Ethical Questions Research Articles

Does an App a Day Keep the Doctor Away? AI Symptom Checker Applications, Entrenched Bias, and Professional Responsibility.

The growing prominence of artificial intelligence (AI) in mobile health (mHealth) has given rise to a distinct subset of apps that provide users with diagnostic information using their inputted health status and symptom information-AI-powered symptom checker apps (AISympCheck). While these apps may potentially increase access to health care, they raise consequential ethical and legal questions. This paper will highlight notable concerns with AI usage in the health care system, further entrenchment of preexisting biases in the health care system and issues with professional accountability. To provide an in-depth analysis of the issues of bias and complications of professional obligations and liability, we focus on 2 mHealth apps as examples-Babylon and Ada. We selected these 2 apps as they were both widely distributed during the COVID-19 pandemic and make prominent claims about their use of AI for the purpose of assessing user symptoms. First, bias entrenchment often originates from the data used to train AI systems, causing the AI to replicate these inequalities through a "garbage in, garbage out" phenomenon. Users of these apps are also unlikely to be demographically representative of the larger population, leading to distorted results. Second, professional accountability poses a substantial challenge given the vast diversity and lack of regulation surrounding the reliability of AISympCheck apps. It is unclear whether these apps should be subject to safety reviews, who is responsible for app-mediated misdiagnosis, and whether these apps ought to be recommended by physicians. With the rapidly increasing number of apps, there remains little guidance available for health professionals. Professional bodies and advocacy organizations have a particularly important role to play in addressing these ethical and legal gaps. Implementing technical safeguards within these apps could mitigate bias, AIs could be trained with primarily neutral data, and apps could be subject to a system of regulation to allow users to make informed decisions. In our view, it is critical that these legal concerns are considered throughout the design and implementation of these potentially disruptive technologies. Entrenched bias and professional responsibility, while operating in different ways, are ultimately exacerbated by the unregulated nature of mHealth.

“We are openly, proudly Subjective … This history is important to our contemporary survival”: queer embodied knowledge and the curatorial work of ICT-based LGBTQIA+ history content creators

PurposeThis article reports on findings from interviews with ICT-based content creators whose work focuses on documenting and curating queer history and culture. The research specifically examines how as amateur historians, the participant’s embodied knowledge plays a central role in how they engage with discourse about queer historical figures, methods of queer historiography and community accountability.Design/methodology/approachThe research deploys a queer constructivist framework to qualitatively gather and analyzes the semi-structured interviews of 31 North American content creators who curate digital project related to queer history and culture. The interviews were gathered between August 2022 and August 2023.FindingsThe research highlights how the subjectivity of queer embodiment aids, rather than hinders, participants' ability to collaborate with LGBTQIA+ communities while also addressing more significant ethical questions around intersectionality and inclusive historiographic work.Research limitations/implicationsThe content creators’ own positionality and commitments to community accountability and queer inclusivity fostered richer stories and historical documentation, while also helping make visible queer identity as affirming and valuable within queer culture. Additionally, practical implications include highlighting the value of ICT-based content within the distribution of educational and informational resources related to queer history.Originality/valueThis research offers an underexamined intersection of historiography and queer embodiment. While extensive scholarship on institutional and community-based historiography work exist the content creators interviewed within this study exist within the space of both, often using a combination of embodied knowledge and traditional curatorial work to translate between such spaces, inviting, in turn, new ways of thinking about queer archival knowledge.

An ethical assessment of professional opinions on concerns, chances, and limitations of the implementation of an artificial intelligence-based technology into the geriatric patient treatment and continuity of care

With the introduction of an artificial intelligence-based dashboard into the clinic, the project SURGE-Ahead responds to the importance of improving perioperative geriatric patient treatment and continuity of care. The use of artificial intelligence to process and analyze data automatically, aims at an evidence-based evaluation of the patient’s health condition and recommending treatment options. However, its development and introduction raise ethical questions. To ascertain professional perspectives on the clinical use of the dashboard, we have conducted 19 semi-structured qualitative interviews with head physicians, computer scientists, jurists, and ethicists. The application of a qualitative content analysis and thematic analysis enabled the detection of main ethical concerns, chances, and limitations. These ethical considerations were categorized: changes of the patient-physician relationship and the current social reality are expected, causing de-skilling and an active participation of the artificial intelligence. The interviewees anticipated a redistribution of human resources, time, knowledge, and experiences as well as expenses and financing. Concerns of privacy, accuracy, transparency, and explainability were stated, and an insufficient data basis, an intensifying of existing inequalities and systematic discrimination considering a fair access emphasized. Concluding, the patient-physician relationship, social reality, redistribution of resources, fair access, as well as data-related aspects of the artificial intelligence-based system could conflict with the ethical principles of autonomy, non-maleficence, beneficence, and social justice. To respond to these ethical concerns, a responsible use of the dashboard and a critical verification of therapy suggestions is mandatory, and the application limited by questions at the end of life and taking life-changing decisions.

Expanding the ethical debate on human artificial placenta trials

Artificial placentas (APs) are technologies that mimic the human placenta to treat extremely preterm infants. Being an invasive and risky technology, it will raise important ethical questions for human trials. Hence, in this Topic Piece we provide a blueprint of further issues to investigate. First, counselling will have the double role of providing trial information as well as (non) treatment counselling. This requires extra training and the development of ad hoc decision aids to support counselling and parents’ decision-making. Second, more stakeholder involvement is needed. Direct stakeholders, such as parents, clinicians, and researchers, can help develop the decision aids and provide insight on potentially overlooked issues. Society should also be involved to determine whether AP trials and implementation should be subsidized, and the ethical implications of not subsidizing. Third, a proper cost-benefit analysis should be conducted to determine the exact cost of the technology.

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.

Paramedical staffs' perception of their role during the continuum of care from detection to treatment in nursing homes: Results of the ONCOPAD-Pre survey.

e13768 Background: Prevalence of cancer in nursing homes (NH) increases. ONCOPAD is a 4-step program dedicated to identifying and acting on educational needs, cultural and ethical barriers associated with cancer treatment in NH. The program included a scoping review (step 1), semi-directive interviews with care providers (step 2) designed to identify the major topics to be included in a tailored intervention and evaluated before and after it. Here we report the results of the survey before the intervention. Methods: Questions were mainly presented as 7-point Likert scales and classified into 6 sections: interviewee’s description, detection phase, treatment phase, relations and communication at work, ethical questioning, continuing education. Statistical analyses included descriptive statistics, exploratory factorial analyses, testing of model sphericity and sampling adequation. Results: From 06/2022 to 03/2023, 65 participants (median age 41 years; females: 84.6%) completed the questionnaire; 40.0% were nurses, 35.4% nurse assistants; 87.7% were full-time employees, and 73.8% were post holder. Interviewees considered their role as important at the detection stage (mean 4.82), to inform the physician (5.58) and their colleagues (5.45), their role during the decisional process (4.40) and to inform the patient on his diagnosis (4.05) were perceived as less important; organizational problems (lack of staff, time, facilities) could impede this stage. Factors perceived important for treatment decision were related to the patient (physical performance, cognition, age), his opinion (4.49), the opinion of his family (4.38), of his physician (5.17) and less to the paramedical team (4.02). The decision to pursue was mainly focused on care: pain relief (5.48), detection of clinical and psychological signs (5.18); the organizational barriers were perceived as major as well. Relations and communication at work, both internal and external to the institutions, were perceived as poor quality; 8 (12.3%) of the interviewees even skipped this section. The ethical questioning was permanent and homogeneous. Considering education, the interviewees felt insufficiently trained and the preferred model for training was short sequences integrated into daily work schedules; coordinating physicians appear as good mediators for such training courses. Conclusions: In this survey, paramedical staffs perceived their role as important during both detection and treatment of cancers, focusing more on care than cure; however, organizational constraints and poor quality of internal and external relations, and communication appear as major barriers in the completion of their role. Educational intervention should be tailored, favoring short sequences integrated into daily work schedules, coordinating physicians appear as good mediators for improvement in the future.

Beyond the veil: Popular culture, morality and the afterlife in contemporary society

Ongoing interest in the afterlife serves to navigate existential crises by offering solace or amplifying anxieties about death. Popular cultural narratives, deeply intertwined with religious doctrines, serve as interpretative frameworks for understanding human experiences, ethical conduct and the mysteries of death. This Special Issue, then, explores how, in an increasingly secular world, the afterlife is portrayed in media narratives, which, while primarily aimed at entertainment, also respond to deep-seated existential and moral questions. It discusses how these portrayals offer a mix of hope, happiness and moral guidance, reflecting broader societal values and beliefs about life, death and what lies beyond. This collection of scholarly contributions aims to dissect the portrayal of morality and religion in media representations of the afterlife, examining how these portrayals reflect, critique or reinforce societal norms and values. By focusing on themes such as digital immortality and the supernatural, the Special Issue not only highlights the evolving nature of afterlife narratives but also underscores the role of popular culture in navigating and negotiating the existential dilemmas of the twenty-first century.

The Intersection of Transhumanism, Prognosis, and AI in Dan Brown’s Origin

The intersection of Transhumanism, Prognosis, and Artificial Intelligence (AI) is a topic that has captured the imagination of science fiction writers for years. In Dan Brown’s novel, Origin, he explores the idea that as AI evolves to the point of self-learning, the prospect of a posthuman world becomes increasingly plausible. Artificial intelligence has become ubiquitous, not only in technology but also in the way people think about the world. Machines are learning, and evolving, and are soon expected to surpass human intelligence. However, this pursuit of creating the ultimate AI raises ethical and moral concerns. The idea of a machine achieving sentience and surpassing human intelligence is a nightmare scenario for some who fear the rise of artificial intelligence. In his quest to create the ultimate AI, the protagonist in “Origin” has plunged into dangerous territory, pushing the limits of what is acceptable. The defining technology of the modern era is artificial intelligence, a force that is transforming every aspect of society from finance to healthcare to transportation. As AI continues to advance, people are becoming increasingly concerned about the ethical implications of creating machines that can think and reason like humans. Transhumanism, which aims to enhance human capabilities through the use of technology, is closely linked with the development of AI. The coalescence of man and machine is becoming a real possibility, and the future belongs to those who can control it. In conclusion, the intersection of transhumanism, prognosis, and AI raises important ethical and moral questions about the future of humanity. As we continue to develop AI, it is essential to consider the potential consequences of creating machines that can think and reason like humans. The quest for the ultimate AI is a double-edged sword, and we must be careful not to plunge too far into dangerous territory.

Advancing primatology through ethical and scientific perspectives on rhesus monkey (Macaca mulatta) cloning.

A critical turning point was reached in research with the recent success in cloning rhesus monkeys (Macaca mulatta), a major advancement in primatology. This breakthrough marks the beginning of a new age in biomedical research, ushered by improved somatic cell nuclear transfer techniques and creative trophoblast replacement strategies. The successful cloning of rhesus monkeys presents the possibility of producing genetically homogeneous models that are highly advantageous for studying complex biological processes, testing drugs, and researching diseases. However, this achievement raises important ethical questions, particularly regarding animal welfare and the broader ramifications of primate cloning. Approaching the future of primate research with balance is critical, as the scientific world stands on the brink of these revolutionary breakthroughs. This paper aims to summarise the consequences, ethical challenges and possible paths forward in primatology arising from rhesus monkey cloning.

Neuralink Human Trials Raise Ethical Questions, Controversy

Neuralink Human Trials Raise Ethical Questions, Controversy

Gendered bodies: A graphic medicine commentary

This final commentary, in comic format, frames this special issue using Graphic Medicine methodologies to explore broader themes and meanings related to the scientific study of gender and health. Comics can be seen as a way to introduce complex human narratives and as an exploratory tool to ask broader social-contextual and ethical questions about health and medicine. This piece is also constructed through the lens of queer scholarship, which, together with the comics format, provides opportunities to build more embodied, complicated narratives about gender, sexuality and health. Most importantly, comics are used as a modality to tell compelling narratives about how individuals, rather than populations, may be impacted by biomedical conceptualizations of gender and health. The commentary includes a series of graphic narratives containing hypothetical stories and cases: stories of how individuals may be harmed within healthcare systems by rigid framings of gender, sex and sexuality, and stories about how gender socialization may impact health in subtle ways. These narratives furthermore examine the inextricable link between gender and power, illustrating how overt and covert manifestations of power may shape a person's health over the life course. Finally, the piece explores how expansive views of gender may contribute to positive health care experiences. The intention of this piece is to nudge scientific researchers and clinicians alike to approach the topic of gender, sexuality and health with nuance and curiosity.

The Ways BCIs can be Abused and The Necessary Preventative Actions

The development of the brain-computer interface (BCI) reveals the plethora of its uses in the modern world. From hospitals and medicine to entertainment and gaming, the BCI shows great potential to improve human lives. As BCIs continue to advance, the question of ethics arises. This paper discusses six main concerns that have emerged with the growth of BCIs, and an explanation of why action must be taken to prevent these possible issues. These issues include: data security and privacy, monitoring and influencing affective states, the manipulation of affective states, unethical uses in a corporate environment, lack of understanding the possible unintended consequences of using such technology, and unequal access to the technology itself. The paper concludes that there are many examples of technologies that have developed rapidly without proper guardrails, and the BCI, with an incredible amount of potential, is another example of technology that poses risks in absence of the right guardrails. It ends with suggesting approaches for enacting, through the government, regulatory oversight to provide the right guardrails to protect society.

The Transformative Power Of Use Of Space in Hardy’s “Satires Of Cırcumstances: In Fifteen Glimpses”: A Change From The Public Space To Private and Vice Versa

“Satires of Circumstances” which is a part of a poetry collection by Thomas Hardy consists of fifteen poems which produce a moral question and a scenery of a daily life of people. The settings of these poems are ordinary places ranging from a living room, bride’s room, in a restaurant, in a store, outdoors, and in the cemetery. There are three poems which take place in the cemetery: “By Her Aunt’s Grave”, “In the Cemetery”, and “In the Moonlight”. These poems are of importance to discuss in terms of cemetery’s dynamism as a both public and a private space are designated through the relations and activities of the people. The cemetery in the three poems as a dynamic area is discussed in terms of public and private space and the dynamism in between drawing on the notions of public space put forward by Mike Devereux and David Littlefield, and definitions of private space by.

Artificial intelligence in maxillofacial and facial plastic and reconstructive surgery.

To provide a current review of artificial intelligence and its subtypes in maxillofacial and facial plastic surgery including a discussion of implications and ethical concerns. Artificial intelligence has gained popularity in recent years due to technological advancements. The current literature has begun to explore the use of artificial intelligence in various medical fields, but there is limited contribution to maxillofacial and facial plastic surgery due to the wide variance in anatomical facial features as well as subjective influences. In this review article, we found artificial intelligence's roles, so far, are to automatically update patient records, produce 3D models for preoperative planning, perform cephalometric analyses, and provide diagnostic evaluation of oropharyngeal malignancies. Artificial intelligence has solidified a role in maxillofacial and facial plastic surgery within the past few years. As high-quality databases expand with more patients, the role for artificial intelligence to assist in more complicated and unique cases becomes apparent. Despite its potential, ethical questions have been raised that should be noted as artificial intelligence continues to thrive. These questions include concerns such as compromise of the physician-patient relationship and healthcare justice.

Reasonable adjustment for inclusive development: a cautionary case study of Australian VET teachers’ experience

PurposeVocational education and training (VET) in Australia has for some time been driven by an agenda of “reasonable adjustment”, in which practices are modified to ensure equitable access and participation by disadvantaged students. However, the growing marketization of VET has instead encouraged the use of more flexible approaches to attract and retain students from diverse backgrounds. They have thus paralleled and confounded reasonable adjustment practices for inclusive development. This study sought to identify the moral dilemmas experienced by VET teachers arising from implementing reasonable adjustment practices.Design/methodology/approachThis phenomenological research project used in-depth conversational interviews with 19 experienced VET teachers from a diversity of teaching fields to identify moral dilemmas experienced as arising from changes in their workplace contexts.FindingsOne of the identified dilemmas was responding flexibly to heightened student diversity, to which study participants largely responded by prioritising the economic imperative over social inclusion. Well-intended actions thus led to unintentionally damaging outcomes, raising important ethical questions about the relative value of economic and social development outcomes and the role of reasonable adjustment in their attainment. The study also highlights the lack of appropriate VET teacher training in managing ethical conflicts to minimise risks to themselves and their employing organizations.Originality/valueAs a case study of inclusive development policies in practice, this research may be seen as a cautionary tale for inclusive development policies in other countries with similarly strong VET economic and socially inclusive development policies for sustainability. The paper thus opens a dialogue for critical reflection on the current problems in a reasonable development approach in the field of comparative and international education. Those two parallel agendas have presented VET teachers and trainers with ethically challenging situations in which the economic and social development imperatives are experienced as being conflict with each other.

Fécondation in vitro : quel impact sur la santé à moyen et long terme des enfants conçus

Among the medical, scientific and ethical questions raised by in vitro fertilization (IVF), those concerning the medium and long-term health of children and young adults thus conceived are essential. Forty-five years after the birth of the first child and while more than 8 million people in the world have been conceived by IVF, the National Academy of Medicine has devoted a report to this theme, mainly analysing the results of numerous international studies. The published results are rather reassuring but they are not always consistent and many uncertainties remain. The Academy of Medicine calls for further epidemiological and clinical studies in better characterized populations and at later ages of life. The Academy also recommends developing basic research to better explain the potential effects of IVF.

Historical comments on ethics in psychiatry : Challenges in the 19th century

With the emergence of an early psychiatry around 1800, anumber of questions arose on dealing with agroup of persons whose "alien", irritating and disruptive behavior was considered to be aphenomenon of being sick. In the context of the growing importance of human rights, the term humanitarianism attained ahigh relevance as the reference for early psychiatrists. Based on historical sources it is shown that despite amultitude of psychiatric beliefs on humanitarianism the established psychiatric practice was dominated by patriarchal order regimes up to the first decade of the twentieth century, later superimposed by the challenges of somatophysiological and experimental research as well as perceptions of biological racism. The associated new ethical questions were partially addressed within psychiatry but did not prevent an increase in the assessment of the mentally ill as "inferior".

Debris: autoethnography, feminist epistemology, ethics, and sexual violence

ABSTRACT This article examines the impact of methodological choices and collaborative processes in a complex study that delved into the intimate experiences of violence as narrated by conscripts to the Peruvian armed forces. Lurgio Gavilán is a Peruvian anthropologist who strongly identifies with the interviewed veterans because of his own experiences, and Jelke Boesten is European feminist scholar with specific ideas about gender justice. Our collaboration allows us to raise fundamental questions around the limitations, validity, and ethics of knowledge production. The “debris” of this collaboration refers to the ethical questions that we may have previously failed to raise and address. Why did each of us embark on this research? Have our respective epistemological positions shifted due to the research? How has the nature of the collaboration, and our different positions of power therein, enlightened or concerned us? With what are we left, and what do we leave behind?

Neither right nor wrong? Ethics of collaboration in transformative research for sustainable futures

Transformative research is a broad and loosely connected family of research disciplines and approaches, with the explicit normative ambition to fundamentally question the status quo, change the dominant structures, and support just sustainability transitions by working collaboratively with society. When engaging in such science-practice collaborations for transformative change in society, researchers experience ethical dilemmas. Amongst others, they must decide, what is worthwhile to be researched, whose reality is privileged, and whose knowledge is included. Yet, current institutionalised ethical standards, which largely follow the tradition of medical ethics, are insufficient to guide transformative researchers in navigating such dilemmas. In addressing this vacuum, the research community has started to develop peer guidance on what constitutes morally good behaviour. These formal and informal guidelines offer a repertoire to explain and justify positions and decisions. However, they are only helpful when they have become a part of researchers’ practical knowledge ‘in situ’. By focusing on situated research practices, the article addresses the need to develop an attitude of leaning into the uncertainty around what morally good behaviour constitutes. It also highlights the significance of combining this attitude with a critical reflexive practice both individually and collaboratively for answering questions around ‘how to’ as well as ‘what is the right thing to do’. Using a collaborative autoethnographic approach, the authors of this paper share their own ethical dilemmas in doing transformative research, discuss those, and relate them to a practical heuristic encompassing axiological, ontological, and epistemological considerations. The aim is to support building practical wisdom for the broader research community about how to navigate ethical questions arising in transformative research practice.

An Ethical Analysis of Therapy for Severe Congenital Kidney and Urinary Tract Anomalies.

Technological advancements before and after delivery have greatly altered the counseling of pregnant patients facing a fetal diagnosis of severe oligohydramnios or anhydramnios secondary to congenital anomalies of the kidneys and urinary tract. Once considered a nearly uniformly lethal abnormality, long-term survival may now be possible secondary to prenatal innovations aimed at restoring the amniotic fluid volume and the availability of more advanced neonatal dialysis techniques. However, these available therapies are far from perfect. The procedures are onerous for pregnant patients without a guarantee of success, and families must prepare themselves for the complex life-long medical care that will be necessary for surviving individuals. Multidisciplinary counseling is imperative to help pregnant individuals understand the complexity of these conditions and assist them in exercising their right to informed decision-making. Moreover, as with any developing field of medicine, providers must contend with ethical questions related to the treatment options, including questions regarding patient-hood, distributive justice, and the blurred lines between research, innovation, and standard care. These ethical questions are best addressed in a multidisciplinary fashion with consideration of multiple points of view from various subspecialties. Only by seeing the entirety of the picture can we hope to best counsel patients about these highly complex situations and help navigate the most appropriate care path.