Key Ethical Principles Research Articles

Balancing key stakeholder priorities and ethical principles to design a trial comparing intervention or expectant management for early-onset selective fetal growth restriction in monochorionic twin pregnancy: FERN qualitative study

ObjectivesAs part of the FERN feasibility study, this qualitative research aimed to explore parents’ and clinicians’ views on the acceptability, feasibility and design of a randomised controlled trial (RCT) of...

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

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

Dignity-Affirming Care in Research-Practice Partnerships

ABSTRACT Research-practice partnerships (RPPs) have the potential to affirm the dignity of participants through caring interactions, which support good relationships. A key ethical principle to guide the cultivation of good relationships in an RPP is a quality of relating that we call dignity-affirming care. We define dignity-affirming care as speech, actions, and dispositions that demonstrate concern for another and their expressed needs and goals in a manner that affirms their essential worth or value. We provide evidence that RPPs can embody the principle of dignity-affirming care while also noting some ways partners experienced ways of relating that did not reflect this kind of care. Further, we describe four underlying mechanisms that support care: the intensity of and concentration of relationships, a willingness to recognize social identities, and the ability to take on new roles.

Perceptions on the Ethical and Legal Principles that Influence Global Brain Data Governance

Advances in neuroscience and other disciplines are producing large-scale brain data consisting of datasets from multiple organisms, disciplines, and jurisdictions in different formats. However, due to the lack of an international data governance framework brain data is currently being produced under various contextual ethical and legal principles which may influence key stakeholders involved in the generation, collection, processing and sharing of brain data thereby raising ethical and legal challenges. In addition, despite the demand for a brain data governance framework that accounts for culture, there is a gap in empirical research and actions to understand how key stakeholders around the world view these issues using neuroscientists who are affected by these ethical and legal principles. Therefore, using the research question how do ethical and legal principles influence data governance in neuroscience? we attempt to understand the perceptions of key actors on the principles, issues and concerns that can arise from brain data research. We carried out interviews with 21 leading international neuroscientists. The analytical insights revealed key ethical and legal principles, areas of convergence, visibility, and the contextual issues and concerns that arise in brain data research around these principles. These issues and concerns circulate around intimately connected areas which include ethics, human rights, regulations, policies and guidelines, and participatory governance. Also, key contextual insights around animal research and ethics were identified. The research identifies key principles, issues, and concerns that need to be addressed in advancing the development of a framework for global brain data governance. By presenting contextual insights from neuroscientists across regions, the study contributes to informing discussions and shaping policies aimed at promoting responsible and ethical practices in brain data research. The research answers the call for a cross cultural study of global brain data governance and the results of the study will assist in understanding the issues and concerns that arise in brain data governance.

Should psychotherapists conduct visual assessments of nonsuicidal self-injury wounds?

Beneficence and nonmaleficence are key ethical principles toward which psychotherapists consistently strive. When patients engage in nonsuicidal self-injury (NSSI) during the course of psychotherapy, therapists may feel responsible for visually assessing the severity of the NSSI wound in order to benefit their patients and keep them from harm. However, there are no guidelines for conducting these visual assessments, and there is no research exploring their effects on patients. This article considers the ethical implications of visually examining NSSI wounds; discusses psychotherapist scope of practice and competence; draws attention to relevant ethical standards; underscores risk management, liability, and standard of care; and addresses the risk of suicide or accidental death resulting from NSSI. It also provides ethical guidance for conducting effective verbal assessments of NSSI wounds and offers suggestions for navigating complex clinical situations, such as when patients routinely and spontaneously show their therapists their wounds and how psychotherapists should handle assessments and interventions related to NSSI scars. It ends with implications for training and therapeutic practice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

GLOBAL EXPERIENCE OF IMPLEMENTATION OF ETHICAL PRINCIPLES IN THE ORGANIZATION OF ECONOMIC SECURITY OF BUSINESS ACTIVITIES

The present era has set forth new demands for entrepreneurial activities, particularly concerning the organization of economic security. Business ethics, once relegated to a theoretical concept, saw its practical significance underestimated for quite some time. Following the adoption of the Sustainable Development Goals by the United Nations in 2015, there has been a significant shift in understanding the importance and necessity of businesses adhering to ethical principles in their operations. This article explores key ethical principles in entrepreneurial activities and their interconnection with the organization of economic security in entrepreneurship. It emphasizes the need for integrating ethical principles into business processes to minimize risks and ensure long-term sustainable development. The paper provides a survey of global brands that successfully implement ethical principles in ensuring their economic security. To illustrate their activities in this direction, the authors investigate examples from various industries, highlighting the methods used for managing social responsibility and corporate ethics. Additionally, the research presents risks and threats to the economic security of entrepreneurial activities associated with non-compliance or violation of ethical principles.

Psychological help for patients with cancer

The article represents the ethical aspects of the activity of oncology specialist, which is an important component of a comprehensive approach to the treatment and care of patients with cancer. It is noted that compliance with the ethical aspects of medical and psychological care for cancer patients requires the knowledge of oncology specialist of a wide range of physical, emotional, psychological and social effects that may arise as a result of the diagnosis and treatment of an oncopathology. The key ethical principles and their characteristics, which the oncology specialists must adhere to, are outlined. There is emphasized the importance of compliance by oncology specialists with ethical principles for the successful treatment and rehabilitation of cancer patients.
 Conclusions. In general, ethical aspects in psycho-oncology are an integral part of professional practice and aim to ensure maximum support, safety and respect for the rights and dignity of each patient. No code of ethics can provide an unequivocal answer to what is right in specific situations, but it serves important functions. It serves as an important basis for decision-making and provides important information to oncologists, their patients and the public about the roles and responsibilities of oncology professionals. In addition, it promotes responsible psychological practice and protection of patients from inappropriate behavior of doctors, and is used as a tool for reflection and improvement of the work of a specialist in the field of oncology.

Principles Governing Ethical Development and Deployment of AI

The ethical development and deployment of artificial intelligence (AI) is a rapidly evolving field with significant implications for society. This paper delves into the multifaceted ethical considerations surrounding AI, emphasising the importance of transparency, accountability, and privacy. By conducting a comprehensive review of existing literature and case studies, it highlights key ethical issues such as bias in AI algorithms, privacy concerns, and the societal impact of AI technologies. The study underscores the necessity for robust governance frameworks and international collaboration to address these ethical challenges effectively. It explores the need for ongoing ethical evaluation as AI technologies advance, particularly in autonomous systems. The paper emphasises the importance of integrating ethical principles into AI design from the outset, fostering sustainable practices, and raising awareness through education. Furthermore, the paper examines current regulatory frameworks across various regions, comparing their effectiveness in promoting ethical AI practices. The findings suggest a global consensus on key ethical principles, though their implementation varies widely. By proposing strategies to ensure responsible AI innovation and mitigate risks, this research contributes to the ongoing discourse on the future of AI ethics, aiming to guide the development of AI technologies that uphold human dignity and contribute to the common good. Research the ethical considerations and societal impacts of AI, focusing on issues like bias in AI algorithms, privacy concerns, or the effect on employment. This can involve a comprehensive review of existing literature and case studies.

The validation of regulatory test methods - Conceptual, ethical, and philosophical foundations.

Validation establishes the reproducibility and relevance of regulatory test methods, particularly for new approach methods (NAMs) as alternatives to animal testing. While validation concepts provide a framework to assess method suitability, they rarely undergo method-critical assessment. This paper explores the philosophical and ethical foundations of the validation process, drawing from various philosophical traditions and contemporary ethical frameworks. How validation intersects with utilitarian principles, ethics of responsibility, and post-modern critiques is examined, offering a multifaceted perspective on its role in scientific progress and societal values. The paper argues for a paradigm shift in validation, moving beyond traditional animal-based comparisons towards more flexible, fit-for-purpose approaches that embrace emerging technologies and ethical con-siderations. Key ethical principles guiding NAM validation are discussed, including beneficence, non-maleficence, justice, and respect for animal welfare. Integrating these principles with scientific rigor can create a more holistic validation framework that balances human safety, animal welfare, and technological innovation. By critically examining the philosophical underpinnings of validation, this paper aims to stimulate dialogue on reforming the process to better align with contemporary scientific knowledge, ethical standards, and societal expectations. It calls for a more adaptive, transparent, and ethically grounded approach to validation that can accelerate the adoption of innovative and human-relevant toxicological methods while maintaining scientific integrity and public trust.

Ethical Considerations in Using AI in Educational Research

This editorial explores the ethical challenges associated with integrating artificial intelligence into educational settings. They highlight key ethical principles to guide AI use in educational research, including transparency, accountability, fairness, and authenticity. The author emphasizes the need for ethical frameworks to address complex issues around biases, attribution, and the human-AI division of labor.

Translating ethical and quality principles for the effective, safe and fair development, deployment and use of artificial intelligence technologies in healthcare.

The complexity and rapid pace of development of algorithmic technologies pose challenges for their regulation and oversight in healthcare settings. We sought to improve our institution's approach to evaluation and governance of algorithmic technologies used in clinical care and operations by creating an Implementation Guide that standardizes evaluation criteria so that local oversight is performed in an objective fashion. Building on a framework that applies key ethical and quality principles (clinical value and safety, fairness and equity, usability and adoption, transparency and accountability, and regulatory compliance), we created concrete guidelines for evaluating algorithmic technologies at our institution. An Implementation Guide articulates evaluation criteria used during review of algorithmic technologies and details what evidence supports the implementation of ethical and quality principles for trustworthy health AI. Application of the processes described in the Implementation Guide can lead to algorithms that are safer as well as more effective, fair, and equitable upon implementation, as illustrated through 4 examples of technologies at different phases of the algorithmic lifecycle that underwent evaluation at our academic medical center. By providing clear descriptions/definitions of evaluation criteria and embedding them within standardized processes, we streamlined oversight processes and educated communities using and developing algorithmic technologies within our institution. We developed a scalable, adaptable framework for translating principles into evaluation criteria and specific requirements that support trustworthy implementation of algorithmic technologies in patient care and healthcare operations.

Gender diversity in autistic clients: an ethical perspective.

Autonomy and dignity are key ethical principles in psychiatric and psychological codes of ethics. Yet, when working with autistic individuals who are transgender/gender non-conforming (TGNC), non-autistic and cisgender clinicians can unintentionally take away client dignity and autonomy by disbelieving or stigmatizing clients' gender identities. Lack of awareness or discomfort around autism and gender dysphoria can lead clinicians to assumptions and interventions that damage both client rapport and client mental health; discouraging clients from being honest with clinicians about their mental health, and potentially leading to harm. Clinicians must take an intersectional view of their autistic clients' gender identities to reduce stigma and recognize the needs of the whole person. Facilitating access to gender-affirming care is an important part of caring for TGNC clients, including those who are autistic. The authors will discuss the ethical imperative to help autistic clients access gender-affirming care, while discussing common concerns clinicians have when helping autistic clients access this care, as well as the need to believe and support autistic clients when they share their gender identities with clinicians.

An ethical framework adapted for infection prevention and control.

The ethical implications of infection prevention and control (IPAC) are recognized, yet a framework to guide the application of ethical principles is lacking. We adapted an ethical framework to provide a systematic approach for fair and transparent IPAC decision making. We conducted a literature search for existing ethical frameworks in IPAC. Working with practicing healthcare ethicists, an existing ethical framework was adapted for use in IPAC. Indications were developed for application to practice, with integration of ethical principles and process conditions specifically relevant to IPAC. Practical refinements were made to the framework based on end-user feedback and application to 2 real-world situations. In total, 7 articles were identified that discussed ethical principles within IPAC, but none proposed a systematic framework to guide ethical decision making. The adapted framework, named the Ethical Infection Prevention and Control (EIPAC) framework, takes the user through 4 intuitive and actionable steps, centering key ethical principles that facilitate reasoned and just decision making. In applying the EIPAC framework to practice, weighing the predefined ethical principles in different scenarios was a challenge. Although no hierarchy of principles can apply to all contexts in IPAC, our experience highlighted that the equitable distribution of benefits and burdens, and the proportional impacts of options under review, are particularly important considerations for IPAC. The EIPAC framework can serve as an actionable ethical principles-based decision-making tool for use by IPAC professionals encountering complex situations in any healthcare context.

Educators’ perceptions of their experiences of transnational education in nursing: A grounded theory study

AimThe study aim was to explore educators’ perceptions of their experiences of participating in transnational education in nursing. BackgroundIn an increasingly globalised world, involvement with the delivery of transnational education has become commonplace across the international higher education sector. In recent years, transnational education within the academic discipline of nursing has developed at pace, evolving in response to a global need to invest in nurse education, address nursing shortages and strengthen nursing leadership. However, despite acknowledgement that transnational education is a complex activity that needs to be more fully understood, research specifically exploring transnational education in nursing is scarce, as previous studies predominantly focus on other academic disciplines. The study addresses this knowledge gap, advancing understanding of transnational education in the context of nursing. DesignThe study was positioned within the interpretivist paradigm and underpinned by a constructivist grounded theory methodological design, acknowledging the prior knowledge and experience of the research team in relation to phenomenon under investigation. MethodsEthical approval was obtained before the study commenced, ensuring adherence to key ethical principles. The study was conducted during May to August 2020, in a university in the North of England that provides undergraduate and postgraduate nurse education in the United Kingdom and transnational context. Participants were recruited via e mail and invited to complete a brief questionnaire, informing a preliminary theoretical sampling strategy. Ten educators with experience of transnational education across a diverse range of international locations participated in individual, semi-structured, online interviews that were recorded and transcribed verbatim. Data were analysed using initial and focused coding, constant comparison, theoretical memos and diagrams. FindingsThe findings uncovered three overarching data categories, each of which were crucial to supporting effective transnational education in nursing. Prepare- involved developing an understanding of the context of healthcare and education, being supported and collaborating with transnational partners. Perform- involved recognising language and cultural influences, adapting to the environment and implementing responsive educational pedagogies. Progress- involved recognition of personal development at individual level and valuing the benefits at organisational level. ConclusionsAlthough transnational education in nursing can be challenging and complex, it can offer worthwhile advantages for all stakeholders. However, effective transnational education in nursing is dependent on strategies which prepare educators appropriately and enable them to perform effectively, thereby promoting successful outcomes at individual, organisational and transnational partner level and facilitating advancement in future potential collaborative activity.

A code of ethical conduct for the public health profession

Aim: Agreeing on a Code of Ethical Conduct is an essential step in the formation and definition of a public health profession in its own right. In this paper we attempt to identify a limited number of key ethical principles to be reflected as professional guidance. Methods: We used a consensus building approach based on narrative review of pivotal literature and theoretical argumentation in search for corresponding terms and - in a second step - attempted to align them to a limited number of key values. The resulting draft code of ethical conduct was validated employing a framework of the Council of Europe and reviewed in two quasi Delphi rounds by members of a global think tank. Results: The alignment exercise demonstrated the acceptability of five preselected key principles: solidarity, equity, efficiency, respect for autonomy, and justice whereas three additional principles were identified during the discussion rounds: common good, stewardship, and keeping promises. Conclusions: In the context of emerging and re-emerging diseases as well as increase in lifestyle-related diseases, the proposed Code of Ethical Conduct may serve as a mirror which public health professionals will use to design and implement public health interventions. Future public health professional chambers or an analogous structure should become responsible for the acknowledgement and enforcement of the Code.

Insights Into Incorporating Trustworthiness and Ethics in AI Systems With Explainable AI

Over the past seven decades since the advent of artificial intelligence (AI) technology, researchers have demonstrated and deployed systems incorporating AI in various domains. The absence of model explainability in critical systems such as medical AI and credit risk assessment among others has led to neglect of key ethical and professional principles which can cause considerable harm. With explainability methods, developers can check their models beyond mere performance and identify errors. This leads to increased efficiency in time and reduces development costs. The article summarizes that steering the traditional AI systems toward responsible AI engineering can address concerns raised in the deployment of AI systems and mitigate them by incorporating explainable AI methods. Finally, the article concludes with the societal benefits of the futuristic AI systems and the market shares for revenue generation possible through the deployment of trustworthy and ethical AI systems.

Routine informed consent for mismatch repair testing in endometrial cancers: Review and ethical analysis

ObjectiveTo review available data regarding consent for tumor testing for mismatch repair (MMR), and to make recommendation for ethical best practices based on synthesis of contemporary data and ethical principles. MethodsPubMed and CINAHL databases were searched through September 2021; articles reporting on consent for MMR tumor testing for patients at risk for Lynch Syndrome were abstracted. Additional articles were identified through review of references. Key data and ethical principles were extracted, summarized, and analyzed in the context of contemporary clinical practice. Results16 articles met inclusion criteria for this review, none of which specifically related to MMR testing for endometrial cancers. All but two studies were published prior to the approval of pembrolizumab for treatment of MMR-deficient tumors. Scant available data suggest that routine consent prior to tumor testing is uncommon; however, several decision aids improved patient knowledge and satisfaction prior to deciding whether to proceed with tumor testing. Previous ethical analyses invoke clinical utility, potential germline implications, and logistical factors in making recommendations regarding consent practices. These analyses varied in their final recommendations; however, all had significant deficits in their arguments related to contemporary clinical care for patients with endometrial cancer. ConclusionCurrent data are needed to assess the impact of potential consent strategies for tumor testing. Based on available data, and consistent with contemporary ethical best practices, we recommend that planned MMR testing of endometrial cancers be discussed routinely with patients verbally or in surgical consent documents.

The role of Data Transfer Agreements in ethically managing data sharing for research in South Africa

A multitude of legislation impacts the use of samples and data for research in South Africa (SA). With the coming into effect of the Protection of Personal Information Act No. 4 of 2013 (POPIA) in July 2021, recent attention has been given to safeguarding research participants’ personal information. The protection of participants’ privacy in research is essential, but it is not the only risk at stake in the use and sharing of personal information. Other rights and interests that must also be considered and safeguarded include the right to non-discrimination, the right to dignity, and the right to enjoy the benefits of scientific progress. This can be achieved by ensuring that the ethical values and universal principles that underpin the research landscape, namely equity, reciprocity, justice and solidarity, are embedded in the regulatory framework for the management and use of personal information. This paper advocates an integrated bioethics approach to the use of personal information for research in SA. A key feature in embedding such an approach is a Data Transfer Agreement (DTA) that appropriately integrates the safeguards and protections set out by our regulatory framework with bioethical rules and procedures when personal information is used and shared for research purposes. This paper thus calls for the development of a national DTA that is guided by key ethical principles when data are shared for research purposes. This paper will be followed by a webinar on 23 June 2022 hosted by the Department of Science and Innovation and the SA Medical Research Council, where the recommendations and suggestions set out herein will be unpacked, discussed and debated by relevant stakeholders.

Patients' Lived Experiences of the Paternalistic Care Behavior: A Qualitative study.

Introduction: The major role of nurses in caring for patients puts them in a position where they can feel a sense of independence or lack of autonomy in dealing with patients throughout their actions. The present study aimed to explain patients’ lived experiences of paternalistic care behaviors. Methods: This qualitative research was conducted with the design of hermeneutic phenomenology consistent with Heidegger’s philosophical view and using the purposeful sampling method. Data richness was achieved after 13 interviews with 7 patients who had been hospitalized and received care in the hospitals of Tehran, Iran. The data were collected during 8 months (November 2020-June 2021) using an unstructured interview and analyzed using Diekelmann et al seven step approach with MAXQDA version 10 software. Results: Data analyses revealed four themes, thirteen sub-themes, and one constitutive pattern (duality of support and suppression of independence) forming the structure of patients’ lived experience of paternalistic caring behaviors. The themes included (1) Support at helplessness, (2) Inflexibility (3) Vague awareness, and (4) Despair due to lack of autonomy. Conclusion: The meanings discovered in this research revealed that patients have dual emotions regarding paternalistic care behavior. On the one hand, they are pleased with the care provided, but on the other hand, they feel desperate and unable to make decisions due to being deprived of their independence. We can see the creation of new ethical values in care behaviors. Performing supportive care behavior with emphasis on patient participation should be considered as a key ethical principle in patient care.

'We will never give up': a qualitative study of ethical challenges Syrian health workers face in situations of extreme violence.

Active conflict settings constitute challenging operating environments for humanitarian health organisations and workers. An emerging feature of some conflicts is direct violence against health workers, facilities, and patients. Since the start of the war in 2011, Syria has endured extreme and deliberate violent attacks on health facilities and workers. This paper reports on the findings from a qualitative study that examined the lived experiences of Syrian humanitarian health workers facing extreme ethical challenges and coping with moral distress. In-depth interviews were carried out with 58 front-line health workers in north-western and southern Syria. Participants described a number of ethical and operational challenges experienced while providing services in extreme conditions, as well as strategies used to deal with them. The complex intersection of personal and organisational challenges is considered and findings are linked to key ethical and humanitarian principles. Both practical recommendations and action steps are provided to guide humanitarian health organisations.