[Artificial Intelligence in Medicine. Ethical reflections from the thought of Edmund Pellegrino]. / Inteligencia Artificial en Medicina. Reflexiones éticas desde el pensamiento de Edmund Pellegrino.

The current scenario of health sciences, and of Medicine in particular, is characterized by the growing role of Artificial Intelligence (AI), thus projecting towards the consolidation of a new model of Medicine. Along with the undeniable advantages offered by the application of AI for the diagnosis and treatment of complex clinical problems, some ethical questions arise, which demand careful reflection. However, most of the literature that addresses the ethical issues associated with the use of AI in medicine does so from the poiesis' perspective. Indeed, a large part of that evidence is related to the design, programming, training and operation of algorithms, problems that exceed the competences of the health professionals that use them. Our proposal is framed in the ethics of virtue outlined by Edmund Pellegrino, which is a valuable epistemological perspective to trace a path of reflection on the ethical problems arising from the use of AI in Medicine. This perspective -based on a sound philosophy of Medicine- adopts the praxis' point of view, that is, of the acting subject. Since the health professional is a moral agent who uses AI as a tool to achieve an end -the good of the patient-,from Pellegrino's perspective it is possible to ask how the use of AI might influence the achievement of the goal of medical work and thus, be considered a criterion of ethical orientation.

Inteligencia Artificial en Medicina. Reflexiones éticas desde el pensamiento de Edmund Pellegrino / Artificial Intelligence in Medicine. Ethical reflections from the thought of Edmund Pellegrino

El escenario actual de las ciencias de la salud, y de modo particular de la Medicina, se caracteriza porel creciente protagonismo de la Inteligencia Artificial (IA), proyectándose así la consolidación de un nuevomodelo de Medicina. Junto a las innegables ventajas que ofrece la aplicación de la IA para el diagnósticoy tratamiento de complejos problemas clínicos, se despiertan interrogantes éticos que reclaman una pon-derada reflexión. Ahora bien, la mayor parte de la literatura que aborda las cuestiones éticas asociadas aluso de la IA en medicina lo hace desde la perspectiva de la poiesis. En efecto, gran parte de los problemasevidenciados se relacionan con el diseño, programación, entrenamiento y funcionamiento de los algo-ritmos, cuestiones que exceden al profesional de salud. Nuestra propuesta de reflexión se enmarca en laética de la virtud delineada por Edmund Pellegrino la cual resulta una valiosa perspectiva epistemológicapara trazar un camino de reflexión sobre los problemas éticos derivados del uso de la IA en Medicina. Di-cha perspectiva —sustentada en una sólida filosofía de la Medicina—, adopta el punto de vista del sujetoque actúa, es decir, de la praxis. Puesto que el profesional de salud es un agente moral que emplea la IAcomo herramienta para conseguir un fin —el bien del paciente—, desde la perspectiva de Pellegrino esposible preguntar cómo influye el uso de la IA en la consecución del fin del quehacer médico cual criteriode orientación ética.(AU)

The current scenario of health sciences, and of Medicine in particular, is characterized by the growingrole of Artificial Intelligence (AI), thus projecting towards the consolidation of a new model of Medicine.Along with the undeniable advantages offered by the application of AI for the diagnosis and treatment ofcomplex clinical problems, some ethical questions arise, which demand careful reflection. However, mostof the literature that addresses the ethical issues associated with the use of AI in medicine does so from thepoiesis’ perspective. Indeed, a large part of that evidence is related to the design, programming, training and operation of algorithms, problems that exceed the competences of the health professionals that usethem. Our proposal is framed in the ethics of virtue outlined by Edmund Pellegrino, which is a valuableepistemological perspective to trace a path of reflection on the ethical problems arising from the use ofAI in Medicine. This perspective —based on a sound philosophy of Medicine— adopts the praxis’ point ofview, that is, of the acting subject. Since the health professional is a moral agent who uses AI as a tool toachieve an end —the good of the patient—,from Pellegrino’s perspective it is possible to ask how the useof AI might influence the achievement of the goal of medical work and thus, be considered a criterion ofethical orientation.(AU)

Cuidado e inteligencia artificial: una reflexión necesaria / Care and artificial intelligence: a necessary reflection / Cuidado e inteligência artificial: una reflexión necesaria

Resumen La enfermería no es ajena al cambio revolucionario que supone la introducción de la inteligencia artificial en el cuidado de la salud. A principios de 2021 se publicaron las conclusiones del think-tank internacional sobre la inteligencia artificial y la enfermería, en las que se reconoce la relevancia del uso de dichas tecnologías para aumentar y extender las posibilidades de esta disciplina, entre ellas, el cuidado. Una valoración ponderada acerca del acierto de estas conclusiones exige, necesariamente, una reflexión epistemológica sobre el cuidado. En el presente artículo reflexionaremos sobre la incidencia de la inteligencia artificial en el cuidado de enfermería desde la perspectiva de la ética del cuidado y a la luz de los principales aportes de Samaritanus Bonus.

Abstract Nursing is no stranger to the revolutionary change brought about by the introduction of artificial intelligence in health care. At the beginning of 2021, the international think-tank on artificial intelligence and nursing published its conclusions, recognizing the relevance of these technologies to increase and extend the capacities of this discipline, including care. A weighted assessment of the correctness of these conclusions necessarily requires an epistemological reflection on care. This article considers the impact of artificial intelligence on nursing care from the ethics of care in light of the main contributions of the Samaritanus Bonus.

Resumo A enfermagem não está alheia à mudança revolucionária que a introdução da inteligência artificial no cuidado da saúde implica. No início de 2021, foram publicadas as conclusões do think-tank internacional sobre a inteligência artificial e a enfermagem, nas quais é reconhecida a relevância do uso dessas tecnologias para aumentar e ampliar as capacidades dessa disciplina, entre elas, o cuidado. Uma avaliação ponderada sobre a assertividade dessas conclusões exige, necessariamente, uma reflexão epistemológica acerca do cuidado. Neste artigo, refletimos sobre a incidência da inteligência artificial no cuidado de enfermagem sob a perspectiva da ética do cuidado e à luz das principais contribuições do Samaritanus Bonus.

An Ethical Pathway to Quality of Life in Critically Ill Newborns.

Advances in perinatology have permitted the survival of fragile neonates. Quality of life (QoL) has been considered a key element in medical decision-making. In this review we analyse the role of QoL regarding the decision of withholding or withdrawing of life-sustaining treatment (LST). The role of QoL is debated because of the conceptual difficulties it raises. The lack of consensus on its definition and the difficulties in measuring it objectively, mean that basing clinical decisions solely on QoL has some risks. To avoid a purely subjective assessment, the principle of totality, and the principle of therapeutic adequacy should be considered. In case of uncertain prognosis, some therapeutic persistence seems reasonable. If this does not benefit the clinical condition of the child, then it may be no longer appropriate to continue the LST in case of severe disabilities. QoL is essential in medical decision-making, but is insufficient as the only criterion.