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

Western medicine was first introduced to Korea by Christian missionaries and then by the Japanese in the late 19th century without its historical, philosophical, cultural, social, political, and economic values being communicated. Specifically, during the Japanese colonial era, only ideologically ‘degenerated’ medicine was taught to Koreans and the main orthodox stream of medicine was inaccessible. Hence, Korean medical education not only focuses on basic and clinical medicine, but also inherited hierarchical discrimination and structural violence. After Korea's liberation from Japan and the Korean war, the Korean medical education system was predominantly influenced by Americans and the Western medical education system was adopted by Korea beginning in the 1980s. During this time, ethical problems arose in Korean medical society and highlighted a need for medical humanities education to address them. For Korean medical students who are notably lacking humanistic and social culture, medical humanities education should be emphasized in the curriculum. In the Fourth Industrial Revolution, human physicians may only be distinguishable from robot physicians by ethical consciousness; consequentially, the Korean government should invest more of its public funds to develop and establish a medical humanities program in medical colleges. Such an improved medical education system in Korea is expected to foster talented physicians who are also respectable people.
Aptitude ; Asian Continental Ancestry Group ; Clinical Medicine ; Consciousness ; Curriculum ; Discrimination (Psychology) ; Education ; Education, Medical ; Ethics, Medical ; Financial Management ; Humanities ; Humans ; Japan ; Korea ; Korean War ; Missionaries ; Rivers ; Societies, Medical ; Students, Medical ; Violence

In the personalized medicine era, utilizing paraffin blocks in pathology archives for investigating human diseases has come into the limelight. This archived material with clinical data will reduce the research time and could prevent new patient recruitment to obtain tissue for research. However, the clause indicating the necessity of consent from human material providers in the Korean Bioethics and Safety Act has made the Institutional Review Board (IRB) deny permission to use paraffin blocks for research without consent, and alternatively to get the same before starting an experiment. Written consent may be waived off in studies using paraffin blocks with anonymous status or conditions not linked to personal information by applying the paragraph 3, article 16 of the current Bioethics and Safety Act. Also, the IRB should recommend researchers to preserve the blocks as medical records of patients in long-term archives.
Anonyms and Pseudonyms ; Bioethics ; Ethics Committees, Research ; Humans ; Medical Records ; Paraffin ; Pathology ; Patient Selection ; Precision Medicine

Nearly 20 years after the Boramea Hospital case, the act on decisions on life-sustaining treatment for patients in hospice and palliative care or at the end of life has taken effect on February 4, 2018 as recommended by the National Bioethics Committee. However, during the legislation process, some parts of the bill that stakeholders and concerned parties did not see eye to eye were either revised or removed. Moreover, the hospice and palliative care part was added in the last minute before the enactment. As a result, the law includes parts that are not in line with the recommendations from the National Bioethics Committee, thereby causing various problems. Therefore, it is crucial to monitor how the decisions on life-sustaining treatments are made in the field and gather various opinions of concerned parties to identify and address problems in the early stage of the implementation of the law. Based on the data, the legislation must be amended to fulfill its purpose that is “to protect the dignity and value of human beings by assuring the best interests of the patients and by respecting their self-determination”.
Bioethics ; Decision Making ; Hospices ; Humans ; Jurisprudence ; Life Support Care ; Palliative Care

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