Medical Ethics Research Articles

Predictive Factors of State Licensure Board Disciplinary Actions in Occupational Therapy.

One primary function of occupational therapy state licensure boards (SLBs) is the discipline of ethical misconduct by licensed occupational therapy practitioners. However, SLB sanctioning is poorly understood by practitioners, regulators, and the public. To identify predictors of occupational therapy practitioner sanctioning outcomes in the United States. Retrospective study; all public final consent orders and database entries provided online by SLBs were analyzed. Supervised gradient boosting machine learning, logistic regression, and contingency tables were used to generate odds ratios for variables associated with each sanctioning outcome. Multinomial testing was used to identify attribute overrepresentation among cases and national practitioner distributions. A total of 2,400 cases were analyzed across 47 states and Washington, DC. None. Numerous complaint and respondent attribute variables were collected from final consent orders and database entries. Complaint reason, practice setting, and complaint source had the highest influence on predicting sanction outcome; geographic region, number of complaints in a given case, and length of investigation in months were secondarily influential. Being male or a certified occupational therapy assistant was associated with higher odds of severe sanctioning outcomes. Disciplinary actions against occupational therapy practitioners were determined by numerous contextual factors; however, the most influential factors were complaint reason, practice setting, and complaint source. These results provide direction for exploring factors that predict sanctioning outcomes in the United States and also provide occupational therapy practitioners and SLBs a basis of applied outcomes that may improve implementation and education regarding clinical practice ethics. Plain-Language Summary: Occupational therapy state licensure boards (SLBs) are responsible for disciplining licensed occupational therapy practitioners for ethical misconduct. SLB sanctioning is poorly understood by practitioners, regulators, and the public. In this study, we identify the factors that predict the sanctioning outcomes of occupational therapy practitioners. The results may help state regulators, educators, and national associations more effectively act in a way that protects the public faith in occupational therapy services by providing contextualized information on practitioner behaviors that result in specific sanctioning outcomes. The study findings also provide occupational therapy practitioners and SLBs a basis of applied outcomes that may improve the implementation of and education regarding clinical practice ethics.

Diseño y análisis de las propiedades psicométricas del instrumento de competencias de trabajo interprofesional para su uso en la población mexicana (CIP-Mx)

IntroductionInterprofessional education includes diverse strategies in order to promote competencies such as communication, ethics, critic reflection and quality processes. It is characterized by simultaneously including diverse discipline participants in the educative process. The assessment of these competencies is essential. AimTo design an assessment instrument for interprofessional health workers competencies and to measure its psychometric properties. MethodAn assessment instrument was designed, it included four competencies (communication, learning and critical reflection, quality and health processes, and ethics and values); in three dimensions (leadership and team work, roles and responsibilities, patient centered care). For content validity assessment, an expert judgement was made. Due to the fact that this instrument can be used as seven separate instruments, or, as well, as the combination of several of them due to intersection of the items between dimensions and competencies; seven exploratory factorial analysis were performed, four by competencies, and three by dimensions. The exploratory factorial analysis used varimax rotation, Bartlett test and KMO.For reliability assessment Cronbach´s Alpha was performed for each dimension, for each competency and two general ones (one for dimension assessment and another one for competencies). ResultsPsychometric properties of the instrument are described. It shows adequate properties to be used in Mexican population. ConclusionsThe instrument is suitable for measuring interprofessional work competencies from different dimensions.

Capacity, Autonomy, and Risk: Reflecting on Asymmetries in Capacity to Consent and Capacity to Refuse

AbstractThere has been renewed interest in whether we should understand standards of decision-making capacity (DMC) to be risk-relative. Critics of risk-relative standards often highlight a puzzling asymmetry that they imply; a patient may have the requisite DMC to consent to a treatment that is in their best interests, whilst lacking the requisite DMC to refuse that same treatment, given the much higher risk that this would entail. Whilst some have argued that this asymmetry suggests that risk-relative standards are nonsensical, in this paper I defend a ‘quality of evidence’ view of such standards. I begin by outlining DMC’s purported gate-keeping role in medical ethics, and identifying three key normative claims that undergird this role. I then explain how two competing theories of risk-relative standards are incompatible with at least one of these claims. Drawing on Douglas’ distinction between standards of ‘true capacity’ and standards invoked in the ‘test’ for capacity, I then outline my ‘quality of evidence’ view. I explain how the view is compatible with the aforementioned normative claims, and outline the nature of the asymmetry it implies. I conclude by responding to the objection that there is no meaningful distinction between ‘true capacity’ and the ‘test’ for capacity.

4.P. Round table: Advancing genomic diagnostics for rare genetic diseases: a focus on non-clinical domains of HTA

Abstract Genetic rare diseases are a burning global public health issue requiring a thorough assessment of the related burden. Unfortunately, curative therapies are oftentimes unavailable for genetic rare diseases; nevertheless, a prompt diagnosis could allow clinicians to elaborate supportive care plans for patients and their caregivers, determine the best care setting, and potentially consider enrolling them in clinical trials, if suitable. Innovative, effective, and sustainable diagnostic techniques, such as Whole genome sequencing (WGS), are needed to address this growing health concern. At global level, there is a paucity of research that specifically investigates the implementation of WGS into clinical practice which is even more constrained at the European level. Furthermore, given the current challenges impacting pediatric patients suspected of having genetic diseases without a definitive diagnosis, there is an urgent need to improve the diagnostic workflow based on genomic techniques, such as WGS. Delving into this topic could contribute valuable insights that can inform policymakers, at macro-level, and health professionals, at micro-level, on how to develop suited genomic policies and clinical guidelines for the proper adoption of WGS within the daily clinical practice. From an international standpoint, it could be argued that these considerations resonate with the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (i.e., “Good health and well-being”) and 10 (i.e., “Reduced inequalities”), as a priority for research and action. Notwithstanding, the broader implementation of WGS encounters hindrances owing to its complexity and the multifaceted social, economic, organizational, and ethical implications. In view of these challenges, Health Technology Assessment (HTA), as an integrated and multidisciplinary process, provides a comprehensive framework for the evaluation of these dimensions. This round table is intended to provide attendees with insights into nonclinical domains of HTA of WGS which, unlike clinical domains, demand a nuanced approach within the framework of the HTA. The intended objective is pursued through the initial presentation of a case study on the evaluation of WGS in paediatric genetic disorders from the Italian National Health Service perspectives followed by an open discussion with experts. The discussion will delve into issues related to economics, genomics, health services organization and ethics. Key messages • For pediatric patients suspected of having a genetic disease, WGS could shorten the so-called diagnostic odyssey. • Context-depending aspects of implementing WGS should be properly taken into account through HTA.

Involving children in health literacy research

Abstract Background The range of health literacy research related to children has not normalised children’s involvement as advisors in health literacy research about them. While research with children can be difficult to facilitate, the principles of involvement and engagement should guide all health literacy work. This presentation shares learning from convening a Children’s Advisory Group to consult children about health literacy research priorities, ethics and methods. Methods Children (n-8) aged 7-11, referred by adults whose networks included children, joined a Children’s Advisory Group as Child Advisors. Consultations focused on a proposed study of how children’s critical health literacy could be supported in a community setting. Child Advisors piloted methods for rapport-building and data collection to be adapted for use with child participants later. Child rights-informed evaluation forms captured children’s reflections on their involvement. Results Consulting with a Children’s Advisory Group has challenges and benefits. Despite equity-focused strategies, e.g. introductory phonecalls and postcard updates, seldom-heard children remained less involved and the extent of parent/caregiver support varied. Child Advisors valued independent consultations led by their interests. Contributions included child-friendly consent documents, livestreamed draw-and-describe inspired by favourite influencers, and a novel Interview to the Alien protocol designed to appeal to middle childhood. Conclusions Taking an equity-focused approach is relevant for research with children focused on critical health literacy. Consulting with Child Advisors provides a way to involve children in health literacy research that holds adult researchers accountable for acting on children’s contributions. It is important to offer Child Advisors more than one option to get involved in research so that their insights can be foregrounded in future health literacy research with children.

Global health resource distribution during COVID-19 and in future pandemics: Here’s what people say

Abstract During the COVID-19 pandemic, countless individuals across the world needed novel and sophisticated health care resources simultaneously, leading to dramatic global shortages. How to distribute resources in such situations? This dilemma is neither new nor understudied: Its complexity is well known to medical ethicists, public health scientists and philosophers. Building on this knowledge, powerful global distribution frameworks were proposed already early into the pandemic. Despite this knowledge, no globally consensual regulations existed (and exist) on the political sphere. Worse still, numerous countries hoarded resources for themselves, increasing global inequalities and prolonging the pandemic for everyone. For future emergencies, it is thus necessary to develop immediately applicable strategies. Because public acceptance is key for such interventions, evidence on the public opinion towards allocation principles is strongly needed. In 2021, we asked representative samples of N = 2694 adults in England and Germany to rate seven COVID-19-specific global allocation principles. In line with literature on justice attitudes in general, extensions of bifactor(S-1) models showed that participants would have preferred a more equity- or equality-based global resource distribution during the pandemic, presenting themselves as more cosmopolitan than global leaders. Trying to understand these attitudes better, we tested preregistered hypotheses on relations with other constructs and found positive associations between equity- and equality-directed preferences and global human identification, among others. To ensure generalisability on future pandemics, we collected data from a second cohort in spring 2024. All results will be presented in detail. With their responses, European citizens call upon the development of fairer and more efficient global distribution mechanisms. This global public health perspective could inform preparations for future global emergencies. Key messages • European citizens would have preferred a more equity- or equality-based global distribution of scarce health care resources during the COVID-19 pandemic than global leaders organised. • Citizens’ global perspective on public health and their strong emphasis on global fairness should inform preparations for future pandemics and other global emergencies.

Social Media and Role of Health Care Professionals: Past, Present and Future Direction

Health care professionals can use social media for variety of purposes. Social media has huge impact in terms of patient education, awareness buildup and patient management strategies. Global impact of social media has been undoubtedly appreciable in terms of different awareness programs. At the same time, for personal branding, social media is contributing more and more than ever. However, potential risks related to unreliable information, violation of medical ethics including patient’s privacy rights should always be considered for safe use of social media and for personal safety against nations copyright act. EWMCJ Vol. 12, No. 1&2, January-July 2024: 1-3

9.L. Round table: “What” and “How” for building competencies for effective policy making in and for public health

Abstract Policymakers operating within the field of public health must regularly draw on their skills or competencies to facilitate engagement in and between policy sectors and with the public, to navigate the larger landscape of public health institutions and governance levels across the policy cycle, to generate, understand, and apply evidence for decision making, as well as to negotiate the demands of diverse stakeholders. What exactly are the competencies needed and how can they be cultivated to enhance the collective capacity of policymaking institutions? The increasing strain placed on public health systems worldwide, owing specially to challenges in population ageing, the burden of non-communicable diseases, and the exigencies introduced by pandemics, environmental disasters, and geo-political instabilities push us to expand the scope of public health. A look to the policy environs and outcomes seen within and across countries demonstrates that the quality of policy is both highly variable and exceedingly subject to the quality of public health leadership itself. These developments shed light on the need for greater investment in the development of competencies needed by policymakers to engage in effective decision making on key issues impacting population health and the resilience of public health systems. This includes efforts to strengthen the abilities of policymakers to identify problems, recognize opportunities, and put forth solutions in line with robust data and evidence, principles of public health ethics, gaps and priorities in public health needs, and in accordance with financial and political realities. The proposed roundtable will examine the state-of-the-art on policymaking competencies in public health, and how to build them by examining the barriers and opportunities. The panel will convene leading experts in the field of public health research and practice to explore: 1) the conceptual definition of competencies for policymaking at different levels of governance and across the policy cycle; 2) the strengths and limits of competency frameworks and their utility in guiding assessment and training tools, as well as policy practice; 3) the challenges associated with developing, maintaining and transferring competencies in fast-changing, multi-level policy making environments; 4) the challenges for public health experts and institutions to be trusted advisors both by policy makers and other stakeholders and the population; and 5) the opportunities to harness the unexploited power of professional networks in some countries of Europe. Key messages • An enhanced research agenda and investment are needed for the development of competencies - individual and collective - for effective public health policy-making and stronger governance. • Innovative approaches to policy-making are needed, and this requires building competencies, including leadership, for addressing the complex nature of public health.

11.Q. Round table: A Guide for creating a code of ethics for public health professionals and institutions

Abstract The professional discipline of public health is driven by its values. Public health professionals face decisions that have far-reaching ethical implications. Our norms, values, beliefs and the way we see the world, as individuals, communities and institutions which serve us, do matter and fundamentally affect our decisions, behaviours, policies, and practice. The ability to be aware and reflect on norms and values when taking decisions, is a decisive professional virtue in public health practice. The World Health Organisation (WHO) and Association of Schools of Public Health in the European Region (ASPHER) Roadmap for the professionalisation of the public health workforce, has highlighted ethics as an essential pillar for professionalisation, a core competency, and the need for a Code of Ethics and Professional Conduct for good public health practice. In order to further advance the issue the Global Network for Academic Public Health (GNAPH), ASPHER, the European Public Health Association (EUPHA), the UK Faculty of Public Health and other partners set up an expert international joint working group on public health ethics and law (PHELWG). The PHEL expert working group - which includes senior public health professionals, ethicists, lawyers and academics - has been working to carry out research and develop a guide for creating a Code of Ethics and Professional Conduct for public health professionals and institutions. This has included consideration of the competencies, principles and values for good public health practice. The project has involved literature review, research and the wide professional experience of the international group of experts who have been working on the issue.The development of a guide for creating a code of ethics for public health professionals and institutions is part of the overall objective of the PHELWG to build a ethico-legal competency, capacity and resilience of public health workforce. The proposed Guide and related resources will be a timely resource, practical tool and support for public health professionals, organisations, or regulatory bodies to develop their own local country code of ethics and build further ethico-legal capacity of their public health professional workforce and institutions. Purpose of the roundtable workshop will be to: - present the guide on creating a code of ethics for public health public health professionals and institutions, which will be launched at that time - Share the proposed ethical competencies/skills, principles and values for good public health practice, with particular consideration of Indigenous knowledge and world views - reflect and consult with the workshop participants around the guide and the proposed pilot sites for implementing the Codes in various centres. Key messages • Development of Code of ethics and professional conduct is a key requirement for public health professionalization. • The Guide for creating code of ethics by international expert group provides significant resource for development of codes locally. Speakers/Panelists Kasia Czabanowska Maastricht University, Maastricht, Netherlands Farhang Tahzib Faculty of Public Health, Haywards heath, UK Paul Athanasopoulos Public Health Department, Stirling, UK

10.F. Skills building seminar: How public health professionals can use the right to health to advance climate action and justice

Abstract The climate crisis is the single biggest threat to global health, peace and security, a crisis multiplier, and a significant driver of health inequalities. In many areas of public health policy, legal action and litigation have delivered significant and long-lasting impacts. In April 2024, the European Court of Human Rights concluded that Switzerland had violated the right to health of older women in Switzerland by failing to meet its past greenhouse gas (GHG) emissions reduction targets and set future GHG targets. State-of-the-art public health evidence provided by the Intergovernmental Panel on Climate Change and Lancet Countdown on Health and Climate Change were vital to the Court’s decision, which has implications for all Council of Europe member states, and globally. Rigorous scientific evidence of health harms, including but not limited to heat stress, can inform other climate litigation grounded in the right to health. Public health researchers and practitioners are essential to this litigation. In recognition of this emerging role, in November 2023 the Faculty of Public Health (UK) and the Aletta Jacobs School of Public Health launched ‘From analysis to action: climate change litigation. A guide for public health professionals’ at the 16th European Public Health Conference. The guide was also endorsed by ASPHER, ASPPH, EUPHA, Global Consortium on Climate and Health Education, Global Network for Academic Public Health, Lancet Countdown, Public Health Ethics and Law Global Network, and WFPHA. This workshop will familiarise participants with recent rights-based climate litigation and explore the role of public health professionals in identifying, collecting, storing, assessing and presenting this evidence in a form that is accessible to court officials without medical training. First, there will be short presentations on 1) the role of the law in climate action and the role of scientific evidence of health harms in human rights litigation, and 2) How to collect and use scientific evidence of health harms in climate litigation (15 minutes). Small group discussions will follow, addressing questions such as: The health harm of climate change-related heat stress was a major factor in the 2024 decision of the European Court of Human Rights in KlimaSeniorinnen v. Switzerland: What other health harms could support future cases? In what population groups? What opportunities do you see today for public health researchers and practitioners to compile such evidence to make the most compelling case? How can public health researchers and practitioners work more closely with legal experts and affected communities to bring this evidence to court? (20 minutes) The workshop will conclude with a plenary discussion of these questions and the small group responses. (25 minutes) As a result of the workshop, participants will be better prepared to identify opportunities to contribute compelling evidence of health harms in climate litigation. Key messages • Rigorous scientific evidence of climate change-related health harms is proving central to success in rights-based climate litigation. • Public health professionals have a key role in identifying and presenting compelling evidence of health harms in climate litigation. Speakers/Panelists David Patterson University of Groningen, Groningen, Netherlands Farhang Tahzib Faculty of Public Health, Haywards Heath, UK

A tripartite taxonomy of character strengths & virtues: toward professional identity formation in medical students & physicians

BackgroundThere are limited comprehensive descriptions of character strengths and virtues specific to the professional identity formation of medical students in the literature. This absence of a satisfactory summation of virtues has stimulated us to attempt a conceptual framework utilizing a tripartite taxonomy. This taxonomy reflects recent interest in and importance of justice and care of the self.MethodsOur taxonomy is grounded within a perennial tradition of medical ethics that focuses on the moral “excellences” or “virtues” that form the character of a good doctor, as acquired over time within a community of practice. Character refers to the whole set of excellences of a practitioner as a member of the medical community.ResultsWe propose a tripartite taxonomical classification of virtues as Other-Regarding Virtues, Self-Regarding Virtues, and Equal-Regarding Virtues. Though synergistic, each category is readily distinguishable with regard to a fundamental mindset. To thrive, a medical student must develop character strengths that encompass all three categories.ConclusionsOur goal in introducing this tripartite taxonomy is to provide a framework of virtues to contribute to the definition of professional identity. We envision the taxonomy will provide a structure for professional identity formation curriculum development and organize the ever-elusive assessment of professionalism in learners. This taxonomy can also be viewed as an aspirational roadmap for practicing physicians and educators, and as a compass for their daily consciousness. We believe that this taxonomy will enhance the well-being and development of physicians and medical students, and the patients in their care.

The Expanding Role of United States Healthcare Chaplains in Clinical Ethics.

Healthcare chaplains in the United States increasingly report being tasked by their organizations to participate in the formal work of clinical ethics, by serving on ethics committees, performing clinical ethics consultations, or leading clinical ethics programs. This mapping study documents that professionally-trained chaplains possess a number of skills and attributes that enhance their capability for this work; however, they often lack certain knowledge specific to the discipline of clinical ethics that is needed for roles they are being asked to perform. The professional associations of both chaplaincy and clinical ethics are encouraged to address this educational gap for the benefit of both disciplines.

A worldwide bibliometric analysis on euthanasia

Introduction: Euthanasia, which allows individuals with an incurable disease to end their lives in an honourable way, is a long-debated practice. It is related to various issues such as culture, philosophy, religion, ethics, public value, and efficient use of health resources. While some advocate for the right of individuals to choose euthanasia, others criticize it on ethical, legal, and religious grounds. Methods: In this study bibliometric analysis was used and the data were obtained from the Web of Science Core Collection database on July 26, 2024. Only English publications and articles were included using keywords such as "euthanasia," "end-of-life decisions," "medical assistance in dying," "physician-assisted death," and "physician-assisted suicide" without time restrictions. VOSviewer software was used to create network and density graphs, and SciMAT software was used to create strategic diagrams. Results: A total of 2,230 studies published between 1980 and 2024 were analyzed. The author with the most publications is Deliens, L, with 86 studies. The majority of studies were published in the USA, Netherlands, and Canada (692, 336, 225 respectively). The most frequently used keywords are euthanasia, palliative care, and ethics. The highest number of publications (149) was in the year 2021. In the strategic diagram for the first period (between 1980 and 2001), the themes of care and ethics were prominent, while for the second period (between 2002 and 2024), the clusters of nurse and shared decision-making were notable. Conclusion: After its legalization in the Netherlands, euthanasia has been accepted and implemented in some countries over the years, with variations in scope. Some countries, like the Netherlands and Belgium, also accept health problems related to old age and mental illness as euthanasia requests. The discussion around euthanasia often revolves around the principles of medical ethics, including autonomy, beneficence, non-maleficence, and justice. Studies have focused on the role of physicians and nurses in the process, as well as end-of-life decision-making by patients. Recently, Canada defined the role of nurses in the euthanasia process, marking a significant development.

Attitudes and awareness in autonomous decision on medical treatment or inclusion in clinical trials amongst Slovenian adolescents: an online survey

BackgroundIn Europe and elsewhere in the world, activities are taking place to improve the awareness of children and adolescents (hereinafter: adolescents) regarding their rights and obligations in autonomous decision-making about their own medical treatment and participation in clinical research.MethodsThe cross-sectional survey of adolescents was carried out using an anonymous online questionnaire. We obtained consent from the Commission of the Republic of Slovenia for Medical Ethics. Participating young people were invited through the network of primary and secondary schools, the Society of Dystrophy of Slovenia and through the dissemination of electronic messages. The online questionnaire was open from April 25 to May 6, 2023. Young people aged 13 to 20 joined the survey. The association between several factors and awareness of the minimum age limit was tested by univariate logistic regression. All statistical testing was performed at a significance level of 0.05.ResultsThe responses of 458 respondents were analysed, of which 281 were male. Only 8.3% of participating adolescents knew the age limit set by law for autonomous decision-making about medical treatment at 15 years old. Most answered that a medical institution should inform them about their rights (62.4%). Only 5.02% responded that they do not need their parents’ consent when making decisions; 2.6% of respondents answered that they autonomously decided to undergo treatment without their parents’ knowledge. The majority obtained information about treatment from a doctor (more than 70%); 42.8% were in favour of new forms of treatment, especially chronic patients (more than 70%); 44.8% had already heard about clinical research, most of them through the media (55.4%); 70% of the respondents answered correctly about making an autonomous decision about participation in research at the age of 18. About three-quarters (75.6%) of respondents who had heard of clinical research believe that an individual should be paid for participating.ConclusionsOur research showed insufficient awareness of the age limit of adolescents regarding medical treatment decisions and clinical research. The prevailing view is that health professionals should inform young people more about their rights. Most adolescents believe they should be paid to participate in clinical research.

Iodine Excess Is Associated with Thyroid Dysfunction Among the Elderly.

The relationship between high water iodine levels and thyroid dysfunction in the elderly remains poorly understood. This study aimed to elucidate how excessive iodine in drinking water affects iodine nutrition and thyroid function in the elderly population. This cross-sectional study was performed in the elderly in Yuncheng, Heze, Shandong. We identified a total of 385 patients with thyroid dysfunction and 385 propensity score-matched controls with euthyroid. Water, urinary, and blood samples were collected to detect the concentrations of iodine in water and urine, as well as thyroid hormones. The median (IQR) iodine concentrations in cooking water and drinking water for the total population were 294.99 (48.99, 478.14) µg/L and 172.87 (20.87, 462.13) µg/L, respectively. Among the elderly, median (IQR) urinary iodine concentration (UIC) was 394.20 (169.47, 764.41) µg/L, and 24-h urinary iodine concentration (24-h UIE) was 523.04 (277.84, 910.76) µg/day. Subjects with thyroid dysfunction reported higher intake of iodine from water (P < 0.001) and urinary iodine levels (P < 0.001) than controls. Logistic regression analysis showed thyroid dysfunction was associated with higher risks of elevated iodine concentrations in cooking water (OR 1.957, 95% CI 1.413-2.711), drinking water (OR 2.206, 95% CI 1.607-3.027), UIC (OR 3.612, 95% CI 2.494-5.230), and 24-h UIE (OR 2.568, 95% CI 1.784-3.698), indicating increased thyroid dysfunction risk among the elderly with high water iodine levels. Elevated iodine levels in water are associated with an increased risk of thyroid dysfunction among the elderly. Clinical trial registry number: Medical Ethics Committee of Tianjin Medical University; Trial registration number: NCT05716191, date of registration was December 08, 2023.

Exploring ethical issues in the Chinese translation of medical terms: The convergence of translation ethics and medical ethics

This article explores the ethical aspects of translating medical terminology into English, with a particular emphasis on the joint influence of medical ethics and translation ethics. This study identified four key issues in current translation practice through the analysis of various cases from the perspective of Chestermans five kinds of translation ethics, including representation ethics, service ethics, communication ethics, norm-based ethics, and commitment ethics. The four issues involve discrimination, superstition, contempt, and overgeneralization. These issues may hinder the provision of appropriate medical services and social acceptance by fueling social stigma, public misunderstandings, and negative perceptions of diseases. This study suggests that medical translation is not only about language conversion, but also involves considerations of cultural, ethical, and social factors. This article attempts to provide practical advice for medical translators and healthcare workers by combining medical ethics with translation ethics. It suggests that future research should prioritize interdisciplinary collaboration to improve ethical standards in medical translation and promote more accurate and respectful descriptions of diseases in different cultures.

Educational needs of midwifery students in medical ethics: A qualitative study.

Background: Ethics education is a basic part of midwifery education program. However, there is no evidence to show that ethics education has been able to meet the educational needs of midwifery students. Purpose: This study aimed to explore the educational needs of students for ethics in midwifery program with a focus on the course of history, ethics, and rules of midwifery. Research design and participants: The present study is qualitative descriptive content analysis research, exploring midwifery students' needs of ethics education in bachelor's degrees. We conducted in-depth semi-structured interviews with 11 undergraduate midwifery students, seven midwives working in hospitals and health centers, and seven midwifery faculty members in Urmia University of Medical Sciences. The participants were selected using a purposeful sampling method and invited to join the study from December 2021 to June 2022. The sampling continued until data saturation. Findings: Content analysis identified four categories and associated subcategories: 1. "The client's rights": respecting the dignity of clients, confidentiality, the client's right to choose and make decisions; 2. "Legal and ethical requirements of fertility": abortion, alternative treatment for infertility, domestic violence; 3. "Communication skills": communication with the client, communication with clients' caregivers and communication with colleagues; and 4. "ethical principles in research": compliance with ethical principles in the research process and ethical principles in publishing research findings. Ethical considerations: The study was approved by the Ethics Committee of Urmia University of Medical Sciences. Before filling the questionnaires, written informed consent was obtained from the participants. The participants were assured of the confidentiality of personal information. Conclusion: The educational needs of midwifery students can be met by providing theoretical and practical training on respecting the pregnant mother, communication skills, legal and ethical aspects of the reproductive period, and incorporating ethical principles in related courses.

The Role of Hospice and Palliative Medicine in the Ars Moriendi.

There is disagreement among physicians and medical ethicists on the precise goals of Hospice and Palliative Medicine (HPM). Some think that HPM's goals should differ from those of other branches of medicine and aim primarily at lessening pain, discomfort, and confusion, while others think that HPM's practices should aim, like all other branches of medicine, at promoting health. I take the latter position: using the ars moriendi to set a standard for what it means to die well, I argue that if HPM's practices were to aim at mitigating suffering with little regard to promoting health, some patients would die worse deaths than if HPM's practices were to aim at health. According to the ars moriendi, flourishing at the end of one's life requires that persons exercise their agency and pursue the goods most important to them. On this view, HPM's practices should promote patients' health to enable them to pursue these goods.

The Construction of Ethical Norms for Translation Technology for Medical Translators

This study explores the construction of ethical norms for medical translators who use translation technologies such as Machine Translation (MT), Neural Machine Translation (NMT), and Computer-Aided Translation (CAT) tools. As these technologies become integral to medical translation, ethical concerns surrounding accuracy, confidentiality, and humanitarian considerations arise. The study emphasizes the importance of maintaining a balance between the efficiency of technology and the ethical imperatives that define medical translation. Using a mixed-methods approach, including literature review, comparative analysis, and textual evaluation, the study investigates the ethical challenges posed by translation technology. It proposes ethical norms focusing on human oversight, data security, empathy, and accountability. The findings suggest that the role of the translator is evolving, requiring not only linguistic expertise but also competence in navigating the ethical complexities introduced by technology. The research contributes to the development of actionable guidelines that ensure the responsible use of translation technology while preserving the core values of medical ethics.

The impact of tau-PET in a selected memory clinic cohort: rationale and design of the TAP-TAU study

BackgroundTau-PET is a diagnostic tool with high sensitivity and specificity for discriminating Alzheimer’s disease (AD) dementia from other neurodegenerative disorders in well-controlled research environments. The role of tau-PET in real-world clinical practice, however, remains to be established. The aim of the TAP-TAU study is therefore to investigate the impact of tau-PET in clinical practice.MethodsTAP-TAU is a prospective, longitudinal multi-center study in 300 patients (≥ 50 years old) with mild cognitive impairment or mild dementia across five Dutch memory clinics. Patients are eligible if diagnostic certainty is < 85% after routine dementia screening and if the differential diagnosis includes AD. More specifically, we will include patients who (i) are suspected of having mixed pathology (e.g., AD and vascular pathology), (ii) have an atypical clinical presentation, and/or (iii) show conflicting or inconclusive outcomes on other tests (e.g., magnetic resonance imaging or cerebrospinal fluid). Participants will undergo a [18F]flortaucipir tau-PET scan, blood-based biomarker sampling, and fill out questionnaires on patient reported outcomes and experiences. The primary outcomes are change (pre- versus post- tau-PET) in diagnosis, diagnostic certainty, patient management and patient anxiety and uncertainty. Secondary outcome measures are head-to-head comparisons between tau-PET and less invasive and lower cost diagnostic tools such as novel blood-based biomarkers and artificial intelligence-based classifiers.ResultsTAP-TAU has been approved by the Medical Ethics Committee of the Amsterdam UMC. The first participant is expected to be included in October 2024.ConclusionsIn TAP-TAU, we will investigate the added clinical value of tau-PET in a real-world clinical setting, including memory clinic patients with diagnostic uncertainty after routine work-up. Findings of our study may contribute to recommendations regarding which patients would benefit most from assessment with tau-PET. This study is timely in the dawning era of disease modifying treatments as an accurate etiological diagnosis becomes increasingly important.Trial registrationThis trial is registered and authorized on December 21st, 2023 in EU Clinical Trials with registration number 2023-505430-10-00.