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Palliative medicine represents the holistic multiprofessional treatment of severely and incurably ill people and their relatives, addressing their complex physical, psychological, social and spiritual needs. The central therapeutic goals are the quality of life and alleviation of suffering. In the course of many neurological diseases, high symptom burden, long and variable trajectories and unfavorable prognosis at times create a need for palliative care even at an early stage, which is currently still inadequately met. This can be countered by qualified neuropalliative care. In addition to intensifying interdisciplinary collaboration, this requires neurologists to have core competencies in palliative care. These include a team-oriented attitude, communication skills, expertise in symptom control and knowledge of biomedical ethics including palliative options at the end of life. [ABSTRACT FROM AUTHOR]

Pro-life and pro-choice advocates battle for rational dominance in abortion debates. Yet, public polling (and general legal opinion) demonstrates the public's preference for the middle ground: that abortions are acceptable in certain circumstances and during early pregnancy. Implicit in this, are two contradictory intuitions: (1) that we were all early fetuses, and (2) abortion kills no one. To hold these positions together, Harman and Räsänen have argued for the Actual Future Principle (AFP) which distinguishes between fetuses that will develop into persons and those that will never develop into persons. However intellectually ingenious their solutions are, they fail to account for a third intuition: that the death of a wanted fetus – e.g. through termination or miscarriage – is of moral significance. Not only is this practically important, but it is also supported by public opinion. The authors of this paper argue that relational ontology can modify the AFP to better account for all three intuitions. Furthermore, it further emphasizes the pivotal role of the pregnant person who relates to their own fetus in either personal or impersonal ways. Addressing the fundamental challenges of relational ontology, the authors defend the position that human personal identity is ultimately relational. [ABSTRACT FROM AUTHOR]

With over 16 years of experience in clinical, research, and educational activities related to transcranial magnetic stimulation (TMS), I have written this article exploring the ethical dimensions of TMS. This article aims to provide valuable and informative content for those unfamiliar with TMS as well as those just starting in the field. Specifically, this article elaborates on four principles of medical ethics, including those applicable to TMS therapy, the disparity between public medical insurance coverage and medical indications in private practice for TMS therapy, and issues concerning research ethics in practice. I also provide recommendations regarding roles and strategies for adoption by academia and those in this field dedicated to making TMS therapy accessible to a larger patient population in a suitable manner. Lastly, it is my hope that this article will serve as a contemporary "Ethics of TMS Neuromodulation", resonating with the inherent human pursuit of "truth, goodness, and beauty" for a sound mind and spirit. [ABSTRACT FROM AUTHOR]

Abstract 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.

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. [ABSTRACT FROM AUTHOR]

Abstract Background In 1926, Fritz Jahr described bio-ethics (German: bio-ethik) as “the assumption of moral obligations not only towards humans, but towards all forms of life.” Jahr summarized his philosophy by declaring, “Respect every living being on principle as an end in itself and treat it, if possible, as such!.” Bioethics was thus originally an ethical system concerned with the “problems of interference with other living beings… and generally everything related to the balance of the ecosystem” according to the 1978 Encyclopedia of Bioethics. This definition was predicated on the work of Fritz Jahr, Menico Torchio, and Van Rensselaer Potter. Methods In order to proceed with depthful analysis of the origin and major bioethical flare up, we will use critical analysis of existing literature, followed by a study trip to relevant bioethical localities (collecting photo and other documentations regarding Menico Torchio). Results While Jahr and Potter are typically given intellectual credit for developing the field of bioethics, the eco-ethical contributions of Menico Torchio have been forgotten.This article will first trace the origins of “bioethics” – now commonly bifurcated into “biomedical ethics” and “environmental bioethics.” The former was developed by Tom Beauchamp from the Philosophy Department and James Childress of the Religious Studies department at Georgetown University and is based on principlism, with a narrow focus on medical settings. The latter addresses the environmental impact of the medical industry and climate change health hazards. Second, we will present a panorama of Torchio’s significant intellectual contribution to bioethics. Menico Torchio’s concept of bioethics synthesized work of both Jahr and Potter, advocating “the need to expand our ethical obligations and embrace the most developed groups of animals, not only physically but also psychologically.” Third, we will reflect on the lasting legacy of “bioethics” on biomedical and environmental bioethics today. Thematic elements such as interconnectedness of planetary health and human health, dedication to living in harmony with nature, and emphasis on systems and symbiosis remain unchanged from the legacy of Tochio onward. Conclusion Our conclusion will underscore the necessity of understanding the connections between planetary, environmental, and human health.

Background: In 1926, Fritz Jahr described bio-ethics (German: bio-ethik) as "the assumption of moral obligations not only towards humans, but towards all forms of life." Jahr summarized his philosophy by declaring, "Respect every living being on principle as an end in itself and treat it, if possible, as such!." Bioethics was thus originally an ethical system concerned with the "problems of interference with other living beings... and generally everything related to the balance of the ecosystem" according to the 1978 Encyclopedia of Bioethics. This definition was predicated on the work of Fritz Jahr, Menico Torchio, and Van Rensselaer Potter. Methods: In order to proceed with depthful analysis of the origin and major bioethical flare up, we will use critical analysis of existing literature, followed by a study trip to relevant bioethical localities (collecting photo and other documentations regarding Menico Torchio). Results: While Jahr and Potter are typically given intellectual credit for developing the field of bioethics, the eco-ethical contributions of Menico Torchio have been forgotten.This article will first trace the origins of "bioethics" – now commonly bifurcated into "biomedical ethics" and "environmental bioethics." The former was developed by Tom Beauchamp from the Philosophy Department and James Childress of the Religious Studies department at Georgetown University and is based on principlism, with a narrow focus on medical settings. The latter addresses the environmental impact of the medical industry and climate change health hazards. Second, we will present a panorama of Torchio's significant intellectual contribution to bioethics. Menico Torchio's concept of bioethics synthesized work of both Jahr and Potter, advocating "the need to expand our ethical obligations and embrace the most developed groups of animals, not only physically but also psychologically." Third, we will reflect on the lasting legacy of "bioethics" on biomedical and environmental bioethics today. Thematic elements such as interconnectedness of planetary health and human health, dedication to living in harmony with nature, and emphasis on systems and symbiosis remain unchanged from the legacy of Tochio onward. Conclusion: Our conclusion will underscore the necessity of understanding the connections between planetary, environmental, and human health. [ABSTRACT FROM AUTHOR]

Objective: Most deaths in Pediatric Intensive Care Units involve forgoing life-sustaining treatment. Such deaths required carefully planned end-of-life care built on compassion and focused on palliative care measures. This study aims to assess topics related to the end of life care in Brazilian pediatric intensive care units from the perspective of a multidisciplinary team. Method: The authors used a tested questionnaire, utilizing Likert-style and open-ended questions. After ethics committee approval, it was sent by email from September to November/2019 to three Pediatric Intensive Care Units in the South and Southeast of Brazil. One unit was exclusively dedicated to oncology patients; the others were mixed units. Results: From 144 surveys collected (23% response rate) 136 were analyzed, with 35% physicians, 30% nurses, 21% nurse technicians, and 14% physiotherapists responding. Overall, only 12% reported enough end-of-life care training and 40% reported never having had any, albeit this was not associated with the physician's confidence in forgoing life-sustaining treatment. Furthermore, 60% of physicians and 46% of other professionals were more comfortable with non-escalation than withdrawing therapies, even if this could prolong suffering. All physicians were uncomfortable with palliative extubation; 15% of all professionals have witnessed it. The oncologic team uniquely felt that “resistance from the teams of specialists” was the main barrier to end-of-life care implementation. Conclusion: Most professionals felt unprepared to forego life-sustaining treatment. Even for terminally ill patients, withholding is preferred over the withdrawal of treatment. Socio-cultural barriers and the lack of adequate training may be contributing to insecurity in the care of terminally ill patients, diverging from practices in other countries.

The Human Cell Atlas (HCA) is striving to build an open community that is inclusive of all researchers adhering to its principles and as open as possible with respect to data access and use. However, open data sharing can pose certain challenges. For instance, being a global initiative, the HCA must contend with a patchwork of local and regional privacy rules. A notable example is the implementation of the European Union General Data Protection Regulation (GDPR), which caused some concern in the biomedical and genomic data-sharing community. We examine how the HCA's large, international group of researchers is investing tremendous efforts into ensuring appropriate sharing of data. We describe the HCA's objectives and governance, how it defines open data sharing, and ethico-legal challenges encountered early in its development; in particular, we describe the challenges prompted by the GDPR. Finally, we broaden the discussion to address tools and strategies that can be used to address ethical data governance. [ABSTRACT FROM AUTHOR]

In this paper, I will examine the Supreme Court of the United States' (SCOTUS) arguments in the majority decision in Dobbs v. Jackson Women's Health Organization, and I will show how some of those arguments are flawed. Primarily, I will show that the right to bodily autonomy is a well-established right, both in the courts and in societal practices, and that the right to an abortion should be understood as an example of the right to bodily autonomy or bodily integrity. Second, I will examine the justices' arguments that viability is not a reasonable place to restrict abortion access, in contrast to both Roe v. Wade and Planned Parenthood v. Casey , and will offer arguments that defend viability as a valid point to limit abortion access. Third, I will highlight some politicians' goals to enact a federal ban on abortion, and show how the attempt to pass Personhood Amendments is a pathway for doing so. The upshot of this essay to is show how the SCOTUS decision is flawed, and how granting personhood to "potential life" has consequences that extend beyond abortion access. [ABSTRACT FROM AUTHOR]

Objective: Most deaths in Pediatric Intensive Care Units involve forgoing life-sustaining treatment. Such deaths required carefully planned end-of-life care built on compassion and focused on palliative care measures. This study aims to assess topics related to the end of life care in Brazilian pediatric intensive care units from the perspective of a multidisciplinary team. Method: The authors used a tested questionnaire, utilizing Likert-style and open-ended questions. After ethics committee approval, it was sent by email from September to November/2019 to three Pediatric Intensive Care Units in the South and Southeast of Brazil. One unit was exclusively dedicated to oncology patients; the others were mixed units. Results: From 144 surveys collected (23% response rate) 136 were analyzed, with 35% physicians, 30% nurses, 21% nurse technicians, and 14% physiotherapists responding. Overall, only 12% reported enough end-of-life care training and 40% reported never having had any, albeit this was not associated with the physician's confidence in forgoing life-sustaining treatment. Furthermore, 60% of physicians and 46% of other professionals were more comfortable with non-escalation than withdrawing therapies, even if this could prolong suffering. All physicians were uncomfortable with palliative extubation; 15% of all professionals have witnessed it. The oncologic team uniquely felt that “resistance from the teams of specialists” was the main barrier to end-of-life care implementation. Conclusion: Most professionals felt unprepared to forego life-sustaining treatment. Even for terminally ill patients, withholding is preferred over the withdrawal of treatment. Socio-cultural barriers and the lack of adequate training may be contributing to insecurity in the care of terminally ill patients, diverging from practices in other countries. [ABSTRACT FROM AUTHOR]

Abstract Background The worldwide increase in older persons demands technological solutions to combat the shortage of caregiving and to enable aging in place. Smart home health technologies (SHHTs) are promoted and implemented as a possible solution from an economic and practical perspective. However, ethical considerations are equally important and need to be investigated. Methods We conducted a systematic review according to the PRISMA guidelines to investigate if and how ethical questions are discussed in the field of SHHTs in caregiving for older persons. Results 156 peer-reviewed articles published in English, German and French were retrieved and analyzed across 10 electronic databases. Using narrative analysis, 7 ethical categories were mapped: privacy, autonomy, responsibility, human vs. artificial interactions, trust, ageism and stigma, and other concerns. Conclusion The findings of our systematic review show the (lack of) ethical consideration when it comes to the development and implementation of SHHTs for older persons. Our analysis is useful to promote careful ethical consideration when carrying out technology development, research and deployment to care for older persons. Registration We registered our systematic review in the PROSPERO network under CRD42021248543.

Urgency of the research. The last century was marked by globalization, the comprehensive integration of various human activity systems, and the formation of unified spaces, including those for information, communication, economics, etc. In response to civilizational challenges, humanity is acquiring the characteristics of a global moral subject. Global bioethics as a system of moral values and principles, a scientific interdisciplinary direction that combines natural and humanitarian sciences and strives to solve the global problems of humanity, is the most important element of a modern doctor’s worldview and, accordingly, an essential component of today’s educational environment. The European transformation vector of the higher education system chosen by Ukraine necessitates the development of new valuebased ethical dimensions, worldviewphilosophical and epistemological foundations of a modern university, one of which is a bioethical worldview. Target setting. Global bioethics, as a new interdisciplinary field of study, started to emerge in the 1970s of the 20th century at the nexus of the natural sciences and humanities. Its primary focus is on considering and resolving the complex ethical dilemmas of preserving an individual’s health and well-being as well as the wellbeing of humanity as a whole and the environment, first and foremost under the circumstances of intensive use of biomedical technologies. With the emergence of global challenges posing a threat to human civilization, there has been a need to increase the role of bioethical education and develop global dimensions of medical education. The modern model of bioethics as a scientific direction and academic discipline cannot be limited to purely medical issues and rely solely on the values of autonomy and freedom of choice of medical service consumers without taking into account humanity’s global ethical problems. In the face of global challenges to contemporary civilization, global bioethics has emerged as a new moral discourse that articulates the values of solidarity, justice, vulnerability, and biodiversity protection. Latest scientific studies and issues analysis. Among the scientists addressing the conceptual foundations of global bioethics are S. V. Pustovit, M. M. Kyseliov, T. V. Hardashuk, T. V. Mishatkina, T. M. Tsyrdia, V. R. Potter, T. Beauchamp and J. Childress, H. Ten Have, M. GailleNikodimov, D. C. Zanella, A. Sganzerla., and L. Pessini. Educational aspects of global bioethics, features off the modern educational environment and its challenges t have been highlighted in the studies of such scholars as V. P. Andrushchenko, A. V. Horpenko, O. P. Kyvliuk, S. V. Pustovit, T. V. Mishatkina, O. Y. Kubar, T. P. Artimonov, N. D. Kovalchuk, L. A. Ovsyankina, N. Ivanenko, and H. ten Have. A number of scientists, including S. Benataar, H. ten Have, B. Gordijn, E. D. Pellegrino & T. K. McElhinney, L. Gruen and W. Ruddick, A. Majumdar, P. Mishra & R. Kaur, А. Morales-González, etc., have devoted their publications to the substantiation of the role of global bioethics as an essential worldview, axiological, and epistemological component of medical education. The research objective. To explore the educational aspects of global bioethics (from traditional Hippocrates’ ethics to V.R. Potter’s global bioethics) - a scientific direction and academic discipline as a needed ideological, axiological and epistemological basis for the functioning of the contemporary medical education system. The statement of basic materials. The educational and sociocultural aspects of global bioethics as an ideological and scientific phenomenon have been addressed. A comparative analysis of two models of bioethics, including T. Bochamp and J. Childres’ biomedical ethics and V. R. Potter’s global bioethics, has been carried out from the point of view of the goals and objectives of the contemporary medical education system. Conclusions. The evolutionary development of medical ethics as an academic discipline and practice, from Hippocrates’ ethics to V.R. Potter’s global bioethics, has been analysed. It has been concluded that the modern model of bioethics cannot be limited to the principles of biomedical ethics, the consideration of purely medical issues, and reliance solely on the values of autonomy and freedom of choice of the individual as a consumer of medical services without taking into account the global bioethical problems of mankind. Global bioethics, as an ethics of respect for the autonomy, dignity, and life of all living beings, as a scientific interdisciplinary direction that unites the natural and human sciences and strives to solve the global problems of mankind, is becoming an essential element of a modern doctor’s worldview and, accordingly, an essential component of the contemporary educational environment. It has been shown that the development of international academic mobility, the migration of medical professionals, health tourism, the globalization of clinical research and biomedical technologies, and the expansion of the most contentious area of bioethics are all factors contributing to the global dimension of bioethical education. [ABSTRACT FROM AUTHOR]

Background: The worldwide increase in older persons demands technological solutions to combat the shortage of caregiving and to enable aging in place. Smart home health technologies (SHHTs) are promoted and implemented as a possible solution from an economic and practical perspective. However, ethical considerations are equally important and need to be investigated. Methods: We conducted a systematic review according to the PRISMA guidelines to investigate if and how ethical questions are discussed in the field of SHHTs in caregiving for older persons. Results: 156 peer-reviewed articles published in English, German and French were retrieved and analyzed across 10 electronic databases. Using narrative analysis, 7 ethical categories were mapped: privacy, autonomy, responsibility, human vs. artificial interactions, trust, ageism and stigma, and other concerns. Conclusion: The findings of our systematic review show the (lack of) ethical consideration when it comes to the development and implementation of SHHTs for older persons. Our analysis is useful to promote careful ethical consideration when carrying out technology development, research and deployment to care for older persons. Registration: We registered our systematic review in the PROSPERO network under CRD42021248543. [ABSTRACT FROM AUTHOR]

Michal Pruski and Richard C. Playford argue that if partial ectogenesis technology becomes available then it would undermine Judith Jarvis Thomson's defense of abortion. Thomson argues that even if a fetus has a right to life, this is not a positive right to be given whatever one needs to survive; it is not a right to use the mother's body or to risk her life without her permission. Pruski and Playford argue that when the risks involved in ectogenesis are comparable to those of abortion, then minimal decency requires gestational mothers to opt for ectogenesis over abortion. This argument hinges on egregious misunderstandings of (1) ectogenesis technology, (2) medical and surgical abortion, and (3) medical consent. [ABSTRACT FROM AUTHOR]

Purpose of Review: This review aims to analyze the evidence regarding the appropriateness of PEG placement in the following clinical situations: short bowel syndrome, head and neck cancer, dementia and palliative use in malignant bowel obstruction. Recent Findings: Percutaneous endoscopic gastrostomy (PEG) tubes are placed for a variety of clinical indications by numerous different specialties. First described in 1980, PEG tubes are now the dominant method of enteral access. Typically, PEG tubes are technically feasible procedures that can come with significant risk for both minor and major complications. Therefore, it is important to perform an in-depth, patient specific risk-benefit analysis when considering insertion. Summary: By analyzing the current evidence regarding benefits in these situations, superimposed by the lens of biomedical ethics, we make recommendations that are accessible to any provider who may be a consultant or proceduralist, helping to provide informed care that is in the patient's best interest. [ABSTRACT FROM AUTHOR]

ContextAlthough patient and physician characteristics are thought to be predictive of discretionary interventions at the end of life (EoL), few studies have data on both parties.ObjectiveTo test the hypothesis that patient preferences and physician attitudes are both independently associated with discretionary interventions at the EoL.MethodsWe report secondary analyses of data collected prospectively from physicians (n = 38) and patients with advanced cancer (n = 265) in the Values and Options in Cancer Care study. Predictor variables were patient attitudes toward EoL care and physician-reported comfort with medical paternalism, assessed indirectly using a modified version of the Control Preference Scale. We explored whether the magnitude of the physician variable was influenced by the inclusion of particular patient treatment-preference variables (i.e., effect modification). Outcomes were a chemotherapy use score (≤14 days before death [scored 2], 15-31 days before death [scored 1], and >31 days [scored 0]) and an emergency department visit/inpatient admission score (two or more admissions in the last 31 days [scored 2], one admission [1], and 0 admissions [0]) in the last month of life.ResultsChemotherapy scores were nearly 0.25 points higher if patients expressed a preference for experimental treatments with unknown benefit at study entry (0.238 points, 95% CI = 0.047-0.429) or reported an unfavorable attitude toward palliative care (0.247 points, 95% CI = 0.047-0.450). A two-standard deviation difference in physician comfort with medical paternalism corresponded to standardized effects of 0.35 (95% CI = 0.03-0.66) for chemotherapy and 0.33 (95% CI = 0.04-0.61) for emergency department visits/inpatient admissions. There was no evidence of effect modification.ConclusionPatient treatment preferences and physician attitudes are independently associated with higher levels of treatment intensity before death. Greater research, clinical, and policy attention to patient treatment preferences and physician comfort with medical paternalism might lead to improvements in care of patients with advanced disease.

This essay arises from the current state of the American medical system. Neither patients nor practitioners are satisfied. This essay focuses on an important source of discontent, the dependence on ethical principlism which is unsupported by a moral virtue. This ethical system is bounded by no recognition of telos of medicine and no articulation of how medicine can advance human flourishing. This essay explores how principlism, and autonomy in particular, attained a dominant stature, and how it damaged patient–practitioner relationships. This essay will conclude with a brief description about the potential benefits of covenantal relationships in medicine. [ABSTRACT FROM AUTHOR]

In the 60+ years that the modern concept of informed consent has been around, researchers in various fields of practice, especially medical ethics, have developed new models to overcome theoretical and practical problems. While (systematic) literature reviews of such models exist within given fields (e.g., genetic screening), this article breaks ground by analyzing academic literature on consent models across fields. Three electronic research databases (Scopus, Google Scholar, and Web of Science) were searched for publications mentioning informed consent models. The titles, abstracts, and if applicable, full publications were screened and coded. The resulting data on fields, models, and themes were then analyzed. We scanned 300 sources from three databases to find 207 uniquely named consent models, and created a network visualization displaying which models occur primarily in one field, and which models overlap between fields. This analysis identifies trends in the consent debate in different fields, as well as common goals of consent models. The most frequently occurring consent models are identified and defined. The analysis contributes toward a cross-disciplinary “consent design toolkit” and highlights that there are more interrelationships between models and fields than are acknowledged in the literature. Where some models are designed to solve distinctively field-specific issues and are specific to biomedical ethics, some may be adaptable and applicable for other fields including engineering and design. [ABSTRACT FROM AUTHOR]

This study aims at increasing our understanding of the research activities of Iranian researchers and institutions in the field of biomedical ethics from 1995 to 2015. A combination of bibliometrics and social network analysis was used to examine the bibliographic data of 580 documents published on Iranian biomedical ethics in Web of Science and Scopus databases to investigate the publication trend, scientific impact, subject keywords network, and social network analysis indicators for international and cross‐institutional co‐authorship networks. The results showed that the publication of documents has had a consistent and increasing growth and that the citation trend has grown along with it. The analysis of thematic clusters by keyword co‐occurrence network shows that Iranian biomedical ethics research has dealt with various topics and that has introduced different research directions. Researchers from 28 countries were identified in the international collaboration network. The main partners of Iranian researchers were from the US (17.8%) and the UK (9.2%). However, there is a tendency to develop and complete cooperation with researchers from different countries. The cross‐institutional collaboration network comprises of 63 institutes, of which Tehran University of Medical Sciences (38%), Shahid Beheshti University of Medical Sciences (11%) and Shiraz University of Medical Sciences (7%) have the largest share in publishing documents. The superiority of the first two universities based on centralization indicators in the cross‐institutional collaboration network has caused the exchange of cross‐network knowledge between and via these players. The network density indicator shows that almost half of the co‐authorship links within the international collaboration network and 8% of the co‐authorship links within the cross‐institutional collaboration network have been implemented and that these networks are not very coherent. [ABSTRACT FROM AUTHOR]

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The precision health era is likely to reduce and respond to antimicrobial resistance (AMR). Our stewardship and precision efforts share terminology, seeking to deliver the "right drug, at the right dose, at the right time." Already, rapid diagnostic testing, phylogenetic surveillance, and real-time outbreak response provide just a few examples of molecular advances we dub "precision stewardship." However, the AMR causal factors range from the molecular to that of global health policy. Mirroring the cross-sectoral nature of AMR science, the research addressing the ethical, legal and social implications (ELSI) of AMR ranges across academic scholarship. As the rise of AMR is accompanied by an escalating sense of its moral and social significance, what is needed is a parallel field of study. In this paper, we offer a gap analysis of this terrain, or an agenda for "the ELSI of precision stewardship." In the first section, we discuss the accomplishments of a multi-decade U.S. national investment in ELSI research attending to the advances in human genetics. In the next section, we provide an overview of distinct ELSI topics pertinent to AMR. The distinctiveness of an ELSI agenda for precision stewardship suggests new opportunities for collaboration to build the stewardship teams of the future. [ABSTRACT FROM AUTHOR]

Objective: To investigate patient perspectives on climate change and climate change mitigation strategies in healthcare., Methods: A cross-sectional survey among gynaecological patients from two Dutch outpatient clinics. Main outcomes included patients' climate-related knowledge and worry, climate friendly healthcare perspectives and willingness to opt for climate friendly treatment alternatives. Multivariable linear regression analyses were performed to explore patient characteristics associated with climate friendly healthcare perspectives., Results: 274 surveys were included. Most patients (79 %) were worried about climate change. Although almost all (91 %) found it important to contribute to climate protection, patients showed hesitance regarding healthcare measures that would impinge on individual choices. 62 % was willing to opt for climate friendly treatments, but this proportion varied by medical condition. Climate-related knowledge and worry were both positively associated with climate friendly healthcare perspectives., Conclusion: Gynaecological patients are concerned about climate change and possess substantial self-reported climate-related knowledge. Patients vary in their support of climate action that involves individual patient care, but the majority is open to choose climate friendly treatment alternatives for certain medical conditions., Practice Implications: This exploratory study holds implications for the feasibility of integrating climate impact into clinical decision-making and provides a foundation for normative evidence for decarbonizing healthcare., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

It is widely acknowledged that high-level AI principles are difficult to translate into practices via explicit rules and design guidelines. Consequently, many AI research and development groups that claim to adopt ethics principles have been accused of unwarranted “ethics washing”. Accordingly, there remains a question as to if and how high-level principles should be expected to influence the development of safe and beneficial AI. In this short commentary I discuss two roles high-level principles might play in AI ethics and governance. The first and most often discussed “start-point” function quickly succumbs to the complaints outlined above. I suggest, however, that a second “cultural influence” function is where the primary value of high-level principles lies. [ABSTRACT FROM AUTHOR]

Abstract Background We describe our experience from a multi-national application of a European Union-funded research-driven paediatric trial (DEEP-2, EudraCT 2012-000353-31; NCT01825512). This paper aims to evaluate the impact of the local and national rules on the trial authorisation process in European and non-European countries. National/local provisions and procedures, number of Ethics Committees and Competent Authorities to be addressed, documentation required, special provisions for the paediatric population, timelines for completing the authorisation process and queries received were collected; compliance with the European provisions were evaluated. Descriptive analysis, Wilcoxon Rank-Sum test and General Linear Model analysis were used to determine factors potentially influencing the timelines. The Cluster Analysis procedure was used to identify homogenous groups of cases. Result The authorisation process was completed in 7.7 to 53.8 months in European countries and in 17.1 to 27.1 months in non-European countries. The main factors influencing these timelines were the requests for changes/clarifications in European countries and the different national legislations in non-European countries. Conclusion This work confirms that the procedures and requirements for the clinical trial application of a paediatric trial are different. In the European Union, the timeframes for submission were generally harmonised but longer. In non-European countries, delays were caused by national dispositions but the entire authorisation process resulted faster with less requests from ECs/CAs. The upcoming application of Regulation (EU) 536/2014 is expected to harmonise practices in Europe and possibly outside. Networks on paediatric research acting at international level will be crucial in this effort.

IntroductionDisclosing amyloid status to cognitively normal individuals remains controversial given our lack of understanding the test's clinical significance and unknown psychological risk.MethodsWe assessed the effect of amyloid status disclosure on anxiety and depression before disclosure, at disclosure, and 6 weeks and 6 months postdisclosure and test-related distress after disclosure.ResultsClinicians disclosed amyloid status to 97 cognitively normal older adults (27 had elevated cerebral amyloid). There was no difference in depressive symptoms across groups over time. There was a significant group by time interaction in anxiety, although post hoc analyses revealed no group differences at any time point, suggesting a minimal nonsustained increase in anxiety symptoms immediately postdisclosure in the elevated group. Slight but measureable increases in test-related distress were present after disclosure and were related to greater baseline levels of anxiety and depression.DiscussionDisclosing amyloid imaging results to cognitively normal adults in the clinical research setting with pre- and postdisclosure counseling has a low risk of psychological harm.

The article discusses the need to increase sexual health education in medical training to ensure ethical medical practice. The lack of sexual health education in medical training poses a risk to patients' well-being and violates biomedical ethics. Addressing sexual health is necessary as it is linked to overall health and well-being. Physicians must be aware of the impact of medications and treatments on sexual health and initiate conversations about sexual health with patients. The provision of sexual health education aligns with the principles of nonmaleficence, beneficence, autonomy, and justice. Barriers to increased sexual health education include financial constraints, lack of time and faculty, and stigma. However, there are proposed solutions to overcome these barriers. Increasing sexual health education in medical training is crucial to support ethical medical practice and improve the health of patients and the public. [Extracted from the article]

With robots being introduced into caregiving, particularly for older persons, various ethical concerns are raised. Among them is the fear of replacing human caregiving. While ethical concepts like well-being, autonomy, and capabilities are often used to discuss these concerns, this paper brings forth the concept of social dignity to further develop guidelines concerning the use of robots in caregiving. By social dignity, we mean that a person's perceived dignity changes in response to certain interactions and experiences with other persons. In this paper, we will first present the concept of social dignity, and then identify a niche where robots can be used in caregiving in an ethical manner. Specifically, we will argue that, because some activities of daily living are performed in solitude to maintain dignity, a care recipient will usually prefer robotic assistance instead of human assistance for these activities. Secondly, we will describe how other philosophical concepts, which have been commonly used to judge robotic assistance in caregiving for the elderly so far, such as well-being, autonomy, and capabilities, are less useful in determining whether robotic assistance in caregiving is ethically problematic or not. To conclude, we will argue that social dignity offers an advantage to the other concepts, as it allows to ask the most pressing questions in caregiving. [ABSTRACT FROM AUTHOR]

This commentary presents three arguments of Potterian thought from an occupational therapy perspective in order to support reflections on the development of sustainable practices in occupational therapy. In this way, it introduces occupational therapists to a global bioethical perspective that can support them in implementing an ecosystemic approach that respects the environment. [ABSTRACT FROM AUTHOR]

June 11-12, 2020 at the O. Bogomolets National Medical University online hosted the II International Scientific and Practical Conference "Philosophy of Religion and Medicine in the Post-Secular Age" (In memory of St. Luke (V. F. Voino-Yasenetskyi). The basic department in the organization of the event was the Department of Philosophy, Bioethics and History of Medicine. The directions of the conference participants' work remained traditional and focused on: Questions of religion and medicine in life and work of St. Luke (V. F. Voino-Yasenetskyi); Methodological and historical aspects of the relationships between religion and medicine in contemporary society; Human health in the context of philosophy, religion and medicine; Religion and clinical medicine; Actual problems of biomedical ethics in contemporary religious discourse; Religion as a social and spiritual determinant of individual and public health; Philosophy of religion and medicine: current challengesю. Along with NMU named after OO Bogomolets co-organizers of the conference were: Department of Religious Studies of the G. S. Skovoroda Institute of Philosophy of the National Academy of Sciences of Ukraine; Personality Development Center "HUMANUS", Plovdiv (Bulgaria); Institute of Social Medicine and Medical Ethics at Faculty of Medicine, Comenius University in Bratislava (Slovakia).

Protection of patients' rights is critical in improving healthcare quality, and hence this study aimed at reviewing patient rights’ practices in healthcare organizations of Iran. Using systematic search, this review was conducted based on Preferred Reporting Items for Systematic Review and MetaAnalysis Protocols (PRISMA-P). Several keywords, including "patient rights", "patient bills of rights" and "patients rights’ charter" were searched bilingually in the databases of SID, Magiran, PubMed, Scopus, and Web of Science from 2010 to 2021, and then, following a three-tier screening using the Critical Appraisal Skills Program (CASP) checklists, 76 articles were extracted. The degree of compliance with the Patients' Rights Charter (PRC) in healthcare organizations was 60.88% on average. As to the observance of the PRC dimensions, respectively, the highest and lowest scores were related to the "right to privacy and confidentiality" (70.16%) and "right to access an efficient complaining system" (53.01 %). Respect for patients' rights in organizations was assessed at a moderate level, and some aspects of patients' rights should be attended to immediately. Therefore, discrepancies in the dimensions of patients' rights and their implementation by organizations should be on the agenda of healthcare managers and policymakers. [ABSTRACT FROM AUTHOR]

Protection of patients' rights is critical in improving healthcare quality, and hence this study aimed at reviewing patient rights’ practices in healthcare organizations of Iran. Using systematic search, this review was conducted based on Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Several keywords, including "patient rights", "patient bills of rights" and "patients rights’ charter" were searched bilingually in the databases of SID, Magiran, PubMed, Scopus, and Web of Science from 2010 to 2021, and then, following a three-tier screening using the Critical Appraisal Skills Program (CASP) checklists, 76 articles were extracted. The degree of compliance with the Patients' Rights Charter (PRC) in healthcare organizations was 60.88% on average. As to the observance of the PRC dimensions, respectively, the highest and lowest scores were related to the "right to privacy and confidentiality" (70.16%) and "right to access an efficient complaining system" (53.01 %). Respect for patients' rights in organizations was assessed at a moderate level, and some aspects of patients' rights should be attended to immediately. Therefore, discrepancies in the dimensions of patients' rights and their implementation by organizations should be on the agenda of healthcare managers and policymakers.

With over 16 years of experience in clinical, research, and educational activities related to transcranial magnetic stimulation (TMS), I have written this article exploring the ethical dimensions of TMS. This article aims to provide valuable and informative content for those unfamiliar with TMS as well as those just starting in the field. Specifically, this article elaborates on four principles of medical ethics, including those applicable to TMS therapy, the disparity between public medical insurance coverage and medical indications in private practice for TMS therapy, and issues concerning research ethics in practice. I also provide recommendations regarding roles and strategies for adoption by academia and those in this field dedicated to making TMS therapy accessible to a larger patient population in a suitable manner. Lastly, it is my hope that this article will serve as a contemporary "Ethics of TMS Neuromodulation", resonating with the inherent human pursuit of "truth, goodness, and beauty" for a sound mind and spirit., Competing Interests: The author declares no conflict of interest. Yoshihiro Noda is serving as one of the Editorial Board members of this journal. We declare that Yoshihiro Noda had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to Gernot Riedel., (© 2024 The Author(s). Published by IMR Press.)

Next-generation sequencing techniques enable unsolicited findings to be detected. This discovery raises ethical questions concerning the return of these findings. Our study aimed to highlight the views of the general public, patients under supervision and health professionals concerning the acceptability of disclosing unsolicited results to patients. In total, 449 participants assessed scenarios, consisted of all combinations of three factors (patient's information and consent, prevention and treatment of the unsolicited disease and doctor's decision). The response profiles were grouped into six clusters. The participants took ethical aspects into account, but health professionals also considered the medical aspects to a greater extent. [ABSTRACT FROM AUTHOR]

The SHAPES Horizon 2020 project supports the wellbeing of the elderly at home. The object of this paper is to help to provide necessary tools and guidelines to health and wellbeing service developers in the SHAPES project for their ethical consideration of cybersecurity actions. This paper examines different views and approaches to the ethics of cybersecurity in healthcare and finds the most relevant and puzzling issues for the SHAPES project. The paper investigates the ethical issues, for example, applying the approach of principlism based on four principles of biomedical ethics (respect for autonomy, nonmaleficence, beneficence and justice) and ethics of care. The essential aims of the employment of information and communication technology in healthcare are efficiency and quality of services, the privacy of information and confidentiality of communication, the usability of services, and safety. Four significant value clusters in cybersecurity are security, privacy, fairness, and accountability. From these four different ethical aspects (biomedical ethics, ethics of care, core value clusters in cybersecurity, and technical aims), this paper proposes a new conceptual model for a system approach to analyse the ethical matters which are related to cybersecurity in digital healthcare and wellbeing. In addition, the paper provides ethical guidelines from a cybersecurity ethics and biomedical ethics perspective for the SHAPES project. [ABSTRACT FROM AUTHOR]

The precision health era is likely to reduce and respond to antimicrobial resistance (AMR). Our stewardship and precision efforts share terminology, seeking to deliver the “right drug, at the right dose, at the right time.” Already, rapid diagnostic testing, phylogenetic surveillance, and real-time outbreak response provide just a few examples of molecular advances we dub “precision stewardship.” However, the AMR causal factors range from the molecular to that of global health policy. Mirroring the cross-sectoral nature of AMR science, the research addressing the ethical, legal and social implications (ELSI) of AMR ranges across academic scholarship. As the rise of AMR is accompanied by an escalating sense of its moral and social significance, what is needed is a parallel field of study. In this paper, we offer a gap analysis of this terrain, or an agenda for “the ELSI of precision stewardship.” In the first section, we discuss the accomplishments of a multi-decade U.S. national investment in ELSI research attending to the advances in human genetics. In the next section, we provide an overview of distinct ELSI topics pertinent to AMR. The distinctiveness of an ELSI agenda for precision stewardship suggests new opportunities for collaboration to build the stewardship teams of the future.

In order to effectively prepare students for medical decisions with complex, ethical disagreements and value-laden conflicts, a progression from simpler case analysis to multi-layered conflicts is often helpful. Presented here is a unique case of pregnancy in a true hermaphrodite from recent medical literature. The case is artificially layered with additional, medical and discoverable contextual issues to help analyze three distinct questions in medical ethics: 1) Is it ethically permissible to perform an elective termination of pregnancy (ETOP) on a minor, 2) Is it ethically permissible to keep this information from the parents, and 3) are additional and complicating medical features included in confidentiality agreements involving minors? The pedagogical goals include introducing and effectively utilizing the Orr-Shelton, four box method of clinical ethics assessment, demonstrating the need to uncover/discover important contextual (cultural, religious, family, etc.) features not usually incorporated fully into patient charts, to prepare medical students to research and become familiar with the local legal environment, and to illustrate that what appears to be a single a single ethical dilemma is likely far more complex requiring a multi-focused assessment. [ABSTRACT FROM AUTHOR]