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Journal of Medical Ethics最新文献

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Fair by chance? On the use of algorithms in therapeutic decisions. 碰巧公平吗？关于算法在治疗决策中的应用。
IF 3.3 2区 哲学
Journal of Medical Ethics Pub Date : 2025-05-02 DOI: 10.1136/jme-2025-110819
Sune Holm
{"title":"Fair by chance? On the use of algorithms in therapeutic decisions.","authors":"Sune Holm","doi":"10.1136/jme-2025-110819","DOIUrl":"https://doi.org/10.1136/jme-2025-110819","url":null,"abstract":"<p><p>Predictive tools made possible by advances in machine learning techniques may help clinicians make more accurate decisions about who should be allocated costly therapies, such as immunotherapy, which only work on a relatively low proportion of patients. In this article, I argue that a fair decision procedure must recognise each patients' chance of responding well. To do so, the procedure should not apply a fixed threshold to probability scores. Rather, each patient should be given a chance of being allocated the therapy matching her probability score. An important consequence of this conclusion is that the fair use of algorithmic scores may not guarantee that the therapy is allocated to those who will respond well to the highest possible degree.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Infanticide and infant bodily rights. 杀婴和婴儿身体权利。
IF 3.3 2区 哲学
Journal of Medical Ethics Pub Date : 2025-04-29 DOI: 10.1136/jme-2025-110749
James G Robinson
{"title":"Infanticide and infant bodily rights.","authors":"James G Robinson","doi":"10.1136/jme-2025-110749","DOIUrl":"https://doi.org/10.1136/jme-2025-110749","url":null,"abstract":"<p><p>Some of the most widely accepted arguments in favour of abortion seem to undermine the view that infanticide is impermissible. In this paper, I outline a proposal that addresses this issue, arguing that the impermissibility of infanticide can be defended in a way that is consistent with traditional arguments in favour of abortion. I argue that killing an infant would violate its <i>bodily rights</i>, and so there are strong presumptive reasons against infanticide. I further argue that fetuses do not have bodily rights, and so these same reasons cannot be used to defend the impermissibility of abortion. To support this argument, I first suggest some ways in which killing someone requires violating their bodily rights. I then argue that bodily rights begin at birth, and so infants have bodily rights, but fetuses do not. When taken together with the traditional arguments in favour of abortion, this proposal suggests an important result in the abortion debate: there are philosophical grounds for defending both the permissibility of abortion and the impermissibility of infanticide.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Artificial intelligence, invisible victims and the trolley problem. 人工智能、隐形受害者和电车问题。
IF 3.3 2区 哲学
Journal of Medical Ethics Pub Date : 2025-04-29 DOI: 10.1136/jme-2024-110626
Jacob M Appel
{"title":"Artificial intelligence, invisible victims and the trolley problem.","authors":"Jacob M Appel","doi":"10.1136/jme-2024-110626","DOIUrl":"https://doi.org/10.1136/jme-2024-110626","url":null,"abstract":"<p><p>The allocation of scarce healthcare resources inherently involves trade-offs between the interests of 'visible' and 'invisible' victims (ie, individuals who are aware that they are shortchanged by trade-offs and those who are not). At present, decisions regarding such trade-offs are often based on highly speculative predictions; the vast array of possible trade-offs simply cannot be enumerated, let alone the optimal outcomes calculated, by human beings. Artificial intelligence has the potential to change that reality by mining large data sets and other sources of information in order to produce far more precise and comprehensive predictions of likely outcomes and to delineate optimal allocation choices. Such technologies will inevitably render 'invisible' victims 'visible', generating a colossal, real-world trolley dilemma for anyone involved in medical or healthcare policy decision-making.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
AI interventions in cancer screening: balancing equity and cost-effectiveness. 人工智能干预癌症筛查：平衡公平和成本效益。
IF 3.3 2区 哲学
Journal of Medical Ethics Pub Date : 2025-04-28 DOI: 10.1136/jme-2025-110707
Cristina Roadevin, Harry Hill
{"title":"AI interventions in cancer screening: balancing equity and cost-effectiveness.","authors":"Cristina Roadevin, Harry Hill","doi":"10.1136/jme-2025-110707","DOIUrl":"https://doi.org/10.1136/jme-2025-110707","url":null,"abstract":"<p><p>This paper examines the integration of artificial intelligence (AI) into cancer screening programmes, focusing on the associated equity challenges and resource allocation implications. While AI technologies promise significant benefits-such as improved diagnostic accuracy, shorter waiting times, reduced reliance on radiographers, and overall productivity gains and cost-effectiveness-current interventions disproportionately favour those already engaged in screening. This neglect of non-attenders, who face the worst cancer outcomes, exacerbates existing health disparities and undermines the core objectives of screening programmes.Using breast cancer screening as a case study, we argue that AI interventions must not only improve health outcomes and demonstrate cost-effectiveness but also address inequities by prioritising non-attenders. To this end, we advocate for the design and implementation of cost-saving AI interventions. Such interventions could enable reinvestment into strategies specifically aimed at increasing engagement among non-attenders, thereby reducing disparities in cancer outcomes. Decision modelling is presented as a practical method to identify and evaluate these cost-saving interventions. Furthermore, the paper calls for greater transparency in decision-making, urging policymakers to explicitly account for the equity implications and opportunity costs associated with AI investments. Only then will they be able to balance the promise of technological innovation with the ethical imperative to improve health outcomes for all, particularly underserved populations. Methods such as distributional cost-effectiveness analysis are recommended to quantify and address disparities, ensuring more equitable healthcare delivery.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Epistemic humility meets virtual reality: teaching an old ideal with novel tools. 认知上的谦卑与虚拟现实相遇：用新颖的工具教授旧的理想。
IF 3.3 2区 哲学
Journal of Medical Ethics Pub Date : 2025-04-25 DOI: 10.1136/jme-2024-110591
Georg Starke, Alexander Sobieska, Kathrin Knochel, Alena Buyx
{"title":"Epistemic humility meets virtual reality: teaching an old ideal with novel tools.","authors":"Georg Starke, Alexander Sobieska, Kathrin Knochel, Alena Buyx","doi":"10.1136/jme-2024-110591","DOIUrl":"https://doi.org/10.1136/jme-2024-110591","url":null,"abstract":"<p><p>The pace of scientific advancements in medicine, driven by artificial intelligence as much as by novel biotechnologies, demands an ever-faster update of professional knowledge from physicians and collaboration in interdisciplinary teams. At the same time, the increased heterogeneity of patients' lifeworlds in socially and culturally diverse societies requires healthcare professionals to consider diverging personal and cultural perspectives in their treatment recommendations. Both developments require conveying to students a professional virtue that can be summarised as <i>epistemic humility</i>-a teaching process which, we argue, can and should be supported by novel technologies. By embedding students in realistic scenarios, virtual reality can play a crucial role in teaching medical students a stance of epistemic humility. Such stance implies acknowledging the limitations of one's knowledge as well as taking individual patients' perspectives and experiences seriously. In this sense, epistemic humility can also provide a crucial step towards tackling epistemic injustice and biases in medicine. We discuss how teaching epistemic humility with virtual reality tools can succeed and suggest the development of novel teaching tools that make use of this technology to immersively enable moral growth. Our paper thereby contributes to the emerging field of digital bioethics, calls for more work in the area of experimental bioethics and informs ongoing debates on how medical ethics teaching can prepare future physicians for the challenges of tomorrow's practice of medicine.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Generational smoking bans: inegalitarian without disadvantage? 世代禁烟：不平等而无劣势？
IF 3.3 2区 哲学
Journal of Medical Ethics Pub Date : 2025-04-24 DOI: 10.1136/jme-2024-110632
James Hart, Sapfo Lignou
{"title":"Generational smoking bans: inegalitarian without disadvantage?","authors":"James Hart, Sapfo Lignou","doi":"10.1136/jme-2024-110632","DOIUrl":"10.1136/jme-2024-110632","url":null,"abstract":"","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Understanding individualised genetic interventions as research-treatment hybrids. 将个性化基因干预理解为研究与治疗的混合体。
IF 3.3 2区 哲学
Journal of Medical Ethics Pub Date : 2025-04-24 DOI: 10.1136/jme-2023-109729
Josephine Johnston, Kathryn Tabb, Danielle Pacia, Sandra Soo-Jin Lee, Wendy K Chung, Paul S Appelbaum
{"title":"Understanding individualised genetic interventions as research-treatment hybrids.","authors":"Josephine Johnston, Kathryn Tabb, Danielle Pacia, Sandra Soo-Jin Lee, Wendy K Chung, Paul S Appelbaum","doi":"10.1136/jme-2023-109729","DOIUrl":"10.1136/jme-2023-109729","url":null,"abstract":"<p><p>Until recently, medicine has had little to offer most of the millions of patients suffering from rare and ultrarare genetic conditions. But the development in 2019 of Milasen, the first genetic intervention developed for and administered to a single patient suffering from an ultrarare genetic disorder, has offered hope to patients and families. In addition, Milasen raised a series of conceptual and ethical questions about how individualised genetic interventions should be developed, assessed for safety and efficacy and financially supported. The answers to these questions depend in large part on whether individualised therapies are understood as human subjects research or clinical innovation, different domains of biomedicine that are regulated by different modes of oversight, funding and professional norms. In this article, with development and administration of the drug Milasen as our case study, we argue that at least some individualised genetic therapies are not, as some have argued, either research or treatment. Instead, they are research-treatment hybrids, a category that has both epistemological and pragmatic repercussions for funding, ethics oversight and regulation.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11669725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141457450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reviewing past and present consent practices in unplanned obstetric interventions: an eye towards the future. 回顾过去和现在计划外产科干预中的同意做法：展望未来。
IF 3.3 2区 哲学
Journal of Medical Ethics Pub Date : 2025-04-24 DOI: 10.1136/jme-2024-109997
Morganne Wilbourne, Frances Hand, Sophie McAllister, Louise Print-Lyons, Meena Bhatia
{"title":"Reviewing past and present consent practices in unplanned obstetric interventions: an eye towards the future.","authors":"Morganne Wilbourne, Frances Hand, Sophie McAllister, Louise Print-Lyons, Meena Bhatia","doi":"10.1136/jme-2024-109997","DOIUrl":"10.1136/jme-2024-109997","url":null,"abstract":"<p><p>Many first-time mothers (primiparous) within UK National Health Service (NHS) settings require an obstetric intervention to deliver their babies safely. While the antepartum period allows time for conversations about consent for planned interventions, such as elective caesarean section, current practice is that, in emergencies, consent is addressed in the moments before the intervention takes place. This paper explores whether there are limitations on the validity of consent offered in time-pressured and emotionally charged circumstances, specifically concerning emergency obstetric interventions. Using the legal framework of the Mental Capacity Act, <i>Montgomery v. Lanarkshire Health Board</i> (2015) and <i>McCulloch v Forth Valley Health Board</i> (2023), we argue that while women have the capacity to consent during labour, their autonomy is best supported by providing more information about instrumental delivery (ID) during the antepartum period. This conclusion is supported by some national guidelines, including those developed by the Royal College of Obstetricians and Gynaecologists, but not all. Further, we examine the extent to which these principles are upheld in modern-day practice. Data suggest there is relatively little antepartum information provision regarding ID within NHS settings, and that primiparous women do not report a thorough understanding of ID before labour. Based on these results, and bearing in mind the pressures under which NHS obstetric services currently operate, we recommend further research into patient and clinician perceptions of the consent process for ID. Pending these results, we discuss possible modes of information delivery in future practice.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141457448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Generational tobacco ban: questions of consistency. 代际烟草禁令：一致性问题。
IF 3.3 2区 哲学
Journal of Medical Ethics Pub Date : 2025-04-24 DOI: 10.1136/jme-2025-110810
Johannes Kniess
{"title":"Generational tobacco ban: questions of consistency.","authors":"Johannes Kniess","doi":"10.1136/jme-2025-110810","DOIUrl":"10.1136/jme-2025-110810","url":null,"abstract":"","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ethics briefing. 道德简报。
IF 3.3 2区 哲学
Journal of Medical Ethics Pub Date : 2025-04-24 DOI: 10.1136/jme-2025-110887
Natalie Michaux
{"title":"Ethics briefing.","authors":"Natalie Michaux","doi":"10.1136/jme-2025-110887","DOIUrl":"https://doi.org/10.1136/jme-2025-110887","url":null,"abstract":"","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":"51 5","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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