Ethics collections
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AI governance ethics : artificial intelligence with shared values and rulesArtificial Intelligence influences already almost all sectors of society, from production, consumption and recycling of products to education and media, from agriculture to military. The search for AI governance from voluntary standards to international convention and standards is fast and urgent. This book unites contributions of authors from all continents. It also offers a representative collection of official recommendations and guidelines on AI governance from national governments, continental entities like EU and AU to UN-organisations.
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Public sector ethics in Sweden : a 4P-model of internal and external determinants in codes of ethicsPublic sector ethics in Sweden : a 4P-model of internal and external determinants in codes of ethics
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Beyond codes of ethics : an integrated framework for stimulating morally responsible behaviour in organisationsBeyond codes of ethics : an integrated framework for stimulating morally responsible behaviour in organisations
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Communicating the ethos of codes of ethics in corporate Australia, 1995-2001: whose rights, whose responsibilities?Communicating the ethos of codes of ethics in corporate Australia, 1995-2001: whose rights, whose responsibilities?
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Ethics in human resource management: potential for burnout among healthcare workers in ART and community care centresEthics in human resource management: potential for burnout among healthcare workers in ART and community care centres
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Inherent Risks of the Construction of High-Risk Individuals in Diabetes Treatment and Prevention: An Ethical ChallengeType 2 diabetes is presented as a current global health challenge of epidemic proportions. In an effort to meet this challenge, identification of high-risk individuals has become an essential part of a strategy blurring the traditional divide between treatment and prevention. This strategy is framed within a risk discourse, where many health risks are defined as the outcome of individual lifestyle choices. As a consequence, individuals are offered new subject positions, attributed with personal responsibility for maintaining their own health. In this chapter, some ethical challenges implicit in this discourse are addressed. Among them are the arbitrary construction of diagnoses like type 2 diabetes and prediabetes, the potential burden of getting a lifelong diagnosis without ever experiencing a symptomatic disease and being diagnosed through ethnic stereotypes built into diabetes risk calculators. Once diagnosed, those identified as carrying a high risk of diabetes carries a further risk of shaming and blaming due to their failure to fulfil the obligations attributed to the subject position of healthy citizens. Finally, the chapter addresses how overlooking structural injustice and poverty may be a major failure of the high-risk approach to diabetes.
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Anti-selection & genetic testing in insurance: an interdisciplinary perspectiveAnti-selection occurs when information asymmetry exists between insurers and applicants. When an applicant knows they are at high risk of loss, but the insurer does not, the applicant may try to use this knowledge differential to secure insurance at a lower premium that does not match risk.
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How to defend mandatory immunization against vaccine hesitancy and vaccine refusal? An ethical assessmentOne of the basic ethical principles in medical practice is to respect personal autonomy. However, it is a widely accepted view that when it comes to health problems that concern not only the individual but also the society, especially in epidemics of infectious diseases, individual autonomy can be violated by prioritizing the benefit of the community. This view is based on the scientific fact that epidemics can only be controlled by immunizing all susceptible individuals. However, whether all susceptible individuals can be compelled to be immunized remains a matter of debate around the world. Especially in the last three years, during the worldwide Coronavirus disease-2019 (COVID-19) pandemic, a significant part of the society has been hesitant about being vaccinated, and some have argued that vaccines should be rejected altogether. In the face of the situation outlined above, the question of "should immunization be mandatory?" has become more important than ever to be able to answer the question in a way that will ensure as broad consensus as possible. In this review article; it was discussed under which conditions mandatory immunization could be justified in terms of ethics and thus, it was aimed to contribute to the solution of the vital problem created by the phenomenon of vaccine hesitancy and rejection in terms of public health. To this aim, first of all, the need to clarify some concepts was mentioned. Afterwards, the arguments "must be compulsory", "should be optional", and "should not be done to anyone" were evaluated with their justifications and it was determined that the argument that immunization should be mandatory could be justified in terms of ethics. In the article, it was argued that the conflicts of "individual freedom X community benefit" and "personal autonomy X community benefit" did not exist in today's actual conditions, but it was stated that an individual with the knowledge of reality experiences a tension in the face of not putting this knowledge into practice. It was emphasized that in order to overcome this tension, consolidation of the theoretical background and also consideration of the macro determinants of vaccine hesitancy and rejection in practice were necessary. What needs to be done to re-establish trust in the medical institution was listed, and it was argued that the question of how to implement mandatory immunization could only be answered in a healthy way through a transformation process that will be implemented through a social dialogue.
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The Anatomy of Physician Fulfillment: Strategies Beyond BurnoutThe persistent tension and power struggle between healthcare executives and physicians is a prevalent issue in healthcare organizations, often leading to a culture of organizational mistrust. This dynamic stems from perceived conflicting goals: executives are frequently seen as primarily focused on financial outcomes, while physicians are viewed as resistant to change. This study explored how physician fulfillment is experienced at work, with the ultimate goal of identifying potential interventions to bridge the gap between these groups. There is vast research and literature available regarding burnout in healthcare; this research focused on understanding what physicians find fulfilling in their work and identifying actionable factors healthcare system leaders can address to enhance their fulfillment. Key factors identified from the literature include meaningful patient contact, quality of professional relationships, and organizational decision-making input. At the same time, challenges such as administrative burden and loss of autonomy were noted as detriments to fulfillment. After conducting and transcribing semi-structured phenomenological interviews with physicians, the data were coded for meaning, resulting in 169 codes. The prevalence of these broad themes varied concerning each research question, reflecting the complex and multifaceted nature of physician fulfillment. By identifying patterns and connections in the physicians’ experiences, this study highlighted the importance of addressing both systemic and individual factors to enhance professional fulfillment. Key findings of the study include the importance of humanizing healthcare goals and several directions for iv healthcare organizations: addressing moral injury, improving patient outcomes, obtaining and utilizing physician input consistently, fostering a supportive culture, and creating time and space for peer support. Targeted interventions to enhance physician fulfillment were proposed, aiming to determine strategies to improve physician fulfillment for healthcare organizations since aligning organizational goals with physicians' intrinsic motivations can foster a collaborative and trusting work environment, benefiting both staff and patients. This dissertation is available in open access at AURA: Antioch University Repository and Archive (https://aura.antioch.edu/) and OhioLINK ETD Center (https://etd.ohiolink.edu).
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Systematic scoping review of cluster randomised trials conducted exclusively in low-income and middle-income countries between 2017 and 2022Acknowledgements The authors would also like to thank Laura Quinn for assisting with full text screening, and Spencer Phillip Hey for assisting with ClincalTrials.gov data extraction and linkage.
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The Doctrine of Double Effect and Medical Ethics: A New Formulation<div> <div> <div> <div> <div> <p>The standard version of the doctrine of double effect, a significant doctrine in applied ethics particularly medical ethics, not only fails to capture some morally significant components of Aquinas’ view, but it does not resort to proper complementary features in order to accommodate the doctrine to our moral intuitions.‎ We attempt to offer a new formulation of the doctrine incorporating the main components of Aquinas’ view and also to extend the view using some complementary features.‎ We will examine the strength of the formulation applying it into some ethically controversial situations, mainly in medical ethics.‎</p> </div> </div> </div> </div> </div>
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The good, the bad and the ugly: pandemic priority decisions and triageIn this analysis we discuss the change in criteria for triage of patients during three different phases of a pandemic like COVID-19, seen from the critical care point of view. Availability of critical care beds has become a hot topic, and in many countries, we have seen a huge increase in the provision of temporary intensive care bed capacity. However, there is a limit where the hospitals may run out of resources to provide critical care, which is heavily dependent on trained staff, just-in-time supply chains for clinical consumables and drugs and advanced equipment. In the first (good) phase, we can still do clinical prioritisation and decision-making as usual, based on the need for intensive care and prognostication: what are the odds for a good result with regard to survival and quality of life. In the next (bad phase), the resources are mostly available, but the system is stressed by many patients arriving over a short time period and auxiliary beds in different places in the hospital being used. We may have to abandon admittance of patients with doubtful prognosis. In the last (ugly) phase, usual medical triage and priority setting may not be sufficient to decrease inflow and there may not be enough intensive care unit beds available. In this phase different criteria must be applied using a utilitarian approach for triage. We argue that this is an important transition where society, and not physicians, must provide guidance to support triage that is no longer based on medical priorities alone.
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Ethics of wearable-based out-of-hospital cardiac arrest detectionOut-of-hospital cardiac arrest is a major health problem, and immediate treatment is essential for improving the chances of survival. The development of technological solutions to detect out-of-hospital cardiac arrest and alert emergency responders is gaining momentum; multiple research consortia are currently developing wearable technology for this purpose. For the responsible design and implementation of this technology, it is necessary to attend to the ethical implications. This review identifies relevant ethical aspects of wearable-based out-of-hospital cardiac arrest detection according to four key principles of medical ethics. First, aspects related to beneficence concern the effectiveness of the technology. Second, nonmaleficence requires preventing psychological distress associated with wearing the device and raises questions about the desirability of screening. Third, grounded in autonomy are empowerment, the potential reidentification from continuously collected data, issues of data access, bystander privacy, and informed consent. Finally, justice concerns include the risks of algorithmic bias and unequal technology access. Based on this overview and relevant legislation, we formulate design recommendations. We suggest that key elements are device accuracy and reliability, dynamic consent, purpose limitation, and personalization. Further empirical research is needed into the perspectives of stakeholders, including people at risk of out-of-hospital cardiac arrest and their next-of-kin, to achieve a successful and ethically balanced integration of this technology in society.
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Ethics of wearable-based out-of-hospital cardiac arrest detectionOut-of-hospital cardiac arrest is a major health problem, and immediate treatment is essential for improving the chances of survival. The development of technological solutions to detect out-of-hospital cardiac arrest and alert emergency responders is gaining momentum; multiple research consortia are currently developing wearable technology for this purpose. For the responsible design and implementation of this technology, it is necessary to attend to the ethical implications. This review identifies relevant ethical aspects of wearable-based out-of-hospital cardiac arrest detection according to four key principles of medical ethics. First, aspects related to beneficence concern the effectiveness of the technology. Second, nonmaleficence requires preventing psychological distress associated with wearing the device and raises questions about the desirability of screening. Third, grounded in autonomy are empowerment, the potential reidentification from continuously collected data, issues of data access, bystander privacy, and informed consent. Finally, justice concerns include the risks of algorithmic bias and unequal technology access. Based on this overview and relevant legislation, we formulate design recommendations. We suggest that key elements are device accuracy and reliability, dynamic consent, purpose limitation, and personalization. Further empirical research is needed into the perspectives of stakeholders, including people at risk of out-of-hospital cardiac arrest and their next-of-kin, to achieve a successful and ethically balanced integration of this technology in society.
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Artificial intelligence in medical education: A cross-sectional needs assessmentBackground As the information age wanes, enabling the prevalence of the artificial intelligence age; expectations, responsibilities, and job definitions need to be redefined for those who provide services in healthcare. This study examined the perceptions of future physicians on the possible influences of artificial intelligence on medicine, and to determine the needs that might be helpful for curriculum restructuring. Methods A cross-sectional multi-centre study was conducted among medical students country-wide, where 3018 medical students participated. The instrument of the study was an online survey that was designed and distributed via a web-based service. Results Most of the medical students perceived artificial intelligence as an assistive technology that could facilitate physicians' access to information (85.8%) and patients to healthcare (76.7%), and reduce errors (70.5%). However, half of the participants were worried about the possible reduction in the services of physicians, which could lead to unemployment (44.9%). Furthermore, it was agreed that using artificial intelligence in medicine could devalue the medical profession (58.6%), damage trust (45.5%), and negatively affect patient-physician relationships (42.7%). Moreover, nearly half of the participants affirmed that they could protect their professional confidentiality when using artificial intelligence applications (44.7%); whereas, 16.1% argued that artificial intelligence in medicine might cause violations of professional confidentiality. Of all the participants, only 6.0% stated that they were competent enough to inform patients about the features and risks of artificial intelligence. They further expressed that their educational gaps regarding their need for "knowledge and skills related to artificial intelligence applications" (96.2%), "applications for reducing medical errors" (95.8%), and "training to prevent and solve ethical problems that might arise as a result of using artificial intelligence applications" (93.8%). Conclusions The participants expressed a need for an update on the medical curriculum, according to necessities in transforming healthcare driven by artificial intelligence. The update should revolve around equipping future physicians with the knowledge and skills to effectively use artificial intelligence applications and ensure that professional values and rights are protected.
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Public involvement in the governance of population-level biomedical research: Unresolved questions and future directionsPopulation-level biomedical research offers new opportunities to improve population health, but also raises new challenges to traditional systems of research governance and ethical oversight. Partly in response to these challenges, various models of public involvement in research are being introduced. Yet, the ways in which public involvement should meet governance challenges are not well understood. We conducted a qualitative study with 36 experts and stakeholders using the World Café method to identify key governance challenges and explore how public involvement can meet these challenges. This brief report discusses four cross-cutting themes from the study: the need to move beyond individual consent; issues in benefit and data sharing; the challenge of delineating and understanding publics; and the goal of clarifying justifications for public involvement. The report aims to provide a starting point for making sense of the relationship between public involvement and the governance of population-level biomedical research, showing connections, potential solutions and issues arising at their intersection. We suggest that, in population-level biomedical research, there is a pressing need for a shift away from conventional governance frameworks focused on the individual and towards a focus on collectives, as well as to foreground ethical issues around social justice and develop ways to address cultural diversity, value pluralism and competing stakeholder interests. There are many unresolved questions around how this shift could be realised, but these unresolved questions should form the basis for developing justificatory accounts and frameworks for suitable collective models of public involvement in population-level biomedical research governance.