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After almost a year and a half of the COVID-19 pandemic, many healthcare institutions in the United States announced that they would mandate COVID-19 vaccination, with medical and religious exceptions, as a term of employment. The mandates resulted in widely publicized protests from hospital staff, including some nurses, who argued that these medical institutions violated the ethical principle of autonomy. As the world enters the "post-pandemic period," decisions such as these, made during times of crisis, must be reviewed to provide clarity for when the next pandemic occurs. In this paper, we support the argument that such mandates are ethically justifiable. We explore the framework of objections that were brought forward by dissenters of this vaccine mandate. Next, we provide an analysis of conflicting ethical principles present when such mandates were deployed. Utilizing the American Nurses Association's Code of Ethics for Nurses, notably provisions 2, 3, and 6 we argue that it is an ethical duty of the nurse to be vaccinated. Specifically, we turn to provision two, which most explicitly underscores the necessity of vaccination as a function of the nurse's primary commitment to the patient. Next, we highlight the International Council of Nurses Code of Ethics which provides similar guidance internationally. Finally, we examine the applicability of the principles of public health, care ethics, and the nursing role as frameworks to underpin such mandates both for the current and for potential future pandemics, arguing that the nurse's ethical duty to be vaccinated spans these contexts. [ABSTRACT FROM AUTHOR]

Public health interventions often involve explicit trade-offs in which the health of the many must be weighed against burdens imposed on individuals. We describe development of public health guidelines for respiratory isolation in community settings for persons with tuberculosis. While stopping the spread of disease is a core moral imperative in public health, the duty to prevent disease transmission does not supersede all other considerations. Community well-being must be balanced with individual well-being, liberty, and social justice. In response to these challenges, the National Tuberculosis Coalition of America's 2024 guidelines for persons with tuberculosis in community settings were developed using a modified GRADE approach supported by a complementary, comprehensive, and context-specific ethical framework. By addressing the distinct roles that evidence (subject to uncertainty), values, justificatory conditions, and procedural legitimacy all play in ethical guideline development, we promote rigor and transparency in the integration of ethics in public health guidelines. [ABSTRACT FROM AUTHOR]

A significant and important ethical tension in resource allocation and public health ethics is between utility and equity. We explore this tension between utility and equity in the context of health AI through an examination of a diagnostic AI screening tool for diabetic retinopathy developed by a team of researchers at Duke-NUS in Singapore. While this tool was found to be effective, it was not equally effective across every ethnic group in Singapore, being less effective for the minority Malay population than for the Chinese majority. We discuss the problematic normative nature of bias in health AI and explore the ways in which bias can interact with various forms of social inequalities. From there, we examine the specifics of the diabetic retinopathy case and weigh up specific trade-offs between utility and equity. Ultimately, we conclude that it is ethically permissible to prioritise utility over equity where certain criteria hold. Given that any medical AI is more likely than not to have lingering bias due to bias in the training data that may reflect other social inequalities, we argue that it is permissible to implement an AI tool with residual bias where: (1) its introduction reduces the influence of biases (even if overall inequality is worsened), and/or (2) where the utility gained is significant enough and shared across groups (even if unevenly). [ABSTRACT FROM AUTHOR]

Background: Though genomic science has rapidly advanced, efforts to demonstrate the population-level utility of genomics have been slow to follow. It has long been argued that the family is an important unit of significance in genomics, yet it has been challenging to address this in clinical care. This is apparent in how hospital administrators and clinicians in the United States typically approach cascade screening, the process of notifying and offering genetic testing to at-risk relatives of a patient with a hereditary condition. The most common notification approach is proband-led contact, in which the index patient is responsible for communicating a health risk to their relatives. This model has been associated with suboptimal outcomes. In contrast, recent research has shown that system-led contact, in which healthcare or public health institutions initiate communication to relatives with the proband’s consent, has been associated with increased clinical utility and acceptability. Summary: With the needs of hospital administrators and clinicians in mind, we revisit normative questions about the appropriate way to notify relatives about their potentially elevated risk of developing an actionable disease. We review evidence demonstrating that system-led direct contact of relatives is feasible and acceptable. We further argue that system-led contact of relatives eligible for cascade screening is ethically justified if these programs are designed with public input, have an opt-out provision, and are implemented for conditions that meet specific criteria which we propose in this article. Key Messages: In this article, we emphasize the usefulness of public health ethics frameworks to inform the design of system-led contact programs. Beyond this, we make the case that such programs are necessary to realize the population utility of genomic medicine equitably. [ABSTRACT FROM AUTHOR]

Background: Although national food guides are designed, ostensibly, to translate scientific evidence with respect to food, dietary patterns, and health, their development has increasingly become a corporate/political process as well as scientific one; often with corporate/political influences overriding science. Our aim was to construct an unbiased, sustainable, evidence-informed Universal Food Guide to serve as a template for countries to develop their unique guides, thereby, provide a valid resource for health professionals, health authorities, and the public. Methods: To address our aim, we conducted an integrative review of multiple evidence-informed sources (e.g., established databases, evidence syntheses, scholarly treatises, and policy documents) related to four areas: 1. Food guides' utility and conflicts of interest; 2. The evidence-based healthiest diet; 3. Constituents of the Universal Food Guide template; and 4. Implications for population health; regulation/governance; environment/climate/planetary health; and ethics. Results: The eating pattern that is healthiest for humans (i.e., most natural, and associated with maximal health across the life cycle; reduced non-communicable disease (NCD) risk; and minimal end-of-life illness) is whole food, low fat, plant-based, especially vegan, with the absence of ultra-processed food. Disparities in national food guide recommendations can be explained by factors other than science, specifically, corporate/political interests reflected in heavily government-subsidized, animal-sourced products; and trends toward dominance of daily consumption of processed/ultra-processed foods. Both trends have well-documented adverse consequences, i.e., NCDs and endangered environmental/planetary health. Commitment to an evidence-informed plant-based eating pattern, particularly vegan, will reduce risks/manifestations of NCDs; inform healthy food and nutrition policy regulation/governance; support sustainable environment/climate and planetary health; and is ethical with respect to 'best' evidence-based practice, and human and animal welfare. Conclusion: The Universal Food Guide that serves as a template for national food guides is both urgent and timely given the well-documented health-harming influences that corporate stakeholders/politicians and advisory committees with conflicts of interest, exert on national food guides. Such influence contributes to the largely-preventable NCDs and environmental issues. Policy makers, health professionals, and the public need unbiased, scientific evidence as informed by the Universal Food Guide, to inform their recommendations and choices. [ABSTRACT FROM AUTHOR]

Background: In the last decades all health systems have experienced a lack of resources. Against this background, the idea of ​​applying personal responsibility of the patient as a criterion for allocation of resources (PRCAR) is gaining increasing attention. Bulgarian healthcare reform has been marked by the implementation of many new strategies, that grounded our scientific interest towards investigating PRCAR in Bulgarian public health law and social legislation. Methods: Through a search of national legal databases 7 documents were selected and subjected to content analysis. Results: Prospective responsibility was found in two and retrospective responsibility - in three documents, two of which imposed explicit penalties on the patient. Two documents did not distinguish between the types of patient responsibility. PRCAR was found to be controversial through the prism of the social justice principle. The discussion was conducted through the perspectives of evidence translation of research to law, particularities of social cohesion in Bulgaria, and the interpretation of principles of public health ethics. Conclusion: Although PRCAR was traceable in Bulgarian legislation, no supporting arguments for its introduction were deduced. The applicability of PRCAR should be further studied and wider public debate should be initiated. Key points: • In the context of insufficient healthcare resources experienced by all healthcare systems, the idea of ​​applying the personal responsibility of the patient as a criterion for the allocation of resources (PRCAR) is appealing. • If striving for a common European vision on PRCAR, then each European country's view on the subject would be of key importance, and studies in this direction are necessary. • Our manuscript offers an in-depth expert analysis of the presence of PRCAR in public health law and social regulation in Bulgaria, which is one of the more recent EU member states but experiences the same developmental trends as other European healthcare systems. • As PRCAR is still an under-researched concept, our results will be of particular interest to other public health researchers. [ABSTRACT FROM AUTHOR]

The primary claim of this essay is that historical fluency is required for effective work in crafting legal and policy interventions as a part of public health emergency preparedness and response (PHEPR). At a broad level, public health law is explicitly recognized as a key systems-level component of PHEPR practice. 1 This essay therefore focuses on the extent to which historical fluency is necessary or at least useful to all aspects of PHEPR that draw on or deploy legal and policy mechanisms (e.g. design, planning, implementation, dissemination, monitoring and evaluation, etc.). The essay collectively refers to these legal and policy mechanisms as epidemic law and policy response (ELAPR). Part I explains the concept of historical fluency. Part II explores the foundations of public health law both as a way of highlighting key structural features of ELAPR and in supporting the claim that historical fluency is critical for ELAPR. Part III applies the previous arguments to a specific case study to highlight the promise and power of historical fluency – the outbreak of bubonic plague in San Francisco in 1900. Tracking this essay's pragmatic focus, part IV offers several recommendations for how specifically historical fluency in public health law and ethics can be operationalized in PHEPR practice and policy. Part V summarizes and concludes. [ABSTRACT FROM AUTHOR]

The development and regulation of hormonal contraception has been problematic—with concerns and safety of patients often being disregarded. Better birth control prescribing may lie in genetic testing. Direct-to-consumer genetic testing aimed at "personalizing the pill" exists, but regulations and clinical guidelines must adapt to meet the diverse needs of patients. This article analyzes emerging socio-ethical-legal tensions as hormonal contraceptives enter the pharmacogenomic era. Using a narrative lens, the author concludes that further patient-centered research—grounded in the voices of distinct populations—should inform policy so as to better serve birth control users and avoid the historical injustices with respect to hormonal contraception. [ABSTRACT FROM AUTHOR]

With the increasing frequency and severity of disasters and the increasing number of patients living with kidney disease, on dialysis and with transplants around the world, the need for kidney care in humanitarian settings is increasing. Almost all humanitarian emergencies pose a threat to kidney health because all treatments are highly susceptible to interruption, and interruption can be deadly. Providing support for people requiring dialysis in humanitarian settings can be complex and is associated with many trade-offs. The global kidney care community must become familiar with the ethics, principles and duties essential to meeting the overarching goals of ethical and effective disaster relief. Ethics principles and values must be considered on the individual, public health and global levels. The wellbeing of a single patient must be considered in the context of the competing needs of many others, and optimal treatment may not be possible due to resource constraints. Public health ethics principles, including considerations of triage and resource allocation, maximization of benefit and feasibility, often become directly relevant at the bedside. Individuals delivering humanitarian relief must be well trained, competent, respectful and professional, while involved organizations need to uphold the highest professional and ethical standards. There may be dissonance between ethical guidance and practical realities in humanitarian settings, which for inexperienced individuals may present significant challenges. Sustaining dialysis care in emergencies brings these issues starkly to the fore. Preparedness for dialysis in emergencies is an ethical imperative that mandates multisectoral stakeholder engagement and action, development of surge response plans, clinical and ethics guidance, and transparent priority setting. This manuscript outlines common ethics challenges and considerations that apply in all humanitarian actions, and illustrates their relevance to kidney care as a whole, using examples of how these may apply to dialysis and kidney disaster relief efforts in humanitarian settings. [ABSTRACT FROM AUTHOR]

In the context of neoliberalism and increasing globalization, technocratization, and scientification of mental health care, people suffering from socio-politico-economic problems ranging from poverty to structural violence are often transmogrified into "patients" with mental health problems to be "treated" with psychopharmaceuticals and individualized psychological therapies. Drawing from three socio-political issues India witnessed in the past 3 years, concerning three marginalized sections, namely, farmers, LGBTQIA+ people, and migrant workers, I illustrate the silence of mainstream mental health disciplines in India on sheer instances of structural violence and social suffering. Deflection of attention from human rights violations by mainstream mental health systems raises critical questions about the ethics and politics of mental health disciplines. The social, political, and material contexts that are central to lived experiences are almost always unaccounted in mental health academia, research, and practice. Engaging people with lived experiences advances equity by breaking down power dynamics, establishing collaborative decision-making, and improving equitable outcomes. Thus, knowledge production in mental health becomes irrelevant to political action and transformative policies that are crucial for positive mental health outcomes. By ignoring and thus implicitly sanctioning discriminatory, exploitive neoliberal architecture, mental health systems maintain the very upstream factors that cultivate and sustain mental distress. In this way, mainstream mental health practice in India fails to undertake world-making , raising deeper questions in public mental health ethics. [ABSTRACT FROM AUTHOR]

Background: Polypharmacy is associated with the prescription of inappropriate medications and avoidable medication-related harm. A novel pharmacist-led intervention aims to identify and resolve inappropriate medication prescriptions in older adults with polypharmacy. Aim: To conduct a preliminary feasibility assessment of the intervention in primary care, testing whether specific components of the intervention procedures and processes can be executed as intended. Method: The mixed-methods study was approved by the New Zealand Health and Disability Ethics Committees and public health agency. Patients from a New Zealand general practice clinic were recruited over 4 weeks to receive the intervention. The preliminary feasibility assessment included measures of intervention delivery, patient-reported outcome measures, and perspectives from ten patients and six clinicians. Data were analysed quantitatively and qualitatively to determine if a full-scale intervention trial is warranted. The study's progression criteria were based on established research and guided the decision-making process. Results: The intervention met the study's progression criteria, including patient recruitment, retention, and adherence to the intervention procedures. However, several modifications were identified, including: (1) enhancing patient recruitment, (2) conducting a preliminary meeting between the patient and pharmacist, (3) supporting pharmacists in maintaining a patient-centred approach, (4) reviewing the choice of patient-reported outcome measure, (5) extending the 8-week follow-up period, (6) allocating more time for pharmacists to conduct the intervention. Conclusion: The study found the intervention feasible; however, additional development is required before progressing to a full-scale trial. This intervention has the potential to effectively reduce medication-related harm and improve outcomes for older adults with polypharmacy. Trial registration number: ACTRN12621000268842 Date registered: 11/03/2021 [ABSTRACT FROM AUTHOR]

The document "Digital Democracy and Emergency Preparedness: Engaging the Public in Public Health" explores the intersection of digital technology and democratic processes in enhancing public health responses during emergencies. It discusses the challenges and benefits of leveraging digital tools for public engagement, emphasizing the importance of community empowerment and inclusivity in decision-making processes. The special issue highlights the need for continued research and interdisciplinary collaboration to integrate digital democracy into public health emergency preparedness effectively. The authors stress the potential rewards of these efforts, such as resilient communities, enhanced public engagement, and more effective emergency responses. [Extracted from the article]

Among measures tackling the impacts of the COVID‐19 pandemic, the selling of private insurance policies covering individual infection is overlooked by the ethics literature. To record the "COVID Claimania" in Taiwan and to assess its ethical implications, we collected 38 policies from 10 insurers sold between January 2020 and May 2022 and found that their risk calculation of the COVID‐19 prevalence ranged from 0.5% to 11.08%. In reality, the prevalence by the end of 2022 was 37% in Taiwan. Selling private insurance policies is ethically problematic in three ways. First, it represents the insurance industry's irresponsible risk‐taking profit‐seeking behaviors. Second, it would jeopardize the effectiveness of the disease‐prevention measures by inducing uncontrollable moral hazards. Third, it would expose the insurance companies to unbearable financial risks and cause substantial negative external impacts. The government should intervene in the private insurance market in preparation for future public health emergencies. [ABSTRACT FROM AUTHOR]

The article examines the ethical implications of race-based screening recommendations for prostate cancer, focusing on the debate over universal versus race-specific guidelines. Topics include the higher incidence and mortality of prostate cancer among Black men compared to other racial groups, the inconsistency and potential issues with using race as a criterion in clinical guidelines, and the public health ethics principles that should guide the development of screening recommendations.

AbstractThis paper argues that bioethics as a field should broaden its scope to include the ethics of war, focusing on war’s public health effects. The “Introduction” section describes the bioethics literature on war, which emphasizes clinical and research topics while omitting public health. The section, “War as a public health crisis” demonstrates the need for a public health ethics approach by framing war as a public health crisis. The section, “Bioethics principles for war and public health” proposes six bioethics principles for war that address its public health dimensions: health justice, accountability, dignified lives, public health sustainability, nonmaleficence, and public health maximization. The section, “Justifying and applying bioethical principles” shows how these principles inform ethical analysis, including just war theory and military ethics. The section, “From principles to practice” envisions ways in which bioethicists can promote these principles in practice through research, teaching, and service. The “Conclusion” section urges bioethicists to engage with war as a public health crisis, including calling attention to war’s impact on civilians, especially women, children, and other vulnerable groups. [ABSTRACT FROM AUTHOR]

Background: In rare diseases, limited access to services and rare disease experts may force families to act as medical advocates for their child; they can volunteer to support clinician-initiated research or initiate and lead research themselves. Ketotic Hypoglycemia International (KHI) is a new, global organization for families affected by idiopathic ketotic hypoglycemia (IKH) and is run solely by volunteers. Doing research together, families and international experts in a collaborative process such as at KHI, also referred to as patient and public involvement and engagement (PPIE) or extreme citizen science, is often praised for its positive effects on the research and the stakeholders involved. Methods: We used auto-ethnographic narratives from parents and medical professionals in KHI to report on their experiences with co-produced health research. All co-authors wrote down their experiences in relation to three topics: time invested, work invested and power dynamics. Results: Whilst the parents and health care professionals felt a new hope for (their) children with IKH, they also felt pressure to contribute time or to be flexible in how and when they dedicated time towards the organization. The power dynamics were characterised by a change in the relationship between the parents and medical experts; the parent being taught by the expert shifted to the expert learning from the lived experience of the parent. Both parents and medical experts struggled with maintaining boundaries and safeguarding their mental health. Conclusion: Our findings call for the need to secure and prioritize funding for patient organizations, to enable them to create the sustainable architecture required for meaningful PPIE within these organizations. The morals and often deeply personal reasons for engaging with voluntary work in health research, can lead to overstepping of boundaries. As a result of our research, we call for the development of ethics of care guidelines within collaborative health research. Plain English Summary: When confronted with a rare disease it is often hard to access information and or medical experts for help. Parents of children affected by idiopathic ketotic hypoglycemia (IKH) have joined in a patient-led organisation to initiate and lead research that could give answers to their medical questions and worries. Medical experts have been invited to join the organisation as members of the Scientific Advisory Board (SAB). When people report on health research conducted in collaboration with patients and or members of the public, they mostly mention positive outcomes. At KHI, some people had left the organisation and we had to deal with some difficult situations; so, we wanted to document and understand these challenges. Nine members of KHI, parents and medical experts, wrote down their stories, using three topics to guide their narrative: time invested, work invested and power dynamics at KHI. Parents and medical experts felt a new hope for (their) children with IKH when working for KHI but they also felt pressured to work at all hours and at the cost of time with their families or their own health. The stories revealed that parents felt less important compared to medical experts, but also that the relationship between parents and experts changed from the parent being taught by the expert, to the expert starting to learn from the lived experience of the parent. To make these collaborations successful we plead for funding for patient-led organisation and ethical guidelines to safeguard volunteers (both medical and lay people). [ABSTRACT FROM AUTHOR]

Introduction: Participatory health research (PHR) as a research paradigm, guides the research process and strives to achieve positive change in society in the interest of people's health. In this scoping review, PHR will be used as an umbrella term considering a wide range of collaborative research approaches in the health context. PHR is conducted 'with' or 'by' those it intends to benefit, as opposed to 'on' and 'for' them. Their involvement throughout the research process seeks to shift power and decision-making from where they traditionally lay within academia toward community, patient and public end-users. Research cannot be truly participatory without concurrently addressing power dynamics within the partnership and power imbalances in decision making. Therefore, power sharing can be defined as a major factor in building effective academic-community collaborations. This scoping review aims to identify, clarify, and map existing literature on power and power sharing in PHR from both theoretical and practical perspectives. Specifically, we will explore how power is conceptualised throughout the literature, and how power and power sharing are applied and addressed in real-life PHR partnerships. Materials and methods: This scoping review will be conducted in accordance with the guidelines outlined in the Joanna Briggs Institute (JBI) Reviewer's Manual. This scoping review will consider both empirical and non-empirical research that report on understanding power and power sharing in participatory health research partnerships. All appropriate studies will be retrieved from the following five electronic databases: PubMed, Scopus, Embase, PsycINFO, SocIndex. This review will be limited to articles published in English and from January 1998 to March 2024. As the scoping review aims to capture more than peer-reviewed and published literature, it will also include grey literature such as theses and dissertations, reports, conference proceedings, and editorials. Data from the included literature will be extracted based on the data extraction tool, defined in advance. Ethics and dissemination: As primary data will not be collected, ethical approval is not required to conduct the scoping review. The findings of this study will be disseminated through peer-reviewed publications. [ABSTRACT FROM AUTHOR]

Over the last three quarters of a century, international guidelines and regulations have undergone significant changes in how children are problematised as participants in biomedical research. While early guidelines enacted children as vulnerable subjects with diminished autonomy and in need of special protection, beginning in the early 2000s, international regulatory frameworks defined the paediatric population as vulnerable due to unaddressed public health needs. More recently, ethical recommendations have promoted the active engagement of minors as research partners. In this paper, I adopt a post-structuralist approach to policy analysis to examine deep-seated assumptions and presuppositions underlying the changes in the problematisation of children as biomedical research participants over time. While biomedical research ethics focuses on the autonomy and vulnerability of minors, ethical guidelines are situated in specific sociocultural contexts, shaped, among other things, by contingent public health needs and changing conceptions of the value of research and science for society. In the process, I demonstrate the challenge of moving away from an approach that in taking adults as the model overshadows the complexity of children's lived experiences as well as their personal, cultural, and social lives. The lack of acknowledgement of this complexity makes children vulnerable to epistemic injustice, which is particularly crucial to address in public involvement initiatives. [ABSTRACT FROM AUTHOR]

This study examines the limits of professional practice in the field of comprehensive esthetics and related areas in Ecuador. A mixed methodological approach was used, including document analysis, practitioner surveys and expert interviews. The central objective was to identify and examine discrepancies between existing regulation and actual practice, along with their implications for patient health and safety. The findings revealed confusion in terminology, diversity in professional training, and lack of regulatory awareness. In addition, it was observed that non-medical professionals perform invasive procedures, despite being prohibited by Ecuadorian law. In conclusion, it is necessary to review and strengthen regulation, as well as improve professional training, to ensure safe and ethical practice in the field of comprehensive esthetics in Ecuador. The health of patients should be the main priority, and this will only be achieved through strict compliance with regulations and the promotion of quality education. [ABSTRACT FROM AUTHOR]

Soda taxes are controversial. While proponents point to their potential health benefits and the public projects that could be funded with their revenue, critics argue that they are paternalistic and regressive. In this paper, we explore the prospects for designing a just soda tax, one that appropriately balances the often-competing ethical considerations of promoting social welfare, respecting people's autonomy and ensuring distributive fairness. We argue that policymakers have several paths forward for designing a just soda tax, but that the considerations relevant to ethical policy design are more complicated than is sometimes acknowledged. [ABSTRACT FROM AUTHOR]

This article forms part of a series on "openness," "non-linearity," and "embodiedhealth" in the post-physical, informational (virtual) era of society. This is vital given that the threats posed by advances in artificial intelligence call for a holistic, embodied approach. Typically, health is separated into different categories, for example, (psycho)mental health, biological/bodily health, genetic health, environmental health, or reproductive health. However, this separation only serves to undermine health; there can be no separation of health into subgroups (psychosomatics, for example). Embodied health contains no false divisions and relies on "optimism" as the key framing value. Optimism is only achieved through the mechanism/enabling condition of openness. Openness is vital to secure the embodied health for individuals and societies. Optimism demands that persons become active participants within their own lives and are not mere blank slates, painted in the colors of physical determinism (thus a move away from nihilism-which is the annihilation of freedom/autonomy/ quality). To build an account of embodied health, the following themes/aims are analyzed, built, and validated: (1) a modern re-interpretation and validation of German idealism (the crux of many legal-ethical systems) and Freud; (2) ascertaining the bounded rationality and conceptual semantics of openness (which underlies thermodynamics, psychosocial relations, individual autonomy, ethics, and as being a central constitutional governmental value for many regulatory systems); (3) the link between openness and societal/individual embodied health, freedom, and autonomy; (4) securing the role of individualism/ subjectivity in constituting openness; (5) the vital role of nonlinear dynamics in securing optimism and embodied health; (6) validation of arguments using the methodological scientific value of invariance (generalization value) by drawing evidence from (i) information and computer sciences, (ii) quantum theory, and (iii) bio-genetic evolutionary evidence; and (7) a validation and promotion of the inalienable role of theoretic philosophy in constituting embodied health, and how modern society denigrates embodied health, by misconstruing and undermining theoretics. Thus, this paper provides and defends an up-to-date non-physical account of embodied health by creating a psychophysical-biological-computational-philosophical construction. Thus, this paper also brings invaluable coherence to legal and ethical debates on points of technicality from the empirical sciences, demonstrating that each field is saying the same thing. [ABSTRACT FROM AUTHOR]

The article discusses the ethical dilemmas surrounding athlete safety and public health during the Paris 2024 Olympics due to the poor water quality of the River Seine. Athletes faced health risks, including infections and visibility challenges, leading to concerns about the decision-making process and lack of transparency regarding water quality standards. The text emphasizes the need for clear communication, independent oversight, and effective risk mitigation strategies to balance athlete safety, public health, and the desire to host high-profile sporting events. It also reflects on past Olympic Games and provides recommendations for future events, such as the LA 2028 Olympics, to prioritize public health and environmental issues. [Extracted from the article]

Antimicrobial resistance (AMR) is an urgent, global threat to public health. The development and implementation of effective measures to address AMR is vitally important but presents important ethical questions. This is a policy area requiring further sustained attention to ensure that policies proposed in National Action Plans on AMR are ethically acceptable and preferable to alternatives that might be fairer or more effective, for instance. By ethically analysing case studies of coercive actions to address AMR across countries, we can better inform policy in a context‐specific manner. In this article, I consider an example of coercive antimicrobial stewardship policy in Canada, namely restrictions on livestock farmers' access to certain antibiotics for animal use without a vet's prescription. I introduce and analyse two ethical arguments that might plausibly justify coercive action in this case: the harm principle and a duty of collective easy rescue. In addition, I consider the factors that might generally limit the application of those ethical concepts, such as challenges in establishing causation or evidencing the scale of the harm to be averted. I also consider specifics of the Canadian context in contrast to the UK and Botswana as example settings, to demonstrate how context‐specific factors might mean a coercive policy that is ethically justified in one country is not so in another. [ABSTRACT FROM AUTHOR]

In the paper, an analysis is conducted on the intricate relationship between ethics, artificial intelligence, and cybersecurity. The ethical principles that govern the advancement of AI are examined, alongside the security issues that arise from its implementation. The ethical utilization of artificial intelligence in the realms of cybersecurity and hacking is explored. Emphasis is placed on the significance of AI ethics, particularly in terms of transparency, accountability, and fairness. Additionally, the paper delves into the security challenges that emerge as AI is adopted, such as safeguarding user privacy and ensuring equitable access to the technology. [ABSTRACT FROM AUTHOR]

The state‐level COVID‐19 response in the United States necessitated collaboration between governor' offices, health departments and numerous other departments and outside experts. To gain insight into how health officials and experts contributed to advising on COVID‐19 policies, we conducted semi‐structured interviews with 25 individuals with a health specialisation who were involved in COVID‐19 policymaking, taking place between February and December 2022. We found two diverging understandings of the role of health officials and experts in COVID‐19 policymaking: the role of 'staying in the lane' of public health in terms of the information that they collected, their advocacy for policies and their area of expertise and the role of engaging in the balancing of multiple considerations, such as public health, feasibility and competing objectives (such as the economy) in the crafting of pandemic policy. We draw on the concept of boundary‐work to examine how these roles were constructed. We conclude by considering the appropriateness as well as the ethical implications of these two approaches to public health policymaking. [ABSTRACT FROM AUTHOR]

Health policies and the problems they constitute are deeply shaped by multiple publics. In this article we conceptualize health policy counterpublics : temporally bounded socio-political forms that aim to cultivate particular modes of conduct, generally to resist trajectories set by arms of the state. These counterpublics often emerge from existing social movements and involve varied forms of activism and advocacy. We examine a health policy counterpublic that has arisen in response to new forms of HIV public health surveillance by drawing on public documents and interview data from 2021 with 26 stakeholders who were critical of key policy developments. Since 2018, the national rollout of molecular HIV surveillance (MHS) and cluster detection and response (CDR) programs in the United States has produced sustained controversies among HIV stakeholders, including among organized networks of people living with HIV. This article focuses on how a health policy counterpublic formed around MHS/CDR and how constituents problematized the policy agenda set in motion by federal health agencies, including in relation to data ethics, the meaningful involvement of affected communities, informed consent, the digitization of health systems, and HIV criminalization. Although familiar problems in HIV policymaking, concerns about these issues have been reconfigured in response to the new sociotechnical milieu proffered by MHS/CDR, generating new critical positions aiming to remake public health. Critical attention to the scenes within which health policy controversies play out ought to consider how (counter)publics are made, how problems are constituted, and the broader social movement dynamics and activist resources drawn upon to contest and reimagine policymaking in public life. [ABSTRACT FROM AUTHOR]

This paper addresses the critiques based on trade-offs and normativity presented in response to our target article proposing the Public Health Emergency Risk and Crisis Communication (PHERCC) framework. These critiques highlight the ethical dilemmas in crisis communication, particularly the balance between promoting public autonomy through transparent information and the potential stigmatization of specific population groups, as illustrated by the discussion of the mpox outbreak among men who have sex with men. This critique underscores the inherent tension between communication effectiveness and autonomy versus fairness and equity. In response, our paper reiterates the adaptability of the PHERCC framework, emphasizing its capacity to tailor messages to diverse audiences, thereby reducing potential stigmatization and misinformation. Through community engagement and feedback integration, the PHERCC framework aims to optimize the effectiveness of communication strategies while addressing ethical concerns. Furthermore, by involving affected communities in the communication strategy from the onset, the framework seeks to minimize ethical trade-offs and enhance the acceptance and effectiveness of public health messages. [ABSTRACT FROM AUTHOR]

The purpose of this research is to investigate Veterans Treatment Courts' (VTCs) operation during the COVID-19 pandemic. Since March of 2020, there have been efforts to transition to a virtual world to guarantee criminal defendants their rights in court during this public health crisis. While many courts had to adapt to the changing conditions due to COVID-19, little is known about what these changes looked like for VTCs, if they varied from court to court, and whether these changes were successful. Through a nationwide survey of VTC courtroom actors such as judges, program coordinators, and Veterans Justice Outreach Specialists, we examine how VTCs' day-to-day operations changed during the COVID-19 pandemic as well as program retention and participants' success in the treatment program during a public health emergency. We discuss VTCs' lessons learned to inform other VTCs and specialty courts about best practices for continuing operations. [ABSTRACT FROM AUTHOR]

Migration research poses several unique challenges and opportunities. Conducting ethical global health practice, especially when studying migrant mental health, is of particular concern. This article explores seven challenges and lessons learned in our mixed‐methods study conducted to assess the impact of the migration experience on Haitian migrants' mental health in Santiago, Chile. The primary challenges were recruiting in a highly mobile population, building trust and community participation, overcoming language barriers, safety considerations during the Covid‐19 pandemic, mitigating potential negative impacts of research on the community, providing psychological support, and finding meaningful ways to benefit the community. We propose moving toward a better and more ethical migrant research practice by ensuring language accessibility, hiring community members for the study team, working with local institutions and nongovernmental organizations, and maintaining sustainable connections. [ABSTRACT FROM AUTHOR]

This paper evaluates the direct and indirect impacts (and their interactions) of individual and social ethics from (primary, secondary, tertiary) education and religion (Buddhism, Christianity, Hinduism, Islam, Judaism) on health and happiness in alternative religious contexts (majority and minority religions) and for alternative education policies (gross enrolment and per-student expenditure). It also specifies the time lag for the short-run indirect impact (and its size) of happiness on health and the long-run equilibria of both happiness and health. The statistical results show that there is no religious or secular ethics with beneficial impacts on both happiness and health at both the individual and social levels. Next, education policies have similar impacts on both happiness and health in all religious contexts, while most religious ethics have larger beneficial impacts on health and happiness if coupled with social and individual education policies, respectively. Combined statistical and analytical results show that the largest short-run indirect impact of happiness on health occurs after 4 years, where 1 out of 10 points of happiness produces approximately 3 additional years of healthy life expectancy at birth. Next, the long-run equilibria of both happiness and health are globally stable and are achieved after 8 years through oscillation dynamics. [ABSTRACT FROM AUTHOR]

Background: The undergraduate bioethics curriculum introduced in a private medical college in Pakistan in 1988 and revised in 2009 has evolved over time to incorporate globally relevant innovations, including integration of bioethics spirally within an existing problem-based learning curricular framework. The present evaluation study shares the results of this integrated bioethics curriculum delivered for 10 years across the five-year undergraduate medical curriculum. The study assessed the effectiveness of the curriculum in terms of student achievement, appropriateness of course contents and efficiency of instructional methods. Methods: The study utilized a mixed method sequential explanatory design. The quantitative method was used in the first phase to gather data by utilizing a structured online questionnaire. This was followed by the second phase of qualitative methods to explain the findings of the first phase and enrich the data gathered. This phase was based on focus group discussions and document review. Results: Student and faculty responses showed the curriculum contents to be relevant, informative, and appropriate as per learning objectives and student achievement. Multi-modal instructional methods used were stated to be effective and engaging; small group teaching and shorter sessions suggested to be preferable for fostering discussion and maintaining student engagement and attention. Large class formats were stated to be less effective. Students affirmed the contribution of bioethics education to their personal and professional development and ethical positioning. The majority of students agreed that the curriculum contributed to their knowledge acquisition (60.3—71.2%), skill development (59.41—60.30%) and demonstration of ethical/professional behavior (62.54—67.65%). The ranges indicate agreement with related sets of questions. Participants suggested that the curriculum could be further strengthened by better integration in clinical years, role modelling and providing opportunities for application in clinical health care settings. Moreover, topics like ethical issues related to the use of social media, public health ethics and ethics and law were suggested as additions to the existing curriculum. These findings have regional and global relevance for the development and assessment of effective bioethics curricula. Conclusion: An effective bioethics curriculum for undergraduate medical education should run longitudinally across the 5 year curriculum and be integrated in the modules and clerkships. Basic acquisition of knowledge and skills takes place in Years 1 & 2 with reinforcement and application in Years 3–5. Learning embedded in an integrated curriculum can help students recognize, critically analyze and address ethical dilemmas. Involvement and commitment of the clinical faculty is essential for reinforcing the ethical principles and concepts learnt in the earlier years. [ABSTRACT FROM AUTHOR]

Debates concerning mask wearing continue in Japan. Here we critically examine the reasons for relaxing these regulations from a public health ethics perspective. We focus on three issues: government responsibility, political motivation, and cultural orientation, also discussing how these issues might have broader application in other parts of the world. [ABSTRACT FROM AUTHOR]

The nascent for-profit psychedelic industry has begun to engage in corporate practices like funding scientific research and research programs. There is substantial evidence that such practices from other industries like tobacco, alcohol, pharmaceuticals and food create conflicts of interest and can negatively influence population health. However, in a context of funding pressures, low publicly funded success rates and precarious academic labor, there is limited ethics guidance for researchers working at the intersection of clinical practice and population health as to how they should approach potential financial sponsorship from for-profit entities, such as the psychedelic industry. This article reports on a reflective exercise among a group of clinician scientists working in psychedelic science, where we applied Adams' (2016) PERIL (Purpose, Extent, Relevant harm, Identifiers, Link) ethical decision-making framework to a fictionalized case of corporate psychedelic financial sponsorship. Our analysis suggests financial relationships with the corporate psychedelic sector may create varying degrees of risk to a research program's purpose, autonomy and integrity. We argue that the commercial determinants of health provide a useful framework for understanding the ethics of industry-healthcare entanglements and can provide an important population health ethics lens to examine nascent industries such as psychedelics, and work toward potential solutions. [ABSTRACT FROM AUTHOR]

This article argues that the liberalism of fear provides a useful theoretical framework for public health ethics in two fronts. First, it helps reconcile the tension between public health interventions and liberal politics. Second, it reinforces the existing justifications for public health interventions in liberal political culture. The article discusses this in the context of political emotions in the COVID-19 pandemic. Fear plays a central role in the experiences of pandemic politics, and such fear is extended to the concern that post-pandemic government would normalize emergency politics and threaten the political culture of liberal democracy. The article proposes that the liberalism of fear provides a theoretical solution not only to alleviate such fear, but also to reconcile the long-established tension between liberal politics and public health intervention. This is particularly so if the liberalism of fear's characteristic of political realism is taken into account. The article makes two points about this, and discusses their pragmatic implications in the case of compulsory vaccination. [ABSTRACT FROM AUTHOR]

The April 2024 issue of the Asian Bioethics Review focuses on the law and ethics of reproduction. It explores various aspects of reproductive law and ethics in Asia, including complex legal regulations, the role of professionals in counseling couples involved in artificial reproductive technologies (ART), the experiences of women breastfeeding, the contribution of religious perspectives, and the challenges of conducting research in the field of genomics. The issue highlights the need for ethical research and international collaboration in the field of reproductive technologies. The articles also discuss the importance of considering diverse family structures, male consent in ART procedures, labor law issues in cross-border surrogacy, counseling for egg donation, Islamic perspectives on sex selection, Hindu and Catholic perspectives on end-of-life issues, breastfeeding as an embodied social practice, and ethical considerations in neonatal care. The issue emphasizes the interconnectedness of reproductive ethics with various other areas of bioethics. [Extracted from the article]

The key objective of this paper is to emphasize the importance of acknowledging breastfeeding as an embodied social practice within interventions related to breastfeeding and lactation and illustrate how this recognition holds implications for public health ethics debates. Recent scholarship has shown that breastfeeding and lactation support interventions undermine women's autonomy. However, substantial discourse is required to determine how to align with public health goals while also recognizing the embodied experiences of breastfeeding and lactating individuals. Presently, interventions in this realm predominantly revolve around health-related messaging and the promotion of individual behaviors, often neglecting the systemic and structural factors that influence choices and practices. I closely examine breastfeeding interventions in India, in particular Mothers' Absolute Affection health promotion program, along with breastfeeding narratives. I argue that for such interventions to evolve, they must acknowledge the intrinsic embodied social nature of breastfeeding during their design and implementation. Furthermore, it is important to emphasize that achieving equity and justice objectives necessitates moving beyond the confines of both conventional public health frameworks and frameworks solely centered on private choices. Instead, a more encompassing approach that embraces the concept of embodiment should be adopted. [ABSTRACT FROM AUTHOR]

Risk and crisis communication (RCC) is a current ethical issue subject to controversy, mainly due to the tension between individual liberty (a core component of fairness) and effectiveness. In this paper we propose a consistent definition of the RCC process in public health emergencies (PHERCC), which comprises six key elements: evidence, initiator, channel, publics, message, and feedback. Based on these elements and on a detailed analysis of their role in PHERCC, we present an ethical framework to help design, govern and evaluate PHERCC strategies. The framework aims to facilitate RCC, incorporating effectiveness, autonomy, and fairness. It comprises five operational ethical principles: openness, transparency, inclusivity, understandability, and privacy. The resulting matrix helps understanding the interplay between the PHERCC process and the principles of the framework. The paper includes suggestions and recommendations for the implementation of the PHERCC matrix. [ABSTRACT FROM AUTHOR]

This Article investigates the character, nature, and application of Crisis Standards of Care ("CSC") in national emergency preparedness plans. Ideally, these standards allow a government to codify frameworks or models for allocating scarce medical resources. The principal mechanism used by healthcare decision-makers to evaluate individuals seeking medical assistance is through triage--a diagnostic process utilizing algorithms to sort, grade, or select those who "qualify" for medical treatment. This Article studies the principles and values incorporated into these medical algorithms and concludes that more federal government leadership is required to convince the states that CSC are an integral part of emergency preparedness; and, secondly, that diagnostic algorithms must be used in an equitable manner that does not discriminate among the medically injured, the aged, or those with comorbidities. [ABSTRACT FROM AUTHOR]

Background: Medical imaging tests are vital in healthcare but can be costly, impacting national health expenditures. Magnetic resonance imaging (MRI) is a crucial diagnostic tool for assessing medical conditions. However, the rising demand for MRI scans has frequently strained available resources. This study aimed to estimate the prevalence of different imaging tests in individuals who eventually had an MRI, in the Israeli public health system. Methods: An online survey of patient experience of scheduling an MRI was conducted in January–February 2023, among 557 Israeli adults, representing all four health maintenance organizations (HMOs). All participants had undergone an MRI in the public health system within the past year. Results: Results showed that 60% of participants underwent other imaging tests before their MRI scan. Of those, computed tomography (CT) scans (43%), X-rays (39%), and ultrasounds (32%) were the most common additional imaging procedures. In addition, of the 60% of participants, 23% had undergone more than one prior imaging examination. Conclusions: These findings highlight the high prevalence of preliminary imaging tests prior to MRI, with many patients undergoing multiple tests for the same problem. The health system may need to evaluate whether current clinical guidelines defining the use of various imaging tests are cost-effective. [ABSTRACT FROM AUTHOR]

Rapid advancements in AI (artificial intelligence) technologies, including machine learning, natural language processing, and computer vision, have developed sophisticated tools capable of performing complex medical tasks. The AI integration in healthcare can revolutionise the industry by improving patient outcomes, optimising resource allocation, and reducing operational costs. However, the AI use in medicine carries certain risks related to ethics and data privacy, shortcomings in the quality of data for training algorithms, and importance of protecting against cyberthreats. There is also a threat of rising medical costs due to the need for a large number of tests and validations of new technologies. This study focuses on the AI application in the diagnostic field, as it is revolutionising the medical industry by offering new opportunities for accurate disease detection, classification, and prediction of treatment outcomes. The diagnostic field specificity is that any changes in it affect both those medical professionals who directly perform diagnostic procedures and those medical specialists who use the results of diagnostic examinations in their work. The research consists of two stages. Stage 1 is a survey of 119 respondents (medical professionals in Ukraine) about their attitude to the integration of AI technologies in diagnostics. Stage 2 is a study of opinions by 10 experts (medical professionals in Ukraine) about their own assessment of AI risk parameters in medical diagnostics. The survey showed the vast majority of Ukrainian doctors (over 84%) had no experience with AI-based diagnostic systems. Simultaneously, 74% of respondents believe AI can be effective in reducing diagnostic errors, and the future of medical diagnostics is associated with AI. They consider its main advantages to be speed, accuracy, objectivity, and ability to detect diseases at early stages. Respondents argue that AI is the most appropriate for diagnosing cancer, genetic research, and chronic conditions with atypical symptoms. Regarding the risks and barriers to AI introduction in medical diagnostics, at the first study stage, respondents named the high cost of implementation, the need for specialised training, and the possible lack of personal interaction between doctor and patient as the main ones. This opinion was clarified at the second study stage. In particular, 10 experts ranked these risks and potential problems in the following order (from the most to least important): unequal access; dependence on technology; ethical issues; legislative and regulatory challenges; lack of personal contact; bias and inequality; data privacy and security; errors in diagnosis and treatment. To mitigate each of these risks, the article develops a set of recommendations. [ABSTRACT FROM AUTHOR]