Hasil untuk "Medical philosophy. Medical ethics"

Yixuan Li, Xuebin Zhang, Baoyun Qi et al.

Abstract Background The ethical use of placebos in herbal medicine (HM) clinical trials remains contested, particularly in contexts where traditional medical systems shape patients’ beliefs and expectations. Complexities in placebo preparation, insufficient transparency, and inconsistent consent practices pose challenges not only to scientific validity but also to ethical standards. This study aimed to explore stakeholder perspectives on placebo use in HM trials, with a specific focus on ethical concerns related to trust, informed consent, and trial integrity. Methods In-depth qualitative interviews were conducted with 23 stakeholders, including clinical investigators, research coordinators, trial managers, pharmaceutical staff, and patient representatives. We applied an inductive, framework-based thematic analysis to identify key perceptions, challenges, and needs regarding placebo use. Results Participants demonstrated diverse understandings and attitudes toward placebos. Medical professionals, who often had higher levels of formal medical training, tended to describe placebos from a scientific perspective, whereas patients more commonly expressed skepticism rooted in concerns about trust and transparency. Pharmacists reported substantial challenges in developing indistinguishable HM placebos, raising questions about the ethical implications of adding small amounts of active ingredients. Participants also highlighted inconsistent practices in placebo composition and similarity evaluation, which raised concerns about blinding integrity and transparency, as well as insufficient communication that affected participant trust and overall trial integrity. Conclusions Differences in professional and educational background appeared to shape how stakeholders perceived HM placebos, influencing informed consent and ethical conduct in trials. Enhancing understanding and transparency in placebo composition and similarity evaluation is essential to uphold ethical and scientific integrity of HM trials and to guide the development of clear guidelines for HM placebo design and communication. Clinical trial number not applicable.

Rui ZHANG, Gang CHEN

Through the analysis of the clinical application effects of shared decision-making (SDM) model in the diagnosis and treatment of parotid tumors within oral and maxillofacial surgery, this study aims to deepen the understanding of various forms of collaborative decision-making, including doctor-patient co-decision making, doctor-patient-family co-decision making, and multidisciplinary team-based decision making. In clinical practice, emphasizing SDM process can significantly enhance patient and family engagement while promoting the equitable SDM authority of SDM, thereby enabling the development of personalized and precise diagnostic and therapeutic strategies. The application characteristics of SDM in oral and maxillofacial surgery were systematically summarised based on patients' educational backgrounds, family circumstances, and multidisciplinary diagnosis and treatment recommendations, with the goal of enhancing the competence of oral and maxillofacial surgeons in implementing SDM.

Mia Svantesson, Jarl Gustav, Falk Wiebke et al.

Abstract Background Intensive care unit (ICU) admissions among older patients are increasing, posing significant challenges to already strained healthcare systems. Decision-making around ICU admission in times of limited resources may provide important knowledge about difficult prioritisations, particularly for older patients. Thus, the aim was to investigate ICU-admission decisions for older patients with COVID-19. Methods A mixed-methods approach. We audio-recorded ten COVID Rounds and nine Moral Case Deliberations for 34 patients across three Swedish hospitals during the pandemic, and collected data from medical records of 329 patients aged ≥ 65 diagnosed with COVID-19. Data were analysed using qualitative content analysis and multiple regression. Results Among 239 patients with documented decisions in medical records, 56% included explicit justifications. The justifications included considerations of medical benefit (not-too- ill/too-ill), general condition (good/frail), age (not-too-old/high age), professional duty (benefit of the doubt/do no harm) and “worth giving it a go” (grit and will to live/lack of will and coping). A minority (31%) of decisions favoured ICU admission. Justifications supporting admission were predominantly drawn from discussions in COVID Rounds and MCDs, where patient grit was a recurring argument. In regression analyses, age ≥ 80 years was the only factor significantly associated with not being admitted to ICU and having a documented justification. Few decisions explicitly referred to COVID-19-specific factors. Conclusion Our findings reflect patterns similar to pre-pandemic ICU decision-making, suggesting continuity in clinical reasoning. However, the limited documentation of justifications—especially in favour of admission—warrants attention, emphasising the need for clearer reasoning in medical records. Our findings identify chronological age as a key triage factor, normatively supported by the ethical principles of non-maleficence, justice, and Sweden’s legal priority-setting principle of Needs and Solidarity—which emphasises care only when benefit is likely. We therefore advocate for national (and potentially international) guidance on triage systems that support a palliative approach for very old patients. While grit may be relevant to ICU admission due to its link to potential benefit, its use raises ethical concerns, particularly in relation to Needs and Solidarity and Human Dignity. We recommend its cautious application pending further research.

Saoudi CE Nouis, Victoria Uren, Srushti Jariwala

Abstract Background While artificial intelligence (AI) has emerged as a powerful tool for enhancing diagnostic accuracy and streamlining workflows, key ethical questions remain insufficiently explored—particularly around accountability, transparency, and bias. These challenges become especially critical in domains such as pathology and blood sciences, where opaque AI algorithms and non-representative datasets can impact clinical outcomes. The present work focuses on a single NHS context and does not claim broader generalization. Methods We conducted a local qualitative study across multiple healthcare facilities in a single NHS Trust in the West Midlands, United Kingdom, to investigate healthcare professionals’ experiences and perceptions of AI-assisted decision-making. Forty participants—including clinicians, healthcare administrators, and AI developers—took part in semi-structured interviews or focus groups. Transcribed data were analyzed using Braun and Clarke’s thematic analysis framework, allowing us to identify core themes relating to the benefits of AI, ethical challenges, and potential mitigation strategies. Results Participants reported notable gains in diagnostic efficiency and resource allocation, underscoring AI’s potential to reduce turnaround times for routine tests and enhance detection of abnormalities. Nevertheless, accountability surfaced as a pervasive concern: while clinicians felt ultimately liable for patient outcomes, they also relied on AI-generated insights, prompting questions about liability if systems malfunctioned. Transparency emerged as another major theme, with clinicians emphasizing the difficulty of trusting “black box” models that lack clear rationale or interpretability—particularly for rare or complex cases. Bias was repeatedly cited, especially when algorithms underperformed in minority patient groups or in identifying atypical presentations. These issues raised doubts about the fairness and reliability of AIassisted diagnoses. Conclusions Although AI demonstrates promise for improving efficiency and patient care, unresolved ethical complexities around accountability, transparency, and bias may erode stakeholder confidence and compromise patient safety. Participants called for clearer regulatory frameworks, inclusive training datasets, and stronger clinician–developer collaboration. Future research should incorporate patient perspectives, investigate long-term impacts of AI-driven clinical decisions, and refine ethical guidelines to ensure equitable, responsible AI deployment. Trial registration : Not applicable.

Carlos Jesús Molina-Ricaurte

El presente artículo examina la actividad de las comisiones nacionales de bioética (CNB) en el debate sobre la maternidad subrogada, un tema crucial tanto para posibles cambios legislativos como para la función consultiva de estas comisiones. A través de una revisión de literatura y análisis de informes, dictámenes y recomendaciones emitidas por CNB de España, EE.UU., Francia e Italia, se pretende desentrañar cómo influyen las CNB en la formulación de políticas públicas y en el debate ético sobre esta práctica. Se concluye que, aunque las CNB no tienen poder legislativo, su rol consultivo y sus informes pueden tener un impacto significativo en la legislación y la opinión pública.

Ilke Coskun Benlidayi

CONFIDENTIALITY IN PEER REVIEW

Margarita Otero Lamas, Ingrid Jaqueline Pratt Rosales

La ética ambiental se enfoca en la responsabilidad humana hacia el entorno, especialmente debido al abuso de los recursos naturales en la actualidad. Esta relación ha causado impactos graves en el medio ambiente y en la vida humana, señalando la necesidad de un cambio genuino y práctico para que la humanidad asuma su responsabilidad en la preservación del entorno. Al considerar los puntos de vista teológicofilosóficos presentados por el papa Francisco y la propuesta ética de Hans Jonas para la era tecnológica, se busca en este estudio fusionar ambas ideas para lograr que fomenten la biodiversidad. Esto implica reconocer el papel del ser humano como administrador responsable, promoviendo una ética que oriente hacia el futuro, manteniendo el respeto por la posición del ser humano como guardián del ecosistema y su diversidad biológica.

Maroun BADR

La dimensión jurídica de la bioética, denominada bioderecho, ocupa un lugar importante en los debates sobre este tema. Para que sean reconocidas, las distintas legislaciones francesas sobre bioética requieren una autoridad política competente: la autoridad civil, cuyo vértice es la Constitución francesa (CF), como acto jurídico y ley fundamental que establece la organización y el funcionamiento del Estado. Sin embargo, en el ámbito en el que tocamos a la persona humana, a los valores y a los principios fundamentales, la autoridad religiosa, como la Doctrina Social de la Iglesia (DSI), tiene un papel que desempeñar. Es la referencia de valores a través de la cual la conciencia humana puede ejercerse libremente en las realidades políticas, sociales y económicas. Así pues, ¿cuáles son los posibles temas comunes entre la CF y la DSI y qué puede aportar la bioética personalista para conciliar ambas vertientes?

Dave Bovens, Eva van Baarle, Bert Molewijk

Abstract Background The field of personal health monitoring (PHM) develops rapidly in different contexts, including the armed forces. Understanding the ethical dimension of this type of monitoring is key to a morally responsible development, implementation and usage of PHM within the armed forces. Research on the ethics of PHM has primarily been carried out in civilian settings, while the ethical dimension of PHM in the armed forces remains understudied. Yet, PHM of military personnel by design takes place in a different setting than PHM of civilians, because of their tasks and the context in which they operate. This case study therefore focusses on obtaining insights into the experiences and related values of different stakeholders regarding an existing form of PHM, the Covid-19 Radar app, in the Netherlands Armed Forces. Methods We carried out an exploratory qualitative study, using semi-structured interviews with twelve stakeholders in the Netherlands Armed Forces. We focussed on participation in the use of PHM, reflections on the practical use and use of data, moral dilemmas and the need for ethics support, all in regard to PHM. The data was analysed using an inductive thematic approach. Results Three interlinking categories reflecting ethical dimensions of PHM emerged: (1) values, (2) moral dilemmas, and (3) external norms. The main values identified were: security (in relation to data), trust and hierarchy. Multiple related values were found. Some, but no broadly shared, moral dilemmas were identified and no strong need for ethics support was expressed. Conclusion This study shed light on key values, provide insights in the experienced and presumed moral dilemmas and bring to mind ethics support considerations when looking at PHM in the armed forces. Some values bring a certain vulnerability to military users when personal and organisational interests are not aligned. Furthermore, some identified values may hinder a careful consideration of PHM because they potentially conceal parts of ethical dimensions of PHM. Ethics support can assist in uncovering and addressing these concealed parts. The findings highlight a moral responsibility for the armed forces to devote attention to the ethical dimensions of PHM.

Jorge Iván Zurutuza Lorméndez, Mario Salvador Caba Vinagre, Pascual Linares-Márquez

La pandemia por SARS-CoV-2 y la enfermedad derivada, la COVID-19, representan un reto que pone a prueba la capacidad de respuesta de las instituciones de salud, pero que afecta todos los ámbitos de la práctica clínica, incluida la investigación. El alto riesgo de contagio en las interacciones ha dificultado todos los aspectos de la socialización. Los médicos que se dedican a la investigación han encontrado una barrera, ya que deben considerar la posibilidad de infección. Este artículo propone modificaciones al consentimiento informado, considerando este riesgo latente, procurando que sea entendible y expresado de forma clara y sencilla para los participantes. Asimismo, se considera importante identificar las medidas extrapoladas de la atención clínica que deben utilizarse en la interacción entre investigadores y sujetos de estudio, buscando la identificación de casos y prevención de la enfermedad, priorizando las consideraciones bioéticas de la investigación, en momentos de incertidumbre..

Juan Antonio Seda

Los apoyos de las familias a sus integrantes con discapacidad intelectual se expresan de diferentes modos, principalmente en cuidados personales y ayuda en la toma de decisiones a lo largo de la vida. Ante esta necesidad de colaboración, se ha planteado como interrogante en varios instrumentos internacionales si esta confluencia no daría lugar a una sustitución de la voluntad en lugar de constituir un apoyo. Aquí se propone como hipótesis que, en los casos de una deficiencia cognitiva significativa, se produce una inevitable comunión entre voluntades. No se trataría entonces propiamente de una sustitución, sino de un apoyo activo en aspectos vitales trascendentes.

Pablo Dias Fortes, Sergio Rego

Resumo O objetivo deste ensaio, dividido em duas partes, é investigar a estrutura geral do vínculo terapêutico. A primeira parte descreve agentes sociais como sujeitos moralmente interpelados pela norma fundamental da justiça (“a cada qual o que lhe é devido”), que na cena particular do cuidado se desdobra em potenciais conflitos intersubjetivos. A segunda representa a relação terapêutica articulada com os “três níveis do juízo médico” apontados por Paul Ricoeur – prudencial, deontológico e reflexivo –, conferindo às prescrições desse âmbito o estatuto de relação francamente moral.

Sarah Messina

The ability to respond quickly to potential viral epidemics like the COVID-19 pandemic could be greatly improved by actively monitoring human waste to detect potential pathogens in a population. Analyzing water at treatment facilities allows researchers to track infectious pathogens that are excreted in urine or feces. This type of monitoring would combat polarizing shame of individuals and whole countries. Waste monitoring would also mitigate a lack of detection and reporting by disorganized governmental systems monitoring potential global pandemics. Viral infections detected in sewage systems could be the key to monitoring and addressing potential global pandemics. Each country’s contagion response system is likely never going to be streamlined and uniform, however, there is a chance that at least those viruses that can be detected in human waste can be detected early with this information. Once the limitations and strengths of new technology are understood, the World Health Organization (WHO) could use the systems for monitoring purposes. Relying on countries to act autonomously and self-report emerging viruses and infections has proven to be insufficient and has resulted in delayed detection. The risks are known; quick transmission with no intervention sacrifices many lives in the long run. With this information made available, response times could make a significant difference in how we work together as a global health community to prevent the next pandemic. A non-invasive early warning tool to alert communities of new viral infections has the potential to enable rapid and coordinated responses to an outbreak. It could ultimately reduce high rates of morbidity and mortality. This new monitoring system would decrease the burden on healthcare systems, resulting in far fewer lives lost due to transmission from the lag in identifying novel viral respiratory diseases. Dozens of researchers have begun analyzing wastewater to estimate the total number of infections. Monitoring waste can be more effective initially than trying to test individuals. Governments must offer individuals COVID-19 testing in an organized and streamlined fashion for testing to be effective. The infrastructure of both impoverished countries and countries without a uniform system, such as the United States, can hinder this effort. Monitoring waste might prove most effective in countries where populations vary in density. Therefore, sewage systems in impoverished nations should be considered a health priority, not only for local health concerns, but global health concerns. This method may be used to detect a resurgence of the coronavirus in the most vulnerable populations.  Thus far, traces of the virus have been analyzed in sewage systems in the Netherlands, the United States and Sweden.[i] One treatment center can potentially have wastewater for more than 1 million people. Monitoring wastewater is more effective than testing individuals. SARS CoV-2 has been isolated from feces and urine within just three days of infection. The median duration of the virus in stool was 22 days.[ii] Wastewater data could provide a better estimate for the actual number of those with the coronavirus than current testing measures. If appropriately implemented, this new system of monitoring could serve as a necessary roadmap for other global health systems. Detection of the virus can be accomplished with nucleic acid-based polymerase chain reaction (PCR) assay which is also the current standard to confirm infection in COVID-19 patients around the world.[iii] This could prove to be a fraction of the cost of traditional clinical testing measures and can be done using the same methods currently being used. Factors such as the efficiency and condition of the sewage monitoring system may be considered by local healthcare authorities. Depending on factors within the treatment facility, detection rates range widely. Important factors include the temperature of the wastewater and the size of the sewage system. 1 in every 114 individuals infected with COVID-19 can be detected in some sewage systems. At a low temperature, virus can be preserved and the wastewater could be tested. If 1 in 2 million people are infected, researchers can potentially detect the presence of a viral pathogen. Although autonomy is an important part of the healthcare system, the preservation of autonomy in global pandemics is a health risk to us all. Arguably, an individual or an entire country could be ostracized if others discover that anyone has contracted a novel virus and could potentially be spreading it. However, I would argue that with a standardized waste monitoring system, the individual is effectively removed from the situation and instead we can collectively coordinate. The testing will reveal which towns viruses have originated from and with swift action it can be contained. Economically, countries would save money with this mass testing method instead of testing individuals. Former EPA scientist, Christian Daugthin, has urged researchers to develop waste-based epidemiology methods for future epidemics. Ultimately, after sampling this method across many countries, test sites ought to be located in vulnerable countries that have dense populations. There is limited foreseeable risk in this testing at the current level of understanding of how this data will be collected and used. It would also be most beneficial for a global agency to monitor these countries to reduce the risk of missed identification due to unstable healthcare systems or government mismanagement.  Current limitations that must be resolved for this method to be effective include accurate and reliable quantification measures. Researchers will need to find out how much viral RNA is excreted in feces and extrapolate the number of infected individuals. Additionally, the test needs to be able to detect the virus at low levels. Sampling, preserving, and processing samples in current human testing conditions will remain a critical issue for detecting a virus with low concentrations in sewage. Similar to the concerns associated with Ebola, it is suspected that viral inactivation could be a problem due to the presence of bacteria. The virus could potentially undergo inactivation between 3 to 7 days. To address this concern, routine monitoring would have to be maintained. Lastly, special attention must be afforded to the aerosol formation during wastewater treatment that poses a significant health risk to those monitoring and working in the sewage plant. Protective measures for the employees working in wastewater treatment plants must be maintained along with adequate personal protective equipment. However, I would suspect that these measures are already in place considering the infrastructure for these systems already exists. Furthermore, protective measures for workers in high risk environments like hospitals and other long-term care facilities, should be addressed as they are more likely to harbor viral pathogens. This is most evident in places like Spain where 15 percent of cases of COVID-19 represent individuals who work in healthcare. Increased efforts to control pandemics are necessary with the next zoonotic virus potentially on the horizon. The consequences of this pandemic have yet to be fully realized. With population densities only increasing, greater surveillance is necessary. Sacrificing personal privacy for the sake of global monitoring is not the only option. Population epidemiology is possible in wastewater monitoring. The exploitation of vulnerable populations has historically occurred when greater risks are placed on the population, i.e., testing a new vaccine on a population of individuals in a disadvantaged group. In this case, I believe a wastewater monitoring system would give greater benefit and poses low risk. The disadvantaged groups represent those who are in the greatest need of early detection and swift action. The benefit of this system vastly outweighs the risks and those who are most at risk of devastation from the next viral contagion could be those who are first tested with the new application of the PCR technology. While testing vaccines and treatments in vulnerable populations can put people at heightened risk, testing a new contagion surveillance system could be a win for all involved. [i] Orive, Gorka, et al. Early SARS-CoV-2 Outbreak Detection by Sewage-Based Epidemiology. Science of The Total Environment, Elsevier, 8 May 2020, www.sciencedirect.com/science/article/pii/S0048969720328151. [ii] Barras, Colin. Monitor Sewage to Track Spread of the Coronavirus. New Scientist (1971), Published by New Scientist Limited., 2 May 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7195334/. [iii] Yaniv, Karin, et al. Regressing SARS-CoV-2 Sewage Measurements onto COVID-19 Burden in the Population: A Proof-of-Concept for Quantitative Environmental Surveillance. MedRxiv, Cold Spring Harbor Laboratory Press, 1 Jan. 2020, www.medrxiv.org/content/10.1101/2020.04.26.20073569v1.

Juan María Cuevas Silva, Guiovane Mendieta Izquierdo

David Sanders, Lu Gram, Benjamin Tsofa et al.

Angéline S. Ferdinand, Ana María Oyarce, Margaret Kelaher et al.

El objetivo de este artículo es reflexionar sobre la creación de una infraestructura de investigación ética más sólida en relación con la investigación de la salud de la población indígena en Chile. Se expone un marco de investigación ética que apunta a apoyar una relación más equitativa y colaborativa entre académicos y comunidades indígenas, lo que puede conducir a investigaciones más pertinentes y a mayores beneficios para las comunidades de conformidad con los principios de la investigación bioética. Se emplearon experiencias internacionales para informar sobre la forma en que se podría establecer una infraestructura de investigación de la salud de la población indígena en el contexto chileno. Luego, se presenta el desarrollo y la adopción de directrices para la investigación ética de la salud de la población indígena y la orientación hacia la investigación colaborativa y dirigida por la comunidad como mecanismos que pueden ayudar a lograr estos objetivos.

Fernando Bolaños, Ariadna Hernández Castrejón

Este artículo se propone identificar problemas metodológicos en el estudio de la efectividad de las intervenciones basadas en la terapia cognitivo conductual (TCC) dirigida a hombres que violentan a su pareja mujer y asisten de forma voluntaria al tratamiento. Con el método de revisión sistemática utilizado se obtuvo solo un estudio que cumplió con los criterios buscados, el cual mostró importantes limitaciones metodológicas. Luego, se realizó un comparativo con otras dos evaluaciones a fin de identificar explicaciones a tales limitaciones y la poca realización de estos estudios. Se corrobora que los estudios son escasos, con moderada o baja calidad en sus evidencias y no es posible elaborar conclusiones sobre su afectividad. Existen retos teórico- metodológicos en el diseño y la implementación de estas intervenciones que aumentan la probabilidad de resultados negativos cuando se evalúan a partir de diseños experimentales como parámetro ideal. Se identificaron evaluaciones desde una lógica experimental sobre el efecto del tratamiento, y trabajos multidisciplinarios que evalúan aspectos particulares del programa. Existen  problemas teórico-metodológicos para las intervenciones y la evaluación de la efectividad, originadas en los estándares de programas con “visión restringida”, así como en los estudios con diseños experimentales como parámetro ideal para conocer el impacto de las intervenciones. Es necesario incluir estos debates en la discusión ética de la salud pública.

Nalin Mehta

Efstathios Drampalos, Vasileios Stogiannos, Panagiotis Psyllakis et al.

The modern infirmary is the evolutional product of the dialectic interface between medical theories at each time and the outcome of their application in clinical practice. The infirmary as we know it today did not exist during antiquity, but the different precursors of the modern hospital emerged as a result of the interaction between medical theory and practice. During antiquity the Hippocratic work decisively contributed to the creation of the Asklipieion, an institution with predetermined structure created to heal diseases. Later in antiquity new types of infirmaries appeared along with the evolution of private practice for physicians. Establishment of the first modern hospitals was an outstanding contribution of Islamic medicine during reign of the Islamic Empire. Although there was little progress in the development of medical theory in medieval West, evolution of the infirmary continued and was mostly influenced by Christian religion and charity. In Constantinople large medieval infirmaries were built, but patient care was frequently offered in monasteries by clergymen. Later on medicine and treatment of diseases were taken over by physicians and taught in universities, and medical theory continued on its course of evolution. It is obvious that the modern infirmary is not only a place for treating diseases, but rather the upshot of a series of advancements in science, the relations between people or even countries, and the way humanity perceives its nature and the future. Our research is focused on the interactive relationship between the evolution of medical theory and the infirmary as an institution during antiquity and the Middle Ages with particular emphasis on the Western World.

Editorial Editorial

El 5 de agosto de 2009 murió a los 87 años el prestigioso primatólogo Jordi Sabater i Pi, catedrático emérito de la Universidad de Barcelona y uno de los científicos catalanes con más proyección internacional en el ámbito de la etología.