BMC Medical Ethics最新文献

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.

Background: Lately, the misconduct in research among scientist has been escalating. The use of artificial intelligence has been converted in a double ace card, on one side it has simplificated the way of obtaining valious data for researchers in an easy way, but in the other hand, has promoted that researchers became careless about the scientific method. This situation has become a problem among university teachers since the students are tempt to obtain results in an easy way, leaving ethics aside. The objective of the study was to determine the knowledge and practices regarding scientific integrity among university students in Peru.

Methods: A descriptive cross-sectional quantitative study was conducted, applying a validated survey on knowledge and practices regarding scientific integrity to 1,420 university students in the Southern Region of Peru, with 60.85% being women. The questionnaire consisted of 21 questions, and data were analysed using descriptive and inferential statistics. Robust statistics were applied, and comparisons were made based on gender, age, and region. Ages ranged from 17 to 29 years (M = 21.14, SD = 2.72).

Results: The majority demonstrated high levels of knowledge and regular levels of practices regarding scientific integrity. Statistically significant differences were found based on gender (women > men), age (older than 23 years > younger than 22 years), and region. Inappropriate practices were identified in the use of artificial intelligence in academic work.

Conclusions: It was concluded that university students have high levels of knowledge regarding scientific integrity; however, they exhibit regular and low levels of application in research projects.

Background: Congenital heart defects (CHD) are a significant cause of prenatal and postnatal morbidity and mortality, leading to complex ethical and moral decisions for parents when diagnosed in utero. The decision to continue or terminate a pregnancy after a CHD diagnosis involves multifaceted considerations, including cultural, religious, and personal values, alongside medical, ethical, and socioeconomic factors. This systematic review delves into the multifaceted moral considerations involved in the decision-making process regarding continuing a pregnancy following a CHD diagnosis.

Methods: A systematic review of the literature was conducted using a narrative synthesis approach. Peer-reviewed qualitative, quantitative, and mixed-methods studies addressing ethical issues related to parental decision-making and clinical care following a prenatal CHD diagnosis were included. A comprehensive search was performed across multiple databases: MEDLINE, PsycINFO, Scopus, Web of Science (WOS), CINAHL, ProQuest, ERIC, and Embase. Findings were synthesized thematically to identify key ethical tensions, factors contributing to moral complexity, challenges faced by parents and healthcare providers, and supportive strategies.

Results: The synthesis of 25 studies from North America, Europe, Australia, and the Middle East (Iran) revealed a universal parental experience of acute psychological crisis following a prenatal diagnosis of CHD. However, the ethical frameworks guiding parental decision-making were highly context-dependent. Three overarching themes emerged: (1) a central ethical tension between the sanctity of life and the quality of life, with perspectives strongly shaped by religious beliefs, legal statutes, and cultural norms; (2) The Lived Experience of the Decision-Making Crisis; and (3) Strategies for Navigating the Ethical Terrain.

Conclusion: A prenatal CHD diagnosis initiates a profound moral journey for parents that extends far beyond a medical decision. The resulting psychological crisis-driven by the tension between sanctity and quality of life-underscores the need for a shift in clinical practice. Evidence supports the adoption of a holistic, multidisciplinary framework grounded in cultural sensitivity and empathetic communication to empower parents in making value-congruent choices during one of life's most difficult experiences.

Background: The debate over legalising assisted dying is complex and multifaceted, eliciting strong and diverse opinions from all involved parties. Recently, the Scottish Parliament held an initial vote on the issue, opting to progress with proposed legislation. Hearing the perspectives of medical students, as future clinicians, is crucial when considering new medico-legal developments in assisted dying in Scotland. This study aimed to explore and examine medical students' views on assisted dying in Scotland and the specific provisions of the proposed Scottish legislation.

Methods: An online survey was distributed to students at the Scottish medical schools between October 2023 and January 2024. Participants were invited to respond to closed, quantitative questions, designed to assess specific attitudes towards the proposed legislation, followed by optional free-text fields for participants to provide qualitative explanations for their answers. These free-text responses were subsequently subjected to thematic analysis.

Results: A total of 295 students responded to the survey. The majority of respondents were in favour of the legalisation of assisted dying in Scotland (72.4%); however, only 48.5% of respondents thought that assisted dying should be introduced into Scottish legislation as proposed in the current bill. Additionally, 23.4% of respondents indicated they would conscientiously object to participation in the process. A significant number of respondents (n = 135) expressed concerns that the proposed safeguards were inappropriate or insufficient. Autonomy was the most cited medical ethics principle underpinning opinions, followed closely by non-maleficence.

Conclusions: The majority of respondents were in support of assisted dying, but a smaller proportion felt the current proposed bill should be implemented, due to different interpretations of the suitability of proposed safeguards. A significant portion of respondents' perspectives were based on information from their previous training and experience within healthcare. Other perspectives mirrored wider public opinion on end-of-life care and assisted dying principles. While a majority of respondents favour legalising assisted dying in Scotland, significant concerns remain regarding the specific provisions of the proposed bill, highlighting the complex and ethically charged nature of this issue. Key stakeholders and policymakers should actively involve medical students, as future medical practitioners, in the assisted dying discussion to help guide legislation and research.

Background: The bioethical principle of respect for patients' autonomy should be implemented in every area of health care. The German rehabilitation system has some characteristics (e.g. the prevalence of inpatient rehabilitation) that make the topic particularly relevant. The aim of the study is to determine the current state of respecting patient autonomy in inpatient medical rehabilitation in Germany and to identify barriers and promoting factors from the perspective of relevant groups.

Methods: A multi-center, prospective, cross-sectional study is being conducted, including interviews with patients (n = 24), interviews with professionals (n = 21) and a survey of medical directors (n = 900). The empirical findings are then reviewed in three validation workshops. In addition, consensus recommendations for practice are derived by means of a Delphi process with experts (n = 30).

Discussion: This study will address an important gap in the empirical literature by identifying the current state and needs of patients, professionals and medical directors of rehabilitation clinics regarding the practice of respecting patient autonomy in inpatient medical rehabilitation in Germany. It is expected that the results can contribute to coming closer to the ideal of respect for patient autonomy in rehabilitation practice.

Trial registration: The study was registered with the German Clinical Trials Registry (ID: DRKS00035893).

Background: As large language models (LLMs) evolve, assessing their competence in ethically sensitive domains such as medical ethics has become increasingly important. Since medical ethics is a universal component of medical education, disparities in AI performance across languages may result in unequal benefits for learners. Therefore, it is essential to examine performances in non-English contexts. While previous studies have evaluated performance of Chat Generative Pre-trained Transformer(ChatGPT) on English-language multiple-choice questions (MCQs) in medical ethics, none have examined version-based improvements across non-English contexts. This study therefore evaluated ChatGPT versions 3.5, 4.0, and 4.5 for MCQs on Korean medical ethics and their English translations, with a focus on performance trends across versions and languages.

Methods: We selected 36 MCQs from the Korean National Medical Licensing Examination and the Comprehensive Clinical Medicine Evaluation databases. Each question was entered ten times per ChatGPT version (3.5, 4.0, 4.5) and language (Korean, English) for a total of 60 trials. Additionally, to assess the model's capacity to identify the ethical core without relying on the options provided, 31 of the 36 questions were modified by masking the correct choice. Accuracy was analyzed using independent sample t-tests and Mann Whitney U test, and consistency was assessed using Krippendorff's alpha.

Results: Overall, the accuracy and consistency of ChatGPT improved with each version. Version 4.5 achieved near-perfect scores and high reliability in both languages, while version 3.5 showed limited performance, particularly in the Korean test. Performance gaps between languages decreased with model upgrades but remained statistically significant in version 4.5 for some questions. In the masked-answer condition, all versions showed notable drops in accuracy and consistency, with version 4.5 still outperforming earlier versions. However, the performance remained below 50%, indicating limitations in the model's autonomous ethical reasoning.

Conclusions: ChatGPT demonstrated substantial improvements in medical ethics MCQ performance across versions, particularly in terms of consistency and accuracy. However, performance disparities between languages and reduced accuracy under masked answer conditions highlight the ongoing limitations of non-English ethical reasoning and context recognition. These findings emphasize the need for further research on language-sensitive fine-tuning and the evaluation of LLMs in specialized ethical domains. The findings suggest that advanced LLMs may serve as valuable supplementary tools in medical education and clinical ethics training. At the same time, the observed language disparities call for context-sensitive adaptations to prevent inequities in practice.

Background: The aging population and advancements in medical technology have intensified the emotional complexities faced by physicians and nurses in making decisions regarding life-sustaining treatment (LST).

Aim: This study explores healthcare professionals' emotional and cognitive experiences in decisions to withdraw LST for ICU patients, identifies the factors influencing such decisions, and provides evidence-based recommendations to enhance their effective involvement in end-of-life decision-making. By addressing key challenges in this process, the findings aim to offer actionable insights and practical guidance for medical practitioners, policymakers, and healthcare institutions, particularly within the Chinese cultural context, to improve patient-centered care in end-of-life scenarios. A phenomenological qualitative approach was employed, utilizing convenience sampling of ten nurses and ten physicians from a tertiary ICU in China. Participants engaged in face-to-face, semi-structured interviews, which were transcribed verbatim and analyzed using Colaizzi's method to identify and code themes.

Findings: Healthcare professionals' experiences in withdrawing LST for ICU patients were classified into three primary themes and eight subthemes: perceptions of LST (professional and humanitarian perspectives); factors influencing decision-making (personal factors of healthcare professionals, family and societal culture, lack of preparedness, and ethical dilemmas); and differing viewpoints of nurses and physicians regarding the execution of LST.

Conclusion: The decision to withdraw LST presents multifaceted challenges, including conflicts arising from personal and professional differences among healthcare providers and the emotional complexities intrinsic to the process. Nurses, often constrained by clinical hierarchies and professional limitations, frequently have minimal influence in decision-making teams. Furthermore, communication between healthcare professionals and patients remains insufficient. To enhance the efficacy of decision-making in end-of-life care, improving interdisciplinary collaboration and fostering patient-centered trust are critical.