Natalie L Clark, Dorothy Coe, Natasha Newell, Mark N A Jones, Matthew Robb, David Reaich, Caroline Wroe
BACKGROUND: In May 2020, England moved to an opt-out organ donation system, meaning adults are presumed to be an organ donor unless within an excluded group or have opted-out. This change aims to improve organ donation rates following brain or circulatory death. Healthcare staff in the UK are supportive of organ donation, however, both healthcare staff and the public have raised concerns and ethical issues regarding the change. The #options survey was completed by NHS organisations with the aim of understanding awareness and support of the change...
April 20, 2024: BMC Medical Ethics
James Shaw, Joseph Ali, Caesar A Atuire, Phaik Yeong Cheah, Armando Guio Español, Judy Wawira Gichoya, Adrienne Hunt, Daudi Jjingo, Katherine Littler, Daniela Paolotti, Effy Vayena
BACKGROUND: The ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice. In this paper we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022. METHODS: The GFBR is an annual meeting organized by the World Health Organization and supported by the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council (MRC) and the South African MRC...
April 18, 2024: BMC Medical Ethics
Pamela Roach, Shannon M Ruzycki, Kirstie C Lithgow, Chanda R McFadden, Adrian Chikwanha, Jayna Holroyd-Leduc, Cheryl Barnabe
BACKGROUND: Despite decades of anti-racism and equity, diversity, and inclusion (EDI) interventions in academic medicine, medical racism continues to harm patients and healthcare providers. We sought to deeply explore experiences and beliefs about medical racism among academic clinicians to understand the drivers of persistent medical racism and to inform intervention design. METHODS: We interviewed academically-affiliated clinicians with any racial identity from the Departments of Family Medicine, Cardiac Sciences, Emergency Medicine, and Medicine to understand their experiences and perceptions of medical racism...
April 15, 2024: BMC Medical Ethics
Amélie Cambriel, Kevin Serey, Adrien Pollina-Bachellerie, Mathilde Cancel, Morgan Michalet, Jacques-Olivier Bay, Carole Bouleuc, Jean-Pierre Lotz, Francois Philippart
BACKGROUND: The often poor prognosis associated with cancer necessitates empowering patients to express their care preferences. Yet, the prevalence of Advance Directives (AD) among oncology patients remains low. This study investigated oncologists' perspectives on the interests and challenges associated with implementing AD. METHODS: A French national online survey targeting hospital-based oncologists explored five areas: AD information, writing support, AD usage, personal perceptions of AD's importance, and respondent's profile...
April 10, 2024: BMC Medical Ethics
Sophie C Renckens, Bregje D Onwuteaka-Philipsen, Agnes van der Heide, H Roeline Pasman
BACKGROUND: Relatives have no formal position in the practice of euthanasia and physician-assisted suicide (EAS) according to Dutch legislation. However, research shows that physicians often involve relatives in EAS decision-making. It remains unclear why physicians do (not) want to involve relatives. Therefore, we examined how many physicians in the Netherlands involve relatives in EAS decision-making and explored reasons for (not) involving relatives and what involvement entails. METHODS: In a mixed-methods study, 746 physicians (33% response rate) completed a questionnaire, and 20 were interviewed...
April 5, 2024: BMC Medical Ethics
Menno T Maris, Ayca Koçar, Dick L Willems, Jeannette Pols, Hanno L Tan, Georg L Lindinger, Marieke A R Bak
BACKGROUND: The emergence of artificial intelligence (AI) in medicine has prompted the development of numerous ethical guidelines, while the involvement of patients in the creation of these documents lags behind. As part of the European PROFID project we explore patient perspectives on the ethical implications of AI in care for patients at increased risk of sudden cardiac death (SCD). AIM: Explore perspectives of patients on the ethical use of AI, particularly in clinical decision-making regarding the implantation of an implantable cardioverter-defibrillator (ICD)...
April 4, 2024: BMC Medical Ethics
João Carlos Macedo, Luísa Castro, Rui Nunes
BACKGROUND: Advance directives (ADs) were implemented in Portugal in 2012. Although more than a decade has passed since Law 25/2012 came into force, Portuguese people have very low levels of adherence. In this context, this study aimed to identify and analyse the attitudes of people aged 18 or older living in Portugal towards ADs and to determine the relationships between sociodemographic variables (gender/marital status/religion/level of education/residence/whether they were a health professional/whether they had already drawn up a living will) and people's attitudes towards ADs...
April 3, 2024: BMC Medical Ethics
Eloy Girela-Lopez, Cristina M Beltran-Aroca, Jaime Boceta-Osuna, Dolores Aguilera-Lopez, Alejandro Gomez-Carranza, Manuel Lopez-Valero, Manuel Romero-Saldaña
BACKGROUND: Moral distress (MD) is the psychological damage caused when people are forced to witness or carry out actions which go against their fundamental moral values. The main objective was to evaluate the prevalence and predictive factors associated with MD among health professionals during the pandemic and to determine its causes. METHODS: A regional, observational and cross-sectional study in a sample of 566 professionals from the Public Health Service of Andalusia (68...
April 3, 2024: BMC Medical Ethics
Sofia B Fernandez, Alya Ahmad, Mary Catherine Beach, Melissa K Ward, Michele Jean-Gilles, Gladys Ibañez, Robert Ladner, Mary Jo Trepka
BACKGROUND: Respect is essential to providing high quality healthcare, particularly for groups that are historically marginalized and stigmatized. While ethical principles taught to health professionals focus on patient autonomy as the object of respect for persons, limited studies explore patients' views of respect. The purpose of this study was to explore the perspectives of a multiculturally diverse group of low-income women living with HIV (WLH) regarding their experience of respect from their medical physicians...
March 27, 2024: BMC Medical Ethics
Rik R van der Linden, Maartje H N Schermer
In line with recent proposals for experimental philosophy and philosophy of science in practice, we propose that the philosophy of medicine could benefit from incorporating empirical research, just as bioethics has. In this paper, we therefore take first steps towards the development of an empirical philosophy of medicine, that includes investigating practical and moral dimensions. This qualitative study gives insight into the views and experiences of a group of various medical professionals and patient representatives regarding the conceptualization of health and disease concepts in practice and the possible problems that surround them...
March 27, 2024: BMC Medical Ethics
Pierre-Marie David, Kayley Laura Lata, Marie-Eve Bouthillier, Jean-Christophe Bélisle-Pipon
Drug exceptional access programs (DEAPs) exist across Canada to address gaps in access to pharmaceuticals. These programs circumvent standard procedures, raising epistemic, economic, social and political issues. This commentary provides insights into these issues by revealing the context and procedures on which these programs depend.
March 26, 2024: BMC Medical Ethics
Berit H Bringedal, Karin Isaksson Rø
BACKGROUND: Whether patients' life-style should involve lower priority for treatment is a controversial question in bioethics. Less is known about clinicians' views. AIM: To study how clinical doctors' attitudes to questions of patient responsibility and priority vary over time. METHOD: Surveys of doctors in Norway in 2008, 2014, 2021. Questionnaires included statements about patients' lifestyle's significance for priority to care, and vignettes of priority cases (only in 2014)...
March 25, 2024: BMC Medical Ethics
Hamideh Mahdiani, Nikolai Münch, Norbert W Paul
Despite clinical evidence of drug superiority, therapeutic modalities, like combination immunotherapy, are mostly considered cost-ineffective due to their high costs per life year(s) gained. This paper, taking an ethical stand, reevaluates the standard cost-effectiveness analysis with that of the more recent justice-enhanced methods and concludes by pointing out the shortcomings of the current methodologies.
March 23, 2024: BMC Medical Ethics
Hilary Bowman-Smart, Adeline Perrot, Ruth Horn
BACKGROUND: Non-invasive prenatal testing (NIPT), which can screen for aneuploidies such as trisomy 21, is being implemented in several public healthcare systems across Europe. Comprehensive communication and information have been highlighted in the literature as important elements in supporting women's reproductive decision-making and addressing relevant ethical concerns such as routinisation. Countries such as England and France are adopting broadly similar implementation models, offering NIPT for pregnancies with high aneuploidy probability...
March 21, 2024: BMC Medical Ethics
Ibtissam El Harch, Soumaya Benmaamar, Nabil Tachfouti, Moustapha Hida, Mohammed Faouzi Belahsen, Tarik Sqalli Houssaini, Karima El Rhazi
BACKGROUND: In Morocco, medical research ethics training was integrated into the medical curriculum during the 2015 reform. In the same year, a law on medical research ethics was enacted to protect individuals participating in medical research. These improvements, whether in the reform or in the enactment of the law, could positively impact the knowledge of these researchers and, consequently, their attitudes and practices regarding medical research ethics. The main objective of this work is to assess Moroccan physicians' knowledge, attitudes, and practices at the beginning of their careers (interns and residents) in medical research ethics...
March 20, 2024: BMC Medical Ethics
Claudia Calderon Ramirez, Yanick Farmer, Andrea Frolic, Gina Bravo, Nathalie Orr Gaucher, Antoine Payot, Lucie Opatrny, Diane Poirier, Joseph Dahine, Audrey L'Espérance, James Downar, Peter Tanuseputro, Louis-Martin Rousseau, Vincent Dumez, Annie Descôteaux, Clara Dallaire, Karell Laporte, Marie-Eve Bouthillier
BACKGROUND: The prioritization protocols for accessing adult critical care in the extreme pandemic context contain tiebreaker criteria to facilitate decision-making in the allocation of resources between patients with a similar survival prognosis. Besides being controversial, little is known about the public acceptability of these tiebreakers. In order to better understand the public opinion, Quebec and Ontario's protocols were presented to the public in a democratic deliberation during the summer of 2022...
March 19, 2024: BMC Medical Ethics
Natalia V Lewis, Beatriz Kalichman, Yuri Nishijima Azeredo, Loraine J Bacchus, Ana Flavia d'Oliveira
BACKGROUND: Studying global health problems requires international multidisciplinary teams. Such multidisciplinarity and multiculturalism create challenges in adhering to a set of ethical principles across different country contexts. Our group on health system responses to violence against women (VAW) included two universities in a European high-income country (HIC) and four universities in low-and middle-income countries (LMICs). This study aimed to investigate professional and policy perspectives on the types, causes of, and solutions to ethical challenges specific to the ethics approval stage of the global research projects on health system responses to VAW...
March 19, 2024: BMC Medical Ethics
Poovishnu Devi Thangavelu, Balamurugan Janakiraman, Renuka Pawar, Pravin H Shingare, Suresh Bhosale, Russel D Souza, Ivone Duarte, Rui Nunes
BACKGROUND: The field of bioethics examines the moral and ethical dilemmas that arise in the biological sciences, healthcare, and medical practices. There has been a rise in medical negligence cases, complaints against healthcare workers, and public dissatisfaction with healthcare professionals, according to reports from the Indian Medical Council and other healthcare associations. We intend to assess the level of knowledge, attitude, and practice of bioethics among the registered healthcare professionals (HCPs) of Maharashtra, India...
March 18, 2024: BMC Medical Ethics
Masunga K Iseselo, Edith A M Tarimo
BACKGROUND: Informed consent as stipulated in regulatory human research guidelines requires volunteers to be well-informed about what will happen to them in a trial. However, researchers may be faced with the challenge of how to ensure that a volunteer agreeing to take part in a clinical trial is truly informed. This study aimed to find out volunteers' comprehension of informed consent and voluntary participation in Human Immunodeficiency Virus (HIV) clinical trials during the registration cohort...
March 13, 2024: BMC Medical Ethics
Victoria Charlton, Michael DiStefano
BACKGROUND: As the UK's main healthcare priority-setter, the National Institute for Health and Care Excellence (NICE) has good reason to want to demonstrate that its decisions are morally justified. In doing so, it has tended to rely on the moral plausibility of its principle of cost-effectiveness and the assertion that it has adopted a fair procedure. But neither approach provides wholly satisfactory grounds for morally defending NICE's decisions. In this study we adopt a complementary approach, based on the proposition that a priority-setter's claim to moral justification can be assessed, in part, based on the coherence of its approach and that the reliability of any such claim is undermined by the presence of dissonance within its moral system...
March 6, 2024: BMC Medical Ethics
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