BMC Medical Ethics最新文献

{"title":"Judicial evaluation of medical consent for patients with impaired decision-making capacity in Japan: a retrospective observational study of court decisions and ethical implications.","authors":"Masayuki Ohira, Satoru Makita, Takashi Osada, Masaki Takao","doi":"10.1186/s12910-026-01470-y","DOIUrl":"https://doi.org/10.1186/s12910-026-01470-y","url":null,"abstract":"<p><strong>Background: </strong>Advance care planning and respect for patient autonomy are central concerns in contemporary medical ethics, particularly for patients whose decision-making capacity may be impaired. This study aimed to examine and identify ethical challenges in judicial judgments in Japan relating to these patients.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of Japanese civil court judgments using Westlaw Japan. We systematically identified judgments addressing physicians' duties of explanation or informed consent for patients with impaired decision-making capacity. Cases were limited to judgments rendered after May 2007, following publication of the national Guidelines on the Decision-Making Process for Medical Care and Care at the End of Life in Japan. We evaluated five items: (1) substantive consideration of patients' wishes and values; (2) individualized assessment of decision-making capacity and underlying conditions; (3) whether family members' wishes were treated merely as surrogate consent; (4) whether a repeated, dialogical decision-making process involving family members and healthcare or care teams was described; and (5) whether advance directives or similar written documents were referenced. Each item was coded dichotomously. We assessed inter-rater agreement between researchers using agreement rates and Cohen's κ statistics.</p><p><strong>Results: </strong>Of 116 identified judgments, 10 civil cases met the inclusion criteria. Patients had a mean age of 79.5 years, and all cases involved impaired decision-making capacity due to conditions such as dementia. Courts explicitly attempted to respect or infer patients' wishes in two cases. Consideration of decision-making capacity and its medical assessment was noted in two cases. In two cases, courts treated family members' wishes as sources for inferring the patient's presumed wishes rather than as surrogate consent. A repeated, dialogical decision-making process was described in four cases. No judgment referred to advance directives. Inter-rater agreement was high for all items.</p><p><strong>Conclusions: </strong>The civil court judgments analyzed in this study for patients with impaired decision-making capacity did not sufficiently reflect principles emphasized in ethical guidelines in Japan. This highlights an important challenge in clinical practice and medico-legal evaluation in Japan and underscores the need for future empirical research to evaluate the implementation of advance care planning in clinical practice.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857670","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":"\"The weight of words\": a phenomenological study of Chinese neonatologists' lived experiences of delivering bad news.","authors":"Yuan Li, Zongrong Zhou, Yan Song, Hanmei Peng, Li-Yu Zhu, Xia Li, Qiong Chen, Jing Shi, Hua Wang, Li Zhang, Yanling Hu, Jun Tang","doi":"10.1186/s12910-026-01469-5","DOIUrl":"https://doi.org/10.1186/s12910-026-01469-5","url":null,"abstract":"<p><strong>Background: </strong>Delivering bad news in the Neonatal Intensive Care Unit (NICU) constitutes a profound ethical and emotional challenge. In China, this complexity is intensified by a defensive medical culture and strained physician-family dynamics. This study explores the lived experiences of Chinese neonatologists navigating these high-stakes interactions to uncover the phenomenon's essential structure.</p><p><strong>Methods: </strong>A descriptive phenomenological study was conducted. Using a purposive sampling strategy, 19 neonatologists from a tertiary NICU in Western China were recruited. Data were collected through individual face-to-face, semi-structured in-depth interviews and analyzed using Colaizzi's seven-step method, with rigorous adherence to the COREQ guidelines to ensure trustworthiness.</p><p><strong>Results: </strong>Five interconnected themes emerged: (1) The defensive paradox-strategic communication in a low-trust arena; (2) \"Pushing the child off the cliff\"-the burden of proxy decision-making; (3) Embodied moral distress-the somatic and emotional toll; (4) From technical anxiety to phronesis-identity reconstruction through virtue ethics; and (5) Systemic solitude-structural deficits and the training-practice gap. The findings reveal a trajectory from defensive adaptation and the moral burden of proxy agency to embodied suffering, mitigated by indigenous cultural meaning-making (xiuxing), yet constrained by systemic solitude.</p><p><strong>Conclusions: </strong>Delivering bad news in the Chinese context transcends information transmission, representing a form of moral practice that leaves indelible somatic marks on physicians. While practitioners cultivate individual resilience through professional wisdom and spiritual reframing, this \"weight\" is compounded by institutional voids. Addressing these challenges requires shifting from individual adaptation to multilevel systemic support, including culturally-adapted training, organizational support structures, and clinical ethics consultation services.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846531","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":"Financial influences and the primacy of patient welfare - an empirical and ethical analysis in German cancer medicine.","authors":"Julia F L Koenig, Birthe Aufenberg, Gereon Brei, Sophia Reitmayer, Sabine Sommerlatte, Wolfgang Greiner, Jan Schildmann, Eva C Winkler, Katja Mehlis","doi":"10.1186/s12910-026-01450-2","DOIUrl":"https://doi.org/10.1186/s12910-026-01450-2","url":null,"abstract":"<p><strong>Background: </strong>Little is known about how financial influences affect medical decision-making and may challenge the primacy principle of patient welfare. First qualitative results in cancer medicine identified specific decision-making situations that can be influenced by financial considerations and characterized by the type of their financial influence. These qualitative findings provide evidence that these influences are largely shaped by reimbursement strategies. Nevertheless, questions on how reimbursement strategies affect medical decision-making, and what their normative dimension is regarding the primacy principle, remain unclear.</p><p><strong>Methods: </strong>To address the research questions, we conducted an empirical qualitative content analysis according to Kuckartz and an ethical analysis using Ives' framework of reflexive balancing following the \"standards of practice in empirical bioethics research\" and the \"framework for empirical bioethics research projects\".</p><p><strong>Results: </strong>The empirical analysis identified six financially incentivized actions: to refrain, to reduce, to deflect, to privilege, to prioritize, and to withhold. These were linked to pre-existing definitions from the normative context: rationing, prioritization, deprioritization, and selection. The ethical analysis showed that a lack of transparency about whether reimbursement strategies implement normative priorities or merely regulate costs makes it difficult to assess their compatibility with the primacy of patient welfare.</p><p><strong>Conclusions: </strong>The empirical and ethical analyses demonstrate that financial influences, as embedded in reimbursement strategies, can challenge the primacy principle by shaping which options appear feasible or appropriate in practice. Greater transparency and clearer justification of the goals embedded in reimbursement systems are required to determine when such influences are ethically acceptable and how they should be governed.</p><p><strong>Trial registration: </strong>Not applicable, as the empirical part of this study is based on qualitative interview data and does not constitute as a clinical trial.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846589","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":"Digital paternalism and adolescent autonomy: ethical reflections on Australia's under-16 social media ban.","authors":"Vedat Menderes Özçiftci, Müge Demir","doi":"10.1186/s12910-026-01473-9","DOIUrl":"https://doi.org/10.1186/s12910-026-01473-9","url":null,"abstract":"<p><p>While social media has become an important medium for adolescents in terms of identity development, belonging, news consumption and public participation, the recommendation algorithms and attention-economy-based design features of platforms can shape adolescents' preferences and weaken their autonomous decision-making processes. This study provides a principle-based bioethical analysis of Australia's regulation (Online Safety Amendment [Social Media Minimum Age] Act 2024; effective: 10 December 2025), which aims to prevent users under the age of 16 from creating accounts on certain social media platforms and maintaining existing accounts, within the framework of digital paternalism and adolescent autonomy. Beauchamp and Childress' principle-based bioethical approach was adopted as the methodology; the regulation was discussed in terms of the principles of respect for autonomy, non-maleficence, beneficence, and justice. The analysis suggests that while the ban can be ethically justified as a protective public health intervention in the context of mental health risks and potential harms of usage, there are debates that the age-based categorical limit does not sufficiently consider the principle of evolving capacities and adolescents' rights to expression/participation. Furthermore, the absolute age ban may generate secondary and unintended harms, such as weakening social support and help-seeking channels, increasing digital inequalities, and directing users towards less secure online environments. The evaluation conducted in this article concludes that, instead of absolute age-based bans, it is recommended to adopt gradual autonomy models, guide companies towards protective and safe design approaches for children, impose a duty of care specific to children on platforms, ensure algorithmic transparency, and adopt a rights-based approach to child protection.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846560","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":"Why care resists coding: the moral limits of medical AI.","authors":"Nils-Frederic Wagner","doi":"10.1186/s12910-026-01467-7","DOIUrl":"https://doi.org/10.1186/s12910-026-01467-7","url":null,"abstract":"<p><p>The growing integration of artificial intelligence (AI) into healthcare raises substantial normative questions about the nature of caregiving. While medical AI can improve clinical efficiency and assist with administrative tasks, I argue that patient-facing medical AI cannot straightforwardly substitute for genuine caregiving-understood as an embodied, relational, and morally responsive practice that remains answerable to patients' vulnerability over time. Drawing on conceptual analysis and empirical evidence, I contend that caregiving exceeds technical competence, requiring context-sensitive responsiveness and a form of moral commitment that grounds responsibility when interpretation and response go wrong. Empirical studies on touch in clinical settings underscore how embodied reassurance and trust are mediated by consent, context, and relational meaning in ways current technological proxies only partially reproduce. Although medical AI may simulate elements of empathy through affective cues and conversational performance, such simulations risk generating interactions that appear supportive while obscuring the locus of responsibility within the care relationship. Hybrid AI-human care models and 'ethics-by-design' approaches, while often proposed as solutions, can diffuse accountability and fragment moral responsibility unless governance and clinical workflow design preserve clear human answerability. More critically, increasing reliance on patient-facing medical AI may not only yield inadequate simulations of care, but also contribute to a gradual redefinition of what caregiving entails. As expectations shift, relational responsiveness may be displaced by procedural adequacy as the prevailing standard.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846584","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":"A nationwide survey of Japanese public perceptions of the necessity of antemortem informed consent for Rapid Autopsy Programs (RAP): comparison with other methods of postmortem human tissue utilization.","authors":"Yuki Fujiwara, Go Okui, Masanori Oikawa, Mia Miyanaga","doi":"10.1186/s12910-026-01465-9","DOIUrl":"https://doi.org/10.1186/s12910-026-01465-9","url":null,"abstract":"<p><strong>Background: </strong>Rapid Autopsy Programs (RAP) are essential research infrastructures for precision medicine, providing high-quality biospecimens. While international standards emphasize the importance of antemortem informed consent, Japan's ethical and legal frameworks for RAP remain underdeveloped. Currently, Japan lacks a consistent approach to postmortem tissue utilization, with requirements for individual consent varying significantly between pathological autopsies, systematic dissection, and organ transplantation. This study aims to clarify Japanese public perceptions regarding the necessity of antemortem consent for RAP in comparison with these established methods to inform the development of future ethical guidelines.</p><p><strong>Methods: </strong>A nationwide internet survey was conducted in January 2025, involving 3,102 participants representative of the Japanese population's sex, age, and regional distribution. Participants viewed an educational video explaining four methods of postmortem tissue utilization: pathological autopsy, RAP, systematic dissection, and organ transplantation. To prevent bias, actual names and current legal statuses were not disclosed. Respondents rated the necessity of antemortem individual consent for each method using a six-point Likert scale. Statistical analyses were performed to identify differences between methods and demographic influences.</p><p><strong>Results: </strong>The survey revealed a strong public preference for antemortem consent across all methods. Specifically, over 70% of respondents agreed that antemortem consent is necessary for pathological autopsies, and over 85% expressed the same view for RAP, systematic dissection, and organ transplantation. The results showed a marked discrepancy between Japan's current legal system-which often relies on family consent-and public ethical awareness emphasizing individual will. While 90% valued antemortem consent for respecting individual wishes, over 50% acknowledged the difficulty of refusing a physician's request and emphasized the importance of family intentions. Women and older adults placed significantly greater importance on antemortem consent for RAP.</p><p><strong>Conclusions: </strong>The Japanese public maintains high expectations for individual antemortem consent that exceed current legal requirements for some procedures. However, the findings also highlight the role of \"relational autonomy,\" where family involvement and the clinical-research power dynamic influence decision-making. Developing an ethical framework for RAP in Japan requires not only prioritizing individual autonomy but also implementing \"supported decision-making\" and a clear separation between clinical and research teams to ensure social trust and cultural compatibility.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846481","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":"Implicit ethical choices in ultra-rare therapy development: researchers' perspectives on patient selection and communication, therapy value, and accessibility.","authors":"Mariia V Maksimova, Rosan L Lechner, Felicia V Y L Lee-Kong, Johannes J M van Delden, Ghislaine J M W van Thiel","doi":"10.1186/s12910-026-01463-x","DOIUrl":"https://doi.org/10.1186/s12910-026-01463-x","url":null,"abstract":"<p><strong>Background: </strong>The development of new highly technological and highly personalized therapies for ultra-rare diseases is one of the fast-advancing areas in biomedicine. Yet such an approach is experimental, resource-intensive, and accessible mostly in affluent countries, thereby provoking ethical concerns. From a constructivist perspective, those therapies are not neutral tools, and ethical concerns are not merely added to science but embedded in the very choices researchers and technology developers make. Early research decisions about how therapy goals are defined, which patients are included, and which diseases are prioritized already include implicit normative decisions that set the further therapy development trajectory. Nonetheless, the perspectives of researchers working on these individualized therapies remain underinvestigated. In this study, we aim to address this gap and explore how researchers developing such therapies understand and enact ethically loaded choices in early therapy development in practice.</p><p><strong>Methods: </strong>We conducted 15 semi-structured interviews with researchers developing a standardized platform for discovering personalized ASOs for ultra-rare neurodevelopmental disorders. Interviews were subjected to inductive thematic analysis, focusing on semantic themes. We report this study according to the Consolidated Criteria for Reporting Qualitative Research.</p><p><strong>Results: </strong>From the analysis, four main semantic themes were developed inductively. Researchers described patient and disease selection as a matter of feasibility, focusing mainly on the technical aspects of therapy development. They saw emotions as a potential source of bias in the selection process and thus advocate for selection committees and decision-making algorithms that reduce personal involvement. Communication with patients and their families was perceived as an ethically fragile area due to false hope phenomena and the emotional pressure of personal communication. Perceptions of therapy's value varied, ranging from symptom relief and reduced family burden to doubts about whether the intervention was justified given the high translational uncertainty. Finally, researchers identified various barriers to therapy accessibility, yet described them as parts of the landscape rather than as sites for personal actions.</p><p><strong>Conclusions: </strong>The early stages of individualized therapy development for ultra-rare diseases include implicit ethical choices that are often seen as purely technical. Explicating the ethical component of these choices can help make the process of therapy development more transparent and fair.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846645","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":"From designer babies to edited food: comparing public attitudes toward CRISPR technology and gene editing in Japan and the United States.","authors":"Momoyo Matsuyama, Tilman Hartwig, Hiromi M Yokoyama, Shotaro Kinoshita, Yuko Ikkatai, Naohiro Takanashi","doi":"10.1186/s12910-026-01459-7","DOIUrl":"https://doi.org/10.1186/s12910-026-01459-7","url":null,"abstract":"","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790228","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":"The face of the other in the clinic: reframing patient impoliteness through phenomenological ethics in provider-patient communication.","authors":"Yi Shan, Ningyu Pan","doi":"10.1186/s12910-026-01453-z","DOIUrl":"https://doi.org/10.1186/s12910-026-01453-z","url":null,"abstract":"","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790177","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":"The last human touch: why AI doesn't belong in life's defining moments.","authors":"Stephen R Milford","doi":"10.1186/s12910-026-01461-z","DOIUrl":"https://doi.org/10.1186/s12910-026-01461-z","url":null,"abstract":"","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719061","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}