Principles Of Beneficence Research Articles

Navigating diverging responsibilities for inclusion in a biobased value chain: the case of Solaris tobacco in South Africa

ABSTRACT Companies operating in international, cross-cultural settings encounter challenges in balancing their business roles with responsibilities towards inclusion. This delicate balance is particularly strained within the bioeconomy where uncertainties emerge. This study explores this novelty: how a company engaging in an emerging biobased value chain can fulfil its moral obligations (i.e. responsibility) towards inclusion, aligning with the principles of beneficence (doing good) and non-maleficence (doing no harm). A case study was conducted in the South African Royal Bafokeng Nation where a biobased project, involving tobacco plant cultivation for foremost oil production, was initiated. Our findings suggest that companies in emerging biobased value chains must incorporate local stakeholders' knowledge when establishing their value chains. However, when the implications of beneficence in a specific context are ambiguous, companies should exercise caution in asserting positive responsibilities. Companies should empower local agents to achieve their objectives while refraining from imposing external norms on local contexts.

Incorporating familial risk, lifestyle factors, and pharmacogenomic insights into personalized noncommunicable disease (NCD) reports for healthcare funder beneficiaries participating in the Open Genome Project.

An ethics-guided decision-making framework was developed for applying pathology-supported genetic testing, a multifaceted pharmacodiagnostic approach that translates population risk stratification into clinical utility. We introduce this service, supported by the Open Genome Project, which aligns with the beneficence principle in personalized medicine. Genetic testing of six noncommunicable disease pathways was conducted as part of a pilot program, benchmarked against a readiness checklist for implementation of genomic medicine in Africa. Patient referral criteria were determined using healthcare funder claims data, employing the Adjusted Clinical Groupers and Resource Utilization Band risk rating structure to identify potential nonresponders to treatment. Three of the 135 doctors (2.2%) invited expressed immediate disinterest in the pilot, while 24 (17.8%) actively participated. Inherited, lifestyle-triggered, and therapy-related pathologies were simultaneously assessed in case reports, with special medical scheme reimbursement tariff codes applied to 25 patient referrals. The findings were used by the participating genetic counselor to select three patients for whole exome sequencing, utilizing a novel, level-up data processing algorithm for adaptive reporting. This study demonstrated the implementation of genomics into an evolving workflow for patients with a history of frequent clinic visits. Eliminating the cost barrier provided valuable insights to guide future reimbursement policy decisions.

Rethinking Animal Consciousness Research to Prioritize Well-Being.

The authors critique the NY Declaration on Animal Consciousness, which does not denounce continued captivity and invasive research in the pursuit of animal consciousness markers. They argue that such research often increases animal suffering by accepting harmful practices. Instead, they propose a nonanthropocentric, ethical framework aligned with the Belmont Report's principle of beneficence, advocating for noninvasive methods in natural habitats. This approach prioritizes animal well-being, recognizing and safeguarding the intrinsic value of all conscious beings.

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.

VACCINATION HESITATION FROM THE BIOETHICAL PERSPECTIVE

Introduction: Vaccine hesitation represents a significant challenge to public health, with serious consequences, such as the resurgence of eradicated diseases, the return of measles and pertussis in Brazil, as well as other immunoprevenable diseases, due to the fall in vaccination coverage. There is a bioethical conflict between the autonomy of parents who choose not to vaccinate their children and the lack of responsibility, as citizens, to protect public health. In addition, the responsibility of health professionals to work in accordance with the principles of beneficence and non-maleficence, so that they always indicate and encourage vaccines duly endorsed by science. Respect for autonomy should be balanced with the collective good, where vaccination hesitation contributes to the resurgence of preventable diseases and generates negative impacts on public health. Objective: Discuss vaccine hesitation from the perspective of bioethics from a real case report, addressing the repercussions of doctors’ instructions to their patients. Additionally, the legal aspects related to the obligation of vaccination in Brazil are discussed, with emphasis on collective protection and ethical duty to promote public health. METHOD: This is a descriptive and qualitative study based on a real case report of meningoencephalitis resulting from chickenpox, whose searches were performed in the Scielo, PubMed and Lilacs databases. Discussion: Varicella is a disease caused by the varicella-zoster virus, whose transmission occurs through respiratory aerosols or contact with the contents of skin lesions. Its main complications are meningoencephalitis, pneumonia, skin and ear infections. Meningoencephalitis is a rare interlocutory appeal that consists of acute central nervous system inflammation and can be fatal. Vaccination against chickenpox prevents injuries resulting from this infection. According to the legislation in force in the country, the obligation to immunize through a vaccine that, registered with a health surveillance body, is part of the National Immunization Program or its obligatory application determined by law is constitutional. Addressing the precepts of principalist bioethics, the present study relates them to the reported case, aiming to broadly discuss vaccine hesitation from medical advice. CONCLUSION: The case report highlights the importance of vaccination against the varicella zoster virus in preventing serious complications and the bioethical dilemma between parents’ autonomy and the responsibility of protecting the health of children and the community. Non -immunization, as in the case of the varicella, highlights the need to prioritize the principles of beneficence and non -maleficence. Although autonomy is essential, it should be balanced with the individual and collective good, especially in vaccination, where protection depends on adherence to immunization policies. Vaccine hesitation is a growing public health problem, requiring health professionals to be well formed to combat misinformation and promote evidence -based practices.

Implementation of Respect for Autonomy in Hospital Services Within the Indonesia National Health Insurance System

The principle of patient autonomy forms the foundation of medical ethics. However, its exploration within the context of national health insurance systems in developing countries remains under-researched. This study aimed to evaluate respect for patient autonomy within Indonesia's National Health Insurance (NHI/JKN) system. The study using a qualitative research interview analyzed thematically. Conducted in Depok, West Java, the study involved in-depth semi-structured interviews with 18 participants, encompassing patients from first-level health facilities (FLHF), general practitioners at FLHF, specialist doctors, and management of referral hospital (RH) officers, and staff members of the JKN. The data were transcribed and analyzed using a thematic approach. The study revealed substantial underutilization of respecting patient autonomy within medical contexts under the JKN. Five themes emerged: challenges in the referral system, knowledge and information dissemination, decision-making and autonomy, quality of healthcare services, and systemic constraints and impact. These themes highlight the lack of patient awareness, restricted medical choices, the dominant role of paternalism (a system in which the government or a person in a position of authority makes decisions for other people) in healthcare decisions, and improper informed consent process. The findings suggest that the principles of beneficence and paternalism often overshadow respect for patient autonomy in the JKN system. This raises concerns about the ethical aspect of patient treatment, particularly the need for greater focus on patient autonomy and shared decision-making to align more closely with global medical ethics practices. This study contributes to understanding autonomy in national health insurance systems in developing countries. It highlights the need for systemic reforms to enhance healthcare efficiency and effectiveness while respecting patient autonomy.

Should Patients Be Allowed to Pay Out of Pocket? The Ethical Dilemma of Access to Expensive Anti-cancer Treatments in Universal Healthcare Systems: A Dutch Case Study.

With the increasing prices of newly approved anti-cancer treatments contributing to rising healthcare costs, healthcare systems are facing complex economic and ethical dilemmas. Especially in countries with universal access and mandatory health insurance, including many European countries, the organizing of funding or reimbursement of expensive new treatments can be challenging. When expensive anti-cancer treatments are deemed safe and effective, but are not (yet) reimbursed, ethical dilemmas arise. In countries with universal healthcare systems, such as the Netherlands, this gives rise to a rather new ethical dilemma: should patients be allowed to pay out of pocket, using private funds, for medical treatments? On the one hand, to allow patients to pay for treatments out of pocket would be in line with the medical-ethical principles of beneficence and autonomy. On the other hand, allowing patients to pay out of pocket for anti-cancer treatments may lead to unequal access to medical treatments and could be considered unfair to patients who are less well-off. Thus, it could undermine the values of equality and solidarity, on which the Dutch healthcare system is built. Furthermore, out-of-pocket payments could potentially lead to financial hardship and distress for patients, which would conflict with the principle of non-maleficence. Does this mean that patients can rightfully be denied access to approved but not (yet) reimbursed anti-cancer treatments? In this article, we will use the Dutch healthcare system, which is based on equal access and solidarity, as a case study to draw attention to this-currently relatively unknown and unresolved-dilemma and to clarify the values at stake. This article contributes to current discussions about the societal problem of rising healthcare costs by informing policymakers, healthcare professionals, and ethicists about the ethical dilemma of out-of-pocket payments in universal healthcare systems, and aims to support health authorities, policymakers and health professionals in developing policy for whether to allow out-of-pocket payment-based access to newly approved but (too) expensive anti-cancer treatments.

Clinical Considerations for Integrating Ethical Principles of Beneficence in the Development of Evidence-Based Interventions: The case of Pediatric Misophonia.

Misophonia is a condition involving decreased tolerance and intense responses to specific sounds, often those that are human-generated and repetitive in nature. Misophonia frequently onsets during childhood and is associated with significant distress, impairment, and diminished quality of life. While misophonia research remains nascent and no definitive practice guidelines exist at present, extant studies offer several promising potential avenues in intervention development for adults with misophonia. However, such research is comparatively limited for youth. Before widespread adoption of promising treatments, it is important to consider the potential for harm or non-beneficence that may arise from the mis-informed application of such treatments. In this article, we identify several potential pitfalls within intervention development for pediatric misophonia and provide recommendations to circumvent them. To that end, we focus on the following three topic areas: (a) challenges arising when psychological mechanisms are not considered in intervention development, (b) importation of a cognitive-behavior therapy (CBT) framework for obsessive-compulsive spectrum disorders without nuanced tailoring to misophonia, and (c) neglecting to include individuals with lived experience in the process of intervention development research. Considering these key areas within misophonia intervention development will be critical for upholding beneficence and minimizing harm in treatment of misophonia across the lifespan.

Ethical considerations of use of hold-out sets in clinical prediction model management

AbstractClinical prediction models are statistical or machine learning models used to quantify the risk of a certain health outcome using patient data. These can then inform potential interventions on patients, causing an effect called performative prediction: predictions inform interventions which influence the outcome they were trying to predict, leading to a potential underestimation of risk in some patients if a model is updated on this data. One suggested resolution to this is the use of hold-out sets, in which a set of patients do not receive model derived risk scores, such that a model can be safely retrained. We present an overview of clinical and research ethics regarding potential implementation of hold-out sets for clinical prediction models in health settings. We focus on the ethical principles of beneficence, non-maleficence, autonomy and justice. We also discuss informed consent, clinical equipoise, and truth-telling. We present illustrative cases of potential hold-out set implementations and discuss statistical issues arising from different hold-out set sampling methods. We also discuss differences between hold-out sets and randomised control trials, in terms of ethics and statistical issues. Finally, we give practical recommendations for researchers interested in the use hold-out sets for clinical prediction models.

Ethical Considerations of Including Minors in Clinical Trials Using the Example of the Indicated Prevention of Psychotic Disorders

Ethical Considerations of Including Minors in Clinical Trials Using the Example of the Indicated Prevention of Psychotic Disorders Abstract: As a vulnerable group, minors require special protection in studies. For this reason, researchers are often reluctant to initiate studies, and ethics committees are reluctant to authorize such studies. This often excludes minors from participating in clinical studies. This exclusion can lead to researchers and clinicians receiving only incomplete data or having to rely on adult-based findings in the treatment of minors. Using the example of the study "Computer-Assisted Risk Evaluation in the Early Detection of Psychotic Disorders" (CARE), which was conducted as an 'other clinical investigation' according to the Medical Device Regulation, we present a line of argumentation for the inclusion of minors which weighs the ethical principles of nonmaleficence (especially regarding possible stigmatization), beneficence, autonomy, and fairness. We show the necessity of including minors based on the development-specific differences in diagnostics and early intervention. Further, we present specific protective measures. This argumentation can also be transferred to other disorders with the onset in childhood and adolescence and thus help to avoid excluding minors from appropriate evidence-based care because of insufficient studies.

Healthcare Worker Attitudes to Living Donation Prior to Planned Withdrawal of Care.

This study assesses the attitudes of healthcare practitioners toward Living Donation Prior to Planned Withdrawal of Care (LD-PPW): the recovery of a living donor organ before withdrawal of life-sustaining measures in a patient who does not meet criteria for brain death, but for whom medical care toward meaningful recovery is deemed futile. An electronic survey was administered to 1735 members of the American Society of Transplant Surgeons mailing list with 187 responses (10.8%). Data from this study revealed that 70% of responding practitioners agreed with LD-PPW due to principles of beneficence and autonomy. Also, 65% of participants felt confident in their ability to declare the futility of care and 70% felt that LD-PPW should be added as an option when registering to become an organ donor. Currently, nearly half of all donation after circulatory determination of death do not proceed to donation. LD-PPW has been proposed as an alternative procedure targeted at increasing the quality and quantity of transplantable organs while respecting the donor's right to donate, though its implementation has been hindered by concerns over public and provider perception. This study revealed support for LD-PPW among healthcare practitioners as an alternative procedure to increase the quality and quantity of transplantable organs while respecting the donor's right to donate.

Key Characteristics of Autonomy, Confidentiality, Beneficence, Non-maleficence, Justice and Privacy principles in Medical Law within the Context of Human Rights

Key Characteristics of Autonomy, Confidentiality, Beneficence, Non-maleficence, Justice and Privacy principles in Medical Law within the Context of Human Rights

Bioethical and Human Right Considerations during COVID-19 Pandemic Period: Reflections of Integrated Oncology Clinical Services from India

AbstractEver since the outbreak of COVID-19, the global health care systems are overwhelmed to cope up with the rapidly evolving disease paradigm through implementation of action plans at societal and medical domains. As per the directives from the World Health Organization and learned professional organizations, the international governments and states have formulated different protocols to prevent disease spread, for diagnosis and treatment of the disease and associated comorbidities, and to educate citizens during this crisis phase. Health care services across the world followed a “prioritizing strategy” for hospital population wherein the non-COVID cases were given less focus. Many hospitals opted for a conscious staff-sparing strategy to minimize exposure and protection of clinically valuable staff. Oncology services across the world reported a decline in the provision of clinical services to patients. There were medical concerns such as missed diagnosis, delayed diagnosis, delayed treatment, stoppage of screening programs, and differed follow-ups during the last 2 years of pandemic. The multidisciplinary oncology teams aim to ensure that cancer patients in the continuum of integrated cancer care pathway get globally accepted standards of optimum care. However, Beauchamp's ethical principles of autonomy, beneficence, nonmaleficence, and distributive justice were arguably compromised during the pandemic period. The articles of UNESCO Universal Declaration on Bioethics and Human Rights (UDBHR) declaration were possibly violated in cancer patients as a vulnerable population. This article analyses the bioethical and human right concerns with respect to medical and societal domains in oncology during the COVID-19 pandemic period.

Teaching and learning with older adults: Research ethics, risk analysis, and covert research

ABSTRACT This article reports a case study of older adults learning English in China. It indicates how, founded on consequentialist ethics, risk analysis, and safeguarding, it was decided to use covert research, drawing on the confluence of risk analysis, risk evaluation, risk management, safeguarding, research ethics, and important contextual and cultural features. Ethical principles of nonmaleficence, beneficence, safeguarding, and protection were addressed, and account was taken of the strength, likelihood, and consequences of risks, safeguards, and benefits, informed by Chinese cultural contexts, values, behaviors, and features of teaching and learning based on andragogy and geragogy. Implications are drawn for teaching and learning with older adults, advocating significant account to be taken of contextual factors.

Should dentists perform independent jaw wiring for weight loss? A principlist analysis

This article presents an ethical analysis for the practice of jaw wiring as an independent weight loss intervention by dentists. The four foundational principles of autonomy, nonmaleficence, beneficence and justice serve as a framework for evaluating the ethical dimensions of the practice, and whether it can be justified. The ethical analysis of this weight loss procedure requires dentists to debate the potential benefits with possible harms, while respecting the autonomy and desires of the patient. While patients possess a fundamental right to autonomous decision-making, conceding to their autonomy is not absolute and dentists need to balance their decisions with considerations of beneficence and nonmaleficence. The ethical analysis concludes that dentists who refuse requests to independently perform jaw wiring for purely weight loss purposes are ethically justified within the principlist framework when the principles of nonmaleficence and beneficence are at stake. The wellbeing and health of the patient, as well as professional obligations, justify their refusal.

Revisiting the relationship between the principle of benevolence and beneficence

The relevance of the research is substantiated by the fact that the principles of the educational process are almost always interconnected in their essence. However, usually a separate principle is taken as a basis, while establishing the relationship between the principles of benevolence and beneficence contributes to a much deeper understanding of the dialectics of educational interactions.The problem statement: without a sense of benevolence and beneficence, learners are less likely to be interested in thinking and acting in ways that meet the needs of others.The goal of the research is to analyze contemporary literature to identify the relationship between the principle of benevolence and beneficence, which should encourage young people to know about the lives of other people and specific circumstances.The object of research is the principles of benevolence and beneficence as humanitarian prerequisites for the moral process, and the subject is the education of the individual on this basis.The research method is conceptual analysis. A detailed examination of the presented concepts, which forms a clear idea of their essence and content, deserves special attention in this work.The conclusions: in order to understand what exactly contributes to the formation of a basis for familiarity with different points of view and worldviews, as well as with the structural causes of social problems and the potential consequences of actions taken to solve them, aspects for the emergence of these principles were considered. Also, during a detailed study of materials devoted to this issue, the principle of justice and charity has been discovered and described in the context of the connection between benevolence and beneficence. It has been noted that the use of the principle of benevolence and beneficence, considering age characteristics, can become one of the foundations in determining the mechanisms for implementing the continuity of teacher education.The results of the study can be used not only in training teachers, but can also be useful for specialists in the field of psychology, culture, etc.

Exploring Ethical Dimensions in Neuropalliative Care.

Neurologic illnesses can be challenging to diagnose, involve changes in consciousness, and are often complicated by prognostic uncertainty. These disorders can affect how individuals interact with their environment, and as a result, many ethical concerns may arise related to their medical care. Key ethical issues in neuropalliative care include shared decision-making, evolving autonomy and capacity, best interest and harm principles, beneficence and nonmaleficence, futile and inappropriate care, justice and equity, and ableism. The four core principles of medical ethics, beneficence, nonmaleficence, justice, and autonomy, are foundational in considering approaches to these ethical challenges. Shared decision-making is rooted in the principle of autonomy. Evolving autonomy and capacity evoke autonomy, beneficence, and nonmaleficence. The best interest and harm principles are rooted in beneficence and nonmaleficence. Questions of futility and inappropriate care are founded in the principles of nonmaleficence, autonomy, and justice. Ableism invokes questions of nonmaleficence, autonomy, and justice. Practitioners of neurology will encounter ethical challenges in their practice. Framing decisions around the core ethical principles of beneficence, nonmaleficence, autonomy, and justice will help clinicians navigate challenging situations while acknowledging and respecting each patient's individual story.

Clinical Application and Ethical Study of Medical Genetics Testing

With the rapid development of genetics technology, medical genetics testing has become an important part of modern medical practice. These tests are able to reveal individual genetic information, which is important for predicting disease risk, guiding treatment choices and promoting health management. However, the sensitivity and complexity of genetic information also raises numerous ethical issues. Types and applications of medical genetics tests are discussed and ethical principles that must be considered when applying these tests in clinical practice are presented, including respect for autonomy, the principle of non-harm, the principle of impartiality and the principle of beneficence.

(128) ABORTION AND THE MYTH OF THE HARM-FREE PREGNANCY

Abstract Introduction A comprehensive description of the impact of pregnancy and childbirth on the human body has never been published. All pregnancies pose an unquantifiable threat to one's health and childbirth has permanent, irreversible effects that are cumulative and often late-manifesting. This reality refutes the anti-abortion, pro-natalist claim that there is any such thing as an elective abortion. Objective Abortion access supports the fundamental human right to bodily autonomy and sexual self-determination, hence every abortion is performed in the service of the pregnant person's health. The neglect of these principles has allowed politically-motivated legislatures to introduce imprecise health exception language that does not acknowledge the actual impact of pregnancy and childbirth. Affirming that abortion is life-saving healthcare refutes the health exception fallacy. Methods Maternal mortality and morbidity statistics are flawed and incomplete. None of the standard measures adequately captures the effects of pregnancy, whether voluntary or forced, upon the health of the parturient or her community. This report elucidates the unpredictable and often unattributed morbidity associated with pregnancy and childbirth, and argues for a human rights approach to abortion policy. Results Abortion bans have downstream effects that negatively impact the care of all pregnancy-capable people and their communities. Allowing non-experts to legislate against evidence-based care creates confusion and leads to mistrust of the healthcare system. Gendered disinformation, gag rules, and criminalization of pregnancy all result in stigma and harm. Conclusions The cultural reluctance to seriously study the effects of pregnancy on health is linked to gender inequality and is correlated with restrictive abortion laws that violate ethical principles of beneficence and patient autonomy. Involuntary pregnancy is a major and preventable cause of human suffering that can be relieved with permissive abortion policies based on ethical and scientific standards of care. Disclosure No.

ChatGPT for good? Taking ‘beneficence’ seriously in the regulation of generative artificial intelligence

ABSTRACT Generative AI platforms such as ChatGPT have found prominence in recent times with their ability to generate texts, images, etc. Several questions pertaining to ethical and legal issues surrounding ChatGPT have arisen. In this paper, I discuss the nature and background of generative AI, situating its development in the historical context of AI. I then discuss my primary research questions: is sufficient attention paid in the literature on ethics of AI to the principle of beneficence and is there theoretical clarity on its meaning? I highlight that while there is great deal of discussion on what harms can arise from generative AI and how to stop them, there is very little discussion on what amounts to AI-for-good, particularly in the literature of AI ethics and regulation. To the extent that such discussion exists, it pushes ahead with suggesting specific solutions, without fully addressing the underlying question of what makes their prescriptions beneficent. I demonstrate that the principle of beneficence as understood in biomedical ethics and human rights frameworks has limited utility for the ethics of generative AI. These gaps in the AI regulation are prominent, as they can derail long term progress of generative AI and the realization of its full potential.