Bebe Loff

The Declaration of Helsinki, CIOMS and the ethics of research on vulnerable populations.

In an attempt to broaden the current debate over proposed revisions to the Declaration of Helsinki, we define vulnerable subjects as those lacking basic rights, and examine the ethical risks inherent in research on such subjects. We then propose special ethical criteria for the conduct and publication of research on vulnerable subjects.

Policy change to create supportive environments for physical activity and healthy eating: which options are the most realistic for local government?

The objective is to identify and test regulatory options for creating supportive environments for physical activity and healthy eating among local governments in Victoria, Australia. A literature review identified nine potential areas for policy intervention at local government level, including the walking environment and food policy. Discussion documents were drafted which summarized the public health evidence and legal framework for change in each area. Levels of support for particular interventions were identified through semi-structured interviews conducted with key informants from local government. We conducted 11 key informant interviews and found support for policy intervention to create environments supportive of physical activity but little support for policy changes to promote healthy eating. Participants reported lack of relevance and competing priorities as reasons for not supporting particular interventions. Promoting healthy eating environments was not considered a priority for local government above food safety. There is a real opportunity for action to prevent obesity at local government level (e.g. mandate the promotion of healthy eating environments). For local government to have a role in the promotion of healthy food environments, regulatory change and suitable funding are required.

Do human rights have a role in public health work

This article presents several arguments regarding the role of human rights in the sphere of public health. The underlying assumption is that in a human rights approach individual rights are protected at all costs yet a rights-based approach does not privilege protection of individual rights over the public good. To ensure clarity in what are understood to be strengths and limitations of bringing human rights into governmental non-governmental and international health work right-based approaches are needed to assess and validate.

Why Education and Choice Won't Solve the Obesity Problem

The authors express their opinion that governments must consider the environment that led to the obesity epidemic when proposing obesity prevention measures. They believe that proposals that focus on the willpower, knowledge, or decision-making ability of individuals will not be successful. They note that changing behavior is a challenge and that increasing levels of knowledge and awareness does not always result in change of behavior.

Health research systems: promoting health equity or economic competitiveness?

International collaborative health research is justifiably expected to help reduce global health inequities. Investment in health policy and systems research in developing countries is essential to this process but, currently, funding for international research is mainly channelled towards the development of new medical interventions. This imbalance is largely due to research legislation and policies used in high-income countries. These policies have increasingly led these countries to invest in health research aimed at boosting national economic competitiveness rather than reducing health inequities. In the United States of America and the United Kingdom of Great Britain and Northern Ireland, the regulation of research has encouraged a model that: leads to products that can be commercialized; targets health needs that can be met by profitable, high-technology products; has the licensing of new products as its endpoint; and does not entail significant research capacity strengthening in other countries. Accordingly, investment in international research is directed towards pharmaceutical trials and product development public-private partnerships for neglected diseases. This diverts funding away from research that is needed to implement existing interventions and to strengthen health systems, i.e. health policy and systems research. Governments must restructure their research laws and policies to increase this essential research in developing countries.

Returning to History: The Ethics of Researching Asylum Seeker Health in Australia

Australias policy of mandatory indefinite detention of those seeking asylum and arriving without valid documents has led to terrible human rights abuses and cumulative deterioration in health for those incarcerated. We argue that there is an imperative to research and document the plight of those who have suffered at the hands of the Australian government and its agents. However, the normal tools available to those engaged in health research may further erode the rights and well being of this population, requiring a rethink of existing research ethics paradigms to approaches that foster advocacy research and drawing on the voices of those directly affected, including those bestowed with duty of care for this population.

Detention of asylum seekers in Australia

Australia places many asylum seekers who have broken no law in open-ended terms of detention. Reports indicate that compromises are being made in the provision of ethical health care offered by the private company Australasian Correctional Management which is responsible for operating the detention centers in Australia on behalf of the federal government. However the Australian Medical Association has asserted that detainees are often deprived of basic medical care particularly emergency care. It has argued that the government should provide temporary access to Australias universal subsidized system of health care. Moreover the Royal Australian and New Zealand College of Psychiatrists has been outspoken in raising the ethical concerns for medical practitioners working in the centers. This presents a dilemma for medical practitioners between the desire to provide appropriate care and the aversion to supporting a pathological system.

Prostitution, public health, and human-rights law

Prostitutes are entitled to enjoy universal human rights. However the complexity of their legal status compounded by international human rights laws places prostitutes in a situation where health protection or promotional activity can rarely be expected to succeed. Legally sanctioned encouragement of prostitutes to use condoms or access screening services both major determinants of the prevalence of sexually transmitted diseases is impossible because of their illegal status. In addition international law that deals with prostitution targets trafficking in women for the purpose of prostitution and counterpoises prostitution with human dignity. It is argued that existing international law undermines efforts to reduce the incidence of HIV/AIDS and discriminates against prostitution on the basis of occupation. The redefinition of prostitution as work is vital if prostitutes are to enjoy equal human rights and in particular their rights as workers. Problems in international law contribute to the vulnerability of prostitutes to disease. Health practitioners should therefore advocate for a review of the human rights law into one that aims to diminish this vulnerability.

Conflict of interest guidelines for clinical guidelines.

Clinical guidelines are being increasingly produced to improve quality of care, but are vulnerable to bias. Only 15% of guidelines on the National Health and Medical Research Council portal from the most prolific developers have published conflict of interest statements, and fewer detail the processes used to manage conflicts. Comprehensive disclosure of conflicts is needed to safeguard the integrity of clinical guidelines and the medical profession. Peak bodies and clinicians should seek to promote an improvement to current poor practice.

Nursing in asylum seeker detention in Australia: care, rights and witnessing

The system of asylum seeker detention in Australia is one in which those seeking refuge are stripped of many of their rights, including the right to health. This presents serious ethical problems for healthcare providers working within this system. In this article we describe asylum seeker detention and analyse the role of nurses. We discuss how far an “ethics of care” and witnessing the suffering of asylum seekers can serve to improve their situation and improve ethical nursing practice.