Bioethical Research Articles

Surreal Becomes Real: Ethical Dilemmas Related to the COVID-19 Pandemic and Professional Identity Formation of Health Professionals.

Fundamental quandaries of clinical and biomedical ethics for health care professionals, committees, and systems have been raised into stark relief by the COVID-19 pandemic. The nature and extent of critical issues raised by this ongoing crisis, including challenging ethical dilemmas for the health care profession, is likely to have an indelible impact on the professional identity formation (PIF) of learners and practitioners across the trajectory of the professional lifecycle. The lifelong process of PIF for health care practitioners, from learner through independent practice, is supported in medical education by intentional reflection, relationships within community of practice include guidance from mentoring, as well as resilience, both emotional and moral. We consider how grappling with ethical dilemmas related to the COVID-19 pandemic can challenge, inform, and even potentially transform the PIF process, thereby supporting development of a morally resilient, humanistic professional identity in health care trainees and health care professionals.

Ethical considerations at the end-of-life care.

The goal of end-of-life care for dying patients is to prevent or relieve suffering as much as possible while respecting the patients’ desires. However, physicians face many ethical challenges in end-of-life care. Since the decisions to be made may concern patients’ family members and society as well as the patients, it is important to protect the rights, dignity, and vigor of all parties involved in the clinical ethical decision-making process. Understanding the principles underlying biomedical ethics is important for physicians to solve the problems they face in end-of-life care. The main situations that create ethical difficulties for healthcare professionals are the decisions regarding resuscitation, mechanical ventilation, artificial nutrition and hydration, terminal sedation, withholding and withdrawing treatments, euthanasia, and physician-assisted suicide. Five ethical principles guide healthcare professionals in the management of these situations.

Trends in Emergency Department Visits for Mental Health Disorder Diagnoses Before and During the COVID-19 Pandemic: A Retrospective Cohort Study 2016-2021

Background: As the pandemic started, Saudi Arabia applied extreme measures in responses to the public health crises. These control measures have adversely affected individuals with reported psychological illnesses such as depression, and anxiety. We aimed to describe trends, and gender-age differences in proportions of psychiatric Emergency department (ED) visits from 2016 to 2021 in two large hospitals in Saudi Arabia.Methods: This is a retrospective cohort study using data from electronic health records in the Ministry of National Guard Health Affairs’ (MNG-HA) in two major hospitals in Saudi Arabia. Individuals aged ≥12 years diagnosed with mental disorder from January 2016 to May 31, 2021, registered in MNG-HA hospitals system were included in the study.Outcomes: A total of 1171 ED psychiatric visits (52% female, 48% male). A constant annual increase in the number of psychiatric ED visits before the pandemic from 2016 to 2019 (2.91%, 6.17%, 9.64%, and 15.25%) was observed. While nearly 42% of total psychiatric visits for the study period occurred during the pandemic 2020-2021. During the pandemic, psychiatric ED visits were significantly higher in females (adjusted OR 1.46; CI 1.14, 1.86) than males. During the pandemic, generalized anxiety disorder was the most common psychiatric ED disorder with reported increase of visits by 48.44% (p-value 0.007).Interpretation: ED psychiatric visit rates have consistently increased before and during the pandemic. During the pandemic, female at greater risk of seeking psychiatric ED services than male. Interventions for mental health related disorders are urgently needed for preventing mental health problems.Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: Biomedical ethics committee of King Abdullah International Medical Research Center (KAIMRC) approved this study (JED-21-427780-99596)

Antimicrobial ethicists: Making ethics explicit in antimicrobial stewardship.

Antimicrobial prescribing and the associated discipline of antimicrobial stewardship have inherent ethical and moral dimensions. We contend that the explicit, formal application of ethical principles and frameworks can strengthen and further justify the value of antimicrobial stewardship programs and their work. To illustrate the value of this process, we highlight 3 ethical scenarios that antimicrobial stewardship programs regularly encounter at the prescriber, institutional, and societal levels, and we analyze these scenarios using the Beauchamp and Childress biomedical ethics framework.

ЭТИЧЕСКИЕ ПРОБЛЕМЫ И ЭПИДЕМИЯ КОРОНАВИРУСНОЙ ИНФЕКЦИИ

The article is an analytical review of English-language articles on contemporary ethical issues related to the coronavirus epidemic. Such principles of biomedical ethics as respect for the freedom of the patient, non-harm are analyzed. A precautionary approach is formulated, the main norms of which are practicality, impartiality, proportionality and justification. It is emphasized that public health advice and action should be part of a broader effort to gain and maintain confidence in the action taken. Reasonable trust requires a serious attitude to the ethical problems associated with the implementation of the intended ethical principles.

Healthful and Unhealthful Plant-Based Diets in Relation to Mortality Among Older Adults in China: A National Community-Based Prospective Study (2008-2018)

Background: Plant-based dietary pattern has been recommended for its potential health and environmental benefits. However, the relation of plant-based diet patterns to mortality warrants further exploration. Our study aimed to examine the prospective association of plant-based dietary patterns with all-cause mortality among older adults in China. Methods: In the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we included a total of 13,154 participants with a mean follow-up of 5·7 years in our analysis. Death cases were ascertained through close family members or official death certificates during follow-up. Overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI) were calculated to assess the dietary patterns. Multivariable time-varying Cox proportional hazard model was applied to estimate the corresponding hazard ratios (HRs) of mortality.Findings8,937 (67·94%) deaths occurred during a total of 74,056 person-years of follow-up. Compared with the lowest quintile, those in the highest quintile of PDI and hPDI had a decreased risk of all-cause mortality (HR pdi = 0·92, 95%CI: 0·87, 0·98; HR hpdi = 0·81, 95%CI: 0·76, 0·87), whereas higher uPDI was associated with an increased risk (HR Q5vsQ1 = 1·17, 95%CI: 1·10,1·26). Associations of PDIs with mortality risk were consistently observed across strata defined by gender, residence, smoking status, and history of major non-communicable disease. Interpretation: Higher adherence to a healthful plant-based diet was associated with a decreased risk of mortality, whereas an opposite association was observed for higher adherence to unhealthful plant-based diets. The quality, not only quantity, of plant-based diet should be emphasized in relevant public health recommendations. Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: The study was approved by the Biomedical Ethics Committee of Peking University, Beijing, China (IR1052-13074).

Pulmonary Benefits of Intervention with HEPA Air Purifier in Schoolchildren: A Double-Blind Crossover Study

Background: The protective effect of air purifiers on the respiratory system of healthy children remains unclear so far. Method: We designed an air purifier intervention crossover study among 125 schoolchildren aged 9–12 years in a boarding school in Beijing, China. The indoor and outdoor PM10, PM2.5, and PM1 concentrations were monitored, and a total of 30 indices, including respiratory symptoms, pulmonary functions, inflammation, and oxidative stress indicators, were analyzed. We used the logistic mixed-effects model and the linear mixed-effects model to evaluate the correlation between exposure (intervention and time-weighted PM concentration) and effects (indicators). Findings: The findings showed that the air purifier intervention was associated with a 13.29% decrease in runny nose, 11.05% decrease in FeNO, 12.03% decrease in EBC IL-1β, and 4.2% decrease in IL-6. The patterns of associations with each 10 µg/m3 decrease in the PM10, PM2.5, and PM1 concentrations were consistent with those for filter intervention. Moreover, lower PM2.5 and PM1 were associated with lower EBC MCP-1, 5.47% and 13.56%, respectively. The pulmonary function indices were negatively associated with the intervention and PM. Interpretation: We screened out some sensitive indices (FeNO, IL-6, IL-1β, MCP-1) related to respiratory symptoms and inflammation, which could reflect the early abnormal response of the respiratory system under short-term PM exposure. Our findings suggested that air purifiers have a protective effect on children’s respiratory system. Funding: This work was supported by the National research program for key issues in air pollution control, China (Grant No. DQGG0405). Declaration of Interest: None to declare. Ethical Approval: The study was approved by the Ethics Review Committee of National Institute of Environmental Health, Chinese Center for Disease Control and Prevention (No. 201803) and the Biomedical Ethics Committee of Peking University (No. IR1052-18089). Parents and schoolchildren were informed about the study beforehand, and all the participants and their parents signed the informed consent.

시민의 자유와 공중보건윤리: 공리주의, 생명의료윤리, 자유주의 등

시민의 자유와 공중보건윤리: 공리주의, 생명의료윤리, 자유주의 등

『생명의료윤리의 원칙들』과 덕성 논의

『생명의료윤리의 원칙들』과 덕성 논의

The role of compassion in ethical frameworks and medical practice

Medicine has made great strides with advances in technology and outcomes. However, compassion is an element that often is missing from medical care and ethics. The paper discusses why compassion is the ideal physician and why it is important to medicine. The benefit of compassion in biomedical ethics by exploring three ethical frameworks is also explored. Compassion is an important concept that has a place in both medical care and ethical practice.

Assessing factors influencing pharmacy interns career choices in Saudi Arabia

BackgroundThe number of students enrolled in the colleges of pharmacy in Saudi Arabia is high, and the number of pharmacy graduates expected to join the workforce in the coming years is expected to grow. There are limited number of studies that assess factors influencing pharmacy students’ career choices in Saudi Arabia in the literature. The aim of this study was to assess the factors that influence career goals and to investigate students’ perceptions about their career goals. MethodsThis study was a prospective cross-sectional survey targeting PharmD students in their last year (i.e. interns) in the academic year of 2018 – 2019. A questionnaire containing four parts and total questions of 32 was completed by interns. Data collected and analyzed using Qualtrics. This study was reviewed and approved by the Unit of Biomedical Ethics Research Committee at King Abdulaziz University. Results93 were reachable via email and all of them attended the interview and completed the survey (100% response rate). The most important job considerations were: work environment (67.7%), advancement opportunities (55.9%), salary (52.7%), benefits (40.9%), flexible work schedule (34%), and finally geographic region (29%). The top ranked career goal upon graduation were in industry and drug company (35.5%), clinical pharmacy (26.9%), (14%) academics/research and hospital pharmacy setting (inpatient/outpatient) (14%) each, and regulatory and community pharmacy (3.2% and 4.3%, respectively) ConclusionThis study showed that work environment, advancement opportunities, and salary were the most important job consideration for pharmacy interns. The top ranked career goals were industry and drug company followed by clinical pharmacy. Further studies across Saudi Arabia are needed to confirm our results.

Laicality and secularity of Bioethics: why I believe in a biologically founded ethics

All living forms are worthy of respect and of bioethical consideration as they keep promoting the DNA of the species and the preservation of its intraspecific variability. However, the ethical consideration varies and has a different weight according to different biological complexity and its ontogenetic cycle. A first hierarchical level of value must be attributed to the specific DNA of a biological entity characterised by a haploid order of genes such as those of a bacterium, a gamete, a spore or an haplophyte. The second hierarchical level leading to complexity in the history of life are the diploid entities, characterised by a diploid order of genes. They differ from the haploid because the fusion of the two haploid DNA filaments presupposes meiosis, which functions as a selective filter of casual mutations, the majority of which lead to the extinction of the haploid entity. The third ethical level of complexity concern those animal species in which the concept of individual is present; individual being defined as a biological entity characterised by uniqueness, unrepeatability, indivisibility for the entire ontogenetic cycle (in other words, individuals resulting from the fusion of gametes produced by the meiotic process of parental generation) and in which the germinal line is potentially active in all individual members of the population. In these groups of living beings the preservation of the characteristic DNA of the species and its intraspecific variability is ensured by precise rules of socialisation. The socio-intellectual control on the environment in the natural system operated by Humanity can represent the quality leading to the fourth hierarchical level of ethical norms. The historically influenced bioethical behaviour of humans can be related to Morality which can assume different norms in different historical contexts. Morality could be therefore governed by religious or normalised by governments. Ethics is instead a pure biological and ecological discipline.

COVID-2019: Una revisión de la nueva crisis pandémica

La pandemia del COVID-19, causada por el nuevo coronavirus 2019-nCoV y responsable del síndrome respiratorio agudo severo por coronavirus 2 (SARS-CoV-2), constituye un punto de inflexión en la historia humana. La patogenicidad del virus y su capacidad para crear rápidamente una infección generalizada con graves consecuencias y alta mortalidad, justifican la adopción de medidas extraordinarias de prevención y control. Las tasas de infección por COVID-19 están en constante evolución, y es muy difícil predecir el comportamiento de la enfermedad, en consecuencia, se requiere el desarrollo urgente de nuevos fármacos o la reutilización de medicamentos conocidos. A pesar de que es un proceso complejo y que las pruebas clínicas tienen graves implicaciones bioéticas, la investigación sigue avanzando, el sector científico está produciendo resultados de calidad, entre ellos el primer antiviral aprobado contra el SARS-CoV-2, el Veklury® o remdesivir. Existen muchos otros agentes terapéuticos en investigación, y se hacen grandes esfuerzos por obtener una posible vacuna. En este artículo se hace una revisión sistemática acerca de algunos aspectos resaltantes del COVID-19, comenzando por ofrecer información acerca de las pandemias a lo largo de la historia, la descripción del nuevo coronavirus 2019-nCoV, los mecanismos de trasmisión y las pruebas de diagnóstico, algunos de los fármacos que se están probando (cloroquina, lopinavir/ritonavir, ribavirina, favipiravir, oseltamivir), así como agentes inmunomoduladores (tocilizumab, anakinra interferones, transfusiones de plasma), agentes coadyuvantes (azitromicina, corticosteroides, mesilato de camostat) y, finalmente, la situación en que se encuentra el desarrollo de una posible vacuna.

Perspectiva de los dilemas éticos relacionados con la pandemia COVID-19

Enfrentar la pandemia del SARS-CoV-2, conocida mundialmente como COVID-19, constituye un desafío enorme, el cual hay que abordar por los múltiples aspectos de esta enfermedad. Sorprende la rapidez con la que el virus SARS-CoV-2 se ha expandido globalmente, es la pandemia que hoy ocupa toda la atención mundial, no solo por los aspectos médico-epidemiológicos sino también por sus consecuencias en la geopolítica, la economía y la sociedad en general. Desde que se inició la pandemia, la información científica ha ido incrementándose diariamente en forma notable, se trabaja y se publica sobre su epidemiología, modo de transmisión, manifestaciones clínicas, diagnóstico de laboratorio, tratamientos médicos alopáticos y ya están en fase 3 algunas vacunas como medida de prevención de esta enfermedad. No obstante, toda pandemia y en especial esta que nos ocupa, inevitablemente trae adicionalmente una serie de dilemas éticos, tanto en las decisiones de Salud Pública, en grupos poblacionales vulnerables, en el desarrollo de protocolos de investigaciones y en la atención de los pacientes afectados por la infección. La resolución de los conflictos éticos que han surgido en la pandemia COVID-19, debe tener como referencia las pautas bioéticas publicadas por organizaciones internacionales (OMS/OPS) y centros y comités nacionales o institucionales dedicados al campo de la Bioética. Esto permitiría una acción responsable frente a la pandemia, sin dañar los derechos humanos y el bienestar individual y social.

Trends of the researches related to ethical topic in Korean nursing students

Purpose: The purpose of this study is to explore the trends of research related to ethical topics in Korean nursing students.Methods: A total of 131 articles that were published from 2000 to 2020 were analyzed and summarized according to publishing type, research design, subject, data analysis method, main research topic, research variables and instrument.Results: Most studies were journal articles (93.9%) and their most frequent research design was survey (75.7%). The research subjects covered all grades (35.1%) or they were divided between clinical nursing practicum (29.8%) or not (21.4%). The main research topics were biomedical ethics, ethical values, moral judgment and ethics education. Recently, ethical decision making and practical ability in nursing practice were reported. The instruments for measuring variables were limited and the same tools were used several times.Conclusion: Based on the findings of this study, it is suggested that the selection of various research topics and the application of research methods related to ethics for nursing students will continue in response to rapidly changing social phenomena in the future. In particular, it is necessary that research related to ethical and practical ability as well as ethical attitudes and perceptions of nursing students be actively carried out.

“Philosophy of Religion and Medicine in the Post-secular Age”: Review of the 2nd International Scientific and Practical Conference

June 11-12, 2020 at the O. Bogomolets National Medical University online hosted the II International Scientific and Practical Conference "Philosophy of Religion and Medicine in the Post-Secular Age" (In memory of St. Luke (V. F. Voino-Yasenetskyi). The basic department in the organization of the event was the Department of Philosophy, Bioethics and History of Medicine. The directions of the conference participants' work remained traditional and focused on: Questions of religion and medicine in life and work of St. Luke (V. F. Voino-Yasenetskyi); Methodological and historical aspects of the relationships between religion and medicine in contemporary society; Human health in the context of philosophy, religion and medicine; Religion and clinical medicine; Actual problems of biomedical ethics in contemporary religious discourse; Religion as a social and spiritual determinant of individual and public health; Philosophy of religion and medicine: current challengesю. Along with NMU named after OO Bogomolets co-organizers of the conference were: Department of Religious Studies of the G. S. Skovoroda Institute of Philosophy of the National Academy of Sciences of Ukraine; Personality Development Center "HUMANUS", Plovdiv (Bulgaria); Institute of Social Medicine and Medical Ethics at Faculty of Medicine, Comenius University in Bratislava (Slovakia).

"임상간호사의 좋은 죽음에 대한 인식, 생명의료윤리의식, 도덕적 민감성이 사전연명의료의향서에 대한 태도에 미치는 영향"

Purpose: This study was a descriptive study to investigate the effects of nurse’ good death recognition, consciousness of bioethics, and moral sensitivity on attitudes toward advance directives. Methods: The study was performed at a university hospital in Incheon between July 10 and 20, 2019. Convenience sampling was used to recruit 176 clinical nurses. Data were collected through self-report questionnaires. Results: The perception of good death was 3.10±0.31, consciousness of biomedical ethics was 2.87±0.21, moral sensitivity was 5.10±0.53 and attitude toward advance directives was 2.88±0.28. Attitude toward advance directives were positively correlated with perception of good death (r=.33, p=.001), consciousness of biomedical ethics (r=.14, p=.077), moral sensitivity (r=.32, p=.001). In the results of analyzing the factors having effects on the attitude toward advance directives, the age (β=.44, p=.006), value of advance directives (β=.20, p=.005), perception of good death (β=.21, p=.004), moral sensitiity (β=.15, p=.034), euthanasia (β=-.16, p=.047) and the explanatory power of regression model was 32.3% (F=7.20, p<.001) Conclusion: It would be necessary to develop the systematic educational programs that could positively improve the attitude toward advance directives by establishing the perception of good death, and increasing the consciousness of biomedical ethics and moral sensitivity of nurses.

Explainability for artificial intelligence in healthcare: a multidisciplinary perspective

BackgroundExplainability is one of the most heavily debated topics when it comes to the application of artificial intelligence (AI) in healthcare. Even though AI-driven systems have been shown to outperform humans in certain analytical tasks, the lack of explainability continues to spark criticism. Yet, explainability is not a purely technological issue, instead it invokes a host of medical, legal, ethical, and societal questions that require thorough exploration. This paper provides a comprehensive assessment of the role of explainability in medical AI and makes an ethical evaluation of what explainability means for the adoption of AI-driven tools into clinical practice.MethodsTaking AI-based clinical decision support systems as a case in point, we adopted a multidisciplinary approach to analyze the relevance of explainability for medical AI from the technological, legal, medical, and patient perspectives. Drawing on the findings of this conceptual analysis, we then conducted an ethical assessment using the “Principles of Biomedical Ethics” by Beauchamp and Childress (autonomy, beneficence, nonmaleficence, and justice) as an analytical framework to determine the need for explainability in medical AI.ResultsEach of the domains highlights a different set of core considerations and values that are relevant for understanding the role of explainability in clinical practice. From the technological point of view, explainability has to be considered both in terms how it can be achieved and what is beneficial from a development perspective. When looking at the legal perspective we identified informed consent, certification and approval as medical devices, and liability as core touchpoints for explainability. Both the medical and patient perspectives emphasize the importance of considering the interplay between human actors and medical AI. We conclude that omitting explainability in clinical decision support systems poses a threat to core ethical values in medicine and may have detrimental consequences for individual and public health.ConclusionsTo ensure that medical AI lives up to its promises, there is a need to sensitize developers, healthcare professionals, and legislators to the challenges and limitations of opaque algorithms in medical AI and to foster multidisciplinary collaboration moving forward.

THE UZBEK MODEL OF BIOETHICS: HISTORY AND MODERNITY

Modern biomedical ethics is based on a rich tradition of systematic moral thought, both philosophical and religious. In the XXI century, the interaction and synthesis of natural and humanitarian disciplines are of paramount importance in the system of biomedical education. One of the ways to solve this problem for future specialists is to study the foundations of biomedical ethics, the formation of a bioethical culture of future doctors. Among the ancient scientists of Central Asia who became famous in the field of medicine and pharmacy, a prominent place is occupied by Abuali Ibn Sino (Avicenna), whose life and work can serve as an example of national and historical identity, patriotic education of the youth of Uzbekistan. The emergence of such a phenomenon as the "Muslim Renaissance" and in this context the life and work of Avicenna, his role in the history of the development of medicine in Uzbekistan, are devoted to many, which, like others, were included in the materials of this study. A kind of bridge from ancient medicine to the medicine of the Renaissance and further to modern medicine was the legacy of doctors in Central Asia and Arab physicians. At present, the social, legal and economic aspects of ethical problems of key issues of bioethics in the field of health, medicine and biomedical technologies in the context of the Islamic faith continue to be studied.

Multidimensional Machine Learning Personalized Prognostic Model in an Early Invasive Breast Cancer Population-Based Cohort in China: Algorithm Validation Study.

BackgroundCurrent online prognostic prediction models for breast cancer, such as Adjuvant! Online and PREDICT, are based on specific populations. They have been well validated and widely used in the United States and Western Europe; however, several validation attempts in non-European countries have revealed suboptimal predictions.ObjectiveWe aimed to develop an advanced breast cancer prognosis model for disease progression, cancer-specific mortality, and all-cause mortality by integrating tumor, demographic, and treatment characteristics from a large breast cancer cohort in China.MethodsThis study was approved by the Clinical Test and Biomedical Ethics Committee of West China Hospital, Sichuan University on May 17, 2012. Data collection for this project was started in May 2017 and ended in March 2019. Data on 5293 women diagnosed with stage I to III invasive breast cancer between 2000 and 2013 were collected. Disease progression, cancer-specific mortality, all-cause mortality, and the likelihood of disease progression or death within a 5-year period were predicted. Extreme gradient boosting was used to develop the prediction model. Model performance was assessed by calculating the area under the receiver operating characteristic curve (AUROC), and the model was calibrated and compared with PREDICT.ResultsThe training, test, and validation sets comprised 3276 (499 progressions, 202 breast cancer-specific deaths, and 261 all-cause deaths within 5-year follow-up), 1405 (211 progressions, 94 breast cancer-specific deaths, and 129 all-cause deaths), and 612 (109 progressions, 33 breast cancer-specific deaths, and 37 all-cause deaths) women, respectively. The AUROC values for disease progression, cancer-specific mortality, and all-cause mortality were 0.76, 0.88, and 0.82 for training set; 0.79, 0.80, and 0.83 for the test set; and 0.79, 0.84, and 0.88 for the validation set, respectively. Calibration analysis demonstrated good agreement between predicted and observed events within 5 years. Comparable AUROC and calibration results were confirmed in different age, residence status, and receptor status subgroups. Compared with PREDICT, our model showed similar AUROC and improved calibration values.ConclusionsOur prognostic model exhibits high discrimination and good calibration. It may facilitate prognosis prediction and clinical decision making for patients with breast cancer in China.