6): 367-370, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-34131004

RESUMO

This is the account of an ongoing appeal initiated in 2009 by 725 doctors from 43 countries concerning medical complicity with torture in Israel. It has been underpinned by a voluminous and still accumulating evidence base from reputable international and regional human rights organisations, quoted below, and has spanned the terms of office of four World Medical Association (WMA) presidencies and two UN special rapporteurs on torture. This campaign has been a litmus test of whether international medical codes regarding doctors and torture actually matter, and are applied rigorously and even-handededly, particularly when compelling evidence incriminates a WMA member association. Our findings in the case of Israel suggest that this is not true, and that impunity largely operates. The WMA seems in partisan violation of its mandate to be the official international watchdog on the ethical behaviour of doctors. And as the IMA case demonstrates, by their inaction national medical associations or other regulatory bodies appear to function at base as buttresses and shields of the state.


Assuntos
Tortura , Bandagens , Cumplicidade , Ética Médica , Humanos , Israel , Papel do Médico
8.
Psychol Assess ; 33(3): 279-285, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33779204

RESUMO

The acceptance of racist practices in psychological assessment, like the use of racist stimuli in testing material, has gone unchallenged for far too long. Such practices are emblematic of the entrenched systems of structural racism and pernicious presence of anti-Black oppression within psychology and beyond. This article brings into focus one glaring example: the inclusion of a noose as an item in one of the most widely used standardized tests in neuropsychology-the Boston Naming Test. The deeply offensive nature of this item has gone publicly unaddressed in the psychological literature for decades despite over 27,000 published articles with this test as a primary keyword. Herein, we review the history of the racialized weaponization of the noose in the United States; the potential psychological harm and test performance degradation imposed by including racist stimuli in assessment materials; and the ethical and cultural competency implications of exposing examinees to racist stimuli during psychological assessments. Finally, we call out the professional complicity underlying this item's persistence in psychology, urging psychologists, test publishers, and members of editorial boards to put an end to the complicit support and take clear corrective action in response to this offense. We also charge our colleagues and community to critically review other psychological assessment measures, language, and procedures in their respective subdisciplines to make the changes that will align professional practice with the antiracist values required to undo the effects of structural racism in psychology. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Testes Psicológicos/normas , Psicologia/normas , Racismo/psicologia , Cumplicidade , Humanos , Transtornos Mentais , Estados Unidos
9.
AMA J Ethics ; 23(1): E31-37, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33554845

RESUMO

Foundational documents of modern biomedical ethics, such as the Nuremberg Code, the World Medical Association's declarations of Geneva and Helsinki, and the Belmont Report, trace their origins to health care professionals' complicity in the Holocaust. Rituals of contemporary medical education, such as white coat ceremonies and oath swearing at graduations, are practices that express professional resolve to never again be complicit in genocide or human exploitation. This article considers a historical approach to teaching the Holocaust's contemporary ethical implications for clinicians and their practices.


Assuntos
Holocausto , Cumplicidade , Ética Médica , Pessoal de Saúde , Humanos , Estudantes
12.
Health Care Anal ; 28(4): 352-361, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33048314

RESUMO

At first glance, it seems difficult to object to any program that merits the label "harm reduction." If harm is bad, as everyone recognizes, then surely reducing it is good. What's the problem? The problem, we submit, is twofold. First, there's more to "harm reduction," as that term is typically used, than simply the reduction of harm. Some of the wariness about harm-reduction programs may result from the nebulous "more." Thus, part of our task is to provide a clear definition of harm reduction. Next, we turn to a second problem: a worry about complicity. Those who object to harm reduction programs fear that participation in such programs would make them complicit in activities they deem immoral. In this paper we argue that this fear is largely unwarranted. We use supervised injection sites (SISs)-safe spaces for the use of risky drugs-as our paradigmatic case of harm reduction. These SISs are generally offered in the hope of reducing harm to both the drug user and the public. For this reason, our analysis focuses on complicity in harm. We draw upon the work of Gregory Mellema as our framework. Mellema offers three ways one can be complicit in harm caused by another: by enabling, facilitating or condoning it. We argue that one who operates an SIS is not complicit in any of these ways, while also laying out the conditions that must be met if one is to argue that harm reduction entails complicity in non-consequentialist wrongdoing.


Assuntos
Cumplicidade , Redução do Dano , Programas de Troca de Agulhas , Humanos
13.
Indian J Med Ethics ; V(2): 151, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32393445

RESUMO

I would like to thank Dr Adriaan Van Es for his commentary (1) on my article (2). To start with, let me make one thing clear: I am not sure why he thinks that I am condoning the practice of penal amputation. As I clearly state in my conclusion, the arguments that may (or may not) justify penal amputation are abhorrent in liberal societies. We are on the same side here. But what of those who live in less secular societies where religious faith may be unquestioned? In my opinion, van Es has resorted to a typical example of a tortured form of ethical logic (3), which researchers from countries that have different value systems and different problems have deplored, albeit in a different context.


Assuntos
Cumplicidade , Crime , Humanos , Índia , Masculino , Princípios Morais
14.
Indian J Med Ethics ; V(2): 149-151, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32393454

RESUMO

Professor Das writes a challenging article about the ethical dilemma of the prohibition on inflicting of harm versus the utilisation of surgical expertise in carrying out penal amputations under Sharia law.


Assuntos
Cumplicidade , Crime , Humanos , Índia , Princípios Morais
15.
J Autism Dev Disord ; 50(7): 2573-2584, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30887409

RESUMO

Recent allegations that pediatrician Hans Asperger legitimized Nazi policies, including forced sterilization and child euthanasia, are refuted with newly translated and chronologically-ordered information that takes into account Hitler's deceptive 'halt' to the T4 euthanasia program in 1941. It is highly unlikely that Asperger was aware of the T4 program when he referred Herta Schreiber to Am Spiegelgrund or when he mentioned that institution 4 months later on the medical chart of another (unrelated) girl, Elisabeth Schreiber. Asperger campaigned vigorously from 1938 to 1943 to have his specialization, Curative Education, take priority in the diagnosis and treatment of disabled children over other fields that promoted Nazi racial hygiene policies. He neither disparaged his patients nor was he sexist. By 1938, he had identified the essentials of Asperger syndrome and described an unnamed boy whom he later profiled (as Ernst K.) in 1944. Rather than doing 'thin' research, Asperger made discoveries that were prescient, and some of his activities conformed to definitions of "individual resistance."


Assuntos
Síndrome de Asperger/história , Cumplicidade , Eugenia (Ciência)/história , Socialismo Nacional/história , Pediatras/história , Áustria/epidemiologia , Criança , Pré-Escolar , Feminino , História do Século XX , Humanos , Lactente , Masculino , Políticas , Comportamento Social
17.
J Eval Clin Pract ; 25(5): 717-725, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30887656

RESUMO

BACKGROUND: In 2018, a so-called crisis developed in the international network of systematic reviewers known as Cochrane. It was widely depicted in terms of two competing narratives-"bad behaviour" by one member of Cochrane's Governing Board and scientific and moral decline within Cochrane. OBJECTIVE: Our goal was to distil insights on the structural issues underpinning the crisis, without taking a definitive position on the accuracy of either narrative. APPROACH AND DATASET: In this paper, we draw on (among other theories) Becker's notion of moral entrepreneurship and Foucault's conceptualisation of power to analyse the claims and counterclaims made by different parties. Our dataset consisted of publicly available materials (blogs, journal articles, newspaper articles) to end 2018, notably those relating to the expulsion of one Governing Board member. MAIN FINDINGS: Both narratives include strong moral claims about the science of systematic review and the governance of scientific organizations. The expelled individual and his supporters defined good systematic reviews in terms of a particular kind of methodological rigour and elimination of bias, and good governance largely in terms of measures to achieve independence from industry influence. Most of Cochrane's Governing Board and their sympathizers evaluated systematic reviews according to a broader range of criteria, incorporating factors such as attention to relationships among reviewers and reflexivity and dialogue around scientific and other judgements. They viewed governance partly in terms of accountability to an external advisory group. Power-knowledge alignments in Cochrane have emerged from, and contributed to, a particular system of meaning which is now undergoing evolution and challenge. CONCLUSION: Polarizing Cochrane's "crisis" into two narratives, only one of which is true, is less fruitful than viewing it in terms of a duality consisting of tensions between the two positions, each of which has some validity. Having framed the conflict as primarily philosophical and political rather than methodological and procedural, we suggest how Cochrane and its supporters and critics might harness their tensions productively.


Assuntos
Empreendedorismo/normas , Medicina Baseada em Evidências , Conselho Diretor/ética , Bibliotecas Médicas , Avaliação de Resultados em Cuidados de Saúde , Qualidade da Assistência à Saúde , Padrão de Cuidado/ética , Cumplicidade , Medicina Baseada em Evidências/ética , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Humanos , Serviços de Informação/normas , Agências Internacionais/organização & administração , Agências Internacionais/normas , Bibliotecas Médicas/organização & administração , Bibliotecas Médicas/normas , Avaliação de Resultados em Cuidados de Saúde/ética , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/normas , Planejamento de Assistência ao Paciente , Filosofia Médica , Revisões Sistemáticas como Assunto
18.
J R Army Med Corps ; 165(4): 248-255, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30792344

RESUMO

INTRODUCTION: The long-standing debate on medical complicity in torture has overlooked the complicity of cognitive scientists-psychologists, psychiatrists and neuroscientists-in the practice of torture as a distinct phenomenon. In this paper, we identify the risk of the re-emergence of torture as a practice in the USA, and the complicity of cognitive scientists in these practices. METHODS: We review arguments for physician complicity in torture. We argue that these defences fail to defend the complicity of cognitive scientists. We address objections to our account, and then provide recommendations for professional associations in resisting complicity in torture. RESULTS: Arguments for cognitive scientist complicity in torture fail when those actions stem from the same reasons as physician complicity. Cognitive scientist involvement in the torture programme has, from the outset, been focused on the outcomes of interrogation rather than supportive care. Any possibility of a therapeutic relationship between cognitive therapists and detainees is fatally undermined by therapists' complicity with torture. CONCLUSION: Professional associations ought to strengthen their commitment to refraining from engaging in any aspect of torture. They should also move to protect whistle-blowers against torture programmes who are members of their association. If the political institutions that are supposed to prevent the practice of torture are not strengthened, cognitive scientists should take collective action to compel intelligence agencies to refrain from torture.


Assuntos
Cumplicidade , Ética Médica , Psicologia/ética , Tortura/ética , Humanos , Neurociências/ética , Médicos/ética , Prisioneiros , Terrorismo , Estados Unidos
19.
J Med Ethics ; 45(1): 69-70, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30018146

RESUMO

International non-governmental organisations (INGO) face a dilemma when deciding whether to intervene in crisis situations where their efforts can be exploited or co-opted by others: intervene and risk becoming complicit with wrongdoing or sit on the sidelines and consign vulnerable people to the ravages of neglect or oppression. In "'He who helps the guilty, shares the crime'? INGOs, moral narcissism and complicity in wrongdoing," Buth et al argue that concerns about complicity often stifle ethical debate and encourage moral narcissism. We argue that neglecting concerns about complicity can foster a different form of moral narcissism and that where worries of complicity are present, aid efforts face three types of risk: risks to others created by contributing to wrongful acts or bad outcomes; risks to the moral integrity of the INGO and its personnel; and risks to social trust in the INGO. In the end, we challenge the assumption that there is a unique, ethically best way to reconcile these values. We suggest that the causes of justice and humanity might be better served by a diverse community of INGOs who each gives different weight to these concerns, than if each INGO adopts the same framework for reconciling these competing demands.


Assuntos
Cumplicidade , Narcisismo , Crime , Culpa , Humanos , Masculino , Princípios Morais
20.
J Nurs Scholarsh ; 51(3): 299-307, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30320966

RESUMO

PURPOSE: This article describes the work of the South African Truth and Reconciliation Commission (TRC) in examining the role of the health sector in human rights violations in the protracted conflicts during apartheid. ORGANIZING CONSTRUCT: The enabling legislation contained in the Promotion of National Healing and Reconciliation Act of 1995 allowed for in-depth examination of violations and complicity in human rights abuses. We provide an overview of the process of the public hearings, soliciting submissions, examining evidence of abuse, personal testimony of conflict in situations of dual accountability, and ultimately the recommendations made by the TRC. The article also outlines the responses of various health professional training institutions to the TRC's recommendations, the implementation of university health and human rights courses, and some current challenges post-TRC. CONCLUSIONS: The health sector hearings of the TRC provided a window into the structural unequal access, racial discrimination, prejudice, and abuse in the health services under the apartheid regime. Examination of past violations perpetrated by an abusive regime and by those such as health workers operating in such a system is imperative to ensure that these abuses are not repeated in the future. CLINICAL RELEVANCE: In delivering comprehensive, compassionate, and ethical care, healthcare professionals have accountability to respect and promote the human rights of their patients. Training in human rights and its relationship to health should be incorporated into all health professional programs.


Assuntos
Educação Profissionalizante/métodos , Pessoal de Saúde/educação , Violações dos Direitos Humanos/prevenção & controle , Direitos Humanos , Cumplicidade , Direitos Humanos/educação , Direitos Humanos/legislação & jurisprudência , Humanos , Preconceito/prevenção & controle , Responsabilidade Social , Fatores Socioeconômicos , África do Sul
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