Robotic wheelchairs (RWs) offer significant potential to enhance autonomy and participation for people with mobility impairments, yet many systems have failed to achieve sustained real-world adoption. This narrative literature review examined the extent and quality of end-user involvement in RW design, development, and evaluation over the past decade (2015–2025), assessed against core principles shared by major user-involvement approaches (e.g., user-/human-centered design, participatory/co-design, and inclusive design). The findings indicate that user involvement remains limited and is predominantly concentrated in late-stage evaluation rather than in early requirements definition or iterative co-design. Of the 399 records screened, only 23 studies (about 6

Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique that delivers weak electrical currents to targeted brain regions in order to modulate neural activity and potentially enhance cognitive and motor functions. Clinical studies have reported benefits for conditions such as depression, stroke, and Parkinson's disease, typically with only minor and transient side effects. While short-term safety is relatively well established, the long-term effects require more systematic data and therefore require caution. At the same time, tDCS is increasingly being used at home without supervision for extended periods, as devices can be purchased online without prescription or even self-assembled. This situation highlights the need for appropriate safeguards to protect unsupervised users and to ensure that research into supervised long-term use is conducted under ethically acceptable conditions. In this paper, we specifically assess the risks that may arise from prolonged and unsupervised application of tDCS and propose measures that should be implemented by researchers, regulators, and commercial stakeholders involved in the distribution of tDCS devices.

BackgroundVisual impairment (VI) significantly impacts quality of life, particularly in autonomous pedestrian navigation. Limitations in independent navigation lead to frustration, diminished confidence, and risks to bodily integrity for individuals with VI. In Colombia, the pilot country of this study, approximately 2 million people live with some form of visual disability. Globally, only 1 in 10 people requiring assistive devices have access to them, with factors such as deficient product design stemming from limited knowledge of user expectations, local needs, and environmental constraints, posing significant challenges, particularly in low- and middle-income countries. ObjectiveWe aimed to evaluate the feasibility and limitations of applying the human-centered design (HCD) principles outlined by the International Organization for Standardization (ISO) 9241-210:2019 standard in assistive technology (AT) development for individuals with VI in Colombia. MethodsWe developed a prototype navigation device using the HCD principles, emphasizing a thorough analysis of user needs and environmental contexts. The project leveraged multidisciplinary collaboration to address challenges associated with user engagement and design adaptability while managing legal and bureaucratic constraints. The navigation system integrates artificial intelligence algorithms, specifically developed by the research team as part of this work, to enhance its adaptability and responsiveness to diverse environments. The development process featured iterative prototyping cycles, incorporating user feedback at each stage, all within the boundaries of applicable regulatory frameworks. ResultsThe development and evaluation of the initial prototype highlighted both the feasibility and key limitations of applying the ISO 9241-210:2019 HCD principles in AT for individuals with VI in the Colombian context. The prototype met several user-defined expectations by prioritizing affordability; extended battery life; autonomy in internet-constrained environments; and improved ergonomics, concealability, aesthetics, and obstacle detection. These achievements demonstrated the potential of HCD to guide context-sensitive innovation. However, the process also revealed significant barriers: limited legal and procedural clarity for engaging users in design phases, difficulties navigating ethics committees, and a lack of practical guidance within the ISO standard itself. These constraints, compounded by challenges in interdisciplinary collaboration, limited the depth and adaptability of user involvement across development stages. ConclusionsImplementing HCD principles in AT development shows promise for creating effective and affordable solutions tailored to user needs and contexts. However, legislative and methodological barriers must be addressed to fully realize HCD’s potential. Future efforts should focus on aligning research methodologies with hardware and software development practices while integrating legislative frameworks to enhance the accessibility and effectiveness of AT innovations.

The reduction of coercion is a central challenge of inpatient mental health services. Little is known about the use of seclusion and restraint in open-door settings. This work aims to analyse the prevalence and risk factors of coercive measures in open inpatient wards of a Swiss university psychiatric hospital. The use of seclusion and restraint was retrospectively analysed between 2017 and 2019. Incidence rate ratios using multivariable Poisson regressions were calculated to determine patient- and hospital stay-related risk factors for coercion. Of 1764 patients, 293 (16.6

Trust is a particularly important element in a healthcare relationship, but it is often misunderstood. In this article, we explore the trust relationship between patients and healthcare professionals and the expectations underpinning it. We then look at some of the expectations of trans* people in the context of medical consultations that are not related to medical transition. In this article, we present lines of thought from a qualitative research currently being analyzed and conducted by Iris Rivoire, Dr. Mira Fey, and Prof. Samia Hurst-Majno.

The immediate context in which a person lives shapes their experience of impairment and disability. Assistive technology (AT) tools are the interface between impairment and context. This article presents a new framework for the design of assistive technology. It provides a theoretical exploration of the relationship between context, assistive technology and impairment. For this, first, we examine the theoretical challenges raised by the interface AT and impairments, considering dominant conceptual models of disability. Then, we analysed the role of context in the design, distribution and use of AT. Our framework addresses the current disconnect between the population the technology aims to serve and the innovation ecosystem. Disability is very diverse, and persons with diverse impairments benefit from different technology. Because of this diversity, we focus on visual impairment. We conclude this article by laying out a new framework for the design of AT that addresses the role of the context in which a person lives and aims to enable personal freedom in it. We do it by using the lenses of the capabilities approach. Our framework goes beyond the classical approach of only looking at AT as a tool for task performance. We argue that AT becomes a conversion tool that enables disabled persons to reach full social participation, addressing the variety of social and environmental contexts in which persons with disabilities live. Finally, we provide recommendations for future research.

Background Informed consent is one of the key principles of conducting research involving humans. When research participants give consent, they perform an act in which they utter, write or otherwise provide an authorisation to somebody to do something. This paper proposes a new understanding of the informed consent as a compositional act. This conceptualisation departs from a modular conceptualisation of informed consent procedures. Methods This paper is a conceptual analysis that explores what consent is and what it does or does not do. It presents a framework that explores the basic elements of consent and breaks it down into its component parts. It analyses the consent act by first identifying its basic elements, namely: a) data subjects or legal representative that provides the authorisation of consent; b) a specific thing that is being consented to; and c) specific agent(s) to whom the consent is given. Results This paper presents a framework that explores the basic elements of consent and breaks it down into its component parts. It goes beyond only providing choices to potential research participants; it explains the rationale of those choices or consenting acts that are taking place when speaking or writing an authorisation to do something to somebody. Conclusions We argue that by clearly differentiating the goals, the procedures of implementation, and what is being done or undone when one consent, one can better face the challenges of contemporary data-intensive biomedical research, particularly regarding the retention and use of data. Conceptualising consent as a compositional act enhances more efficient communication and accountability and, therefore, could enable more trustworthy acts of consent in biomedical science.

Despite scientific and technological advances in the field of assistive technology (AT) for people with visual impairment (VI), technological designs are frequently based on a poor understanding of the physical and social context of use, resulting in devices that are less than optimal for their intended beneficiaries. To resolve this situation, user-centred approaches in the development process of AT have been widely adopted in recent years. However, there is a lack of systematization on the application of this approach. This systematic review registered in PROSPERO (CRD42022307466), assesses the application of the ISO 9241-210 human-centred design principles in allegedly "user-centred designed" AT developments for persons with VI (see Supplementary PROSPERO Protocol). The results point to a wide variation of the depth of understanding of user needs, a poor characterization of the application of the User Centred Design (UCD) approach in the initial design phases or in the early prototyping, and a vague description of user feedback and device iteration. Among the principles set out in ISO 9241-210, the application of 5.6: "the design team includes multidisciplinary skills and perspectives" is the one for which the least evidence is found. The results show there is not enough evidence to fully assess the impact of UCD in (1) promoting innovation regarding AT products and practices, and (2) Judging if AT produced following such standards is leading to better user access, wellbeing outcomes and satisfaction. To address this gap it is necessary to, first, generate better implementation of UCD in AT development and second, to strengthen evidence regarding the implementation and outcomes of using UCD for AT. To better engage with the realities of persons with VI, we propose capacity building across development teams regarding UCD, its principles and components; better planning for UCD implementation; and cross-fertilization across engineering disciplines and social and clinical science. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=307466 PROSPERO (CRD42022307466).

Despite cardiopulmonary resuscitation (CPR) and do-not-attempt-resuscitation (DNAR) decisions are increasingly considered an essential component of hospital practice and patient inclusion in these conversations an ethical imperative in most cases, there is evidence that such discussions between physicians and patients/surrogate decision-makers (the person or people providing direction in decision making if a person is unable to make decisions about personal health care, e.g., family members or friends) are often inadequate, excessively delayed, or absent. We conducted a study to qualitatively explore physician-reported CPR/DNAR decision-making approaches and CPR/DNAR conversations with patients hospitalized in the internal medicine wards of the four main hospitals in Ticino, Southern Switzerland. We conducted four focus groups with 19 resident and staff physicians employed in the internal medicine unit of the four public hospitals in Ticino. Questions aimed to elicit participants’ specific experiences in deciding on and discussing CPR/DNAR with patients and their families, the stakeholders (ideally) involved in the discussion, and their responsibilities. We found that participants experienced two main tensions. On the one side, CPR/DNAR decisions were dominated by the belief that patient involvement is often pointless, even though participants favored a shared decision-making approach. On the other, despite aiming at a non-manipulative conversation, participants were aware that most CPR/DNAR conversations are characterized by a nudging communicative approach where the physician gently pushes patients towards his/her recommendation. Participants identified structural cause to the previous two tensions that go beyond the patient-physician relationship. CPR/DNAR decisions are examples of best interests assessments at the end of life. Such assessments represent value judgments that cannot be validly ascertained without patient input. CPR/DNAR conversations should be regarded as complex interventions that need to be thoroughly and regularly taught, in a manner similar to technical interventions.

BackgroundExistential suffering is often a part of the requests for assisted suicide (AS). Its definitions have gained in clarity recently and refer to a distress arising from an inner realization that life has lost its meaning. There is however a lack of consensus on how to manage existential suffering, especially in a country where AS is legal and little is known about the difficulties faced by professionals confronted with these situations. ObjectivesTo explore the perspectives of Swiss professionals involved in end-of-life care and AS on the management of existential suffering when it is part of AS requests, taking into account the question of roles, as well as on the difficulties they encounter along the way and their views on the acceptability of existential suffering as a motive for AS. MethodsA qualitative study based on face-to-face interviews was performed among twenty-five participants from the fields of palliative and primary care as well as from EXIT right-to-die organization. A semi-structured interview guide exploring four themes was used. Elements from the grounded theory approach were applied. ResultsAlmost all participants reported experiencing difficulties when facing existential suffering. Opinions regarding the acceptability of existential suffering in accessing AS were divided. Concerning its management, participants referred to the notion of being present, showing respect, seeking to understand the causes of suffering, helping give meaning, working together, psychological support, spiritual support, relieving physical symptoms and palliative sedation. ConclusionThis study offers a unique opportunity to reflect on what are desirable responses to existential suffering when it is part of AS requests. Existential suffering is plural and implies a multiplicity of responses as well. These situations remain however difficult and controversial according to Swiss professionals. Clinicians' education should further address these issues and give professionals the tools to better take care of these people.

Observational population studies indicate that prevention of dementia and cognitive decline is being accomplished, possibly as an unintended result of better vascular prevention and healthier lifestyles. Population aging in the coming decades requires deliberate efforts to further decrease its prevalence and societal burden. Increasing evidence supports the efficacy of preventive interventions on persons with intact cognition and high dementia risk. We report recommendations for the deployment of second-generation memory clinics (Brain Health Services) whose mission is evidence-based and ethical dementia prevention in at-risk individuals. The cornerstone interventions consist of (i) assessment of genetic and potentially modifiable risk factors including brain pathology, and risk stratification, (ii) risk communication with ad-hoc protocols, (iii) risk reduction with multi-domain interventions, and (iv) cognitive enhancement with cognitive and physical training. A roadmap is proposed for concept validation and ensuing clinical deployment.

The objective of this study was to investigate reasons for or against anonymity that are pertinent to kidney paired donations (KPD). We conducted a systematic review of reasons using PubMed and Google Scholar until May 2022 and through snowballing. Inclusion criteria were publications that: 1) discussed organ donation anonymity; 2) was peer-reviewed; 3) presented at least one reason on anonymity. Exclusion criteria: 1) not published in a scientific journal; 2) grey literature and dissertations. Four researchers independently reviewed and selected papers based on the criteria, extracted text passages and coded them into narrow and broad reason types, selected reasons that were valid for kidney paired donations. 50 articles were included, 62 narrow reasons (n = 24 for; n = 38 against) and 13 broad reasons were coded. Broad reasons were: protection against harm, general benefits, gratitude, curiosity, unrealistic to implement, fundamental rights, respect people's wishes, professional neutrality, timing is important, information disclosure, altruism, reciprocity and donation pool. We did not find reasons that justify legal prohibition of donor-recipient interactions for KPD, if they consented to meet. Professional counselling, follow-up and careful evaluations to prevent potential harm.

Applying equity to health care is difficult and it is especially challenging when applied to cases that involve urgent military medicine care under resource scarcity. Part of the difficulty centers on the concept of equity itself. It is not clear what the best concept of equity applicable to medical care would be, or that there should be only one, or the same ones, across all levels of military health care. Despite the fact that equity is a key concern in health care, particularly in the age of the COVID-19 pandemic, it may be that there is no single theory of justice that would be most justified for military physicians to use. This paper examines whether a hybrid position of equity might be both theoretically robust and applicable in practice. After briefly introducing the discussion, we outline four major philosophical definitions of equity – (1) Egalitarianism, (2) Prioritarianism, (3) Desertism, and (4) Sufficientism. We then report empirical findings suggesting that a practice-based hybrid concept of equity is used by physicians within the practice of micro-allocation. Our findings will shed lights on ethical justifications and reasoning which should guide medical rules for military and humanitarian health care providers.

Background Implicit prejudice can lead to disparities in treatment. The effects of specialty and experience on implicit obesity and mental illness prejudice had not been explored. The main objective was to examine how specializing in psychiatry/general medicine and years of experience moderated implicit obesity and mental illness prejudice among Swiss physicians. Secondary outcomes included examining the malleability of implicit bias via two video interventions and a condition of cognitive load, correlations of implicit bias with responses to a clinical vignette, and correlations with explicit prejudice. Methods In stage 1, participants completed an online questionnaire including a clinical vignette. In stage 2, implicit prejudice pre- and post- intervention was tested using a 4 × 4 between-subject design including a control group. In stage 3, explicit prejudice was tested with feeling thermometers and participants were debriefed. Participants were 133 psychiatrists and internists working in Geneva, hospital-based and private practice. Implicit prejudice was assessed using a Weight IAT (Implicit Association Test) and a Mental Illness IAT. Explicit feelings towards the obese and the mentally ill were measured using Feeling Thermometers. A clinical vignette assessed the level of concern felt for a fictional patient under four conditions: control, obese, depression, obese and depression. Linear regression was conducted to test for association of gender, experience, and specialty with responses to vignettes, pre-intervention IATs and explicit attitudes, and to test for association of interventions (or control) with post-intervention IATs and explicit attitudes. Reported effect sizes were computed using Cohen’s d. Two-tailed p < 0.05 was selected as the significance threshold. Results Compared to internists, psychiatrists showed significantly less implicit bias against mentally vs. physically ill people than internists and warmer explicit feelings towards the mentally ill. More experienced physicians displayed warmer explicit feelings towards the mentally ill and a greater level of concern for the fictional patients in the vignette than the less experienced, except when the patient was described as obese. Conclusions Specialty moderates both implicit and explicit mental illness prejudice. Experience moderates explicit mental illness bias and concern for patients. The effect of specialty on implicit prejudice seems to be based principally on self-selection.

La méthode des forums citoyens a été utilisée dans le cadre d’une étude réalisée en Suisse romande afin de recueillir les opinions – quant aux espoirs et aux craintes – à propos des avancées de la médecine génomique en oncologie. L’intention était de favoriser le dialogue et les apprentissages mutuels entre spécialistes – en génétique, oncologie, sociologie, anthropologie et éthique – et des membres de la société civile. Cet article a pour objectif d’analyser l’organisation de groupes de discussion soumis à des exercices délibératifs favorisant les échanges d’opinions, ainsi que l’expérience vécue lors des forums par le public citoyen. Les résultats de l’analyse ont fait apparaître les avantages et les limites de la méthode des forums. Les échanges se caractérisent par des temps forts souvent appuyés par l’expérience personnelle, animés par la diversité des points de vue, ainsi que par l’horizontalité des discussions entre les citoyens et citoyennes, valorisées par l’écoute attentive des experts et expertes. Les personnes participantes se sont engagées dans un processus de réflexivité critique au niveau personnel et collectif, prolongé parfois par des discussions avec leur entourage et opérant ainsi un processus de démultiplication des échanges. Toutefois, la difficulté pour adapter les activités proposées à des niveaux variés de connaissances dans le domaine de la médecine génomique a été relevée, ainsi que la situation de « double casquette » de l’équipe de recherche dans sa fonction d’expertise et de modération.

Objective To investigate staff attitudes toward assisted suicide in the hospital setting in Switzerland. Design Cross-sectional study. Setting Two University Hospitals in French speaking regions of Switzerland. Participants 13’834 health care professionals, including all personnel caring for patients, were invited to participate. Main outcome measures and other variables Attitudes towards the participation of hospital health care professionals in assisted suicide were investigated with an online questionnaire. Results Among all invited professionals, 5’127 responded by filling in the survey at least partially (response rate 37.0%), and 3’683 completed the entire survey (26.6%). 73.0% of participants approved that this practice should be authorized in their hospital and saw more positive than negative effects. 57.6% would consider assisted suicide for themselves. Non-medical professionals were 1.28 to 5.25 times more likely to approve assisted suicide than physicians (p<0.001). 70.7% of respondents indicated that each professional should have the choice of whether to assist in suicide. Conclusions This multiprofessional survey sheds light on hospital staff perceptions of assisted suicide happening within hospital walls, which may inform the development of rules considering their wishes but also their reluctances. Further research using a mixed-methods approach could help reach an in-depth understanding of staff’s attitudes and considerations towards assisted suicide practices.

BACKGROUND AND PURPOSE:Advances in medicine have resulted in treatments that can extend the survival of patients with prolonged disorders of consciousness (PDOC) for several years. However, several diagnostic and prognostic uncertainties remain, particularly in the care of pediatric patients. In the absence of international guidelines, we aimed to explore physicians' decision-making when managing pediatric patients with PDOC.METHODS:We conducted a qualitative study using semistructured, individual interviews and employed an inductive thematic analytical approach to explore physicians' subjective experiences and decision-making when managing pediatric patients with PDOC. We recruited a purposive sample of 19 Italian-speaking physicians currently or previously employed in intensive care units or pediatric, internal medicine, or neurology departments in Switzerland.RESULTS:Participants stated that making clinical decisions involving pediatric patients with PDOC is extremely challenging, because the decisional process requires finding a balance between several contending factors. We found that physicians experienced ambivalence in three domains of care (time, goals of care, and target of care), and that they were aware of the risk of self-fulfilling prophecies for both prognosis and main clinical outcomes.CONCLUSIONS:Our study confirmed that experienced clinicians acknowledge the complex nature and challenge of clinical decision-making in the care of pediatric patients with PDOC. More research is warranted to improve and expand existing guidelines aimed at assisting and facilitating clinical and ethical decision-making, and improving physicians' awareness of the factors affecting their decisions when dealing with patients with PDOC.