Developing World Bioethics最新文献

{"title":"Anaesthesia Waste Gases and Bioethics: Balancing Patient Care, Environmental Responsibility, and Occupational Safety.","authors":"Shibu Sasidharan, Harpreet Dhillon","doi":"10.1111/dewb.12489","DOIUrl":"https://doi.org/10.1111/dewb.12489","url":null,"abstract":"<p><p>Anaesthesia waste gases (AWGs) represent a significant yet often overlooked contributor to healthcare's environmental footprint, with implications extending beyond ecological concerns to encompass occupational hazards and complex ethical considerations. This article examines the intersection of AWGs and bioethics through the framework of environmental stewardship, occupational health principles, patient-centered care, and distributive justice. Contemporary volatile anaesthetics possess global warming potentials thousands of times greater than carbon dioxide, while implicated occupational exposures raise concerns about reproductive health and neurological function among healthcare workers. The bioethical paradigms of principalism-encompassing nonmaleficence, beneficence, autonomy, and justice-and environmental ethics provide structured approaches to addressing these multifaceted challenges. This review synthesizes current evidence regarding AWGs' environmental and occupational impacts, evaluates emerging mitigation strategies, and proposes an integrated ethical framework to guide clinical practice, institutional policy, and professional standards in anaesthesiology.</p>","PeriodicalId":50590,"journal":{"name":"Developing World Bioethics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303419","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":"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":"Ethics of Futile Care: Who Decides When Enough Is Enough?-A Commentary From the Indian Context on Moral Distress in ICU Staff.","authors":"Shibu Sasidharan, Harpreet Dhillon","doi":"10.1111/dewb.12492","DOIUrl":"https://doi.org/10.1111/dewb.12492","url":null,"abstract":"<p><p>This paper examines the ethical dilemmas surrounding futile care in Indian intensive care units, specifically focusing on the moral distress experienced by healthcare professionals when administering potentially non-beneficial interventions to terminally ill patients. Through analysis of recent literature, including systematic reviews and randomized controlled trials, this commentary explores the complex intersection of medical ethics, cultural values, resource allocation, and decision-making frameworks within India's unique healthcare landscape. The paper highlights the need for culturally sensitive approaches to end-of-life care, improved communication between healthcare providers and families, and institutional support systems to address moral distress among ICU staff. Additionally, it proposes policy recommendations and practical strategies to navigate these challenging ethical terrain while respecting patient dignity, family autonomy, and professional integrity in the Indian healthcare system.</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":"144276517","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":"Low- and Middle-Income Countries Should Also Consider Assisted Dying.","authors":"Krishna Prasad Acharya, Sarita Phuyal","doi":"10.1111/dewb.12488","DOIUrl":"https://doi.org/10.1111/dewb.12488","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":"144152729","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}

{"title":"Inaccessibility of induced abortion in Türkiye: Bioethics in the shadow of reproductive governance.","authors":"Maide Barıș","doi":"10.1111/dewb.12481","DOIUrl":"https://doi.org/10.1111/dewb.12481","url":null,"abstract":"<p><p>In Türkiye, although induced abortion (I/A) is legal and recognized as a free public health service within the first ten weeks of pregnancy, reports and qualitative studies indicate that women encounter difficulties accessing I/A services in public health institutions. This paper suggests, based on various local reports and studies, that the denial of I/A in the last decade is, in part, attributable to various reproductive governance mechanisms that create a chilling effect on clinicians and institutions, making them unwilling to perform or provide abortions. Finally, based on a socio-political analysis of the status quo, this paper emphasizes that when discussing the inaccessibility of I/A or any topic related to reproductive ethics, it is essential that bioethical discussions must recognize and consider the role of politics and the reproductive governance mechanisms at play in reproductive healthcare, as they have significant ethical implications for the access and provision of these services. This approach allows for a deeper exploration of the less visible ethical implications of restrictive policies on legal reproductive services.</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":"143755741","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":"Disproportionality and discrimination in public health emergencies: Lessons from Trinidad and Tobago's COVID-19 cremation ban.","authors":"Leon Budrie","doi":"10.1111/dewb.12483","DOIUrl":"https://doi.org/10.1111/dewb.12483","url":null,"abstract":"<p><p>At the height of the COVID-19 pandemic, the world experienced unprecedented mortality rates, forcing families to navigate the dual burden of grief and restrictive public health measures. These restrictions often disrupted traditional last rites, exacerbating emotional distress and burdens on the grieving. Trinidad and Tobago enforced regulations aimed at curbing COVID-19 which suspended citizens' constitutional rights; one such restriction was the ban on open-air cremations. While this restriction may have been inconsequential to many, it had profound effects on individuals for whom open-air cremation was an essential cultural and religious practice. An ethical analysis of the cremation ban prior to its implementation would have shown the measure to be ineffective, disproportionate, and discriminatory. This underscores the need to integrate public health ethics in public health emergency policy development to ensure interventions are evidence-based, equitable in burden distribution, and capable of maintaining public trust.</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":"143755739","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}