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About the Journal
The Journal of Healthcare Ethics & Administration (JHEA) is an international open-access online journal that reflects the issues on medicine and healthcare administration. The JHEA welcomes original researches, review articles and case studies by scholars, medical and law professionals, and healthcare administrators who desire to share knowledge through the dissemination of published works. Each published article in the journal is approved by an international editorial board before publication using a double-blind, peer-review process.
Current Issue Vol.12 No. 3 (Summer 2026)
Pages: 1-17
Anabolic-Androgenic steroids (AAS) are a class of drugs primarily used for hormone replacements; however, many athletes take them to elevate performance and physical capabilities. While previously AAS were primarily used by professional athletes, over time adolescent individuals have begun to use these substances despite the slew of negative side effects. In this paper we will discuss the current state of AAS, specifically what they are and their mode of action, side effects of using various AAS, the ease of use, general opinions of high school students and young adults, potential influencing factors that can lead to abusing AAS, ethical considerations regarding AAS-use and their current status, and a discussion reading how to minimize addiction among the American youth.
In order to gauge public opinion on AAS, we surveyed 111 individuals, ranging from 14 to 22 years of age. We approached public gym-goers and asked them if they wanted to participate in an anonymous survey regarding their opinions on AAS. We collected data from five gyms and three high schools in different parts of Philadelphia, Pa and Boston, Ma. Survey results suggested that sports, especially high-contact sports, can heavily influence a person to use AAS. It was also determined that a large gap in formal education regarding these drugs exists, and a majority of the survey respondents have learned about AAS through social media.
Pages: 18-37
This essay analyses how the concept of ‘privacy’ is construed in determining the U.S. regulatory approach to research involving human subjects. It begins by setting out how the federal policy for the protection of human research subjects – also known as the Common Rule – identifies privacy, showing how the Common Rule’s rendering of the concept is fundamentally incomplete. It then describes how modern technology has expanded the wealth of information that might be considered private, at the same time as it has moved further into the realm of what has been considered private, offering investigators new opportunities to look into various aspects of people’s lives. The essay then uses some key U.S. Supreme Court decisions turning on the idea of a right to privacy alleged to be embedded in the Constitution of the United States to illustrate how the concept has evolved in response to technological developments in the generation and transmission of information. Based on these considerations, I proceed to argue that classifying all information as either ’public’ or ‘private’ is inadequate, and that the regulated research community and the public at large should directly address the challenges of how to use information that is neither public nor private, but rather ‘restricted social information (RSI)’. This in turn implies that there is human behavior that is neither public nor private, which should be classified as ‘restricted access social behavior’ (RASB). And this affects the question of what is left of privacy, and how investigators should approach the investigation of what is truly private. I offer recommendations for regulatory revisions to the Common Rule, considering the views of some of the leading theorists about privacy.
Pages: 38-47
Background: The resurgence of vaccine-preventable diseases and declining trust in public health institutions in the United States have coincided with the rise of digital platforms that shape how individuals interpret vaccine-related information.
Methods: A qualitative thematic analysis was conducted using a sample of Reddit posts related to vaccine safety, vaccine mandates, and delayed vaccination from January to February 2026. Data was analyzed through a human-in-the-loop AI-assisted workflow with manual validation.
Results: Four themes emerged: declining institutional trust driven by profit narratives, tension between individual autonomy and collective responsibility, prioritization of personal experience over epidemiologic data, and algorithm-driven reshaping of authority. These themes reflected a broader shift toward protective individualism, fragmented epistemic trust, and the replacement of institutional expertise with digitally mediated personal authority.
Conclusion: Vaccine hesitancy in digital spaces reflects structural and cultural shifts, underscoring the urgent need for adaptive, trust-centered public health communication strategies that account for the rapidly evolving social media information landscape.
Pages: 48-61
This paper evaluates, through an environmental justice perspective, the distribution of benefits and harms of the widely used herbicide glyphosate. It examines not only the toxic and carcinogenic risks of glyphosate, but also the populations who disproportionately bear these effects. Glyphosate is the world’s most widely used herbicide and has been a major subject of regulatory controversy. The International Agency for Cancer Research (IARC) and the U.S. Environmental Protection Agency (EPA) have reached different conclusions regarding glyphosate’s carcinogenicity, differences that appear to stem from the use of public peer-reviewed studies versus proprietary industry-supplied data. This calls into question the reliability of confidential industry evidence in regulatory decision-making. This paper argues that current regulatory frameworks fail to equitably protect vulnerable populations and instead externalize health risks onto marginalized communities. Glyphosate exposure is disproportionately associated with harm among migrant workers, racial minorities, children, and low-income populations, who often experience elevated exposure levels and reside in high-risk environments. An ethical framework grounded in respect for persons, beneficence, and justice is applied to argue that current regulatory practices fail to protect marginalized populations. By applying an environmental justice lens, this paper proposes two comprehensive practice guidelines, one for farmworkers and one for physicians serving agricultural populations, as structural remedies to these systemic failures.
Pages: 62-67
Healthcare professionals are anchored by moral commitments to compassion, integrity, and fairness. Rapid organizational change—particularly mergers, divestitures, and workforce reductions—can place these commitments in tension with institutional realities, creating conditions for moral injury among healthcare leaders. Drawing on literature in moral psychology and organizational ethics, this article conceptualizes survivor guilt, a specific manifestation of moral injury, in healthcare leadership as an appraisal-driven response to perceived inequity and constrained agency during organizational transitions. This article outlines individual, organizational, and system-level contributors, and proposes practical, leadership-oriented interventions—including modified Schwartz Rounds, ethics rounds, and chaplain-led logotherapeutic support—to mitigate moral distress.
Pages: 68-80
Legal protections related to stealthing, the non-consensual condom removal, remain uneven in the U.S. This study applies a legal content analysis to the congressional Stealthing Act, evaluating its provisions through the Availability, Accessibility, Acceptability, and Quality human rights framework. The analysis reveals that the Act advances human rights protections by establishing a federal civil cause of action with clear definitions and broad remedies, enhancing availability of legal recourse nationwide. However, the Act lacks explicit provisions addressing accessibility barriers such as filing fee waivers, trauma-informed procedures, and equity measures, potentially limiting access for marginalized survivors. These findings highlight both the progress represented by the Act and areas requiring further legislative or policy development. By integrating a human rights framework into legal analysis, this study offers an innovative approach to assessing health legislation at the intersection of law, health, and human rights, providing guidance for future policymaking to strengthen survivor-centered justice. The findings further underscore the ethical importance of protecting bodily autonomy, informed consent, and equitable access to justice through federal legislation.
Pages: 81-109
The emergence of carfentanil as a highly potent synthetic opioid circulating in illicit drug markets represents a significant escalation in the ongoing opioid epidemic. Addressing this crisis requires an interdisciplinary approach that synthesizes existing literature while recommending community-based strategies and further methods. Carfentanil has recently been detected in Kensington, Philadelphia and continues to affect communities burdened by poverty, housing instability, and disparities in healthcare, which increase overdose risks. The extreme potency of carfentanil creates unique clinical hazards and complicates overdose response and treatment efforts. Existing toxicology and surveillance methods face limitations in detection and monitoring of this drug effectively. The presence of carfentanil highlights the need for comprehensive harm reduction strategies, including access to naloxone, supervised consumption sites, and drug checking. Ethical considerations related to the responsibilities of the pharmaceutical industry, health equity, and social justice are critical to developing effective solutions. An integrated response aims to reduce the devastating effects of ultra potent synthetic opioids, raise awareness of their risks, and decrease their circulation within communities
Issue Vol.12 No.2 (Spring 2026)
Pages: 1-24
Xylazine-adulterated opioids have created complex, treatment-resistant wounds among individuals with opioid use disorder (OUD), posing challenges that traditional wound care inadequately addresses. This study examines placenta-derived biomaterials as a therapeutic intervention for opioid-related chronic wounds, focusing on xylazine-induced tissue damage. A multidisciplinary analysis evaluated the scientific rationale, social implications, financial considerations, and medical applications of placental therapies for opioid-related wound care by synthesizing clinical studies and cost-effectiveness research. Placental tissues contain growth factors, anti-inflammatory cytokines, antimicrobial peptides, and extracellular matrix components that address the pathophysiology of xylazine-induced injuries. Dehydrated human amniotic/chorion membranes achieve 77-92% healing rates within 4-6 weeks, compared with negligible improvement with standard care. A cost analysis shows healing costs of $1,771 per wound with placental therapies, up to $8,800 with conventional treatments. Implementation barriers include inconsistent insurance coverage, social stigma, and limited provider education. Given the vulnerability of people who use drugs (PWUD), the ethical dimensions of informed consent, stigma reduction, and equitable implementation remain central to the adoption of placental therapies. Placental-derived biomaterials offer a cost-effective solution for chronic wounds in OUD. However, successful implementation requires policy interventions including expanded coverage, integration with harm-reduction programs, and enhanced provider training, to ensure equitable access.
Pages: 25-33
This paper seeks to identify the principle of vulnerability as a key operational ethical resource in the context of caregiving. Those both most susceptible to harm and in need of the greatest empowerment require responsive and responsible caregiving capable of delivering these twin objectives. This paper will first explain the principle of vulnerability and its importance in the context of care. It will then highlight some of the moral pitfalls associated with applying the principle of vulnerability. The paper will then conclude with the articulation of an operational framework for applying the principle vulnerability. In doing so, the hope is to empower caregivers to promote the basic moral imperative that the principle of vulnerability involves: to protect the vulnerable from harm while simultaneously building capacities to realize basic human goods.
Pages: 34-44
This study uses infodemiology methods to examine public engagement with stealthing, or non-consensual condom removal, through Google Trends data spanning 2020 to 2025, especially whether public search interest corresponded with legislative developments and how terminology may influence awareness. National and state-level search patterns were analyzed using relative search volume (RSV) data for the terms: “stealthing,” “condom removal,” and “non-consensual condom removal.” Findings reveal that search activity was episodic and closely aligned with policy events, particularly in California and Washington, while other states showed little or no relation between legislation and public search patterns. Regional differences emerged, with some subregions demonstrating RSVs three standard deviations above the national average, while others showed little to no engagement. Furthermore, the analysis highlights a disconnect between colloquial and formal terminology where the term “stealthing” consistently generated search interests while the more descriptive legal phrase yielded minimal results. These findings underscore the importance of aligning legal and public health communication with accessible language to improve population-level awareness and engagement. Infodemiology offers a valuable tool for monitoring public understanding of emerging sexual health issues and informing more responsive policy communication strategies.
Issue Vol.12 No.1 (Winter 2026)
Pages: 1-27
Pertussis, also known as whooping cough, is an infection of the respiratory system, characterized by inflammation of the lungs and airways, and is caused by Bordetella pertussis. Studies suggest that pertussis is highly contagious, affecting around 90% of individuals exposed to the pathogen in the household and 50-80% of individuals exposed to it in schoolrooms. In 1934, the United States (U.S.) reported around 265,000 pertussis cases, which decreased to about 7,000 cases in 2023; however, the U.S. witnessed a five-fold increase in reported pertussis cases in 2024. Therefore, this paper outlines possible factors contributing to the surge in pertussis cases, lays out evidence-based effective approaches and preventive measures to curtail future pertussis and, possibly, other air-borne disease outbreaks, and provides ethical arguments for adopting the initiatives/changes recommended herein.
Pages: 28-38
Introduction: Biomarkers of cellular aging (e.g., telomere length) reflect biological aging and are influenced by environmental and social factors. Veterans often face health disparities, and understanding telomere dynamics could inform personalized approaches to improve their health outcomes.
Methods: Using data from the National Health and Nutrition Examination Survey, we analyzed telomere length among 929 U.S. male veterans aged 20-84 years, examining associations with socioeconomic status, health conditions, and lifestyle factors through survey-weighted linear regression models.
Results: Veterans exhibited significantly shorter telomeres compared to civilians, with an average reduction of approximately 229.61 base pairs (bp) (p < .0001). Factors such as poverty, obesity, and COPD were independently associated with greater telomere shortening; for example, veterans living below the poverty line had about 261 bp less telomere length, and those with COPD showed a reduction of approximately 182 bp. Obese veterans had about 152 bp shorter telomeres, and the combination of poverty and obesity resulted in a cumulative shortening of approximately 424 bp, indicating a synergistic effect on cellular aging. These associations persisted after adjusting for age and other confounders, emphasizing the impact of socioeconomic and health-related factors on biological aging among veterans.
Conclusion: These findings are associated with shorter telomeres and may inform risk stratification and targeted prevention.
Pages: 39-46
Emergency department (ED) crowding and patient boarding have emerged as critical threats to patient safety, healthcare quality, and provider well-being. Crowding occurs when the demand for emergency services exceeds available resources, leading to prolonged wait times, delayed care, and treatment in non-traditional spaces. Boarding, the retention of admitted patients in the ED due to lack of inpatient capacity, is the most significant driver of ED crowding and is associated with increased morbidity, mortality, adverse events, and staff burnout. Legal implications are substantial: malpractice data reveal significant financial losses, with boarding cases twice as likely to close with indemnity payments and nearly half involving patient death. Regulatory bodies such as The Joint Commission (TJC) and the Centers for Medicare and Medicaid Services (CMS) have proposed measures to mitigate boarding, recognizing its impact on patient outcomes. Ethically, boarding undermines the principles of beneficence, nonmaleficence, autonomy, and justice by delaying treatment, eroding privacy and dignity, and exacerbating health inequities. It also contributes to moral distress and violence against healthcare workers. Addressing this crisis requires systemic, multidisciplinary reforms. Strategies include optimizing weekend discharges, harmonizing elective admissions, creating admission-hold units, expanding staffing, and implementing full capacity protocols. ED-level interventions, such as fast track models, observation units, and telemedicine, can improve throughput, while policy action is needed to mandate maximum boarding times and to restructure reimbursement models that incentivize efficiency. Ultimately, ED crowding and boarding represent an ethically unacceptable and legally dangerous consequence of systemic capacity failures. Comprehensive institutional and policy reforms are essential to safeguard patient welfare, reduce liability, and preserve the ED’s role as the healthcare safety net.
