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  Subjects -> HEALTH AND SAFETY (Total: 1313 journals)
    - CIVIL DEFENSE (21 journals)
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    - HEALTH AND SAFETY (538 journals)
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HEALTH AND SAFETY (538 journals)                  1 2 3 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
16 de Abril     Open Access  
A Life in the Day     Hybrid Journal   (Followers: 10)
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Scientiarum. Health Sciences     Open Access  
Adultspan Journal     Hybrid Journal  
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11)
Advances in Public Health     Open Access   (Followers: 23)
African Health Sciences     Open Access   (Followers: 2)
African Journal for Physical, Health Education, Recreation and Dance     Full-text available via subscription   (Followers: 6)
African Journal of Health Professions Education     Open Access   (Followers: 6)
Afrimedic Journal     Open Access   (Followers: 2)
Ageing & Society     Hybrid Journal   (Followers: 37)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 4)
AJOB Primary Research     Partially Free   (Followers: 3)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Health Economics     Full-text available via subscription   (Followers: 13)
American Journal of Health Education     Hybrid Journal   (Followers: 32)
American Journal of Health Promotion     Hybrid Journal   (Followers: 25)
American Journal of Health Sciences     Open Access   (Followers: 6)
American Journal of Health Studies     Full-text available via subscription   (Followers: 11)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 27)
American Journal of Public Health     Full-text available via subscription   (Followers: 230)
American Journal of Public Health Research     Open Access   (Followers: 29)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4)
Annals of Global Health     Open Access   (Followers: 9)
Annals of Health Law     Open Access   (Followers: 3)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 15)
Applied Biosafety     Hybrid Journal  
Applied Research In Health And Social Sciences : Interface And Interaction     Open Access   (Followers: 2)
Archive of Community Health     Open Access  
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Arquivos de Ciências da Saúde     Open Access  
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 8)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 3)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 8)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 3)
Association of Schools of Allied Health Professions     Full-text available via subscription   (Followers: 6)
Atención Primaria     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 3)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access   (Followers: 6)
Behavioral Healthcare     Full-text available via subscription   (Followers: 6)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 9)
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 8)
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 5)
BMC Pregnancy and Childbirth     Open Access   (Followers: 20)
BMJ Simulation & Technology Enhanced Learning     Full-text available via subscription   (Followers: 8)
Brazilian Journal of Medicine and Human Health     Open Access  
Buletin Penelitian Kesehatan     Open Access   (Followers: 2)
Buletin Penelitian Sistem Kesehatan     Open Access  
Bulletin of the World Health Organization     Open Access   (Followers: 18)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Cambridge Quarterly of Healthcare Ethics     Hybrid Journal   (Followers: 11)
Canadian Family Physician     Partially Free   (Followers: 13)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 12)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Canadian Journal of Public Health     Full-text available via subscription   (Followers: 20)
Case Reports in Women's Health     Open Access   (Followers: 3)
Case Studies in Fire Safety     Open Access   (Followers: 15)
Central Asian Journal of Global Health     Open Access   (Followers: 2)
Central European Journal of Public Health     Full-text available via subscription   (Followers: 4)
CES Medicina     Open Access  
Child Abuse Research in South Africa     Full-text available via subscription   (Followers: 1)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 10)
Children     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access  
Christian Journal for Global Health     Open Access  
Ciência & Saúde Coletiva     Open Access   (Followers: 2)
Ciencia y Cuidado     Open Access   (Followers: 1)
Ciencia, Tecnología y Salud     Open Access  
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 2)
CME     Hybrid Journal   (Followers: 1)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 2)
Conflict and Health     Open Access   (Followers: 8)
Contraception and Reproductive Medicine     Open Access  
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 3)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Digital Health     Open Access   (Followers: 3)
Disaster Medicine and Public Health Preparedness     Hybrid Journal   (Followers: 12)
Dramatherapy     Hybrid Journal   (Followers: 2)
Drogues, santé et société     Full-text available via subscription  
Duazary     Open Access   (Followers: 1)
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 17)
East African Journal of Public Health     Full-text available via subscription   (Followers: 3)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 19)
EcoHealth     Hybrid Journal   (Followers: 4)
Education for Health     Open Access   (Followers: 5)
electronic Journal of Health Informatics     Open Access   (Followers: 6)
ElectronicHealthcare     Full-text available via subscription   (Followers: 4)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 5)
Emergency Services SA     Full-text available via subscription   (Followers: 2)
Ensaios e Ciência: Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Disease     Open Access   (Followers: 2)
Environmental Sciences Europe     Open Access   (Followers: 2)
Epidemics     Open Access   (Followers: 4)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 5)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 19)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 3)
Ethiopian Journal of Health Development     Open Access   (Followers: 8)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 7)
Ethnicity & Health     Hybrid Journal   (Followers: 13)
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 2)
European Medical, Health and Pharmaceutical Journal     Open Access  
Evaluation & the Health Professions     Hybrid Journal   (Followers: 10)
Evidence-based Medicine & Public Health     Open Access   (Followers: 6)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Expressa Extensão     Open Access  
Face à face     Open Access   (Followers: 1)
Families, Systems, & Health     Full-text available via subscription   (Followers: 8)
Family & Community Health     Partially Free   (Followers: 12)
Family Medicine and Community Health     Open Access   (Followers: 6)
Family Relations     Partially Free   (Followers: 11)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 2)
Food and Public Health     Open Access   (Followers: 11)
Frontiers in Public Health     Open Access   (Followers: 7)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 9)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Health : Science and Practice     Open Access   (Followers: 5)
Global Health Promotion     Hybrid Journal   (Followers: 16)
Global Journal of Health Science     Open Access   (Followers: 9)
Global Journal of Public Health     Open Access   (Followers: 12)
Global Medical & Health Communication     Open Access   (Followers: 1)
Global Mental Health     Open Access   (Followers: 5)
Global Security : Health, Science and Policy     Open Access  
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 3)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 16)
Health & Justice     Open Access   (Followers: 5)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 7)
Health and Human Rights     Free   (Followers: 9)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 7)
Health and Social Work     Hybrid Journal   (Followers: 55)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 2)
Health Care Analysis     Hybrid Journal   (Followers: 14)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 16)
Health Issues     Full-text available via subscription   (Followers: 2)
Health Notions     Open Access  
Health Policy     Hybrid Journal   (Followers: 41)
Health Policy and Technology     Hybrid Journal   (Followers: 3)
Health Professional Student Journal     Open Access   (Followers: 2)
Health Promotion International     Hybrid Journal   (Followers: 22)
Health Promotion Journal of Australia : Official Journal of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 10)
Health Promotion Practice     Hybrid Journal   (Followers: 16)
Health Prospect     Open Access   (Followers: 1)
Health Psychology     Full-text available via subscription   (Followers: 52)
Health Psychology Research     Open Access   (Followers: 20)
Health Psychology Review     Hybrid Journal   (Followers: 42)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 12)
Health SA Gesondheid     Open Access   (Followers: 2)
Health Science Reports     Open Access  
Health Sciences and Disease     Open Access   (Followers: 2)
Health Services Insights     Open Access   (Followers: 2)
Health Systems     Hybrid Journal   (Followers: 3)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 13)
Health, Risk & Society     Hybrid Journal   (Followers: 11)
Healthcare     Open Access   (Followers: 2)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 9)
Healthy-Mu Journal     Open Access  
HERD : Health Environments Research & Design Journal     Full-text available via subscription  
Highland Medical Research Journal     Full-text available via subscription  
Hispanic Health Care International     Full-text available via subscription  
HIV & AIDS Review     Full-text available via subscription   (Followers: 11)
Home Health Care Services Quarterly     Hybrid Journal   (Followers: 6)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 2)
Hospitals & Health Networks     Free   (Followers: 4)
IEEE Journal of Translational Engineering in Health and Medicine     Open Access   (Followers: 3)
IMTU Medical Journal     Full-text available via subscription  
Indian Journal of Health Sciences     Open Access   (Followers: 2)
Indonesian Journal for Health Sciences     Open Access   (Followers: 1)
Inmanencia. Revista del Hospital Interzonal General de Agudos (HIGA) Eva Perón     Open Access  
Innovative Journal of Medical and Health Sciences     Open Access  
Institute for Security Studies Papers     Full-text available via subscription   (Followers: 5)
interactive Journal of Medical Research     Open Access  
International Health     Hybrid Journal   (Followers: 5)
International Journal for Equity in Health     Open Access   (Followers: 7)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 35)
International Journal of Applied Behavioral Sciences     Open Access   (Followers: 2)
International Journal of Behavioural and Healthcare Research     Hybrid Journal   (Followers: 8)
International Journal of Circumpolar Health     Open Access   (Followers: 1)
International Journal of Community Medicine and Public Health     Open Access   (Followers: 5)
International Journal of E-Health and Medical Communications     Full-text available via subscription   (Followers: 2)

        1 2 3 | Last

Journal Cover Hastings Center Report
  [SJR: 0.566]   [H-I: 46]   [3 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0093-0334 - ISSN (Online) 1552-146X
   Published by John Wiley and Sons Homepage  [1597 journals]
  • “What's in a name'” CAR-T Gene Therapy
    • Authors: Eric Kodish
      PubDate: 2017-11-24T02:26:09.32478-05:0
      DOI: 10.1002/hast.786
  • Global bioethics
    • Authors: Carolyn P. Neuhaus
      Abstract: This August, I participated in the conference “Genome Editing: Biomedical and Ethical Perspectives,” hosted by the Center for the Study of Bioethics at the University of Belgrade and cosponsored by the Division of Medical Ethics of NYU Langone Health and The Hastings Center. The prime minister of Serbia, Ana Brnabić, spoke of the significance of bringing together an international community of bioethicists, acknowledging that ethical, social, and legal issues surrounding gene editing technologies transcend national boundaries. Europe's Oviedo Convention prohibits human germline gene editing, and UNESCO's Universal Declaration on the Human Genome and Human Rights says that germline editing “could be contrary to human dignity,” an assault on humanity itself. Whether one agrees or not, engaging with the idea forces us to think about what it means to be part of the global human community and about the moral significance of the human genome to creating that community. The conference highlighted for me how challenging having international, much less global, conversations about bioethics can be.
      PubDate: 2017-11-24T02:26:07.449392-05:
      DOI: 10.1002/hast.775
  • Social Practices
    • Pages: 2 - 2
      Abstract: In one way or another, several pieces in the November-December 2017 of the Hastings Center Report reflect an insistence on turning away from abstractions to learn how a whole community understands a problem at issue—how a community understands what's at stake in individuals’ autonomous choices, how a community understands the results of a clinical trial, how a community understands, and generates and adjusts, medical standards. In the lead article, Kayte Spector-Bagdady and colleagues argue that, given extensive research showing that electronic fetal monitoring during childbirth offers very little benefit to the mother and child, a mechanism is needed to ensure that the medical standard of care is based on the right kinds of considerations. The core claim of the second article, by Laura Bothwell and Aaron Kesselheim, is that adaptive-trial designs are premised on the idea that trial designs should be maximally persuasive to the medical community. In the third article, Frederick Zimmerman argues that a richer understanding of autonomy makes it possible to see that public health is more frequently compatible with autonomy than is commonly recognized. A supplement to the issue contains a special report that explores what “just reproduction” means “in the face of multifarious understandings of both justice and autonomy and in light of increasingly complex and costly reproductive technologies.”
      PubDate: 2017-11-24T02:26:07.246021-05:
      DOI: 10.1002/hast.776
  • Contemplating Resectability
    • Authors: Andrew G. Shuman
      Pages: 3 - 4
      Abstract: Suzie loves to talk. A successful mid-thirties businesswoman, she is a self-described social butterfly—which made her diagnosis of tongue cancer even more devastating. She came to the clinic complaining of a lump in her throat, which in most young healthy people turns out to be benign and easily treated. But not for Suzie, who had a very rare salivary tumor arising in the back of her tongue. Its slow growth was both a blessing and a curse; such tumors do not kill people quickly, but they typically require surgery. It would slowly and relentlessly grow until and unless we removed most of her tongue. In head and neck surgery, issues of appearance, identity, function, and communication are the foremost considerations when we decide when, and whether, to operate. As the adage goes, knowing when not to operate is the sine qua non of the wise surgeon. But the inverse is also true.
      PubDate: 2017-11-24T02:26:08.240071-05:
      DOI: 10.1002/hast.777
  • Delegating Informed Consent
    • Authors: Valerie Gutmann Koch
      Pages: 5 - 6
      Abstract: Ten years ago, Megan Shinal sought the care of neurosurgeon Steven Toms for the surgical treatment of a recurrent nonmalignant tumor in the pituitary region of her brain. In their twenty-minute meeting, Shinal did not make a final decision about which surgical approach she wished to pursue. Subsequently, she spoke with Tom's physician assistant once by phone and once in person, when she signed the consent form, which did not appear to designate which surgical approach she had chosen. During the operation—a total resection—Toms perforated Shinal's carotid artery, resulting in hemorrhage, stroke, brain injury, and partial blindness. The jury found that Toms had fulfilled his informed-consent obligations prior to performing the resection; however, in June 2017, the Supreme Court of Pennsylvania overturned the decision, relying on the Pennsylvania Medical Care Availability and Reduction of Error Act. The court found that the language of the act is unambiguous in its requirement that “a physician's duty to provide information to a patient sufficient to obtain her informed consent is non-delegable.” Presumably, this rule of nondelegation applies beyond the surgical theater to other major treatment decisions. And it is unclear whether it applies to other professionals in a subordinate position to the treating physician, such as residents and fellows.
      PubDate: 2017-11-24T02:26:07.324549-05:
      DOI: 10.1002/hast.778
  • Erratum
    • Pages: 6 - 6
      PubDate: 2017-10-03T11:40:20.338705-05:
      DOI: 10.1002/hast.773
  • Real-World Evidence, Public Participation, and the FDA
    • Authors: Jason L. Schwartz
      Pages: 7 - 8
      Abstract: For observers of pharmaceutical regulation and the Food and Drug Administration, these are uncertain times. Events in late 2016 raised concerns that the FDA's evidentiary standards were being weakened, compromising the agency's ability to adequately perform its regulatory and public health responsibilities. Two developments most directly contributed to these fears—the approval of eteplirsen, a treatment for Duchenne muscular dystrophy, against the recommendations of both FDA staff and an advisory committee and the December 2016 signing of the 21st Century Cures Act, which encouraged greater use by the FDA of “real-world” evidence not obtained through randomized controlled trials. The arrival of the Trump administration—with its deregulatory, industry-friendly approach—has only amplified concerns over the future of the FDA. It is too early to know whether the recent developments are truly harbingers of an FDA less likely to prevent unsafe or ineffective products from reaching the market. But elements in the two events—the role of patient narratives in deliberations regarding eteplirsen and the enthusiasm for real-world evidence in the 21st Century Cures Act—raise critical issues for the future of evidence in the FDA's work. The rigorous, inclusive approach under way to consider issues related to real-world evidence provides a model for a similarly needed inquiry regarding public participation in FDA decision-making.
      PubDate: 2017-11-24T02:26:08.738034-05:
      DOI: 10.1002/hast.779
  • The Morality of Health Care Reform: Liberal and Conservative Views and the
           Space between Them
    • Authors: Timothy Stoltzfus Jost
      Pages: 9 - 13
      Abstract: We have just completed an exhausting nine-month debate on the future of the Affordable Care Act. I see this debate as having ended—as of this writing—in a draw. After months of repeal efforts, Republicans in the House barely passed in early May, with a 217-to-213 margin, the American Health Care Act, which would have significantly amended the ACA. Republicans in the Senate spent the summer trying to arrive at amendments to the AHCA that could attract fifty of their fifty-two votes, but in the end, the clock ran out on their opportunity to enact an amendment without Democratic input. With this legislative failure, we appear to be in a stalemate. The Affordable Care Act remains in place as the law of the land, but the Trump administration seems committed to at best condemning the ACA to malign neglect and at worst actively undermining it at every opportunity. Given the political stalemate, the time is right to reassess the deeper issues at stake and ponder the prospects for a considered compromise on health reform.
      PubDate: 2017-10-27T13:25:21.290738-05:
      DOI: 10.1002/hast.774
  • Ending DACA Has Pragmatic and Ethical Implications for U.S. Health Care
    • Authors: Danish Zaidi; Mark Kuczewski
      Pages: 14 - 15
      Abstract: In 2012, Loyola University Chicago's Stritch School of Medicine became the first medical school in the United States to actively recruit and accept undocumented immigrants who received protections granted under the Deferred Action for Childhood Arrivals program that was established by presidential memorandum. By 2016, sixty-one medical schools were considering applications from DACA recipients for admission, and more than 110 students applied. According to the American Association of Medical Colleges, sixty-five DACA recipients matriculated in U.S. medical schools in the 2016–2017 school year. These students contribute both diversity and talent to our medical community; they could also have a significant impact on the care of underserved and immigrant populations. The recent decision by the Trump administration to rescind DACA therefore comes with serious pragmatic and ethical ramifications, impeding our medical community's efforts to develop a diverse and representative workforce committed to improving access to quality care for all patients.
      PubDate: 2017-11-24T02:26:06.894085-05:
      DOI: 10.1002/hast.780
  • Stemming the Standard-of-Care Sprawl
    • Authors: Kayte Spector-Bagdady; Raymond Vries, Lisa Hope Harris, Lisa Kane Low
      Pages: 16 - 24
      Abstract: The “best interests of the patient” standard—a complex balance between the principles of beneficence and autonomy—is the driving force of ethical clinical care. Clinicians’ fear of litigation is a challenge to that ethical paradigm. But is it ever ethically appropriate for clinicians to undertake a procedure with the primary goal of protecting themselves from potential legal action' Complicating that question is the fact that tort liability is adjudicated based on what most clinicians are doing, not the scientific basis of whether they should be doing it in the first place. In a court of law, clinicians are generally judged based on the “reasonably prudent” standard: what a reasonably prudent practitioner in a similar situation would do. But this legal standard can have the effect of shifting the medical standard of care—enabling a standard-of-care sprawl where actions undertaken for the primary purpose of avoiding liability reset the standard of care against which clinicians will be adjudicated. While this problem has been recognized in the legal literature, neither current ethical models of care nor legal theory offer workable solutions.One of the best examples of the conflict between evidence-based medicine and common clinical practice is the use of electronic fetal monitoring. Despite strong evidence and professional guidelines that argue against the use of EFM for healthy pregnancies, the practice persists. One of the main reasons for this is often assumed to be physicians’ concerns about liability.
      PubDate: 2017-11-24T02:26:08.379429-05:
      DOI: 10.1002/hast.781
  • The Sticky Standard of Care
    • Authors: Michelle Oberman
      Pages: 25 - 26
      Abstract: The problem at the heart of “Stemming the Standard-of-Care Sprawl: Clinician Self-Interest and the Case of Electronic Fetal Monitoring,” an article by Kayte Spector-Bagdady and colleagues in the November-December 2017 issue of the Hastings Center Report, is the persistence of a suboptimal standard of care long after evidence-driven approaches would dictate a change. That problem is not simply defensive medicine, or what the authors call “standard-of-care sprawl.” Instead, it is that, in some cases, the standard of care lags behind best practices. It gets stuck. The authors point to the genesis of the stickiness problem in their passing reference to a core truth: “The problem is that standard of care is not synonymous with best or evidence-based medicine.” In my view, we might best understand the persistence of ineffective and even harmful medical interventions by acknowledging the regulatory vacuum in which such practices thrive. It is by default, not by design, that the profession relies on medical malpractice law to set the boundaries on acceptable practice.
      PubDate: 2017-11-24T02:26:08.005263-05:
      DOI: 10.1002/hast.782
  • The Real-World Ethics of Adaptive-Design Clinical Trials
    • Authors: Laura E. Bothwell; Aaron S. Kesselheim
      Pages: 27 - 37
      Abstract: From the earliest application of modern randomized controlled trials in medical research, scientists and observers have deliberated the ethics of randomly allocating study participants to trial control arms. Adaptive RCT designs have been promoted as ethically advantageous over conventional RCTs because they reduce the allocation of subjects to what appear to be inferior treatments. Critical assessment of this claim is important, as adaptive designs are changing medical research, with the potential to significantly shift how clinical trials are conducted. Policy-makers are swiftly moving to encourage greater use of adaptive designs. In 2016, the newly enacted 21st Century Cures Act instructed the Food and Drug Administration to help product sponsors incorporate adaptive methods into proposed clinical trial protocols and applications for investigational drugs and also biological products. In this article, we review the ethical justifications commonly offered for adaptive designs, explore these arguments in the context of actual trials, and contend that clinical equipoise is a useful standard for adaptive-trial ethics. We distinguish between theoretical and clinical equipoise and explain why ethical arguments related to adaptive trials tend to focus on the former. Yet we contend that theoretical equipoise can be an unreliable standard for adaptive ethics. While we contend that clinical equipoise is the most critical principle for the primary ethical concerns posed by adaptive trials, we suggest ethical approaches to deal with some additional concerns unique to adaptive designs.
      PubDate: 2017-11-24T02:26:08.867513-05:
      DOI: 10.1002/hast.783
  • Public Health Autonomy: A Critical Reappraisal
    • Authors: Frederick J. Zimmerman
      Pages: 38 - 45
      Abstract: The ethical principle of autonomy is among the most fundamental in ethics, and it is particularly salient for those in public health, who must constantly balance the desire to improve health outcomes by changing behavior with respect for individual freedom. Although there are some areas in which there is a genuine tension between public health and autonomy—childhood vaccine mandates, for example—there are many more areas where not only is there no tension, but public health and autonomy come down to the same thing. These areas of overlap are often rendered invisible by a thin understanding of autonomy. Better integrating newer theoretical insights about autonomy into applied ethics can make discussions of public health ethics more rigorous, incisive, and effective. Even more importantly, bringing modern concepts of autonomy into public health ethics can showcase the many areas in which public health and autonomy have the same goals, face the same threats, and can be mutually advanced by the same kinds of solutions.This article provides a schema for relational autonomy in a public health context and gives concrete examples of how autonomy can be served through public-health interventions. It marshals insights from sociology, psychology, and philosophy to advance a theory of autonomy and coercion that recognizes three potential threats to autonomy: threats to choice sets, threats to knowledge, and threats to preferences.
      PubDate: 2017-11-24T02:26:07.672461-05:
      DOI: 10.1002/hast.784
  • Being Better Bodies
    • Authors: Joel Michael Reynolds
      Pages: 46 - 47
      Abstract: Bioethics has an uneasy relationship with embodiment. Only with vigilance does knowledge of the body as it is lived counterbalance the momentous inertia of knowledge of the body as an object brought about by modern medical sciences. As a field tethered to detached, technical ways of knowing the world, bioethics must toil to treat the body as more than mere material and machine. To be more is, among other things, to be social—to live in the thickets of interdependence and the institutions and practices we build, hone, and defend to facilitate it. I take this tension to define the ultimate stakes of Melinda Hall's The Bioethics of Enhancement: Transhumanism, Disability, and Biopolitics. Hall homes in on transhumanism, the idea that we should embrace technology to vault beyond current human limitations. Yet the work serves as a reminder for all bioethicists and philosophers of how easily one can be led astray by otherwise irreproachable values when they are disconnected from the conditions and realities of human life, including being irremediably interdependent embodied beings. Put more acerbically, the book is a reminder of how thinking goes wrong when divorced from the principal sources out of which human appraisals emerge: our fleshy, messy, social bodies.
      PubDate: 2017-11-24T02:26:09.209852-05:
      DOI: 10.1002/hast.785
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