Bioethical Research Articles

Application of the Principles of Biomedical Ethics to the Labor and Delivery Unit During the COVID-19 Pandemic.

After its identification as a human pathogen in 2019, the novel coronavirus, SARS-CoV-2, has spread rapidly around the world. Health care workers worldwide have had the task of preparing and responding to the pandemic with little evolving data or guidelines. Regarding the protocols for our labor and delivery unit, we focused on applying the four pillars of biomedical ethics-beneficence, nonmaleficence, autonomy, and justice-while considering the women, their fetuses, their significant others and support persons, health care professionals and auxiliary staff, and society as a whole. We also considered the downstream effect of our decisions in labor and delivery on other disciplines of medicine, including pediatrics, anesthesiology, and critical care. This article focuses on how these prima facie principles helped guide our recommendations in this unprecedented time.

Microethics In Clinical Practice

Ethics is defined as moral philosophy or code of morals practiced by a person or group of people.When the term 'ethics' is considered in clinical practice or medical education one tends to think only about the long established ethics like biomedical ethics, research ethics etc. but there are more.

DETECTION OF DISSEMINATED TUMOR CELLS IN THE BONE MARROW OF PATIENTS WITH NON-SMALL CELL LUNG CANCER

Introduction. There is evidence that disseminated tumor cells (DOCs) in the bone marrow (BM) are precursors of subsequent distant metastases. The detection of DOCs in non-small cell lung cancer (NSCLC) will provide important information about the features of metastasis, as well as the possibilities of identifying new targets for the treatment of NSCLC. Purpose of the study is to evaluate the possibility of detection DOCs in BM and to identify the frequency of BM involvement in patients with NSCLC. Materials and methods . Morphological and immunological methods studied 62 BM samples from patients with NSCLC. DOCs analysis was performed using flow cytometry (FACSCanto II, USA, Kaluza Analysis v 2.1 software), monoclonal antibodies to CD45, cytokeratins directly labeled with various fluorochromes were used. Results . DOCs (EPCAM+CD45–) in the BM were found in 43.5 % of patients (threshold level: 1 cell per 10 million myelocaricytes). The presence of DOCs did not correlate with tumor size, lymph node status, stage of the tumor process. The highest detection rates of DOCs were observed at stages IA and IIA: 60.7 % (3/5) and 58.3 % (7/12) respectively. BM involvement in adenocarcinoma was observed in 45 % (15/33) cases, in squamous cell carcinoma – in 37 % (10/27) samples (p = 0.501). It was found that DOCs are more often detected in more differentiated tumors (p = 0.023). Significant correlations between the presence of DOCs in the BM and myelogram parameters have not been established. A decrease in the number of granulocyte germ cells was observed in 4 % of BM involvement (p = 0.036). Conclusion. The possibility of detecting DOCs in the BM of NSCLC patients has been established. BM involvement was 43.5 %. DOCs are detected even in the early stages of NSCLC. Relationship between BM involvement and the degree of tumor differentiation was found. More frequent BM involvement was observed in adenocarcinoma compared with squamous cell carcinoma of the lung. Compliance with patient rights and principles of bioethics The study protocol was approved by the biomedical ethics committee of N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia. All patients gave written informed consent to participate in the study.

EFFECT OF HLA-DR ANTIBODY CONCENTRATION ON ESTIMATION OF THE NUMBER OF CD14+HLA-DRLOW /–-CELLS IN THE BLOOD OF PATIENTS WITH B-CELL chronic lymphocytic leukemia

Introduction. Immunoregulatory functions of myeloid-derived suppressor cells have been extensively studied over the recent decades. Additionally, myeloid-derived suppressor cells have been investigated as a prognostic factor.Objective. To optimize the measurement of monocytic myeloid-derived suppressor cells in the peripheral blood of patients with B-cell chronic lymphocytic leukemia.Materials and methods. The number of myeloid-derived suppressor cells with CD14+HLA-DRlow/–-phenotype was determined in the peripheral blood of patients with B-cell chronic lymphocytic leukemia and healthy donors by flow cytometry. The measurement was carried out at two points, which differed in the concentration of anti-HLA-DR antibodies − 15 and 4 μl.Results. The median amount of myeloid-derived suppressor cells in the peripheral blood of B-cell chronic lymphocytic leukemia patients with 15 μl of anti-HLA-DR antibody was 1.9 %, and with 4 μl of antibody concentration – 7 %. Healthy donors had that median of 0.15 % with 15 μl of antibody and 0.3 % with 4 μl concentration.Conclusion. The number of CD14+HLA-DRlow/–-cells in the blood of patients with B-cell chronic lymphocytic leukemia is sensitive to the concentration of the HLA-DR antibody.Compliance with patient rights and principles of bioethics. The study protocol No 3 of 13.02.2020 was approved by the biomedical ethics committee of Research Institute of Experimental Diagnostics and Therapy of Tumors N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of the Russian Federation. All patients gave written informed consent to participate in the study.

Health justice in the Anthropocene: medical ethics and the Land Ethic

Industrialisation, urbanisation and economic development have produced unprecedented (if unevenly distributed) improvements in human health. They have also produced unprecedented exploitation of Earth’s life support systems, moving the planet into...

The Ethics of Tobacco Harm Reduction: An Analysis of E-Cigarette Availability From the Perspectives of Utilitarianism, Bioethics, and Public Health Ethics.

Much evidence suggests e-cigarettes are substantially less harmful than combustible cigarettes. Assuming this is true, we analyze the ethical case for a policy of e-cigarette availability (ECA) as a tobacco harm reduction strategy. ECA involves making e-cigarettes available to allow smokers to switch to them, and informing smokers of the lower risks of e-cigarettes vis-à-vis smoking. After suggesting that utilitarian/consequentialist considerations do not provide an adequate ethical analysis, we analyze ECA using two other ethical frameworks. First, ECA is supported by a public health ethics framework. ECA is a population-level intervention consistent with respecting individual autonomy by using the least restrictive means to accomplish public health goals, and it supports equity and justice. Second, ECA is supported by four principles that form a biomedical ethics framework. By reducing smokers' health risks and not harming them, ECA fulfills principles of beneficence and non-maleficence. Because ECA allows smokers to make informed health decisions for themselves, it fulfills the principle requiring respect for persons and their autonomy. Here, we consider whether nicotine addiction and thus ECA undermine autonomy, and also discuss the ethical warrant for special protections for youth. Finally, ECA can also advance justice by providing a harm reduction alternative for disadvantaged groups that disproportionately bear the devastating consequences of smoking. Policies of differential taxation of cigarettes and e-cigarettes can facilitate adoption of less harmful alternatives by those economically disadvantaged. We conclude that public health and biomedical ethics frameworks are mutually reinforcing and supportive of ECA as a tobacco harm reduction strategy. Implications: Making e-cigarettes and information about them available is supported as ethical from multiple ethical perspectives.

Queering medicalized gender variance

The International Statistical Classification of Diseases (ICD) and The Diagnostic and Statistical Manual of Mental Disorders (DSM) formulate a fundament for biomedical ethics of gender variance, governing clinical practices, systems and policies. I discuss the diagnostic details and bioethical ramifications of so-called gender diagnoses in ICD and DSM. I then subject medicalized gender variance to concept analytical and queer bioethical scrutiny. I find both diagnostic systems to make sense of gender variance through incongruence, dysphoria and desire in bioethically confusing ways. In my treatment, medicalized gender variance does not necessarily entail pathologization. I conclude that medicalized gender variance can be used for balancing access to care and stigma but persist that evaluation of this must be more informed by queer bioethics. Despite progress compared to previous versions of ICD and DSM, both are still in need of further queer bioethical scrutiny. This includes a thorough evaluation of queer vulnerabilities in gender diagnostics, currently building on convoluted definitions of incongruence, desire and dysphoria. This convolution confuses medical ethics of gender and sexual variance. Further, it can trigger moral harms, including cascading queer vulnerabilities. La Classification statistique internationale des maladies (CIM) et le Manuel diagnostique et statistique des troubles mentaux (DSM) formulent les fondements de l’éthique biomédicale de la variance entre les sexes, régissant les pratiques cliniques, les systèmes et les politiques. Je discute les détails du diagnostic et des ramifications bioéthiques des diagnostics de genre dans la CIM et le DSM. J’ai ensuite soumis la variance de genre médicalisée à un examen de la queer bioéthique. Je trouve que les deux systèmes de diagnostic donnent un sens à la variance entre les sexes à travers l’incongruence, la dysphorie et le désir de manière bioéthiquement confuse. Dans mon traitement, la variance de genre médicalisée n’implique pas nécessairement une pathologisation. Je conclus que la variance de genre médicalisée peut être utilisée pour équilibrer l’accès aux soins et la stigmatisation, mais l’évaluation de cela doit être éclairée par la queer bioéthique. Malgré les progrès par rapport aux versions précédentes de la CIM et du DSM, les deux ont encore besoin d’un examen queer bioéthique supplémentaire. Cela comprend une évaluation approfondie des vulnérabilités queer dans les diagnostics de genre, en s’appuyant actuellement sur des définitions alambiquées de l’incongruence, du désir et de la dysphorie, conduisant à une éthique médicale alambiquée et aggravant les problèmes queer bioéthique.

Questioning representations of athletes with elevated testosterone levels in elite women’s sports: a critical policy analysis

ABSTRACT Sport sociologists are often required to interpret, question and respond to the ways in which fairness and eligibility concerns in elite sports are represented in policy frameworks produced by sports governing bodies. Drawing on Carol Bacchi’s critical policy analysis framework, ‘what is the problem represented to be?’, this paper explores the importance in developing a critical eye and reading about representations of women athletes with particular differences of sex development (DSD) with elevated testosterone levels and the idea of regulating their testosterone levels in the female classification. Through using the above critical policy analysis line of questioning, this analysis aims to consider what the problem of women athletes with relevant DSDs with elevated testosterone levels in female elite sports is represented to be; what the assumptions underlying these representations of the problem are; how these representations of the problem have come about; what is left unproblematic in this problem representation; what the lived effects produced by these representations of the problem are; and how these representations of the problem have been produced, disseminated, defended, questioned, disrupted and even could be replaced. The critical policy analysis argues that the continuing persistence of policies marking particular women with DSDs as a problem, is related in part to societal views defining particular bodies and athletic abilities in the female classification as either ‘right’ or ‘wrong’ and in need of fixing. In moving forward and redressing the problem, it requires the embodiment of biomedical ethics and human rights advocacy work by sports governing bodies.

The Doctrine of Double Effect: An Aid in Decision-Making

Human society of the modern world, which is greatly affected by technological and economic advancements, has to address moral problems with a new urgency. In many instances, the decision does not bring only positive effects. Such cases can be found in applied ethics: bio-medical ethics, business ethics, and legal ethics, but also in other areas of human activity, too, most recently, in debates, concerning the use of autonomous vehicles or autonomous machines in general. This paper aims to describe and explain the principle of ‘double effect’, when solving complicated and, from the perspective of morality, profoundly dilemmatic situations. The principle of double effect was gradually developed as a means of seeking the right moral decisions. It has a firm and respected position within Catholic medical ethics, but also in secular legislation. The paper presents current thought experiments, which clarify moral decision-making in dilemmatic situations. What seems to be a shortcoming here, is that ethical thought experiments are far too abstract. On the one hand, they refine our knowledge, but on the other hand, they are very partial. The evolution of medical imaging methods, has enabled us to take a closer look at the relationship between the deontological and utilitarian approaches to making moral judgments, but it does not relieve us of our responsibility for the decisions that we have made. The positive side of the principle of double effect, is that it protects us from the slippery slope of utilitarian consequentialism, where the admission of a lesser evil, is only a step away from committing evil in the name of the greater good.

Consent and confidentiality in children

Confidentiality is central to the establishment and preservation of trust between a doctor and their patient, yet is one of the lesser-discussed principles of medical bio-ethics. A "duty of confidence arises when one person discloses information to another in circumstances where it is reasonable to expect that information to be held in confidence".1
 Its moral basis is in that it should improve patient welfare, and as such, it is encompassed during all aspects of the treatment process, beginning with the initial consultation where patient autonomy and informed consent are first addressed.

Mycosis Fungoides: A Case Report

Objectives: Mycosis fungoides (MF) is the most common group of cutaneous T-cell lymphomas. We reported this rare diagnosed case of MF in National Dermatology Center of Mongolia. Methods: Diagnosis was based on physical examination and laboratory testing. Bioethical permission for this research was given by the Biomedical Ethics Committee of Ministry of Health in Mongolia, May 23, 2017. Results: A 78-year-old woman presented for evaluation of a 7-year history of recurrent pruritic lesions that appeared as red patches and plaques on non-sun exposed areas. She was given the initial clinical diagnosis of psoriasis. Upon examination, the morphology, histopathology and immunohistochemistry indicated MF, IB stage. Conclusions: A reliable diagnosis of mycosis fungoides might be feasible only in conjunction with clinical, histopathological, and molecular criteria.

Стовбурові клітини пуповинної крові: клінічне застосування алогенного матеріалу, проблеми та перспективи банківського зберігання

Human umbilical cord blood (UCB) is an important source of hematopoietic stem cells (HSCs), successfully used for allogeneic transplantation to treat a wide range of serious diseases. This article discusses a number of topical problems associated with the functioning of public low-temperature banks of UCB. The principles of standardization, quality control and the effective selection of the cryopreserved units at the transplant centers request are considered from the point of view of the world transplantation practice for this unique biological material. The issues related to the trends in therapy using mesenchymal stromal/stem cells from the fetoplacental complex tissues and their cryopreservation are also deliberated. Special attention is paid to the issues of biomedical ethics and the prospects of public UCB bank establishing in Ukraine, its role in the development of the national HSCs unrelated transplantation. Probl Cryobiol Cryomed 2020; 30(3): 213–235

Ethical considerations for artificial intelligence: an overview of the current radiology landscape.

Artificial intelligence (AI) has great potential to accelerate scientific discovery in medicine and to transform healthcare. In radiology, AI is about to enter into clinical practice and has a wide range of applications covering the whole diagnostic workflow. However, AI applications are not smooth sailing. It is crucial to understand the potential risks and hazards that come with this new technology. We have to implement AI in the best possible way to reflect the time-honored ethical and legal standards while ensuring the adequate protection of patient interests. These issues are discussed under the light of core biomedical ethics principles and principles for AI-specific ethical challenges while giving an overview of the statements that were proposed for the ethics of AI applications in radiology.

Psychiatric Interventions in Virtual Reality: Why We Need an Ethical Framework.

Recent improvements in virtual reality (VR) allow for the representation of authentic environments and multiple users in a shared complex virtual world in real time. These advances have fostered clinical applications including in psychiatry. However, although VR is already used in clinical settings to help people with mental disorders (e.g., exposure therapy), the related ethical issues require greater attention. Based on a thematic literature search the authors identified five themes that raise ethical concerns related to the clinical use of VR: (1) reality and its representation, (2) autonomy, (3) privacy, (4) self-diagnosis and self-treatment, and (5) expectation bias. Reality and its representation is a theme that lies at the heart of VR, but is also of specific significance in a clinical context when perceptions of reality are concerned, for example, during psychosis. Closely associated is the autonomy of VR users. Although autonomy is a much-considered topic in biomedical ethics, it has not been sufficiently discussed when it comes to applications of VR in psychiatry. In this review, the authors address the different themes and recommend the development of an ethical framework for the clinical use of VR.

Surgical approaches of drug-free in vitro activation and laparoscopic ovarian incision to treat patients with ovarian infertility

To demonstrate our procedures of drug-free invitro activation (IVA) for treating patients with premature ovarian insufficiency (POI) or diminished ovarian reserve (DOR), as well as the laparoscopic ovarian incision (LOI) procedure for treating patients with resistant ovary syndrome (ROS). Step-by-step video demonstration of the surgical procedures. Fertility clinic and reproductive medicine department. Women were diagnosed with POI based on recent amenorrhea before 40 years of age or with DOR according to the Bologna criteria, showing growth of a few antral follicles after ovarian stimulation. ROS patients were diagnosed based on amenorrhea with hypergonadotropic hypoestrogenism but showing age-appropriate number of antral follicles under transvaginal ultrasound. The drug-free IVA consists of the following 4 steps: removing a part of the cortex from one or both ovaries; cutting ovarian cortical pieces into small cubes invitro; making pockets for ovarian tissue grafting; and grafting ovarian cortical cubes. The LOI procedure consisted of only one step: cutting ovarian cortex in situ. Both procedures were followed by ovarian hyperstimulation for at least 1 year. Informed consent was obtained from patients and approval was granted by the Biomedical Ethics Committee of the International University School of Medicine and the Rose Ladies Clinic. The present clinical trial was carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki). Follicle growth. These procedures can be completed within 1 hour under laparoscopic surgery. There were no complications. In 13 of 15 patients treated with drug-free IVA, increases in antral follicle numbers were found, followed by a higher number of retrieved oocytes for invitro fertilization. In addition to one spontaneous pregnancy, embryo transfer allowed four live births and one ongoing pregnancy. Five additional patients and one miscarriage patient have cryopreserved embryos for future transfer. We also found follicle growth to the preovulatory stage in seven of 11 ROS patients who have not responded to any endogenous and exogenous follicle-stimulating hormone stimulations for follicle growth prior to LOI treatment, allowing the retrieval of mature oocytes for invitro fertilization. Four ROS patients became pregnant, followed by the delivery of three healthy infants and one ongoing pregnancy. A drug-free IVA approach provided an infertility treatment for recent POI or DOR patients. This procedure promoted growth of residual ovarian follicles following ovarian tissue fragmentation invitro, leading to Hippo signaling disruption. Although ROS patients exhibited symptoms of hypergonadotropic hypoestrogenism similar to that of POI patients, they still had multiple secondary follicles. Hippo signaling disruption invivo based on cutting ovarian cortex using LOI could promote follicle growth. UMIN000029807.

Teaching bioethics at the Medical School, University of Ibadan, Nigeria: Prospects and challenges

Abstract Background Teaching bioethics (BE) is one way to contribute to reflecting if research on humans, health policies and interventions are legitimate. Nonetheless, BE and law have been a relatively new subjects in medical schools in Nigeria, with increasing interest only since the late 1990s following the Pfizer Trovan study. Literature in this emerging field mostly refers to experiences from high-income countries (HIC), literature on low-and middle-income countries (LMIC) is scarce. Objectives This presentation describes over 10 years’ experience of teaching BE in the residency program, to doctors and within a Masters in BE Program of the University of Ibadan, Nigeria. The paper discusses the content, skills, teaching approach and tools employed in these activities. Challenges of the teaching process are identified and future teaching strategies suggested. Results The crop of students are largely unemployed young graduates, health professionals, ethics committee members. They come from Southern Nigeria; there is a weak representation from the Northern states of Nigeria. Based on students and lecturer evaluation reports, we can report that it is important to teach BE in LMICs such as Nigeria. A country that has experienced many ethically challenging and even evil activities in medicine and medical research coupled with a radically changing value system. Teaching universal norms of BE in a country with a high level of illiteracy and cultural differences where religion plays a major role in defining what is right, wrong or appropriate remains a challenge. Conclusions For BE training to be impactful and result in systemic and structural changes in health policy and education in Nigeria, the government must invest in proper institutionalization of research and clinical ethics in curricula in Nigeria. Key messages Efforts need to be increased in Nigeria and other LMICs to teach BE. HIC institutions could offer guidance by becoming partners organizing ethics training.

Elective Surgery and COVID-19: A Framework for the Untested Patient.

∗Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, Stanford University, Stanford, California †Quality, Safety and Clinical Effectiveness, Stanford Health Care, Stanford, California ‡Stanford Center for Biomedical Ethics, Stanford University, Stanford, California. [email protected]. Reprints will be available from the authors. This work did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors do not report any conflicts of interest.

Diálogo Bioético y del Bioderecho en torno a la conformación y naturaleza biojurídica de la familia homoparental

Diálogo Bioético y del Bioderecho en torno a la conformación y naturaleza biojurídica de la familia homoparental

Abstract 5413: Terry Fox PRecision Oncology For Young peopLE (PROFYLE): A Canadian precision medicine program for children, adolescents and young adults with hard-to-treat cancer

Abstract Introduction: Over 4300 children, adolescents, and young adults (CAYA) are diagnosed with cancer each year in Canada, 1/3 of whom will have refractory or metastatic disease or will relapse with a very poor prognosis. Most CAYA cancer survivors suffer significant late effects that impose an enormous burden to them, their family and the health care system. To address this urgent medical and socioeconomic need, a pan-Canadian collaborative program, PRecision Oncology For Young peopLE (PROFYLE), was created with the objective to develop and implement the first Canadian precision oncology pipeline providing access to tumour molecular profiling with the aim of identifying novel targeted therapeutic options in a clinically relevant timeframe for CAYA with hard-to-treat cancer. Design: Prior to PROFYLE, 3 programs (Personalized Oncogenomics Project (POG), SickKids Cancer Sequencing Program (KiCS), and Personalized Targeted Therapy in Refractory or Relapsed Cancer in Childhood (TRICEPS)) constituted the bulk of childhood precision oncology efforts in Canada. PROFYLE was designed to unite and build upon them, and consists of interconnected nodes including: genomics/bioinformatics, proteomics, cancer modeling, biomarkers, biobanking/data repositories, therapeutics/clinical trial design and biomedical ethics; unified by a shared governance structure. There are 16+ institutions in the PROFYLE consortium. The PROFYLE profiling strategy consists of initial reporting from a >800 cancer gene panel, followed by whole genome (paired germline/cancer samples) and whole transcriptome analyses. Eligibility criteria: ≤29y; treatment at a Canadian oncology center; diagnosis with a hard-to-treat cancer. Profiling results are reviewed by multidisciplinary Molecular Tumour Boards. A patient-specific molecular research report including summary of results and recommendations (actionable finding, potential targeted therapies, any open clinical trials which the patient may be eligible for, change of diagnosis, and/or referral for genetic counselling) is provided to the treating oncologist. Results: To date, 644 patients have taken part in PROFYLE (n=338) and POG, KiCS, TRICEPS. For the first 100 participants, cancer diagnoses include 43 sarcomas, 23 CNS tumors, 10 leukemia and lymphomas, 10 neuroblastoma and 14 other rare cancers. At study entry, 48% had not yet relapsed, 40% 1 relapse, 10% 2 relapses, and 2% 3+ relapses. 13 had a cancer-predisposing germline mutation and 82 had at least one potentially actionable somatic alteration. The most commonly mutated genes/pathways included TP53, CDNK2A/B, FGFR, MYC, and FLT1/3/4. 82% had results/recommendations from the MTB that informed a medical decision to alter diagnosis, prognosis, or treatment of their disease. In 71%, management recommendations were provided. Analyses of the complete dataset will be presented at the meeting. Conclusion: The goal of developing a national precision oncology pipeline has been realized through the establishment of the PROFYLE initiative. PROFYLE continues to grow through increased recruitment, additional institutions, contribution of new knowledge to the field of precision oncology, improving access to clinical trials for CAYA patients, and advocacy and partnerships on local, national and international scales. Citation Format: Stephanie A. Grover, Jason N. Berman, Jennifer A. Chan, Rebecca J. Deyell, David D. Eisenstat, Conrad V. Fernandez, Paul E. Grundy, Cynthia Hawkins, Meredith S. Irwin, Nada Jabado, Steven J. Jones, Michael Moran, Shahrad R. Rassekh, Adam Shlien, Daniel Sinnett, Poul H. Sorensen, Patrick J. Sullivan, Michael D. Taylor, Anita Villani, James A. Whitlock, David Malkin, on behalf of the Terry Fox PROFYLE Consortium. Terry Fox PRecision Oncology For Young peopLE (PROFYLE): A Canadian precision medicine program for children, adolescents and young adults with hard-to-treat cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5413.

Ethical aspects in the use of radiation in medicine: update from ICRP Task Group 109.

Whereas scientific evidence is the basis for recommendations and guidance on radiological protection, professional ethics is critically important and should always guide professional behaviour. The International Commission on Radiological Protection (ICRP) established Task Group 109 to advise medical professionals, patients, families, carers, the public, and authorities about the ethical aspects of radiological protection of patients in the diagnostic and therapeutic use of radiation in medicine. Occupational exposures and research-related exposures are not within the scope of this task group. Task Group 109 will produce a report that will be available to the different interested parties for consultation before publication. Presently, the report is at the stage of a working document that has benefitted from an international workshop organised on the topic by the World Health Organization. It presents the history of ethics in medicine in ICRP, and explains why this subject is important, and the benefits it can bring to the standard biomedical ethics. As risk is an essential part in decision-making and communication, a summary is included on what is known about the dose-effect relationship, with emphasis on the associated uncertainties. Once this theoretical framework has been presented, the report becomes resolutely more practical. First, it proposes an evaluation method to analyse specific situations from an ethical point of view. This method allows stakeholders to review a set of six ethical values and provides hints on how they could be balanced. Next, various situations (e.g. pregnancy, elderly, paediatric, end of life) are considered in two steps: first within a realistic, ethically challenging scenario on which the evaluation method is applied; and second within a more general context. Scenarios are presented and discussed with attention to specific patient circumstances, and on how and which reflections on ethical values can be of help in the decision-making process. Finally, two important related aspects are considered: how should we communicate with patients, family, and other stakeholders; and how should we incorporate ethics into the education and training of medical professionals?