BMC Medical Ethics最新文献

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.

The relationship between cognitive enhancements (CE) and human autonomy or authenticity is generally positioned as how CE impact human autonomy or authenticity. But rarely, if ever, do we consider whether the value and pursuit of CE is an authentic one. In this paper, I will argue that the moral permissibility of cognitive gene enhancements is undone by the legitimate concern that the near universal value for such modifications is likely driven by oppressive norms for superintelligence and productivity. I argue that these norms derive from the capitalist meritocracy: an economic system that structures inclusion and success based on patriarchal and racist norms of intelligence and productivity. The claim that the use of such enhancements fits within the autonomous scope of individual power is thus far weaker than it claims to be, particularly within the context of genetic modification.

Background: The rapid digitalization of healthcare-from telemedicine and Artificial Intelligence (AI)-driven diagnostics to wearable biosensors-has profoundly disrupted traditional norms of patient confidentiality. Classical privacy theories, anchored in physical co-presence and individual control, struggle to address the ethical challenges posed by opaque, persistent, and infrastructural data exposures in digital clinical environments.

Methods: This study employs a theoretical-conceptual methodology to develop a multidimensional privacy framework responsive to the spatial and technological complexities of the digital clinic. Drawing from Edward T. Hall's proxemics theory and the concept of cyberspace, we reinterpret interpersonal spatial zones (intimate, personal, social, public) in cyberspace. We introduce "cyberspatial privacy" as a transversal dimension that modulates privacy expectations across physical and digital layers. A hypothetical case-"Patient X," a woman undergoing hybrid care-is used to demonstrate the framework's practical utility in ethical analysis.

Results: The proposed framework reconceptualizes privacy as a dynamic continuum structured by both spatial proximity and digital mediation. By mapping risks across four proxemic zones and overlaying a cyberspatial dimension, the model reveals how privacy breaches differ not only in kind but in normative weight. For instance, biometric data collected by wearables (intimate zone) carries higher ethical risk than metadata exposed via public interfaces. The case of Patient X illustrates how classical theories fail to capture this gradient, while the new model enables zone-sensitive assessments of vulnerability, exposure, and trust.

Conclusions: This framework advances the ethical understanding of privacy in digitally mediated healthcare by offering a granular, relational, and context-aware approach. It supports clinicians, designers, and policymakers in tailoring privacy safeguards to the spatial and digital contours of care. By reframing privacy as a condition of relational co-presence rather than isolated consent, this model promotes ethically robust design and governance in the era of cyber-augmented medicine.

Background: Social Egg Freezing (SEF), often promoted in Western contexts as a means to enhance reproductive autonomy, has seen varied uptake in countries with wider gender disparities. In such settings, where reproductive decisions are shaped by strong societal norms, SEF raises ethical concerns about whether it enables autonomy or reinforces prevailing expectations.

Objectives: This study examines how SEF is framed and regulated in countries ranking in the lowest quintile of the 2024 Gender Gap Index (GGI), where reproductive autonomy is emergent and SEF is increasingly promoted as a demographic intervention.

Methods: A scoping review was conducted on SEF literature published between 2013 and 2025 across 29 countries in the lowest GGI quintile. English-language sources were retrieved from PubMed, while Japanese (J-Stage, Ichushi-web) and Arabic (Arabase [al-manẓūma], E-Marefa) were searched. Supplementary materials-including government policies, religious texts, and professional guidelines-were identified through Google Advanced Search, manual screening, and documents from the International Islamic Fiqh Academy (IIFA). Eligible sources included empirical and normative publications addressing SEF in the countries under review. Three reviewers screened and extracted data. Themes were developed iteratively.

Results: Sixty-eight sources met inclusion criteria and were organized into five themes: (1) awareness and education; (2) sociocultural and religious values; (3) policy and legal frameworks; (4) clinical practices and outcomes; and (5) commercialization and autonomy. Most sources (73.9%) focused on themes (2)-(4), while awareness (12.2%) and commercialization (13.9%) received limited attention. In most Muslim-majority countries reviewed, religious frameworks restricted SEF to married women. Turkey is a notable exception, permitting SEF for single women though embryo transfer requires marriage. Only 23 of the 68 sources were empirical, and just four employed qualitative methods.

Conclusion: Although SEF is often framed as empowering, this promise is context-dependent and frequently illusory. Cultural and structural constraints shape women's choices, limiting the autonomy SEF claims to offer. Rather than imposing hegemonic neo-liberal assumptions, future policy and research should engage with local moral reasoning while examining how norms may reinforce inequality. Empirical studies are urgently needed to illuminate lived realities and improve policy development.

Aim: The study aims to explore (1) Chinese medical students' prioritization of various factors in decision-making about disclosing information to patients with life-threatening illness, (2) heterogeneous subgroups with respective prioritization of factors and, (3) between-subgroup differences in basic demographics and background information.

Methods: In a cross-sectional observational survey, 196 second-year master's medical students in mainland China reported preferences for disclosing diagnoses and prognoses to terminal cancer patients in 18 scenarios varying in patient preference, family preference, patient sex, age, education, and finance. Conjoint analysis was performed on the entire sample for diagnosis and prognosis disclosure preferences. Cluster analysis identified homogeneous subgroups, followed by conjoint analysis within each cluster. ANOVAs and chi-squared tests compared basic demographics and background information between clusters.

Results: Conjoint analysis found similar factor prioritization for both diagnosis and prognosis disclosure. The most important are patient preference (27.57%) and family preference (24.88%), followed by patient age (15.38%), finance (13.14%), education (11.10%), and sex (7.74%). With diagnosis and prognosis disclosure preference scores combined, cluster analysis identified three subgroups: A preference-driven group (n = 109) that mainly considers patient preference and family preference; a condition-driven group (n = 29) that prioritizes patient age and finance; and a balanced consideration group (n = 58) that takes relatively even consideration of all factors. Between-cluster comparisons unveiled significant differences in sex and major.

Conclusion: Incorporating both Western and Confucian values, as well as practical factors, these medical students act as active agents in the decision-making process, guided by their personal identities and professional beliefs.