BMC Medical Ethics最新文献

Background: The ongoing absence of a national Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) policy means that there remains a lack of explicit guidance on how clinicians should select, measure and assess relevant factors when deciding whether to implement a DNACPR order. Although previous studies have raised this as a concern, this qualitative study explores the extent to which individual clinicians not only adopt personal strategies to assess patients, but also value having a degree of professional autonomy when making DNACPR decisions.

Methods: Sixteen semi-structured interviews were conducted with National Health Service (NHS) clinicians via video calls. Participants were recruited via snowball sampling. Thematic analysis was conducted using an inductive approach. Initial codes were generated from the interview transcripts, which were then organised into overarching themes based on patterns and relationships identified across the coded data.

Results: Four main groupings summarise the different considerations adopted by doctors when making DNACPR decisions: age, frailty, assessment of quality of life, and perceived outcome. However, whilst the same general areas for consideration were drawn on, the participating doctors nevertheless assessed them differently and often prioritised them in different ways. In the absence of explicit, standardised guidance for weighting these factors, decisions were often made on the basis of individual judgement and local convention.

Conclusion: This study demonstrates that physician-level variation in DNACPR decision-making reflects the inherent tension clinicians experience when balancing individual patient needs with the absence of explicit, standardised guidance. The ability to make decisions on a case-by-case basis, with the freedom to weigh diverse factors in a nuanced way is an important aspect of clinical decision-making. However, this can lead to inadvertent bias if decisions are based on factors not necessarily supported by established evidence.

Recommendations: Our findings highlight a clear need for a more robust and equitable framework for these critical conversations, whilst also enabling clinicians to be able to make case-by-case decisions. The development of a national DNAPR policy that integrates evidence-based data may help doctors select and weigh factors appropriately, and provide a framework for the initiation of DNACPR discussions. However, such a policy must nevertheless be sufficiently flexible to permit doctors the autonomy required to make nuanced decisions on the basis of a range of patient-specific contextual assessments. Our key recommendation, therefore, is that clinicians should be supported not only by improved procedures and processes, but also by confidence that their professional judgement is rooted in the most current clinical evidence.

Background: Paediatric oral health research in Malaysia is governed by international ethical frameworks and national regulatory requirements. While reporting of ethics approval and parental consent is well established, the documentation of child assent remains inconsistent. The frequent classification of dental studies as minimal risk may permit expedited review pathways or consent waivers, raising concerns about transparency. This scoping review aimed to map the reporting of ethics approval, parental consent and child assent in Malaysian paediatric oral health research published between 2001 and 2025, with particular focus on describing current practices and documenting how assent procedures are reported in the absence of mandated requirements.

Methods: The review followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation guideline. An electronic search of five databases: PubMed, Web of Science (WOS), Scopus, MyJurnal and the National Medical Research Registry (NMRR) was conducted. Eligible studies comprised empirical research involving children aged 0-17 years in Malaysia. Data extraction focused on ethics approval, parental consent, and child assent. Transparency of assent reporting was assessed using a structured three-point framework informed by Malaysian Medical Research and Ethics Committee (MREC) guidelines for children aged 7-17 years.

Results: Seventy-one articles met the inclusion criteria. Of these, 88.7% (n = 63) reported ethics committee approval and 91.5% (n = 65) documented parental consent, whereas child assent appeared in only 6.9% (n = 5). Reporting of ethics committee approval and parental consent increased substantially, rising from below 50% in 2001-2005 to above 95% after 2015. Child assent was not reported until 2021-2025, appearing in 17.9% of studies during this period. Among the five studies reporting assent, three used written forms, two relied on implied assent, and only one provided a detailed procedure aligned with ethical standards.

Conclusions: Ethics approval and parental consent are now routinely reported in Malaysian paediatric oral health research. However, documentation of child assent remains limited and often lacks procedural detail. Strengthening ethical transparency will require standardised, age-appropriate assent procedures and clearer editorial expectations. Improving reporting practices will better support children's developing autonomy, reinforce responsible research conduct, and promote greater trust in paediatric oral health research.

Background: This systematic review aims to synthesize the current knowledge about the applications and challenges of Artificial Intelligence (AI) technologies in healthcare, while evaluating the extent to which the European Union (EU) AI Act and the European Health Data Space (EHDS) contribute to ensuring responsible, secure, and ethically sound adoption of AI in clinical practice.

Methods: This review adheres to the guidelines set by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and has also been registered in PROSPERO. The PubMed^®, Web of Science™, Scopus and ScienceDirect^® databases were used as scientific search strategy. In addition, records identified through other sources (grey literature) were also assessed for eligibility and included. All studies published between 2020 and 2024 about the application of AI and its regulation and ethical implications, particularly in healthcare, were included. Eligible studies were assessed for potential risk of bias during data extraction and quality evaluation screening.

Results: A total of 76 studies were included. Although AI technologies have several applications in the healthcare sector such as disease diagnosis, treatment, clinical data management, automated surgery, remote health monitoring, elderly patient care and/ or biomedical research, important ethical issues are raised when using AI, namely data privacy, safety, lack of transparency, explainability, trust and potential biases.

Conclusions: A proper application and compliance with established ethical principles, and legal regulations such as the EU AI Act and the EHDS are fundamental to ensure a responsible, safe, sustainable and trustworthy use of AI in healthcare.

Background: The exploding food supplement trade makes ensuring and monitoring their proper use and risk minimization by individuals increasingly difficult. Even though there is a common legal framework for those activities in the European Union (EU), too little importance has been given to respecting ethics in making them available to patients. Pharmacists involved in activities related to food supplements could play a decisive role in protecting the rights of patients who use them. The purpose of this study was to determine the position of European pharmacists in this field and to propose ethical standards for their activities related to food supplements.

Methods: We used textual analysis to investigate the pharmacists' codes of ethics in force in the EU Member States. Our findings led us to develop proposals to optimize the ethical standards for pharmacist activities related to food supplements. To position our proposals internationally, we performed a comparative analysis with ethical standards adopted in Australia and the United States (US).

Results: Most of the codes of ethics we analysed address some of those activities through explicit and/or implicit provisions. From those provisions, we derived common ethical standards regarding the responsibility of pharmacists for the quality, safety and effectiveness of food supplements dispensed from pharmacies and for honesty and loyalty in promoting and advertising food supplements. As policy recommendations, we proposed optimized ethical standards, including standards for research and development, marketing notification, manufacturing, wholesale distribution, market surveillance, and risk management of food supplements. In the Australian Code of Ethics and US guidelines, we observed similar standards for most of these activities.

Conclusions: Establishing ethical standards for all pharmacists' activities related to food supplements would stimulate discussion, reflection, the evolution of their codes of ethics and practices, and professional development. The standards we proposed could serve as a starting point for developing national and international policies, using the motivational power of ethics. The commitment of professional associations of pharmacists, food companies, and competent health authorities to adopt ethical policies in all activities related to food supplements would make an important contribution to respecting patients' rights in using them.