Background/Objectives: This systematic review explores the evolving landscape of ethical dilemmas and legal responsibilities in hospital-based patient care, with particular attention to how they intersect with institutional safety. Drawing from 40 studies published within the last decade and supplemented by seminal theoretical works, the review examines clinical, technological, legal, and policy-driven challenges that compromise ethical clarity and organisational accountability. Methods: Methods included a structured literature search across major academic databases, guided by inclusion and exclusion criteria aligned with PRISMA guidelines and a quality appraisal ensuring inclusion of only medium- and high-quality studies. Results: Findings reveal that ethical complexity has shifted from individual decision-making to system-level vulnerabilities, particularly in contexts involving artificial intelligence (AI), data governance, consent procedures, and end-of-life care. Moreover, hospitals often lack sufficient protocols for disclosure, cross-border telemedicine accountability, and ethically responsive infrastructure. The results support a growing call for ethics-by-design approaches, where ethical reflexivity is embedded into institutional processes and digital systems. Conclusions: Overall, ethical resilience in hospital care depends not only on clinical training but on proactive organisational structures that support transparency, equity, and patient dignity.

Background: Pain is one of the symptoms for which any man is willing not only to go to the doctor but also to resort to any means, including self-medication, to “get rid” of it. Self-medication is not only a current practice but also a public health problem, under the circumstances that it can influence the way in which a disease is diagnosed and/or treated in a timely manner, and, consequently, repercussions may occur on the cost of treatment, in the case of severe forms. Pain is a vital symptom, and the diminution until the disappearance of pain is a fundamental right of each individual; the analysis of ethical issues in the case of self-administration of analgesic medication has not been a major concern. Areas of Uncertainty: Understanding the problem is important to realize whether self-medicating for pain is a necessity or an abuse, and in this respect, we review scientific articles from international databases: PubMed and ProQuest. Data Sources: The study is based on the consultation of scientific articles from international databases—PubMed and ProQuest, the main keywords in the search being pain and self-medication, to which a stigma or public health is sequentially added. Results: Pain is becoming more and more a global problem and the extent of its spread can substantiate our assertion about pathology with pandemic impact. Under the pressure of patient associations, of the media, and of nonmedical authorities, the opinion about the need for a stoic approach to pain has long become an outdated theory, and chronic pain, beyond a multidimensional approach, is increasingly considered not only a useless element but also even a destructive one. Conclusions: Pain and self-medication must be addressed, including in medical practice, starting from their multidimensionality from the following perspectives: medicobiological, sociocultural, instructive-educational, legal-political, and especially ethical. They are not only individual health problems but also become, when connected with a stigma, a public health problem.

This study investigates the impact of different clinical and demographic factors on the quality of life in people with epilepsy hospitalized at a health institution of Brasov County, Romania, using a QOLIE-31-P questionnaire and to reflect on the opportunities and limitations of incorporating such an instrument into the clinical practice. Methods: Ninety-one patients with a diagnosis of epilepsy evaluated by video-electroencephalography in the Clinical Hospital of Psychiatry and Neurology in Brasov, Romania, were recruited. After the confirmation of the diagnosis based on clinical, electrophysiological and imagistic examination, and of their compliance with the hospitalization criteria, the patients filled in the QOLIE-31-P questionnaire. Socio-demographic and clinical data were collected. Results: The seizure frequency was negatively correlated with almost all QOLIE-31-P domains (p < 0.05). Age, employment status, level of education and uncontrolled disease were significant factors associated with a low quality of life. The mean (SD) QOLIE-31-P scores were 64.89 (14.72), the mean age was 43.04 (14.92) years, with the average age of the first seizure onset 30.66 (17.45) years. Conclusion: The use of measuring instruments to assess the quality of life of patients with epilepsy despite the challenges should become a routine practice, the information collected in this way can improve the outcomes in the care of these patients. In addition to the goal of reducing the frequency of seizures, physicians must also take into account other parts of the experiences of people with epilepsy.

Background: This study aimed to assess the influence of various clinical factors on the quality of life perception of patients with epilepsy over a follow-up period in current clinical practice. Methods: Thirty-five PWE evaluated via video-electro-encephalography in the Clinical Hospital of Psychiatry and Neurology in Brasov, Romania, were included, and the quality of life was assessed using the Romanian version of the QOLIE-31-P questionnaire. Results: At baseline, the mean age was 40.03 (±14.63) years; the mean duration of epilepsy was 11.46 (±12.90) years; the mean age at the first seizure was 28.57 (±18.72); and the mean duration between evaluations was 23.46 (±7.54) months. The mean (SD) QOLIE-31-P total score at the initial visit (68.54 ±15.89) was lower than the mean (SD) QOLIE-31-P total score at the follow-up (74.15 ± 17.09). Patients with epileptiform activity recorded via video-electro-encephalography, using polytherapy, those with uncontrolled seizures, and those with one or more seizures per month had statistically significantly lower QOLIE-31-P total scores at baseline and follow-up. Multiple linear regression analyses revealed seizure frequency as a significant inverse predictor of quality of life in both evaluations. Conclusions: The QOLIE-31-P total score was improved during the follow-up period, and medical professionals should use instruments to evaluate quality of life and identify patterns while trying to improve the outcomes of patients with epilepsy.

Background and Objectives: Mental health disorders, including major depressive disorder and adjustment disorder with mixed anxiety and depressed mood, present a significant global burden, with early onset and progression leading to substantial individual and social impacts. While pharmacotherapy remains the standard treatment, many patients experience inadequate symptom relief or intolerable side effects. In this context, transcranial magnetic stimulation (TMS) has emerged as a non-invasive, well-tolerated neuromodulation technique offering an alternative treatment option. Although its clinical efficacy is well-documented, limited research exists on patient perceptions, decision-making processes and barriers to TMS utilization in private healthcare settings, particularly in Romania. This study explores patients’ experiences with TMS, factors influencing their treatment choices and comparative views on its acceptability relative to pharmacological interventions. Materials and Methods: A qualitative research design was employed, using semi-structured interviews with 20 patients diagnosed with MDD or AD who had undergone TMS therapy as part of two pilot studies which were non-randomized in Romanian private practices. Data were collected via interviews and analyzed thematically to identify patterns in patient perceptions, decision-making factors and treatment experiences. Results: Participants reported predominantly positive perceptions of TMS, citing improvements in mood, anxiety reduction, and enhanced daily functioning. The most common motivations for seeking TMS included dissatisfaction with pharmacotherapy, recommendations from physicians or peers and information obtained via online sources. TMS was perceived as a safer and more tolerable alternative to medication, particularly due to its lack of systemic side effects. However, barriers such as high treatment costs, limited insurance coverage and logistical challenges in accessing TMS services were noted as significant deterrents. Conclusions: The study highlights the strong preference for TMS among patients who seek alternatives to pharmacotherapy, with key motivators including efficacy, tolerability and non-invasiveness. However, systemic barriers to access remain a critical challenge in private healthcare settings. Future research should focus on expanding accessibility, improving patient education and integrating TMS into broader mental healthcare frameworks to optimize treatment outcomes.

Patient safety emerges where clinical risk governance intersects with ethical duties of non-maleficence, respect for autonomy, and institutional accountability. Safety culture surveys and patient-reported experience measures often evolve on separate analytic tracks, leaving uncertainty about how staff-facing metrics translate into patient-facing ethical practices such as disclosure after harm. We conducted an exploratory cross-sectional multi-informant survey in an acute-care hospital in Romania. Healthcare workers (defined as physicians, nurses, hospital auxiliary staff, and other clinical/non-clinical personnel involved in care delivery or immediate supervision; n = 104) completed the AHRQ Hospital Survey on Patient Safety Culture version 2.0 and the Speaking Up About Patient Safety Questionnaire, capturing safety culture composites, speaking up behaviour, and psychological safety. Inpatients (n = 101) completed a project-specific, not externally validated structured questionnaire covering perceived safety, communication and information, consent and involvement, confidentiality and complaint mechanisms, coordination and organisational reliability, observed safety practices, and experiences of incident communication. We conducted exploratory analyses including composite means, percent positive scores, internal consistency estimates, and examined ward-level associations. Staff composites peaked for teamwork (mean 3.84/5; 74.3% positive) and communication about error (3.74/5; 70.8% positive), while staffing and work pace (2.74/5; 29.3% positive), response to error (31.7% positive), and hospital management support (34.0% positive) showed marked compression. Patients rated coordination and organisation (mean 3.67/5) and consent and involvement (3.60/5) higher than communication and information (3.42/5). Eleven patients (10.9%) perceived a safety incident; among them, ratings for apology, explanation and follow-up clustered at the lower end of the scale (mean 1.73/5). Ward-level overall safety culture scores showed negligible associations with patient global safety, perceived safety and recommendation. Exploratory ward-group analyses suggested that patient-rated coordination aligned more closely with handoffs and information exchange than with global safety culture measures. Other cross-level associations were inconsistent and were interpreted cautiously because of broad clinical-area aggregation and limited between-group variation. Favourable speaking up climate correlated with overall safety culture (r = 0.484, p < 0.001) and management support (r = 0.547, p < 0.001). In this setting, patient-perceived safety aligned more closely with interface processes than with global culture scores, and incident communication surfaced as a salient ethical deficit. Strategies integrating psychological safety, management responsiveness, and structured disclosure practices warrant prospective evaluation as potential ways to advance moral accountability and risk governance. Given the cross-sectional, single-site design and modest sample size, these associations should be interpreted as exploratory and non-causal. Not applicable.