ORCID Profile
0000-0002-8195-6404
Current Organisation
University of Sydney
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Publisher: Oxford University Press (OUP)
Date: 17-02-2011
DOI: 10.1093/PHE/PHR005
Publisher: Routledge
Date: 02-03-2017
Publisher: Wiley
Date: 10-03-2020
DOI: 10.1111/CTS.12756
Publisher: CMA Joule Inc.
Date: 12-2016
DOI: 10.1503/CJS.006016
Abstract: Canadians are motivated to travel abroad for bariatric surgery owing to wait times for care and restrictions on access at home for various reasons. While such surgery abroad is typically paid for privately, if "bariatric tourists" experience complications or have other essential medical needs upon their return to Canada, these costs are borne by the publicly funded health system. In this commentary, we discuss why assigning responsibility for the costs of complications stemming from bariatric tourism is complicated and contextual.
Publisher: Cambridge University Press
Date: 10-03-2011
Publisher: MDPI AG
Date: 31-10-2018
DOI: 10.3390/TROPICALMED3040115
Abstract: The World Health Organization has produced ethical guidance on implementation of the End TB strategy, which must be considered in local context. The Asia-Pacific Region has important distinctive characteristics relevant to tuberculosis, and engagement with the ethical implications raised is essential. This paper highlights key ethical considerations for the tuberculosis elimination agenda in the Asia-Pacific Regions and suggests that further programmatic work is required to ensure such challenges are addressed in clinical and public health programs.
Publisher: BMJ
Date: 12-2022
DOI: 10.1136/BMJGH-2022-009945
Abstract: In times of a public health emergency, lawyers and ethicists play a key role in ensuring that government responses, such as travel restrictions, are both legally and ethically justified. However, when travel bans were imposed in a broadly discriminatory manner against southern African countries in response to the Omicron SARS-CoV-2 variant in late 2021, considerations of law, ethics or science did not appear to guide politicians’ decisions. Rather, these bans appeared to be driven by fear of contagion and electoral blowback, economic motivations and inherently racist assumptions about low-income and middle-income countries (LMICs). With a new pandemic treaty and amendments to the WHO’s International Health Regulations (IHR) on the near-term horizon, ethics and international law are at a key inflection point in global health governance. Drawing on ex les of bordering practices to contain contagion in the current pandemic and in the distant past, we argue that the current IHR is not adequately constructed for a just and equitable international response to pandemics. Countries impose travel restrictions irrespective of their need or of the health and economic impact of such measures on LMICs. While the strengthening and reform of international laws and norms are worthy pursuits, we remain apprehensive about the transformative potential of such initiatives in the absence of collective political will, and suggest that in the interim, LMICs are justified in seeking strategic opportunities to play the same stark self-interested hardball as powerful states.
Publisher: Oxford University Press (OUP)
Date: 02-2013
DOI: 10.1093/PHE/PHT003
Publisher: Springer Science and Business Media LLC
Date: 04-04-2017
Publisher: CMA Joule Inc.
Date: 08-10-2018
DOI: 10.1503/CMAJ.171514
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 04-2019
Abstract: xamine how frontline health care workers (HCWs) and decision-makers working in tuberculosis (TB) care and mental health care conceptualise liberty, harm and the harm principle-which are often invoked in health care legislation to justify liberty restrictions-in the treatment and care of persons with TB and severe and persistent mental illness (SPMI). itative study of 20 semi-structured interviews with HCWs and decision-makers working in public or mental health from three public health units and two psychiatric hospitals in the Greater Toronto Area in Ontario, Canada. Interviews were evaluated using thematic analysis. e themes were identified: 1) the contextual nature of liberty restrictions 2) the concept of liberty as a matter of degree and 3) the challenges of balancing the treatment and care goals of TB and mental health for persons with both TB and SPMI. is understood by HCWs caring for persons with TB and/or SPMI in a context-dependent manner. This is compounded in the case of persons with both TB and SPMI. Liberty restrictions to advance public health goals entail reciprocal obligations from society, including social protections and additional resources, to ease the effects and range of liberty restrictions. Attention is required to ensure that treatment and care for SPMI does not impede that of TB and vice versa. .
Publisher: Elsevier BV
Date: 09-2023
Publisher: Public Library of Science (PLoS)
Date: 10-11-2016
Publisher: Informa UK Limited
Date: 03-04-2015
Publisher: JSTOR
Date: 2015
Publisher: Springer Science and Business Media LLC
Date: 19-12-2019
DOI: 10.1007/S11673-019-09954-W
Abstract: To identify the ethical challenges associated with the development and implementation of new tuberculosis (TB) drugs and diagnostics. Twenty-three semi-structured qualitative interviews conducted between December 2015 and September 2016 with programme administrators, healthcare workers, advocates, policymakers, and funders based in the Americas, Europe, and Africa. Interviews were analysed using thematic analysis. Divergent interests and responsibilities, coupled with power imbalances, are a primary source of ethical challenges the uncertain risk profiles of new drugs present an additional one. Although this challenge can be partially mitigated through stringent pharmacovigilance, respondents highlighted that high-burden countries tend to lack the resources to facilitate safe implementation. Increased advocacy and community engagement are considered an ethical imperative for future TB development and implementation. This project helps identify some of the ethical challenges of new TB technologies. It demonstrates that investigating ethical challenges through qualitative research is one way to apprehend the difficulty of implementing new TB technologies. Addressing this difficulty will require that those in positions of power reconsider their interests in relation to disempowered communities. Efforts to build consensus regarding what values should underpin the global governance of TB research, prevention, and care are essential to facilitate the ethical implementation of new TB technologies.
Publisher: BMJ
Date: 07-2021
Publisher: BMJ
Date: 2016
Publisher: BMJ
Date: 03-2022
DOI: 10.1136/BMJGH-2021-007873
Abstract: In January 2021, Dr Tedros Adhanom Ghebreyesus, director–general of the WHO, warned that the world was ‘on the brink of a catastrophic moral failure [that] will be paid with lives and livelihoods in the world’s poorest countries’. We are now past the brink. Many high-income countries have vaccinated their populations (which, in some cases, includes third and even fourth doses) and are loosening public health and social measures, while low-income and middle-income countries are struggling to secure enough supply of vaccines to administer first doses. While injustices abound in the deployment and allocation of COVID-19 vaccines, therapies and diagnostics, an area that has hitherto received inadequate ethical scrutiny concerns the upstream structures and mechanisms that govern and facilitate the research and development (R& D) associated with these novel therapies, vaccines and diagnostics. Much can be learnt by looking to past experiences with the rapid deployment of R& D in the context of public health emergencies. Yet, much of the ‘learning’ from past epidemics and outbreaks has largely focused on technical or technological innovations and overlooked the essential role of important normative developments namely, the importance of fostering multiple levels of trust, strong and fair governance, and broad research collaborations. In this paper, we argue that normative lessons pertaining to the conduct of R& D during the 2014–2016 Ebola epidemic in West Africa provide important insights for how R& D ought to proceed to combat the current COVID-19 pandemic and future infectious disease threats.
Publisher: Elsevier BV
Date: 04-2010
Publisher: Informa UK Limited
Date: 02-01-2015
Publisher: Elsevier BV
Date: 10-2020
Publisher: Springer Science and Business Media LLC
Date: 26-03-2012
Abstract: Pandemic influenza may exacerbate existing scarcity of life-saving medical resources. As a result, decision-makers may be faced with making tough choices about who will receive care and who will have to wait or go without. Although previous studies have explored ethical issues in priority setting from the perspective of clinicians and policymakers, there has been little investigation into how the public views priority setting during a pandemic influenza, in particular related to intensive care resources. To bridge this gap, we conducted three public town hall meetings across Canada to explore Canadian's perspectives on this ethical challenge. Town hall discussions group discussions were digitally recorded, transcribed, and analyzed using thematic analysis. Six interrelated themes emerged from the town hall discussions related to: ethical and empirical starting points for deliberation criteria for setting priorities pre-crisis planning in-crisis decision-making the need for public deliberation and input and participants' deliberative struggle with the ethical issues. Our findings underscore the importance of public consultation in pandemic planning for sustaining public trust in a public health emergency. Participants appreciated the empirical and ethical uncertainty of decision-making in an influenza pandemic and demonstrated nuanced ethical reasoning about priority setting of intensive care resources in an influenza pandemic. Policymakers may benefit from a better understanding the public's empirical and ethical 'starting points' in developing effective pandemic plans.
Publisher: Wiley
Date: 25-01-2019
DOI: 10.1111/BIOE.12554
Publisher: Oxford University Press (OUP)
Date: 04-09-2014
DOI: 10.1093/PHE/PHU026
Publisher: Wiley
Date: 06-07-2015
DOI: 10.1111/JEP.12406
Publisher: Springer Science and Business Media LLC
Date: 21-01-2016
Publisher: Springer Science and Business Media LLC
Date: 08-07-2020
Publisher: Springer Science and Business Media LLC
Date: 04-07-2019
Publisher: Informa UK Limited
Date: 18-03-2010
Publisher: BMJ
Date: 05-2008
Abstract: Demand for organisational ethics capacity is growing in health organisations, particularly among managers. The role of clinical ethicists in, and perspective on, organisational ethics has not been well described or documented in the literature. To describe clinical ethicists' perspectives on organisational ethics issues in their hospitals, their institutional role in relation to organisational ethics, and their perceived effectiveness in helping to address organisational ethics issues. Qualitative case study involving semi-structured interviews with 18 clinical ethicists across 13 health organisations in Toronto, Canada. From the clinical ethicists' perspective, the most pressing organisational ethics issues in their organisations are: resource allocation, staff moral distress linked to the organisation's moral climate, conflicts of interest, and clinical issues with a significant organisational dimension. Clinical ethicists were consulted in particular on issues related to staff moral distress and clinical issues with an organisational dimension. Some ethicists described being increasingly consulted on resource allocation, conflicts of interest, and other corporate decisions. Many clinical ethicists felt they lacked sufficient knowledge and understanding of organisational decision-making processes, training in organisational ethics, and access to organisational ethics tools to deal effectively with the increasing demand for organisational ethics support. Growing demand for organisational ethics expertise in healthcare institutions is reshaping the role of clinical ethicists. Effectiveness in organisational ethics entails a re-evaluation of clinical ethics training to include capacity building in organisational ethics and organisational decision-making processes as a complement to traditional clinical ethics education.
Publisher: Oxford University Press (OUP)
Date: 05-06-2018
DOI: 10.1093/PHE/PHY011
Publisher: BMJ
Date: 2022
DOI: 10.1136/BMJGH-2021-007407
Abstract: Owing to its potential human, social and economic costs, antimicrobial resistance (AMR) is frequently referred to as a threat to health security. Simultaneously, health security and the preservation of antimicrobials are often described as a global public good. However, how the term ‘public good’ is used in the context of health security, and the values that underpin it, remains ambiguous. Policymaking is never value-free, and a better examination of such values is critical to understanding how issues such as AMR are problematised and how policy decisions are informed. We used McDougall’s version of critical interpretive synthesis to capture the recurring concepts and arguments within public policy, political science and applied ethics literature on AMR. Articles were analysed by identifying recurring ideas and developing themes across the literature. A total of 77 papers were included in our review. In the context of health security and AMR, the concept of ‘public good’ appears to be used interchangeably with ‘common good’, reflecting confusion, but sometimes meaningful differences, regarding how antimicrobials, as a good, are conceived. Main approaches to addressing AMR are statism, globalism and regionalism, which appeal to different values in guiding policymakers. Common justificatory values underpinning preservation of antimicrobials as a public good were prevention of harm, solidarity, justice and rights. The findings suggest that within the literature there is a lack of conceptual clarity as to whether antimicrobials constitute a public good or a common good. Moreover, the way in which antimicrobials are conceived and the approaches through which AMR as a threat to health security is addressed appear to be grounded in values that are often implicit. Being explicit about the values that underpin AMR and health security is not simply an intellectual exercise but has very real policy and programmatic implications.
Publisher: Elsevier BV
Date: 09-2020
Publisher: International Union Against Tuberculosis and Lung Disease
Date: 05-2020
Abstract: Involuntary isolation of people with tuberculosis is rarely medically required, ethically permitted or justified on the ground of human rights law. The rare circumstances that do call for involuntary isolation must only occur once a number of conditions are met. These include just procedural protections and ensuring that all other options have been exhausted before resorting to involuntary isolation. This article is intended to outline for healthcare workers, policy makers and advocates the ethical reasoning behind isolation and involuntary isolation, as well as describing the requisite human rights laws that impinge on the topic. Finally, we present a list of conditions that must be met to justify involuntary isolation on the grounds of both ethics and human rights.
Publisher: Springer Science and Business Media LLC
Date: 06-2015
Publisher: Oxford University Press (OUP)
Date: 07-2011
DOI: 10.1093/PHE/PHR021
Publisher: Emerald
Date: 20-11-2009
Publisher: Springer Science and Business Media LLC
Date: 20-10-2010
Publisher: Springer Science and Business Media LLC
Date: 09-2013
Publisher: Springer Science and Business Media LLC
Date: 10-09-2022
DOI: 10.1007/S41649-022-00218-1
Abstract: Efforts to improve public health, both in the context of infectious diseases and non-communicable diseases, will often consist of measures that confer risk on some persons to bring about benefits to those same people or others. Still, it is unclear what exactly justifies implementing such measures that impose risk on some people and not others in the context of public health. Herein, we build on existing autonomy-based accounts of ethical risk imposition by arguing that considerations of imposing risk in public health should be centered on a relational autonomy and relational justice approach. Doing so better captures what makes some risk permissible and others not by exploring the importance of power and context in such deliberations. We conclude the paper by applying a relational account of risk imposition in the cases of (a) COVID-19 measures and (b) the regulation of sugar-sweetened beverages to illustrate its explanatory power.
No related grants have been discovered for Diego Silva.