Knowledge, attitudes, and practices of the ethics in medical research among Moroccan interns and resident physicians.

BACKGROUND: In Morocco, medical research ethics training was integrated into the medical curriculum during the 2015 reform. In the same year, a law on medical research ethics was enacted to protect individuals participating in medical research. These improvements, whether in the reform or in the enactment of the law, could positively impact the knowledge of these researchers and, consequently, their attitudes and practices regarding medical research ethics. The main objective of this work is to assess Moroccan physicians' knowledge, attitudes, and practices at the beginning of their careers (interns and residents) in medical research ethics. PATIENTS AND METHODS: This is a multicenter cross-sectional study conducted in 2021 among Moroccan physicians. Three scores were created and validated to assess physicians' level of knowledge, attitudes, and practices regarding research ethics. A descriptive analysis was carried out, followed by a univariate analysis and a multivariate analysis using multivariate binary logistic regression to study the factors associated with the different calculated scores. RESULTS: A total of 924 physicians were included in the study, with an average age of 27.8 ± 2.2 years. 40.7% had a high medical research ethics knowledge score, and 68.8% had good attitudes. These two scores were positively associated with age and were statistically higher in residents and in physicians who had received training in medical research ethics during their medical curriculum. Only 29,9% of physicians who had participated in research studies had adequate practices with medical research ethics. This score was statistically higher in residents and in physicians who had heard about research ethics. CONCLUSION: A genuine introduction to ethics in the medical curriculum is essential to enhance researchers' knowledge, attitudes, and practices. This, in turn, can lead to an increase in both the quantity and quality of research conducted in Morocco.

Development of a Medical Social Media Ethics Scale and Assessment of #IRad, #CardioTwitter, and #MedTwitter Posts: Mixed Methods Study.

BACKGROUND: Social media posts by clinicians are not bound by the same rules as peer-reviewed publications, raising ethical concerns that have not been extensively characterized or quantified. OBJECTIVE: We aim to develop a scale to assess ethical issues on medical social media (SoMe) and use it to determine the prevalence of these issues among posts with 3 different hashtags: #MedTwitter, #IRad, and #CardioTwitter. METHODS: A scale was developed based on previous descriptions of professionalism and validated via semistructured cognitive interviewing with a sample of 11 clinicians and trainees, interrater agreement, and correlation of 100 posts. The final scale assessed social media posts in 6 domains. This was used to analyze 1500 Twitter posts, 500 each from the 3 hashtags. Analysis of posts was limited to original Twitter posts in English made by health care professionals in North America. The prevalence of potential issues was determined using descriptive statistics and compared across hashtags using the Fisher exact and χ2 tests with Yates correction. RESULTS: The final scale was considered reflective of potential ethical issues of SoMe by participants. There was good interrater agreement (Cohen κ=0.620, P<.01) and moderate to strong positive interrater correlation (=0.602, P<.001). The 6 scale domains showed minimal to no interrelation (Cronbach α=0.206). Ethical concerns across all hashtags had a prevalence of 1.5% or less except the conflict of interest concerns on #IRad, which had a prevalence of 3.6% (n=18). Compared to #MedTwitter, posts with specialty-specific hashtags had more patient privacy and conflict of interest concerns. CONCLUSIONS: The SoMe professionalism scale we developed reliably reflects potential ethical issues. Ethical issues on SoMe are rare but important and vary in prevalence across medical communities.

Balance and Change in Forensic Psychiatry.

The practice of forensic psychiatry requires balance; the forensic psychiatrist encounters the need for balance routinely and in a variety of areas. Balance is necessary for sound judgment and objectivity when striving for excellence in the field. It is also necessary to effectively balance a career in forensic psychiatry with one's personal life. The American Academy of Psychiatry and the Law (AAPL) has stressed the virtue of balance in the preamble of its ethics guidelines, noting the importance of balancing competing obligations to the individual and society. Keeping in mind the importance of balance will assist forensic psychiatry with the many challenges of a postinternet era, such as rapidly changing technology, culture, and society. A substantial challenge for forensic psychiatry, now and in the future, involves data overflow and the so-called big data explosion. Information now flows too fast and in such vast amounts that a single individual can no longer keep pace. Balance may be pursued by adapting and leveraging certain skills to confront these challenges more effectively. The current inflection point of rapid technological, social, and cultural change, stresses the importance of balance through teamwork, technology, and prioritizing civil discourse.

Clarifying Human Dignity in Forensic Practice.

The notion of human dignity remains a relatively complex concept that has roots in classical Greek and Roman antiquity and links to religious teachings and Kantian philosophical notions. From the Latin dignitas, human dignity means worth and implies excellence and distinction. Human dignity, also found in 20th century constitutions and international declarations, has been considered in bioethics, general medicine, and psychiatry. The application of dignity to forensic psychiatry practice has received less attention. Through a review of texts in medicine and related fields, such as philosophy and anthropology, we aim to clarify the concept of human dignity and its application in forensic psychiatry practice. We first outline the historical origins of the term. We then consider several varieties of human dignity applied in medical ethics and psychiatry. We review individuals' lived experiences of indignity and dignity's place in forensic practice in different loci. We present recent scholarship related to human dignity and highlight the importance of dignity in forensic practice. Focusing on dignity in evaluator-evaluee and doctor-patient relationships should improve forensic work. Training in dignity-imbued forensic practice should remind us of the human dimensions of those we serve in the forensic arena.

Ética e inteligencia artificial / Ethics and artificial intelligence

La relación entre ética e inteligencia artificial en medicina es un tema crucial y complejo y se encuadra en su contexto más amplio. Así, la ética en inteligencia artificial médica implica asegurar que las tecnologías sean seguras, justas y respeten la privacidad de los pacientes. Esto incluye preocuparse de la precisión de los diagnósticos proporcionados por la inteligencia artificial, la equidad en el tratamiento de pacientes y la protección de los datos personales de salud. Los avances en inteligencia artificial pueden mejorar significativamente la atención médica, desde diagnósticos más precisos hasta tratamientos personalizados. Sin embargo, es esencial que los desarrollos en inteligencia artificial médica se realicen con una consideración ética fuerte, involucrando a los pacientes, profesionales de la salud e inteligencia artificial y especialistas en ética para guiar y supervisar su implementación. Por último, es fundamental la transparencia en los algoritmos de inteligencia artificial y la formación continua para los profesionales médicos. (AU)

The relationship between ethics and artificial intelligence in medicine is a crucial and complex topic that falls within its broader context. Ethics in medical artificial intelligence involves ensuring that technologies are safe, fair, and respect patient privacy. This includes concerns about the accuracy of diagnoses provided by artificial intelligence, fairness in patient treatment, and protection of personal health data. Advances in artificial intelligence can significantly improve healthcare, from more accurate diagnoses to personalized treatments. However, it is essential that developments in medical artificial intelligence are carried out with strong ethical consideration, involving healthcare professionals, artificial intelligence experts, patients, and ethics specialists to guide and oversee their implementation. Finally, transparency in artificial intelligence algorithms and ongoing training for medical professionals are fundamental. (AU)

La objeción de conciencia en el ámbito sanitario: un equilibrio entre derechos y deberes / L’objecció de consciència en l'àmbit sanitari: un equilibri entre drets i deures / Conscientious objection in the healthcare domain: A balance between rights and responsibilities

La entrada en vigor de la Ley Orgánica 3/2021 sobre eutanasia en España (2021), ha propiciado un debate de relevancia en el ámbito de la bioética, como es el de la objeción de conciencia (OC) de los profesionales de la salud. Ahora bien, a pesar de que la literatura científica ha abordado esta cuestión, lo cierto es que la comprensión de los motivos subyacentes que impulsan a los profesionales a objetar no está del todo clara. Diversos autores han destacado que la OC halla sus fundamentos en creencias personales, ética profesional, aspectos emocionales y dinámicas del propio sistema. A su vez, se ha observado cómo hay posiciones diversas sobre la legitimidad de la OC, generando debates sobre su validez.Los objetivos de este artículo son revisar el concepto objeción de conciencia en el ámbito sanitario; analizar los factores que motivan este derecho; examinar las consecuencias de la OC en la carga asistencial de los profesionales no objetores; y explorar su posible conflicto ético con la justicia distributiva en la atención sanitaria. Por último, se reflexionará sobre la posibilidad de la OC institucional y sus posibles consecuencias en los derechos de pacientes y trabajadores.(AU)

L'entrada en vigor de la Llei Orgànica 3/2021 sobre l'eutanàsia a Espanya (2021) ha suscitat un debat rellevant en l'àmbit de la bioètica, com és el de l’objecció de consciència(OC) dels professionals de la salut. Tanmateix, malgrat que la literatura científica ha abordat aquesta qüestió, és cert que la comprensió dels motius subjacents que impulsen els professionals a objectar no està del tot clara. Diversos autors han destacatque l’OC troba els seus fonaments en creences personals, ètica professional, aspectes emocionals i dinàmiques del propi sistema. Al seu torn, s'ha observat com hi ha posicions diverses sobre la legitimitat de l’OC, generant debats sobre la seva validesa. Els objectius d'aquest article són revisar el concepte d’objecció de consciència en l'àmbit sanitari; analitzar els factors que motiven aquest dret; examinar les repercussions de l’OC en la càrrega assistencial dels professionals no objectors; i explorar el seu possible conflicte ètic amb la justícia distributiva en l'atenció sanitària. Finalment, es reflexionarà sobre la possibilitat de l’OC institucional i les seves possibles repercussions en els drets dels pacients i treballadors.(AU)

The enactment of Organic Law 3/2021 on euthanasia in Spain has sparked a significant debate in the field of bioethics, namely the issue of conscientious objection (CO) among healthcare professionals. However, despite the scientific literature addressing this matter, the understanding of the underlying reasons that drive professionals to object is not entirely clear. Several authors have highlighted that CO is rooted in personal beliefs, professional ethics, emotional aspects, and dynamics within the healthcare system. Simultaneously, there have been varying stances on the legitimacy of CO, leading to debates regarding its validity.The objectives of this article are to review the concept of conscientious objection in the healthcare context, analyze the factors motivating this right, examine the consequences of CO on the workload of non-objecting professionals, and explore its potential ethical conflict with distributive justice in healthcare. Finally, we will reflect on the possibility of institutional CO and its potential implications for the rights of patients and healthcare workers.(AU)

Ethical and Professional Issues Encountered by Fourth-Year Medical Students during a Critical Care Clerkship before and during the COVID-19 Pandemic.

OBJECTIVES: The objective of this study was to describe ethical and professional issues encountered and the ethical and professional values cited by medical students during their critical care clerkship, with a comparison of issues encountered before and during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: In this single-center, retrospective mixed-methods study, two investigators at a midwestern US academic medical center performed qualitative content analysis on reflections written by fourth-year medical students about ethical and professional issues encountered during their critical care rotations between March 2016 and September 2021. We also analyzed the ethical/professional values mentioned in their reflections. Descriptive and inferential (χ2) statistics were performed to examine differences in issues and values cited before and during the pandemic. RESULTS: Respondents highlighted several key themes identified in prior studies, including decision making (64.1%), communication between clinicians and families (52.2%), and justice-related issues (32.1%), as well as interdisciplinary communication (25.7%) and issues related to the role of students in the intensive care unit (6.1%). Six novel subthemes were identified in this group, predominantly related to resource availability and end-of-life care. Of 343 reflections, 69% were written before the pandemic. Analysis of ethical and professional issues before and during COVID were notable for several significant differences, including increased discussion of inadequate tools/supplies/equipment (1.3% before vs 17.6% during, P = 0.005) and/or access to care (3.9% before vs 17.6% during, P = 0.03) and increased concerns about the tension between law and ethics (21.2% before vs 41.2% during, P = 0.028). Primacy of patient welfare (49.8% before vs 47.2% during, P = 0.659) and patient autonomy (51.1% before vs 38.9% during, P = 0.036) were the most commonly cited ethical principles in both time frames, often discussed concurrently and in tension. CONCLUSIONS: Although the COVID-19 pandemic was associated with increased reflection by medical students about resources in the intensive care unit, their perception of ethical issues arising in critical illness remained largely focused on enduring challenges in shared decision-making. These findings should be considered when developing ethics curricula for critical care rotations.

Analyzing the composition of the editorial boards in high-impact medical ethics journals: a survey study.

BACKGROUND: The underrepresentation of scholarly works from low- and middle-income countries (LMICs) in academic literature is a documented concern, attributed partly to editorial biases. This trend, prevalent across various disciplines, has been less explored in the context of medical ethics journals. This study aimed to examine the composition of editorial board members (EBM) in high-impact medical ethics journals and to evaluate the extent of international diversity within these editorial teams. METHODS: This study incorporated an analysis of 16 high-impact medical ethics journals. Information regarding the EBM of these journals was systematically gathered and categorized based on the World Bank's country income classifications. An in-depth examination of the editorial board compositions was then conducted. RESULTS: The study identified 669 EBM across the selected journals. A predominant 89.84% (601) of these members were from high-income countries (HICs), with upper-middle-income countries contributing 7.47% (50) and lower-middle-income countries 2.69% (18). No EBM were associated with low-income countries. A regional breakdown indicated that North America was the most represented area, accounting for 48.88% (327), followed by Europe & Central Asia (27.50%, 184), East Asia & Pacific (13.45%, 90), Latin America & Caribbean (4.63%, 31), Sub-Saharan Africa (4.19%, 28), Middle East & North Africa (0.75%, 5), and South Asia (0.60%, 4). In total, these EBMs hailed from 46 different countries, with the United States representing the largest proportion (43.80%, 293), followed by the United Kingdom (13.15%, 88), Australia (7.92%, 53), Germany (6.73%, 45), and Canada (5.08%, 34). CONCLUSIONS: There is a significant lack of international representation within the EBM of high-impact medical ethics journals. The majority of editors in this field are affiliated with HICs, leading to a severe underrepresentation of LMICs within the editorial boards.

The importance of global bioethics to paediatric health care.

The paradigm of values adopted by the global health community has a palpable, albeit often unseen, impact on patient health care. In this Viewpoint, we investigate an inherent tension in the core values of medical ethics and clinical practice that could explain why paediatric health care faces resource constraints despite compelling economic and societal imperatives to prioritise child health and wellbeing. The dominant narrative in the philosophy of medicine tends to disproportionately underscore values of independence and self-determination, which becomes problematic in the context of paediatric patients, who by their very nature epitomise vulnerability and dependence. A double-jeopardy situation arises when disadvantaged children see their inherent dependence leveraged against them. We illustrate this predicament through specific examples relating to rights and obligations and to autonomy. Alternative value perspectives-communitarianism and relational autonomy-might offer more robust protection for vulnerable children. A shift away from the dominant narrative towards a more explicit and inclusive discussion of values is necessary. Such a shift requires giving a legitimate platform to diverse perspectives, with the presumption that collective moral progress is possible; this endeavour is embodied by global bioethics. Successful implementation of global bioethics, in turn, hinges on close collaboration between practicing clinicians and bioethicists. Taking global bioethics seriously and actively pursuing collaboration could help the global health community achieve more equitable health care.

[ChatGPT: aid to medical ethics decision making?] / ChatGPT: Hilfe bei der medizinethischen Entscheidungsfindung?

BACKGROUND: Physicians have to make countless decisions every day. The medical, ethical and legal aspects are often intertwined and subject to change over time. Involving an ethics committee or arranging an ethical consultation are examples of potential aids to decision making. Whether and how artificial intelligence (AI) and the large language model (LLM) of the company OpenAI (San Francisco, CA, USA), known under the name ChatGPT, can also help and support ethical decision making is increasingly becoming a matter of controversial debate. MATERIAL AND METHODS: Based on a case example, in which a female physician is confronted with ethical and legal issues and presents these to ChatGPT to come up with answers, the first indications of the strengths and weaknesses are ascertained. CONCLUSION: Due to the rapid technical development and access to ever increasing quantities of data, the utilization should be closely observed and evaluated.

The medical licensing assessment will fall short of determining whether a UK medical graduate behaves ethically.

UK medical graduates will soon need to pass the medical licensing assessment, which assesses skills and knowledge in ethics using multiple choice questions (eg single best answer questions) and objective structured clinical examination. However, educational leaders have recognised that these methods lack the sophistication needed to accurately assess medical ethics. The reasons are two-fold. First, there may be a knowledge and practice gap in medical schools when it comes to preparing students for the assessment. To this end, this article shares peer advice about how best to use objective structured clinical examinations and single best answer questions for assessing medical ethics to help prepare students for the medical licensing assessment. Second, the design of the assessment is unlikely to adequately measure graduates' ethical values and behaviour in real world scenarios. Further work is needed to design assessments that are sophisticated enough to examine candidates' ethical reasoning and their actual behaviour.

Teaching medical ethics and medical professionalism in Saudi public and private medical schools.

Medical ethics and professionalism are two essential parts of building up the identity of a competent physician. This study was conducted to determine the nature, content, and methods of medical ethics and professionalism education in Saudi public and private medical schools. It also sought to identify the challenges and obstacles in teaching and assessing medical ethics and professionalism and suggest appropriate changes. A cross-sectional study was carried out in Saudi private and public medical schools. To achieve the study's aim, an assessment tool in the form of a novel self-administered questionnaire was developed, piloted, and then used. A representative from each of the 28 Saudi medical schools participated in the study. Twenty-four (82.1%) responding medical schools have no medical ethics department. Most of the medical schools (64.2%) have 25% or less of their faculty staff who teach ethics holding a qualification in medical ethics. Most schools have a specific course for medical ethics and professionalism (85.7% and 57.1%, respectively). Multiple-choice questioning is the most popular assessment method in medical ethics and professionalism courses (89.3% and 60.7%, respectively). The need for more qualified staff and clear guidelines/resources is a significant drawback to the teaching of medical ethics. Therefore, the study recommends developing national guidelines dedicated to the undergraduate teaching curriculum from which courses would be designed to enhance medical ethics and medical professionalism.