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A cross-sectional study of genomic knowledge comfort, attitudes, ethical and educational perspectives on precision medicine among medical students in Ecuador.

BACKGROUND: Precision medicine is increasingly transforming clinical practice, yet its effective implementation depends on adequately trained healthcare professionals. OBJECTIVE: This study assessed genomic knowledge comfort, attitudes, ethical perceptions, and educational perspectives regarding precision medicine among medical students in Samborondón, Greater Guayaquil, Ecuador. METHODS: A cross-sectional survey was conducted between August and November 2025 using a structured questionnaire. A total of 340 students participated. Descriptive and inferential statistical analyses, including non-parametric tests and Spearman correlation, were performed. RESULTS: Participants demonstrated relatively high but uneven genomic knowledge comfort (median 81.3%) and positive attitudes toward precision medicine (65.6%), alongside moderate ethical (62.5%) and educational perception scores (68.8%). While students strongly recognized the importance of precision medicine, perceived preparedness remained limited. Lower confidence was observed in advanced topics such as pharmacogenomics and next-generation sequencing. Ethical concerns were more pronounced at the societal level, particularly regarding health inequities, rather than individual risks. Correlation analyses revealed generally weak associations across domains, with only a moderate relationship between ethical and educational perceptions. CONCLUSION: These outcomes highlight a gap between acceptance and readiness, suggesting fragmented competency development. Strengthening curricula through integrated, applied, and context-specific training is essential to support effective implementation of precision medicine in low- and middle-income settings.

Attitudes

Structure of ethics teaching in physical therapy: a survey.

Courses called "Ethics" have long been included in physical therapy education programs. This paper reports the findings of a survey designed to assess current practices in teaching ethics in baccalaureate-level physical therapy programs. Of 59 questionnaires sent, 29 were returned and analyzed. The findings are compared with similar recent surveys of medical and nursing schools. Suggestions are made for assuring that the high standard of teaching maintained in other areas of physical therapy professional preparation also are maintained in ethics teaching.

Curriculum

Ethics in professional nursing practice.

With expanded roles in nursing comes increased responsibility, often without clear authority. Understanding professional ethics and their practical application is essential to professional practice. The authors review the concept of ethics and discuss examples for application of ethical judgment from OGN nursing practice.

Ethics, Nursing

Governmental population incentives: ethical issues at stake.

Governmental incentives to influence population-related decisions are examined in terms of the ethical issues at stake. A typology of incentive schemes is presented, and ethical implications of various incentives are discussed. It is argued that, in a just scheme, a progressive, negative incentive or fee, calculated as a surtax on a modified income tax or an equivalent standard, would distribute burdens equally. A set of guidelines for ethical evaluation of incentive schemes is proposed.

Contraception Behavior

Some ethical considerations in the development of psychopharmacological research and practice in the future.

1. The author sees this issue as philosophical with paradoxical moral overtones. Ethical questions may have an inhibiting effect on drug research. 2. The individual morals and professional ethics of physicians and researchers are seen as central to the conduct of psycho-pharmacotherapeutic research. 3. The effect on ethics of religion, culture and social setting is discussed. 4. Human subjects in drug research are discussed. 5. Control of the drug industry (research, quality control, distribution) is discussed and supra national control advocated.

Ethics, Medical

Medical humanities: an aid to ethical discussions.

'The ethical landscape', the title given to part of a course devised by Mr. Moore, is described in full in this paper. The whole course is a new adventure in medical education designed to help students to explore the ethical problems in the practice of medicine. The 'ethical landscape' is seen through discussion based on passages from literature depicting doctors' and patients' dilemmas. As the results summarized in the tables show, the students found the course well worth while, and thought that they had gained a new insight into the problems with which they would be confronted and also into their own personalities and those of their fellow students whom previously they had only known superficially. The Chairman of the course, Mr. Moore, was also subjected to assessment from his students, because on the skill of the Chairman such a course would fail or succeed.

Australia

The teaching of medical ethics at Southampton University Medical School.

For centuries medical schools in Britain and elsewhere had a fairly static curriculum based on what might be called the 'three Rs' of medicine, and consequently had to make room for new subjects as the need arose in a fashion which was sometimes makeshift. However, Southampton University has only had a medical school for six years, and therefore their course on medical ethics and legal medicine was carefully integrated into the curriculum after some preliminary experiments carried out by a subcommittee which is continually reviewing the situation. Medical ethics has now a definite place in the fourth year, preceded by an introduction to ethical problems encountered in medicine in the first year. Not only do members of the medical faculty participate in this teaching but also members of the faculties of law and the arts.

Curriculum

The teaching of medical ethics: University College, Cork, Ireland.

Dolores Dooley Clarke describes how the course in medical ethics at University College, Cork is structured, how it has changed and how it is likely to change as time goes on. Originally, the students seemed to view it as an intrusion 'to be tolerated' in their programme of 'strictly medical' studies. However, having moved on from that and away from the lecturer always being a Roman Catholic priest as well as a member of the Philosophy Department, the students now appear to view it as producing a stimulus for a new interest in the area of ethics for physicians. This seems to have come about through the more extensive participation of students in researching and presenting issues of medical ethics.

Bioethical Issues

Law and medical ethics.

Summarising the interrelationship between law and medical ethics, I would say that in cases which do not touch the patient's body or integrity, such as professional secrecy, statutory law may take precedence over rules of medical ethics. But in cases where the human subject becomes a victim because of domestic statutory laws which are in contradiction with medical ethics, the medical practitioners should insist on adhering to their professional standards in such a way that the legislators will have to adapt their legislations to the laws of humanity and public conscience. Legislators, as well as medical practitioners, should not forget that the term 'being' is preceded and qualified by 'human'.

Abortion, Legal

Ethical issues in community organization.

The health educator's role as a community organizer raises a number of ethical dilemmas for the practitioner. Such basic prescriptions given the health educator as "start where the people are" and "change by choice, not by coercion" must be carefully examined in light of the realities which sometimes make strict adherence to these theoretical goals difficult in practice and problematic from an ethical perspective. The importance of avoiding unintentional "victim-blaming" in the selection of targets for community organization and the necessity of acquainting communities with possible negative or unanticipated outcomes of organizing efforts are underscored as critical ethical issues for the health educator engaged in community organization activities.

Attitude to Health

"It just feels morally not right to Sell the data": Ethical and social perspectives on human genomic data sharing in Uganda-A phenomenological qualitative study.

While genomic data sharing enhances transparency and research efficiency, it also raises significant ethical and social challenges. This study explored stakeholders' perspectives on these issues, particularly around privacy, confidentiality, and equity in collaborative research. A phenomenological qualitative study was conducted between August and December 2023 at Makerere University College of Health Sciences, other research-intensive institutions, and national regulatory bodies. The study engaged 86 participants: 47 key informants (16 researchers, 14 ethics committee members, nine community advisory board members, and eight research regulators) and four deliberative focus group discussions with 39 participants. Interviews were transcribed verbatim, and thematic analysis was conducted using NVivo 14. Three major themes emerged: (1) stakeholders' experiences in genomic research, including their roles as participants, implementers, or overseers; (2) ethical concerns, such as informed consent, third-party data access, inequities between high-income and low- and middle-income country (LMIC) researchers and participants, and the lack of benefit-sharing frameworks; and (3) social implications, including stigma, discrimination, labeling, community perceptions of fairness, and the need for meaningful engagement. Participants emphasized the importance of protecting participant rights, promoting equity, and ensuring robust data governance and security. The theoretical frameworks of principlism and distributive justice provided a valuable lens for examining these concerns, particularly by highlighting the need to safeguard privacy and fairly distribute responsibilities and benefits in global collaborations. Participants also noted that perceptions of fairness are shaped by trust, local context, and past experiences with research factors that are critical for building equitable and respectful partnerships. This study underscores the urgent need to strengthen protections for research participants and promote fairness in genomic data sharing. Policies should, if adopted, emphasize culturally contextualized consent, active community engagement, restricted third-party data access, and strong data protection mechanisms to address existing inequities and prevent misuse.

LMICs

Exploring new ethics for public health: developing a fair alcohol policy.

Alcoholism policy since the repeal of Prohibition has been largely based on the assumption that alcohol problems are the result of the failure of a small minority to "control" their drinking. Thus, in sharp contrast to the approach to other drug policies, the problem of alcohol abuse has been viewed as one of "bad users" rather than "bad substances." This regard of alcoholism has helped exonerate the majority of drinkers and the alcohol industry from responsibility. However, mounting epidemiological evidence demonstrates that a primary factor in rates of diseases such as cirrhosis is the per capita use of alcohol and suggests that alcohol problems can be controlled or reduced only if all involved in the manufacture, sale or consumption of alcohol accept the burdens of restrictions over its availability and use. This acceptance will not be forthcoming, however, unless the prevailing market ethic of individual responsibility and minimal collective obligations to protect and preserve life is replaced with a new public health ethic rooted in social justice. This new ethic would assign the highest priority to life and would stress the obligations of all citizens to share the burdens of reasonable restrictions over all health hazards. In this paper a new alcohol policy is outlined based on just and reasonable limits on the availability, marketing and consumption of this substance.

Alcohol Drinking

In search of an ethic of medical librarianship.

Why is the literature on the ethics of librarianship so sparse? Some of the codes of ethics proposed or officially adopted during this century are examined, with an informal commentary on the reasons why they seem to have aroused so little sustained interest and discussion. Attention is directed particularly to library--user relationships and to some of the unique ethical situations in medical libraries.

Ethics, Professional

Ethical and legal issues in family practice.

The unique goal of family practice, that of caring for the entire family's broadly defined health needs, places the family physician in an especially uncomfortable position when there is intrafamily conflict. In particular, the question of "whose agent (physician) are you?" when a family is in conflict often creates a serious ethical dilemma for the family physician. The roles of three experts who deal with family conflict, the psychotherapist, the lawyer, and the family physician, are compared and contrasted. The physician as expert is a useful approach only insofar as there are clearcut answers to a particular problem. But the ambiguity inherent in ethical problems makes this approach less than satisfactory. The role of the physician as teacher/facilitator is explored as an alternative to resolving the ethical dilemmas of intrafamily conflict.

Conflict, Psychological

Controlled clinical trials and medical ethics.

During the past 5 years, a great deal of public attention has been paid in the Federal Republic of Germany to legal and ethical implications of controlled clinical trials. If a physician is bound by a contract for treatment, the ethics of individual benefit have to be applied and this might inhibit a controlled trial. To avoid ethical and legal difficulties, a contract for experimentation may have to be introduced.

Clinical Trials as Topic

Problems with ethical aspects of psychotropic drug use.

1. Research is an important area within the purview of medical ethics. The Nuremberg Code and the Helsinki Declaration provide well established guidelines in this field. 2. Specific ethical issues still requiring clarification in psychopharmacological research are the informed consent, the benefit/risk ratio and the choice of placebo or standard. 3. Peer review committees, if well chosen for their objectivity, general competence and special expertise, are likely to be the best arbiters regarding such questions. 4. Legislation and other political interventions--unfortunately not always objective, competent or expert in the exercise of their powers--have recently developed into rampant paraethical problems that are plaguing medical treatment and research in many parts of the world and need to be dealt with urgently through internationally coordinated efforts. The WHO would appear to be the most appropriate agency for such action.

Ethics Committees, Clinical

Ethical review in the pharmaceutical industry.

1. There seems no reason why clinical pharmacology studies conducted within the pharmaceutical industry should be exempt from the requirement of ethical review, and independent review in this situation reduces the vulnerability of the company and its employees, in addition to serving its primary function of protecting the volunteer subjects. 2. Experience within one company has shown that independent ethical review need not seriously influence the pace of research. 3. It is important that such committees should be seen to be independent and competent.

Drug Evaluation

The American Physical Therapy Association's code of ethics: its historical foundations.

This paper surveys selected historical foundations of the present American Physical Therapy Association's CODE OF ETHICS, showing the extent to which the present code draws upon oaths, ideas in ethics textbooks, and other sources. The article presenta a basis for understanding the significance of these historical influences and provides one means by which physical therapists can more fully appreciate the relevance of the code today.

Codes of Ethics