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

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

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

PURPOSE: This study tried to understand discourses of life-sustaining treatments in general daily and healthcare newspapers. METHODS: A text-network analysis was conducted using the NetMiner program. Firstly, 572 articles from 11 daily newspapers and 258 articles from 8 healthcare newspapers were collected, which were published from August 2013 to October 2016. Secondly, keywords (semantic morphemes) were extracted from the articles and rearranged by removing stop-words, refining similar words, excluding non-relevant words, and defining meaningful phrases. Finally, co-occurrence matrices of the keywords with a frequency of 30 times or higher were developed and statistical measures—indices of degree and betweenness centrality, ego-networks, and clustering—were obtained. RESULTS: In the general daily and healthcare newspapers, the top eight core keywords were common: “patients,” “death,” “LST (life-sustaining treatments),” “hospice palliative care,” “hospitals,” “family,” “opinion,” and “withdrawal.” There were also common subtopics shared by the general daily and healthcare newspapers: withdrawal of LST, hospice palliative care, National Bioethics Review Committee, and self-determination and proxy decision of patients and family. Additionally, the general daily newspapers included diverse social interest or events like well-dying, euthanasia, and the death of farmer Baek Nam-ki, whereas the healthcare newspapers discussed problems of the relevant laws, and insufficient infrastructure and low reimbursement for hospice-palliative care. CONCLUSION: The discourse that withdrawal of futile LST should be allowed according to the patient's will was consistent in the newspapers. Given that newspaper articles influence knowledge and attitudes of the public, RNs are recommended to participate actively in public communication on LST.
Advisory Committees ; Bioethics ; Delivery of Health Care ; Euthanasia ; Farmers ; Hospice and Palliative Care Nursing ; Hospice Care ; Hospices ; Humans ; Jurisprudence ; Life Support Care ; Palliative Care ; Periodicals ; Proxy ; Semantics

PURPOSE: This study aims to determine the bioethical subjectivity of nursing students with experience volunteering in elderly care facilities, and the characteristics that comprise the types thereof. METHODS: Q methodology, which analyzes the subjectivity of each type, was used. The 37 selected Q statements from 32 participants were classified into the shape of a normal distribution using a 9-point scale. The collected data were analyzed using the PC-QUANL program. RESULTS: The survey revealed that the bioethical subjectivity of nursing students with experience volunteering in elderly care facilities can be divided into three types: a rational dignity emphasis, an autonomous right to life belief, and conflict avoidance. All three attitudes regard human beings as possessing dignity, and life and death as elements to be experienced as aspects of human life. Bioethical values are critical to treatment and care; however, it is sometimes also held that humans have the right to commit suicide. CONCLUSION: This study enhanced our awareness of nursing students' bioethics. The findings can be used as a basis for the design of differentiated bioethics education according to each type of bioethical subjectivity. This calls for diverse research on bioethics and the implementation of effective bioethics education.
Aged ; Bioethics ; Education ; Humans ; Nursing ; Students, Nursing ; Suicide ; Value of Life

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

PURPOSE: The purpose of this study was to identify how nursing students' awareness of biomedical ethics and ethical values affect their attitudes towards a do-not-resuscitate (DNR) order. METHODS: This cross-sectional correlation study was conducted with 275 nursing students enrolled at two universities in North Chungcheong Province and North Gyeongsang Province of South Korea. Data were collected in April 2017 using a self-reported questionnaire. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficient and stepwise multiple regression with the SPSS/WIN 23.0 program. RESULTS: The students' attitudes towards DNR were positively correlated with attitudes that seek ethical values but negatively correlated with their biomedical ethics awareness. The explained variance for attitudes towards DNR was 20%, which was significant (F=13.01, P < 0.001). CONCLUSION: These findings suggest that nursing students' biomedical ethics awareness and ethical values were associated with their attitudes towards DNR. Curriculum organization and various educational programs should be developed and applied to help nursing students develop ethical values and awareness of biomedical ethics.
Bioethics* ; Curriculum ; Ethics ; Humans ; Korea ; Nursing* ; Resuscitation Orders ; Statistics as Topic ; Students, Nursing*