The selective deployment of AI in healthcare: An ethical algorithm for algorithms.

Machine-learning algorithms have the potential to revolutionise diagnostic and prognostic tasks in health care, yet algorithmic performance levels can be materially worse for subgroups that have been underrepresented in algorithmic training data. Given this epistemic deficit, the inclusion of underrepresented groups in algorithmic processes can result in harm. Yet delaying the deployment of algorithmic systems until more equitable results can be achieved would avoidably and foreseeably lead to a significant number of unnecessary deaths in well-represented populations. Faced with this dilemma between equity and utility, we draw on two case studies involving breast cancer and melanoma to argue for the selective deployment of diagnostic and prognostic tools for some well-represented groups, even if this results in the temporary exclusion of underrepresented patients from algorithmic approaches. We argue that this approach is justifiable when the inclusion of underrepresented patients would cause them to be harmed. While the context of historic injustice poses a considerable challenge for the ethical acceptability of selective algorithmic deployment strategies, we argue that, at least for the case studies addressed in this article, the issue of historic injustice is better addressed through nonalgorithmic measures, including being transparent with patients about the nature of the current epistemic deficits, providing additional services to algorithmically excluded populations, and through urgent commitments to gather additional algorithmic training data from excluded populations, paving the way for universal algorithmic deployment that is accurate for all patient groups. These commitments should be supported by regulation and, where necessary, government funding to ensure that any delays for excluded groups are kept to the minimum. We offer an ethical algorithm for algorithms-showing when to ethically delay, expedite, or selectively deploy algorithmic systems in healthcare settings.

Application of Topic Modeling on Artificial Intelligence Studies as a Foundation to Develop Ethical Guidelines in African American Dementia Caregiving.

We applied natural language processing and topic modeling to publicly available abstracts and titles of 263 papers in the scientific literature mentioning AI and demographics (corpus 1 before Covid-19, corpus 2 after Covid-19) extracted from the MEDLINE database. We found exponential growth of AI studies mentioning demographics since the pandemic (Before Covid-19: N= 40 vs. After Covid-19: N= 223) [forecast model equation: ln(Number of Records) = 250.543*ln(Year) + -1904.38, p = 0.0005229]. Topics related to diagnostic imaging, quality of life, Covid, psychology, and smartphone increased during the pandemic, while cancer-related topics decreased. The application of topic modeling to the scientific literature on AI and demographics provides a foundation for the next steps regarding developing guidelines for the ethical use of AI for African American dementia caregivers.

Assistência ginecológica aos transgênero / Gynecological care for transgenders

Transgênero (trans) é um termo que alberga toda a diversidade de gênero. A incongruência de gênero faz parte desse espectro e refere-se à pessoa cuja identidade de gênero é oposta ao sexo que lhe foi atribuído no nascimento. A terapia hormonal de afirmação de gênero, bem como a cirurgia de afirmação de gênero, é necessária para adequar o corpo ao gênero ao qual a pessoa se identifica. Os homens trans necessitam da terapia com testosterona, que visa reduzir as concentrações de estradiol e incrementar a testosterona circulante para níveis fisiológicos masculinos, resultando em masculinização. A mulher trans receberá o estradiol, associado ou não a um antiandrogênico, visando reduzir a testosterona e incrementar o estrogênio para níveis femininos, resultando em feminização. A cirurgia de afirmação de gênero é, frequentemente, requerida para completar as modificações fenotípicas para o homem e a mulher trans. O ginecologista e obstetra tem um papel crucial no provimento de cuidados a essa população. O presente artigo visa sistematizar algumas ações que o ginecologista e obstetra pode oferecer e que têm potencial para melhorar a qualidade de vida dos homens e mulheres trans. (AU)

Transgenero (trans) is an umbrella term that encompasses all gender diversity. Gender Incongruity is part of this spectrum and refers to the person whose gender identity is opposed to the sex assigned to them at birth. Gender-affirming hormone therapy as well as gender-affirming surgery are necessary to adapt the body to the gender to which the person identifies. Trans men require testosterone therapy to reduce estradiol concentrations and increase circulating testosterone to male physiological levels resulting in masculinization. Trans women will receive estradiol associated or not with an antiandrogenic to reduce testosterone and increase estrogen to female levels resulting in feminization. gender-affirming surgery is often required to complete phenotypic modifications for trans men and women. The gynecologist and obstetrician plays a crucial role in to provide care to this population. This article aims to systematize some actions that the gynecologist and obstetrician can offer to improve the quality of life of trans men and women. (AU)

Sociocognição e saúde mental: a 'leitura do outro' no cuidado em saúde / Cognición social y salud mental: la 'lectura de la mente' en la assistencia a salud / Social cognition and mental health: the mindreading in the healthcare work

RESUMO. Teoria da mente é a habilidade sociocognitiva de inferir pensamentos, sentimentos e intenções. É uma habilidade que sustenta as relações sociais e parece particularmente relevante para o exercício de certas atividades que estão ligadas à 'leitura do outro', como a prática de profissionais que exercem o cuidado em equipamentos de saúde, como ocorre nos Centros de Atenção Psicossocial. Este estudo teórico teve o objetivo de analisar a importância das habilidades sociocognitivas para o trabalho em saúde, especialmente na saúde mental, a fim de identificar e discutir possíveis fatores que podem ter impacto na inferência que os profissionais fazem a respeito do que os usuários do serviço estão pensando, sentindo ou querendo. A análise permitiu observar as formas pelas quais a teoria da mente pode se tornar importante ferramenta para o profissional no processo terapêutico. Além disso, foi possível identificar que, no formato em que tem funcionado atualmente, o trabalho em Centros de Atenção Psicossocial tem exposto o profissional a diversos estressores que parecem produzir efeitos em suas habilidades sociocognitivas, podendo prejudicar não apenas sua saúde como também o exercício do cuidado.

RESUMEN. Teoría de la mente es la capacidad sociocognitiva de inferir pensamientos, sentimientos e intenciones. Es una habilidad que apoya las relaciones sociales y parece particularmente relevante para el ejercicio de determinadas actividades que están vinculadas a 'leer al otro', como la práctica de los profesionales que brindan atención en equipos de salud, como ocurre en los Centros de Atención Psicosocial. Este estudio teórico tuvo como objetivo analizar la importancia de las habilidades socio-cognitivas para el trabajo en salud, especialmente en salud mental, buscando identificar y discutir posibles factores que pueden incidir en la inferencia que hacen los profesionales sobre lo que piensan, sienten o sienten los usuarios del servicio. El análisis permitió observar las formas en que la teoría de la mente puede convertirse en una herramienta importante para los profesionales en el proceso terapéutico. Además, se pudo identificar que, en el formato en el que se ha operado actualmente, el trabajo en Centros de Atención Psicosocial ha expuesto a los profesionales a diversos estresores que parecen afectar sus habilidades sociocognitivas, los cuales pueden perjudicar no solo su salud sino también el ejercicio del cuidado.

ABSTRACT. Theory of mind is a social cognition ability to infer thoughts, feelings and intentions. It is a skill that underpins social relationships and seems particularly relevant to the exercise of certain activities linked to mindreading, such as healthcare practice, for example, in Psychosocial Care Centers. This theoretical study aims to analyze the importance of social cognition skills for mental health practitioners, seeking to identify and discuss possible factors that impact how these professionals infer what service users are thinking, feeling or wanting. The analysis allowed us to observe how the theory of mind can become an important tool for professionals in the therapeutic process. In particular, the study concludes that work in Psychosocial Care Centers has exposed professionals to various stressors that seem to have an effect on their social cognition skills, which can harm not only their health but also their ability to attend to the needs of service users.

Artificial Intelligence in Cardiovascular Imaging: "Unexplainable" Legal and Ethical Challenges?

Nowhere is the influence of artificial intelligence (AI) likely to be more profoundly felt than in health care, from patient triage and diagnosis to surgery and follow-up. Over the medium-term, these effects will be more acute in the cardiovascular imaging context, in which AI models are already successfully performing at approximately human levels of accuracy and efficiency in certain applications. Yet, the adoption of unexplainable AI systems for cardiovascular imaging still raises significant legal and ethical challenges. We focus in particular on challenges posed by the unexplainable character of deep learning and other forms of sophisticated AI modelling used for cardiovascular imaging by briefly outlining the systems being developed in this space, describing how they work, and considering how they might generate outputs that are not reviewable by physicians or system programmers. We suggest that an unexplainable tendency presents 2 specific ethico-legal concerns: (1) difficulty for health regulators; and (2) confusion about the assignment of liability for error or fault in the use of AI systems. We suggest that addressing these concerns is critical for ensuring AI's successful implementation in cardiovascular imaging.

Do-not-resuscitate order in COVID-19 times: bioethics and professional ethics.

OBJECTIVE: To reflect about the do-not-resuscitation order at COVID-19 in Brazil, under bioethical focus and medical and nursing professional ethics. METHOD: Reflection study based on the principlist bioethics of Beauchamps and Childress and in professional ethics, problematizing actions, and decisions of non-resuscitation in the pandemic. RESULTS: It is important to consider the patient's clinic, appropriation of treatment goals for people with comorbidities, elderly people, with less chance of surviving to resuscitation, or less quality of life, with the palliative care team, to avoid dysthanasia, use of scarce resources and greater exposure of professionals to contamination. CONCLUSION: COVID-19 increased the vulnerabilities of professionals and patients, impacting professional decisions and conduct more widely than important values ​​such as the restriction of freedom. It propelled the population in general to rethink ethical and bioethical values ​​regarding life and death, interfering in decisions about them, supported by human dignity.

Cómo debemos comunicar malas noticias en tiempos de pandemia / How to communicate bad news in times of pandemic

Introducción: La humanidad ha quedado sorprendida por el impacto de la pandemia de la COVID-19, su contagiosidad y letalidad constituyen grandes causas de preocupación en todo el mundo; en este contexto resulta muy difícil para el personal de la salud comunicar malas noticias. Objetivo: Expresar la necesidad de desarrollar habilidades para comunicar malas noticias por el personal de la salud ante esta pandemia de la COVID-19. Material y Métodos: Se realizó una revisión bibliográfica acerca del impacto sobre la salud mental de la pandemia de la COVID-19 y la necesidad de preparación del personal sanitario para ofrecer malas noticias. Resultados: Se han descrito reacciones de depresión, ansiedad, trastornos del sueño y estrés postraumático, causadas por esta pandemia. Se describen varios protocolos que se pueden seguir al realizar esta práctica: el Protocolo de Buckman, Spikes y ABCDE. Conclusiones: La pandemia de la COVID-19 ha producido grandes afectaciones de la salud mental en la población general en todo el mundo, por lo que se necesita que el personal de la salud esté bien entrenado para comunicar malas noticias, se creen espacios idóneos para esta práctica y las instituciones diseñen e implementen sus protocolos de actuación para llevar a cabo esta tarea(AU)

Introduction: Humanity has been surprised by the impact of the COVID-19 pandemic; its contagiousness and lethality are great causes for concern around the world. In this context, it is very difficult for the health personnel to communicate bad news. Objective: To express the need to develop skills among the health care personnel to communicate bad news in the context of the COVID-19 pandemic. Material and Methods: A bibliographic review about the impact of the COVID-19 pandemic on mental health and the need to prepare the health personnel to communicate bad news was carried out. Results: Reactions of depression, anxiety, sleep disorders and post-traumatic stress caused by this pandemic have been described. Several protocols that can be followed when performing this practice are described; they include: The Buckman, Spikes and ABCDE protocols. Conclusions: The COVID-19 pandemic has caused great effects on the mental health of the general population around the world. Therefore, it is necessary for the health personnel to be well trained in communicating bad news, as well as to create suitable spaces for this practice. On the other hand, the institutions should design and implement their action protocols to carry out this task(AU)

[Scientific medicine and care relationship: From the therapeutic alliance to the therapeutic effect of the alliance]. / Médecine scientifique et relation de soin : de l'alliance thérapeutique à l'effet thérapeutique de l'alliance.

The new paradigm of precision medicine in oncology questions today the respective place of evidence-based medicine and doctor-patient relationship. Based on the results of a randomized study comparing the efficacy of a homeopathic molecule in the prevention of nausea and vomiting induced by chemotherapy in non-metastatic breast cancer, this article extends and develops the discussion of maintaining an unresolved tension between medical art and medical science, between care and cure. This tension sets a base for the authors of the therapeutic alliance in medicine, defined as a dialectic constantly adjourned between the alliance of the doctor with the patient and his therapy, and the therapeutic effect of this alliance. Because if a policy or a public opinion were to promote an exclusively rational medicine deprived of the field of relation to care, or on the contrary a medicine based only on clinical sense and intuition, then respectively the ethics of care and the progress of therapy would be threatened. It is advisable to be aware of erring from the truth, amplified today by social networks, as much due to a tide of scientific positivism, as an excess of the "good caring soul". Taking into account the therapeutic alliance makes it possible to no longer oppose scientific medicine and care relationship.

Consentimiento informado en las prestaciones de salud / Informed consent in health care services / Consentimento informado nas prestações de saúde

Resumen: Por regla general, las prestaciones de salud requieren el consentimiento informado del paciente. Los fundamentos éticos detrás de esta exigencia son la autonomía del paciente para decidir sobre su propio cuerpo y el respeto a su dignidad, que impide instrumentalizarlo. La manera en que el ordenamiento jurídico materializa estos fines es consagrando deberes de información y de consejo, y disciplinando las condiciones bajo las cuales debe prestarse el consentimiento. Jurídicamente, estos deberes delimitan la relación médico-paciente y ayudan a definir hipótesis de responsabilidad civil. En este artículo se revisan las condiciones para la satisfacción de estos deberes, así como los supuestos en que su infracción pueden dar lugar a responsabilidad civil.

Abstract: As a general rule, medical interventions require to be informingly consented by the patient. This requirement is ethically founded in the autonomy of the patient to decide on his own body and the respect for his dignity that prevent to instrumentalise it. The way in which the law materialises those ends is by implementing duties to inform and duties to advise, and regulating the conditions under which the consent must be given. Legally, those duties delimit the relation physician-patient and give guidance to define hypothesis of civil liability. In this article, we revise the conditions for the satisfaction of those duties and the cases in which their breach give rise to civil liability.

Resumo: Por regra general, as prestações de saúde requerem o consentimento informado do paciente. Os fundamentos éticos por trás dessa exigência são a autonomia do paciente para decidir sobre seu próprio corpo e o respeito à sua dignidade, que impede instrumentalizálo. A maneira em que o ordenamento jurídico materializa estes fins é consagrando deveres de informação e de aconselhamento, e disciplinando as condições sob as quais deve prestar-se o consentimento. Juridicamente, estes deveres delimitam a relação médico-paciente e ajudam a definir hipóteses de responsabilidade civil. Neste artigo se revisam as condições para a satisfação destes deveres, assim como os pressupostos em que sua infração podem dar lugar à responsabilidade civil.

Evaluation of moral intelligence of healthcare professionals via the "Survey for Measuring Moral Intelligence in the Provision of Healthcare Services" / Evaluación de la inteligencia moral de profesionales de la salud a través de la "Encuesta para medir la inteligencia moral en la prestación de servicios de salud" / Avaliação da inteligência moral de professionais de saúde via "Levantamento para Medir a Inteligência Moral na Provisão de Serviços de Cuidados à Saúde"

Abstract: Moral intelligence -through which an individual makes mental evaluation before taking action about a decision- is important in individual-centered healthcare. Using Lawshe Method, we designed the "Survey for Measuring Moral Intelligence in the Provision of Healthcare Services" with "equality", "empathy", "moral intelligence", "justice", "tolerance", "self-control", and "politeness" dimensions (α=.966). Age of the population (physicians and nurses) was 36.44±9.52, consisting 517 (65.5%) women, 538 married participants, 653 employed in public hospitals, and 352 had work experience of 8 hours/day. Using dimensions of this survey as skills is expected to ensure due diligence about rights and dignity in healthcare services.

Resumen: La inteligencia moral, mediante la cual un individuo realiza una evaluación mental antes de tomar medidas sobre una decisión, es importante en la atención médica centrada en el individuo. Usando el método Lawshe, diseñamos la "Encuesta para medir la inteligencia moral en la provisión de servicios de salud" con dimensiones de "igualdad", "empatía", "inteligencia moral", "justicia", "tolerancia", "autocontrol" y "cortesía" (α=.966). La edad de la población (médicos y enfermeras) era de 36.44±9.52, que consistía en 517 (65,5%) mujeres, 538 participantes casados, 653 empleados en hospitales públicos y 352 tenían una experiencia laboral de 8 horas/día. Se espera que el uso de las dimensiones de esta encuesta como habilidades garantice la debida diligencia sobre los derechos y la dignidad en los servicios de atención médica.

Resumo: Inteligência moral -através da qual um individuo faz uma avaliação mental antes de agir frente a uma decisão- é importante em cuidados à saúde centrados na pessoa. Usando o Método Lawshe, nós elaboramos o "Levantamento para Medir a Inteligência Moral na Provisão de Serviços de Cuidados à Saúde" com as dimensões "igualdade", "empatia", "inteligência moral", "justiça", "tolerância", "autocontrole" e "polidez (α=.966). A idade da população (médicos e enfermeiras) foi 36.44±9.52 anos, consistindo de 517 (65.5%) mulheres, 538 participantes casados, 653 empregados em hospitais públicos e 352 tinham experiência de trabalho 8 horas/dia. Usando dimensões deste levantamento como habilidades, espera-se que garanta a devida presteza sobre direitos e dignidade em serviços de cuidados à saúde.

Care Delivery and Treatment Decision Making: Bioethical and Nursing Considerations During and After the COVID-19 Pandemic.

BACKGROUND: The disruption in the supply chain of resources and interruptions in cancer treatments caused by the pandemic presented tremendous challenges to the healthcare system. OBJECTIVES: This article describes the National Academy of Medicine-defined states of medical and nursing care delivery for which local plans should be drawn and the shifting and evolving systems framework that can guide decisions to optimize the crisis standards of care. METHODS: A case study is presented to describe the process of shifting the state of medical and nursing care delivery and bioethical nursing considerations during the pandemic and beyond. FINDINGS: An evolving and shifting systems framework for crises rooted in deontology, principlism, and the ethics of care model provide meaningful guidance for establishing priorities for patient care.

Stem Cell Treatments in India: An Ethnography of Regular Practice.

In this article I explore how experimental stem cell treatments have become a therapeutic choice in India. Drawing on ethnographic fieldwork, I illustrate six sociotechnical pathways by which clinically unproven treatment is rendered regular health care practice for consumers and providers across the country. Through each pathway, based on the themes of bioconsumption, integration, consumer contacts, treatment experience and rituals, and political culture, I demonstrate how the experimental status of stem cell treatment is undermined and thereby experienced by key stakeholders as just another medical option. In analyzing the pathways, I argue that unproven stem cell treatment practices are promoted and sustained by multiple social, political and technical forces. The discussion on pathways is therefore situated within a conceptual framework of "normalization," derived from studies that investigate the multidimensional aspects to controversial and/or new medical technologies becoming routine.

Ethical challenges for women's healthcare highlighted by the COVID-19 pandemic.

Healthcare policies developed during the COVID-19 pandemic to safeguard community health have the potential to disadvantage women in three areas. First, protocols for deferral of elective surgery may assign a lower priority to important reproductive outcomes. Second, policies regarding the prevention and treatment of COVID-19 may not capture the complexity of the considerations related to pregnancy. Third, policies formulated to reduce infectious exposure inadvertently may increase disparities in maternal health outcomes and rates of violence towards women. In this commentary, we outline these challenges unique to women's healthcare in a pandemic, provide preliminary recommendations and identify areas for further exploration and refinement of policy.

A Crucial Moment for Reflection on the Importance of Ethical Leadership in Academic Medicine.

The extreme disturbances caused by the COVID -19 pandemic on our academic medical centers compounded by a recurrent surge of violence against people of color have reopened our wounds exposing fragility, inequality, and continued racial disparities in society and health. At the center of this severe institutional disruption, leaders will be compelled to take action to keep their constituents and patients safe and their hospitals and departments afloat during and after a pandemic, all while simultaneously addressing and implementing the cultural changes required to eliminate systemic racism and discrimination. Organizational disruptions of this magnitude will naturally test one's principles, loyalties and responsibilities while challenging the practical burdens of leadership. If the goal of responding to these upheavals is to bring them to resolution and ultimately to bring about organizational change for the better, ethical leadership is critical. Applying ethical principles allows leaders to chart clear paths to solutions both in the short and long term. We review the principles of ethical leadership exemplified by a case illustration and provide a novel resource to help ensure ethical leadership in academic medicine and beyond.

Reporting of screening and diagnostic AI rarely acknowledges ethical, legal, and social implications: a mass media frame analysis.

BACKGROUND: Healthcare is a rapidly expanding area of application for Artificial Intelligence (AI). Although there is considerable excitement about its potential, there are also substantial concerns about the negative impacts of these technologies. Since screening and diagnostic AI tools now have the potential to fundamentally change the healthcare landscape, it is important to understand how these tools are being represented to the public via the media. METHODS: Using a framing theory approach, we analysed how screening and diagnostic AI was represented in the media and the frequency with which media articles addressed the benefits and the ethical, legal, and social implications (ELSIs) of screening and diagnostic AI. RESULTS: All the media articles coded (n = 136) fit into at least one of three frames: social progress (n = 131), economic development (n = 59), and alternative perspectives (n = 9). Most of the articles were positively framed, with 135 of the articles discussing benefits of screening and diagnostic AI, and only 9 articles discussing the ethical, legal, and social implications. CONCLUSIONS: We found that media reporting of screening and diagnostic AI predominantly framed the technology as a source of social progress and economic development. Screening and diagnostic AI may be represented more positively in the mass media than AI in general. This represents an opportunity for health journalists to provide publics with deeper analysis of the ethical, legal, and social implications of screening and diagnostic AI, and to do so now before these technologies become firmly embedded in everyday healthcare delivery.

The Impact of the COVID-19 Pandemic on Genitourinary Cancer Care: Re-envisioning the Future.

CONTEXT: The coronavirus disease 2019 (COVID-19) pandemic necessitated rapid changes in medical practice. Many of these changes may add value to care, creating opportunities going forward. OBJECTIVE: To provide an evidence-informed, expert-derived review of genitourinary cancer care moving forward following the initial COVID-19 pandemic. EVIDENCE ACQUISITION: A collaborative narrative review was conducted using literature published through May 2020 (PubMed), which comprised three main topics: reduced in-person interactions arguing for increasing virtual and image-based care, optimisation of the delivery of care, and the effect of COVID-19 in health care facilities on decision-making by patients and their families. EVIDENCE SYNTHESIS: Patterns of care will evolve following the COVID-19 pandemic. Telemedicine, virtual care, and telemonitoring will increase and could offer broader access to multidisciplinary expertise without increasing costs. Comprehensive and integrative telehealth solutions will be necessary, and should consider patients' mental health and access differences due to socioeconomic status. Investigations and treatments will need to maximise efficiency and minimise health care interactions. Solutions such as one stop clinics, day case surgery, hypofractionated radiotherapy, and oral or less frequent drug dosing will be preferred. The pandemic necessitated a triage of those patients whose treatment should be expedited, delayed, or avoided, and may persist with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in circulation. Patients whose demographic characteristics are at the highest risk of complications from COVID-19 may re-evaluate the benefit of intervention for less aggressive cancers. Clinical research will need to accommodate virtual care and trial participation. Research dissemination and medical education will increasingly utilise virtual platforms, limiting in-person professional engagement; ensure data dissemination; and aim to enhance patient engagement. CONCLUSIONS: The COVID-19 pandemic will have lasting effects on the delivery of health care. These changes offer opportunities to improve access, delivery, and the value of care for patients with genitourinary cancers but raise concerns that physicians and health administrators must consider in order to ensure equitable access to care. PATIENT SUMMARY: The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the care provided to many patients with genitourinary cancers. This has necessitated a transition to telemedicine, changes in threshold or delays in many treatments, and an opportunity to reimagine patient care to maintain safety and improve value moving forward.

LifeTime and improving European healthcare through cell-based interceptive medicine.

Here we describe the LifeTime Initiative, which aims to track, understand and target human cells during the onset and progression of complex diseases, and to analyse their response to therapy at single-cell resolution. This mission will be implemented through the development, integration and application of single-cell multi-omics and imaging, artificial intelligence and patient-derived experimental disease models during the progression from health to disease. The analysis of large molecular and clinical datasets will identify molecular mechanisms, create predictive computational models of disease progression, and reveal new drug targets and therapies. The timely detection and interception of disease embedded in an ethical and patient-centred vision will be achieved through interactions across academia, hospitals, patient associations, health data management systems and industry. The application of this strategy to key medical challenges in cancer, neurological and neuropsychiatric disorders, and infectious, chronic inflammatory and cardiovascular diseases at the single-cell level will usher in cell-based interceptive medicine in Europe over the next decade.

GnRHa ('Puberty Blockers') and Cross Sex Hormones for Children and Adolescents: Informed Consent, Personhood and Freedom of Expression.

Ethical concerns have been raised about routine practice in paediatric gender clinics. We discuss informed consent and the risk of iatrogenesis in the prescribing of gonadotropin-releasing hormone analogues (GnRHas) and cross sex hormones to children and adolescents respectively. We place those clinical concerns in a wider societal context and invite consideration of two further relevant ethical domains: competing rights-based claims about male and female personhood; and freedom of expression about those claims. When reflecting on the assessment and medicalization of children and adolescents presenting at gender clinics, the matters of informed consent and iatrogenic risk should be the most pressing for clinicians. However, this is not just a matter of medical ethics, it also implies the need for a full ethical debate on competing notions of personhood and the defence of freedom of expression about transgender and its implications within contemporary democracies.