BACKGROUND: Clinical ethics consultants support mental health professionals in identifying and analyzing moral problems in clinical practice.
OBJECTIVE: Presentation of key ethical concepts and normative theories that are relevant for clinical ethics consultation in mental healthcare.
METHODS: Conceptual and ethical analyses.
RESULTS: After distinguishing between morality, ethics and law, moral problems are differentiated from other types of problems encountered in clinical practice. Subsequently, key ethical concepts and the concept of moral distress are clarified. In relation to the normative framework a distinction is made between philosophical ethical theories and medical ethical theories, such as principlism and the ethics of care. Finally, justification tests for ethical decision-making in situations of danger to self or others based on the harm principle and soft paternalism are proposed.
CONCLUSIONS: Knowledge of key ethical concepts and normative theories is important for the identification and analysis of moral problems in mental healthcare and should be given greater weight in the training of clinical ethics consultants.
UNASSIGNED: HINTERGRUND: Im Rahmen klinischer Ethikberatung unterstützen Ethikberater*innen im Gesundheitswesen Professionelle in der Psychiatrie dabei, moralische Probleme zu identifizieren und zu analysieren.
UNASSIGNED: Darstellung von zentralen ethischen Grundbegriffen und Begründungsansätzen, die für die klinische Ethikberatung in der Psychiatrie von Relevanz sind.
METHODS: Konzeptionelle und ethische Analyse.
UNASSIGNED: Nach einer Unterscheidung von Moral, Ethik und Recht werden moralische von anderen Problemen abgegrenzt. Im Anschluss werden ethische Grundbegriffe geklärt und das Konzept des moralischen Stresses vorgestellt. Im Hinblick auf ethische Begründungsansätze werden philosophische ethische Theorien von medizinethischen Theorien, wie der Prinzipienethik und der Care-Ethik, abgegrenzt. Abschließend werden Rechtfertigungstests auf Grundlage des Schadensprinzips und des schwachen Paternalismus zur ethischen Entscheidungsfindung in Situationen von Eigen- oder Fremdgefährdung erläutert.
CONCLUSIONS: Die Kenntnis ethischer Grundbegriffe und Begründungsansätze ist wichtig für die Identifikation und Analyse moralischer Probleme in der Psychiatrie und sollte in der Ausbildung von Ethikberater*innen im Gesundheitswesen stärker vermittelt werden.

OBJECTIVE: Germline DNA sequencing is increasingly used within pediatric oncology, yet parental experiences remain underexplored.
METHODS: Parents of children undergoing cancer predisposition gene panel sequencing (143 genes) were surveyed before and after disclosure of results. Questionnaires assessed knowledge, expectations, worries, satisfaction, and regret. Next to descriptives, linear mixed models and generalized mixed models were utilized to explore factors associated with knowledge and worries.
RESULTS: Out of 325 eligible families, 310 parents (176 mothers and 128 fathers of 188 families) completed all after-consent questionnaires whereas 260 parents (150 mothers and 110 fathers of 181 families) completed all after disclosure questionnaires. Most parents hoped their participation would benefit others, although individual hopes were also common. Sequencing-related worries were common, particularly concerning whether their child would get cancer again, cancer risks for family members and psychosocial implications of testing. Parental satisfaction after disclosure was high and regret scores were low. Lower education was associated with lower knowledge levels, whereas foreign-born parents were at increased risk of experiencing worries.
CONCLUSIONS: Germline sequencing of children with cancer is generally well received by their parents. However, careful genetic counseling is essential to ensure that parents are adequately informed and supported throughout the process.

Head and neck cancer is a potentially traumatizing disease with the potential to impact many of the functions which are core to human life: eating, drinking, breathing, and speaking. Patients with head and neck cancer are disproportionately impacted by socioeconomic challenges, social stigma, and difficult decisions about treatment approaches. Herein, the authors review foundational ethical principles and frameworks to guide care of these patients. The authors discuss specific challenges including shared decision-making and advance care planning. The authors further discuss palliative care with a discussion of the role of surgery as a component of palliation.

BACKGROUND: In the years to come, artificial intelligence will become an indispensable tool in medical practice. The digital transformation will undoubtedly affect today\'s medical students. This study focuses on trust from the perspective of three groups of medical students - students from Croatia, students from Slovakia, and international students studying in Slovakia.
METHODS: A paper-pen survey was conducted using a non-probabilistic convenience sample. In the second half of 2022, 1715 students were surveyed at five faculties in Croatia and three in Slovakia.
RESULTS: Specifically, 38.2% of students indicated familiarity with the concept of AI, while 44.8% believed they would use AI in the future. Patient readiness for the implementation of technologies was mostly assessed as being low. More than half of the students, 59.1%, believe that the implementation of digital technology (AI) will negatively impact the patient-physician relationship and 51,3% of students believe that patients will trust physicians less. The least agreement with the statement was observed among international students, while a higher agreement was expressed by Slovak and Croatian students 40.9% of Croatian students believe that users do not trust the healthcare system, 56.9% of Slovak students agree with this view, while only 17.3% of international students share this opinion. The ability to explain to patients how AI works if they were asked was statistically significantly different for the different student groups, international students expressed the lowest agreement, while the Slovak and Croatian students showed a higher agreement.
CONCLUSIONS: This study provides insight into medical students\' attitudes from Croatia, Slovakia, and international students regarding the role of artificial intelligence (AI) in the future healthcare system, with a particular emphasis on the concept of trust. A notable difference was observed between the three groups of students, with international students differing from their Croatian and Slovak colleagues. This study also highlights the importance of integrating AI topics into the medical curriculum, taking into account national social & cultural specificities that could negatively impact AI implementation if not carefully addressed.

BACKGROUND: The patient\'s right to refuse pacemaker therapy is mentioned in the relevant European consensus statement but additional information is only available on deactivation of implantable cardioverter deactivator and not on other cardiac implantable electronic devices such as pacemakers. Therefore, we were interested in opinions, concerns and attitudes of cardiologists, who are the primary contact persons for such requests, since the number of patients asking for withdrawal of pacemaker therapy is likely to increase leaving cardiologists and healthcare professionals with a difficult medical but also ethical problem.
METHODS: An anonymous questionnaire was sent to all German cardiology departments (N = 288).
RESULTS: 48% of cardiology departments responded by sending back 247 completed questionnaires. Most participating cardiologists were experienced when considering the duration of their professional activity. Almost all of the respondents regularly perform check-ups of pacemakers. The majority of cardiologists answering our questionnaire were prepared to deactivate a pacemaker upon patients\' request, and have done so. In pacemaker dependency, however, the willingness to withdraw decreases, even if death is imminent, for fear of causing distressing symptoms, sense of being responsible for patients possible immediate death, or fear of legal consequences.
CONCLUSIONS: The survey could clearly show that uncertainties remain among cardiologists dealing with a patient\'s wish for withdrawal, especially in cases of pacemaker dependency. We suggest that official statements of cardiologic societies in Europe are issued to clarify ethical, legal and practical aspects of pacemaker withdrawal.
BACKGROUND: Registered in the German Clinical Trials Register (DRKS00026168) on 30.08.2021.

Robotics and artificial intelligence have marked the beginning of a new era in the care and integration of people with disabilities, helping to promote their independence, autonomy and social participation. In this area, bioethical reflection assumes a key role at anthropological, ethical, legal and socio-political levels. However, there is currently a substantial diversity of opinions and ethical arguments, as well as a lack of consensus on the use of assistive robots, while the focus remains predominantly on the usability of products. The article presents a bioethical analysis that highlights the risk arising from using embodied artificial intelligence according to a functionalist model. Failure to recognize disability as the result of a complex interplay between health, personal and situational factors could result in potential damage to the intrinsic dignity of the person and human relations with healthcare workers. Furthermore, the danger of discrimination in accessing these new technologies is highlighted, emphasizing the need for an ethical approach that considers the social and moral implications of implementing embodied AI in the field of rehabilitation.

In this narrative essay, a happenstance encounter with a journal article rekindles the author\'s intense memories of a cardiac resuscitation 25 years earlier during internship. Recollections of observations, emotions, and professional interactions around this event prompt reflection about the painful experiences from training that remain seared into memory and the value of  these formative moments across a professional lifetime.

BACKGROUND: Poor communication about serious injury in older adults can lead to treatment that is inconsistent with patient preferences, create conflict and strain healthcare resources. We developed a communication intervention called Best Case/Worst Case-intensive care unit (ICU) that uses daily scenario planning, that is, a narrative description of plausible futures, to support prognostication and facilitate dialogue among patients, their families and the trauma ICU team. This article describes a protocol for a multisite, randomised, stepped-wedge study to test the effectiveness of the intervention on the quality of communication (QOC) in the ICU.
METHODS: We will follow all patients aged 50 and older admitted to the trauma ICU for 3 or more days after a serious injury at eight high-volume level 1 trauma centres. We aim to survey one family or \'like family\' member per eligible patient 5-7 days following their loved ones\' admission and clinicians providing care in the trauma ICU. Using a stepped-wedge design, we will use permuted block randomisation to assign the timing for each site to begin implementation of the intervention and routine use of the Best Case/Worst Case-ICU tool. We will use a linear mixed-effects model to test the effect of the tool on family-reported QOC (using the QOC scale) as compared with usual care. Secondary outcomes include the effect of the tool on reducing clinician moral distress (using the Measure of Moral Distress for Healthcare Professionals scale) and patients\' length of stay in the ICU.
BACKGROUND: Institutional review board (IRB) approval was granted at the University of Wisconsin, and all study sites ceded review to the primary IRB. We plan to report results in peer-reviewed publications and national meetings.
BACKGROUND: NCT05780918.

Drs. Futatsuka, Eto, and Uchino expressed their opinions in the Journal of the Japanese Society for Hygiene in the form of a review of my book, \"Minamata Disease and the Responsibility of Medicine.\" (The reviewers translated it as \"Responsibility of Medical Authorities,\" but for my purposes in writing this book, I believe it should be translated as \"Responsibility of Medicine.\") The nine major comments of the three reviewers described in this book review were reviewed from the basic perspective of toxicology, epidemiology, and neuroscience. This book review is fraught with either medical, logical, or ethical problems in all the nine points as follows: (1) the inadequate way in which exposure and health hazards are considered from the toxicological perspective, (2) problems in interpreting epidemiological information, (3) the failure to consider recent achievements in methylmercury toxicosis studies, (4) presenting the reviewers\' own theories without regard to the content of my book while calling it a \"book review,\" (5) presenting and criticizing what Takaoka does not claim as if he does, and (6) making claims that are inconsistent with the three reviewers\' own views. The problems with this book review will become even clearer when you read \"Minamata Disease and the Responsibility of Medicine\" itself.

BACKGROUND: Informed decisions to enrol in the clinical investigations of Alzheimer\'s disease and related dementias (ADRD) require careful consideration of complex risks and uncertain benefits. Decisions regarding whether to receive information about biomarker status are complicated by lack of scientific consensus regarding biomarkers as surrogate endpoints for Alzheimer\'s disease and how information about individual risk should be evaluated and shared with research participants. This study aims to establish stakeholder consensus regarding ethically optimal approaches to sharing individual results with ADRD research participants.
METHODS: This Delphi consensus-building study consists of multiple online surveys conducted with Alzheimer\'s disease research experts, including neurologists, neuropsychologists, ethicists, research oversight specialists and clinical trialists. Panellists will be administered questionnaires developed from a synthesis of researcher- and participant-endorsed considerations and decisional needs identified in published literature and a decisional needs assessment conducted with support from an Alzheimer\'s Association Research Grant. Panellists will also be asked their views on the content and implementation of processes for sharing individual research results. ≥75% agreement will be required to achieve consensus. Response rates, level of agreement, medians, interquartile ranges and group rankings will be analysed. Following each round of data collection, our research team will undertake qualitative content analysis of open-ended responses.
BACKGROUND: Ethical approval will be obtained from the Cleveland Clinic Institutional Review Board (Study Number 22-766). Delphi panellists will receive participant information sheets describing the study before agreeing to participate in the Delphi process. Results from the data we anticipate will be generated through this research and will be submitted for peer-reviewed journal publication and presentation at international conferences.