Exploring the Challenges in Palliative Care As Perceived by the Saudi Physicians: A Cross-Sectional Study.

BACKGROUND: Palliative care is essential for managing patients with life-limiting illnesses. In Saudi Arabia, providing effective palliative care is uniquely challenging due to cultural, religious, and social factors. Despite healthcare advancements, there is a gap in understanding the challenges faced by physicians in palliative care within this context. AIMS: This study aimed to explore the challenges encountered in palliative care as perceived by physicians in Riyadh, Saudi Arabia. METHODS: A cross-sectional survey was conducted using an electronic questionnaire distributed among physicians involved in palliative care at the specified healthcare institutions. The questionnaire assessed their perceptions of the challenges in palliative care and the influence of their socio-demographic backgrounds on these perceptions. Data were analyzed using the Statistical Package for the Social Sciences (SPSS). RESULTS: The age distribution of the enrolled physicians showed that a majority were between 20-40 years old (48.48%, n = 96). Male physicians accounted for 64.65% (n = 128), and females for 35.35% (n = 70). Various specialties were represented, with critical care (15.66%, n = 31) and radiation oncology (16.67%, n = 33) being the most common. Major challenges identified included limited outpatient and inpatient services (54.55%, n = 108), restricted access to allied healthcare professionals (60.61%, n = 120), ethical dilemmas due to triaging (63.13%, n = 125), lack of telemedicine facilities (57.07%, n = 113), and the impact of the COVID-19 pandemic on pain and palliative care research (60.1%, n = 119). Strategies adopted to mitigate these challenges included creating triage systems (54.55%, n = 108), using telemedicine (60.61%, n = 120), advanced care planning (63.13%, n = 125), and providing necessary personal protective equipment (PPE) (60.1%, n = 119). CONCLUSION: This study highlights significant barriers in palliative care, such as limited services, ethical dilemmas, and lack of telemedicine facilities. Addressing these challenges requires ethical support for healthcare providers, integration of telemedicine, continuous education, and improved access to multidisciplinary care teams, which are crucial for enhancing palliative care quality and ensuring comprehensive patient support.

Exploration of clinical ethics consultation in Uganda: a case study of Uganda Cancer Institute.

INTRODUCTION: Globally, healthcare providers (HCPs), hospital administrators, patients and their caretakers are increasingly confronted with complex moral, social, cultural, ethical, and legal dilemmas during clinical care. In high-income countries (HICs), formal and informal clinical ethics support services (CESSs) have been used to resolve bioethical conflicts among HCPs, patients, and their families. There is limited evidence about mechanisms used to resolve these issues as well as experiences and perspectives of the stakeholders that utilize them in most African countries including Uganda. METHODS: This phenomenological qualitative study utilized in-depth interviews (IDIs) and focus group discussions (FGDs) to collect data from Uganda Cancer Institute (UCI) staff, patients, and caretakers who were purposively selected. Data was analyzed deductively and inductively yielding themes and sub-themes that were used to develop a codebook. RESULTS: The study revealed there was no formal committee or mechanism dedicated to resolving ethical dilemmas at the UCI. Instead, ethical dilemmas were addressed in six forums: individual consultations, tumor board meetings, morbidity and mortality meetings (MMMs), core management meetings, rewards and sanctions committee meetings, and clinical departmental meetings. Participants expressed apprehension regarding the efficacy of these fora due to their non-ethics related agendas as well as members lacking training in medical ethics and the necessary experience to effectively resolve ethical dilemmas. CONCLUSION: The fora employed at the UCI to address ethical dilemmas were implicit, involving decisions made through various structures without the guidance of personnel well-versed in medical or clinical ethics. There was a strong recommendation from participants to establish a multidisciplinary clinical ethics committee comprising members who are trained, skilled, and experienced in medical and clinical ethics.

The nexus of fertility and politics: exploring the influence of social tolerance, religiosity, and political conservatism on the acceptance of assisted reproduction in Spain.

STUDY QUESTION: How do individual religious, political, and social tolerance orientations influence the acceptance of ART among Spanish citizens? SUMMARY ANSWER: Social tolerance and religiosity are predictive factors for the acceptance of ART, with more tolerant individuals and those with lower levels of religiosity being more accepting of ART; political conservatism mediates the relationship between social tolerance and acceptance of ART, particularly for left-leaning individuals. WHAT IS KNOWN ALREADY: The rapid advancement of ART has raised questions about its societal acceptance, especially in the context of religious, political, and social beliefs. STUDY DESIGN, SIZE, DURATION: The analysis utilized data from the combined Europe Values Study and World Values Survey, comprising cross-sectional national surveys from 1981 to 2021. Each country's population was surveyed a maximum of seven times and a minimum of two times during this period. This study uses the cross-sectional data of 2021. After filtering for Spanish citizens and deleting cases with missing key variables, a sample of 1030 valid responses from Spanish citizens was obtained. Quotas were set for sex, age, and educational level, following guidance from the Spanish Statistics Institute. PARTICIPANTS/MATERIALS, SETTING, METHODS: The study surveyed participants' attitudes towards ART, their religious and political orientations, and collected demographic information. The sample consisted of 51.7% women, most respondents were married or in common-law partnerships, and 61.6% had children. Catholicism was the dominant religion (53.0%) and a majority had completed secondary education (66.2%), with half earning over 1400 euros per month. MAIN RESULTS AND THE ROLE OF CHANCE: Using two linear models to test hypotheses, the study found that social tolerance and religiosity significantly predict acceptance of ART, with more tolerant and less religious individuals being more accepting. Political conservatism mediated the relationship between social tolerance and ART acceptance, particularly among left-leaning individuals. LIMITATIONS, REASONS FOR CAUTION: This study is cross-sectional and based on self-reported data, which may have limitations. Additionally, the findings are based on a Spanish sample and may not be universally applicable. WIDER IMPLICATIONS OF THE FINDINGS: The results have significant implications for policymakers and healthcare professionals in the field of reproductive technologies. They also contribute to public debates on ethical considerations surrounding ART. STUDY FUNDING/COMPETING INTEREST(S): This work was funded by the Mineco-FrontVida Program, Frontiers of Life, Social Change, and Changing Values Around the Beginning and End of Life (grant number PID2019-106882RB-I00), as part of the State Program for Knowledge Generation and Scientific and Technological Strengthening, and the State R&D Program Oriented to the Challenges of Society, 2019, Ministry of Science, Innovation, and Universities of Spain. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. TRIAL REGISTRATION NUMBER: N/A.

Developing an Ethical Perspectives Scale.

Many theories hold that ethical perspectives inform moral judgments, but few such theories have corresponding individual difference scales. The present research aimed to develop an Ethical Perspectives Scale (EPS) reflecting specifically the five-perspective Markkula framework: utilitarianism; rights; fairness/justice; common good; and virtue. The authors wrote and progressively revised five sets of three items, each set intended to represent one and only one Markkula perspective, before obtaining responses from the present convenience sample (n = 621; 463 female, 157 male, 1 unspecified; Mage = 19.13, SD = 1.44) of university students. Kaiser-Meyer-Olkin (KMO = 0.867) and Bartlett's sphericity tests (χ2 = 3211.5, p < .001) showed that the data were suitable for factor analysis. An EFA with Direct Oblimin rotation yielded a five-factor structure corresponding to the five Markkula perspectives. A CFA yielded satisfactory indices of fit (χ2(80) = 92.81, p = .155, CFI = 0.991, TLI = 0.989, SRMR = 0.039, RMSEA = 0.023, HI90 ≤ .001, and LO90 = 0.041). The five subscales displayed satisfactory internal consistency (M subscale α = .76). Responses from a separate student sample (n = 148) yielded satisfactory three-week test-retest reliability (M subscale r = .72). EPS sub-scales significantly predicted evaluations of contemporary moral dilemma decisions that involved drug legalization, free speech, and pandemic restrictions. The results were interpreted as promising first steps toward an EPS useful for future research and application.

Moral Distress and its Impact on Healthcare Workers in a European NICU.

In a qualitative study of 15 NICU workers in a large European NICU, the author asks the subjects to consider what sorts of work environments are likely to result in moral distress and whether support by colleagues, administrators, the institution itself and even perceived societal support may reduce some kinds of moral distress. The majority of providers felt that the support of colleagues was essential; there was some disagreement about whether the larger community was aware of the nature of the work done in NICUs by health workers. These healthcare providers were also asked about memorable patient encounters.

Navigating moral and ethical dilemmas in digital transformation processes within healthcare organizations.

Objective: Healthcare systems around the world face a turbulent and unstable global and local ecosystem that changes daily and impacts the healthcare organization and its workforce. This challenging environment, coupled with economic pressures, is forcing healthcare systems to change and adopt strategic and technological processes to adapt to change at all levels of the system (macro-holistic multi-systemic, mezzo-organizational, and micro-personal). Methods: In this study, through 32 in-depth, semi-structured interviews with healthcare professionals working in public general hospitals in central Israel, we examined, mapped, and highlighted the conflicts and moral dilemmas they have faced in recent years, alongside the processes of strategic, technological, and digital changes that the healthcare system has undergone. Results: The findings from both a categorical-deductive approach and an inductive approach analysis reveals four main themes: innovation paradox, quality and treatment conflict, information and knowledge conflict, and personal needs and values. The themes and sub-themes are sorted across the three levels of the healthcare system. Conclusions: These findings represent a wide range of conflicts and moral dilemmas that arise from the implementation of strategic change and digital transformation, adding to the already numerous ethical issues and moral dilemmas in healthcare and bioethics that are associated with three levels of the system. These challenges and moral conflicts can be barriers to implementing the necessary changes, as well as challenging individuals' internal values, potentially leading to burnout and moral distress. Given the importance of this issue and the intensification of change processes over the next few years, it is up to the management and key stakeholders to implement these processes in a way that addresses the conflicts and challenges that health professionals face. Minimizing the level of challenges and moral distress in the health sector will be to the benefit of the system, its workers, and the patients it serves.

Assessing Generative Pretrained Transformers (GPT) in Clinical Decision-Making: Comparative Analysis of GPT-3.5 and GPT-4.

BACKGROUND: Artificial intelligence, particularly chatbot systems, is becoming an instrumental tool in health care, aiding clinical decision-making and patient engagement. OBJECTIVE: This study aims to analyze the performance of ChatGPT-3.5 and ChatGPT-4 in addressing complex clinical and ethical dilemmas, and to illustrate their potential role in health care decision-making while comparing seniors' and residents' ratings, and specific question types. METHODS: A total of 4 specialized physicians formulated 176 real-world clinical questions. A total of 8 senior physicians and residents assessed responses from GPT-3.5 and GPT-4 on a 1-5 scale across 5 categories: accuracy, relevance, clarity, utility, and comprehensiveness. Evaluations were conducted within internal medicine, emergency medicine, and ethics. Comparisons were made globally, between seniors and residents, and across classifications. RESULTS: Both GPT models received high mean scores (4.4, SD 0.8 for GPT-4 and 4.1, SD 1.0 for GPT-3.5). GPT-4 outperformed GPT-3.5 across all rating dimensions, with seniors consistently rating responses higher than residents for both models. Specifically, seniors rated GPT-4 as more beneficial and complete (mean 4.6 vs 4.0 and 4.6 vs 4.1, respectively; P<.001), and GPT-3.5 similarly (mean 4.1 vs 3.7 and 3.9 vs 3.5, respectively; P<.001). Ethical queries received the highest ratings for both models, with mean scores reflecting consistency across accuracy and completeness criteria. Distinctions among question types were significant, particularly for the GPT-4 mean scores in completeness across emergency, internal, and ethical questions (4.2, SD 1.0; 4.3, SD 0.8; and 4.5, SD 0.7, respectively; P<.001), and for GPT-3.5's accuracy, beneficial, and completeness dimensions. CONCLUSIONS: ChatGPT's potential to assist physicians with medical issues is promising, with prospects to enhance diagnostics, treatments, and ethics. While integration into clinical workflows may be valuable, it must complement, not replace, human expertise. Continued research is essential to ensure safe and effective implementation in clinical environments.

Social Workers' Perceptions Regarding Legal Intervention for Older Adults without Significant Cognitive Decline Who Are Abused by Their Adult Child.

Social workers aiding older adults facing abuse from their adult child confront an ethical dilemma: whether to honor autonomy or prevent harm. The study explores how social workers perceive legal intervention against the older adult's will. Twenty-one aging-specialized social workers took part in semi-structured interviews using a vignette. The analysis was conducted inductively, guided by content analysis principles. Two main themes emerged, focusing on the disadvantages and benefits of legal intervention. The findings underscore that combining teleological and deontological considerations could form a foundation for developing decision-making tools to aid social workers in navigating this dilemma effectively.

Moral Dilemmas Regarding Physical Restraints in Intensive Care Units: Understanding Autonomy, Beneficence, Non-Maleficence and Justice in the Use of Physical Restraints.

In intensive care units, patients are often restrained to ensure their safety, with physical restraints being the most commonly used method. However, physical restraints compromises the patient's freedom, health and comfort, and nurses often face moral dilemmas when deciding whether to use physical restraints. This article examines physical restraints through the four universal principles of autonomy, beneficence, non-maleficence and justice. Through these principles, the authors will critically explore whether the physical restraints of patients by nurses is ethical in practice and what moral issues exist. This paper also explores conflicts and moral dilemmas for nurses in this context. Finally, suggestions are made on changes to education and clinical practice.

Reflexive control in emergency medicine.

Emergency physicians (EPs) navigate high-pressure environments, making rapid decisions amidst ambiguity. Their choices are informed by a complex interplay of experience, information, and external forces. While cognitive shortcuts (heuristics) expedite assessments, there are multiple ways they can be subtly manipulated, potentially leading to reflexive control: external actors steering EPs' decisions for their own benefit. Pharmaceutical companies, device manufacturers, and media narratives are among the numerous factors that influence the EPs' information landscape. Using tactics such as selective data dissemination, framing, and financial incentives, these actors can exploit pre-existing cognitive biases like anchoring, confirmation, and availability. This creates fertile ground for reflexive control, where EPs may believe they are acting independently while unknowingly serving the goals of external influencers. The consequences of manipulated decision making can be severe: misdiagnoses, inappropriate treatments, and increased healthcare costs. Ethical dilemmas arise when external pressures conflict with patient well-being. Recognizing these dangers empowers EPs to resist reflexive control through (1) critical thinking: examining information for potential biases and prioritizing evidence-based practices, (2) continuous education: learning about cognitive biases and mitigation strategies, and (3) institutional policies: implementing regulations to reduce external influence and to promote transparency. This vulnerability of emergency medicine decision making highlights the need for awareness, education, and robust ethical frameworks. Understanding reflexive control techniques is crucial for safeguarding patient care and promoting independent, ethical decision making in emergency medicine.

Investigation on the Attitudes and Perspectives of Medical and Nursing Staff About Euthanasia: Data From Four Regional Greek Hospitals.

INTRODUCTION: The good and benefit of the patient are the main drivers of the decisions that health professionals are asked to make. However, the definition of the good and the actions required for benefit are not always simple and self-evident. The intractable ethical dilemma of euthanasia has been the subject of extensive debates over the years, and numerous studies have been carried out in an attempt to record the attitudes and opinions of both health professionals and the general population. METHOD: This research aims to investigate the opinions and perspectives of the medical and nursing staff of the four regional hospitals regarding euthanasia and to detect the factors that advocate for and against it. Two hundred and eighteen medical and nursing staff members from four regional hospitals in Lasithi participated in the research, whose opinions and influencing factors were investigated using a questionnaire consisting of four sections. The first included demographic and general characteristics questions; the second was the Euthanasia Attitude Scale (EAS); the third was the Death Attitude Profile-Revised (DAP-R); and the last was the Daily Spiritual Experience Scale (DSES). The SPSS software version 25.0 (IBM Corp., Armonk, NY) was used to analyse the data. RESULTS: Of the total, 78.0% of the participants were women, with an average sample age of 44.5 years. 65.1% were married, 23.4% were physicians, while 76.6% were nurses. The mean Euthanasia Attitude score (70.89) is moderate, ranging from 30 to 120, with higher scores suggesting more favourable sentiments. Euthanasia was viewed positively by 24.3% of respondents. There was no significant difference in positive attitudes between medical and nursing staff. However, the nursing staff had significantly lower average levels of General Orientation for Euthanasia, for the Role of Healthcare Professionals in Euthanasia, Values & Ethics, or Daily Spiritual Experience, and conversely higher levels of scores on Patients' Rights Issues for Euthanasia or Death Acceptance. CONCLUSIONS: Health professionals were found to have moderate attitudes about euthanasia, with no significant difference between them, as well as moderate degrees of death and everyday spiritual experience. Overall, a more favourable euthanasia attitude was shown to be strongly associated with individuals who were single, divorced, or widowed, with less death acceptance or more neutral acceptance, but not with daily spiritual experience.

Service Allocators' Experiences of Ethical Dilemmas and Strategies in Long-Term Care: A Qualitative Study.

The provision of long-term care services for older adults is characterised by increasing needs and scarce resources, leading to ethical dilemmas. This qualitative study explored the ethical dilemmas experienced by healthcare professionals when allocating long-term care services to older adults and the strategies used to handle ethical dilemmas. Data from semi-structured individual interviews, focus group interviews, and observations of service allocators assessing needs and assigning long-term care services to older adults were analysed using content analysis. The overarching theme was the struggle for safe and equitable service allocation. The identified dilemmas were: (i) Struggles with A Just Allocation of Services due to Limited Time and Trust, (ii) Pressure on Professional Values Concerning Safety and Dignity, and (iii) Difficulties in Prioritising One Group Over Another. The strategies to deal with ethical dilemmas were: (i) Assessing Needs Across the Entire Municipality, (ii) Ensuring Distance to Service Recipients, (iii) Working as a Team, and (iv) Interprofessional Decision-Making. Scarce resources, organisational limitations, and political expectations drive the ethical dilemmas in long-term care service allocation. An open public discussion regarding the acceptable minimum standard of long-term care is needed to reduce the ethical pressure on service allocators.

Physiotherapists' moral distress: Mixed-method study reveals new insights.

BACKGROUND: Moral distress is a well-recognized term for emotional, cognitive, and physical reactions of  professionals, when facing conflicts between perceived obligations and institutional constraints. Though studied across medical roles, limited research exists among physiotherapists. RESEARCH QUESTION: What factors contribute to Moral distress among physiotherapists and how do they cope? OBJECTIVES: To develop and test a multifaceted model of Moral distress and gain an in-depth understanding of the phenomena. RESEARCH DESIGN: A 2017-2022 mixed-methods study: (1) Survey of 407 physiotherapists quantitatively testing a literature-based model analyzing relationships between Moral distress, Moral sensitivity, Locus of control, Self-efficacy, Ethical climate perceptions and demographics, analyzed by descriptive and inferential statistics, multiple comparisons and structural equation modelling (SPSS26, SAS, AMOS); (2) Semi-structured interviews with 21 physiotherapists examining Moral distress experiences using meticulous phenomenological analysis. PARTICIPANTS AND CONTEXT: Israeli physiotherapists from various occupational settings recruited via professional networks. ETHICAL CONSIDERATIONS: The Haifa University Ethics Committee authorized the study. Informed consent was obtained for the anonymous survey and before interviews regarding recording, and quote use. FINDINGS: Quantitative results showed moderately high average Moral distress, significantly higher among women and paediatric physiotherapists, positively correlating with Moral sensitivity. Qualitative findings revealed intense emotions around Moral distress experiences, inner conflicts between care ideals and constraints, and coping strategies like reflective skills. Senior therapists, despite higher self-efficacy and moral sensitivity, still reported persistent high distress. DISCUSSION: Moral distress has complex links with moral sensitivity, self-efficacy, perceived professional autonomy and organizational support. A renewed framework emerged explaining relations between moral distress and personal, professional and organizational factors. CONCLUSIONS: Multidimensional insights help identify Moral distress causes and coping strategies among physiotherapists, advancing theory. Conclusions can shape ethics training programs and competencies.

Exploration of Clinical Ethics Consultation in Uganda: A case study of Uganda Cancer Institute.

Introduction: Globally, healthcare providers (HCPs), hospital administrators, patients and their caretakers are increasingly confronted with complex moral, social, cultural, ethical, and legal dilemmas during clinical care. In high-income countries (HICs), formal and informal clinical ethics support services (CESS) have been used to resolve bioethical conflicts among HCPs, patients, and their families. There is limited evidence of mechanisms used to resolve these issues as well as experiences and perspectives of the stakeholders that utilize them in most African countries including Uganda. Methodology: This qualitative study utilized in-depth-interviews (IDIs) and focus group discussions (FGDs) to collect data from Uganda Cancer Institute (UCI) staff, patients, and caretakers, who were purposively selected. Data was analyzed deductively and inductively yielding themes and sub-themes that were used to develop a codebook. Results: There was no formal committee nor mechanism utilized to resolve ethical dilemmas at the UCI. The study uncovered six fora where ethical dilemmas were addressed: individual consultations, tumor board meetings, morbidity and mortality meetings, core management meetings, rewards and sanctions committee meetings, and clinical departmental meetings. Participants expressed apprehension regarding the efficacy of these fora due to their non-ethics related agendas as well as members lacking training in medical ethics and the necessary experience to effectively resolve ethical dilemmas. Conclusion: The fora employed at the UCI to address ethical dilemmas were implicit, involving decisions made through various structures without the guidance of personnel well-versed in medical or clinical ethics. There was a strong recommendation from participants to establish a multidisciplinary clinical ethics committee comprising members who are trained, skilled, and experienced in medical and clinical ethics.

Is physical restraint unethical and illegal?: a qualitative analysis of Korean written judgments.

BACKGROUND: Physical restraint (PR) is used to ensure the safety of care recipients. However, this causes an ethical dilemma between the autonomy and dignity of the recipients and the provision of effective treatment by health workers. This study aimed to analyze legal and ethical situations related to the use of PR using written judgments. METHODS: This study uses a qualitative retrospective design. Qualitative content analysis was performed on South Korean written judgments. A total of 38 cases from 2015 to 2021 were categorized. The types of court decisions and ethical dilemma situations were examined according to the four principles of bioethics, and the courts' judgments were compared. RESULTS: Written judgments related to PR were classified into three types according to the appropriateness of PR use, the presence or absence of duty of care, and legal negligence. Ethical dilemmas were categorized into three situations depending on whether the four principles of bioethics were followed. The courts' decisions regarding the ethical dilemmas differed depending on the situational factors before and after the use of PR and the conflicting conditions of the ethical principles. CONCLUSIONS: Health workers should consider legal and ethical requirements when determining whether to use PR to provide the care recipient with the necessary treatment.

The Moral Psychology of Artificial Intelligence.

Moral psychology was shaped around three categories of agents and patients: humans, other animals, and supernatural beings. Rapid progress in artificial intelligence has introduced a fourth category for our moral psychology to deal with: intelligent machines. Machines can perform as moral agents, making decisions that affect the outcomes of human patients or solving moral dilemmas without human supervision. Machines can be perceived as moral patients, whose outcomes can be affected by human decisions, with important consequences for human-machine cooperation. Machines can be moral proxies that human agents and patients send as their delegates to moral interactions or use as a disguise in these interactions. Here we review the experimental literature on machines as moral agents, moral patients, and moral proxies, with a focus on recent findings and the open questions that they suggest.

Research on ethical dilemmas in scientific research among medical graduate students / 中国医学伦理学

The ethical dilemma in scientific research exists at all stages of the scientific research activities among medical graduate students， mainly involving conflicts of interest， clinical trials， animal experiments， and the relationship between teachers and students. If medical graduate students are in the ethical dilemma in scientific research for a long time， their research activities will be greatly affected. By discussing the connotation， evaluation tools， current situation， influencing factors， and improvement measures of ethical dilemmas in scientific research， this paper proposed some suggestions， such as comprehensively investigating the influencing factors of ethical dilemmas in scientific research， and formulating targeted improvement measures， with a view to helping medical graduate students identify and get rid of ethical dilemmas in scientific research， and promote the stability of research activities.

A semantic exploration: Nurse ethicist, medical ethicist, or clinical ethicist: Do distinctions matter?

Since the 1960s, it has been recognized that "medical ethics," the area of inquiry about the obligations of practitioners of medicine, is inadequate for capturing and addressing the complexities associated with modern medicine, human health, and wellbeing. Subsequently, a new specialty emerged which involved scholars and professionals from a variety of disciplines who had an interest in healthcare ethics. The name adopted is variously biomedical ethics or bioethics. The practice of bioethics in clinical settings is clinical ethics and its primary aim is to resolve patient care issues and conflicts. Nurses are among these clinical ethicists. They are drawn to the study and practice of bioethics and its applications as way to address the problems encountered in practice. A significant number are among the ranks of clinical ethicists. However, in the role of bio- or clinical ethicist, some retained the title of their original profession, calling themselves nurse ethicists, and some did not. In this article, we explore under which conditions it is permissible or preferable that one retains one's prior profession's nomenclature as a prefix to "ethicist," under which conditions it is not, and why. We emphasize the need for transparency of purpose related to titles and their possible influence on individual and social good.

Health workers' experience of providing second-trimester abortion care in Ethiopia: a qualitative study.

BACKGROUND: Second-trimester abortions are less common than abortions in the first trimester, yet they disproportionately account for a higher burden of abortion-related mortality and morbidity worldwide. Health workers play a crucial role in granting or denying access to these services, yet little is known about their experiences. Ethiopia has been successful in reducing mortality due to unsafe abortion over the past decade, but access to second trimester abortion remains a challenge. The aim of this study is to better understand this issue by exploring the experiences of second-trimester abortion providers working in Addis Ababa, Ethiopia. METHODS: A qualitative study with 13 in-depth semi-structured interviews with 16 health workers directly involved in providing second-trimester abortions, this included obstetrician and gynaecologist specialists and residents, general practitioners, nurses, and midwives. Data was collected at four public hospitals and one non-governmental clinic in Addis Ababa, Ethiopia and analysed using Malterud's text-condensation method. RESULTS: The providers recognized the critical need for second-trimester abortion services and were motivated by their empathy towards women who often sought care late due to marginalisation and poverty making it difficult to access abortion before the second trimester. However, service provision was challenging according to the providers, and barriers like lack of access to essential drugs and equipment, few providers willing to conduct abortions late in pregnancy and unclear guidelines were commonly experienced. This led to highly demanding working conditions. The providers experienced ethical dilemmas pertaining to the possible viability of the fetus and women desperately requesting the service after the legal limit. CONCLUSIONS: Second-trimester abortion providers faced severe barriers and ethical dilemmas pushing their moral threshold and medical risk-taking in efforts to deliver second-trimester abortions to vulnerable women in need of the service. Effort is needed to minimize health system barriers and improve guidelines and support for second-trimester abortion providers in order to increase access and quality of second-trimester abortion services in Ethiopia. The barriers forcing women into second trimester abortions also need to be addressed.