Hematological malignancies such as acute myeloid leukemia or myelodysplastic syndrome occur predominantly in older individuals. For many of these patients, hematopoietic cell transplantation is currently the only treatment modality with curative potential. However, older age tends to be associated with increasing co-morbidities, rendering patients more susceptible to toxicities associated with the transplantation procedure. Further, transplantation carries the risk of inducing graft-versus-host disease, the clinical result of the immunological attack of donor cells against the patient's body, even if the donor is matched (for human leukocyte antigen) with the patient. These complications affect quality of life and may prove fatal. More conventional chemotherapy does not carry the risk of these complications; however, in most patients, it does not cure the disease. Therefore, multiple patient and disease characteristics are being considered in the decision-making process regarding the two treatment strategies, and the decision is generally based on statistics from previous studies. Of course, those statistics do not consider individual patient personalities nor physician attitudes, which clearly affect patient decisions. Thus, these discussions involve considerable uncertainty and ethical considerations as to the greatest benefit at the lowest "cost" for the patient.
Objective This article provides a review to identify the concerns of Artificial Intelligence (A.I.) and machine learning (ML) in dentistry, thus highlighting the broader insight into ethical standards required for good machine learning practice as part of patient care. Materials and methods Researchers conducted an in-depth review in MEDLINE/PubMed and GoogleScholar for papers published in the English language in the last ten years. Results Out of 2541 eligible papers, 42 articles have information for meaningful assessments. Study methodologies include Artificial Intelligence and articles applied to dental technologies. Conclusions The use of A.I. and ML has a significant impact on the dental profession. The constant evolution of digital technologies creates unforeseen challenges in the bio-ethical areas. including but not limited to anonymity, informed consent, privacy, and security. Clinical significance The constraints of A.I. application in dentistry with a comprehensive perspective on evaluating it from a technical and a clinical point of view are often overlooked. Key aspects addressed are verifiability of A.I. applications, explicit formalization of policies to demystify technical, and ethical challenges for safe, and democratized use of A.I. in dentistry.
With the advent of advanced computing power, artificial intelligence (AI) has gained traction in all areas of human life. The field of medicine is no exception to the influence of AI because technology is intricately linked to the advancement of modern-day clinical practice. However, many challenges must still be addressed to ensure that broad adoption of AI in health care is practically feasible, safe, and accepted by health care professionals. This review focuses on the ethical challenges of implementing and developing AI algorithms to augment patient care in health care settings. More specifically, we discuss the issues of bias, privacy, security, lack of transparency and explainability, and the potential impacts on physician−patient relationships when large-scale AI models are incorporated into modern-day medicine.
Technology is defined functionally as the way we get things done, thus including the people, protocol, and occasions, as well as the "things" intended to change communities when implemented. A relatively small group of individuals is engaged in technology development. They are paid a salary or otherwise given rewards for following standards approved by their peers. There is also a technology of use, where individuals derive value from changing their life patterns to take advantage of new ways of using technology. The ethics of the technology of use is different from and more complicated than the ethics of technology development because of multiple, interacting perspectives that may evolve over times. Examples are given from the general literature and from dentistry. A simple rule, act so as to bring about the community one wishes to live in, is suggested as an approximation for the ethics of technology use.
Risk taking is unique to each individual. The concept of individual risk taking has been extensively studied in Finance but not so in Medicine. As the medical community has become focused on reducing medical errors and bias, the authors believe a better understanding of risk-taking bias can be one of the many ways to reduce errors. Prior research found that medical professionals are risk averse and that risk aversion is contextual and varies by medical specialty. High risk aversion can lead to over prescription of medications, diagnostic tests and unnecessary surgery. The potential side-effects of over diagnosis can outweigh the benefits from "playing it safe". Research also shows that doctors more often select a safer medical treatment for their patients than for themselves. This raises ethical questions on the extent to which a doctor believes a safer choice is in fact the right choice. Understanding risk taking biases can help mitigate erroneous recommendations and deliver better outcomes to patients. Radiologists can be on both sides of the risk aversion spectrum. Underdiagnosis (more likely in low-risk averse practitioners) is a well-known error. On the other end of the spectrum is overdiagnosis (more likely in high-risk averse practitioners). This became better understood with large screening with mammography. Risk aversion research in psychology can be applied to identify both individuals. In psychology, risk aversion parameters give a value to an individual’s risk tolerance. Utility parameters are used to assess the psychological value of good and bad decisions and depends on risk tolerance parameters. Using these parameters, the authors believe we can a
Existential distress is variously defined as a group of symptoms including a sense of hopelessness, disappointment, loss of self-worth, remorse, meaningless, and disruption of personal identity. Additionally, there is also anxiety grounded in loss of control, independence, generalized and specialized fear of death, panic, and isolation. Spirituality is regarded as meaning-making and is distinct from religion. Spirituality has increasingly been acknowledged in the medical community as necessary for healing and health. This article advocates for fully integrating spiritual care providers (SCPs) into inter- and multidisciplinary healthcare teams for optimum patient-centered care.
The reported incidence of thyroid cancer has increased dramatically due to improved access to healthcare and high-quality imaging modalities. Most newly diagnosed thyroid cancers are papillary thyroid microcarcinomas, with typically indolent courses and extremely favorable clinical outcomes without treatment. This raises the question of overdiagnosis and overtreatment of the disease, which may lead to unwarranted risks. The 2015 American Thyroid Association guidelines included active surveillance as an alternative treatment option for low-risk papillary thyroid microcarcinoma in addition to immediate surgery. Despite initial promising results, active surveillance has not been widely adapted worldwide due to physician concerns and attitudes towards safety of active surveillance, patient and societal beliefs regarding cancer, and the paucity of long-term data on clinical outcomes. Concurrent with this has been the introduction and proliferation of radio frequency ablation as an outpatient treatment option for thyroid lesions, including small cancers. Increased education and shared decision making between the physician and patient can help establish a safe and effective personalized treatment strategy.
Our health care system is a natural social artifact, something we have created because of natural features making us subject to illness and bodily faults. It is like language in that its current structure is the result of many different decisions by many different individuals. Like language, it is not fixed but evolves because many different individuals with differing interests and different ends make different decisions that affect our health. Our health care system is thus a hodgepodge, with inefficiencies and significant failures to provide even the basic minimal health care goods to so many. It is a tragedy that preventable medical mistakes are the third leading cause of death, after cancer and heart disease, with over 400,000 deaths a year, but it is also a telling mark of a system that fails in achieving its basic goals. Our health care system ought to be organized to achieve a set of basic goods−that birth and infancy occur so we have the highest chance of continuing to live without harm, that those of us who live have the best preventive care so that we will be least prone to disease and bodily faults, that those of us subject to disease and bodily faults are well taken care of, that when we are elderly, we receive adequate care, that we have each and all of these without significantly harming such other interests as our financial well-being, and that every one of us has reasonable and assured access to these minimally adequate basic goods. Every complex human enterprise has effects, some a result of its design and some of its incoherence. The 400,000 deaths a year from preventable medical mistakes are unintended, unwanted and unwarranted in a system that ought to be designed to achieve the basic goods of any health care system.
Engaging students in the teaching of engineering ethics can often be facilitated by offering interesting cases for discussion and debate. In this paper, I present a dozen moral conundrums related to engineering ethics that may be useful to instructors wanting to encourage classroom dialogue. In each scenario presented, a brief commentary follows that may be of didactic value, even though the commentary offered does not always provide a specific approach to addressing the conundrum and even though students and instructors may disagree with some of the points made in the discussion.
The Hippocratic Oath, despite being a remarkable historic document and despite containing many important principles that are still relevant today, contains many teachings that are unsuitable for contemporary medical practice. This paper takes a critical look at medicine’s oldest surviving guide to medical ethics and identifies some of its shortcomings. Alternative oaths more appropriate to the modern world are presented.
Over 60% of the population in the United States received the SARS-Co-V-Type 2 mRNA vaccine, manufactured by Pfizer-BioNTech and by Moderna. The pace at which these mRNA vaccines have been developed may be alarming to the public when compared to timelines for development of traditional vaccines for other diseases, eliciting issues of mistrust. Ethical issues arise regarding the pace of vaccine development and have been described and highlighted by the media. In addition, testing and validation of basic science and clinical findings, combined with potential side effects of the mRNA vaccines have contributed to public mistrust of this vaccine development platform. The following paper focuses on the current ethical concerns involved with vaccine development and identifies the ethical concerns that mitigate the role of public vaccine hesitancy and effort to minimize the role of such issues. As the number of vaccinated people increase, the likelihood of herd immunity increases as well. The following paper addresses some of the scientific concerns cited by the public in their hesitancy to obtain the mRNA vaccines.
The 9th International Conference on Ethics in Biology, Engineering, and Medicine (ICEBEM 2018) was held at the Florida International University in Miami, Florida, USA, April 14th and 15th, 2018. It was attended by over one hundred biomedical engineers, scientists, philosophers, physicians, dentists and both undergraduate and graduate students. Dr. Subrata Saha from Florida International University and the University of Washington, and Dr. Zachary Danziger from the Florida International University were the conference co-chairs. The call for abstracts included a large number of the topics of interest: a) Ethics in Bioengineering, b) Ethics in Biomedical Research, c) Ethics of Nanobiotechnology, d) Ethics of Genetic Engineering, e) Ethics of Stem Cell Research, f) Responsible Conduct of Research, g) Ethics of Synthetic Biology, h) Biotechnology and Law, i) Medical Ethics and Health Policy, j) Clinical Trials & Animal Experiments, k) Ethics in Tissue Engineering, l) Neuroethics, m) Privacy and Data Sharing, n) Ethics of Biobanks, o) Ethics in Global Health, and p) Ethics in STEM Education. Many of these topics were presented and discussed during the conference.
Thanks to significant medical and surgical advancements and innovations in the past century, most children with critical heart disease can hope to live a long and healthy life. Unfortunately, despite these advancements, some children do not respond to conventional therapies and are at high-risk of dying. Under these heart-breaking circumstances, some families and medical teams may understandably search for alternative therapies that may help save the child’s life. Under such dire circumstances, unconventional cardiac surgical or catheter-based interventions are sometimes considered. These interventions are often unproven, with unclear risks and benefits. The use of unconventional heroic therapies can in some cases be lifesaving and in other cases only place additional burdens on the child without a positive outcome. These decisions are rife with ethical questions. An ethical approach to the consideration of unconventional interventions under these dire and often time-pressured circumstances in the cardiac intensive care unit is necessary to protect the best-interests of the child and optimize the medical decision-making process. Pediatric cardiac intensivist care providers are well-positioned to support ethical decision-making. This manuscript provides a framework for intensive care providers to understand and apply the ethical considerations of the use of unconventional interventions in this setting.
Neurological research shows enormous promise for improving educational systems, combatting mental disorders, and curing diseases. But some corporations use results from psychology and neurology research and lessons from machine learning and advertising to target influences that maximize impact on children. These "addictive designers" have intentionally used medical research on addiction to render their products more addictive in the service of greater profits to their companies. This is an example of the unethical misuse of medical research to pursue greater profits for a few at the expense of diminishing the personal autonomy of millions. In this work, I lay out a (hierarchical, continual, diachronic, and relational) conception of autonomy that I believe should be promoted by a liberal democratic state. I explain how addiction subverts autonomy and argue for doing more to combat the unethical use of addictive design technology.
When demand for life-saving resources outstrips supply during a pandemic, age discrimination must be eschewed in favor of a lottery. Arguments for favoring the young include widespread approval of age discrimination, life-stage considerations, utilitarianism, and Rawlsian considerations. All of these arguments are flawed. Moreover, it is crucial to present alternatives to patients in a way that avoids bias and pressure.
Recently, many places worldwide are witnessing uprisings and violence, some of which are linked to environmental scarcity. These are threats to global health, peace, development, and security because violence of any type is a global health and security menace. Environmental scarcity, especially the scarcity of renewable resources (arable land, freshwater, and forest), and bad government policies deepen preexisting ethnoreligious and political crises in a state, causing security and health threats to its citizens. These security issues include conflicts, armed robbery, violence, insurgencies, migration, displacement, and unemployment. Health consequences include hunger, food insecurity, disease burden, epidemics, and poverty. These security and health threats make life dangerous, causing death, injuries, sicknesses, and mass migration. Refugees, immigrants, and violent conflicts are both security and health threats because they are the preconditions that cause illness, diseases, deaths, injuries, and displacements. It is no wonder refugees and immigrants receive specific attention from the International Public Health Department as disease and infection carriers, which strain a nation's resources. They are also seen as a security threat in their area of settlement. The increasing number of migrants and refugees in the world is a global health problem; the cause, in most cases, is environmentally induced because of resource scarcities. Therefore, this article expresses concern about environmentally induced violence across the world as a global health challenge, threatening the global economy and health, as well as security, social, and political activities. It seeks to propose solutions to this new form of violence that is seriously affecting the global community.
Use of outcomes from animal research for prediction of human response in tissue engineering studies has many ethical considerations. This article aims to contribute to the ethical discussion by delineating the framework of animal research and the ethical considerations at play, in particular with respect to cartilage tissue engineering. The history of animal research regulation and the current status of animal research in orthopedic tissue engineering is discussed. Questions addressed include how the proper animal models are chosen, how regulatory bodies ensure animal wellness and safety, and how guidelines are implemented and maintained throughout the life cycle of a project. Finally, we provide examples of both in vitro and in vivo cartilage tissue engineering research where animal models were employed as a predictive model of human response.
Artificial intelligence (AI) has been on the horizon for several decades and offers applications for the medical field, such as radiographic interpretation. Deep AI involves a neural network that is the equivalent of an electronic model of brain neurons. The network is a keystone for deep AI but involves no specific ethical reasoning. Given the spectrum of potential commercial developments, stakeholders must consider the ethics of decision making. The first of four basic elements of medical ethics is autonomy, which provides the patient with independence of thought and decision making and freedom from coercion or coaxing, leading to fully informed patient consent. The second is justice, in which new or experimental treatments share burdens and benefits that are distributed throughout all groups. The third is beneficence or the intent to do good for the patient. The fourth is nonmaleficence, where the goal is to do no harm to patient or society as a whole. AI is no longer the future; it is here and growing in orthopaedics-related applications. Knowledge of and consideration for medical ethics are critical when evaluating AI applications. In this article, we discuss the impact of the 2019 coronavirus disease epidemic and the international approach to ethical considerations.
Personalized medicine, with a focus on providing customized care to each patient, has been gaining traction over the past decade. Although the idea of catering treatments to individuals is not new, the tools for applying individualized diagnosis, treatment, and preventive measures have developed rapidly. Although these developments are exciting, there are many ethical considerations that need to be examined before the introduction of such a large shift in health care can be successful. To better understand potential dilemmas that could stop personalized medicine from reaching its full potential to improve health care, we consider some of the ethical concerns associated with it and offer guidelines and considerations to avoid them.
Throughout most of the recent past century, regulations such as the Belmont Report have been put in place to ensure the ethical conduct of research and the protection of human subjects. Nevertheless, underrepresentation of research subjects from historically marginalized populations has been pervasive over time. Oncology research includes the development of novel treatments to improve survival, strategies to manage symptoms and treatment side effects to preserve quality of life, and interventions to promote healthy behaviors for cancer prevention and early detection. Most recently, precision oncology has emerged as a promising approach to delivering individualized oncology care that accounts for a person's genomic and health determinants (e.g., social, structural, biologic). Given the potential benefit of this research to both participants and society at large, ensuring that all individuals with or at risk for cancer have access to these studies is imperative. At the same time, the application of novel research methods requires a comprehensive understanding of their ethical implications. With a view of the past and a look toward the future, we explore the ethical considerations and inequities currently inherent in precision oncology research, including: biomarkers and wearables, digital health/technology and social media, health behaviors, social and environmental factors, and health literacy.
