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1.
Heliyon ; 10(16): e35607, 2024 Aug 30.
Artículo en Inglés | MEDLINE | ID: mdl-39224360

RESUMEN

The human rights and mega sport events (SMEs) discourses gain massive importance and have grown immensely in recent years. Most of the time, the sports governance bodies are responsible for administration and management of these sport mega events. Keeping in consideration the situation regarding increasing involvement, the study focuses on the field of sport along with pleasure and basic rights. Through re-evaluation the commercial factors of sports, the mega governing bodies of sport (IOC & FIFA), and researchers discuss what is referred to commonly as Ruggie Principle, and both would be applied to IOC & FIFA practices, operation, and management regarding their events. This study is essential as it emphasizes the contribution and importance of carrying out human rights impact assessments, particularly in the context of hosting rights. The survey's findings reveal that human rights and due diligence assessments are integral components of organizations such as FIFA and the IOC. This study, being an empirical investigation, allowed us to arrive at some normative conclusions that had significant implications for practices and policy issues. Additionally, it laid the groundwork for future research in the crucial area of SMEs globally.

2.
J Eat Disord ; 12(1): 134, 2024 Sep 06.
Artículo en Inglés | MEDLINE | ID: mdl-39243050

RESUMEN

Decisions about the treatment of eating disorders do not occur in a socio-political vacuum. They are shaped by power relations that produce categories of risk and determine who is worthy of care. This impacts who gets access to care and recognition of rights in mental health services. Globally, there are calls for more human rights-based approaches in mental health services to reduce coercion, improve collaborative decision making and enhance community care. Treating individuals with longstanding, Severe and Enduring Eating Disorders (SEED) or Severe and Enduring Anorexia Nervosa (SE-AN) can be particularly problematic when it involves highly controversial issues such as treatment withdrawal and end-of-life decisions and, where legally permissible, medically assisted dying. In this article, we argue that the socio-political context in which clinical decision making occurs must be accounted for in these ethical considerations. This encompasses considerations of how power and resources are distributed, who controls these decisions, who benefits and who is harmed by these decisions, who is excluded from services, and who is marginalised in decision making processes. The article also presents tools for critically reflective practice and collaborative decision-making that can support clinicians in considering power factors in their practice and assisting individuals with longstanding eating disorders, SEED and SE-AN to attain their rights in mental health services.

3.
Br J Nurs ; 33(16): 772-777, 2024 Sep 05.
Artículo en Inglés | MEDLINE | ID: mdl-39250445

RESUMEN

This article examines the connection between human rights and elder abuse, employing a human rights-based approach. Through a critical examination of a fictional case study on elder abuse, the discussion highlights the vital role of nurses when safeguarding the rights of older individuals in residential care settings. The PANEL framework - encompassing Participation, Accountability, Non-discrimination, Empowerment and Legality - is a comprehensive guide for safeguarding practice and is applied to the example provided. By applying this human rights-based approach, nurses can proactively address elder abuse, ensuring individuals' rights are protected, promoted and supported. Through accountability measures, non-discriminatory practices, empowerment strategies and adherence to legal standards, the authors advocate for a holistic approach to enhance the quality of care and foster a safe environment for older adults.


Asunto(s)
Abuso de Ancianos , Derechos Humanos , Abuso de Ancianos/prevención & control , Abuso de Ancianos/legislación & jurisprudencia , Humanos , Anciano , Derechos Humanos/legislación & jurisprudencia , Rol de la Enfermera , Reino Unido
4.
Med Res Arch ; 12(3)2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-39220179

RESUMEN

The year 2023 marked the 60th anniversary of screening newborns in the United States for diseases that benefit from early identification and intervention. All around the world, the goal of NBS is to facilitate timely diagnosis and management to improve individual health outcomes in all newborns regardless of their place of birth, economic circumstances, ability to pay for treatment, and access to healthcare. Advances in technology to screen and treat disease have led to a rapid increase in the number of screened conditions, and innovations in genomics are expected to exponentially expand this number further. A system where all newborns are screened, coupled with rapid technological innovation, provides a unique opportunity to improve pediatric health outcomes and advance children's rights, including the unique rights of sick and disabled children. This is especially timely as we approach the 100th anniversary of the 1924 Geneva Declaration of the Rights of the Child, which includes children's right to healthcare, and the 1989 United Nations Convention on the Rights of the Child that expanded upon this aspect and affirmed each child's right to the highest attainable standard of health. In this manuscript, we provide background on the evolving recognition of the rights of children and the foundational rights to healthcare and non-discrimination, provide two examples that highlight issues to access and equity in newborn screening that may limit a child's right to healthcare and best possible outcomes, detail ways the current approach to newborn screening advances the rights of the child, and finally, propose that the incorporation of genomics into newborn screening presents a useful case study to recognize and uphold the rights of every child.

5.
Child Abuse Negl ; 157: 107036, 2024 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-39265441

RESUMEN

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.

6.
Disabil Rehabil ; : 1-12, 2024 Sep 17.
Artículo en Inglés | MEDLINE | ID: mdl-39287052

RESUMEN

PURPOSE: This paper introduces a practice framework for individualised positive behaviour support (PBS). The framework incorporates existing function-based PBS principles and integrates contemporary research and Australian legislation to frame practice elements through a human rights lens. It is designed to support people with disability of varied aetiologies across the lifespan in various settings (e.g. home, schools, and aged care). METHODS: Existing research and literature have been reviewed, including key theories and current formulations to inform a new practice framework that reflects recommendations for applications in community settings. RESULTS: The PBS Pathway (PBS-P) framework promotes culturally sensitive and socially valid strategies for empowering the person and their supporters via a clear practice framework. It emphasises evidence-based practices while acknowledging the need for flexibility to meet individual needs. CONCLUSIONS: The PBS-P framework offers a pragmatic approach and focused lens for critical thinking and reflective applications within PBS. It promotes a universal approach across the lifespan and service settings, contributing to a shared understanding of PBS as a rights-based practice. The framework's alignment with current legislation supports adoption within existing systems; however, successful implementation requires skilled practitioners, adequate funding, and policies to support knowledge translation.


The positive behaviour support pathway framework guides individualised practices for people across the lifespan and service settings, with emphasis on data-based decision making to inform socially and culturally valid intervention planning.The framework aligns with current legislation and addresses current concerns relating to poor behaviour support practices and urgent recommendations for practices that protect and promote human rights.

7.
World Psychiatry ; 23(3): 364-386, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39279422

RESUMEN

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.

8.
J Law Biosci ; 11(2): lsae017, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39239310

RESUMEN

Although national criminal offender DNA databases (NCODDs) including autosomal short tandem repeats (STRs) have been a successful tool to identify criminals for decades in many countries, yet there are many criminal cases they cannot solve. In cases with mixed male-female samples, particularly sexual assault, expanding NCODDs with Y-chromosomal STR (Y-STR) profiles allows database matching in the absence of autosomal STR profiles. Although Y-STR matches are not individual-specific, this can be largely overcome with rapidly mutating Y-STRs (RM Y-STR) allowing separation of paternally related men. Expanding NCODDs with Y-STR profiles is also beneficial for law enforcement in cases without known suspects via familial searching. Expanding NCODDs with Y-STR profiles may raise concerns about genetic privacy and fundamental human rights. A legal analysis of the European Convention on Human Rights revealed that when primarily for reidentifying convicted sex offenders, it would be in line with the case law of the European Court of Human Rights, while a generalized approach primarily for familial searching and involving all types of offenders may not. This paper aims to stimulate a debate among various stakeholders regarding the benefits and risks of expanding NCODDs with Y-STR profiles that in some countries has already been practically implemented.

9.
Int J Older People Nurs ; 19(5): e12643, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39262204

RESUMEN

BACKGROUND: People with dementia often experience violations of fundamental human rights and impeded access to healthcare. This study aims to investigate the views of experts regarding the use of the United Nations Convention on the Rights of People with Disabilities (CRPD) principles as quality standards for human rights-based care. METHODS: A single-round Delphi e-consultation with 15 dementia experts was designed to evaluate each CRPD principle and collect feedback on their views about the application of the CRPD principles in dementia care. RESULTS: The CRPD principles were fully endorsed as quality standards; however, several experts commented on the complexities of the use of CRPD principles in relation to information disclosure, capacity assessment, stakeholders' involvement in decision-making, respecting needs and preferences, holistic approaches in care practice, and protection against abuse, neglect and discrimination. CONCLUSIONS: These findings indicate the CRPD quality standards were fully applicable for people with dementia although some clarification around interpretation could assist in their use. Future research should elaborate on further points of support and guidance for dementia care providing examples of good practice from across the globe, and develop a concordant, human rights-based scheme for the implementation and evaluation of dementia services. IMPLICATIONS FOR PRACTICE: This study suggests that the CRPD can serve as a benchmark for human rights-based practices in dementia services globally that could enhance nursing care practice. Nursing staff are encouraged to consider human rights in relation to the complexities associated with people with dementia, their caregivers, and other services involved in their care.


Asunto(s)
Técnica Delphi , Demencia , Derechos Humanos , Humanos , Demencia/enfermería , Calidad de la Atención de Salud , Femenino , Masculino , Naciones Unidas , Personas con Discapacidad , Anciano
10.
Violence Against Women ; : 10778012241279823, 2024 Sep 12.
Artículo en Inglés | MEDLINE | ID: mdl-39262386

RESUMEN

Forced displacement results in social inequalities negatively affecting the well-being of displaced women. Addressing the economic, social, cultural, and environmental dimensions of their vulnerability is crucial. This article examines the perspectives of 59 displaced women in informal settlements in northern Colombia on violations of their rights. Interpretative phenomenological analysis reveals economic hurdles, such as limited access to decent work and workplace discrimination. Social barriers, like stigmatization and discrimination, impede integration and access to essential services. Despite challenges, increasing awareness and implementing inclusive policies can enhance the living conditions of displaced women.

11.
Soc Sci Med ; 359: 117274, 2024 Aug 26.
Artículo en Inglés | MEDLINE | ID: mdl-39217716

RESUMEN

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.

12.
Soins ; 69(888): 16-24, 2024 Sep.
Artículo en Francés | MEDLINE | ID: mdl-39218516

RESUMEN

This article provides healthcare professionals with an overview of research on coercive control, a paramount concept for understanding domestic violence, primarily targeting women and children. It aims to foster interdisciplinary dialogue and integrate advances into professional practices and (psycho)education. To this end, we present the conceptual evolution of coercive control and the perpetrators' behavioral patterns, their risks for victims and professionals, their devastating impact on the rights and biopsychosocial health of adult and child victims, and the challenges posed by technology, particularly generative artificial intelligence.


Asunto(s)
Coerción , Humanos , Femenino , Violencia Doméstica/prevención & control , Derechos Humanos , Adulto , Niño , Víctimas de Crimen/psicología
13.
Oxf J Leg Stud ; 44(3): 535-562, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39234500

RESUMEN

This article seeks to make the human rights case against human rights penality-that is, against the reliance upon and foregrounding of penal mechanisms in the protection of (certain) human rights. The rationale for the alliance between human rights and state penality has at least three central dimensions: effectiveness, accountability and equal protection. In particular, the mobilisation of criminal law (enforcement) and punishment is often treated as the most effective means of preventing and/or redressing human rights violations. Moreover, the criminal process and sanction are often understood as the pinnacle of accountability for serious human rights violations. Finally, the egalitarian rationale for human rights penality views it as redistributing protection to under-protected persons. While remaining committed to human rights, I unpack (some of) the ways in which human rights penality ultimately fails to uphold and even undermines the principles that it has been promoted as fulfilling within the human rights frame.

14.
Humanidad. med ; 24(2)ago. 2024.
Artículo en Español | LILACS-Express | LILACS | ID: biblio-1564581

RESUMEN

Introducción: En el Perú las mujeres en los establecimientos penitenciarios carecen de acceso a la salud ante la falta de políticas públicas que conduce a una brecha de desigualdad en dicho acceso. La investigación tiene por objetivo diagnosticar la situación del acceso a los servicios de la salud en los establecimientos penitenciarios de mujeres del Perú durante el año 2021. Métodos: Se realizó un estudio descriptivo, transversal, con datos de los 13 establecimientos, que constituyen la totalidad de los establecimientos penitenciarios de mujeres en el Perú. Resultados: Los resultados señalan que las atenciones en salud se concentraron en la región penitenciaria de Lima, se encontró que las regiones que no presentaban profesionales de la salud permanentes carecían de atención adecuada. Discusión: el Estado peruano no ha cumplido con su rol como garante en relación con el derecho fundamental al acceso a los servicios de salud por parte de las entidades penitenciarias en beneficio de todas las mujeres internas que integran los Establecimientos Penitenciarios de Mujeres en el Perú. Se recomienda, bajo los principios de razonabilidad y proporcionalidad, es más que urgente definir nuevas directrices de acceso a la salud femenina, coadyuvando a que el personal de salud desempeñe un enfoque preventivo, con la capacidad de integrar la buena cultura de la institución penitenciaria.


Introduction: In Peru, women in prisons lack access to health due to the lack of public policies that lead to an inequality gap in said access. The objective of the research is to diagnose the situation of access to health services in women's penitentiary establishments in Peru during the year 2021. Method: A descriptive, cross-sectional study was carried out with data from the 13 establishments, which constitute all of the women's penitentiary establishments in Peru. The results indicate that health care was concentrated in the prison region of Lima; it was found that regions that did not have permanent health professionals lacked adequate care. Results: Therefore, the importance of placing permanent health professionals in penitentiary centers is accentuated to guarantee care for women. Discussion: The peruvian state has not fulfilled its role as guarantor in relation to the fundamental right of access to health services by penitentiary entities for the benefit of all female inmates who make up the Women's Penitentiary Establishments in Peru. It is recommended, under the principles of reasonableness and proportionality, that it is more than urgent to define new guidelines for access to women's health, helping health personnel to carry out a preventive approach, with the ability to integrate the good culture of the penitentiary institution.

15.
Front Reprod Health ; 6: 1399289, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39166176

RESUMEN

Introduction: Despite substantial investment in improving healthcare among adolescents in low- and middle-income countries, barriers to access and utilization of services persist, especially to sexual and reproductive health (SRH) services. In response to adolescents' health service needs due to their vulnerability, interventions aimed at improving access and utilization of sexual and reproductive health services have been implemented in specific regions of Zambia. To highlight progress in the access and the overall delivery of services in Zambia, in the wake of a system-level funding mechanism, this paper aims to understand the accessibility, availability, acceptability and quality (AAAQ) of health services provided to young people. Materials and methods: In a qualitative case study, 48 discussions- 32 individual interviews with stakeholders and 16 focus group discussions, consisting of 128 male and female adolescents were conducted in six districts from Eastern, Southern and Muchinga provinces of Zambia. Interviews were audio-recorded, recordings transcribed verbatim, and transcripts were analysed using deductive thematic analysis, using the AAAQ framework and Atun's framework on integration, as a guide to reporting the findings. Results: We found that adolescents knew of and had access to common commodities and services- male condoms, health education and HIV counselling and testing. However, availability was affected by access-related barriers such as frequent stock-outs and insufficiently trained healthcare providers. In addition, accessibility was more restricted during the COVID-19 pandemic lockdown and compounded by the low acceptability of SRH service among adolescents across all contexts. This led to the use of alternatives such as herbal medicine and maintained common myths and misconceptions. The overall quality was marred by the lack of dedicated spaces for adolescent health services and the lack of information, education and communication (IEC) materials in some spaces. Conclusion: While it was noted that some services were available for adolescents in all the study sites, numerous barriers inhibited access to these services and had an impact on the quality-of-service provision. With the added restriction to SRH service asses for young people, due to the low acceptability of adolescent SRH service use, the overall integration of adolescent SRH interventions into routine service provision was low and can be improved by targeting contextual barriers and maintaining best practices.

16.
Med Sci Law ; : 258024241270818, 2024 Aug 16.
Artículo en Inglés | MEDLINE | ID: mdl-39152630

RESUMEN

Femicide, the killing of women, girls, and infants, is a pervasive problem affecting all global societies. Policy and research are impeded by inaccurate and missing prevalence data, gaps in understanding of femicide, especially for hard-to-reach marginalized populations, and conflicting perceptions between jurisdictions. Leveraging on a combined socio-ecologic model and Public Health approach, the paper spans the methods of a computed tomography-based injury study, an in-depth media-analysis, a legislation evaluation study, and a data barriers' study. Injury patterns, media depiction, and end-user consultations will close the loop on residual problems such as implementation, data gaps, and cultural perceptions. By mixed methods research representing multiple regions, and stakeholders, this project will enhance knowledge on interpersonal, institutional, and societal factors of femicide, advancing the humanitarian forensic discipline. The research method will identify emerging trends and facilitate improvements in tertiary prevention of femicide, specific to resource settings.

17.
Cult Health Sex ; : 1-16, 2024 Aug 02.
Artículo en Inglés | MEDLINE | ID: mdl-39092503

RESUMEN

The notion of 'sexual justice' has gained traction in academic and policy arenas in recent years. This paper presents a scoping literature review of the regimes of truth, following Foucault, of 'sexual justice' appearing in the scientific literature from 2012 to 2022. Thirty-eight papers were coded using (1) content analysis of the studies' central problematics, the programmes referred to, and institutional location(s); and (2) thematic analysis of how the notion was deployed. Central problematics centred on (1) critiques of, or alternatives to, dominant approaches to sexual and reproductive health; and (2) highlighting injustices. As such, 'sexual justice' is fighting for legitimacy in the truth stakes. There is a distinct paucity of papers tackling the translation of 'sexual justice' into practice. South Africa dominates as the site in which papers on 'sexual justice' have been produced, but there is a lack of South-South collaboration. Two themes were apparent around which conceptions of sexual justice cohere. Firstly, sexual justice is seen as a vital, yet politically ambivalent goal, with neoliberal co-optation of progressive rights agendas being warned against. Secondly, sexual justice is viewed as a means, in which sexual justice is described as having potential to repair established frameworks' shortcomings and oppressive legacies.

18.
Med Humanit ; 2024 Aug 19.
Artículo en Inglés | MEDLINE | ID: mdl-39160064

RESUMEN

Providing for people with psychosocial conditions in crisis is a complex and controversial endeavour that has gained significant attention over the past decade. This increased focus is driven by global calls to reduce coercion, including by the United Nations Committee on the Rights of Persons with Disabilities, who interpret Article 12 of the United Nations Convention on the Rights of Persons with Disabilities in General Comment 1 to advocate for the replacement of substituted decision-making with supported decision-making. Psychiatrists occupy a central role in determining how to care for and respond to individuals with psychosocial conditions in crisis in the midst of these debates. They must protect the rights of people with psychosocial conditions in crisis and provide appropriate support within challenging and dynamic contexts. This responsibility includes promoting the autonomy of people with psychosocial condition while ensuring their long-term health, safety and well-being.In this study, we conducted a phenomenological analysis with a sample of nine psychiatrists in South Africa to explore their experiences with involuntary care and the complex dilemmas they face in delivering healthcare to individuals with mental health conditions. Our findings indicate that psychiatrists encounter significant challenges in preserving patient autonomy, particularly within the resource-limited context of South Africa. Pervasive stigma and insufficient support infrastructure complicate efforts to prioritise autonomy. At the same time, professionals must address the critical need to ensure the long-term safety and well-being of their patients. The absence of involuntary care can exacerbate a person's vulnerability to community stigma and inadequate community support, posing severe risks to their welfare. Balancing between protecting a person's autonomy and addressing the limitations of support structures creates a complex predicament for mental health professionals, often resulting in feelings of isolation and moral distress among psychiatrists.

19.
Confl Health ; 18(1): 54, 2024 Aug 27.
Artículo en Inglés | MEDLINE | ID: mdl-39192353

RESUMEN

INTRODUCTION: Attacks on healthcare have further weakened the already fragile health system in the Central African Republic. We investigated attacks on healthcare in three conflict-affected prefectures-Ouaka, Haute-Kotto, and Vakaga-from 2016 to 2020. The study aim was to gain an in-depth understanding of the immediate and long-term effects of attacks on healthcare workers, facilities, supply chain, quality of care, and other components of the health system. We provide a qualitative description of the incidents, assess their impacts, identify mitigation efforts, and discuss challenges to recovery. METHODS: We used purposive and snowball sampling to identify participants in the study. Semi-structured key informant interviews were conducted with administrative and health authorities, front-line personnel, and staff of non-governmental organizations. Interviews were done in Sango, French, or English. Recorded interviews were transcribed and notes taken for non-recorded interviews. Transcripts and notes were analyzed using inductive coding, allowing participant responses to guide findings. RESULTS: Of 126 attacks identified over the study period, 36 key informants discussed 39 attacks. Attacks included killings, physical and sexual assault, abductions, arson, shelling with grenades, pillage, occupations, and verbal threats. The violence led to extended closures and debilitating shortages in healthcare services, disproportionately affecting vulnerable populations, such as children under five, or people who are elderly, chronically ill, or displaced. Healthcare workers faced psychological trauma and moral injury from repeated attacks and the inability to provide adequate care. Personnel and communities made enormous efforts to mitigate impacts, and advocate for assistance. They were limited by failed reporting mechanisms, ongoing insecurity, persistent lack of resources and external support. CONCLUSION: Effective strategies to safeguard healthcare from violence exist but better support for communities and health workers is essential, including measures to assess needs, enhance security, and facilitate recovery by quickly rebuilding, resupplying, and re-staffing facilities. CAR's government, international organizations, and donors should make concerted efforts to improve reporting mechanisms and end impunity for perpetrators. Their investment in community organizations and long-term health system support, especially for health worker training, salaries, and psychosocial care, are vital steps towards building resilience against and mitigating the impacts of attacks on healthcare.

20.
R Soc Open Sci ; 11(8): 240197, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-39113763

RESUMEN

Careless speech is a new type of harm created by large language models (LLM) that poses cumulative, long-term risks to science, education and shared social truth in democratic societies. LLMs produce responses that are plausible, helpful and confident, but that contain factual inaccuracies, misleading references and biased information. These subtle mistruths are poised to cumulatively degrade and homogenize knowledge over time. This article examines the existence and feasibility of a legal duty for LLM providers to create models that 'tell the truth'. We argue that LLM providers should be required to mitigate careless speech and better align their models with truth through open, democratic processes. We define careless speech against 'ground truth' in LLMs and related risks including hallucinations, misinformation and disinformation. We assess the existence of truth-related obligations in EU human rights law and the Artificial Intelligence Act, Digital Services Act, Product Liability Directive and Artificial Intelligence Liability Directive. Current frameworks contain limited, sector-specific truth duties. Drawing on duties in science and academia, education, archives and libraries, and a German case in which Google was held liable for defamation caused by autocomplete, we propose a pathway to create a legal truth duty for providers of narrow- and general-purpose LLMs.

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