Ethics, Medicine and Public Health最新文献_第7页

Focus philosophy: Transgenderism, conceptual and ethical aspects 关注哲学：跨性别主义，概念和伦理方面

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-01-01 DOI: 10.1016/j.jemep.2025.101163

P. Le Coz

Context

Usually, a person’s identity is defined in terms of their physical characteristics. A “man” is someone who looks like a man; a “woman” is someone who looks like a woman. Our spontaneous criteria are a person’s physical appearance, silhouette and mannerisms. “Man” is a gender assigned to “males” based on physical features: XY karyotype, increased body hair and muscle mass, deeper voice, testosterone dominance, penis, testicles, sperm, etc. “Woman” is a gender assigned to “females” identifiable by a different set of traits: XX karyotype, breasts, estrogen dominance, vulva, clitoris, vagina, ovaries, etc. These different elements are now being debated and called into question in the case of gender dysphoria.

Methodology

The theme addressed here is analyzed from a philosophical and ethical perspective. Attention is paid both to the form, dealing with the notions of sex, gender, transgenderism or transexualism, and to the substance, by mobilizing philosophical and ethical principles that enable us to reflect on the notion of identity.

Results/discussion

Society posits that gender identity (man, woman) is a matter of biological characteristics (male, female). From a transgender perspective however, a person’s true identity depends on their personal experience. Nobody is better placed to know whether a person is a man or a woman than the person themself, because gender arises from internal bodily experience. Contrary to conventional wisdom, a transgender individual doesn’t necessarily change sex but asserts a different gender from the one assigned to them by society based on biological criteria. Moral dilemmas arise from the moment the transgender person wishes to benefit from a treatment whose effects are dangerous and irreversible. In this case, decisions depend on the therapeutic alliance, physicians being obliged to not perform acts whose efficacy they consider doubtful. Interventions on a healthy body should only be considered if they are based on a firm will and reiterated over long time scale. They can only be covered by health insurance on the basis of a medical indication.

Conclusion/outlook

The issue of transgenderism is increasingly being raised in relation to children, an audience for whom caution is particularly important. Their brain is still developing and their desire may evolve so that they no longer feel out of step with their anatomical characteristics. According to the Hippocratic precept, in medicine it is important above all not to harm.

通常，一个人的身份是根据他们的身体特征来定义的。“男人”是指看起来像男人的人；“女人”是指看起来像女人的人。我们自发的标准是一个人的外表、轮廓和举止。“男人”是根据身体特征分配给“男性”的性别：XY核型，体毛和肌肉量增加，声音低沉，睾酮主导，阴茎，睾丸，精子等。“女人”是分配给“女性”的性别，通过一组不同的特征来识别：XX核型，乳房，雌激素主导，外阴，阴蒂，阴道，卵巢等。这些不同的因素现在正在被讨论，并在性别焦虑的情况下受到质疑。方法学这里讨论的主题是从哲学和伦理的角度分析的。我们既注意形式，处理性、性别、跨性别主义或易性主义的概念，也注意实质，通过调动使我们能够反思身份概念的哲学和伦理原则。结果/讨论社会认为性别认同（男人、女人）是生理特征（男性、女性）的问题。然而，从跨性别者的角度来看，一个人的真实身份取决于他们的个人经历。没有人比这个人自己更能知道一个人是男是女，因为性别来自于内在的身体体验。与传统观念相反，跨性别者并不一定要改变性别，而是主张一种不同于社会根据生理标准赋予他们的性别。当跨性别者希望从一种危险且不可逆转的治疗中获益时，道德困境就出现了。在这种情况下，决定取决于治疗联盟，医生有义务不执行他们认为疗效可疑的行为。对健康身体的干预，只有基于坚定的意志，并在很长一段时间内反复进行，才应予以考虑。他们只有在有医疗指征的情况下才能享受健康保险。结论/展望跨性别主义的问题越来越多地与儿童有关，对儿童群体来说，谨慎尤为重要。他们的大脑仍在发育，他们的欲望可能会进化，这样他们就不会再感到与他们的解剖学特征不一致。根据希波克拉底的格言，在医学上最重要的是不要伤害他人。

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引用次数: 0

How can euthanasia and assisted suicide regulation guarantee patient health and autonomy? Lesson from nine European countries 安乐死和协助自杀法规如何保障病人的健康和自主权？来自9个欧洲国家的教训

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-01-01 DOI: 10.1016/j.jemep.2025.101131

M. Gulino , M. Martelli , P. Ricci , S. Marinelli , G. Montanari Vergallo

Background

This paper aims to reflect on whether substantive limits should be implemented and what procedural rules should be introduced by legislators wishing to legalize euthanasia or assisted suicide (EAS) to guarantee health and autonomy of both the mentally ill and other patients.

Methodology

We analyzed and compared the rules of the nine European States (the Netherlands, Belgium, Luxembourg, Austria, Portugal, Spain, Italy, Switzerland and Germany) where EAS is lawful.

Discussion

The increase of countries that in the last years have implemented or introduced regulations on EAS leads us to think that: (a) substantive requirements should not be reduced, for example, allowing healthy people to access EAS; (b) substantive requirements must be ascertained through procedures that offer all of the guarantees of protection of the rights to life and self-determination provided for by the different regulations of the aforementioned countries, including, for example, clinical-psychological counselling to ensure autonomy of choice as well as preventive and ex-post control commission on compliance with substantive and procedural requirements. No law or ruling provided for the introduction of policies aimed at eliminating, before executing EAS, the socio-economic causes that led to the request to die.

Perspective

The framework regulating EAS should be integrated with policies and measures to guarantee favorable family and socio-economic conditions, offer full access to palliative care, and allow free and equal decision-making.

本文旨在反思立法者是否应该实施实质性限制，以及应该引入哪些程序规则，以期使安乐死或协助自杀（EAS）合法化，以保障精神病患者和其他患者的健康和自主权。方法：我们分析并比较了EAS合法的九个欧洲国家（荷兰、比利时、卢森堡、奥地利、葡萄牙、西班牙、意大利、瑞士和德国）的规则。讨论过去几年来，越来越多的国家实施或引入了关于紧急医疗服务的法规，这使我们认为：(a)实质性要求不应降低，例如，允许健康的人获得紧急医疗服务；(b)必须通过程序确定实质性要求，这些程序提供上述国家不同条例所规定的保护生命权和自决权的一切保障，例如包括临床-心理咨询，以确保自主选择，以及预防和事后管制委员会遵守实质性和程序性要求。没有任何法律或裁决规定采取旨在在执行紧急安乐死之前消除导致请求死亡的社会经济原因的政策。缓和治疗框架应与政策和措施相结合，以保证有利的家庭和社会经济条件，提供充分的姑息治疗机会，并允许自由和平等的决策。

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引用次数: 0

Cadaver dissection and biohazard risks under the specter of bioethics 生物伦理下的尸体解剖和生物危害风险

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-01-01 DOI: 10.1016/j.jemep.2025.101126

M. Pettiti , L. Nogueira , L. Lupi , O. Hamel

The use of fresh, unembalmed specimens is an essential source for anatomy laboratories in France, and raises the preliminary question of the biological risks associated with their handling. In the context of anatomical work, this exposure is major and the risk concerns all recipients of cadavers: anatomists and researchers, as well as students and laboratory technicians, all of whom are required to handle a freshly deceased person. In view of this, we wondered if the regulations governing the body donation for scientific purposes, recently included in the French bioethics laws, have sufficiently taken this risk into account, and what is really the extent of this risk when we explore the literature.

Data on the prevalence of infections on anatomical models is disparate, dating back to the last century. The persistence of pathogen viability after death, as described in the literature, does not allow us to reach a scientific consensus on the absence of postmortem contagiousness. The lack of obligation to test bodies prior to anatomical work, despite the risks of accidental injury inherent in handling sharp objects or splashing

human fluids, could lead to infected bodies being made available, without the knowledge of users. The need to incorporate “biological risk prevention” measures linked to anatomical work into the bioethics laws that have governed body donations since 2021 should also be raised, given that the few studies in this field show a wide disparity in the way these risks are understood and managed. Finally, promoting studies to provide solid scientific evidence on the risks of post-mortem transmission of infectious diseases on bodies kept in cold storage for scientific and educational purposes should be encouraged, to provide a clear and definitive answer to the question of post-mortem contagiousness

使用新鲜的、未经防腐处理的标本是法国解剖学实验室的一个重要来源，并提出了与处理这些标本相关的生物风险的初步问题。在解剖工作的背景下，这种接触是主要的，风险涉及到所有尸体的接受者：解剖学家和研究人员，以及学生和实验室技术人员，他们都需要处理一个刚刚死去的人。鉴于此，我们想知道，最近纳入法国生物伦理法的关于科学目的的遗体捐赠的规定是否充分考虑到了这种风险，以及当我们研究文献时，这种风险的真正程度是什么。从上个世纪开始，解剖学模型上感染流行率的数据各不相同。正如文献中所描述的那样，死亡后病原体生存能力的持续存在，使我们无法就没有死后传染性达成科学共识。尽管处理尖锐物体或溅起人体体液固有的意外伤害风险，但没有义务在解剖工作之前对尸体进行检测，这可能导致在用户不知情的情况下提供受感染的尸体。鉴于该领域的少数研究表明，人们对这些风险的理解和管理方式存在很大差异，因此还应提出将与解剖工作相关的“生物风险预防”措施纳入2021年以来管理遗体捐赠的生物伦理法的必要性。最后，应鼓励促进研究，就为科学和教育目的而冷藏的尸体在死后传播传染病的风险提供确凿的科学证据，从而为死后传染问题提供明确和明确的答案

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引用次数: 0

Incorporating Evidence-Based Medicine into health diplomacy: A strategic imperative for equitable global health 将循证医学纳入卫生外交：实现全球卫生公平的战略要求

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-01-01 DOI: 10.1016/j.jemep.2025.101175

A. Dutta

Background

Health diplomacy is an emerging domain within international relations, playing a vital role in addressing global health challenges through multilateral cooperation. Integrating Evidence-Based Medicine (EBM) into health diplomacy offers a systematic and scientific foundation for shaping health policies and interventions.

Objective

This article aims to explore the role of EBM in health diplomacy, emphasizing its potential to guide evidence-informed decision-making, strengthen international collaborations, and improve healthcare equity and outcomes globally.

Methods

A narrative analysis was conducted, drawing upon interdisciplinary literature and case examples to examine the integration of EBM into diplomatic processes. The study also identifies key challenges and strategic approaches for operationalizing EBM within international health frameworks.

Results

The incorporation of EBM into health diplomacy can enhance global health security and intervention efficiency. However, implementation faces barriers including political interests, cultural variations, and disparities in scientific literacy. Promising strategies include establishing evidence translation units, embedding scientific advisors in diplomatic missions, and building capacity among diplomats. The article also highlights the need for incorporating traditional medicine within EBM frameworks, through research, regulation, and respect for cultural diversity.

Conclusion

The evolving field of health diplomacy stands to benefit significantly from EBM integration. Addressing challenges and leveraging strategic interventions can enable more effective, equitable, and ethical global health governance. The article recommends enhancing global evidence-sharing mechanisms, promoting cross-sectoral expertise, and establishing ethical guidelines for evidence use in diplomatic contexts.

卫生外交是国际关系中的一个新兴领域，在通过多边合作应对全球卫生挑战方面发挥着至关重要的作用。将循证医学纳入卫生外交为制定卫生政策和干预措施提供了系统和科学的基础。本文旨在探讨循证医学在卫生外交中的作用，强调其在指导循证决策、加强国际合作以及改善全球卫生保健公平和成果方面的潜力。方法进行叙事分析，借鉴跨学科文献和案例，考察实证医学与外交进程的整合。该研究还确定了在国际卫生框架内实施循证医学的主要挑战和战略方针。结果循证医学与卫生外交相结合，可提高全球卫生安全和干预效率。然而，实施面临着包括政治利益、文化差异和科学素养差异在内的障碍。有希望的战略包括建立证据翻译单位、在外交使团中安插科学顾问以及建设外交官的能力。这篇文章还强调了通过研究、管理和尊重文化多样性将传统医学纳入循证医学框架的必要性。结论不断发展的卫生外交领域将显著受益于循证医学整合。应对挑战和利用战略干预措施可以实现更有效、公平和合乎道德的全球卫生治理。这篇文章建议加强全球证据共享机制，促进跨部门专业知识，并为外交背景下的证据使用制定道德准则。

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引用次数: 0

Health equity checklist for research 研究健康公平检查表

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-01-01 DOI: 10.1016/j.jemep.2025.101064

Nipher Malika , Stacie Salsbury , Ian Coulter , Kieran Cooley , Margaret Chesney , Marcia Prenguber , Kim Tippens , Michele Maiers

Health equity is the principle of ensuring that all individuals have optimal opportunities to attain the best health possible, addressing disparities in access, outcomes, costs, quality, and appropriateness of care. This focus on health equity is important in healthcare research, driven by the need to investigate systemic injustices and foster fair health outcomes for all, regardless of background or circumstances. Researchers have an ethical imperative to focus on issues relevant to populations bearing the highest burdens of illness and inequities. To address the gap in structured guidance for incorporating health equity principles in health-related research, this study aims to introduce a comprehensive health equity checklist developed by the RAND Research Across Complementary and Integrative Health Institutions (REACH) Center. The checklist is designed to ensure that every stage of the research process integrates health equity considerations. RAND, in collaboration with complementary and integrative health academic institutions across the United States, Canada and Puerto Rico, developed a health equity checklist. They combed through literature to assess existing guidance and developed the checklist based on gaps in literature and the specific needs identified through consultations with community partners and stakeholders. This checklist emphasizes creating a health equity research culture, involving community partners, designing inclusive research/interventions, securing equitable funding, and engaging diverse participants. It also advocates for equitable intervention delivery, data collection, analysis, and effective dissemination and sustainability of research findings. The health equity checklist provides a practical guide for researchers, community partners, and participants to reflect on inclusivity, cultural relevance, and social justice in health research. By implementing this checklist, researchers can ensure that their studies are both inclusive and impactful in advancing health equity across all areas of health-related research. Achieving health equity in research requires a comprehensive approach and significant investment in building sustainable partnerships. The RAND REACH Center's recommendations provide a guide to ensure research advances scientific understanding while actively contributing to health equity. This paradigm shift necessitates support from funding agencies and a long-term commitment to creating equitable health outcomes.

卫生公平是确保所有人都有最佳机会获得尽可能最好的健康，解决在获得、结果、成本、质量和适当性保健方面的差异的原则。这种对卫生公平的关注在卫生保健研究中很重要，其驱动因素是需要调查系统性不公正现象，并促进所有人（无论背景或情况如何）获得公平的卫生结果。研究人员在道德上必须关注与承受最高疾病负担和不平等的人群相关的问题。为了解决将健康公平原则纳入健康相关研究的结构化指导方面的差距，本研究旨在引入兰德研究跨互补和综合卫生机构（REACH）中心开发的综合健康公平清单。该清单旨在确保研究过程的每个阶段都纳入卫生公平考虑因素。兰德公司与美国、加拿大和波多黎各的互补性和综合性卫生学术机构合作，制定了一份卫生公平清单。他们对文献进行了梳理，以评估现有的指导方针，并根据文献中的差距和通过与社区合作伙伴和利益相关者协商确定的具体需求制定了清单。该清单强调创建卫生公平研究文化，让社区伙伴参与，设计包容性研究/干预措施，确保公平资助，并吸引不同的参与者。它还倡导公平的干预措施提供、数据收集、分析以及研究成果的有效传播和可持续性。卫生公平检查表为研究人员、社区合作伙伴和参与者反思卫生研究中的包容性、文化相关性和社会公正提供了实用指南。通过实施这份清单，研究人员可以确保他们的研究在促进健康相关研究的所有领域的健康公平方面既具有包容性又具有影响力。在研究中实现卫生平等需要采取综合办法，并在建立可持续伙伴关系方面进行大量投资。兰德REACH中心的建议提供了一个指南，以确保研究促进科学理解，同时积极促进健康公平。这种模式转变需要供资机构的支持，并需要长期致力于创造公平的卫生结果。

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引用次数: 0

Health care workers’ attitude toward Covid-19 vaccination campaign in Armenia — A questionnaire analysis 亚美尼亚卫生保健工作者对Covid-19疫苗接种运动的态度——问卷分析

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-01-01 DOI: 10.1016/j.jemep.2025.101137

A. Brotgandel , G. Ohan , D. Samvelian , M. Sahradyan , A.Z. Oxner , M.M. Ter-Stepanyan

Objective

The purpose of this study was to measure healthcare workers’ opinions at two clinics in Yerevan, Armenia on the Covid-19 vaccine as well as a hypothetical future pandemic, focusing on their views of the best way to respond to it.

Method

A survey was sent to all clinical and non-clinical staff, in 2024 and received 185 responses. The results of the survey given in 2024 were divided based on the profession of the healthcare workers, and they were compared to results from a similar survey given in 2021, that received 300 responses.

Results

The results showed that healthcare workers’ reasons for getting vaccinated have changed as the pandemic has progressed from mainly being focused on government regulations in 2021 to the need to prevent infections and complications of infections in 2024. Additionally, healthcare workers in Armenia were still mostly hesitant about vaccination in the case of a future pandemic, with only 54.6% having heard of the need to prepare for the next pandemic.

Discussion

The significance of this study stems from the understanding that specific cultural and historical factors impact vaccine hesitancy in a society. By considering what local factors affect acceptance of new vaccines in Armenia, new public health interventions can be developed for meeting the WHO goals of preparedness for “Pandemic X.” This study additionally emphasizes that the Armenian healthcare system is not prepared for the next pandemic, especially in reaching the expected threshold for herd immunity.

本研究的目的是测量亚美尼亚埃里温两家诊所的医护人员对Covid-19疫苗以及假设的未来大流行的看法，重点关注他们对应对疫情的最佳方式的看法。方法于2024年对所有临床及非临床工作人员进行问卷调查，共收到185份问卷。2024年的调查结果根据医护人员的专业进行了划分，并将其与2021年的类似调查结果进行了比较，该调查收到了300份回复。结果结果显示，随着疫情的发展，医护人员接种疫苗的原因发生了变化，从2021年主要关注政府法规，到2024年主要关注预防感染和感染并发症的需要。此外，亚美尼亚的卫生保健工作者在未来大流行的情况下对接种疫苗仍然大多犹豫不决，只有54.6%的人听说过需要为下一次大流行做准备。本研究的意义源于对特定文化和历史因素影响社会中疫苗犹豫的理解。通过考虑当地因素对亚美尼亚接受新疫苗的影响，可以制定新的公共卫生干预措施，以满足世卫组织为“x大流行”做好准备的目标。这项研究还强调，亚美尼亚卫生保健系统没有为下一次大流行做好准备，特别是在达到预期的群体免疫阈值方面。

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引用次数: 0

Short report: Surrogacy reforms in the Netherlands 简短报道：荷兰的代孕改革

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-01-01 DOI: 10.1016/j.jemep.2025.101133

A. den Exter

Background

In July 2023, a revised draft Law regulating non-commercial surrogacy in the Netherlands was presented to Parliament. The Bill aims to create greater legal certainty for the surrogate mother and intended parents while emphasising the child’s best interests. Key elements of the proposal include: 'surrogacy agreements' that are recorded prior to conception and submitted to the court for approval, and the child’s right to information about parentage. To facilitate this right, a register will be established containing the donor details, information about the surrogate mother, details regarding domestic and foreign adoption, and other general information about biological parentage.

Methodology

This brief report examines the proposed normative framework for regulating surrogacy arrangements in the Netherlands from a legal perspective, questioning whether it provides greater legal certainty for the surrogate mother and intended parents.

Results/discussion

Key elements of the surrogacy bill are the non-commercial character of surrogacy, judicial review of the surrogacy agreement, and the child's right to parentage information. This draft Law complies with the protective interests of the child under Article 8 of the ECHR and various provisions of the Convention on the Rights of the Child. It also guarantees the reproductive autonomy of the surrogate mother and her right to protection against exploitation. For the intended parents, on the other hand, there is no absolute human rights protection for having a child. In this sense, there is no right of access to surrogacy.

Conclusion

The bill leaves some questions unanswered, which would be better addressed by judicial discretion.

2023年7月，荷兰向议会提交了一份修订后的关于非商业代孕的法律草案。该法案旨在为代孕母亲和准父母创造更大的法律确定性，同时强调孩子的最大利益。该提案的关键内容包括：“代孕协议”要在受孕前记录下来，并提交法院批准，以及孩子有权了解父母的身份。为了促进这一权利，将建立一个登记册，其中载有捐助者的详细资料、代孕母亲的资料、国内和国外收养的详细资料以及其他关于亲生父母的一般资料。这篇简短的报告从法律的角度审视了拟议的规范框架，以规范荷兰的代孕安排，质疑它是否为代孕母亲和准父母提供了更大的法律确定性。结果/讨论代孕法案的关键要素是代孕的非商业性质，代孕协议的司法审查，以及孩子获得亲子信息的权利。该法律草案符合《欧洲人权公约》第8条和《儿童权利公约》关于保护儿童利益的各项规定。它还保障代孕母亲的生殖自主权和保护她不受剥削的权利。另一方面，对于准父母来说，生孩子没有绝对的人权保护。从这个意义上说，没有权利获得代孕。结论该法案留下了一些悬而未决的问题，这些问题最好通过司法自由裁量权来解决。

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引用次数: 0

Commercial determinants of infant and child health: A focus on Nestlé’s baby food products marketed in Africa 婴幼儿健康的商业决定因素：以雀巢在非洲销售的婴儿食品为重点

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-01-01 DOI: 10.1016/j.jemep.2025.101186

E.W. Dumbili , J. Bwalya , A. Osborne

Background

The transnational baby food industry (TBFI), which operates in Africa, engages in aggressive marketing and deploys corporate practices to maximise profits. However, there is a paucity of studies examining the impact and ethical implications of TBFI’s practices on the health of African children. Using the Commercial Determinants of Health (CDoH) framework, we reviewed the recent investigation by Public Eye and the International Baby Food Action Network (IBFAN) on Nestlé’s double-standard practices in Africa, drawing on other published literature to discuss the implications.

Results

Nestlé promotes commercial milk formulas and other baby food products with added sugar in Africa, while the same products in Europe are sugar-free. For example, Nestlé’s biscuit-flavoured cereals for babies 6 months plus, available in Switzerland, contain no added sugar. Still, Cerelac cereals with the same flavour sold in Senegal and South Africa contain 6 g of added sugar per serving. Furthermore, Nestlé’s Cerelac wheat-based cereals for six-month-old babies sold in Germany and the UK contain no added sugar. However, the same product available in Ethiopia contains 5.2 g per serving. The investigation further shows that of 114 Nestlé products examined, 93% (106) contained added sugar. Regarding Nestlé’s commercial milk formula for babies aged 1–3 years sold in Africa, 21 out of 29 (i.e., 72%) contained added sugar. Nestlé also practices misinformation because while its product labels in Ethiopia, Nigeria and Senegal provide no information about the added sugar, they “prominently highlighted the vitamins, minerals and other nutrients… using idealizing imagery”.

Conclusion

We discuss the implications of this, recommending ways to mitigate Nestlé’s commercial and corporate practices that undermine the health of infants and young children.

跨国婴儿食品工业（TBFI），在非洲经营，从事积极的营销和部署企业的做法，以实现利润最大化。然而，很少有研究审查tfi的做法对非洲儿童健康的影响和伦理问题。利用健康的商业决定因素（CDoH）框架，我们回顾了Public Eye和国际婴儿食品行动网络（IBFAN）最近对雀巢雀巢在非洲的双重标准做法的调查，并借鉴了其他已发表的文献来讨论其影响。结果雀巢雀巢在非洲推广含有添加糖的商业配方奶粉和其他婴儿食品，而在欧洲同样的产品是无糖的。例如，雀巢在瑞士为6个月以上的婴儿提供的饼干口味的谷物，不含添加糖。尽管如此，在塞内加尔和南非销售的同样口味的Cerelac谷物每份含有6克添加糖。此外，雀巢在德国和英国销售的6个月大婴儿用的Cerelac小麦谷物不含添加糖。然而，在埃塞俄比亚，同样的产品每份含有5.2克。调查进一步表明，在114种雀巢雀巢产品中，93%（106种）含有添加糖。在非洲销售的雀巢1-3岁婴幼儿配方奶粉中，29款中有21款（即72%）含有添加糖。雀巢雀巢也在制造虚假信息，因为尽管其在埃塞俄比亚、尼日利亚和塞内加尔的产品标签上没有提供有关添加糖的信息，但它们“突出强调了维生素、矿物质和其他营养成分……使用理想化的图像”。我们讨论了这一结论的含义，并提出了减轻雀巢损害婴幼儿健康的商业和企业做法的方法。

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引用次数: 0

Delivery of perinatal mental health services in India, and the National Nursing and Midwifery Commission Act, 2023: The connotations 印度提供围产期精神卫生服务和《2023年国家护理和助产委员会法》：内涵

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-01-01 DOI: 10.1016/j.jemep.2025.101130

R. Behl

Background

The WHO recently recommended regular screening of postnatal depression and anxiety, and delivery of treatment interventions, which can be competently undertaken by non-specialist health workers as well. In India, the National Nursing and Midwifery Commission (NNMC) Act, 2023 has been recently enforced to regulate, and maintain standards of education, and services prescribed for nursing and midwifery professionals, and the development and adoption of scientific advancements in healthcare models.

Aim

To understand if delivery of perinatal mental health (PMH) services in the context of provisions of the NNMC Act, 2023 can be feasibly undertaken by nursing and midwifery personnel in India, and which group of the personnel can feasibly deliver the same.

Methods

Normative Juridical method was used to identify the provisions of the NNMC Act relating to nursing and midwifery personnel, and a comparative interpretative method was utilized to analyze the feasibility of delivery of PHM services by these personnel.

Results

The NNMC Act, 2023 expansively differentiates between nursing, and midwifery, and provides for different cadres under the nursing, and midwifery groups of personnel. The Nurse Practitioner in Midwifery (NPM) can most optimally deliver PMH services, and in their absence, Midwifery Professionals can undertake the task through an integrated approach. However, an acute shortage of nursing and midwifery personnel exists at the nationwide level.

Conclusion

The NNMC Act, 2023 can facilitate the delivery of PMH services but the number of available human resources must be increased, and the existing healthcare personnel must be sufficiently trained.

世卫组织最近建议定期筛查产后抑郁和焦虑，并提供治疗干预措施，非专业卫生工作者也可以胜任这些工作。在印度，最近实施了《2023年国家护理和助产委员会法》，以规范和维持护理和助产专业人员的教育标准和规定的服务，以及发展和采用医疗保健模式中的科学进步。目的了解在《2023年NNMC法》规定的范围内，印度的护理和助产人员是否可以切实提供围产期精神卫生服务，以及哪一类人员可以切实提供这种服务。方法采用规范性法学方法对NNMC法案中有关护理和助产人员的规定进行识别，并采用比较解释法分析这些人员提供PHM服务的可行性。结果《NNMC法案，2023》对护理和助产进行了广泛的区分，并规定了护理和助产人员组下的不同干部。助产士执业护士（NPM）可以最理想地提供PMH服务，在他们缺席的情况下，助产士专业人员可以通过综合方法承担这项任务。然而，在全国范围内，护理和助产人员严重短缺。结论2023年NNMC法案可以促进PMH服务的提供，但必须增加现有人力资源的数量，并对现有的卫生保健人员进行充分的培训。

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引用次数: 0

Protection of the elderly patient and preservation of decision-making autonomy at the end of life in Belgian law 比利时法律对老年病人的保护和在生命结束时保留决策自主权

Q3 Medicine

Ethics, Medicine and Public Health

Pub Date : 2025-01-01 DOI: 10.1016/j.jemep.2025.101046

G. Genicot

Context

In Belgian law, medical decisions are placed under the banner of the patient's self-determination, expressed, if necessary, in the form of binding advance directives or conveyed by a representative – freely chosen, or designated by the law or the judge – who has decision-making powers.

Methodology

The way in which the law understands reality differs from that of other disciplines, including the humanities and social sciences. For this subject, reality is studied through the development of rules (issues, content, spirit), but also through their practical application, especially in the case of litigation, through the study of court decisions that may be handed down. This method is used here in relation to end of life.

Results/discussion

The patient's decision-making autonomy is the cornerstone of Belgian medical law, and it remains – simply exercised in a different way – when patients are no longer able to exercise their rights themselves. Belgian law provides for (i) an absolute right of an adult patient to refuse any treatment, including in the form of advance directives; (ii) the right to appoint a health proxy whose decision will be binding both on (other) family members and on the doctor; (iii) and, failing that, a "cascade" mechanism designating in any event a person empowered to exercise the rights of a patient who is incapable of doing so, and giving the immediate family a decision-making role rather than a merely advisory one, with a hierarchy among family members (priority being given to the spouse, whether married or not).

Conclusion/outlook

In medical matters, and especially at the end of life, the crucial point which is illustrated by the legal framework is probably the decision-making model itself. The law should suggest a model which, in this field, is as much societal (and ethical) as strictly legal. In this respect, the scheme set up in Belgian law has the salutary effect to adequately meet the needs of healthcare practice, and the legitimate aspirations of citizens. By placing the centre of gravity of medical decisions on the side of the patient and not the doctor, including at the end of life, it is fundamentally different from a consultation scheme, which results in a decision that is certainly concerted, but remains medical.

在比利时法律中，医疗决定是在病人自决的旗帜下作出的，必要时以具有约束力的预先指示的形式表达，或由具有决策权的代表（自由选择或由法律或法官指定）转达。法学法学理解现实的方式不同于其他学科，包括人文科学和社会科学。对于这一学科，通过规则（问题、内容、精神）的发展来研究现实，但也通过它们的实际应用来研究现实，特别是在诉讼的情况下，通过研究可能下达的法院判决。这种方法在这里用于生命的终结。结果/讨论患者的决策自主权是比利时医疗法的基石，当患者不再能够行使自己的权利时，它仍然存在-只是以不同的方式行使。比利时法律规定(i)成年患者有拒绝任何治疗的绝对权利，包括预先指示的形式；（二）有权指定一名健康代理人，其决定对（其他）家庭成员和医生都具有约束力；（iii）如果做不到这一点，则应设立“级联”机制，在任何情况下指定一名有权行使无能力行使病人权利的人，并赋予直系亲属一个决策角色，而不仅仅是一个咨询角色，并在家庭成员之间划分等级（优先考虑配偶，无论已婚与否）。结论/展望在医疗问题上，特别是在生命结束时，法律框架所说明的关键点可能是决策模式本身。法律应该提出一种模式，在这一领域，既要符合严格的法律，又要符合社会（和道德）标准。在这方面，比利时法律规定的计划对充分满足保健实践的需要和公民的合法愿望具有有益的作用。通过将医疗决定的重心放在病人而不是医生一边，包括在生命结束时，它与会诊计划有着根本的不同，会诊计划的结果肯定是协调一致的，但仍然是医疗决定。

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引用次数: 0