Journal of evaluation in clinical practiceBoris Nikolic
RATIONALE, AIMS AND OBJECTIVE: The maxim primum non nocere ("first, do no harm") remains emblematic of medical ethics, yet much of modern therapeutics accepts foreseeable and sometimes near-certain injury in pursuit of benefit: surgery injures tissue, chemotherapy produces systemic toxicity, and ablation and embolization achieve their effect through controlled destruction. This paper asks how such therapeutic injury is to be ethically understood, and whether non-maleficence still describes the operative morality of clinical practice. METHOD: The paper proceeds by critical conceptual and ethical analysis rather than empirical study, situating the question within the literature that has sought to refine non-maleficence-principlism, the doctrine of double effect, proportionality reasoning, threshold deontology, and the ethics of risk. RESULTS: Contemporary medicine is argued to operate not through literal non-maleficence but through comparative harm management: the selection among competing, foreseeable harms under uncertainty. A distinct and growing class of interventions produces injury that is not a side effect but the therapeutic mechanism itself, a case the inherited frameworks address only obliquely. Comparative harm management is shown to describe the architecture of clinical decision-making rather than to add a further criterion of justification such as proportionality. CONCLUSIONS: Non-maleficence retains a regulative and cautionary value but no longer describes the operational morality of modern medicine. The physician is best understood not as a guarantor of freedom from harm but as a steward of proportionate therapeutic injury under conditions of uncertainty, vulnerability, and competing obligations.
For thirty years, several healthcare systems have been offering medical assistance in dying (MAID) in the form of euthanasia or assisted suicide. This development is transforming medicine's relationship to death. From a legal perspective, MAID does not constitute a right to die, but rather, as a form of conditional decriminalization, an exception to the general prohibition on killing, under certain strict and controlled conditions. Nevertheless, the number of MAID cases and of countries decriminalizing MAID is increasing: what meaning should be given to this development? This shift raises the question of the meaning of death as a "natural fact" or a "voluntary act," a meaning that cannot, in any case, be reduced to its purely biological dimension. Is MAID an exception? Or does it establish new rules that integrate MAID into ordinary medical care? The answer does not belong solely to the medical field, but to ethical choices that resonate with citizens' expectations.
Albert Schweitzer's life integrated theology, philosophy, music, and medicine into a unified ethical commitment to humanity. Awarded the 1952 Nobel Peace Prize, he articulated a moral vision grounded in deep empathy and respect for all living beings. This article examines the developmental, relational, and cultural influences that shaped his life trajectory, including his upbringing in Alsace, formative experiences of privilege and moral sensitivity, and the intellectual impact of philosophical and religious traditions. It traces his transition from a distinguished academic career to the pursuit of medicine and his lifelong humanitarian work in Gabon. Attention is given to the emergence of his ethical framework and its expression through clinical service. Drawing on concepts of narrative identity and generativity, the article situates Schweitzer's life within a redemptive narrative that continues to inform contemporary understandings of the medical vocation. His legacy offers an enduring model for integrating empathy, ethical responsibility, and meaning in clinical practice.
Journal of evaluation in clinical practiceBjørn Hofmann
BACKGROUND: In reducing medical overactivity and healthcare waste, there is much focus on reducing overdiagnosis of disease. Surprisingly, there is little attention on the underdiagnosis of health. OBJECTIVE: This article investigates how avoiding underdiagnosis of health can reduce medical overactivity. METHODS: Conceptual analysis drawing philosophy of medicine and medical ethics is used to address five specific research questions: 1) What is health? 2) What is underdiagnosis? 3) What is underdiagnosis of health? 4) What is the relationship between underdiagnosis of health and overdiagnosis (of disease)? 5) What are the implications of the answers to questions 1-4? RESULTS: Underdiagnosis of health is contingent on the concept of health, e.g. health as wellbeing, capability, homeostasis, well-functioning, sense of coherence, resilience, and ability to realize vital goals. Underdiagnosis is reconceptualized as an epistemic omission that applies as much to health as to disease. On this basis, four types of underdiagnosis of health are identified, three of which are inherently related to overdiagnosis of disease. Unlike overdiagnosis, which is primarily detectable at the population level, underdiagnosis of health can often be identified at the level of the individual clinical encounter. Given the asymmetry of aversion-where omissions are often judged more harshly than commissions-there may be a stronger moral appeal to avoid underdiagnosis of health than to avoid overdiagnosis of disease. However, there are conceptual and practical challenges associated with underdiagnosis of health. CONCLUSION: While acknowledging the many challenges with the concept, focusing on underdiagnosis of health may be a fruitful strategy to mitigate medical overactivity including overdiagnosis of disease.
African journal of reproductive healthShouwei Guo, Juan Yan
This study explores how ideological and political education contributes to equipping medical students with ethical sensitivity in providing adolescent reproductive healthcare. Using a quantitative cross-sectional design, the research surveyed Chinese medical students through a structured questionnaire assessing their exposure to such education, along with measures of ethical competence, empathy, empowerment orientation, and preparedness for care delivery. Data analysis encompassed descriptive statistics, correlation assessments, regression analysis, and mediation modeling. Results indicated a positive link between ideological and political education and enhanced preparedness for adolescent care. Ethical competence, empathy, and empowerment orientation served as mediators in this relationship, with empathy emerging as the most significant mediator. The findings highlight the importance of integrating values-based training into medical curricula to enhance students' readiness for ethical, gender-sensitive, and adolescent-centered care. This approach aligns strongly with the objectives of Sustainable Development Goals 3 and 5.
AbstractDoes the principle of nonmaleficence in medicine need updating? And if so, what should such an updating look like? This article engages with these questions by critically discussing the relation-centered view of nonmaleficence presented by Christopher Crenner and Skylar Bird. It contends that an adequate account of the principle must do two things: It must establish the integrity of the principle as one that is distinct from the more general principle of beneficence, and it must show it to have sufficient content to warrant its inclusion as a fundamental principle in clinical medical ethics. The proposal to focus on relational harms in the medical relationship is a good one, but such a proposal must be integrated into a more comprehensive account of the principle of nonmaleficence. This more comprehensive account relates relational harms to medical professionalism and derives the content of the principle of nonmaleficence from the standards of acceptable medical practice. After clarifying this more comprehensive view of medical nonmaleficence, the article concludes by responding to an important autonomy-based objection to it. This response raises large and difficult questions about the nature and point of medical practice in modern societies.
The Journal of clinical ethicsChris Crenner, Skylar Bird
AbstractThis article argues that the ethical principle of nonmaleficence, to "do no harm," has become conceptually thin. Harm in medical settings is ubiquitous and typically in balance with beneficent intent, making nonmaleficence subsidiary to beneficence. Other independent applications of nonmaleficence have lost some of their original force. We propose to expand the conventional concept of nonmaleficence to add the obligation and the goal to avoid harm to the medical relationship. We offer scenarios demonstrating how connecting nonmaleficence to the ethics of care and relational autonomy helps to address key weaknesses in conventional principlism. We pose these relational obligations in prohibitory form because optimal clinical relationships remain context dependent, varying by setting and condition. In addition, this reframing of nonmaleficence foregrounds the risk of relational harm posed by an increasingly fragmented and compartmentalized medical realm that still relies heavily on trust, open communication, and confidentiality between clinicians and patients.
Philosophy, ethics, and humanities in medicine : PEHMAntonia Sahm
BACKGROUND: Traditional approaches in medical ethics have primarily focused on the consequences of diagnoses, emphasizing their impact on patients' lives, treatment options, and social perception. While this perspective remains indispensable, it is limited in its consideration of the conditions under which diagnostic categories are created and applied. However, understanding these processes is essential, as they shape not only individual patient experiences but also broader social norms and the framework conditions of health systems. METHODS: Drawing on Michel Foucault's work, this paper examines the intersection between epistemic authority and ethics in the production of medical knowledge. Foucault's analyses of medicine reveal how diagnostic practices are not purely objective but are embedded in institutional frameworks that regulate the production and application of medical knowledge. This perspective resonates with recent discussions in medical ethics such as epistemic injustice. However, as these often converge with Foucault's ideas, his work provides a suitable basis for a comprehensive examination of the way in which diagnoses are handled. RESULTS: Diagnoses are not merely neutral descriptions of objective biological phenomena, but emerge from specific epistemic and institutional frameworks that structure medical knowledge. A Foucauldian lens allows for the formulation of critical questions that encourage a shift in perspective, from evaluating only the consequences of diagnoses to interrogating the processes that produce and validate them. This approach highlights the ethical significance of medical epistemology itself and its influence on patient care, social norms, and health governance. CONCLUSIONS: Ethical analysis in medicine must extend beyond the immediate effects of diagnosis. Attention to the production and structuring of medical knowledge is necessary to fully understand how diagnoses influence patients' experiences, shape social expectations, and reinforce systems of power. With the help of a Foucauldian Shift, medical ethics can more comprehensively address the moral dimensions of diagnosis, moving from consequences to the broader conditions that generate them.
JMIR medical educationKarishma R Desai, Anna L Gorsky, Nicole A Zelenski
BACKGROUND: The emergence of AI technology has sparked curiosity regarding the capabilities of large language models (LLMs) in the field of medicine. Minimal research exists regarding the proficiency of various AI models in ethics scenarios, specifically in specialty-based scenarios. OBJECTIVE: This study aimed to compare the performance of GPT-4o and Claude Sonnet 4 on ethics questions with that of medical students and orthopedic residents. METHODS: A total of 200 ethical or legal scenario questions were randomly selected from question banks targeted for third- and fourth-year medical students (UWorld, AMBOSS) and orthopedic residents (OrthoBullets). Questions at the medical student level were exclusively text-based, while resident-level questions included text-based questions accompanied by images. Each question was entered identically into each AI model 3 separate times. If answers varied between trials, the answer provided most frequently by the model was used as the selected answer. RESULTS: GPT-4o correctly answered 140 (70%) of 200 questions, which was similar to the average human test taker score of 71% (~142/200 questions). Claude correctly answered 180 (89%) questions, a score greater than that of human test takers and significantly better than GPT-4o (P<.001). Claude scored significantly higher than GPT-4o in almost all question categories. GPT-4o provided different responses to identically worded trials for 27 (21%) of 130 general questions and 3 (4%) of 70 orthopedic questions (P=.002), while Claude did not have a significant difference in variability between these 2 groups (general: 16/130, 12% vs orthopedic: 3/70, 4%; P=.06). GPT-4o selected the incorrect response for 60 (30%) total questions and chose the incorrect response most commonly selected by humans significantly more frequently on UWorld interpersonal-specific questions (30/40, 75%) than on UWorld all social sciences (27/40, 68%; P=.03). Claude showed no significant difference in the rate of most common incorrect response selection between question categories. CONCLUSIONS: These results suggest that GPT-4o can potentially answer both general and specialty-specific ethical questions with similar proficiency to sample groups of both medical students and orthopedic residents, while Claude AI performs significantly better than both humans and GPT-4o. Variables such as AI model framework and training data may drive the observed difference in performance, but the exact cause cannot be definitively isolated without intentional testing. Therefore, further research is needed to ensure safety by minimizing output variability before integrating AI as a patient-facing resource.
INTRODUCTION: The rapid integration of artificial intelligence (AI) technologies in healthcare, ranging from diagnostic tools to clinical decision support systems, is transforming medical practice and education. However, without deliberate integration of ethics, there is a risk that medical education will reproduce a technosolutionist orientation by privileging efficiency and data-driven outputs over patient autonomy, justice and professional integrity. While AI-related courses are increasingly being introduced into medical curricula, ethical considerations often remain peripheral, with most frameworks emphasising technical skills over moral reasoning. As future clinicians will face complex ethical challenges related to autonomy, safety, bias, transparency and accountability in AI-integrated clinical settings, there is an urgent need to evaluate how ethics is incorporated into AI education. With AI curricula still in their formative stages, this moment presents a critical opportunity to proactively design ethical components, rather than introducing them after harms have emerged. This scoping review aims to systematically map the ethical-technical balance in AI-related medical education curricula, identifying current practices, gaps and opportunities for curriculum development. METHODS AND ANALYSIS: This scoping review will follow the Joanna Briggs Institute methodology and be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. The review will address how ethical considerations are integrated into AI-related curricula in medical education and examine the balance between ethical and technical content. A comprehensive search strategy will be employed across multiple databases, including MEDLINE, Web of Science, Google Scholar, EBSCO, the Virtual Health Library, the Bioethics Literature Database and PhilPapers, as well as grey literature sources such as institutional reports, curricula and policy documents. Publications from January 2020 to December 2025 will be included. Data will be charted and analysed using descriptive qualitative content analysis, followed by a theory-informed interpretive analysis drawing on the hidden curriculum theory of medical education. ETHICS AND DISSEMINATION: This review does not require ethics approval, as it involves analysis of publicly available data. Findings will be disseminated through a peer-reviewed publication and presented at relevant conferences and workshops focused on medical education or bioethics.
Current medical research and opinionDörthe Brüggmann, Doris Klingelhöfer
OBJECTIVE: Medical Ethics integrates scientific approaches from ethics, philosophy, religious studies, history, and sociology into all relevant fields and subdisciplines of medicine, biomedicine, and healthcare. However, there is a lack of detailed analysis of research activity and networking of peer-reviewed research in Medical Ethics. METHODS: Consequently, this study employs established bibliometric methods to examine the chronological, geographical, and thematic patterns of global research, as well as network structures, by analyzing metadata retrieved from the Web of Science. RESULTS: The analysis identified a total of 11,663 articles published in journals in the field of Medical Ethics. The number of articles peaked slightly in 2015 but remained more or less constant otherwise. From a global perspective, the USA was the dominant country in absolute numbers, followed by China and Japan. By contrast, the European countries Sweden, Austria, and Norway were positioned first when the research activity was related to the population size. Large parts of Africa, South Asia, and South America/Caribbean are virtually not present in the global landscape of Medical Ethics research, although these areas offer many open questions. Although a far-reaching, global network has been established, networking primarily takes place among English-speaking countries such as the USA, the UK, Canada, and Australia, while developing countries in particular are underrepresented. CONCLUSIONS: The growth in publication numbers is not as steep as in other fields and is imbalanced from a global viewpoint. Therefore, countries with weaker economies should be systematically encouraged to participate in international research collaborations.
MedEdPORTAL : the journal of teaching and learning resourcesDanielle M Fernandes, Talya Lisker, Shitij Arora, Aaron Hui, Adira Hulkower, Sunit Jariwala, Janice Thomas John
INTRODUCTION: As artificial intelligence (AI) is integrated into health care, it is critical for physicians to understand the ethical foundations of its use in medicine so that they can provide just care to patients and use AI technology to effectively support clinical care. This novel ethics session was designed to provide students with the opportunity to discuss ethical principles related to the use of AI in medicine. METHODS: We designed a case-based small-group session for preclerkship medical students as part of their required bioethics course. Interdisciplinary bioethics faculty facilitated this session. After the session, participants completed a retrospective pre-post survey with questions on a 5-point Likert scale and open-ended questions. RESULTS: One hundred seventy students attended the session, and 94 completed the survey (response rate 55%). Students reported a stronger understanding of the ethical issues surrounding AI use in medicine following the session. Content analysis of narrative responses showed that students valued the opportunity to discuss AI ethics with peers and facilitators. DISCUSSION: Students valued this innovative session and recommended it be repeated in future years. Data from this session demonstrate a self-reported improvement in understanding of core bioethics concepts related to AI use in medicine. This case-based small-group session offers a timely and effective approach for integrating core domains of AI ethics-bias and inequity, data privacy and patient autonomy, and potential harms of AI-into the undergraduate medical school education curriculum, providing students with a foundational understanding as they prepare to use AI throughout their careers.
Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science editionHui Liang, Lei Wang
This article focuses on the legal transformation of medical ethics in China during the new era of socialism with Chinese characteristics, since the 18th National Congress of the Communist Party of China. By employing diachronic review and normative analysis, it systematically presents the internal logic and practical pathways of the field's evolution from fragmented self-regulation to integrated governance. Academically, the discipline has advanced through four stages: theoretical foundation and foreign introduction, practical shift and institutional exploration, critical reflection and systemic optimization, and legal-led, full-coverage advancement. Legally, a refined regulatory system has been established, centered on national laws and supported by specialized review regulations. In governance, a transition from passive response to proactive shaping has been achieved, with ethical review expanding across all domains of life science research, and procedural management and accountability fully incorporated into the rule of law. Looking ahead, it is essential to balance institutional rigidity with practical flexibility, contribute ethical wisdom to the Healthy China initiative, and offer a Chinese solution to global science and technology ethics governance.
BACKGROUND: Oncogeriatrics is a sensitive medical specialty dealing with malignant neoplastic diseases in elderly patients. Ethical challenges have emerged due to both the specific characteristics of the affected population and the severity of the disease. AIM: To report and analyze the ethical issues raised in oncogeriatrics. RESULTS: Oncogeriatrics is an emerging specialty that has developed in response to two major epidemiological observations: the aging population and the increasing number of cancer patients. Assessing these patients using specific scoring tools is essential to identify their particular needs. The unique characteristics of this population give rise to several ethical dilemmas, including end-of-life issues (such as therapeutic obstinacy and euthanasia) and those related to the patient's capacity for discernment and informed consent. The main ethical concerns discussed in this paper include access to care, research, consent and the right to information, and end-of-life issues. Addressing these challenges involves applying the four fundamental principles of medical ethics: respect for autonomy, non-maleficence, beneficence, and justice. CONCLUSION: Adhering to the four principles of ethics provides a framework for managing ethical issues. However, in oncogeriatrics, applying these principles must be carefully evaluated due to the specific characteristics of the elderly population.
Indian journal of medical ethicsDharmendra Kumar Gupta
The practice of classical medicine is grounded in the integration of the best available scientific evidence, clinical expertise, and patient values. While this triad defines evidence-based medicine, a less obvious yet highly consequential aspect of contemporary care is the physician's preference for specific diagnostic laboratories, imaging centres, radiology specialists, or referral institutions for advanced management. This issue merits careful ethical scrutiny, as it encompasses both legitimate clinical judgement and potential conflicts of interest [1].
Perspectives in biology and medicineLainie Friedman Ross
In May 2026, the author was honored to serve as a medical school commencement speaker. It coincided with the 40th anniversary of her own medical school graduation. It was a wonderful opportunity to reflect. The author offered the graduates four insights ("Pearls"): (1) Practicing medicine is a privilege and a responsibility; (2) Physicians must embrace the uncertainty in medicine; (3) Physicians must be open to change; and (4) Every clinical encounter is an ethical encounter. Within each pearl, she emphasized how the graduates can only succeed by being present, expressing curiosity and humility, and by embracing the ethical foundation of the doctor-patient relationship. That is the essence of good doctoring.
The Psychiatric clinics of North AmericaDaniel Cohrs, Awais Aftab
"Critical psychiatry" encompasses a diverse spectrum of critiques challenging foundational assumptions and practices within psychiatry, emphasizing the role of power, relational dynamics, and sociocultural contexts in understanding psychological distress and disability. We provide an overview of these topics relevant to medical ethics. Major themes explored here include critiques of biological reductionism, psychiatric classification and diagnosis, overmedicalization, models of psychopharmacology, iatrogenic harm, institutional corruption, and epistemic injustice. The article advocates for a critical vision of psychiatry that is pluralistic and integrative, recognizing the importance of empirical evidence from natural sciences while emphasizing sociopolitical determinants, pluralism, epistemic humility, and meaningful service-user participation.
South Dakota medicine : the journal of the South Dakota State Medical AssociationJane Clare Joyner, Ann Freeman Cook, Gretchen M Spars, Jerome W Freeman
Medical literature suggests that a shift towards shared decision-making has been ongoing for more than 40 years and has coincided with a transition in medicine from paternalism toward greater patient autonomy in decision making. While many definitions of shared decision-making have been developed, most describe a collaborative process where the physician's medical expertise and the patient's values and goals are considered when evaluating and deciding on treatment options. Patient decision aids and other tools, including ethics consultations, may be used to promote the shared decision-making process. Ongoing challenges for physicians include variation among patients concerning the extent to which the patient wants to participate in making decisions, and shifting patient perspectives on their treatment decisions. The use of the internet, social media and the growth of direct to consumer advertising, as well as the rapidly expanding use of artificial intelligence, may create additional challenges to shared decision-making. Finally, challenges may develop if perspectives are misaligned and the patient requests drugs or treatments that conflict with a physician's personal ethics or deeply held beliefs. Shared decision-making is a fluid process requiring an ongoing commitment and engagement with patients.