Developing World Bioethics最新文献

This article examines the ethical imperatives of migration health, focusing on displaced populations such as the Rohingya and Syrian refugees. Forced migration, driven by conflict, persecution, and climate disasters, presents profound ethical challenges to global healthcare systems. Utilizing deontological ethics, utilitarianism, and human rights-based approaches, the research addresses key principles like justice, equity, autonomy, and non-maleficence in healthcare provision for refugees. Empirical insights reveal significant barriers to healthcare access for displaced populations, including systemic discrimination, resource scarcity, and cultural constraints. Ethical dilemmas are particularly evident in resource allocation, prioritization of acute over chronic conditions, and neglect of mental health services. Through case studies from Rohingya camps in Bangladesh and Syrian refugee settings in Turkey and Jordan, the study highlights inequities in healthcare delivery, exacerbated by cultural and logistical challenges. The article emphasizes on culturally sensitive training, participatory healthcare design, and equitable resource distribution as critical pathways to ethical healthcare. Policy recommendations include prioritizing mental health, harmonizing national policies with international human rights law, and fostering global accountability frameworks.

In Türkiye, although induced abortion (I/A) is legal and recognized as a free public health service within the first ten weeks of pregnancy, reports and qualitative studies indicate that women encounter difficulties accessing I/A services in public health institutions. This paper suggests, based on various local reports and studies, that the denial of I/A in the last decade is, in part, attributable to various reproductive governance mechanisms that create a chilling effect on clinicians and institutions, making them unwilling to perform or provide abortions. Finally, based on a socio-political analysis of the status quo, this paper emphasizes that when discussing the inaccessibility of I/A or any topic related to reproductive ethics, it is essential that bioethical discussions must recognize and consider the role of politics and the reproductive governance mechanisms at play in reproductive healthcare, as they have significant ethical implications for the access and provision of these services. This approach allows for a deeper exploration of the less visible ethical implications of restrictive policies on legal reproductive services.

At the height of the COVID-19 pandemic, the world experienced unprecedented mortality rates, forcing families to navigate the dual burden of grief and restrictive public health measures. These restrictions often disrupted traditional last rites, exacerbating emotional distress and burdens on the grieving. Trinidad and Tobago enforced regulations aimed at curbing COVID-19 which suspended citizens’ constitutional rights; one such restriction was the ban on open-air cremations. While this restriction may have been inconsequential to many, it had profound effects on individuals for whom open-air cremation was an essential cultural and religious practice. An ethical analysis of the cremation ban prior to its implementation would have shown the measure to be ineffective, disproportionate, and discriminatory. This underscores the need to integrate public health ethics in public health emergency policy development to ensure interventions are evidence-based, equitable in burden distribution, and capable of maintaining public trust.

Innovative therapy, as a new paradigm of medical intervention deviating from standard routine practice, prioritizes the best interests of patients, offering alternative therapeutic pathways where standard treatments fail. In China, their application is increasing alongside advancements in medical technology. However, innovative therapy poses various ethical challenges in clinical settings, including misconceptions of being viewed as research rather than therapy, benefit-risk assessment complexities, conflicts of interest, and barriers to the development of effective regulatory strategies. This paper elucidates the concept of innovative therapy and critically examines these challenges within the Chinese clinical context, emphasizing patients’ best interests. It proposes establishing guidelines and a comprehensive, adaptable regulatory framework to address the unmet healthcare-related needs of individual patients and mitigate risks. Engaging in these discussions provides some ethical insights from China on innovative therapy, serving as a reference for fostering the development and responsible utilization of innovative therapy.

Growing population aging is accompanied by a growing fear of suffering dementia. Four hundred and thirty-six Mexican and Colombian adults completed a survey about their opinion on Medical Assistance in Dying (MAID) for patients with dementia, both in the early stage of the disease and in the advanced stage through an advance directive. In Colombia, MAID is allowed while in Mexico it is banned. The main reasons given by those who agreed with MAID were “right to decide” and “avoiding suffering.” Religious beliefs were the main reason for disagreeing. More Mexicans than Colombians agreed with MAID possibly because Mexicans showed a lower degree of religiosity, and also possibly because there are religious movements against euthanasia in Colombia. The results were discussed considering the current debate about MAID in cases of dementia in general, and about requesting it through an advance directive for patients in the advanced stage of the disease.

This article suggests that the concept of global health – and to an extent the field that it designates - is problematic in various ways. Within public health, the concept of the ‘public’ has been widely investigated. However, “global health” has been introduced in academic, policy, and public discussion with comparably lower level of conceptual, philosophical scrutiny. Thus, while public health ethics addresses the ethical and political issues that the different meanings of ‘public’ allow to identify, global health ethics tends to leave ethical and political issues raised by the concept of ‘global health’ implicit and insufficiently analysed. I will briefly present the debate around the ‘public’ in public health, describing some of the ethical and political questions that might arise, depending on what ‘public’ is taken to mean. I will then use this discussion as a conceptual map for an analogous analysis of the concept of ‘global’ in global health. I will discuss what dimensions ‘global’ adds to the concept of ‘public’. In the second part of the article, I will briefly introduce the philosophical debate on the concept of health, before suggesting that its cultural sensitivity makes it ill-suited to be qualified as ‘global’. All in all, this article wants to bring to light the ethical implications that the terminology of ‘global health’ introduces in academic research and public policy that goes under that heading, as a first step towards better defining the ethical contours of this discipline.