Papers by Maxwell J Smith
PloS one, Apr 16, 2024
Research ethics review committees (ERCs) worldwide faced daunting challenges during the COVID-19 ... more Research ethics review committees (ERCs) worldwide faced daunting challenges during the COVID-19 pandemic. There was a need to balance rapid turnaround with rigorous evaluation of high-risk research protocols in the context of considerable uncertainty. This study explored the experiences and performance of ERCs during the pandemic. We conducted an anonymous, cross-sectional, global online survey of chairs (or their delegates) of ERCs who were involved in the review of COVID-19-related research protocols after March 2020. The survey ran from October 2022 to February 2023 and consisted of 50 items, with opportunities for descriptive responses to open-ended questions. Two hundred and three participants [130 from high-income countries (HICs) and 73 from low-and middle-income countries (LMICs)] completed our survey. Respondents came from diverse entities and organizations from 48 countries (19 HICs and 29 LMICs) in all World Health Organization regions. Responses show little of the increased global funding for COVID-19 research was allotted to the operation of ERCs. Few ERCs had pre-existing internal policies to address operation during public health emergencies, but almost half used existing guidelines. Most ERCs modified existing procedures or designed and implemented new ones but had not evaluated the success of these changes. Participants overwhelmingly endorsed permanently implementing several of them. Few ERCs added new members but non-member experts were consulted; quorum was generally achieved. Collaboration among ERCs was infrequent, but reviews conducted by external ERCs were recognized and validated. Review volume increased during the pandemic, with COVID-19-related studies being prioritized. Most protocol reviews were reported as taking less than three weeks. One-third of respondents reported external pressure on their ERCs from different stakeholders to approve or reject specific COVID-19-related protocols. ERC members faced significant challenges to keep their committees functioning during the pandemic. Our findings can inform ERC approaches towards future public health emergencies. To our knowledge, this is the first international, COVID-19-related study of its kind.
Public health ethics analysis, 2024
Monash bioethics review, Feb 13, 2024
BMC Public Health, Dec 11, 2023
Background Vaccine hesitancy is driven by a heterogeneous and changing set of psychological, soci... more Background Vaccine hesitancy is driven by a heterogeneous and changing set of psychological, social and historical phenomena, requiring multidisciplinary approaches to its study and intervention. Past research has brought to light instances of both interpersonal and institutional trust playing an important role in vaccine uptake. However, no comprehensive study to date has specifically assessed the relative importance of these two categories of trust as they relate to vaccine behaviors and attitudes. Methods In this paper, we examine the relationship between interpersonal and institutional trust and four measures related to COVID-19 vaccine hesitancy and one measure related to general vaccine hesitancy. We hypothesize that, across measures, individuals with vaccine hesitant attitudes and behaviors have lower trust-especially in institutions-than those who are not hesitant. We test this hypothesis in a sample of 1541 Canadians. Results A deficit in both interpersonal and institutional trust was associated with higher levels of vaccine hesitant attitudes and behaviors. However, institutional trust was significantly lower than interpersonal trust in those with high hesitancy scores, suggesting that the two types of trust can be thought of as distinct constructs in the context of vaccine hesitancy. Conclusions Based on our findings, we suggest that diminished institutional trust plays a crucial role in vaccine hesitancy. We propose that this may contribute to a tendency to instead place trust in interpersonally propagated belief systems, which may be more strongly misaligned with mainstream evidence and thus support vaccine hesitancy attitudes. We offer strategies rooted in these observations for creating public health messages designed to enhance vaccine uptake.
Journal of Bioethical Inquiry, Sep 6, 2023
Exploratory research in clinical and social pharmacy, Jul 1, 2023
medRxiv (Cold Spring Harbor Laboratory), Sep 25, 2023
Journal of Long-term Effects of Medical Implants, 2008
2015 APHA Annual Meeting & Expo (Oct. 31 - Nov. 4, 2015), Nov 3, 2015
Innovation in Aging, Dec 1, 2021
Health behaviors, which predict physical and mental health, are patterned by social factors, with... more Health behaviors, which predict physical and mental health, are patterned by social factors, with some groups engaging in more health-enhancing behaviors than others. LGB+ people face more economic and social barriers to participation in healthy behaviors, along with the stress of discrimination that could lead to unhealthy behaviors to cope. Although some studies have examined variation in health behaviors by sexual identity, they focus almost exclusively on adolescents and young adults. However, such differences may decline across adulthood, as stress related to sexual identity declines with age among LGB+ individuals. Addressing this issue, we use data from the National Health Interview Survey (2016-2018) to examine differences by sexual identity in substance use, weight-related behaviors, healthcare utilization, and sleep. We compare the patterns across three age groups-young, middle-aged, and older adults. Results for each health behavior reveal that differences by sexual identity are indeed greatest among young adults. The magnitude is smaller in middle age, and no significant differences by sexual minority status are observed at older ages.
American Journal of Industrial Medicine
The labor market is undergoing a rapid artificial intelligence (AI) revolution. There is currentl... more The labor market is undergoing a rapid artificial intelligence (AI) revolution. There is currently limited empirical scholarship that focuses on how AI adoption affects employment opportunities and work environments in ways that shape worker health, safety, well‐being and equity. In this article, we present an agenda to guide research examining the implications of AI on the intersection between work and health. To build the agenda, a full day meeting was organized and attended by 50 participants including researchers from diverse disciplines and applied stakeholders. Facilitated meeting discussions aimed to set research priorities related to workplace AI applications and its impact on the health of workers, including critical research questions, methodological approaches, data needs, and resource requirements. Discussions also aimed to identify groups of workers and working contexts that may benefit from AI adoption as well as those that may be disadvantaged by AI. Discussions were ...
The Lancet Infectious Diseases
Journal of Medical Ethics
Some organisations make vaccination a condition of employment. This means prospective employees m... more 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 whetherexistingemployees should be expected to meet newly introduced vaccination conditions (eg, against COVID-19). Unlike prospective employees who will not behiredif they do not meet vaccination conditions, existing employees who fail to meet new vaccination conditions risk beingfired. 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 r...
DIGITAL HEALTH
Throughout the COVID-19 pandemic, a variety of digital technologies have been leveraged for publi... more Throughout the COVID-19 pandemic, a variety of digital technologies have been leveraged for public health surveillance worldwide. However, concerns remain around the rapid development and deployment of digital technologies, how these technologies have been used, and their efficacy in supporting public health goals. Following the five-stage scoping review framework, we conducted a scoping review of the peer-reviewed and grey literature to identify the types and nature of digital technologies used for surveillance during the COVID-19 pandemic and the success of these measures. We conducted a search of the peer-reviewed and grey literature published between 1 December 2019 and 31 December 2020 to provide a snapshot of questions, concerns, discussions, and findings emerging at this pivotal time. A total of 147 peer-reviewed and 79 grey literature publications reporting on digital technology use for surveillance across 90 countries and regions were retained for analysis. The most frequen...
Journal of intensive care medicine, Jan 22, 2016
Controlled donation after circulatory determination of death (cDCDD) concerns donation after with... more Controlled donation after circulatory determination of death (cDCDD) concerns donation after withdrawal of life-sustaining therapy (W-LST). We examine the ethical issues raised by W-LST in the cDCDD context in the light of a review of cDCDD protocols and the ethical literature. Our analysis confirms that W-LST procedures vary considerably among cDCDD centers and that despite existing recommendations, the conflict of interest in the W-LST decision and process might be difficult to avoid, the process of W-LST might interfere with usual end-of-life care, and there is a risk of hastening death. In order to ensure that the practice of W-LST meets already well-established ethical recommendations, we suggest that W-LST should be managed in the ICU by an ICU physician who has been part of the W-LST decision. Recommending extubation for W-LST, when this is not necessarily the preferred procedure, is inconsistent with the recommendation to follow usual W-LST protocol. As the risk of conflicts...
Frontiers in digital health, Jul 24, 2023
IntroductionThe COVID-19 pandemic prompted a surge in digital public health surveillance worldwid... more IntroductionThe COVID-19 pandemic prompted a surge in digital public health surveillance worldwide, with limited opportunities to consider the effectiveness or impact of digital surveillance. The news media shape public understanding of topics of importance, contributing to our perception of priority issues. This study investigated news media reports published during the first year of the pandemic to understand how the use and consequences of digital surveillance technologies were reported on.MethodsA media content analysis of 34 high- to low-income countries was completed. The terms “COVID-19,” “surveillance,” “technologies,” and “public health” were used to retrieve and inductively code media reports.ResultsOf the 1,001 reports, most were web-based or newspaper sources on the development and deployment of technologies directed at contact tracing, enforcing quarantine, predicting disease spread, and allocating resources. Technology types included mobile apps, wearable devices, “smart” thermometers, GPS/Bluetooth, facial recognition, and security cameras. Repurposed data from social media, travel cards/passports, and consumer purchases also provided surveillance insight. Media reports focused on factors impacting surveillance success (public participation and data validity) and the emerging consequences of digital surveillance on human rights, function creep, data security, and trust.DiscussionDiverse digital technologies were developed and used for public health surveillance during the first year of the COVID-19 pandemic. The use of these technologies and witnessed or anticipated consequences were reported by a variety of media sources worldwide. The news media are an important public health information resource, as media outlets contribute to directing public understanding and shaping priority public health surveillance issues. Our findings raise important questions around how journalists decide which aspects of public health crises to report on and how these issues are discussed.
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Papers by Maxwell J Smith
Virtually all modern countries currently allow the declaration of death to occur following either the irreversible cessation of circulatory and respiratory function or the irreversible loss of all brain function. In practice, either of these two conditions is considered sufficient for an individual to be declared dead and, if there is no family objection, to be treated as an organ donor.
The justification for each criterion, in addition to a number of medical and philosophical issues regarding the relationship between them, generate concern that the legal standards for declaring death may be allowing organ procurement in ways that already violate the dead donor rule. The claim that perhaps the dead donor rule is not being respected, despite the fact that donors are commonly described as “deceased”, is the tautological result of assuming that these individuals may be alive. Thus, it is important to evaluate both if and how these practices may be currently violating the dead donor rule and examine whether such a violation is acceptable.
The objective of this presentation is to discuss whether the dead donor rule is needed to protect donors from harm at the moment of organ procurement. We will suggest that the assumption according to which individuals cannot be harmed once they have been declared dead is not only unsound but, in the case of DCD, also dangerous for donors’ safety. While the objective of increasing the donor pool without undermining public trust has been the main reason to frame international policies of organ procurement within the limits of the dead donor rule, we argue that this strategy is problematic as it neglects to meet two essential requirements: ensuring that the donor is sufficiently protected and respected, and ensuring that society is fully informed of the inherently debatable nature of any criterion to declare death.
This proposal has an important implication on how the theoretical debates about the definition of death should be framed. We believe that the fundamental question regarding the criteria used for the procurement of vital organs ought to be posed not as an objective question regarding when death occurs —as the dead donor rule necessitates— but rather as a moral question regarding the conditions under which it could be morally acceptable to procure vital organs from dying patients. By shifting the focus in this way, discussions of organ procurement would centre more on the interests of donors and less on the seemingly unanswerable question of when death occurs."
In light of this, some physicians and patients opt for multifetal pregnancy reduction (MFPR) and selective termination procedures. Both procedures involve the termination of one or more fetuses during a multifetal pregnancy in an attempt to improve perinatal and obstetric outcomes. Selective terminations aim to terminate biologically or genetically anomalous fetuses that may threaten a pregnancy, whereas MFPR aims to reduce a pregnancy with otherwise healthy fetuses in order to increase the likelihood of successful gestation and delivery.
MFPR is most common in higher-order pregnancies (triplets or more) but increasingly women are choosing to reduce lower-order (twin) pregnancies. Further, individuals are increasingly citing non-medical reasons for reduction, including personal convenience or lack of economic means to raise multiples. Where advocates of MFPR initially cited necessity for the reduction of higher-order pregnancies, ethical tensions have now heightened in the consideration of more 'elective' reductions and the reductions of lower-order pregnancies.
Like abortion, fetal reduction has advocates and opponents. Beyond current debates regarding singleton abortion, however, recent discussions of fetal reductions have been rather limited in their moral scope and analysis. Some opponents of these procedures, for example, claim that a woman’s right to the determination of whether she is pregnant does not extend to the right to determine how many fetuses she is pregnant with. Alternatively, proponents of these procedures claim that it is illogical to deny a woman the right to reduce the number of fetuses in her pregnancy when she has the right to terminate the entire pregnancy.
As a result of the political and personal sensitivity regarding fetal reduction, those who practice these procedures do so without much ethical discussion or guidance. As the utilization of ARTs increases, there is a moral impetus to provide these stakeholders with ethical guidance regarding MFPR and selective termination. Does the improvement in perinatal health justify MFPR and selective termination, and are there any limits to how and when they are performed?
These procedures represent a significant step to mitigating the adverse perinatal outcomes subsequent to multifetal pregnancies. In an attempt to better inform practitioners, patients, and policy, this presentation strives to assess the ethical dimensions of fetal reduction practices and whether improved perinatal outcomes justify their use. Finally, this presentation seeks to start a more robust discussion regarding these measures that seek to improve perinatal outcomes, as the ethical milieu in which the procedures operate has not nearly had the rigorous moral evaluation or deliberation that it deserves.
http://www.royalcollege.ca/portal/page/portal/rc/common/documents/bioethics/section4/case_4_3_5_e.html