As humanity's marked effects on Earth's natural systems become increasingly apparent, we witness with alarm the impact on health and healthcare delivery. In this review, interrelationships between climate change, kidney health, and peritoneal dialysis (PD) therapies are described, and expansion of duty of care to the environment while maintaining the highest-quality healthcare is explored. Practical, high-yield actions that can be undertaken by patients and providers through the principles of sustainable care are introduced, including medication and single-use plastic consumables optimization, incremental PD, remote health monitoring, innovative PD effluent drainage, waste optimization, and importantly, patient empowerment as partners in sustainability. To ensure sustainable practices are embedded in clinical care, creation of a network of green champions, alignment with low carbon sustainable health systems more broadly, and appropriate uptake of emerging innovations in PD therapy that may be offered through sustainable procurement and regional or point of care dialysate production are crucial.

Digital technologies are on the rise to promote health. To improve the engagement and effectiveness of these technologies, there is a growing interest in algorithmic personalization. However, the user input data for these algorithms (e.g., data from wearables or self-reported data) can come with ethical and regulatory implications. Despite a growing amount of theoretical work, there is no practical precedent on how to consider these implications in the development of personalization algorithms. Therefore, our work aims to tackle this challenge by proposing a stepwise method for Responsible Data Selection (ReDS) for algorithmic personalization of mHealth. The ReDs method acts from a duty of care and promotes an active search for ethically less risky data. We demonstrate the six-step method through a real-world use case on an mHealth app promoting adolescents' mental well-being, using a dataset of 1181 adolescents (5199 interactions) who received coping strategy challenges based on cognitive behavioral therapy. First, we identified the personalization objective in the case study (step 1). The objective was to personalize the type of challenge to promote adherence while diversifying the coping strategy types within the completed challenges. Next, we identified the emotional state of the adolescent and prior completion rates as promising input data (step 2). However, personal emotion data can be considered sensitive, personal, and private, implying ethical implications (step 3). As a potential alternative, tiredness data can be perceived as less sensitive to share and collect (step 4). Subsequently, we analyzed the utility of all data features (step 5) using evaluative simulations with reinforcement learning models. This revealed that solely using the completion rates of the previous day could already benefit the personalization objective and that adding emotion data or tiredness data could similarly further increase the performance of the personalization algorithm. When determining the utility-risk trade-off (step 6), we conclude that tiredness data can be used as an alternative for emotion data if risk mitigation strategies are deployed. Through this case study, we demonstrate the practical utility of the ReDS method. We hope that our work will inspire future developers of personalization algorithms to explicitly incorporate ethical considerations in the algorithm development process.

ABSTRACT Touch is a key element of social interactions within early childhood and forms part of a relational pedagogy. Children naturally use touch daily and research demonstrates that it is a vital component of child development. Effective educators use touch sensitively and appropriately to support children from hand-holding for safety, to high-fives for praise. However, using touch is not without challenges and in recent years there has been a resurgence of ‘no-touch’ policies in schools and settings. Through the lenses of current literature and research alongside attachment and traditional theory, this literature-based conceptual paper seeks to demonstrate how these policies go against current research and offers an evidence-informed argument to counter them. Arguing that educators have a duty of care acting in loco-parentis, incorporating sensitive and appropriate touch between educators and children in schools and settings strengthens social and emotional bonds, enhances learning and is vital within childhood and essential for human survival.

ABSTRACT Drawing on in-depth interviews with sex workers across 11 European countries, conducted within the European Sex Workers’ Rights Alliance project, this article explores how sex worker citizenship – understood in terms of access to rights, recognition, and inclusion within existing structures of care – is constructed and negotiated through encounters with the police as victims of crime. Across four policy regimes – criminalisation, partial criminalisation, the Swedish model, and regulation – three recurring police responses were identified: misrecognition, responsibilisation, and punishment. This systemic denial of victimhood excludes sex workers from the police’s duty of care. Within a broader landscape of repressive or restrictive policies and enforcement-led policing that structure the everyday lives of sex workers, these practices contribute to conditions that are conceptualised here as policed abandonment: a mode of governance that amplifies the visibility of sex workers as subjects of control and punishment, while rendering them invisible as subjects of rights, protection, and care.

This article focuses on the legal frameworks in the UK that underpin how allegations of clinical negligence are legally assessed and managed. Key terminology and concepts including duty of care, breach of duty, causation and harm are explored. The author also discusses the important role of expert nursing witnesses in supporting legal teams in the assessment of clinical negligence allegations.

Physician adoption of new information about a medical procedure can affect patient outcomes. Medical malpractice law may influence physician use of such information. We analyze how physician reactions to information shocks regarding vaginal births after cesarean sections (VBACs) in the 1990s were mediated by tort reform and the standard used in malpractice claims to determine a physician's duty of care to patients. Differentiating states according to whether they capped non-economic damages in malpractice claims (Caps) and whether they defined the duty of care using a national or a local reference point, we analyze how physicians under the four legal regimes reacted to a series of adverse information shocks regarding VBACs over the period. Our results suggest that physicians whose duty of care is determined by standard practices nationwide are less likely to adopt innovations which have not yet been incorporated into those practices and more likely to adopt innovations once they are incorporated into those practices. Caps may moderate these effects. Our results also suggest intuitive heterogeneity in the effects of legal regime on physician decisions.

Balancing duty and risk: Ethical dimensions of community-based one health surveillance among frontline health workers in Mombasa, Kenya

Care approaches to oral health are shaped by the perspectives of both aged care and dental care professionals. This study provides a new and comprehensive understanding of how these two professional groups conceptualise and address oral care for care-dependent older adults. Researchers conducted 13 focus group discussions with 4-6 participants each in two Danish municipalities within the Lifelong Oral Health research project: nine with aged care staff and four with managers from aged care and dental care. Two semi-structured interviews were conducted with dental care staff. The research was guided by a qualitative methodological framework using inductive thematic analysis to explore participants' experiences and perspectives. Aged care and dental care staff held varying perspectives on four distinct care approaches: (1) knowledge of oral health; (2) prioritisation of oral health; (3) care practice in relation to oral health; (4) handling refusal of oral care. In contrast to dental care staff, aged care staff had rudimentary oral health knowledge and prioritised other care tasks over oral care. Aged care staff took a rehabilitative approach to oral care, whereas dental care staff favoured a compensatory approach. Aged care staff stated that the right to self-determination overruled the duty of care presented by dental care staff when patients refused oral care. These differences affected daily oral care practices and collaboration between both staff groups, who both endorsed better collaboration. Divergent care approaches to oral care between aged care and dental care staff can hinder good oral health in care-dependent older adults. To enhance oral health in older adults, this article identifies four divergent approaches and explores how they challenge inter-professional collaboration.

This study explored paediatric nurses' decision-making regarding resuscitation in patients with unequivocal signs of death and no Do Not Resuscitate (DNR) order. A cross-sectional survey was conducted between October 2023 and April 2024 across the paediatric wards of four Australian hospitals. Participants were asked to respond to two hypothetical clinical scenarios involving a three-year-old boy and a twelve-year-old girl, both clearly deceased-neither of whom had documented DNR orders. Participants indicated their intended resuscitation plan and reasoning for each scenario. Data were analysed descriptively. All respondents (n = 26) (100 per cent) indicated that they would initiate resuscitation for the younger child, while 84.6 per cent (n = 22) would do so for the twelve-year-old. The absence of a DNR order and perceived duty of care were key reasons for their decisions. Findings reveal ethical, legal, and clinical challenges inherent to paediatric resuscitation decisions. This highlights the need for clearer policies, education, and support to guide determination of when resuscitation is appropriate.

Australia recently became the first country to reschedule methylenedioxymethamphetamine (MDMA) to permit authorized prescribing for post-traumatic stress disorder (PTSD) outside of clinical trials. This study explored the direct experience of Australian clinicians, researchers, and patients regarding the use of MDMA-assisted psychotherapy (MDMA-AP) for PTSD to inform guideline development. In-depth semi-structured interviews were conducted with clinicians, researchers, and patients who had direct experience with the use of MDMA-AP or PTSD. Interviews were transcribed verbatim and coded. Themes were developed using both inductive and deductive approaches (guided by the World Health Organization Guide to Good Prescribing framework). Twenty-one interviews were conducted with clinicians (mental health-focused general practitioners, psychiatrists, psychologists, therapists), researchers (health economist, pharmacologist, social worker, trial researcher), and patients. Eleven themes emerged: (1) role of MDMA-AP in relation to established PTSD therapies; (2) importance of expectation management and shared decision-making; (3) perceived therapeutic benefits of MDMA-AP; (4) importance of comprehensive baseline screening (medical, psychological, financial, and social support); (5) variable patient values and preferences; (6) desire for flexible treatment protocols; (7) importance of comprehensive and ongoing consent; (8) duty of care in establishing strong therapeutic alliance; (9) patient need for information about process and logistics; (10) treatment monitoring and discontinuation; and (11) importance of post-treatment continuity of care. Australians with direct experience of the use of MDMA-AP or PTSD highlight the importance of expectation management, comprehensive screening, consent, safeguard measures, therapeutic alliance, integration of care, and training of healthcare providers. As MDMA-AP becomes implemented into clinical practice, there is scope to incorporate these insights into a national guideline.

Post-donation care is variable in Canada. A virtual workshop including donors and health providers was conducted to advance recommendations for a new national standard of living donor follow-up. Attendees participated in facilitated breakout groups to deliberate pre-set questions on a draft care model informed by a survey of 685 previous donors. Deliberations were audio-recorded, transcribed, and imported into HyperRESEARCH software to facilitate inductive, systematic and auditable coding of the data. Final meeting recommendations were approved by attendees and then presented for consideration of endorsement by all Canadian programs. We identified four themes: (1) Establishing a donor centric long-term follow-up plan; (2) Generating data to optimize donor outcomes; (3) Safeguarding donors and (4) Partnership to strengthen care (transplant centers enacting duty of care, setting expectations with donors for follow up, supporting a collaborative model with primary care doctors, harnessing technology, ensuring consistency, regularity, and feasibility). Post-donation care should be donor-centric, flexible and based on a strong collaboration between primary care providers and transplant programs. The new model should include a "safety net" to provide specialist care when needed, as well as donor consent for capture of long-term health outcomes in a national registry. The recommendations are endorsed by all Canadian living donor programs. Although necessary, the provision of universal health care coverage alone is insufficient to ensure long-term donor health and inform future practice. A new national model of long-term donor follow-up informed by the lived experience of past donors and input from primary care and transplant providers was proposed.

Dental implantology has traditionally been a postgraduate subject; however, as dental implants become an increasingly popular tooth replacement option for dentists and patients, there is a growing need for newly graduated dentists to be familiar with core aspects of implant dentistry. Furthermore, as the field of implant dentistry advances, so has the breadth of treatment indications and complexity. Therefore, not only are there more implant patients, there are more complex implant patients in the community. The care of implants and treatment of peri-implant tissues falls within the scope of the general dental practitioner (GDP), and it is widely considered that GDPs have a duty of care to monitor and maintain dental implants. It is important that undergraduate dental education reflects these evolutions in clinical dentistry to equip newly graduated dentists with the competencies to identify, monitor and maintain dental implants. In recognition of the continuing challenges concerning the delivery of undergraduate dental implant education in the UK and Ireland, this article aims to reflect on progress over the past 40 years, examine its status today and identify the future education priorities to be addressed.

ABSTRACT The rise of the internet as the dominant information platform has brought numerous legal challenges, prompting governments worldwide to reconsider the immunity granted to online services as content intermediaries. The UK introduced the Online Safety Act 2023 (OSA) to establish a safer digital environment. The Act imposes new ‘duty of care’ on regulated user-to-user and search services, requiring them to assess systemic risks, specifically regarding illegal content and material harmful to children. This paper evaluates whether the OSA has created a comprehensive online governance framework and whether its illegal content risk assessment provides a structured approach to intermediary liability. Drawing on European Court of Human Rights jurisprudence, Delfi AS, MTE & Index, and Sanchez, it examines whether these obligations comply with freedom of expression standards. The OSA strengthens a previously fragmented landscape, and the assessment obligation appears to be a reasonable approach to strengthening intermediary liability. However, this paper identifies several areas requiring improvement, particularly the inconsistent application of proportionality regarding risk-level categorisation and mitigation measures. Furthermore, the absence of effective user remedies may potentially infringe upon free speech online.

Persistent digital divides and gendered health inequalities constrain women's participation in the digital economy, even in highly connected contexts like China. This study develops an explanatory framework for how information-technology-enabled entrepreneurship (ITEE) affects women's economic security, health, and capabilities. Using a constructivist grounded theory approach based on 80 interviews in China, the analysis reveals four themes. Capability formation shows how increased income and flexibility allow women to invest in health. Algorithmic exposure highlights the dual nature of platform visibility, boosting sales but also enabling harassment and anxiety. Care negotiation examines how unpaid care duties and infrastructure impact sustainability, showcasing adaptive strategies. Trajectory configuration integrates these into differentiated pathways, from vulnerable to healthenhancing, depending on aligned support. The findings position health centrally in digital capability and link platform governance and care ecologies to sustainable empowerment, suggesting safe platforms, caring support, and integrated policies are essential for women's wellbeing.

The death of Mahsa Amini in September 2022 and subsequent protests placed Iranian physicians in an ethical dilemma: comply with state mandates that endangered patients or uphold their duty of care at significant personal risk. This essay examines how Iranian physicians navigated these dual obligations, protecting patients while confronting systemic repression, and situates their struggle within a broader history of medical neutrality under authoritarian regimes. Drawing on core bioethical principles and comparative case studies from Bahrain, Syria and Chile, the essay explores how physicians often assume politicised roles not by choice, but through the inescapable demands of clinical ethics in environments where care itself becomes resistance. In Iran, hospitals were transformed into sites of surveillance, and treating protest-related injuries could lead to arrest or professional sanction. In response, many physicians engaged in quiet resistance-falsifying records, concealing identities and offering covert care-to preserve both ethical integrity and clinical trust. To navigate such challenges, the 'sliding scale of moral obligation' is proposed as an adaptive ethical framework accounting for individual risk, proximity to harm and capacity to act. This model avoids prescribing a universal standard of heroism and instead affirms a baseline duty of non-complicity, offering a flexible yet principled approach to ethical action under duress. By exploring the tension between neutrality and resistance, this essay advocates for a more nuanced understanding of physicians' roles in repressive contexts. For medical students, engaging with these dilemmas deepens ethical literacy, prepares us to navigate moral complexities and equips us to better support colleagues under political duress.

Background: Hospital-related patient safety incidents and medical negligence disputes have increased pressure on Indonesia's health governance system, revealing a significant legal gap. Article 193 of Law No. 17 of 2023 limits hospital liability to vicarious liability for health personnel, yet differing interpretations raise questions about whether hospitals also bear central responsibility for duty of care and facility management. Objective: It aims to analyze hospital legal liability for unlawful acts in health service provision, focusing on three aspects: the scope of hospital liability, the application of compensation, and the legal basis for unlawful acts. Methods: It employs a descriptive-analytical method with a normative-juridical approach, relying on primary, secondary, and tertiary legal materials, complemented by interviews. Data were analyzed qualitatively without statistical methods. Results: The findings reveal that hospital liability extends beyond vicarious liability to include centralized institutional responsibility for duty of care and facilities. Compensation for unlawful acts is applied analogically from Articles 1243–1248 of the Civil Code, covering costs, losses, and interest, including both material and immaterial damages, provided there is no contributory negligence by the patient. Furthermore, liability for unlawful acts under Articles 1365–1367 of the Civil Code should be directed not at the hospital as an entity, but at the controlling legal body, such as a company (PT) or government institution. Conclusion: Indonesian hospital liability law requires harmonization. Article 193 should be interpreted broadly to include both forms of responsibility, and legal reforms are needed to clarify liability and improve mechanisms for patient compensation.

Internal auditing is an independent, objective assurance and consulting activity designed to add value and improve an organization's operations (Kahn, 2005). According to Marxist theory, internal auditing is viewed as an independent assurance activity designed to protect the integrity of and contribute to the expansion of the circuit of industrial capital so that the surplus value in products might be fully realized through their sale and that capital might not go to waste, which helps an organisation accomplish its objectives by bringing a systematic approach to evaluating and improving the effectiveness of its risk management, control, and governance processes (Marx, 1981). This study's aim was to analyze the challenges of internal auditing in strengthening internal controls in public sector organizations in Zambia: A case study of the Ministry of Education. The specific objectives of the study were to examine the role of internal auditors in strengthening internal corporate governance in the public sector in Zambia, to determine factors that pose challenges in corporate governance in the public sector in Zambia, and to assess the independence and competence of internal auditors in strengthening corporate of public sector in Zambia. The researcher adopted a mixed approach and employed qualitative and quantitative research designs. Stratified simple random sampling is suitable for the quantitative phase because the Zambia MoE workforce is heterogeneous, consisting of multiple positions, departments, and stations. Stratification ensures that all key subgroups such as customer care, teaching department, accounts, logistics, and general duties staff are adequately represented in the sample. The research comprised questionnaires and interview schedules. The questionnaires were used because they are the main means of collecting quantitative primary data. The questionnaires enabled quantitative data collected in a standardized manner to ensure the data is consistent and coherent for the analysis. From the findings, the study concludes there are significant concerns regarding the independence of internal auditors from internal pressure within the Ministry of Education. A substantial proportion of respondents, 35.4%, indicated that internal auditors are perceived to experience internal pressure that may influence their audit work, findings, and recommendations. Furthermore, findings indicate that a majority of respondents (63.4%) perceive internal auditors as capable of using control assessment and risk analysis techniques, with 46.2% agreeing and 17.2% strongly agreeing. Furthermore, the mean score of 3.64 and a median/mode of 4 reflect an overall positive perception of the auditors’ competencies. Pearson correlation analysis between internal auditors’ knowledge of modern technologies and their access to records and information showed a very weak positive correlation (r = 0.081, p = 0.112), which was not statistically significant. This indicates that technology knowledge is not significantly associated with cooperation or access to information in this context.” Pearson correlation analysis between internal auditors’ knowledge of modern technologies and the adequacy of the internal audit department’s staffing revealed a very weak positive correlation (r = 0.039, p = 0.447), which was not statistically significant. This suggests that auditors’ technology skills are not associated with the number of employees in the department.” It depicts a very strong, statistically significant positive correlation between the availability of necessary resources for auditing activities and the consideration of internal auditors’ reports in management decision-making and internal controls (r = 0.904, p < 0.01). This indicates that better resourced auditors are more likely to have their reports taken seriously by management.

The research groups Collaborative Economies and P2P Production at IBICT and NetLab of the School of Communication at UFRJ now publish the second issue of the eleventh volume of their journal P2P & INNOVATION. Our research groups once again take a stand in defense of democracy, freedom of expression, and academic research freedom. This is not an abstract defense of principles, but rather a defense of our own freedom and autonomy in our work. NetLab is a research laboratory focused on the Internet and Social Networks, dedicated to diagnosing digital disinformation as a historical fact and its social consequences, as well as discussing and suggesting guidelines and means for its Regulation, Oversight, and Control. Its agenda has made it possible to publish important and recognized scientific evidence. The attacks on NetLab have many faces, the main one being an avalanche of slander, defamation, and online pressure. NetLab resists and continues its work. It is worth mentioning the formation of a broad solidarity network in defense of the freedom to investigate disinformation and hate networks. It is important to highlight the decision of the Federal Supreme Court in the last week of June 2025, which adopted a regulatory solution based on three criteria: private notification for general crimes; court order in cases of slander, libel, and defamation; and duty of care for serious unlawful content such as terrorism, racism, and femicide — situations in which platforms must act preventively, blocking publication via algorithms. We would like to conclude by informing our authors and readers of the editorial decision to give the journal greater focus by also reducing the breadth of its scope. Among the specific topics that will remain within the journal’s scope are: innovation policies and practices; intellectual property; digital technologies and artificial intelligence; digital platforms; regulation and oversight of the use of digital technologies; information management; and the political economy of information and communication. The editorial transition of the journal P2P & Innovation will take place in the second half of this year, in order to allow for the necessary operational changes.

Electromagnetic hypersensitivity (EHS) and children Michael Bevington from Electrosensitivity UK discusses children’s susceptibility to the harmful effects of EMFs and calls for increased awareness and protective action regarding exposure. Children are physically more sensitive than adults to man-made electromagnetic fields (EMFs). These EMFs, often found at home and school, include Wi-Fi, Bluetooth, smart-meters, mobile phone masts and handsets, and power cables. Parents and teachers have a duty of care to safeguard their children by protecting them from harmful EMFs.

The widespread adoption of conditionally autonomous vehicles has rendered it imperative for China to regulate them within the criminal law framework. Confronted with challenges including the determination of criminal liability subjects, the assessment of subjective fault, and the delineation of causal relationships, the traditional model for identifying criminal liability in conventional vehicle cases is no longer applicable to autonomous vehicles, as autonomous driving systems cannot qualify as subjects of criminal liability. Drawing on the theory of objective imputation, the principle of reliance, and the objectives of industry development and legal regulation, this paper positively identifies the criminal liability of producers across the production and circulation stages, categorizes the duty of care for drivers into pre-driving and in-driving phases, and emphasizes the need to restrict such duties. From the perspective of criminal liability exemption, it negatively limits the scope of liability for relevant subjects by examining various potential natural or man-made exceptional circumstances. This approach achieves the dynamic transfer and multi-layered control of risks associated with conditionally autonomous vehicles between drivers and producers, ensuring the reasonable distribution of criminal liability among all stakeholders.