The self-fulfilling prophecy in medicine.

Theoretical medicine and bioethics Pub Date : 2024-10-01 Epub Date: 2024-08-09 DOI:10.1007/s11017-024-09677-z
Mayli Mertens
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Abstract

This article first describes the mechanism of any self-fulfilling prophecy through discussion of its four conditions: credibility, employment, employment sensitivity, and realization. Each condition is illustrated with examples specific to the medical context. The descriptive account ends with the definition of self-fulfilling prophecy and an expansion on collective self-fulfilling prophecies. Second, the normative account then discusses the moral relevance of self-fulfilling prophecies in medicine. A self-fulfilling prophecy is typically considered problematic when the prediction itself changes the predicted outcome to match the prediction (transformative self-fulfillment). I argue that also self-fulfilling prophecies that do not change the outcome but change the ways in which the outcome was realized (operative self-fulfillment), have significant ethical and epistemic ramifications. Because it is difficult to distinguish, retrospectively, between a transformative and an operative self-fulfilling prophecy, and thus between a false or true positive, it becomes equally difficult to catch mistakes. Moreover, since the prediction necessarily turns out true, there is never an error signal warning that a mistake might have been made. On the contrary, accuracy is seen as the standard for quality assurance. As such, self-fulfilling prophecies inhibit our ability to learn, inviting repetition and exacerbation of mistakes. With the rise of automated diagnostic and prognostic procedures and the increased use of machine learning and artificial intelligence for the development of predictive algorithms, attention to self-fulfilling feedback loops is especially warranted. This account of self-fulfilling prophecies is practically relevant for medical research and clinical practice. With it, researchers and practitioners can detect and analyze potential self-fulfilling mechanisms in any medical case and take responsibility for their ethical and epistemic implications.

医学中的自我实现预言。
本文首先通过讨论自我实现预言的四个条件:可信度、就业、就业敏感性和实现,描述了自我实现预言的机制。每个条件都有具体的医学实例加以说明。描述性论述以自我实现预言的定义和对集体自我实现预言的扩展结束。其次,规范性论述讨论了医学中自我实现预言的道德意义。当预言本身改变了预测结果,使之与预言相符时,自我实现预言通常被认为是有问题的(变革性自我实现)。我认为,如果自我实现预言没有改变结果,但改变了实现结果的方式(操作性自我实现),也会产生重大的伦理和认识论影响。由于回溯起来很难区分改变性自我实现预言和操作性自我实现预言,也就很难区分是假预言还是真预言,因此同样也很难发现错误。此外,由于预测的结果必然是真的,因此从来没有错误信号警告人们可能犯了错误。相反,准确性被视为质量保证的标准。因此,自我实现的预言会抑制我们的学习能力,导致错误的重复和加剧。随着自动诊断和预后程序的兴起,以及机器学习和人工智能在预测算法开发中的应用日益广泛,我们尤其需要关注自我实现的反馈回路。对自我实现预言的阐述对医学研究和临床实践具有实际意义。有了它,研究人员和从业人员可以检测和分析任何医疗案例中潜在的自我实现机制,并对其伦理和认识论影响负责。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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