At the 2024 NATO Special Operations Forces Medical Panel, representatives from 20 NATO Allied and 2 Partner Nations identified care for the expectant (dying) patient during conflict as a significant gap in recognised international standards. Recognising the gap, a position statement on care of the dying patient during conflict was developed. This position statement details recommendations for addressing disparities in care of the dying patient spanning multiple domains including standardised terminology, research and development, clinical practice guidelines, legal clarity, training and respect for individuals. The potential for high numbers of casualties during large scale combat operations makes it even more critical that the international military medical community pre-emptively develop best practices in order to deliver ethical and compassionate care to dying patients during conflict while simultaneously mitigating the risk of moral injury among providers.

To develop a format of the behavioural criteria of ethical care with dementia so as to support nursing pedagogy and ethical practice in dementia care. Literature review, group workshop and Delphi method. This project underwent three stages of literature review, initial construction and Delphi method from June 2020 to June 2023. Nine databases were searched with key words for articles relevant to ethical care with dementia that were published before 2022. Johns Hopkins Evidence Level and Quality Guidelines were employed for quality appraisal. A process of highlighting, comparing, merging and categorising was employed by two reviewers for data synthesis. The original behavioural criteria of ethical care with dementia were constructed by team members based on literature review and group discussions. Fifteen experts were invited and two rounds of consultation were completed. Statistics were generated for comprehensive evaluations. Revisions were made with expert suggestions to obtain a final format. A total of 3299 titles and abstracts were initially retrieved, 242 full text articles were reviewed and 15 articles were included, with evidence type of I to V and evidence level b. Ten ethical principles and 12 categories of ethical issues closely relevant to dementia care were achieved by syntheses. An initial format of the behavioural criteria was developed for the Delphi method. Modestly acceptable correspondence was obtained by two rounds of expert consultation. The final format of the criteria included 10 ethical principles, 37 ethical issues and their corresponding cases, scenarios and three modalities (the recommended, the obscure and the false) of ethical care behaviours with dementia. Therefore, this format of the case-based narrative behavioural criteria could be useful for training the nurses' competencies of ethical reasoning and setting the professional boundaries of nurses' ethical care behaviours, which could facilitate nurses in their pedagogical and clinical practice of ethical care with dementia. No patient or public contributions.

This case narrative explores the ethical challenges that arise when culturally rooted surrogate decision-making conflicts with standard biomedical care. A 20-year-old Somali man presented with suspected autoimmune encephalitis requiring urgent immunosuppressive treatment to prevent permanent brain injury. Lacking decisional capacity due to encephalopathy, his mother served as his surrogate. Guided by religious and cultural beliefs, his family attributed his condition to demonic possession and declined medical treatment in favor of a spiritual healing ritual. This decision generated profound moral distress among the healthcare team and underscored the need for structured ethical support. This case illuminates the intersection of cultural pluralism, surrogate decision-making, and the moral boundaries of medical authority. The ethics consultation centered on the question of whose morality should guide care when a patient lacks capacity and cultural worldviews diverge. Drawing on Kleinman’s explanatory model, principles of cultural humility, and Fadiman’s framework of “collision of systems,” the ethics team reframed the conflict through cross-cultural moral negotiation (Kleinman, 1988; Fadiman, 1997). Ultimately, this case calls for a shift from moral certainty to moral accompaniment, an ethic of care that prioritizes understanding across differences when consensus cannot be reached.

Development and validation of the children's subjective service experience scale during social service delivery in Mainland China.

Quantum-enhanced throughput pathways: Integrating Rodgers' TPM with quantum ethical frameworks for AI-driven cybersecurity.

95. Preparation for ethical adolescent practice: a needs assessment of pediatric residents' adolescent care ethics training

Ethical, clinical, and legal challenges of mental health care in prisons: between constraints and clinical integrity.

ABSTRACT Bullying in schools presents ethical challenges that extend beyond disciplinary and psychological frameworks. This article argues that bullying constitutes a moral failure in education and requires responses grounded in ethical responsibility. Drawing on care ethics, relational responsibility, and Buddhist concepts of loving-kindness (mettā) and self-compassion, the paper develops a conceptual framework for rethinking bullying prevention as an ethical praxis. Based on a systematic review of recent studies, the anaysis indicate that loving-kindness and self-compassion are associated with reduced aggression, enhanced empathy, and increased prosocial behaviors, contributing to more inclusive school climates. These practices address the harm of bullying while fostering ethical subjectivity among students and teachers. By situating these insights within critiques of neoliberal schooling, the article highlights the need to reorient education toward compassion, relational care, and ethical flourishing, offering an intercultural contribution to debates in ethics and education.

The rapid expansion of psychedelic research has opened significant pathways of opportunity in treating mental health disorders. Participants in recent clinical trials consistently report mystical-type experiences during dosing sessions, and some scholars posit that such experiences themselves help mediate clinical improvements in depression, PTSD, anxiety, and substance use disorders. These reports are in keeping with the historical reality that the use of psychedelic substances and plant medicine has been tied to spiritual experience and shamanic ceremonial practice. Professional clinical chaplains are trained and experienced in providing spiritual and emotional support for people encountering illness, life change, and trauma. They regularly assist participants who seek to make meaning of their experiences in the context of their own beliefs and spirituality. This article argues that as subject matter experts in spirituality and health, chaplains are an asset to psychedelic assisted therapies and should be utilized in research trials and clinical practice, especially given a relative lack of training in spirituality and religion among interprofessional practitioners. We offer this set of competencies for chaplains to provide high quality, safe, and ethical care in the context of psychedelic medicines. These competencies include spiritual and religious care, spiritual inquiry, empathic presence, ethical engagement, and advocacy. We recognize that chaplains will need to pursue specialized education and supervised experience beyond their standard professional requirements, and pathways of personal preparation are discussed. The presence of qualified chaplains will help ensure that participants navigate non-ordinary states of consciousness with safety, sensitivity, and insight regarding improvement and growth.

Global citizenship education as an ethics of care

This article analyzes, from the perspective of Integral Ecology, a case study in the locality of San Juan de Abajo, Nayarit, focusing on the engagement with watermelon producers and cattle ranchers. Through participatory methodologies and dialogue of knowledges, the study identified the main challenges faced in the territory: environmental degradation derived from agro-industrial monocultures, climate vulnerability, social fragmentation, institutional mistrust, loss of traditional knowledge, and limited financial capacities. The findings show that these conditions deepen the gap between producers of different scales, hinder the transition toward sustainable practices, and constrain collective organization. From the standpoint of Integral Ecology, the study concludes that environmental regeneration requires understanding the territory as a web of living relationships, strengthening the social fabric, and building situated transdisciplinary processes that integrate socio-environmental justice, an ethic of care, and long-term sustainability.

Unlike criminal defense with its cab-rank duty, surgeons are constrained by nonmaleficence. This review examines when declining aesthetic surgery requests constitutes ethical care rather than prejudice. To identify professional standards and empirical evidence guiding ethical decision-making when surgeons consider declining aesthetic surgery requests, and to provide a framework for principled refusal. Narrative review of professional standards (GMC, RCS, ASPS, ISAPS), outcome data on higher-risk procedures, comparative analysis of jurisdictional safeguards, and ethics literature from plastic surgery.PubMed searches used terms: [(aesthetic surgery OR cosmetic surgery) AND (ethics OR informed consent OR patient selection OR refusal OR body dysmorphic disorder)] for 2014-2025, supplemented by professional society websites. Global demand reached 38 million aesthetic procedures in 2024.Ethics discourse remains underrepresented (approximately one in 1000 articles), with autonomy disproportionately emphasized over beneficence, nonmaleficence, and justice.Abdominoplasty complications cluster around 2-4%; gluteal fat grafting carries elevated mortality. Modifiable risks include nicotine, cannabis, and GLP1 therapy. Body dysmorphic disorder prevalence approaches 18.6% among candidates.Contemporary guidance emphasizes surgeon-led consent, cooling-off periods, psychological screening, and discretion to decline when benefit is doubtful. Ethically defensible refusal requires articulable clinical reasons, documentation, and alternatives-never moral disapproval. Structured frameworks applying the four bioethical principles-autonomy, beneficence, nonmaleficence, and justice-provide actionable guidance. Principled refusal, when clinically indicated and compassionately explained, is not failure but expression of professionalism. This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Young adults in Indonesia who identify as men attracted to men face intense pressure to conform to heteronormative expectations, particularly regarding marriage. During quarter-life crisis, this pressure often leads to internal conflict and emotional distress. This study explored how these individuals perceive marriage and how such perceptions impact their mental and emotional well-being during a critical life transition. A qualitative phenomenological approach guided by Colaizzi's method was used. Ten participants aged 22-29 were recruited through purposive and snowball sampling. In-depth, semi-structured interviews were conducted in Bandung, Indonesia and analysed thematically. Participants reported psychological tension arising from the clash between personal identity and societal expectations. Emotional suppression and spiritual guilt were common. Trust in mental health services was limited due to prior stigma. Findings are context-specific and based on a small, urban sample of Muslim participants. Cross-cultural generalisability is limited. Mental health nurses must address identity-related distress with cultural humility and emotional safety. Nursing education and practice should prioritise inclusive assessment, spiritual care and stigma-free environments. This study provides critical insight into how young men navigating same-sex attraction in Indonesia experience emotional conflict during early adulthood due to cultural and religious pressures to marry. These findings highlight the urgent need for inclusive, identity-affirming and culturally sensitive approaches in mental health nursing. By understanding the unique psychological vulnerabilities of this group, mental health nurses can deliver more compassionate, ethical and effective care, reduce stigma in practice settings and contribute to the development of safe, non-judgemental spaces for all clients regardless of sexual or spiritual identity.

Purpose This study aims to investigate how inner values, community relationships and place-based practices contribute to the long-term viability and environmental connectedness of community-based enterprises (CBEs), focusing on a rural handicraft cooperative in India. It explores how value-driven leadership and rootedness in local contexts can offer pathways to sustainable and inclusive development. Design/methodology/approach Using a qualitative case study approach, the research examines Earthcraft Cooperative, a community enterprise built by and with rural artisans. Guided by an ecofeminist lens, the study investigates how ethics of care, non-extractive relationships with nature and shared purpose shape organizational practices. Findings Findings show that the enterprise thrives not only through economic activity, but by cultivating a deeper sense of collective purpose and well-being. The care-centered intent of the leadership, often informed by relational and reflective values, plays a key role in sustaining the enterprise. The study highlights how embodied craftsmanship and rooted community participation serve as counterpoints to technology-dominated, growth-centric models of work. Practical implications The study provides insights for policymakers, social entrepreneurs and development actors seeking to support inclusive, values-led rural enterprises that align economic goals with ecological and human flourishing. Originality/value This research offers a nuanced understanding of CBEs by foregrounding the ethical, relational and quietly spiritual dimensions of enterprise. It adds to emerging scholarship on alternative economies by showing how inner values and community-rooted care can drive sustainable transformation.

Federal Policy, Stigma, and the Ethics of HIV Care.

To develop a comparative meta-theory of nine caring theories by explicating their assumptions, operative mechanisms and consequences for nursing. Qualitative meta-theoretical document analysis. Canonical texts were analysed using an intra-source strategy. Paginated statements were extracted and coded across assumptions, metaparadigm anchors (person, health, environment, nursing and care) and mechanisms linking caring intention to clinical action. Synthesis produced a typology and meta-theoretical propositions. Caring functioned as a generative principle that reorganised person, health, environment and nursing and care into distinct practice architectures. Six mechanism-based subfamilies were identified: transpersonal caritas; phenomenological and embodied clinical wisdom; ethical and relational caring; cultural and contextual caring; systemic and organisational caring; and operationalisable caring. Ten propositions linked assumptions to mechanisms and expected effects. The caring school is best understood as an ordered set of non-equivalent caring mechanisms rather than a single doctrine, supporting translation to practice design, education and congruent evaluation. Mechanism-based comparison can reduce conceptual ambiguity and improve alignment between caring interventions and intended outcomes. This study addresses the under-specification of how caring theories work. It provides a comparative typology and propositions that make mechanisms explicit, informing nursing education, theory development and caring-based practice in diverse settings. No EQUATOR reporting checklist is available for meta-theoretical discursive analyses; the manuscript follows Journal of Advanced Nursing guidance for discursive papers. This study did not include patient or public involvement in its design, conduct, or reporting.

ABSTRACT This article explores and critiques the current status quo of queer teachers in the United States (US) while suggesting ways to build LGBTQ+ allyship to make school an equitable workplace for all teachers and educators. The study combined the two theories of intersectionality and ethics of care to present a nuanced understanding of queer teachers’ experiences. Using multimedia autoethnographic methods including journaling, poetry, music elicitation, and photovoice, the third author documented their daily life as a queer teacher working at a US public middle school with complex feelings, thoughts, and sensations inside and outside of school as the workplace. The first and second authors, as ‘critical friends’, collaboratively coded and analysed the data. The findings exhibited various manifestations of queer identities in contexts typically shaped by cis-heteronormative expectations and institutional policies. It also unpacks challenges met by a queer teacher in navigating workplace culture.

Abstract A persistent problem in corporate governance is the defining scope of the fiduciary and other duties of directors of public corporations, private companies, and other organisations that adopt a corporate form. Moreover, over the past three decades, public policy initiatives have sought to foster greater director accountability not just as a solution to the agency problem but also in aid of broader social goals. This push-and-pull of policy can confuse decision-making and for directors pose a version of the famous “trolley problem” in ethics, with the added complication that boards must decide on how to act collectively and not as individuals. This conceptual paper poses the question: Might the ethics of care – sometimes labelled “feminist ethics” – come to the rescue?

ABSTRACT Ethical practice is central to audiology and speech therapy (STA), yet ethical decision-making in South African practice management occurs within complex structural constraints. Conceptualising ethics as a situated and relational practice, this study explored ethical challenges encountered by practitioners and how these are negotiated across public and private contexts. A qualitative design was used, drawing on semi-structured interviews conducted in 2025 with 92 practitioners. Data were thematically analysed, with descriptive and exploratory statistical analyses used to examine sectoral patterns for analytical insight. Four interrelated themes emerged: resource-driven ethical dilemmas in the public sector; tensions between business ethics and financial sustainability in private practice; challenges related to culturally sensitive and ethical care; and ethical tensions associated with advocacy and systemic reform. Findings highlight ethics as everyday moral work that is structurally and relationally produced rather than solely individual. Addressing these challenges requires strengthened ethics education, mentorship, institutional support, and contextually grounded ethical guidance.

We aimed to conduct a comparative analysis of the open disclosure frameworks in Australia and New Zealand to identify the strengths, weaknesses and trade-offs of their respective approaches and to propose a hybrid model that integrates the best practices from both systems. This qualitative comparative policy analysis systematically reviewed key policy documents from Australia and New Zealand. Data extraction focussed on the principles, processes, governance, legal aspects and implementation strategies of each framework. A multi-theoretical approach was adopted, applying four core theoretical frameworks-institutional theory, regulatory governance, ethics of care and implementation science-to analyse the extracted data. The analysis involved thematic coding, a cross-country comparison through each theoretical lens and a synthesis of the findings to identify the trade-offs between the two models and to inform the development of a refined hybrid model. The analysis revealed that Australia's framework, which is embedded in national safety standards, emphasises system-wide governance and accreditation, offering flexibility but at the risk of implementation variability. In contrast, New Zealand's model, which is legally mandated under consumer rights legislation, prioritises individual accountability and patient rights, ensuring strong enforcement but potentially fostering a compliance-driven culture. The key differences between the two frameworks emerged in their legal specificity, enforcement mechanisms and the practicalities of their implementation. The analysis highlighted the critical role of ethical considerations, workforce capacity and organisational readiness for the effective implementation of open disclosure. Both the Australian and New Zealand open disclosure frameworks offer valuable insights into the challenge of balancing systemic governance and consumer rights. A hybrid approach that integrates Australia's focus on systemic learning with New Zealand's robust legal mandate for patient rights and explicit ethical considerations could provide a more effective and equitable framework for open disclosure, and could enhance healthcare quality and transparency. Future research should focus on the empirical evaluation of the practical implementation and outcomes of such hybrid models.