Journal Article > CommentaryAbstract Only
J Med Ethics. 2016 September 26; Volume 43 (Issue 4); 266-266.; DOI:10.1136/medethics-2016-103397
Calain P
J Med Ethics. 2016 September 26; Volume 43 (Issue 4); 266-266.; DOI:10.1136/medethics-2016-103397
Chiara Lepora and Robert Goodin invite us to join their insightful ‘conversation’ on complicity and compromise. Their book makes a dense, utterly precise and rewarding reading, as one proceeds stepwise through the logic of their philosophical arguments. For those unfamiliar with the relatively new discipline of ‘humanitarian ethics’, it might be disconcerting at first to see humanitarian actions brought to illustrate theories on complicity, with the Rwandan refugees crisis of 1994 and the tortured patient taken as two exemplary cases. Actually, this connects with an increasing body of research and reflexions, showing that humanitarian workers face frequent ethical challenges, some of them amounting to a distressful sense of complicity.
Journal Article > ResearchFull Text
Emerg Infect Dis. 2012 January 1; Volume 68 (Issue 1); DOI:10.1111/j.1365-2648.2011.05934.x
Sanchez-Padilla E, Dlamini T, Ascorra A, Rusch-Gerdes S, Tefera ZD, et al.
Emerg Infect Dis. 2012 January 1; Volume 68 (Issue 1); DOI:10.1111/j.1365-2648.2011.05934.x
In Africa, although emergence of multidrug-resistant (MDR) tuberculosis (TB) represents a serious threat in countries severely affected by the HIV epidemic, most countries lack drug-resistant TB data. This finding was particularly true in the Kingdom of Swaziland, which has the world's highest HIV and TB prevalences. Therefore, we conducted a national survey in 2009-2010 to measure prevalence of drug-resistant TB. Of 988 patients screened, 420 new case-patients and 420 previously treated case-patients met the study criteria. Among culture-positive patients, 15.3% new case-patients and 49.5% previously treated case-patients harbored drug-resistant strains. MDR TB prevalence was 7.7% and 33.8% among new case-patients and previously treated case-patients, respectively. HIV infection and past TB treatment were independently associated with MDR TB. The findings assert the need for wide-scale intervention in resource-limited contexts such as Swaziland, where diagnostic and treatment facilities and health personnel are lacking.
Journal Article > CommentaryAbstract
Public Health Ethics. 2014 September 17; Volume 7 (Issue 3); DOI:10.1093/phe/phu030
Calain P
Public Health Ethics. 2014 September 17; Volume 7 (Issue 3); DOI:10.1093/phe/phu030
Journal Article > CommentaryFull Text
Bull World Health Organ. 2015 August 31; Volume 93 (Issue 10); 737-738.; DOI:10.2471/BLT.14.144816
Eckenwiler L, Hunt M, Ahmad ASI, Calain P, Dawson A, et al.
Bull World Health Organ. 2015 August 31; Volume 93 (Issue 10); 737-738.; DOI:10.2471/BLT.14.144816
Journal Article > LetterFull Text
Lancet. 2016 August 13; Volume 388 (Issue 10045); 659-660.; DOI:10.1016/S0140-6736(16)31272-7
Calain P, Roux L, Kolakofsky D
Lancet. 2016 August 13; Volume 388 (Issue 10045); 659-660.; DOI:10.1016/S0140-6736(16)31272-7
Journal Article > CommentaryFull Text
Soc. Sci. Med. 2015 December 1; Volume 147; DOI:10.1016/j.socscimed.2015.10.063
Calain P, Poncin M
Soc. Sci. Med. 2015 December 1; Volume 147; DOI:10.1016/j.socscimed.2015.10.063
Journal Article > CommentaryFull Text
J Med Ethics. 2016 August 29; Volume 44 (Issue 1); 3-8.; DOI:10.1136/medethics-2016-103474
Calain P
J Med Ethics. 2016 August 29; Volume 44 (Issue 1); 3-8.; DOI:10.1136/medethics-2016-103474
The West African Ebola epidemic has set in motion a collective endeavour to conduct accelerated clinical trials, testing unproven but potentially lifesaving interventions in the course of a major public health crisis. This unprecedented effort was supported by the recommendations of an ad hoc ethics panel convened in August 2014 by the WHO. By considering why and on what conditions the exceptional circumstances of the Ebola epidemic justified the use of unproven interventions, the panel's recommendations have challenged conventional thinking about therapeutic development and clinical research ethics. At the same time, unanswered ethical questions have emerged, in particular: (i) the specification of exceptional circumstances, (ii) the specification of unproven interventions, (iii) the goals of interventional research in terms of individual versus collective interests, (iv) the place of adaptive trial designs and (v) the exact meaning of compassionate use with unapproved interventions. Examination of these questions, in parallel with empirical data from research sites, will help build pragmatic foundations for disaster research ethics. Furthermore, the Ebola clinical trials signal an evolution in the current paradigms of therapeutic research, beyond the case of epidemic emergencies.
Journal Article > CommentaryFull Text
Public Health Ethics. 2009 April 1; Volume 2 (Issue 1); DOI:10.1093/phe/phn037
Calain P, Fiore N, Poncin M
Public Health Ethics. 2009 April 1; Volume 2 (Issue 1); DOI:10.1093/phe/phn037
Outbreaks of filovirus (Ebola and Marburg) hemorrhagic fevers in Africa are typically the theater of rescue activities involving international experts and agencies tasked with reinforcing national authorities in clinical management, biological diagnosis, sanitation, public health surveillance and coordination. These outbreaks can be seen to be as a paradigm for ethical issues posed by by epidemic emergencies, through the convergence of such themes as: isolation and quarantine, privacy and confidentiality and the interpretation of ethical norms across different ethnocultural settings. With an emphasis on the boundaries between public health investigations and research, this article reviews specific challenges, past practices and current normative documents relevant to the application of ethical standards in the course of outbreaks of filovirus hemorrhagic fevers. Aside from the commonly identified issues of informed consent, and institutional review process, we argue for more clarify over the specification of which communities are expected to share benefits, and we advocate for the use of collective definitions of duty to care and standard of care. We propose new elaborations around existing normative instruments, and we suggest some pathways toward more comprehensive approaches to the ethics of research in outbreak situations.
Journal Article > CommentaryFull Text
Public Health Ethics. 2011 December 30; Volume 5 (Issue 1); DOI:10.1093/phe/phr036
Calain P
Public Health Ethics. 2011 December 30; Volume 5 (Issue 1); DOI:10.1093/phe/phr036
For medical humanitarian organizations, making their sources of legitimacy explicit is a useful exercise, in response to: misperceptions, concerns over the 'humanitarian space', controversies about specific humanitarian actions, challenges about resources allocation and moral suffering among humanitarian workers. This is also a difficult exercise, where normative criteria such as international law or humanitarian principles are often misrepresented as primary sources of legitimacy. This essay first argues for a morally principled definition of humanitarian medicine, based on the selfless intention of individual humanitarian actors. Taking Médecins Sans Frontières (MSF) as a case in point, a common source of moral legitimacy for medical humanitarian organizations is their cosmopolitan appeal to distributive justice and collective responsibility. More informally, their legitimacy is grounded in the rightfulness of specific actions and choices. This implies a constant commitment to publicity and accountability. Legitimacy is also generated by tangible support from the public to individual organizations, by commitments to professional integrity, and by academic alliances to support evidence-based practice and operational research.
Journal Article > CommentaryAbstract
Rev Int Croix Rouge. 2013 September 12; Volume 94 (Issue 887); DOI:10.1017/S1816383113000374
Calain P
Rev Int Croix Rouge. 2013 September 12; Volume 94 (Issue 887); DOI:10.1017/S1816383113000374