Bioethical Research Articles

Clinicians' Perspectives and an Ethical Analysis of Safer Supply Opioid Prescribing.

In British Columbia, Canada, many physicians providing care to individuals with high-risk opioid use disorder adopted safer supply (SS) opioid prescribing in the spring of 2020 with the goal of facilitating public health measures for COVID-19. This prescribing practice continued after measures were lifted. This study aimed to explore prescribers' perspectives following several years of local experience in prescribing SS opioids, primarily in the form of hydromorphone tablets, and to apply ethical concepts to explore current challenges and ongoing sources of provider distress. Addiction medicine SS prescribers participated in individual or small group semi-structured interviews. Each interview was transcribed and analysed for recurrent themes. Themes were then integrated into a narrative ethics discussion. Eleven addiction medicine physicians practicing in various settings within Vancouver participated in this study. Six themes were identified: clinical assessment, clinician distress, gaps in care, models of safer supply, research, and special populations. Ethical dilemmas in prescribing SS are identified and explored through a discussion of biomedical ethics principles and the physician role.

Palliative neurology

Palliative medicine represents the holistic multiprofessional treatment of severely and incurably ill people and their relatives, addressing their complex physical, psychological, social and spiritual needs. The central therapeutic goals are the quality of life and alleviation of suffering. In the course of many neurological diseases, high symptom burden, long and variable trajectories and unfavorable prognosis at times create aneed for palliative care even at an early stage, which is currently still inadequately met. This can be countered by qualified neuropalliative care. In addition to intensifying interdisciplinary collaboration, this requires neurologists to have core competencies in palliative care. These include ateam-oriented attitude, communication skills, expertise in symptom control and knowledge of biomedical ethics including palliative options at the end of life.

A Comparison of Conventional Root Canal Sealers With Ones That Use Green Synthesized Nanoparticles for Antimicrobial Activity: Protocol for a Systematic Review.

Root canal failure and secondary endodontic infection are frequent clinical scenarios in dentistry. The main microorganisms implicated in root canal therapy failure are persistent Enterococcus faecalis, Candida albicans, and Staphylococcus aureus. To combat the impact of disease resistance, scientists are concentrating on alternative antimicrobial root canal sealers. Nanomaterials are a recent development in endodontic materials that exhibit great antimicrobial properties, making them an ideal material choice for root canal sealers. This systematic review aims to compare the antimicrobial properties of conventional root canal sealers to those incorporating green synthesized nanoparticles between 2010 and 2024. A well-constructed protocol was established and registered with PROSPERO (CRD42021286373). Ethics approval was obtained from the Biomedical Research and Ethics Committee from the University of the Western Cape (UWC; BM22/1/4). PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) reporting guidelines were followed. The included criteria demonstrate the green synthesized nanoparticles studies where the nanoparticles (NPs) are incorporated in root canal sealers. MeSH (Medical Subject Headings) terms were used for the search strategy of the systematic electronic databases for articles published in English between 2010 and 2024. The selected databases included Scopus, PubMed, Web of Science, Science Direct, EBSCOhost, SpringerLink, and Wiley Online. A quality assessment tool for laboratory studies will be used to critically appraise the included studies. If applicable, statistical measures (mean, SD, etc) will be used for data analysis and presentation of the results. The protocol is registered with PROSPERO. A preliminary search was conducted using a determined search strategy across 8 electronic databases, and the review is now complete. It is anticipated that the results of this systematic review may reveal the increased interest and application for nanoparticle-enhanced root canal sealers. This will aid in the future development of root canal sealants and mitigate the risk of endodontic failure. PROSPERO CRD42021286373; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=286373. DERR1-10.2196/51351.

Risk factors, timing and frequency of occurrence of post-COVID syndrome in workers with intensive computer workload

According to leading experts of the World Health Organization, the threat of a new strain of SARS-CoV-2 coronavirus remains, which will lead to a sharp increase in morbidity and mortality. The severity of complications after COVID-19 depends not only on how severe the disease was, but also on other factors: genetic predisposition, age, concomitant diseases, and working conditions. This makes it urgent to conduct further scientific research on the ranking of the factors of the production environment that accelerate the spread of COVID-19. The study aims to determine the degree of occupational risk, taking into account the timing and frequency of manifestations of post-COVID syndrome (U09.9; U10.9 according to ICD–X) in specialists with intensive computer workload. In the period 2020–2024, the researchers conducted a survey at the workplaces of Kislovodsk enterprises and examined 556 people with an intensive computer load associated with servicing the flows of mass consumers during the pandemic and in the post-pandemic period. We have studied the timing and frequency of the occurrence of post-COVID syndrome, objectified by the degree of health risk factors in various categories of workers with intensive computer workload. The timing and frequency of seven post-COVID syndrome manifestations ranked (according to the degree of occupational health risk factors) (U09.9; U10.9 according to ICD-X) that occur in workers with intensive computer workload in the first two weeks after discharge from the hospital during hospitalization for COVID-19 (occupational health risk factors category A) or arising within three to four weeks after discharge from the hospital during hospitalization for COVID-19 (occupational health risk factors of category B). Based on statistical and clinical and hygienic data obtained in the period from 2020 to 2024, post-COVID manifestations in the gradations of "high" and "moderately high" occupational health risk for employees (n=556) with intensive computer load were ranked by the timing and frequency of occurrence of the named syndrome, as well as by the degree of risk of potential COVID-19 infections of the named groups of specialists associated with servicing mass consumer flows infected with constantly mutating representatives of enveloped RNA viruses. According to the degree of occupational risk to the health of persons with intensive computer workload, six groups of specialists associated with servicing mass consumer flows, potentially infected with COVID-19 and other representatives of enveloped RNA viruses, were ranked. Limitations. Post-COVID syndromes that occur within one to two and three to four weeks after discharge from the hospital have been studied. Ethics. Scientists have conducted research in accordance with the principles of biomedical ethics and approved by the local Ethics Committee of Izmerov Research Institute of Occupation Health, Moscow (Protocol No. 4 dated 04/14/2021). Each participant of the study submitted a voluntary written informed consent signed by him after explaining to him the potential risks and benefits.

Ethical principles for ecology and environmental ethics: What ecology can learn about applied ethics from biomedical ethics

AbstractThis article uses a familiar and successful framework to organize and systematize the ethics of ecology and environmental science. Mid‐level principles have helped make the field of bioethics well understood and enabled it to influence laws, policies, and clinical decision‐making. We propose that a new set of principles could do the same for the larger field of environmental ethics. As was true with bioethics, the principles chosen need to already be well‐established. The insight is that to offer a complete analysis of a case or situation one must consider all of the principles. Thus one must choose a small set of mutually exclusive and jointly exhaustive principles. While there are thousands of articles using each of our principles, no one has identified them as a set of principles that can be easily taught and used to resolve dilemmas. Thus this article can help advance ecological and environmental ethics. Each of the four principles is briefly defined, and a little of their history and some current examples provided for each. The principles are: The Precautionary Principle, Biodiversity, Environmental Justice, and Sustainability. As a group they represent a complete picture of the ethical territory we must deal with in every value‐laden choice, clarifying why disagreements happen and what is at stake when trade‐offs must be made.

Features of the immune profile of workers of a non-ferrous metallurgy enterprise in conditions of contamination of biological media with rare earth elements (using the example of thulium)

Introduction. The active use of rare earth elements, including thulium (Tm), in various technological processes increases the risks of health problems associated with the professional activities of the employee. The purpose of the study is to study the characteristics of the immune profile of workers at a non-ferrous metallurgy enterprise under conditions of contamination of biological media with rare earth elements (using the example of thulium). Materials and methods. 35 employees of a non-ferrous metallurgy enterprise were examined. The comparison group consisted of workers with the level of thulium concentration in the blood within the reference interval (n=17), the observation group — workers whose blood thulium content was 2 times higher than the upper limit of the reference values (n=18). The content of thulium in biological media (blood) was studied using mass spectrometry with inductively coupled plasma. Flow cytometry was used to detect Annexin V-FITC+7AAD+-lymphocytes (late apoptosis/necrosis), enzyme immunoassay — IL6, TNF, general IgE, allergosorbent — specific IgG to lanthanides. Results. It was found that the workers in the observation group had a 2.3-fold increase in the content of total IgE and a 2.0-fold increase in the expression of specific IgG to lanthanides in relation to the results of the comparison group (p<0.05). It was found that with an excess thulium content in the blood, there is an inhibition of cell death by 15% relative to the values of the comparison group. Limitations of the study. Limitations of the study relate to the limited sample size. Ethics. The study protocol was approved by the Biomedical Ethics Committee of the local ethical committee of the Federal Budgetary Institution "FSC MPT URZN" No. 2 dated March 22, 2023. The study was carried out in accordance with the requirements set out in the WMA Declaration of Helsinki "Ethical Principles for Medical Research Involving Human Subjects" (1964, 2013). Voluntary informed consent to participate in the study and use of personal data was signed by all participants.

Ethical Issues in Living Donor Kidney Transplantation: An Update from a Psychosocial Perspective.

Living donor kidney transplantation (LDKT) currently represents the treatment of choice for patients with end-stage renal failure. LDKT is a serious event with profound psychological, interpersonal, familial, and social implications. Over the last few years, there has been an exponential growth in living donation programs involving genetically and emotionally related donors, as well as people who donate to an unrelated and unknown subject. The implementation of paired exchange programs, Samaritan donation, and preemptive transplantation raise further ethical issues, which are inextricably linked to the unique psychosocial context of both the donor and the recipient. The present narrative review aims to provide an update on the main ethical challenges related to LDKT. We conducted a comprehensive literature search in PubMed/Medline. The results of the most relevant studies were narratively synthesized from a psychosocial perspective around the four principles of biomedical ethics: autonomy, beneficence, non-maleficence, and justice. Finally, we discussed the potential future directions to provide an effective, patient-centered, and ethical psychosocial assessment and follow-up of living donors and recipients that underwent LDKT.

Biomedical Data Science, Artificial Intelligence, and Ethics: Navigating Challenges in the Face of Explosive Growth.

Advances in biomedical data science and artificial intelligence (AI) are profoundly changing the landscape of healthcare. This article reviews the ethical issues that arise with the development of AI technologies, including threats to privacy, data security, consent, and justice, as they relate to donors of tissue and data. It also considers broader societal obligations, including the importance of assessing the unintended consequences of AI research in biomedicine. In addition, this article highlights the challenge of rapid AI development against the backdrop of disparate regulatory frameworks, calling for a global approach to address concerns around data misuse, unintended surveillance, and the equitable distribution of AI's benefits and burdens. Finally, a number of potential solutions to these ethical quandaries are offered. Namely, the merits of advocating for a collaborative, informed, and flexible regulatory approach that balances innovation with individual rights and public welfare, fostering a trustworthy AI-driven healthcare ecosystem, are discussed.

Cybersecurity behavior change: A conceptualization of ethical principles for behavioral interventions

The importance of changing behaviors is gradually being acknowledged in cybersecurity, and the reason is the realization that a notable portion of security incidents have a human-related component. Thus, enhancing behaviors at individual level, can bring a significant reduction in security breaches overall. Behavior change refers to any modification of human behavior through some type of intervention. Interventions from behavioral economics and psychology are being increasingly introduced in the field, however, the ethics surrounding such interventions are largely neglected. In this paper, we raise the ethical issues associated with behavioral intervention approaches. We draw on the traditionally more mature field of biomedical ethics and propose six clusters of ethical principles suitable for cybersecurity behavior change. We conducted a survey (N = 141) to identify individuals’ perceptions on the proposed ethical principles and validate their perceived usefulness. We analyze an existing intervention in the light of our six-principle conceptualization to showcase how it can be used as a practical apparatus. Our set of ethical principles are aimed for cybersecurity professionals, policy makers, and behavioral intervention designers, and can serve as a starting point for best-practice development in cybersecurity behavior change ethics.

Palliative neurology

Palliative medicine represents the holistic multiprofessional treatment of severely and incurably ill people and their relatives, addressing their complex physical, psychological, social and spiritual needs. The central therapeutic goals are the quality of life and alleviation of suffering. In the course of many neurological diseases, high symptom burden, long and variable trajectories and unfavorable prognosis at times create aneed for palliative care even at an early stage, which is currently still inadequately met. This can be countered by qualified neuropalliative care. In addition to intensifying interdisciplinary collaboration, this requires neurologists to have core competencies in palliative care. These include ateam-oriented attitude, communication skills, expertise in symptom control and knowledge of biomedical ethics including palliative options at the end of life.

Ethics in Patients' Health Literacy: a scoping review and a critical discussion.

A growing body of literature has acknowledged that a high number of populations with low Health Literacy (HL) is related to poor health outcomes, inequities in healthcare and high economic costs. Those findings have formulated the research questions of this review: (i) what ethical issues arise within the context of patients' HL and (ii) What is the relationship between HL and quality of life? This review followed the guidelines of Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) and it was conducted in five databases: PubMed, CINAHL, MEDLINE, Scopus and Science Direct between June 2022 and December 2023. Out of the 3164 titles retrieved, 285 abstracts were eligible to proceed. Following a thorough examination of the full text of 61 papers, 45 sources were identified that met the inclusion criteria. The data analysis process was guided by the research questions, employing a thematic approach. Four themes were identified: the use of language and patient understanding, human rights, the principlism approach (justice, beneficence, non-maleficence and autonomy) and quality of life. The first theme mainly focused on the relation of HL with the notion of consent forms and national action plans. Human rights in relation to HL were discussed as a minor issue. The bioethical framework by Beauchamp and Childress (Principles of Biomedical Ethics, 6th edn. Oxford University Press, New York, NY, 2009), was addressed by several studies, with a particular focus on justice and the loss of autonomy. Quality of life indicated a positive correlation with HL by most of the authors, while few studies revealed a moderate correlation.

Legal Certainty of Patients’ Right to Autonomy Protection in High-Risk Health Services

The relationship between medical personnel and patients in health services should be viewed as a legal relationship between humans who have equal rights. There are two basic human rights in health services, the right to autonomy and the right to information. The results of the study indicate that the protection of patients' autonomy rights is one of the principles in biomedical ethics used as the moral basis for the provision of health services. The form of protection of patients' autonomy rights in health services is realized through regulations related to Informed Consent in Law Number 17 of 2023 Concerning Health and Minister of Health Regulation Number 290 of 2008 Concerning Consent to Medical Actions. Meanwhile, regulations related to the protection of patients' autonomy rights for high-risk health care actions have not met legal certainty because the health care actions are not classified as high-risk.

An ethics analysis of antipsychotic dose reduction and discontinuation: Principles for supporting recovery from psychosis.

To examine the evidence and practice of antipsychotic dose reduction from the lens of biomedical ethics (specifically principlism) to support evidence-based practice and patient choice and self-determination. An overview of the evidence from randomized controlled trials of antipsychotic dose reduction versus maintenance is presented. This is followed by a theoretical examination of the four key biomedical ethical principles of autonomy, nonmaleficence, beneficence, and justice and how they apply in the case of antipsychotic dose reduction. Existing clinical trial research is dominated by relapse as the primary outcome, with dose reduction associated with a higher risk of relapse than maintenance. Few studies have measured other patient-centered outcomes but have shown preliminary evidence for superior cognitive functioning, lower negative symptoms, and better functioning following dose reduction. Respect for autonomy is a cornerstone of psychiatric rehabilitation, and this includes the right of people to choose to reduce or discontinue antipsychotic medication. Reduced capacity for treatment decision making can be supported. Autonomy and appraisal of nonmaleficence and beneficence associated with dose reduction can be facilitated through shared or supported decision making. Clinicians should continue to strive for justice through the fair allocation of resources to support all people who request antipsychotic dose reduction. Clinicians have a responsibility to balance the four core ethical principles to the best of their ability when supporting a person in their recovery journey. Exploring, trialing, and supporting antipsychotic dose reduction may be part of this process if that is the patient's choice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Study of Current Legislative Statement of Organ Transplantation

The main purpose of our research highlights a lack of awareness about donor laws, inadequate implementation, and critical challenges that require legal reform, enhanced support for donors, and better training for healthcare professionals. The legislative framework for organ transplantation varies widely across Asian countries, reflecting differences in cultural, ethical, and legal perspectives. Organ transplantation involves transferring organs, tissues, or cells from donors to recipients, with a significant global demand surpassing the available supply. Biomedical ethics, as outlined by Beauchamp and Childress, and further examined by Veatch and Harris, provide a framework for addressing the moral dilemmas associated with transplantation. In Mongolia, the organ transplantation framework is guided by international standards, though there are gaps in legislation, social welfare, and insurance coverage, which impact the effectiveness of the transplant system.

International scope of biomedical research ethics review.

Many countries consider long-term implications for society.

Global bioethics in european context

The article analyses the foundations and principles of global bioethics in the European ethical, legal and philosophical contexts. An analysis of European bioethics shows that there are at least three modern models of European bioethics: bioethics as metaethics; bioethics as biolaw; bioethics as applied biomedical ethics. European bioethics originates in the global bioethics of V.R. Potter and F. Jahr, and encompasses not only moral issues of medicine and public health, but also global environmental and social problems. In this context, the convergence of the natural and the human is seen as a rehabilitation of practical philosophy, a further study and development of the principles of practical reason, understood by analogy with the objective laws of nature. The study of constitutions, legislative and legal regulations of European countries has revealed a variety of bioethical principles in the field of biomedicine. However, at the level of legislation in biomedicine, there is a certain influence of the American model of bioethics, biomedical ethics, which is manifested in the principlism methodology and the weak connection between medical and environmental issues. Global bioethics in the European context is characterized by an intensification of bioethical reflection, social relationships and legislative activity in biomedicine within pan-European structures, such as the European Council and the European Union. The defining feature of global bioethics as a phenomenon of European culture and ethos is that its principles can be “activated” only as a semantic and logical integrity. Bioethical principles serve as a kind of harmonising factor of European biopolitics.

FOREST FOOD RESOURCES IN THE SAKHA REPUBLIC (YAKUTIA)

According to the “Ecosystem Services of Russia” Prototype of National Report (2016), data on terrestrial ecosystem resources in Russia are fragmented. The purpose of this work is to fill the existing gaps in the knowledge of the biodiversity of plant species and the sustainability of traditional food systems across the economic zones of the Sakha Republic (Yakutia). Materials and methods. Although the range of edible plants in Yakutia counts more than 100 species, only nine species of berries, eight species of mushrooms, and three species of other food plants were classified as resource-significant based on the consolidated archive materials of the IBPC at FRC YaSC SB RAS and the results of the field studies carried out in 2002-2019. This list of twenty species was tested via a socio-economic survey undertaken as part of the RISE project in 2021-2023. The study was conducted with the permission of the local biomedical ethics committee of the Medical Institute of the North-Eastern Federal University. Each participant signed an informed consent form to be surveyed, according to the World Medical Association’s Declaration of Helsinki, which regulates the research involving human subjects. The study embraced 400 rural households. Results. The data on biological stocks of resource-significant food species of Yakutia’s forests were presented based on the consolidated archive materials and results of the field studies undertaken by the IBPC at FRC YaSC SB RAS. Coupled research methods of natural and social sciences were used to produce the estimates of the economic reserves of berries and mushrooms across economic zones of the Sakha Republic (Yakutia) and the volumes of their harvesting by rural households and the population of the region in general. Conclusion. Social methods have proven reliable for studying biodiversity in a large-sized region. They allow to fill the gaps in the databases built on the results of field studies, particularly in terms of popularity and, accordingly, the prevalence of certain food species. The higher productivity and diversity of flora in Southern Yakutia were confirmed compared to the Arctic and other economic zones. Funding. The reported study was performed under the e-Asia Climate Call and funded by RFBR, project number 21-55-70104, and project VI.52.1.8. “Theoretical and applied aspects of investigation the diversity of the vegetation of Northern and Central Yakutia (East Siberia)” 0376-2016-0001; registration number АААА-А17-117020110056-0.

Algorithm of complex therapy and prevention of emotional burnout in doctors-psychiatrists during the war and its effectiveness

Abstract. The purpose - to develop and determine the effectiveness of the algorithm of complex therapy and prevention of emotional burnout (EB) among psychiatrists during the war, to resolve the issue of its recommendation for wide implementation in the system of mental health care institutions. The research sample, which was formed in compliance with the principles of biomedical ethics and based on informed consent, included 120 psychiatrists who worked in the city of Kyiv in the period from February 24, 2022. During 2022, the persons under examination were divided into three groups: the first group included 37 persons (30.8%) – doctors with no signs of professional maladjustment (PMA), and a low level of EB; the second group consisted of 57 persons (47.5% ) with signs of professional PMA, and a moderate level of EB; the third group consisted of 26 persons ( 21.7%) and they were respondents with clinically established and pronounced PMA, and a high level of EB. As a result of the study, the personal, psychopathological, psychosocial, professional and emotional-interpersonal factors of the formation and progression of EB among psychiatrists during the war were established, and their interrelationships in its genesis, on the basis of which the basic principles of a comprehensive approach to the therapy and prevention of EB were formulated for psychiatrists (complexity, personalization, phasing and availability), the main goals of treatment and prevention measures are defined and 4 therapeutic strategies of diagnosis, therapy and prevention are proposed within the framework of providing specialized medical care to psychiatrists during the war. These are recommended to be implemented taking into account the degree PMA as a key descriptor of EB, and in accordance with the key vectors of pathological changes in the respondents. The implementation and further evaluation of the effectiveness of the mentioned measures proved their effectiveness in eliminating manifestations of EB and PMA, normalization of mental state with levelling of psychopathological symptoms, improvement of social and psychological adaptation and quality of life of psychiatrists. The results obtained make it possible to recommend this algorithm for wide implementation in the practice of mental health care institutions.

ChatGPT for good? Taking ‘beneficence’ seriously in the regulation of generative artificial intelligence

ABSTRACT Generative AI platforms such as ChatGPT have found prominence in recent times with their ability to generate texts, images, etc. Several questions pertaining to ethical and legal issues surrounding ChatGPT have arisen. In this paper, I discuss the nature and background of generative AI, situating its development in the historical context of AI. I then discuss my primary research questions: is sufficient attention paid in the literature on ethics of AI to the principle of beneficence and is there theoretical clarity on its meaning? I highlight that while there is great deal of discussion on what harms can arise from generative AI and how to stop them, there is very little discussion on what amounts to AI-for-good, particularly in the literature of AI ethics and regulation. To the extent that such discussion exists, it pushes ahead with suggesting specific solutions, without fully addressing the underlying question of what makes their prescriptions beneficent. I demonstrate that the principle of beneficence as understood in biomedical ethics and human rights frameworks has limited utility for the ethics of generative AI. These gaps in the AI regulation are prominent, as they can derail long term progress of generative AI and the realization of its full potential.

Bioethics of over- and undertreatment in older adults with cancer.

9046 Background: Over-/undertreatment are pervasive in older adults with cancer, despite oncologists prescribing with best intentions. What “ought” to be prescribed with limited evidence creates challenges in adhering to the principles of bioethics: beneficence, nonmaleficence, justice, and respect for autonomy. Our objective for this study was to elucidate whether and how tensions among these ethical principles can contribute to over-/undertreatment in older patients. Methods: We designed a modified Delphi study, convening a panel of 13 experts in biomedical ethics (5 male, 8 female; 4 MD, 4 PhD, 2 MD/MA, 1 MD/PhD, 1 JD/MDiv, 1 DNP) from U.S. and Canadian institutions for three iterative rounds of data collection. In the first round—an electronic questionnaire—we presented definitions of overtreatment and undertreatment in older adults with cancer (DuMontier, J Clin Oncol, 2020) and asked questions delineating which ethical principles related to each definition, followed by questions regarding how over-/undertreatment might occur from conflicts among different ethical principles. Consensus for each question was defined as ≥75% of experts answering “agree” or “strongly agree”. The second round consisted of a virtual synchronous focus group of 9 of the panel experts led by a qualitative researcher to review round one results and discuss questions that did not reach consensus, followed by a second questionnaire including these questions. Results: After the first round, experts reached consensus that bioethical principles applied to over-/undertreatment in older adults with cancer. Specifically, 92% felt that overtreatment can occur when oncologists overemphasize beneficence that values the potential benefit of cancer treatments, while underemphasizing non-maleficence with respect to treatment adverse effects. Moreover, 77% felt that overtreatment can also occur when oncologists prioritize patient autonomy (preference to be treated) over non-maleficence (oncologists' concerns that treatment harms outweigh benefits). 84% felt that undertreatment can occur due to a lack of justice in equitable consideration of cancer treatments that could provide similar benefits in older adults as they would in younger adults. Moreover, 77% felt that undertreatment can occur when oncologists underemphasize patient autonomy, failing to consider patient preferences regarding which benefits to pursue and risks to take. Data collection for the second questionnaire and qualitative analysis of the focus group are underway. Conclusions: Our findings suggest that tension in ethical principles can lead to over- and undertreatment in older adults with cancer. The “right” treatment in older patients in the context of limited evidence is not simply one that aims to aggressively target their cancer, but that balances both benefits and harms in light of the whole patient and their preferences, while not restricting therapies based on age alone.