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Background: The Convention on the Rights of the Child acknowledges the fundamental rights of children. Despite the adverse effects of corporal punishment, it continues to be prevalent, especially among sub-Saharan African countries, including Ghana., Objective: This study explored whether parents ever used corporal punishment on their children at home and their motivations for doing so. It also explored whether parents perceive corporal punishment as a violation of children's rights and their views on continuing or discontinuing corporal punishment at home., Participants and Setting: This study involved (100) parents across the ten regions of Ghana., Methods: A semi-structured interview guide was used to conduct interviews with parents. Thematic analysis was used to analyse the qualitative data using the aid of QSR NVivo version 10., Results: All parents reported that they had ever punished their children. Three sub-themes emerged under the motivation of parents to punish their children. These include (a) building a sense of discipline in the child to prevent future misbehaviour, (b) releasing frustrations on children, and (c) toughening up the child to confront life challenges. Also, parents had mixed opinions on whether corporal punishment violates children's human rights and whether corporal punishment should be practiced at home., Conclusions: This study demonstrated that parents perceived corporal punishment as beneficial for their children's development. There is a need for community mobilisation programmes to change parents' and society's attitudes, norms, and beliefs regarding corporal punishment., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Medical treatments that aim to modify the appearance of the genitals in children who are born with a difference of sex development/intersex (DSD/I*) condition are highly controversial. Human Rights bodies worldwide have argued that such treatments are conflicting with the child's right of personal autonomy and should be legally restricted to the unique situation where the child's physical health is in danger., Design: We here review the current status of legal initiatives in Europe that have addressed the issue of medical treatments in minors who have a DSD for which they have not been able to give personal informed consent due to their young age., Patients: The management of a 3 years old child who has congenital adrenal hyperplasia (CAH) and grows up with atypical-looking genitals is discussed., Results: In spite of extensive psychosocial support to the child and family from birth onwards, and good medical control of CAH, the child develops signs of emotional distress, suspected to be attributable to the genital difference. Our discussions include perspectives from the multidisciplinary DSD team caring for the child, a human rights specialist, and an intersex activist. From our discussions, we conclude that with evolving medical care, new ethical and human rights challenges are raised. A truly holistic human rights approach should not only consider physical but also mental health and psychosocial and psychosexual adaptation of the child to the medical condition, when reflecting on the acceptability of medical treatments in minors for which no personal informed consent can be obtained due to their young age. In addition it is paramount to include the meaningful participation of the child in the clinical management at the earliest possible stage., Conclusions: Continued convergence of clinical management and the human rights framework can be realised based on constructive discussions involving all stakeholders, and with the best interest of the child - and adult that they will become - as a common goal., (© 2023 John Wiley & Sons Ltd.)

The ubiquitous and global ecological footprint arising from the rapidly increasing rates of plastic production, use, and release into the environment is an important modern environmental issue. Of increasing concern are the risks associated with at least 16,000 chemicals present in plastics, some of which are known to be toxic, and which may leach out both during use and once exposed to environmental conditions, leading to environmental and human exposure. In response, the United Nations member states agreed to establish an international legally binding instrument on plastic pollution, the global plastics treaty. The resolution acknowledges that the treaty should prevent plastic pollution and its related impacts, that effective prevention requires consideration of the transboundary nature of plastic production, use and pollution, and that the full life cycle of plastics must be addressed. As a group of scientific experts and members of the Scientists' Coalition for an Effective Plastics Treaty, we concur that there are six essential "pillars" necessary to truly reduce plastic pollution and allow for chemical detoxification across the full life cycle of plastics. These include a plastic chemical reduction and simplification, safe and sustainable design of plastic chemicals, incentives for change, holistic approaches for alternatives, just transition and equitable interventions, and centering human rights. There is a critical need for scientifically informed and globally harmonized information, transparency, and traceability criteria to protect the environment and public health. The right to a clean, healthy, and sustainable environment must be upheld, and thus it is crucial that scientists, industry, and policy makers work in concert to create a future free from hazardous plastic contamination., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Susanne M Brander reports financial support was provided by National Science Foundation. Andy Booth reports financial support was provided by The Research Council of Norway. Andy Booth reports financial support was provided by European Commission. Annika Jahnke reports financial support was provided by Heimholtz Association. Dorte Hertz reports financial support was provided by The Research Council of Norway. Amila Abeynayaka reports financial support was provided by European Union Horizon Europe Research and Innovation. Susanne Brander reports a relationship with Southern California Coastal Water Research Project that includes: consulting or advisory. Brander previously consulted for the Environmental Defense fund and is on advisory boards or groups for the Plastic Pollution Coalition, as well as the Department of Toxic Substances Control (California) and the San Francisco Estuary Institute. Martin Wagner is an unremunerated member of the Scientific Advisory Board of the Food Packaging Forum Foundation and received travel support for attending annual board meetings. Marina Fernandez is a member of the Endocrine Society's delegation at the Intergovernmental Negotiating Committee (INC) to develop an international legally binding instrument on plastic pollution. All authors are members of the Scientists Coalition for an Effective Plastics Treaty, and Susanne Brander, Martin Wagner, Marina Fernandez, Trisia Farrelly, Kristian Syberg, Amila Abeynayaka, and Bethanie Carney Alroth are Scientists Coalition Steering Committee Members. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Crown Copyright © 2024. Published by Elsevier B.V. All rights reserved.)

Mental health and capacity laws applicable to children and young people in Northern Ireland (NI) lack clarity and coherence, with significant gaps in service provision and safeguarding. Drawing on an examination of such laws, we argue that law reform is needed. In the short term, we suggest there is merit in publishing statutory guidance, such as a Code of Practice, to address both the issue of evolving capacity in children and to facilitate best practice in policy and practice. This modest reform in the short term should be accompanied by a firm political commitment to ensuring that NI's innovative fusion mental capacity legislation is fully brought into force in the medium term. Meanwhile, law reform should form part of a holistic approach on the part of NI's policy-makers towards improving mental healthcare provision for children and young people in line with a human rights-based approach. This would include the following: increased allocation of funding and resources to facilitate more timely access to suitable treatment and related services; enhancing participation in policy, judicial, and clinical decision-making that impacts their lives; and employing a range of executive accountability mechanisms to drive improvements in such provision over time., (© The Author(s) 2024. Published by Oxford University Press.)

This paper analyses the experiences of public healthcare workers in Uganda under the Anti Homosexuality Act (AHA) 2023, who specialise in the provision of HIV prevention and treatment services to criminalised 'key populations' for HIV, including men who have sex with men, transgender women, and female sex workers. Utilising in-depth semi-structured interviews with 17 public healthcare workers and participant observation with LGBTQ+ and HIV activists, public health officials, and development workers, this ethnographic study explored the legal, social and ethical challenges that public healthcare providers faced. Public healthcare workers have experienced various types of stigma from their work, including socio-legal stigma from the criminalisation of 'promoting homosexuality', stigma by association with key populations, concealment stigma, and denial. Legal ambiguities stemming from the AHA 2023 have led to security incidents for some public healthcare workers. The study highlights the ethical dilemmas that have arisen from the 'duty to report' clause, which conflicts with professional healthcare ethics of confidentiality, and the role the Ministry of Health played in passing the AHA 2023, instilling confusion about its enforcement, and minimising and denying the risks the legislation has had on Uganda's HIV epidemic.

There have been growing ethical concerns about the widespread use of HIV-related molecular epidemiological public health surveillance and research-or what has come to be known as molecular HIV surveillance. The varied concerns of the practice originate due to lack of informed consent, lack of demonstrated benefit for communities, potential for eroded patient care relationships leading to poor health outcomes, and potential implications for information sharing and findings which could increase stigmatization and other negative impacts in contexts where HIV, drug use, sex work, migration, and poverty are criminalized. As people living with HIV, lawyers, clinicians, and social scientists, we are part of the growing movement calling for critical and ethical attention to the practice of molecular HIV surveillance and the public health logic which underwrites the practice. We urge Canadian public health actors and researchers working with molecular surveillance data to heed global guidance and recommendations for culturally informed ethical practices, to engage community members in HIV surveillance programs, and to ensure that people living with HIV are provided appropriate consent processes for uses of secondary data analysis. Furthermore, we urge researchers and Research Ethics Boards to interrogate assumptions of impracticality in seeking subsequent consent to use persons' health information held in data repositories and explore new methods of informed consent., (© 2024. The Author(s) under exclusive license to The Canadian Public Health Association.)

Introduction: This study explored the association between food insecurity and tobacco product use and urine cotinine-measured smoking intensity., Methods: This cross-sectional study included 13 705 adults representative of the Korean population. The 18-item Household Food Security Survey Module was administered to the primary food managers in households with the scores applied to household members. The use of three tobacco products-combustible cigarettes, heated tobacco products and electronic cigarettes (e-cigarettes)-was assessed. Based on the urine cotinine level, the smoking status of each participant was classified into one of three groups: non-smoker, low-intensity smoker and high-intensity smoker. Logistic regression analysis was used to determine the association between food insecurity and tobacco product use and urine cotinine-measured smoking intensity. ORs and 95% CIs were estimated., Results: Among the survey participants, 3.2% had mild food insecurity and 0.7% had moderate-to-severe food insecurity. Those with mild food insecurity (23.5%, OR: 1.38, 95% CI: 1.01 to 1.89) and those with moderate-to-severe food insecurity (45.1%, OR: 3.36, 95% CI: 1.87 to 6.03) compared with those with non-food insecurity (18.4%) were positively associated with combustible cigarette use. Those with moderate-to-severe food insecurity was positively associated with e-cigarette use (5.5%, OR: 3.49, 95% CI: 1.31 to 9.28). Compared with those with non-food security (7.9%), those with mild food insecurity (14.3%, OR: 1.61, 95% CI: 1.09 to 2.38) and moderate-to-severe food insecurity (22.1%, OR: 2.25, 95% CI: 1.04 to 4.86) were associated with high-intensity smoking., Conclusion: Food insecurity is associated with both combustible and e-cigarette use. Those with food insecurity are associated with engagement in high-intensity smoking., Competing Interests: Competing interests: No, there are no competing interests., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Savulescu and Cameron supported selectively locking down the elderly during the COVID-19 pandemic on two grounds: first, that preserving total lockdown would entail levelling down and, second, that levelling down is wrong. Their first assumption has been thoroughly addressed, but more can be said about their wider antiegalitarian point that levelling down is simply wrong. Egalitarians are not defenceless against the levelling-down objection. Even though some consider it the most serious challenge to supporters of equality, egalitarianism possesses sound reasons to assert, not only that something valuable is preserved when we level down, but also that preserving it may be, in certain circumstances, preferable to pursuing other fundamental moral goals. Although troublesome from a well-being maximising standpoint, levelling down ensures that healthcare policy reflects a commitment with the idea that people are equal in moral worth. That commitment is important enough to trump certain improvements in individual well-being. In the case of pandemic lockdowns, not all the interests protected by free movement are as fundamental as to pursue them at the cost of equality. Savulescu and Cameron's framework is so reliant on the view that levelling down is wrong that it fails to account for the valuable loss that having the elderly suffer alone represents., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Reproduction is broadly recognised as fundamental to human flourishing. The presumptive priority of reproductive freedom forms the predominant position in the literature, translating in the non-sexual reproductive realm as an almost inviolable right to access assisted reproductive technology (ART). This position largely condemns refusal or restriction of ART by clinicians or the state as discriminatory. In this paper, I critically analyse the moral rights individuals assert in reproductive pursuit to explore whether reproductive rights entitle hopeful parents to ART. I demonstrate that none of the protected actions performed, or entitlements generated are sui generis 'reproductive' rights, leading to the claim that there is no such thing as a right to reproduce. Under scrutiny, the reproductive right is a far narrower and weaker rights assertion than is recognised in the literature. I argue that the predominant position is grounded in a fundamental misunderstanding of the scope and strength of reproductive claims.I also highlight a significant conceptual inconsistency in the literature. On one hand, there is broad consensus that reproductive rights are predominantly negative, yet access to fertility treatment is framed as a component of the right. This wrongly contorts the negative nature of reproductive rights into a positive claim-right to ART. I conclude that this mistakenly frames ART access as sitting within the scope of reproductive freedom. I offer a revised conceptual paradigm of reproductive rights that has important clinical and policy implications for the provision and regulation of ART., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Self-harm within immigration detention centres has been a widely documented phenomenon, occurring at far higher rates than the wider community. Evidence suggests that factors such as the conditions of detention and uncertainty about refugee status are among the most prominent precipitators of self-harm. While important in explaining self-harm, this is not the entire story. In this paper, we argue for a more overtly political interpretation of detainee self-harm as resistance and assess the ethical implications of this view, drawing on interviews with detainees from Australia's offshore system. Self-harm by detainees is not only a medical 'condition' arising in response to oppression but a form of political action to lessen or contest it. We first establish how self-harm could be conceptualised as resistance. We then discuss its political purpose, noting it serves at least three functions: intrinsic, instrumental and disruptive or coercive. Viewing detainee self-harm as political resistance is a supplement to (rather than a substitute for) a medical approach. However, conceptualising self-harm this way has several advantages, namely, moving away from the idea that such behaviour is 'maladaptive', recognising detainees as political agents, combatting government claims of 'manipulation' and 'blackmail' and clarifying the duties of healthcare workers who work in detention., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

This study explores the subjective experiences of participants in a 5-day Open Dialogue (OD) workshop and a 1-year pilot practice, conducted as part of the WHO QualityRights Project in South Korea. Twenty-four participants, selected through purposive sampling, completed surveys immediately after the workshop and 1 year later. Data were analyzed through both statistical and thematic approaches. A statistically significant decrease in the availability of "Flexibility and Mobility" was observed across all participants ( p = 0.044) and a significant reduction in the availability of "Tolerance of Uncertainty" ( p = 0.04) was noted among participants who engaged in network meetings over the course of 1 year. Qualitative analysis revealed that participants initially felt ambivalent toward OD due to systemic, cultural, and professional challenges. However, through experiential learning, their ambivalence shifted to hope, fostering solidarity and a more positive outlook for future OD practice. Participants recognized that implementing OD supported human rights, while addressing personal, organizational, and policy challenges. The findings provide important insights for developing OD training and implementation guidelines in South Korea. Recommendations include focusing on experiential learning and selecting mixed-group trainees from catchment area institutions, emphasizing the support of client rights, and considering individual, organizational, and systemic levels for successful implementation. This study represents a new case of OD dissemination through a top-down national research and development project and its integration into the WHO QualityRights service package, suggesting complementary potential between OD and global human rights-based mental health initiatives., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Cho, Cho, Noh, Jeong, Kim and Kim.)

Objectives: The role of the current research is to set up a conceptual and analytical framework of the security, democracy and human rights linkage in contemporary society mainly based on the indexing, monitoring and research of online content for the period 1945-2019., Methods and Methodology: Due to the focused timeline outlining the scientific research for the period 1945-2019, the paper favors both quantitative and qualitative approaches that follow a systemic framework of several thematic clusters which act as supporting pillars of analytical research by using Google Ngrams: (a) norms and constitutional values and principles; (b) civil and legal liberties; (c) human and individual approaches; (d) institutional governance and organizational establishment; (e) freedoms, civil and political rights., Results and Discussions: The research results explore the variations in the frequency of appearances of the selected concepts in the specialized literature indexed by the Google platform indicating essential aspects of the conceptual and theoretical evolutions in strict dependence to the significant resolutions of the Security Council of the United Nations adopted in the same period and focusing on three central concepts: security, democracy and human rights. The spectrum of research singles out fifteen figures and an integrated analysis of contextual, historical, political, institutional, legal and social factors., Conclusion: The research aims to expand the field of reference and analysis of the three notions of security, democracy and human rights by integrating the multifactorial and multi-conditional analysis for the interpretation of the results of the fifteen figures. In the broader framework of online monitoring and complementarily with the spectrum of UNSC resolutions, the research will use contemporary topics, intensely debated, used and monitored, focusing on the conceptual and linguistic study and on the relationship between the analytical inventory of scientific research and the international decision-making spectrum. This relationship is mediated by the lexicon of politics and the sociology of international relations, which reflected a growing evolutionary linguistic semantics since 1945, the year of the establishment of the United Nations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Olimid, Georgescu and Gherghe.)

Objective: To determine the perceptions of persons with tuberculosis (TB) and health workers on Care TB - a mobile application for the community-led monitoring (CLM) of TB services., Methods: We used a qualitative research method. Six people with tuberculosis and ten health workers were chosen through purposive sampling for semi-structured interviews. The narrative data produced from the interviews were subjected to qualitative content analysis in order to uncover salient themes and patterns., Results: The community-led monitoring mobile application was shown to be acceptable both to TB healthcare providers and patients. It enhances information access and streamlines the process of reporting care barriers. The application also allows persons with TB to interact with one another, potentially eliminating stigma and discrimination. Potential challenges to implementing the CLM program include issues with internet connectivity, costs, and human resources., Conclusion: This study provides preliminary evidence of the acceptability and perceived feasibility of a mobile application for the community-led monitoring of TB services. For the CLM initiative to be scaled up across the country, more financial and technical support is required., Competing Interests: All authors declared no conflicts of interest. The sponsors/funders had no role in the design, execution, interpretation, or writing of the study., (© 2024 Acta Medica Philippina.)

In recent years, bodies such as the United Nations and the World Health Organization have highlighted the need for mental healthcare and legislation to better conform to contemporary human rights principles. They place particular emphasis on the right of people with mental health conditions to make their own decisions in all areas of life, including mental health treatment. One of the challenges in this context is that a person can lose the capacity to make these decisions during episodes of severe mental illness. Advance Healthcare Directives (AHDs), also known as Advance Choice Documents (ACDs), can help to overcome this challenge and allow people to exercise more agency over their care choices. AHDs are statements about the type of treatment a person would or would not like to receive in future if they are in a situation where they require treatment but are unable to make or communicate their decision. Despite an expanding body of evidence that AHDs enhance autonomy and are supported by patients and staff alike, uptake of AHDs is extremely low across many jurisdictions. Legislative reform and educational initiatives to enhance knowledge and awareness are vital for advancing and enlivening this field in clinical practice. This paper explores one such legislative development (Ireland's Assisted Decision Making (Capacity) Act, 2015) and one such educational initiative (the www.advancechoice.org website and videos). We highlight the need for further developments in the realms of both legislative reform and outreach and accessibility, in addition to greater advocacy by clinicians for the use of AHDs in mental health care., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier Ltd.)

Twenty years ago, the British Journal of Psychiatry published an editorial regarding racism and psychiatry. Three decades ago, the journal published a lecture by Professor Michael Sheperd about Kraepelin's contributions to racist degeneration theories. A century ago, Albert Einstein visited the Brazilian Academy of Sciences, where he was hosted by Juliano Moreira [1872-1933], one of the most distinguished Brazilian scientists of that time. The only son of a former enslaved woman, he is regarded as one of the founding fathers of scientific psychiatry in Brazil. Moreira may have been a case of 'exceptional racism', the strategy of praising outstanding people from oppressed groups as a way of denying or covering up processes of structural racism.

Background: Even though human rights advocacy is a part of mental health care, psychiatric nurses in South Africa's primary healthcare (PHC) setting face substantial challenges when advocating for the rights of mental health care users (MHCUs). The study aimed to develop a conceptual framework to facilitate psychiatric nurses' advocacy for mental healthcare users' human rights in a PHC setting., Methods: A qualitative, exploratory, descriptive, and contextual design was used to investigate the psychiatric nurses' experiences advocating for MHCUs' human rights in a PHC setting. Three phases were followed: the empirical phase, the classification of concepts, and a development phase. Following the empirical phase, a conceptual framework was developed to facilitate psychiatric nurses' advocacy for MHCUs human rights in a PHC setting., Results: Three themes were derived from focus group interviews with psychiatric nurses in the empirical phase. These themes yielded the central concept as 'the facilitation of empowerment' of psychiatric nurses in advocating for MHCUs' human rights. The central concepts were also classified. A conceptual framework was developed that included the relationship, working and termination phases., Conclusion: The study described the development of a conceptual framework to facilitate psychiatric nurses' advocacy for mental healthcare users' human rights in a PHC setting. Psychiatric nurses play a key role in advocating for the human rights of MHCUs. This task is important and should be implemented from the government to the societal level, including all stakeholders., (© 2024. The Author(s).)

This text addresses the process of biomedicalization in the responses to the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (aids), based on field research in Rio de Janeiro and document and literature reviews. Considering the socio-anthropological perspective and social studies of science, the current predominance of preventative biomedical strategies implies both reconfigurations of the scientific and institutional order and interventions in health and sexuality. These transformations reveal an established definition of the epidemic as a clinical problem, reconfiguration of debates on sexuality and stigma, and erasure of the discussion on structural inequalities and human rights, and new studies on HIV/aids within social sciences and humanities are needed.

Purpose: To explore how principles of social justice and equity are integrated into research concerning accessibility to public buildings for individuals with mobility disabilities., Methods: Utilising a scoping review methodology to assess literature based on the criteria set by the Joanna Briggs Institute, seven databases were screened. Studies were selected using the framework: "persons with mobility disabilities" AND "accessibility" AND "public buildings". A theoretical framework helped to extract codes and develop themes through an inductive-deductive analysis method. The results are presented descriptively., Results: The examination of 84 studies uncovered a complex interplay between agencies, systemic challenges, discriminatory practices, and societal attitudes perpetuating marginalisation of individuals with mobility disabilities in their access to public buildings. The recommendations emphasize importance of practical measures, research imperatives, and policy developments to promote inclusivity. We present a 'Ten-step approach' to integrate social justice and equity into research on accessibility in public buildings for people with mobility disabilities., Conclusion: Integrating diversity, active participation, and inclusive methodologies are essential to address systemic issues, discriminatory practices, and societal attitudes that hinder accessibility and inclusion. Collaborations with diverse stakeholders are crucial for policy changes, resource allocation, and advancing social justice and equity in accessibility research and practice., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Mohapatra S et al.)

In recent years, a growing body of research in positive epidemiology has sought to expand the traditional focus of epidemiologic research beyond risk factors for disease and towards a more holistic understanding of health that includes the study of positive assets that shape well-being more broadly. While this paradigm shift holds great promise for transforming people's lives for the better, it is also critiqued for showcasing decontextualized perspectives that could cause great harm to the public's health if translated uncritically into population-based interventions. In this commentary, we argue for orienting positive epidemiology within a human rights and economic justice framework to mitigate this threat, and we discuss two examples of previously proposed health assets (religious involvement and marriage) that demonstrate the urgent need for positive epidemiologic research to center health equity. Finally, to advance the field, we provide recommendations for how future research can address shortcomings of the extant literature by moving from individual-level to societal-level applications. In doing so, we believe that positive epidemiology can be transformed into a powerful force for health equity. This article is part of a Special Collection on Mental Health., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

This article discusses Earth's Rights as an environmental justice mechanism of reparation, protection, and justice for indigenous communities, environmental defenders, and other populations in Latin America. We argue that Earth's rights encompass and include the right to health and can be integrated into international human rights frameworks to protect all forms of life, responding to colonial legacies of discrimination and violence. We respond to the scarcity of literature discussing Earth's rights in relation to situations where human rights and Earth's rights are violated. We ground our argument in the theoretical conceptualization of Latin American proposals of Earth's rights and its potential for actionable policy approaches that include human health as inevitably interconnected to our planet's well-being. We address the environmental injustices that affect the right to health and argue that an Earth's rights framework can support reparations for historically marginalized communities., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Political opportunism of the far-right threatens the efficacy of public health policies and political stability in general. In this commentary, we outline some of the ways that the European far-right has misused public health concerns as propaganda tools. This is a significant threat to the goals of making health and science more inclusive, and we recommend some policies for mitigating the racist effect of the far-right. Notably, we recommend (a) transparency in health policies and robust implementation of the rule of law, (b) the use of operative public values and human rights in health policy making, and (c) investment in decolonizing mindsets which may be corrosive of health policies., (© 2024. Journal of Bioethical Inquiry Pty Ltd.)

Sleep is integral to human health and well-being; it is recognized as a fundamental right by international bodies. Nevertheless, deliberate sleep deprivation is frequently employed as a form of torture, violating the right to health. Legal cases such as LeMaire v Maass, Ireland v UK, and Huertas v Secretary Pennsylvania Dept of Corrections illustrate the varying interpretations of sleep deprivation as torture or cruel and unusual punishment. Ambiguity in domestic and international legal definitions underscores the need for collaboration between health and legal professionals. Clinicians can offer expertise about physiological and psychological consequences of sleep deprivation, which informs what legally counts as torture. This commentary explores the intersection of sleep deprivation, human rights, and the role of medical professionals in addressing, identifying, and preventing sleep deprivation as a means of coercion and abuse., (Copyright 2024 American Medical Association. All Rights Reserved.)

Objective: In Australia, an estimated 1 in 10 households experiences food insecurity. The objective of this study was to devise a visual synthesis to summarise the activities, processes and principles that support the right to food for everyone in Australia., Methods: Semi-structured key informant interviews (n=30) were conducted during 2019-20. Content analysis synthesised perspectives and assisted co-authors in revising an initial draft (shared during the interview) to finalise the road map through semantic realist data analysis and re-design., Results: The six components of the right to food road map summarise the actions, processes, and principles to address the human right to food. These include i) policy leadership, ii) advocate and enact, iii) empowerment, iv) resourcing, v) monitoring and accountability and vi) healthy, equitable and sustainable food systems., Conclusions: When all the right to food actions, processes and principles are present, the "cogs" within the map are hypothesised to interact and realise the right to food for all Australians., Implications for Public Health: Considering the cost of living pressures and unrelenting demand for food relief, better solutions are needed for food insecurity. Human rights - this language, their international recognition and as a "method of working", offer an alternative to the dominant responses to food insecurity., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Psychiatry shares most ethical issues with other branches of medicine, but also faces special challenges. The Code of Ethics of the World Psychiatric Association offers guidance, but many mental health care professionals are unaware of it and the principles it supports. Furthermore, following codes of ethics is not always sufficient to address ethical dilemmas arising from possible clashes among their principles, and from continuing changes in knowledge, culture, attitudes, and socio-economic context. In this paper, we identify topics that pose difficult ethical challenges in contemporary psychiatry; that may have a significant impact on clinical practice, education and research activities; and that may require revision of the profession's codes of ethics. These include: the relationships between human rights and mental health care, research and training; human rights and mental health legislation; digital psychiatry; early intervention in psychiatry; end-of-life decisions by people with mental health conditions; conflicts of interests in clinical practice, training and research; and the role of people with lived experience and family/informal supporters in shaping the agenda of mental health care, policy, research and training. For each topic, we highlight the ethical concerns, suggest strategies to address them, call attention to the risks that these strategies entail, and highlight the gaps to be narrowed by further research. We conclude that, in order to effectively address current ethical challenges in psychiatry, we need to rethink policies, services, training, attitudes, research methods and codes of ethics, with the concurrent input of a range of stakeholders, open minded discussions, new models of care, and an adequate organizational capacity to roll-out the implementation across routine clinical care contexts, training and research., (© 2024 World Psychiatric Association.)

Neuroscientific evidence documenting continued neural development throughout adolescence has been leveraged in advocacy for more lenient treatment of adolescents in the criminal justice system. In recent years, developmental science, including neuroscience, has progressed and enabled more nuanced interpretations of what continuing neural development in adolescence likely means functionally for adolescents' capabilities. However, oversimplified interpretations equating continuing neural development to overall "immaturity" are frequently used to make the case that adolescents should have fewer legal rights to make decisions on their own behalf, including regarding reproductive and voting rights. Here we address ongoing debates about adolescents' autonomy rights and whether such rights should be expanded or restricted. We review extant neuroscientific and developmental research that can inform these debates. We call for: (1) a more nuanced application of developmental neuroscience to specific rights issues in specific contexts; (2) additional research designed to inform our understanding of the developmental benefits or harms of rights-based policies on young people over time; and (3) the grounding of developmental neuroscientific research on adolescents within a human rights framework. We offer suggestions to developmental and neuroscience scholars on how to discuss the science of adolescent development with those seeking guidance in their design of law and policy., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

For decades, global health actors have centered technology in their interventions. Today, artificial intelligence (AI) is emerging as the latest technology-based solution in global health. Yet, AI, like other technological interventions, is not a comprehensive solution to the fundamental determinants of global health inequities. This article gathers and critically appraises grey and peer-reviewed literature on AI in global health to explore the question: What is avoided when global health prioritizes technological solutions to problems with deep-seated political, economic, and commercial determinants? Our literature search and selection yielded 34 documents, which we analyzed to develop seven areas where AI both continues and disrupts past legacies of technological interventions in global health, with significant implications for health equity and human rights. By focusing on the power dynamics that underpin AI's expansion in global health, we situate it as the latest in a long line of technological interventions that avoids addressing the fundamental determinants of health inequities, albeit at times differently than its technology-based predecessors. We call this phenomenon the 'politics of avoidance.' We conclude with reflections on how the literature we reviewed engages with and recognizes the politics of avoidance and with suggestions for future research, practice, and advocacy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Many legal jurisdictions offer some form of hospital diversion and disposal as an alternative to incarceration in prison for mentally disordered offenders. Such diversion is commonly understood as offering a non-punitive alternative in terms of sentencing decisions. However, complete loss of responsibility with respect to acts of violence is rare and indicative of extreme degrees of mental disorder. This raises challenges for sentencers when considering disposal options. From the perspective of the patient and healthcare providers while hospital may be framed as non-punitive, it still involves marked loss of freedom and rights. In this essay, it is argued that failure to acknowledge the punitive element, inherent in hospital detention, risks its repression, and a false dichotomy being established with prison being seen as solely punitive and hospital as solely therapeutic. It is suggested that this division is unhelpful, even potentially harmful, and that a synthesis as solution to this dialectic opposition may be generative in terms of therapeutic work in hospitals, clarification of the role of hospitals in terms of criminal justice disposal, and greater transparency in relation to multi-agency working and the social circumstances of patients detained in secure hospitals. Further work to understand this process is suggested with a particular emphasis being placed on the experience of specific groups of patients, such as women, who may find themselves in a notably precarious state within secure care., Competing Interests: Declaration of conflicting interestsThe author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Can a human right to good mental health be justified? This is an under-explored question: until recently, rights in relation to mental health have been framed and debated primarily in terms of their relevance to psychosocial disability and mental ill-health/mental distress. By contrast, in this article, I propose the basis of a normative justification for a population-wide right to good mental health, focusing in particular on individuals who do not experience mental ill-health/distress or do not have (or may never have) a psychiatric diagnosis or a psychosocial disability. The article is structured into three parts. First, I will outline the emergence of a population-wide right to good mental health in mental health discourse, led by recent reports published by the former United Nations Special Rapporteur on the Right to Health, Danius Pūras. I will then go on to explore what we might understand by 'good mental health'. Finally, I will explain how a right to good mental health may be justified, drawing on insights from compassion, 'vulnerable agency', and James Wilson's account of 'a right to public health'. I then respond to feasibility and demandingness concerns about such a right, which together inform the basis of the qualified public health right to good mental health I propose., (© 2024 John Wiley & Sons Ltd.)

Access to social services like healthcare, education, housing, and welfare are integral to creating an equitable society. While many populations inherently benefit from these services, sex workers are often denied these rights and services because of the nature of their work. The purpose of this study was to examine perceptions of deservingness of sex workers for a wide range of rights and services. This study distinguished those attitudes across legal and illegal forms of sex work, identified attitudinal and demographic correlates associated with those perceptions, and examined potential interactions between respondents' gender and age. Participants included a nationwide sample of adults from the USA (n = 549). Results indicated that participants perceived legal sex work as more deserving of rights and services compared to illegal sex work. Perceptions of deservingness were associated with attitudes toward abortion, LGBTQ+ rights, and perceptions of government legitimacy. Overall, older individuals were less willing to extend rights and services to sex workers and women were more likely to perceive sex workers as deserving of rights and services. There was an interaction between gender and age. For illegal sex work, gender differences in perceptions converged as participants aged, whereas for legal sex work, gender differences were exacerbated with age, with men reporting particularly restrictive perceptions of deservingness., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The purpose of this study was to identify the impacts of perceived stress, neglect, online and offline violence, and respect for human rights on depression. To fulfill the purpose of the study, the data of 6277 middle and high school students (M = 15.64, SD = 1.69) from the Survey on the Human Rights of Children and Youth (2018) were used. The main results of the hierarchical multiple regression analysis are as follows. First, gender and age had significant impacts on depression. Second, neglect, perceived stress, and online violence were positively related to depression, whereas offline violence showed no relationship with depression. Third, respect for human rights, which is the final stage of the hierarchical multiple regression analysis, was negatively associated with depression. This study contributed to the research by verifying that perceived respect for human rights is a protective factor against depression., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Competing Interests: Intérêts concurrents :: Aucun déclaré.

Background: Ireland's Mental Health Bill 2024 proposes the most significant revision of mental health legislation since the Mental Health Act 2001., Aims: To explore the 2024 Bill and provide suggestions for the subsequent Act., Methods: Review of the 2024 Bill and related literature., Results: The 2024 Bill proposes useful new definitions (e.g., 'mental disorder', 'treatment') and provisions governing specific practices (e.g., 'physical restraint'). Revision is needed to better provide care and protect rights: (a) proposed treatment criteria for involuntary admission should be retained, but 'risk' criteria deleted; (b) treatment provisions should ensure mental health legislation provides for timely, accountable treatment for all patients; (c) detailed provisions about the content of treatment plans do not belong in primary legislation, which is ill-suited to micro-managing individual care and (d) the Mental Health Commission should be incorporated into the Health Information and Quality Authority., Conclusions: The 2024 Bill proposes useful changes but requires revision, especially for involuntary patients who lack decision-making capacity and decline care, for whom the Assisted Decision-Making (Capacity) Act 2015 does not (and was not designed to) provide solutions. Relying on a convoluted combination of the 2015 Act, Circuit Court and High Court would be legally impossible, clinically impracticable and de facto denial of the rights of people with serious mental illness and their families. The final Act can accord with principles of the 2015 Act without relying on its provisions and should benefit patients and support staff in delivering mental health care that is essential and often life-saving., (© 2024. The Author(s).)

A powerful regime for regulating trade, the Group of Seven (G-7) has increasingly negotiated its digital trade through bilateral and preferential trade agreements, including with non-member states in the Global South. Focusing on the dominant concept shaping these agreements, Japan's "Data Free Flow with Trust" (D.F.F.T.), we trace its discursively contested emergence and meaning within a national ("Society 5.0") vision for Japan's digital transformation, and its subsequent transnationalization in international fora and institutionalization in global digital trade policy. Drawing on our interviews with Japanese government ministers, business elites, and legal experts who contributed to the processual development of D.F.F.T., as well as diverse additional primary sources, we find that the D.F.F.T. has become more than a trade policy, covering a wider range of social and geopolitical issues. In particular, we show that contention over "data localization measures" has restructured international relations of trust, especially across the Global North/South divide. Ultimately, this research report contributes to our understanding of how D.F.F.T. poses threats to human rights, democracy, and the global knowledge economy that may undermine its goals of enhancing innovation capacity and economic growth., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Dale and Aizawa.)

Background: Human rights are an important part of nursing care, and nurses deal with human rights matter daily. Despite their relevance and acknowledgement of their importance, human rights issues remain limited in nursing education. Aim: The study's aim was to describe how human rights education has been addressed in nursing education. Method: A scoping review was conducted according to the Preferred Reporting Items for Scoping reviews (PRISMA-ScR) and Joanna Briggs Institute (JBI) recommendations. The search was conducted in March 2023, with an updated search in February 2024. We searched in the following databases provided by EBSCO: Academic Search Elite, CINAHL, Education Source, ERIC, ScienceDirect and MEDLINE. Additionally, we also searched in Embase via Ovia and Scopus. The papers were screened for eligibility by title, abstract and full text independently by at least two reviewers, and the whole research team was involved in this process. Ethical considerations: The scoping review was guided by ethical conduct and scientific guidelines. Findings: Nine papers matched the inclusion criteria. Three thematic groups were identified: (a) focus of human rights education, (b) the learning design of the coursework and (c) learning outcomes in human rights education. Conclusion: Human rights education can benefit from being tailored to the students' experiences and including voices from the rights-holders. Bringing in the students' experiences and rights-holders' voices can enable self-reflection and discussion regarding human rights concerns. Hence, if the intention is to support nursing students to develop an awareness and act upon human rights concerns, the curriculum ought to include opportunities for reflection and discussion around human rights concerns and experiences in the students' own context., Competing Interests: Declaration of conflicting interestsThe authors declare no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Background: Ethical competencies dealing with decision-making for clinicians involved in artificially administered nutrition and hydration (AANH) have not been defined in the literature. Although clinical assessments identify nutrition needs and appropriate routes of nutrition administration, an assessment of the ethical, cultural, and spiritual implications of the medical nutrition therapy may be overlooked., Methods: Eleven competency statements were developed by members of two international sections of the American Society for Parenteral and Enteral Nutrition. This descriptive cross-sectional survey study was conducted to measure the importance of the competency statements to the membership of two sections using a five-point Likert scale of 1-5 (1-low to 5-high)., Results: A total of 113 responses (12.5% response rate) were obtained predominantly from physicians and dietitians from 25 countries. There was a wide range of world regions of the 49% respondents outside of the United States. Means and SDs were calculated for agreement with the 11 competency statements with overall means ranging from 4.32 to 4.67. Most of the participants cared for adult/older adult patients (63.7%) exclusively, and 12.4% cared for pediatric/neonate patients exclusively; the remainder (23.9%) cared for both populations. Respondents reported they were either experienced, competent, or expert (88.6%) in dealing with ethical issues related to AANH., Conclusion: This international interdisciplinary group agreed that the integration of ethical, cultural, and spiritual competencies into clinical decision-making regarding artificially AANH is important., (© 2024 American Society for Parenteral and Enteral Nutrition.)

Neurodiversity has come hugely to the fore in recent years in a variety of contexts, and is now subject to academic debate, activist discussion, and increasingly embedded in a range of institutional and corporate settings in the Global North, from workplaces to early years education, from psychotherapy to mainstream political discourses. The term has gained traction in Medical Humanities, as well as debate within bioethics, philosophy of psychology, and of law. Institutionally, it is now relied on in therapeutic practice, autism service provision, as well as in higher education, in particular. In this conceptual article we examine what is at stake in these usages and the implications in need of scrutiny. We resituate neurodiversity in relation to questions of disability by examining the deployment of neurology as the basis for identity, rights and benefits. The emergence of the term and the understandings to which it gives rise, we argue, leave out urgent questions of what is at stake for disabled people in a political climate of increasing harshness and ableism., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

In accordance with China's regulations on the prevention and control of HIV/AIDS, individuals diagnosed with HIV are required to disclose their medical condition when soliciting medical care in Mainland China. Empirical field investigations, however, indicate that people living with HIV (PLHIV) predominantly comply with this mandate only under conditions of absolute necessity. The ensuing conundrum, juxtaposing the imperative of privacy against the duty of disclosure, has materialised into a recurrent vicious cycle in its practical application, intensifying the intrinsic trust disparities characterising doctor-patient interactions. A meticulous scrutiny of pertinent legal precedents, coupled with in-depth field studies, reveals that the genesis of these complications can be traced back to an unforeseen metamorphosis in the legislative intent underpinning HIV/AIDS prevention and therapeutic strategies. While the initial objective was risk mitigation, the effect of enactment in real-world scenarios has significantly decreased. Owing to factors including extensive media reporting as well as prevailing public discourse, PLHIV, rather than being perceived as rights-bearing entities in legal frameworks, are increasingly relegated to the restrictive and dehumanising labels of 'HIV/AIDS'. As these individuals navigate their rights through alternative non-regulatory channels, circumventing formal legal obligations, their efficacy in actualising these rights is concurrently undermined., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Children and young people constitute a structurally vulnerable group who often experience specific barriers when trying to exercise their rights, including the right to health. The aim of this study was to examine core concepts of human rights and inclusion of vulnerable groups in a sample of national health and well-being policy documents relevant to children and young people in Ireland. Using EquiFrame, a validated policy content analysis tool, 3 policy documents were analysed in relation to their commitment to 21 core concepts of human rights and inclusion of 13 vulnerable groups. The Overall Summary Ranking of each policy varied: 'Better Outcomes, Brighter Futures'-Moderate, 'Sláintecare'-Moderate, and the 'Wellbeing Policy Statement'-Low. Across all three documents, Core Concept Coverage was high while Core Concept Quality was low. The findings demonstrate that these documents cover a wide range of human rights but fail to provide specific policy actions to address human rights or an intention to monitor human rights.

This paper describes the results of the study I Want More! The Lives of Sex Workers During the COVID-19 Pandemic, which is part of the EPIC community research program. The study analyzed the effects of the pandemic on the lives of cis, trans and travesti sex workers in nine Brazilian states and 11 cities throughout 2020 and 2021. This article focuses on the qualitative component of the study, which was based on semi-structured, remote and face-to-face interviews carried out with 43 sex workers, and its comparison with the quantitative component. The effects are analyzed in relation to the Brazilian pandemic framework, considering the social, economic and political dimensions of the COVID-19 virus. Some of the key themes of the analysis are cases of illness, specific social isolation practices, prevention and care management practices, individual vaccination and collective vaccination strategies. We also share the daily and activist responses drawn up by sex workers in a political agenda that opposes the individualistic, familialist, domestic, and neoliberal logic of isolation by adopting community care perspectives, which was the only line of health action for this work category during the pandemic. Collective actions reposition sex work at the interface between public health and human rights and take as their principle the "street knowledge", from activism, and the workers' power of decision over their own bodies.

Globally, calls for drug law reform are growing. Importantly, many argue that reforms should be guided by human rights. These calls, while welcome, assume a shared understanding of and approach to human rights, and that human rights can effectively guide less punitive approaches to drugs. Such assumptions fail to recognise important critiques, including that human rights have not always protected the interests of those who fail to fit normative ideals of the 'human'. Are human rights the best framework to repair drug policy injustices? This paper explores these issues, drawing on in-depth interviews conducted with 30 human rights experts - about half of whom openly identify as people who use drugs - from around the world. We find a variety of approaches to human rights, with both optimism and pessimism about their utility for drug policy. These perspectives incorporate reflections on the different 'levels' at which rights operate, the limitations of rights and the need to think and do rights relationally, or in more-than-human ways (e.g. Braidotti 2019; Schippers, 2019; Grear 2018; Barad 2007, 2003). This emphasis on relationality stems from identified entanglements between drug policy, animals, habitats, the environment, and humans. Combining Donna Haraway's work on 'companion species' (2003), 'making kin and making kind' (2016), with Suzanne Fraser's (Early online) call to trouble drugs, we consider ways to trouble human rights by making kin through them. We argue that rights are a potentially generative space within which to explore relationality and new kinds of kin-making. We argue for a 'more-than-human rights' approach, following the work of legal scholars such as Marie-Catherine Petersmann (Early online, 2022, 2021) and Emily Jones (2021). We argue that this approach allows us to be and become 'response-able' (that is, able to respond, following Haraway) to the world in which we live and the challenges our world faces., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

The idea of a 'right to mental integrity', sometimes referred to as a 'right against mental interference,' is a relatively new concept in bioethics, making its way into debates about neurotechnological advances and the establishment of 'neurorights.' In this paper, we interrogate the idea of a right to mental integrity. First, we argue that some experts define the right to mental integrity so broadly that rights violations become ubiquitous, thereby trivialising some of the very harms the concept is meant to address. Second, rights-based framing results in an overemphasis on the normative importance of consent, implying that neurointerventions are permissible in cases where people consent to have their mental states influenced or read off, a confidence in consent that we argue is misguided. Third, the concept often collapses the ethics of brain inputs and brain outputs, potentially resulting in a loss of important conceptual nuance. Finally, we argue that the concept of a right to mental integrity is superfluous-what is wrong with most violations of mental integrity can be explained by existing concepts such as autonomy, manipulation, privacy, bodily rights, surveillance, harm and exploitation of vulnerabilities. We conclude that bioethicists and policy-makers ought to either make use of these concepts rather than arguing for the existence of a new right, or they need to avoid making rights violations ubiquitous by settling on a narrower and more rigorous definition of the right., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

The current human rights framework can shield people from many of the risks associated with neurotechnological applications. However, it has been argued that we need either to articulate new rights or reconceptualise existing ones in order to prevent some of these risks. In this paper, we would like to address the recent discussion about whether current reconceptualisations of the right to mental integrity identify an ethical dimension that is not covered by existing moral and/or legal rights. The main challenge of these proposals is that they make mental integrity indistinguishable from autonomy. They define mental integrity in terms of the control we can have over our mental states, which seems to be part of the authenticity condition for autonomous action. Based on a fairly comprehensive notion of mental health (ie, a notion that is not limited to the mere absence of illness), we propose an alternative view according to which mental integrity can be characterised both as a positive right to (medical and non-medical) interventions that restore and sustain mental and neural function, and promote its development and a negative right protecting people from interventions that threaten or undermine these functions or their development. We will argue that this notion is dissociated from cognitive control and therefore can be adequately distinguished from autonomy., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

The possibility of neurotechnological interference with our brain and mind raises questions about the moral rights that would protect against the (mis)use of these technologies. One such moral right that has received recent attention is the right to mental integrity. Though the metaphysical boundaries of the mind are a matter of live debate, most defences of this moral right seem to assume an internalist (brain-based) view of the mind. In this article, we will examine what an extended account of the mind might imply for the right to mental integrity and the protection it provides against neurotechnologies. We argue that, on an extended account of the mind, the scope of the right to mental integrity would expand significantly, implying that neurotechnologies would no longer pose a uniquely serious threat to the right. In addition, some neurotechnologies may even be protected by the right to mental integrity, as the technologies would become part of the mind. We conclude that adopting an extended account of the mind has significant implications for the right to mental integrity in terms of its protective scope and capacity to protect against neurotechnologies, demonstrating that metaphysical assumptions about the mind play an important role in determining the moral protection provided by the right., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Many technology ethicists hold that the time has come to articulate neurorights : our normative claims vis-à-vis our brains and minds. One such claim is the right to mental integrity ('MI'). I begin by considering some paradigmatic threats to MI (§1) and how the dominant autonomy-based conception ('ABC') of MI attempts to make sense of them (§2). I next consider the objection that the ABC is overbroad in its understanding of what threatens MI and suggest a friendly revision to the ABC that addresses the objection (§3). I then consider a second objection: that the ABC cannot make sense of the MI of the non-autonomous This objection appears fatal even to the revised ABC (§4). On that basis, I develop an alternative conception on which MI is grounded in a plurality of simpler capacities, namely, those for affect , cognition , and volition Each of these more basic capacities grounds a set of fundamental interests, and they are for that reason worthy of protection even when they do not rise to the level of complexity necessary for autonomy (§5). This yields a fully general theory of MI that accounts for its manifestations in both the autonomous and the non-autonomous., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Millions of women worldwide annually undergo manual vacuum aspiration (MVA) with no pain medication, which is a violation of their basic human dignity. We designed a novel device (Chloe SED®) to administer paracervical block (PCB) during MVA in countries where pain medication is not typically given due to the high cost of the necessary tools., Methods: We conducted a single-blinded, randomized controlled non-inferiority trial including 61 patients at two hospitals in Kisumu, Kenya, to validate Chloe SED® for administration of PCB during MVA. PCB administered with Chloe SED® was compared to PCB administered with a standard spinal needle. Patients requiring MVA were block randomized in blocks of six, each provider completing six PCBs-three with the Chloe SED® and three with the standard spinal needle. The trial was registered with the Kenya Pharmacy and Poisons Board, ECCT/19/03/01 (https://ctr.pharmacyboardkenya.org/applications/index/protocol_no:RUNDVC8xOS8wMy8wMQ__/filter:/investigator:/sites:/pages:5/start_date:/end_date:/disease_condition:/users:/ercs:/stages). An intention-to-treat analysis was completed. The primary outcome was the non-inferiority of the pain score during uterine evacuation with a non-inferiority margin of 2 points on an 11-point numerical rating scale. Secondary outcomes included the non-inferiority of the pain score at four other time points and patient satisfaction., Results: Chloe SED® showed non-inferiority of the primary outcome with a mean pain score during evacuation of 3.8 [90% confidence interval (CI): 3.1-4.6] compared with the spinal needle at 4.1 (90% CI: 3.5-4.7). Non-inferiority of the pain score was shown at all time points. Most patients expressed a desire for the continued use of the device to administer PCB for MVA. No adverse events were noted., Conclusion: In summary, the Chloe SED® appears non-inferior to the spinal needle and desirable for the administration of PCB during MVA., Competing Interests: Subsequent to the completion of this study, AR, SG, K-HT, and RB received grant funding from Grand Challenges Canada to complete a larger randomized controlled trial of the device, which is currently underway. AR, SG, K-HT, and EK have formed two start-up companies, Chloe Innovations, LLC, and Chloe SED, LLC, to hold the device intellectual property and to market the device. AR, SG, K-HT, and EK have received patent protection of the intellectual property in Kenya and internationally. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Ramanathan, Samenjo, Bailey, Imbamba, Odenyo, Koksal, Diehl, Omoto and Gwer.)