Intraoperative application of mixed and augmented reality for digital surgery: a systematic review of ethical issues.

Introduction: Head-mounted displays (HMDs) that superimpose holograms onto patients are of particular surgical interest as they are believed to dramatically change surgical procedures by including safety warning and allowing real-time offsite consultations. Although there are promising benefits of mixed and augmented reality (MR/AR) technologies in surgery, they also raise new ethical concerns. The aim of this systematic review is to determine the full spectrum of ethical issues that is raised for surgeons in the intraoperative application of MR/AR technology. Methods: Five bibliographic databases were searched for publications on the use of MR/AR, HMDs and other devices, their intraoperative application in surgery, and ethical issues. We applied qualitative content analysis to the n = 50 articles included. Firstly, we coded the material with deductive categories derived from ethical frameworks for surgical innovations, complications and research. Secondly, clinical aspects with ethical relevance were inductively coded as ethical issues within the main categories. Thirdly, we pooled the ethical issues into themes and sub-themes. We report our findings according to the reporting guideline RESERVE. Results: We found n = 143 ethical issues across ten main themes, namely patient-physician relationship, informed consent, professionalism, research and innovation, legal and regulatory issues, functioning equipment and optimal operating conditions, allocation of resources, minimizing harm, good communication skills and the ability to exercise sound judgement. The five most prevalent ethical issues are "Need for continuous research and innovation", "Ensuring improvement of the learning curve", "MR/AR enables new maneuvers for surgeons", "Ensuring improvement of comfort, ergonomics, and usability of devices," and "Not withholding MR/AR if it performs better". Conclusions: Recognizing the evidence-based limitations of the intraoperative MR/AR application is of paramount importance to avoid ethical issues, but clinical trials in surgery pose particular ethical risks for patients. Regarding the digital surgeon, long-term impact on human workforce, potentially harmful "negative training," i.e., acquiring inappropriate behaviors, and the fear of surveillance need further attention. MR/AR technologies offer not only challenges but significant advantages, promoting a more equitable distribution of surgical expertise and optimizing healthcare. Aligned with the core principle of social justice, these technologies enable surgeons to collaborate globally, improving training conditions and addressing enduring global healthcare inequalities.

Medication of Hydroxychloroquine, Remdesivir and Convalescent Plasma during the COVID-19 Pandemic in Germany-An Ethical Analysis.

This paper aims to analyze the ethical challenges in experimental drug use during the early stage of the COVID-19 pandemic, using Germany as a case study. In Germany uniform ethical guidelines were available early on nationwide, which was considered as desirable by other states to reduce uncertainties and convey a message of unity. The purpose of this ethical analysis is to assist the preparation of future guidelines on the use of medicines during public health emergencies. The use of hydroxychloroquine, remdesivir and COVID-19 convalescent plasma in clinical settings was analyzed from the perspective of the ethical principles of beneficence, non-maleficence, justice and autonomy. We observed that drug safety and drug distribution during the pandemic affects all four ethical principles. We therefore recommend to establish ethical guidelines (i) to discuss experimental treatment options with patients from all population groups who are in urgent need, (ii) to facilitate the recording of patient reactions to drugs in off-label use, (iii) to expand inclusion criteria for clinical studies to avoid missing potentially negative effects on excluded groups, and (iv) to maintain sufficient access to repurposed drugs for patients with prior conditions.

Harvesting the uncollected fruits of other people's intellectual labour / Beneficiarse de los frutos inutilizados del trabajo intelectual ajeno / Colhendo os frutos não coletados do trabalho intelectual de outras pessoas

Abstract: Intellectual property regimes necessarily create artificial scarcity leading to wastage, both by blocking follow-up research and impeding access to those who are not able to pay the full retail price. After revising the traditional arguments to hinder access to people's intellectual labour, we examine why we should be more open to allow free-riding of inventive efforts, especially in cases where innovators have not secured the widest access to the fruits of their research. We do so by questioning the voluntariness involved in the consumption of objects of innovation, restating the positive social externalities that arise when wider access to the fruits of innovation is facilitated, and examining the eventual harms innovators face.

Resumen: Los regímenes de propiedad intelectual crean necesariamente una escasez artificial que conduce al despilfarro, tanto mediante el bloqueo de investigación derivada y al prohibir el acceso a aquellos que no son capaces de pagar el precio total de venta. Después de analizar los argumentos tradicionales para limitar el acceso al trabajo intelectual ajeno, examinaremos por qué debemos ser más abiertos en permitir el uso gratuito de los esfuerzos inventivos ajenos, especialmente en los casos en que los innovadores no han ofrecido el más amplio acceso a los frutos de sus investigaciones. Para este propósito cuestionaremos la voluntariedad involucrada en el consumo de los objetos de la innovación, mencionaremos las externalidades sociales positivas que surgen cuando se facilita un mayor acceso a los frutos de la innovación, y haremos un examen del tipo de daños que los innovadores eventualmente enfrentan.

Resumo: Os regimes de propriedade intelectual criam, necessariamente, escassez artificial, levando ao desperdício, tanto por meio do bloqueio de pesquisa de acompanhamento quanto pelo impedimento dreo acesso àqueles que não são capazes de pagar o preço comercial total. Após rever os argumentos tradicionais para dificultar o acesso ao trabalho intelectual, nós examinamos porque nós devemos ser mais abertos e permitir o parasitismo dos esforços inovadores, especialmente em casos no qual os inovadores não têm assegurado o acesso mais amplo aos frutos de sua pesquisa. Nós o fazemos por questionar a voluntariedade envolvida no consumo de objetos de inovação, reafirmando as externalidades sociais positivas que surgem quando o acesso mais amplo dos resultados da inovação é facilitado, e examinar a eventuais prejuízos que os inovadores possam enfrentar.