Asian Bioethics Review最新文献

{"title":"When can we Kick (Some) Humans “Out of the Loop”? An Examination of the use of AI in Medical Imaging for Lumbar Spinal Stenosis","authors":"Kathryn Muyskens,&nbsp;Yonghui Ma,&nbsp;Jerry Menikoff,&nbsp;James Hallinan,&nbsp;Julian Savulescu","doi":"10.1007/s41649-024-00290-9","DOIUrl":"10.1007/s41649-024-00290-9","url":null,"abstract":"<div><p>Artificial intelligence (AI) has attracted an increasing amount of attention, both positive and negative. Its potential applications in healthcare are indeed manifold and revolutionary, and within the realm of medical imaging and radiology (which will be the focus of this paper), significant increases in accuracy and speed, as well as significant savings in cost, stand to be gained through the adoption of this technology. Because of its novelty, a norm of keeping humans “in the loop” wherever AI mechanisms are deployed has become synonymous with good ethical practice in some circles. It has been argued that keeping humans “in the loop” is important for reasons of safety, accountability, and the maintenance of institutional trust. However, as the application of machine learning for the detection of lumbar spinal stenosis (LSS) in this paper’s case study reveals, there are some scenarios where an insistence on keeping humans in the loop (or in other words, the resistance to automation) seems unwarranted and could possibly lead us to miss out on very real and important opportunities in healthcare—particularly in low-resource settings. It is important to acknowledge these opportunity costs of resisting automation in such contexts, where better options may be unavailable. Using an AI model based on convolutional neural networks developed by a team of researchers at NUH/NUS medical school in Singapore for automated detection and classification of the lumbar spinal canal, lateral recess, and neural foraminal narrowing in an MRI scan of the spine to diagnose LSS, we will aim to demonstrate that where certain criteria hold (e.g., the AI is as accurate or better than human experts, risks are low in the event of an error, the gain in wellbeing is significant, and the task being automated is not essentially or importantly human), it is both morally permissible and even desirable to kick the humans out of the loop.</p></div>","PeriodicalId":44520,"journal":{"name":"Asian Bioethics Review","volume":"17 1","pages":"207 - 223"},"PeriodicalIF":1.3,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s41649-024-00290-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140977722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-jurisdictional Data Transfer in Health Research: Stakeholder Perceptions on the Role of Law","authors":"Hui Yun Chan,&nbsp;Hui Jin Toh,&nbsp;Tamra Lysaght","doi":"10.1007/s41649-024-00283-8","DOIUrl":"10.1007/s41649-024-00283-8","url":null,"abstract":"<div><p>Large data-intensive health research programmes benefit from collaboration amongst researchers who may be located in different institutions and international contexts. However, complexities in navigating privacy frameworks and data protection laws across various jurisdictions pose significant challenges to researchers seeking to share or transfer data outside of institutional boundaries. Research on the awareness of data protection and privacy laws amongst stakeholders is limited. Our qualitative study, drawn from a larger project in Singapore, revealed insights into stakeholders’ perceptions of the role of law in cross-national health data research. Stakeholders in our study demonstrated a range of perceptions regarding the role of data protection law in governing the collection and transfer of health data for research. The main criticisms included inadequate legal protection to data and lack of uniformed data protection standards. Despite these criticisms, participants recognised the importance of data protection law in supporting cross-border data transfers and proposed measures to improve perceived limitations of existing laws. These measures include strengthening existing legal framework, establishing contractual agreements and imposing severe punishments for data misuse.</p></div>","PeriodicalId":44520,"journal":{"name":"Asian Bioethics Review","volume":"16 4","pages":"663 - 682"},"PeriodicalIF":1.3,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s41649-024-00283-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140988527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Update on the Ethical Breadth of the Human Rights Concept","authors":"Steven B. Rothman,&nbsp;Karina Dyliaeva,&nbsp;Nader Ghotbi","doi":"10.1007/s41649-024-00288-3","DOIUrl":"10.1007/s41649-024-00288-3","url":null,"abstract":"<div><p>The Universal Declaration of Human Rights (UDHR) approved by the United Nations (UN) in 1948 includes the most widely accepted list of individual rights all over the world. Although it has been a catalyst in the pursuit of a <i>universal ethic</i> for human rights, it has not been updated for over 75 years during which significant progress has been made in the recognition of more human rights. It is time to examine whether the current global society aspires for more/other human rights that are not reflected in previous declarations. We offer a review of literature on the potential areas that human rights may be extended to in the current sociocultural atmosphere and share the results of a survey at an international university in Japan which examines the views of 232 young Asian students from Japan, Korea, Vietnam, Thailand, China, Indonesia, etc. regarding the human rights declaration items and their implications, as well as new hypothetical items that they would like to see recognized as human rights. The results demonstrate stronger support for 15 out of the 21 surveyed items by all respondents, as well as stronger support for 10 out of the 21 items by female respondents. These results suggest a variable expansion in the breadth of the human rights concept which is worthy of further research. Also, gender inequality may be the basis for the stronger support of certain human rights by female respondents.</p></div>","PeriodicalId":44520,"journal":{"name":"Asian Bioethics Review","volume":"16 4","pages":"595 - 613"},"PeriodicalIF":1.3,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140659524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the Landscape of Digital Twins in Medicine: A Relational Bioethical Inquiry","authors":"Brandon Ferlito,&nbsp;Michiel De Proost,&nbsp;Seppe Segers","doi":"10.1007/s41649-024-00280-x","DOIUrl":"10.1007/s41649-024-00280-x","url":null,"abstract":"<div><p>This perspective article explores the use of digital twins (DTs) in medicine, highlighting its capacity to simulate risks and personalize treatments while examining the emerging bioethical concerns. Central concerns include power dynamics, exclusion, and misrepresentation. We propose adopting a relational bioethical approach that advocates for a comprehensive assessment of DTs in medicine, extending beyond individual interactions to consider broader structural relations and varying levels of access to power. This can be achieved through two key relational recommendations: acknowledging the impact of uneven relational structures on access to medical care and promoting social justice by evaluating resource allocation. While DTs in medicine offer promising advancements, a relational bioethical lens may provide a nuanced understanding, fostering equitable, inclusive and responsible integration of DTs into medical practice.</p></div>","PeriodicalId":44520,"journal":{"name":"Asian Bioethics Review","volume":"16 3","pages":"471 - 481"},"PeriodicalIF":1.3,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140672241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethics Review of Biomedical Research in Uzbekistan: Policy and Program Gaps","authors":"Dilfuza Aniyozova,&nbsp;Martin A. Strosberg","doi":"10.1007/s41649-023-00273-2","DOIUrl":"10.1007/s41649-023-00273-2","url":null,"abstract":"<div><p>We describe the national health research ethics review system of Uzbekistan and identify policy and program gaps that impede the protection of human research subjects. We find that the National Ethic Committee (NEC), functioning at the national level, is solely responsible for conducting research ethics review. There is little evidence that regional ethics committees work as intended, and there is no research ethics review at medical institutes and research centers even though they conduct CDTs (clinical drug trials). There is no national policy for the ethical review of non-clinical trials. We recommend the establishment of institutional review boards (IRBs) at medical institutes and research centers while at the same time building capacity at the national level to oversee and support the research ethics review system of the entire country.</p></div>","PeriodicalId":44520,"journal":{"name":"Asian Bioethics Review","volume":"16 4","pages":"653 - 661"},"PeriodicalIF":1.3,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140693277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transnational Health and Self-care Experiences of Japanese Women who have taken Oral Contraceptives in South Korea, including Over-the-counter Access: Insights from Semi-structured Interviews","authors":"Seongeun Kang,&nbsp;Kazuto Kato","doi":"10.1007/s41649-024-00293-6","DOIUrl":"10.1007/s41649-024-00293-6","url":null,"abstract":"<div><p>In an increasingly globalized world, the accessibility of healthcare and medication has expanded beyond local healthcare systems and national borders. This study aims to investigate the transnational health and self-care experiences of 11 Japanese women who have resided in South Korea for a minimum of six months and have utilized oral contraceptives, including those that were acquired over-the-counter (OTC). Data were gathered through semi-structured interviews and analyzed by utilizing the NVivo software. The analysis yielded three significant thematic categories, namely (1) experiences and perceptions of obtaining and utilizing contraceptive pills, including OTC access; (2) individual and social perceptions of pills and their accessibility in Japan, insights from actual users; and (3) enhancing pill accessibility, transnational health and self-care experiences and perspectives. Participants acknowledged that oral contraceptives are a global product and experienced communication challenges with healthcare providers as a result of differing understandings of these medications. Additionally, this study identified transnational strategies, such as purchasing an adequate supply of pills just before departure and seeking pills from local families or acquaintances. This study not only highlights the implications of clinical care for transnational patients but also underscores their critical global perspectives on access to oral contraceptives. Furthermore, it proposes two models for improving accessibility within the Japanese healthcare system, even in prescription-only contexts, by introducing OTC options.</p></div>","PeriodicalId":44520,"journal":{"name":"Asian Bioethics Review","volume":"16 4","pages":"711 - 737"},"PeriodicalIF":1.3,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s41649-024-00293-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140715266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Path Dependency in Vietnam’s Healthcare Legal Framework: Exploring Public–Private Collaboration in Ho Chi Minh City during the COVID-19 Crisis","authors":"Tran Viet Dung,&nbsp;Ngo Nguyen Thao Vy","doi":"10.1007/s41649-023-00276-z","DOIUrl":"10.1007/s41649-023-00276-z","url":null,"abstract":"<div><p>The COVID-19 pandemic prompted a nudge for public–private cooperation in healthcare to rapidly cope with limited resource. However, Vietnam’s historical reliance on a public healthcare system, combined with a traditional emphasis on socialization in the Polanyian sense, hindered the swift integration of the private sector. This research investigates path dependency in Vietnam’s public health sector, using theories including path dependency, Karl Polanyi’s double movement with legal analysis method to analyze the interplay of historical decisions, and socialist policies in healthcare. Recognizing these institutional and market governance flaws, a deeper understanding of the role of law becomes vital in crafting strategies for a more resilient and sustainable healthcare system in Vietnam. In this article, Ho Chi Minh City is chosen as a case study due to its notable mix of public–private healthcare facilities and its status as a leading area in infection cases during the third COVID-19 wave. The article suggests that there should be a change in the way public and private sectors work together, one that is more in line with market-driven solutions which requires solid legal framework for cooperation beyond merely mobilizing resources.</p></div>","PeriodicalId":44520,"journal":{"name":"Asian Bioethics Review","volume":"16 4","pages":"771 - 791"},"PeriodicalIF":1.3,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140730374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary Use of Health Data for Medical AI: A Cross-Regional Examination of Taiwan and the EU","authors":"Chih-hsing Ho","doi":"10.1007/s41649-024-00279-4","DOIUrl":"10.1007/s41649-024-00279-4","url":null,"abstract":"<div><p>This paper conducts a comparative analysis of data governance mechanisms concerning the secondary use of health data in Taiwan and the European Union (EU). Both regions have adopted distinctive approaches and regulations for utilizing health data beyond primary care, encompassing areas such as medical research and healthcare system enhancement. Through an examination of these models, this study seeks to elucidate the strategies, frameworks, and legal structures employed by Taiwan and the EU to strike a delicate balance between the imperative of data-driven healthcare innovation and the safeguarding of individual privacy rights. This paper examines and compares several key aspects of the secondary use of health data in Taiwan and the EU. These aspects include data governance frameworks, legal and regulatory frameworks, data access and sharing mechanisms, and privacy and security considerations. This comparative exploration offers invaluable insights into the evolving global landscape of health data governance. It provides a deeper understanding of the strategies implemented by these regions to harness the potential of health data while upholding the ethical and legal considerations surrounding its secondary use. The findings aim to inform best practices for responsible and effective health data utilization, particularly in the context of medical AI applications.</p></div>","PeriodicalId":44520,"journal":{"name":"Asian Bioethics Review","volume":"16 3","pages":"407 - 422"},"PeriodicalIF":1.3,"publicationDate":"2024-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s41649-024-00279-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140735191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Tempered Rationalism for a Tempered Yuck Factor—Using Disgust in Bioethics","authors":"Konstantin Eckl,&nbsp;Konstantin Deininger","doi":"10.1007/s41649-023-00278-x","DOIUrl":"10.1007/s41649-023-00278-x","url":null,"abstract":"<div><p>When it comes to invasive manipulation of animals on the biological level, reactions of disgust are common and often influential on people’s moral judgments. As a case in point, the Belgian Blue, a breed of hyper-enhanced cattle which will serve as a case study for the present article, has historically been met with revulsion. Traditionally, in bio- and animal ethics, this ‘yuck factor,’ has been denied any productive role in proper moral justification, since rationalism is still a dominant paradigm in those disciplines. This is not surprising since rationalism offers the fulfilment of certain expectations we have of morality, like universality, intersubjective communicability, and objectivity. Increasingly, however, the preconceptions of rationalism have been brought into question, both through empirical as well as philosophical insights. In this paper, we will explore a way in which researchers who are, accordingly, critical of rationalism, and who wish to take seriously the role disgust plays in the formation of moral judgments when it comes to biological manipulation of animals, can do so without abandoning those virtues of rationalism which make it such an appealing position. We will do so by offering what we call a ‘tempered’ kind of rationalism, that is, one which conceives of rationality in the terms of Mary Midgley, not as distinct from, but as a possible function of, well-ordered emotion.</p></div>","PeriodicalId":44520,"journal":{"name":"Asian Bioethics Review","volume":"16 4","pages":"575 - 594"},"PeriodicalIF":1.3,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s41649-023-00278-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140369750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a Framework for Self-regulatory Governance in Healthcare AI Research: Insights from South Korea","authors":"Junhewk Kim,&nbsp;So Yoon Kim,&nbsp;Eun-Ae Kim,&nbsp;Jin-Ah Sim,&nbsp;Yuri Lee,&nbsp;Hannah Kim","doi":"10.1007/s41649-024-00281-w","DOIUrl":"10.1007/s41649-024-00281-w","url":null,"abstract":"<div><p>This paper elucidates and rationalizes the ethical governance system for healthcare AI research, as outlined in the ‘Research Ethics Guidelines for AI Researchers in Healthcare’ published by the South Korean government in August 2023. In developing the guidelines, a four-phase clinical trial process was expanded to six stages for healthcare AI research: preliminary ethics review (stage 1); creating datasets (stage 2); model development (stage 3); training, validation, and evaluation (stage 4); application (stage 5); and post-deployment monitoring (stage 6). Researchers identified similarities between clinical trials and healthcare AI research, particularly in research subjects, management and regulations, and application of research results. In the step-by-step articulation of ethical requirements, this similarity benefits from a reliable and flexible use of existing research ethics governance resources, research management, and regulatory functions. In contrast to clinical trials, this procedural approach to healthcare AI research governance effectively highlights the distinct characteristics of healthcare AI research in research and development process, evaluation of results, and modifiability of findings. The model exhibits limitations, primarily in its reliance on self-regulation and lack of clear delineation of responsibilities. While formulated through multidisciplinary deliberations, its application in the research field remains untested. To overcome the limitations, the researchers’ ongoing efforts for educating AI researchers and public and the revision of the guidelines are expected to contribute to establish an ethical research governance framework for healthcare AI research in the South Korean context in the future.</p></div>","PeriodicalId":44520,"journal":{"name":"Asian Bioethics Review","volume":"16 3","pages":"391 - 406"},"PeriodicalIF":1.3,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s41649-024-00281-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140383235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}