Marcel Verweij

The ethics of mandatory vaccination against influenza for health care workers.

Vaccination of health care workers (HCW) in long-term care results in indirect protection of patients who are at high-risk for influenza. The voluntary uptake of influenza vaccination among HCW is generally low. We argue that institutions caring for frail elderly have the responsibility to implement voluntary programmes for vaccination against influenza of HCW. When uptake falls short a mandatory programme may be justified. The main justification stems from the duty of care givers not to harm ones patient when one knows there is a significant risk of harm and the intervention to reduce this chance has a favourable balance of benefit over burdens and risks.

Considerations of strategies to provide influenza vaccine year round

There is potential for influenza vaccine programmes to make a substantial impact on severe disease in low-resource settings, however questions around vaccine composition and programmatic issues will require special attention. Some countries may benefit from immunization programmes that provide year-round supply of vaccine; however the best way to ensure adequate vaccine supply has yet to be determined. In this report, we discuss vaccine composition, availability, and programmatic issues that must be considered when developing year-round influenza immunization programmes. We then explore how these considerations have influenced immunization practices in the Latin American region as a case study. We identify three different approaches to achieve year-round supply: (1) alternating between Northern Hemisphere and Southern Hemisphere formulations, (2) extending the expiration date to permit extended use of a single hemisphere formulation, and (3) local vaccine manufacture with production timelines that align with local epidemiology. Each approach has its challenges and opportunities. The growing data suggesting high influenza disease burden in low resource countries underscores the compelling public health need to determine the best strategies for vaccine delivery.

Parental Opinions about the Expansion of the Neonatal Screening Programme

Background: Advances in genomics will open up opportunities in the fields of genetic testing, early diagnosis and disease treatment. While neonatal screening is the field of application par excellencefor these developments, the debate on its potential benefits and drawbacks is mainly theoretically driven and based on the opinions of professionals. Methods: We conducted a qualitative study of the perceptions, preferences and needs of parents (and parents to be) with respect to expansion of the neonatal screening programme. Seven focus group discussions were conducted. Using disease scenarios, 4 examples of conditions amenable to neonatal screening were discussed in depth. All focus group discussions were audio taped and content analysed. Results: Participants thought that the medical benefits of screening were very important for the child. Assuming the availability of effective early medical treatment, almost 100% would be willing to participate in a screening programme. If such treatment were absent, their potential willingness would be much lower. Conclusions: The divergence in attitudes and preferences we found in this study reflected the complexity inherent in any consideration of screening for additional conditions. To implement such options successfully and to direct applied research in genomics, it is important to develop a better understanding of the thinking of target groups, namely parents.

Moral assessment of growth hormone therapy for children with idiopathic short stature.

The prescription of growth hormone therapy for children who are not growth hormone deficient is one of the controversies in contemporary paediatric endocrinology. Is it morally appropriate to enhance the growth, by means of medical treatment, of a child wish idiopathic short stature? The medical, moral, and philosophical questions in this area are many. Data on the effects of human growth hormone (hGH) treatment will not on their own provide us with answers, as these effects have to be evaluated from a normative perspective. In this article we consider hGH treatment for children of idiopathic short stature from three normative perspectives: the goals of medicine, the good of the patient, and the public good. We argue that the prevention of psychological and social problems due to short stature (and not merely the enhancement of growth) should be the ultimate goal of medical treatment and research.

The Precautionary Principle and the Tolerability of Blood Transfusion Risks

Tolerance for blood transfusion risks is very low, as evidenced by the implementation of expensive blood tests and the rejection of gay men as blood donors. Is this low risk tolerance supported by the precautionary principle, as defenders of such policies claim? We discuss three constraints on applying (any version of) the precautionary principle and show that respecting these implies tolerating certain risks. Consistency means that the precautionary principle cannot prescribe precautions that it must simultaneously forbid taking, considering the harms they might cause. Avoiding counterproductivity requires rejecting precautions that cause more harm than they prevent. Proportionality forbids taking precautions that are more harmful than adequate alternatives. When applying these constraints, we argue, attention should not be restricted to harms that are human caused or that affect human health or the environment. Tolerating transfusion risks can be justified if available precautions have serious side effects, such as high social or economic costs.

Nudges in Public Health: Paternalism Is Paramount

Open Peer Commentary to Blumenthal-Barby, J. S., and H. Burroughs. 2012. Seeking better health care outcomes: The ethics of using the “nudge.” American Journal of Bioethics 12(2): 1–10.

Ottawa Statement from the Sparking Solutions Summit on Population Health Intervention Research

The Cape Town Statement was released on October 3, 2014 following the Third Global Symposium on Health Systems Research. The Statement covered a number of action themes, including health systems development, capacity development for research, cutting-edge and innovative research methods, and learning communities and knowledge translation. Following the Cape Town Statement’s release, a call to action that included action themes and recommendations for implementation research and delivery science (IRDS) was issued. Directed at health policy-makers and managers, funding organizations, researchers and academic institutions, journal editors and publishers, and civil society organizations, it aimed to facilitate the development of responsive health systems that are effective, efficient, equitable, and people-centered. This call to action is in keeping with the tenets of population health approaches throughout North America, much of Europe, and in many other places around the world. While the Cape Town Statement focused on health systems, the Ottawa Statement emphasizes the science of population health interventions. These include policies, programs and resource distribution approaches that are designed to have impact at the population level by changing the underlying conditions of risk and reducing health inequities. Examples of such interventions with a primary prevention orientation include organizational changes in workplace design, housing policies to reduce homelessness, immunization programs, and tax policy that discourages consumption of tobacco and other harmful products at a population level. Thus, population health intervention research (PHIR) is not clinical or laboratory-based. Rather, it is defined as research that involves the use of scientific methods to produce knowledge about interventions that operate within or outside of the health sector and have the potential to impact the health of populations and health equity (Population Health Intervention Research Initiative for Canada [PHIRIC]).

Futility Without a Dichotomy: Towards an Ideal Physician-Patient Relationship

The futility debate may be considered as an effort to provide a clear and justified borderline between physician and patient decision-making authority. In this paper we argue that the search for a definition of futility that provides physicians with a final argument in discussions about life-prolonging treatment, is misplaced. An acceptable and meaningful criterion of futility that satisfies this effort seems impossible. As a consequence, we reject a dichotomous domain of decision-making power as the starting point for definitions of futility. A good decision about withholding life-sustaining treatment should be justified from the perspectives of both physician and patient. In this light, a range of definitions of futility is still useful as it can clarify intuitions that a treatment is inappropriate.

Big food's ambivalence: Seeking profit and responsibility for health

In this article, we critically reflect on the responsibilities that the food industry has for public health. Although food companies are often significant contributors to public health problems (e.g., obesity, type 2 diabetes), the mere possibility of corporate responsibility for public health seems to be excluded in the academic public health discourse. We argue that the behavior of several food companies reflects a split corporate personality, as they contribute to public health problems and simultaneously engage in activities to prevent them. By understanding responsibility for population health as a shared responsibility, we reassess the moral role of the food industry from a forward-looking perspective on responsibility and ask what food companies can and should do to promote health.

An inventory of concerns behind blood safety policies in five Western countries

The availability of costly safety measures against transfusion‐transmissible infections forces Western countries to confront difficult ethical questions. How to decide about implementing such measures? When are such decisions justified? As a preliminary to addressing these questions, we assessed which concerns shape actual donor blood safety policymaking in five Western countries.