Joint Centre for Bioethics, University of Toronto, Toronto, Canada.
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
BMC Med Ethics. 2019 Jul 25;20(1):53. doi: 10.1186/s12910-019-0391-9.
The field of bioethics has evolved over the past half-century, incorporating new domains of inquiry that signal developments in health research, clinical practice, public health in its broadest sense and more recently sensitivity to the interdependence of global health and the environment. These extensions of the reach of bioethics are a welcome response to the growth of global health as a field of vital interest and activity.
This paper provides a critical interpretive review of how the term "global health ethics" has been used and defined in the literature to date to identify ethical issues that arise and need to be addressed when deliberating on and working to improve the discourse on ethical issues in health globally.
Selected publications were analyzed by year of publication and geographical distribution, journal and field, level of engagement, and ethical framework. Of the literature selected, 151 articles (88%) were written by authors in high-income countries (HIC), as defined by the World Bank country classifications, 8 articles (5%) were written by authors in low- or middle-income countries (LMIC), and 13 articles (7%) were collaborations between authors in HIC and LMIC. All of the articles selected except one from 1977 were published after 1998. Literature on global health ethics spiked considerably from the early 2000s, with the highest number in 2011. One hundred twenty-seven articles identified were published in academic journals, 1 document was an official training document, and 44 were chapters in published books. The dominant journals were the American Journal of Bioethics (n = 10), Developing World Bioethics (n = 9), and Bioethics (n = 7). We coded the articles by level of engagement within the ethical domain at different levels: (1) interpersonal, (2) institutional, (3) international, and (4) structural. The ethical frameworks at use corresponded to four functional categories: those examining practical or narrowly applied ethical questions; those concerned with normative ethics; those examining an issue through a single philosophical tradition; and those comparing and contrasting insights from multiple ethical frameworks.
This critical interpretive review is intended to delineate the current contours and revitalize the conversation around the future charge of global health ethics scholarship.
半个世纪以来，生命伦理学领域不断发展，纳入了新的研究领域，这些领域标志着健康研究、临床实践、最广义上的公共卫生以及最近对全球健康与环境相互依存关系的敏感性等领域的发展。生命伦理学领域的这种扩展是对全球健康作为一个至关重要和活跃的领域的增长的一种受欢迎的回应。
本文对迄今为止文献中“全球健康伦理”一词的使用和定义进行了批判性解释，以确定在审议和努力改善全球健康伦理问题的论述时出现并需要解决的伦理问题。
所选出版物按出版年份和地理分布、期刊和领域、参与程度以及伦理框架进行了分析。在所选择的文献中，151 篇文章（88%）的作者来自高收入国家（HIC），如世界银行国家分类所定义，8 篇文章（5%）的作者来自低收入或中等收入国家（LMIC），13 篇文章（7%）是 HIC 和 LMIC 作者之间的合作。除了一篇发表于 1977 年的文章外，所有被选中的文章都发表于 1998 年之后。全球健康伦理方面的文献从 21 世纪初开始大幅增加，2011 年达到峰值。确定的 127 篇文章发表在学术期刊上，1 篇是官方培训文件，44 篇是已出版书籍的章节。主要期刊是《美国生物伦理学杂志》（n=10）、《发展中世界生物伦理学》（n=9）和《生物伦理学》（n=7）。我们根据在不同层面上的伦理领域内的参与程度对文章进行了编码：（1）人际，（2）机构，（3）国际，和（4）结构。使用的伦理框架对应于四个功能类别：那些检验实际或狭义应用伦理问题的框架；那些关注规范伦理的框架；那些通过单一哲学传统来检验问题的框架；以及那些比较和对比来自多个伦理框架的见解的框架。
本文的批判性解释性综述旨在描绘当前的轮廓，并重新激发关于全球健康伦理学术研究的未来职责的对话。
