Ethics, Medicine and Public Health最新文献

{"title":"Chronic postoperative pain, current controversy on inguinal hernia, expert patient perspective, bioethics, and global health","authors":"P.-H. Moury,&nbsp;S. David-Tchouda","doi":"10.1016/j.jemep.2026.101329","DOIUrl":"10.1016/j.jemep.2026.101329","url":null,"abstract":"<div><h3>Background</h3><div>We aim to draw attention to a meaningful public health concern regarding chronic pain after inguinal hernia repair, emphasizing the need for thoughtful, evidence‑based, and patient‑focused management. Despite its frequency (27% of men), this procedure, often perceived as benign, can lead to disabling pain (0.5–6% of cases) and daily handicap, which is underestimated by official registries.</div></div><div><h3>Method and results</h3><div>Our hypothesis was drawn from the French figures, over 200,000 surgeries are performed annually, yet fewer than 30 serious adverse events per year were reported between 2020 and 2024. We used a minimum rate of complication at 0.5%. We performed a Monte Carlo simulation based on a beta–binomial distribution to describe the credibility interval of an estimate grounded in real‑world surgical practice expecting 1066 (CI95%: 604–1650) complications.</div></div><div><h3>Discussion</h3><div>Our article highlights the discrepancy between clinical data, registry data, and the reality experienced by patients with chronic postoperative pain—pain that is often undertreated, overlooked, or misunderstood — and who still tend to be attributed psychological causes (such as anxiety or depression) rather than organic factors (such as BMI or hernia size). Surgical techniques, with or without prostheses, and approaches (open, laparoscopic) vary, but their long-term evaluation lacks data. Medico-economic costs and disparities in access to care (rich countries vs. low-income countries) exacerbate inequalities.</div><div>Chronic pain requires multidisciplinary management (medications, neurectomies, neuromodulation, psychology), but care pathways remain fragmented and siloed. Health authorities have acknowledged the urgency, yet scientific societies struggle to integrate patients' experiential knowledge and effective monitoring of medical devices. Although outpatient surgery is efficient and widely adopted, its streamlined nature may make complications less visible.</div></div><div><h3>Perspectives</h3><div>In light of this body of evidence, we call for an independent and truly systemic approach—one that integrates robust epidemiological registries, transparent evaluation of medical devices through national health data infrastructures, and meaningful patient involvement in decision‑making. Public health must move beyond disciplinary silos to foster care that is both more humane and more equitable.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"34 ","pages":"Article 101329"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148951203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The ethical map as a visual tool for ethical decision-making in zoonotic disease control","authors":"C.S. Fonseca de Oliveira,&nbsp;L.D.M. Silva Maia,&nbsp;B. Oliveira Lima Ramos,&nbsp;É.L. Martins Araújo,&nbsp;L. Belchior Souza de Oliveira,&nbsp;B. Moreira de Souza,&nbsp;L. de Jesus Silva,&nbsp;F. do Carmo Magalhães,&nbsp;D. Ferreira de Magalhães Soares,&nbsp;R.R. Nicolino,&nbsp;C. Forte Maiolino Molento,&nbsp;B. Divino Rocha","doi":"10.1016/j.jemep.2026.101319","DOIUrl":"10.1016/j.jemep.2026.101319","url":null,"abstract":"<div><div>Zoonotic disease control often involves uncertain decisions in which public health, animal welfare, human agency, legal duties, environmental protection, and social vulnerability may conflict. This exploratory study presents the Ethical Map, a visual deliberative tool intended to support transparent ethical reasoning in field situations involving possible animal euthanasia. The tool complements, rather than replaces, the ethical matrix by translating stakeholder-based, One Health, public health, and veterinary ethics into a practical visualization of lawful options. In an in-person workshop, 27 veterinarians discussed rabies-related exposure, severe feline sporotrichosis, and highly pathogenic avian influenza scenarios. Participants assessed legally plausible interventions before and after structured deliberation. The process required identification of stakeholders, expected benefits and harms, uncertainty, justice, proportionality, human agency, and proxy representation of animal interests before positioning action cards on the map. Responses were analyzed descriptively using a four-point ordinal scale and paired Wilcoxon signed-rank tests. Participants favored home observation in the rabies scenario, accepted euthanasia more in severe refractory sporotrichosis, and preferred isolation, monitoring, disinfection, and movement restrictions over large-scale euthanasia in the avian influenza scenario. The Ethical Map appeared to support collective justification and visualization of value conflicts, but requires further validation, usability testing, reliability assessment, and real-world application.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"34 ","pages":"Article 101319"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148951204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scientific facilitation of inter-transdisciplinary health research","authors":"B. Hogedez","doi":"10.1016/j.jemep.2026.101317","DOIUrl":"10.1016/j.jemep.2026.101317","url":null,"abstract":"<div><h3>Background and objective</h3><div>Inter- and transdisciplinary (ITD) health research is increasingly promoted as a way of addressing complex problems, yet collaboration remains shaped by epistemic, social and institutional tensions. This article examines the ethical and collaborative effects of a scientific facilitation intervention, the Toolbox Dialogue Initiative (TDI), implemented in an interdisciplinary clinical research team in Québec.</div></div><div><h3>Methods</h3><div>We conducted a qualitative case study of a nine-member clinical research team studying the effects of manual therapies on the vagus nerve. The intervention combined a philosophical instrument-questionnaire with a facilitated dialogue workshop. Its evaluation drew on process evaluation and program theory to distinguish individual-level mechanisms (reflexivity, perspective-taking) from group-level outcomes (mutual understanding, socio-cognitive integration). Data were collected through participant observation, pre- and post-intervention questionnaires, and semi-structured interviews, and analysed using inductive thematic coding and triangulation.</div></div><div><h3>Results</h3><div>TDI acted as a catalyst for reflexivity by making tacit epistemic divergences visible and fostering mutual understanding within the team. However, these mechanisms did not translate into sustained socio-cognitive integration: the research object was ultimately recentred according to a dominant disciplinary framing, and the absence of follow-up limited the intervention’s long-term effects. Although participants reported a positive workshop experience overall, the patient partner described feeling vulnerable and “under scrutiny”, suggesting that procedural fairness and psychological safety were unevenly achieved.</div></div><div><h3>Conclusion</h3><div>TDI illustrates both the promise and the ambivalence of scientific facilitation in health research. It can support epistemic justice and shared reflexivity, but its effects remain fragile when facilitation is conceived as a one-off, peripheral activity. Scientific facilitation should therefore be understood as a situated professional and ethical practice, embedded in project governance and supported by sustained reflexive work.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"34 ","pages":"Article 101317"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148853902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpreting the Ars Moriendi of Michelangelo Buonarroti (1475-1564)","authors":"D. de Campos ,&nbsp;V. Salerno","doi":"10.1016/j.jemep.2026.101265","DOIUrl":"10.1016/j.jemep.2026.101265","url":null,"abstract":"<div><div>This paper commemorates the 150th anniversary of the publication of a landmark study on Michelangelo Buonarroti (1475–1564) and emphasizes its relevance as both a historical and medical reference. The work introduces, for the first time, a documented account of the drugs administered during the artist’s final medical care, together with the costs associated with transporting his body for burial. Examined within its medical and cultural framework, this material provides important insight into Michelangelo’s final days and his engagement with the <em>Ars Moriendi</em>. The <em>Ars Moriendi</em>, a current within Catholic literature devoted to guiding believers toward a Christian “good death”, focused on the salvation of the soul and became widely known and extensively practiced, remaining influential and actively used until the seventeenth century. Modern analyses of the <em>Ars Moriendi</em> offer valuable perspectives for ethical consideration of death, particularly in healthcare settings. When integrated with iconodiagnostic methods, these perspectives foster multidisciplinary interpretations that enrich medical and cultural knowledge, especially in situations where historical clinical records are limited. This aspect is especially pertinent to Michelangelo’s final medical documentation, first written in Italian–Latin and not yet published in a medical scientific journal. To facilitate a clearer understanding Michelangelo's involvement with the <em>Ars Moriendi</em>, the present study presents the original source along with an English translation of the Italian–Latin text to evaluate his therapeutic care. This study aims to assist students and researchers interested in Renaissance medicine and in the medical history surrounding Michelangelo’s final medical treatment.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"34 ","pages":"Article 101265"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147420440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On the securitization of science","authors":"Jukka Ruohonen","doi":"10.1016/j.jemep.2025.101237","DOIUrl":"10.1016/j.jemep.2025.101237","url":null,"abstract":"<div><div>Securitization is a political process through which a phenomenon is framed as a security issue for gaining legitimacy for subsequent political decisions. At the moment, science too is increasingly being securitized. By focusing on recent developments in Europe, this short report reflects upon the political decisions made, their origins and legitimizing arguments, the contradictions that have emerged, and the potential consequences for academic freedom. Although it is still too early to robustly evaluate all potential consequences, a reflection is needed because the securitization process affects the very core of science in democratic societies.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"34 ","pages":"Article 101237"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can One Health help reduce the environmental impacts of the healthcare system in Switzerland? Insights from an interdisciplinary focus group","authors":"G. Brulé ,&nbsp;P. Boiko ,&nbsp;T. Maillet Mezeray ,&nbsp;D. Nadal ,&nbsp;S. Vuilleumier ,&nbsp;N. Senn ,&nbsp;J. Fehr ,&nbsp;L. Crivelli ,&nbsp;J. Zinsstag ,&nbsp;N. Probst-Hensch","doi":"10.1016/j.jemep.2025.101227","DOIUrl":"10.1016/j.jemep.2025.101227","url":null,"abstract":"<div><h3>Background</h3><div>Healthcare systems contribute to about 5% of the emissions of the greenhouse gases globally when taken together. With 6.7% of its national emissions of greenhouse gases, the Swiss healthcare system is among the biggest contributors worldwide when taken per capita. Although isolated initiatives to reduce environmental impacts have emerged these last years, there is a strong need for better understanding the barriers and the possibilities for a heuristic framework like One Health to facilitate transformation, in particular in the Swiss context.</div></div><div><h3>Objective</h3><div>The main objective is to explore to what extent One Health can facilitate transformation of the Swiss healthcare system and a secondary objective is to examine the role of bioethics in reducing healthcare's environmental impact.</div></div><div><h3>Methods</h3><div>A focus group was conducted with nine experts from different disciplines (medicine, environment, veterinary medicine, public health) at the premises of the Swiss Medical Association in Bern on January 27th, 2025. The discussion lasted 180 min and was audio-recorded. Verbatim was transcribed and analyzed using thematic analysis following COREQ guidelines. Three additional individual interviews were conducted with participants who were not able to attend the focus group.</div></div><div><h3>Results</h3><div>Six key themes emerged: the need to reorganize healthcare delivery, the specificity of the Swiss governance system, the need to adopt solutions that are “good enough”, One Health as a heuristic framework for systemic change, the required expansion of the borders of bioethics to include environmental and animal welfare considerations and the possible tensions between different dimensions within the One Health framework.</div></div><div><h3>Conclusions</h3><div>Integrating environmental perspectives through a One Health approach is a possible solution to reduce the environmental impacts of the Swiss healthcare system. The study identifies both barriers (complexity of the Swiss healthcare system, siloed departments) and opportunities (professional willingness to collaborate, the development of post-Covid initiatives) for implementing sustainable healthcare transformation in Switzerland.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"34 ","pages":"Article 101227"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Womb for rent: The deep ethical fault lines of commercial surrogacy","authors":"R.A. Arceño ,&nbsp;C.J.N. Ong ,&nbsp;M.M. Ahmed ,&nbsp;R. Nazari ,&nbsp;D.E. Lucero-Prisno III","doi":"10.1016/j.jemep.2025.101226","DOIUrl":"10.1016/j.jemep.2025.101226","url":null,"abstract":"","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"34 ","pages":"Article 101226"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colonial transitions in health","authors":"P.-H. Moury","doi":"10.1016/j.jemep.2025.101217","DOIUrl":"10.1016/j.jemep.2025.101217","url":null,"abstract":"<div><div>The challenges of colonial transitions in health interact with epidemiology and philosophy, which are necessary to understand the contexts of health disparities found in the French colonies of New Caledonia and the Antilles developed here.</div><div>Colonialism interact with the global health transitions, including demographic, epidemiological, and climatic transitions, through persistent colonial phenomenon in forms of neocolonialism and post-colonialism. This underscores the necessity of revaluating our relationship with nature and the boundaries of our existing perceptions, calling for an ethic grounded in distributive justice.</div><div>The narrative of epidemiology spans from the practices of colonial physicians to the tenets of modern bioethics, delving into the chlordecone scandal. We explore the contributions of figures such as Frantz Fanon, who combated racism and colonialism, and address ongoing debates regarding the incorporation of race in epidemiological research.</div><div>We underscore the essential incorporation of social inequalities in health, with a focus on intersectionality as a lens for revisiting epidemiology, alongside ecofeminism, the \"One Health\" approach, and art to comprehend the determinants of health.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"34 ","pages":"Article 101217"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards ethical frameworks for reproductive genome editing","authors":"A. Midler","doi":"10.1016/j.jemep.2026.101312","DOIUrl":"10.1016/j.jemep.2026.101312","url":null,"abstract":"","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"34 ","pages":"Article 101312"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148539472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The “rediscovery” of an anatomical study of the external jugular vein by Michelangelo Buonarroti and its iconodiagnostic importance","authors":"D. de Campos,&nbsp;V. Salerno","doi":"10.1016/j.jemep.2026.101307","DOIUrl":"10.1016/j.jemep.2026.101307","url":null,"abstract":"<div><div>In semiological terms, knowledge of the anatomy of the external jugular vein is important in medical training, as specific alterations in its appearance can reveal hemodynamic, cardiac, and even endocrine disorders. Accordingly, the semiological and anatomical significance of the external jugular vein extends to iconodiagnostic analysis, an approach incorporated into the current curricula of many medical schools. Therefore, this article presents an anatomical study of the external jugular vein made in 1530 by Michelangelo Buonarroti (1475–1564) that remained largely overlooked in the Ashmolean Museum in Oxford, England. In that study, the representation of the external jugular vein appears anatomically accurate, including the depiction of one of its valves. This is particularly noteworthy because Michelangelo may have produced one of the earliest known anatomical representations of a venous valve, predating the first medical publications on these structures, which appeared around 1540. The drawing also helps explain other works by Michelangelo in which the external jugular vein is prominently depicted, including protrusions corresponding to its valves. This feature may be interpreted as a deliberate artistic refinement reflecting Michelangelo’s anatomical knowledge of a vein that can become distended during normal states of physical or emotional stress. This may also help explain, in part, the recurrent appearance of the external jugular vein in his works, as its accurate depiction can convey the emotional state of the subject and enhance realism. These observations may contribute to the development of future iconodiagnostic analyses and to the field of medical humanities.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"34 ","pages":"Article 101307"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148634428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}