BMC Medical Ethics最新文献

{"title":"Institutional financial incentives in healthcare: a review of normative considerations.","authors":"Roshni Jegan, Anuradha Rose, Kris Dierickx","doi":"10.1186/s12910-025-01252-y","DOIUrl":"10.1186/s12910-025-01252-y","url":null,"abstract":"<p><strong>Background: </strong>Institutional financial incentives(FIs) are used to improve the quality of healthcare services and patient outcomes. In spite of their growing use, empirical evidence regarding their impact remains inconclusive. Moreover, the normative implications of institutional FIs remain underexplored. This study aims to map the normative considerations and tensions in using institutional FIs in healthcare.</p><p><strong>Methods: </strong>We performed a systematic review of reasons to identify and map the normative considerations in institutional FIs. Six databases, namely PubMed, Embase, Scopus, Web of Science, ProQuest Central and EconPapers, and additionally Google Scholar were searched. We included peer-reviewed literature in English on financial incentives or pay-for-performance in healthcare at the institutional level, and excluded grey literature, and studies on individual provider incentives.</p><p><strong>Results: </strong>Sixteen articles met the inclusion criteria, representing diverse disciplines such as health economics, medicine, law, public health and health policy. Two categories of normative considerations are identified: firstly, considerations at the macro and meso level (societal and institutional level), and secondly, considerations at the micro (departmental or individual) level. The key normative principles identified are effectiveness, utility, solidarity, distributive justice, procedural justice, professional values, conflicts of interest and proportionality. The tensions inherent in each normative principle are closely linked to contextual elements such as institutional characteristics, incentive design and performance measures: for instance, the type of performance measure used (process or outcome measure, relative or absolute improvement) impacts procedural justice.</p><p><strong>Discussion: </strong>This study is limited in including only English language literature. Notwithstanding this limitation, this review provides an overview of the normative implications of institutional financial incentives. As robust empirical evidence on the institution and societal-level effects of FI is lacking, these findings emphasize the need for further normative deliberation on institutional FIs and more caution while implementing institutional FIs as a policy measure.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"92"},"PeriodicalIF":3.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12247344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610408","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":"Strengthening ethical oversight in genomics and biobanking: a retrospective analysis of research practices in Zimbabwe.","authors":"Oppah Kuguyo, Alice Matimba, Florence Mutevedzi, Andrew Chimatira, Vasco Chikwasha, Abigail Kangwende, Lovemore Gwanzura, Paul Ndebele","doi":"10.1186/s12910-025-01257-7","DOIUrl":"10.1186/s12910-025-01257-7","url":null,"abstract":"<p><strong>Background: </strong>As genomics and biobanking expanded rapidly across Africa, ethical governance frameworks for genomic research and biobanking often failed to keep pace, particularly in countries like Zimbabwe, where research increasingly involved international collaboration, but regulatory oversight remained limited. This study analysed how Zimbabwean researchers addressed the ethical, legal, and sociocultural issues (ELSIs) central to human biospecimen and genomic research.</p><p><strong>Methods: </strong>We conducted a comprehensive review of research protocols submitted to the Medical Research Council of Zimbabwe between 2009 and 2016, specifically those involving human biospecimen collection, biobanking, and genomic research. A structured abstraction form was employed to evaluate how these protocols addressed key ELSIs, including informed consent, biospecimen and data sharing, benefit sharing, and intellectual property considerations.</p><p><strong>Results: </strong>Of the 200 eligible protocols, 92(46%) were submitted by independent research institutions and 67(33.5%) by universities. Consent practices varied: 99(49.5%) protocols utilized specific consent, 37(18.5%) employed broad consent, and 37(18.5%) used blanket consent. Notably, 2(1%) protocols did not use consent forms, opting instead for broad or specific notifications. Only 44(22%) protocols included plans for the destruction of collected samples. While 44(22%) protocols involved exporting biospecimens, nearly two-thirds of these lacked a material transfer agreement (MTA). Critically, benefit sharing was absent across all protocols, and only 26(13%) addressed intellectual property rights.</p><p><strong>Conclusions: </strong>This review exposes systemic gaps in the ethical planning of genomics and biobanking research in Zimbabwe. Although researchers are increasingly engaging in cutting-edge science, the regulatory and ethical frameworks require transformation. The limited attention to benefit sharing, consent for future use, and intellectual property reflects deeper governance and equity challenges. To protect research participants and ensure ethical integrity, Zimbabwe urgently needs updated national guidelines that define minimum standards for addressing a full range of ELSIs, moving beyond consent and privacy to embrace justice, accountability, and long-term stewardship. Strengthening these frameworks is crucial to ensuring ethical integrity in Zimbabwe's growing biobanking and genomic research landscape.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"91"},"PeriodicalIF":3.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12243164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602311","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":"Construction and validation of a predictive model for the acceptance of kidney xenotransplantation among patients awaiting kidney transplantation: a cross-sectional study from China.","authors":"Shujun Yang, Hao Wei, Haihong Yang, Jiang Peng, Panfeng Shang, Shengkun Sun","doi":"10.1186/s12910-025-01247-9","DOIUrl":"10.1186/s12910-025-01247-9","url":null,"abstract":"<p><strong>Background: </strong>Kidney xenotransplantation (KXTx) has the potential to address the shortage of kidney donations. To construct and validate a predictive model for the willingness to receive KXTx, data were collected from Chinese patients awaiting kidney transplantation.</p><p><strong>Methods: </strong>The data were collected from 539 questionnaires from June 20, 2023, to April 3, 2024. A random allocation method was used to conduct univariate analysis and multiple logistic regression analysis to explore the factors that affect KXTx acceptance. A prediction model was constructed in the form of a nomogram, and the accuracy of the prediction model was evaluated using multiple methods.</p><p><strong>Results: </strong>The results of multivariate logistic regression revealed that medical insurance (No vs. Yes, odds ratio [OR] 3.10, 95% confidence interval [CI] 1.52-6.12), religion (no belief as the reference group; Atheist: OR 2.56, 95% CI 1.26-5.33; Buddhism: OR 2.03, 95% CI 0.78-4.89; Taoism: OR 2.33, 95% CI 0.72-6.77; Islam: OR 5.78, 95% CI 1.38-21.10; Catholicism: OR 4.52, 95% CI 0.74-22.7; Christianity: OR 7.69, 95% CI 0.36-66.5; Other: OR 0.93, 95% CI 0.05-5.26), and knowing about KXTx (No vs. Yes, OR 3.39, 95% CI 1.89-6.08) were independent risk factors for KXTx acceptance. A nomogram was constructed based on the abovementioned factors, and the area under the curve was 0.717. The calibration curves decision curve analysis also revealed good performance. Additionally, previous research has shown that KXTx-related risk factors are the primary concern for these patients.</p><p><strong>Conclusion: </strong>This study constructed a predictive model for the acceptance of KXTx among patients awaiting kidney transplantation. This model has significance for studying the acceptance and attitudes of this population.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"90"},"PeriodicalIF":3.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12243268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602310","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":"Evaluating accountability, transparency, and bias in AI-assisted healthcare decision- making: a qualitative study of healthcare professionals' perspectives in the UK.","authors":"Saoudi Ce Nouis, Victoria Uren, Srushti Jariwala","doi":"10.1186/s12910-025-01243-z","DOIUrl":"10.1186/s12910-025-01243-z","url":null,"abstract":"","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"89"},"PeriodicalIF":3.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592988","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":"Returning of individual genetic findings to biobank participants: a mixed methods study results in Lithuania.","authors":"Jūratė Lekstutienė, Rūta Žiliukaitė, Marija Jakubauskienė, Eugenijus Gefenas","doi":"10.1186/s12910-025-01250-0","DOIUrl":"10.1186/s12910-025-01250-0","url":null,"abstract":"","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"86"},"PeriodicalIF":3.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12231843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565529","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":"How participation in deliberative engagement affects awareness of, and attitudes towards, genomics research and data sharing: evidence from rural Ghana.","authors":"Irene Honam Tsey, Pamela Emefa Selormey, John Ganle, Patricia Akweongo, Paulina Tindana","doi":"10.1186/s12910-025-01251-z","DOIUrl":"10.1186/s12910-025-01251-z","url":null,"abstract":"","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"87"},"PeriodicalIF":3.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12231673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565526","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":"Turkish medical oncologists' perspectives on integrating artificial intelligence: knowledge, attitudes, and ethical considerations.","authors":"Efe Cem Erdat, Filiz Çay Şenler","doi":"10.1186/s12910-025-01249-7","DOIUrl":"10.1186/s12910-025-01249-7","url":null,"abstract":"<p><strong>Background: </strong>Integrating artificial intelligence (AI), especially large language models (LLM) into oncology has potential benefits, yet medical oncologists' knowledge, attitudes, and ethical concerns remain unclear. Understanding these perspectives is particularly relevant in Türkiye, which has approximately 1340 practicing oncologists.</p><p><strong>Methods: </strong>A cross-sectional, online survey was distributed via the Turkish Society of Medical Oncology's channels from October 16 to November 27, 2024. Data on demographics, AI usage, self-assessed knowledge, attitudes, ethical/regulatory perceptions, and educational needs were collected. Quantitative analyses were performed using descriptive statistics and graphics were generated using R v.4.3.1, and qualitative analysis of open-ended responses was conducted manually.</p><p><strong>Results: </strong>Of 147 respondents (representing about 11% of Turkish oncologists), 77.5% reported prior AI use, mainly LLMs, yet only 9.5% had formal AI education. While most supported integrating AI into prognosis estimation, research, and decision support, concerns persisted regarding patient-physician relationships and social perception. Ethical reservations centered on patient management, scholarly writing, and research design. Over 79% deemed current regulations inadequate and advocated ethical audits, legal frameworks, and patient consent. Nearly all were willing to receive AI training, reflecting a substantial educational gap.</p><p><strong>Conclusions: </strong>Turkish medical oncologists exhibit cautious optimism toward AI but highlight critical gaps in training, clear regulations, and ethical safeguards. Addressing these needs could guide responsible AI integration. Limitations include a single-country perspective. Further research is warranted to generalize findings and assess evolving attitudes as AI advances.</p><p><strong>Trial registration: </strong>Not applicable due to cross-sectional survey design.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"82"},"PeriodicalIF":3.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565530","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":"Design and psychometric properties of a tool to assess Adherence to the Code of Ethics in Midwifery.","authors":"Zahra Kiani, Masoumeh Simbar, Abbas Ebadi, Soheila Nazarpour","doi":"10.1186/s12910-025-01246-w","DOIUrl":"10.1186/s12910-025-01246-w","url":null,"abstract":"","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"88"},"PeriodicalIF":3.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12231620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565525","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":"Bioethics at the intersection of politics, society, and healthcare: the significance of media debate analyses.","authors":"Niklas Ellerich-Groppe, Bettina M Zimmermann","doi":"10.1186/s12910-025-01233-1","DOIUrl":"10.1186/s12910-025-01233-1","url":null,"abstract":"<p><p>Since the \"empirical turn\" in bioethics, empirical inquiries have gained momentum in bioethical research. However, the relevance of the systematic analysis of media debates for empirical bioethics and the corresponding methodological requirements have so far been rather underexplored. Thus, the existing approaches are methodologically heterogeneous and their significance for bioethical inquiries has not been systematically discussed. In this paper, we provide a critical reflection on the significance of media debate analyses for bioethics, which lies in the possibility of investigating the unique intersection of bioethics, politics, society, and healthcare. Through a rapid scoping review, we outline the characteristics of published media debate analyses and show the heterogeneity of the field in terms of methodologies, academic disciplines, and topics covered. We identify four levels on which these publications contribute to bioethics research: (1) by providing a descriptive empirical context; (2) by describing ethical aspects of a health topic; (3) by identifying and evaluating moral problems; and (4) by providing an ethical evaluation of media debates. Based on this, we outline basic methodological requirements, address the limitations of media debate analyses for bioethics, and indicate recent and future advancements in the field.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"85"},"PeriodicalIF":3.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12231874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565524","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":"Preferences for life-sustaining treatments in advance decisions: a cross-sectional survey of Taiwanese general public.","authors":"Daniel Fu-Chang Tsai, Yu-Chen Juang, Chun-Tung Kuo, Ping-Hsueh Lee, Duan-Rung Chen","doi":"10.1186/s12910-025-01242-0","DOIUrl":"10.1186/s12910-025-01242-0","url":null,"abstract":"<p><strong>Background: </strong>Taiwan passed the Patient Right to Autonomy Act in 2016 and introduced a legal document called advance decision to address dilemmas in making life-sustaining treatment (LST) decisions for incompetent patients. However, the proportion of Taiwanese adults who have completed an advance decision remains low, and public preference trends are unclear.</p><p><strong>Methods: </strong>A cross-sectional telephone survey was conducted among Taiwanese adults using a structured questionnaire to assess preferences regarding five types of LSTs across four hypothetical clinical scenarios (late-stage motor neuron disease, severe dementia, irreversible coma, and terminal cancer). Participants were categorized based on their preference patterns, and factors associated with each subgroup were analyzed.</p><p><strong>Results: </strong>Of the 3188 individuals contacted, 2440 declined to participate, and 748 (24.3%) respondents were successfully interviewed. A total of 747 responses were included in the analysis. Latent class analysis identified four preference subgroups: pro-forgo (more than half of the respondents), neutral, aggressive, and motor-neuron-disease specific. Older age, higher education, and better quality of life were associated with a greater likelihood of belonging to the pro-forgo group, while being male, unmarried, currently not working, or not residing in northern Taiwan were associated with a lower likelihood.</p><p><strong>Conclusions: </strong>Most respondents expressed a consistent preference to forgo LSTs in the hypothetical clinical scenarios. This suggests that the advance decision, implemented in 2019, may align with public needs. However, given the low completion rate and prevalent preference patterns, policymakers should increase efforts to ensure that those in need have access to appropriate resources and consider implementing a tiered signing process.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"83"},"PeriodicalIF":3.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12231297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565527","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}