Ethics, Medicine and Public Health最新文献

{"title":"The Impact of Patient Characteristics on Total Hospital Cost in Patients Undergoing Coronary Artery Bypass Grafting","authors":"J. Katsiroubas ,&nbsp;J. Wong ,&nbsp;K. Jonnalagadda ,&nbsp;T.S. Guy","doi":"10.1016/j.jemep.2025.101072","DOIUrl":"10.1016/j.jemep.2025.101072","url":null,"abstract":"<div><h3>Introduction</h3><div>Coronary artery bypass graft (CABG) is one of the most common surgeries in the United States, with an average cost around $40,000. However, the burden of these costs may fall unequally among patients of different demographic groups. The objective of this study is to characterize factors associated with increased total cost after coronary artery bypass graft surgery.</div></div><div><h3>Methods</h3><div>The Statewide Planning and Research Cooperative System (SPARCS) database for years 2017–2021 was queried to identify patients who had undergone CABG in New York State. Patient characteristics including gender, age, race, and All Patient Refined (APR) severity of illness (SOI), and risk of mortality (ROM) were analyzed. The Primary outcome was total cost. Data was analyzed using Student t-test and univariate analysis.</div></div><div><h3>Results</h3><div>Between 2017 and 2021, 38,344 patients, 76.6% male, underwent CABG in New York State. Race was documented identifying 67.0% White, 7.0% Black/African American, 0.7% multiracial, and 25.4% other. The mean length of stay (LOS) was 9.9 days. The average total hospital cost was $61,596.90. The average hospital cost for Black/African Americans was $71,683.12, 19.7% ($14,119.67) more than Whites, the lowest paying racial group (13.56 <em>P</em> &lt; 0.05). Black/African Americans also had the longest average LOS of 11.7 days, compared to 9.6 days for white patients, 11.3 days for multi-racial patients and 10.3 days for those who identified as other. Univariate analysis exhibited factors associated with the top quartile of hospital cost (≥$68,608) for CABG included Black/ African American race (2.01 CI 0.61−0.78), LOS more than 6 days (9.68, CI 2.18–2.35), major APR severity of illness (5.55, CI 1.15–1.91) and extreme (28.09, CI 3.13–3.54) and major (5.28, CI 1.56–1.76) and extreme APR risk of mortality (16.9, CI 2.72–2.94).</div></div><div><h3>Conclusion</h3><div>The cost of coronary artery bypass grafting surgery is influenced by a variety of factors including race, APR severity score, mortality risk and length of stay.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101072"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143577660","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}

{"title":"The US healthcare system facilitates medical conspiracy theories: A call to action","authors":"C. Bobier,&nbsp;J. Obeid","doi":"10.1016/j.jemep.2025.101090","DOIUrl":"10.1016/j.jemep.2025.101090","url":null,"abstract":"<div><div>Medical conspiracy theories pose a public health risk and erode trust in healthcare providers. While research continues on the psychological, social, and evolutionary foundations of conspiratorial thinking, as well as on intervention strategies, less attention has been given to the role of healthcare system structures. This paper examines how the design and delivery of the U.S. healthcare system contribute to the spread of medical conspiracy theories. Using a two-pronged analytical framework, we (1) identify key features of the U.S. healthcare system and patient experience and (2) map these features onto known psychological and social drivers of conspiratorial beliefs. We argue that addressing medical conspiracy theories requires not only individual or community-level interventions but also structural reforms in healthcare. Researchers should therefore explore the feasibility and impact of systematic changes in mitigating conspiratorial thinking.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101090"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776544","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}

{"title":"Shifting landscapes: Post-COVID-19 infectious disease focus in Vietnam","authors":"N.X. Ha ,&nbsp;A.M. Nguyen ,&nbsp;R. Elsheikh ,&nbsp;A.M. Makram ,&nbsp;N.T. Huy","doi":"10.1016/j.jemep.2025.101083","DOIUrl":"10.1016/j.jemep.2025.101083","url":null,"abstract":"","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101083"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760116","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}

{"title":"Emerging infectious threats: first identification of reovirus cases in Bangladesh","authors":"S. Jamil ,&nbsp;S. Biswas ,&nbsp;N. Ali ,&nbsp;F. Ahmed","doi":"10.1016/j.jemep.2025.101050","DOIUrl":"10.1016/j.jemep.2025.101050","url":null,"abstract":"","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101050"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143429537","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}

{"title":"Bioethical challenges and artificial intelligence, focus Quebec/France","authors":"O. Gout ,&nbsp;M. Lacroix","doi":"10.1016/j.jemep.2025.101058","DOIUrl":"10.1016/j.jemep.2025.101058","url":null,"abstract":"<div><div>The authors discuss the potential benefits of AI for the healthcare system. To do this, they consider the importance of ensuring the confidentiality of medical data, maintaining a patient-doctor relationship imbued with humanity, as well as liability remedies specific to stemming the potential abuses of AI.</div></div><div><h3>Context</h3><div>In the healthcare sector, both in France and in Canada, AI is expected to be a tool for transforming and democratising healthcare by improving its quality, safety and effectiveness. We therefore need to analyse the legal framework in place to ensure that these objectives are met.</div></div><div><h3>Methodology</h3><div>The question is addressed on the basis of a study of the rules through the diversity of their conception, their implementation by the courts (case law) and their analysis by the authors making up the doctrine.</div></div><div><h3>Results/discussion</h3><div>The authors discuss the potential benefits of AI for the healthcare system. To do this, they consider the importance of ensuring the confidentiality of medical data, maintaining a patient-doctor relationship imbued with humanity, as well as liability remedies specific to stemming the potential abuses of AI.</div></div><div><h3>Conclusion/outlook</h3><div>While the regulations applicable to AI are considered to be relevant and appropriate for taking account of the various issues, particularly in terms of privacy and liability, it will be necessary to remain attentive to their implementation in order to ensure that the objectives are effectively achieved.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101058"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143213226","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}

{"title":"The impact of United States’ withdrawal from the WHO on global health equity and pandemic preparedness","authors":"Y.B. Abdullahi ,&nbsp;M.M. Ahmed","doi":"10.1016/j.jemep.2025.101057","DOIUrl":"10.1016/j.jemep.2025.101057","url":null,"abstract":"","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101057"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143213227","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}

{"title":"The minor’s healthcare","authors":"L. Sauvé","doi":"10.1016/j.jemep.2025.101089","DOIUrl":"10.1016/j.jemep.2025.101089","url":null,"abstract":"<div><div>This article explores the regulation of children’s healthcare under French law, taking into consideration the role of parents, the welfare of the child, and the child’s autonomy. Parents primarily make healthcare decisions on behalf of their child’s, acting as representatives of the child’s best interests within the framework of parental authority. The level of consent required depends on the seriousness of the medical decision at hand; for everyday medical matters, one parent’s consent may suffice, while decisions involving the child’s physical well-being may necessitate consent from both parents. Despite the central role of parents, French law underscores that all parental decisions must prioritise the child’s welfare. Consequently, parents cannot make arbitrary decisions, and certain actions are mandatory, even if parents are unwilling to carry them out. Furthermore, in the past four decades, there has been a growing emphasis on children’s rights, prompting the French legislator to increasingly acknowledge children’s voices, especially in healthcare-related matters. Today, the legislator grants various rights to the child, such as the right to veto, the right to consent to decisions alongside their parents, and sometimes the right to act independently without consulting their parents. In sum, French legislation has aimed to strike a balance between recognising the child’s autonomy and the imperative of protecting them from their own decisions.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101089"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Focus philosophy: Transgenderism, conceptual and ethical aspects","authors":"P. Le Coz","doi":"10.1016/j.jemep.2025.101163","DOIUrl":"10.1016/j.jemep.2025.101163","url":null,"abstract":"<div><h3>Context</h3><div>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.</div></div><div><h3>Methodology</h3><div>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.</div></div><div><h3>Results/discussion</h3><div>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.</div></div><div><h3>Conclusion/outlook</h3><div>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.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101163"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878775","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}

{"title":"How can euthanasia and assisted suicide regulation guarantee patient health and autonomy? Lesson from nine European countries","authors":"M. Gulino ,&nbsp;M. Martelli ,&nbsp;P. Ricci ,&nbsp;S. Marinelli ,&nbsp;G. Montanari Vergallo","doi":"10.1016/j.jemep.2025.101131","DOIUrl":"10.1016/j.jemep.2025.101131","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methodology</h3><div>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.</div></div><div><h3>Discussion</h3><div>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.</div></div><div><h3>Perspective</h3><div>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.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101131"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313005","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}

{"title":"Cadaver dissection and biohazard risks under the specter of bioethics","authors":"M. Pettiti ,&nbsp;L. Nogueira ,&nbsp;L. Lupi ,&nbsp;O. Hamel","doi":"10.1016/j.jemep.2025.101126","DOIUrl":"10.1016/j.jemep.2025.101126","url":null,"abstract":"<div><div>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.</div><div>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</div><div>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</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101126"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144205146","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}