Public health research often involves human participants. Although some authors have argued that ... more Public health research often involves human participants. Although some authors have argued that there are significant moral differences between public health research and public health practice, few have claimed that public health research presents unique ethical issues from other types of human participant research. Definitions of public health research have been slow to develop and, it has been suggested, are largely unsatisfying attempts to resolve ethical problems through categorization and redefinition. In this article, we focus on the ethics of one type of public health research in which the overall goal is to contribute to our understanding of how to prevent the onset of disease or injury within an otherwise healthy population. In this respect, we focus on population-based research that often involves a specified group or community. The purpose of this article is to highlight the ethical issues related to public health research that traditional human participant regulations and guidelines have not adequately addressed, presumably because the regulations were not written with this type of research in mind. In particular, we argue that the current regulatory framework does not provide adequate moral guidance for investigators conducting primary prevention research in community settings. Assuming communities as well as individuals have interests, and perhaps even rights, investigators studying communities should consider these interests and the correlative responsibilities they generate in thinking through the ethics of their research. Specifically, at least three possible kinds of duties to communities need to be considered: The duty to respect the community, the duty not to harm the community, and whether a duty to benefit the community exists.
The regulation of e-cigarettes and the e-liquids they deliver has proved challenging for the US F... more The regulation of e-cigarettes and the e-liquids they deliver has proved challenging for the US Food and Drug Administration given the relatively short time these products have been widely distributed and the inconclusive data about their effects on human health. While conventional tobacco cigarette use continues to drop among adults and teenagers, e-cigarette use has skyrocketed, particularly among school aged children and young adults.
Ethical issues abound in healthcare administration including conflicts of interest and commitment... more Ethical issues abound in healthcare administration including conflicts of interest and commitment, fairness and transparency in personnel management and human resources, resource scarcity and budgeting, stakeholder management, reporting fraud and abuse, and administrative professionalism. Historically, bioethics has been the field focused upon the dilemmas that occur in the context of clinical care and biomedical research. More recently, discourse in bioethics has expanded to include population health and empirical accounts of the ethical domain. Little explored or addressed in bioethics are the ethical issues faced by heath system leaders and administrators, particularly mid-level managers through c-level executives. Countless healthcare administrators face ethical conflicts, moral obligations, and potential solutions to ethical problems are different from either those at the bedside or the bench or the realms of public health policy and government. Conventional topics and approach...
Decision-making regarding treatment for newborns with disabilities in resource-poor settings is a... more 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?
Bioethics commissions have been critiqued on the basis that they are not sufficiently public or a... more Bioethics commissions have been critiqued on the basis that they are not sufficiently public or are too reliant upon expertise to have legitimacy or authority in regard to public policy debates. Adequately assessing the legitimacy and authority of commissions requires thinking clearly about the "publics" these commissions serve, the primary tasks of public bioethics, and how those tasks might be performed with a certain kind of ethical expertise and limited authority that makes them legitimate players in public policy debates concerning bioethics.
State legislatures, state medical licensing boards, and medical societies have encouraged and/or ... more State legislatures, state medical licensing boards, and medical societies have encouraged and/or mandated the use of 'opioid contracts' for patients with non-malignant chronic pain. Despite a paucity of evidence supporting their effectiveness in improving patient care, use of these documents has proliferated in recent years as the principle means to increase opioid therapy adherence and prevent opioid abuse and diversion. They have also become a de facto form of patient consent to treatment involving opioids. Contract proponents laud these as sufficient demonstration of informed consent, including patient responsibilities, and requirements for drug testing, compliance monitoring and a treatment plan. Despite concerns that we briefly review, it is stipulated that contracts likely will remain the default form of consent and compliance monitoring for opioid treatment. Given this fact, we argue that a better form of contract must be developed, and submit a model for consideratio...
HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues, 2014
One of the challenges of modern healthcare ethics practice is the navigation of boundaries. Pract... more One of the challenges of modern healthcare ethics practice is the navigation of boundaries. Practicing healthcare ethicists in the performance of their role must navigate meanings, choices, decisions and actions embedded in complex cultural and social relationships amongst diverse individuals. In light of the evolving state of modern healthcare ethics practice and the recent move toward professionalization via certification, understanding boundary navigation in healthcare ethics practice is critical. Because healthcare ethics is endowed with many boundaries which often delineate concerns about professional expertise and authority, epistemological reflection on the relationship between theory and practice points toward the social context as relevant to the conceptualization of boundaries. The skills of social scientists may prove helpful to provide data and insights into the conceptualization and navigation of clinical ethics qua profession. Empirical ethics research, which combines ...
... Increased attention to “states and bioethics,” to the point that there would be a theoretical... more ... Increased attention to “states and bioethics,” to the point that there would be a theoretical and practical shift of attention in the field from Washington to the capitals of the US states, has been advocated by, among others, Myra Christopher, James Fossett, Glenn McGee and ...
Public health research often involves human participants. Although some authors have argued that ... more Public health research often involves human participants. Although some authors have argued that there are significant moral differences between public health research and public health practice, few have claimed that public health research presents unique ethical issues from other types of human participant research. Definitions of public health research have been slow to develop and, it has been suggested, are largely unsatisfying attempts to resolve ethical problems through categorization and redefinition. In this article, we focus on the ethics of one type of public health research in which the overall goal is to contribute to our understanding of how to prevent the onset of disease or injury within an otherwise healthy population. In this respect, we focus on population-based research that often involves a specified group or community. The purpose of this article is to highlight the ethical issues related to public health research that traditional human participant regulations and guidelines have not adequately addressed, presumably because the regulations were not written with this type of research in mind. In particular, we argue that the current regulatory framework does not provide adequate moral guidance for investigators conducting primary prevention research in community settings. Assuming communities as well as individuals have interests, and perhaps even rights, investigators studying communities should consider these interests and the correlative responsibilities they generate in thinking through the ethics of their research. Specifically, at least three possible kinds of duties to communities need to be considered: The duty to respect the community, the duty not to harm the community, and whether a duty to benefit the community exists.
The regulation of e-cigarettes and the e-liquids they deliver has proved challenging for the US F... more The regulation of e-cigarettes and the e-liquids they deliver has proved challenging for the US Food and Drug Administration given the relatively short time these products have been widely distributed and the inconclusive data about their effects on human health. While conventional tobacco cigarette use continues to drop among adults and teenagers, e-cigarette use has skyrocketed, particularly among school aged children and young adults.
Ethical issues abound in healthcare administration including conflicts of interest and commitment... more Ethical issues abound in healthcare administration including conflicts of interest and commitment, fairness and transparency in personnel management and human resources, resource scarcity and budgeting, stakeholder management, reporting fraud and abuse, and administrative professionalism. Historically, bioethics has been the field focused upon the dilemmas that occur in the context of clinical care and biomedical research. More recently, discourse in bioethics has expanded to include population health and empirical accounts of the ethical domain. Little explored or addressed in bioethics are the ethical issues faced by heath system leaders and administrators, particularly mid-level managers through c-level executives. Countless healthcare administrators face ethical conflicts, moral obligations, and potential solutions to ethical problems are different from either those at the bedside or the bench or the realms of public health policy and government. Conventional topics and approach...
Decision-making regarding treatment for newborns with disabilities in resource-poor settings is a... more 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?
Bioethics commissions have been critiqued on the basis that they are not sufficiently public or a... more Bioethics commissions have been critiqued on the basis that they are not sufficiently public or are too reliant upon expertise to have legitimacy or authority in regard to public policy debates. Adequately assessing the legitimacy and authority of commissions requires thinking clearly about the "publics" these commissions serve, the primary tasks of public bioethics, and how those tasks might be performed with a certain kind of ethical expertise and limited authority that makes them legitimate players in public policy debates concerning bioethics.
State legislatures, state medical licensing boards, and medical societies have encouraged and/or ... more State legislatures, state medical licensing boards, and medical societies have encouraged and/or mandated the use of 'opioid contracts' for patients with non-malignant chronic pain. Despite a paucity of evidence supporting their effectiveness in improving patient care, use of these documents has proliferated in recent years as the principle means to increase opioid therapy adherence and prevent opioid abuse and diversion. They have also become a de facto form of patient consent to treatment involving opioids. Contract proponents laud these as sufficient demonstration of informed consent, including patient responsibilities, and requirements for drug testing, compliance monitoring and a treatment plan. Despite concerns that we briefly review, it is stipulated that contracts likely will remain the default form of consent and compliance monitoring for opioid treatment. Given this fact, we argue that a better form of contract must be developed, and submit a model for consideratio...
HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues, 2014
One of the challenges of modern healthcare ethics practice is the navigation of boundaries. Pract... more One of the challenges of modern healthcare ethics practice is the navigation of boundaries. Practicing healthcare ethicists in the performance of their role must navigate meanings, choices, decisions and actions embedded in complex cultural and social relationships amongst diverse individuals. In light of the evolving state of modern healthcare ethics practice and the recent move toward professionalization via certification, understanding boundary navigation in healthcare ethics practice is critical. Because healthcare ethics is endowed with many boundaries which often delineate concerns about professional expertise and authority, epistemological reflection on the relationship between theory and practice points toward the social context as relevant to the conceptualization of boundaries. The skills of social scientists may prove helpful to provide data and insights into the conceptualization and navigation of clinical ethics qua profession. Empirical ethics research, which combines ...
... Increased attention to “states and bioethics,” to the point that there would be a theoretical... more ... Increased attention to “states and bioethics,” to the point that there would be a theoretical and practical shift of attention in the field from Washington to the capitals of the US states, has been advocated by, among others, Myra Christopher, James Fossett, Glenn McGee and ...
Ethical issues abound in healthcare administration including conflicts of interest and commitment... more Ethical issues abound in healthcare administration including conflicts of interest and commitment, fairness and transparency in personnel management and human resources, resource scarcity and budgeting, stakeholder management, reporting fraud and abuse, and administrative professionalism. Historically, bioethics has been the field focused upon the dilemmas that occur in the context of clinical care and biomedical research. More recently, discourse in bioethics has expanded to include population health and empirical accounts of the ethical domain. Little explored or addressed in bioethics are the ethical issues faced by heath system leaders and administrators, particularly mid-level managers through c-level executives. Countless healthcare administrators face ethical conflicts, moral obligations, and potential solutions to ethical problems are different from either those at the bedside or the bench or the realms of public health policy and government. Conventional topics and approaches to teaching bioethics do not prepare healthcare administrators, and by extension this population regularly registers frustration with outcroppings of ethical issues for which they are armed only with intuition, law and previous anecdotal experience.
Based upon the experiences of teaching ethics in a health care administration program, we will present three different aspects of this issue: (1) an outline of the topics that arise as ethical issues for health care managers and administrators, differentiating these from traditional health care ethics, (2) an argument that these issues require taking a different approach to professional education in the entire healthcare executive echelon, and (3) a novel approach to inculcating healthcare management ethics based on teaching those organizational ethics, business ethics, medical professionalism and mainstream bioethics skills identified as missing in (2) above.
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Papers by Summer McGee
Historically, bioethics has been the field focused upon the dilemmas that occur in the context of clinical care and biomedical research. More recently, discourse in bioethics has expanded to include population health and empirical accounts of the ethical domain. Little explored or addressed in bioethics are the ethical issues faced by heath system leaders and administrators, particularly mid-level managers through c-level executives. Countless healthcare administrators face ethical conflicts, moral obligations, and potential solutions to ethical problems are different from either those at the bedside or the bench or the realms of public health policy and government. Conventional topics and approaches to teaching bioethics do not prepare healthcare administrators, and by extension this population regularly registers frustration with outcroppings of ethical issues for which they are armed only with intuition, law and previous anecdotal experience.
Based upon the experiences of teaching ethics in a health care administration program, we will present three different aspects of this issue: (1) an outline of the topics that arise as ethical issues for health care managers and administrators, differentiating these from traditional health care ethics, (2) an argument that these issues require taking a different approach to professional education in the entire healthcare executive echelon, and (3) a novel approach to inculcating healthcare management ethics based on teaching those organizational ethics, business ethics, medical professionalism and mainstream bioethics skills identified as missing in (2) above.