Objectives and Methodology: The purpose of this paper is to demonstrate how maternal and fetal interests can sometimes be conflicting, and a situation can place care providers in a difficult position when it comes to ...Objectives and Methodology: The purpose of this paper is to demonstrate how maternal and fetal interests can sometimes be conflicting, and a situation can place care providers in a difficult position when it comes to decisionmaking. The study also intends to cover the health laws that deal with such situations in the legal systems of the United States and Islamic Law. This study takes the form of a critical literature review. The literature search was conducted using electronic citation databases that included Pub Med, Medline, Google Scholar, and others. The keywords used in this research related to medical and legal terms concerned with fetal rights, such as embryo, fetus, abortion, fetal rights, health law in the United States, Islamic health law, and comparative studies. The search was conducted in English as well as Arabic. Data were collected from books, journals, government documents, and Internet websites. Results: Doctors sometimes have to make difficult decisions when caring for pregnant women, since one person’s care directly affects another’s. The fetus depends fully on its mother for survival in the uterus. Nevertheless, at times it so happens that the interests of the mother and fetus differ. In such cases, a conflict between the two arises. Due to advances in technology in the medical field, doctors can now specifically target the fetus during medical procedures. When treating two different patients, health practitioners must choose that which is best for each patient independently. Approach to the maternal-fetal conflict must consider medical concerns, as well as legal ones. While there is some consistency in the medical approach between different countries, the legal part varies considerably, even among different states in America, as fetal legal status, personhood, and rights differ greatly. Islamic Law is practiced in many countries and has a special consideration for the fetus that is worth attention and understanding. Conclusion: Medically, when the interests of the mother and the fetus are in opposition, a maternal-fetal conflict arises. The two main forms are harmful maternal behavior to the fetus and maternal refusal to undergo specific procedures to improve the health condition of the fetus. Different states in the US have different health laws to deal with some aspects of maternal fetal conflicts, but on many occasions, no explicit rules can be found and healthcare workers need to use their own judgment. In Islamic Law, both conditions (i.e. , harmful maternal behavior or refusal to employ lifesaving procedures for the fetus) follow the general jurisprudence rule (damage needs to be removed), and the mother will be legally accountable if her actions result in fetal damage or death.展开更多
Background Reactive case detection(RACD)for malaria control has been found effective in low transmission set-tings,but its impact and cost-effectiveness in moderate-to-high transmission settings are unknown.We conduct...Background Reactive case detection(RACD)for malaria control has been found effective in low transmission set-tings,but its impact and cost-effectiveness in moderate-to-high transmission settings are unknown.We conducted an economic evaluation alongside an empirical trial of a modified RACD strategy(1,7-mRCTR)in three moderate-to-high malaria transmission districts in Tanzania.Methods The costs and cost savings associated with the intervention relative to passive case detection alone were estimated in the study sites of Kilwa,Kibiti,and Rufiji districts in Tanzania from 2019-2021.Empirical cost data were collected using household surveys.The incremental costs of the intervention were calculated from under a societal perspective.Costs are reported in 2022 US dollars.Trial data and malaria registers from health facilities were used to calculate the number of malaria cases detected.We simulated unobserved and distal health effects of the intervention to assess cost-effectiveness in terms of incremental cost-effectiveness ratios(ICERs).Propagated uncertainty was assessed via second-order Monte Carlo simulation,including bootstrapping of empirical data distributions.Incremental costs per disability-adjusted life year(DALY)averted were compared to a willingness-to-pay threshold based on estimated opportunity costs of healthcare spending in Tanzania.Results The programmatic cost of the 1,7-mRCTR intervention was 5327 United States Dollars(USD)per 1000 popu-lation.The combination of reactive and passive case detection in the intervention arm resulted in an additional 445 malaria cases detected per 1000 compared to passive detection alone,yielding an incremental cost per additional case detected of 12.0 USD.Based on modelling results,for every percentage point decline in malaria prevalence,the intervention averted 95.2 cases and 0.04 deaths per 1000 population.On average,the 1,7-mRCTR intervention averted 19.1 DALYs per 1000 population.Compared to passive malaria detection,the ICERs for the 1,7-mRCTR inter-vention were 7.3 USD per case averted,16,884 USD per death averted,and 163 USD per DALY averted.Conclusions Our analysis demonstrates that the 1,7-mRCTR intervention appears to be cost-effective under a will-ingness-to-pay threshold of 417 USD per DALY averted,showing that modified RACD strategies can provide value for money in moderate-to-high transmission settings.展开更多
文摘Objectives and Methodology: The purpose of this paper is to demonstrate how maternal and fetal interests can sometimes be conflicting, and a situation can place care providers in a difficult position when it comes to decisionmaking. The study also intends to cover the health laws that deal with such situations in the legal systems of the United States and Islamic Law. This study takes the form of a critical literature review. The literature search was conducted using electronic citation databases that included Pub Med, Medline, Google Scholar, and others. The keywords used in this research related to medical and legal terms concerned with fetal rights, such as embryo, fetus, abortion, fetal rights, health law in the United States, Islamic health law, and comparative studies. The search was conducted in English as well as Arabic. Data were collected from books, journals, government documents, and Internet websites. Results: Doctors sometimes have to make difficult decisions when caring for pregnant women, since one person’s care directly affects another’s. The fetus depends fully on its mother for survival in the uterus. Nevertheless, at times it so happens that the interests of the mother and fetus differ. In such cases, a conflict between the two arises. Due to advances in technology in the medical field, doctors can now specifically target the fetus during medical procedures. When treating two different patients, health practitioners must choose that which is best for each patient independently. Approach to the maternal-fetal conflict must consider medical concerns, as well as legal ones. While there is some consistency in the medical approach between different countries, the legal part varies considerably, even among different states in America, as fetal legal status, personhood, and rights differ greatly. Islamic Law is practiced in many countries and has a special consideration for the fetus that is worth attention and understanding. Conclusion: Medically, when the interests of the mother and the fetus are in opposition, a maternal-fetal conflict arises. The two main forms are harmful maternal behavior to the fetus and maternal refusal to undergo specific procedures to improve the health condition of the fetus. Different states in the US have different health laws to deal with some aspects of maternal fetal conflicts, but on many occasions, no explicit rules can be found and healthcare workers need to use their own judgment. In Islamic Law, both conditions (i.e. , harmful maternal behavior or refusal to employ lifesaving procedures for the fetus) follow the general jurisprudence rule (damage needs to be removed), and the mother will be legally accountable if her actions result in fetal damage or death.
基金supported by Bill&Melinda Gates Foundation(OPP1198779 and OPP1213975)The funder did not participate in the study design,data collection,analysis,or writing of the manuscript.
文摘Background Reactive case detection(RACD)for malaria control has been found effective in low transmission set-tings,but its impact and cost-effectiveness in moderate-to-high transmission settings are unknown.We conducted an economic evaluation alongside an empirical trial of a modified RACD strategy(1,7-mRCTR)in three moderate-to-high malaria transmission districts in Tanzania.Methods The costs and cost savings associated with the intervention relative to passive case detection alone were estimated in the study sites of Kilwa,Kibiti,and Rufiji districts in Tanzania from 2019-2021.Empirical cost data were collected using household surveys.The incremental costs of the intervention were calculated from under a societal perspective.Costs are reported in 2022 US dollars.Trial data and malaria registers from health facilities were used to calculate the number of malaria cases detected.We simulated unobserved and distal health effects of the intervention to assess cost-effectiveness in terms of incremental cost-effectiveness ratios(ICERs).Propagated uncertainty was assessed via second-order Monte Carlo simulation,including bootstrapping of empirical data distributions.Incremental costs per disability-adjusted life year(DALY)averted were compared to a willingness-to-pay threshold based on estimated opportunity costs of healthcare spending in Tanzania.Results The programmatic cost of the 1,7-mRCTR intervention was 5327 United States Dollars(USD)per 1000 popu-lation.The combination of reactive and passive case detection in the intervention arm resulted in an additional 445 malaria cases detected per 1000 compared to passive detection alone,yielding an incremental cost per additional case detected of 12.0 USD.Based on modelling results,for every percentage point decline in malaria prevalence,the intervention averted 95.2 cases and 0.04 deaths per 1000 population.On average,the 1,7-mRCTR intervention averted 19.1 DALYs per 1000 population.Compared to passive malaria detection,the ICERs for the 1,7-mRCTR inter-vention were 7.3 USD per case averted,16,884 USD per death averted,and 163 USD per DALY averted.Conclusions Our analysis demonstrates that the 1,7-mRCTR intervention appears to be cost-effective under a will-ingness-to-pay threshold of 417 USD per DALY averted,showing that modified RACD strategies can provide value for money in moderate-to-high transmission settings.
