Global displacement in the 21st century: towards an ethical framework

The global rise of chronic diseases requiring long-term management highlights the need for effective palliative care. Nurses play a central role in providing this care, yet frequently face ethical challenges such as moral distress, complex decision-making, and occupational stress. This systematic review aimed to identify, categorize, and synthesize evidence on nurses’ ethical perspectives, challenges, and professional interventions in palliative care for patients with chronic diseases in both hospital and home settings. The review addressed the following questions: (1) What are nurses’ ethical perspectives in delivering palliative care ? (2) What ethical challenges and decision-making dilemmas do they encounter? (3) Which strategies and interventions support ethically sound care? Following PRISMA 2020 guidelines, five databases (PubMed, Scopus, Web of Science, SID, and Magiran) and gray literature via Google Scholar were systematically searched for studies published between 2015 and 2025 in English or Persian. Eligible studies included qualitative, quantitative, mixed-methods, and peer-reviewed reviews addressing nurses’ ethical challenges in palliative care. Qualitative data were analyzed using inductive content analysis, quantitative findings were synthesized descriptively, and mixed-methods results were integrated to allow convergence across study designs. Extracted codes were organized into themes, grouped into categories, and synthesized into overarching domains. Thirty-four studies met inclusion criteria. Four main domains of ethical challenges emerged: (1) Clinical decision-making and patient autonomy—dilemmas regarding life-sustaining treatments, medication and fluid management, palliative sedation, and conflicts between patient preferences and family/cultural expectations; (2) Justice and resource allocation—insufficient ethics education, high workload, limited organizational support, poor interprofessional collaboration, and scarce resources; (3) Beneficence and patient-centered care—ethical issues related to technological innovations, informed consent, data privacy, and environmental pressures such as ICU or emergency care conditions; (4) Non-maleficence and moral distress prevention—moral distress, burnout, reduced ethical courage, and legal concerns affecting clinical decisions. Nurses encounter substantial ethical challenges in delivering palliative care for patients with chronic diseases. Addressing these challenges requires ethics education, structured organizational guidance, interprofessional collaboration, and context-sensitive strategies to safeguard patient dignity and reduce moral distress. These findings provide evidence for policymakers, educators, and managers to develop practical interventions and ethical frameworks across diverse care settings.

Infertility remains a global challenge, with assisted reproductive technology (ART) progressively gaining relevance in developing countries, including Ghana. However, associated ethico-legal challenges have not received the needed policy attention. This study explored the legal and ethical challenges of ART practice in Ghana. The study employed an exploratory phenomenological approach to examine ART in Ghana, focusing on ethics and law governing this practice. Respondents were ART practitioners, managers, facility owners, representatives of surrogacy/gamete donor agencies, and regulatory body representatives. A semi-structured interview guide was used to collect data.The in-depth interviews were audiotaped, and responses transcribed for analysis through coding, followed by generation of themes and sub-themes, supported with direct quotes. It emerged that there are no ethical and legal frameworks for ART practice in Ghana, and this adversely affects ART practice. Ethical challenges identified border on informed consent, clients' privacy and clinical data protection, gamete donation issues, multiple gestations, single parenting, and social and religious issues. The legal challenges identified include the non-existence of a legal regime for regulating ART practice and the absence of a professional body with clear-cut guidelines on ART practice. In the absence of legal and ethical frameworks in Ghana, practitioners intimated they do comply with internationally accepted principles and general ethics in medical practice. There are no regulations on ART in Ghana. Legal and ethical guidelines are essential to the provision of safe and successful ART practices to protect providers and users. Governmental efforts to regulate Ghana need to be prioritized. This study had no external funding support. It was funded privately from researchers' contributions.

How decisions are made and communication is handled are essential to ensuring a good outcome.In the case of Scardoni v Hawryluck,1 Mrs H was an 81-year-old woman with advanced Alzheimer disease, cardiovascular illness, and septic shock whose family and physician could not agree on goals for care, requiring that a legal decision be made regarding the level of care to be provided. Over time and after much discussion, the multidisciplinary team on the intensive care unit (ICU) reached a consensus that intensive care for Mrs H would not improve her condition. So it was decided that after Mrs H was stepped down to a general medical unit, should an infection or respiratory distress develop, she would not be returned to the ICU. The attending ICU physician informed the family that instead of ICU care, “the hospital would offer her palliative care: painkillers and sedatives to keep her comfortable while her afflictions took their course.”2 In this particular case, the patient’s family challenged the health care team’s recommendations and insisted that their mother be readmitted to the ICU so that aggressive life-sustaining treatment would continue.This case, although Canadian, is relevant to ICU settings throughout North America. The purpose of this discussion is not to provide an in-depth ethical analysis, but rather to use the case of Mrs H to characterize one type of health care situation that clinical ethicists could help facilitate. Medical recommendations such as those involved in the care of Mrs H are made to prevent the “revolving door” patient, who according to ICU teams will receive no medical benefit if returned to the ICU. Decisions not to readmit are euphemistically referred to by some ICU staff as the “one-way ticket out of ICU” or “celestial transfer.” Such language shared between colleagues reflects a coping strategy, a “gallows humor,” intended to manage difficult feelings like sadness, anger, grief, sympathy, or moral distress. Cases like that of Mrs H are of particular concern to critical care nursing. Research has indicated that moral distress, a significant contributing factor to burnout, is encountered by ICU nurses when the care they are providing to a patient is regarded as futile.3It is not uncommon for hospital-based clinical ethicists to receive a request for consultation when disputes regarding similar recommendations for care arise between substitute decision makers and the ICU treatment team. These cases can lead to moral distress because of commonly held opinions among team members that futile treatment is being provided. Although staff can provide many life-sustaining treatments to such a patient, ethical questions often arise during the patient’s stay in the ICU. What ought to happen when an ICU team decides that a patient should be transferred to a general medical unit to receive comfort measures only, with no readmission to the ICU? Although teams discuss the practical questions about what can be done, the ethical questions about what ought to be done are sometimes not as clear. The following discussion explores how clinical ethicists can provide valuable assistance with the kinds of ethical challenges these situations customarily present. Particular emphasis will be placed on working within a process-driven, interdisciplinary framework that maintains a communication-oriented approach to ethical decision making.Clinical ethics is a relatively new field, and the role and purpose of clinical ethicists can vary somewhat according to the particular health care setting. For the purpose of this discussion, the authors describe the knowledge, skills, and activities of clinical ethicists through their review of relevant literature as well as their own training and experiences as staff clinical ethicists at 2 acute care settings in Ontario, Canada.Greater legal clarity or legislative measures to specifically address conflicts that arise over withdrawal or withholding of treatment for terminally ill patients are required, according to at least one legal expert. Current Canadian law, according to this same scholar, leaves doctors, patients and their families in a “grey zone” as to who should have ultimate authority on such decisions.4 The daily reality in most North American ICUs is that this gray zone persists—for better or worse. Although hospitals attempt to provide guidelines for addressing conflicts such as the one involving Mrs H, it is the quality of communication and relationship within the interdisciplinary team and between the treating team and the patient’s family that has a marked influence on decision making.5–7 In most cases similar to this one, consensus about level of care is first achieved by the interdisciplinary team, and a subsequent agreement is reached between the treatment team and the patient’s substitute decision maker and family. However, when agreement cannot be reached because of irreconcilable notions pertaining to what constitutes benefit to the patient and what constitutes harm, the results can be uncertain, stressful, and most unsatisfactory for both the health professionals involved and the patient’s family. This combination of an unfortunate turn of events for the patient, sharing of bad news with family members, and the recommendation for care outside of the ICU is a juncture of decision making at which conflict can occur and ethical challenges are most apparent to members of the interdisciplinary team.8,9Much has been written about the difficulties in communication within the ICU and how this affects patient care. Considerable evidence indicates that communication between the ICU team, patients, and patients’ families can be inadequate, leading to conflict and a possible long-term effect on the patient’s family.6,8,10,11 In one study,8 46% of families who had a loved one die in the ICU reported conflict over decisions to withdraw or withhold life-support measures. These family members also reported conflict over the manner in which staff communicated with or behaved toward them. The authors of that study8 cited family members who felt pressured by staff to “hasten their loved one’s death because they placed a burden on valued resources.” The importance of communication between treatment teams and patients and patients’ families cannot be overstated. In addressing the difficulties and deficiencies that have been identified, 2 experts concluded, “communication with caregivers is consistently identified as the most important and least achieved factor in patient/family satisfaction surveys.”12Intensive care is primarily intended to provide maximum benefit to those patients who are likely to recover from their infirmity or trauma.13 When the interdisciplinary team is not clearly communicating ethical considerations as well as the criteria they are using to determine the effectiveness or success of the treatment plan, patients’ families may develop erroneous expectations that life-sustaining interventions will continue to be offered.6 At the same time as a loved one is receiving ICU care with a grim prognosis, families are struggling to come to terms with impending loss. Family functioning or experience in coping with loss,14 unrealistic expectations regarding health outcome, within a societal context of diverse religious or cultural beliefs, can markedly influence families’ decision making about end-of-life care. Such formidable contributing factors further emphasize that effective communication strategies, as well as an appropriate level of sensitivity, ought to be used in ICUs when dealing with patients’ families.11Team communication, in particular communication between disciplines, also has proven problematic in decisions about end-of-life care in the ICU. Critical care nurses have cited difficulties in communication and decision making within interdisciplinary ICU teams. Ferrand et al15 reported that 75% of the nursing staff who participated believed that “collaboration was inadequate during decision making” despite general agreement that such team collaboration is necessary and desired. In another study,16 about one-third of the ICU nurses who participated felt “excluded by physicians from patient care decisions and felt their exclusion to be a detriment to patient care.”In terms of the burdens carried in making decisions about end-of-life care, some evidence suggests that physicians and nurses experience equal burdens. Physicians experience the burdens associated with having to make these decisions, and nurses feel the burden of having to carry out care decisions made by someone else.17 Given the shared burdens that members of the interdisciplinary team face, as well as the reported difficulties in end-of-life care decision making in the ICU, ensuring effective communication is a key feature of high-quality patient care.7 The following discussion is intended to demonstrate how clinical ethicists can be supportive of such strategies for effective communication and decision making.Medical recommendations like those pertaining to the care of patients such as Mrs H are based on best-practice standards of care and are informed by ethical principles like beneficence, nonmaleficence, and autonomy. Continued life-sustaining support in situations where benefit is in question can be regarded as futile, a concept with inherent ethical challenges. As Weijer et al18 point out, the values inherent in medical futility arguments often confuse treatment considered ineffective and treatment that will be effective but will ultimately result in a controversial outcome such as permanent unconsciousness. A team’s decision to not readmit a patient for ICU care can be an attempt to address futility based on controversial outcomes that the team may perceive as causing more harm for the patient than good. Poignantly stated, “if the welfare of the patient is the whole purpose of providing treatment and if that treatment brings needless suffering, then the whole purpose of medicine is defeated.”19 Although the concept of futility in ICU care is a subject worthy of ethical debate, it will not be the focus of this discussion. Rather, the subject of this discussion is the role of clinical ethicists in helping decision makers address ethical considerations such as futility.The results of inadequate communication, misunderstandings, or disagreements arising from divergent views about what is beneficent and the institutional realities surrounding resource allocation can be seen in the moral distress and subsequent moral residue experienced by both the patient’s family members and the health care staff involved. Moral distress occurs when a person can identify the ethically appropriate course of action, but does not feel able to carry this action forward because of barriers that may include lack of resources, legal limits, institutional obstacles, or imbalances in power, for example. Effects of moral distress on an individual can include feelings of anger, frustration, anxiety, or depression.20 Moral residue can be encountered when “deeply held beliefs, values and principles” are set aside at the expense of one’s personal sense of integrity.21 For families of patients, moral residue can manifest in lifelong memories about difficult health care experiences.The experience of moral distress and moral residue are of particular importance to critical care nursing. Some evidence indicates a relationship between an ICU care nurse’s perception of providing futile care, inadequate communication about the care plan within the interdisciplinary team, and the incidence of moral distress, emotional exhaustion, and burnout.3,16,22 Cases like that of Mrs H can present these kinds of challenges to nurses providing care at the bedside. The discussion also highlights how clinical ethicists can assist interdisciplinary teams in addressing ethical challenges that can lead to moral distress.Finally, the ethical climate within our health care settings is shaped by the organizational values inherent in hospital policies, approaches to handling conflict, allocation of human and material resources, the daily-lived experience of staff providing care, and those to whom care is provided.23,24 Economic constraints, resource allocation difficulties, and staffing shortages contribute to the moral climate of health settings, the moral distress of staff, and burnout among health care providers.25,26In cases such as that of Mrs H, the ethical challenges are not just about treatment requests considered inadvisable but also about scarce resources like ventilator-equipped beds in ICU settings. In the minds of some families, the need for an ICU bed is the primary reason that palliative measures are now being recommended. When conflict surrounds decisions about level of care, it is the bedside ICU nurse who fields the questions, concerns, and emotions expressed by patients’ families.It is through such challenging decision making, in which no agreement is reached, that the moral climate is regrettably defined for all persons with a stake in the decision. However oppressive these disagreements feel to both health care professionals and patients’ family members, most often the disagreements, ironically, do not result from a lack of good intentions on either side of the debate. Rather, these circumstances reflect the complex ethical challenges that are inherent in contemporary health care settings. Clinical ethicists can be an important resource to health care teams, patients, and patients’ families in addressing these difficult challenges.Clinical ethicists who provide consultative services may be requested by the ICU team when conflicts such as the one surrounding the planning of Mrs H’s level of care arise. What are the characteristics, skills, and knowledge that make clinical ethicists a useful resource in helping to address conflict over decisions about level of care for stable but critically ill ICU patients?Clinical ethicists come from a diverse background of training: clinical and academic experiences that include but are not limited to medicine, nursing, social work, theology, philosophy, and anthropology. Most clinical ethicists have advanced academic degrees and/or training in clinical ethics. Despite this diversity in background, clinical ethicists engage in common functions: consultative services, research, education and the development of policies pertaining to patient care and organizational ethics.27–29Clinical ethicists are trained to view ethical problems within an interdisciplinary health care environment whose primary commitment should always be to provide the best patient care possible. Patient care and goals for care are best understood through the wishes, beliefs, and values of the patient and the patient’s family. The approach taken by clinical ethicists in providing consultation is to model interdisciplinary collaboration and effective communication with patients and their families, with the objective of enhancing ethical decision making.28–30In effect, clinical ethicists in cases such as the one involving Mrs H act as facilitators of communication and decision making about goals for care, while directing attention to the ethical considerations underlying such decisions. Generally, clinical ethicists can help clarify differences in the way ethical considerations such as sanctity or quality of life are valued on the basis of religious, personal, or cultural values. Some evidence suggests that ethics consultation generally has been useful in preventing or resolving conflicts, and in reducing the incidence of prolonged controversial treatment.31,32 Current trends in the training and education of clinical ethicists have emphasized skills, knowledge, and expertise better suited to provide ethics support in real time as dilemmas and conflict around decisions related to patient care unfold.28What is particularly important about the approach used by most clinical ethicists is the emphasis placed on fair and just processes for decisions of such importance and consequence in an ICU environment.In cases such as the one involving Mrs H, it is not just what decision ought to be made that is of interest to clinical ethicists, but if and why a particular decision is ethically defensible. If so, to whom is it ethically defensible? How ought discussions and conflicts be managed? These questions raise ethical concerns about justice, fairness, and a reasoned approach to decisions of such consequence. Ethical consideration must also be given to the moral climate, how people feel treated, and the concerns and opinions of key persons with a stake in the decision making, with overarching consideration given to trust in the process used to make such important decisions. Therefore clinical ethicists are as concerned with procedural fairness as they are with outcome when assisting with ethically challenging situations in health care settings.Principal aspects of procedural fairness are as follows: that the process for decision making be as transparent as possible to all involved; that concerns of key persons with a stake in the decision making be considered; that the reasons or rationale behind decisions can be understood and defended; that people responsible for decisions be held accountable; and that in the event disagreement occurs, decisions can be reviewed, taking into account the concerns of those who disagree.33 Process-driven approaches to decision making or to resolving conflict used by clinical ethicists are dependent on using frameworks to guide communication. Such frameworks for communication are not just ethically defensible; they have been shown empirically to be part of good practice standards in ICU settings.6,11,34 Lilly et al35(pS398) found that using a standardized framework for communication resulted in health care providers seeing decision making as a “process rather than as an event”—an attribute consistent with principles for ethical decision making.An example of such a framework to guide communication is described by Lautrette et al,34 who identify such attributes as timeliness, opportunities for the patient’s family to speak, use of appropriate and sensitive language, and ensuring that the setting is private and comfortable. In addition to these attributes, clinical ethicists would include discussion of the values in conflict and ethical obligations that underscore decision making.Frameworks for communication appear well supported in the literature anyway, so what makes the involvement of clinical ethicists of added benefit?Despite advances in implementing communication strategies in many settings, improvement in general is needed in managing communication, enhancing understanding, and meeting needs of ICU patients and their families.6,8,10,11 Furthermore, Sherwin36 believes that communication frameworks and hospital policies can be used coercively, to enforce a particular outcome, if those who lead these discussions or who adhere to policies are not reflecting on personal biases, institutional pressures, and ethical considerations.Clinical ethicists act as facilitators, helping to raise important ethical questions, model effective communication, and model ethical decision making by using teachable moments to heighten the awareness and understanding of the ethical considerations in each case. Within most health care settings, necessary and unavoidable imbalances in power are present between various persons who have a stake in the decision making. Clinical ethicists assist in discussing the values that underlie decisions of such importance, making these transparent to and understood by key involved parties. They model the principles of procedural fairness. Inherently challenging decisions about level of care, as in the case of Mrs H, are often met with challenging feelings and opinions, making fairness and ethical reflection more important than less to involved parties.Clinical ethicists advocate for policies and practices that reduce coercive consequences that can arise when members of the ICU treatment team, patients, or patients’ family members feel overruled or dismissed. In conducting an ethics consultation, the clinical ethicist leads discussions with the interdisciplinary team members about ethical considerations that contribute to moral distress, for example, the conflict in the way benefit and harm associated with a particular therapy or level of care are understood. In most instances, the clinical ethicist must ensure that concerns raised by members of the interdisciplinary team and concerns expressed by patients’ family members are shared and considered. This process is handled in an open and transparent manner. In creating an opportunity through the consultative process for the interdisciplinary team to address concerns, related to both areas of conflict and moral distress, clinical ethicists are also capitalizing on valuable teachable moments in which knowledge about ethics and decision making can be enhanced. As Kälvemark Sporrong et al37(p835) concluded, “Ethical competence is a key factor in preventing or reducing moral distress.”We have found that consultation on an individual case often helps treatment teams identify preventative strategies to reduce or avoid conflict and to engage in more timely discussion about ethics the next time a complex care situation arises. Such measures are necessary in creating a moral climate in which discussion about ethics in daily practice can be supported and thus reducing the effects or incidence of moral distress. The potential exists for all members of the interdisciplinary ICU team, including the most responsible physician, to be so engaged in ethical reflection and decision making on challenging cases. Clinical ethicists model skills of effective communication, ethical reflection, and decision making as well as principles of procedural fairness within the consultative process that they facilitate.We are not suggesting that effective communication, procedural fairness, ethical reflection, and decision making are deficient whenever clinical ethicists are not involved in such cases. In reality, complex and ethically challenging cases occur routinely in ICU settings, most often without the involvement of clinical ethicists. What is being proposed is that clinical ethicists should be seen as a valuable resource for addressing challenging cases in the ICU. Better understanding is needed about the role of clinical ethicists and the kinds of assistance they can provide.In most cases, the ICU team and patient’s family agree on recommendations that comfort measures be provided on a medical intermediate care unit or a palliative care unit for a stable but critically ill patient. However, as in the case of Mrs H, these decisions may be met with considerable emotion from the patient’s family and with differences of opinion about benefit and the appropriate level of care. We think that clinical ethicists can be a valuable resource when challenging cases arise. By providing consultation, clinical ethicists can model effective communication, ethical reflection, and decision making, while following principles of procedural fairness, all of which are key elements to upholding ethics in daily practice and are of particular importance when conflict occurs about level of care in the ICU.The following are practical considerations for critical care nurses:

This article examines ethical questioning as an inquiry process germane to making ethical choices in applied theatre research. Focusing on reflexivity through reflection before, in and on action, I consider ethical questioning as a framework to amplify resistance, promote participation and strengthen decolonization in the research process. I situate ethical questioning within critical pedagogy for applied theatre practice and construct an ethical questioning framework that rests on both individualism and collective processes. I conclude by briefly examining some processes in my doctoral research and reflecting on the implications of ethical questioning on applied theatre and the call to turn from a morality debate about ethics to a political act rooted in the awareness of oneself in relation to the other.

While applied epistemology has been neglected for much of the twentieth century, it has seen emerging interest in recent years, with key thinkers in the field helping to put it on the philosophical map. Although it is an old tradition, current technological and social developments have dramatically changed both the questions it faces and the methodology required to answer those questions. Recent developments also make it a particularly important and exciting area for research and teaching in the twenty-first century. The Routledge Handbook of Applied Epistemology is an outstanding reference source to this exciting subject and the first collection of its kind. Comprising entries by a team of international contributors, the Handbook is divided into six main parts: The Internet Politics Science Epistemic institutions Individual investigators Theory and practice in philosophy. Within these sections, the core topics and debates are presented, analyzed, and set into broader historical and disciplinary contexts. The central topics covered include: the prehistory of applied epistemology, expertise and scientific authority, epistemic aspects of political and social philosophy, epistemology and the law, and epistemology and medicine. Essential reading for students and researchers in epistemology, political philosophy, and applied ethics the Handbook will also be very useful for those in related fields, such as law, sociology, and politics.

In an effort to increase student readiness for college and career, many States have adopted new academic standards encouraged by education reform advocates. These standards are commonly referred to as the Common Core Standards. Schools from States that have adopted the Common Core Standards have been compelled to significantly restructure their existing curriculum and adjust how they teach that curriculum. These requirements can be particularly onerous for rural schools. Neoliberalism is the underlying political philosophy undergirding these changes in the current school reform movement and is similar to the political philosophy that drove the changes in agricultural policies in the mid 20th century. Neoliberal political and economic philosophy as it correlates to education policy is buttressed by three values: (1) education fosters economic growth; (2) education policy modeled on efficiency and business practices; (3) high stakes testing to measure what a student has learned. These values have created an educational policy structure that attempts to quantify student learning, teacher effectiveness and school district value. By understanding the similarities between agricultural policies in the mid 20th century and current education policies, rural schools and communities will be able to change the narrative surrounding the education of their children.

(2006). Witnessing on the Web: Asylum Seekers and Letter-Writing Projects on Australian Activist Websites. a/b: Auto/Biography Studies: Vol. 21, Epistolarity in the Twenty-First Century, pp. 44-57.

Artificial intelligence (AI) is a relatively new medical resource with the potential to revolutionize current practices in the prevention and treatment of disease. AI has been defined as computer programs accomplishing tasks traditionally associated with human intelligence such as learning and solving problems. As the ethical benefits of increased efficiency and productivity of AI systems are being realized, the consequences of implementing such transformative technologies has raised ethical and regulatory questions across the globe. AI represents a tool to address longstanding issues in healthcare delivery and can achieve a caliber of healthcare quality that was previously beyond our grasp. However, AI systems may incorporate and often amplify existing patterns of practice, including societal biases and inequitable healthcare practices. Surmounting these ethical and regulatory challenges represents the next frontier in the successful implementation of AI to promote human development and wellbeing. In this study, we examined the current literature and analyzed the scope of practice around the ethical and regulatory issues surrounding AI in medicine and its application to healthcare. Knowledge integration was performed across disciplines relevant to the potential role for AI in facilitating progress, innovation, and quality assurance in healthcare. Thematic analysis was conducted on qualitative data pertaining to both ethical and regulatory challenges concerning the implementation of AI into healthcare practices. The project provided exposure to the innovative field of AI and various strategies related to ethical issues, regulatory laws, quality improvement, and healthcare management. We explored both the reliability and current limitations of AI in order to create best practices guidelines designed to facilitate the successful incorporation of AI into healthcare fields. Ethical challenges of AI such as risk management, data security, and a lack of transparency span all sectors working to implement these new technologies. All medical disciplines working to leverage the potential applications of AI struggle with the ethical challenges of informed consent, autonomy, accountability, biases, and equitable healthcare delivery. The field of laboratory medicine and pathology was a pioneer in the implementation of AI technology. Laboratory medicine and pathology face additional hurdles when ensuring accurate interpretation of results such as unequal contexts, opportunity costs, and low levels of acceptable risk and uncertainty. Rather than an all-or-nothing approach, we suggest a stepwise, transparent, and patient-centered approach with clear boundaries to the incorporation of new tools. The AI-assisted era of medical care will be transformative but will never be void of all risk or ethical challenges. This work represents the first of many steps in using AI technology to optimize healthcare delivery in a way that protects and strengthens the ethical values of medical care.

Little attention is paid in most national asylum policies and legislation to the specific position of female asylum seekers, and to gendered aspects of refugee and asylum situations. Further, even in those countries that have adopted asylum legislation to specifically address the question of women asylum seekers and victims of gender specific persecution, problems still remain in the implementation of these policies and in the full recognition of persecutions specific to women. Whilst the issue of protection of women victims of this type of violence have been put on the international agenda, at least to some extent, through directives on the defence of women’s human rights and on the protection of female refugees and asylum seekers, the international norms which have thus been created have been implemented unevenly and unequally in different national contexts. This article seeks to analyse the extent to which national asylum legislation and policies have integrated a concern with the protection of women victims of gender specific forms of persecution, and how effective this implementation has been. The article will engage critically with existing accounts of global norm creation to examine the uneven diffusion and implementation of norms on the protection of female refugees, pointing to the importance of discursive opportunity structures open to actors in mobilising around these issues at local and national levels. It will also argue that even where policies and legislation dealing specifically with women refugees and asylum seekers do exist, they may not actually address some of the important insecurities facing these women because of an approach that does not fully comprehend and act upon gendered structures and relations of power.

Expansion of data-driven research in the 21st century has posed challenges in the evolution of the international agreed framework of research ethics. The World Medical Association (WMA)’s Declaration of Helsinki (DoH) has provided ethical principles for medical research involving humans since 1964, with the last update in 2013. To complement the DoH, WMA issued the Declaration of Taipei (DoT) in 2016 to provide additional principles for health databases and biobanks. However, the ethical principles for secondary use of data or material obtained in research remain unclear. With such a perspective, the Working Group on Ethics (WGE) of the International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine (IFAPP) suggests a closer scientific linkage in the DoH to the DoT focusing specifically on areas that will facilitate data-driven research, and to further strengthen the protection of research participants.

The aim of this special edition is to explore and discuss the complex relation between religion and education. This relation can, at times, be fraught and be the focus for conflict. This special edition will highlight some of the conflicts that have arisen in different national contexts in the twentieth and twenty-first centuries and identify some of the attempts to address the causes and effects of conflict. Religion continues to be an influence on the life and lifestyle of a significant number of people throughout the world. The Pew Research Center (2012) has produced an estimate of the contemporary global religious landscape. The Center estimates that 2.2 billion of the world’s population are Christian (31.5%), 1.6 billion are Muslim (23.2%), 1 billion are Hindus (15%) and there are 500 million Buddhists (7.1%). There are 400 million Folk religionists (includes, for example, African religions and Chinese folk religions) (5.8%), 58 million following other religions, including, for example, Bahai, Jains and Sikhs (0.8%) and 14 million Jews (0.2%). There are 1.1 billion people (around one in six in the population of the world) who have no affiliation to religion (16.3%). According to the Pew Research Center, then, around 83.7% of the population has some form of adherence to religion. Although this special edition is focused on religion, conflict and education we prefix our discussion with an acknowledgement of the positive influence of religion for individuals, communities and countries in the contemporary world. Religion provides many people with purpose, hope and a sense of belonging in life and can be integral in the construction and development of their identities. Religion can motivate and inspire people to act for the good and well-being of others. Religions can have a very powerful influence in society acting as pressure groups that challenge leaders and governments over issues of social justice and equity: fighting for the rights of the vulnerable, the voiceless and the dispossessed. In the late twentieth/early twenty-first centuries this has been focused on issues such as: the just treatment of migrants, refugees and asylum seekers; the alleviation of pov

<p>Since the turn of the twenty-first century Australia and New Zealand have become an increasingly popular destination for asylum seekers and refugees in search of a better life. Many of these people do not reach this new life so easily, with thousands trapped both literally and metaphorically somewhere between their homeland and their future home, but belonging to neither. Nauru, an isolated island in the Central Pacific, is host to a prison-like Australian offshore processing centre that currently detains people in inhumane conditions. Amnesty International cites the Regional Processing Centre situation as: “...a toxic mix of uncertainty, unlawful detention and inhumane conditions...the facility totally inappropriate and ill-equipped, with 387 men cramped into 5 rows of leaking tents, suffering from physical and mental ailments.” This thesis is centred on the following research question: How can architecture be perceived as a temporary ‘home’ to asylum seekers from disparate backgrounds all brought together in one place for an unknown period of time? The aim of this design-led research is to critically consider how architecture can play a significant role in remediating the authoritarian, prison-like conditions of processing centres while assisting the transition for asylum seekers to their future home. This thesis proposes a sense of worth and belonging can be established through developing an architecture that is connected intrinsically to the landscape and cultural context in which it sits. The objectives of this thesis are to investigate how the architectural design of a large asylum seeker processing facility can: 1) provide a sense of place to a wide range of asylum seekers from differing ethnicities, cultures, and social backgrounds; 2) improve their sense of individuality, self-worth, belonging, and community; 3)prepare them for entering a new Western culture where they can more readily assimilate; 4) mitigate the appearance of power and authority in a large processing facility; 5) provide a sense of human-scale, order and orientation within a large processing facility; 6) and engage with, and contribute to, the local host indigenous community. This thesis also argues that through architecture, an asylum seeker’s temporary home can be symbolically interpreted as a gateway or threshold to their future home, providing a sense of place, belonging and hope.</p>

<p>Since the turn of the twenty-first century Australia and New Zealand have become an increasingly popular destination for asylum seekers and refugees in search of a better life. Many of these people do not reach this new life so easily, with thousands trapped both literally and metaphorically somewhere between their homeland and their future home, but belonging to neither. Nauru, an isolated island in the Central Pacific, is host to a prison-like Australian offshore processing centre that currently detains people in inhumane conditions. Amnesty International cites the Regional Processing Centre situation as: “...a toxic mix of uncertainty, unlawful detention and inhumane conditions...the facility totally inappropriate and ill-equipped, with 387 men cramped into 5 rows of leaking tents, suffering from physical and mental ailments.” This thesis is centred on the following research question: How can architecture be perceived as a temporary ‘home’ to asylum seekers from disparate backgrounds all brought together in one place for an unknown period of time? The aim of this design-led research is to critically consider how architecture can play a significant role in remediating the authoritarian, prison-like conditions of processing centres while assisting the transition for asylum seekers to their future home. This thesis proposes a sense of worth and belonging can be established through developing an architecture that is connected intrinsically to the landscape and cultural context in which it sits. The objectives of this thesis are to investigate how the architectural design of a large asylum seeker processing facility can: 1) provide a sense of place to a wide range of asylum seekers from differing ethnicities, cultures, and social backgrounds; 2) improve their sense of individuality, self-worth, belonging, and community; 3)prepare them for entering a new Western culture where they can more readily assimilate; 4) mitigate the appearance of power and authority in a large processing facility; 5) provide a sense of human-scale, order and orientation within a large processing facility; 6) and engage with, and contribute to, the local host indigenous community. This thesis also argues that through architecture, an asylum seeker’s temporary home can be symbolically interpreted as a gateway or threshold to their future home, providing a sense of place, belonging and hope.</p>

Introducing public health ethics poses two special challenges. First, it is a relatively new field that combines public health and practical ethics. Its unfamiliarity requires considerable explanation, yet its scope and emergent qualities make delineation difficult. Moreover, while the early development of public health ethics occurred in a western context, its reach, like public health itself, has become global. A second challenge, then, is to articulate an approach specific enough to provide clear guidance yet sufficiently flexible and encompassing to adapt to global contexts. Broadly speaking, public health ethics helps guide practical decisions affecting population or community health based on scientific evidence and in accordance with accepted values and standards of right and wrong. In these ways, public health ethics builds on its parent disciplines of public health and ethics. This dual inheritance plays out in the definition the U.S. Centers for Disease Control and Prevention (CDC) offers of public health ethics: “A systematic process to clarify, prioritize, and justify possible courses of public health action based on ethical principles, values and beliefs of stakeholders, and scientific and other information” (CDC 2011). Public health ethics shares with other fields of practical and professional ethics both the general theories of ethics and a common store of ethical principles, values, and beliefs. It differs from these other fields largely in the nature of challenges that public health officials typically encounter and in the ethical frameworks it employs to address these challenges. Frameworks provide methodical approaches or procedures that tailor general ethical theories, principles, values, and beliefs to the specific ethical challenges that arise in a particular field. Although no framework is definitive, many are useful, and some are especially effective in particular contexts. This chapter will conclude by setting forth a straightforward, stepwise ethics framework that provides a tool for analyzing the cases in this volume and, more importantly, one that public health practitioners have found useful in a range of contexts. For a public health practitioner, knowing how to employ an ethics framework to address a range of ethical challenges in public health—a know-how that depends on practice—is the ultimate take-home message.

ABSTRACTAsylum seekers are rarely treated with respect. This is perhaps especially true of institutions that adjudicate the extension of refugee status. In asylum interviews, those seeking refuge are sometimes asked to reveal deeply upsetting stories of their persecution while facing hostility and distrust from their interviewers. I argue that this arises from a failure to properly balance respect with fairness. A maximally fair scheme may not promote respect because ‘fairness‐first’ systems require extensive information to make their judgements. A maximally respectful system might be unfair: without any questioning, some may free‐ride on the trust of others. This article argues that we often place too much emphasis on fairness to the detriment of respect, with a particular focus on the asylum interview. First, I outline the limited discussion of asylum interviews in political philosophy. Second, I consider striking a ‘dynamic balance’ between fairness and respect, as set out by Jonathan Wolff. Third, I argue that a highly idealised version of contemporary asylum interviews puts fairness first at the cost of respect. This fairness‐first model leads to respect deficits in how asylum seekers are treated. Finally, I consider what a respectful asylum determination system might look like, offering three possible routes: civility, humility, and abolition.