BMC Medical Ethics最新文献

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.

Background: People involved in co-creation act as embedded moral agents as they bear a relational responsibility. The approaches taken or decisions made by individuals when facing ethical challenges during co-creation have important ethical ramifications for the process. Literature in the field of co-creation lacks an in-depth and systematic exploration of individual responses and reasoning that shape ethical decision-making. The current scoping review aims to identify authors' responses and related moral reasoning as reported within the academic literature, to the ethical challenges encountered during co-creation for health promotion.

Methods: A scoping review was conducted to identify articles that reflected on ethical challenges encountered during co-creation. Fifteen scientific articles were included following the title, abstract and full-text screening. Subsequently, a qualitative interpretative analysis was performed to extract and link the following data items: ethical challenge, response and (moral) reasoning. The resulting coding schemes, consultation with ethicists and researcher memos contributed to the synthesis of the results.

Results: Integrating discussions throughout co-creation in combination with adopting a flexible attitude and communicating expectations were frequently reported responses. Institutional procedures and pragmatic considerations influenced responses greatly. Moral reasoning was partly shaped by principles of co-creation, normative ethical frameworks and, personal moral codes, values and perceptions.

Conclusions: Academic authors' responses to ethical challenges in co-creation were largely influenced by their intention or willingness to adhere to the principles of research integrity within this context. Ethical frameworks like the ethics of care and public health ethics provided guidance, though some authors did not explicitly engage with these frameworks, suggesting a disconnect between theory and practice. An extensive description of authors' moral reasoning remains absent. Future research might consider performing meta-ethnographies to account for more detailed information about moral reasoning in responding to ethically challenging situations in co-creation for health promotion.

Introduction: The overall goal of intensive care treatment is to ensure patients return to an acceptable functional state, and, the decision-making in administering life-sustaining treatment (LST) is a key determinant of patients' survival in intensive care units (ICUs). We explored the decision-making experiences and practices of healthcare providers (HCPs) regarding their use of LST in ICUs in Uganda.

Methodology: This was a phenomenological study, conducted in ICUs of a public and private hospital in Uganda's capital Kampala. Twenty in-depth interviews were conducted with purposively selected clinicians involved in making decisions regarding providing LST in both hospitals. Data were thematically analysed using NVivo software, series 1.0.

Results: We found that, clinicians' decision-making for administering LST followed a thorough assessment of the patient's condition and engaged the patient's family in the process. However, some dilemmas arose when the intensivists and the patient's family disagreed on treatment decisions and in dealing with advanced directives. There were no standard guidelines followed while deciding on LST in the ICUs. The decisions to withdraw or withhold LST were influenced by; financial capacity of the patient's family, resource capacity of the hospital, the status of clinical examination, the patient's age characteristic.

Conclusion and recommendations: Whereas some clinicians' practices were based on internationally recommended clinical ethical conduct such as engaging the patient's family in decision-making, the lack of national and/or institutional standard processes that guide decision-making remains a challenge. Establishing structured and functional clinical ethics committees, treatment guidelines or protocols could guide decision-making and improve the survival of patients in these ICUs.

Objective: According to legal and ethical obligations, patients must be thoroughly informed about the trial in which they could enrol, requiring them to consider and digest a significant amount of complex information. Many cancer patients feel overwhelmed which hinders their ability to make informed decision regarding their care. There is a need for further evidence-based strategies on how to improve both physician-patient-communication and informed consent (IC) documents in this area. We explored the views of experts from various disciplines on communication in IC processes in oncology.

Methods: Seventeen semi-structured interviews with multidisciplinary experts were conducted and analysed using framework analysis.

Results: Several experts stated that IC documents have become highly legalistic, often prioritizing the interests of sponsors and further institutions involved over patient understanding. IC conversations are considered essential, as many patients do not thoroughly read IC documents. Conducting an unbiased IC conversation in an understandable manner may be challenging for physicians because they often have vested interests in recruiting patients for trials. Introducing evidence-based checklists for IC conversations and involving nursing staff may assist in addressing practical issues patients may have, reduce anxiety, and increase consent rates. Strategies to improve IC documents include reducing potentially irrelevant information (e.g., on contraception), improving the adaptation of international consent forms to local settings and incorporating graphical abstracts and study flowcharts to offer brief and visually engaging summaries. Additionally, fostering open dialogue and involvement of all relevant stakeholders (including patient representatives from various sociodemographic backgrounds) in designing IC documents may enhance IC processes. Many experts expressed the need for further research on the needs of different target groups, such as individuals with a migrant background or visual or other impairments.

Conclusions: There is a significant gap between legal and ethical obligations related to IC and patients not being able to understand the abundance of unfamiliar, complex information provided to them. Evidence-based IC checklists, involving nursing staff and improved written IC materials may help improve communication in this area. Further interventional research is required to IC processes in oncology with the aim to provide optimal, patient-centred care.