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Journal of Medical Ethics最新文献

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Generational tobacco ban: questions of consistency.
IF 3.3 2区 哲学 Q1 ETHICS Pub Date : 2025-02-12 DOI: 10.1136/jme-2025-110810
Johannes Kniess
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引用次数: 0
Beochaoineadh: grieving but not bereaved.
IF 3.3 2区 哲学 Q1 ETHICS Pub Date : 2025-02-12 DOI: 10.1136/jme-2024-110610
Martha Finnegan
{"title":"Beochaoineadh: grieving but not bereaved.","authors":"Martha Finnegan","doi":"10.1136/jme-2024-110610","DOIUrl":"https://doi.org/10.1136/jme-2024-110610","url":null,"abstract":"","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Relational epistemic humility in the clinical encounter.
IF 3.3 2区 哲学 Q1 ETHICS Pub Date : 2025-02-08 DOI: 10.1136/jme-2024-110241
Kathryn Muyskens, Chloe Ang, Eric Thomson Kerr

Epistemic humility has garnered increased attention in recent years, including within the realm of clinical ethics and is increasingly accepted as an important part of patient-centred practice and clinical care. However, while literature on the topic often states what epistemic humility is not, there have been few positive definitions given for the term. Further, these few positive definitions downplay the relational nature of epistemic humility, in other words, the ways in which epistemic humility is developed within the clinical encounter through the relationship between doctor and patient. In this paper, we will present a positive account of epistemic humility, situated in ethical medical education and practice, and show how it can be identified, modelled and cultivated. We provide a character-based account of epistemic humility that emphasises the relational nature of epistemic humility, that is, that views epistemic humility as formed through relationships rather than solely inhering in an individual's internal mental processes or external presentation and which is embedded in a social context such as a clinical encounter.

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引用次数: 0
'Chết phải toàn thây': belief in Vietnamese culture and its impact on organ donation.
IF 3.3 2区 哲学 Q1 ETHICS Pub Date : 2025-02-05 DOI: 10.1136/jme-2024-110513
Quang Thanh Nguyen, Ngoc Luong Khanh Nguyen, Thuy Minh Ha
{"title":"'Chết phải toàn thây': belief in Vietnamese culture and its impact on organ donation.","authors":"Quang Thanh Nguyen, Ngoc Luong Khanh Nguyen, Thuy Minh Ha","doi":"10.1136/jme-2024-110513","DOIUrl":"https://doi.org/10.1136/jme-2024-110513","url":null,"abstract":"","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ethics in digital phenotyping: considerations regarding Alzheimer's disease, speech and artificial intelligence.
IF 3.3 2区 哲学 Q1 ETHICS Pub Date : 2025-01-31 DOI: 10.1136/jme-2024-110252
Francesca Rose Dino, Peter Scott Pressman, Kevin Bretonnel Cohen, Veljko Dubljevic, William Jarrold, Peter W Foltz, Matt DeCamp, Mohammad H Mahoor, Lawrence E Hunter

Artificial intelligence (AI)-based digital phenotyping, including computational speech analysis, increasingly allows for the collection of diagnostically relevant information from an ever-expanding number of sources. Such information usually assesses human behaviour, which is a consequence of the nervous system, and so digital phenotyping may be particularly helpful in diagnosing neurological illnesses such as Alzheimer's disease. As illustrated by the use of computational speech analysis of Alzheimer's disease, however, neurological illness also introduces ethical considerations beyond commonly recognised concerns regarding machine learning and data collection in everyday environments. Individuals' decision-making capacity cannot be assumed. Understanding of analytical results will likely be limited even as the personal significance of those results is both highly sensitive and personal. In a traditional clinical evaluation, there is an opportunity to ensure that information is relayed in a way that is highly customised to the individual's ability to understand results and make decisions, and privacy is closely protected. Can any such assurance be offered as digital phenotyping technology continues to advance? AI-supported digital phenotyping offers great promise in neurocognitive disorders such as Alzheimer's disease, but it also poses ethical challenges. We outline some of these risks as well as strategies for risk mitigation.

{"title":"Ethics in digital phenotyping: considerations regarding Alzheimer's disease, speech and artificial intelligence.","authors":"Francesca Rose Dino, Peter Scott Pressman, Kevin Bretonnel Cohen, Veljko Dubljevic, William Jarrold, Peter W Foltz, Matt DeCamp, Mohammad H Mahoor, Lawrence E Hunter","doi":"10.1136/jme-2024-110252","DOIUrl":"https://doi.org/10.1136/jme-2024-110252","url":null,"abstract":"<p><p>Artificial intelligence (AI)-based digital phenotyping, including computational speech analysis, increasingly allows for the collection of diagnostically relevant information from an ever-expanding number of sources. Such information usually assesses human behaviour, which is a consequence of the nervous system, and so digital phenotyping may be particularly helpful in diagnosing neurological illnesses such as Alzheimer's disease. As illustrated by the use of computational speech analysis of Alzheimer's disease, however, neurological illness also introduces ethical considerations beyond commonly recognised concerns regarding machine learning and data collection in everyday environments. Individuals' decision-making capacity cannot be assumed. Understanding of analytical results will likely be limited even as the personal significance of those results is both highly sensitive and personal. In a traditional clinical evaluation, there is an opportunity to ensure that information is relayed in a way that is highly customised to the individual's ability to understand results and make decisions, and privacy is closely protected. Can any such assurance be offered as digital phenotyping technology continues to advance? AI-supported digital phenotyping offers great promise in neurocognitive disorders such as Alzheimer's disease, but it also poses ethical challenges. We outline some of these risks as well as strategies for risk mitigation.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Jecker and Atuire's African reflections on being a person: more welcome non-western thought about moral status.
IF 3.3 2区 哲学 Q1 ETHICS Pub Date : 2025-01-30 DOI: 10.1136/jme-2025-110712
Thaddeus Metz
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引用次数: 0
How (not) to define 'assisted dying'.
IF 3.3 2区 哲学 Q1 ETHICS Pub Date : 2025-01-29 DOI: 10.1136/jme-2024-110415
David Albert Jones

In the last 20 years 'assisted dying' (and/or its variants 'assisted death', 'assistance in dying', 'aid in dying') has become increasingly prevalent as a term to denote the intentional ending of the life of a patient by or with the assistance of a doctor. However, there is no agreed definition. This paper focuses on the debate over the definition of this term in the UK. It notes that, broadly speaking, there are two ways in which 'assisted dying' has been defined. There are generic definitions, which cover a variety of practices, including self-administration of a lethal drug (assisted suicide) and administration by a healthcare professional (euthanasia) with or without specific eligibility criteria. In contrast, there are stipulative definitions which limit the term to a particular practice, for example, assisted suicide (not euthanasia) of adults (not minors) who are terminally ill (not those with chronic conditions). Examples of the former kind of definition are provided by the British Medical Association in its 2020 members' survey and the POSTbrief on Assisted dying. Examples of the latter are provided by the British Medical Journal and the British Broadcasting Corporation. This paper argues that stipulative definitions are problematic in that they exclude practices that are widely referred to as 'assisted dying'. The attempt to restrict the definition leads to the term being used inconsistently. Stipulative definitions can be used consistently if it is acknowledged that they are secondary to the generic sense. This matters because clarity of terminology is a prerequisite of rational debate.

{"title":"How (not) to define 'assisted dying'.","authors":"David Albert Jones","doi":"10.1136/jme-2024-110415","DOIUrl":"https://doi.org/10.1136/jme-2024-110415","url":null,"abstract":"<p><p>In the last 20 years 'assisted dying' (and/or its variants 'assisted death', 'assistance in dying', 'aid in dying') has become increasingly prevalent as a term to denote the intentional ending of the life of a patient by or with the assistance of a doctor. However, there is no agreed definition. This paper focuses on the debate over the definition of this term in the UK. It notes that, broadly speaking, there are two ways in which 'assisted dying' has been defined. There are generic definitions, which cover a variety of practices, including self-administration of a lethal drug (assisted suicide) and administration by a healthcare professional (euthanasia) with or without specific eligibility criteria. In contrast, there are stipulative definitions which limit the term to a particular practice, for example, assisted suicide (not euthanasia) of adults (not minors) who are terminally ill (not those with chronic conditions). Examples of the former kind of definition are provided by the British Medical Association in its 2020 members' survey and the POSTbrief on Assisted dying. Examples of the latter are provided by the British Medical Journal and the British Broadcasting Corporation. This paper argues that stipulative definitions are problematic in that they exclude practices that are widely referred to as 'assisted dying'. The attempt to restrict the definition leads to the term being used inconsistently. Stipulative definitions can be used consistently if it is acknowledged that they are secondary to the generic sense. This matters because clarity of terminology is a prerequisite of rational debate.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Seeking consensus on dilemmas related to euthanasia in dementia based on an advance directive: a Delphi study from a medical, ethical and legal perspective.
IF 3.3 2区 哲学 Q1 ETHICS Pub Date : 2025-01-28 DOI: 10.1136/jme-2024-110276
Marike E de Boer, Djura O Coers, Eefje M Sizoo, Danique M J Ten Bokkel Huinink, Carlo J W Leget, Cees M P M Hertogh

Euthanasia in dementia based on advance euthanasia directives (AEDs) is possible within the Dutch Euthanasia law. Yet, physicians struggle with the responsibility of interpreting the law's open norms in cases of advanced dementia, which includes the fulfilment of the due care criteria. This Delphi study aims to analyse arguments and seek consensus from medical, ethical and legal perspectives on ethical dilemmas in such cases. Thirty participants, equally divided in expertise, took part in a three-round Delphi with a total of 11 statements on ethical dilemmas. Despite differences in opinions and argumentations between panellists, consensus was reached on seven statements regarding different topics. Consensus was reached that the (behavioural) expressions of a person with dementia should be considered throughout the progression of decision-making disabilities. In such cases, a wish to live should be prioritised over an AED. Although substitute decision-making is not an option in case of euthanasia requests, both people around the person with dementia as well as their AED can be supportive in the decision-making process. Advance directives with formulations such as 'if I have to admitted to a nursing home, then I want euthanasia' are found to be infeasible. At all times, it is important to pay attention to alternatives to euthanasia, which includes following existing guidelines on problem behaviour. Physicians may benefit from the arguments pertaining to dilemmas encountered and the fulfilment of the due care criteria to either justify their decisions in euthanasia cases based on an AED, or to support decisions to refrain from euthanasia.

{"title":"Seeking consensus on dilemmas related to euthanasia in dementia based on an advance directive: a Delphi study from a medical, ethical and legal perspective.","authors":"Marike E de Boer, Djura O Coers, Eefje M Sizoo, Danique M J Ten Bokkel Huinink, Carlo J W Leget, Cees M P M Hertogh","doi":"10.1136/jme-2024-110276","DOIUrl":"https://doi.org/10.1136/jme-2024-110276","url":null,"abstract":"<p><p>Euthanasia in dementia based on advance euthanasia directives (AEDs) is possible within the Dutch Euthanasia law. Yet, physicians struggle with the responsibility of interpreting the law's open norms in cases of advanced dementia, which includes the fulfilment of the due care criteria. This Delphi study aims to analyse arguments and seek consensus from medical, ethical and legal perspectives on ethical dilemmas in such cases. Thirty participants, equally divided in expertise, took part in a three-round Delphi with a total of 11 statements on ethical dilemmas. Despite differences in opinions and argumentations between panellists, consensus was reached on seven statements regarding different topics. Consensus was reached that the (behavioural) expressions of a person with dementia should be considered throughout the progression of decision-making disabilities. In such cases, a wish to live should be prioritised over an AED. Although substitute decision-making is not an option in case of euthanasia requests, both people around the person with dementia as well as their AED can be supportive in the decision-making process. Advance directives with formulations such as 'if I have to admitted to a nursing home, then I want euthanasia' are found to be infeasible. At all times, it is important to pay attention to alternatives to euthanasia, which includes following existing guidelines on problem behaviour. Physicians may benefit from the arguments pertaining to dilemmas encountered and the fulfilment of the due care criteria to either justify their decisions in euthanasia cases based on an AED, or to support decisions to refrain from euthanasia.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Generational smoking bans: inegalitarian without disadvantage? 世代禁烟:不平等而无劣势?
IF 3.3 2区 哲学 Q1 ETHICS Pub Date : 2025-01-27 DOI: 10.1136/jme-2024-110632
James Hart, Sapfo Lignou
{"title":"Generational smoking bans: inegalitarian without disadvantage?","authors":"James Hart, Sapfo Lignou","doi":"10.1136/jme-2024-110632","DOIUrl":"https://doi.org/10.1136/jme-2024-110632","url":null,"abstract":"","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Assessing the performance of ChatGPT in medical ethical decision-making: a comparative study with USMLE-based scenarios.
IF 3.3 2区 哲学 Q1 ETHICS Pub Date : 2025-01-25 DOI: 10.1136/jme-2024-110240
Ali A Khan, Ali R Khan, Saminah Munshi, Hari Dandapani, Mohamed Jimale, Franck M Bogni, Hussain Khawaja

Introduction: The integration of artificial intelligence (AI) into healthcare introduces innovative possibilities but raises ethical, legal and professional concerns. Assessing the performance of AI in core components of the United States Medical Licensing Examination (USMLE), such as communication skills, ethics, empathy and professionalism, is crucial. This study evaluates how well ChatGPT versions 3.5 and 4.0 handle complex medical scenarios using USMLE-Rx, AMBOSS and UWorld question banks, aiming to understand its ability to navigate patient interactions according to medical ethics and standards.

Methods: We compiled 273 questions from AMBOSS, USMLE-Rx and UWorld, focusing on communication, social sciences, healthcare policy and ethics. GPT-3.5 and GPT-4 were tasked with answering and justifying their choices in new chat sessions to minimise model interference. Responses were compared against question bank rationales and average student performance to evaluate AI effectiveness in medical ethical decision-making.

Results: GPT-3.5 answered 38.9% correctly in AMBOSS, 54.1% in USMLE-Rx and 57.4% in UWorld, with rationale accuracy rates of 83.3%, 90.0% and 87.0%, respectively. GPT-4 answered 75.9% correctly in AMBOSS, 64.9% in USMLE-Rx and 79.6% in UWorld, with rationale accuracy rates of 85.4%, 88.9%, and 98.8%, respectively. Both versions generally scored below average student performance, except GPT-4 in UWorld.

Conclusion: ChatGPT, particularly version 4.0, shows potential in navigating ethical and interpersonal medical scenarios. However, human reasoning currently surpasses AI in average performance. Continued development and training of AI systems can enhance proficiency in these critical healthcare aspects.

{"title":"Assessing the performance of ChatGPT in medical ethical decision-making: a comparative study with USMLE-based scenarios.","authors":"Ali A Khan, Ali R Khan, Saminah Munshi, Hari Dandapani, Mohamed Jimale, Franck M Bogni, Hussain Khawaja","doi":"10.1136/jme-2024-110240","DOIUrl":"https://doi.org/10.1136/jme-2024-110240","url":null,"abstract":"<p><strong>Introduction: </strong>The integration of artificial intelligence (AI) into healthcare introduces innovative possibilities but raises ethical, legal and professional concerns. Assessing the performance of AI in core components of the United States Medical Licensing Examination (USMLE), such as communication skills, ethics, empathy and professionalism, is crucial. This study evaluates how well ChatGPT versions 3.5 and 4.0 handle complex medical scenarios using USMLE-Rx, AMBOSS and UWorld question banks, aiming to understand its ability to navigate patient interactions according to medical ethics and standards.</p><p><strong>Methods: </strong>We compiled 273 questions from AMBOSS, USMLE-Rx and UWorld, focusing on communication, social sciences, healthcare policy and ethics. GPT-3.5 and GPT-4 were tasked with answering and justifying their choices in new chat sessions to minimise model interference. Responses were compared against question bank rationales and average student performance to evaluate AI effectiveness in medical ethical decision-making.</p><p><strong>Results: </strong>GPT-3.5 answered 38.9% correctly in AMBOSS, 54.1% in USMLE-Rx and 57.4% in UWorld, with rationale accuracy rates of 83.3%, 90.0% and 87.0%, respectively. GPT-4 answered 75.9% correctly in AMBOSS, 64.9% in USMLE-Rx and 79.6% in UWorld, with rationale accuracy rates of 85.4%, 88.9%, and 98.8%, respectively. Both versions generally scored below average student performance, except GPT-4 in UWorld.</p><p><strong>Conclusion: </strong>ChatGPT, particularly version 4.0, shows potential in navigating ethical and interpersonal medical scenarios. However, human reasoning currently surpasses AI in average performance. Continued development and training of AI systems can enhance proficiency in these critical healthcare aspects.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143039611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of Medical Ethics
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