Zohar Lederman

Social prescribing to mitigate loneliness has been gaining traction worldwide in the past two decades. Patients found to be lonely by their clinicians are linked with social services and are encouraged to engage in non-clinical, social activities such as painting and music classes, Tai Chi, outdoor excursions etc. The science grounding the cost-effectiveness of these interventions, however, has been scarce. From a justice perspective which prioritizes resource allocation based on desired outcomes, social prescribing may be hard to justify. Care ethics, however, may be more adept at justifying and indeed compelling the investment of limited public resources in social prescription activities aimed at reducing loneliness. The assumption is that individuals have an entitlement to such activities first because they have a right to health, and second because, as inherently social creatures, they have a right to not be lonely.

Introduction: Loneliness and social isolation are critical public health issues linked to significant adverse health outcomes and increased healthcare utilisation, including visits to the emergency department (ED). The ED often serves as a primary societal safety net, providing care for vulnerable populations who may be disproportionately affected by these conditions. In fact, loneliness and social isolation might be the underlying reasons they presented to the ED in the first place either consciously or not. For such individuals, the ED encounter may represent a rare point of human contact, yet the stressful and depersonalising nature of the ED environment may paradoxically exacerbate their sense of isolation. Furthermore, ED staff may lack the training and awareness of the scope of the problem to properly screen for loneliness and address it. Yet, the compounded impact of the ED experience on lonely or socially isolated patients and the relationship between loneliness and healthcare utilisation remains poorly understood. This paper presents a protocol for a scoping review designed to systematically map the existing evidence on the experiences of these patients and the perspectives of the clinicians who care for them. Methods and analysis: This scoping review will be conducted following the Arksey and O’Malley methodological framework in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The findings will be reported according to the Extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews (PRISMA-S; see online supplemental file 1). A comprehensive search will be performed across five electronic databases (PubMed, Embase, Scopus, Web of Science, CNKI) and grey literature sources. Studies published in English or Chinese that address loneliness or social isolation in the ED context, from the perspective of adult or paediatric patients or clinical staff, will be included. A novel, artificial intelligence (AI)-assisted screening process will be utilised for initial relevance assessment, followed by full manual screening and data extraction by two independent reviewers to ensure rigour and mitigate bias. Findings will be synthesised using a narrative approach and thematic analysis to identify key concepts, themes and existing gaps in the literature. Ethics and dissemination: As this study synthesises data from previously published literature, it does not require formal ethical approval. The findings will be disseminated through a manuscript submitted to a peer-reviewed, open-access journal. The aim is to provide an evidence-based roadmap to guide future research, inform policy and support the development of interventions designed to improve care and outcomes for this vulnerable population within the acute care setting. Registration number: The review has been registered at Open Science Framework, DOI 10.17605/OSF.IO/MBVSR.

The recent Marburg Virus Disease outbreak in Rwanda has been praised as a public health and One Health (OH) success story. In this essay, I question this praise. I point to several knowledge gaps or inconsistencies in the narrative of the origins of the outbreak as reported in the scientific literature. Most importantly, I argue that the occurrence of the outbreak, together with some aspects of the response, raises questions about whether OH ethics were adequately implemented. The main aspects are the health and needs of local populations including miners, the health and needs of animal populations and environmental sustainability versus Rwanda’s reliance on mining for economic development. This essay articulates ‘OH ethics’ based on predominant publications in the bioethics literature. I espouse four guiding principles in assessing the outbreak and the response to it. These principles are: the Principle of Interdisciplinary Collaboration, the Principle of Equivalence, the Principle of Shared Benefits and the Principle of Natural Connection.

The ethics of slow codes has been debated for 5 decades, with most commentators opposing to it. The empirical evidence justifying or opposing the practice

This paper discusses the idea of moral deference in the context of the ongoing war in Gaza. This idea is particularly pertinent where many ethicists seem to share the sense that the Israeli onslaught in Gaza is immoral, and yet only few articulate it in writing. Moral deference, I suggest, can be a temporary measure against such paralysis, by referring to international humanitarian law.

Throughout the decades, the ethical debate on ‘slow code’ has traversed a spectrum. Most have condemned it as deceptive, while others argued for its usefulness in balancing clinician integrity and family wishes in an otherwise emotionally complex dilemma, albeit desperately and imperfectly. The study by Sprengholz, “ Public Preferences Regarding Slow Codes in Critical Care” , contributed empirical data to a discourse chiefly shaped by expertise and opinion by exploring the layperson's perception of the practice's ethicality. Sprengholz's attempt, though commendable, falls short in its underdeveloped methodology, thus raising concern about the validity of its claimed conclusion. This article critically evaluates the study's limitations and misguidances, simultaneously beginning to propose modifications for future research designs.

This Current Controversy article critically reviews the recent motion by delegates of the British Medical Association to boycott the Israel Medical Association (IMA) for not upholding medical neutrality. While I generally support this motion, I disagree with the reasons justifying it. I also argue that the main issue here is not whether the IMA upheld medical neutrality but rather whether it upheld its duty to engage in political and social advocacy, by which I mean espousing a moral stance and lobbying the Israeli government and the Israeli public to accept it and act on it. Lastly, I argue that the greatest value in the boycott of the IMA lies in its symbolism of solidarity and deontological justification rather than its utility.