RESUMEN
Democratic societies that separate church and state face major challenges in accommodating religious convictions. This applies especially to determining healthcare policies. Building on our prior work on the demands and limits of religious accommodation in democratic societies, we propose a set of ethical standards that can guide societies in meeting this challenge. In applying and defending these standards, we explore three topics: vaccine resistance, abortion, and concerns about rights to healthcare. We clarify these and other issues of religious accommodation and propose ethical standards for approaching these and other problems.
Asunto(s)
Aborto Inducido , Atención a la Salud , Embarazo , Femenino , Humanos , Política de Salud , Obligaciones Morales , Diversidad CulturalRESUMEN
Gender-affirming healthcare (GAH) interventions are medical or surgical interventions that aim to allow trans and non-binary people to better affirm their gender identity. It has been argued that rights to GAH must be grounded in either a right to be cured of or mitigate an illness-gender dysphoria-or in harm prevention, given the high rates of depression and suicide among trans and non-binary people. However, these grounds of a right to GAH conflict with the prevalent view among theorists, institutions and activists that trans and non-binary people do not have a mental illness and that one can be trans and entitled to GAH without being depressed or suicidal. This paper challenges the orthodoxy that a right to GAH must be grounded in either of these ways and instead argues for a right to GAH grounded in a right to live and act with integrity. The standard view, which this paper explains, is that our rights to live and act with integrity ground a right to religious accommodation in many cases such as a right to not be denied social security due to one's refusal to work a job on a holy day. This paper argues that if our rights to live and act with integrity can ground prima facie rights to religious accommodation, our rights to live and act with integrity ground prima facie rights to GAH.
Asunto(s)
Identidad de Género , Personas Transgénero , Femenino , Humanos , Masculino , Facies , Atención a la SaludRESUMEN
O Sistema Único de Saúde (SUS) trouxe a diretriz da participação da sociedade nas discussões e deliberações acerca das políticas públicas e ações de saúde, cuja importância é fundamental para a formulação, implementação e consolidação do sistema. O objetivo do estudo é descrever as facilidades, dificuldades e oportunidades na atuação do controle social para a garantia do acesso à saúde enquanto direito. Trata-se de uma revisão integrativa da literatura, cujos artigos selecionados podem ser encontrados nas bases de dados Scientific Electronic Library Online (Scielo), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) e Banco de Dados em Enfermagem (BDENF), abrangendo as publicações no período de 2010 a 2019. Selecionaram-se dez artigos. As facilidades identificadas para a atuação do controle social foram a garantia de uma efetiva ação por parte do governo e a proximidade que a Estratégia Saúde da Família apresenta, considerando sua inserção dentro do serviço de saúde. As dificuldades correspondem à falta de representatividade e de conhecimento dos conselheiros, aos conflitos particulares, à influência partidária e à falta de autonomia dos conselhos de saúde. Algumas alternativas foram identificadas para diminuir as dificuldades, como a presença de diálogo entre os membros do conselho de saúde e a oportunidade de Educação Permanente. Assim, é importante que usuários, gestores, trabalhadores e conselheiros de saúde reconheçam o seu papel na defesa do sistema público de saúde, da democracia e do fortalecimento da participação social em busca de um SUS que garanta o acesso à saúde como direito de todo cidadão.
The Unified Health System (SUS) brought the guideline for society's participation in discussions and deliberations about public policies and health actions, which has been important for its formulation, implementation and consolidation. The objective of the study is to describe the facilities, difficulties and opportunities in the performance of social control to guarantee access to health as a right. It is an integrative literature review, whose articles were selected from the Scientific Electronic Library Online (SciELO), Latin American and Caribbean Literature in Health Sciences (LILACS) and Nursing Database (BDENF) databases, covering publications from 2010 to 2019. 10 articles were selected. The facilities identified for the performance of social control were the guarantee of effective action by the government and the proximity that the Family Health Strategy presents, considering its insertion within the health service. The difficulties relate to the lack of representation and knowledge of the counselors, private conflicts, party influence and the lack of autonomy of the health councils. Some alternatives were identified to reduce the difficulties, such as the presence of dialogue between the members of the health council and the opportunity for Permanent Education. Thus, it is important that users, managers, workers and health counselors recognize their role in defending the public health system, democracy and strengthening social participation in search of a SUS that guarantees access to health as a right for every citizen.
El Sistema Único de Salud (SUS) trajo consigo la pauta para la participación de la sociedad en las discusiones y deliberaciones sobre las políticas públicas y acciones de salud, lo que ha sido importante para la formulación, implementación y consolidación de ese sistema. El objetivo de este estudio es describir las facilidades, dificultades y oportunidades en el desempeño del control social para garantizar el acceso a la salud como derecho. Se trata de una revisión integradora de la literatura, cuyos artículos fueron seleccionados de las bases de datos Scientific Electronic Library Online (SciELO), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS) y Base de Datos de Enfermería (BDENF), abarcando las publicaciones de 2010 a 2019. Se seleccionaron diez artículos. Las instalaciones identificadas para la realización del control social fueron la garantía de la acción efectiva por parte del gobierno y la cercanía que presenta la Estrategia de Salud Familiar, considerando su inserción dentro del servicio de salud. Las dificultades se relacionan con la falta de representación y conocimiento de los consejeros, los conflictos privados, la influencia partidaria y la falta de autonomía de los consejos de salud. Se identificaron algunas alternativas para reducir las dificultades, como la presencia de diálogo entre los miembros del consejo de salud y la oportunidad de Educación Permanente. Por ello, es importante que usuarios, gestores, trabajadores y consejeros de salud reconozcan su rol en la defensa del sistema público de salud, la democracia y el fortalecimiento de la participación social en busca de un SUS que garantice el acceso a la salud como un derecho de todos los ciudadanos.
Asunto(s)
Política Pública , Control Social Formal , Salud Pública , Consejos de Salud , Participación Social , Servicios de SaludRESUMEN
BACKGROUND: The European Charter of Patients' Rights (ECPR) presents basic patients' rights in health care. We analysed the characteristics of patients' complaints about their rights submitted through the official complaints system and to a non-governmental organization in Croatia. METHODS: The official system for patients'complaints in Croatia does not have a common pathway but offers different modes for addressing patient complaints. In this cross-sectional study, we analysed the reports about patients' complaints from the official regional committees sent to the Ministry of Health. We also analysed the complaints received by the Croatian Association for the Protection of Patient's Rights (CAPR) and mapped them to the ECPR. RESULTS: The aggregated official data from the Ministry of Health in 2017 and 2018 covered only 289 individual complaints from 10 out of 21 counties. Complaints were most frequently related to secondary and tertiary healthcare institutions and details were not provided. CAPR received a total of 440 letters, out of which 207 contained 301 complaints about violations of patients' rights in 2017-2018. The most common complaint was the Right of Access to health care (35.3%) from the ECPR, followed by the Right to Information (29.9%) and the Right to Safety (21.7%). The fewest complaints were about the Right to Complain (1.9%), Right to Innovation (1.4%), Right to Compensation (1.4%), and Right to Preventive Measures (1.0%). CONCLUSIONS: Reporting and dealing with patients' complaints about violations of their patients' rights does not appear to be effective in a system with parallel but uncoordinated complaints pathways. Mapping patient's complaints to the ECPR is a useful tool to assess the perception of patients' rights and to plan actions to improve the complaints system for effective health care.
Asunto(s)
Atención a la Salud , Derechos del Paciente , Croacia , Estudios Transversales , Instituciones de Salud , HumanosRESUMEN
Individual rights to healthcare (RTHCs) are increasingly common in law. Yet even plausible theoretical defences thereof raise a classic problem in the philosophy of rights: How do individual rights relate to 'collective' rights within the same domain? Collective rights are common in international law and in the domestic laws of states that recognize RTHCs. These collective rights often include health-related components. There are at least prima facie plausible reasons to think that such collective 'health rights' should exist. A complete account of health rights should thus explain how individual and collective health rights claims relate to one another and what one should do in cases where the claims conflict. This work contributes to our understanding of health rights by analysing the relationship between individual RTHCs and a plausible candidate collective health right, namely a sub-state national right to control healthcare law and policy. It argues that concerns about rights conflicts in this context make sense, but genuine conflicts between individual health rights and national control over healthcare are rare. The strongest cases for sub-state national 'self-determination' rights do not implicate healthcare, or tend not to provide reasons to override any individual RTHCs. Conflicts are possible in rare cases and may even favour fulfilling the collective rights claims. Yet individual RTHCs remain important even in those cases. Individual rights remain useful measures for evaluating the exercise of collective rights: exercises that violate (or even fail to fulfil) individual health rights are worse for so doing.
Asunto(s)
Derecho a la Salud , Instituciones de Salud , Accesibilidad a los Servicios de Salud , Derechos Humanos , Humanos , PolíticasRESUMEN
OBJECTIVES: The catastrophic effects of armed conflict, particularly prolonged armed conflict, on individual and public health are well established. The 'right' to healthcare during armed conflict and its lack of enforcement despite a range of United Nations mandated requirements regarding health and healthcare provisions is likely to be a significant feature in future conflicts, as zoonotic-induced pandemics become a more common global public health challenge. The issue of enforcement of health rights assurance and its implications for the public health management of global pandemics such as coronavirus disease 2019 (COVID-19) in and between countries and regions in conflict is the objective of this Review. STUDY DESIGN: A narrative review was conducted. METHODS: Referenced to the framework of International humanitarian law (IHL) and International human rights law (IHRL) to explore and discuss the deficits in health rights assurances in conflict settings and illustrate how gaps in protection and lack of enforcement compounds the disease response. Both IHL, and IHRL can be leveraged to ensure human and health rights are assured in conflict settings. There is a distinct lack of international criteria with regard to standards of healthcare coverage, infrastructure and service preservation to the civilian population during times of armed conflict. This has far reaching consequences when confounded by a pandemic or even localised disease outbreak. RESULTS: We illustrate how in a pandemic disease emergency, such as COVID-19, all life is threatened; and how leaving the citizen population exposed to this contagion is a human rights breach and an indirect method of warfare. The consequences of failure to effectively address such pandemic infections, (i.e. COVID-19), in a conflict setting are potentially catastrophic as prevention and containment responses are severely constrained by state insecurity, political instability, terrorism, repression, rights abuses, and displacement of citizens. Neglect by State actors potentially constitutes a breach of the universal right to life. States cannot justify their failures to mitigate disease based on claims of lack of resources, even when available resources are minimal. Where discrimination of people with a disease, such as COVID-19, or minority groups at the point of access to health facilities occurs, this further breaches the principle of medical neutrality. CONCLUSIONS: The example of the COVID-19 response may offer a viable route to leverage greater access and coverage of healthcare in conflict and humanitarian settings. A radicalised partnership approach during these times of emergency is warranted, based on an ethical 'humanitarian intervention' approach to provide care to all affected by contagious disease in conflict settings.
Asunto(s)
Altruismo , COVID-19 , Derechos Humanos , Derecho a la Salud , Zoonosis , Animales , Urgencias Médicas , Instituciones de Salud , Personal de Salud , Accesibilidad a los Servicios de Salud , Pandemias , Salud Pública , SARS-CoV-2RESUMEN
In this paper, we analyse the most important documents establishing the criteria for the treatment and exclusion of COVID-19 patients, especially in regard to the giving of respiratory support, in Italy and Spain. These documents reflect a tension that stems from limited healthcare resources which are insufficient to save lives that, under normal conditions, could have been saved, or at least could have received the best possible treatment. First, we analyse the healthcare systems of these two countries before the spread of the virus, both of which have seen decreases in the number of intensive care beds and have been marked by financial cuts during the last ten years. It is a fact that a greater number of people, especially those over 70 years of age, have been left without respiratory support treatment, and therefore, there have been a greater number of deaths. It is also a fact that there has been a higher infection rate among healthcare professionals due to the delay in the management of protective measures and the inability to provide adequate care for those in nursing homes, as recognised by WHO. In the context of this health emergency, healthcare professionals have suffered a real 'moral distress' because, knowing first-hand the causes of the limitation of resources, they have had to put triage protocols into practice. Finally, we set forth a series of concrete ethical proposals with which to face the successive waves of COVID-19 infection, as well as other future pandemics.
RESUMEN
A pandemic may cause a sudden imbalance between available medical resources and medical needs where fundamental care to a patient cannot be delivered. Inability to fulfil a professional commitment to deliver care as needed can lead to distress among caregivers and patients. This distress is sometimes alleviated through mechanisms that hide the facts that care is rationed and not all medical needs are met. We have identified three mechanisms that jeopardise accountable and optimal allocation of resources: (1) hidden value judgements that allow rationing under the disguise of triage or prioritisation, (2) disguised conflict of interest between societal and individual patient's needs and (3) concealed biases in the application of medical tools. Under these three pitfalls decisions of resource allocation and who gets treated are handled as medical decisions: normative decisions are concealed and perceived as falling with the realm of medical judgement. Value judgements and moral agency are hidden to offer a 'false sense of medical judgement', while in fact there are several ethical judgements and biases at stake. The three pitfalls entail hidden normative deliberation and are inappropriate for sustainable healthcare delivery and resource allocation. We believe it is necessary to maintain transparency in decision making under conditions of insufficient resources to maintain trust in professional care givers and secure fair treatment allocation. Recognition of the pitfalls, by applying our recommendations, may help to ensure transparent and accountable distribution of care and contribute to public acceptance of the ethics behind rationing.
RESUMEN
Health insurance coverage for incarcerated citizens is generally acceptable by Western standards. However, it creates internal tensions with the prevailing justifications for public healthcare. In particular, a conceptualization of medical care as a source of autonomy enhancement does not align with the decreased autonomy of incarceration and the needs-based conceptualization of medical care in cases of imprisonment; and rejecting responsibility as a criterion for assigning medical care conflicts with the use of responsibility as a criterion for assigning punishment. The recent introduction of sofosbuvir in Germany provides a particularly instructive illustration of such tensions. It requires searching for a refined reflective equilibrium regarding the scope, limits, and justifications of publicly guaranteed care.
Asunto(s)
Coerción , Sofosbuvir , Atención a la Salud , Alemania , HumanosRESUMEN
The role and importance of solidarity for effective health provision is the subject of lengthy and heated debate which has been thrown into even sharper relief by the COVID-19 pandemic. In various ways, and by various authorities we have all been asked, even instructed, to engage in solidarity with one another in order to collectively respond to the current crisis. Under normal circumstances, individuals can engage in solidarity with their compatriots in the context of public health provision in a number of ways, including paying taxes which fund welfare state initiatives, and avoiding others when ill. While there has been significant engagement in solidarity worldwide, there have also been high profile examples of refusals and failures to engage in solidarity, both by individual agents, and governments. In this paper I examine the consequence of these failures with reference to the actions of the current British government, which has failed to deliver an effective response to the crisis. This failure has effectively devolved responsibility for responding to the crisis to people who are simultaneously more vulnerable to infection, and less able to do anything about it. I argue that such responses represent mismanagement of a public health crisis, and a rejection of important democratic and egalitarian norms and values.
Asunto(s)
Atención a la Salud/ética , Gobierno , Pandemias , Salud Pública/ética , SARS-CoV-2 , Justicia Social , Responsabilidad Social , COVID-19 , Humanos , Reino UnidoRESUMEN
In June 2020, Gilead agreed to provide the USA with 500 000 doses of remdesivir-an antiviral drug which at that time was percieved to show promise in reducing the recovery time for patients with COVID-19. This quantity represented Gilead's then full production capacity for July and 90% of its capacity for August and September. Similar deals are evident around access to proposed vaccines for COVID-19, and such deals are only likely to increase. These attempts to secure preferential access to medicines and vaccines, so-called vaccine/treatment nationalism, jeopardise supplies of life-saving treatments and vaccines available elsewhere, and jeopardise global equitable distribution of such vaccines/treatments more generally. Much of the focus to date has been on States' role in negotiating such deals. However, such developments also demonstrate the power patent holders have in controlling access to life-saving healthcare, determining who obtains access first and at what price. This article argues that the extent of control currently given to patent holders for COVID-19 must be questioned. This article demonstrates that patents have significant implications for healthcare acting as private governance tools over patented inventions. It is only by greater probing of patent holders' role in delivering access to medicines, diagnostics and vaccines for COVID-19 that equitable global equitable access can be achieved.
RESUMEN
It has recently been reported that some hospitals in the UK have placed a blanket restriction on the provision of maternal request caesarean sections (MRCS) as a result of the COVID-19 pandemic. Pregnancy and birthing services are obviously facing challenges during the current emergency, but we argue that a blanket ban on MRCS is both inappropriate and disproportionate. In this paper, we highlight the importance of MRCS for pregnant people's health and autonomy in childbirth and argue that this remains crucial during the current emergency. We consider some potential arguments-based on pregnant people's health and resource allocation-that might be considered justification for the limitation of such services. We demonstrate, however, that these arguments are not as persuasive as they might appear because there is limited evidence to indicate either that provision of MRCS is always dangerous for pregnant people in the circumstances or would be a substantial burden on a hospital's ability to respond to the pandemic. Furthermore, we argue that even if MRCS was not a service that hospitals are equipped to offer to all pregnant persons who seek it, the current circumstances cannot justify a blanket ban on an important service and due attention must be paid to individual circumstances.
Asunto(s)
Cesárea/ética , Toma de Decisiones/ética , Asignación de Recursos para la Atención de Salud/ética , Derechos Humanos , Pandemias/ética , Complicaciones Infecciosas del Embarazo/prevención & control , Betacoronavirus , COVID-19 , Cesárea/efectos adversos , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/virología , Procedimientos Quirúrgicos Electivos/efectos adversos , Procedimientos Quirúrgicos Electivos/ética , Femenino , Salud , Hospitales , Humanos , Madres , Pandemias/prevención & control , Autonomía Personal , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/virología , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/etiología , Complicaciones Infecciosas del Embarazo/virología , Mujeres Embarazadas , SARS-CoV-2 , Reino UnidoRESUMEN
COVID-19 is reducing the ability to perform surgical procedures worldwide, giving rise to a multitude of ethical, practical and medical dilemmas. Adapting to crisis conditions requires a rethink of traditional best practices in surgical management, delving into an area of unknown risk profiles. Key challenging areas include cancelling elective operations, modifying procedures to adapt local services and updating the consenting process. We aim to provide an ethical rationale to support change in practice and guide future decision-making. Using the four principles approach as a structure, Medline was searched for existing ethical frameworks aimed at resolving conflicting moral duties. Where insufficient data were available, best guidance was sought from educational institutions: National Health Service England and The Royal College of Surgeons. Multiple papers presenting high-quality, reasoned, ethical theory and practice guidance were collected. Using this as a basis to assess current practice, multiple requirements were generated to ensure preservation of ethical integrity when making management decisions. Careful consideration of ethical principles must guide production of local guidance ensuring consistent patient selection thus preserving equality as well as quality of clinical services. A critical issue is balancing the benefit of surgery against the unknown risk of developing COVID-19 and its associated complications. As such, the need for surgery must be sufficiently pressing to proceed with conventional or non-conventional operative management; otherwise, delaying intervention is justified. For delayed operations, it is our duty to quantify the long-term impact on patients' outcome within the constraints of pandemic management and its long-term outlook.
Asunto(s)
Infecciones por Coronavirus/complicaciones , Toma de Decisiones/ética , Ética Médica , Cirugía General/ética , Equidad en Salud/ética , Pandemias/ética , Selección de Paciente/ética , Neumonía Viral/complicaciones , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/virología , Análisis Costo-Beneficio , Inglaterra , Análisis Ético , Teoría Ética , Humanos , Consentimiento Informado/ética , Obligaciones Morales , Neumonía Viral/virología , Guías de Práctica Clínica como Asunto , Ética Basada en Principios , Medición de Riesgo , SARS-CoV-2 , Medicina Estatal , Cirujanos , Procedimientos Quirúrgicos OperativosRESUMEN
BACKGROUND: Data processing of health research databases often requires a Data Protection Impact Assessment to evaluate the severity of the risk and the appropriateness of measures taken to comply with the European Union (EU) General Data Protection Regulation (GDPR). We aimed to define and apply a comprehensive method for the evaluation of privacy, data governance and ethics among research networks involved in the EU Project Bridge Health. METHODS: Computerised survey among associated partners of main EU Consortia, using a targeted instrument designed by the principal investigator and progressively refined in collaboration with an international advisory panel. Descriptive measures using the percentage of adoption of privacy, data governance and ethical principles as main endpoints were used for the analysis and interpretation of the results. RESULTS: A total of 15 centres provided relevant information on the processing of sensitive data from 10 European countries. Major areas of concern were noted for: data linkage (median, range of adoption: 45%, 30%-80%), access and accuracy of personal data (50%, 0%-100%) and anonymisation procedures (56%, 11%-100%). A high variability was noted in the application of privacy principles. CONCLUSIONS: A comprehensive methodology of Privacy and Ethics Impact and Performance Assessment was successfully applied at international level. The method can help implementing the GDPR and expanding the scope of Data Protection Impact Assessment, so that the public benefit of the secondary use of health data could be well balanced with the respect of personal privacy.
RESUMEN
Lippert-Rasmussen and Petersen discuss my 'Moral case for legal age change' in their article 'Age change, official age and fairness in health'. They argue that in important healthcare settings (such as distributing vital organs for dying patients), the state should treat people on the basis of their chronological age because chronological age is a better proxy for what matters from the point of view of justice than adjusted official age. While adjusted legal age should not be used in deciding who gets scarce vital organs, I remind the readers that using chronological age as a proxy is problematic as well. Using age as a proxy could give wrong results and it is better, if possible, for states to use the vital information directly than use age as a proxy.
Asunto(s)
Atención a la Salud , Principios Morales , Humanos , Justicia SocialRESUMEN
The UK's 2014 Immigration Act aimed to create a 'Hostile Environment' for migrants to the UK. One aspect of this was the restriction of access to secondary care for overseas visitors to the UK, although it remains the case that everybody living in the UK has the legal right to access primary care. In this paper, we argue that the effects of this policy extend beyond secondary care, including preventing eligible people from registering with a General Practice (GP), although as an unintended consequence. This problem arises from misinterpretation of policy wording, misleading GP websites and gatekeeping behaviour from front-line staff, even though there are no grounds in the current guidelines or law to support this. Free access to primary healthcare among refugees and asylum seekers living in deprived populations is particularly important in protecting patient health, given the burden of ill-health in this population and the multiple barriers to accessing early intervention they face. The medical profession has a duty to communicate their rights to this patient group-their legal entitlement to access free healthcare, and the vital importance of doing so.
Asunto(s)
Refugiados , Migrantes , Emigración e Inmigración , Accesibilidad a los Servicios de Salud , Humanos , Atención Primaria de SaludRESUMEN
Institutional guidelines for transgender children and adolescent minors fail to adequately address a critical juncture of care of this population: how to proceed if a minor and their parents have disagreements concerning their gender-affirming medical care. Through arguments based on ethical, paediatric, adolescent and transgender health research, we illustrate ethical dilemmas that may arise in treating transgender and gender diverse youth. We discuss three potential avenues for providing gender-affirming care over parental disagreement: legal carve-outs to parental consent, the mature minor doctrine and state intervention for neglect. Our discussion approaches this parent-child disagreement in a manner that prioritises the developing autonomy of transgender youth in the decision-making process surrounding medically assisted gender affirmation. We base our arguments in the literature surrounding the risks and benefits of gender-affirming therapy in transgender children and the existing legal basis for recognising minors' decision-making authority in certain medical situations.
Asunto(s)
Consentimiento Paterno , Personas Transgénero , Adolescente , Niño , Identidad de Género , Humanos , Consentimiento Informado , PadresRESUMEN
Following the recent condemnation of the National Health Service charging regulations by medical colleges and the UK Faculty of Public Health, we demonstrate that through enactment of this policy, the medical profession is betraying its core ethical principles. Through dissection of the policy using Beauchamp and Childress' framework, a disrespect for autonomy becomes evident in the operationalisation of the charging regulations, just as a disregard for confidentiality was apparent in the data sharing Memorandum of Understanding. Negative consequences of the regulations are documented to highlight their importance for clinical decision makers under the principles of beneficence and non-maleficence. Exploration of the principle of justice illuminates the core differentiation between the border-bound duties of the State and borderless duties of the clinician, exposing a fundamental tension.
Asunto(s)
Determinación de la Elegibilidad/ética , Emigración e Inmigración , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Justicia Social/ética , Medicina Estatal , Beneficencia , Estudios de Casos y Controles , Toma de Decisiones , Determinación de la Elegibilidad/legislación & jurisprudencia , Emigración e Inmigración/legislación & jurisprudencia , Emigración e Inmigración/estadística & datos numéricos , Regulación Gubernamental , Accesibilidad a los Servicios de Salud/ética , Historia del Siglo XX , Humanos , Obligaciones Morales , Autonomía Personal , Relaciones Médico-Paciente , Bienestar Social , Medicina Estatal/ética , Medicina Estatal/legislación & jurisprudencia , Reino Unido/epidemiología , Poblaciones Vulnerables/etnología , Indias Occidentales/epidemiologíaRESUMEN
The sexual citizenship of disabled persons is an ethically contentious issue with important and broad-reaching ramifications. Awareness of the issue has risen considerably due to the increasingly public responses from charitable organisations which have recently sought to respond to the needs of disabled persons-yet this important debate still struggles for traction in academia. In response, this paper continues the debate raised in this journal between Appel and Di Nucci, concurring with Appel's proposals that sexual pleasure is a fundamental human right and that access to sexual citizenship for the severely disabled should be publicly funded. To that endeavour, this paper refutes Di Nucci's criticism of Appel's sex rights for the disabled and shows how Di Nucci's alternative solution is iniquitous. To advance the debate, I argue that a welfare-funded 'sex doula' programme would be uniquely positioned to respond to the sexual citizenship issues of disabled persons.
Asunto(s)
Personas con Discapacidad , Financiación de la Atención de la Salud/ética , Conducta Sexual/ética , Adulto , Personas con Discapacidad/psicología , Doulas/economía , Doulas/ética , Femenino , Derechos Humanos/economía , Derechos Humanos/ética , Humanos , Masculino , Disfunciones Sexuales Fisiológicas/economía , Disfunciones Sexuales Fisiológicas/terapiaRESUMEN
Few conditions have sparked as much controversy as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Professional consensus has long suggested that the condition should be classified as psychiatric, while patients and advocacy groups have insisted it is a serious biological disease that requires medical care and research to develop it. This longstanding debate shifted in 2015, when U.S. governmental health authorities fully embraced medical classification and management. Given that some globally respected health authorities now insist that ME/CFS is a serious biological disease, this paper asks whether it can be ethical for the U.K. practice guideline now in development to characterize the condition as a mental health disorder. Following a brief history of ME/CFS controversy, I offer three arguments to show that it would be unethical for the U.K. to now characterize ME/CFS as a mental health condition, considering the relevance of that conclusion for ME/CFS guidelines elsewhere and for other contested conditions.