The Universal Declaration of Human Rights (UDHR), the ethical foundation of the human rights system since the end of World War II. As the Cold War subsided, the global community adopted a more comprehensive approach to human rights, including the right to health. 11 For specific procedures of the Human Rights Council, see http://www.ohchr.org/EN/HRBodies/.
Human rights are increasingly being used to frame responses to global public health challenges (Adorno 2009; Mann 1997.
Social Determinants of Health
This is particularly critical in the field of mental health, where efforts have been made to clarify the links between SDH and psychological well-being (Marmot et al. Although HIV-positive status can have negative social consequences, Zinner illustrates how social factors increase the risk of infection in the first place.
Summary
Case 1: The Ethics of HIV Testing Policies
- Background
- Case Description
- Discussion Questions
In general, HIV testing policies range from voluntary or client-initiated counseling and testing to provider-initiated approaches (eg, routine testing, mandatory HIV screening. And although public health officials are a minority, some argue for mandatory HIV testing (Schuklenk and Kleinsmidt 2007), who see it as the only way to control the HIV epidemic Failure to use standard methods of disease control, some argue, devalues public health and social justice (Frieden et al.
The Minister of Health of a sub-Saharan nation has asked you, a public health official and physician from a Western country, to recommend an effective HIV testing policy. Other colleagues insist that human rights-based approaches undermine public health's ability, as well as responsibility, to control the HIV epidemic. How can an emphasis on protecting human rights in HIV prevention reduce the importance of public health and social justice.
Shadow on the continent: public health and HIV/AIDS in Africa in the 21st century. Reconsidering mandatory HIV testing during pregnancy in areas of high HIV prevalence: ethical and policy issues. Correction: Routine HIV testing in Botswana: a population survey of attitudes, practices and human rights issues.
- Background
- Case Description
- Discussion Questions
Its effectiveness in the general population of women, in sex workers, and in young women in relationships with fathers (ie, young women in unequal relationships with older men) is not known. African groups at high risk of contracting new infections (and thus good potential candidates for PrEP) include sex workers, men who have sex with men, serodiscordant couples, and girls in sex with fathers. These sugar daddies generally engage in multiple sexual relationships, possibly with a husband and several young women, while putting their daughters at risk of HIV.
Each case of HIV infection averted increases economic productivity, reduces the risk of social unrest, strengthens the workforce, and improves the investment climate (in 2011. Your organization is piloting Truvada in populations at high risk of HIV infection. Many populations in the community are at high risk of HIV infection, including homosexual and bisexual men who regularly have sex with other men, girls in relationships with fathers, sex workers and serodiscordant couples.
One of your organization's goals is to respect cultural norms and beliefs if the health of those at risk of HIV/AIDS is not compromised. Interim guidance: Pre-exposure prophylaxis for the prevention of HIV infection in men who have sex with men. FDA approves first drug to reduce risk of sexually acquired HIV infection.
- Background
- Case Description
- Discussion Questions
Only a small part of the population can afford advanced private and corporate hospital care in the country's urban pockets. Many illiterate, poor and unaware of the implications of participation are vulnerable to exploitation (Srinivasan and Nikarge 2009. These involved poor people from lower castes who signed up for drug trials without adequate consent, resulting in serious side effects, including death (Lloyd- Roberts 2012.
In 2000, the Ministry of Health and Family Welfare established legal guidelines governing the conduct of research in India, which conform to international guidelines on research ethics, including the International Conference on Harmonization of Good Clinical Practice (ICH-GCP, the Declaration of Helsinki (World Medical Association) 2008 ) and the Council of International Organizations of Medical Sciences (CIOMS) guidelines ( 2002. From a colleague who served as a study site for this trial, Sharada's cardiologist hears that pilot testing of the drug has shown promising results. Shortly thereafter, the high number serious drug-related complications force discontinuation of the drug trial.
What are the risks and benefits of enrolling impoverished, uneducated patients in developing countries in clinical drug trials? Are multinational pharmaceutical companies that benefit from cost-effective drug trials in developing countries obligated to improve the lives of people in those countries? Report of the National Rural Health Mission (NRHM) working group for the Twelfth Five Year Plan.
Case 4: Ethical Issues in Responding to International Medication Stock-Outs
- Background
- Case Description
- Discussion Questions
Medication side effects often result in delayed treatment, an increased risk of drug resistance in incompletely treated people, and the potential for untreated or incompletely treated people to infect others. Stock-outs occur for a variety of reasons, including budget constraints, poor drug procurement policies and distribution networks, and political corruption that slows drug availability (Stop Stock-outs Campaign 2010. Although GDF and GLC are essential players in ensuring that nations at risk have adequate drug stocks , are both limited in how quickly they can respond to stock outs.
Advocacy groups and non-governmental organizations can generate widespread public attention in the hope of faster resolution of reservations. You search for drug stocks in this country using Internet search engines and come across stocks for other drugs, but find no mention of TB drug stocks. You return to a weekly clinic meeting and notice that the news has not covered the backups your colleagues are experiencing in their clinics.
How does your limited understanding of local institutional hierarchy and governance inform your ethical analysis of whether or not to advocate advocacy around stockouts? In terms of perceptions and consequences from the media and ministries, how might your public coverage of the stockout differ from a local official reporting on it? If so, what approaches could international and local non-governmental organizations, World Health Organization branches and patient advocacy groups use to effectively communicate and resolve supply shortages.
- Background
- Case Description
- Discussion Questions
Haiti, a country of ten million people, occupies the western part of the island of Hispaniola in the Caribbean. In mid-October 2010, upstream of the Artibonite River, a sudden rush of people started showing up at the local hospital with acute diarrhea, marking the first cholera cases. NGOs and some international donor agencies, including the UN, which were already in Haiti to deal with the aftermath of the earthquake, diverted resources to fight cholera.
They were stationed in a camp on a tributary of the Artibonite River near where the epidemic began. The Secretary-General convened an independent panel of experts tasked with determining the source of the cholera outbreak. These deficiencies, together with favorable environmental and epidemiological conditions, allowed the spread of the organism Vibrio cholerae in the environment, with which a large number of people became infected.
Many commentators believe that the Haitian government is partly to blame for the systemic flaws that allowed the outbreak. A particular issue is whether and how the victims of the outbreak should be compensated. Population genetics of Vibrio cholerae from Nepal in 2010: Evidence for the origin of the Haitian outbreak.
- Background
- The Case of Iraq
- The Case of Syria
- Ethical Considerations
- Case Description
- Discussion Questions
Two examples of the use of sanctions were those imposed by the United Nations (UN) against Iraq in the 1990s and against Syria from 2011. Other studies on the health impact of sanctions on Iraq have similar negative findings (Armijo-Hussein et al) ., 1991; Hurwitz and David 1992; Central Statistical Organization, Iraq. Since May 2011, economic sanctions against Syria have significantly affected the exchange rate and devalued its Syrian Lira (SL).
The collapse of the exchange rate increased the cost of health services and medicine. You are a public health worker from a Middle Eastern country researching the impact of economic sanctions on public health. You also have expertise in public health ethics and have written extensively on ethics in the use of economic sanctions.
What are the range of ethical considerations for and against the use of economic sanctions. Can economic sanctions be ethically justified? a) as an alternative to prolonged political repression and human rights violations. The impact of economic sanctions on health and well-being, Relief and Rehabilitation Network, Paper 31, 1–4.
- Background
- Case Description
- Discussion Questions
On a practical and ethical level, the debate about human research and informed consent continues (Tri-Council 2010; Marshall 2008; Nuffield Council on Bioethics 2002. De-identified data and information 14 present an additional complication in obtaining proper informed consent. However, in countries that lack sufficient research ethics infrastructure, it is problematic on several levels to waive informed consent.
Ultimately, the goal of such standards and policies should be to ensure that research participants and their information are protected at the origin and through every step of the research process. You carefully review the methods section of the preliminary report, focusing on how consent was obtained. Who would you approach at your institution for guidance regarding your involvement in the research, co-authorship of the manuscript, and other contributions to this research study.
What are some appropriate ways to obtain informed consent when conducting research in areas with cultures or languages different from yours? Does the use of multiple methods of obtaining consent raise questions about the reliability of the data or the validity of the research project. What are some appropriate ways to obtain informed consent for research conducted in countries with different consent standards and requirements.
