The Human Genome Organisation (HUGO) and a vision for Ecogenomics: the Ecological Genome Project.

BACKGROUND: The following outlines ethical reasons for widening the Human Genome Organisation's (HUGO) mandate to include ecological genomics. MAIN: The environment influences an organism's genome through ambient factors in the biosphere (e.g. climate and UV radiation), as well as the agents it comes into contact with, i.e. the epigenetic and mutagenic effects of inanimate chemicals and pollution, and pathogenic organisms. Emerging scientific consensus is that social determinants of health, environmental conditions and genetic factors work together to influence the risk of many complex illnesses. That paradigm can also explain the environmental and ecological determinants of health as factors that underlie the (un)healthy ecosystems on which communities rely. We suggest that The Ecological Genome Project is an aspirational opportunity to explore connections between the human genome and nature. We propose consolidating a view of Ecogenomics to provide a blueprint to respond to the environmental challenges that societies face. This can only be achieved by interdisciplinary engagement between genomics and the broad field of ecology and related practice of conservation. In this respect, the One Health approach is a model for environmental orientated work. The idea of Ecogenomics-a term that has been used to relate to a scientific field of ecological genomics-becomes the conceptual study of genomes within the social and natural environment. CONCLUSION: The HUGO Committee on Ethics, Law and Society (CELS) recommends that an interdisciplinary One Health approach should be adopted in genomic sciences to promote ethical environmentalism. This perspective has been reviewed and endorsed by the HUGO CELS and the HUGO Executive Board.

Against loneliness we unite: A solidarity-based account of loneliness.

Loneliness is ubiquitous and is bad for our health, making it a bioethical concern. It is perhaps true now more than ever before. Recent publications in bioethics have discussed loneliness in the context of responsibility, solidarity, and autonomy, especially relational autonomy. In this paper, I elaborate on the relation between solidarity and loneliness, proposing an account of loneliness as lack of solidarity. Some cases of loneliness, I argue, may be defined and explained by not having someone to identify with you in some relevant aspect or without someone to assist you. I specifically use the work of George Orwell to make my case.

Dying a lonely death: A conceptual and normative analysis.

This paper argues that a lonely death is, by definition, a bad death and that society as a whole, as well as individuals in society are obligated to assure a certain degree of well-being, flourishing, or care among and for fellow individuals. Individuals can then be said to have a right against dying a lonely death. Such a right has corresponding duties. The paper further specifies what such duties may entail based on what individuals may need on their deathbed, specifically focusing on the need for human touch. Assuming that human touch might indeed be needed by some individuals in order to avoid a lonely death, the paper explores potential implications from a public health perspective, particularly during infectious disease outbreaks such as COVID.

The duty of care and the right to be cared for: is there a duty to treat the unvaccinated?

Vaccine hesitancy or refusal has been one of the major obstacles to herd immunity against Covid-19 in high-income countries and one of the causes for the emergence of variants. The refusal of people who are eligible for vaccination to receive vaccination creates an ethical dilemma between the duty of healthcare professionals (HCPs) to care for patients and their right to be taken care of. This paper argues for an extended social contract between patients and society wherein vaccination against Covid-19 is conceived as essential for the protection of the right of healthcare providers to be taken care of. Thus, a duty of care is only valid when those who can receive vaccination actually receive it. Whenever that is not the case, the continuing functioning of HCPs can only be perceived as supererogatory and not obligatory.

Loneliness-a clinical primer.

INTRODUCTION: loneliness is prevalent worldwide. It is also associated with an increased risk for depression, high blood pressure, cardiovascular disease, stroke and early death. As such, loneliness is a major public health issue. This paper summarizes the salient points clinicians should know and encourages clinicians to assume an active part in the identification, mitigation and prevention of loneliness. SOURCES OF DATA: white papers, academic publications. AREAS OF AGREEMENT: loneliness is a distressful subjective experience, which does not always correlate with social isolation. Both internal (personal) and external (contextual, societal) factors determine whether an individual would feel lonely in a given situation. AREAS OF CONTROVERSY: identifying loneliness in the clinic may be time consuming and challenging. There is a scarce robust evidence to support interventions. GROWING POINTS: due to increased individualization and incidence of infectious diseases, loneliness is likely to become even more prevalent. AREAS TIMELY FOR DEVELOPING RESEARCH: more research is needed to further elucidate the health impacts of loneliness as well as to find evidence-based interventions to prevent and mitigate loneliness that could then be implemented by policy-makers and clinicians.

Loneliness at the age of COVID-19.

Loneliness has been a major concern for philosophers, poets and psychologists for centuries. In the past several decades, it has concerned clinicians and public health practitioners as well. The research on loneliness is urgent for several reasons. First, loneliness has been and still is extremely ubiquitous, potentially affecting people across multiple demographics and geographical areas. Second, it is philosophically intriguing, and its analysis delves into different branches of philosophy including phenomenology, existentialism, philosophy of mind, etc. Third, empirical research has shown that loneliness is a significant health risk factor. Loneliness may thus be defined as a (negative) social determinant of health.Having that said, COVID-19 has demonstrated how little we as members of humanity have been prepared to face the loneliness resulting from the global response to the virus. As people worldwide are literally dying from loneliness, we still do not know what makes one feel lonely while making another feel being in solitude, or how is it that one feels lonely in the heart of London.In this essay, I first review loneliness in general and specifically in the context of COVID-19. I then argue that loneliness should be understood as a social determinant of health. Lastly, I argue that individuals have a right not to be lonely. Such right stems in turn from the right to healthcare or even a right to health.

Technological solutions to loneliness-Are they enough?

Loneliness is a major public health concern, particularly during pandemics such as Covid. It is extremely common, and it poses a major risk to human health. Technological solutions including social media, robots, and virtual reality have been advocated and implemented to relieve loneliness, and their use will undoubtedly increase in the near future. This paper explores the use of technological solutions from a normative perspective, asking whether and to what extent such measures should indeed be relied upon. The conclusion is that technological solutions are unquestionably part of the solution to loneliness, but that they cannot and should not constitute the whole solution. It is important to note that this is not a straw-man argument, as several organizations and scholars have strictly focused on such technological solutions for loneliness.

The responsibility of bioethicists: The case study of Yemen.

In this article, we describe in detail the health and general living conditions resulting from the ongoing armed conflict in Yemen, including the historical and geopolitical underpinnings. In addition to mere reporting, we use Yemen as a case study to examine the responsibility of bioethicists in general. We find it unacceptable that bioethics neglects the largest humanitarian crisis taking place in the world at the moment as well as the largest Cholera outbreak in history. We argue that bioethicists should do more to address armed conflicts and their resulting basic human rights violations. We end with a few recommendations to prevent such neglect.

Responsibility and vaccine nationalism in the Israeli-Palestinian conflict.

In this article we articulate a case from moral responsibility to assist Palestinians living in the Occupied Palestinian Territory (OPT). We contextualize this responsibility by focusing on access to healthcare and the provision of vaccines against COVID-19. We specifically present two arguments from responsibility, one that is global or cosmopolitan, and one that is country-specific. For the latter, we focus on Israel.

Eating in Isolation: A Normative Comparison of Force Feeding and Solitary Confinement.

The practice of solitary confinement (SC) is established within the literature as a common occurrence of torture within the prison system, and many international and national human rights organizations have called for its abolition. A somewhat more contentious topic in the literature is the practice of force feeding (FF) of hunger-striking prisoners. The paper aims to make a case against FF by establishing a parity argument that states the following: If SC is considered an immoral practice (and indeed it should be), it should follow that FF is morally impermissible as well. In conclusion, this paper will argue that FF of hunger-striking prisoners is a violation of their fundamental moral rights and constitutes cruel and inhumane treatment and, therefore, should be abolished.

Three for me and none for you? An ethical argument for delaying COVID-19 boosters.

This paper argues in support of the WHO's proposal to forego COVID-19 booster shots until 10% of people in every country are fully vaccinated. The Ethical Argument section shows that we save the most lives and ensure the least amount of suffering by allocating doses first to unvaccinated people. It also argues that there is a duty to support decent lives and to promote health equity, which establish that refraining from boosters is a requirement of justice, not charity. The Replies to Objections section answers objections that appeal to pragmatism, nationalism, ownership, scientific advancement, self-interest, semantics and futility. The Conclusion section emphasizes that for now, wealthy nations should not boost vaccinated people's immunity and should instead send doses to poorer nations where they are most urgently needed.

The bioethics of loneliness.

This article poses an invitation for bioethicists to engage with loneliness as a bioethics and public health concern. I argue that loneliness is a relevant issue for bioethicists for three main reasons: it causes ill-health; particularly in the age of Covid-19, it is becoming prominent on the clinical and public health agenda, affecting millions worldwide; and it engenders several ethical and philosophical questions as a social determinant of health with a rich conceptual background. In what follows I first review the link between loneliness and ill-health and argue that it should concern bioethicists because of this link. I also demonstrate how pertinent the issue of loneliness is being considered nowadays, and mark this as another reason for bioethicists to become engaged. I then move on to define loneliness and its various forms, drawing from modern and contemporary philosophers. The way we choose to cope with the pandemic of loneliness depends in part on its theoretical underpinnings, as well as its empirical scope. Theory thus combines with empirical data in order to devise and implement a rational public health policy, necessitating the kind of interdisciplinary approach that is the bedrock of bioethics. I conclude by suggesting future areas of research and recommendations.

Together we lived, and alone you died: Loneliness and solidarity in Gaza.

This essay discusses and weaves together three interrelated topics: loneliness as a neglected bioethics problem, solidarity as one potential solution to loneliness, and the Israeli-Palestinian Conflict as a neglected bioethics problem in which loneliness is stark. I first present and define various kinds of loneliness, focusing on ethical loneliness, defined as suffering injustice without a proper repair process. I next discuss current health conditions in Gaza, focusing on healthcare providers who, according to the UN, are being intentionally targeted by Israel. I explain how the various kinds of loneliness are reflected among people in Gaza. I lastly relate together the notions of solidarity, responsibility and personal autonomy, arguing that bioethicists and healthcare providers have a duty to support the people in Gaza, stemming from solidarity and an extended responsibility perspective.

Stamping Out Animal Culling: From Anthropocentrism to One Health Ethics.

Culling is used in traditional public health policies to control animal populations. These policies aim primarily to protect human interests but often fail to provide scientific evidence of effectiveness. In this article, we defend the need to move from a strictly anthropocentric approach to disease control towards a One Health ethics, using culling practices as an example. We focus on the recent badger culls in the UK, claiming that, based on data provided by the English Government, these culls may be unjustified, all thing considered. We highlight the relevance of ethical reasoning rooted in One Health for this discussion, and make several suggestions including a moratorium on culling until data are provided to support the effectiveness of culling; to conduct a randomized trial to compare proactive culling with alternative methods; to apply deliberative democratic methods to assess public opinion towards the culls, and to find in Brexit an opportunity for aiming for more effective control measures.

One health ethics: a response to pragmatism.

Johnson and Degeling have recently enquired whether one health (OH) requires a comprehensive normative framework, concluding that such a framework, while not necessary, may be helpful. In this commentary, we provide a context for this debate, and describe how pragmatism has been predominant in the OH literature. We nevertheless argue that articulating a comprehensive normative theory to ground OH practice might clear existing vagueness and provide stronger guidance in relevant health dilemmas. A comprehensive theory will also be needed eventually to ground notions such as universal good. We, thus, call for the systematic articulation of a comprehensive, metaethical theory, concomitantly with already ongoing normative work.

One Health and Streptococcus Canis in the Emergency Department: A Case of Cellulitis and Bacteremia in an Immunocompromised Patient Treated With Etanercept.

BACKGROUND: One Health is a biomedical approach that aims to optimize the health of humans, animals, and the environment through interdisciplinary collaboration. Cellulitis is an infection of the dermis and subcutaneous fat that may be caused by zoonotic streptococci species. CASE REPORT: We report a case of cellulitis caused by Streptococcus canis in a woman who was taking Etanercept. We frame the presentation within a One Health approach and urge emergency physicians to collaborate with veterinarians in the management of patients with zoonotic diseases who are discharged home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pets are a source for zoonotic diseases, including resistant bacteria, that pose particular risk to immunocompromised patients. Emergency physicians often discharge patients with potential zoonotic infections such as cellulitis home without a long-term, holistic care plan, according to a One Health approach. Physicians should then collaborate with veterinarians in caring for humans and animals.

A call from justice to support the people in Gaza.

Using Madison Powers and Ruth Faden's definition of 'well-being,' the authors argue that Israel, the international community and public health practitioners have a justice-based obligation to assist the Palestinian people in the Occupied Palestinian Territories. Focusing on Palestinians in Gaza, the authors first outline a normative framework of justice, as articulated by Powers and Faden. Following Powers and Faden's assumption that empirical assessments of justice can be made using the six dimensions of well-being, the authors next present current data on the living conditions in Gaza and describe how these conditions prevent residents from achieving sufficient levels of well-being. Using these indicators to demonstrate that Palestinians living in Gaza suffer deficiencies in these dimensions of well-being, the authors present a strong argument from justice to assist the residents of Gaza. The medical, public health, and bioethics community cannot sit idle while injustice continues.

Family Presence During Cardiopulmonary Resuscitation.

Most professional guidelines advocate family presence during resuscitation (FPDR). Many clinicians, however, are still reluctant to implement this recommendation. In this article I present the most comprehensive case for FPDR to date. I review the little that has been written about the ethics of FPDR, as well as the available empirical evidence. More importantly, I present and defend three arguments for FPDR: adherence to professional guidelines, benefit to patients and relatives, and patients' autonomy. I conclude with suggestions for future research.