Introduction It is common for certain public health measures to be characterised as ‘coercive’, which often carries negative moral connotations that can fuel opposition to their use. Yet, coercion admits of myriad definitions and justifications. This lack of conceptual clarity not only risks the inconsistent implementation and evaluation of policy but can also undermine public trust and weaken the legitimacy of public health governance.Methods A scoping review of the public health literature was conducted to understand (1) how coercion is defined in the public health literature and (2) which justificatory conditions, if any, are identified to support the use of coercion for public health purposes. The search strategy covered five databases. Results were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline.Results 56 publications were included. Definitions appeared most within the contexts of infectious disease (n=30) and public health ethics (n=34). While definitions lacked consistency and often conceptual precision, several publications (n=16) drew on established philosophical accounts of coercion (eg, Wertheimer, Nozick, Feinberg). We identified five elements central to how coercion is commonly understood and invoked in public health: limiting alternative options; influencing voluntariness; inducing fear of consequences; using state powers to enforce a rule; leaving someone worse off if they do not comply.Conclusion This review reveals an important gap in the public health literature. Despite the ubiquity of the term ‘coercion’ in public health, it remains poorly and inconsistently defined. This ambiguity risks the imprecise and at times inappropriate categorisation and evaluation of public health interventions as coercive, potentially compromising both policy effectiveness and public co-operation. Future research could aim to synthesise a definition of coercion agreeable to most public health stakeholders.

During COVID-19, most intensive care units (ICUs) in Canada implemented strategies to manage a surge in demand for critical care to avoid turning people away, termed “triage-avoidant strategies.” These strategies, including redeploying non-ICU staff to the ICU to increase patient capacity, and transferring people over long distances to available beds, may have caused negative consequences for patients, healthcare staff, and equity-deserving groups. This study explores the perspectives of equity-deserving groups and organizations on triage-avoidant strategies during COVID-19, examined organization-specific responses, and identified system-level recommendations to improve equity, access, and preparedness. A qualitative descriptive study was conducted between July and December 2023 across five provinces in Canada. Participants, including staff from organizations serving equity-deserving groups, as well as government and healthcare representatives, were recruited through professional networks and snowball sampling. A semi-structured interview guide was used to elicit perspectives, which were then analyzed inductively using thematic analysis. 23 individuals from Ontario (n=12), British Columbia (n=4), Saskatchewan (n=4), Nova Scotia (n=2) and New Brunswick (n=1) participated. 15 participants (65%) identified as persons of colour or among equity-deserving groups; 13 (57%) participants worked within organizations representing decision-makers, clinicians, and/or equity-deserving groups. We identified three themes: 1) Triage-avoidant strategies were perceived to have disproportionately harmful effects on equity-deserving groups and healthcare providers; 2) organizations acted to mitigate effects of triage-avoidant strategies; and 3) various system-level actions could help mitigate the perceived effects of these strategies in future surges in demand. This study contributes to the literature by incorporating perspectives of representatives from diverse organizations and equity-deserving groups on how triage-avoidant strategies disproportionately harmed the populations they serve. Our findings can inform the development/implementation of triage-avoidant strategies that mitigate the perceived harmful effects on decision-makers, clinicians, and equity-deserving groups, while promoting equitable care. Twenty-three individuals from Ontario (n=12), British Columbia (n=4), Saskatchewan (n=4), Nova Scotia (n=2) and New Brunswick (n=1) participated. Fifteen participants (65%) identified as persons of color or from systemically marginalized groups; thirteen (57%) participants worked within organizations representing decision-makers, clinicians, and/or systemically marginalized groups, such as race, illness, disability, socioeconomic factors or health status. We identified three main themes relating to participants’ perspectives of triage-avoidant strategies: Triage-avoidant strategies had disproportionately harmful impacts on systemically marginalized populations and healthcare providers; organizations acted to mitigate effects of triage-avoidant strategies; and, various system-level actions could help mitigate the perceived effects of these strategies in the future. Findings can inform the development and implementation of triage or triage-avoidant strategies that may mitigate the perceived harmful effects of such strategies on decision-makers, clinicians, and/or systemically marginalized groups, and promote equitable care.

An ethical and legal obligation generally exists for informed consent to be obtained prior to the administration of medical interventions. This includes vaccinations. For an individual's informed consent to be valid, it must be given voluntarily Hence, when individuals are required to be vaccinated-for example, as a condition of employment-we might ask whether this impairs the voluntariness of their informed consent, thereby rendering it invalid. If this turns out to be the case, then this would count as a pro tanto reason to think vaccine mandates are unethical. Assuming vaccine mandates count as 'coercive', interrogating this question requires an account of consent under third-party coercion, since the pressure or coercion exerted by vaccine mandates is exerted by third parties, such as employers, rather than the recipients of consent. Accordingly, this paper draws on Maximilian Kiener's Interpersonal Consenter-Consentee Justification account of the voluntariness of medical consent under third-party coercion to develop an explicit argument as to why vaccine mandates do not vitiate the voluntariness of informed consent. Vaccine mandates do not necessarily impair the voluntariness of informed consent because, in such cases, the consent-receiver neither contributes to a vaccine mandate's coercive threat nor wrongs the consent-giver in any way. Consent is not obtained by coercion in such cases, even though it may be motivated by it. The mere presence of third-party coercion does not invalidate consent since third parties cannot directly negate the voluntariness of consent.

Artificial intelligence (AI) holds promise as a tool that can be used by practitioners in the field of occupational health and safety (OHS). This study aimed to identify AI applications specifically used for OHS and examine their impact on worker morbidity or mortality outcomes. We conducted a comprehensive systematic review. We searched six databases to identify published quantitative studies of OHS AI applications across the hierarchy of controls that were published between years 2018 to 2024. Title/abstract and full-text screening was conducted to identify eligible studies which were then assessed for quality and risk of bias and synthesized. Of the 1255 articles identified by our search, only two met eligibility criteria; one of which was appraised as medium quality and the other as low quality. The one medium quality study identified by our review was an AI-based chatbot health promotion tool which was shown to improve musculoskeletal symptoms. Our systematic review shows that we are at the early stages of understanding the role AI can play in OHS and it may be premature to recommend the wide-spread use of AI for health and safety practice within workplaces. There is a critical need for future research to unpack how considerations taken in the development and adoption of workplace AI tools for OHS can determine their effectiveness in addressing worker injury or illness. PROSPERO CRD42023414422.

With estimates suggesting 350 million individuals are at-risk for type 2 diabetes (T2D), there is an urgent need to critically understand the processes of risk communication with primary care providers. Prior research has shown that primary care is the most likely place where initial conversations with a patients about T2D risk occur, but there remains a paucity of research exploring what may govern this communication. The purpose of this study was to critically explore discourses of risk for preventing T2D from the perspective of primary care providers. Semi-structured interviews (n = 14) were conducted with primary care providers including family physicians (n = 4), medical residents (n = 2), nurses (n = 3), dietitians (n = 4), and a pharmacist (n = 1) working in family health team (FHT) clinics in Southwestern, Ontario, Canada. Foucauldian Discourse Analysis through thematic analysis was applied to analyze the data and generate themes detailing how provider communications about risk for T2D are governed through discourse. Themes included: (1) patient-centred practice; (2) diagnosing prediabetes; (3) contextualizing symptoms; (4) time contingent; (5) adapting to patient knowledge; (6) carefully discussing weight; and (7) age as a balancing act. Overall, providers note using discourses of patient-centred practice to guide approaches to communicating about risk for T2D to patients. There are tensions with fulfilling this ideal patient-centred approach from more powerful discourses of prediabetes, assumptions about patient knowledge, and age that may override the ability to be patient-centred with communications about risk for T2D.

BACKGROUND:Artificial intelligence (AI) can modernize occupational health and safety (OHS) practice and provide solutions to the most complex health and safety challenges. Empirical data on firm-level AI utilization in OHS practice remain limited. The objective of this study was to examine AI use for OHS and firm-level descriptive and OHS characteristics associated with AI use. METHODS:A total of 810 OHS professionals in British Columbia and Ontario, Canada were surveyed in the summer of 2024. Surveys asked about firm-level AI use for OHS and items asked about descriptive and OHS characteristics. Participants were also asked about perceived AI concerns and OHS impact. A multivariate logistic regression model was fitted to examine factors associated with firm-level AI use for OHS. RESULTS:In total, 29% reported firm-level AI use for OHS. Larger-sized firms and those with hybrid work arrangements had a greater odds of AI use for OHS. Also, firms with high workplace hazard exposure had a greater odds of AI OHS use. More positive perceptions of AI's impact on OHS were associated with firm-level AI use for OHS. CONCLUSIONS:AI use for OHS may be concentrated among hazardous firms and those with the conditions to support technological adoption. Research examining AI's effectiveness in OHS settings is needed to guide evidence-based implementation in occupational health practice.

The workshop, Coercing for Health: Transdisciplinary Approaches to the Ethics of Coercive Public Health Policies was held at the University of Oxford on July 3rd and 4th, 2024. This paper provides both a summary of the workshop proceedings and reflections and directions for future research on coercive public health measures. The workshop consisted of four key parts: defining coercion; history and legal analysis of coercion; public health ethics perspectives on coercion; experiences of coercive public health measures. According to our reflections, some important questions remaining for further research include: what is the difference between coercion and enforcement? Who gets to define and address coercion? How do structural factors affect health and experiences of coercion? We encourage others to continue to work on this important area, to ensure the ethically acceptable and thoughtful implementation of any future coercive measures in the sphere of public health.

Vaccine certificates were deployed during the COVID-19 pandemic to enable the partial restoration of social and economic activities whilst protecting the public's health. Despite widespread adoption, their use was (and remains) controversial, especially because of concerns regarding their impact on liberty. Getting clarity on the conditions under which vaccine certificates should and should not be considered is critical as the world prepares for future infectious disease threats, including those that may differ substantially from the COVID-19 pandemic. To this end, we offer a framework which argues that as three key factors increase - the pathogenicity of the infectious disease, the prevalence of the infectious disease, and the protective effects of its associated vaccine - so, too, does the pro tanto justification for considering the use of vaccine certificates, while lower levels diminish the justification. This is because higher 'scores' for each of these dimensions will provide stronger justification for trade-offs with liberty that are likely to occur as a result of vaccine certificate use. While not a comprehensive framework for evaluating the use of vaccine certificates, these three conditions comprise a framework that can aid decision-makers in determining whether vaccine certificates are worthy of further consideration in the face of a future threat.

This methodological reflection is developed from a nursing research study that compared health systems in Canada and Saudi Arabia, using both English and Arabic languages for data collection. Conducting research in a language not spoken by all the research team members is relatively common, yet addressing the nuanced details of implementing bilingual work has limited guidance within extant literature. This includes consideration of promising practices for concept development, translation, data analysis, and presenting the findings. This article discusses the strengths and limitations of bilingual research and recommendations regarding these issues from our own experiences. Ultimately, it is proposed that via bilingual research, the accumulation of knowledge pertaining to qualitative research concepts, translation, analysis, and dissemination of comprehensive frameworks can be enacted, ultimately enhancing the rigor of qualitative research and increasing confidence in applying knowledge created in the chosen language of participants.

Introduction The value of a short life characterized by disability has been hotly debated in the literature on fetal and neonatal outcomes. Methods We conducted a scoping review to summarize the available empirical literature on the experiences of families in the context of trisomy 13 and 18 (T13/18) with subsequent thematic analysis of the 17 included articles. Findings Themes constructed include (1) Pride as Resistance, (2) Negotiating Normalcy and (3) The Significance of Time. Interpretation Our thematic analysis was guided by the moral experience framework conceived by Hunt and Carnevale (2011) in association with the VOICE (Views On Interdisciplinary Childhood Ethics) collaborative research group. Relevance This article will be of interest and value to healthcare professionals and bioethicists who support families navigating the medically and ethically complex landscape of T13/18.

Background Facebook is a prominent social medial platform frequently used for business marketing. Researchers are starting to recognize the utility of this platform for developing research awareness, information dissemination, and more recently participant recruitment. Purpose This paper will provide an overview of methods used in Facebook recruitment through an exemplar study. It will highlight successes and challenges and provide insight into future opportunities for its’ use. Methods Two methods of Facebook recruitment are outlined in this paper: the use of Facebook groups and paid advertising. A step-by-step guide highlights how researchers can implement these specific methods of Facebook recruitment. Results Facebook was successfully utilized to recruit participants in the exemplar study. Recruitment was completed over a period of 82 days with a total cost of $157.09 Canadian dollars. Conclusion Facebook is a viable method of recruiting research participants. This method can be cost-effective, timely, and efficient in comparison to traditional research recruitment methods. However, one must balance the benefits and challenges of this type of recruitment.

Abstract Research conducted during infectious disease outbreaks or pandemics can be crucial to control or ameliorate their consequences, but scientists are confronted with significant ethical questions about how to conduct research in such contexts. This chapter examines foundational ethical questions and considerations undergirding the research enterprise in pandemic contexts, including whether pandemics necessitate deviations from ethical and scientific standards for research, how research priorities are and ought to be set during pandemics, the ethics of conducting research alongside pandemic response efforts, and how pandemic research ought to be governed and coordinated. Scientists may have only a brief interval to understand the disease and develop medical countermeasures, and social pressures to produce fast results may seem overwhelming. Despite these challenges, this does not justify relaxing fundamental ethical or scientific standards, although there is scope for accelerating procedural requirements. Even during a pandemic, provision of most biomedical research funding by high-resource countries can influence the directions and results of research, leading to interventions that are more applicable in resource-rich than in resource-poor countries. The World Health Organization and other institutions are trying to correct or at least reduce these discrepancies. Biomedical research and health care response to a pandemic need not be rivals for funding support. The 2014 Ebola and 2019 COVID-19 experiences have demonstrated that the two can work synergistically. Both medical care and research responses are integral to our defenses against emerging or re-emerging infectious disease. Finally, the COVID-19 pandemic has made clear the need for changes in global architecture for pandemic response. The scientific and organizational adaptations required must be guided by ethical principles, such as the need to reduce the glaring inequities between high-income and low-income settings across the world as well as within countries. Preparing for the next pandemic will require a blueprint to accelerate the organization, coordination, and conduct of critical research and development.

Some organisations make vaccination a condition of employment. This means prospective employees must demonstrate they have been vaccinated (eg, against measles) to be hired. But it also means organisations must decide whether existing employees should be expected to meet newly introduced vaccination conditions (eg, against COVID-19). Unlike prospective employees who will not be hired if they do not meet vaccination conditions, existing employees who fail to meet new vaccination conditions risk being fired. The latter seems worse than the former. Hence, objections to vaccination mandates commonly centre on the harms that will be visited on existing employees who are unwilling to be vaccinated. However, because this objection does not necessarily entail the claim that vaccination is unnecessary for the effective and safe performance of certain jobs, those making this objection should have less of an objection, or no objection at all (at least on these grounds), to introducing vaccination requirements in some cases for prospective employees. Yet, in this paper, I shall argue that if one has reason to believe vaccination requirements can be justified for prospective employees, one should also believe they are justified for existing employees despite any asymmetry in consequences experienced by the two groups. As a consequence, common objections made against vaccination mandates grounded solely in the harms that may be experienced by existing employees who are unwilling to be vaccinated should be considered unpersuasive.

AbstractResearch conducted during epidemics may warrant adaptations or adaptive designs owing to practical constraints, time pressures, uncertainty, the importance of flexibility, and the potential for research to detract from epidemic response. Adapting research entails choosing different research designs or methods if research goals, contexts or constraints justify or require a different approach. Adaptive research, by contrast, is a type of research that prospectively plans for modifications after research has been initiated, while maintaining the validity and integrity of the research. While adaptation and adaptive designs introduce an important degree of flexibility to research conducted during epidemics and help to address research objectives and constraints, adaptation and adaptive designs require close ethical scrutiny and are no different from other research in that they are expected to align with universally accepted ethical standards. Important ethical questions exist regarding the conditions that justify adaptations to research, the kinds of adaptive research designs that can be ethically justified, and how ethics review bodies ought to evaluate such novel approaches to research in epidemic contexts. The five cases included in this chapter prompt reflection on the ethical considerations and implications of adapting research in response to epidemic-related risks and the public health measures deployed in response to those risks, as well as the ethical implications of not adapting research in such contexts. These cases also highlight ethical questions and issues arising during the conduct of adaptive trials, including when treatments under study, treatment doses, sample size, and other study features are reviewed in response to evolving evidence. This chapter invites reflection on these key ethical dimensions when considering adaptive designs and adaptations to standard research procedures during epidemics. What these cases make clear is that adaptive designs and adaptations to research do not reduce the need for rigorous scientific evaluation and adherence to universal ethical standards, and must be explicitly ethically justified and reviewed through transparent and inclusive processes.

This summary reports on the design and proceedings of a collaborative case-based workshop and panel on how we ‘ought’ to consider the best interests of children in medical decision-making, presented virtually at the Canadian Bioethics Society - Société Canadienne de Bioéthique Workshop and Community Forum in May of 2023.