BMC Medical Ethics最新文献

Background: Certain populations face challenges in accessing online health information, leading to the emergence of Proxy Online Health Information Seeking (Proxy OHIS). Due to their close contact with patients and medical knowledge, nursing interns frequently encounter requests from patients to perform Proxy OHIS, which presents various ethical challenges. Currently, no research specifically focuses on nursing interns within the context of their Proxy OHIS activities.

Aim: This study aims to explore the ethical decision-making processes of nursing interns when engaging in Proxy OHIS for patients during their clinical practice and to analyze the associated ethical challenges, thereby contributing to improved ethical decision-making among nursing students.

Methods: This qualitative study was guided by a constructivist paradigm. Rest's Four-Component Model of ethical decision-making served as the theoretical framework for examining the decision-making process. Participants were recruited via purposive sampling from a tertiary Grade A hospital in Zibo between August and September 2025. Individual semi-structured interviews were conducted with eligible participants until data saturation was achieved. The study involved nursing interns at multiple educational levels (diploma, bachelor's, and postgraduate) from eight different universities. Data were transcribed verbatim and analyzed using Graneheim and Lundman's conventional qualitative content analysis approach with NVivo 14.0 software.

Results: A total of 18 nursing interns participated. Content analysis identified four primary categories: "Identifying ethical issues and risks", "Formulating appropriate ethical judgments", "Balancing multiple ethical motivations" and "Implementing prudent behavioral strategies".

Conclusion: Guided by Rest's Four-Component Model, this study revealed that nursing interns encounter a range of ethical challenges throughout their decision-making process when performing Proxy OHIS for patients. These challenges span the entire process, from initial issue recognition to the implementation of final actions. To address these challenges effectively, interventions should focus on two key areas: ethics and online health information seeking. In the future, nursing education stakeholders can build a comprehensive ethical support system, including establishing structured supervision protocols for handling Proxy OHIS requests.

Background: In many Western countries, there is a growing tendency to seek control over death and dying. This leads to a practice in which people anticipate their hypothetical future by a timely explication of their end-of-life choices, such as do-not-resuscitate orders or euthanasia requests. These choices are often presented as individual, autonomous acts, potentially overlooking their relational dimensions. Against this background, this study examined how individual values and understandings of autonomy shape communication around end-of-life choices, and explored whether and how individualistic ideals are articulated, negotiated, or challenged within relational choice-making practices.

Methods: A longitudinal, multiperspective, qualitative study was conducted, providing 70 in-depth interviews over two years with community-dwelling older adults (75 + years old) and their close ones. Empirical observations were combined with theoretical insights to investigate how autonomy and communication are enacted in anticipatory end-of-life decision-making and to enrich our conceptual thinking regarding respect for autonomy.

Results: Our findings illustrate that older adults often articulate end-of-life choices as individual decisions, while close ones tend to defer, even when feeling intimately involved or morally responsible. These tensions are intensified when meaningful dialogue is absent or when close ones feel unable to voice their values or concerns, revealing moral frictions between the ideal of individual autonomy and the relational reality of choice-making processes.

Conclusions: Our findings highlight the limitations of framing end-of-life choices primarily as autonomous acts. We argue for a shift toward a more fundamentally relational conception, emphasizing interdependence and dialogue over more common notions of independence and non-interference. This approach may better align with the experiences of older adults and their close ones and provide a foundation for end-of-life care practices and policies that acknowledge and respond to the complexity of end-of-life decision-making.

Background: Nurses working in NICU and PICU frequently encounter ethical dilemmas that can erode their moral sensitivity and trigger distress that can jeopardize patient safety, undermine staff well-being, and hinder interprofessional collaboration. Traditional lecture-based ethics education often fails to engage nurses deeply or produce durable improvements in ethical reasoning. The flipped classroom (FC) model, which delivers core content before class and uses face-to-face time for interactive case discussions, may offer a more effective route to strengthening ethical insight and reflective practice in critical care settings.

Methods: In this randomized controlled trial, 80 NICU and PICU nurses at Afzalipour Hospital in Kerman, Iran, were enrolled by census sampling and randomly assigned (1:1) to an FC intervention group (n = 40) or a control group (n = 40). Both groups received the hospital's standard ethics in-service program. The FC group additionally reviewed five digital pre-class modules over 20 days and attended three 2-hour interactive workshops on managing moral distress, building resilience, and heightening moral sensitivity. Outcomes were assessed at baseline, immediately post-intervention, and at two-week follow-up using Corley's Moral Distress Scale-Revised and Lützén's Moral Sensitivity Questionnaire. Within-group changes were evaluated with paired t-tests and between-group differences with independent t-tests (α = 0.05).

Results: Baseline demographic and professional characteristics were similar between groups (all p > 0.05). The FC group's mean moral distress score decreased from 70.44 ± 26.35 at baseline to 50.60 ± 36.46 immediately post-intervention (p < 0.001) and remained significantly lower at two-week follow-up (p < 0.01). Their mean moral sensitivity score increased from 171.37 ± 23.15 to 182.97 ± 18.24 immediately after training (p = 0.003) and remained elevated at follow-up (p = 0.005). The control group indicated no significant reduction in moral distress (p = 0.07) and only a non-sustained rise in moral sensitivity (p = 0.20).

Conclusions: Flipped classroom-based ethics education substantially mitigates moral distress and enhances moral sensitivity among NICU and PICU nurses compared with conventional training. Incorporating FC strategies into critical care nursing curricula may strengthen ethical competence in demanding clinical settings.

Trial registration: IRCT20220203053920N4 (Registered 03 February 2022).

Background: Hospital Ethics Committees (HECs) aim to address complex ethical dilemmas and provide ethical counselling and guidance in hospital and clinical setting. Despite their formal and legalistic authority in Israel, little is known about their actual practices, structure and perceived role by their members.

Methods: This qualitative study employed Interpretative Phenomenological Analysis (IPA) to explore the lived experiences of HEC members in Israeli hospitals and the meaning they attach to their roles. Thirteen semi-structured interviews were conducted with committee chairs and members with diverse professional and institutional backgrounds in nine hospitals throughout the country. Data were analyzed using thematic coding to identify key patterns and insights.

Results: Five major themes emerged: (1 Offering support through decisive means; (2) Committee composition, member characteristics and ethics training; (3) Common ethical issues discussed in the Ethics Committee; (4) Committee's decisional functioning; and (5) Committee's relationships with various entities, and the limitations of its operation.

Conclusions: HECs in Israel serve a unique dual role as legal and ethical decision-making bodies. While they support clinicians and, to some extent, patients, their potential is hindered by systemic gaps in training, collaboration and engagement. Further research is recommended to explore patient experiences and evaluate committee effectiveness in advancing ethical clinical practice.