Asian Bioethics Review最新文献

Consent in research is inarguably a highly contentious and debated topic. One of the biggest debates in research ethics revolves around the determination of when consent is necessary, as there is a need to balance participant protections and research advancements. Contrary to popular belief, obtaining informed consent may not necessarily be better for the participant. One illustration of this can be taken from the United States’ (US) 2011 proposal to require consent for the research use of de-identified bio-specimens under the applicable regulations (what is often referred to as the “Common Rule”). The proposed transition from no consent to broad consent was met with strong opposition from researchers and the public alike, highlighting the possible superiority of not requiring consent when de-identified bio-specimens are used in research. Against this backdrop, this article uses legal and bioethical perspectives to evaluate Singapore’s consent procedures for the secondary research use of de-identified bio-specimens, arguing that Singapore is ready and in need of further liberties to allow for more robust research advancements and better participant outcomes.

The proliferation of medical clinics on urban streets in Pakistan presents a paradoxical situation that leads to healthcare fragmentation. Low- and middle-income countries like Pakistan face various challenges, exacerbating inequalities in access to delivery of treatment, low-quality standards, behavioral issues, a lack of accountability, and reduced patient satisfaction, which lead to inefficiencies. This study examines the elements that contribute to this condition, such as patient preferences, organizational incentives, and the amount of patient knowledge. Data was collected through surveys (N = 158) and semi-structured interviews (N = 15) with patients, doctors, and healthcare staff. The research found that the proliferation of clinics and fragmentation of healthcare are not accidental. Various factors contribute to this situation, such as patient preferences and conveniences, referrals by initial physician, organizational panel, proximity, cost, and the level of patient education, among others. The findings highlight the need for concerted efforts to address the issues of trust, coordination, and doctor-patient contact in the healthcare environment.

Machine learning technologies deployed in several sub-Saharan African countries to assist medical practitioners have shown how such technologies can significantly extend the reach of limited medical personnel and equipment resources. However, while I praise the efficiency of these technologies in carrying out medical diagnosis and treatment recommendations, I raise some critical concerns about the normative shift that may occur in their usage in the region. An uncritical use or overreliance on these technologies may threaten shared decision-making between patients and doctors. While shared decision-making is an integral component of patient-centred care in contemporary medicine that must be respected, from a phenomenological perspective, the stakes are higher for sub-Saharan Africans. For Africans, the threat to shared decision-making may negatively impact a significant aspect of the community–interpersonal relationships. I contend that over-relying on these systems for clinical diagnosis and recommendations may diminish the value of interpersonal relationships between patients and doctors. I show how the practice of interpersonal relationships is integral in making a moral agent (to becoming a member of the moral community) within the sub-Saharan African value systems. Finally, this paper seeks to make novel contributions to value-sensitive healthcare/healthcare technology policies, guidelines and regulations within sub-Saharan Africa and countries in the global South that share similar ethical/cultural worldviews.

Tuberculosis (TB) and multidrug-resistant TB (MDRTB) are a major global health problem, and the Western Province of Papua New Guinea (PNG) has some of the highest rates of TB and MDRTB in the world. Due to its geographical location at the intersection of PNG, Australia and Indonesia, MDRTB in Western Province has significant health security implications. This article explores TB and MDRTB from a global health perspective with reference to the United Nations Millennium Development Goals and Sustainable Development Goals, followed by analysis of the unprecedented outbreak of MDRTB in Western Province PNG. This is followed by a focused history of the regulatory instrument, Public Health Emergency of International Concern (PHEIC), the advantages and disadvantages of declaring a PHEIC for MDRTB, and whether a PHEIC declaration is the right instrument to assist in combating MDRTB in Western Province, and MDRTB globally.

Post-mortem examinations (PME) often yield valuable information regarding the cause and manner of death. They aid in identifying underlying disease, support public health efforts, and inform criminal investigations. In the clinical context, PME improves understanding of disease processes, prevents future illness in others, and provides comfort and closure to families. In Saudi Arabia, a multitude of cultural, religious, and ethical concerns often preclude frank discussions and contribute to the reluctance of both families and practitioners to pursue these examinations. In this paper, we contend that clinical PME should be routinely offered to family members after the unexplained death of an individual. To that end, we propose a religiously informed and culturally sensitive ethical framework, one that is cognizant of local cultural, ethical, and religious needs. We begin with an overview of PME, its development, and its current state in Saudi Arabia. Next, we examine the cultural, religious, and ethical challenges that contribute to the underutilization of PME. Finally, we address these challenges through our proposed framework in the hope that a more representative approach to PME will permit more utilization and benefit.

Gender discrimination in the medical profession is a pressing issue in Pakistan, and the derogatory term “Doctor Bride” has perpetuated harmful stereotypes about female doctors. This paper argues that gender biases and societal expectations hinder women from pursuing careers in medicine. The focus on the term and stereotyping of female doctors is based on prejudice, which results in epistemic injustices. It fails to address the systemic issues that keep female doctors out of clinical practice. The cultural norms and prejudices towards women in professional settings exacerbate the challenges they face in pursuing a medical career. These challenges include social and cultural expectations of prioritizing family over careers, biases in healthcare organizations, and discouragement for married women or those with children to pursue certain specialties. This paper highlights the need to address gender discrimination and create a more inclusive environment for women in the medical profession in Pakistan and globally.

Notwithstanding its potential medical benefits, there are unproven stem cell–based therapies being offered across the globe. Little is known about the landscape of Malaysia’s private stem cell sector of which this study aims to explore. Qualitative study was conducted to explore its status through empirical interviews with stakeholders in the private sector. This study reveals that private researchers face with limited funding and overwhelming bureaucracies resulting in a low output. There is also a lack of governance for stem cell therapy, and some concerns over how stem cell–based therapies are being offered. Hence, urgent interventions by regulatory authorities are vital to ensure ethical and safe clinical practices in the private sector to protect the reputation of this promising industry.

China and Japan have similar cultures but differing healthcare systems. In both countries, admissions of medical error and apologies by doctors continue to be an important but difficult issue. The present study aimed to examine and compare the thoughts and behaviors of Chinese and Japanese doctors when faced with the unexpected death of a patient. Qualitative descriptive analysis was performed to compare the responses of 20 doctors from each country to a hypothetical scenario involving the death of a patient. We found that almost all doctors in both countries considered the treatment process described in the hypothetical scenario to be inappropriate and most would feel regret when faced with the young patient’s death. There was a disagreement concerning responsibility for the patient death among the doctors regardless of their nationality. Doctors decided how to behave facing the patient death after anticipating the bereaved family’s reaction and their initial responses varied widely. Japanese doctors indicated that they would communicate with the patient’s family after a patient died, whereas none of the Chinese doctors indicated they would do so due to a fear of physical violence from the bereaved family. Finally, the decision on whether to disclose the medical error and apology was made after careful and complex consideration. In conclusion, significant differences were observed between Chinese and Japanese doctors with respect to communicating with, and disclosing errors and apologizing to, the bereaved family. We discuss both the ethical and social implications of these differences.