With the increasing feasibility of space colonization, the issue of reproduction in space is becoming more relevant. As new settlements on the Moon, Mars, and other celestial bodies emerge, ensuring generational continuity will be essential for the survival and growth of these communities. The challenges of space living, such as extreme environmental conditions and limited resources, raise critical questions about the practicality and morality of reproduction in these contexts. This paper argues that in extraterrestrial space, human reproduction based on assisted reproductive technologies is morally preferable to sexual reproduction. We explore the benefits of technologies like embryo selection, genome editing, and artificial wombs, emphasizing their potential to mitigate the risks posed by space environments. There is no doubt that the idea of human reproduction based solely on technology is controversial and counterintuitive, even if it were to be applied only, at least initially, for the continued existence of the human population settled in space. Nevertheless, there are strong rationales for the fact that non-sexual reproduction is not only beneficial, but also has moral advantages. Finally, we also examine the social and political implications of a society that moves beyond sexual reproduction, including the reduction of gendered oppression and the redefinition of family structures. We suggest that these advancements could transform reproduction not only in space but also on Earth, potentially reducing injustices caused by human biology and reshaping societal norms and traditional view on family.
The rapid expansion of edible insect production has focused primarily on rearing, processing efficiency, safety, and nutritional composition, while the slaughter of insects has received comparatively little scientific and ethical scrutiny. This narrative review examines insect slaughter as a critical control point linking bioethics, physiology, and ingredient quality. The review synthesizes evidence from neurobiology, food science, and processing studies to evaluate how commonly used slaughter methods interact with biological aspects of insects. Existing literature shows that slaughter techniques influence protein stability and hydrolysis, lipid oxidation, antioxidant retention, techno-functional properties such as emulsification and gelation, as well as sensory attributes and consumer acceptance. Available evidence suggests that methods designed to rapidly suppress metabolic activity may be associated with improved preservation of certain nutritional and functional parameters, although findings remain species- and context-dependent. The review further highlights major knowledge gaps, including the lack of species- and life-stage-specific welfare indicators and standardized assessment protocols. Overall, the findings support the need to reconceptualize insect slaughter as a strategic upstream decision rather than a neutral processing step. Integrating ethical considerations with nutritional, functional, and regulatory perspectives is essential for establishing science-based standards and ensuring the responsible development of edible insect-based food and feed systems.
The Brazilian legislative debate on end-of-life practices involves ethical-axiological tensions related to euthanasia, assisted suicide, palliative care, and advance directives, in which divergent conceptions of these practices and of the value of life confront one another, influencing the normative formulation of the dying process. This study analyzes how such tensions are constructed and justified in the discourses of the Federal Legislative Branch, examining the normative meanings and the hierarchy of values attributed to the palliative care framework and to advance directives, as well as their ethical and moral implications. A qualitative documentary study was conducted, guided by a hermeneutic-dialectical approach and grounded in contemporary frameworks of the bioethics of responsibility and everyday bioethics. A total of 193 federal legislative documents (1981-2020) were examined. The analysis yielded two thematic categories: (1) the palliative care framework: meanings and attributions, which reveals the legislative tendency to limit the right to therapeutic refusal; and (2) instruments and mechanisms for the reversal of advance directives, which exposes restrictions on instruments intended to protect autonomy. The findings indicate the predominance of arguments grounded in vital values treated as absolute, to the detriment of personal values such as human dignity, autonomy, and self-determination, which may restrict the right to die with dignity in Brazil. El debate legislativo brasileño sobre prácticas de fin de vida involucra tensiones ético-axiológicas relacionadas con la eutanasia, el suicidio asistido, los cuidados paliativos y las directivas anticipadas de voluntad, en el que se confrontan concepciones divergentes de estas prácticas y el valor de la vida, influyendo en la formulación normativa del proceso de morir. Este estudio analiza cómo tales tensiones son construidas y justificadas en los discursos del Poder Legislativo Federal, comprendiendo los sentidos normativos y la jerarquía de valores atribuidos a los cuidados paliativos y a las directivas anticipadas de voluntad, así como sus implicaciones ético-morales. Se realizó una investigación documental cualitativa, orientada por la hermenéutica-dialéctica y fundamentada en referentes contemporáneos de la bioética de la responsabilidad y de la bioética cotidiana. Se examinaron 193 documentos legislativos federales (1981–2020). Del análisis emergieron dos categorías temáticas: 1) conjunto paliativo: sentidos y atribuciones, que evidencia la tendencia legislativa a limitar el derecho a la negativa terapéutica; y 2) instrumentos y mecanismos de acción para la inversión de las directivas anticipadas de voluntad, que revela la restricción de instrumentos destinados a la protección de la autonomía. Los resultados señalan la prevalencia de argumentos basados en valores vitales, tratados como absolutos, en detrimento de valores personales como la dignidad humana, la autonomía y la autodeterminación, lo que puede restringir el derecho a morir con dignidad en Brasil.
Male ritual circumcision (MRC) and female genital mutilation (FGM) are traditional practices involving irreversible modification of the genitalia, deeply embedded in cultural and religious contexts but subject to radically different medico-legal and ethical evaluations. While MRC is generally tolerated or regulated within European legal systems as an expression of religious freedom, FGM is universally condemned as a serious violation of human rights. This paper examines whether a meaningful medico-legal comparison between these two practices is possible. A narrative, non-systematic review was conducted, drawing on historical sources, forensic and medical literature, bioethical analyses, and European legal frameworks. The comparison focuses on consent, parental authority, assessment of harm, protection of bodily integrity, and the role of cultural and religious justification. Despite significant differences in extent of injury, health consequences, and intent, both MRC and FGM are performed on minors incapable of providing informed consent and result in permanent bodily alteration. The medico-legal tolerance of MRC is largely grounded in its perceived proportionality of harm, potential health benefits, and cultural recognition, whereas FGM is characterized by intrinsic harm, lack of medical benefit, and its function in controlling female sexuality. The divergent legal treatment reflects not only objective assessments of medical risk but also normative and political choices regarding which cultural practices are deemed compatible with fundamental rights. The comparison between MRC and FGM exposes a persistent asymmetry in medico-legal and ethical standards applied to non-consensual genital modification of minors. While FGM remains rightly subject to absolute prohibition, MRC continues to challenge the coherence of child-protection principles in pluralistic societies. Greater emphasis on bodily integrity, proportionality, and the possibility of deferring non-therapeutic interventions until personal autonomy can be exercised is needed to reconcile cultural freedom with the paramount interest of the child.
Promoting physical activity (PA) among nursing home (NH) residents, particularly those with cognitive impairment, often generates ethical tensions that may be rooted in paternalism, risk-averse cultures, and institutional routines. Therefore, it is necessary to address ethical considerations that can inform policy and practice aimed at promoting safe and effective PA intervention strategies. PA promotion was examined through the bioethical principles of autonomy, beneficence, nonmaleficence, and justice. The analysis was extended by introducing a relational autonomy framework suited to contexts of cognitive vulnerability. By situating agency within relational, cultural, and organizational structures, the relational autonomy framework clarifies how ethically grounded and cognitively responsive PA can be enabled or constrained in long-term care settings. The analysis further demonstrated that principlist approaches alone are insufficient to address the relational dependencies and fluctuating capacities that shape NH residents' participation. Meaningful PA requires communication strategies attuned to cognitive fluctuation, identity-aligned activity design, and institutional flexibility that reduces structural barriers. Integrating relational autonomy into PA policy, staff training, and everyday care practices is ethically necessary to not only promote overall health, but to uphold agency, equity, and personhood for cognitively impaired NH residents.
Burden influences caregiving experiences for family caregivers and patients. While family caregivers are crucial in end-of-life, their burden remains under-researched, particularly regarding the role of spiritual intelligence in shaping this experience. To explore the level and type of burden of family caregivers of palliative adult cancer patients and its relationship to variables related to: caregiver; patient; and caregiving process; exploring associated factors of burden. A quantitative, cross-sectional study including adult, unpaid, primary family caregivers providing support in at least one daily life activity to adult cancer patients. Caregiver burden was assessed using the Zarit Caregiver Burden Scale and spiritual intelligence through Spiritual Intelligence Self-Assessment Inventory. Linear regression analysis was used to examine significant relationships. The study followed the STROBE guidelines for reporting observational research and ethical procedures were ensured. The mean burden level was intense, predominantly on burden subdimension "Expectations Towards Caregiving". Significant correlations were found between burden and caregiver age, social support, financial status, caregiver having chronic diseases or being on pain medication and resilience. The multivariable model identified key associated factors: caregiver's older age, having no social support, having other dependents, and lower resilience, explaining approximately 40% of the burden. Spiritual Intelligence subdimension of "Personal Meaning Production" was associated with lower burden on "Self-efficacy Perception" subdimension. Family caregivers face specific struggles. Policies should provide structured support and financial resources. Interventions to prevent burden should include resilience and spiritual intelligence training, aiming to improve caregivers' self-efficacy.
Dravet syndrome (DS) is a rare genetic epilepsy syndrome, characterized by refractory seizures, delayed development, intellectual disability and behavioural difficulties. Caring for a child with DS can negatively affect parents' mental well-being. Therefore, this study aimed to (1) explore experiences of parents caring for a child with DS; and (2) assess distress and empowerment in these parents and the interplay between these aspects. We used a sequential exploratory mixed-method design. We conducted focus groups with parents of children/adults with DS, analysed these data through iterative coding to identify themes and used the Distress Thermometer for parents (DT-P) and the Dutch Family Empowerment Scale (FES) for quantitative measures. Results were validated in a final focus group. Twenty parents participated in focus groups and 65 completed questionnaires. Four themes emerged: handling the unpredictable behaviour of a child with DS, attending to one's mental health needs and well-being, adjusting life and accepting changes to meet the child's needs and struggles navigating the (health)care system. Quantitative analyses showed a significant correlation between higher parental empowerment and lower distress, and more behavioural difficulties in their child with DS and higher parental distress. Parental distress is high, especially for those parenting a child with DS and behavioural difficulties. Effective management of these issues and enhancing empowerment can improve overall family well-being.
Child undernutrition is a critical public health issue in Pakistan. While multiple factors contribute to undernutrition, the role of household-level access to Water, Sanitation, and Hygiene (WASH) services remains inadequately explored. This study aims to examine the relationship between household WASH services access and the nutritional status of children under five. This cross-sectional study utilised data from the Pakistan Demographic and Health Survey (PDHS 2017-18). Household WASH services access was the primary independent variable categorised using WHO/UNICEF JMP scale, while child nutritional outcomes, including stunting, wasting, and underweight, were taken as dependent variables. Multivariate logistic regression was used to evaluate these associations, with adjustments made for potential confounders. Data analysis was conducted using R Studio. The prevalence of stunting, wasting, and underweight in the study cohort was 38%, 8%, and 21.6%, respectively. In adjusted analyses absence of water service (aOR = 1.52; 95% CI: 1.01-2.26; p = 0.041), basic sanitation (aOR = 1.38; 95% CI: 1.07-1.63; p = 0.040) and hygiene facilities (aOR = 1.66; 95% CI: 1.34-2.25; p = 0.036) were associated with higher odds of underweight. Similarly, lack of hygiene facilities (aOR = 1.61; 95% CI: 1.07-2.44; p = 0.023) and water service (aOR = 1.49; 95% CI: 1.01-2.21; p = 0.046), and unimproved sanitation facilities (aOR = 1.30; 95% CI: 1.03-1.65; p = 0.027) increased the odds of stunting in children under five. However, no significant association was found between WASH indicators and wasting. Child age, low maternal education, recent diarrheal illness, and household poverty were among other strong predictors of undernutrition. Province-wise analysis revealed that higher undernutrition coincided with poorer household-level WASH access, particularly in Balochistan, FATA, and Sindh, while GB and ICT showed both better services and outcomes. Inadequate household-level access to water, sanitation, and hygiene services is significantly associated with higher odds of underweight and stunting in Pakistani children under five. However, household WASH services access was not significantly associated with wasting. Targeted WASH interventions may help reduce chronic undernutrition, especially in underserved regions.
Previous research indicates high concussion knowledge is not associated with better concussion reporting, with research examining the relationship between reporting and global concussion knowledge. Concussion knowledge has not yet been investigated in United States Major League Rugby (MLR) players. This study evaluated domain-specific concussion knowledge, concussion history, and reporting behaviors among active MLR players. In a cross-sectional design, 207 MLR athletes (age 26.6 ± 3.4 years) completed a survey assessing concussion history, knowledge, and nondisclosure reasons. While in the MLR, 24% reported an undisclosed concussion, with nondisclosure reasons related to a lack of concussion knowledge, a desire to continue playing, or not wanting to let the coach and/or team down. Significant positive correlations between concussion knowledge statements indicated three concussion knowledge domains: Immediate Management, Potential Post-Concussion Consequences, and Concussion Recognition. MLR players demonstrated the least knowledge in the Concussion Recognition domain and the greatest knowledge in the Potential Post-Concussion Consequences domain. Athletes with more reported concussions (across measures) or ding/bell rung instances were more likely to correctly disagree with false statements about concussions (rs range -0.153 to rs = -0.371), particularly in the concussion recognition domain. Understanding gaps in specific concussion knowledge domains and how those gaps influence concussion reporting could inform more targeted concussion education and potentially improve concussion reporting where nondisclosure is due to concussion knowledge misconceptions. Future research should explore domain-specific concussion knowledge in diverse athletic populations.
Disseminated tuberculosis, specifically tuberculous pericarditis, represents a diagnostically challenging yet critical contributor to unexpected death in forensic practice, particularly among young migrants from endemic regions who lack access to healthcare. Forensic histopathology is often the first and only means to identify this reportable disease. Without a systematic forensic autopsy including histology, this death would have been certified as "undetermined". The present case emphasizes the necessity of improved TB screening initiatives for high-risk populations such as recent immigrants from endemic nations. We present the case of a 24-year-old male immigrant of Black ethnicity who was referred for forensic autopsy after an unexpected death. The individual was pronounced dead upon arrival at the hospital. No previous clinical history or antemortem medical data were available. External examination revealed a slim, cachectic physique with a slumped posture. Autopsy examination showed granulomatous pericarditis and extensive purulent lung abnormalities, with no signs of trauma or toxication. Histopathological analysis of the pericardium showed multinucleated giant cells, lymphocytes, epithelioid cells, and central necrosis, all of which are indicative of tuberculous pericarditis. Additionally, lung tissue examination revealed disseminated tuberculous involvement with granulomatous inflammation. The cause of death was determined to be disseminated tuberculosis, which resulted in respiratory and circulatory collapse, despite the absence of documented premortem symptoms or medical history. This case highlights the indispensable role of systematic autopsy and histopathological examination in identifying undiagnosed tuberculosis in medicolegal investigations, especially in high-risk populations. Forensic pathology enhances mortality data quality, enables contact tracing to prevent transmission, and informs targeted screening programs to strengthen TB control.
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Forensic epigenetics is emerging as a powerful extension of traditional forensic genetics, offering the capacity to infer age, lifestyle, and environmental exposures from epigenetic marks. Yet its promise is shadowed by significant ethical, legal, and social questions. This article analyzes the scientific foundations and practical applications of forensic epigenetic techniques while interrogating their implications for privacy, discrimination, and human rights. It argues that the promise of enhanced investigative capability must be balanced against risks of misuse, stigmatization, and function creep. Drawing on comparative perspectives in law and bioethics, the authors emphasize the importance of proportional governance frameworks that uphold transparency, accountability, and respect for persons. Suggestions are made for the responsible integration of epigenetic data in forensic contexts, if and when, it meets sufficiently rigorous standards.
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To determine whether transitioning from a two-visit consent process led by an expert consenter to a decentralized model of consenting using an educational video and a clinical care provider translated into sustained decisional satisfaction and comparable levels of understanding about genomic sequencing for cancer predisposition. A total of 150 parents of children with cancer agreed to participate in this study approximately 4 weeks (±2 weeks) after a consent conversation for genomic sequencing using a decentralized model to assess their genetic knowledge and decision satisfaction. Results were compared with a cohort of parents (n = 121) consented with an expert consenter using a two-visit process consisting of an informational session followed by knowledge reinforcement 5 weeks (±3 weeks) after diagnosis. Among parents in the decentralized consent process, 94% recalled providing consent. However, 53% could not recall who conducted the consent conversation. Less than half (44%) recalled reviewing a copy of the consent form, and only 17% viewed the educational video. Overall, parents endorsed consenting to sequencing as the right choice (mean 4.4/5-point Likert) without decisional regret (1.5 of 5). Parents who consented through the decentralized process did not significantly differ in genetic knowledge from the baseline preconsent genetic knowledge assessment for the comparison sample. Only 56% of parents who consented through the decentralized process answered at least 75% of the knowledge questions correctly (P < .001), compared with 82% of parents who consented through the expert consenter model. While the decentralized consenting processes translated into lower knowledge scores, parents maintained high levels of decisional satisfaction. Further research is warranted to maximize knowledge exchange and ensure values-aligned consent in decentralized models.
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Histologically normal mammary tissue from breast cancer patients can harbor significant genetic alterations that could precede visible tumor development and influence disease progression. Whole-exome sequencing was performed on 408 samples from 77 breast cancer patients with poor prognosis, 49 patients recruited without prognosis-based selection, and 15 individuals undergoing non-cancer-related mammoplasty. Paired primary tumor and histologically normal mammary gland tissues were analyzed. Variant classification adhered to strict filtering criteria, incorporating allele frequency thresholds, multiple annotation databases, and in silico prediction tools. Duplex sequencing was employed to detect and confirm pathogenic PIK3CA and TP53 variants in normal mammary tissue samples from 11 breast cancer patients with unfavorable prognosis. Statistical analyses included hypergeometric testing, Kaplan-Meier survival analysis, and Cox proportional hazards modeling. Post-zygotic pathogenic variants in cancer-associated genes were significantly more prevalent in normal mammary tissue of poor-prognosis patients (29%) than in unselected patients (12.5%) (p = 0.0008578). Variant presence and per-individual burden were similar across age-matched cohorts and intrinsic subtypes, indicating that subtype composition, germline predisposition and age do not account for the excess UM variant load in BCAP. Truncating variants were exclusive to poor-prognosis cases. Frequently altered genes included AKT1, PIK3CA, PTEN, TBX3, and TP53, with TP53 variants detected only in patients with adverse outcomes. Duplex sequencing confirmed the presence of low-frequency variants (as low as 1.34%) in regions of histologically normal breast tissue from patients with a poor prognosis. Notably, nearly one-quarter of all identified cases (24%, 12/49) harbored pathogenic variants in normal tissue absent from corresponding primary tumors, suggesting that at least some mosaic clones in uninvolved mammary tissue represent independent evolutionary events rather than residual tumor cells. Post-zygotic pathogenic variants are frequent in histologically normal mammary tissue from breast cancer patients, including alterations in key cancer-associated genes. These findings indicate that mosaic clonal changes outside the tumor are more common than previously appreciated and warrant further investigation. Assessing such variants in non-tumorous tissue may, in the future, help refine approaches to breast cancer risk evaluation and management.
Monoclonal antibodies (mAbs) targeting the Calcitonin Gene-Related Peptide (CGRP) pathway are safe and effective treatments for migraine prevention. However, the high cost of these novel therapies has led to reimbursement policies requiring patients to try multiple traditional preventives before access. Here, we evaluate the real-world effectiveness of onabotulinumtoxinA (BoNT-A) as first-line treatment and describe the sequential transition to anti-CGRP monoclonal antibodies in patients who did not achieve sufficient response, within the Polish chronic migraine treatment program. In this retrospective cohort study, we included 94 patients with chronic migraine who received BoNT-A treatment according to the PREEMPT protocol every 3-4 months for 12 months as first-line treatment. Headache diaries and documentation were used to evaluate reductions in monthly headache days (MHD) and MIDAS scores. Patients were divided into two subgroups based on their response after three BoNT-A administrations: insufficient response (≤ 50% reduction in MHD) and sufficient response (> 50% reduction in MHD). We included 94 patients (93.62% female, age range 22-66 years). Following three BoNT-A injection cycles, 70 patients (74.47%) did not achieve the ≥ 50% response threshold and were sequentially transitioned to fremanezumab per programme protocol. In the insufficient response group, MHD decreased from 18.26 ± 4.46 to 13.90 ± 4.64 days (t(69) = 15.49, p < 0.001), representing a 23.9% reduction, while MIDAS scores decreased from 93.77 ± 41.80 to 61.69 ± 35.56 (t(69) = 10.22, p < 0.001, 34.2% reduction). In the sufficient response group (n = 24, 25.53%), MHD decreased from 17.83 ± 1.95 to 7.83 ± 1.83 days after 3 injections (56.1% reduction, t(23) = 31.97, p < 0.001), and further to 4.13 ± 1.77 days after 5 injections (76.7% reduction, t(22) = 32.59, p < 0.001). Pearson's correlation analysis revealed moderate positive correlation between MHD and MIDAS after 3 injections (r = 0.392, p < 0.001), which weakened substantially after 5 injections (r = 0.082, p = 0.691). Baseline MIDAS scores were numerically higher in the sufficient response group (116.62 ± 61.12 vs. 93.77 ± 41.80, t(92) = 2.04, p = 0.044); however, given the outcome-dependent nature of group allocation, this difference should not be interpreted causally or as a prognostic marker. For patients who did not experience sufficient improvement after the third BoNT-A administration, treatment was changed to fremanezumab. Our real-world data demonstrate that 74.47% of patients with chronic migraine did not achieve the ≥ 50% MHD reduction threshold after three onabotulinumtoxinA injections, supporting the current Polish therapeutic algorithm that allows sequential transition to anti-CGRP monoclonal antibodies for insufficient responders.
Sharing biomedical research data can accelerate scientific discovery, leading funders and journals to increasingly mandate sharing. However, data openness must be balanced with protecting research participants from harm in an evolving legal and social landscape. Drawing on experiences from the Electronic Medical Records and Genomics (eMERGE-IV) Network-a US-based, multi-site consortium gathering genomic and medical data focused on underrepresented groups to refine disease risk prediction-we examine challenges in implementing data sharing that are "as open as possible, as closed as necessary." Recent US legal developments, including the Dobbs decision and gender-affirming care bans, highlight the urgency of considering data-sharing risks and required the Network to rethink strategies to prevent individual- and group-level harms from genomic analyses. eMERGE-IV implemented several strategies to mitigate concerns, including cell suppression for race/ethnicity data and not extracting certain diagnostic codes from participants' electronic health records. These decisions balanced immediate protection and long-term scientific benefits for relevant populations. Participant agreement to broad data sharing in informed consent is often required for research participation to make data as open as possible. No consent form, however, can define the terms of "as closed as necessary"-a construct that is subject to sociolegal changes across the life cycle of research studies. Providing protection requires robust data governance, including engagement with prospective and actual participants. The research enterprise must reconsider its consenting approach and develop transparent, inclusive governance structures responsive to evolving vulnerabilities while maintaining scientific progress. Public trust depends on the research enterprise successfully navigating these competing demands.