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Seattle Children’s Research Institute is identifying the amount and type of health equity scholarship being conducted institution wide. However, methods for categorizing how scholarship is equity-focused are lacking. We developed and evaluated the reliability of a health equity scholarship coding schema applied to Seattle Children’s affiliated scholarship.
Methods:
A 2021–2022 Ovid MEDLINE affiliation search yielded 3551 affiliated scholarship records, with 1079 records identified via an existing filter as scholarship addressing social determinants of health. Through reliability testing and examining concordance and discordance across three independent coders of these records, we developed a coding schema to classify health equity scholarship (yes/no). When health equity scholarship proved positive/Yes, the coders assigned a one through five maturity rating of the scholarship towards addressing inequities. Subsequent reliability testing including a new coder was conducted for 992 subsequent affiliated scholarship records (Oct 2022–June 2023), with additional testing of the sensitivity and specificity of the existing filter relative to the new coding schema.
Results:
Reliability for identifying health equity scholarship was consistently high (Fleiss kappas ≥ .78) and categorization of health equity scholarship into maturity levels was moderate (Fleiss kappas ≥ .47). The coding schema identified additional health equity scholarship not captured in an existing filter for social determinants of health scholarship. Based on the new schema, 23.3% of Seattle Childrens’ affiliated scholarship published October 2002–June 2023 was health equity focused.
Conclusions:
This new coding schema can be used to identify and categorize health equity scholarship to help quantitate the health equity focus of portfolios of human-focused research.
The principle of nonmaleficence states a prohibition on causing harm to others in the absence of justifying circumstances. After surveying some prominent accounts of the nature of harm, we defend a counterfactual account: you harm someone if and only if you make them worse off than they would have been in the absence of your intervention. Using this account we specify nonmaleficence into several general moral rules corresponding to ways in which individuals can be harmed. These foundational reflections are followed by discussions of three areas of ethical concern in which rules concerning harm are prominent: (1) the ethics of torture, including health professionals’ involvement in torture; (2) the limits of permissible risk in pediatric research; and (3) the ethics of medical assistance-in-dying. We argue for a prohibition of torture, a specific risk ceiling for pediatric research, and a liberal approach, with various safeguards, to medical assistance-in-dying.
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