Fatores clínicos do bem-estar de mulheres em parturição: perspectivas deontológicas e da bioética principialista / Clinical factors of women in labor well-being: deontological and bioethical principlism perspectives / Factores clínicos del bienestar de la mujer en trabajo de parto: perspectivas deontológicas y de la bioética principialista

Objetivo: avaliar os fatores clínicos associados ao bem-estar das mulheres durante o trabalho de parto e parto à luz da bioética principialista e da deontologia. Método: estudo transversal com abordagem quantitativa. Participaram 396 puérperas internadas em um hospital municipal do sudoeste da Bahia, e os dados foram coletados no período de janeiro a maio de 2023, após aprovação do comitê de ética em pesquisa. Os dados foram organizados no software Excel e analisados via SPSS v.25. a partir da regressão logística multinomial. Resultados: a maior parte da amostra apresentou bem-estar com assistência em saúde, mulheres que tiveram parto realizado por profissionais não médicos apresentaram mais chances de níveis de bem-estar "adequado". E mulheres que não tiveram a via de parto cesárea apresentaram aumento de chances de bem-estar. Conclusão: é necessário que os profissionais reflitam sobre suas ações, condicionando-as à humanização no parto, em observância aos princípios bioéticos.

Objective: to evaluate the clinical factors associated with women's well-being during labor and delivery in the light of bioethics principlism and deontology. Method: a cross-sectional study with a quantitative approach was conducted. It involved 396 postpartum women admitted to a municipal hospital in the southwest of Bahia. Data were collected from January to May 2023, after approval from the research ethics committee. The data were tabulated using Excel software and analyzed using SPSS v.25 through Multinomial Logistic Regression. Results: majority of the sample exhibited well-being with health care assistance. Women who underwent delivery performed by non-medical professionals showed higher chances of "adequate" levels of well-being. Additionally, women who did not undergo cesarean delivery showed increased chances of well-being. Conclusion: It is necessary for professionals to reflect on their actions, conditioning them to the humanization of childbirth, according to bioethical principles.

Objetivo: evaluar los factores clínicos asociados al bienestar de la mujer durante el trabajo de parto y parto a la luz de la bioética y la deontología principialista. Método: estudio transversal con enfoque cuantitativo. Incluyó 396 puérperas ingresadas en un hospital municipal del suroeste de Bahía. Recolección de datos de enero a mayo de 2023, con aprobación del comité de ética en investigación. Los datos se tabularon en el software Excel y se analizaron mediante SPSS v.25. utilizando regresión logística multinomial. Resultados: la mayoría de las participantes de la muestra presentó bienestar con la atención para la salud; las que tuvieron partos realizados por profesionales no médicos tenían más probabilidades de tener niveles "adecuados" de bienestar; las que no tuvieron parto por cesárea tenían mayores probabilidades de tener bienestar. Conclusión: es necesario que los profesionales reflexionen sobre sus acciones y las adecuen para humanizar el parto, respetando los principios bioéticos.

Ethical issues in the application of genome-wide association studies to US military recruitment and personnel assignments.

Genome-wide association studies seek to associate an organism's genotypes with phenotypes. The goal of such research is to identify specific genetic variants that may be used to predict an individual's risk for a specific physical or mental disease. Recently, it has been recommended that policymakers in the USA should employ genomic surveillance so that it can be used for initial military personnel selection and personnel assignments. However, such a proposal highlights the necessity of subjecting such recommendations to rigorous ethical analysis, including concerns regarding recruitment, transparency and the return of genetic results.

Artificial Intelligence in Otolaryngology: Topics in Epistemology & Ethics.

To fuel artificial intelligence (AI) potential in clinical practice in otolaryngology, researchers must understand its epistemic limitations, which are tightly linked to ethical dilemmas requiring careful consideration. AI tools are fundamentally opaque systems, though there are methods to increase explainability and transparency. Reproducibility and replicability limitations can be overcomed by sharing computing code, raw data, and data processing methodology. The risk of bias can be mitigated via algorithmic auditing, careful consideration of the training data, and advocating for a diverse AI workforce to promote algorithmic pluralism, reflecting our population's diverse values and preferences.

Ethical and Equity Guidance for Transplant Programs Considering Thoracoabdominal Normothermic Regional Perfusion (TA-NRP) for Procurement of Hearts.

Donation after circulatory determination of death (DCDD) is an accepted practice in the United States, but heart procurement under these circumstances has been debated. Although the practice is experiencing a resurgence due to the recently completed trials using ex vivo perfusion systems, interest in thoracoabdominal normothermic regional perfusion (TA-NRP), wherein the organs are reanimated in situ prior to procurement, has raised many ethical questions. We outline practical, ethical, and equity considerations to ensure transplant programs make well-informed decisions about TA-NRP. We present a multidisciplinary analysis of the relevant ethical issues arising from DCDD-NRP heart procurement, including application of the Dead Donor Rule and the Uniform Definition of Death Act, and provide recommendations to facilitate ethical analysis and input from all interested parties. We also recommend informed consent, as distinct from typical "authorization," for cadaveric organ donation using TA-NRP.

Restoring the Organism as a Whole: Does NRP Resurrect the Dead?

The introduction of normothermic regional perfusion (NRP) in controlled donation after circulatory determination of death (cDCDD) protocols is by some regarded as controversial and ethically troublesome. One of the main concerns that opponents have about introducing NRP in cDCDD protocols is that reestablishing circulation will negate the determination of death by circulatory criteria, potentially resuscitating the donor. In this article, I argue that this is not the case. If we take a closer look at the concept of death underlying the circulatory criterion for determination of death, we find that the purpose of the criterion is to show whether the organism as a whole has died. I argue that this purpose is fulfilled by the circulatory criterion in cDCDD protocols, and that applying NRP does not negate the determination of death or resuscitate the donor.

Impact of Responsible AI on the Occurrence and Resolution of Ethical Issues: Protocol for a Scoping Review.

BACKGROUND: Responsible artificial intelligence (RAI) emphasizes the use of ethical frameworks implementing accountability, responsibility, and transparency to address concerns in the deployment and use of artificial intelligence (AI) technologies, including privacy, autonomy, self-determination, bias, and transparency. Standards are under development to guide the support and implementation of AI given these considerations. OBJECTIVE: The purpose of this review is to provide an overview of current research evidence and knowledge gaps regarding the implementation of RAI principles and the occurrence and resolution of ethical issues within AI systems. METHODS: A scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines was proposed. PubMed, ERIC, Scopus, IEEE Xplore, EBSCO, Web of Science, ACM Digital Library, and ProQuest (Arts and Humanities) will be systematically searched for articles published since 2013 that examine RAI principles and ethical concerns within AI. Eligibility assessment will be conducted independently and coded data will be analyzed along themes and stratified across discipline-specific literature. RESULTS: The results will be included in the full scoping review, which is expected to start in June 2024 and completed for the submission of publication by the end of 2024. CONCLUSIONS: This scoping review will summarize the state of evidence and provide an overview of its impact, as well as strengths, weaknesses, and gaps in research implementing RAI principles. The review may also reveal discipline-specific concerns, priorities, and proposed solutions to the concerns. It will thereby identify priority areas that should be the focus of future regulatory options available, connecting theoretical aspects of ethical requirements for principles with practical solutions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/52349.

Developing an Evidence-Based Ethics Education Program for Surgical Residents in Guatemala.

OBJECTIVE: This study assessed 2 modalities for teaching responsible conduct of research and human subjects protection (RCR/HSP) to surgical residents in Guatemala-an "off the shelf" online curriculum and a new in-person curriculum specific to the local context. METHODS: In 2018, 160 surgical residents in 3 large urban hospitals in Guatemala City completed 2 online programs in RCR/HSP. Residents in the intervention arm also completed 7 weeks of in-person training. Pre- and post-assessments tested awareness of key concepts with particular attention to international and Guatemalan research regulations. Group differences in matched (pre- and post-) mean scores were analyzed using t-tests. RESULTS: One hundred forty residents completed pre- and post-training assessments and were included in the analytic sample. Overall mean scores improved modestly from 52.7 to 58.7 points out of 100. Intervention-arm trainees reported greater confidence in recognizing ethical issues, understanding legal and ethical requirements for research, and identifying, reporting and avoiding scientific misconduct than control-arm trainees. CONCLUSION: Given the limited availability of RCR/HSP faculty, financial resources, and time in the surgical training schedule, the investigators recommend that academic authorities in Guatemala consider online training programs in RCR/HSP in all surgical residency programs as an affordable and scalable strategy to build ethical research skills in its surgical workforce. Investment in human resources to support in-person ethics education as a way to build self-efficacy in ethical decision-making should be considered.

Beneath the Sword of Damocles: Moral Obligations of Physicians in a Post-Dobbs Landscape.

Since the U.S. Supreme Court's decision in Dobbs vs. Jackson Women's Health Organization, a growing web of state laws restricts access to abortion. Here we consider how, ethically, doctors should respond when terminating a pregnancy is clinically indicated but state law imposes restrictions on doing so. We offer a typology of cases in which the dilemma emerges and a brief sketch of the current state of legal prohibitions against providing such care. We examine the issue from the standpoints of conscience, professional ethics, and civil disobedience and conclude that it is almost always morally permissible and praiseworthy to break the law and that, in a subset of cases, it is morally obligatory to do so. We further argue that health care institutions that employ or credential physicians to provide reproductive health care have an ethical duty to provide a basic suite of practical supports for them as they work to ethically resolve the dilemmas before them.

Anti-obesity Medications: Ethical, Policy, and Public Health Concerns.

New anti-obesity medications (AOMs) have received widespread acclaim in medical journals and the media, but they also raise critical ethical, public health, and public policy concerns that have largely been ignored. AOMs are very costly, need to be taken by a patient in perpetuity (since significant rebound weight gain otherwise occurs), and threaten to shift resources and focus away from other crucial efforts at obesity treatment and prevention. Many people may feel less motivated to exercise or reduce their caloric consumption, if they assume that obesity is now medically treatable. Policy-makers may similarly come to feel that the solution to the obesity pandemic is simply to prescribe medications and that prevention efforts are far less necessary. These drugs raise concerns about justice (since AOMs will disproportionately benefit the wealthy), medicalization, and marketing. Policy-makers, clinicians, and others need to engage in multipronged educational and policy efforts to address these challenges.

The Open Donor View and Procreative Beneficence.

This letter responds to the article "What Do Prospective Parents Owe to Their Children?," by Abigail Levin, in the March-April 2024 issue of the Hastings Center Report.

Better Conversations for Better Informed Consent: Talking with Surgical Patients.

For more than sixty years, surgeons have used bioethical strategies to promote patient self-determination, many of these now collectively described as "informed consent." Yet the core framework-understanding, risks, benefits, and alternatives-fails to support patients in deliberation about treatment. We find that surgeons translate this framework into an overly complicated technical explanation of disease and treatment and an overly simplified narrative that surgery will "fix" the problem. They omit critical information about the goals and downsides of surgery and present untenable options as a matter of patient choice. We propose a novel framework called "better conversations." Herein, surgeons provide context about clinical norms, establish the goals of surgery, and comprehensively delineate the downsides of surgery to generate a deliberative space for patients to consider whether surgery is right for them. This paradigm shift meets the standards for informed consent, supports deliberation, and allows patients to anticipate and prepare for the experience of treatment.

Artificial intelligence in veterinary diagnostic imaging: Perspectives and limitations.

The field of veterinary diagnostic imaging is undergoing significant transformation with the integration of artificial intelligence (AI) tools. This manuscript provides an overview of the current state and future prospects of AI in veterinary diagnostic imaging. The manuscript delves into various applications of AI across different imaging modalities, such as radiology, ultrasound, computed tomography, and magnetic resonance imaging. Examples of AI applications in each modality are provided, ranging from orthopaedics to internal medicine, cardiology, and more. Notable studies are discussed, demonstrating AI's potential for improved accuracy in detecting and classifying various abnormalities. The ethical considerations of using AI in veterinary diagnostics are also explored, highlighting the need for transparent AI development, accurate training data, awareness of the limitations of AI models, and the importance of maintaining human expertise in the decision-making process. The manuscript underscores the significance of AI as a decision support tool rather than a replacement for human judgement. In conclusion, this comprehensive manuscript offers an assessment of the current landscape and future potential of AI in veterinary diagnostic imaging. It provides insights into the benefits and challenges of integrating AI into clinical practice while emphasizing the critical role of ethics and human expertise in ensuring the wellbeing of veterinary patients.

Editor's Highlights - July 2024.

Artificial intelligence (AI) is revolutionizing dermatology by enhancing diagnostic accuracy and offering personalized treatment recommendations based on individual patient characteristics and medical history. This month's editorial discusses the transformative role of AI in dermatology, emphasizing its potential to enhance diagnostic accuracy, personalize treatment, and improve healthcare delivery efficiency. It highlights three manuscripts addressing AI's applications in dermatopathology, climate change-related skin disorders, and health care for undocumented immigrants. Ethical concerns, such as AI transparency and overdiagnosis, are also noted. Additionally, new treatments for atopic dermatitis (AD) are examined. We specifically recommend two recent reports on the efficacy of dupilumab in pediatric AD and refractory hand eczema (HE), demonstrating advancements in dermatological therapy for treatment-resistant conditions.

The Case for Heterogeneity in Metacognitive Appraisals of Biased Beliefs.

ACADEMIC ABSTRACT: Prominent theories of belief and metacognition make different predictions about how people evaluate their biased beliefs. These predictions reflect different assumptions about (a) people's conscious belief regulation goals and (b) the mechanisms and constraints underlying belief change. I argue that people exhibit heterogeneity in how they evaluate their biased beliefs. Sometimes people are blind to their biases, sometimes people acknowledge and condone them, and sometimes people resent them. The observation that people adopt a variety of "metacognitive positions" toward their beliefs provides insight into people's belief regulation goals as well as insight into way that belief formation is free and constrained. The way that people relate to their beliefs illuminates why they hold those beliefs. Identifying how someone thinks about their belief is useful for changing their mind. PUBLIC ABSTRACT: The same belief can be alternatively thought of as rational, careful, unfortunate, or an act of faith. These beliefs about one's beliefs are called "metacognitive positions." I review evidence that people hold at least four different metacognitive positions. For each position, I discuss what kinds of cognitive processes generated belief and what role people's values and preferences played in belief formation. We can learn a lot about someone's belief based on how they relate to that belief. Learning how someone relates to their belief is useful for identifying the best ways to try to change their mind.

[Japanese Code of Ethics for Pharmacists and Professionalism].

In their role as providers of pharmaceutical products to society, pharmacists must demonstrate professionalism if they are to gain the trust of the community. The Japan Pharmaceutical Association has published the Pharmacist Platform in Japan and the Japanese Code of Ethics for Pharmacists; these resources provide clear guidelines for pharmacists and are an important component of the profession. Becoming a pharmacist involves joining a professional community and thereby pledging to accept a set of ethical standards. This concept of the pharmacy profession is shared by other countries, and the International Pharmaceutical Federation has indicated that professionalism is an issue that should be addressed in every country. This review introduces the Pharmacist Platform in Japan, the Japanese Code of Ethics for Pharmacists established by the Japan Pharmaceutical Association, and the background of each establishment.

Public involvement and engagement in scientific research and higher education: the only way is ethics?

BACKGROUND: Involving and engaging the public in scientific research and higher education is slowly becoming the norm for academic institutions in the United Kingdom and elsewhere. Driven by a wide range of stakeholders including regulators, funders, research policymakers and charities public involvement and public engagement are increasingly seen as essential in delivering open and transparent activity that is relevant and positively impacts on our society. It is obvious that any activities involving and engaging members of the public should be conducted safely and ethically. However, it is not clear whether conducting activities ethically means they require ethical approval from a research ethics committee. MAIN BODY: Although there is some guidance available from government organisations (e.g. the UK Health Research Authority) to suggest ethical approval is not required for such activities, requests from funders and publishers to have ethical approval in place is commonplace in the authors' experience. We explore this using case studies from our own institution. CONCLUSION: We conclude that any public-facing activity with the purpose to systemically investigate knowledge, attitudes and experiences of members of the public as research and as human participants requires prior approval from an ethics committee. In contrast, engaging and involving members of the public and drawing on lived experience to inform aspects of research and teaching does not. However, lack of clarity around this distinction often results in the academic community seeking ethical approval 'just in case', leading to wasted time and resources and erecting unnecessary barriers for public involvement and public engagement. Instead, ethical issues and risks should be appropriately considered and mitigated by the relevant staff within their professional roles, be it academic or a professional service. Often this can involve following published guidelines and conducting an activity risk assessment, or similar. Moving forward, it is critical that academic funders and publishers acknowledge the distinction and agree on an accepted approach to avoid further exacerbating the problem.

Involving and engaging members of the public is recognised best practice in university research and teaching. Involvement and engagement activities (for instance, working with the public to design a research study) continue to increase in priority and are an important part of an academic's role. However, there is often confusion amongst researchers and educators around whether involving the public in these activities requires prior ethical approval, similar to what would be the case when inviting members of the public to participate in a clinical research study, or to donate samples such as blood for experiments. As an example, sometimes researchers are asked for ethical approval by scientific journals when trying to publish the findings from their public involvement and engagement work, when in fact this is not needed. The ongoing uncertainty about the difference between actual research on one hand and public involvement and engagement on the other hand wastes precious time and resources, and is a barrier for scientists to working with the public. We have developed guidance for academic staff on when ethical approval is and is not required, using examples from our own experience. We wrote this article to bring awareness to this problem; share our views with the wider academic community; encourage discussion around the problem and possible solutions; and ultimately contribute to educating on when research ethics approval is needed, and when not.

COVID-19 and the vaccine tax: an egalitarian, market-based approach to the global vaccine inequality.

The global inequality in the distribution of vaccines is unjust. As countries scrambled to ensure enough vaccines, the world's poorest were left to fend for themselves, and the generosity meant to mitigate this through COVAX was not sufficiently forthcoming. In light of this, I proposed a vaccine tax, which obligates those willing and able to pay to protect their own population to contribute to protecting those residing in the world's low-income countries. Petrovic has offered an important critique of this proposal, questioning both the fairness and the efficiency of the tax. However, when properly specified, the vaccine tax is not vulnerable to these critiques.