BMC Medical Ethics最新文献

Background: Scientific research projects involving animals are required to undergo ethical evaluation, generally known as harm-benefit analysis (HBA), to ensure that they address important ethical concerns related to animal welfare and the scientific quality of the research to maximize the likelihood of their potential benefits. Research continuously shows the challenges encountered by decision-makers, prompting researchers to review how HBA is conducted and to propose tools to aid decision-making. However, the extent to which such resources are currently available, their jurisdictions of applicability, and how they guide decision-making are not entirely clear.

Method: Through a Scoping Review methodology, a systematic literature search was conducted in PubMed, Scopus and Web of Science for publications in Europe and North America (USA and Canada) from 1985 to 2023. Title and abstract, full-text, and reference screenings, followed by data charting, respectively, were carried out for retrieved publications using pre-developed and registered review protocol.

Results: 17 resources that can guide HBA and decision-making were identified. They discussed what should constitute harm to animals and benefits of research, and how these two interests can be balanced to make a decision. Some adopt mathematical calculations, some propose guidelines for committee discussions, while others propose the combination of different approaches to decision-making.

Conclusions: Decision-making based on deliberation among committee members should be supported over the use of scoring approaches. Additionally, making ethical decisions on a case-by-case basis is preferable to accuracy, which may not be realistically practicable.

Background: Code status determination typically relies on the expected benefits and harms of treatment intensification and patient values and preferences. Resource availability may also influence code status decisions. During the COVID-19 pandemic, the demand for critical care often exceeded the available resources. This study investigated the association between critical care occupancy and code status decisions during the COVID-19 pandemic.

Methods: We conducted a retrospective cohort study of adult patients hospitalized at Geneva University Hospital for acute COVID-19-related illness during two successive pandemic waves, in spring and autumn 2020. Multivariable logistic regression was used to analyze the association between critical care occupancy at admission and code status attribution while accounting for clinical and demographic characteristics, including age, sex, ROX index (pulse oximetry/fraction of inspired oxygen/respiratory rate), comorbidities, malignancy, nationality, insurance, and socioeconomic status.

Results: A total of 2,122 patients were included in the analysis. Higher critical care occupancy was associated with an increased likelihood of being assigned an intensive care unit (ICU)-ineligible code status. The odds ratios (ORs) were 1.61 (95% CI 1.11-2.32), 1.59 (1.11-2.28) and 1.71 (1.06-2.76) for critical care occupancy levels of 100-119%, 120-139% and ≥ 140%, respectively, compared with the prepandemic baseline capacity. Other factors significantly associated with the assignment of an ICU-ineligible code status included age 70-79 years (OR 8.56; 95% CI 4.12-17.77), 80-89 years (OR 32.78; 95% CI 16.16-66.50) and ≥90 years (OR 49.04; 95% CI 23.05-104.31) and a higher comorbidity index (OR 1.22; 95% CI 1.07-1.39). Conversely, complementary hospitalization insurance was associated with lower odds of being assigned an ICU-ineligible code status (OR 0.52; 95% CI 0.29-0.92).

Conclusions: Our study revealed a positive association between critical care occupancy and ICU-ineligible code status, suggesting the presence of implicit triaging during periods of high resource strain. This raises several ethical concerns, including the use of non-consensual triage criteria, lack of transparency and the risk of moral distress for healthcare professionals.

Background and objective: In German healthcare, the colloquial term "Morbus Mediterraneus" is often used to dismiss pain complaints from racialized patients-particularly women of Mediterranean or non-White backgrounds-as exaggerated or dramatized. Although this label has no scientific basis, it perpetuates biased assumptions that lead to serious consequences, including undertreatment, misdiagnoses, and loss of trust in medical institutions. This paper provides a conceptual and literature-based analysis of how "Morbus Mediterraneus" reflects broader racist beliefs about pain tolerance, rooted in both colonial history and cultural norms in Germany.

Methodology: This is a conceptual study drawing on previously published qualitative findings, historical records, and contemporary literature regarding racism, pain perception, and healthcare disparities. We review how confusion around racial terminology in German discourse impedes recognition and measurement of systemic racism. We integrate scholarship from critical race theory, intersectionality, and structural competence to highlight the deep-seated impact of racial biases on clinical decision-making.

Results: Our analysis shows that "Morbus Mediterraneus" arises from a longstanding pattern of racialized medicine, where factors such as colonial research abuses, cultural misinterpretations of pain expression, and implicit provider biases converge. These biases systematically devalue the pain of racialized patients, especially women, and undermine patient-provider trust. Furthermore, we identify how gendered and racial stereotypes about emotional display and stoicism compound to create unique barriers to proper pain management.

Conclusions: Confronting biases tied to "Morbus Mediterraneus" requires integrated reforms across medical education, clinical practice, and policy. We recommend mandatory anti-racism and structural competence training, greater racial diversity among healthcare workers, standardized pain-assessment protocols, and improved data collection on race and ethnicity. By acknowledging colonial legacies and cultural norms that shape pain perception, German healthcare can better address systemic racism, ensure equitable pain management, and ultimately improve patient outcomes for all.

Background: Research ethics is crucial for protecting participants' rights in medical studies. Although several studies have explored general awareness and attitudes toward research ethics among medical students, few have systematically examined the behavioral determinants of adherence to Research Ethical Codes (REC) using established theoretical models. This study addresses this gap by identifying the determinants of REC adherence among students at Kermanshah University of Medical Sciences (KUMS), applying the Theory of Planned Behavior (TPB) as a conceptual framework.

Methods: A descriptive-analytical study was conducted in 2024 among KUMS students. A cluster sampling approach was used, with structured questionnaires distributed to gather data on demographics and TPB constructs. Data were analyzed using SPSS, employing Pearson correlation and linear regression analyses.

Results: The study included 271 participants with a mean age of 23.99 years. The adherence level to ethical codes was 69.1%. The adjusted R² value was 0.352, indicating that 35.2% of the variance in adherence to REC behavior was explained by the model. Notably, attitude (B = 0.694, p < 0.001) and intention (B = 0.857, p = 0.002) were significant predictors. The highest adherence was for confidentiality (mean score = 4.04), while the lowest was for obtaining ethical approval before data collection (mean score = 2.68).

Conclusions: The findings indicate a 69.1% adherence to ethical research codes, with attitude and intention identified as key predictors of ethical behavior. These results emphasize the importance of targeted educational strategies to strengthen students' commitment to ethical research practices.

Background: Predictive analytics and early warning systems are now widely used in nursing practice worldwide. While these tools can improve efficiency and patient safety, but at the same time posing ethical challenges related to data privacy, algorithmic fairness, accountability, professional autonomy, and patient rights. Through a systematic rapid review, we identify the major ethical risks in nursing contexts and propose actionable governance pathways to inform clinical practice and policy.

Methods: This study used a systematic rapid review, searching eight databases-PubMed, Embase, Web of Science, Scopus, Cochrane Library, Ovid, EBSCOhost, and ProQuest-for English-language articles published from 2015 through May 2025. Two reviewers independently screened records and extracted data, with a third reviewer resolving disagreements, yielding 22 included studies. Using inductive thematic analysis, we summarized the ethical-risk dimensions and governance pathways of predictive analytics and early warning systems in nursing practice, and conducted an overall quality appraisal of the included literature.

Results: The included studies came from 11 countries, with publication volume rising markedly in recent years-reflecting growing attention to ethical issues in nursing. Most were reviews or commentaries, with fewer qualitative and mixed-methods studies. Thematic analysis identified five ethical-risk dimensions: (i) Data- and Algorithm-Related Ethical Risks; (ii) Professional Role and Responsibility Attribution Risks; (iii) Patient Rights and Humane-Care Ethical Risks; (iv) Ethical-Governance and Misuse Risks; and (v) Technological Accessibility and Social Acceptance Barriers. In response, the literature proposes four governance pathways-Technical-Data Governance, Clinical Human-Machine Collaboration, Organizational-Capacity Building, and Institutional-Policy Regulation-with concrete measures including privacy protection, algorithmic-bias monitoring and fairness audits, transparency and explainability enhancement, nurse training and digital literacy, interdisciplinary collaboration and co-creation, and policy and regulatory guidelines.

Conclusions: Predictive analytics and early warning systems in nursing practice show substantial promise yet are accompanied by multidimensional ethical risks. For the first time in a nursing context, this study proposes a "five ethical-risk dimensions-four governance pathways" framework, offering actionable ethical-governance guidance for nurses, administrators, and policymakers. Future work should pursue interdisciplinary, multicenter empirical studies to evaluate the framework's feasibility and effectiveness and to align technological benefits with ethical values, thereby improving nursing quality and patient safety.

Background: As dementia progresses, individuals with Alzheimer's disease and related forms of dementia often lose decision-making capacity, raising complex ethical challenges related to autonomy, surrogate decision-making, dignity, privacy, and justice. This review examines the dilemmas in caring for patients who are no longer capable of providing informed consent, comparing Lebanon's situation with those of countries across the Global North and South, and proposes practical, culturally grounded recommendations for improvement.

Objective: To conduct a comprehensive thematic review comparing international practices with Lebanon's ethical, legal, and institutional approaches to caring for individuals with advanced dementia who lack capacity.

Methods: A systematic yet flexible review approach, guided by the PRISMA framework, was applied. Studies focusing on Alzheimer's disease and other related dementias were retrieved from PubMed, Scopus, PsycINFO, Web of Science, and the Cochrane Library up to April 2025. A total of 121 studies, including 112 international and 9 from Lebanon, met the inclusion criteria. These included qualitative, quantitative, and policy sources. Studies were thematically analyzed for ethical relevance across five themes.

Results: Five major ethical themes emerged: surrogate decision-making, patient autonomy, surveillance and technology, legal frameworks, and cultural and economic factors. A clear North-South divide was observed, with countries in the Global North generally relying on formal legal safeguards, advance directives, and structured institutional ethics oversight. In contrast, Lebanon and comparable countries in the Global South often operated with informal, family-centered models, limited legal clarity, and minimal institutional ethics support.

Conclusion: Lebanon reflects broader Global South patterns: strong familial caregiving traditions, but inadequate legal and institutional frameworks to ensure dignity-based, ethically consistent care. This review proposes culturally sensitive reforms in law, public education, and ethics infrastructure to better protect the rights and dignity of individuals with advanced dementia.