Developing world bioethics
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Published data show that new HIV prevention strategies including treatment-as-prevention and pre-exposure prophylaxis (PrEP) using oral antiretroviral drugs (ARVs) are highly, but not completely, effective if regimens are taken as directed. Consequently, their implementation may challenge norms around HIV prevention. Specific concerns include the potential for ARV-based prevention to reframe responsibility, erode beneficial sexual norms and waste resources. ⋯ PrEP remains an important option for receptive partners who face increased biological vulnerability. We conclude that the use of ARV for prevention is ethically justified, despite imperfect global to drugs for those in clinical need. The determination of which ARV-based HIV prevention strategy is ethically preferable is complex and must take into account both public health and interpersonal considerations.
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One of the characteristics of the relationship between the developed and developing worlds is the 'brain drain'- the phenomenon by which expertise moves towards richer countries, thereby condemning poorer countries to continued comparative and absolute poverty. It is tempting to see the phenomenon as a moral problem in its own right, such that there is a moral imperative to end it, that is separate from (and additional to) any moral imperative to relieve the burden of poverty. However, it is not clear why this should be so - why, that is, there is a moral reason to stem the flow of expertise in addition to seeking to improve welfare. In this paper, I examine three explanations of the putative moral aspect of the brain drain.
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Case Reports
News media reports of patient deaths following 'medical tourism' for cosmetic surgery and bariatric surgery.
Contemporary scholarship examining clinical outcomes in medical travel for cosmetic surgery identifies cases in which patients traveled abroad for medical procedures and subsequently returned home with infections and other surgical complications. Though there are peer-reviewed articles identifying patient deaths in cases where patients traveled abroad for commercial kidney transplantation or stem cell injections, no scholarly publications document deaths of patients who traveled abroad for cosmetic surgery or bariatric surgery. Drawing upon news media reports extending from 1993 to 2011, this article identifies and describes twenty-six reported cases of deaths of individuals who traveled abroad for cosmetic surgery or bariatric surgery. ⋯ The paper makes a strong case for promoting normative analyses and empirical studies of medical travel. In particular, the paper argues that empirically informed ethical analysis of 'medical tourism' will benefit from rigorous studies tracking global flows of medical travelers and the clinical outcomes they experience. The paper contains practical recommendations intended to promote debate concerning how to promote patient safety and quality of care in medical travel.