BMC Medical Ethics最新文献

Background: The integration of Team Based Learning (TBL) into medical ethics education has gained attention as a means of promoting active engagement, ethical reasoning, and professional development. This systematic review evaluates the characteristics, outcomes, challenges and quality of studies on TBL in teaching medical ethics across healthcare education contexts.

Methods: Following PRISMA guideline, a systematic search was conducted in PubMed, Scopus, Web of Science, and Google Scholar from 2000 to March 31, 2025. Only peer-reviewed empirical studies published in English and focusing on TBL in ethics education were included. Data were extracted on study characteristics, TBL interventions, measurement tools and outcomes. The identified outcomes were then analyzed and categorized using the Kirkpatrick framework to evaluate their hierarchical levels. Methodological quality was assessed using the MERSQI instrument. Due to heterogeneity, a narrative synthesis was conducted.

Results: The 15 studies, involving 2,134 participants, demonstrated TBL's effectiveness in ethics education across diverse global settings. Studies originated from the United States (6), Turkey (2), Korea (2), a joint Bahrain/Ireland study (1), and single studies from the United Arab Emirates, Malaysia, Oman, and Nepal. Asia contributed 9 studies, North America 6, and Europe 1. Most studies were published between 2019 and 2025. When evaluated through the Kirkpatrick model, TBL demonstrated positive outcomes across multiple levels. Learner Reaction (Level 1) was highly favorable, with consistent reports of high satisfaction and engagement. In terms of Learning (Level 2), the intervention enhanced knowledge retention, ethical reasoning, and moral sensitivity. Furthermore, there was evidence of Behavioral change (Level 3), as students transferred learning to practice by applying ethical principles more effectively, demonstrating deeper cultural awareness, and engaging in more robust team-based decision-making. The fostering of a stronger professional identity suggests a foundational shift aligned with long-term Results (Level 4). Challenges included low pre-reading compliance, resource intensity, and ambiguous assessments. MERSQI scores ranged from 7.5 to 13.0, with an average of 10.2, indicating moderate methodological quality overall.

Conclusions: TBL is an effective pedagogical approach for medical ethics education, fostering critical thinking, ethical behavior, and engagement in diverse global settings. Its interactive, learner-centered design promotes cultural and moral awareness and team-based decision-making, with high student satisfaction. Despite implementation challenges, the evidence supports its broader adoption in ethics teaching. Future research should prioritize rigorous study designs, validated assessment tools, and long-term outcome evaluation.

Background: Ethical decision-making in child and adolescent psychiatry (CAP) is inherently complex, shaped by developmental vulnerability, evolving autonomy, and competing responsibilities to patients, families, and the legal system. Clinicians often face moral dilemmas when navigating adolescent confidentiality, parental authority, and mandatory reporting duties, especially in high-stakes or culturally sensitive contexts. As large language models (LLMs) enter clinical settings, their potential to support ethical reasoning remains underexplored, particularly outside Western paradigms. This study qualitatively investigates how different LLMs provide ethical, legal, and emotional guidance to clinicians facing ethically challenging scenarios in CAP, situated within Turkiye's sociocultural and legal landscape.

Method: A scenario-based qualitative design was employed. Three expert-developed case vignettes reflecting ethically charged dilemmas, such as adolescent autonomy, parental conflict, and confidentiality, were submitted to the three LLMs (ChatGPT 4.0, Gemini 2.5 Flash, and GROK 3). Responses were analyzed using content and thematic analysis to identify key patterns of ethical-legal reasoning, alongside discourse analysis to examine tone, empathy, and cultural sensitivity. Two researchers, with backgrounds in CAP and medical ethics, conducted independent coding and reached consensus through a reflexive, interdisciplinary approach.

Results: All LLMs addressed core ethical principles (autonomy, non-maleficence, beneficence, and justice) and referenced Turkish legal frameworks such as the Child Protection Law, Patient Rights Regulation, and mandatory reporting obligations, situating their guidance within the national regulatory context. They also differed in their engagement with sociocultural sensitivities: GROK 3 emphasized therapeutic communication and relational trust, Gemini 2.5 Flash applied a highly structured, rule-based style focused on procedural compliance, while ChatGPT 4.0 provided concise and practical suggestions. Despite thematic overlaps, these varying approaches shaped how effectively the models aligned with Turkiye's clinical realities. Notably, LLMs frequently acted as "thinking companions," offering ethical and legal justifications while leaving interpretive responsibility with clinicians.

Conclusion: LLMs in CAP hold promise not only as cognitive aids but also as emotionally attuned, context-sensitive companions in ethical decision-making processes. Their effectiveness depends not just on algorithmic precision but also on explainability, empathy, and cultural alignment. Rather than replacing clinician judgment, LLMs may serve to ease emotional burden, enhance therapeutic reflection, and foster ethically sound care in complex, high-pressure situations.

Background: Increasing donor consent rates in countries with low post-mortem donation rates such as Türkiye is paramount. This study explores the experiences of donor relatives in Türkiye who approved post mortem organ donation after brain death, aiming to identify emotional, cognitive, and ethical factors influencing their decisions and post-decision experiences, to inform strategies for increasing consent rates in developing countries.

Methods: This qualitative study involved semi-structured interviews with eight donor relatives who consented to organ donation, and data were analysed using thematic analysis.

Results: Two main fields were identified: (1) Factors influencing the donation decision, with themes: (a) decision-related factors, (b) health system factors, and (c) individual factors; and (2) post-decision experiences, with themes: (a) satisfaction with the decision, (b) curiosity about the recipient, (c) meaning of donation, and (d) creating donation awareness.

Conclusion: Empathic motivations, previously stated wishes, the attitude of healthcare professionals, and understanding brain death influence the decisions of donors' relatives. Trust in healthcare professionals helps reduce ethical uncertainty, contributing to a more confident and informed decision-making process. The study found that concerns during the decision-making process and uncertainties such as 'What will happen next?' were replaced by spiritual satisfaction and contentment after the decision. The research results provide evidence-based insights into the organ donation decision-making process and offer recommendations for improving public perception and increasing consent rates.

Background: Consumer and community involvement (CCI) is widely recognised as an ethical imperative in health and biomedical research. However, there is a lack of evidence and guidance regarding ethical approaches. The aim of this research was to test and refine an existing ethical framework for consumer partnerships in research to enhance understanding of ethical issues and approaches to CCI in research.

Methods: A sub-analysis of a co-produced ethnographic study which explored the processes and outcomes of consumer engagement over three and a half years in a PhD research partnership, was conducted against an existing ethical framework for CCI. The framework included organisational ethics, research integrity, relational ethics, and research ethics. Participants included four consumers, two academics, and a PhD candidate in an Australian capital city. Two consumer co-researchers collaborated in this study across the research cycle. Data were obtained over three and a half years from six interviews, six focus groups, monthly online logs, field notes, and a reflexive diary. Descriptive statistics and qualitative content analysis were used to analyse 2035 units of data.

Findings: A total of 1911 (93.9%) units of data aligned to an ethical category. Hence, the research team were constantly encountering ethical decision-making. A combination of organisational ethics and relational ethics was most frequently coded (30.1%, n = 576), followed by relational ethics alone (24.3%, n = 465), and research integrity and relational ethics (n = 229, 12.0%). Qualitative analysis identified some ethical tensions and many more practical and planned ethical approaches to support meaningful research partnership and positive research processes and outcomes. Examples and quotes are provided against each of the four ethical categories to illustrate and expand on the framework. An update to the framework is provided.

Conclusions: The updated framework highlighted the complexities of CCI and focused beyond traditional research ethics to include relationships, organisational factors, and research integrity. The narrative of ethical issues being a challenge to overcome in CCI, needs to change. An emphasis on adopting a proactive approach to promote ethical and authentic team power sharing, reflection, and active communication is needed.

Background: Staff in low resourced emergency units of a low-income country face the challenge of obtaining informed consent for incapacitated patients or their next of kin in a time-constrained situation often in an overcrowded environment. Therefore, we aimed to establish the informed consent practices for emergency surgical care among healthcare professional at two emergency surgical units at two tertiary teaching hospitals in Uganda.

Methods: In October 2022 - February 2023we conducted key informant interviews in Uganda and purposively selected 16 staff in surgical emergency units at two tertiary teaching hospitals and directly observed the informed consent practices. Data was managed and analyzed inductively using NVivo version 12.

Results: Six themes emerged from key informant interviews including knowledge and perspectives on informed consent; processes, procedures, and practices regarding informed consent; communication strategies for informed consent; ethical considerations; benefits of informed consent during surgery; and challenges to emergency informed consent. Staff had adequate knowledge about informed consent but faced several challenges during the consent process due to lack of guiding institutional policies. Overall, the informed consent process was inadequate at both institutions with greeting of patients, disclosure of risks and assessment of understanding poorly done. Consent was conducted in a noisy environment at both institutions and there was no privacy in the public hospital.

Conclusion: Although knowledge about consent practices by emergency staff at both institutions was good, in practice there was inadequate disclosure of risks, inadequate knowledge about the surgical procedure, risks, and benefits. Emergency staff identified the need for procedure specific consent documents which capture the information that is given to the patient and guiding policies on consent for incapacitated patients who have no surrogates.

Background: Treatment limitation decision (TLD) is a complex process affected by comorbidities and cultural aspects. We hypothesized that presence of delirium is associated with TLD in hospitalized patients.

Objective: to compare the proportion of patients with at least one TLD order between delirium and non-delirium patients, to describe factors associated with TLD orders, and to explore the association between TLD, delirium and the 90-day risk of death or hospital readmission.

Method: All patients admitted to internal medicine at a single hospital between November 2019 and January 2020 had a formal delirium assessment with a neuropsychologist within 48 h of hospitalization. TLD orders, death at 90 days and readmission were recorded.

Results: 217 patients were included, of whom 119 (54.9%) had a "do not resuscitated" order, 107 (49.3%) had a "do not intubate" order and 77 (35.5%) had a "do not admit to intensive care unit" order. Age, Charlson comorbidity index, cognitive impairment, kidney failure, antidepressant or neuroleptics use, and malnutrition were associated with TLD orders. The presence of at least one TLD order was more common in patients with delirium (24/32 patients, 77.4%) than in patients without delirium (95/185 patients, 51.1%, OR = 3.3 (95%CI: 1.3-8.0); p < 0.01). This association was not significant in the adjusted model (aOR = 2.0; 95%CI: 0.7-5.6; p = 0.20). A TLD order (aHR = 1.8; 95%CI:1.1-3.0.1.0) and delirium (aHR = 1.8; 95%CI:1.1-3.1) were both associated with 90-day hospital readmission or death.

Conclusions: Patients diagnosed with delirium within 48 h of admission have frequent treatment limitations orders, but the association faints after accounting for comorbidities.