Developing World Bioethics最新文献

Assisted reproductive technology is a complex medical intervention with many potential social sensitivities. Within this domain, oocyte cryopreservation has emerged as an important research area for preserving female fertility. Against the backdrop of the hotly debated first legal case in China of a single woman wishing to freeze her eggs, and the implementation of the ‘three-child policy’ in China, there is an urgent need to evaluate policies and address ethical considerations surrounding oocyte cryopreservation for non-medical reasons. This review examines current policies, explores China's practices and research, and examines the latest ethical challenges surrounding non-medical oocyte cryopreservation. It develops strategies and recommendations that will be relevant in China and other developing countries seeking to navigate this complex landscape.

Medical professionalism faces serious challenges in homophobic societies. A case in point: Uganda. The country has gained global notoriety for having implemented one of the toughest anti-LGBTQ laws in the world. It includes the death penalty for something called ‘aggravated homosexuality’, as well as a 20-year prison sentence for ‘promoting’ homosexuality.1

When issuing a different, less draconian anti-gay legislation some years back, the country's health minister assured Ugandans, as well as the international community, that all people, regardless of sexual orientation, would receive ‘full treatment’ and added that ‘health workers will live up to their ethics of keeping confidentiality of their patients’.2 Gay patients experienced a quite different reality. In 2017 the activist group Sexual Minorities Uganda issued a report under the title ‘Even if they spit at you, don't be surprised’.3 I recommend the document to your attention. It's replete with first-person accounts of unprofessional conduct by health care professionals. It ranges from the use of derogatory language to refusal of service provision to actual physical attacks. There is also evidence of medical school training containing scientific misinformation on homosexuality.

While unusual by today's global standards, Uganda isn't the only country with anti-gay legislation on its books. Less draconian legislation can be found in homophobic societies like Jamaica, for instance. There is a high number of former British colonies with such laws, but it's unclear whether that's mere correlation or whether there is a causation-type relationship. While the legislation in place oftentimes is a relic of colonial era laws, there also appears to be widespread societal support for such measures in these predominantly Christian societies. While some Caribbean nations have recently decriminalized consensual same-sex relations, six Caribbean countries, among them larger countries like Jamaica, still criminalise consensual same-sex sexual relations. They are not alone, some 66 countries reportedly criminalise consensual same-sex relations.4 The World Medical Association saw it fit, against this background, to issue a strong statement condemning the participation of medical professionals in anal examinations ostensibly designed to assist in determinations of same-sex sexual activities.5 Apparently such examinations actually happen in certain societies, even though they are based on humbug science.6

This raises a number of important issues regarding the health care that patients who identify as gay or queer, or who participate in same-sex sexual relations, can reasonably expect in such societies. The uncontroversial objective of health care provision is to increase or maximise the number of life-years a person can live with a good quality of life that makes their life worth living, in their own considered judgment. Health care professionals value judgments about the lifest

In Africa, homosexuality is routinely understood as a form of immoral behaviour. This has great implications for the physical and psychological well-being of homosexuals in Africa. One of the reasons why homosexuals are sometimes understood to be behaving immorally is because it is believed that same-sex relations are unnatural. I think that this conception of unnatural is grounded on the perverted faculty argument, although this is not often expressed in such terms. In this article, I will develop a concept of natural grounded on the concept of Ukama. I will show that despite Ukama implying a functional conception of nature, just like in the perverted faculty argument, it does not imply that homosexuality is immoral.

A woman's right to a safe legal abortion in South Africa conflicts with a health care professional's freedom of conscience. Conscientious objection or treatment refusal on the basis of conscience may be protected by the constitution but its morality has not been explored. This study uses Kantian Deontology to elucidate the ethical duties of health care professionals based on the Physician's Pledge. It concludes that conscience is morally empty and that health care professionals have a duty to treat all patients equally irrespective of the condition they present. Drawing on Kantian promise keeping, the study also concludes that health care professionals should place patients health and wellbeing above all other considerations. Using the categorical imperative, the study shows that health care professionals have a perfect duty not to refuse treatment. The study recommends that conscientious objection be rejected in all circumstances except where the psychological wellbeing of the health care professional will be affected. This can be achieved through legislative and professional body regulation of conscientious objection.

In this paper, I raise some doubts about Nicole Hassoun's account of the obligations of states, pharmaceutical firms, and consumers with regard to global health, presented in Global Health Impact. I argue that it is not necessarily the case, as Hassoun claims, that if states are just, and therefore satisfy all of their obligations, then consumers will not have strong moral reasons, and perhaps obligations, to make consumption choices that are informed by principles and requirements of justice. This is because there may be justice-based limits on what states can permissibly and feasibly do both to promote access to existing drugs for all of those who need them, and to promote research and development for new drugs that could treat diseases that primarily affect the global poor. One important upshot of my argument is that there can be reasons for organizations like the Global Health Impact Organization to exist, and to do the kind of work that Hassoun argues is potentially valuable in our deeply unjust world, even in much less unjust worlds in which states and firms largely, or even entirely, comply with their obligations.

During the COVID-19 pandemic, healthcare professionals around the world were driven by universal values of solidarity and duty to provide care. However, local societal norms and existing healthcare systems influenced interactions among physicians, and with patients and their families. An exploratory qualitative study design using in-depth interviews was undertaken with physicians working at two public sector hospitals in Karachi, Pakistan. Using the constant comparison method of data analysis, several key themes were identified highlighting norms of kinship and interdependencies characteristic of collectivistic societies that influenced professional interactions. The role of seniors in the hierarchical society of Pakistan played a major role in provision of care. Physicians reported numerous challenges in dealing with patients and their families amidst public denial fueled due to ill-formed government policies. This included interruption of funeral rites which undermined public trust. The study provides insights into the local moral world of two healthcare institutions in Pakistan.

As neuroethics continues to grow as an established discipline, it has been charged with not being sufficiently sensitive to the way in which the identification, conceptualization, and management of the ethical issues raised by neuroscience and its applications are shaped by local systems of knowledge and structures. Recently there have been calls for explicit recognition of the role played by local cultural contexts and for the development of cross-cultural methodologies that can facilitate meaningful cultural engagement. In this article, we attempt to fill this perceived gap by providing a culturally situated analysis of the practice of electroconvulsive therapy (ECT) in Argentina. ECT was introduced as a psychiatric treatment in Argentina in the 1930s but it is largely underutilized. While the use of ECT remains low in several countries, what makes the Argentinian case interesting is that the executive branch of government has taken a stance regarding both the scientific and moral appropriateness of ECT, recommending its prohibition. Here, we begin with a recent controversy over the use of ECT in Argentina and explain the legal recommendation to ban its application. Next, we offer an overview of some of the salient aspect of the international and local discussions on ECT. We argue that the governmental recommendation to ban the procedure should be rethought. While acknowledging the role that contexts and local conditions play in shaping the identification and assessment of the relevant ethical issues, we caution against using contextual and cultural considerations to avoid a necessary ethical debate on controversial issues.

Biobanks’ activity is based not only on securing the technology of collecting and storing human biospecimen, but also on preparing formal documentation that will enable its safe use for scientific research. In that context, the issue of informed consent, the reporting of incidental findings and the use of Transfer Agreements remain a vast challenge. This paper aims to offer first–hand tangible solutions on those issues in the context of collaborative and transnational biobanking research. It presents a four-step checklist aiming to facilitate researchers on their compliance with applicable legal and ethical guidelines, when designing their studies, when recruiting participants, when handling samples and data, and when communicating research results and incidental findings. Although the paper reflects the outcomes of the H2020 B3Africa project and examines the transfers from and to the EU as a case study, it presents a global checklist that can be used beyond the EU.