Journal of Bioethical Inquiry, Volume 12, Issue 1 (March 2015)
Guest Editor: Catherine Myser

Editorials

Intergenerational Global Heath

David M. Shaw and Leigh E. Rich

Defining “Global Health Ethics”

Catherine Myser

Ethical Aspects of the Glasgow Effect

David M. Shaw

How Do We Thank Thee? Let Us (Try to) Count the Ways

Leigh E. Rich

Letters to the Editor

Situating the Trovan Trial With the Use of Experimental Ebola Therapies Is Like Comparing an Apple With an Orange

Muhammed O. Afolabi

In-House Plagiarism and Editorial Unaccountability

Horacio Rivera and Ana Isabel Vásquez-Velásquez

Recent Developments

Untangling the Surrogacy Web and Exploring Legal Duties Following the Discharge of Mental Health Patients
Bernadette Richards, Bill Madden, and Tina Cockburn

Symposium

Editorial Note: “Remembering Stephanie” by Charlee Brodsky

Leigh E. Rich

Remembering Stephanie (read for free online)

Charlee Brodsky
Stephanie Byram was my friend who died at age 38 of breast cancer. Stephanie and I worked together during her illness to share how she lived a full life, even with the dire prognosis of an incurable disease. We produced gallery exhibitions, various articles, a book, and a video. This essay is a remembrance of Stephanie, 12 years after her death.

Critical Perspectives

Teaching Corner: An Undergraduate Medical Education Program Comprehensively Integrating Global Health and Global Health Ethics as Core Curricula

Sara Teichholtz, Jonah Susser Kreniske, Zachary Morrison, Avraham R. Shack, and Tzvi Dwolatzky

Teaching Corner: The Prospective Case Study

Kearsley A. Stewart

Teaching Corner: Child Family Health International

Jessica Evert

Teaching Corner: “First Do No Harm”: Teaching Global Health Ethics to Medical Trainees Through Experiential Learning

Tea Logar, Phuoc Le, James D. Harrison, and Marcia Glass

Teaching Corner: Raising the Bar: Ethical Considerations of Medical Student Preparation for Short-Term Immersion Experiences

Nathan Kittle and Virginia McCarthy

Essay: My Own Feet

Natalie Cassell

Essay: A Lesson in Living

Alison Connor

Essay: The Thrill Is Back (With Some Gray Hairs)

Michael Clark

Essay: Dear Tenzin

Gilbert O. A. Lam

Essay: Leaky Pipes

Melissa McCoy

Essay: Break the Silence

Nauzley Abedini

Essay: Freedom

Carmelle Tsai

Essay: On Stars
Lisa Simon

Original Research

Nonconsensual Clinical Trials: A Foreseeable Risk of Offshoring Under Global Corporatism

Bethany Spielman
This paper explores the connection of offshoring and outsourcing to nonconsensual global pharmaceutical trials in low-income countries. After discussing reasons why the topic of nonconsensual offshored clinical trials may be overlooked in bioethics literature, I suggest that when pharmaceutical corporations offshore clinical trials today, nonconsensual experiments are often foreseeable and not simply the result of aberrant ethical conduct by a few individuals. Offshoring of clinical trials is structured so that experiments can be presented as health care in a unique form of outsourcing from the host country to pharmaceutical corporations. Bioethicists’ assessments of the risks and potential benefits of offshore corporate pharmaceutical trials should therefore systematically include not only the hoped for benefits and the risks of the experimental drug but also the risk that subjects will not have consented, as well as the broader international consequences of nonconsensual experimentation.

The Political and Ethical Challenge of Multi-Drug Resistant Tuberculosis

Chris Degeling, Christopher Mayes, Wendy Lipworth, Ian Kerridge, and Ross Upshur
This article critically examines current responses to multi-drug resistant tuberculosis (MDR-TB) and argues that bioethics needs to be willing to engage in a more radical critique of the problem than is currently offered. In particular, we need to focus not simply on market-driven models of innovation and anti-microbial solutions to emergent and re-emergent infections such as TB. The global community also needs to address poverty and the structural factors that entrench inequalities—thus moving beyond the orthodox medical/public health frame of reference.

“With Human Health It’s a Global Thing”: Canadian Perspectives on Ethics in the Global Governance of an Influenza Pandemic

Alison K. Thompson, Maxwell J. Smith, Christopher W. McDougall, Cécile Bensimon, and Daniel Felipe Perez
We live in an era where our health is linked to that of others across the globe, and nothing brings this home better than the specter of a pandemic. This paper explores the findings of town hall meetings associated with the Canadian Program of Research on Ethics in a Pandemic (CanPREP), in which focus groups met to discuss issues related to the global governance of an influenza pandemic. Two competing discourses were found to be at work: the first was based upon an economic rationality and the second upon a humanitarian rationality. The implications for public support and the long-term sustainability of new global norms, networks, and regulations in global public health are discussed.

Ethical Considerations of Physician Career Involvement in Global Health Work: A Framework

Lawrence Chew Loh, Sae Rom Chae, Jennifer E. Heckman, and Daniel S. Rhee
Examining the ethics of long-term, career involvement by physicians in global health work is vital, given growing professional interest and potential health implications for communities abroad. However, current literature remains heavily focused on ethical considerations of short-term global health training experiences. A literature review informed our development of an ethics framework centered on two perspectives: the practitioner perspective, further subdivided into extrinsic and intrinsic factors, and community perspectives, specifically that of the host community and the physician’s home community. Some physician factors included cultural/linguistic differences, power imbalances, and sustainable skills/competencies. Receiving community factors included resource limitations, standard of care disparities, and community autonomy. Home community factors focused on the opportunity cost of an unavailable physician who was trained and supported by the local community. Descriptive review permitted comparison with existing short-term literature, noting similarities and differences. Our framework provides a basis for further research and critical analysis of ethical implications of career-long physician global health work.

Making a Commitment to Ethics in Global Health Research Partnerships: A Practical Tool to Support Ethical Practice

Jill Murphy, Jennifer Hatfield, Kaosar Afsana, and Vic Neufeld
Global health research partnerships have many benefits, including the development of research capacity and improving the production and use of evidence to improve global health equity. These partnerships also include many challenges, with power and resource differences often leading to inequitable and unethical partnership dynamics. Responding to these challenges and to important gaps in partnership scholarship, the Canadian Coalition for Global Health Research (CCGHR) conducted a three-year, multi-regional consultation to capture the research partnership experiences of stakeholders in South Asia, Latin America, and sub-Saharan Africa. The consultation participants described persistent inequities in the conduct of global health research partnerships and called for a mechanism through which to improve accountability for ethical conduct within partnerships. They also called for a commitment by the global health research community to research partnership ethics. The Partnership Assessment Toolkit (PAT) is a practical tool that enables partners to openly discuss the ethics of their partnership and to put in place structures that create ethical accountability. Clear mechanisms such as the PAT are essential to guide ethical conduct to ensure that global health research partnerships are beneficial to all collaborators, that they reflect the values of the global health endeavor more broadly, and that they ultimately lead to improvements in health outcomes and health equity.

Reviews

Developing Global Health Programming: A Guidebook for Medical and Professional Schools (Second Edition)

Renaud F. Boulanger

Disaster Bioethics: Normative Issues When Nothing Is Normal

James D. Hearn

Case Studies

Response to the Case of Short-Term International Development Work

Alyson V. F. Holland and Timothy A. Holland

Helping or Hindering? Some Ethical Implications of Global Health Work

Malika Sharma