Journal of Medical Ethics最新文献

{"title":"Machine learning models, trusted research environments and UK health data: ensuring a safe and beneficial future for AI development in healthcare.","authors":"Charalampia Xaroula Kerasidou, Maeve Malone, Angela Daly, Francesco Tava","doi":"10.1136/jme-2022-108696","DOIUrl":"10.1136/jme-2022-108696","url":null,"abstract":"<p><p>Digitalisation of health and the use of health data in artificial intelligence, and machine learning (ML), including for applications that will then in turn be used in healthcare are major themes permeating current UK and other countries' healthcare systems and policies. Obtaining rich and representative data is key for robust ML development, and UK health data sets are particularly attractive sources for this. However, ensuring that such research and development is in the public interest, produces public benefit and preserves privacy are key challenges. Trusted research environments (TREs) are positioned as a way of balancing the diverging interests in healthcare data research with privacy and public benefit. Using TRE data to train ML models presents various challenges to the balance previously struck between these societal interests, which have hitherto not been discussed in the literature. These challenges include the possibility of personal data being disclosed in ML models, the dynamic nature of ML models and how public benefit may be (re)conceived in this context. For ML research to be facilitated using UK health data, TREs and others involved in the UK health data policy ecosystem need to be aware of these issues and work to address them in order to continue to ensure a 'safe' health and care data environment that truly serves the public.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":"838-843"},"PeriodicalIF":4.1,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10715536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9214301","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}

{"title":"Revisiting the comparison between healthcare strikes and just war.","authors":"Luke Brunning","doi":"10.1136/jme-2023-108941","DOIUrl":"10.1136/jme-2023-108941","url":null,"abstract":"<p><p>In the UK, healthcare workers are again considering whether to strike, and the moral status of strike action is being publicly debated. Mpho Selemogo argued that we can think productively about the ethical status of healthcare strikes by using the ethical framework often applied to armed conflict (2014). On this view, strikes need to be just, proportionate, likely to succeed, a last resort, pursued by a legitimate organisation and publicly communicated. In this article, I argue for a different approach to the just war comparison. Selemogo adopts a traditional, collectivist conception of just war reasoning but this is not the only view. So-called 'individualist' approaches to the morality of war can also be applied to strike action. Taking an individualist perspective complicates the traditional picture of a dispute arising between three well-defined groups of healthcare workers, employers and the innocent subjects of collateral damage: patients and the public. We arrive instead at a more complicated moral picture: some people might be more morally liable to be harmed than others during a strike, or can justly bear increased risks, and some are more obliged to strike than others. I describe this shift of framework before critically examining some of the traditional <i>jus ad bellum</i> conditions as applied to strikes.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":"799-802"},"PeriodicalIF":4.1,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9469228","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}

{"title":"Is there a duty to routinely reinterpret genomic variant classifications?","authors":"Gabriel Watts, Ainsley J Newson","doi":"10.1136/jme-2022-108864","DOIUrl":"10.1136/jme-2022-108864","url":null,"abstract":"<p><p>Multiple studies show that periodic reanalysis of genomic test results held by clinical laboratories delivers significant increases in overall diagnostic yield. However, while there is a widespread consensus that implementing routine reanalysis procedures is highly desirable, there is an equally widespread understanding that routine reanalysis of individual patient results is not presently feasible to perform for all patients. Instead, researchers, geneticists and ethicists are beginning to turn their attention to one part of reanalysis-reinterpretation of previously classified variants-as a means of achieving similar ends to large-scale individual reanalysis but in a more sustainable manner. This has led some to ask whether the responsible implementation of genomics in healthcare requires that diagnostic laboratories routinely reinterpret their genomic variant classifications and reissue patient reports in the case of materially relevant changes. In this paper, we set out the nature and scope of any such obligation, and analyse some of the main ethical considerations pertaining to a putative duty to reinterpret. We discern and assess three potential outcomes of reinterpretation-upgrades, downgrades and regrades-in light of ongoing duties of care, systemic error risks and diagnostic equity. We argue against the existence of any general duty to reinterpret genomic variant classifications, yet we contend that a suitably restricted duty to reinterpret ought to be recognised, and that the responsible implementation of genomics into healthcare must take this into account.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":"808-814"},"PeriodicalIF":4.1,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9482870","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}

{"title":"Abortion policies at the bedside: a response.","authors":"Bruce Philip Blackshaw","doi":"10.1136/jme-2023-108948","DOIUrl":"10.1136/jme-2023-108948","url":null,"abstract":"<p><p>Hersey <i>et al</i> have outlined a proposed ethical framework for assessing abortion policies that locates the effect of government legislation between the provider and the patient, emphasising its influence on interactions between them. They claim that their framework offers an alternative to the personal moral claims that lie behind legislation restricting abortion access. However, they fail to observe that their own understanding of reproductive justice and the principles of medical ethics are similarly predicated on their individual moral beliefs. Consequently, the conclusions obtained from their framework are also derived from their individual beliefs, and have no claim to being objective.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":"852-853"},"PeriodicalIF":4.1,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9283401","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}

{"title":"Professionalism or prejudice? Modelling roles, risking microaggressions.","authors":"Emily Miller, Sonya Tang Girdwood, Anita Shah, Chidiogo Anyigbo, Elizabeth Lanphier","doi":"10.1136/jme-2023-109295","DOIUrl":"10.1136/jme-2023-109295","url":null,"abstract":"We agree with McCullough, Coverdale and Chervenak that ‘medical educators and academic leaders are in a pivotal and powerful position to role model’ to counter ‘incivility’ in medicine, which can include ‘dismissing’ or ‘demeaning others’. They note that ‘women may be at greater risk for experiencing incivility compared with men’, as may other individuals who experience ‘patterns of disrespect based on minority status’. The authors promote ‘professionalism’ and ‘etiquette’ to foster civility within medicine. Yet theory and experience suggest that medical educators and academic leaders are also in powerful positions to mobilise these concepts to perpetuate exclusions from, and biases within, medicine, upholding racist, sexist and ableist norms.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":"822-823"},"PeriodicalIF":4.1,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9824227","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}

{"title":"With great power comes great vulnerability: an ethical analysis of psychedelics' therapeutic mechanisms proposed by the REBUS hypothesis.","authors":"Daniel Villiger, Manuel Trachsel","doi":"10.1136/jme-2022-108816","DOIUrl":"10.1136/jme-2022-108816","url":null,"abstract":"<p><p>Psychedelics are experiencing a renaissance in mental healthcare. In recent years, more and more early phase trials on psychedelic-assisted therapy have been conducted, with promising results overall. However, ethical analyses of this rediscovered form of treatment remain rare. The present paper contributes to the ethical inquiry of psychedelic-assisted therapy by analysing the ethical implications of its therapeutic mechanisms proposed by the relaxed beliefs under psychedelics (REBUS) hypothesis. In short, the REBUS hypothesis states that psychedelics make rigid beliefs revisable by increasing the influence of bottom-up input. Put differently, patients become highly suggestible and sensitive to context during a psychedelic session, amplifying therapeutic influence and effects. Due to that, patients are more vulnerable in psychedelic-assisted therapy than in other therapeutic interventions; they lose control during a psychedelic session and become dependent on the therapeutic setting (including the therapist). This enhanced vulnerability is ethically relevant and has been exploited by some therapists in the past. Therefore, patients in current research settings and starting mainstream medical settings need to be well informed about psychedelics' mechanisms and their implications to give valid informed consent to treatment. Furthermore, other security measures are warranted to protect patients from the vulnerability coming with psychedelic-assisted therapy.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":"826-832"},"PeriodicalIF":4.1,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9283402","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}

{"title":"Emotions and affects: the missing piece of the jigsaw puzzle of understanding risk attitudes in medical decision-making.","authors":"Supriya Subramani","doi":"10.1136/jme-2023-109374","DOIUrl":"10.1136/jme-2023-109374","url":null,"abstract":"Nicholas Makins argues persuasively that medical decisions should be made with consideration for patients’ higher order risk attitudes. I will argue that an understanding of risk attitudes in medical decisionmaking is incomplete without critical engagement with emotions and affects (feelings associated with something good or bad). The primary aim of this commentary is to emphasise that clinical decisions are often emotionally charged, and it is crucial to engage closely with emotions and affects that shape these decisions, particularly when navigating complex and uncertain situations. In the face of uncertainty, emotions such as fear, sadness or anxiety play a significant role in risk attitudes and medical decisions. I contend that recognising risk as a feeling is crucial to respecting patients’ values, preferences and decisions in light of the substantial body of research on risk perception and attitudes that suggests individuals make decisions based not only on what they think, but also on how they feel. In recent years, scholars have begun to acknowledge the value of emotions in understanding medical decisions and healthcare decisionmaking processes, especially under uncertainty. Furthermore, some philosophers and social scientists in field of risk research acknowledge emotions as both affective and cognitive in nature, and influence risk perceptions and attitudes. Risk is often understood in terms of its possible outcomes and probabilities. For example, in case of stock trading, one might understand the risk of an investment as the likelihood of losing money, and the probability of that loss being 10%. When it comes to medical decisions, however, the concept of risk is often more complex, as it must take into account not only the likelihood of a given outcome, but also its potential impact on the patient’s health and wellbeing under uncertain probabilities and varied contexts. Medical decisions often understand risk in terms of the probability of a negative outcome, such as a poor prognosis or a lifethreatening complication. The risk of a medical decision is also understood in terms of its potential costs, such as the cost of treatment or the cost of not treating a condition. As such, medical decisionmaking requires thoughtful consideration of the risks associated with any proposed plan of action or not, along with a comprehensive understanding of the probable outcomes and their potential consequences. The influence of emotion and affect on decisions cannot be avoided in the context of clinical medicine when understanding risk perception and risk attitudes. For instance, anxiety about undergoing a procedure can give rise to a person making a riskaverse decision, even if the risks of the procedure are quite low. Physicians can also be influenced by their emotions when assessing risk perception. For instance, a physician’s fear of making a mistake can lead to an overly cautious recommendation, or a physician’s desire to be liked can lead to an ","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":"746-747"},"PeriodicalIF":4.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10013781","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}

{"title":"When uncertainty is a symptom: intolerance of uncertainty in OCD and 'irrational' preferences.","authors":"Jared Smith","doi":"10.1136/jme-2023-109378","DOIUrl":"10.1136/jme-2023-109378","url":null,"abstract":"In ‘Patients, doctors and risk attitudes,’ Makins argues that, when physicians must decide for, or act on behalf of, their patients they should defer to patient risk attitudes for many of the same reasons they defer to patient values, although with a caveat: physicians should defer to the higherorder desires of patients when considering their risk attitudes. This modification of what Makins terms the ‘deference principle’ is primarily driven by potential counterexamples in which a patient has a firstorder desire with one risk attitude (either riskseeking or averse) and a secondorder desire that this risk attitude not be effective in guiding their choices. There are two reasons we might think people with obsessive–compulsive disorder (OCD) are particularly relevant patients for evaluating Makins’ proposal. Not only might their firstorder risk attitudes be irrational, but many people with OCD also judge their own OCD behaviours to be excessive or unwarranted making them structurally similar to the counterexamples outlined above. Yet, I argue that recent research about risk and decisionmaking under uncertainty for those with OCD complicates Makins’ proposal by raising questions of whether and to what degree their risk attitudes are irrational such that they should not play a part in the surrogate decisions made by physicians. This places more pressure on Makins to identify general criteria for when risk attitudes are problematically irrational as opposed to merely unusual.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":"757-758"},"PeriodicalIF":4.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10020765","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}

{"title":"On the elusiveness of higher-order risk attitudes.","authors":"Jasper Debrabander","doi":"10.1136/jme-2023-109331","DOIUrl":"10.1136/jme-2023-109331","url":null,"abstract":"Makins formulates a deference principle which states that patients’ attitudes towards the health outcomes associated with different treatment options should drive decisionmaking and not physicians’ attitudes towards these health outcomes. Although this deference principle is widely agreed on, it is less obvious which role patients’ risk attitudes should play. Makins takes patients’ attitudes towards health outcomes to be sufficiently analogous to patients’ risk attitudes in order to extend his deference principle. His extended deference principle states that patients’ attitudes towards the health outcomes and risks associated with different treatment options should drive decisionmaking and not physicians’ attitudes towards these health outcomes and risks. This extension is not only taken to be ethically preferable, but also practically realisable as one can reliably trace patients’ (risk) attitudes. Problematic situations arise when patients exhibit risk attitudes they do not reflexively endorse. For instance, patients might systematically make more risky choices than they think they should make. In response to these kinds of situations, Makins proposes to revise his deference principle. His revised deference principle states that patients’ reflexively endorsed attitudes towards the health outcomes and risks associated with different treatment options should drive decisionmaking and not physicians’ reflexively endorsed attitudes towards these health outcomes and risks. That is, only the (risk) attitudes that are endorsed by patients’ higherorder (risk) attitudes should drive decisionmaking. This view is reminiscent of what are often called ‘Frankfurtian’ accounts of authenticity even if Frankfurt himself did not explicitly discuss authenticity. 3 Makins, however, does not discuss the literature that is critical towards these Frankfurtian accounts of authenticity while formulating his revised deference principle. The main theoretical problem Frankfurtian accounts of authenticity face is the following. Firstorder attitudes are authentic if and only if they are reflexively endorsed by secondorder attitudes. However, the question can be raised whether these secondorder attitudes need to be authentic as well. If secondorder attitudes need not be authentic, then what Christman (p7) calls the ‘ab initio problem’ arises. For if secondorder attitudes need not be endorsed by higherorder attitudes in order to be authentic, why does authenticity require firstorder attitudes to be endorsed by secondorder attitudes in the first place? If secondorder attitudes need to be authentic in order for them to be able to convey authenticity on firstorder attitudes, a regression looms. For the authenticity of secondorder attitudes can only be established by thirdorder attitudes, etc. Frankfurt 3 tried to stop this regression nonarbitrarily by stating that a decisive identification could end it. We do not need to decide here whether Frankfurt successfully avoided the regr","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":"748"},"PeriodicalIF":4.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10020548","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}

{"title":"Why there is no dilemma for the birth strategy: a response to Bobier and Omelianchuk.","authors":"Prabhpal Singh","doi":"10.1136/jme-2022-108813","DOIUrl":"10.1136/jme-2022-108813","url":null,"abstract":"<p><p>Bobier and Omelianchuk argue that the Birth Strategy for addressing analogies between abortion and infanticide is saddled with a dilemma. It must be accepted that non-therapeutic late-term abortions are either, impermissible, or they are not. If accepted, then the Birth Strategy is undermined. If not, then the highly unintuitive claim that non-therapeutic late-term abortions are permissible must be accepted. I argue that the moral principle employed to defend the claim that non-therapeutic late-term abortions are morally impermissible fails to do so. Furthermore, the principle that people have a right to bodily autonomy can be used as an argument for the conclusion that non-therapeutic late-term abortions are permissible and is intuitively stronger than the intuition for the opposite of this conclusion. This is because people having a right to bodily autonomy explains the impermissibility of rape and sexual assault. Consequently, the posited dilemma is defused and does not undermine the Birth Strategy.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":"779-780"},"PeriodicalIF":4.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10454290","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}