Ethics, Medicine and Public Health最新文献

英文中文

Comparing health systems in Australia and India through the WHO Framework: a narrative review 通过世卫组织框架比较澳大利亚和印度的卫生系统：叙述性审查

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2026-01-01 DOI: 10.1016/j.jemep.2026.101244

S. Mitra , S.S. Chatterjee

Background

Australia and India, despite shared democratic values and commitments to health equity, operate vastly different health systems. Understanding these differences through a structured framework enables identification of opportunities for mutual learning and system improvement. This review aims at comparing and contrasting the health systems of Australia and India using the World Health Organization (WHO) Health System Framework, highlighting their respective strengths, weaknesses, and sustainability challenges.

Methods

This narrative-based comparative review applied the WHO Health System Framework, encompassing six building blocks: (1) health workforce, (2) service delivery, (3) health information systems, (4) access to essential medicines and technologies, (5) health financing, and (6) leadership and governance. Literature was sourced from PubMed, Scopus, Google Scholar, and official databases (WHO, AIHW, MOHFW, etc.) with publications from 2007 to 2025.

Results and discussion

Australia’s health system is characterized by universal coverage via Medicare, robust data infrastructure, regulated workforce planning, and strong financial risk protection. However, it faces challenges in equitable service distribution, fiscal sustainability, and funding inefficiencies. In contrast, India’s system grapples with underfunding, workforce shortages, and high out-of-pocket expenses. Yet, it exhibits innovations in low-cost care, community-based models (e.g., ASHA), frugal technologies, and expanding insurance schemes like PM-JAY. Both systems face issues of aging populations, geographic inequity, and sustainability.

Conclusion

Australia and India represent contrasting models -- one resource-rich and structured, the other resource-constrained but adaptive. Australia can learn from India’s cost-effective service innovations, while India may adopt Australia’s regulatory rigor and universal coverage design. Cross-learning offers potential for strengthening global health systems facing diverse challenges.

澳大利亚和印度尽管有着共同的民主价值观和对卫生公平的承诺，但两国的卫生系统截然不同。通过一个结构化的框架来理解这些差异，可以确定相互学习和系统改进的机会。本综述旨在使用世界卫生组织（WHO）卫生系统框架对澳大利亚和印度的卫生系统进行比较和对比，突出各自的优势、劣势和可持续性挑战。方法这一基于叙述的比较审查应用了世卫组织卫生系统框架，其中包括六个组成部分：(1)卫生人力，(2)服务提供，(3)卫生信息系统，(4)获得基本药物和技术，(5)卫生筹资，(6)领导和治理。文献来源于PubMed、Scopus、b谷歌Scholar和官方数据库（WHO、AIHW、MOHFW等），出版时间为2007年至2025年。结果和讨论澳大利亚的卫生系统的特点是通过医疗保险实现全民覆盖、健全的数据基础设施、规范的劳动力规划和强大的财务风险保护。然而，它面临着服务公平分配、财政可持续性和资金效率低下等挑战。相比之下，印度的医疗体系面临着资金不足、劳动力短缺和高额自费等问题。然而，它在低成本护理、社区模式（如ASHA）、节俭技术和扩大保险计划（如PM-JAY）方面展示了创新。这两个系统都面临人口老龄化、地域不平等和可持续性等问题。结论：澳大利亚和印度代表了两种截然不同的模式——一种是资源丰富且结构化的模式，另一种是资源受限但适应性强的模式。澳大利亚可以学习印度具有成本效益的服务创新，而印度可以采用澳大利亚严格的监管和普遍覆盖的设计。交叉学习为加强面临各种挑战的全球卫生系统提供了潜力。

{"title":"Comparing health systems in Australia and India through the WHO Framework: a narrative review","authors":"S. Mitra , S.S. Chatterjee","doi":"10.1016/j.jemep.2026.101244","DOIUrl":"10.1016/j.jemep.2026.101244","url":null,"abstract":"<div><h3>Background</h3><div>Australia and India, despite shared democratic values and commitments to health equity, operate vastly different health systems. Understanding these differences through a structured framework enables identification of opportunities for mutual learning and system improvement. This review aims at comparing and contrasting the health systems of Australia and India using the World Health Organization (WHO) Health System Framework, highlighting their respective strengths, weaknesses, and sustainability challenges.</div></div><div><h3>Methods</h3><div>This narrative-based comparative review applied the WHO Health System Framework, encompassing six building blocks: (1) health workforce, (2) service delivery, (3) health information systems, (4) access to essential medicines and technologies, (5) health financing, and (6) leadership and governance. Literature was sourced from PubMed, Scopus, Google Scholar, and official databases (WHO, AIHW, MOHFW, etc.) with publications from 2007 to 2025.</div></div><div><h3>Results and discussion</h3><div>Australia’s health system is characterized by universal coverage via Medicare, robust data infrastructure, regulated workforce planning, and strong financial risk protection. However, it faces challenges in equitable service distribution, fiscal sustainability, and funding inefficiencies. In contrast, India’s system grapples with underfunding, workforce shortages, and high out-of-pocket expenses. Yet, it exhibits innovations in low-cost care, community-based models (e.g., ASHA), frugal technologies, and expanding insurance schemes like PM-JAY. Both systems face issues of aging populations, geographic inequity, and sustainability.</div></div><div><h3>Conclusion</h3><div>Australia and India represent contrasting models -- one resource-rich and structured, the other resource-constrained but adaptive. Australia can learn from India’s cost-effective service innovations, while India may adopt Australia’s regulatory rigor and universal coverage design. Cross-learning offers potential for strengthening global health systems facing diverse challenges.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"34 ","pages":"Article 101244"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

On the securitization of science 论科学的证券化

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2026-01-01 DOI: 10.1016/j.jemep.2025.101237

Jukka Ruohonen

Securitization is a political process through which a phenomenon is framed as a security issue for gaining legitimacy for subsequent political decisions. At the moment, science too is increasingly being securitized. By focusing on recent developments in Europe, this short report reflects upon the political decisions made, their origins and legitimizing arguments, the contradictions that have emerged, and the potential consequences for academic freedom. Although it is still too early to robustly evaluate all potential consequences, a reflection is needed because the securitization process affects the very core of science in democratic societies.

证券化是一种政治过程，通过这种过程，一种现象被定义为安全问题，从而为随后的政治决策获得合法性。目前，科学也日益被证券化。通过关注欧洲最近的事态发展，这篇简短的报告反映了做出的政治决定，它们的起源和合法化的论点，已经出现的矛盾，以及对学术自由的潜在后果。尽管现在对所有潜在的后果进行强有力的评估还为时过早，但由于证券化过程影响了民主社会中科学的核心，因此有必要进行反思。

引用次数: 0

Faith, fear, and the false beliefs: the unspoken roots of HPV vaccine hesitancy in Pakistan 信仰、恐惧和错误的信念：巴基斯坦人对HPV疫苗犹豫不决的不言而喻的根源

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2026-01-01 DOI: 10.1016/j.jemep.2026.101240

H. Faisal , Chanchan , K. Chaman Lal

引用次数: 0

From literature to the emergency department: Reading Dostoevsky’s Marmeladov through the lens of modern trauma care 从文学到急诊科：从现代创伤护理的视角解读陀思妥耶夫斯基的《马尔梅拉多夫》

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2026-01-01 DOI: 10.1016/j.jemep.2026.101242

İ. Şirin

引用次数: 0

Revisiting Halil Pasha’s Yaşlı Halayık: A case of pseudostrabismus

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2026-01-01 DOI: 10.1016/j.jemep.2026.101239

H. Elbe , C. Karalezli

Background

Esotropia is a form of strabismus, a condition characterized by the misalignment of the eyes. The false appearance of esotropia in the alignment of the visual axes is what defines pseudoesotropia. Halil Pasha was a Turkish painter known for his contributions to the art scene during the late 19th and early 20th centuries.

Methodology

This study reevaluated the artistic depictions of strabismus in Halil Pasha’s portraits of the same woman at different ages. "Yaşlı Halayık" is one of the most iconic paintings in Turkish art.

Results

It is noticeable that the elderly maidservant may have a mild strabismus in her left eye. In our previous publication, this finding was interpreted as a possible pseudostrabismus due to age-related facial asymmetry. However, in the newly discovered portrait of the same woman at a younger age by the same painter, no ocular deviation was observed.

Conclusions

Both art historians and medical practitioners should evaluate medical scenes in works of art. Today, physicians and medical students should examine such works more carefully in order to develop their observational skills. Paintings by the same artist can be evaluated together, taking into account the historical context in which they were created. Thorough museum research should be conducted for this purpose.

背景：斜视是斜视的一种形式，以眼睛的不对准为特征。内斜视在视轴方向上的假象是假性斜视的定义。哈利勒·帕夏是一位土耳其画家，因其在19世纪末和20世纪初对艺术界的贡献而闻名。本研究重新评估了哈利勒·帕夏在不同年龄对同一女性的肖像中对斜视的艺术描绘。“yalyi Halayık”是土耳其艺术中最具代表性的画作之一。结果老年婢女左眼可能有轻度斜视。在我们之前的出版物中，这一发现被解释为可能是由于年龄相关的面部不对称导致的假性斜视。然而，在新发现的同一位女性年轻时的肖像中，没有观察到眼部偏差。结论艺术史家和医学从业者都应该对艺术作品中的医疗场景进行评价。今天，医生和医科学生应该更仔细地检查这些作品，以培养他们的观察技能。同一艺术家的画作可以一起评估，同时考虑到它们创作的历史背景。为此，应该进行彻底的博物馆研究。

{"title":"Revisiting Halil Pasha’s Yaşlı Halayık: A case of pseudostrabismus","authors":"H. Elbe , C. Karalezli","doi":"10.1016/j.jemep.2026.101239","DOIUrl":"10.1016/j.jemep.2026.101239","url":null,"abstract":"<div><h3>Background</h3><div>Esotropia is a form of strabismus, a condition characterized by the misalignment of the eyes. The false appearance of esotropia in the alignment of the visual axes is what defines pseudoesotropia. Halil Pasha was a Turkish painter known for his contributions to the art scene during the late 19th and early 20th centuries.</div></div><div><h3>Methodology</h3><div>This study reevaluated the artistic depictions of strabismus in Halil Pasha’s portraits of the same woman at different ages. \"<em>Yaşlı Halayık</em>\" is one of the most iconic paintings in Turkish art.</div></div><div><h3>Results</h3><div>It is noticeable that the elderly maidservant may have a mild strabismus in her left eye. In our previous publication, this finding was interpreted as a possible pseudostrabismus due to age-related facial asymmetry. However, in the newly discovered portrait of the same woman at a younger age by the same painter, no ocular deviation was observed.</div></div><div><h3>Conclusions</h3><div>Both art historians and medical practitioners should evaluate medical scenes in works of art. Today, physicians and medical students should examine such works more carefully in order to develop their observational skills. Paintings by the same artist can be evaluated together, taking into account the historical context in which they were created. Thorough museum research should be conducted for this purpose.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"34 ","pages":"Article 101239"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Training the eye and diagnosing the canvas in the Museum ‘A perspective on art-based medical education’ 在博物馆中训练眼睛和诊断画布——从艺术医学教育的角度看

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2026-01-01 DOI: 10.1016/j.jemep.2026.101243

T.M. van Gulik , S.A. Bult , P.E.J. de Ruiter , F. Huizing , A. Leijdesdorff , S. Lagarde , A. de Mol van Otterloo

Art-based observational training in museums has the potential to enhance observational and communicational skills and to augment competences as empathy and tolerance of ambiguity. We developed and implemented art-based observational courses for residents at three central surgical training centers in collaboration with major local museums.

Groups of 6–12 residents participated in guided sessions in a museum led by an art historian and an experienced surgeon. The ABCD-method was used to structure layered examination and discussion of an artwork, supported by targeted exercises. Artworks were selected based on visual content and the possibility of depicted medical features for iconodiagnosis.

Around 150 surgical residents participated in the program. The process of observing and interpreting artworks, exchanging reflections and debating visual physical abnormalities was highly valued. Works by famous masters such as Rembrandt, Rosselli, Rubens and Vermeer were examined and discussed from medical and art-historical perspectives. Herein, three works by Rosselli, Ket and Rembrandt, respectively, are reviewed in iconodiagnostic detail. Course design and group interaction not only showed educational value but also strengthened team cohesion.

The synergy of observational training and iconodiagnosis in art-based settings enhanced the educational program. The courses were highly valued by the participating surgical residents and potentially improved their professional competencies. Our experiences support the integration of visual arts courses in surgical training. This approach may be applied in all medical disciplines.

博物馆以艺术为基础的观察训练有可能提高观察和沟通技能，并增强同情和容忍歧义的能力。我们与当地主要博物馆合作，为三家中央外科培训中心的住院医师开发并实施了以艺术为基础的观察课程。每组6-12名居民参加由艺术历史学家和经验丰富的外科医生带领的博物馆指导课程。ABCD-method是通过有针对性的练习来组织艺术作品的分层考试和讨论。艺术作品的选择是基于视觉内容和描绘医学特征的可能性来进行图像诊断。大约150名外科住院医师参加了该项目。观察和解读艺术作品的过程、交换思考和讨论视觉物理异常的过程受到高度重视。从医学和艺术史的角度对伦勃朗、罗塞利、鲁本斯和维米尔等著名大师的作品进行了研究和讨论。本文分别对罗塞利、凯特和伦勃朗的三幅作品进行了图像诊断的详细回顾。课程设计和小组互动不仅体现了教育价值，还增强了团队凝聚力。在以艺术为基础的环境中，观察训练和图像诊断的协同作用增强了教育计划。这些课程受到参与的外科住院医师的高度评价，并有可能提高他们的专业能力。我们的经验支持将视觉艺术课程整合到外科训练中。这种方法可应用于所有医学学科。

{"title":"Training the eye and diagnosing the canvas in the Museum ‘A perspective on art-based medical education’","authors":"T.M. van Gulik , S.A. Bult , P.E.J. de Ruiter , F. Huizing , A. Leijdesdorff , S. Lagarde , A. de Mol van Otterloo","doi":"10.1016/j.jemep.2026.101243","DOIUrl":"10.1016/j.jemep.2026.101243","url":null,"abstract":"<div><div>Art-based observational training in museums has the potential to enhance observational and communicational skills and to augment competences as empathy and tolerance of ambiguity. We developed and implemented art-based observational courses for residents at three central surgical training centers in collaboration with major local museums.</div><div>Groups of 6–12 residents participated in guided sessions in a museum led by an art historian and an experienced surgeon. The ABCD-method was used to structure layered examination and discussion of an artwork, supported by targeted exercises. Artworks were selected based on visual content and the possibility of depicted medical features for iconodiagnosis.</div><div>Around 150 surgical residents participated in the program. The process of observing and interpreting artworks, exchanging reflections and debating visual physical abnormalities was highly valued. Works by famous masters such as Rembrandt, Rosselli, Rubens and Vermeer were examined and discussed from medical and art-historical perspectives. Herein, three works by Rosselli, Ket and Rembrandt, respectively, are reviewed in iconodiagnostic detail. Course design and group interaction not only showed educational value but also strengthened team cohesion.</div><div>The synergy of observational training and iconodiagnosis in art-based settings enhanced the educational program. The courses were highly valued by the participating surgical residents and potentially improved their professional competencies. Our experiences support the integration of visual arts courses in surgical training. This approach may be applied in all medical disciplines.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"34 ","pages":"Article 101243"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Biological skin and psychic skin: rethinking the connection through “Tact-Pulsion” 生物皮肤与心灵皮肤：通过“触觉-触觉”重新思考两者的联系

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2026-01-01 DOI: 10.1016/j.jemep.2026.101241

R. Prat , C. Déchelette

The skin constitutes the primary interface between the organism and its environment. Serving not only as a protective barrier and a sensory organ but also as a psychic support, it goes beyond its biological functions to become a foundation of the self, a surface where tactile and relational experiences are inscribed.

In the 1960s, Esther Bick showed that when the skin fails to fulfil its role as a psychic container, the individual constructs a “second skin”: an early defensive structure, protective against primitive anxieties but later limiting affect expression and connection with others. Then, in 1972, Didier Anzieu developed the concept of the “Skin-Ego,” defining the skin as a psychic envelope supporting the emerging self and ensuring continuity between body and psyche. In 2022, Régine Prat identified an intermediate zone between biological skin and psychic skin, which she named Tact-Pulsion, explaining that tactile stimulations from conception—contacts with the uterine wall and the fetus’s exploratory movements—constitute a form of early libidinal investment.

Thus, from the emergence of cutaneous sensory receptors in utero to the cerebral release of neurotransmitters involved in emotions, attachment, mood, and relationships (oxytocin, dopamine, serotonin), touch appears as both a sensory and psychic phenomenon, linking sensory perception, bodily sensations, and libidinal life, transforming physical contact into affective and relational experiences.

This article aims to raise awareness among medical students and clinicians about the importance of contact and touch, which are crucial for the development of the self in early childhood and later essential in caregiving relationships. Touch, far from being a mere technical gesture, carries relational and symbolic value at the heart of clinical encounters.

皮肤是生物体与其环境之间的主要界面。它不仅作为一个保护屏障和感觉器官，而且作为一个精神支持，它超越了它的生物功能，成为自我的基础，一个触觉和关系体验的表面。20世纪60年代，埃丝特·比克（Esther Bick）指出，当皮肤不能履行其作为精神容器的作用时，个体就会构建“第二层皮肤”：早期的防御结构，保护人们免受原始的焦虑，但后来限制了情感表达和与他人的联系。然后，在1972年，Didier Anzieu提出了“皮肤-自我”的概念，将皮肤定义为支持新兴自我的精神外壳，并确保身体和精神之间的连续性。2022年，Prat发现了一个介于生物皮肤和精神皮肤之间的中间区域，她将其命名为触觉-波力，并解释说，来自受孕的触觉刺激——与子宫壁的接触和胎儿的探索运动——构成了一种早期的力比多投资。因此，从子宫内皮肤感觉受体的出现到涉及情感、依恋、情绪和关系（催产素、多巴胺、血清素）的神经递质的大脑释放，触摸既是一种感官现象，也是一种精神现象，将感官知觉、身体感觉和性欲生活联系起来，将身体接触转化为情感和关系体验。这篇文章的目的是提高医学生和临床医生对接触和触摸的重要性的认识，这对儿童早期的自我发展和后来的照顾关系至关重要。触摸，远非仅仅是一种技术姿态，在临床接触的核心中具有关系和象征价值。

{"title":"Biological skin and psychic skin: rethinking the connection through “Tact-Pulsion”","authors":"R. Prat , C. Déchelette","doi":"10.1016/j.jemep.2026.101241","DOIUrl":"10.1016/j.jemep.2026.101241","url":null,"abstract":"<div><div>The skin constitutes the primary interface between the organism and its environment. Serving not only as a protective barrier and a sensory organ but also as a psychic support, it goes beyond its biological functions to become a foundation of the self, a surface where tactile and relational experiences are inscribed.</div><div>In the 1960s, Esther Bick showed that when the skin fails to fulfil its role as a psychic container, the individual constructs a “second skin”: an early defensive structure, protective against primitive anxieties but later limiting affect expression and connection with others. Then, in 1972, Didier Anzieu developed the concept of the “Skin-Ego,” defining the skin as a psychic envelope supporting the emerging self and ensuring continuity between body and psyche. In 2022, Régine Prat identified an intermediate zone between biological skin and psychic skin, which she named Tact-Pulsion, explaining that tactile stimulations from conception—contacts with the uterine wall and the fetus’s exploratory movements—constitute a form of early libidinal investment.</div><div>Thus, from the emergence of cutaneous sensory receptors in utero to the cerebral release of neurotransmitters involved in emotions, attachment, mood, and relationships (oxytocin, dopamine, serotonin), touch appears as both a sensory and psychic phenomenon, linking sensory perception, bodily sensations, and libidinal life, transforming physical contact into affective and relational experiences.</div><div>This article aims to raise awareness among medical students and clinicians about the importance of contact and touch, which are crucial for the development of the self in early childhood and later essential in caregiving relationships. Touch, far from being a mere technical gesture, carries relational and symbolic value at the heart of clinical encounters.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"34 ","pages":"Article 101241"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The night I became a doctor 我成为医生的那天晚上

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2026-01-01 DOI: 10.1016/j.jemep.2026.101245

G. Magro

The Night I Became a Doctor is a reflective narrative that captures the moment when the practice of medicine transcends clinical training and becomes an existential realization. Set in southern Italy during a time of healthcare crisis, the story follows a young neurologist covering emergency night shifts in understaffed wards. Through the account of an elderly patient with metastatic cancer who dies unexpectedly despite apparently stable parameters, the author explores the dissonance between medical rationality and human vulnerability. The narrative moves from the procedural security of numerical scales and protocols to the emotional disorientation of loss, revealing how medicine is not a linear science but a labyrinth of uncertainty, ethics, and compassion. By drawing parallels with literary metaphors, the author reframes the physician’s journey as one of continuous searching within the limits of knowledge and the inevitability of death. Ultimately, the piece portrays the moment of transition from being a doctor in title to becoming one in spirit; when empathy and acceptance replace control and certainty.

《我成为医生之夜》是一部反思性的叙事作品，它捕捉到了医学实践超越临床训练，成为一种存在意识的时刻。故事发生在医疗危机时期的意大利南部，讲述了一位年轻的神经科医生在人手不足的病房里负责紧急夜班的故事。通过对一位老年转移性癌症患者的描述，尽管参数明显稳定，但他却意外死亡，作者探讨了医学合理性与人类脆弱性之间的不和谐。叙述从数字尺度和协议的程序安全转移到失去的情感迷失，揭示了医学不是线性科学，而是不确定性，伦理和同情的迷宫。通过与文学隐喻的类比，作者将医生的旅程重新定义为在知识和死亡的必然性范围内不断探索的旅程。最后，这幅作品描绘了从名义上的医生转变为精神上的医生的时刻；当同理心和接受取代了控制和确定性。

引用次数: 0

Healthcare resource allocation in aging societies during Covid-19: ethical considerations complementing acute crisis frameworks Covid-19期间老龄化社会的医疗资源配置：补充急性危机框架的伦理考虑

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2026-01-01 DOI: 10.1016/j.jemep.2026.101238

Y. Egashira, H. Nakada, R. Watanabe

Background

This study examines ethical challenges in healthcare resource allocation during Covid-19, focusing on implications for aging societies in Asia. Emanuel et al. framework provided crucial pandemic guidance with multiple ethical values. As this framework was primarily developed for acute care settings, exploring what additional considerations might be relevant for aging societies—where healthcare needs extend beyond immediate life-saving to include quality of life maintenance, and dignity—represents a valuable direction for framework development.

Methodology

The study employed philosophical-ethical analysis based on Japan's experience as the world's most aged society. We examined four healthcare domains—elective surgery, rehabilitation, palliative care, and home healthcare—which, while not immediately life-saving, are essential for maintaining autonomy and quality of life among older adults. Analysis drew from academic literature, policy documents, and healthcare system data from Asian countries.

Results

Service disruptions significantly impacted dimensions of care on which aging populations depend. Notably, palliative care interruptions represented not delays but irreversible losses of opportunity for dignified end-of-life experiences. The study identified emerging challenges including cumulative surgical backlogs and increased home healthcare demand, demonstrating how demographic aging amplifies consequences of acute service restrictions.

Conclusions

Building on Emanuel et al. ethical framework, this study explored additional considerations for aging societies. Our analysis suggests that complementary attention to quality of life maintenance, dignity may enhance framework applicability when healthcare systems serve predominantly older populations. For rapidly aging Asian countries, exploring such framework adaptations represents both a practical need and an important area for future interdisciplinary research.

本研究探讨了2019冠状病毒病期间医疗资源分配中的伦理挑战，重点关注对亚洲老龄化社会的影响。Emanuel等人的框架提供了具有多重伦理价值的重要流行病指导。由于该框架主要是为急性护理环境开发的，因此探索与老龄化社会相关的其他考虑因素可能代表了框架开发的一个有价值的方向——在老龄化社会，医疗保健需求不仅限于立即挽救生命，还包括维持生活质量和尊严。研究方法：基于日本作为世界上老龄化最严重的社会的经验，本研究采用了哲学伦理分析。我们研究了四个医疗保健领域——选择性手术、康复、姑息治疗和家庭医疗保健——它们虽然不能立即挽救生命，但对于保持老年人的自主性和生活质量至关重要。分析来自亚洲国家的学术文献、政策文件和医疗保健系统数据。结果服务中断显著影响了老年人所依赖的护理维度。值得注意的是，姑息治疗中断并不代表延迟，而是不可逆转地丧失了获得有尊严的临终体验的机会。该研究确定了新出现的挑战，包括累积的手术积压和增加的家庭医疗保健需求，表明人口老龄化如何放大急性服务限制的后果。基于Emanuel等人的伦理框架，本研究探讨了老龄化社会的其他考虑因素。我们的分析表明，当医疗保健系统主要为老年人服务时，对生活质量维护和尊严的补充关注可能会增强框架的适用性。对于快速老龄化的亚洲国家来说，探索这种框架适应既是现实需要，也是未来跨学科研究的重要领域。

{"title":"Healthcare resource allocation in aging societies during Covid-19: ethical considerations complementing acute crisis frameworks","authors":"Y. Egashira, H. Nakada, R. Watanabe","doi":"10.1016/j.jemep.2026.101238","DOIUrl":"10.1016/j.jemep.2026.101238","url":null,"abstract":"<div><h3>Background</h3><div>This study examines ethical challenges in healthcare resource allocation during Covid-19, focusing on implications for aging societies in Asia. Emanuel et al. framework provided crucial pandemic guidance with multiple ethical values. As this framework was primarily developed for acute care settings, exploring what additional considerations might be relevant for aging societies—where healthcare needs extend beyond immediate life-saving to include quality of life maintenance, and dignity—represents a valuable direction for framework development.</div></div><div><h3>Methodology</h3><div>The study employed philosophical-ethical analysis based on Japan's experience as the world's most aged society. We examined four healthcare domains—elective surgery, rehabilitation, palliative care, and home healthcare—which, while not immediately life-saving, are essential for maintaining autonomy and quality of life among older adults. Analysis drew from academic literature, policy documents, and healthcare system data from Asian countries.</div></div><div><h3>Results</h3><div>Service disruptions significantly impacted dimensions of care on which aging populations depend. Notably, palliative care interruptions represented not delays but irreversible losses of opportunity for dignified end-of-life experiences. The study identified emerging challenges including cumulative surgical backlogs and increased home healthcare demand, demonstrating how demographic aging amplifies consequences of acute service restrictions.</div></div><div><h3>Conclusions</h3><div>Building on Emanuel et al. ethical framework, this study explored additional considerations for aging societies. Our analysis suggests that complementary attention to quality of life maintenance, dignity may enhance framework applicability when healthcare systems serve predominantly older populations. For rapidly aging Asian countries, exploring such framework adaptations represents both a practical need and an important area for future interdisciplinary research.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"34 ","pages":"Article 101238"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Child Malnutrition: Somalia’s Silent Emergency 儿童营养不良：索马里无声的紧急状况

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2026-01-01 DOI: 10.1016/j.jemep.2026.101246

I. Abdullahi Khalif, A. Abdullahi Mohamed, S.G. Bashir

引用次数: 0

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Ethics, Medicine and Public Health

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀