BMC Medical Ethics最新文献

{"title":"Informed consent processes with First Nations peoples undergoing surgery or invasive procedures: a scoping review.","authors":"Camila A Kairuz Santos, Kate Hunter, Bianca Barnier, Bobby Porykali, Belinda Ford, Keziah Bennett-Brook, Tamara Mackean, Edward Litton, Jacquita S Affandi, Courtney Ryder, Siva Senthuran, Julieann Coombes","doi":"10.1186/s12910-025-01280-8","DOIUrl":"10.1186/s12910-025-01280-8","url":null,"abstract":"<p><strong>Background: </strong>Informed consent is a cornerstone of medical practice, however, is not always ethically obtained. For First Nations people, this can be hindered by different worldviews and health paradigms. Although best practice entails consideration of patient's cultural beliefs and needs, the extent towhich informed consent is adequately obtained from First Nations patients is unknown. We aimed to conduct a scoping review to map and analyse informed consent processes with First Nations peoples in Australia, New Zealand and North America who are undergoing surgery or an invasive medical procedure.</p><p><strong>Methods: </strong>A systematic search was conducted using PubMed, Web of Science, Embase and Health InfoNet. Google scholar and webpages of relevant medical organisations were manually searched. Descriptions of informed consent processes were analysed against the guidelines to obtaining informed consent of the respective jurisdictions in which the research was conducted. The experiences of First Nations people undergoing informed consent processes, impact of gaps, healthcare staff views and strategies to enhance informed consent were thematically analysed.</p><p><strong>Results: </strong>Nine qualitative studies were included. Processes reported failed to address all the considerations stated in the respective guidelines. Participants reported feeling coerced due to racism and power imbalances. Physicians tended to prioritise what they thought was better over patient's cultural values and protocols. Inadequate processes resulted in fear, disengagement of health services and negative impact on wellbeing. Engagement of professional interpreters, use of diagrams and workforce training that fosters reflective practice were found to enhance informed consent.</p><p><strong>Conclusion: </strong>Evidence suggests that consent forms are often signed by patients who are not fully informed. For First Nations people, this is aggravated by language barriers, culturally different understanding of health and racism leading to coercion. Better assessment of informed consent processes with First Nations people, training and ongoing quality improvement are required to identify and address gaps. Partnership with First Nations people is required to enhance current guidelines and to develop strategies to ensure true informed consent.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"121"},"PeriodicalIF":3.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193809","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}

{"title":"Navigating the ethical world of clinical researchers in China: challenges and pathways for improvement.","authors":"Hua Zhang, Shuwen Shi, Chanjuan Liu","doi":"10.1186/s12910-025-01298-y","DOIUrl":"10.1186/s12910-025-01298-y","url":null,"abstract":"<p><strong>Background: </strong>Over the past decade, China has witnessed a sharp increase in clinical trials, exceeding 4,000 in 2023. Yet, this growth has brought emerging ethical challenges and concerning researcher misconduct. Despite growing scholarly attention to clinical trial regulation, a critical knowledge gap remains regarding the ethical world of clinical researchers. This study investigates ethical challenges in clinical research, their contributing factors, and pathways for improvement.</p><p><strong>Methods: </strong>The research design involved mixed methods, specifically a nationwide questionnaire survey (quantitative) and semi-structured interviews (qualitative). Using stratified random sampling from China's Clinical Trial Registry (ChiCTR), 1,800 questionnaires were distributed and 287 valid responses analyzed descriptively with SPSS 22 to identify key challenges. Subsequently, 37 clinical researchers were interviewed, and transcripts thematically analyzed with NVivo 11 to explore underlying causes and triangulate the survey findings, thereby identifying potential pathways for improvement.</p><p><strong>Results: </strong>The descriptive analysis of the questionnaire results, triangulated with interview findings, reveals that general misconduct is common despite the rarity of severe violations; ethical behavior often lags behind ethical cognition and attitude; researchers show blunted moral sensitivity; and most adopt a passive stance toward ethical compliance rather than active engagement. The thematic analysis identifies two core contributors to these challenges: individual factors-including personal traits, dulled moral sensitivity, limited ethical knowledge, and low ethical awareness; and environmental factors-including weak ethical oversight, an inadequate ethical climate, unhealthy research competition, and researcher-subject knowledge asymmetry.</p><p><strong>Conclusions: </strong>Ethical challenges in China's clinical research persist due to the interaction of personal ethical limitations and structurally weak oversight systems. To mitigate these challenges, a dual approach is proposed, integrating internal moral cultivation and external oversight. Internally, efforts should focus on creating an ethical space for dialogue, promoting moral consensus, fostering ethical identity and sensitivity, and cultivating a sense of ethical responsibility through moral practice. Externally, improvements are needed in post-approval ethical monitoring, targeted training programs, research climate, and public understanding of clinical trials and ethics.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"122"},"PeriodicalIF":3.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193800","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}

{"title":"Willingness to develop an advance directive: perspectives of older persons at a national referral hospital in Uganda.","authors":"Catherine Alupo, Erisa S Mwaka, Betty Kwagala, Joseph Ochieng","doi":"10.1186/s12910-025-01287-1","DOIUrl":"10.1186/s12910-025-01287-1","url":null,"abstract":"<p><strong>Background: </strong>Understanding the treatment preferences of terminally ill patients is critical for the provision of quality care at the end of life. However, there is limited literature on the perspectives and willingness to develop advance directives among older persons in low-resource settings. This study explored the perspectives and willingness of older persons to develop an advance directive.</p><p><strong>Methods: </strong>This was a qualitative study that involved older persons aged 60 years and over at a national referral hospital in Uganda. Data were collected through in-depth interviews and transcribed verbatim. Thematic analysis was performed, and the findings were reported using themes along with illustrative quotes from the participants.</p><p><strong>Results: </strong>The study included 15 participants with an average age of 65.5 years (SD 4.4); most were male (10/15), married (12/15), and unemployed (10/15). Three themes were identified from the data, including: (1) understanding of advance directives, (2) perceptions about advance directives, and (3) willingness to develop advance directives. Most respondents had a limited understanding of advance directives. Advance directives were perceived as a foreign practice that was only applicable to the very sick and terminally ill. However, respondents were willing to develop advance directives for several reasons, including autonomy over one's health and the need to prevent family suffering and conflict in the event of death.</p><p><strong>Conclusion: </strong>The study revealed a general lack of awareness and limited understanding of advance directives. There is a need for public sensitization on the importance of advance directives to healthcare practice and among older persons, given their high risk of morbidity and mortality due to aging. Promoting the use of advance directives in healthcare practice ethically recognizes one's autonomous rights of self-control.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"119"},"PeriodicalIF":3.1,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180423","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}

{"title":"Navigating the path to planned endings: understanding Chinese older adults' engagement with advance care planning through constructivist grounded theory.","authors":"Wenyu Yue, Qing Chu, Xiaoqin Ma","doi":"10.1186/s12910-025-01278-2","DOIUrl":"10.1186/s12910-025-01278-2","url":null,"abstract":"<p><strong>Background: </strong>Advance care planning implementation reveals complex tensions between ethical principles and cultural-specific moral frameworks. Within the Chinese healthcare context, medical decision-making operates within a unique ethical landscape shaped by Confucian values, yet systematic ACP promotion in this context remains limited.</p><p><strong>Objective: </strong>This study aims to (1) develop a grounded theory of older adults' engagement with advance care planning in the Chinese context; (2) understand how participants navigate decision-making processes within China's cultural and healthcare systems.</p><p><strong>Design: </strong>The investigation employed Charmaz's constructivist grounded theory methodology guided by Nie's framework of Chinese medical ethics through a three-stage approach across diverse geographical regions in China.</p><p><strong>Participants: </strong>Twenty-five participants (13 males/12 females) aged 60-95 years from representative regions of China.</p><p><strong>Methods: </strong>Following Charmaz's constructivist grounded theory methodology, data collection progressed from pre-experimental convenience sampling (3 participants), to Stage 1 purposive sampling (12), and Stage 2 theoretical sampling (13) until saturation. Analysis employed concurrent interviews and constant comparative methods guided by Chinese medical ethical principles.</p><p><strong>Results: </strong>The analysis produced the substantive theory \"Navigating the Path to Planned Endings,\" encompassing three interconnected categories: Negotiating Death Discourse, The Locus of Decision, and Systemic Support Infrastructure. \"The Locus of Decision\" emerged as the core category where participants reconcile individual autonomy, filial obligations, and family harmony.</p><p><strong>Conclusions: </strong>The theoretical framework reveals complex ethical processes through which Chinese older adults engage with advance care planning, highlighting the crucial role of moral agency where traditional values and modern bioethical principles intersect. These findings necessitate culturally sensitive ACP implementation approaches acknowledging family roles while upholding principles of autonomy and justice.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"118"},"PeriodicalIF":3.1,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180385","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}

{"title":"From chaos to symbiosis: exploring adaptive co-evolution strategies for generative AI and research integrity systems.","authors":"Wenqing Miao, Huan Zang, Qirui Liu, Tianlei Zheng, Yan Zhou, Chunmei Liu, Na Yang, Hengzhi Zhang, Yuwan Zhang, Ying Zhang, Shengli Li, Shenyang Zhang, Hao Zhang","doi":"10.1186/s12910-025-01288-0","DOIUrl":"10.1186/s12910-025-01288-0","url":null,"abstract":"<p><strong>Objective: </strong>The information age has transformed technologies across disciplines. Generative artificial intelligence (GenAI), as an emerging technology, has integrated into scientific research. Recent studies identify GenAI-related scientific research integrity concerns. Using Complex Adaptive Systems (CAS) theory, this research examines risk factors and preventive measures for each agent within the scientific research integrity management system during GenAI adoption, providing new perspectives for integrity management.</p><p><strong>Method: </strong>This study applies CAS theory to analyze the scientific research integrity management system, identifying four core micro-level agents: researchers, research subjects, scientific research administrators, and academic publishing institutions. It examines macro-system complexity, agent adaptability, and the impact of agent interactions on the overall system. This framework enables analysis of GenAI's effects on the research integrity management system.</p><p><strong>Results: </strong>The scientific research integrity management system exhibits structural, hierarchical, and multidimensional complexities, with internal circulation of policy, funding, and information elements. In response to GenAI integration, four micro-level agents-researchers, research subjects, scientific research administrators, and academic publishing institutions-adapt their behaviors to systemic changes. Through these interactions, behavioral outcomes emerge at the macro level, driving evolution of the research integrity management system.</p><p><strong>Conclusions: </strong>Risks of scientific misconduct permeate the entire research process and require urgent governance. This study recommends that scientific research administrators promptly define applicable boundaries for GenAI in research to guide researchers. Concurrently, they should collaborate with relevant departments to establish regulatory frameworks addressing potential GenAI-related misconduct. Academic publishing institutions must assume quality assurance responsibilities by strengthening review and disclosure protocols. Furthermore, research integrity considerations should be systematically integrated into GenAI's technological development and refinement.</p><p><strong>Highlights: </strong>● Develops an analytical framework grounded in Complex Adaptive Systems (CAS) theory to map evolving interactions among researchers, research subjects, scientific research administrators, and academic publishing institutions within GenAI-integrated research ecosystems.  ● Identifies self-reinforcing dynamics between GenAI adoption and integrity governance, wherein adaptive rule adjustments by agents reshape system-wide integrity thresholds.  ● Proposes adaptive governance mechanisms that balance innovation safeguards with integrity guardrails, emphasizing context-sensitive policy calibration over universal solutions.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"120"},"PeriodicalIF":3.1,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180415","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}

{"title":"Surrogate decision-making for people with congenital or acquired incapacity of judgement in the absence of known preferences: a scoping review.","authors":"Hannah V Schmieg, Eva De Clercq, Daniel Gregorowius, Patrizia Kalbermatten-Casarotti, Ruth Baumann-Hölzle, Jürg C Streuli","doi":"10.1186/s12910-025-01276-4","DOIUrl":"10.1186/s12910-025-01276-4","url":null,"abstract":"","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"116"},"PeriodicalIF":3.1,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139583","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}

{"title":"Interventions to promote medical research integrity: a scoping review.","authors":"Sihui Liu, Yang Yang, Miqi Li","doi":"10.1186/s12910-025-01275-5","DOIUrl":"10.1186/s12910-025-01275-5","url":null,"abstract":"<p><strong>Objective: </strong>This study reviewed the current status of interventions for medical research integrity. The forms and methods of interventions, the timing and duration of interventions, outcome indicators, and evaluation methods and time were systematically reviewed. It provided a reference for the development of intervention programs for medical research integrity. So as to improve the integrity awareness and behavior norms of researchers.</p><p><strong>Methods: </strong>Studies related to medical research integrity and intervention measures were retrieved from databases (PubMed, Web of Science, Scopus, EBSCOhost, Sinomed, China National Knowledge Infrastructure, Wangfang Data, VIP Database). The time limit for retrieval extends from the establishment of the database to June 15,2024. Two researchers independently screened and analyzed the retrieved literature, and the third researcher was asked to decide if there was any doubt.</p><p><strong>Results: </strong>The study included 17 references from 10 countries. A systematic review of the literature found that the intervention of medical research integrity runs through all stages of school and work. There were various forms of intervention measures, including policy intervention, environmental intervention, educational intervention and software intervention. Educational intervention was the most commonly used intervention for medical research integrity. Most interventions were short-lived and lack long-term follow-up and standardized assessments.</p><p><strong>Conclusions: </strong>Different interventions have different characteristics and advantages in promoting the integrity of medical research. At present, there is still a lack of uniform standards and long-term evaluation mechanisms for medical research integrity. In the future, various levels and forms of intervention measures should be formulated to improve the integrity of medical research.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"117"},"PeriodicalIF":3.1,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12462000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139552","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}

{"title":"Psychometric properties of the ethical safety questionnaire in acute healthcare environments - a cross-sectional study.","authors":"Adrienne Grech, Kati Naamanka, Janet Mattsson, Amir Pakpour, Suvi Kivelä, Maria Cassar, Katri Manninen, Kristaps Circenis, Agita Melbārde-Kelmere, Nina Korsström, Elena Marqués-Sule, Sara Cortés-Amador, David Hernández-Guillén, Tarja Poikkeus, Gunilla Björling","doi":"10.1186/s12910-025-01279-1","DOIUrl":"10.1186/s12910-025-01279-1","url":null,"abstract":"","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"115"},"PeriodicalIF":3.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031187","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}

{"title":"Correction: Ethics, orthodoxies and defensive practice: a cross-sectional survey of nurse's decision-making surrounding CPR in deceased inpatients without Do Not Resuscitate orders.","authors":"Gemma McErlean, Suzanne Bowdler, Joanne Cordina, Heidi Hui, Edwina Light, Wendy Lipworth, Susan Maitland, Eamon Merrick, Amy Montgomery, Anne Preisz, Linda Sheahan, Suzanne Sheppard-Law, George Skowronski, Cameron Stewart, Judeil Krlan Teus, Michael Watts, Sahn Zanotti, Ian Kerridge","doi":"10.1186/s12910-025-01281-7","DOIUrl":"https://doi.org/10.1186/s12910-025-01281-7","url":null,"abstract":"","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"114"},"PeriodicalIF":3.1,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12398002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979023","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}

{"title":"Public trust of AI in healthcare in South Africa: results of a survey.","authors":"Donrich Thaldar, Dane Bottomley","doi":"10.1186/s12910-025-01272-8","DOIUrl":"10.1186/s12910-025-01272-8","url":null,"abstract":"<p><strong>Background: </strong>The integration of Artificial Intelligence (AI) in healthcare promises significant advancements in patient care, yet its success heavily relies on public trust and acceptance, particularly in diverse socio-economic contexts like South Africa. This study investigates South African residents' willingness to trust AI in healthcare decisions, exploring the impact of socio-demographic factors such as age and religion on their preferences.</p><p><strong>Methods: </strong>Utilizing a cross-sectional online survey distributed via Facebook, we gathered data from 341 respondents across South Africa. The survey assessed participants' preference for human versus AI doctors in serious health scenarios, alongside demographic information including age, gender, educational attainment, religion, and home language. Weighting adjustments were applied to align the sample with South Africa's demographic proportions for home language and gender. Data were analysed to explore correlations between these demographics and preferences for AI in healthcare.</p><p><strong>Results: </strong>A significant majority (73.7% weighted) expressed a preference for a human doctor over an AI doctor. Notably, the importance of religion (p < .001) and specific age groups (p = .025) significantly influenced preferences. A significant proportion of respondents for whom religion was \"not too important,\" as well as those in the 40-49 age group, preferred an AI doctor.</p><p><strong>Conclusions: </strong>This study underscores the need for innovative governance models tailored to resource-constrained settings, where traditional human-in-the-loop requirements may not always be feasible. Future research should explore how socio-cultural factors and trust dynamics influence public attitudes toward AI in healthcare and investigate models that ensure safety and accountability while addressing practical limitations in healthcare delivery systems.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"113"},"PeriodicalIF":3.1,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12379453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978967","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}