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Biomedical research on autism in low- and middle-income countries: Considerations from the South African context. 中低收入国家的自闭症生物医学研究:南非的考虑因素。
IF 2.2 3区 哲学 Q3 ETHICS Pub Date : 2024-02-26 DOI: 10.1111/dewb.12446
Siobhan de Lange, Dee Muller, Chloe Dafkin

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by social/communicative difficulties and perseverative behaviours. While research on autism has flourished recently, few studies have been conducted on the disorder in non-Western contexts. In low- and middle-income countries (LMICs), biomedical research on autism is required to better understand the needs of the population and to develop contextually appropriate interventions. However, autistic individuals are a vulnerable study population and LMICs present with various considerations. While the presentation of autism is heterogeneous, stigma is a common social consequence affecting research. Drawing specifically on the South African context, the ethical intersections of these issues are discussed, along with the limitations of the current informed consent process. Community engagement is recommended as an adjunct to informed consent to ensure that biomedical research is conducted in a more inclusive way. Practical pointers are provided for implementing systematic support for conducting community engagement alongside biomedical research.

自闭症谱系障碍(ASD)是一种以社交/沟通障碍和顽固行为为特征的神经发育疾病。虽然有关自闭症的研究近来蓬勃发展,但在非西方环境下对该疾病进行的研究却很少。在低收入和中等收入国家(LMICs),需要对自闭症进行生物医学研究,以更好地了解人群的需求,并制定适合当地情况的干预措施。然而,自闭症患者是一个易受伤害的研究群体,而中低收入国家又有各种不同的考虑因素。虽然自闭症的表现形式多种多样,但污名化是影响研究的常见社会后果。本文以南非的具体情况为背景,讨论了这些问题的伦理交叉点以及当前知情同意程序的局限性。建议将社区参与作为知情同意的辅助手段,以确保以更具包容性的方式开展生物医学研究。本文还提供了一些实用指南,以便为在开展生物医学研究的同时进行社区参与提供系统支持。
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引用次数: 0
From moral rights to legal rights? Lessons from healthcare contexts 从道德权利到法律权利?医疗保健领域的经验教训。
IF 2.2 3区 哲学 Q3 ETHICS Pub Date : 2024-02-09 DOI: 10.1111/dewb.12444
Michael Da Silva

Many believe the existence of a moral right to some good should lead to recognition of a corresponding legal right to that good. If, for instance, there is a moral right to healthcare, it is natural to believe countries should recognize a legal right to healthcare. This article demonstrates that justifying legal rights to healthcare is more difficult than many assume. The existence of a moral right is insufficient to justify recognition of a corresponding justiciable constitutional right. Further conditions on when it is appropriate to recognize constitutional rights are rarely satisfied in the healthcare case. And focusing on aspirational or statutory rights presents costs for those seeking to justify legal rights on the basis of corresponding moral ones while maintaining empirical challenges for justifying constitutional rights. This suggests movement from a moral right to a corresponding legal one is far from straightforward and justifies examining alternative means of realizing moral socio-economic rights such as the proposed moral right to healthcare.

许多人认为,对某种物品的道德权利的存在应导致承认对该物品的相应法律权利。例如,如果存在获得医疗保健的道德权利,人们自然会认为各国应承认获得医疗保健的法律权利。本文表明,证明医疗保健法律权利的合理性比许多人想象的要困难得多。道德权利的存在不足以证明承认相应的可诉宪法权利是合理的。在医疗保健案件中,很少能满足关于何时适合承认宪法权利的进一步条件。对于那些寻求在相应道德权利的基础上证明法律权利正当性的人来说,专注于愿望权利或法定权利会带来成本,同时在证明宪法权利正当性方面仍面临经验挑战。这表明,从道德权利到相应法律权利的转变远非一蹴而就,因此有必要研究实现道德社会经济权利的其他方式,如拟议的医疗保健道德权利。
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引用次数: 0
Morality and Access to Essential Medicines: Pairing the Theoretical and Practical 道德与基本药物的获取:理论与实践的结合。
IF 2.2 3区 哲学 Q3 ETHICS Pub Date : 2024-02-08 DOI: 10.1111/dewb.12445
Michael Da Silva SJD, Andreas Albertsen PhD
<p>Access to essential medicines is uneven within and across states. Many persons do not have secure access to medicines necessary to live even less demanding conceptions of the good life, however defined. Questions concerning access to essential medicines implicate fundamental health justice concerns central to the branch of contemporary bioethics concerned with the field's relationship to political philosophy. A striking part of this inequality is its global dimension. Access to essential medicines is particularly restricted for those who live in less affluent countries. These concerns are acute in the context of ‘developing world’ bioethics given that issues in relevant states cluster with other disadvantages and state capacities that are limited in other aspects.</p><p>This situation raises two questions in particular: (1) What makes inequalities in access to essential medicines wrongful? and (2) What can and should be done about it (and by whom)? It is tempting to sever these questions and understandable to do so given their magnitude and scope. Important work treats each independently and thereby provides valuable insights. The first question pertains to core theoretical issues regarding value and justice. Such conceptual concerns can be fruitfully addressed without in-depth analysis of practical details. Indeed, details of real-world cases can skew intuitions about concepts. The second question then appears explicitly practical. One may worry that focusing on ‘philosophical’ questions can stop one from taking necessary action. If, as it would seem, a lack of access to essential medicines is a problem on (almost) any moral view, one may be better served by addressing the problem head-on rather than worrying about the precise nature of the wrong to be addressed.</p><p>However, as readers of this journal are aware, different moral problems can call for different practical responses, and many practical interventions need a clear sense of the problem at hand to properly solve it. Bioethics is partly characterized by its attention to interactions between theoretical and practical questions. Therefore, treating the two questions in tandem can be helpful even if one emphasizes one more than the other. This allows for perspectives where our answers to one inform those given to another.</p><p>The works in this special issue demonstrate how answers to each question implicate answers to the other and the value of treating them in tandem instead of in isolation. Nicole Hassoun's <i>Global Health Impact: Extending Access to Essential Medicines</i>1 provides proof of concept for this dual analysis and is a touchstone for each article. Existing data on absolute and relative access to essential medicines highlights global, regional, national, and even sub-national inequalities that naturally raise questions regarding who (if anyone) is responsible for assisting those who are worse off. In relation to health, these questions also pertain to whether responsi
各州内部和各州之间获得基本药物的情况并不均衡。许多人无法安全地获得必要的药品,以过上即使要求不高的美好生活,无论其定义如何。有关获得基本药物的问题牵涉到基本的健康正义问题,这对当代生命伦理学中有关该领域与政治哲学关系的分支至关重要。这种不平等的一个显著特点是它的全球性。生活在不太富裕国家的人们获得基本药物的机会尤其有限。在 "发展中世界 "的生命伦理学中,这些问题显得尤为突出,因为相关国家的问题与其他方面的不利条件和有限的国家能力密切相关。这种情况特别提出了两个问题:(1) 是什么导致了在获得基本药物方面的不平等? (2) 能够并应该对此采取什么措施(以及由谁来做)?将这些问题割裂开来是很有诱惑力的,而且考虑到这些问题的严重性和范围,这样做也是可以理解的。重要的工作是将每个问题独立处理,从而提供有价值的见解。第一个问题涉及价值与正义的核心理论问题。这些概念性问题无需深入分析实践细节即可得到有效解决。事实上,现实世界中的案例细节可能会扭曲对概念的直觉。那么,第二个问题就显得非常实际了。有人可能会担心,专注于 "哲学 "问题会阻止人们采取必要的行动。然而,正如本刊读者所知,不同的道德问题可能需要不同的实际对策,许多实际干预措施需要对当前问题有清晰的认识,才能妥善解决。生命伦理学的部分特点就是关注理论问题与实践问题之间的相互作用。因此,将这两个问题结合起来处理会有所帮助,即使一个问题比另一个问题更受重视。本特刊中的作品展示了对每个问题的回答如何牵涉到对另一个问题的回答,以及串联而非孤立处理这两个问题的价值。尼科尔-哈松(Nicole Hassoun)的《全球健康影响》:扩大基本药物的可及性1 为这种双重分析提供了概念证明,也是每篇文章的试金石。关于基本药物绝对和相对获取途径的现有数据凸显了全球、地区、国家甚至国家以下各级的不平等,这自然会引发关于谁(如果有的话)有责任帮助那些境况较差的人们的问题。就健康而言,这些问题还涉及到全球不平等的责任是否应由富裕国家、制药公司或富裕个人承担。全球健康影响》以利益为基础,论证了享有最低限度美好生活所必需的基本药物的权利,以及对这一权利的法律承认和执行。全球健康影响》以利益为基础,论证了最低限度美好生活所必需的基本药物权,以及法律对这一权利的承认和执行。然后,它为实现这一权利的方法进行了辩护,从而解决了基本药物获取方面的问题,尤其是在国家未能实现哈苏恩所捍卫的权利的情况下。哈苏恩认为,法律权利将促进解决药品获取问题所需的 "创造性决心",并以 "全球健康影响项目"(Global Health Impact Project)为例,提出了一个可能的创造性解决方案。该项目将允许制药公司在其所有产品上标注 "来自具有影响力的公司 "字样,这些公司开发的产品价格低廉,并能明显减轻全球疾病负担。哈苏恩认为,如果消费者认识到他们有责任进行道德消费,他们就会在不同的标签竞争中做出购买决定。这反过来又会激励开发价格合理、疗效显著的药品,帮助实现获得基本药物的权利,并解决相关的错误。根据这一观点,哈松的回答具有以下特点:(1) 无法获得基本药物是不法行为,因为它妨碍了人们过上最起码的美好生活的能力,而这种不法行为侵犯了权利;(2) 国际社会应承认获得这些物品的法律权利,各国应承认相应的国内法律权利,制药公司和消费者应填补各国在实现这些权利方面的空白,而全球健康影响项目则为实现这些权利提供了一个富有成效的潜在途径。
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引用次数: 0
Global Health Impact: Human rights, access to medicines, and measurement 全球健康影响:人权、药品获取和衡量。
IF 2.2 3区 哲学 Q3 ETHICS Pub Date : 2024-02-07 DOI: 10.1111/dewb.12441
Nicole Hassoun

Should people have a legal human right to health? And, if so, what exactly does protecting this right require? This essay defends some answers to these questions recently articulated in Global Health Impact. It explains how these answers depend on a particular way of thinking about health and the minimally good life, how quality of life matters at and over time, what various agents should do to help people who are unable to live well enough, and many other things. Moreover, it suggests some ways of improving common metrics for measuring and advancing our collective global health impact.

人们是否应该享有合法的健康人权?如果是,保护这一权利究竟需要什么?本文为最近在《全球健康影响》(Global Health Impact)上阐述的这些问题的一些答案进行辩护。文章解释了这些答案如何取决于对健康和最低限度的美好生活的特定思考方式,生活质量在任何时候以及随着时间的推移是如何重要的,各种机构应该做些什么来帮助那些无法过上足够美好生活的人,以及其他许多事情。此外,它还提出了一些改进通用指标的方法,以衡量和推进我们对全球健康的集体影响。
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引用次数: 0
The wisdom of claiming ownership of human genomic data: A cautionary tale for research institutions. 主张人类基因组数据所有权的智慧:研究机构的警示故事。
IF 0.9 3区 哲学 Q3 ETHICS Pub Date : 2024-01-31 DOI: 10.1111/dewb.12443
Donrich Thaldar

This article considers the practical question of how research institutions should best structure their legal relationship with the human genomic data that they generate. The analysis, based on South African law, is framed by the legal position that although a research institution that generates human genomic data is not automatically the owner thereof, it is well positioned to claim ownership of newly generated data instances. Given that the research institution exerts effort to generate the data, it can be argued that it has a moral right to claim ownership of such data. Combined with the fact that it has an interest in having comprehensive rights in such data, it appears that the prudent policy for research institutions is to claim ownership of the human genomic data instances that they generate. This policy is tested against two opposing policy positions. The first opposing policy position is that research participants should own the data that relate to them. However, in light of data protection legislation that already provides extensive protections to research participants, bestowing data ownership on research participants would offer little benefit to such individuals, while leading to significant practical problems for research institutions. The second opposing policy position is that the concept of ownership should be abandoned in favour of data custodianship. This opposing position is problematic, as avoiding reference to ownership is a denial of legal reality and hence not a useful policy. Also, avoiding reference to ownership will leave research institutions with limited legal remedies in the event of appropriation of data by third parties. Accordingly, it is concluded that the wisest policy for research institutions is indeed to explicitly claim ownership of the human genomic data instances that they generate.

本文探讨的实际问题是,研究机构应如何以最佳方式构建与其生成的人类基因组数据之间的法律关系。分析以南非法律为基础,其法律立场是,虽然产生人类基因组数据的研究机构并不自动拥有这些数据,但它完全有能力主张对新产生的数据实例的所有权。鉴于研究机构为生成数据付出了努力,可以说它在道义上有权主张对这些数据的所有权。再加上研究机构希望对这些数据拥有全面的权利,因此研究机构的审慎政策似乎是要求对其生成的人类基因组数据实例拥有所有权。这一政策要接受两种对立政策立场的检验。第一个对立的政策立场是,研究参与者应拥有与其相关的数据。然而,鉴于数据保护法已经为研究参与者提供了广泛的保护,赋予研究参与者数据所有权对这些人来说好处甚微,同时也会给研究机构带来严重的实际问题。第二种对立的政策立场是,应放弃所有权概念,转而采用数据监护权。这一反对立场是有问题的,因为避免提及所有权是对法律现实的否定,因此不是一项有用的政策。此外,避免提及所有权会使研究机构在数据被第三方盗用时只能获得有限的法律补救。因此,结论是研究机构最明智的政策确实是明确主张对其生成的人类基因组数据实例的所有权。
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引用次数: 0
Ethical and legal challenges of medical AI on informed consent: China as an example. 医疗人工智能对知情同意的伦理和法律挑战:以中国为例。
IF 2.2 3区 哲学 Q3 ETHICS Pub Date : 2024-01-19 DOI: 10.1111/dewb.12442
Yue Wang, Zhuo Ma

The escalating integration of Artificial Intelligence (AI) in clinical settings carries profound implications for the doctrine of informed consent, presenting challenges that necessitate immediate attention. China, in its advancement in the deployment of medical AI, is proactively engaging in the formulation of legal and ethical regulations. This paper takes China as an example to undertake a theoretical examination rooted in the principles of medical ethics and legal norms, analyzing informed consent and medical AI through relevant literature data. The study reveals that medical AI poses fundamental challenges to the accuracy, adequacy, and objectivity of information disclosed by doctors, alongside impacting patient competency and willingness to give consent. To enhance adherence to informed consent rules in the context of medical AI, this paper advocates for a shift towards a patient-centric information disclosure standard, the restructuring of medical liability rules, the augmentation of professional training, and the advancement of public understanding through educational initiatives.

人工智能(AI)在临床环境中的应用不断升级,对知情同意原则产生了深远的影响,提出了需要立即关注的挑战。中国在推进医疗人工智能应用的同时,也在积极制定法律和伦理法规。本文以中国为例,以医学伦理原则和法律规范为理论基础,通过相关文献资料对知情同意和医疗人工智能进行了分析。研究发现,医疗人工智能对医生披露信息的准确性、充分性和客观性提出了根本性挑战,同时也影响了患者的能力和同意意愿。为了在医疗人工智能的背景下加强对知情同意规则的遵守,本文提倡向以患者为中心的信息披露标准转变,调整医疗责任规则,加强专业培训,并通过教育活动增进公众理解。
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引用次数: 0
Understanding cultural values, norms and beliefs that may impact participation in genome-editing related research: Perspectives of local communities in Botswana. 了解可能影响参与基因组编辑相关研究的文化价值观、规范和信仰:博茨瓦纳当地社区的观点。
IF 2.2 3区 哲学 Q3 ETHICS Pub Date : 2024-01-11 DOI: 10.1111/dewb.12440
Setlhomo Koloi-Keaikitse, Mary Kasule, Irene Kwape, Dudu Jankie, Dimpho Ralefala, Dolly Mogomotsi Ntseane, Gaonyadiwe George Mokone

Gene-editing research is a complex science and foreign in most communities including Botswana. Adopting a qualitative deliberative framework with 109 participants from 7 selected ethnic communities in Botswana, we explored the perceptions of local communities on cultural values, norms, and beliefs that may motivate or deter likely participation in the use of gene-editing related research. What emerged as the ethnic community's motivators for research participation include the potential for gene-editing technologies to promote access to individualized medications, and the possibility of protecting family members from genetic related diseases. Deterrents for research participation include cultural values such as implications of lineage for chieftainship, trust, fear or anxiety, uncertainty, and sensitivity on the use of gene-editing. Findings of our study have implications for continuous engagement with local communities to explore potential ways of addressing cultural sensitivities that can further deter their participation in future gene-editing related research.

基因编辑研究是一门复杂的科学,在包括博茨瓦纳在内的大多数社区都是陌生的。我们采用定性审议框架,与来自博茨瓦纳 7 个选定民族社区的 109 名参与者共同探讨了当地社区对文化价值观、规范和信仰的看法,这些价值观、规范和信仰可能会激励或阻止人们参与基因编辑相关研究的使用。少数民族社区参与研究的动机包括基因编辑技术促进获得个性化药物的潜力,以及保护家庭成员免受遗传相关疾病的可能性。阻碍参与研究的因素包括文化价值观,如血统对酋长身份的影响、信任、恐惧或焦虑、不确定性以及对基因编辑使用的敏感性。我们的研究结果对继续与当地社区合作,探索解决文化敏感性的潜在方法具有重要意义,这些文化敏感性可能会进一步阻碍他们参与未来的基因编辑相关研究。
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引用次数: 0
Retraction of health science articles by researchers in Latin America and the Caribbean: A scoping review. 拉丁美洲和加勒比地区研究人员撤回健康科学文章的情况:范围审查。
IF 2.2 3区 哲学 Q3 ETHICS Pub Date : 2024-01-09 DOI: 10.1111/dewb.12439
Percy Herrera-Añazco, Daniel Fernandez-Guzman, Fernanda Barriga-Chambi, Jerry K Benites-Meza, Brenda Caira-Chuquineyra, Vicente Aleixandre Benites-Zapata

We aimed to conduct a scoping review to assess the profile of retracted health sciences articles authored by individuals affiliated with academic institutions in Latin America and the Caribbean (LAC). We systematically searched seven databases (PubMed, Scopus, Web of Science, Embase, Medline/Ovid, Scielo, and LILACS). We included articles published in peer-reviewed journals between 2003 and 2022 that had at least one author with an institutional affiliation in LAC. Data were collected on the year of publication, study design, authors' countries of origin, number of authors, subject matter of the manuscript, scientific journals of publication, retraction characteristics, and reasons for retraction. We included 147 articles, the majority being observational studies (41.5%). The LAC countries with the highest number of retractions were Brazil (n = 69), Colombia (n = 16), and Mexico (n = 15). The areas of study with the highest number of retractions were infectology (n = 21) and basic sciences (n = 15). A retraction label was applied to 89.1% of the articles, 70.7% were retracted by journal editors, and 89.1% followed international retraction guidelines. The primary reasons for retraction included errors in procedures or data collection (n = 39), inconsistency in results or conclusions (n = 37), plagiarism (n = 21), and suspected scientific fraud (n = 19). In conclusion, most retractions of scientific publications in health sciences in LAC adhered to international guidelines and were linked to methodological issues in execution and scientific misconduct. Efforts should be directed toward ensuring the integrity of scientific research in the field of health.

我们旨在进行一次范围界定审查,以评估拉丁美洲和加勒比地区(LAC)学术机构所属个人撰写的健康科学论文被撤稿的概况。我们系统检索了七个数据库(PubMed、Scopus、Web of Science、Embase、Medline/Ovid、Scielo 和 LILACS)。我们收录了 2003 年至 2022 年间在同行评审期刊上发表的文章,这些文章的至少一位作者与拉丁美洲和加勒比地区的机构有关联。收集的数据包括发表年份、研究设计、作者原籍国、作者人数、稿件主题、发表期刊、撤稿特征和撤稿原因。我们共收录了 147 篇文章,其中大部分为观察性研究(41.5%)。撤稿数量最多的拉丁美洲和加勒比国家是巴西(69 篇)、哥伦比亚(16 篇)和墨西哥(15 篇)。撤稿数量最多的研究领域是感染学(21 篇)和基础科学(15 篇)。89.1%的文章贴有撤稿标签,70.7%由期刊编辑撤稿,89.1%遵循国际撤稿指南。撤稿的主要原因包括程序或数据收集错误(39 篇)、结果或结论不一致(37 篇)、抄袭(21 篇)和涉嫌科学欺诈(19 篇)。总之,拉丁美洲和加勒比地区卫生科学出版物的撤稿大多符合国际准则,并与执行方法问题和科学不端行为有关。应努力确保卫生领域科学研究的完整性。
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引用次数: 0
THANK YOU TO DEVELOPING WORLD BIOETHICS REVIEWERS 感谢发展中国家生物伦理审查员
IF 2.2 3区 哲学 Q3 ETHICS Pub Date : 2023-12-12 DOI: 10.1111/dewb.12433
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引用次数: 0
A qualitative study on patients' selection in the scarcity of resources in the COVID-19 pandemic in a communal culture 关于在社区文化中 COVID-19 大流行的资源稀缺情况下患者选择的定性研究
IF 2.2 3区 哲学 Q3 ETHICS Pub Date : 2023-12-11 DOI: 10.1111/dewb.12438
Ervin Dyah Ayu Masita Dewi, Lara Matter, Astrid Pratidina Susilo, Anja Krumeich
The scarcity of resources during the COVID-19 pandemic caused ethical dilemmas in prioritizing patients for treatment. Medical and ethical guidance only emphasizes clinical procedures but does not consider the sociocultural aspect. This study explored the perception of former COVID-19 patients and their families on the decision-making process of the patient's selection at a time of scarcity of resources. The result will inform the development of an ethical guide for allocating scarce resources that aligns with Indonesian culture. We conducted qualitative research with in-depth interviews between May - December 2022 involving sixteen participants from various cities in Indonesia. We transcribed the interviews and analyzed the results using thematic analysis. This study found that doctor's decisions often differed from patient's expectations in allocating scarce resources, and therefore, it should be communicated appropriately. Medical decisions were not sufficiently made ethically, but must also be made communicatively. In Indonesia's strong communal culture, community involvement was essential to distributing limited resources. A better approach to ethical education, including adequate communication skills, is necessary to prepare health professionals for facing unpredictable future pandemics.
在 COVID-19 大流行期间,由于资源匮乏,在确定患者治疗的优先次序时出现了伦理难题。医疗和伦理指南只强调临床程序,而没有考虑社会文化方面。本研究探讨了前 COVID-19 患者及其家属对资源匮乏时期患者选择决策过程的看法。研究结果将为制定符合印尼文化的稀缺资源分配伦理指南提供参考。我们在 2022 年 5 月至 12 月期间开展了定性研究,对来自印度尼西亚不同城市的 16 名参与者进行了深入访谈。我们转录了访谈内容,并使用主题分析法对结果进行了分析。本研究发现,在分配稀缺资源时,医生的决定往往与患者的期望不同,因此应适当沟通。医疗决策不仅要符合道德规范,还必须以沟通的方式做出。在印度尼西亚浓厚的社区文化中,社区的参与对于分配有限的资源至关重要。有必要采取更好的伦理教育方法,包括适当的沟通技巧,使卫生专业人员做好准备,应对未来不可预测的大流行病。
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引用次数: 0
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Developing World Bioethics
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