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New Bioethics-A Multidisciplinary Journal of Biotechnology and the Body最新文献

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Machine learning, healthcare resource allocation, and patient consent. 机器学习、医疗资源分配和患者同意。
IF 1.4 Q2 ETHICS Pub Date : 2024-09-01 Epub Date: 2024-11-15 DOI: 10.1080/20502877.2024.2416858
Jamie Webb

The impact of machine learning in healthcare on patient informed consent is now the subject of significant inquiry in bioethics. However, the topic has predominantly been considered in the context of black box diagnostic or treatment recommendation algorithms. The impact of machine learning involved in healthcare resource allocation on patient consent remains undertheorized. This paper will establish where patient consent is relevant in healthcare resource allocation, before exploring the impact on informed consent from the introduction of black box machine learning into resource allocation. It will then consider the arguments for informing patients about the use of machine learning in resource allocation, before exploring the challenge of whether individual patients could principally contest algorithmic prioritization decisions involving black box machine learning. Finally, this paper will examine how different forms of opacity in machine learning involved in resource allocation could be a barrier to patient consent to clinical decision-making in different healthcare contexts.

医疗保健领域的机器学习对患者知情同意的影响目前已成为生命伦理学的重要研究课题。然而,这一话题主要是在黑盒诊断或治疗建议算法的背景下被考虑的。医疗资源分配中的机器学习对患者同意的影响仍未被充分理论化。本文将在探讨将黑盒机器学习引入资源分配对知情同意的影响之前,先确定患者同意在医疗资源分配中的相关性。然后,本文将考虑让患者了解机器学习在资源分配中的应用的论据,然后探讨患者个人能否对涉及黑盒机器学习的算法优先级决定提出主要质疑。最后,本文将探讨在不同的医疗环境下,资源分配中涉及的机器学习的不同形式的不透明会如何阻碍患者对临床决策的同意。
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引用次数: 0
Artificial Intelligence for Clinical Decision-Making: Gross Negligence Manslaughter and Corporate Manslaughter. 人工智能用于临床决策:重大过失过失杀人罪和公司过失杀人罪。
IF 1.4 Q2 ETHICS Pub Date : 2024-09-01 Epub Date: 2024-10-22 DOI: 10.1080/20502877.2024.2416862
Helen Smith

This paper discusses the risk of gross negligence manslaughter (GNM) and corporate manslaughter charges (CM) when clinicians use an artificially intelligent system's (AIS's) outputs in their practice. I identify the elements of these offenses within the context of the law of England and Wales and explore how they could be applied in a potential scenario where a patient's death has followed AIS use by a clinician. The risk of a conviction due to making an AIS-augmented workplace mistake highlights the non-trivial nature of AIS adoption in healthcare, and that the consequences of its use must be considered by all interested parties prior to AIS adoption.

本文讨论了当临床医生在诊疗过程中使用人工智能系统(AIS)的输出结果时,可能面临的重大过失过失杀人罪(GNM)和公司过失杀人罪(CM)指控风险。我根据英格兰和威尔士的法律确定了这些罪行的要素,并探讨了在临床医生使用人工智能系统导致病人死亡的潜在情况下如何应用这些要素。由于在工作场所犯错而被定罪的风险凸显了在医疗保健领域采用自动识别系统的非同小可性,以及在采用自动识别系统之前,所有相关方都必须考虑使用该系统的后果。
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引用次数: 0
A quantitative analysis of stored frozen surplus embryos in the UK. 对英国储存的冷冻剩余胚胎进行定量分析。
IF 1.4 Q2 ETHICS Pub Date : 2024-09-01 Epub Date: 2024-06-26 DOI: 10.1080/20502877.2024.2354979
Zishang Yue, Calum MacKellar

The number of surplus frozen human embryos in storage in the United Kingdom (UK) is at its highest level since records began in 1991 and the formation of the UK Human Fertilisation and Embryology Authority (HFEA). This study features a quantitative analysis of data from 1991 to 2019 provided by the HFEA as well as a commentary on observed trends within this data. We also discuss trends relating to the final destiny of surplus embryos. Data analysis show that at least 130,000 stored embryos have been discarded in the UK since 1991, while another 500,000 embryos are currently being stored in a frozen state, of which a significant proportion is likely to be discarded in the future. However, this creates a moral dilemma since UK legislation relating to human embryos is based on the 1984 Warnock Report which recognizes that they have a special moral status.

自 1991 年英国人类受精与胚胎学管理局(HFEA)成立以来,英国储存的多余冷冻人类胚胎数量达到了最高水平。本研究对 HFEA 提供的 1991 年至 2019 年的数据进行了定量分析,并对数据中观察到的趋势进行了评述。我们还讨论了与剩余胚胎最终命运相关的趋势。数据分析显示,自 1991 年以来,英国至少有 13 万个储存的胚胎被丢弃,另有 50 万个胚胎目前处于冷冻储存状态,其中很大一部分可能在未来被丢弃。然而,这造成了一种道德困境,因为英国有关人类胚胎的立法是以 1984 年《沃诺克报告》为基础的,该报告承认人类胚胎具有特殊的道德地位。
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引用次数: 0
Moral Distress and its Impact on Healthcare Workers in a European NICU. 欧洲新生儿重症监护室医护人员的精神压力及其影响。
IF 1.4 Q2 ETHICS Pub Date : 2024-09-01 Epub Date: 2024-07-20 DOI: 10.1080/20502877.2024.2370084
Susan E Zinner

In a qualitative study of 15 NICU workers in a large European NICU, the author asks the subjects to consider what sorts of work environments are likely to result in moral distress and whether support by colleagues, administrators, the institution itself and even perceived societal support may reduce some kinds of moral distress. The majority of providers felt that the support of colleagues was essential; there was some disagreement about whether the larger community was aware of the nature of the work done in NICUs by health workers. These healthcare providers were also asked about memorable patient encounters.

作者对欧洲一家大型新生儿重症监护室的 15 名工作人员进行了一项定性研究,要求受试者考虑什么样的工作环境可能会导致道德困扰,以及同事、管理人员、机构本身的支持,甚至社会的支持是否会减少某些类型的道德困扰。大多数医疗服务提供者认为同事的支持是必不可少的;对于整个社会是否了解医务工作者在新生儿重症监护室所从事工作的性质,存在一些分歧。这些医疗服务提供者还被问及与病人的难忘接触。
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引用次数: 0
The Fertility Fix: the Boom in Facial-matching Algorithms for Donor Selection in Assisted Reproduction in Spain. The Fertility Fix: the Boom in Facial-Matching Algorithms for Donor Selection in Assisted Reproduction in Spain.
IF 1.4 Q2 ETHICS Pub Date : 2024-07-09 DOI: 10.1080/20502877.2024.2371738
Rebecca Close

This article reads the uptake of facial-matching algorithms by fertility clinics in Spain through the lens of 'the fertility fix': a software fix to the social reconfiguration of kinship and a fixed capital investment made by competing fertility companies and firms. 'The fertility fix' is proposed as a critical, ethical lens through which to situate algorithmic facial-matching in assisted reproduction in the context of the racial politics of the face and phenotype and the spatial politics of market expansion. While an 'infertility crisis' is often mentioned when explaining the growth of the assisted reproductive technologies (ARTs) industry, the use of donated reproductive cells is tied up in societal, ecological and economic shifts. Combining Software Studies analysis with Marxist Feminist and trans*feminist perspectives on shifting re/production dynamics, the article details the role of computational technologies in promoting certain ideas and beliefs about family and fixing certain territories of capital flow.

这篇文章从 "生育固定 "的角度解读了西班牙生育诊所对面部匹配算法的采用:这是对亲属关系社会重构的一种软件固定,也是竞争性生育公司和企业的一种固定资本投资。生育修复 "是一个批判性的伦理视角,通过它可以将辅助生育中的面部匹配算法置于面部和表型的种族政治以及市场扩张的空间政治的背景之下。在解释辅助生殖技术(ARTs)产业的增长时,"不孕不育危机 "经常被提及,而捐赠生殖细胞的使用则与社会、生态和经济的转变息息相关。文章将软件研究分析与马克思主义女权主义和变性*女权主义对不断变化的再/生产动态的观点相结合,详细阐述了计算技术在促进有关家庭的某些观念和信仰以及固定某些资本流动区域方面所起的作用。
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引用次数: 0
'Sit down and thrash it out': opportunities for expanding ethics consultation during conflict resolution in long-term care. 坐下来好好谈谈":在解决长期护理中的冲突时扩大伦理咨询的机会。
IF 1.2 Q2 ETHICS Pub Date : 2024-06-01 Epub Date: 2024-03-20 DOI: 10.1080/20502877.2024.2330275
David N Hoffman, Gianna R Strand

Objective: To identify the frequency and nature of care conflict dilemmas that United States long-term care providers encounter, response strategies, and use of ethics resources to assist with dispute resolution.

Design: An online cross-sectional survey was distributed to the Society for Post-Acute and Long-Term Care Medicine (AMDA).

Results: Two-thirds of participants, primarily medical directors, have rejected surrogate instructions and 71% have managed family conflict. Conflict over treatment decisions and issues interpreting advance directives were frequently reported. Half of facilities lack a formal dispute mediation policy. Only five respondents have called an ethics consult for assistance.

Conclusion: Ethically tense care conflicts commonly arise in long-term and post-acute care facilities. Few facility procedures incorporate ethics resources into actual practice. Recommendations are made to create actionable policy, increase access to ethics services, and support staff skill development in order to improve the end-of-life care experiences for patients, families, and care facility staff.

目的:确定美国长期护理服务提供者遇到护理冲突困境的频率和性质:确定美国长期护理服务提供者遇到护理冲突困境的频率和性质、应对策略以及使用道德资源协助解决纠纷的情况:设计:向急性期后和长期护理医学会(AMDA)分发了一份在线横截面调查:结果:三分之二的参与者(主要是医务主任)拒绝过代理指示,71%的参与者处理过家庭冲突。关于治疗决定的冲突和预先指示的解释问题经常被报道。半数医疗机构缺乏正式的争议调解政策。只有五名受访者曾向伦理顾问寻求帮助:结论:在长期护理和康复后护理机构中,经常会出现伦理紧张的护理冲突。很少有机构的程序将伦理资源纳入到实际操作中。建议制定可行的政策,增加获得伦理服务的途径,并支持员工技能发展,以改善患者、家属和护理机构员工的临终关怀体验。
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引用次数: 0
The Extent to Which the Wish to Donate One's Organs After Death Contributes to Life-Extension Arguments in Favour of Voluntary Active Euthanasia in the Terminally Ill: An Ethical Analysis. 死后捐献器官的愿望在多大程度上有助于支持临终病人自愿主动安乐死的生命延续论点:伦理分析》(The Extension Arguments in favour of Voluntary Active Euthanasia in the Terminally Ill: An Ethical Analysis)。
IF 1.2 Q2 ETHICS Pub Date : 2024-06-01 Epub Date: 2024-02-05 DOI: 10.1080/20502877.2024.2308346
Richard C Armitage

In terminally ill individuals who would otherwise end their own lives, active voluntary euthanasia (AVE) can be seen as life-extending rather than life-shortening. Accordingly, AVE supports key pro-euthanasia arguments (appeals to autonomy and beneficence) and meets certain sanctity of life objections. This paper examines the extent to which a terminally ill individual's wish to donate organs after death contributes to those life-extension arguments. It finds that, in a terminally ill individual who wishes to avoid experiencing life he considers to be not worth living, and who also wishes to donate organs after death, AVE maximizes the likelihood that such donations will occur. The paper finds that the wish to donate organs strengthens the appeals to autonomy and beneficence, and fortifies the meeting of certain sanctity of life objections, achieved by life-extension arguments, and also generates appeals to justice that form novel life-extension arguments in favour of AVE in this context.

对身患绝症的人来说,主动自愿安乐死(AVE)可以被视为延长生命而不是缩短生命,否则他们就会结束自己的生命。因此,主动自愿安乐死支持支持安乐死的主要论点(呼吁自主权和恩惠),也符合某些反对生命神圣不可侵犯的观点。本文研究了身患绝症的人死后捐献器官的愿望在多大程度上有助于这些延长生命的论点。本文发现,如果一个身患绝症的人希望避免过他认为不值得过的生活,同时也希望在死后捐献器官,那么 AVE 会最大限度地增加这种捐献的可能性。本文发现,捐献器官的愿望加强了对自主权和恩惠的呼吁,并强化了生命延续论据所实现的对某些生命神圣性反对意见的回应,还产生了对正义的呼吁,在这种情况下形成了支持反邪教的新的生命延续论据。
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引用次数: 0
'Assisted dying' as a comforting heteronomy: the rejection of self-administration in the purported act of self-determination. 辅助死亡 "是一种令人欣慰的异质自治:在所谓的自决行为中拒绝自我管理。
IF 1.2 Q2 ETHICS Pub Date : 2024-06-01 Epub Date: 2024-01-30 DOI: 10.1080/20502877.2024.2307698
David Albert Jones

'Assisted dying' (an umbrella term for euthanasia and/or assisted suicide) is frequently defended as an act of autonomous self-determination in death but, given a choice, between 93.3% and 100% of patients are reluctant to self-administer (median 99.5%). If required to self-administer, fewer patients request assisted death and, of these, a sizable proportion do not self-administer but die of natural causes. This manifest avoidance runs counter to the concept of autonomous self-determination, even on the supposition that suicide could truly be autonomous. The avoidance of self-administration does not show that self-administration, when it occurs, is necessarily autonomous. It suggests, rather, that there are other frames by which assisted dying is being understood. One such is desire for medical control, a desire shared by patients and doctors. Such a frame is not directed towards an exacting autonomy (self-directed action by the patient) but towards a comforting heteronomy (letting the doctor take control).

协助死亡"(安乐死和/或协助自杀的总称)经常被辩护为一种自主自决的死亡行为,但如果让病人选择,93.3%到100%的病人都不愿意自行用药(中位数为99.5%)。如果要求患者自行用药,要求辅助死亡的患者人数会减少,其中相当一部分患者不会自行用药,而是自然死亡。这种明显的回避与自主自决的概念背道而驰,即使假设自杀真的可以自主自决也是如此。回避自行服药并不表明自行服药在发生时一定是自主的。相反,这表明人们对协助死亡的理解还存在其他框架。其中之一就是对医疗控制的渴望,这是病人和医生的共同愿望。这种框架并不是针对严格的自主性(由病人自主行动),而是针对令人欣慰的异质性(让医生控制)。
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引用次数: 0
Editorial. 社论
IF 1.2 Q2 ETHICS Pub Date : 2024-03-01 Epub Date: 2024-05-26 DOI: 10.1080/20502877.2024.2354048
Matt James
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引用次数: 0
Motivational Enhancement: What Ancient Technologies of the Self and Recent Biotechnologies Have in Common. 动机增强:古代自我技术和现代生物技术的共同点。
IF 1.2 Q2 ETHICS Pub Date : 2024-03-01 Epub Date: 2023-10-22 DOI: 10.1080/20502877.2023.2269635
Cristian Iftode

Motivational enhancement of any kind can be conceived of either as a way to reduce the need for effort, or as a change in the subjective perception of effort. However, in both cases, effort is not all that matters. In the evaluation of praiseworthy conduct, the practical goals pursued by the subject, their dedication, and the discernment they exercise are equally important. I further argue that not only in terms of the general purpose, but also in terms of the means employed for human enhancement, we cannot, in fact, establish significant differences between the traditional technology of the self and biomedical technologies for enhancing motivation. There are two key features they all share. The traditional techniques of the self also aim at the gradual reduction of effort through their steady practice, and they are all mental conditioning and self-conditioning techniques based on repetition and training.

任何形式的动机增强都可以被认为是减少努力需求的一种方式,或者是改变对努力的主观感知。然而,在这两种情况下,努力并不重要。在评价值得赞扬的行为时,主体追求的实际目标、他们的奉献精神以及他们所表现出的洞察力同样重要。我进一步认为,不仅从总体目的来看,而且从人类增强所用的手段来看,事实上,我们无法在传统的自我技术和增强动机的生物医学技术之间建立显著的差异。它们共有两个关键特性。传统的自我调节技术也是以通过稳定的练习逐渐减少努力为目标的,它们都是基于重复和训练的心理调节和自我调节技术。
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引用次数: 0
期刊
New Bioethics-A Multidisciplinary Journal of Biotechnology and the Body
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