Cisplatin is a widely used chemotherapeutic anti-cancer drug. However, high-dose cisplatin is also known for its dose-limiting toxicities, including irreversible cisplatin-induced hearing loss (CIHL). Sodium thiosulphate (STS) can bind to cisplatin to form an inactive and harmless complex. A topical application is desired, allowing cisplatin to retain its systemic anti-cancer effect. The SOUND trial is an investigator-initiated randomised controlled multicentre phase III trial to study the efficacy of transtympanic administration of STS against CIHL in a cohort of 100 patients with head and neck cancer treated with cisplatin at a dose of ≥200 mg/m2. Each subject will receive transtympanic STS injections in one ear, chosen by randomisation, before each cisplatin infusion. The contralateral ear serves as an internal control. The primary objective is efficacy (ie, clinically relevant benefit) of transtympanic STS injections against CIHL, defined as a difference in threshold shift of ≥10 decibels between baseline and 3 months after treatment in favour of the STS-treated ear. Secondary objectives include the difference in mean threshold shifts on frequencies essential for speech and extended high frequencies, as well as the difference between both ears in the gradation of hearing loss as defined by ototoxicity grading scales. The medical ethics committee in the Netherlands approved the trial (Clinical Trials Information System (CTIS) 2023-503313-30-00). The results will be disseminated through the CTIS and peer-reviewed scientific journals. CTIS 2023-503313-30-00 approved by Medical Research Ethics Committee NedMec.

Ethical and Legal Considerations of Medical Artificial Intelligence.

Abstract In this issue of The Journal of Clinical Ethics, persons who knew bioethicist and lawyer Nancy Dubler celebrate her and the most important contributions she made to the practice of clinical ethics consultation (CEC). Her insights and the many discussions here include the unmet needs of prisoners, optimal approaches to bioethics mediation that prioritize the feelings of and relations between people, ethics consultants asking families of patients who can't speak for themselves what the patient was like as a person before they discuss ethics, allocating resources consistently and fairly, learning CEC by role-playing in disempowered roles, distinguishing what is ethical from what is legal, increasing contributions from nonmedical people, increasing interconnections between health systems and the broader bioethics community, replacing oral feedings with tube feedings, fostering substitute decision makers whom patients most want, and appreciating root causes of patients' and families' mistrust. All these topics are likely to be optimal CEC practices, if not already implemented.

Human joint motion monitoring is essential for disease diagnosis, rehabilitation, health management, and enhancing human-computer interaction experiences. This work presents the development and validation of a flexible segmented assemblable fiber optic sensor (FSAFOS) specifically designed for human multi-joint monitoring. The FSAFOS is composed of miniature LEDs, segmented polymethyl methacrylate optical fibers, and photoconductive chips encapsulated in a flexible cladding, allowing it to accurately sense joint bending angles while maintaining high flexibility and comfort. The modularity of the FSAFOS enables rapid customization and assembly through magnetic connectors, adapting to various joint configurations and sizes. Experimental results demonstrate that the sensor exhibits good stability, low hysteresis (<5%), and high linearity (R2 = 0.996) in measuring bending angles. In validation experiments, the FSAFOS accurately measured finger joint and spinal bending angles with errors less than 1.85° compared to ground truth. The FSAFOS represents a significant advancement in the field of biomechanical monitoring, offering potential applications in personalized posture monitoring and human-machine interfaces. The study protocol was approved by the Medical Ethics Committee from the Department of Psychology and Behavioral Sciences, Zhejiang University, China (reference number: [2022]098).

Teaching medical ethics through Ethical Grand Rounds

Abstract Nancy Dubler pioneered "bioethics mediation" as a method of clinical ethics consultation (CEC), arguing that "bioethics consultation is largely, although not entirely, a matter of conflict resolution." By the time she published the second edition of Bioethics Mediation in 2011, she had garnered significant support for the idea that mediation had an important role to play in CEC. But in the intervening decade and a half, a new generation of CEC thought leaders have emerged, and there is clear evidence that, for them, conflict management has very little to do with the practice of CEC. Today, there are not only just a small proportion of ethics consultants (ECs) trained in mediation skills but also only a small proportion of ECs who view such skills as essential to the practice of CEC. Yet conflict among patients, families, and healthcare providers remains a significant problem in U.S. healthcare institutions. The new trends in CEC make it unlikely that ethics will be the locus for the conflict management services hospitals need; therefore, I will argue that it is time to transfer the mediator role from ethics to the newly emerging Patient and Guest Relations departments. I believe that this offers the best prospects for defending Dubler's legacy.

In 21st-century workplaces, where the pace of digital change is fast, ethical issues are exponential, with 70% workers indicating unease due to AI. In particular, millennials and Gen Z expressed 30% more ethical and trust-related concerns in AI workplaces. Although AI rapid integration in workplaces has increased lately, including Healthcare and IT, generational differences in digital ethics perceptions remain a neglected aspect of influencing employee well-being, and that is what this review seeks to determine with the following objectives: i) to synthesize existing research on generational attitudes toward digital ethics in AI-driven healthcare and IT workplaces. ii) to examine the relationship between generational attitudes toward digital ethics and employee well-being, including stress, trust, and job satisfaction, among employees aged 24 to 55 in AI-driven health and IT workplaces, and iii) to identify research gaps and provide practical recommendations for organizations to foster ethical AI adoption through training, clear policies, and inclusive practices in multigenerational workplaces. Following the PRISMA framework, a systematic review was conducted, and data were sourced across three databases, i.e., ScienceDirect, PubMed, and Google Scholar, using keywords “digital ethics”, generational differences”, well-being, and AI workplaces with Boolean operators. A total of 33 full-text studies were included that met the inclusion criteria. The results showed a significant generational disparity in the interpretation of digital ethics, with the younger employees being more accepting and the older generation being more concerned about AI-related privacy and transparency. Such perceptual differences affect employees’ psychological well-being, trust, stress, and job satisfaction, more particularly in the field of healthcare, regarding ethical sensitivity related to patient data privacy.

In their recent Authors Meet Critics contribution to the Journal of Medical Ethics, Nancy S Jecker and Caesar Alimsinya Atuire invite a re-examination of personhood that extends beyond Western individualism and incorporates relational, cross-cultural insights. Their account effectively recentres moral discourse on community, continuity and mutual recognition. This response agrees with Jecker and Atuire that personhood cannot be reduced to autonomy or cognitive capacity alone, but it argues that a further conceptual distinction is needed to preserve clarity between moral and institutional recognition.I propose a dual-layered framework of personhood. The metaphysical person is the enduring subject of moral concern whose identity persists through time, relation and narrative; the legal person is the socially constructed bearer of rights and duties recognised within juridical and political systems. While the two frequently overlap, conflating them risks conceptual ambiguity and ethical inconsistency, particularly in cases such as dementia, embryonic life and artificial intelligence.Jecker and Atuire's relational model richly captures the metaphysical dimension of personhood but leaves open the question of how legal and moral status diverge and interact. The proposed two-layer approach clarifies this interface: moral personhood provides grounding for respect and care, while legal personhood institutionalises those obligations within normative systems. Recognising these distinct yet complementary layers retains Jecker and Atuire's relational insights while safeguarding conceptual precision across diverse bioethical contexts.

The accelerating digital transformation of healthcare across countries—driven by the adoption of Electronic Medical Records (EMR)—has reshaped the relationship between technology, ethics, and law. While EMR systems promise efficiency and interoperability, they also raise pressing issues of privacy, accountability, and equitable access. In developing contexts such as Indonesia, the challenge lies not only in technological implementation but also in ensuring that digital governance upholds the principles of social justice and human dignity. This study investigates how legal and ethical frameworks governing EMR in Indonesia align with global standards of justice and digital welfare. It aims to identify the normative gaps between regulation, ethics, and practice in digital health governance, proposing a regional framework for “digital justice.” Employing a qualitative legal-ethical approach, the study conducts comparative document analysis and case study evaluation of EMR regulations, including Indonesia’s Law No. 27/2022 on Personal Data Protection (Republic of Indonesia, 2022). These are benchmarked against international references such as the General Data Protection Regulation (GDPR), the WHO Digital Health Ethics Framework, and the OECD Principles on Data Governance. The comparative analysis reveals four thematic insights: (1) legal compliance and ethical governance; (2) digital inclusion and justice are hindered by structural disparities; (3) accountability mechanisms are underdeveloped; and (4) social justice principles are not yet institutionalized in digital health policy. The paper argues that sustainable digital transformation must integrate ethical equity, legal accountability, and participatory governance as interdependent pillars of “social justice in digital transformation.” The proposed model contributes to policy harmonization in Indonesia and reinforces the legitimacy of digital health governance within global welfare discourse.

Older adults who have undergone percutaneous coronary intervention (PCI) face a heightened risk of major adverse cardiovascular and cerebrovascular events (MACCE). While physical activity is known to lower MACCE risk, improve long-term prognosis, and enhance quality of life, studies consistently report inadequate physical activity levels in this population. The relationships and potential mechanisms linking physical activity with its influencing factors remain incompletely understood, limiting the development of effective interventions. Therefore, this study aimed to identify key factors affecting physical activity and examine their underlying pathways in elderly post-PCI patients. A cross-sectional study was conducted in Zhengzhou, China, from December 2024 to May 2025. Four hundred and eighty elderly individuals aged over 60 years who had undergone PCI completed the International Physical Activity Questionnaire-Long Form, Coronary Heart Disease Patients' Rehabilitation Exercise Questionnaire, Cardiac Rehabilitation Exercise Self-efficacy Scale, 7-item Generalized Anxiety Disorder Scale, Patient Health Questionnaire-9, and a socio-demographic data sheet. Data analysis was performed using SPSS 25.0 for descriptive statistics, Spearman correlation, and binary logistic regression. Mediation analysis was conducted via structural equation modeling (SEM) in MPLUS 8.3. 52.90% of participants did not meet the recommended physical activity guidelines. Physical activity self-efficacy significantly mediated the relationship between physical activity knowledge and physical activity (β = 0.730, P < 0.001). Although anxiety and depression symptoms were not directly associated with physical activity (P > 0.05), they exerted significant indirect negative effects through reduced physical activity self-efficacy(anxiety: β=-0.287, 95% confidence interval [-0.553,-0.118]; depression: β=-0.394, 95% confidence interval [-0.683,-0.204]). This study found that the prevalence of being physically inactive was high in elderly adults after PCI. The present study's findings suggested that healthcare providers should try to enhance physical activity self-efficacy, knowledge, and positive emotions of elderly adults after PCI to improve their physical activity with a focus on physical activity self-efficacy. Registry: The Central China Cardiovascular Hospital in Fuwai, TRN: 2025 No. 29, Registration date: 12 March 2025. Registry: The First Affiliated Hospital of Henan University of Traditional Chinese Medicine's Ethics Committee, TRN:2025HL-030-01, Registration date: 13 February 2025.

In the August issue of Sexual Health, a public health ethics analysis for and against doxycycline pre-exposure prophylaxis (Doxy-PEP) to prevent sexually transmitted infections in men who have sex with men was published. The authors discuss the potential for increasing antimicrobial resistance with Doxy-PEP use against tetracyclines in a number of pathogens. Mycoplasma genitalium is a commensal organism that is prone to developing antibiotic resistance due to a number of factors. As doxycycline is the backbone for the treatment of M. genitalium infections, antimicrobial resistance surveillance in M. genitalium needs to be prioritized as Doxy-PEP becomes increasingly used as a strategy to prevent sexually transmitted infections.

Refusal to undergo treatment, including one of its manifestations, discharge against medical advice, must be informed, just as consent is, which is considered a core ethical principle in contemporary medical ethics. The aim of this study was to explore physicians' attitudes and intended behaviour toward patients' refusal of necessary treatment and to identify factors associated with their clinical decisions in such situations. A cross-sectional anonymous online survey of 393 physicians working in Lithuanian public hospitals was conducted between November 2020 and March 2021 using the secure national platform manoapklausa.lt. A convenience sampling strategy ensured representation of both large university and smaller regional hospitals, and all responses were complete due to mandatory fields in the questionnaire. Most physicians (85%; 95% CI 81.2 to 88.5) have encountered situations of refusal to undergo treatment. Women (p < 0.05) and senior physicians (aged 51 years and over) (p < 0.05) tend to apply treatment without patients' consent more often in all clinical cases, especially in surgical ones (VN1 and VN2). Difficulty in the decision-making process was associated with chronic conditions and the influence of individual religious beliefs. Insufficient patient information on the intervention was indicated as the main cause of refusal to undergo treatment (62.9%; 95% CI 58.0 to 67.4). Refusal to undergo treatment was associated with physicians' concern about the patient (57.5%; 95% CI 52.7 to 62.3) and anxiety (38.9%; 95% CI 34.1 to 43.8). Physicians' attitudes towards patients' refusal to undergo treatment reflect paternalistic patterns and are mainly associated with the physician's older age, gender, and duration of professional experience. Insufficient patient information on the intervention was indicated as the most important factor determining patients' refusal to undergo treatment. Under Lithuanian law, patients have a clear legal right to refuse treatment, and physicians who proceed without consent may face criminal liability. Our findings show that, despite the legal restrictions, many physicians would still choose to treat against a patient's will, reflecting a persistent paternalistic attitude even in the presence of clear legal prohibitions.

The article presents an analysis of modern concepts of human nature transformations in the light of traditional spiritual and religious teachings. Modernity is considered in the light of the Renaissance ideas, Christian in their origins. The development of rational ideas about human nature is associated with the development of medicine as a practice of helping a person to restore mental and physical harmony and health, as well as with the general scientific attitude to rationalize knowledge about a person. The latest medical technologies in ideological aspects intersect with the ideological attitudes of transhumanism as a teaching that presents a person with absolute freedom in physical and spiritual self-determination. The spiritual tradition emphasizes that all aspects of human corporeality are associated with his identity and self-awareness. In this sense, medical intervention is a possible violation of the natural course of things, a person’s rejection of the idea of ​​​​predestination. Considering that neither spiritual teachings nor medical ethics have unambiguous answers in specific existential situations of human moral choice, the attention of researchers, experts and pastors in solving and interpreting moral issues arising in connection with the development of new medical technologies should be focused precisely on human moral choice.

BackgroundThis study aims to explore adolescents’ perspectives on their experiences with Growing Healthy Kids (GHK), a multidisciplinary weight management service, evaluating their overall satisfaction and identifying areas for improvement in service delivery, acceptability, and effectiveness.MethodsA qualitative study using semi-structured interviews explored the perspectives of adolescents living with obesity who had received weight management services through the GHK Service. Interviews were conducted between July 2022 and July 2023 by a non-treating clinician, either face-to-face or by telephone, with written informed consent obtained prior. Interviews were digitally audio-recorded and transcribed verbatim. Thematic analysis was completed in NVivo by three independent researchers. Ethics approval was granted by the South Western Sydney Local Health District (SWSLHD) Human Research and Ethics Committee.ResultsA total of 22 adolescents were interviewed. Thematic analysis of the interviews revealed four key themes: (i) initial experiences and feelings, (ii) perceptions of service delivery, (iii) impact of the service, and (iv) recommendations for improvement.ConclusionsThis study emphasises the benefits of a multidisciplinary tailored interventions which meet the unique needs of adolescents in weight management services. It identifies emotional challenges such as anxiety and judgment, highlighting the importance of clear communication, empathetic care, and supportive environments. Participants expressed a need for long-term support, flexible appointments, and access to resources like gym equipment. These findings suggest that extending access to weight management services and offering adaptable care can enhance the effectiveness of programs like GHK, promoting sustained engagement and positive health outcomes for adolescents.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12887-025-06239-7.

Organ Harvesting is one of the alarming practices that take place in the field of medicine in the modern day of profit-driven ambitions. There are several instances where organ trafficking, transplant tourism, and human trafficking have been pointed out as a normal course of action in the medical sector. Although cases such as iatrogenesis for the purpose of organ trafficking are heavily discussed and criticized by Governments and Unions all over the world there is one striking form of organ harvesting that has materialised as a result of war, receiving little to no attention from the media, medical experts, legalists and policy experts. This Paper focuses on those issues which are faced by the families or relatives of deceased civilians from war-related events. The main focus of the paper will be on how the Israel Defense Force is accused of Harvesting organs from deceased civilians belonging to both Israel and Gaza and how the transplant tourism in Israel which is rapidly rising compounded with the ongoing war is fuelling these illicit activities. The Medical Staff in the IDF despite being at war, should keep in mind that the main duty of a doctor is to serve the public and save lives, thereby dissociating from the aforementioned activities. This paper proceeds to showcase that harvesting organs of dead civilians is not only a war crime but a medical crime as well, and examines the extraordinary circumstance where the intersection of war and medical practice and by extension medical ethics occur. The controversial history of Israel and organ transplants dates back to its very first heart transplant surgery, where the hospital is accused of performing the extraction of the heart from the donor without the consent of his family. This points to how the rise in transplant tourism is quite controversial in the current scenario especially as accusations of Israel keeping bodies in freezers for a long period and a fair amount of bodies being reported missing are on the rise. It is to be noted that it is not only the civilians from Gaza that fall victim to the actions of the IDF but also the Israeli nationals, highlighting the reality that the medical staff’s consideration or duty of care to its own citizens is being violated and that the patient's rights is a scuffling interest, furthering concern regarding this issue. This paper shall hence attempt to understand the legal and ethical dynamics at play in the event of war, where the citizens are extraordinarily vulnerable and the authorities possess unchecked power to act against the interest of the citizens. It also analyses the extent of medico-legal principles which expands the doctor’s duty of care beyond the course of treatment till even after the death of the patient and in the handling of the bodies of the deceased. In addition, it will also inspect upon the nature of the contractions that arise out of situations such as war, where the Doctor’s duty of care towards any human is in conflict with the order of authority imposed upon them.

Medical education must adapt to society's needs, ensuring that the skills acquired by students align with those perceived as necessary for high-quality medical practice. The aim of this study was to assess the perceptions of medical trainees who graduated from University of Coimbra's Faculty of Medicine between 2020/21 and 2022/23, currently working as foundation year or specialty trainee doctors, regarding competencies acquired during training. Secondarily, we aimed to evaluate differences across medical career stages. We applied an online questionnaire (5-point Likert scale) covering five domains: general competencies, practical skills, emergency department performance, communication skills, and professional values. Descriptive and inferential statistics were applied. The sample included 381 participants (193 foundation year doctors and 188 specialty trainees). The highest-rated competencies were medical ethics, holistic patient approach, history-taking and clinical communication. Areas of perceived deficiency involved technical procedures, therapeutic management and prescribing, patient social navigation, palliative care, leadership skills and National Health Service organizational knowledge. Differences were observed between career stages in problem-solving, prescribing, team leadership and pressure management. These findings highlight the need to restructure training and strengthen practical instruction and develop non-technical competencies, to better prepare future doctors for clinical challenges.

With the implementation of the fundamental task of “establishing morality and cultivating people”, the construction of the pattern of “Great Ideological and Political Education” has become an important measure for colleges and universities to promote the concept of “all-round education, whole-process education, and all-staff education” at present. In this process, teachers should deeply grasp the characteristics and advantages of ideological and political education in courses, realize the goal of ideological and political guidance through the integration of ideological and political elements with professional courses, and gradually build a pattern of “Great Ideological and Political Education” featuring “full participation, whole-process implementation, and all-aspect fulfillment.” This paper explores the course of Medical Microbiology, expounds the problems faced by the teaching of Medical Microbiology in colleges and universities under the pattern of “Great Ideological and Political Education”, and then puts forward the paths and strategies for the curriculum reform of Medical Microbiology in colleges and universities under this pattern. In this way, it organically integrates value shaping, knowledge impartment, and ability cultivation, realizes the parallel development of the Medical Microbiology course and ideological and political education, and provides strong support for cultivating outstanding medical talents with both virtue and ability, as well as noble medical ethics in the new era.

Bayanihan, commonly understood as the spirit of cooperation with the kapwa (shared identity), is often attributed as a distinctly Filipino trait that motivates altruistic and ethical actions. Despite this popular image, a lacuna exists in understanding how this concept applies to foreign migrants residing in the Philippines. In this paper, we aim to explore the identified gap and, in turn, propose a normative framework for migration health ethics grounded in the Filipino philosophical concepts of bayanihan and kapwa, arguing that these concepts offer an interesting alternative to the dominant theories and policies on migration. To accomplish this aim, we begin with a discussion of the conceptual foundation of migration health ethics. Afterwards, we situate bayanihan and kapwa, highlighting their ethical significance as well as their limitations and possible misuses. Finally, we propose how theseFilipino concepts can guide the development of an equitable and inclusive framework for migration health ethics in the Philippines.

The extent to which clinical ethics consultations should be neutral with respect to religion is the subject of ongoing debate. One important position says that clinical ethics consultants ought to appeal to the secular bioethical consensus that is available to everyone inasmuch as possible, and that they can do so without the subsequent need to defend an underlying moral theory. This view has been criticized because it is doubtful that such a consensus exists. Abram Brummett argues for a more nuanced approach where clinical ethicists must appeal to the bioethical consensus in clinical settings, but that the consensus and underlying moral principles can be debated in academic contexts (2020). Furthermore, he suggests that the consensus need not avoid making at least some moral, epistemological, and metaphysical commitments, though not to the level of embracing a full-fledged comprehensive worldview. I argue that Brummett's approach fails because it does not successfully avoid the implications of the lack of a secular bioethical consensus. Any defense of such a consensus is only possible at a superficial level where there may be agreement on which moral concepts to use, even though deep disagreement remains about their nature and application. While Brummett's approach is more honest than some secular alternatives because it does not seek to avoid making any judgments about underlying commitments, it is ultimately uninformative in failing to address the fact of pluralism. To conclude, I suggest that even if I am mistaken and there really is a secular bioethical consensus, Brummett's view implies that the consensus can never be legitimately challenged in clinical settings.

The Role of Hope in Improving the Physician–Patient Relationship: A Comparative Study of the Persian Medicine Ethical Viewpoint with Modern Medical Ethics