• Ethical considerations of using artificial intelligence in healthcare

    Gaillard, Nathan (2023-12-04)
    This bachelor’s Thesis explores the necessity of frameworks in the use of artificial intelligence (AI) in healthcare settings, emphasizing the ethical implications and responsible implementation. The emergence of AI tools and the COVID-19 pandemic have raised significant ethical concerns related to bias, transparency, and accountability in healthcare.
 The research is composed of a comprehensive literature review focusing on the current use of AI as well as the status of ethical questions and solutions in medicine. It also includes qualitative interviews and a survey. This is made to gain a broad understanding of the topic from multiple perspectives. This approach allows us to align ethical guidelines with the values, needs and concerns of most people. This also fosters interdisciplinary dialogue.
 Key findings highlight the need for a universal ethical framework in using AI in healthcare. The necessity for transparency, informed consent, participatory design, adequate training for medical professionals, balance between technological prowess and human element, have all been identified during the study. These insights help decision-makers, researchers, healthcare professionals, as well as actors from other sectors who might be confronted with similar ethical questions, adopt safely AI technology.
 In conclusion, the thesis proposes a set of guidelines for the safe and ethical implementation and use of AI in healthcare. This serves as a tool for stakeholders to understand AI in the medical and pharmaceutical fields responsibly, considering the diverse viewpoints of the three main actors noted in the study: patients, medical professionals, and AI developers.
  • Ethical Challenges of Organ Transplantation: Current Debates and International Perspectives

    Hansen, Solveig Lena; Schicktanz, Silke (transcript VerlagDEUBielefeld, 2024-02-23)
    This collection features comprehensive overviews of the various ethical challenges in organ transplantation. International readings well-grounded in the latest developments in the life sciences are organized into systematic sections and engage with one another, offering complementary views. All core issues in the global ethical debate are covered: donating and procuring organs, allocating and receiving organs, as well as considering alternatives. Due to its systematic structure, the volume provides an excellent orientation for researchers, students, and practitioners alike to enable a deeper understanding of some of the most controversial issues in modern medicine.
  • Jenseits der Therapie: Philosophie und Ethik wunscherfüllender Medizin

    Eichinger, Tobias (transcript VerlagDEUBielefeld, 2024-02-19)
    Perfektes Aussehen und ewige Jugend, Intelligenz und Kreativität, Kraft und Konzentration. All diese Wünsche soll und will die Medizin heute erfüllen. Ob Anti-Aging, Schönheitschirurgie, Neuroenhancement oder Gendoping - neben ihrem klassisch-therapeutischen Auftrag folgt ärztliche Hilfe zunehmend auch dem Ziel der Wunscherfüllung. Ganz ohne Krankheitsbezug und Indikationsstellung, als Medizin für Gesunde. Nach einer philosophischen Untersuchung der Bedeutung von Wünschen und Bedürfnissen analysiert Tobias Eichinger die theoretischen Grundlagen wunscherfüllender Medizin. Er zeigt auf: Ärztliche Hilfe jenseits der Therapie kann zu erheblichen ethischen Problemen führen.
  • New Zealand's 'Cannabis Legalisation and Regulation Bill': an evidence-based assessment and critique of essential regulatory components towards policy outcomes.

    Fischer, Benedikt; Daldegan-Bueno, Dimitri (2023-03-17)
    New Zealand will hold a public referendum in 2020 on the possible replacement of current cannabis prohibition with legalisation of use and supply policy. Cannabis legalisation policies have been implemented-albeit with heterogeneous regulatory frameworks-in several (eg, North/South America) jurisdictions, with yet inconclusive evidence on main health and social outcomes. The New Zealand government has recently presented the final draft of its Cannabis Legalisation and Regulation Bill, including main regulatory parameters and provisions of the legalisation framework. As regulation elements are known to determine feasibility and outcomes of legalisation policy, we have undertaken a critical review and assessment of 10 of the Bill's main regulation components, based on evidence from and experiences with cannabis policy elsewhere as well as other substance policy areas. The reviewed components include: "political promises; age of use/access; places of use; penalties for underage use; 'home-growing'; retail distribution; licensed production; products available; new/remaining offenses; research and monitoring". New Zealand's cannabis legalisation plan is embedded within an overall public health-oriented framework. However, multiple essential regulatory provisions appear questionable for feasibility, consistency with public health principles or practice, or may lead to-possibly un-intended-adverse outcomes. These regulatory elements should be re-considered and adjusted, ideally before possible implementation of legalisation if supported by the referendum.
  • Oral Language and Communication Factors to Consider When Supporting People with FASD Involved with the Legal System

    Nelson, M; Trussler, M; Hand, Linda; Pickering, Megan; Kedge, Sally; McCann, Clare (SPRINGER, 2018-10-03)
  • Tracheostomy decannulation rates in Japan: a retrospective cohort study using a claims database

    石崎, 美保; 當山, まゆみ; 井村, 春樹; 高橋, 由光; 中山, 健夫; 40450598; 70217933; Ishizaki, Miho; Toyama, Mayumi; Imura, Haruki; et al. (Springer Nature, 2024-01-29)
    Despite the exponential increase in the use of tracheostomy worldwide, rates of tracheostomy decannulation are unknown. We conducted a retrospective cohort study to investigate tracheostomy decannulation rates among adult patients over a two-year period and explored factors associated with prolonged tracheostomy. A health insurance claims database including 3, 758, 210 people in Japan was used. The primary outcome was time to decannulation. Assessed patient and hospital factors included age, sex, emergency endotracheal intubation, disease, and hospital size. A total of 917 patients underwent tracheostomy, and 752 met the eligibility criteria. Decannulation rates were 40.8% (95% confidence interval 36.8-44.9) at 3 months, 63.9% (58.4-69.0) at 12 months, and 65.0% (59.2-70.3) at 24 months. Hazard ratios of patient and hospital factors for tracheostomy decannulation were 0.44 for age (65-74 years) (95% confidence interval 0.28-0.68), 0.81 (0.63-1.05) for female sex, and 0.59 (0.45-0.76) for emergency endotracheal intubation. Cerebrovascular disease, head injuries, and cardiac arrest had lower hazard ratios compared to other diseases. Decannulation rates among adult patients in Japan increased rapidly up to 3 months after tracheostomy, reaching a plateau after 12 months. Older age, female sex, emergency endotracheal intubation, cerebrovascular disease, head injuries, and cardiac arrest were associated with prolonged tracheostomy.
  • Ethical and regulatory challenges of AI technologies in healthcare: A narrative review

    Ciro Mennella; Umberto Maniscalco; Giuseppe De Pietro; Massimo Esposito (Elsevier, 2024-02-01)
    Over the past decade, there has been a notable surge in AI-driven research, specifically geared toward enhancing crucial clinical processes and outcomes. The potential of AI-powered decision support systems to streamline clinical workflows, assist in diagnostics, and enable personalized treatment is increasingly evident. Nevertheless, the introduction of these cutting-edge solutions poses substantial challenges in clinical and care environments, necessitating a thorough exploration of ethical, legal, and regulatory considerations.A robust governance framework is imperative to foster the acceptance and successful implementation of AI in healthcare. This article delves deep into the critical ethical and regulatory concerns entangled with the deployment of AI systems in clinical practice. It not only provides a comprehensive overview of the role of AI technologies but also offers an insightful perspective on the ethical and regulatory challenges, making a pioneering contribution to the field.This research aims to address the current challenges in digital healthcare by presenting valuable recommendations for all stakeholders eager to advance the development and implementation of innovative AI systems.
  • Sich einen Begriff vom Leiden Anderer machen: Eine Praktische Philosophie der Sorge

    Schuchter, Patrick (transcript VerlagDEUBielefeld, 2024-02-15)
    Sorge-Beziehungen in Medizin und Pflege sind geprägt von existenzieller Auseinandersetzung mit entscheidenden Fragen des Menschseins. Was kann die antike Philosophie hierzu beitragen? Patrick Schuchter hat die antiken philosophischen Praktiken der Sorge um sich für die Praktiken der Sorge für Andere ("Care") in der Gegenwart aufbereitet. Ausgehend von einem weiten und hermeneutisch fundierten Begriff der Sorge mündet die Schrift in eine radikale Neubegründung der Ethik und liefert so einen Impuls für eine aufgeklärte philosophische Praxis und Lebenskunst mitten im Alltag des Lebens und Arbeitens.
  • DigitalEthics:‘Ethical’ considerations of post-research ICT impact

    Brooks, Anthony Lewis; Brahnam, Sheryl; Kapralos, Bill; Jain, Lakhmi C.; Brooks, Anthony Lewis (Springer, 2017-02-20)
    This contribution posits a supposition on the topic of ‘ethical’ consideration when advanced, engaging, and playful ICT, i.e. beyond that available to the public, is researched. In focus are participants without communicative competence - especially young children diagnosed with Profound and Multiple Learning Disabilities (PMLD) – who are unable to express their desire for continued access/use/play. The position results from a mature body of empirical work that began in 1985 that, through specific case studies, stresses the need to contemplate affect on participants, thus promoting funding applications to include post-research access to content for participants as well to support staff intervention training to optimize content use.
  • Navigating our way through a hospital ransomware attack: ethical considerations in delivering acute orthopaedic care.

    Hoffman, Thomas William; Baker, Joseph Frederick (BMJ, 2023-04-21)
    Ransomware attacks on healthcare systems are becoming more prevalent globally. In May 2021, Waikato District Health Board in New Zealand was devastated by a major attack that crippled its information technology system. The Department of Orthopaedic Surgery faced a number of challenges to the way they delivered care including, patient assessment and investigations, the deferral of elective surgery, and communication and patient confidentiality. These issues are explored through the lens of the four key principles of medical ethics in the hope that they will provide some guidance to future departments who may experience such attacks.
  • Assessing Trustworthy AI in Times of COVID-19: Deep Learning for Predicting a Multiregional Score Conveying the Degree of Lung Compromise in COVID-19 Patients

    Allahabadi, H. (author); Amann, J. (author); Balot, I. (author); Beretta, A. (author); Binkley, C. (author); Bozenhard, J. (author); Bruneault, F. (author); Brusseau, J. (author); Umbrello, S. (author) (2022)
    This article’s main contributions are twofold: 1) to demonstrate how to apply the general European Union’s High-Level Expert Group’s (EU HLEG) guidelines for trustworthy AI in practice for the domain of healthcare and 2) to investigate the research question of what does “trustworthy AI” mean at the time of the COVID-19 pandemic. To this end, we present the results of a post-hoc self-assessment to evaluate the trustworthiness of an AI system for predicting a multiregional score conveying the degree of lung compromise in COVID-19 patients, developed and verified by an interdisciplinary team with members from academia, public hospitals, and industry in time of pandemic. The AI system aims to help radiologists to estimate and communicate the severity of damage in a patient’s lung from Chest X-rays. It has been experimentally deployed in the radiology department of the ASST Spedali Civili clinic in Brescia, Italy, since December 2020 during pandemic time. The methodology we have applied for our post-hoc assessment, called Z-Inspection®, uses sociotechnical scenarios to identify ethical, technical, and domain-specific issues in the use of the AI system in the context of the pandemic.
  • New Zealand transplant patients and organ transplantation in China: some ethical considerations

    Malpas, Phillipa (New Zealand Medical Association, 2019-03-21)
    In this viewpoint article we consider the situation of organ procurement from China, and address some of the ethical aspects arising for health professionals when New Zealand transplant patients contemplate traveling to China for an organ. We also consider some of the challenges facing health professionals involved in providing care to such patients.
  • Neurotechnology in criminal justice: key points for neuroscientists and engineers

    UCALL / Aansprakelijkheid en verantwoordelijkheid; Strafrecht en strafprocesrecht 1; Forensische psychiatrie / psychologie; Rechtstheorie; Montaigne Centrum voor Rechtspleging en conflictoplossing; Empirical Legal Research (ELS); Geukes, S.H.; Bijlsma, Johannes; Meynen, Gerben; Raemaekers, M.A.H.; et al. (2024-01-09)
  • The ethical decisions UK doctors make regarding advanced cancer patients at the end of life - the perceived (in) appropriateness of anticoagulation for venous thromboembolism: A qualitative study

    Johnson, Miriam; Maraveyas, Anthony; Sheard, Laura; Prout, Hayley; Dowding, Dawn; Noble, Simon; Watt, Ian (Springer Verlag, 2012-09-04)
    Background: Cancer patients are at risk of developing blood clots in their veins - venous thromboembolism (VTE) - which often takes the form of a pulmonary embolism or deep vein thrombosis. The risk increases with advanced disease. Evidence based treatment is low molecular weight heparin (LMWH) by daily subcutaneous injection. The aim of this research is to explore the barriers for doctors in the UK when diagnosing and treating advanced cancer patients with VTE. Method: Qualitative, in-depth interview study with 45 doctors (30 across Yorkshire, England and 15 across South Wales). Doctors were from three specialties: oncology, palliative medicine and general practice, with a mixture of senior and junior staff. Framework analysis was used. Results: Doctors opinions as to whether LMWH treatment was ethically appropriate for patients who were symptomatic from VTE but at end of life existed on a shifting continuum, largely influenced by patient prognosis. A lack of immediate benefit coupled with the discomfort of a daily injection had influenced some doctors not to prescribe LMWH. The point at which LMWH injections should be stopped in patients at the end of life was ambiguous. Some perceived overcaution in their own and other clinicians treatment of patients. Viewpoints were divergent on whether dying of a PE was considered a "good way to go". The interventionalism and ethos of palliative medicine was discussed. Conclusions: Decisions are difficult for doctors to make regarding LMWH treatment for advanced cancer patients with VTE. Treatment for this patient group is bounded to the doctors own moral and ethical frameworks.
  • An examination of service user satisfaction in forensic mental health settings

    Khan, Al Adiya; Stirrup, Victoria; MacInnes, D. (SAGE Publications, 2024)
    High levels of service user satisfaction are viewed as a reliable indicator of a service providing good care and treatment. There has been limited research looking into levels of satisfaction in forensic mental health settings with most work focused on staff satisfaction in these settings. This study examined service users’ levels of satisfaction with a forensic mental health service in the United Kingdom. The service covered two sites; one a purpose-built secure unit and the other based in an old cottage hospital. Thirty-nine in-patients completed a 60-item validated forensic satisfaction scale. The scale measured seven domains of satisfaction as well as reporting an overall satisfaction score. The results indicated the service users were reasonably satisfied with the care and treatment they received. The domains of rehabilitation, safety, staff interaction and overall care showed the highest level of satisfaction. The high rehabilitation satisfaction score demonstrated the importance of meaningful activities for users accessing forensic services and may have been influenced by the security measures on the wards. The high safety domain score indicated respondents felt safe and secure within the wards and were likely to be influenced by positive interpersonal interactions. Good staff interaction was also an important factor in helping service users feel safe on the wards. These interactions are likely to be associated with longer periods of admission in secure services allowing therapeutic relationships to develop. Financial advice/support was the one domain that recorded negative satisfaction levels. Financial literacy training may help develop money management skills.
  • Sharing Responsibility: Responsibility for Health Is Not a Zero-Sum Game

    LS Wijsgerige Ethiek; OFR - non-affiliated publications; Verweij, Marcel; Dawson, Angus (2019-07-01)
  • Surprising pandemic experiences : a confrontation between principle‐based and virtue ethics, and a plea for virtue ethics training for medical students and residents : a rudimentary outline of a four‐step model

    Zuckerman, Shlomit; Kimsma, Gerrit K.; Devisch, Ignaas (Wiley, 2023)
    BackgroundIn past years, physicians have, with a certain continuity, reported increasing numbers of burnout, depression and compassion fatigue in their daily practice. These problems were attributed, not only but also, to a loss of public trust and an increase in violent behaviour of patients and family members towards medical professionals in all walks of life. Recently, however, during the breakout of the coronavirus disease 2019 (COVID-19) pandemic in 2020, there were public expressions of appreciation and respect for health care workers that almost universally have been assessed as indications of a re-establishment of public trust in physicians and appreciation for the medical professions' commitments. In other words, shared experiences of what society was in need of: the experience of a 'common good'. Those responses during the COVID-19 pandemic increased positive feelings among practicing physicians, such as commitment, solidarity, competency, and experiences concerning obligations for the common good and a sense of belonging to one and the same community for all. Essentially, these responses of raised self-awareness of commitment and solidarity between (potential) patients and medical personal point towards the social importance and power of these values and virtues. This shared domain in ethical sources of behaviour seems to hold a promise of overcoming gaps between the different spheres of doctors and patients. That promise justifies stressing the relevance of this shared domain of Virtue Ethics in the training of physicians. MethodsIn this article, therefore, we shall make a plea for the relevance of Virtue Ethics before proposing an outline of an educational programme for Virtue Ethics training for medical students and residents. Let us start by very briefly presenting on Aristotelian virtues and its relevance to modern medicine in general, and during the current pandemic in particular. ResultsWe shall follow up this short presentation by a Virtue Ethics Training Model and the respective settings in which it takes place. This model has four steps as follows: (a) include moral character literacy in the formal curriculum; (b) provide ethics role modelling and informal training in moral character in the healthcare setting by senior staff; (c) create and apply regulatory guidelines regarding virtues and rules; and (d) assess success of training by evaluation of moral character of physicians. ConclusionApplying the four-step model may contribute to strengthening the development of moral character in medical students and residents, and decrease the negative consequences of moral distress, burnout and compassion fatigue in health care personnel. In the future, this model should be empirically studied.
  • Rationale and design of the BECA project: Smartwatch-based activation of the chain of survival for out-of-hospital cardiac arrest

    Roelof G. Hup; Emma C. Linssen; Marijn Eversdijk; Bente Verbruggen; Marieke A.R. Bak; Mirela Habibovic; Willem J. Kop; Dick L. Willems; Lukas R.C. Dekker; Reinder Haakma (Elsevier, 2024-03-01)
    Aim: Out-of-hospital cardiac arrest is a major health problem, and the overall survival rate is low (4.6%–16.4%). The initiation of the current chain of survival depends on the presence of a witness of the cardiac arrest, which is not present in 29.7%–63.4% of the cases. Furthermore, a delay in starting this chain is common in witnessed out-of-hospital cardiac arrest. This project aims to reduce morbidity and mortality due to out-of-hospital cardiac arrest by developing a smartwatch-based solution to expedite the chain of survival in the case of (un)witnessed out-of-hospital cardiac arrest. Methods: Within the ‘Beating Cardiac Arrest’ project, we aim to develop a demonstrator product that detects out-of-hospital cardiac arrest using photoplethysmography and accelerometer analysis, and autonomously alerts emergency medical services. A target group study will be performed to determine who benefits the most from this product. Furthermore, several clinical studies will be conducted to capture or simulate data on out-of-hospital cardiac arrest cases, as to develop detection algorithms and validate their diagnostic performance. For this, the product will be worn by patients at high risk for out-of-hospital cardiac arrest, by volunteers who will temporarily interrupt blood flow in their arm by inflating a blood pressure cuff, and by patients who undergo cardiac electrophysiologic and implantable cardioverter defibrillator testing procedures. Moreover, studies on psychosocial and ethical acceptability will be conducted, consisting of surveys, focus groups, and interviews. These studies will focus on end-user preferences and needs, to ensure that important individual and societal values are respected in the design process.