While the effects of COVID-19 are being felt globally, the pandemic disproportionately affects lower- and middle-income countries (LMICs) by exacerbating existing global health disparities. In this article, we illustrate how intersecting upstream social determinants of global health form a disparity pathway that compromises LMICs' ability to respond to the pandemic. We consider pre-existing disease burden and baseline susceptibility, limited disease prevention resources, and unequal access to basic and specialized health care, essential drugs, and clinical trials. Recognizing that ongoing and underlying disparity issues will require long-term correction efforts, this pathway approach is nonetheless helpful to inform ethical responses to this global pandemic. It can facilitate international cooperation during the pandemic to reduce the disparate burdens among different regions without imposing significant burden on any particular contributor. The pathway approach allows international stakeholders in various social positions to respond to different components of the pathway based on their respective strengths and resources to help break the cycle of global health inequity. Guided by the ethical principles of relational and pragmatic solidarity, we argue for a coordinated global division of labor such that different stakeholders can collaborate to foster equitable healthcare access during this pandemic.
This article explores the relationship between zoonotic outbreaks and the interconnected nature of globalization through the lens of the One Health framework. It argues that global ecological changes driven by climate changes, deforestation, intensified agriculture, wildlife trade, and urban expansion have significantly elevated the risk of zoonotic disease transmission. It emphasizes how globalization has intensified some of the factors that contribute to the emergence of zoonotic outbreaks, and has also facilitated the spread of infectious diseases. Drawing on recent examples, such as the emergence of H1N1, COVID-19 and Nipah virus outbreaks, the article emphasizes the need for robust, interdisciplinary collaboration among human, animal, and environmental health sectors. The article advocates for a comprehensive global strategy rooted in the One Health approach to mitigate future zoonotic threats. It argues that this approach is based on an ethical principle of solidarity, which refers to the enacted commitment to support others based on the recognition of shared vulnerabilities or similarities. This principle is essential for collective responses to global challenges like zoonotic diseases. The One Health approach requires reinvesting in multilateral governance, enhancing wildlife and livestock surveillance, and addressing socio-environmental drivers of disease emergence, thereby promoting planetary health and global biosecurity. However, it also highlights the vulnerabilities created by nationalistic and populist policies, based on a distrust of multilateral organizations and international cooperation, and that have underfunded global health institutions, particularly affecting low-resource regions where early detection systems are lacking.
Bioethics should pay more attention to globalization and some of its consequences than it has done so far. The COVID-19 pandemic would not have been possible without globalization, which has also increased some of its negative consequences. Globalization has intensified wildlife trade in the world. One of the main hypotheses about the origin of this pandemic is that it originated in illegal forms of wildlife trade in China. In the last 30 or 40 years, there have been zoonotic outbreaks at a much frequent pace than before, many of those have been related to wildlife trade. Legal and illegal wildlife trade has grown in the shadow of globalization. Second, globalization has had a huge impact on the redistribution of wealth in the world. Since 1990 income inequality has increased in most high- and in many middle- and low-income countries. A country's level of pre-COVID income inequality is the best predictor of the COVID death rate. These two issues are not unrelated. People living in poverty in LMIC tend to suffer more from infectious diseases and tend to be marginalized from the health sector. Additionally, poverty tends to reproduce the conditions under which zoonotic diseases can more easily spread.
In this article, I explain what makes a global bioethics "feminist" and why I think this development makes a better bioethics. Before defending this assertion explicitly, I engage in some preliminary work. First, I attempt to define global bioethics, showing why the so-called feminist sameness-difference debate [are men and women fundamentally the same or fundamentally different?] is of relevance to this attempt. I then discuss the difference between rights-based feminist approaches to global bioethics and care-based feminist approaches to global bioethics. Next, I agree with a significant number of feminist bioethicists that care is a more fundamental moral value and practice than justice. Finally, I conclude that feminists' insights about care, even more than rights, can bring us closer to achieving an inclusive, diverse, and fair feminist global bioethics.
The advent of the COVID-19 pandemic has profoundly transformed grief around the world. What are the impacts of context factors regarding the COVID-19 pandemic on dysfunctional symptoms of grief? This is a study with a qualitative approach, integrative review, whose article data collection was carried out in the following databases: Biblioteca Virtual de Saúde (BVS), Portal Brasileiro de Publicações e Dados Científicos em Acesso Aberto (Oasisbr), United States National Library of Medicine (PubMed), Scientific Electronic Library (SciELO) and Web of Science. Thirty-three articles were selected for the analysis. The studies showed different results when the risk factors were detailed individually. However, the pandemic context proved to be a complex element that created vulnerability associated with grieving. Bioethics presents itself as a locus of interdisciplinary discussion for a more profound understanding of the complex specificities and, based on the social and political responsibility of Protection Bioethics to protect vulnerable populations, it is recommended to mental health professionals who intentionally explore the impacts of the pandemic on the grieving process. The suffering of people bereaved during the pandemic must be publicly recognized, offering safe spaces for reception and sharing.
The ability to predict the risk of severe mental disorders holds considerable promise for individuals at risk, potentially enabling prevention and early intervention. Although the clinical application of such predictive models in child and adolescent psychiatry remains a future prospect, it is essential to consider their social and ethical implications that their use may entail. This study explores child and adolescent psychiatrists' views on these issues through a cross-sectional online survey distributed to members of the European Society for Child and Adolescent Psychiatry. Of the 81 respondents, the majority identified the most significant benefits of using prediction tools as enabling earlier intervention by healthcare professionals (81.5%), improving the quality of care (77.8%), and helping families enhance their resilience (63%). Participants also expressed concern about potential harms, particularly violations of privacy (74.1%), discrimination (92.6%), and the lack of explainability in Artificial Intelligence algorithms (74.1%). While most participants recognise potential medical benefits in the clinical use of predictive tools, numerous concerns must be addressed before such technologies can be considered viable. These include unresolved ethical challenges, such as risks related to privacy, potential of stigmatisation and discrimination, and algorithmic opacity, as well as limitations of healthcare systems.
This paper argues that as we move to redefine global bioethics, there is a need to be attentive to the ethical issues associated with the environmental sustainability of data and digital infrastructures in global health systems. We show that these infrastructures have thus far featured little in environmental impact discussions in the context of health, and we use a case study approach of biobanking to illustrate this. We argue that this missing discussion is problematic because biobanks have environmental impacts associated with data and digital infrastructures. We consider several ethical questions to consider these impacts: what ethical work does the concept of environmental sustainability add to the debate; how should this concept be prioritised in decision-making; and who should be responsible for doing so? We call on global bioethics to play a role in advancing this dialogue and addressing these questions.
Climate change, ecological degradation and global inequalities are symptoms of an eco-social polycrisis that threatens global health and health equity. This polycrisis is deeply rooted in Western value systems. These can be described as anthropocentric and individualistic and support the prevailing neoliberal economic model. Bioethics is now called to respond to the urgent health-related ethical challenges of the polycrisis and has recently begun to engage with Planetary Health and One Health in this regard. Both have mainly emerged in the Western scientific community and understand human health to be inextricably linked to the state of environmental and structural societal determinants. We argue that bioethics should indeed embrace holistic or integrated understandings of health but also carefully revisit the foundational Western value systems at the root of the polycrisis. If Planetary Health and One Health stay grounded in Western value systems, an extensive conceptual engagement might be problematic for bioethics. Instead of turning to Western concepts of health, bioethics should engage deeply with Indigenous and non-Western ways of knowing and critically reflect on its own role in inadvertently maintaining the status quo.
The Covid-19 pandemic is associated with an increase in ethics publications and an upsurge of interest in global bioethics. This commentary argues that global bioethics is broader than international bioethics, as defined by Macklin, because the nature of moral problems is determined by processes and practices of globalization, and because a broader theoretical perspective is required. Such perspective acknowledges the connectedness and relationality of human beings, as assumed in the care-based feminist bioethics defended by Tong. The commentary finally claims that a rights-based approach is not opposed to but reinforces a care-based global bioethics.
Synthetic Biology (SynBio) is a rapidly advancing interdisciplinary field that holds immense potential to address pressing global issues, including food insecurity, medical innovation, and environmental sustainability. Yet, the ethical discourse surrounding its development has often struggled to keep pace with its scientific progress. This stagnation, I argue, arises largely from the persistence of dualistic frameworks - such as "natural" versus "artificial" or "human" versus "machine" - that dominate bioethical inquiry. These dichotomies limit the scope of moral reflection and hinder the development of more holistic ethical frameworks. This paper seeks to reframe these debates by drawing upon the non-dualistic worldview of Sanātana Dharma, the foundation of Indian Hindu philosophy. Through this lens, I propose a different perspective that emphasizes interconnectedness, responsibility, and reverence for all forms of life, natural and synthetic alike, offering a more inclusive and holistic approach to evaluate emerging biotechnologies.
The Japanese government and medical professionals have negative attitudes toward the provision of prenatal testing and related information due to social concern regarding discrimination against persons with disabilities. However, with the rapid increase in the number of non-invasive prenatal tests, particularly at non-certificated medical facilities, in response to the growing demand from pregnant women, the Japanese government and medical professional associations have enacted radical changes marking an active commitment to the provision of information on these services. While a major justification for these policy changes is to ensure respect for reproductive autonomy and women's self-determination, they may reinforce the concern regarding discrimination. This article investigated the argument that these new policies may reinforce discrimination and examined three objections to this argument. The results revealed that the recent policy changes, particularly for specific fetal traits, may imply a negative belief about people living with the same traits. Consequently, fundamental institutional changes are necessary.
A truly global bioethics involves cooperation and collaboration among countries. Most of the articles published in bioethics journals address a problem that exists in one or more countries, but the articles typically do not discuss solutions that require collaboration or cooperation. COVAX is one example of proposed international cooperation related to the current COVID-19. pandemic. Yet it is evident that nations have been proceeding on their own with little, if any collaboration. Despite international research ethics guidance from the World Health Organization (WHO), an article published under WHO auspices violates an ethical principle rejecting "double standards" in the conduct of global research. The COVID pandemic provides an opportunity for countries to learn from the recent lack of international cooperation and employ a multi-national strategy in future global health crises.
When it is ethically justifiable to stop medical treatment? For many Muslim patients, families, and clinicians this ethical question remains a challenging one as Islamic ethico-legal guidance on such matters remains scattered and difficult to interpret. In light of this gap, we conducted a systematic literature review to aggregate rulings from Islamic jurists and juridical councils on whether, and when, it is permitted to withdraw and/or withhold life-sustaining care. A total of 16 fatwās were found, 8 of which were single-author rulings, and 8 represented the collective view of a juridical council. The fatwās are similar in that nearly all judge that Islamic law, provided certain conditions are met, permits abstaining from life-sustaining treatment. Notably, the justifying conditions appear to rely on physician assessment of the clinical prognosis. The fatwās differ when it comes to what conditions justify withdrawing or withholding life- sustaining care. Our analyses suggest that while notions of futility greatly impact the bioethical discourse regarding with holding and/or withdrawal of treatment, the conceptualization of futility lacks nuance. Therefore, clinicians, Islamic jurists, and bioethicists need to come together in order to unify a conception of medical futility and relate it to the ethics of withholding and/or withdrawal of treatment.
The United Nations Educational, Scientific and Cultural Organisation's (UNESCO) Declaration on Bioethics and Human Rights refers to the importance of cultural diversity and pluralism in ethical discourse and care of humanity. The aim of this meta-narrative review is to identify indigenous ethical values pertaining to the Ojibway (Canada), Xhosa (South Africa), and Mayan (Mexico and Central American) cultures from peer-reviewed sources and cultural review, and to ascertain if there are shared commonalities. Three main themes were identified, namely illness, healing, and health care choices. Illness was described with a more complex and dynamic picture than from the western view, as illness is not considered to be one dimensional. Healing needs to take place on various levels in order to restore a state of equilibrium between the different spheres. Health care choices were also considered from a multi-level perspective. In all three of the indigenous cultures explored, good decision-making is seen to have occurred when choices are informed by commitments to one's moral and ethical responsibilities towards the community, nature, and the spirit world.
Cervical cancer screening remains limited in developing countries due to barriers such as lack of convenience and privacy. These challenges hinder both screening uptake and the process of obtaining informed consent. This study aimed to explore ways to address these barriers and support ethical participation in screening research. The study was conducted in three rural and one urban kebele in Butajira, Southern Ethiopia. A total of 58 participants - including community elders, religious leaders, women's representatives, and traditional association leaders - were selected through purposive sampling for focus group discussions and in-depth interviews. Two interview guides were used to explore consent, decision-making, and screening preferences. Data were analysed using qualitative content analysis via QCAmap software. Participants generally understood the concept of voluntary participation but emphasized the need for clear communication about benefits. Although women could decide independently, many noted the importance of involving husbands. Initial suspicion about written consent was addressed through trust-building. A strong preference emerged for female providers during consent and procedures to enhance comfort. Self-sampling raised concerns about technical difficulty and cultural norms. Addressing cultural and ethical concerns is vital for improving cervical cancer screening participation. Insights from this study should guide future research and interventions in similar settings.
The ethical complexities of technological advancement are growing as fields such as climate adaptation, microbiology, healthcare, robotics, and artificial intelligence (AI) evolve rapidly. While these technologies offer innovative solutions to global challenges, they raise significant ethical concerns. In climate adaptation, AI-driven models and remote sensing technologies prompt questions about data privacy, environmental justice, and equitable access, especially for vulnerable populations. Similarly, advancements in microbiology and healthcare, such as genetic research and digital health tools, present ethical dilemmas related to informed consent, data security, and the exploitation of marginalized communities. In robotics and AI, ethical concerns are heightened due to their potential to automate decision-making, affect employment, and infringe on personal freedoms. The influence of AI in healthcare, law enforcement, and public services highlights the urgent need for ethical oversight to prevent bias and protect human rights. The EU AI Act addresses these challenges by categorizing AI systems by risk and setting stringent guidelines for high-risk applications, especially in sensitive sectors like healthcare. This article emphasizes the importance of balancing innovation with ethical responsibility, advocating for comprehensive regulatory frameworks, interdisciplinary collaboration, and global cooperation to ensure that technological advancements align with ethical standards and societal values.
Quality of Life (QOL) is essential for healthy aging and through the WHOQOL-Old, it is possible to analyze factors that increase vulnerability and reduce QOL. Aligned with healthy aging is Potter's global bioethics proposing expanded ethics and social justice. To analyze the QOL of Brazilian elderly from the perspective of Potteŕs global bioethics. Analytical observational research with a quantitative approach composed of 280 Brazilian, aged 60 or over, of both gender, volunteers, who answered the WHOQOL-Old online. Global score of 77.9%, with the mean ± standard deviation: Functioning of the senses 86% (17.22 ± 2.80); Autonomy 78.5% (15.7 ± 2.60); Past, present, and future activities 77.3% (15.46 ± 2.34); Social participation 74.9% (14.99 ± 2.62); Death and dying 71.6% (14.33 ± 3.88) and Intimacy 79.1% (15.82 ± 2.82). Elderly perceived their QOL positively. In the quest to promote healthy aging, it is necessary to broaden the vision for social justice proposed by Potteŕs global bioethics.
There appears to be a conflict between global bioethical principles and the local understanding and application of these principles, but this conflict has misleadingly been characterized through the east-west dichotomy. This dichotomy portrays bioethical principles as western and as alien to non-western cultures. In this paper, I present reasons to reject the east-west dichotomy. Using the discussion around the principle of informed consent as an example, I propose that while bioethical values are common, bioethical governance must display a certain flexibility akin to Aristotle's metaphor about the Lesbian rule. Such flexibility combined with a deeper understanding of the lived experiences of bioethical subjects might lead to the purging of tensions between global and local, giving us Glocal Bioethics.
Engaging young people in health research has been promoted globally. We explored the outcomes of youth advisory group on health and research engagement (YAGHRE) in rural Cambodia. In May 2021, the Mahidol Oxford Tropical Medicine Research Unit (MORU) partnered with a local health centre and a secondary school to establish a youth engagement group. Ten students underwent training and led health engagement activities in schools and communities. Activities were documented as field notes and audio-visual materials which underwent content analysis using theory of change supplemented by iterative discussions with YAGHRE members and stakeholders. Five major outcomes were identified: 1. Increased respect. Engagement activities developed based on input from students and stakeholders may have fostered greater respect. 2. Built trust and relationships. Frequent visits to MORU's laboratory and interactions with researchers appeared to contribute to the building of trust and relationship. 3. Improved health and research literacy. Learning new health and research topics, through participatory activities may have improved literacy; 4. Improved uptake of health and research interventions. Health promotional activities and communication with research participants potentially increased the uptake of interventions; 5. Improved community health. YAGHRE's health promotional interventions may have contributed in enhancing community's health.
Nigeria is experiencing, together with the rest of the world, consequences of relentlessly accelerating technological developments, in the contexts of relative lagging of developments in the Humanities, new discoveries in sciences and technological innovations, advances in medicine, changes in government policies and norms, rapid changes in the society, unhealthy practices in the area of food and agriculture, degradation of the environment as well as climate change. Furthermore, Nigeria as a Member State of UNESCO Bioethics is expected to have a National Bioethics Committee to enhance her participation in global concerns, as well as increase her opportunities to tap into global Bioethics resources. For this Committee to be established, the National Bioethics Framework and Policy Documents must be put in place. This paper discusses the rigorous process of developing the National Bioethics Framework and the National Bioethics Policy Documents as well as the need for a National Bioethics Committee in Nigeria.