The editors of the _Journal of Medical Ethics_ support the call of the UK Health Alliance on Climate for urgent action to ensure that the current Conference of the Parties to the United Nations Framework Convention on Climate Change ‘finally delivers climate justice for Africa and vulnerable countries’. 1 As they note ‘Africa has suffered disproportionately although it has done little to cause the crisis’. The burden of climate change has thus far fallen disproportionately on Global South countries. The monsoon (...) in Pakistan this year killed over 1100 people and the public health implications of the flooding might affect the health of over 5 million people. 2 The South Asian monsoon impacts the lives of a billion people and the flooding associated with wet seasons is likely to occur eight times more frequently in future years than at present. 3 For many pacific islands such as Kiribati,... (shrink)

The widely accepted understanding in contemporary discourse is that race and ethnicity fundamentally arose as social constructs devoid of inherent biological or scientific significance.1 Despite this consensus, discussions abound, including in this journal,2 regarding the extent and manner in which racial and ethnic categorisations should influence the landscape of medical research, practice and policy. In an ideal paradigm, medicine should exude an unwavering commitment to impartiality, extending care and treatment to every individual, unfettered by considerations of their racial or ethnic (...) background—an approach that can be described as ‘colour blind.’ Yet, a cursory examination of medicine’s historical trajectory and the enduring realities of human prejudices unravels a precarious tension. This tension resides at the intersection of two seemingly conflicting imperatives: one, the ethical mandate for medicine to operate as a colour-blind entity, and the other, the ethical duty to candidly acknowledge, confront and rectify the historical and contemporary shortcomings woven into the fabric of our healthcare systems. Navigating this precarious balance demands a nuanced and introspective approach, one that aspires to forge a path towards a more equitable healthcare landscape while remaining steadfastly committed to the principles of honesty, accountability and the pursuit of a just and inclusive future. Scientific journals are confronted with the intricate dilemma of addressing racist scientific records.3 The question at hand pertains to whether content …. (shrink)

Death by neurological criteria (DNC) continues to stir global controversy. Philosophers and theologians contest its moral significance, clinicians and bioscientists debate its probative accuracy, a...

This book is a contribution to the nascent discourse on global health and biomedical research ethics involving Muslim populations and Islamic contexts. It presents a rich sociological account about the ways in which debates and questions involving Islam within the biomedical research context are negotiated - a perspective which is currently lacking within the broader bioethics literature. The book tackles some key understudied areas including: role of faith in moral deliberations within biomedical research ethics, the moral anxiety and frustration experienced (...) by researchers when having to negotiate multiple moral sources and how the marginalisation of women, the prejudice and abuse faced by groups such as sex workers and those from the LGBT community are encountered and negotiated in such contexts. The volume provides a valuable resource for researchers and scholars in this area by providing a systematic review of ethical guidelines and a rich case-based account of the ethical issues emerging in biomedical research in contexts where Islam and the religious moral commitments of Muslims are pertinent. The book will be essential for those conducting research in low and middle income countries that have significant Muslim populations and for those in Muslim-minority settings. It will also appeal to researchers and scholars in religious studies, social sciences, philosophy, anthropology and theology, as well as the fields of biomedical ethics, Islamic ethics and global health.. (shrink)

In this paper, I will share findings from a qualitative study that offers a thematic analysis of 76 interviews with Muslim patients and families as well as doctors, nurses, allied health professionals, chaplains and community faith leaders across the United Kingdom. The data show that for many Muslims, Islam—its texts and lived practice—is of central importance when they are deliberating about death and dying. Central to these deliberations are virtues rooted within Islamic theology and ethics, the traditions of adab (virtue) (...) and aqhlaq (proper conduct). Themes analysed include theological and moral understandings around the virtues of hope and acceptance. The study provides an analysis of these themes in relation to the experiences of Muslim patients and families arriving at meaning making around death and dying and how this interfaces with their interaction with biomedicine and healthcare. The study shows that the juxtaposition of different values and moral frameworks require careful negotiation when Muslim patients and families encounter the healthcare system. The study also describes how healthcare professionals and staff of other faiths and no faith encounter Muslim beliefs and practices, and the challenges they face in interpreting virtues and values rooted in faith, especially when these are perceived to be mutually opposed or inconsistent. (shrink)

Socially responsible publishers, such as the BMJ Publishing Group, have demonstrated a commitment to health equity and working towards rectifying the structural racism that exists both in healthcare and in medical publishing. 1 The commitment of academic publishers to collecting information relevant to promoting equity and diversity is important and commendable where it leads to that result. 2 However, collecting sensitive demographic data is not a morally neutral activity. Rather, it carries with it both known and potential risks. Among these (...) are issues around privacy or data misuse, as well as more basic concerns about how, when or why people should be categorised in certain ways and/or prompted to conceive of themselves or their identities in certain terms. 3 If such data are to be collected, therefore, their effectiveness in achieving the stated ends must have a sufficiently compelling evidence base so as to justify the... (shrink)

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. (shrink)

Antimicrobial resistance (AMR) poses an increasing threat to patient care and population health and there is a growing need for novel therapies to tackle AMR. Bacteriophage (phage) therapy is a re-emerging antimicrobial strategy with the potential to transform how bacterial infections are treated in patients and populations. Currently, in the UK, phages can be used as unlicensed medicinal products on a ‘named-patient’ basis. We make an ethical case for why it is crucially important for the UK to invest in Good (...) Manufacturing Practice (GMP) for both ongoing unlicensed and future licensed phage therapy. Access to phages produced to GMP (GMP phages) will ensure effective patient care and better outcomes as well as health systems benefits. The UK also has the potential to become a global leader in the timely and cost-efficient manufacturing and supply of a therapy that meets internationally recognised standards. (shrink)

Context: Comparing the Covid-19 related experiences of vulnerable groups can help to improve public health.?The United States and the United Kingdom are both characterized by underfunded public health in the context of racist systems. We reviewed differences in Covid-19 outcomes between groups in the US and UK and compared intergroup differences between the two countries. Methods: The scoping review analyzed articles published in English during the Covid-19 pandemic focusing on the US or the UK. Using Scopus and PubMed, research articles (...) were chosen based on titles, abstracts, and relevance to the research question. Certain demographic groups known to be differentially affected by Covid-19 were chosen a priori for inclusion. Data was extracted by the first author and reviewed by senior authors. 63 studies met the inclusion criteria. Results: Two studies compared the US and UK. One found that minority status is an important social determinant of health (SDOH) of Covid-19 related health outcomes in both countries, likely through association with other SDOH. Another found that the risk of confirmed infection was higher in African-Americans, Hispanic Americans, and Asian Americans in the US and in African-Caribbean/Black-Africans, South-Asians, and Mixed-race people in the UK, compared with their respective White peers. Asian ethnicity is subject to different definitions in the US and the UK. Individual articles focusing on either the US or the UK also found that, in both countries, essential workers were impacted; those with disabilities were more often affected by Covid-19 related comorbidities in both countries. In addition, in both the US and the UK, people living in multigenerational families were more susceptible to Covid-19. Misclassification of causes of morbidity and mortality was noted in both countries. Discussion and conclusion: A limited literature indicates that, in both the US and UK, non-White populations were more affected by the Covid-19 pandemic, possibly due to association of SDOH with racist systems. Racial definitions differ between these countries and this needs further research. In both countries, data focused on LGBTQ+ groups and people with disabilities is lacking. (shrink)

Bioethics, as a field, grapples with ethical implications of biological and medical advancements. The global nature of these challenges necessitates international collaboration and discourse. At th...