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Papers by Leonardo De Castro
Annals of the Academy of Medicine, Singapore
Developing World Bioethics, 2021
Abstract The COVID‐19 pandemic led to a health crisis with widespread social and economic adverse... more Abstract The COVID‐19 pandemic led to a health crisis with widespread social and economic adverse effects. To address the fallout, vaccine development has been pursued in record time. Several vaccines have already been deployed in countries worldwide, but as the supply is limited, these have been provided selectively. Various allocation schemes, premised on ensuring an equitable distribution, have prioritized the elderly, given their apparent susceptibility. For the Philippines and possibly other countries with extremely limited supplies, the elderly need not always be given primary preference. The level of available supplies can be so low that the immediate focus of allocation should be on mitigating both infection and transmission. The proposed alternative vaccine allocation framework gives priority to groups rendered more vulnerable, such as those who are unable to avoid prolonged exposure to possibly infected people because of medical necessity or occupational conditions. Vulnerable groups include healthcare and other essential workers as well as patients requiring continued healthcare services. The proposed allocation scheme is meant to be complementary to concurrent public health measures, which have to be maintained though made less restrictive as the pandemic is brought under control.
Encyclopedia of Global Bioethics, 2016
Annals of Bioethics: Regional Perspectives in Bioethics, 2005
npj Genomic Medicine, 2021
Our article aims to provide a comprehensive portrayal of how seven Asian jurisdictions have sough... more Our article aims to provide a comprehensive portrayal of how seven Asian jurisdictions have sought to address the challenge of genetic discrimination (GD) by presenting an analysis of the relevant legislation, policies, and practices. Based on our findings, policy discussion and action on preventing or mitigating GD have been narrowly framed in terms of employment, insurance, disability, marriage, and family planning. Except for South Korea, none of the jurisdictions we examined has adopted specific legislation to prevent GD. However, for Asia to truly benefit from its recent scientific and technological progress in genomics, we highlight the need for these jurisdictions to engage more proactively with the challenges of GD through a coordinated regulatory and governance mechanism.
Developing World Bioethics, 2020
Abstract Using a fair allocation approach, this paper identifies and examines important concerns ... more Abstract Using a fair allocation approach, this paper identifies and examines important concerns arising from the Philippines’ COVID‐19 response while focusing on difficulties encountered by various sectors in gaining fair access to needed societal resources. The effectiveness of different response measures is anchored on addressing inequities that have permeated Philippine society for a long time. Since most measures that are in place as part of the COVID‐19 response are meant to be temporary, these are unable to resolve the inequities that have led to the magnitude of morbidity and mortality associated with the pandemic. These cannot improve the country’s readiness to deal with pandemics and other emergencies in the future. Transition to a new normal recognizes the possibility that other infectious diseases could come and endanger our health security. Our pandemic experiences are proving that having an egalitarian society will serve the interests not only of disadvantaged sectors but also of everybody else, including the privileged. Response measures should thus take the opportunity to promote equity by giving importance to the concerns of the underprivileged and vulnerable while giving preference to initiatives that can be sustained beyond the period of the current pandemic.
Journal of Global Health Science, 2020
Asian Bioethics Review, 2020
A patient's age serves as a very useful guide to physicians in deciding what disease manifestatio... more A patient's age serves as a very useful guide to physicians in deciding what disease manifestations to anticipate, what treatment to offer for certain conditions, and how to prepare for possible emergencies. In the context of the COVID-19 pandemic, determining treatment options on the basis of a patient's chronological age can easily give rise to unjustified discrimination. This is of particular significance in situations where the allocation of scarce critical care resources could have a direct impact on who will live and who will die. This paper examines the fairness of recommendations contained in resource allocation guidelines in the Philippines that have implications for the way elderly patients could be treated or excluded from some forms of critical care treatment in the context of the ongoing Corona virus emergency.
Asian Bioethics Review, 2016
Asian Bioethics Review, 2015
Daluyan Journal Ng Wikang Filipino, May 9, 2013
Asian Bioethics Review, 2014
This issue of the Asian Bioethics Review contains articles on topics that remind us of the need f... more This issue of the Asian Bioethics Review contains articles on topics that remind us of the need for comprehensive-and democratic-bioethics education. The two essays on assisted reproductive techniques and surrogacy highlight a need for more guidance in terms of legal regulations or guidelines in India and Japan. The necessity for legislative updating and thus, for public consultations regarding specific proposals, leads us to query the nature, objectives and adequacy of consultations that have to be undertaken. The article on undue inducement for participation in clinical trials in the Philippines points in the same direction. While the author does not contemplate legislation as a way to resolve differences in approach and practice, he recognises the importance of finding a way forward within the context of local culture and traditions. Thus, extensive community consultations would appear to be a minimal requirement for an exercise that would enable participants to search within themselves for culturally-informed validation of pertinent proposals. The yearning for more definitive regulatory or legal guidance has to be sorted out. One way to address this is to pass legislation that provides definitive guidance where not yet available, or that which plugs discernible loopholes in existing regulations. In either case, the introduction of legislation requires preparatory public consultations to determine the views of experts and the sentiments of the general public concerning the practices under consideration. This editorial takes the view that public consultations about important issues related to these topics should take the opportunity to profit from
Bulletin of the World Health Organisation
There is a broad range of topics and issues covered in this issue of the Asian Bioethics Review, ... more There is a broad range of topics and issues covered in this issue of the Asian Bioethics Review, reflecting the broad range of bioethics as articulated in Asia. The article by Allen Andrew Alvarez on preintrinsic value in relation to healthcare rationing serves as an example of bioethical reflection that aims specifically to respond to some of the most pressing problems in the Asian region. Alvarez tries to avoid the trodden path of dominant healthcare rationing debates that take for granted a context of scarcity, but not to a degree often encountered in developing world countries. While most rationing analyses tend to assume moderate scarcity, the paper notes that extreme poverty has not been given enough attention in discussions of the problem of healthcare rationing. The paper seeks to examine the implications of extreme scarcity for healthcare distribution. Since governments in low-income countries have a very limited capacity to provide basic healthcare to many of their poor citizens and considering that the majority of the world’s poor live in Asia, addressing this issue has crucial relevance. In a context of moderate scarcity, it seems too easy to just accept a correspondingly moderate level of deprivation that rationing might require. Alvarez argues against a similar attitude in the event of extreme scarcity, since adopting the same assumptions could result in justifying extreme standards of deprivation in rationing, e.g. even depriving the poor the most basic and inexpensive healthcare they would need. Advocates of social protection for the poor, especially in these times of global financial crises, could find in some of the arguments presented by Alvarez a valuable tool for debate. Hans-Martin Sass calls attention to the use of the term “bioethics” by the German Friz Jahr in a 1927 editorial in the leading German science journal of his time. The use of the term by Jahr preceded the often cited publication on bioethics in the United States by Van Rensellaer Potter, which came only in the
Annals of the Academy of Medicine, Singapore
Developing World Bioethics, 2021
Abstract The COVID‐19 pandemic led to a health crisis with widespread social and economic adverse... more Abstract The COVID‐19 pandemic led to a health crisis with widespread social and economic adverse effects. To address the fallout, vaccine development has been pursued in record time. Several vaccines have already been deployed in countries worldwide, but as the supply is limited, these have been provided selectively. Various allocation schemes, premised on ensuring an equitable distribution, have prioritized the elderly, given their apparent susceptibility. For the Philippines and possibly other countries with extremely limited supplies, the elderly need not always be given primary preference. The level of available supplies can be so low that the immediate focus of allocation should be on mitigating both infection and transmission. The proposed alternative vaccine allocation framework gives priority to groups rendered more vulnerable, such as those who are unable to avoid prolonged exposure to possibly infected people because of medical necessity or occupational conditions. Vulnerable groups include healthcare and other essential workers as well as patients requiring continued healthcare services. The proposed allocation scheme is meant to be complementary to concurrent public health measures, which have to be maintained though made less restrictive as the pandemic is brought under control.
Encyclopedia of Global Bioethics, 2016
Annals of Bioethics: Regional Perspectives in Bioethics, 2005
npj Genomic Medicine, 2021
Our article aims to provide a comprehensive portrayal of how seven Asian jurisdictions have sough... more Our article aims to provide a comprehensive portrayal of how seven Asian jurisdictions have sought to address the challenge of genetic discrimination (GD) by presenting an analysis of the relevant legislation, policies, and practices. Based on our findings, policy discussion and action on preventing or mitigating GD have been narrowly framed in terms of employment, insurance, disability, marriage, and family planning. Except for South Korea, none of the jurisdictions we examined has adopted specific legislation to prevent GD. However, for Asia to truly benefit from its recent scientific and technological progress in genomics, we highlight the need for these jurisdictions to engage more proactively with the challenges of GD through a coordinated regulatory and governance mechanism.
Developing World Bioethics, 2020
Abstract Using a fair allocation approach, this paper identifies and examines important concerns ... more Abstract Using a fair allocation approach, this paper identifies and examines important concerns arising from the Philippines’ COVID‐19 response while focusing on difficulties encountered by various sectors in gaining fair access to needed societal resources. The effectiveness of different response measures is anchored on addressing inequities that have permeated Philippine society for a long time. Since most measures that are in place as part of the COVID‐19 response are meant to be temporary, these are unable to resolve the inequities that have led to the magnitude of morbidity and mortality associated with the pandemic. These cannot improve the country’s readiness to deal with pandemics and other emergencies in the future. Transition to a new normal recognizes the possibility that other infectious diseases could come and endanger our health security. Our pandemic experiences are proving that having an egalitarian society will serve the interests not only of disadvantaged sectors but also of everybody else, including the privileged. Response measures should thus take the opportunity to promote equity by giving importance to the concerns of the underprivileged and vulnerable while giving preference to initiatives that can be sustained beyond the period of the current pandemic.
Journal of Global Health Science, 2020
Asian Bioethics Review, 2020
A patient's age serves as a very useful guide to physicians in deciding what disease manifestatio... more A patient's age serves as a very useful guide to physicians in deciding what disease manifestations to anticipate, what treatment to offer for certain conditions, and how to prepare for possible emergencies. In the context of the COVID-19 pandemic, determining treatment options on the basis of a patient's chronological age can easily give rise to unjustified discrimination. This is of particular significance in situations where the allocation of scarce critical care resources could have a direct impact on who will live and who will die. This paper examines the fairness of recommendations contained in resource allocation guidelines in the Philippines that have implications for the way elderly patients could be treated or excluded from some forms of critical care treatment in the context of the ongoing Corona virus emergency.
Asian Bioethics Review, 2016
Asian Bioethics Review, 2015
Daluyan Journal Ng Wikang Filipino, May 9, 2013
Asian Bioethics Review, 2014
This issue of the Asian Bioethics Review contains articles on topics that remind us of the need f... more This issue of the Asian Bioethics Review contains articles on topics that remind us of the need for comprehensive-and democratic-bioethics education. The two essays on assisted reproductive techniques and surrogacy highlight a need for more guidance in terms of legal regulations or guidelines in India and Japan. The necessity for legislative updating and thus, for public consultations regarding specific proposals, leads us to query the nature, objectives and adequacy of consultations that have to be undertaken. The article on undue inducement for participation in clinical trials in the Philippines points in the same direction. While the author does not contemplate legislation as a way to resolve differences in approach and practice, he recognises the importance of finding a way forward within the context of local culture and traditions. Thus, extensive community consultations would appear to be a minimal requirement for an exercise that would enable participants to search within themselves for culturally-informed validation of pertinent proposals. The yearning for more definitive regulatory or legal guidance has to be sorted out. One way to address this is to pass legislation that provides definitive guidance where not yet available, or that which plugs discernible loopholes in existing regulations. In either case, the introduction of legislation requires preparatory public consultations to determine the views of experts and the sentiments of the general public concerning the practices under consideration. This editorial takes the view that public consultations about important issues related to these topics should take the opportunity to profit from
Bulletin of the World Health Organisation
There is a broad range of topics and issues covered in this issue of the Asian Bioethics Review, ... more There is a broad range of topics and issues covered in this issue of the Asian Bioethics Review, reflecting the broad range of bioethics as articulated in Asia. The article by Allen Andrew Alvarez on preintrinsic value in relation to healthcare rationing serves as an example of bioethical reflection that aims specifically to respond to some of the most pressing problems in the Asian region. Alvarez tries to avoid the trodden path of dominant healthcare rationing debates that take for granted a context of scarcity, but not to a degree often encountered in developing world countries. While most rationing analyses tend to assume moderate scarcity, the paper notes that extreme poverty has not been given enough attention in discussions of the problem of healthcare rationing. The paper seeks to examine the implications of extreme scarcity for healthcare distribution. Since governments in low-income countries have a very limited capacity to provide basic healthcare to many of their poor citizens and considering that the majority of the world’s poor live in Asia, addressing this issue has crucial relevance. In a context of moderate scarcity, it seems too easy to just accept a correspondingly moderate level of deprivation that rationing might require. Alvarez argues against a similar attitude in the event of extreme scarcity, since adopting the same assumptions could result in justifying extreme standards of deprivation in rationing, e.g. even depriving the poor the most basic and inexpensive healthcare they would need. Advocates of social protection for the poor, especially in these times of global financial crises, could find in some of the arguments presented by Alvarez a valuable tool for debate. Hans-Martin Sass calls attention to the use of the term “bioethics” by the German Friz Jahr in a 1927 editorial in the leading German science journal of his time. The use of the term by Jahr preceded the often cited publication on bioethics in the United States by Van Rensellaer Potter, which came only in the