Cervical cancer during pregnancy poses a rare and complex clinical and ethical challenge, particularly in low- and middle-income countries such as the Philippines. The dual obligation to preserve maternal life while protecting fetal viability requires a nuanced balance between medical science, ethics, and cultural values.This commentary explores the ethical implications of treating cervical cancer in pregnancy using Intensity Modulated Radiation Therapy (IMRT) at reduced standard radiation volumes, highlighting how medical innovation intersects with the principles of biomedical ethics.

The COVID-19 pandemic has given rise to medical and non-medical issues. One of the subtler, but equally important issues are the ethical ones. Most prominent among these is the ethical dilemma of health care professionals faced with the decision of whether or not they should continue working and serving the country despite the risks. This paper intends to analyze the said bioethical dilemma by first, examining the ethical conundrum and defining its parameters; second, by assessing a previous attempt to arbitrate this issue and in the process, evaluating two different theories in ethics: egoism and Christian ethics; and third, by proposing a more nuanced normative ethical framework to fully understand the moral picture. In the end, the bioethical dilemma of healthcare professionals cannot be completely analyzed using the lens of egoism and Christian ethics as previously asserted by another scholar. A fuller understanding can be reached by using an Aristotelian normative framework as an anchor for analysis. All healthcare professionals want the good. While a dilemma may ensue because of conflict of values (e.g. for work and for safety), Aristotelian ethics subscribes to the need for hitting the mean between two extremes by honing one's practical wisdom and deliberation. Healthcare professionals exercise this faculty in confronting their dilemma.
Bioethics ; COVID-19 ; Philippines ; Health Personnel

PURPOSE: The purpose of this study was to identify nursing students’ knowledge and attitude toward advance directives and factors influencing the attitude. METHODS: A cross-sectional survey design was used and 196 nursing students participated in the study. Data were collected from July 1 to August 30, 2018 using a structured questionnaire which included biomedical ethics, awareness of good death, knowledge and attitude toward advance directives. Data were analyzed using SPSS/WIN 25.0 program with descriptive statistics, t-test, ANOVA, correlation, and multiple regression. RESULTS: The mean score of biomedical ethics, awareness of good death, knowledge and attitude toward advance directives were 2.88±0.59, 3.18±0.48, 7.68±31.32, 31.00±3.09. Factors influencing the attitude toward advance directives were awareness of good death (β=.28, p<.001), intention of writing their advance directives (β=.19, p=.006), the knowledge related to advance directives (β=.15, p=.029). A total of 14% of attitude toward advance directives was explained by awareness of good death, the knowledge related to advance directives, and ntention of writing their advance directives. CONCLUSION: The findings of the study indicate that it is necessary to provide a systemic education program regarding advance directives for nursing students in order to provide knowledge related to advance directives and to help them establish positive attitudes toward advance directives.
Advance Directives ; Bioethics ; Cross-Sectional Studies ; Education ; Humans ; Intention ; Nursing ; Students, Nursing ; Writing

It aimed to present the definition of personal information based on Korean laws that protect personal information and the process of protection of personal information in journal publishing based on the guidelines of the International Committee of Medical Journal Editors and Committee of Publication Ethics. Two Korean laws relate to the protection of personal information in human subject research: the Personal Information Protection Act and the Bioethics and Safety Act. These laws were enacted to prevent the unauthorized use of Koreans’ personal information including medical information. Personal information can be divided into personally identifiable information including resident registration numbers and sensitive information including health information. To protect personal information in journal publishing, institutional review board (IRB) approval and obtaining informed consent from patients is recommended or mandatory in clinical studies. However, retrospective chart reviews may be exempted from IRB approval, while obtaining informed consent is recommended for all case reports. Journal policies may vary with regard to whether a copy of the informed consent form is collected from authors, since the Committee of Publication Ethics guideline does not specifically recommend collecting it. In discussions of adopting clinical data-sharing policies, transfer of data including nonidentifiable personal information to another country is an unresolved issue. Furthermore, a public data repository site should be established in Korea for data to be deposited. To protect subjects’ privacy and to prevent legal issues potentially arising from privacy concerns, editors and publishers should do their best to publish articles with appropriate oversight on subjects’ personal information.
Bioethics ; Computer Security ; Consent Forms ; Ethics ; Ethics Committees, Research ; Humans ; Informed Consent ; Jurisprudence ; Korea ; Personally Identifiable Information ; Privacy ; Publications ; Republic of Korea ; Retrospective Studies

Sperm banking from recruited donors is an important way to help infertile couples who want to achieve pregnancy by therapeutic artificial insemination, even in the era of in vitro fertilization. Korea has the lowest population density of newborns among all Organization for Economic Co-operation and Development countries, with a total fertility rate of 1.17 and an annual birth rate of 300,000 or less as of 2017. This situation emerged due to various causes, including late marriage, fecundity problems, and air pollution. Nevertheless, we have imposed strict limits on basic research and clinical activities, including the operation of sperm banks, in the field of human reproduction under the 2005 Bioethics and Safety Act. Therefore, cryopreserved sperm for artificial insemination is almost absent in the sperm banks of major human reproduction centers. To resolve this difficult situation, as well as to increase the operation of sperm banks in Korea to the global standard level, the author evaluates the underlying reasons for donor sperm use by azoospermic patients from medical, ethical, legal, religious, and cultural perspectives, and then proposes a plan to resolve this situation including highly regulated standard operating procedures to ensure comprehensive safety practices for voluntary sperm donors and infertile couples, as well as to build an ideal sperm donation program.
Air Pollution ; Bioethics ; Birth Rate ; Family Characteristics ; Fertility ; Fertilization in Vitro ; Humans ; Infant, Newborn ; Insemination, Artificial ; Korea ; Marriage ; Population Density ; Pregnancy ; Reproduction ; Sperm Banks ; Spermatozoa ; Tissue Donors

Chapter 9 of the Bioethics Law has several problems due to strict research standards and strong penalties. Therefore, biomedical researchers in Korea have raised several objections to this Law. To make matters worse, the normative power of the Law is significantly diminished because norms and penalties are divergent. Articles 2, 24, 26, 27, 28, and 32 of the Law require amendment because the current regulations on sperm retrieval, sperm management, and sperm use are insufficient. At a minimum, legislation for artificial insemination and in vitro fertilization should be consolidated. It is also necessary for sperm researchers and donors to be notified of their rights and duties. Section 9 of the Bioethics Law should therefore be amended. In particular, its legal formulation should be modified in order to enhance the effectiveness of bioethics law. This is in accord with the spirit of the Constitution. The principle of proportionality should be maintained. The statutory form should be revised to the level of abortion. Not only are the actors in embryo research diverse, including medical personnel, medical institutions, donors, veterans, and mediators, but embryo research involves multiple behavioral aspects, including intentional acts and negligence (violation of state duty). Excessively free-form activity is prescribed. Although the value of life is important, heavy punishment violates human dignity and human values. This legislation should not reflect to be grounded in emotional reactions such as anger.
Anger ; Bioethics ; Constitution and Bylaws ; Embryo Research ; Embryonic Structures ; Fertilization in Vitro ; Humans ; Insemination, Artificial ; Jurisprudence ; Korea ; Malpractice ; Personhood ; Punishment ; Social Control, Formal ; Sperm Retrieval ; Spermatozoa ; Tissue Donors ; Value of Life ; Veterans

Artificial insemination by donor is an important means of improving the likelihood of pregnancy in couples affected by male factor infertility, but it poses medical, legal, and ethical issues due to the involvement of third parties, such as the sperm donor. In Korea, the Bioethics and Safety Act was enacted for the purpose of preventing and eliminating unethical research on germ cells, and such research was limited to matters related to the use of assisted reproductive technologies, centering on embryos, oocytes, and protecting the health of oocyte donors. However, this law is incomplete in terms of specific standards or regulations relating to the donation and receipt of sperm. In Korea, artificial insemination by donor has been carried out without a standard operating protocol for donation and receipt of sperm, which would include testing sperm donors for diseases, limiting the number of donor offspring, compensation for donations, and the role of anonymity and non-anonymity. The diversity of policies worldwide shows that each country has its unique set of guidelines tailored for its own specific needs and practical considerations. Herein, I present a standard operating protocol of medical, legal, and ethical principles for artificial insemination by donor that is suitable for domestic circumstances, along with a comparison of recommendations and guidelines of other countries concerning sperm donation issues.
Anonyms and Pseudonyms ; Bioethics ; Compensation and Redress ; Embryonic Structures ; Ethics ; Family Characteristics ; Germ Cells ; Humans ; Infertility ; Infertility, Male ; Insemination, Artificial ; Jurisprudence ; Korea ; Male ; Oocytes ; Pregnancy ; Reproductive Techniques, Assisted ; Social Control, Formal ; Spermatozoa ; Tissue Donors

PURPOSE: This study was conducted to investigate the differences of the Code of Ethics, level of application of the Code of Ethics and consciousness of biomedical ethics of nurses about clinical practice experience, ethical values and biomedical ethics education experience of nursing students. METHODS: A descriptive research design, t-test and one-way ANOVA were used. The data were collected 1st June to 31st August 2016 from two large cities. The participants were 246 nursing students with a mean age of 22.57 years. Among them, 209 (84.6%) were female, 94 (38.2%) had clinical practice experience, 155 (63.0%) listed their ethical value as different depending on the situation, and 127 (51.6%) had biomedical ethics education experience. RESULTS: The scores were: awareness of the Code of Ethics of Nurses 4.29±0.60; application of the Code of Ethics of Nurses 4.24±0.64; and consciousness of biomedical ethics 2.91±0.19. There were significant differences in application of the Code of Ethics of Nurses (t=−1.97, p=.050); consciousness of biomedical ethics (t=−2.25, p=.025) related to clinical practice experience; and consciousness of biomedical ethics related to biomedical education experience (t=2.67, p=.007). CONCLUSION: Clinical practice and biomedical ethics education experience contributed to enhance the level of application of the Code of Ethics of Nurses and consciousness of biomedical ethics of nursing students.
Bioethics* ; Codes of Ethics* ; Consciousness* ; Education* ; Ethics ; Ethics, Nursing* ; Female ; Humans ; Nursing* ; Research Design ; Students, Nursing

PURPOSE: This study examines the effectiveness of an educational program of nursing biomedical ethics for nursing students to increase awareness of the Code of Ethics for Nurses, moral sensitivity, and application of the Code of Ethics for Nurses. METHODS: A quasi-experimental research design and t-test were used. The experimental group (n=31) and control group (n=32) were second-year university nursing students in two major cities. The experimental group received 15 hours of nursing ethics education during the 15-week semester. The training was not provided to the control group. RESULTS: The application of the Code of Ethics for Nurses increased significantly in the experimental group (t=−1.06, p=.017), nurses and patient (t=−2.23, p=.029), obligation of nurse as an expert (t=−2.08, p=.042), nurse and cooperator (t=−2.54, p=.014). The consciousness of biomedical ethics increased significantly in the experimental group (t=4.28, p=.021), newborn's right to live (t=−2.61, p=.011), euthanasia (t=−2.36, p=.021). CONCLUSION: The results of the study show that providing a nursing biomedical ethics program to nursing students is an effective method to enhance the application of the Code of Ethics for Nurses and Consciousness of Biomedical Ethics. Implementing an intervention program of the Code of Ethics for Nurses in the regular nursing curriculum may reduce conflicts involving ethical decision making by nurses.
Bioethics* ; Codes of Ethics* ; Consciousness* ; Curriculum ; Decision Making ; Education* ; Ethics ; Ethics, Nursing ; Euthanasia ; Humans ; Methods ; Morals ; Nursing* ; Research Design ; Students, Nursing*

PURPOSE: This descriptive study was conducted to examine factors that affect hospital workers in their decision to withdraw from life-sustaining treatment, such as knowledge, attitude, and perception of organ donation, transplantation, death and hospice palliative care. METHODS: A questionnaire was completed by 228 workers of a tertiary general hospital, and data were analyzed using t-test, ANOVA, and Pearson's correlation by using SPSS 21.0. RESULTS: The subjects' knowledge of biomedical ethics awareness differed by age, education level, occupation, affiliated department, and biomedical ethics education. Their knowledge of brain death, organ donation and transplantation was positively correlated with attitudes toward tissue donation and transplantation, knowledge of hospice palliative care, and perception of hospice palliative care. Their attitudes toward tissue donation and transplantation were significantly correlated with knowledge of hospice palliative care, perception of hospice palliative care, and withdrawal of life-sustaining treatment. Their awareness of death was significantly correlated with knowledge of hospice palliative care, perception of hospice palliative care and withdrawal of life-sustaining treatment. The perception of hospice palliative care was significantly correlated with withdrawal of life-sustaining treatment. Factors associated with their withdrawal of life-sustaining treatment were work at the hospice ward (32.5%), attitudes toward tissue donation and transplantation and perception of hospice palliative care. CONCLUSION: This study has shown that work at the hospice ward, attitudes toward tissue donation and transplantation and perception of hospice palliative care were related to attitudes toward withdrawal of life-sustaining treatment. More research is needed to further develop various curriculums based on biomedical methods.
Bioethics ; Brain Death ; Curriculum ; Education ; Hospice Care ; Hospices* ; Hospitals, General* ; Occupations ; Palliative Care ; Tissue and Organ Procurement* ; Transplantation