Emerging technologies such as artificial intelligence are actively revolutionizing the healthcare industry. While there is widespread concern that these advances will displace human practitioners within the healthcare sector, there are several tasks – including original and nuanced ethical decision making – that they cannot replace. Further, the implementation of artificial intelligence in clinical practice can be anticipated to drive the production of novel ethical tensions surrounding its use, even while eliminating some of the technical tasks which currently compete with ethical deliberation for clinicians’ limited time. A new argument therefore arises to suggest that although these disruptive technologies will change the face of medicine, they may also foster a revival of several fundamental components inherent to the role of healthcare professionals, chiefly, the principal activities of moral philosophy. Accordingly, “machine medicine” presents a vital opportunity to reinvigorate the field of bioethics, rather than withdraw from it.
{"title":"Medical Machines: The Expanding Role of Ethics in Technology-Driven Healthcare","authors":"C. Brenna","doi":"10.7202/1077638AR","DOIUrl":"https://doi.org/10.7202/1077638AR","url":null,"abstract":"Emerging technologies such as artificial intelligence are actively revolutionizing the healthcare industry. While there is widespread concern that these advances will displace human practitioners within the healthcare sector, there are several tasks – including original and nuanced ethical decision making – that they cannot replace. Further, the implementation of artificial intelligence in clinical practice can be anticipated to drive the production of novel ethical tensions surrounding its use, even while eliminating some of the technical tasks which currently compete with ethical deliberation for clinicians’ limited time. A new argument therefore arises to suggest that although these disruptive technologies will change the face of medicine, they may also foster a revival of several fundamental components inherent to the role of healthcare professionals, chiefly, the principal activities of moral philosophy. Accordingly, “machine medicine” presents a vital opportunity to reinvigorate the field of bioethics, rather than withdraw from it.","PeriodicalId":37334,"journal":{"name":"Canadian Journal of Bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43896330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Danielle Gionnas, A. Bianchi, Leonard Benoit, K. Rodrigues
The purpose of this commentary is to present and respond to the gap that currently exists in providing culturally inclusive residential long-term care options for Indigenous peoples in Ontario. After presenting statistics regarding the Indigenous population and long-term care options, we argue that we have an ethical responsibility to offer more culturally inclusive long-term care.
{"title":"Accessing Indigenous Long-Term Care","authors":"Danielle Gionnas, A. Bianchi, Leonard Benoit, K. Rodrigues","doi":"10.7202/1077634AR","DOIUrl":"https://doi.org/10.7202/1077634AR","url":null,"abstract":"The purpose of this commentary is to present and respond to the gap that currently exists in providing culturally inclusive residential long-term care options for Indigenous peoples in Ontario. After presenting statistics regarding the Indigenous population and long-term care options, we argue that we have an ethical responsibility to offer more culturally inclusive long-term care.","PeriodicalId":37334,"journal":{"name":"Canadian Journal of Bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46845759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Some healthcare providers regularly intervene in remote and isolated areas to offer various care and services. This situation is often experienced as a hardship as it becomes difficult for them to meet their private needs without compromising their professionalism. We propose a scenario that raises a number of ethical issues surrounding substance use-related privacy. This scenario will be analyzed according to different conceptual frameworks. If the proposed situation raises several ethical issues, we will see that the conceptual frameworks used to reflect and deliberate on the situation pose themselves ethical issues. We will conclude by showing that if the professional aims for the best, there is also a risk of harm. It follows that there is tragedy in ethical life if reflection and deliberation are based on a single conceptual framework.
{"title":"Réflexion éthique sur les doubles rôles en régions éloignées et isolées","authors":"Chloe Trahan, Jacques Quintin","doi":"10.7202/1077624AR","DOIUrl":"https://doi.org/10.7202/1077624AR","url":null,"abstract":"Some healthcare providers regularly intervene in remote and isolated areas to offer various care and services. This situation is often experienced as a hardship as it becomes difficult for them to meet their private needs without compromising their professionalism. We propose a scenario that raises a number of ethical issues surrounding substance use-related privacy. This scenario will be analyzed according to different conceptual frameworks. If the proposed situation raises several ethical issues, we will see that the conceptual frameworks used to reflect and deliberate on the situation pose themselves ethical issues. We will conclude by showing that if the professional aims for the best, there is also a risk of harm. It follows that there is tragedy in ethical life if reflection and deliberation are based on a single conceptual framework.","PeriodicalId":37334,"journal":{"name":"Canadian Journal of Bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43254834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The prospect of including artificial intelligence (AI) in clinical decision-making is an exciting next step for some areas of healthcare. This article provides an analysis of the available kinds of AI systems, focusing on macro-level characteristics. This includes examining the strengths and weaknesses of opaque systems and fully explainable systems. Ultimately, the article argues that “grey box” systems, which include some combination of opacity and transparency, ought to be used in healthcare settings.
{"title":"What Kind of Artificial Intelligence Should We Want for Use in Healthcare\u0000 Decision-Making Applications?","authors":"Jordan Joseph Wadden","doi":"10.7202/1077636AR","DOIUrl":"https://doi.org/10.7202/1077636AR","url":null,"abstract":"The prospect of including artificial intelligence (AI) in clinical decision-making is an exciting next step for some areas of healthcare. This article provides an analysis of the available kinds of AI systems, focusing on macro-level characteristics. This includes examining the strengths and weaknesses of opaque systems and fully explainable systems. Ultimately, the article argues that “grey box” systems, which include some combination of opacity and transparency, ought to be used in healthcare settings.","PeriodicalId":37334,"journal":{"name":"Canadian Journal of Bioethics","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41385229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In 2008, the American Medical Association Journal of Ethics dedicated an entire volume to ethical issues in sleep medicine. Texts published in the “Educating for Professionalism” and “Law, Policy, and Society” sections of this volume serve as theorical starting points to establish a correlation between lack of medical training in sleep disorders and ethical dilemmas encountered by expert witnesses during trials related to problematic automatic behaviours that occurred during REM sleep.
{"title":"La médecine du sommeil sous-représentée dans les curriculums des programmes de médecine : quelles implications éthiques pour les témoignages et la production de rapports médico-légaux?","authors":"Josianne Barrette-Moran","doi":"10.7202/1077635AR","DOIUrl":"https://doi.org/10.7202/1077635AR","url":null,"abstract":"In 2008, the American Medical Association Journal of Ethics dedicated an entire volume to ethical issues in sleep medicine. Texts published in the “Educating for Professionalism” and “Law, Policy, and Society” sections of this volume serve as theorical starting points to establish a correlation between lack of medical training in sleep disorders and ethical dilemmas encountered by expert witnesses during trials related to problematic automatic behaviours that occurred during REM sleep.","PeriodicalId":37334,"journal":{"name":"Canadian Journal of Bioethics","volume":"4 1","pages":"89-93"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47403719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This short perspective piece is about the documentation of clinical ethics consultation in Canada. It is written at a time when the Canadian Association of Practicing Health Care Ethicists (CAPHE) is endeavoring to develop standards of practice for clinical ethics in Canada. This brief commentary is informed by my experience working in clinical ethics in three different provinces, but it is primarily an attempt to draw attention to the normative questions: How much and what kinds of information should be included in clinical ethics documentation? Where should ethics consultation reports be saved, and who should have access to them? These questions are, more fundamentally, about how we should balance concern for privacy, confidentiality, professional integrity, accountability and the promotion of trust. They are also about where clinical ethics fits within the broader Canadian health system.
{"title":"Documenting Clinical Ethics Consultation","authors":"A. Porter","doi":"10.7202/1077633AR","DOIUrl":"https://doi.org/10.7202/1077633AR","url":null,"abstract":"This short perspective piece is about the documentation of clinical ethics consultation in Canada. It is written at a time when the Canadian Association of Practicing Health Care Ethicists (CAPHE) is endeavoring to develop standards of practice for clinical ethics in Canada. This brief commentary is informed by my experience working in clinical ethics in three different provinces, but it is primarily an attempt to draw attention to the normative questions: How much and what kinds of information should be included in clinical ethics documentation? Where should ethics consultation reports be saved, and who should have access to them? These questions are, more fundamentally, about how we should balance concern for privacy, confidentiality, professional integrity, accountability and the promotion of trust. They are also about where clinical ethics fits within the broader Canadian health system.","PeriodicalId":37334,"journal":{"name":"Canadian Journal of Bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44629825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
As older people begin to develop dementia, we confront ethical questions about when and how to intervene in their increasingly compromised decision-making. The prevailing approach in bioethics to tackling this challenge has been to develop theories of “decision-making capacity” based on the same characteristics that entitle the decisions of moral persons to respect in general. This article argues that this way of thinking about the problem has missed the point. Because the disposition of property is an identity-dependent right, what matters in dementia and decision-making is an individual’s personal identity with their prior self, not their moral personhood. Therefore, in considering when and how we ought to intervene in the decision-making of those with dementia, we must look to the philosophy of personal identity rather than personhood.
{"title":"“As Long As I’m Me”: From Personhood to Personal Identity in Dementia and Decision-making","authors":"James Toomey","doi":"10.7202/1077627AR","DOIUrl":"https://doi.org/10.7202/1077627AR","url":null,"abstract":"As older people begin to develop dementia, we confront ethical questions about when and how to intervene in their increasingly compromised decision-making. The prevailing approach in bioethics to tackling this challenge has been to develop theories of “decision-making capacity” based on the same characteristics that entitle the decisions of moral persons to respect in general. This article argues that this way of thinking about the problem has missed the point. Because the disposition of property is an identity-dependent right, what matters in dementia and decision-making is an individual’s personal identity with their prior self, not their moral personhood. Therefore, in considering when and how we ought to intervene in the decision-making of those with dementia, we must look to the philosophy of personal identity rather than personhood.","PeriodicalId":37334,"journal":{"name":"Canadian Journal of Bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46102506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This review examines Laurent Ravez’s book, Introduction a l’ethique de la sante publique, and highlights the importance of being familiar with public health ethics, both for those working in bioethics and those working in public health.
本文回顾了Laurent Ravez的著作《公共卫生伦理导论》(Introduction al’ethque de la sante publicque)，并强调了熟悉公共卫生伦理的重要性，无论是对那些从事生物伦理学工作的人还是那些从事公共卫生工作的人。
{"title":"Ravez L. Introduction à l’éthique de la santé publique (2020)","authors":"Julien Brisson","doi":"10.7202/1077643AR","DOIUrl":"https://doi.org/10.7202/1077643AR","url":null,"abstract":"This review examines Laurent Ravez’s book, Introduction a l’ethique de la sante publique, and highlights the importance of being familiar with public health ethics, both for those working in bioethics and those working in public health.","PeriodicalId":37334,"journal":{"name":"Canadian Journal of Bioethics","volume":"4 1","pages":"124-125"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44834767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Psychopharmacological cognitive enhancements could lead to a higher quality of life of healthy individuals with lower cognitive capacities, but the current regulatory framework does not seem to enable access to this group. This article discusses why Sen’s Capability Approach could open up such access, while two other modern social justice theories – utilitarianism and Rawls’ Justice as Fairness – could not. In short, the utilitarian approach is proven to be inadequate, due to practical reasons and having a low chance of real-world success. Rawls’ Justice as Fairness seems to be problematic because of conflicting stances that follow from his First Principle of Justice. The Capability Approach has the greatest chance of success in the context of these substances, because of arguments that can be identified under the banners of agency/self-respect and the way the public views those who take the capability path out of their poor situation. The article also discusses general and practical problems with psychopharmacological cognitive enhancement that should be addressed when writing new policy on this topic.
{"title":"Social Justice Theories as the Basis for Public Policy on Psychopharmacological\u0000 Cognitive Enhancement","authors":"Astrid Maria Elfferich","doi":"10.7202/1077629AR","DOIUrl":"https://doi.org/10.7202/1077629AR","url":null,"abstract":"Psychopharmacological cognitive enhancements could lead to a higher quality of life of healthy individuals with lower cognitive capacities, but the current regulatory framework does not seem to enable access to this group. This article discusses why Sen’s Capability Approach could open up such access, while two other modern social justice theories – utilitarianism and Rawls’ Justice as Fairness – could not. In short, the utilitarian approach is proven to be inadequate, due to practical reasons and having a low chance of real-world success. Rawls’ Justice as Fairness seems to be problematic because of conflicting stances that follow from his First Principle of Justice. The Capability Approach has the greatest chance of success in the context of these substances, because of arguments that can be identified under the banners of agency/self-respect and the way the public views those who take the capability path out of their poor situation. The article also discusses general and practical problems with psychopharmacological cognitive enhancement that should be addressed when writing new policy on this topic.","PeriodicalId":37334,"journal":{"name":"Canadian Journal of Bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47338662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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