Indian journal of medical ethics最新文献

{"title":"Voluntary and rights-based family planning for women: Observations from a community-based study in southern India.","authors":"S G Shruthee, Senthil Arasi, P Seenivasan","doi":"10.20529/IJME.2025.010","DOIUrl":"10.20529/IJME.2025.010","url":null,"abstract":"<p><strong>Background: </strong>Family planning programmes globally emphasise voluntarism and rights in contraceptive provision, shifting the focus away from fertility regulation. With the intent of measuring the policy-practice gap, this study aims to determine access to voluntary rights-based family planning services among women of reproductive age.</p><p><strong>Methods: </strong>Between November 2018 and January 2019, 390 married women aged 18 to 44 years residing in Kanchipuram, Tamil Nadu, were interviewed, after obtaining written informed consent from the participants. Agreement between intended and actual family size and spacing, perceived informed choice and contraceptive coercion during client-provider interaction were the primary outcomes studied. Univariate analysis using Pearson's or Trend chi square tests and multivariate logistic regression were used to analyse the factors associated with contraceptive coercion; adjusted odds ratios (AOR) with their 95% confidence intervals are reported.</p><p><strong>Results: </strong>Of the 390 most recent pregnancies, 114 (29%) were found to be unintended. Reported concurrence of intended versus actual family size and spacing among respondents was 76% (118/155) and 42% (121/287), respectively. During interaction with a healthcare provider, only 139 (36%) were offered a choice of two or more modern contraceptives; others were advised either tubectomy (69, 18%) or intrauterine devices (IUD) (50, 13%) as the sole option. In the past five years, 181 (46%) women reported adopting a modern method voluntarily, while 33 (8.5%) were forced and 8 (2.0%) were coerced to use modern contraception. Multivariate analysis revealed that women's employment status (AOR: 13.1[1.3,127.6], P=0.027), public healthcare facilities (AOR: 18.7 [1.8, 193.2], P=0.014), and long-acting reversible contraception (AOR: 30.5 [8.2, 112.6], P <0.001), IUD in particular, were strongly associated with contraceptive coercion.</p><p><strong>Conclusion: </strong>Provider bias and coercion to use selective modern methods in a limited contraceptive choice setting leaves much to be desired. Expanding the basket of choices and mainstreaming indicators pertaining to informed decision making and rights-based care is imperative.</p>","PeriodicalId":517372,"journal":{"name":"Indian journal of medical ethics","volume":" ","pages":"183-190"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560589","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":"Combating silicosis in India: From compensation to prevention.","authors":"Ashwin Upreti, Siddharth Upreti","doi":"10.20529/IJME.2025.034","DOIUrl":"10.20529/IJME.2025.034","url":null,"abstract":"<p><p>Silicosis is a fibrotic lung disease with no curative remedy available. Largely affecting those in the vicinity of industrial sites, this branch of pneumoconiosis is one of the most pervasive occupational health hazards. Despite its ancient origins, little progress had been made towards devising a cohesive strategy to combat silicosis. However, at the turn of the 21st century, instrumentalities of the state as well as civil society began to gradually uncover the wide dragnet this disease had cast over unsuspecting workers. Demographically, silicosis patients comprise of unregistered, socio-economically vulnerable labourers in desperate need of state support. In the last decade, institutional response to combat silicosis has by and large remained limited to provision of compensation for silicosis patients. Through this paper, we seek to elaborate on how efforts must now evolve further towards establishing preventive mechanisms that limit the prevalence of silicosis.</p>","PeriodicalId":517372,"journal":{"name":"Indian journal of medical ethics","volume":"X 3","pages":"222-227"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454368","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 impact of biotechnology on the global insulin market.","authors":"Colleen Fuller","doi":"10.20529/IJME.2025.038","DOIUrl":"10.20529/IJME.2025.038","url":null,"abstract":"<p><p>Biotechnology has had a dramatic impact on how insulin is manufactured, and how much it costs to produce it. This paper examines the political, economic and social impact of biotechnology on the global insulin market. It provides an assessment of claims made by manufacturers since the early 1980s that insulin produced using recombinant DNA technology would enhance affordability, safety, effectiveness, and access to this vital medicine. This study utilises primary and secondary sources, historical and current, over the period 1921 to 2024 including academic and medical journals, archival databases, legal opinions, government reports, newspaper and magazine articles and books, and personal files. The study finds that biotechnology has failed on each of the counts claimed by the manufacturers, ie, affordability, safety, effectiveness, and access. Instead, it has transformed the global insulin market, leading to a collapse of domestic manufacturing in many countries and the emergence of a powerful oligopoly composed of three corporations: Novo Nordisk, Eli Lilly, and Sanofi. This has jeopardised the welfare of those who need secure access to safe and affordable insulin, particularly - but not only - those in low- and middle-income countries. A growing movement of diabetes activists around the globe is demanding changes to the global insulin market and to government policies.</p>","PeriodicalId":517372,"journal":{"name":"Indian journal of medical ethics","volume":"X 3","pages":"191-202"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454409","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":"CASE STUDY: ICC's Code of Conduct and political interference in cricket: inconsistent stances.","authors":"Souvik Naha","doi":"10.20529/IJME.2025.031","DOIUrl":"https://doi.org/10.20529/IJME.2025.031","url":null,"abstract":"<p><p>This case study examines the International Cricket Council's (ICC) suspension of Zimbabwe Cricket in 2019 on the grounds of political interference in its administration. It unpacks the contradictions in the ICC's code of conduct, exploring its double standard regarding the explicit contract of participation in the game. It considers the ethical problems with ICC's ruling and the potential victimisation of Zimbabwe an example of inequity in the global body's organisational culture. The ICC's administration is based on a coherent set of ethical principles that should be uniform for every member, but which, on closer examination, often demonstrates norm-divergent behaviour.</p>","PeriodicalId":517372,"journal":{"name":"Indian journal of medical ethics","volume":"X 2","pages":"117-120"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500074","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":"Navigating ethical dimensions in algorithmic radiology: A call for action to ensure representation of low-resource contexts.","authors":"H Shafeeq Ahmed","doi":"10.20529/IJME.2025.001","DOIUrl":"10.20529/IJME.2025.001","url":null,"abstract":"<p><p>Artificial intelligence (AI) has revolutionised medicine, particularly radiology, transforming our ability to interpret complex imaging data. While traditional methods rely on subjective visual assessments, AI excels at recognising intricate patterns and providing quantitative and automated evaluations. In this commentary, I delve into the various ethical considerations in algorithmic radiology, beyond the conventional concerns. Focusing on utilitarianism, patient understanding, virtue ethics, and social contract theory, the paper contributes to a comprehensive understanding of the ethical landscape surrounding AI technologies. The challenges in the use of algorithmic AI in radiology underscore the significance of the ethics of care, responsiveness to context, and the role of human emotion, whether pertaining to the practitioner, the patient, or both. The social contract theory guides the responsibilities of healthcare professionals, urging action to address biases in AI algorithms and ensuring equitable representation of various ethnic and racial populations. Diversity in data must be prioritised to avoid disparities in administering healthcare and uphold patient rights in the adoption of AI. In terms of virtue ethics, professionalism and responsibility are crucial for radiologists adopting AI. Also, an absence of explicit guidelines on the use of AI in healthcare poses challenges, necessitating further discourse. Finally, a utilitarian perspective on public health mandates a fair distribution of imaging technologies to address prevalent health issues in a given population. In conclusion, this paper advocates for an ethical approach to AI integration, which aligns technology with human values and wellbeing, as we shape the future of healthcare.</p>","PeriodicalId":517372,"journal":{"name":"Indian journal of medical ethics","volume":" ","pages":"138-145"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560585","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":"Using case-based role-play to learn professionalism in Pharmacology.","authors":"Rohini Ann Mathew, Aniket Kumar, Premila M Wilfred, Margaret Shanthi","doi":"10.20529/IJME.2024.086","DOIUrl":"10.20529/IJME.2024.086","url":null,"abstract":"<p><strong>Background: </strong>Professionalism has been identified as a key competency for physicians to conduct, effective and ethical practice. The current competency-based medical education curriculum lays great emphasis on the development of attitude, ethics, and communication (AETCOM) among medical students which is embedded in the core concepts of professionalism. Comprehending these concepts early in the course of medical training is especially important as such a change may lead to reducing future incidents of professional misconduct. However, teaching this complex topic to undergraduate students through routine didactic lectures alone is challenging.</p><p><strong>Methods: </strong>To address this, we divided the batch of second-year MBBS students into 5 random groups and assigned 1 case scenario for role play to each group with sub-questions for discussion and reflection. After a short introductory lecture on professionalism, each group presented their role-play and discussed the sub-questions. Assessment for the improvement in knowledge was done using pre and post-test multiple choice questions.</p><p><strong>Results: </strong>Our findings show a statistically significant improvement in the mean (± Standard Deviation) scores for post-test (16.76±3.00) vs the pre-test (11.56±2.81) (p< 0.0001). Participant feedback was overwhelmingly positive based on the 5-point Likert scale.</p><p><strong>Conclusion: </strong>This shows that an interactive and engaging model, such as relevant case scenarios and role-play with reflection, along with assessment and feedback, could be effective for medical students, in learning the complex topic of professionalism.</p>","PeriodicalId":517372,"journal":{"name":"Indian journal of medical ethics","volume":" ","pages":"128-137"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143559444","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":"COMMENTARY: Aspiring for inclusive sport: reflecting on intersections around exclusion.","authors":"Meena Gopal","doi":"10.20529/IJME.2025.005","DOIUrl":"10.20529/IJME.2025.005","url":null,"abstract":"<p><p>This paper attempts to address the intersections of gender, caste, class, sexuality, region, and other social attributes, that constitute the social web in India influencing the possibilities and exclusions within sport. Being at the margins of this social web makes individuals vulnerable to unethical practices such as discrimination, exclusion, and erasures of their lived realities, by both systemic and everyday practices. Using the lens of social reproduction the paper attempts to capture not just the productive work that sustains a sporting milieu in society, but the labour that produces leisure, entertainment, play, rest, fitness, pleasure, well-being, and care that sustains and is further generated by families, communities and entire societies. It examines the social identities/locations of being queer and located in caste society, as specific instances but also as intersecting with other social locations that may exclude or offer opportunity within a specific sport.</p>","PeriodicalId":517372,"journal":{"name":"Indian journal of medical ethics","volume":" ","pages":"101-104"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560569","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 UNESCO draft Recommendations on ethics of Neurotechnology - A commentary.","authors":"Mala Ramanathan","doi":"10.20529/IJME.2025.028","DOIUrl":"https://doi.org/10.20529/IJME.2025.028","url":null,"abstract":"<p><p>The United Nations Educational, Scientific and Cultural Organization (UNESCO) released a draft of the Recommendations on Ethics of Neurotechnology (henceforth, 'the Recommendations') in October 2024 [1]. It was accompanied by a preliminary report on the process leading to the draft Recommendations. The Recommendations define neurotechnology as \"devices, systems and procedures - encompassing both hardware and software - that directly access, monitor, analyse, predict or modulate the nervous system to understand, influence, restore, or anticipate its structure, activity, function, or intentions (speech, motor)\" [1].</p>","PeriodicalId":517372,"journal":{"name":"Indian journal of medical ethics","volume":"X 2","pages":"89-91"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500079","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":"CASE STUDY: Assessment for inclusion: Promoting equity and justice in Disability Assessment Boards in India.","authors":"Om Rathod, Satendra Singh, Prannv Dhawan, Rahul Bajaj","doi":"10.20529/IJME.2025.015","DOIUrl":"10.20529/IJME.2025.015","url":null,"abstract":"<p><p>This case study involves a successful medical aspirant with 88% mobility disability who was denied admission by the Disability Assessment Board (DAB). After failing to get relief from the High Court, the candidate challenged the decision in the Supreme Court. The Court ordered a reassessment by another DAB but found their approach - based on the medical model of disability - unsatisfactory. Consequently, the Court directed an independent functional competency assessment conducted by a doctor with a disability. The new assessment adopted a human rights model of disability while offering opportunities such as simulation labs and detailed discussions on clinical accommodations to assess his abilities rather than focusing on his disability. The Supreme Court endorsed the ability-based assessment, critiqued the National Medical Commission's guidelines, and ordered the candidate's admission. Additionally, the Court directed the regulator to revise the existing guidelines, considering technological advancements, disability justice, and input from doctors with disabilities.</p>","PeriodicalId":517372,"journal":{"name":"Indian journal of medical ethics","volume":" ","pages":"153-157"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560570","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":"Robust public health evidence should concede multifactorial causation.","authors":"Mathew George","doi":"10.20529/IJME.2025.004","DOIUrl":"10.20529/IJME.2025.004","url":null,"abstract":"<p><p>The recent controversy surrounding Covishield vaccine and its rare side effects reported by AstraZeneca raises an important ethical question in public health practice. Public health ethics has not been perceived as distinct from medical ethics and by default, evidence in medicine is at times interpreted as being the same as public health evidence, when the context of practice of the two disciplines is distinct. There is a tendency in public health practice to opt for those interventions with maximum benefit to the maximum number, guided by utilitarian ethics, whereas in medical ethics the focus is on benefits vs risks. It is important to examine whether the side effects of any public health intervention can be justified against the risk it can pose to even a single healthy individual?</p>","PeriodicalId":517372,"journal":{"name":"Indian journal of medical ethics","volume":" ","pages":"149-152"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560588","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}