Teaching bioethics contributes to promoting sound clinical decisions, but a research gap persists in Jordan regarding the ethical challenges facing physicians and their training requirements. This cross-sectional online survey assessed bioethics education, ethical awareness, perceived competence, and ethical practices among physicians practicing in Jordan. An anonymous questionnaire was distributed using convenience sampling through social media, professional networks, and medical associations. A total of 559 physicians participated. Most respondents were male (59.4%), aged 26-30 years (47.8%), and medical graduates from Jordan (83.5%). Although 64.2% reported at least 3 credit hours of ethics education, only 45.3% reported awareness of the four core bioethical principles. Most participants reported being able to identify ethical issues (83.5%) and to find answers to ethical dilemmas at least sometimes (84.4%). Ethical challenges were most often reported in relation to traditions and values (57.8%), law (53.1%), religion (52.6%), finance (51.7%), and conflict of interest (50.1%). Participants expressed strong interest in additional training, particularly treatment refusal, informed consent, diagnosis/prognosis communication, and end-of-life care. Findings suggest a need for practice-oriented, culturally grounded, and continuing bioethics education that links foundational principles to common clinical dilemmas. Education should develop case-based reasoning, reflective clinical judgment, and communication skills rather than terminology recognition alone.
The Biomedical Ethics and Regulatory Capacity Building for Portuguese Speaking African Countries (BERC-Luso) Project aimed to strengthen biomedical ethics and regulatory capacity in Lusophone African Countries. At the legislative level, it promoted the alignment of national laws with international best practices for biomedical research. At the institutional level, it promoted the establishment and strengthening of National Regulatory Authorities (NRA) and National Ethics Committees (NECs). This project also included professional training to enhance national expertise; however, this article focused primarily on the legislative and institutional developments achieved in São Tomé and Príncipe. It examines how capacity building translated into national regulatory reform. At the project's onset, São Tomé and Príncipe had minimal legislative and institutional frameworks and no specific authorities or legislation in the field. Despite these shortcomings, political commitment and stakeholder engagement enabled major developments. The country established an NEC for scientific research, competent in clinical research oversight and advanced the legal and institutional proposal for an NRA, setting key building blocks for future clinical trials. These advancements underline the transformative potential of capacity-building programs in resource-limited settings. This experience may serve as a model for similar initiatives in countries seeking to strengthen ethical and regulatory frameworks for biomedical research.
This paper explores what Confucius might say about the use of generative AI-based digital doppelgängers in healthcare for patients who are newly dead, dying, or comatose. We focus on the use of these technologies to support patients’ family members, loved ones, and surrogate decision-makers. Since Confucian approaches are largely missing from bioethics discussions of AI-based digital doppelgängers and patient preference predictors, this paper helps to fill an important gap. Section I introduces three cases involving digital doppelgängers representing people who are newly dead, dying, or comatose. Section II considers a Confucian response to the three cases. Section III applies Confucian values to a further situation, where the digital doppelgänger for a comatose patient functions as a patient preference predictor helping with a surrogate decision for a comatose patient. Section IV sets forth ethical benchmarks for using digital doppelgängers in healthcare. Section V recommends proceeding with caution and highlights the importance of further understanding the benefits and risks of using these tools in diverse cultural contexts.
On 20 May 2025, the World Health Organization (WHO) adopted the Pandemic Agreement at the World Health Assembly in Geneva. After nearly three years of negotiations and after failing to adopt it in 2024, this is a decisive step towards more combined efforts to address future pandemics. The final text of the treaty highlights the need for equitable access to pandemic-related health products and aims to improve the ability of international health regulators to guide countries during future pandemics. There is hope that by learning from mistakes made during the COVID-19 pandemic, the Agreement can be used to address global inequities and make globally equitable resource sharing the norm, preventing harmful practices, such as vaccine hoarding and barriers to data sharing. However, while the current Pandemic Agreement puts equitable access to surveillance, therapeutics, vaccines, and other pandemic-related products at the forefront, many important questions are yet to be answered. The authors of this paper draw attention to ethics preparedness efforts. The piece considers the importance of building the necessary infrastructure for the provision of ethical advice on health-related matters as part of the implementation phases of the WHO Pandemic Agreement to ensure that we learn from the mistakes made during the COVID-19 pandemic.
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.
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.
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.
This paper explores the application of the One Health approach through an analysis of the response to the 2007 crisis in Chile's salmon aquaculture industry. To evaluate the extent to which the case aligns with a “minimal” One Health framework, we draw on four key dimensions of this framework (methodological, epistemic, ontological, and ethical) and contrast the case with the response to the 2009 Q fever outbreak in the Netherlands. We conclude that the Dutch response to Q fever, characterized by limited institutional collaboration, a narrow disciplinary focus, and an anthropocentric ethical stance, fell short of even a minimal One Health approach. In contrast, the response by the Aquaculture Health Management Program (PGSA) to Chile's salmon aquaculture crisis represents a more integrated approach, involving multisectoral collaboration, interdisciplinary dialogue, and concern for animal and environmental health. While the Chilean case does not fully achieve a strong One Health model, it demonstrates the practical benefits of adopting a minimal One Health perspective, including reduced antibiotic use and improved disease control. The paper concludes that One Health should be understood as a flexible, problem-solving framework, and that clarity regarding its core dimensions is essential for strengthening One Health approaches.
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.
Verbal autopsy research is vital for understanding community mortality, informing health interventions and policies in low- and middle-income countries. However, overlooking the community perspectives on deaths can undermine the ethical conduct and effectiveness of such research. This study explored community-based concepts of death, interpretations, and coping mechanisms in five Southeast Asian countries, with this manuscript highlighting key findings from the body mapping exercise that revealed diverse cultural and religious understandings on death. Participants’ views ranged from seeing death as a cessation to life's struggles to an inevitable end, reflecting deep cultural and spiritual beliefs. Coping mechanisms, often grounded in religious practice and community support, played a crucial role in managing grief. The study also underscores the importance of addressing emotional well-being for both participants and researchers. Recommendations include integrating mental health support into research protocols and tailoring practices to local cultural contexts. These findings inform the design of more ethically grounded verbal autopsy tools and procedures that are sensitive to local beliefs and emotional dynamics, ultimately improving data quality and community trust.
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.
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.
In this short analysis, we argue that while One Health approaches have remained anthropocentric (i.e. morally and practically prioritizing human health), One Health is due for its “Jurassic Park moment.” Such a moment would mark a shift in moral priority, balancing human interests against nonhuman interests. Examples of theory and practice in One Health support the potential for such a shift.
Dementia is responsible for untold suffering, most significant is the fear that someone will lose themselves. This fear raises very serious pastoral questions: Who is the person living with dementia? Are they the same person they have always been or someone new? In either case, how do we treat them? Using the well-known case of Margo and the discussions between Dworkin and Dresser around advanced care directives, this article radically challenges the standard psychology view of personhood as being pastorally unhelpful in dementia cases. We argue that a relational view of personhood is not only epistemologically consistent but better suited to the pastoral challenge presented by dementia than that of the standard psychological view. While dementia represents the loss of cognitive abilities, and in many cases an entire change in personality, it does not represent either the loss of a person nor a change of personhood. Through dementia a person remains a person because they are personally related to by the same community of persons who have always loved them. This normative framework offers those living with dementia, their community, and their carers with a coherent, yet pastorally helpful response to the existential questions raised by dementia.
One of the ways that environmental inequalities manifest is through the market economy. Research increasingly shows how the weight of capitalist interests cause disequilibria in nature: these imbalances spread to the welfare of animals and back to humans through socio-economic interactions. One Health recognises this connection as generative of unhealthy environments, but little has so far been said about the morality of balancing conflicting interests between animals and humans for resources and space. This paper focusses on One Health’s interdisciplinarity; and provides an alternative research methodology, based on concordance of the “right to science,” to analyse ethical collaborations between markets and ecological economies. The argument is illustrated by the financing of space exploration and its cost to the environment. My modest ambition is to enhance the ethical debate of a planetary “eco-” [Greek: oikos “house, dwelling place, habitation”] by connecting health, economies [oikonomia “household management”], and ecology [logia “study of”] to a sense of normative environmentalism.
The equitable distribution of vaccines has emerged as a major issue in pandemic treaty negotiations following the COVID-19 pandemic. Failures in global procurement and distribution have been attributed to ineffective allocation mechanisms and a general lack of cooperation. More than four years after the onset of the pandemic, this article presents a perspective on how to achieve a more equitable global allocation of medical supplies for future pandemics, drawing on the distinction between “ideal” and “non-ideal” schemes of cooperation. We will consider two perspectives: first, improving solutions under current, non-ideal circumstances where non-cooperation dominates in the short and medium term, given the challenges of an uncooperative international landscape; and second, implementing long-term policies that aim at ideal proposals, assuming an increased level of cooperation in the future. This evaluation will address the past successes and shortcomings of the COVAX facility, and also the negotiations on a pandemic treaty led by the World Health Organizations, to better address future pandemics. We will discuss key issues that ought to be of central concern when moving towards more cooperative solutions in the future.
While there is limited practical experience and guidance on post-trial access (PTA) in clinical trials in low- and middle-income countries, the concept of benefit-sharing is firmly established in international ethical guidelines. Few studies have been conducted in sub-Saharan African on PTA despite its importance in distributive justice. This study aims to explore the stakeholders’ perspectives on PTA and its feasibility in Ethiopia. An exploratory qualitative study using in-depth interviews was conducted with 22 stakeholders involved in clinical trials study and review. Deductive thematic analysis was used to analyze the data. We found that research participants had limited knowledge on PTA. They opined that both trial participants and communities should benefit from clinical trials and multi-stakeholder collaboration was key in PTA planning and arrangements. However, they were uncertain of PTA feasibility in Ethiopia mostly due to a lack of legislation, regulations and guidelines on PTA and fear of losing sponsors because of increased costs resulting from them being obligated to provide PTA. It was recommended that Ethiopia establishes legislation and guidelines to govern PTA. Multi-stakeholder engagement in PTA planning and arrangements is key for meaningful PTA as the responsibility is shouldered by all parties.
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.
