Ethics, Medicine and Public Health最新文献

英文中文

Womb for rent: The deep ethical fault lines of commercial surrogacy 子宫出租：商业代孕的深层道德断层

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-12-01 DOI: 10.1016/j.jemep.2025.101226

R.A. Arceño , C.J.N. Ong , M.M. Ahmed , R. Nazari , D.E. Lucero-Prisno III

引用次数: 0

Silent ethnicization and ethical tensions in French hospitals: Towards an alterity-inclusive public health system 沉默的种族化和法国医院的伦理紧张：走向包容另类的公共卫生系统

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-11-27 DOI: 10.1016/j.jemep.2025.101225

P. Ahtoy

Introduction

This article examines the insidious effects of silent ethnicization in French hospitals, taking a sociolinguistic, postcolonial and feminist approach to medical practices. Based on a corpus of participant observations, qualitative interviews, life stories and experiences of racialized patients, it sheds light on the implicit racial biases that permeate healthcare relationships, influence diagnoses, and contribute to a hierarchization of pain.

Results

Drawing on the works of Frantz Fanon¹, as well as that of Joëlle Palmieri²on algology and « la douleur impensée » (pain which has not been considered), the article shows how certain types of sufferings - particularly those of racialized women - are systematically disqualified, downplayed or psychologized. This factory of ignorance, inherited from a long sexist and colonial medical past, still fuels unequal care practices today, often invisible to institutions which may even lead to deaths.

Discussion

The analysis also looks at healthcare professionals from diasporas, who find themselves caring for patients who resemble them, while having to deal with the dominant norms of the hospital institution. This paradox highlights the need to rethink medical training and dominant biomedical reading grids, in order to decolonize healthcare knowledge and recognize minoritized pain as legitimate, politically situated signals.

Conclusion

The article concludes with a call for a situated ethic of care. Like the pioneering Sorbonne University course recently featured in Le Monde (« Quand la médecine s'interroge sur ses ‘biais implicites raciaux » - « When medicine questions its « implicit racial bias »), 20243, it argues for an in-depth transformation of medical practices towards a public health inclusive of otherness, emancipated from the prejudices that kill in silence.

本文探讨了沉默的种族化在法国医院的潜在影响，采取社会语言学，后殖民和女权主义的方法来医疗实践。基于参与者观察、定性访谈、生活故事和种族化患者的经历的语料，它揭示了渗透到医疗保健关系中的隐性种族偏见，影响诊断，并有助于疼痛的分层。基于Frantz Fanon1，以及Joëlle palmieri2关于algology和“la douleur impenssame”（未被考虑的痛苦）的作品，这篇文章展示了某些类型的痛苦——尤其是那些种族化的女性——是如何被系统地排除、淡化或心理化的。这个无知的工厂是从长期的性别歧视和殖民医疗历史中继承下来的，今天仍然助长了不平等的护理做法，这些做法往往被机构所忽视，甚至可能导致死亡。该分析还关注了散居海外的医疗保健专业人员，他们发现自己照顾与自己相似的病人，同时不得不应对医院机构的主导规范。这一悖论凸显了重新思考医学培训和占主导地位的生物医学阅读网格的必要性，以便将医疗保健知识去殖民化，并将少数人的疼痛视为合法的、政治上的信号。文章最后呼吁建立一种情境关怀伦理。就像《世界报》（Le Monde）最近推出的索邦大学（Sorbonne University）的开创性课程（《Quand la m decine s'interroge sur ses ' biais implicites raciaux》——《当医学质疑其“隐性种族偏见”时》），243年，它主张对医疗实践进行深入改革，使其成为一种包容他人的公共卫生，从沉默中杀戮的偏见中解放出来。

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引用次数: 0

Hitler's DNA? The perfect example of what not to do in molecular genetics 希特勒的DNA ?这是分子遗传学中不能做的最好的例子

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-11-26 DOI: 10.1016/j.jemep.2025.101224

P. Charlier

引用次数: 0

Death, and after? An anthropology of post-mortem digital health data 死后呢？死后数字健康数据人类学

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-11-26 DOI: 10.1016/j.jemep.2025.101211

P. Charlier

引用次数: 0

From ‘exceptionalism’ to authors’ rights: Fairer publishing policies for more impactful science 从“例外论”到作者权利：为更有影响力的科学制定更公平的出版政策

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-11-25 DOI: 10.1016/j.jemep.2025.101219

J.A. Teixeira da Silva , Y. Yamada , J.C. Türp , T. Daly

Public mistrust in science is exacerbated by ethical inconsistencies within academic publishing. Despite their role as the primary generators of knowledge, authors seem to occupy the lowest tier of a hierarchical system that is dominated by publishers and editors. The observed discordance between public perception and the internal academic power structures contributes to a distorted understanding of responsibility and accountability. This review draws from indexed literature, including PubMed, Scopus, and Web of Science, as well as case studies from the authors' professional experience. We define the concept of ethical exceptionalism—the unequal application of ethical standards based on power or status—and examine it. Our analysis delineates a publishing hierarchy in which authors are subject to more stringent ethical scrutiny than editors or publishers, despite their comparatively limited influence. Examples of such disparities include discrepancies in the disclosure of conflicts of interest, the ramifications of misconduct, and the accessibility of publication opportunities. Conversely, editors and publishers may not be held to the same standards of accountability. This ethical imbalance (ethical exceptionalism) is shown to reinforce systemic injustices and erode the credibility of academic publishing, and has the potential to erode the foundations of fairness and trust in scholarly communication. As a result, we propose four key reforms: recognition of ethical exceptionalism as a category for scholarly analysis; encouragement for researchers to publish case studies that document inequitable practices; development of a formal charter to establish shared standards; promotion of post-publication peer review as a means of decentralizing power and increasing transparency.

公众对科学的不信任因学术出版中的伦理矛盾而加剧。尽管作者是知识的主要创造者，但他们似乎占据了由出版商和编辑主导的等级制度的最底层。公众认知与内部学术权力结构之间的不一致导致了对责任和问责制的扭曲理解。这篇综述来自索引文献，包括PubMed、Scopus和Web of Science，以及来自作者专业经验的案例研究。我们定义了道德例外主义的概念——基于权力或地位的道德标准的不平等应用——并对其进行了研究。我们的分析描绘了一个出版等级制度，在这个等级制度中，作者比编辑或出版商受到更严格的道德审查，尽管他们的影响力相对有限。这种差异的例子包括在披露利益冲突、不当行为的后果以及获得出版机会方面的差异。相反，编辑和出版商可能不会被要求遵守同样的问责标准。这种伦理失衡（伦理例外论）被证明会加强系统性的不公正，侵蚀学术出版的可信度，并有可能侵蚀学术交流中的公平和信任的基础。因此，我们提出了四项关键改革：承认伦理例外论作为学术分析的范畴；鼓励研究人员发表记录不公平做法的案例研究；制定正式章程，建立共同标准；促进出版后同行评议，作为权力下放和增加透明度的手段。

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引用次数: 0

Bringing death into the conversation: Communication strategies for discussing assisted dying in palliative care 将死亡带入对话：讨论姑息治疗中协助死亡的沟通策略

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-11-21 DOI: 10.1016/j.jemep.2025.101223

A. Avakian , K. Avakian , A. Singh

Background and Objective

In palliative care, promoting comfort, dignity, and autonomy often requires sensitive conversations about end-of-life options, including assisted dying. Despite the increasing legalization of Medical Aid in Dying (MAID), many clinicians remain hesitant or underprepared to initiate these discussions. This narrative review clarifies how barriers to these discussions have been identified and integrates evidence-based strategies from interdisciplinary literature. This study examines the ethical imperatives and clinical significance of assisted dying communication and aims to provide practical strategies for clinicians.

Methods

A narrative literature review was conducted using PubMed, Scopus, and Google Scholar databases for publications from 2010 to 2025. Search combinations included “assisted dying,” “medical aid in dying,” “physician-assisted death,” “communication,” “palliative care,” “ethics,” and “end-of-life discussion.” Studies were included if they examined clinician–patient communication about assisted dying, associated ethical considerations, or strategies for end-of-life dialogue. Findings were synthesized thematically to identify recurring barriers and communication approaches. This review analyzed previously published data and ethical analyses; no patient or identifying information was used, and ethical approval was therefore not applicable.

Results

Findings reveal persistent barriers, including legal uncertainties, cultural and religious sensitivities, clinician discomfort, and limited training in end-of-life communication. Evidence indicates that interdisciplinary team collaboration and structured communication frameworks improve confidence and patient satisfaction. These approaches improved clinician confidence, facilitated alignment of care with patient values, and increased patient satisfaction. Ethical analyses further underscore that avoiding or inadequately addressing assisted dying undermines autonomy and may compromise quality of care.

Conclusions

Engaging in open discussions about assisted dying is both a clinical responsibility and an ethical duty in palliative care. Addressing barriers through targeted training and structured communication strategies enables clinicians to approach these conversations with greater confidence and compassion. Such dialogue ensures that patient values and preferences are respected, ultimately fostering more dignified and patient-centered end-of-life care.

背景和目的在姑息治疗中，促进舒适、尊严和自主往往需要对临终选择进行敏感的对话，包括协助死亡。尽管死亡医疗援助（MAID）日益合法化，许多临床医生仍然犹豫不决或准备不足，以启动这些讨论。这篇叙述性综述阐明了如何确定这些讨论的障碍，并整合了跨学科文献中的循证策略。本研究探讨了协助死亡沟通的伦理要求和临床意义，旨在为临床医生提供实用的策略。方法采用PubMed、Scopus和b谷歌Scholar数据库对2010 ~ 2025年发表的文献进行叙述性文献综述。搜索组合包括“协助死亡”、“医疗协助死亡”、“医生协助死亡”、“沟通”、“姑息治疗”、“伦理”和“临终讨论”。如果研究调查了医患之间关于协助死亡的沟通、相关的伦理考虑或临终对话策略，则纳入研究。研究结果按主题进行综合，以确定反复出现的障碍和沟通方法。本综述分析了先前发表的数据和伦理分析；没有使用患者或识别信息，因此不适用伦理批准。研究结果揭示了持续存在的障碍，包括法律的不确定性、文化和宗教的敏感性、临床医生的不适以及临终沟通方面的培训有限。证据表明，跨学科的团队合作和结构化的沟通框架提高了信心和患者满意度。这些方法提高了临床医生的信心，促进了护理与患者价值观的一致，并提高了患者满意度。伦理分析进一步强调，避免或不充分处理协助死亡会破坏自主权，并可能损害护理质量。结论开展关于辅助死亡的公开讨论是姑息治疗的临床责任和伦理义务。通过有针对性的培训和结构化的沟通策略来解决障碍，使临床医生能够更有信心和同情心地处理这些对话。这样的对话确保病人的价值观和偏好得到尊重，最终促进更有尊严和以病人为中心的临终关怀。

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引用次数: 0

Biobanks in open-access scientific research 开放获取科学研究中的生物库

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-11-18 DOI: 10.1016/j.jemep.2025.101222

A. Valverde , J.A. González , F. Sevilla , M. Calderón-Ferrey , G. Jiménez , S. Monge-Ureña , I. Araya-Zúñiga , R. González

Introduction

Biobanks are repositories of biological samples and data used to generate new knowledge through research basic and applied to address societal issues.

Aim

This paper analyzes the bioethical principles associated with biobanks and open-access scientific information. Methods: We reviewed bioethical analyses, laws, and regulations on biobanks—facilities storing human or non-human specimens with linked data—and their intersection with open-access practices. We mapped governance, consent, privacy, data sharing, benefit-risk, and justice domains. Ethical constructs guided abstraction. Multidisciplinary searches (PubMed, Scopus, Web of Science, CAB, grey literature) plus cross-references captured sector-specific challenges in veterinary, agricultural, and public-health contexts, informing policy.

Results

Various classes of biomedical studies use biological samples and genetic data from donors stored in biobanks. Ethical and legal concerns arise, nonetheless, regarding the operation of these repositories. Biobanks have at their disposal multiple ways of handling and storing biomaterials, for example, genetic information security measures and informed consent. Moreover, an international regulatory framework of biobanks, supports the development of bio-legal standards to regulate these facilities worldwide. Data and biomaterial sharing drives reproducibility and innovation, despite barriers to competition, intellectual property ownership claims, and reduced access to technology in countries with fewer economic resources.

Conclusion

Sharing data/biomaterials under beneficence, justice, and honesty speeds reproducibility and innovation. Competition, intellectual property, technology hinder progress; robust governance, consent, privacy, regulation uphold autonomy, trust, and global collaboration for societal benefit. Biobanks, guided by ethical principles and clear established policies, strengthen trust, and promote scientific collaboration and social well-being.

生物银行是生物样本和数据的存储库，用于通过基础研究和应用于解决社会问题来产生新的知识。目的分析与生物库和开放获取科学信息相关的生物伦理原则。方法：我们回顾了生物库的生物伦理分析、法律和法规，以及它们与开放获取实践的交集。我们绘制了治理、同意、隐私、数据共享、利益风险和司法领域的地图。伦理构造引导抽象。多学科搜索（PubMed、Scopus、Web of Science、CAB、灰色文献）加上交叉参考，捕获了兽医、农业和公共卫生领域的特定部门挑战，为政策提供了信息。结果各类生物医学研究使用的生物样本和基因数据来自储存在生物库中的供体。然而，关于这些存储库的操作，出现了道德和法律问题。生物银行有多种处理和储存生物材料的方法，例如遗传信息安全措施和知情同意。此外，生物银行的国际监管框架支持制定生物法律标准，以规范世界范围内的这些设施。数据和生物材料共享推动了可复制性和创新，尽管在经济资源较少的国家存在竞争障碍、知识产权所有权要求以及获取技术的机会减少。结论在善意、公正和诚实的前提下共享数据/生物材料，加快了可重复性和创新性。竞争、知识产权、技术阻碍进步；健全的治理、同意、隐私和监管维护了自治、信任和全球合作，以造福社会。生物库以伦理原则和明确的既定政策为指导，加强信任，促进科学合作和社会福祉。

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引用次数: 0

Male patients appeared in Chinese papers on female diseases 男性患者出现在中国有关女性疾病的论文中

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-11-18 DOI: 10.1016/j.jemep.2025.101221

H. Zhang

引用次数: 0

No elder left behind: embedding ‘Pag-amuma’ in Philippine digital care 不让一个老人掉队：在菲律宾数字护理中嵌入“paga -amuma”

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-11-18 DOI: 10.1016/j.jemep.2025.101218

J.C. Colegado, R.P. Colegado

引用次数: 0

Colonial transitions in health 卫生领域的殖民转型

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-11-17 DOI: 10.1016/j.jemep.2025.101217

P.-H. Moury

The challenges of colonial transitions in health interact with epidemiology and philosophy, which are necessary to understand the contexts of health disparities found in the French colonies of New Caledonia and the Antilles developed here.

Colonialism interact with the global health transitions, including demographic, epidemiological, and climatic transitions, through persistent colonial phenomenon in forms of neocolonialism and post-colonialism. This underscores the necessity of revaluating our relationship with nature and the boundaries of our existing perceptions, calling for an ethic grounded in distributive justice.

The narrative of epidemiology spans from the practices of colonial physicians to the tenets of modern bioethics, delving into the chlordecone scandal. We explore the contributions of figures such as Frantz Fanon, who combated racism and colonialism, and address ongoing debates regarding the incorporation of race in epidemiological research.

We underscore the essential incorporation of social inequalities in health, with a focus on intersectionality as a lens for revisiting epidemiology, alongside ecofeminism, the "One Health" approach, and art to comprehend the determinants of health.

殖民地在卫生方面的转变所带来的挑战与流行病学和哲学相互作用，这对于了解在这里形成的新喀里多尼亚和安的列斯的法国殖民地所发现的卫生差异的背景是必要的。通过新殖民主义和后殖民主义形式的持续殖民现象，殖民主义与全球健康转型（包括人口、流行病学和气候转型）相互作用。这强调了重新评估我们与自然的关系以及我们现有观念的界限的必要性，呼吁以分配正义为基础的伦理。流行病学的叙述从殖民地医生的实践到现代生物伦理学的原则，深入到十氯酮丑闻。我们探讨了弗朗茨·法农等人物的贡献，他们与种族主义和殖民主义作斗争，并讨论了有关将种族纳入流行病学研究的持续辩论。我们强调必须将社会不平等纳入卫生领域，重点关注交叉性，作为重新审视流行病学的视角，同时关注生态女权主义、“同一个健康”方法和艺术，以理解健康的决定因素。

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