Developing World Bioethics最新文献

{"title":"Making Advanced Therapies Affordable and Accessible: Two Strategic Approaches.","authors":"Ubaka Ogbogu, Lauren Albrecht","doi":"10.1111/dewb.70004","DOIUrl":"https://doi.org/10.1111/dewb.70004","url":null,"abstract":"<p><p>This article explores two complementary strategies for addressing the affordability and access challenges facing advanced therapies. As high development costs and limited market access have led to the withdrawal of several therapies, the article examines how these barriers create 'valleys of death' that prevent innovation from reaching patients. Through the case of Glybera and other examples, it outlines a rehabilitative approach focused on reforming current systems through improved reimbursement schemes, regulatory streamlining, and more efficient manufacturing. It also presents a transformative approach that embeds affordability and access from the beginning of the research and development process, encouraging local innovation, equitable intellectual property practices, and adaptive regulatory frameworks. Lessons from the COVID-19 vaccine experience demonstrate the real-world potential of these strategies to ensure that promising therapies are not only developed, but also equitably delivered worldwide.</p>","PeriodicalId":50590,"journal":{"name":"Developing World Bioethics","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Confucian Case for a Married Couple's Social Embryo Freezing.","authors":"Rui Deng, Ruiping Fan","doi":"10.1111/dewb.70002","DOIUrl":"https://doi.org/10.1111/dewb.70002","url":null,"abstract":"<p><p>Current policies in mainland China strictly distinguish between social egg or embryo freezing and medical egg or embryo freezing. Single women are not allowed to undergo social egg freezing, and even married couples are prohibited from social embryo freezing. This paper argues, from the perspective of Confucian virtue ethics, which is still the most influential traditional ethical framework in contemporary Chinese society, that prohibiting married couples from social embryo freezing cannot be justified. It also refutes the arguments supporting this ban point by point, showing that they are morally unfounded. The paper concludes that the ban should be lifted. This is not intended to encourage married couples to freeze embryos or to consider social embryo freezing an ideal reproductive choice according to Confucian ethics. Rather, it aims to highlight an important Confucian ethical point: just because social embryo freezing is not an ideal reproductive choice, it does not necessarily justify prohibition by state power.</p>","PeriodicalId":50590,"journal":{"name":"Developing World Bioethics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical, Bioethical, and Regulatory Challenges in Pregnancy With Death by Neurological Criteria: An Analysis in the Colombian Context.","authors":"Boris Julián Pinto-Bustamante, María Carolina Abaunza-Barrero, Andrés José Vargas-Ardila, Ana Isabel Gómez-Córdoba, Liliana Paola Correa-Pérez, Julián Rodríguez-Cely, Habib Georges Moutran-Barroso, Diana Alejandra Alfonso-Ayala, Edna Margarita De la Hoz-Suárez, Laura Natalia Cabra-Rojas","doi":"10.1111/dewb.70003","DOIUrl":"https://doi.org/10.1111/dewb.70003","url":null,"abstract":"<p><p>This article explores the ethical and legal challenges of death by neurological criteria (DNC) in a 20-week pregnant patient, focusing on the tension between patient autonomy and fetal well-being. Through an educational clinical case, it analyzes the clinical, bioethical, and legal aspects, considering advance directives, family expectations, and biomedical possibilities. The case raises ethical concerns about the instrumentalization of the woman's body when prolonging life support during pregnancy. The analysis emphasizes the importance of respecting the patient's autonomy and ensuring posthumous dignity. It also highlights the role of interdisciplinary teams in balancing clinical, ethical, and emotional factors in decision-making. The discussion underscores principles such as autonomy, best interests, and proportionality, promoting ethical management aligned with individual values. Finally, it offers practical tools for healthcare professionals facing similar situations, fostering comprehensive family support and informed bioethical deliberation.</p>","PeriodicalId":50590,"journal":{"name":"Developing World Bioethics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mpox and the Ethics of Outbreak Management: Lessons for Future Public Health Crises.","authors":"Adetayo E Obasa, Marietjie Botes, Anita Kleinsmidt, Ciara Staunton","doi":"10.1111/dewb.70001","DOIUrl":"https://doi.org/10.1111/dewb.70001","url":null,"abstract":"<p><p>Mpox, first identified in captive monkeys in 1958 and recognized in humans by 1970 in the Democratic Republic of Congo, was historically confined to sporadic zoonotic outbreaks in Central and West Africa. These outbreaks, often driven by rodent-to-human transmission in resource-limited settings, reflect persistent systemic health disparities. In recent years, mpox has also been reported in high-income countries (including the United States, United Kingdom and Europe), underscoring its global health implications beyond traditionally endemic regions. This article examines the mpox outbreak through the lens of public health ethics, evaluating how core ethical frameworks-justice (encompassing equitable vaccine distribution and addressing health inequities), solidarity and respect for rights (including intellectual property considerations)-shape outbreak management strategies. These strategies are ensuring equitable access to vaccines and therapeutics amid intellectual property barriers, combating stigma and misinformation through transparent risk communication and fostering international solidarity in coordinating responses. The analysis highlights how neglect of these principles exacerbates existing disparities and undermines the effectiveness of interventions. Integrating ethical principles into outbreak responses is critical for building public trust, accountability and community resilience. By distilling lessons from the mpox response, this article contributes to ongoing debates in public health ethics and outbreak preparedness, arguing that ethically grounded approaches are essential for fair and effective management of future public health crises.</p>","PeriodicalId":50590,"journal":{"name":"Developing World Bioethics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Austerity Kills: The Ethical Cost of US HIV/AIDS Policy Shifts","authors":"Udo Schüklenk","doi":"10.1111/dewb.70000","DOIUrl":"10.1111/dewb.70000","url":null,"abstract":"&lt;p&gt;It is difficult to offer a comprehensive account of the current US government's impact on global HIV/AIDS efforts. However, two particularly troubling developments merit urgent ethical scrutiny due to their immediate and long-term consequences for people living with HIV and for the future trajectory of the pandemic in the Global South.&lt;/p&gt;&lt;p&gt;At the core of both developments lies the United States’ unilateral decision to terminate support for PEPFAR (the President's Emergency Plan for AIDS Relief), a cornerstone of global HIV/AIDS funding for treatment, prevention, and research. Interestingly, PEPFAR was the brainchild of another Republican administration, albeit led by a different President, George W. Bush. In March 2025, the US Agency for International Development (USAID) was effectively dismantled by a newly appointed government efficiency czar, resulting in the abrupt cessation of financial support for these programmes. Simultaneously, the National Institutes of Health (NIH) implemented sweeping changes to its research funding policies, effectively ending its capacity to subcontract research to institutions in the Global South.&lt;/p&gt;&lt;p&gt;According to UNAIDS, the termination of PEPFAR could result in up to 4.2 million HIV-related deaths by 2029, assuming affected national governments are unable or unwilling to replace the lost funding.1 UNAIDS has also provided detailed country-level assessments of the impact of these cuts, which underscore the scale of the unfolding crisis.2&lt;/p&gt;&lt;p&gt;The second major consequence of these policy shifts is the widespread disruption—and in many cases, termination—of ongoing HIV vaccine and therapeutic research in the Global South. These projects, often midstream, were halted without prior warning, undermining years of scientific progress and infrastructure development.3&lt;/p&gt;&lt;p&gt;The harmful effects of these funding cuts then, in terms of life-years lost, are both immediate, in that people with HIV lose access to life-preserving drugs, as well as long-term, given that they undermine the development of a preventive vaccine. Glenda Gray, a globally leading HIV researcher in South Africa, lays out the immediate practical implications of the policy changes implemented by the US government. She writes, ‘basically you lose the knowledge or the value of understanding HIV prevention, HIV vaccines or therapeutics. We [&lt;i&gt;in South Africa&lt;/i&gt;] have the infrastructure, we have the burden of disease, and we have the ability to answer these questions. And so it's going to take much longer to answer these questions than if you had South Africa there’.4 Gray's colleague, Francoise Venter, offers an equally sobering assessment: ‘We're watching the largest HIV treatment programme in the world unravelling in real time’.5&lt;/p&gt;&lt;p&gt;In Gray's considered view South Africa, a middle-income country, doesn't have the financial capacity to continue funding the existing projects and infrastructure. She puts it in these stark terms, ‘I'm going from ban","PeriodicalId":50590,"journal":{"name":"Developing World Bioethics","volume":"25 3","pages":"167-168"},"PeriodicalIF":1.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dewb.70000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"At the Crossroads of Culture and Medicine: Navigating Brain Death and Organ Donation Ethics in Contemporary India.","authors":"Shibu Sasidharan, Shalendra Singh, Harpreet Dhillon, Divya Sinha, Tarun Yadav, Vignesh Jayaprakash","doi":"10.1111/dewb.12490","DOIUrl":"https://doi.org/10.1111/dewb.12490","url":null,"abstract":"<p><p>The concept of brain death as death remains contentious in many societies, particularly in India, where cultural, religious, and social factors significantly influence end-of-life decisions. This article examines the ethical complexities surrounding brain death determination and organ donation in the Indian context, focusing on three critical areas: diagnostic dilemmas in brain death declaration, conflicts between familial beliefs and medical protocols, and emerging ethical concerns in donation after circulatory death (DCD). Despite legislative frameworks like the Transplantation of Human Organs Act (THOA), significant challenges persist in reconciling traditional Indian perspectives on death with contemporary biomedical definitions. The paper analyzes how cultural perceptions of bodily integrity, religious beliefs about the soul's departure, and family-centered decision-making create unique ethical tensions in the Indian organ donation landscape. We argue that an ethically sound approach to organ donation in India requires culturally sensitive protocols, improved communication frameworks, enhanced medical education, and public awareness initiatives that respect pluralistic perspectives while advancing life-saving transplantation practices.</p>","PeriodicalId":50590,"journal":{"name":"Developing World Bioethics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Interdependence, Just Vaccine Allocation, and Compensatory Justice: A New Model.","authors":"Kalen J Fredette","doi":"10.1111/dewb.12486","DOIUrl":"https://doi.org/10.1111/dewb.12486","url":null,"abstract":"<p><p>During the COVID-19 pandemic, numerous models were offered for how scarce vaccine resources should be distributed. Proposed vaccine distribution models generally were divided between nationalist models, which give preference to nationals, and cosmopolitan models, which ignore national boundaries. More defensible international vaccine distribution program proposals incorporate ethical considerations from both cosmopolitanism and nationalist models. To date, however, proposed models have insufficiently considered how global interdependence has resulted in economic and ecological harms by high-income countries (HICs) against low-to-middle income countries (LMICs). Because these harms create health burdens for the populations of LMICs, compensatory justice should impact distribution determinations. This paper argues that adequately factoring in global interdependence, compensatory justice, as well as the disproportionate impact of pandemics on LMICs, just vaccine distribution may require prioritizing LMIC populations over those of HICs.</p>","PeriodicalId":50590,"journal":{"name":"Developing World Bioethics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-centring equity in emergency public health restrictions: A response to Budrie (2025).","authors":"Lien-Chung Wei, Wen Ling Chen","doi":"10.1111/dewb.12487","DOIUrl":"https://doi.org/10.1111/dewb.12487","url":null,"abstract":"","PeriodicalId":50590,"journal":{"name":"Developing World Bioethics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When criminal law hinders public health emergency responses","authors":"Sinara Gumieri,&nbsp;Debora Diniz","doi":"10.1111/dewb.12484","DOIUrl":"10.1111/dewb.12484","url":null,"abstract":"&lt;p&gt;At the height of the COVID-19 pandemic, maternal mortality in Brazil nearly doubled. Between 2019 and 2021, the maternal mortality ratio in the country went from 59.1 deaths for every 100,000 live births to 117.4 deaths for every 100,000 live births.&lt;sup&gt;1&lt;/sup&gt; This is a multicausal and complex issue involving biomedical factors as well as class and race-related social determinants that shape the low-quality and unequal access to prenatal and obstetric care in Brazil. On one hand, it is well documented that pregnant women are more likely to develop severe cases of COVID-19, especially if other medical conditions coexist.&lt;sup&gt;2&lt;/sup&gt; On the other hand, it is also known that, in the first months of the pandemic, one in four Brazilian pregnant women who died from COVID-19 did not have access to an intensive care unit despite desperately needing it.&lt;sup&gt;3&lt;/sup&gt; Multiple studies have shown that COVID-19-related maternal mortality risks were much higher for Black women and for women living in rural areas or away from urban centers in Brazil.&lt;sup&gt;4&lt;/sup&gt;&lt;/p&gt;&lt;p&gt;Even amid the uncertainties at the start of the pandemic, many studies drew attention to pregnancy termination or early delivery as part of the therapeutic measures to be considered for pregnant women severely ill from COVID-19.&lt;sup&gt;5&lt;/sup&gt; Such guidance was somewhat reflected in some Brazilian protocols for the clinical management of pregnant people with COVID-19, which acknowledged that delivery and pregnancy termination decisions should be based on gestational age, maternal condition and fetal stability.&lt;sup&gt;6&lt;/sup&gt; From a bioethical perspective, these biomedical criteria must be based on reproductive freedom, which means that women's autonomy is central to any decision made. The necessary legal framework was also in place: abortion in case of risk to life is recognized as a ground for legal abortion in Brazil since 1940. Additionally, several studies carried out since the early 2000s with doctors and medical students have shown that abortion in the event of life-threatening conditions is the best known and least rejected legal abortion ground among these professionals.&lt;sup&gt;7&lt;/sup&gt;&lt;/p&gt;&lt;p&gt;Legal abortion should have been an option for pregnant Brazilian women infected with COVID-19 and severely ill, but it wasn't. In the interviews we conducted with family members of 25 Brazilian pregnant or postpartum women who died of COVID-19 between 2020 and 2021,&lt;sup&gt;8&lt;/sup&gt; it was clear that the few conversations about pregnancy termination as a therapeutic option were deeply impacted by stigma. It was difficult for pregnant women, their families, and medical professionals alike to understand and talk about abortion as a legitimate health need that could potentially save women's lives. Even when it was openly stated as a possibility, pregnancy termination was shrouded by the apprehension of something that can be considered morally reprehensible and often put off for the sake of pregnancy development, un","PeriodicalId":50590,"journal":{"name":"Developing World Bioethics","volume":"25 2","pages":"83-84"},"PeriodicalIF":0.9,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dewb.12484","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical imperatives in migration health: Justice and care in forced migration contexts.","authors":"Akm Ahsan Ullah","doi":"10.1111/dewb.12482","DOIUrl":"https://doi.org/10.1111/dewb.12482","url":null,"abstract":"<p><p>This article examines the ethical imperatives of migration health, focusing on displaced populations such as the Rohingya and Syrian refugees. Forced migration, driven by conflict, persecution, and climate disasters, presents profound ethical challenges to global healthcare systems. Utilizing deontological ethics, utilitarianism, and human rights-based approaches, the research addresses key principles like justice, equity, autonomy, and non-maleficence in healthcare provision for refugees. Empirical insights reveal significant barriers to healthcare access for displaced populations, including systemic discrimination, resource scarcity, and cultural constraints. Ethical dilemmas are particularly evident in resource allocation, prioritization of acute over chronic conditions, and neglect of mental health services. Through case studies from Rohingya camps in Bangladesh and Syrian refugee settings in Turkey and Jordan, the study highlights inequities in healthcare delivery, exacerbated by cultural and logistical challenges. The article emphasizes on culturally sensitive training, participatory healthcare design, and equitable resource distribution as critical pathways to ethical healthcare. Policy recommendations include prioritizing mental health, harmonizing national policies with international human rights law, and fostering global accountability frameworks.</p>","PeriodicalId":50590,"journal":{"name":"Developing World Bioethics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}