BMC Medical Ethics最新文献

{"title":"Public funding for mitochondrial donation: An Australian public deliberation.","authors":"Ainsley J Newson, Jane Williams, Giuliana Fuscaldo, Ashleigh Hill, Ezra Kneebone, Karinne Ludlow, Catherine Mills, Megan Munsie, Sarah Norris, Paul Scuffham, Liz Sutton, David R Thorburn, Chris Degeling","doi":"10.1186/s12910-025-01284-4","DOIUrl":"https://doi.org/10.1186/s12910-025-01284-4","url":null,"abstract":"<p><strong>Background: </strong>Mitochondrial donation (MD) is a reproductive technique that aims to allow individuals at-risk of having a child with mitochondrial DNA disease avoid this outcome. Research to inform possible clinical use of MD is underway in Australia and births following the use of this technique have been announced in the United Kingdom. However, how the availability of MD will be funded in the mid- to long-term remains uncertain. One factor impacting funding decisions is public sentiment, yet there is scant evidence globally regarding attitudes toward MD funding. We sought to discern attitudes of informed members of the Australian public to how the provision of MD should be funded.</p><p><strong>Methods: </strong>We held three community juries to gauge public views on how MD should be funded. A community jury involves providing a diverse group of citizens with expert testimony and facilitating deliberation to arrive at a position.</p><p><strong>Results: </strong>Forty-two jurors participated across three juries. All juries voted by majority to support public funding for MD. Each jury made slightly different funding choices: one preferred full public funding, another preferred co-payment, while the third was divided among full public funding, co-payment, and no public funding. Reasons in favour of public funding comprised value for money, equity (i.e., the fair and just distribution of MD) and promoting innovation. Reasons against were opportunity cost, that MD wasn't necessary, and ethical objections to MD. Jurors also devised conditions for future funding: external review, capped services, better funding for alternative interventions and means testing.</p><p><strong>Conclusions: </strong>Should the current Australian MD research trial enable clinical provision, assuming that our participants' views are consistent with those of most Australians when informed of the trade-offs, benefits and costs, then it is likely that there will be strong public support for governments to fund access. However, some people may object to this expenditure.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"131"},"PeriodicalIF":3.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Injection‑induced sciatic nerve injuries in Turkey: a public health and patient safety analysis of Supreme Court decisions.","authors":"Elif Simin Issı, Furkan İncebacak","doi":"10.1186/s12910-025-01283-5","DOIUrl":"https://doi.org/10.1186/s12910-025-01283-5","url":null,"abstract":"<p><strong>Background: </strong>Intramuscular injections are routine interventions worldwide, yet when executed incorrectly they can cause sciatic nerve injury (SNI) that leaves patients with lifelong motor-sensory disability. Although international guidelines recommend the ventrogluteal site, the dorsogluteal region remains dominant in Turkey, potentially elevating risk. This study analysed Turkish Supreme Court decisions on injection-induced SNI from public-health, ethical and legal perspectives.</p><p><strong>Methods: </strong>We conducted a retrospective cross-sectional content analysis of all publicly available Supreme Court criminal and civil decisions issued between January 2006 and April 2025 that contained SNI-related keywords. After deduplication and relevance screening, 92 unique cases were eligible. Two investigators independently coded each judgment; disagreements were resolved by consensus. Variables recorded were legal category, injection site, clinical indication, drug class, injector profession, defendant identity, symptom latency, electrophysiological pattern, first-instance verdict and Supreme Court outcome. Frequencies and percentages were calculated with SPSS v.29.</p><p><strong>Results: </strong>Negligent bodily injury was the leading charge (50/92, 54%); 32% of files also sought monetary compensation. Gluteal injections accounted for 79% of cases, most administered for postoperative analgesia (33%) or antibiotic therapy (27%). Nurses performed 60% of injections, physicians 9%. Individual health professionals (physicians ± nurses) were defendants in 65% of lawsuits, while hospitals (alone or jointly) appeared in 23%. Symptoms emerged immediately or within 1 h in 76% of plaintiffs, and electromyography typically revealed severe axonal damage-predominantly of the peroneal division. The Supreme Court overturned 100% of firstinstance convictions and 32% of acquittals, most often citing inadequate expert evaluation (35%), contradictory reports (20%), uncertainty over negligence versus complication (18%) or missing informedconsent documentation (10%).</p><p><strong>Conclusions: </strong>Injection-related sciatic nerve injuries in Turkey remain potentially preventable. The entrenched use of the dorsogluteal site, limited anatomical awareness, inadequate informed consent practices, and inconsistencies in medico-legal evaluations continue to contribute to both patient harm and an increased burden of litigation. Transitioning to the ventrogluteal technique, mandating annual refresher training, standardising consent forms, and accrediting neurophysiology expert panels could help reduce both injury incidence and courtroom burden-advancing the WHO's \"zero harm\" patient safety goal.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"130"},"PeriodicalIF":3.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethics review or compliance check? an empirical analysis of 6740 requests for information in Belgian clinical trial evaluations (2017-2024).","authors":"Audrey Van Scharen, Michel Deneyer, Pieter Cornu","doi":"10.1186/s12910-025-01296-0","DOIUrl":"https://doi.org/10.1186/s12910-025-01296-0","url":null,"abstract":"<p><p>The EU Clinical Trials Regulation (CTR) was introduced to harmonize clinical trial evaluations across Member States while upholding participant protection and ethical integrity. This study analyzes 6740 Requests for Information (RFIs) issued by Belgian Medical Research Ethics Committees (MRECs) across 266 trial dossiers evaluated between 2017 and 2024, spanning both the CTR pilot phase and the initial CTIS implementation. Using framework content analysis, we examined the number and content of RFIs in relation to trial outcomes, sponsor type (commercial vs. non-commercial), and the MREC's role as Reporting Member State (RMS) or Member State Concerned (MSC).Results show a decline in total RFIs over time, mainly due to a reduction in typographical and linguistic remarks, yet significant variability persists in the formulation and scope of ethical feedback. While statistical and methodological concerns remained central in Part I evaluations, RFIs increasingly addressed newer challenges such as decentralized trials, e-consent, and data collection on ethnicity. Part II RFIs continued to focus heavily on informed consent documents. We further observed that MSCs raised fewer RFIs than RMSs for Part I, prompting reflection on the necessity and efficiency of full multi-state review in this section.The study also highlights a growing emphasis on regulatory compliance-sometimes at the expense of ethical deliberation-and the limited authority of policy advisors to correct inconsistencies, despite their expertise. We recommend clearer guidance, formalized roles for policy advisors in quality control, improved pre-submission processes, and limited direct communication between MRECs and sponsors. These findings support ongoing efforts to improve ethics review efficiency and quality under the CTR, with broader relevance for harmonization across Europe.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"129"},"PeriodicalIF":3.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical competence: the cornerstone of care in the cardiac operating room, a phenomenological study.","authors":"Seyed Kianoosh Hosseini, Fateme Mohammadi, Seyed Reza Borzou, Mostafa Bijani, Seyedeh Zahra Masoumi","doi":"10.1186/s12910-025-01295-1","DOIUrl":"https://doi.org/10.1186/s12910-025-01295-1","url":null,"abstract":"<p><strong>Background: </strong>Ethical competence leads to the provision of principled and ethical care, which subsequently improves health and increases patient satisfaction. Among these, the cardiac operating room is one of the most challenging and stressful therapeutic environments, in which the ethical competencies of healthcare professionals can significantly impact the performance and quality of care. Therefore, it is critical to describe healthcare professionals' experiences in the operating room regarding ethical competency. The present study aimed to investigate the experiences and perceptions of ethical competency among healthcare professionals in a cardiac operating room.</p><p><strong>Methods: </strong>This qualitative research project utilized a phenomenological design and included 23 participants selected through purposeful sampling. Data were collected from July 2023 to March 2024. Sampling continued until data saturation was achieved. Data were collected through semi-structured interviews. The collected data were analyzed using the Colaizzi approach.</p><p><strong>Results: </strong>The mean age of the participants was 36.64 ± 3.53 years. Three final themes with ten theme clusters \"respect to the dignity of the patient (respecting the patient's identity, respecting physical and sexual privacy, protecting information privacy), promoting the patient's mental health (paying attention to the patient's independence, providing comprehensive information, compassion) and expansion of moral obligations (promoting moral courage, avoiding discrimination, expansion ethical and principled care, promotion of ethical knowledge) were extracted from the data.</p><p><strong>Conclusion: </strong>According to this research, respecting the dignity of patients, paying attention to their identity and privacy, and promoting mental health and professional support are the most important indicators of ethical competence, which are associated with developing moral courage and fair and thoughtful decision-making in healthcare professionals. Based on this, officials and policymakers can take fundamental steps towards achieving and promoting the ethical competence of healthcare providers by creating fair policies that preserve human dignity and adhere to the principles of professional ethics.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"128"},"PeriodicalIF":3.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moral disengagement in critical care nurses: a conventional content analysis.","authors":"Ali Khanipour-Kencha, Alun C Jackson, Saba Barati-Rizi, Fatemeh Bahramnezhad","doi":"10.1186/s12910-025-01282-6","DOIUrl":"https://doi.org/10.1186/s12910-025-01282-6","url":null,"abstract":"<p><strong>Background: </strong>Given the high-stakes environment of intensive care units, understanding how nurses navigate moral challenges and engage in ethical decision-making is critical for maintaining patient safety and care quality. One important process in this field is moral disengagement, which is growing in the nursing literature. However, there is a lack of foundational and qualitative studies addressing this issue. This study presents a qualitative content analysis aimed at exploring moral disengagement among nurses working in intensive care units.</p><p><strong>Method: </strong>This qualitative study employed conventional content analysis from June to December 2024 in Tehran, Iran. Purposive sampling was used to recruit participants. Data were collected using in-depth, unstructured interviews at the beginning, followed by semi-structured interviews. Sampling continued until data saturation was reached, resulting in 30 interviews with 25 eligible intensive care unit nurses. The conventional qualitative content analysis approach developed by Graneheim and Lundman was employed.</p><p><strong>Results: </strong>Three main categories with eight subcategories were identified from the initial 765 codes. The findings revealed three main categories: \"cognitive justification of unethical behavior,\" \"protective strategies for personal security,\" and \"normalization of unconventional practices.\" These categories include subcategories such as \"externalization of responsibility,\" \"moral-cognitive justification,\" \"positive reframing of the event,\" \"preservation of job position and security,\" \"psychological stabilization,\" \"strategic violation of regulations for survival,\" \"reduction of emotional and psychological pressure,\" and \"protective framing of behavior.\"</p><p><strong>Conclusion: </strong>This study reveals various aspects of moral disengagement among critical care nurses, which can pave the way for future studies to better understand the phenomenon, its related factors, and help with the development of preventive measures.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"127"},"PeriodicalIF":3.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric properties of instruments measuring ethical climate among healthcare professionals in care settings pre-pandemic: a systematic review.","authors":"Sabine Björk, Margareta Brännström, Ulf Isaksson","doi":"10.1186/s12910-025-01311-4","DOIUrl":"https://doi.org/10.1186/s12910-025-01311-4","url":null,"abstract":"<p><strong>Background: </strong>The ethical climate in healthcare is part of the work environment and a basis for professional nursing practice. The ethical climate is crucial as it is closely associated with staff job satisfaction, the quality-of-care provision, and nurses' intention to stay in their current occupation and position. Even though several instruments assessing ethical climate in healthcare have been developed over the years, their psychometric properties have not been systematically reviewed.</p><p><strong>Objectives: </strong>This study was conducted to identify and critically appraise the psychometric properties of instruments used to measure the ethical climate among healthcare professionals in care settings prior to the COVID-19 pandemic.</p><p><strong>Methods: </strong>A systematic review was performed, covering papers published between 1994 and 2019, excluding grey literature sources. The literature search was performed in October 2019 in Cinahl, PsychINFO, PubMed, and SocIndex. Empirical studies were included describing the psychometric properties of instruments measuring the ethical climate among healthcare professionals in healthcare settings. Data on psychometric properties were extracted and a quality assessment was performed following the quality criteria for measurement properties proposed by Terwee et al. criteria 2007.</p><p><strong>Result: </strong>Our search yielded 15,150 publications. After title and abstract screening, 611 studies were retained for full-text analysis, of which eight studies describing five instruments were included (five instrument development studies and three translation studies). Four studies concerned the Hospital Environment Climate Scale (HECS). All instruments had been assessed for content validity and internal consistency. Information concerning criterion validity, construct validity, and reproducibility was lacking or intermediate. No information concerning floor/ceiling effect or interpretability was reported in most cases. One study reported having performed a test-retest analysis. None of the included studies fulfilled all the Terwee et al. criteria.</p><p><strong>Conclusion: </strong>Five instruments were identified as having undergone psychometric testing; however, none fulfilled all the criteria outlined by Terwee et al. Also, only one of the instruments had been subjected to the well-established test-retest analysis. This highlights a need for further well-structured validation studies of instruments assessing the ethical climate among healthcare professionals in care settings.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"125"},"PeriodicalIF":3.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Project DECIDE II: evaluating the efficacy of supported advance care decision making within routine care in dementia: a randomized controlled trial.","authors":"Ermioni Athanasiadi, Jochen René Thyrian, Janina Florack, Anna Theile-Schürholz, Jonas Karneboge, Tanja Müller, Kristian Kleinke, Stefanie Kremer, Charlotte Boes, Helene Böhm, Anja Herder-Peyrounette, Manuela Kremer, Celina Sander, Ronja Müller-Späth, Heiko Ullrich, Melanie Boekholt, Marc Hassenzahl, Ruben Albers, Simon Forstmeier, Philipp Schaper, Julia Haberstroh","doi":"10.1186/s12910-025-01290-6","DOIUrl":"https://doi.org/10.1186/s12910-025-01290-6","url":null,"abstract":"","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"124"},"PeriodicalIF":3.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging ethical gaps in digital health research: a framework for informed consent aligned with NIH guidance.","authors":"Rahma Rizky Alifia, Malihe Sadeghi, Maheswari Eluru, Mohammad Jafari, Maria Adela Grando","doi":"10.1186/s12910-025-01291-5","DOIUrl":"https://doi.org/10.1186/s12910-025-01291-5","url":null,"abstract":"<p><strong>Background: </strong>Digital health technologies, including mobile applications, wearable devices, and sensors, are rapidly transforming clinical research. However, current informed consent practices often fall short of addressing the unique ethical risks introduced by these technologies. This study aims to develop and assess a comprehensive ethical consent framework to improve transparency, equity, and participant protection in digital health research.</p><p><strong>Methods: </strong>We developed a consent framework aligned with national research ethics guidance, including 63 attributes and 93 subattributes across four domains: Consent, Grantee (Researcher) Permissions, Grantee (Researcher) Obligations, and Technology. We conducted thematic analysis under guidance and then reviewed 25 informed consent forms from real-world digital health studies to expand the guidance and assess each form's alignment with the framework. We used descriptive statistics to measure attribute completeness and to identify missing ethical elements.</p><p><strong>Results: </strong>None of the consent forms fully adhered to all the required or recommended ethical elements, especially those related to technology-specific risks. The highest completeness for the required attributes reached only 73.5%. We also identified four ethically salient consent elements not present in the current national guidance: commercial profit sharing, study information disclosure, during-study result sharing, and data removal requests.</p><p><strong>Conclusions: </strong>These findings reveal persistent ethical gaps in participant protection and highlight the need for more comprehensive, equity-oriented consent practices. Our framework offers a practical tool to strengthen transparency, autonomy, and justice in digital health research.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"132"},"PeriodicalIF":3.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How do medical professionals justify their involvement with live tissue training?","authors":"C S Swain, G Helgesson","doi":"10.1186/s12910-025-01304-3","DOIUrl":"https://doi.org/10.1186/s12910-025-01304-3","url":null,"abstract":"<p><strong>Background: </strong>\"Live tissue training\" (LTT) is simulation that uses a live anaesthetised animal in place of a human patient. It is a training practice which is significantly contested, but continues to occur despite availability of alternative simulator models. The aim of this study was to explore if, and how, medical professionals who participate in LTT justify their own professional involvement.</p><p><strong>Methods: </strong>Fifteen semi-structured interviews of physicians who had knowledge and prior experience of LTT were performed as part of a wider research project and initially analysed using the Framework Method. Data categorised as 'ethical views' underwent a secondary thematic analysis to answer this research aim. Data were grouped by similar meaning to produce themes in the form of beliefs or views expressed by the participants.</p><p><strong>Results: </strong>Although no participant used language to explicitly indicate moral theorising, there is a set of identifiable coherent beliefs/views among the cohort. A belief that training must be conducted in order to save human patients' lives (1); that human life is of higher value than animal life (2); and that there is no sufficiently good alternative to LTT (3). It is felt that LTT is reasonable as the numbers of animals used are minimised and opportunities for learning or other uses maximised (4); animals are well cared for and are not suffering (5) and reasonable in comparison to other animal uses (6).</p><p><strong>Conclusion: </strong>There is a predominant consequentialist thinking regarding the use of live animals, with evidence that the 3Rs principles are being considered, if not explicitly, as a restriction on the use of animals for LTT and also partly to justify or defend medical professionals' involvement. We suggest that professional identity is likely to have a role in forming these justificatory arguments, but personal views about the moral standing of animals and notions of speciesism could also influence decisions about being involved in LTT.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"126"},"PeriodicalIF":3.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Public trust of AI in healthcare in South Africa: results of a survey.","authors":"Donrich Thaldar, Dane Bottomley","doi":"10.1186/s12910-025-01293-3","DOIUrl":"10.1186/s12910-025-01293-3","url":null,"abstract":"","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"123"},"PeriodicalIF":3.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}