BMC Medical Ethics最新文献

{"title":"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/s12910-025-01224-2","DOIUrl":"10.1186/s12910-025-01224-2","url":null,"abstract":"<p><strong>Background: </strong>In hospital, nurses are often the first to identify patients in cardiorespiratory arrest and must decide whether to call a CODE BLUE and commence cardiopulmonary resuscitation (CPR). In Australia, there are no legal or policy obligations to commence CPR when unequivocal signs of death are present. The use of CPR where it cannot provide any benefit to a patient raises profound questions about decision-making and ethical practice. The aim of this empirical ethics study was to describe hospital-based nurses' decision-making, perspectives, and experiences of initiating CPR in hospitalised patients who have unequivocal signs of death but lack a Do-Not-Resuscitate (DNR) order.</p><p><strong>Methods: </strong>The study was a multisite cross-sectional descriptive survey conducted between October 2023-April 2024. Nurses were presented with two clinical scenarios in which patients were found to have no signs of life: Mr. D, an 84-year-old male with cancer, and Mr. G, a 35-year-old male post-motor vehicle accident. Eligible participants were all nurses working in in-patient units. Descriptive statistics, Pearson Chi-square or Fisher's exact tests, McNemar test, and binomial logistic regression were used to analyse the data.</p><p><strong>Results: </strong>531 nurses completed the survey. For Mr D, 61.5% (n = 324) would call a CODE BLUE, 24.1% (n = 127) would perform limited CPR. Only 14.4% (n = 76) would confirm death. For Mr G, 93.9% (n = 492) would call a CODE BLUE, 4.4% (n = 23) would perform limited CPR, and 1.7% (n = 9) would confirm death. The major reasons why nurses initiate a CODE BLUE were 'In the absence of an DNR order, there is no option but to begin CPR', 'I am required by hospital policy to do so', 'I am required by law to do so' and 'It is what I was trained to do'.</p><p><strong>Conclusions: </strong>Most nurses would commence CPR in patients with clear signs of death in the absence of a DNR order. This seems most likely related to ignorance or misunderstanding of law, policy and/or the misapplication or professional norms. These results raise important questions about the drivers of nurses understanding of and engagement with CPR. This highlights ethical concerns for care and treatment of patients at the end of their life and underscores the need to examine ethical practice, agency, and professionalism and supports review of policy, practices and education regarding ethical end-of-life decision making and care.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"65"},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112408","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":"Informed consent and ethics committee involvement in case reports and case series: cross-sectional meta-research study.","authors":"Matea Valešić, Marta Čivljak, Livia Puljak","doi":"10.1186/s12910-025-01226-0","DOIUrl":"10.1186/s12910-025-01226-0","url":null,"abstract":"<p><strong>Background: </strong>Although the research should guarantee the protection of privacy and personal data, case reports and case series frequently lack the involvement of the ethics board and informed consent that includes the required information. This study aimed to analyze the reporting about informed consent and ethics committees in case reports and case series.</p><p><strong>Methods: </strong>This cross-sectional meta-research study analyzed case reports and case series published in 2021, indexed in PubMed, and available as open-access articles. Extracted variables included authorship details, country, journal name, number of cases, and documentation of informed consent and ethics committee approval.</p><p><strong>Results: </strong>This study analyzed 2053 case reports and case series. Most articles (86%) reported a single case. Statements about informed consent were reported in 79% of cases. Informed consent was primarily obtained from patients (74%). Statements about an ethics committee were reported in 46% of articles. In 24% of articles, it was reported that approval was obtained from an ethics committee. Case reports were significantly more likely to include a statement on informed consent than case series. On the contrary, case series were significantly more likely to report ethics committee statements than case reports.</p><p><strong>Conclusion: </strong>The findings reveal inconsistencies in ethics reporting, with 46% of articles mentioning ethics committee involvement and varying justifications for exemption. While 79% of articles reported informed consent, further improvements in transparency and standardization are needed. Clear guidelines on ethical approval requirements and consent documentation should be established to enhance the quality and ethical rigor of case reports.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"64"},"PeriodicalIF":3.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103257","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":"Risks and benefits of engaging youth living with HIV in research: perspectives from Kenyan Youth, caregivers, and subject matter experts.","authors":"Emma Gillette, Winstone Nyandiko, Ashley Chory, Michael Scanlon, Josephine Aluoch, Hillary Koros, Celestine Ashimosi, Whitney Biegon, Dennis Munyoro, Janet Lidweye, Jack Nyagaya, Allison DeLong, Rami Kantor, Rachel Vreeman, Violet Naanyu","doi":"10.1186/s12910-025-01225-1","DOIUrl":"10.1186/s12910-025-01225-1","url":null,"abstract":"<p><strong>Background: </strong>Involving children and adolescents (youth) living with HIV (YLWH) in research is critical for developing appropriate HIV care services and interventions. However, this vulnerable population may not adequately weigh risks against benefits when participating in research, forming an ethical concern, yet little is known about how YLWH perceive these risks and benefits. To inform research-related policies and procedures, we sought perspectives of Kenyan YLWH, their caregivers and subject matter experts (SMEs) on risks and benefits of participation in research in a setting with a high burden of youth HIV infection.</p><p><strong>Methods: </strong>We conducted a qualitative inquiry on identifying, enrolling, and protecting YLWH (age 10-24 years) in research using semi-structured interviews with YLWH involved in research, their caregivers, YLWH with no prior research experience, and other SMEs at the AMPATH care and research sites in western Kenya. Transcripts were thematically analyzed and emerging themes derived to characterize perspectives of each group on risks and benefits of engaging YLWH in research.</p><p><strong>Results: </strong>Interviews were conducted with 40 YLWH (50% female; median age 17.5 years), 20 caregivers (70% female), and 39 SMEs [healthcare providers (N = 10), community leaders (N = 10) community advisory board members (N = 4), IRB experts (N = 5), clinical researchers (N = 6), social science researchers (N = 4) and laboratory experts (N = 1).] Participants in all groups identified accidental disclosure of HIV status, stigma and discrimination, risks of blood draws, mental health effects, and coercion due to study compensation as risks of research involvement. Benefits fell into 5 categories: clinical, informational, personal, future and community or household benefits. Benefits included access to health care, learning about HIV, gaining hope and community, improving HIV care, and reducing stigma. All participant groups largely held similar views; however, caregivers were the only group to identify misuse of study compensation as a risk, and YLWH less frequently cited clinical benefits.</p><p><strong>Conclusion: </strong>These findings suggest that participants commonly cite indirect risks and benefits of research participation, yet these are often excluded from institutional guidelines for consent documentation. Researchers should consider including indirect risks and benefits, such as the risk of stigma or the benefit of gaining knowledge and community, to study documentation.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"63"},"PeriodicalIF":3.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082228","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":"A literature review of non-financial conflicts of interest in healthcare research and publication.","authors":"David Bauer, Devin A Orchard, Philip G Day, Marc Tunzi, David J Satin","doi":"10.1186/s12910-025-01221-5","DOIUrl":"10.1186/s12910-025-01221-5","url":null,"abstract":"<p><strong>Background: </strong>Conflicts of interest (COIs) in healthcare research have received substantial attention over the past three decades. Although financial COI (FCOI) has an extensive literature, publications about non-financial COI (NFCOI) are comparatively rare. Disagreements surrounding the importance of NFCOIs in research and publication, including whether competing non-financial interests should even be considered COIs, present significant gaps in the literature. This lack of clarity prompted our literature review's aim to determine the current consensus about how NFCOIs should be treated in healthcare research and publication.</p><p><strong>Methods: </strong>We searched the PubMed database using MeSH terms and keywords to identify articles published before November 6, 2023 about NFCOI in biomedical research and publication. We applied relevance, appropriateness, transparency, and soundness (RATS) criteria to develop a final dataset of 206 publications and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Qualitative and quantitative analyses revealed major themes and conclusions regarding consensus within the field.</p><p><strong>Results: </strong>The literature centers around fundamental disagreements about (1) whether competing non-financial interests constitute COIs like FCOIs, (2) whether they need to be addressed in research, and (3) whether they should be managed with disclosure or with other strategies. Despite these disagreements, the balance of evidence and arguments suggests that (1) NFCOIs are meaningful conceptual entities like FCOIs [96%], (2) they require management [76%], and (3) disclosure is necessary but insufficient [55%] or necessary and sufficient [27%] as a management strategy.</p><p><strong>Conclusion: </strong>The topic of NFCOI enjoys far less attention and consensus compared to FCOI's robust body of literature developed over decades. We found general agreement about the relevance of NFCOIs and the need to address them, but not how to do so. Our results are consistent with Wiersma et al., the first review on this topic. Taken together, these reviews suggest a path forward for researchers, publishers, and healthcare professionals requiring new approaches for NFCOI management.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"61"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082263","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":"Do mental or somatic diagnoses influence emotional response and perception of physician-assisted suicide in Germany? A vignette-based experiment.","authors":"Laura Hofmann, Birgit Wagner","doi":"10.1186/s12910-025-01223-3","DOIUrl":"10.1186/s12910-025-01223-3","url":null,"abstract":"<p><strong>Background: </strong>Physician-assisted suicide (PAS) is increasingly being legalized in a growing number of countries and is the focus of societal and ethical debates. However, there is limited knowledge regarding the perception and acceptance of PAS across different physical and mental health conditions. This study aimed to explore emotional responses, understanding, and willingness to support individuals with the wish for PAS.</p><p><strong>Methods: </strong>Participants from the general German population (N = 512) were presented with four case vignettes of PAS depicting individuals in an online study: one with cancer, one with depression, one with schizophrenia, and one healthy individual. Participants were asked to evaluate the emotional reactions elicited by the desire for PAS, the extent of their understanding of this wish, and their willingness to support each individual.</p><p><strong>Results: </strong>The study revealed significant differences in reactions to the case vignettes. Pro-social emotions were lowest and anger highest when considering the healthy individual. Participants demonstrated the greatest understanding and highest willingness to support the individual with cancer, while the least understanding and support were observed for the healthy person.</p><p><strong>Conclusions: </strong>The differential levels of support for PAS across various conditions underscore the complex interplay between societal values, perceived quality of life, and ethical considerations, particularly when mental health is involved.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"62"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12079990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082226","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":"Attitudes of physicians, nurses, and the general public toward End-of-Life (EoL) decisions in European countries: an umbrella review.","authors":"Pietro Refolo, Costanza Raimondi, Salvatore Simone Masilla, Antonina Argo, Emma Capulli, Silvia Ceruti, Silvia Gonella, Francesca Ingravallo, Guido Miccinesi, Mario Picozzi, Pietro Redaelli, Antonio Gioacchino Spagnolo","doi":"10.1186/s12910-025-01219-z","DOIUrl":"https://doi.org/10.1186/s12910-025-01219-z","url":null,"abstract":"<p><strong>Background: </strong>End-of-life (EoL) decisions represent some of the most ethically complex and emotionally charged aspects of healthcare. Understanding the attitudes of physicians, nurses, and the public toward EoL decisions is crucial for aligning care provided with the personal values and preferences of patients.</p><p><strong>Aim: </strong>To explore the attitudes of physicians, nurses, and the general public toward EoL decisions, including the withdrawal or withholding of life-sustaining treatments, euthanasia, physician-assisted suicide (PAS), palliative sedation, and advance care planning (ACP) within European countries.</p><p><strong>Design: </strong>An umbrella review was conducted, covering the period from January 2010 to June 2024. The search strategy included Medline, CINAHL, and PsycINFO, supplemented by manual searches of reference lists of all included studies to identify additional relevant studies.</p><p><strong>Results: </strong>The search identified 587 papers, 11 of which were included in the synthesis. Of these, six addressed euthanasia and PAS, three focused on ACP, one on the withdrawal of life-sustaining treatments, and one on palliative sedation. In Europe, the general public expressed the highest level of support for EoL practices such as euthanasia and PAS, followed by nurses, while physicians often held a more cautious perspective. For withdrawal of treatment, palliative sedation, and ACP, a critical recurring theme was the need to improve communication between patients and healthcare professionals.</p><p><strong>Conclusions: </strong>The divergence underscores the intricate complexity of navigating ethical, cultural, and professional considerations in EoL care. Effective communication serves as a cornerstone for respecting patient autonomy and ensuring that healthcare decisions align with individual values, goals and preferences.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"60"},"PeriodicalIF":3.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046508","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":"Perception of the ethical climate among hospital employees in a public healthcare system: a cross-sectional survey at the University Hospital of Split, Croatia.","authors":"Zrinka Hrgović, Luka Ursić, Jure Krstulović, Marin Viđak, Ljubo Znaor, Ana Marušić","doi":"10.1186/s12910-025-01217-1","DOIUrl":"https://doi.org/10.1186/s12910-025-01217-1","url":null,"abstract":"<p><strong>Background: </strong>In this cross-sectional study, we assessed the ethical climate at the University Hospital of Split in Croatia and investigated its potential indicators.</p><p><strong>Methods: </strong>We used a validated Croatian translation of the 36-item Ethical Climate Questionnaire, which we distributed online (via an e-mail sent by the hospital administration to hospital employees) and as a paper and pen survey directly to all hospital departments. We compared ECQ scores between doctors of medicine (MDs)/doctors of dental medicine (DMDs) and other employees; MDs/DMDs and nurses; employees working with patients and those not working with patients; and employees working in the ICU versus those not working in the ICU using the Mann-Whitney U test. We used linear regression to explore the relationship of each ethical climate with gender, age, degree level, and years spent working in the hospital.</p><p><strong>Results: </strong>We collected 325 physical and 222 online questionnaires (547 responses in total), after which we excluded 146 incomplete responses. This left 401 questionnaires for analysis, primarily from doctors (n = 175; 43.6%) and nursing staff (n = 131; 32.7%). The two dominant climates were 'Company rules' and 'Laws and professional codes'. Stratified by profession, we observed higher scores for 'Personal morality' among doctors of medicine or dental medicine, whereas the group comprising other health professionals and non-medical staff had higher scores for 'Team interests', 'Efficiency', 'Social responsibility', and 'Laws and professional codes'. In comparing nurses and doctors of medicine/dental medicine, we observed the former group had higher scores for 'Social responsibility', 'Efficiency', and 'Team interest', while the latter had higher scores for 'Personal morality'. Those who worked outside of the ICU had higher scores for 'Social responsibility' compared to those who did not. In the regression analyses, age was a significant positive predictor of the 'Laws and professional codes' climates, and years spent working in the hospital acted as a positive predictor of the 'Self-interest' climate.</p><p><strong>Conclusion: </strong>A large university hospital center in a fully publicly funded national healthcare system has a positive ethical work climate, which could be further developed by further development and implementation of codes of ethics to outline expected behaviors from all employees.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"59"},"PeriodicalIF":3.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040872","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":"Why did not all studies conducted during Darfur's armed conflict obtain ethics approval? Insights from a qualitative study.","authors":"Ghaiath Hussein, Khalifa Elmusharaf","doi":"10.1186/s12910-025-01194-5","DOIUrl":"https://doi.org/10.1186/s12910-025-01194-5","url":null,"abstract":"<p><strong>Background: </strong>Armed conflicts are associated with multiple factors that may deem applying the ethical standards of research conducted in war-affected areas hard to achieve, compared to research conducted in peace time.</p><p><strong>Objective: </strong>Using the example of studies conducted by the humanitarian agencies in the war-troubled region of Darfur, west Sudan between 2004 and 2012, a qualitative study was pursued to have a deeper understanding of the factors that affected the reporting of gaining the ethical approval in the published reports of these studies.</p><p><strong>Methods: </strong>A qualitative study was used that involved conducting interviews and focus groups with the relevant stakeholders, namely the representatives of the national and international non-governmental organizations, UN agencies, and the national humanitarian and research governance bodies in Sudan.</p><p><strong>Results: </strong>38 participants were involved (5 interviewees and 33 participants in the focus groups). The participants expressed a consensus on the need for an ethical oversight for research in the humanitarian settings in Sudan and particularly Darfur. Following a thematic analysis, four main themes were identified to explain why the humanitarian studies in Darfur were not submitted to formal ethical approval. These are (1) Inconsistent definitions of research, (2) Perceptions of low-risk, (3) Perceived urgency due to emergency context, (4) Prior study or tool approval, and (5) Lack of knowledge about ethics review procedures.</p><p><strong>Conclusion: </strong>Institutional gaps in humanitarian governance structures are identified, urging the need for specialized ethics oversight mechanisms. The dynamic nature of humanitarian crises prompts nuanced approaches to ethical scrutiny, emphasizing policy initiatives to harmonize research and humanitarian governance frameworks and learning lessons from research ethics oversight in public health emergencies.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"58"},"PeriodicalIF":3.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12054246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000205","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":"Health leaders' perspectives and attitudes on medical assistance in dying and its legalization: a qualitative study.","authors":"Amanda Yee, Eryn Tong, Rinat Nissim, Camilla Zimmermann, Sara Allin, Jennifer L Gibson, Madeline Li, Gary Rodin, Gilla K Shapiro","doi":"10.1186/s12910-025-01208-2","DOIUrl":"https://doi.org/10.1186/s12910-025-01208-2","url":null,"abstract":"<p><strong>Background: </strong>Medical Assistance in Dying (MAiD) has transformed health policy and practice on death and dying. However, there has been limited research on what shaped its emergence in Canada and the beliefs and views of health leaders who hold positions of influence in the healthcare system and can guide policy and practice. The objective of this study was to examine health leaders' perspectives on the factors that led to the emergence of MAiD and explore their attitudes about the legalization of MAiD.</p><p><strong>Methods: </strong>In this qualitative study, we conducted online semi-structured interviews with health leaders from April 2021 to January 2022. Purposive and snowball sampling techniques were used to recruit health leaders who have expertise and engagement with the delivery of MAiD or palliative and end-of-life care, and who hold positions of leadership relevant to MAiD in their respective organisations. Inductive thematic analysis was used to analyze the transcribed interviews.</p><p><strong>Results: </strong>Thirty-six health leaders were interviewed. Participants identified six factors that they believed to have led to the introduction of MAiD in Canada: public advocacy and influence; judicial system and notable MAiD legal cases; political ideology and landscape; policy diffusion; healthcare system emphasis on a patient-centred care approach; and changes in societal and cultural values. Participants expressed wide-ranging attitudes on the legalization of MAiD. Some described overall agreement with the introduction of MAiD, while still raising concerns regarding vulnerability. Others held neutral attitudes and indicated that their attitudes changed on a case-by-case basis. Participants described four factors that they considered to have had influence on their attitudes: personal illness experiences; professional experiences and identity; moral and religious beliefs; and, the valence of patient autonomy and quality of life.</p><p><strong>Conclusions: </strong>This study highlights the wide-ranging and complex attitudes health leaders may hold towards MAiD and identifies the convergence of multiple factors that may have contributed to the legalization of MAiD in Canada. Understanding health leaders' attitudes and perspectives on the legalization of MAiD may inform stakeholders in other countries who are considering the legalization of assisted dying.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"57"},"PeriodicalIF":3.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058847","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":"A balancing act: exploring ethical and legal concerns associated with release of personal information in alert systems for missing persons with dementia.","authors":"Adebusola Adekoya, Christine Daum, Antonio Miguel-Cruz, Lili Liu","doi":"10.1186/s12910-025-01214-4","DOIUrl":"10.1186/s12910-025-01214-4","url":null,"abstract":"<p><strong>Background: </strong>Technology, such as alert systems, can foster community engagement in locating missing persons with dementia and minimize potential harm. However, concerns arise about implications of public disclosure of missing individual's personal information (such as age, photographs, physical descriptions, and medical conditions) within alert systems. Until now, there has been no review of these concerns, particularly in the Canadian context. Our study aimed to explore community members' perspectives on the ethical and legal concerns associated with the release of personal information in alert systems for missing persons with dementia.</p><p><strong>Methods: </strong>Using a qualitative descriptive approach, we conducted semi-structured interviews with 18 participants: people living with dementia, care partners, service providers, first responders, and experts in ethics, policy, and the law from Canada and the United Kingdom. We conducted a thematic analysis of the interview data to inductively explore ethical and legal concerns.</p><p><strong>Results: </strong>Our findings identified the following concerns: Balancing safety and privacy, stigmatization, risk of victimization and abuse, and informed consent. There is a challenge of balancing safety with privacy due to the urgency of locating missing persons when sharing personal information publicly. Disclosure of personal information, such as cognitive impairment, can increase the risk of stigmatization, victimization, and abuse for both the missing individuals and their care partners. Unfortunately, conversations about alert systems and consent do not typically occur before someone goes missing, even though people living with dementia have the right to participate in these conversations.</p><p><strong>Conclusions: </strong>Alert systems can promote community involvement in locating missing persons with dementia but must balance safety and privacy concerns. Implementation of education and policies would mitigate stigmatization, victimization, and abuse. Early conversations with people living with dementia and their care partners to understand their preferences, along with an advance consent process, can help address consent concerns. Our framework, which emphasizes ethical and legal considerations, can guide policy, practice, and decision-making to support the autonomy of people living with dementia.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"56"},"PeriodicalIF":3.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12051343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013020","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}