Fatores clínicos do bem-estar de mulheres em parturição: perspectivas deontológicas e da bioética principialista / Clinical factors of women in labor well-being: deontological and bioethical principlism perspectives / Factores clínicos del bienestar de la mujer en trabajo de parto: perspectivas deontológicas y de la bioética principialista

Objetivo: avaliar os fatores clínicos associados ao bem-estar das mulheres durante o trabalho de parto e parto à luz da bioética principialista e da deontologia. Método: estudo transversal com abordagem quantitativa. Participaram 396 puérperas internadas em um hospital municipal do sudoeste da Bahia, e os dados foram coletados no período de janeiro a maio de 2023, após aprovação do comitê de ética em pesquisa. Os dados foram organizados no software Excel e analisados via SPSS v.25. a partir da regressão logística multinomial. Resultados: a maior parte da amostra apresentou bem-estar com assistência em saúde, mulheres que tiveram parto realizado por profissionais não médicos apresentaram mais chances de níveis de bem-estar "adequado". E mulheres que não tiveram a via de parto cesárea apresentaram aumento de chances de bem-estar. Conclusão: é necessário que os profissionais reflitam sobre suas ações, condicionando-as à humanização no parto, em observância aos princípios bioéticos.

Objective: to evaluate the clinical factors associated with women's well-being during labor and delivery in the light of bioethics principlism and deontology. Method: a cross-sectional study with a quantitative approach was conducted. It involved 396 postpartum women admitted to a municipal hospital in the southwest of Bahia. Data were collected from January to May 2023, after approval from the research ethics committee. The data were tabulated using Excel software and analyzed using SPSS v.25 through Multinomial Logistic Regression. Results: majority of the sample exhibited well-being with health care assistance. Women who underwent delivery performed by non-medical professionals showed higher chances of "adequate" levels of well-being. Additionally, women who did not undergo cesarean delivery showed increased chances of well-being. Conclusion: It is necessary for professionals to reflect on their actions, conditioning them to the humanization of childbirth, according to bioethical principles.

Objetivo: evaluar los factores clínicos asociados al bienestar de la mujer durante el trabajo de parto y parto a la luz de la bioética y la deontología principialista. Método: estudio transversal con enfoque cuantitativo. Incluyó 396 puérperas ingresadas en un hospital municipal del suroeste de Bahía. Recolección de datos de enero a mayo de 2023, con aprobación del comité de ética en investigación. Los datos se tabularon en el software Excel y se analizaron mediante SPSS v.25. utilizando regresión logística multinomial. Resultados: la mayoría de las participantes de la muestra presentó bienestar con la atención para la salud; las que tuvieron partos realizados por profesionales no médicos tenían más probabilidades de tener niveles "adecuados" de bienestar; las que no tuvieron parto por cesárea tenían mayores probabilidades de tener bienestar. Conclusión: es necesario que los profesionales reflexionen sobre sus acciones y las adecuen para humanizar el parto, respetando los principios bioéticos.

Aristotelian Practical Wisdom (Phronesis) as the Key to Professional Ethics in Teaching.

This article is about a virtue ethical approach to the professional ethics of teaching, centred around the ideal of phronesis (practical wisdom) in an Aristotelian sense. It is grounded empirically in extensive research conducted at the Jubilee Centre for Character and Virtues into teachers and other UK professionals, and it is grounded theoretically in recent efforts to revive an Aristotelian concept of phronesis as excellence in ethical decision-making. The article argues for the need for a virtue-based approach to professional practice, based on time-honoured Aristotelian assumptions and culminating in a conceptually viable construct of phronesis as a psycho-moral integrator and adjudicator. After setting some of the historical background in Sect. 1, Sect. 2 charts the most relevant empirical findings. Section 3 introduces a call for phronesis as a guide to virtue-based professional ethics: its role, nature, and methods of instruction. Section 4 adds some caveats and concerns about if and how phronesis can be cultivated as part of teacher training. Finally, Sect. 5 offers some concluding remarks about the novelty and radicality of the approach on offer in this article.

Actions speak louder than words: the case for responsible scientific activism in an era of planetary emergency.

The world's understanding of the climate and ecological crises rests on science. However, scientists' conventional methods of engagement, such as producing ever more data and findings, writing papers and giving advice to governments, have not been sufficiently effective at persuading politicians to act on the climate and ecological emergency. To date, governments' decisions (such as continuing with vast subsidies for fossil fuels) clearly show that powerful vested interests have been much more influential than the amassed scientific knowledge and advice. We argue that in the face of this inaction, scientists can have the maximum amount of influence by lending their support to social movements pressing for action, joining as active participants and considering civil disobedience. Scientists seeking to halt continued environmental destruction also need to work through our institutions. Too many scientific organizations, from national academies of science to learned societies and universities, have not taken practical action on climate; for example, many still partner with fossil fuel and other compromised interests. We therefore also outline a vision for how scientists can reform our scientific institutions to become powerful agents for change.

The Fourth Industrial Revolution: Its Impact on Artificial Intelligence and Medicine in Developing Countries.

Artificial intelligence (AI) is the ability of a digital computer or computer-controlled robot to perform tasks commonly associated with intelligent beings. Artificial intelligence can be both a blessing and a curse, and potentially a double-edged sword if not carefully wielded. While it holds massive potential benefits to humans-particularly in healthcare by assisting in treatment of diseases, surgeries, record keeping, and easing the lives of both patients and doctors, its misuse has potential for harm through impact of biases, unemployment, breaches of privacy, and lack of accountability to mention a few. In this article, we discuss the fourth industrial revolution, through a focus on the core of this phenomenon, artificial intelligence. We outline what the fourth industrial revolution is, its basis around AI, and how this infiltrates human lives and society, akin to a transcendence. We focus on the potential dangers of AI and the ethical concerns it brings about particularly in developing countries in general and conflict zones in particular, and we offer potential solutions to such dangers. While we acknowledge the importance and potential of AI, we also call for cautious reservations before plunging straight into the exciting world of the future, one which we long have heard of only in science fiction movies.

Mapping the Apps: Ethical and Legal Issues with Crowdsourced Smartphone Data using mHealth Applications.

More than 5 billion people in the world own a smartphone. More than half of these have been used to collect and process health-related data. As such, the existing volume of potentially exploitable health data is unprecedentedly large and growing rapidly. Mobile health applications (apps) on smartphones are some of the worst offenders and are increasingly being used for gathering and exchanging significant amounts of personal health data from the public. This data is often utilized for health research purposes and for algorithm training. While there are advantages to utilizing this data for expanding health knowledge, there are associated risks for the users of these apps, such as privacy concerns and the protection of their data. Consequently, gaining a deeper comprehension of how apps collect and crowdsource data is crucial. To explore how apps are crowdsourcing data and to identify potential ethical, legal, and social issues (ELSI), we conducted an examination of the Apple App Store and the Google Play Store in North America and Europe to identify apps that could potentially gather health data through crowdsourcing. Subsequently, we analyzed their privacy policies, terms of use, and other related documentation to gain insights into the utilization of users' data and the possibility of repurposing it for research or algorithm training purposes. More specifically, we reviewed privacy policies to identify clauses pertaining to the following key categories: research, data sharing, privacy/confidentiality, commercialization, and return of findings. Based on the results of these app search, we developed an App Atlas that presents apps which crowdsource data for research or algorithm training. We identified 46 apps available in the European and Canadian markets that either openly crowdsource health data for research or algorithm training or retain the legal or technical capability to do so. This app search showed an overall lack of consistency and transparency in privacy policies that poses challenges to user comprehensibility, trust, and informed consent. A significant proportion of applications presented contradictions or exhibited considerable ambiguity. For instance, the vast majority of privacy policies in the App Atlas contain ambiguous or contradictory language regarding the sharing of users' data with third parties. This raises a number of ethico-legal concerns which will require further academic and policy attention to ensure a balance between protecting individual interests and maximizing the scientific utility of crowdsourced data. This article represents a key first step in better understanding these concerns and bringing attention to this important issue. Supplementary Information: The online version contains supplementary material available at 10.1007/s41649-024-00296-3.

Developing a Framework for Self-regulatory Governance in Healthcare AI Research: Insights from South Korea.

This paper elucidates and rationalizes the ethical governance system for healthcare AI research, as outlined in the 'Research Ethics Guidelines for AI Researchers in Healthcare' published by the South Korean government in August 2023. In developing the guidelines, a four-phase clinical trial process was expanded to six stages for healthcare AI research: preliminary ethics review (stage 1); creating datasets (stage 2); model development (stage 3); training, validation, and evaluation (stage 4); application (stage 5); and post-deployment monitoring (stage 6). Researchers identified similarities between clinical trials and healthcare AI research, particularly in research subjects, management and regulations, and application of research results. In the step-by-step articulation of ethical requirements, this similarity benefits from a reliable and flexible use of existing research ethics governance resources, research management, and regulatory functions. In contrast to clinical trials, this procedural approach to healthcare AI research governance effectively highlights the distinct characteristics of healthcare AI research in research and development process, evaluation of results, and modifiability of findings. The model exhibits limitations, primarily in its reliance on self-regulation and lack of clear delineation of responsibilities. While formulated through multidisciplinary deliberations, its application in the research field remains untested. To overcome the limitations, the researchers' ongoing efforts for educating AI researchers and public and the revision of the guidelines are expected to contribute to establish an ethical research governance framework for healthcare AI research in the South Korean context in the future.

Scoping Review Shows the Dynamics and Complexities Inherent to the Notion of "Responsibility" in Artificial Intelligence within the Healthcare Context.

The increasing integration of artificial intelligence (AI) in healthcare presents a host of ethical, legal, social, and political challenges involving various stakeholders. These challenges prompt various studies proposing frameworks and guidelines to tackle these issues, emphasizing distinct phases of AI development, deployment, and oversight. As a result, the notion of responsible AI has become widespread, incorporating ethical principles such as transparency, fairness, responsibility, and privacy. This paper explores the existing literature on AI use in healthcare to examine how it addresses, defines, and discusses the concept of responsibility. We conducted a scoping review of literature related to AI responsibility in healthcare, searching databases and reference lists between January 2017 and January 2022 for terms related to "responsibility" and "AI in healthcare", and their derivatives. Following screening, 136 articles were included. Data were grouped into four thematic categories: (1) the variety of terminology used to describe and address responsibility; (2) principles and concepts associated with responsibility; (3) stakeholders' responsibilities in AI clinical development, use, and deployment; and (4) recommendations for addressing responsibility concerns. The results show the lack of a clear definition of AI responsibility in healthcare and highlight the importance of ensuring responsible development and implementation of AI in healthcare. Further research is necessary to clarify this notion to contribute to developing frameworks regarding the type of responsibility (ethical/moral/professional, legal, and causal) of various stakeholders involved in the AI lifecycle.

The Role of Engineering Ethics in Mitigating Corruption in Infrastructure Systems Delivery.

Indications that corruption mitigation in infrastructure systems delivery can be effective are found in the literature. However, there is an untapped opportunity to further enhance the efficacy of existing corruption mitigation strategies by placing them explicitly within the larger context of engineering ethics, and relevant policy statements, guidelines, codes and manuals published by international organizations. An effective matching of these formal statements on ethics to infrastructure systems delivery facilitates the identification of potential corruption hotspots and thus help establish or strengthen institutional mechanisms that address corruption. This paper reviews professional codes of ethics, and relevant literature on corruption mitigation in the context of civil engineering infrastructure development, as a platform for building a structure that connects ethical tenets and the mitigation strategies. The paper assesses corruption mitigation strategies against the background of the fundamental canons of practice in civil engineering ethical codes. As such, the paper's assessment is grounded in the civil engineer's ethical responsibilities (to society, the profession, and peers) and principles (such as safety, health, welfare, respect, and honesty) that are common to professional codes of ethics in engineering practice. Addressing corruption in infrastructure development continues to be imperative for national economic and social development, and such exigency is underscored by the sheer scale of investments in infrastructure development in any country and the billions of dollars lost annually through corruption and fraud.

[The Basel model of principle-oriented clinical ethics consultation 2.0 : An introduction for psychiatry]. / Das Basler Modell der prinzipienorientierten klinischen Ethikkonsultation 2.0 : Eine Einführung für die Psychiatrie.

BACKGROUND: The effectiveness of clinical ethics counselling in medicine in terms of satisfaction of the participants, support of ethical decision-making, perceived impact on clinical care, moral competence and quality of communication is now empirically well validated. In psychiatry, more and more institutions have structures for clinical ethics consultation as well; however, there is still a lack of evaluative accompanying research on the benefits and differential indications of the various forms and models of clinical ethics counselling in psychiatry. AIM OF THE WORK: The article presents the principles and the step by step application of the principle-oriented clinical ethics consultation according to the Basel model 2.0. MATERIAL AND METHODS: The article is based on material and procedures developed at the Clinical Ethics Unit of the University Hospital Basel and the University Psychiatric Clinics Basel for the principle-oriented clinical ethics consultation according to the Basel model 2.0. RESULTS AND DISCUSSION: Principle-oriented clinical ethics consultation according to the Basel model 2.0 is suitable for dealing with moral issues and conflicts in psychiatric practice and for their ethical reflection; however, further evaluative accompanying research is needed on the benefits and differential indications of this and other models of clinical ethics support in psychiatry.

The ethics of natural immunity exemptions to vaccine mandates: the Supreme Court petition.

The Supreme Court of the United States has recently been petitioned to revisit legal issues pertaining to the lawfulness of imposing a vaccine mandate on individuals with proof of natural immunity during the COVID-19 pandemic. While the petition accepts that the protection of public health during COVID-19 was an important governmental interest, the petitioners maintain that the imposition of a vaccine mandate on individuals with natural immunity was not 'substantially related' to accomplishing that purpose. In this short report, we outline how some of the petition's general arguments interact with points we raised in a 2022 article in this journal defending natural immunity exemptions, in light of new evidence. In particular, we reflect on new evidence pertaining to differences between vaccine-induced immunity, natural immunity, and so-called 'hybrid' immunity. We suggest that the nuanced nature of this evidence highlights the importance of making fine-grained judgements about proportionality and necessity when considering vaccine mandates. We conclude by claiming that if future pandemics necessitate the imposition of vaccine mandates, then those seeking to justify them should clearly articulate the relevance (and the evidence) for the comparative protection of vaccine-induced, natural, and hybrid immunity.

Reassessing reverse triage in future conflict.

Future warfare will likely involve near-peer or peer-peer conflict in which there is a great risk of mass casualty scenarios. Because of anti-access and area denial, air superiority will not be guaranteed, which will hamper rapid evacuation of casualties as well as resupply. Under such circumstances, military medical personnel may be forced, due to the constraints of the battlefield and tactical necessity to return servicemembers to duty, to implement reverse triage in which servicemembers with less severe injuries are treated first. However, reverse triage is potentially incongruent with international humanitarian law. Furthermore, should reverse triage need to be implemented, from the extant military doctrine it is not certain when this would be appropriate or the steps that might be followed, which highlight the gaps that exist before reverse triage should be considered as military doctrine on the battlefield. Lastly, we question the psychological impact that reverse triage could portend on military medical personnel, unit morale and unit cohesion. While there have been recent recommendations that reverse triage might need to be implemented in a near-term future conflict, these issues linger. It is time for Western militaries to assess the merits of reverse triage and the potential drawbacks.

Moral courage of emergency nurses in care-limited environments: A mixed-methods study.

BACKGROUND: Professional ethics in nursing exist to guide care and allow for decision-making to be patient-centered. In the current medicolegal landscape post-Roe and in light of bans on gender-affirming care, the decision-making processes of emergency nurses in the clinical environment of care as informed by both professional and personal ethics are an important area of inquiry. AIM: The aim of this study was to examine the contribution of moral courage to decision-making by emergency nurses. RESEARCH DESIGN: A mixed-methods exploratory sequential approach was used, using a standard demographics form and the Nurses Moral Courage Scale to collect quantitative data. These data were used to inform an interview guide for qualitative data collection. Situational analysis was used to analyze the interview data. ETHICAL CONSIDERATIONS: Prior to recruitment, this study was reviewed and approved by the University of Massachusetts IRB (#00003909). Participants were provided with an informed consent document at the time of registration and at the time of interview; participants provided both signed consent and verbal assent. Participants were assigned study codes to maintain anonymity and data were maintained in a secure University cloud. PARTICIPANTS AND RESEARCH CONTEXT: US-based emergency nurses working in environments with care limitations. RESULTS: 70% of respondents reported that they would speak up if they were aware of a situation that was ethically challenging. Respondents reported that it was fairly easy or very easy to defend their values when addressing ancillary staff, coworkers, authorities outside the organization, patients, and patient families. Respondents reported challenges in defending their professional values to charge nurses, physicians, or administrators. In response to a serious ethical problem, 65.8% of respondents answered that they would bring up the problem for discussion, 21.1% would file an internal report, and 13.2% would report externally. Interview participants reported significant social and professional barriers to acting in response to an ethical violation. Willingness to act centered on personal values and not professional codes of ethics. CONCLUSIONS: While emergency nurses in this study reported high perceived levels of moral courage, they also reported low willingness to act directly, citing burnout and significant social and professional barriers. Adherence to professional codes of ethics is not the primary driver of moral courage.

An ethical assessment of powered exoskeletons: Implications from clinical use to industry and military contexts.

Exoskeletons are technologies that can help to increase or improve mobility, dexterity, and strength. They can be used as assistive devices, to restore lost affordances, or for rehabilitation. While mechanical exoskeletons are passive and rely on the body's power for movement, powered exoskeletons are active mechanical systems that can assist or enhance a user's capacity, including in strength and performance. They also offer scope to augment or enhance beyond simple medical support, with potential in the future for superhuman power and strength. While these technologies present promising clinical opportunities, including for those who want to regain walking capacity, they also bring ethical questions, such as about data privacy and accessibility. In addition, the physical features of the technology can prove mentally, physically, and financially demanding, and may be deployed in contexts where user choice and autonomy is constrained. In this article, we discuss these issues, and raise some pertinent ethical questions, not all of which can be easily answered. We touch upon medical and therapeutic uses, for industrial and workplace settings, and in military contexts specially, given these are contexts where such technology may be required or even imposed. We argue that reasonable optimism for such technologies needs to be tempered by sufficient ethical assessment to identify and address barriers to research, development, and use. As well as managing any impacts and expectations for the health and wellbeing of users, the potential impact on autonomy and the risk of coercion, we have to consider what kind of data may be recorded or used, and the risk that these technologies could exacerbate existing inequalities or harms.

[Palliative neurology]. / Palliativneurologie.

Palliative medicine represents the holistic multiprofessional treatment of severely and incurably ill people and their relatives, addressing their complex physical, psychological, social and spiritual needs. The central therapeutic goals are the quality of life and alleviation of suffering. In the course of many neurological diseases, high symptom burden, long and variable trajectories and unfavorable prognosis at times create a need for palliative care even at an early stage, which is currently still inadequately met. This can be countered by qualified neuropalliative care. In addition to intensifying interdisciplinary collaboration, this requires neurologists to have core competencies in palliative care. These include a team-oriented attitude, communication skills, expertise in symptom control and knowledge of biomedical ethics including palliative options at the end of life.

Current status and future of genomics in fetal and maternal medicine: A scientific review commissioned by European Board and College of Obstetrics and Gynaecology (EBCOG).

This EBCOG guidance reviews the current and future status of genomics within fetal and maternal medicine. This document addresses the clinical uses of genetic testing in both screening and diagnostic testing prenatally. The role of genomics within fetal and maternal medicine is described. The research and future implications of genetic testing as well as the educational, ethical and economic implications of genomics are discussed.

Educational approach for public health ethics in nursing: Focusing on COVID-19.

Background: With the increasing ethical challenges and dilemmas faced by nurses due to various disasters such as COVID-19 worldwide, there is a need for a new public health ethics education curriculum to strengthen competencies for ethical responses in the nursing field. Objectives: This study was aimed to identify the impact of a teaching method utilizing news articles and panel discussion material in the public health ethics education program on nursing students' thinking regarding ethical issues. Design: This was an exploratory study to identify the thinking styles inherent in ethical reflection by analyzing the reflection contents written by nursing students using text mining techniques. Participants: 73 among the students taking a nursing ethics course at a university in Seoul, South Korea, voluntarily participated in this study after providing informed consent. Methods: The public health ethics program was conducted with sessions held once a week for a total of 7 weeks, and reflections written by nursing students were collected as text files during session 5 to 7. In this study, data preprocessing process, keyword analysis, and LDA topic modeling were sequentially conducted utilizing the R program according to the data analysis procedure of text mining techniques. Ethical considerations: This study was conducted under ethics approval from the institution where participants were recruited. Findings and discussion: The results of this study show that the teaching method utilizing news articles enhanced rational ethical deliberation from the cognitive aspect, whereas the teaching method utilizing panel discussion material strengthened the response to emotions on a more internal level. Conclusions: The teaching method utilizing news articles and panel discussion materials in public health ethics education is expected to be mutually complementary and effective, so further studies are recommended.

Impact of Race in Missed Appointments in Pediatric Neurology Resident Clinic at a Large Tertiary Medical Center.

Missed medical appointments are a common problem across specialties. The discontinuity of care leads to unplanned health care utilization, increased costs, and poor health outcomes. Previous studies evaluating pediatric epilepsy have shown significant socioeconomic barriers to care. In several specialties, resident clinic no-show rates are higher than faculty clinics because of socioeconomic barriers. We sought to understand the relationship between race, socioeconomic factors, and missed appointments in a pediatric neurology resident clinic at a large tertiary care hospital. Resident clinic encounters for 1 year were extracted and analyzed for missed appointments, socioeconomic factors, and health care utilization. We found that missed appointments occur for 1 in 5 patients and correlate with socioeconomic factors (eg, income and insurance) and race. Race was a more significant factor than socioeconomic factors for missed appointments. These results provide areas to target and track interventions to improve health outcomes in children in pediatric neurology clinics.

Do ethical views of end-of-life patients' family members impact organ donation decisions?

Background: The relatives of patients who decide to donate their loved one's organs experience dilemmas about organ donation and are affected by culture, religion, and individual views.Aim: The aim of this study was to determine the relationship between the ethical position and personal characteristics of the family members of the patients receiving end-of-life care and their thoughts about organ donation in Turkey.Research design and participants: The study was completed with 158 family members. For data collection, a personal information form and the Ethics Position Questionnaire were used.Ethical considerations: This study was obtained from the ethics committee of the faculty of medicine in Turkey. It was based on voluntary participation, informed consent, confidentiality, and anonymity.Results: All participants in the study shared the same faith and were Muslims. The idealism and relativism tendencies of the participants tended to be high. The number of children, the participants have, participants' status of waiting for an organ transplant, the view that the clergy and health personnel will increase interest in organ donation were identified as factors associated with idealism tendencies. Participants' status of having children, the number of children participants have, participants' status of organ transplant waiting, the view that the health personnel will increase interest in organ donation were identified as factors associated with relativism tendencies (p < 0.0.5).Conclusion: The results of this study demonstrated a relationship between participants' idealism and relativism tendencies, among those with a large number of children, waiting for organ donation, advocating for clergy guidance to increase organ donations, and believing healthcare professionals need not guide to increase organ donations. In light of this finding, it may be recommended to establish a multidisciplinary team, including healthcare professionals and clergy, and to inform the society with accurate information to increase the number of organ donations.