To study Finnish physicians’ attitudes and opinions toward euthanasia and physician-assisted suicide (PAS).

A nationwide cross-sectional study.

An online survey was conducted via the Finnish Medical Association in the autumn of 2023 covering all Finnish physicians.

8857 Finnish physicians answered the survey, yielding a response rate of 31%.

Finnish physicians’ attitudes towards euthanasia and PAS and background factors influencing these attitudes and opinions.

Of the responders, 29% fully agreed and 29% fully disagreed with the statement ‘Euthanasia should be legalised in Finland’, respectively. Fewer responders (18%) fully agreed that physicians should be able to assist a patient in suicide. Factors such as being female and having experience in end-of-life care were associated with disagreement about legalising euthanasia and assistance in suicide. Conversely, having faced a request for euthanasia or PAS was associated with agreeing on legalising euthanasia and assistance in suicide. One out of seven respondents fully agreed that they could practise euthanasia, and one out of six fully agreed that they could assist a patient in suicide if these practices were legal in Finland.

Finnish physicians’ attitudes and opinions towards assistance in dying are highly divided, emphasising the controversy of this challenging subject.

To examine how the WHO and the World Medical Association (WMA) frame bioethical principles and address implementation barriers in their pain management policies, providing insights for global health policy and ethical analysis.

Qualitative content analysis of international policy documents using the Standards for Reporting Qualitative Research to ensure methodological transparency and analytical rigour.

Analysis of publicly available policy documents produced by the WHO and WMA between January 2000 and December 2024.

Documents addressing pain management with ethical content, current and not superseded (n=18 from 314 screened).

18 policy documents were retrieved through relevance screening and analysed with reference to ethical values and systemic constraints using MAXQDA Analytics Pro 2022. Thematic coding identified ethical principles, structural barriers and strategic policy directions shaping global pain management frameworks.

Nine ethical principles underpin global pain management policies, including human rights-based access, professional duty to relieve suffering and equitable care. Seven major barriers, such as regulatory restrictions, educational deficiencies and systemic inequities, hinder implementation. Five policy directions were identified to bridge principles and practice.

WHO and WMA frameworks articulate a shared normative commitment to equitable, safe and person-centred pain management but differ in emphasis between public health and clinical ethics perspectives. Addressing identified structural barriers, integrating biopsychosocial approaches, and promoting culturally sensitive ethical guidance are critical for improving global pain management policies. While international guidelines provide the ethical foundations, achieving equitable global pain care requires coordinated transformation across regulatory, educational and health system domains. The persistent gap between ethical commitments and real-world implementation underscores the urgent need for binding accountability mechanisms, stronger international coordination and systematic approaches to address structural determinants of inequity.

Equity, diversity and inclusion (EDI), patient engagement and shared decision-making are important considerations throughout clinical trials, including the research ethics review stage. Meaningfully integrating these considerations can enhance the relevance and generalisability of trial results and reduce participation barriers among equity-deserving populations. Presently, it is unclear to what extent such guidance is provided at the ethics application stage for clinical trials. This study aimed to report the degree of guidance on EDI, patient engagement and shared decision-making in clinical trial research ethics documents.

This was an embedded mixed methods study conducted in collaboration with Clinical Trials Ontario.

This study analysed research ethics board (REB) forms and templates from 17 institutions across seven provinces in Canada.

15 REB application forms, 9 protocol templates and 17 informed consent document (ICD) templates were assessed for guidance related to EDI, patient engagement and shared decision-making. The Place of residence, Race, ethnicity, culture and language, Occupation, Gender and sex, Religion, Education, Socio-economic status, Social capital (PROGRESS)-Plus framework, International Association for Public Participation Spectrum of Public Participation, Patient-Oriented Research Level of Engagement Tool, Indigenous Research Level of Engagement Tool and shared decision-making standards guided our coding. We engaged with patients and persons with lived experience to inform interpretation, reporting and dissemination.

EDI guidance from 15 ethics application forms and 9 protocol templates predominantly covered the ‘Race, ethnicity, culture, language’ (n=14; 93.3%), ‘Age’ (n=13; 86.7%) and ‘Gender and sex’ (n=12; 80%) categories of PROGRESS-Plus but lacked nuance on diverse gender identities (n=1; 6.7%). Patient engagement guidance mostly covered the ‘inform’ level (n=7; 46.7%) and applying ‘knowledge in practice’ with non-Indigenous (n=7; 46.7%) or Indigenous communities (n=13; 86.7%). All 17 (100%) ICD templates included guidance on information about options, disclosures, key elements, ethical issues and study design. No guidance was available on time-dependent relationships, empowering patients and communities in co-leading trials or providing structured guidance in making trial participation decisions (all n=0; 0%).

We provided a comprehensive view of EDI, patient engagement and shared decision-making guidance in trial ethics applications in Canada. REB guidance may be strengthened in several areas to support the inclusion of equity-deserving populations in trials, meaningful engagement with patients and Indigenous communities and evidence-informed, values-aligned decisions about trial participation.

To synthesise existing qualitative and conceptual literature on the implementation, ethical considerations and policy implications of Medical Assistance in Dying for Mental Disorder as a Sole Underlying Medical Condition (MAiD MD-SUMC) in Canada and internationally.

A qualitative evidence synthesis using a thematic analysis approach. Empirical, conceptual and policy papers addressing MAiD for mental disorders were identified through major databases and grey literature. Studies were thematically analysed to identify recurring ethical, clinical and policy themes related to eligibility, assessment and implementation.

Data was extracted from a systematic search of Medline and Embase for peer-reviewed studies published from 1974 onwards, supplemented by relevant policy documents and legal cases.

Studies were included if they examined MAiD MD-SUMC and explored ethical, legal or clinical considerations or provided stakeholder perspectives. Exclusion criteria included studies focusing solely on non-psychiatric conditions or not published in English.

Two independent reviewers screened, extracted and analysed data using an iterative thematic synthesis approach. Key themes were identified through consensus discussions.

The synthesis identified four major themes: (1) Irremediability and treatment resistance—persistent uncertainty regarding when mental disorders can be considered irremediable. (2) Capacity and vulnerability—ongoing debate about assessing capacity amid fluctuating symptoms and social influences. (3) Ethical and policy considerations—divergent interpretations of autonomy, justice and safeguards highlighting the need for standardised criteria. (4) Public and professional perspectives—public and family support for inclusion, although clinician hesitancy exists.

The evidence supports a thoughtful, structured approach to potential implementation of MAiD MD-SUMC in Canada. Future priorities include refining criteria for irremediability, standardising capacity assessments, addressing disorder-specific complexities and strengthening mental health infrastructure. Continued research, engagement and transparent policy dialogue will be essential to ensure that any expansion of MAiD upholds ethical integrity, protects vulnerable persons and maintains public trust.

We surveyed authors of publications in high-impact psychiatry journals to assess the (1) proportion that disseminated results to study participants or others with lived experience, and, among those who disseminated, (2) methods (eg, email) and (3) tools (eg, plain-language summary) used.

Meta-research review.

PubMed search on 14 December 2022 and emails to study authors for information on dissemination.

Eligible studies collected primary human data and were published in psychiatry journals with 2021 impact factor ≥10.

Study information was extracted by one investigator and validated by a second investigator, with conflicts resolved by consensus, with a third investigator consulted as necessary. We emailed authors approximately 2 years post-publication to ensure sufficient time had passed to share results. We estimated the proportion of authors that may have disseminated results to participants or others with lived experience, assuming that non-respondents (1) did not disseminate, (2) were half as likely to disseminate as respondents or (3) disseminated in the same proportion as respondents.

Of 141 studies, 94 (67%) authors responded. Among respondents, 21 (22%) reported disseminating to study participants, and an additional 9 (10%) reported disseminating lay materials to people with lived experience (total of 30 studies, 32%). Overall, we estimated that 15% (95% CI 10% to 22%) to 23% (95% CI 17% to 30%) of authors may have disseminated results directly to study participants and 21% (95% CI 15% to 29%) to 32% (95% CI 25% to 40%) to participants or others with lived experience. Among the 30 that reported disseminating, the most common methods were sending mail or emails to study participants (17 studies, 57%) and posting on social media (15 studies, 50%). The most common tools were plain-language summaries (22 studies, 73%) and webinars or other meetings (15 studies, 50%).

Dissemination of results to participants in mental health research is uncommon. Funding agencies, ethics committees, journals and academic institutions should support dissemination.

To assess whether emergency physicians prescribe morphine differently for patients with or without sickle cell disease (SCD). Given the difficulty of comparing strictly homogeneous patients in real clinical settings, we used a standardised clinical vignette to ensure that all clinical information was identical except for SCD status and sex.

International, randomised controlled, vignette-based study conducted online. The four vignette versions differed only in patient sex and SCD status, with all other clinical information fully standardised. Vignettes were validated by an expert panel and randomly allocated using a computer-generated sequence.

Emergency physicians practising in France, the UK, Belgium and Switzerland were invited to complete an online survey between 17 February and 17 March 2025.

A total of 1060 physicians responded, of whom 953 (90%) met eligibility criteria and were included in the analysis. Respondents were practising emergency department (ED) physicians without exclusion based on seniority or training level.

The primary outcome was the proportion of simulated patients for whom morphine was prescribed. Secondary outcomes included the number and type of analgesics prescribed and the proportion of cases meeting predefined criteria for maximal level of care (urgent triage category, lactate sampling, CT imaging and morphine administration).

Morphine was prescribed in 444 of 492 (90%) SCD vignettes and 389 of 461 (84%) non-SCD vignettes (absolute difference: 6% (95% CI 1% to 10%)). Morphine monotherapy was used in 41% of SCD cases and combined analgesia in 50%. No significant differences were observed according to patient sex or physician characteristics. Maximal level of care was recommended in 22% of SCD cases.

In this randomised vignette study, emergency physicians prescribed morphine more frequently for simulated patients with SCD than for those without SCD, despite identical clinical presentations. These findings contrast with real-world reports of inadequate analgesia in SCD and suggest that the absence of perceptual cues—such as skin colour or names—may reduce implicit bias in opioid prescribing.

NCT06835335. IRB CHU Nîmes No 25.02.01.

Artificial intelligence (AI) in healthcare often requires large, confidential clinical datasets. However, a recent UK government survey revealed that 20–40% of the public remain sceptical of its use in health research due to concerns about data security, patient–practitioner communication and commercialisation of data. A greater understanding of public attitudes is therefore needed, particularly in the context of stroke research.

In this article, we describe the patient and public involvement work undertaken for the AI-Based-Stroke-Risk-fActor-Classification-and-Treatment (ABSTRACT) project, which aims to train AI models to predict future stroke risk from the electronic health records of 1 18 736 patients.

We aimed to evaluate the opinions of stroke/transient ischaemic attack (TIA) patients, caregivers and members of the public on the following themes: (1) the acceptability of using AI to predict stroke from electronic health records, (2) obtaining these data using an opt-out model of consent and (3) allowing access to this dataset from members both within and outside of the routine clinical care team.

A total of 83 participants were recruited via the National Health Service social media and by approaching hospital inpatients. Participants were first provided with background information on stroke, AI in medical research and ABSTRACT’s proposed data handling protocol. A mixed methods approach was then used to explore each of the above themes using online survey, semistructured focus groups and one-to-one interviews.

Nearly all participants felt that it was appropriate to use patient data to train AI models to predict stroke risk and that it was acceptable to obtain these data via an opt-out model of consent. Almost all participants also agreed that data could be shared within and outside of the routine clinical care team, provided it was General Data Protection Regulation compliant and used for medical research only.

The public and those with lived stroke/TIA experience appeared to support using deidentified medical datasets for AI-driven stroke risk prediction under an opt-out consent model. However, this is provided that the research conducted is transparent, for a clear medical purpose and adheres to strict data security measures.

To examine how clinicians’ scepticism regarding patients’ self-reports of subjective symptoms can be internalised, leading to psychosocial and medical harms.

In-depth, semi-structured qualitative interviews with the resulting data analysed using reflexive thematic analysis.

43 individuals with Ehlers-Danlos syndrome (EDS) from Europe and North America completed a pre-survey, and 39 of those participants completed interviews for this study. Purposive sampling was used to obtain approximately equal numbers of participants with hypermobile EDS and the molecularly defined types of EDS.

Patients with both hypermobile and molecularly defined types of EDS reported high levels of self-doubt, with 73% of survey respondents questioning the extent—and even reality—of their private experiences of pain. Participants attributed much of their self-doubt to repeated dismissal and minimisation of their symptoms in healthcare settings, especially during childhood. Ultimately, self-doubt transformed not merely how they communicated their symptoms but also how they recognised, evaluated and even experienced them at a phenomenological level. While some participants developed coping strategies, others withdrew from the conventional medical system altogether.

These findings have important implications for clinicians, who may inadvertently reinforce self-doubt through discussion of diagnostic uncertainty. Doubt need not be delegitamising. Recognising and mitigating these potential harms requires epistemic humility and attention to the psychosocial dynamics of patient-provider interaction.

The use of data science for health research produces complex ethical, legal and social challenges that traditional ethical oversight mechanisms struggle to address. In Nigeria, the current ethical guidelines were not designed for these challenges which include pervasive data environments, consent for secondary data use, algorithmic decision-making and bias, privacy risks, involvement of commercial entities, data colonisation, inequitable benefit-sharing and commercial data holdings. To address these gaps, we developed a draft guideline incorporating principles like trust, veracity, global justice and alternative ethical approval mechanisms. Here, we describe the protocol for a study aimed at validating the guideline through stakeholder consensus on the content, feasibility and acceptability of this subcode for national implementation.

We describe the use of a modified e-Delphi approach to iteratively synthesize expert opinions about ethical oversight for data science health research (DSHR) led by a multidisciplinary working group from the Bridging Gaps in the ELSI of Data Science Health Research in Nigeria (BridgELSI) team. We will invite 65 experts, including health researchers, ethics committee members, data scientists, health policymakers, funders and key opinion leaders in Nigeria to participate. Participants will rate 13 core principles, including global justice, algorithmic bias, data governance and related governance provisions on importance, desirability for inclusion in national guidelines, feasibility and confidence in implementation, using 5-point Likert scales, with optional free-text comments. We will summarise responses using descriptive statistics, assess consensus and polarity using pre-specified thresholds for the mean and IQR, and iteratively refine statements between rounds using qualitative content analysis of comments.

Ethical approval was obtained from the Nigerian National Health Research Ethics Committee and the University of Maryland IRB, and participants will provide informed consent. Results will be shared with the expert panel and national regulators and disseminated via publications and conferences.

Moral distress is a significant challenge in contemporary nursing practice, posing a substantial threat to nurses’ well-being and patient safety. Nurses in the emergency department are considered a high-risk group for experiencing this distress due to their unique working environment. Although numerous qualitative studies have explored this issue, a systematic synthesis of this fragmented evidence is notably absent. This qualitative meta-synthesis aims to integrate existing evidence to construct a comprehensive conceptual framework of the experiences, processes and coping mechanisms related to moral distress among emergency nurses.

This study will be a qualitative systematic review and meta-synthesis, adhering to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement and the Joanna Briggs Institute (JBI) methodology. A systematic search will be conducted in international and Chinese databases, including PubMed, CINAHL, Embase, CNKI, etc. All peer-reviewed qualitative studies exploring the first-person experiences of emergency nurses will be included. Two independent reviewers will perform study selection, data extraction and methodological quality appraisal using the JBI Critical Appraisal Checklist for Qualitative Research. Data synthesis will employ a theory-integrated meta-aggregation approach, systematically mapping findings onto the Stress, Appraisal, and Coping Theory to construct a nuanced conceptual framework that explains the dynamic process of moral distress. Confidence in the synthesised findings will be assessed using the ConQual approach.

As this study is a secondary analysis of published data, ethical approval is not required. The findings will be disseminated through publication in a peer-reviewed journal and presentations at academic conferences.

CRD420251041396.

The study aims to define the prevalence of Do-Not-Resuscitate (DNR) orders among patients with shock in the emergency department (ED) and explore their impact on clinical management and mortality outcomes.

A retrospective observational cohort study was conducted involving patients presenting to the ED with shock.

An ED in a tertiary hospital in western China.

2001 patients (aged ≥18 years) presenting to the ED with shock from 1 January 2022 to 31 December 2023.

The enrolled patients were divided into DNR (order issued within 24 hours of ED admission)/non-DNR groups. Demographics, vitals, comorbidities, laboratory values, medications and prognoses were obtained from electronic healthcare records. DNR prevalence and its associations with mortality, ICU admission, vasopressor administration and antibiotic administration were assessed via logistic regression.

Compared with patients without DNR orders, patients with DNR orders (n=399 (19.9%)) were older (p

Compared with patients with shock in the ED who did not have DNR status, those with DNR status (prevalence ~20%) had higher in-hospital and 30-day mortality (but most survived) and similar ICU admission and intervention treatments.