As the use of digital information technologies has grown and transformed health care practices and ecologies, concerns have been raised about the implications for health care relationships. But it is no simple matter to pin down what makes health care relationships good and valuable, nor to assess whether and how digitalisation changes this. ‘Relationship goods’ such as care, compassion and respect are conceptually and practically complex. Longstanding models based on assumptions of dyadic relationships between individual health care practitioners and patients are no longer fully fit for purpose. This paper makes a case for re-thinking health care relationships to reflect the ongoing shift to digital health care ecologies. It outlines some of the key questions and considerations that will need to be addressed to support more rigorous evaluations of the implications of digital technologies and to better guide future design and health care improvement work. It illustrates some of the resources that exist within contemporary philosophy and ethics to support this agenda and calls for collaborative interdisciplinary working to investigate and help preserve the value of health care relationships through ongoing change.
Rapid advances in AI for medical applications are accompanied by an increasing demand for vast datasets. Privacy constraints – legal restrictions such as GDPR, as well as more general ethical concerns – pose significant barriers to the acquisition and use of data. Synthetic medical data (SMD) is AI-generated data that mimics real patient information. SMD is being promoted as an ethical solution that preserves privacy while enabling scalable model training. However, as we will show, the use of SMD raises its own set of issues. SMD’s emphasis on privacy and scalability subtly embeds ethical and epistemic trade-offs that undermine the principles commonly regarded as being paramount in medical ethics. These trade-offs lack the kind of ethical justification one would expect in decisions that disrupt commonly accepted values and priorities, such as those captured by Beauchamp and Childress’ four principles. In the discourse on the ethical advantages of SMD, privacy tends to be treated as a value in its own right. We show that this is a problematic assumption. Transparency, privacy, scalability, and fidelity are all linked in complex ways with the principles of medical ethics. We map these relationships and show that when privacy is privileged over other values, it conflicts with autonomy and beneficence. Our aim here is not to establish that this privileging is wrong per se, but to show that it needs careful analysis before we can accept the idea that SMD is indeed ethically advantageous.
Is “existential disease” a meaningful concept? This study scrutinizes six arguments in support of the concept. First, putative existential diseases are already discussed in the academic literature, including existential neurosis and existential OCD. Second, existential disease may be understood as occurring in the absence of “existential health,” a notion that has received increasing scholarly attention. Third, the very practices of diagnosing “existential suffering” and providing “existential therapy” appear to entail a concept of existential disease. Fourth, in the same way as physical and mental suffering corresponds to physical and mental disease, existential suffering corresponds to existential disease. Fifth, existential suffering arguably falls under several traditional definitions of disease, thereby supporting the legitimacy of the concept of existential disease. Sixth, medical interventions such as palliative sedation and assisted dying in response to existential suffering—interventions typically reserved for disease—seem to presuppose an existential form of disease. Although most of these arguments face important objections, certain conceptions of disease do warrant the category of existential disease. Nonetheless, there is a substantial risk of medicalizing existential concerns, and it is not clear that framing existential suffering as disease is the best way to respond to those who suffer existentially, especially given that health professionals may not be well equipped to address such forms of distress. Hence, more and better arguments are needed to ascertain the concept of existential disease.
Healthcare provisioning reflects the social context in which it operates, where caste-based identities and hierarchies continue to shape institutional behaviour and care delivery. Drawing on social identity theory and research on implicit bias, this study examines how caste - a rigid, hereditary, and endogamous status hierarchy, structures explicit and implicit attitudes among public healthcare providers in India. Using structured survey measures, open-ended responses, and the Implicit Association Test (IAT), we collected data from 106 providers across public health facilities in Uttar Pradesh. Results indicate widespread caste bias: over 60
This comment reviews he article, "Quantifying the HumanMortality Costs of Patent-based Intellectual Property: How Many PrematureDeaths are due to Patents?", by Joshua M. Pearce and argues that the analysisis overly simplistic.While theaffordability of medicine is a troubling challenge, one must examine thebenefits of intellectual property protection as well as the costs in order toprovide meaningful analysis.By failingto do so the author does us all a disservice by blaming the IP system, anobvious target.The truth is far morenuanced and serious readers deserve an analysis that reflects this and shedslight on the subtleties of the problem rather than turning to an easyscapegoat.Keywords: intellectual property, patents, insulin.
Artificial intelligence (AI) is increasingly embedded in healthcare delivery, and when systems are scaled across clinical workflows, errors may have system-wide consequences. The Artificial Intelligence Act (AIA) and the Medical Device Regulation (MDR) establish important safety requirements for AI-based medical devices placed on the EU market, but they do not, in themselves, guarantee that AI tools deliver quality care for patients in real-world clinical settings. This article examines how the EU Public Procurement Directive (PPD) can complement the AIA and MDR to strengthen quality assurance when AI tools are adopted in healthcare systems across EU Member States. The article proposes specific procurement mechanisms as a prerequisite for adoption, thereby translating regulatory safeguards into practice. The article also argues that healthcare providers play a critical role in shaping the quality of AI. Beyond CE-marking, procurement should require evidence of clinical relevance, context-specific documentation, transparency in system design, and clearly defined quality criteria, including diagnostic accuracy and patient outcomes. Embedding legal and ethical requirements in procurement provides a pathway from law to care, ensuring that AI supports safe, equitable, and high-quality healthcare.
Disposition decisions in emergency departments involve multiple, often conflicting objectives. This study aimed to develop avalue assessment framework, expressed as a hierarchy of objectives, based on emergency physicians' values. We used value-focused thinking to analyze the disposition decision through semi-structured interviews with thirteen emergency physicians in Sweden. A hierarchy of objectives was developed through content analysis and refined through iterative group interviews with the participants. Three fundamental objectives were identified: maximizing patient health, maximizing alignment with patient preferences, and maximizing healthcare equity. Maximizing patient healthencompassed minimizing morbidity and mortality risk while maximizing wellbeing. Maximizing healthcare equity required balancing individual patient needs against those of other patients in the ED, hospital, and broader healthcare system. This study conceptualizes the disposition decision as a value-based decision about subsequent care after an ED visit. The hierarchy of objectives provides a transparent framework for analyzing value conflicts, supporting stakeholder communication, and facilitating the development and evaluation of disposition alternatives.
Reasonable access to contraceptive services is essential for reproductive autonomy, allowing individuals to decide when to become pregnant. However, 19 million women of reproductive age in the United States live in a pharmacy desert, having no reasonable access to a health center that can provide the full range of contraceptive services. Pharmacists are increasingly positioned to fill the service gap through direct prescribing. To synthesize the available literature on pharmacist-prescribed contraceptive services, exploring implementation, barriers, facilitators, and outcomes to inform pharmacists considering implementation. A literature search was conducted on PubMed for articles between 2015 and 2025 on pharmacist-prescribed contraceptive services. The synthesis of the evidence confirms that, while pharmacist prescribing of contraception services has been shown to attain high degrees of patient satisfaction, one study found that 97
This mixed-methods study examines the push–pull factors influencing physician emigration from Turkey and assesses the feasibility of reverse brain drain, framing physician migration as a challenge for health governance rather than merely an individual career choice. Quantitative data from 1331 physicians (700 specialists, 631 interns) across 19 provinces and qualitative interviews with 32 emigrated physicians in four destination countries reveal that violence against healthcare workers (81.6
This paper presents the Ulysses Framework, a navigational approach to forensic psychiatric practice developed through clinical work with gender violence survivors in Spain’s specialised legal system. I argue that forensic psychiatry at the intersection of law, culture, and clinical care requires navigation between incommensurable frameworks rather than synthesis. Like Odysseus choosing between Scylla and Charybdis, the forensic psychiatrist must make strategic, conscious choices about what to sacrifice while maintaining orientation toward healing and justice even when these conflict. The framework draws on criminal law theory, phenomenological psychiatry, cultural psychiatry, and feminist epistemology—particularly Fricker’s account of testimonial and hermeneutical injustice and Beauvoir’s ethics of ambiguity. A composite clinical case shows how conventional diagnostic approaches fail to capture the entanglement of trauma, cultural meaning, legal demands, and contested credibility characterising gender violence cases. Three principles structure the framework: primacy of movement, framework plurality, and conscious sacrifice. The concept of métis—cunning practical wisdom that operates in ambiguous situations—is the central competence for forensic practice, distinct from cultural competence, evidence-based practice, and clinical intuition. The framework’s distinctive contribution is its refusal of consoling syntheses: it provides tools for navigating conflicts between perspectives while acknowledging the costs. For gender violence survivors, it holds simultaneously trauma and agency, injury and resilience; for forensic clinicians, it makes explicit the navigation occurring, often implicitly, in complex clinical-legal encounters.
Assisted reproductive technologies (ART) have expanded rapidly in India, raising significant ethical and distributive justice concerns relating to accessibility, affordability and reproductive healthcare governance. Despite growing scholarly attention to ART regulation, empirical evidence examining public perceptions of access, perceived equity barriers and ethical governance within the Indian context remains limited. This study addresses this gap through an empirical bioethics analysis of public perceptions regarding ART accessibility and governance in India. A cross-sectional survey of 560 respondents from urban, semi-urban and rural settings was conducted using a structured questionnaire. Data were analysed using descriptive statistics, reliability analysis, correlation analysis and one-way ANOVA with Tukey post hoc comparisons. The findings reveal significant geographic disparities in access to ART services, with urban respondents reporting substantially greater access than semi-urban and rural respondents (F = 35.040, p < 0.001). Descriptive findings further indicate moderate levels of awareness and regulatory trust alongside lower perceptions of access and greater perceived equity barriers. The study highlights the continuing influence of structural inequality on reproductive healthcare accessibility in India and underscores the need for policy interventions aimed at improving equitable access, institutional accountability and inclusive reproductive healthcare governance.
Perioperative risk assessment still relies largely on models that estimate outcomes from variables measured at a single time point. These tools remain useful for cohort stratification, communication of baseline risk, and perioperative planning, but they often underrepresent the temporal dynamics that shape individual postoperative trajectories. That mismatch may reflect more than ordinary clinical variability. At least in part, it may point to a limitation in how perioperative risk itself is conceptualized. This paper offers a conceptual analysis drawing on physiology, critical care medicine, and dynamic systems theory. Its central claim is simple: perioperative risk may be better understood as a trajectory through physiological state space than as a fixed probability assigned before surgery. Surgical interventions can then be viewed as structured perturbations imposed on already reconfigured biological systems, with responses shaped by prior states, adaptive capacity, and physiological resilience. From this perspective, postoperative complications are not merely isolated adverse events. They may instead mark transitions between physiological regimes. Processes such as sterile inflammation, microcirculatory dysfunction, organ crosstalk, and loss of physiological complexity may help explain why postoperative trajectories diverge so sharply. Cardiac surgery provides a particularly clear setting in which these dynamics become visible, although the broader argument likely extends beyond it. The analysis has practical implications for clinical reasoning in high-risk settings. Rather than displacing static prediction, it highlights dimensions of perioperative risk, such as state dependence, irreversibility, and loss of resilience, that static models represent only incompletely. That shift does not solve the problem of perioperative uncertainty. It does, however, describe it more faithfully.
Contemporary health care discourse increasingly recognises the need to move beyond purely functional and optimisation-based models of health. Yet prevailing approaches often fragment the human person into biological, psychological, and—when included—spiritual domains, without a coherent anthropological basis capable of integrating them. This article introduces Holostasis as an anthropological framework in which health is understood as personal orientation sustained through change—a stability-in-change proper to personal existence, distinct from equilibrium-based or functional conceptions. Rather than proposing a physiological mechanism or an operative clinical model, Holostasis is articulated at a pre-clinical and epistemological level, offering a conceptual criterion for rethinking health and illness from the unity of the person. Drawing on philosophical anthropology and the philosophy of medicine, the paper distinguishes Holostasis from regulatory notions such as homeostasis and allostasis, as well as from additive holistic and integrative approaches. It develops an account of health as continuity of meaning, orientation toward truth, and relational integrity, including conditions of vulnerability, illness, and functional limitation. By foregrounding the therapeutic relationship and the limits of optimisation paradigms, Holostasis is proposed as an open interpretative contribution to contemporary debates on personhood, health, and person-centred care.
Cancer remains a leading cause of disease-related mortality worldwide. Advances in oncology have enabled the development of novel therapies, including targeted therapies and immunotherapies, that act more selectively on cancer cells than conventional treatments. In Türkiye, medicine reimbursement is administered by the Social Security Institution (SSI) through the national health insurance system. However, some newly developed and high-cost cancer medicines are not reimbursed, leading some patients to seek public coverage through litigation. This practice raises ethical concerns by creating tension between individual claims to the right to health and the fair allocation of scarce resources, while also drawing attention to inequities in access to healthcare. This article analyzes litigation-based access to cancer medicines in Türkiye through the four principles of biomedical ethics and discusses key ethical challenges, with a focus on fair, transparent, and sustainable reimbursement processes.
Recent debates in global mental health reveal a persistent gap between normative commitments and clinical reality. This commentary engages with two recent contributions in International Journal of Law and Psychiatry—on CRPD indicators and on institutionalized ignorance in court—alongside parallel discussions in global health governance and artificial intelligence in psychiatry. It is argued that the limited progress in implementing human rights is not primarily due to insufficient ethical commitment, but to a structural misalignment between legal, clinical, and administrative modes of judgment. The paper proposes a shift from indicator-based compliance toward criteria of functional adequacy and cross-context consistency. Without restoring epistemic adequacy, both human rights frameworks and AI-driven tools risk reinforcing the institutional patterns they are intended to improve.
Recent debates in global mental health reveal a persistent gap between normative commitments and clinical reality. This commentary engages with two recent contributions in International Journal of Law and Psychiatry-on CRPD indicators and on institutionalized ignorance in court-alongside parallel discussions in global health governance and artificial intelligence in psychiatry. It is argued that the limited progress in implementing human rights is not primarily due to insufficient ethical commitment, but to a structural misalignment between legal, clinical, and administrative modes of judgment. The paper proposes a shift from indicator-based compliance toward criteria of functional adequacy and cross-context consistency. Without restoring epistemic adequacy, both human rights frameworks and AI-driven tools risk reinforcing the institutional patterns they are intended to improve.
This study presents a four-step methodology to analyze and improve the provision of high-complexity healthcare services (HCHS) at national level: (i) data analysis and identification of municipalities with a concentration of HCHS provision, referred to as supplier municipalities; (ii) measurement of accessibility to supplier municipalities; (iii) identification of new facility locations through optimization techniques; and (iv) determination of the level of service provision required at the new locations. The proposed methodology is applied to the case of Colombia, where 65.25
Biotechnological interventions in biological aging could provide substantial opportunities to reduce, mitigate, or even eliminate this process, and could create better conditions for the pursuit of meaningful life projects. In this article, we contrast two (allegedly) opposing ethical perspectives on these interventions: on the one hand, individual welfarist approaches; and on the other, those rooted in social-structural considerations. After providing an overview of the current state of the literature on the ethics of aging, we show why it is generally believed that both perspectives offer distinct assessments of biotechnological interventions in biological aging, relying on arguments that seem a priori irreconcilable. However, in the second and third section, we argue that this idea is misguided and that both perspectives are intertwined and complement each other. First, we argue that the concepts of well-being, disability, and aging encompass both individual and social dimensions. Second, we critically discuss how both perspectives are essential for assessing the desirability of these biotechnological interventions.
