Ethics, Medicine and Public Health最新文献

{"title":"Protection of the elderly patient and preservation of decision-making autonomy at the end of life in Belgian law","authors":"G. Genicot","doi":"10.1016/j.jemep.2025.101046","DOIUrl":"10.1016/j.jemep.2025.101046","url":null,"abstract":"<div><h3>Context</h3><div>In Belgian law, medical decisions are placed under the banner of the patient's <em>self-determination</em>, expressed, if necessary, in the form of <em>binding</em> advance directives or conveyed by a representative – freely chosen, or designated by the law or the judge – who has <em>decision-making powers</em>.</div></div><div><h3>Methodology</h3><div>The way in which the law understands reality differs from that of other disciplines, including the humanities and social sciences. For this subject, reality is studied through the development of rules (issues, content, spirit), but also through their practical application, especially in the case of litigation, through the study of court decisions that may be handed down. This method is used here in relation to end of life.</div></div><div><h3>Results/discussion</h3><div>The patient's decision-making autonomy is the cornerstone of Belgian medical law, and it remains – simply exercised in a different way – when patients are no longer able to exercise their rights themselves. Belgian law provides for (i) an absolute right of an adult patient to refuse any treatment, including in the form of advance directives; (ii) the right to appoint a health proxy whose decision will be binding both on (other) family members and on the doctor; (iii) and, failing that, a \"cascade\" mechanism designating <em>in any event</em> a person empowered to exercise the rights of a patient who is incapable of doing so, and giving the immediate family a decision-making role rather than a merely advisory one, with a hierarchy among family members (priority being given to the spouse, whether married or not).</div></div><div><h3>Conclusion/outlook</h3><div>In medical matters, and especially at the end of life, the crucial point which is illustrated by the legal framework is probably <em>the decision-making model itself</em>. The law should suggest a model which, in this field, is as much societal (and ethical) as strictly legal. In this respect, the scheme set up in Belgian law has the salutary effect to adequately meet the needs of healthcare practice, and the legitimate aspirations of citizens. By placing the centre of gravity of medical decisions on the side of the <em>patient</em> and not the doctor, including at the end of life, it is fundamentally different from a <em>consultation scheme</em>, which results in a decision that is certainly concerted, but remains medical.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101046"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143099345","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":"Concerns regarding patient’s safety and oral health risks associated with counterfeit dental materials","authors":"Shalini Kushwaha ,&nbsp;Pooja Puri ,&nbsp;Kavita Goyal ,&nbsp;Christine Jeyaseelan","doi":"10.1016/j.jemep.2024.101038","DOIUrl":"10.1016/j.jemep.2024.101038","url":null,"abstract":"","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101038"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143099353","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":"Parental paternalism as an equity issue: A case study of parental influence on adolescents’ reproductive health in Medellín, Colombia","authors":"J. Brisson","doi":"10.1016/j.jemep.2025.101108","DOIUrl":"10.1016/j.jemep.2025.101108","url":null,"abstract":"<div><h3>Background</h3><div>In bioethics, parental paternalism in adolescent healthcare is typically analyzed through the lens of autonomy and consent, emphasizing parents’ role and adolescents’ capacity to make independent decisions. However, this approach may overlook the role of parental self-interest in shaping healthcare decisions, particularly in the context of reproductive health, and may contribute to inequitable outcomes for adolescents. This exploratory empirical bioethics study examines these dynamics through an equity lens, offering a broader perspective on how relational and social factors can differentially constrain adolescents’ reproductive choices, such as the use of contraceptives.</div></div><div><h3>Methods</h3><div>In 2024, semi-structured interviews were conducted with parents of adolescents aged 10–19 in Medellín, Colombia. Participants were recruited through a sexual and reproductive health clinic and community networks. Transcripts were analyzed using the public health ethics principle of equity.</div></div><div><h3>Results</h3><div>Of the 28 participants, 79% were mothers, and together they had 35 adolescents with a mean age of 14. While parental paternalism is typically framed as solely altruistic, some participants described influencing adolescents’ contraceptive decisions to avoid assuming caregiving roles as young grandparents. In a context like Colombia, where adolescent pregnancy is prevalent and grandparents often provide care, such motivations raise equity concerns about how parental self-interest may unequally constrain adolescents’ reproductive choices.</div></div><div><h3>Conclusions</h3><div>These findings highlight an underexplored equity concern: when parental self-interest shapes adolescents’ healthcare decisions, it can create unjust disparities in their ability to make reproductive health choices. Equity-oriented approaches must address how family dynamics can reinforce structural barriers to adolescent health and well-being.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101108"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143882331","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":"Anthropological study on the perception of skin aging and aesthetic procedures: An international, generational analysis","authors":"L. McEwen ,&nbsp;C. Déchelette ,&nbsp;S. Fauverghe","doi":"10.1016/j.jemep.2025.101109","DOIUrl":"10.1016/j.jemep.2025.101109","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Skin aging is perceived differently across generations, influencing their views on skin aging and aesthetic procedures. This study analyses the attitudes of five current generations: the Silent Generation; Baby Boomers; Generation X; Generation Y or Millennials; and Generation Z, toward skin aging and aesthetic treatments. By combining anthropological and medical perspectives, we identified the perceptions, motivations, knowledge and emerging trends in aesthetic medicine for each generation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methodology&lt;/h3&gt;&lt;div&gt;A semi-structured online survey consisting of 20 questions was conducted. A total of 1,303 responses were collected from respondents across 54 countries, representing the five sociological age groups (Gen Z, Millennials, Gen X, Baby Boomers, and the Silent Generation), with a gender distribution of 60% women, 40% men, and three non-binary individuals. A thematic roundtable with dermatologists and aesthetic surgeons was then conducted. Quantitative and qualitative analyses of all data, including the open and closed questions as well as citations from the roundtable, was conducted and eight axes of analysis were used to structure the interpretation of the data (neutral/negative; external/internal; active/passive; informed/uninformed). This resulted in detailed, nuanced profiles of each generation’s perceptions, orientations, and practices related to skin aging and aesthetic procedures.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Each generation reflects a different relationship with their skin and perception of skin aging. A noticeable generation gap emerged between Generation X and the Baby boomers. The three younger generations (Gen X, Millennials, and Gen Z) displayed a more active, informed approach to skin aging and aesthetic procedures; as opposed to the more passive, uninformed orientation of the two older generations (Baby Boomers, Silent Generation). Nuanced evidence of the “prejuvenation” concept was present in the form of a conceptual spectrum that spanned the generations: Gen Z emphasized prevention and protection; the Millennials and Gen X focused on rejuvenation and anti-aging; and the Baby boomers on care. The Millennials were the most active in their approach to skin aging. There was evidence of an increasingly negative vision of skin aging as the age of the generations increased.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;With the rise of social media and advancements in aesthetic medicine, behaviors related to anti-aging treatments have evolved. While older generations seek discreet interventions, younger generations adopt a preventive approach known as “prejuvenation” and normalize aesthetic procedures from an early age. Our results confirm several of the major trends in the literature and in aesthetic medicine; namely that the 26–55 groups are the most knowledgeable and active consumers of aesthetic dermatology and aesthetic medicine. The overall negative conception of skin aging is","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101109"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143923016","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":"Mengele, the banality of evil and the perversion of medicine","authors":"P. Charlier","doi":"10.1016/j.jemep.2025.101113","DOIUrl":"10.1016/j.jemep.2025.101113","url":null,"abstract":"","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101113"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143894976","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":"Prevalence of depression, suicidal ideation, and its risk factors in leprosy patients: A systematic review","authors":"G. Keerthana ,&nbsp;S. Neeraja ,&nbsp;S. Padmakar ,&nbsp;S. Kousar Sada ,&nbsp;G. Bhargavi","doi":"10.1016/j.jemep.2025.101116","DOIUrl":"10.1016/j.jemep.2025.101116","url":null,"abstract":"<div><h3>Background</h3><div>Leprosy is a chronic disease with significant physical, psychological, and social implications. The disability and stigma associated with leprosy can lead to mental health challenges including depression and suicidal ideation (SI). Understanding these condition’s prevalence and risk factors is critical to improving the mental status of affected individuals.</div></div><div><h3>Methods</h3><div>PRISMA guidelines were used to perform this systematic review. Databases like Google Scholar, Scopus, PubMed, PsycINFO, and Embase were used to collect articles using the following terms: leprosy, Hansen’s disease, suicidal ideation, depression, and psychosocial factors. The Joanna Briggs Institute's critical assessment checklist tool was used to assess the methodological quality of the research studies.</div></div><div><h3>Results</h3><div>This systematic review includes seventeen studies. Depression prevalence among leprosy patients ranged from 12.5% to 89.8%, while SI prevalence varied from 6.7% to 76%. The majority of studies employed the Patient Health Questionnaire (PHQ-9) to assess depression. Gender, disability, unemployment, age, marital status, and stigma were the most frequently reported risk factors for depression among leprosy patients. Psychiatric comorbidities are the leading risk factor for SI in leprosy patients.</div></div><div><h3>Conclusion</h3><div>Depression and SI are widespread among patients with leprosy, emphazing the critical importance of incorporating mental health treatments into leprosy care programs. Reducing stigma, strengthening social support systems, and offering psychological counselling are vital strategies to address these challenges and improve patient health.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101116"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143943754","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":"Magical-religious, social or psychiatric zombie: Interdisciplinary analysis of new recent cases of « zombies » in Haiti","authors":"J.-R. Senatus ,&nbsp;P. Charlier","doi":"10.1016/j.jemep.2025.101100","DOIUrl":"10.1016/j.jemep.2025.101100","url":null,"abstract":"<div><h3>Background</h3><div>Haitian zombies are an anthropological entity corresponding to four legal, administrative, and pathological states: ritual poisoning with social death, criminal poisoning, psychiatric disorders, and identity theft.</div></div><div><h3>Methodology</h3><div>In this article, we review the latest data from the anthropological, legal, and medical literature on this uniquely Haitian phenomenon. We also discuss new, unpublished cases recently examined in Haitian courts, with clear implications for public health and law.</div></div><div><h3>Results</h3><div>These new cases question the status of the human person, the identification, and the care of individuals desocialized and deliberately placed in a state of social death.</div></div><div><h3>Conclusion</h3><div>An interdisciplinary approach is absolutely necessary, with collaboration between the humanities and fundamental sciences, around this complex phenomenon of zombies in Haiti. Their frequency (around 50,000, for a total population of around 11 million inhabitants) is certainly marginal, but significant, and constitutes a real public health problem, as well as a relevant concept in medical anthropology and health law.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101100"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833056","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":"Genetics’ exceptionality – A short perspective from clinical care","authors":"C. Bourgain","doi":"10.1016/j.jemep.2025.101104","DOIUrl":"10.1016/j.jemep.2025.101104","url":null,"abstract":"<div><div>Genetics exceptionality relies on the strong imaginaries associated with this particular type of biological information – its capacity to disclose the invisible intimate- and on the concerns for controlling its possibly negative social impacts – the genetic information is always both highly specific and shared within families and populations. The paper claims that together with specific legal frameworks, this exceptionality is also embodied by the amount of effort performed in the clinic to control the strong uncertainties associated with the usage of this scientific knowledge in care contexts.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101104"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855222","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":"Mysterious illness outbreaks in the Democratic Republic of Congo: A multidimensional public health emergency","authors":"M.M. Hassan ,&nbsp;I.I. Okon ,&nbsp;O.J. Okesanya ,&nbsp;M.M. Ahmed","doi":"10.1016/j.jemep.2025.101069","DOIUrl":"10.1016/j.jemep.2025.101069","url":null,"abstract":"","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101069"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143577661","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":"A comprehensive analysis of mental illness and neurological dysfunction in Tamil cinema: A questionnaire-based survey and its outcomes","authors":"T. Gangadharan ,&nbsp;A. Jayaraman","doi":"10.1016/j.jemep.2025.101115","DOIUrl":"10.1016/j.jemep.2025.101115","url":null,"abstract":"<div><h3>Background</h3><div>Mass media significantly shape public perceptions, and Tamil cinema (Kollywood) plays a vital role in this cultural narrative. However, it often perpetuates stereotypes associated with mental illness, contributing to stigma and misunderstanding within society. Given the growing influence of cinema, it is essential to examine how psychiatric conditions are represented in Kollywood films and the impact these portrayals have on public perception.</div></div><div><h3>Methodology</h3><div>The study analyzed Tamil-language films from the past four decades that depicted psychiatric illnesses. A Google search was conducted to compile a list of relevant Kollywood movies. Each film was then screened and evaluated based on character demographics, exhibited symptoms, diagnoses, and the scientific accuracy of these portrayals. A total of twenty-eight films from the last 45 years were analyzed. Additionally, a questionnaire-based survey was administered to the general public to assess perceptions of mental illness and neurological dysfunction as depicted in Tamil cinema.</div></div><div><h3>Results/Discussion</h3><div>The analysis revealed that most characters with mental health issues were portrayed as middle-aged, unmarried, employed, and from affluent backgrounds. The most commonly depicted symptom was aggression, and the dominant diagnosis presented was psychopathy. These portrayals often showed a decline in the characters’ mental health over time. Survey responses indicated that such cinematic depictions significantly influence audience perceptions, reinforcing negative stereotypes and contributing to the social stigma surrounding mental illness.</div></div><div><h3>Conclusion/Perspectives</h3><div>The study highlights the critical role of Kollywood in shaping societal attitudes toward mental health. The recurring inaccuracies and dramatized portrayals in films can perpetuate misinformation and reinforce stigma. By drawing attention to these trends, this research calls for more accurate, sensitive, and responsible representations of mental illness in Tamil cinema, with the potential to foster awareness, empathy, and destigmatization in the broader public consciousness.</div></div>","PeriodicalId":37707,"journal":{"name":"Ethics, Medicine and Public Health","volume":"33 ","pages":"Article 101115"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143943763","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}