{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T13:00:27Z","timestamp":1790427627176,"version":"4.1.0"},"reference-count":28,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hip fracture in frail older adults is commonly managed surgically, but non\u2010operative management may be appropriate for selected patients with extreme frailty, limited life expectancy, severe cognitive impairment, multimorbidity or limited expected benefit from surgery. However, when \u2018no surgery\u2019 is chosen, documentation of consent or refusal may complete a procedural requirement without ensuring ethically sufficient decision\u2010making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A structured, literature\u2010informed conceptual ethical analysis was conducted using PubMed and Scopus searches, citation tracking and synthesis guided by the four principles of biomedical ethics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four ethical gaps are identified: non\u2010operative burdens are often naturalised, \u2018conservative treatment\u2019 may be mistaken for comfort care, family signatures may not fully represent patient values, and refusal of surgery does not end clinical responsibility. These recurring concerns are organised into a five\u2010domain framework: Burden, Goal, Voice, Balance and Commitment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Non\u2010operative hip fracture care should move from procedural consent to ethical consent. The proposed framework may support balanced risk communication, goal clarification, patient\u2010centred decision making and continued care planning when \u2018no surgery\u2019 is chosen.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jep.70597","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T18:29:05Z","timestamp":1788892145000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["When \u2018No Surgery\u2019 Is Chosen: A Five\u2010Domain Framework for Evaluating Ethical Consent in Non\u2010Operative Hip Fracture Care"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9310-8683","authenticated-orcid":false,"given":"Liang","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Orthopedic The Second Affiliated Hospital of Harbin Medical University Harbin China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/medsci13030089"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-016-0332-0"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.5535\/arm.21110"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2022.0089"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/17453674.2021.1959155"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afae134"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.16732"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1302\/2633-1462.410.BJO-2023-0069.R1"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.112120"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.54518\/rh.5.4.2025.717"},{"key":"e_1_2_10_12_1","volume-title":"Principles of Biomedical Ethics, 4th ed","author":"Beauchamp T. 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