Islamic bioethics is a recent, albeit growing, academic discipline. Despite commendable contributions, the field remains critically limited. Most notably, its methodology of strict application of Islamic law to ethical analyses and recommendations often lacks sufficient moral analysis, intellectual engagement, or social context. The practice's emphasis on religio-legal rulings- without an investigation of their underpinning moral values- has resulted in a field of inquiry devoid of robust normative foundations and dependent upon ineffective and unsubstantiated claims. This paper calls for a revival of Islamic philosophical discourse to enrich Islamic bioethical practice. Although once popularized by Medieval Muslim philosophers like Ibn Sina (Avicenna) and Ibn Rushd (Averroes), philosophical discourse has fallen out of favor in the Muslim world, largely due to a perceived tension with religion. This work highlights the rich tradition of philosophical discourse in the Medieval Muslim world, disproving claims of an inherent conflict between philosophy and Islam. Following an Islamic philosophical framework, three goals for Islamic bioethics are established. First, theoretical rigor aimed at continually re-assessing and re-understanding concepts integral to the practice of bioethics such as personhood, dignity, futility, autonomy, and justice. Second, a shift from essentialist understandings of the Quran- and other sources of Islamic law- to more contextual examinations in the formulation of ethical opinions. Third, an active and interdisciplinary collaboration between Muslim scholars in the determination of Islamic rulings on medical matters. Only when these goals are met is the practice of Islamic bioethics capable of meeting the needs of Muslim patients and clinicians.
In a scientific and implementation consortium, we developed an adaptive AI platform that enables doctors to create accurate and comprehensive Electronic Health Records (EHRs) through advanced speech recognition and context analysis tailored to Polish medical language. This system ensures stability with consistent performance across real-world clinical settings, achieving expected values for speech and context recognition during extensive testing. Its robustness is demonstrated by handling diverse inputs-such as regional accents, complex terminology, and noisy environments-supported by error-correction mechanisms and a specialized acoustic probe. Sustainability is achieved through seamless integration with existing healthcare infrastructures, scalable design, and ongoing updates to medical dictionaries, facilitating long-term use and adaptation. Structured data from electronic health records (EHRs) supports scientific research based on Real-World Data (RWD), verified by medical specialists using evidence-based medicine (EBM). The platform covers 10 clinical situations. The applied method was illustrated using one situation-a breast X-ray examination-employing clinically approved structures and real-world validation. Approved by the Bioethics Committee, the system is currently being tested at the hospital, marking a significant step toward efficient, reliable, and sustainable healthcare documentation.
Period poverty has led to many initiatives across the world. In some places, period (or menstrual hygiene management [MHM]) products are free and readily found in restaurants, universities and pubs. However, conversations on mensuration management have also led to discussions on sustainability. One ad in a bathroom states, 'why not try swapping (from tampons or pads) to a…carbon lowering menstrual cup?' This begs the question not only how can menstruation management be more sustainable, but also, since it (ostensibly) is not, do females have an ethical obligation to limit, or eliminate, periods for the sake of environmental conservation? This question speaks to deeper themes whereby females are vilified for their bodies (think: blaming the victim in sexual assault; blaming females in the developing world for having 'too many children'; and blaming females for miscarriages related to high-risk behaviours). This paper will first offer the background of the period poverty movement. It will then explore salient themes related to gender, ecology, ethics and health through the lenses of eco-feminism and feminist bioethics. The third task of the paper will be to analyse the implications of environmental ethics on female physical functioning, with specific attention to menstruation: this may be thought of as a case study in the underdeveloped area of eco-feminist bioethics. After describing the ethical and social issues surrounding sustainability and menstrual hygiene management, the paper, fourth, will return to the question initially raised: the ethical obligation to eliminate menstrual periods for the sake of the environment. The paper will claim that (1) females do not have a special obligation for menstrual elimination based on an environmental rationale, but, like all people, have a general ethical obligation to sustainability in all areas of life, including health care choices. (2) Females retain the right for period elimination for any reason, including environmental reasons.
This paper explores the role of bioethics in addressing the specific challenges faced by LGBTQI+ victims in Colombia's transitional justice process. It argues that queer and feminist bioethics offer both theoretical and practical contributions to the core aims of truth, reparation, and non-repetition by critically engaging with the biomedical discourses at the base of prejudice-based violence. The pathologization of sexual and gender diversity is examined as a structural condition of victimization and re-victimization during and after the armed conflict. Drawing on reports, testimonies, and conceptual frameworks, the paper reflects on how bioethical perspectives can support recognition, dignity, and structural transformation. Rather than advancing prescriptive solutions, the analysis emphasizes the need for ongoing critical engagement with the medical, legal, and social imaginaries that sustain inequality. The article positions bioethics as a field capable of contributing to transitional justice by fostering reflection on difference, responsibility, and the epistemic dimensions of reparation.
Most people with dementia live in low- and middle-income countries (LMICs), but scientific knowledge about dementia is dominated by Global North perspectives. This interdisciplinary article combines expertise from Latin America, India, and Europe, using a mixed-methodology approach that incorporates expert discussions, a narrative review, and five illustrative case studies. The review on dementia in the Global South yielded 82 results, highlighting the themes of challenges in diagnosis and assessment, socioeconomic and systemic barriers to cognitive health and care pathways, and the need for local capacity building. Those themes were then used to interpret case studies on functionality assessment, genetic heterogeneity, bilingualism, structural inequalities, and North-South collaborations. These cases highlight the misalignment between Northern frameworks on dementia and the realities of LMICs, and illustrate the potential for locally generated knowledge to enrich global understanding. Through several rounds of expert discussion, we identified priorities for Global South perspectives for dementia research and policy.
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.
Based on 24 semi-structured interviews with secondary hospital doctors, we empirically investigate how a new two-way referral system in China influences the alignment between referring doctors, patients, and doctors who receive referrals. In particular, we focus on how this system addresses the challenges of trust, autonomy, and bioethics during the shared decision-making process. Our research shows that the two-way referral system has spawned new acquaintance networks, therefore improving communication and collaboration between doctors. Especially during upward referrals, benefits associated with care continuity have been made possible. However, doctors still tend to adopt defensive patient-centered strategies in referral communication. They consult patients' desires and play an information provider role. This is influenced by both procedural requirements imposed by managerial rules and uncertainty caused by medical consumerism. Thus, we argue that the Chinese bioethical issue of doctor-patient relationships has gradually turned to a mismatch of concerns between doctors and patients.
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Pragmatic clinical trials (PCTs) offer insights into real-world intervention effectiveness, but they may involve challenging ethical issues. Empirical ethics research may inform deliberations about them. We conducted a scoping review of empirical ethics research related to PCTs. This involved searching in PubMed and Embase, charting findings, and analyzing themes to identify trends and gaps. Eighty-two publications were included, which examined a vast number of issues encompassing 22 themes. The five most prominent were: consent/disclosure; risk assessment; trust and transparency; burdens, barriers, and costs; and engagement. Written consent is often impractical, prompting interest in opt-out or general notification approaches. Challenges in risk assessment include variability in defining minimal risk, thereby complicating regulatory determinations for the appropriateness of particular participant protections and communicating research risks. Trust-building practices, such as result-sharing and data-use disclosure, can foster confidence. Stakeholder engagement can address logistical barriers, improve recruitment, and align research with participant needs. Time, financial, and regulatory burdens are significant obstacles to implementing PCTs. There has been progress in understanding many ethical issues encountered in PCTs, including appropriately navigating alternatives to obtaining written informed consent, trust-building, and the operational role of stakeholder engagement. However, critical gaps remain, with research concentrated in Western contexts and reliant on surveys and hypothetical scenarios, limiting generalizability and real-world insights. Addressing these gaps with geographically inclusive studies, innovative methods, and nested empirical work will be important for more comprehensively understanding the ethical issues in PCTs and developing appropriate approaches to mitigating them.
Dengue is an arthropod borne viral illness which infects millions of people each year. Despite the huge global losses, an effective medication is still unavailable against the disease. For vaccine development, reverse vaccinology approach is being tremendously used as it saves time, energy, cost and resources by selecting the potential epitopes for developing an effective vaccine formulation. In our previous study, we have also used reverse vaccinology approach to propose a multi-epitope vaccine formulation (dvac) against dengue, by targeting the conserved epitopes from all of its serotypes. In this study, we have performed population coverage analysis and molecular dynamic simulation studies which predicted that dvac could offer protection to 98.5% of world population against dengue and forms stable interactions with TLR3/TLR4 receptors, respectively. Moreover, we have performed in-lab gene cloning and expression analysis of dvac in Escherichia coli. The purified dvac is subjected to anti-NS1, anti-dNS1 and anti-EDIII antibodies, raised in rabbits, and the ELISA results confirmed the individuality and intactness of the epitopes incorporated in the refolded dvac molecule. The results from this study endorse the use of dvac as a potential dengue vaccine candidate and also support the reverse vaccinology approach for developing novel therapeutic formulations.
African populations remain substantially under-represented in research studies and global genomic databases. As the ancestral home of anatomically modern humans, Africa holds pride of place regarding human genetic diversity, with a deep and complex evolution over hundreds of thousands of years of human migration, admixture, and exposure to climate changes and infectious agents. Yet our present view of genomic diversity in Africa is sparse and poorly captures the rich variation across its more than 2,000 ethnolinguistic groups. To enhance representation, the Assessing Genetic Diversity in Africa (AGenDA) project, under the umbrella of the Human Heredity and Health in Africa (H3Africa) consortium, identified under-represented groups across nine different African countries for human whole-genome sequencing, with a view to enriching global datasets. Here we share our processes, including community engagement, obtaining ethics approvals, navigating legal compliance and developing a common governance framework. AGenDA is a testament to the determination of the scientific community to undertake research in challenging environments. It is led from Africa by African investigators who are the decision-makers in data-sharing processes. AGenDA is a step towards greater African representation in global genomic datasets to advance genomic research towards enabling precision medicine for Africa and the world.
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.
Parkinson disease (PD) is the fastest-growing neurodegenerative disorder in the world, with prevalence expected to exceed 12 million by 2040, which poses significant health care and societal challenges. Artificial intelligence (AI) systems and wearable sensors hold potential for PD diagnosis, personalized symptom monitoring, and progression prediction. Nonetheless, ethical AI adoption requires several core principles, including user trust, transparency, fairness, and human oversight. This study aims to explore and synthesize the perspectives of diverse stakeholders, such as individuals living with PD, health care professionals, AI experts, and bioethicists. The aim was to guide the development of AI-driven digital health solutions, emphasizing transparency, data security, fairness, and bias mitigation while ensuring robust human oversight. These efforts are part of the broader Artificial Intelligence-Based Parkinson's Disease Risk Assessment and Prognosis (AI-PROGNOSIS) European project, dedicated to advancing ethical and effective AI applications in PD diagnosis and management. An exploratory qualitative approach, based on 2 datasets constructed from cocreation workshops, engaged key stakeholders with diverse expertise to gather insights, ensuring a broad range of perspectives and enriching the thematic analysis. A total of 24 participants participated in the cocreation workshops, including 11 (46%) people with PD, 6 (25%) health care professionals, 3 (13%) AI technical experts, 1 (4%) bioethics expert, and 3 (13%) facilitators. Using a semistructured guide, key aspects of the discussion centered on trust, fairness, explainability, autonomy, and the psychological impact of AI in PD care. Thematic analysis of the cocreation workshop transcripts identified 5 key main themes, each explored through various corresponding subthemes. AI trust and security (theme 1) was highlighted, focusing on data safety and the accuracy and reliability of the AI systems. AI transparency and education (theme 2) emphasized the need for educational initiatives and the importance of transparency and explainability of AI technologies. AI bias (theme 3) was identified as a critical theme, addressing issues of bias and fairness and ensuring equitable access to AI-driven health care solutions. Human oversight (theme 4) stressed the significance of AI-human collaboration and the essential role of human review in AI processes. Finally, AI's psychological impact (theme 5) examined the emotional impact of AI on patients and how AI is perceived in the context of PD care. Our findings underline the importance of implementing robust security measures, developing transparent and explainable AI models, reinforcing bias mitigation and reduction strategies and equitable access to treatment, integrating human oversight, and considering the psychological impact of AI-assisted health care. These insights provide actionable guidance for developing trustworthy and effective AI-driven digital PD diagnosis and management solutions.
There is a rapid increase in disease registries all over the world, propelled by innovations in electronic health records and computer technologies. Unlike the developed world, where many registries are well established, many disease registries in the developing world are still in their incipient stage. Establishment of disease registries is blighted by many ethical concerns. These include but are not limited to data capture and data transfer happening without explicit patient consent; data sharing with third parties for various purposes including research, policy making and advocacy; and retrospective consent waiver. This is compounded by the lack of ethical guidelines and international best practices. This paper presents an ethical analysis of the ethics of informed consent for data registries.
With the rapid advancement and iterative development of new artificial intelligence technologies, there remains a regulatory vacuum in corresponding governance measures among governments worldwide. Simultaneously, a technological and governance gap exists between developing countries and developed economies. In response, the World Health Organization (WHO) has released "Ethics and Governance of Artificial Intelligence for Health: Guidance on Large Multi-Modal Models" to assist governments in strengthening governance capabilities in this field. This paper provides an in-depth analysis of the Guidance, aiming to identify challenges and risks associated with the application of multimodal large models in healthcare. Guided by ethical principles for advancing health through artificial intelligence, the paper examines the three-tier governance framework and recommendations outlined in the Guidance. Additionally, it evaluates the current state of AI governance in China, offering insights and reference points for improving AI governance in China's healthcare sector. 随着人工智能技术的快速发展，各国政府在人工智能监管方面存在空白或滞后性，发展中国家与发达经济体之间在相关治理能力上存在“智能鸿沟”和治理代差。为此，世界卫生组织发布了《医学领域人工智能的伦理与治理：多模态大模型指南》（以下简称《指南》），旨在提升各国在该领域的治理能力。本文将深入解读该《指南》，明确多模态大模型在医学健康领域应用的挑战与风险，并以促进健康的伦理原则共识为指引，分析《指南》提出的三级治理框架及相关建议，再结合我国现况，为我国医学健康领域的人工智能治理提供借鉴。.
Introduction: Market access, pricing, and reimbursement of digital health technologies (DHTs) in Europe are significantly challenged by regulatory fragmentation and various assessment methodologies. Understanding the challenges and priorities of technology developers is essential for developing effective and relevant policy responses. This study explores perceived barriers and developer-driven priorities to inform the development of a harmonized health technology assessment (HTA) framework under the EDiHTA project. Methods: A mixed-methods approach was adopted, including a scoping review to identify key challenges, a survey of 20 DHT developers, and interviews and focus groups with 29 industry representatives from startups to multinational companies across 10 European countries during 2024. Results: Key challenges included a lack of transparency in reimbursement processes, fragmented HTA requirements, and misalignment between traditional evidence models and the agile development of DHTs. Developers highlighted the need to integrate real-world evidence, consider usability and implementation factors, and provide structured, lifecycle-based guidance. Financial barriers and procedural burdens were particularly significant for small and medium-sized enterprises. Conclusions: These findings highlight the need for an HTA framework that reflects the iterative nature of digital development, integrates real-world evidence, and reduces uncertainty for developers. The EDiHTA project aims to respond to these challenges by building a harmonized and flexible approach that aligns with the goals of the European HTA Regulation.
Period poverty is a broad and complex issue that intersects with various areas, including health, education, infrastructure, and human rights, among others, affecting countless women and girls around the world. Despite remarkable technological, social, and economic advances this century, menstruation remains a taboo subject, which leads to widespread misinformation and stigma. Prejudice and a lack of access to knowledge and essential sanitation resources, such as clean water, hygiene products, and safe private spaces, heighten the vulnerability of those affected. Integrated and multisectoral approaches that involve legislature, health, education, and sanitation are necessary to face this public health issue effectively. These efforts involve developing and implementing comprehensive plans that unite government, society, and the private sector. Some examples of these actions include making information about menstruation and menstrual health available in schools, cutting taxes on feminine hygiene products, improving basic sanitation, building decent public restrooms, and providing free sanitary pads in schools and workplaces. These initiatives have the potential to promote menstrual health and dignity, ensuring that people who menstruate can manage their periods in healthy, safe, and supportive environments. This review aims to shed light on menstrual poverty in Brazil as a global issue and a human rights violation, especially when it comes to the rights to health, education, and dignity. It stresses that efforts to end this social stigma and align with the 2030 Agenda, which seeks to eliminate poverty and inequality worldwide, and provides a plan of action to tackle this stigma.
Lower respiratory infections (LRIs) remain the world's leading infectious cause of death. This analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides global, regional, and national estimates of LRI incidence, mortality, and disability-adjusted life-years (DALYs), with attribution to 26 pathogens, including 11 newly modelled pathogens, across 204 countries and territories from 1990 to 2023. With new data and revised modelling techniques, these estimates serve as an update and expansion to GBD 2021. Through these estimates, we also aimed to assess progress towards the 2025 Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) target for pneumonia mortality in children younger than 5 years. Mortality from LRIs, defined as physician-diagnosed pneumonia or bronchiolitis, was estimated using the Cause of Death Ensemble model with data from vital registration, verbal autopsy, surveillance, and minimally invasive tissue sampling. The Bayesian meta-regression tool DisMod-MR 2.1 was used to model overall morbidity due to LRIs. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for all locations, years, age groups, and sexes. We modelled pathogen-specific case-fatality ratios (CFRs) for each age group and location using splined binomial regression to create internally consistent estimates of incidence and mortality proportions attributable to viral, fungal, parasitic, and bacterial pathogens. Progress was assessed towards the GAPPD target of less than three deaths from pneumonia per 1000 livebirths, which is roughly equivalent to a mortality rate of less than 60 deaths per 100 000 children younger than 5 years. In 2023, LRIs were responsible for 2·50 million (95% uncertainty interval [UI] 2·24-2·81) deaths and 98·7 million (87·7-112) DALYs, with children younger than 5 years and adults aged 70 years and older carrying the highest burden. LRI mortality in children younger than 5 years fell by 33·4% (10·4-47·4) since 2010, with a global mortality rate of 94·8 (75·6-116·4) per 100 000 person-years in 2023. Among adults aged 70 years and older, the burden remained substantial with only marginal declines since 2010. A mortality rate of less than 60 deaths per 100 000 for children younger than 5 years was met by 129 of the 204 modelled countries in 2023. At a super-regional level, sub-Saharan Africa had an aggregate mortality rate in children younger than 5 years (hereafter referred to as under-5 mortality rate) furthest from the GAPPD target. Streptococcus pneumoniae continued to account for the largest number of LRI deaths globally (634 000 [95% UI 565 000-721 000] deaths or 25·3% [24·5-26·1] of all LRI deaths), followed by Staphylococcus aureus (271 000 [243 000-298 000] deaths or 10·9% [10·3-11·3]), and Klebsiella pneumoniae (228 000 [204 000-261 000] deaths or 9·1% [8·8-9·5]). Among pathogens newly modelled in this study, non-tuberculous mycobacteria (responsible for 177 000 [95% UI 155 000-201 000] deaths) and Aspergillus spp (responsible for 67 800 [59 900-75 900] deaths) emerged as important contributors. Altogether, the 11 newly modelled pathogens accounted for approximately 22% of LRI deaths. This comprehensive analysis underscores both the gains achieved through vaccination and the challenges that remain in controlling the LRI burden globally. Furthermore, it demonstrates persistent disparities in disease burden, with the highest mortality rates concentrated in countries in sub-Saharan Africa. Globally, as well as in these high-burden locations, the under-5 LRI mortality rate remains well above the GAPPD target. Progress towards this target requires equitable access to vaccines and preventive therapies-including newer interventions such as respiratory syncytial virus monoclonal antibodies-and health systems capable of early diagnosis and treatment. Expanding surveillance of emerging pathogens, strengthening adult immunisation programmes, and combating vaccine hesitancy are also crucial. As the global population ages, the dual challenge of sustaining gains in child survival while addressing the rising vulnerability in older adults will shape future pneumonia control strategies. Gates Foundation.
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