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2.
Hastings Cent Rep ; 54(3): 28-34, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38842853

RESUMO

In 1971, two years before Roe v. Wade affirmed federal protection for abortion, Judith Jarvis Thomson attempted to demonstrate the wrongs of forced gestation through analogy: you awake to find that the world's most esteemed violinist is wholly, physically dependent on you for life support. Here, the authors suggest that Thomson's intuition, that there is a relevant similarity between providing living kidney support and forced gestation, is realized in the contemporary practice of living organ donation. After detailing the robust analogy between living kidney donation and gestation, we turn to current ethical guidelines incorporated in the United Network for Organ Sharing's requirements for legally authorized organ donation and transplantation. We conclude that if, as we-and Thomson-suggest, organ donation and gestation are relevantly similar, then the ethical framework supporting donation may aid in articulating ethical grounds that will be compelling in informing the legal grounds for a defense of abortion.


Assuntos
Aborto Induzido , Obtenção de Tecidos e Órgãos , Humanos , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Aborto Induzido/ética , Aborto Induzido/legislação & jurisprudência , Feminino , Gravidez , Estados Unidos , Doadores Vivos/ética , Transplante de Rim/ética , Transplante de Órgãos/ética
3.
Hastings Cent Rep ; 54(3): 57-58, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38842870

RESUMO

What ethically justifies the provision of invasive and irreversible treatments to minors? In this commentary, I examine this question in response to Moti Gorin's article "What Is the Aim of Pediatric 'Gender-Affirming' Care?," which critiques autonomy-based arguments for justification of gender-affirming care in minors. Minors generally lack sufficient autonomy to make significant medical decisions or major life decisions. For this reason, parents are generally their decision-makers, working with medical professionals to choose treatments that serve the best interests of the minor. Medical care in minors is justified by beneficence, not autonomy, and this should be no different for gender-affirming care. This severely undermines autonomy-based arguments for provision of gender-affirming care to minors. Given the lack of conclusive evidence for benefit, the nature of the treatment, and the fact that gender dysphoria in minors resolves spontaneously in most cases, there is presently insufficient justification for provision of such care to minors.


Assuntos
Disforia de Gênero , Menores de Idade , Autonomia Pessoal , Humanos , Disforia de Gênero/terapia , Pessoas Transgênero , Adolescente , Criança , Feminino , Tomada de Decisões/ética , Masculino , Consentimento Informado por Menores/ética , Assistência à Saúde Afirmativa de Gênero
4.
Hastings Cent Rep ; 54(3): 2, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38842868

RESUMO

The privacy of the dead is an interesting area of concern for bioethicists. There is a legal doctrine that the dead can't have privacy rights, but also a body of contrary law ascribing privacy rights to the deceased and kin in relation to the deceased. As women's abortion privacy is under assault by American courts and legislatures, the implications of ascribing privacy rights to embryos and fetuses is more important than ever. Caution is called for in this domain.


Assuntos
Aborto Induzido , Privacidade , Humanos , Feminino , Estados Unidos , Aborto Induzido/legislação & jurisprudência , Aborto Induzido/ética , Privacidade/legislação & jurisprudência , Gravidez , Aborto Legal/legislação & jurisprudência , Aborto Legal/ética
5.
Hastings Cent Rep ; 54(3): 61-62, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38842879

RESUMO

This letter responds to the letter "The Open Donor View and Procreative Beneficence," by Daniel Groll, in the same, May-June 2024, issue of the Hastings Center Report.


Assuntos
Beneficência , Humanos , Doadores de Tecidos/ética , Obtenção de Tecidos e Órgãos/ética
6.
Hastings Cent Rep ; 54(3): 55-56, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38842885

RESUMO

This commentary responds to Moti Gorin's article "What Is the Aim of Pediatric 'Gender-Affirming' Care?" We argue that Gorin's case against pediatric gender-affirming care rests upon numerous false conceptual binaries: female/male, public/private, objective/subjective, and medically necessary/elective. Drawing on feminist bioethics, we show how such dichotomous thinking is both inaccurate and marginalizing of gender minorities.


Assuntos
Feminismo , Humanos , Bioética , Feminino , Pessoas Transgênero , Masculino , Pediatria/ética , Minorias Sexuais e de Gênero , Identidade de Gênero , Assistência à Saúde Afirmativa de Gênero
7.
Sci Eng Ethics ; 30(3): 23, 2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38833046

RESUMO

The Defining Issues Test 2 (DIT-2) and Engineering Ethical Reasoning Instrument (EERI) are designed to measure ethical reasoning of general (DIT-2) and engineering-student (EERI) populations. These tools-and the DIT-2 especially-have gained wide usage for assessing the ethical reasoning of undergraduate students. This paper reports on a research study in which the ethical reasoning of first-year undergraduate engineering students at multiple universities was assessed with both of these tools. In addition to these two instruments, students were also asked to create personal concept maps of the phrase "ethical decision-making." It was hypothesized that students whose instrument scores reflected more postconventional levels of moral development and more sophisticated ethical reasoning skills would likewise have richer, more detailed concept maps of ethical decision-making, reflecting their deeper levels of understanding of this topic and the complex of related concepts. In fact, there was no significant correlation between the instrument scores and concept map scoring, suggesting that the way first-year students conceptualize ethical decision making does not predict the way they behave when performing scenario-based ethical reasoning (perhaps more situated). This disparity indicates a need to more precisely quantify engineering ethical reasoning and decision making, if we wish to inform assessment outcomes using the results of such quantitative analyses.


Assuntos
Tomada de Decisões , Avaliação Educacional , Engenharia , Estudantes , Humanos , Engenharia/ética , Engenharia/educação , Tomada de Decisões/ética , Universidades , Pensamento , Princípios Morais , Desenvolvimento Moral , Masculino , Feminino , Ética Profissional/educação , Resolução de Problemas/ética
8.
J Robot Surg ; 18(1): 240, 2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38833111

RESUMO

Remote surgery provides opportunity for enhanced surgical capabilities, wider healthcare reach, and potentially improved patient outcomes. The network reliability is the foundation of successful implementation of telesurgery. It relies on a robust, high-speed communication network, with ultra-low latency. Significant lag has been shown to endanger precision and safety. Furthermore, the full-fledged adoption of telerobotics demands careful consideration of ethical challenges too. A deep insight into these issues has been investigated during the first Telesurgery Consensus Conference that took place in Orlando, Florida, USA, on the 3rd and 4th of February, 2024. During the Conference, the state of the art of remote surgery has been reported from robotic systems displaying telesurgery potential. The Hinotori, a robotic-assisted surgery platform developed by Medicaroid, experienced remote surgery as pre-clinical testing only; the Edge Medical Company, Shenzen, China, reported more than one hundred animal and 30 live human surgeries; the KanGuo reported human telesurgical cases performed with distances more than 3000 km; the Microport, China, collected more than 100 human operations at a distance up to 5000 km. Though, several issues-cybersecurity, data privacy, technical malfunctions - are yet to be addressed before a successful telesurgery implementation. Expanding the discussion to encompass ethical, financial, regulatory, and legal considerations is essential too. The Telesurgery collaborative community is working together to address and establish the best practices in the field.


Assuntos
Procedimentos Cirúrgicos Robóticos , Telemedicina , Humanos , Telemedicina/tendências , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/ética , Animais , Congressos como Assunto , China , Segurança Computacional
9.
Sci Eng Ethics ; 30(3): 24, 2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38833207

RESUMO

While the technologies that enable Artificial Intelligence (AI) continue to advance rapidly, there are increasing promises regarding AI's beneficial outputs and concerns about the challenges of human-computer interaction in healthcare. To address these concerns, institutions have increasingly resorted to publishing AI guidelines for healthcare, aiming to align AI with ethical practices. However, guidelines as a form of written language can be analyzed to recognize the reciprocal links between its textual communication and underlying societal ideas. From this perspective, we conducted a discourse analysis to understand how these guidelines construct, articulate, and frame ethics for AI in healthcare. We included eight guidelines and identified three prevalent and interwoven discourses: (1) AI is unavoidable and desirable; (2) AI needs to be guided with (some forms of) principles (3) trust in AI is instrumental and primary. These discourses signal an over-spillage of technical ideals to AI ethics, such as over-optimism and resulting hyper-criticism. This research provides insights into the underlying ideas present in AI guidelines and how guidelines influence the practice and alignment of AI with ethical, legal, and societal values expected to shape AI in healthcare.


Assuntos
Inteligência Artificial , Atenção à Saúde , Guias como Assunto , Confiança , Inteligência Artificial/ética , Humanos , Atenção à Saúde/ética , Princípios Morais
10.
Gigascience ; 132024 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-38837943

RESUMO

Genomic information is increasingly used to inform medical treatments and manage future disease risks. However, any personal and societal gains must be carefully balanced against the risk to individuals contributing their genomic data. Expanding our understanding of actionable genomic insights requires researchers to access large global datasets to capture the complexity of genomic contribution to diseases. Similarly, clinicians need efficient access to a patient's genome as well as population-representative historical records for evidence-based decisions. Both researchers and clinicians hence rely on participants to consent to the use of their genomic data, which in turn requires trust in the professional and ethical handling of this information. Here, we review existing and emerging solutions for secure and effective genomic information management, including storage, encryption, consent, and authorization that are needed to build participant trust. We discuss recent innovations in cloud computing, quantum-computing-proof encryption, and self-sovereign identity. These innovations can augment key developments from within the genomics community, notably GA4GH Passports and the Crypt4GH file container standard. We also explore how decentralized storage as well as the digital consenting process can offer culturally acceptable processes to encourage data contributions from ethnic minorities. We conclude that the individual and their right for self-determination needs to be put at the center of any genomics framework, because only on an individual level can the received benefits be accurately balanced against the risk of exposing private information.


Assuntos
Genômica , Humanos , Genômica/métodos , Genômica/ética , Segurança Computacional , Computação em Nuvem , Consentimento Livre e Esclarecido
11.
JMIR Res Protoc ; 13: e52349, 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38838329

RESUMO

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.


Assuntos
Inteligência Artificial , Inteligência Artificial/ética , Humanos , Responsabilidade Social
13.
Hastings Cent Rep ; 54(3): 15-27, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38842894

RESUMO

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.


Assuntos
Obrigações Morais , Médicos , Humanos , Médicos/ética , Estados Unidos , Gravidez , Feminino , Aborto Induzido/ética , Aborto Induzido/legislação & jurisprudência , Decisões da Suprema Corte
14.
Hastings Cent Rep ; 54(3): 6-10, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38842904

RESUMO

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.


Assuntos
Fármacos Antiobesidade , Política de Saúde , Obesidade , Saúde Pública , Humanos , Obesidade/tratamento farmacológico , Saúde Pública/ética , Estados Unidos
15.
Hastings Cent Rep ; 54(3): 60-61, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38842905

RESUMO

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.


Assuntos
Beneficência , Humanos , Pais/psicologia , Doadores de Tecidos/ética
16.
Hastings Cent Rep ; 54(3): 11-14, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38842906

RESUMO

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.


Assuntos
Consentimento Livre e Esclarecido , Relações Médico-Paciente , Humanos , Consentimento Livre e Esclarecido/ética , Relações Médico-Paciente/ética , Comunicação , Autonomia Pessoal , Procedimentos Cirúrgicos Operatórios/ética , Tomada de Decisões/ética
17.
BMC Prim Care ; 25(1): 194, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38824511

RESUMO

BACKGROUND: The lack of trust between patients and physicians has a variety of negative consequences. There are several theories concerning how interpersonal trust is built, and different studies have investigated trust between patients and physicians that have identified single factors as contributors to trust. However, all possible contributors to a trusting patient-physician relationship remain unclear. This review synthesizes current knowledge regarding patient-physician trust and integrates contributors to trust into a model. METHODS: A systematic search was conducted using the databases MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Eric (Ovid). We ran simultaneous searches for a combination of the phrases: patient-physician relationship (or synonyms) and trust or psychological safety. Six-hundred and twenty-five abstracts were identified and screened using pre-defined criteria and later underwent full-text article screening. We identified contributors to trust in the eligible articles and critically assessed whether they were modifiable. RESULTS: Forty-five articles were included in the review. Patient-centered factors that contributed modifiable promoters of trust included psychological factors, levels of health education and literacy, and the social environment. Physician-centered factors that added to a trusting patient-physician relationship included competence, communication, interest in the patient, caring, the provisioning of health education, and professionalism. The patient-physician alliance, time spent together, and shared decision-making also contributed to trusting relationships between patients and physicians. External contributors included institutional factors, how payments are made, and additional healthcare services. DISCUSSION: Our model summarized modifiable contributors to a trusting patient-physician relationship. We found that providing sufficient time during patient-physician encounters, ensuring continuity of care, and fostering health education are promising starting points for improving trust between patients and physicians. Future research should evaluate the effectiveness of interventions that address multiple modifiable contributors to a trusting patient-physician relationship.


Assuntos
Relações Médico-Paciente , Confiança , Humanos , Letramento em Saúde , Relações Médico-Paciente/ética
19.
Crit Care Nurs Q ; 47(3): 218-222, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38860951

RESUMO

Moral distress can impact nurses and the care team significantly. A profession dedicated to the principles of caring and compassion is often subjected to patients receiving futile treatment. With the proliferation of extreme life-prolonging measures come the difficulties in the withdrawal of those medical modalities. If a prognosis is poor and care is perceived as curative rather than palliative, providers may often feel conflicted and distressed by their interventions. The American Association of Colleges of Nursing has expressed growing concern about an increase in the use of inappropriate life-support treatments related to futile care. The compelling case of a severely beaten 69-year-old homeless man who had cardiac-arrested and was resuscitated after an unknown amount of down-time, provides the contextual framework for this report. Ethical conflicts can become very challenging, which inevitably increases the suffering of the patient and their caregivers. Research findings suggest that health care organizations can benefit from enacting processes that make ethical considerations an early and routine part of everyday clinical practice. A proactive approach to ethical conflicts may improve patient care outcomes and decrease moral distress.


Assuntos
Futilidade Médica , Humanos , Idoso , Masculino , Futilidade Médica/ética , Cuidados para Prolongar a Vida/ética , Princípios Morais , Suspensão de Tratamento/ética , Estresse Psicológico , Pessoas Mal Alojadas/psicologia
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