Asian Bioethics Review最新文献

The necessity of obtaining pediatric assent for research participation is well established within international ethical guidelines. However, the effective implementation of these guidelines poses significant challenges for research ethics committees in numerous developing countries, such as Pakistan, characterized by diverse cultural and socio-economic contexts. This paper critically examines the moral underpinnings of assent, rooted in the principle of respect for persons, which aims to empower, engage, and educate children involved in research processes. Through a case example, this paper reveals the unique obstacles faced by researchers and clinicians in Pakistan, which stem from socio-cultural norms and economic disparities. Such challenges endanger the ethical foundation of assent, creating a disconnect between its philosophical basis and practical execution. Although international guidelines permit contextual adaptation of assent procedures, such flexibility is not adequately articulated within the guidelines, nor is it typically prioritized in practice. This gap undermines the purpose of assent and inadvertently increases the risk of harm to child participants—not from the research itself but rather from a process designed to protect and empower them. This paper emphasizes greater awareness among stakeholders regarding these challenges, urging a reimagined assent process in diverse global contexts. By introducing a clear rationale within research guidelines, the intent is to ensure that researchers and Institutional Review Boards (IRBs) prioritize the contextual understanding of assent, transforming it from a mere procedural formality into a meaningful practice that mitigates potential risks to children and adolescents involved in research.

Modern medicine is continually evolving, yet developing and validating new treatments for paediatric patients presents significant challenges. Ethical dilemmas often arise when parents consider nonstandard treatments for their children, driven by desperation and the hope of finding effective interventions. Therefore, there is an urgent need for robust ethical frameworks to guide thier decision-making processes. Such frameworks must include the necessity for informed consent, ensuring that parents understand the potential risks and benefits of unproven treatments. Additionally, clear and open communication between parents and healthcare providers throughout the treatment journey is crucial. This ensures that decisions are made in the best interest of paediatric patients, considering their unique needs and vulnerabilities. By addressing the ethical considerations of trying unproven treatment for seriously ill children, healthcare professionals can better navigate these complexities, and ultimately foster a more compassionate and ethically sound healthcare environment.

Ethical conundrums are common in neonatal medicine, particularly around continuing or withdrawing intensive treatment in a critically ill baby. A common scenario is a baby born with compromised oxygen delivery around the time of birth (perinatal asphyxia) leading to a condition named hypoxic ischemic encephalopathy (HIE) which can have a high probability of death or long-term neurologic disability. This article reviews the key ethical dilemmas that underpin the clinical management of babies with severe HIE. The discussions, however, could be relevant in any newborn with a life-threatening illness where withdrawal or redirection of intensive treatment is being considered.

Risk prediction in emergency medicine (EM) holds unique challenges due to issues surrounding urgency, blurry research-practise distinctions, and the high-pressure environment in emergency departments (ED). Artificial intelligence (AI) risk prediction tools have been developed with the aim of streamlining triaging processes and mitigating perennial issues affecting EDs globally, such as overcrowding and delays. The implementation of these tools is complicated by the potential risks associated with over-triage and under-triage, untraceable false positives, as well as the potential for the biases of healthcare professionals toward technology leading to the incorrect usage of such tools. This paper explores risk surrounding these issues in an analysis of a case study involving a machine learning triage tool called the Score for Emergency Risk Prediction (SERP) in Singapore. This tool is used for estimating mortality risk in presentation at the ED. After two successful retrospective studies demonstrating SERP’s strong predictive accuracy, researchers decided that the pre-implementation randomised controlled trial (RCT) would not be feasible due to how the tool interacts with clinical judgement, complicating the blinded arm of the trial. This led them to consider other methods of testing SERP’s real-world capabilities, such as ongoing-evaluation type studies. We discuss the outcomes of a risk–benefit analysis to argue that the proposed implementation strategy is ethically appropriate and aligns with improvement-focused and systemic approaches to implementation, especially the learning health systems framework (LHS) to ensure safety, efficacy, and ongoing learning.

This paper considers what a human rights–based approach to the use of social listening to counter infodemics during a serious health threat might entail, using COVID-19 as a primary example. The paper considers social listening in the context of human rights including health, life, free speech, and privacy, and outlines what a rights-compliant form of social listening to infodemics might entail. The paper argues that human rights offer guardrails against illicit and unethical forms of social listening as well as signposts towards a more equitable, ethical, and effective public health tool. The paper first expands on the human rights dimensions of COVID-19, infodemics, and social listening. Second, it considers the human rights dimensions of social listening in relation to rights to health, life, and free speech, given international human rights law principles for limiting these rights. Finally, using this framework, the paper poses four key questions to frame a rights-based approach to social listening: Why do we listen? How do we listen? Who do we listen to and who is doing the listening? And what are the outcomes of such listening?

The utilisation of human organoids has the potential to expedite the cycle of biological innovation significantly, yet it also raises a series of ethical and societal concerns. This study aims to evaluate the perceptions and attitudes of researchers regarding the ethical and social challenges associated with the research and application of human organoids. A 20-item questionnaire was developed to assess various aspects: four items evaluated the overall understanding of organoids, 13 items addressed ontological, ownership, informed consent and additional ethical issues, while the remaining four items focused on ethical governance and regulatory concerns. This questionnaire was distributed to attendees of the 3rd China Symposium on 3D Cell Culture and Organoids in May 2023. Basic descriptive statistical analyses and chi-square tests were conducted. The work has been reported in line with the ARRIVE guidelines 2.0. A substantial majority (over 70%) of participants expressed concerns that the research and application of human organoids might raise ethical issues, such as moral status, informed consent and commercialisation. In contrast, a minor segment (4.5%, n = 8) reported feelings of disgust or nausea towards human-animal neural chimeras, with a significant gender difference (p = 0.004). Regarding informed consent for human organoid samples, over 90% of researchers rejected blanket consent for all purposes, and more than half preferred a model of continuous consent, which entails resoliciting consent for new uses. Further, over 40% of participants believed that the commercialisation of human organoids is dependent on their specific type. Our findings show that some researchers held that as long as human embryonic stem cells are not utilised in human organoid research and application, there are no ethical relevant issues. Most researchers also showed indifference towards the concern of moral status and humanisation of animals. The majority believe that the “consent for governance” model is preferable than broad consent or specific consent. We believe to realise the promise of human organoids for medicine, navigating complex ethics tensions and proactively engaging diverse stakeholders are required. Only with prudent, thoughtful and effective guidance, mutual understanding and trust between scientists and public can be fostered; the promising field of organoids can progress rapidly and responsibly.

Witnessing suffering and death in palliative care can cause moral distress, emotional exhaustion and maladaptive coping strategies. How sense and meaning is made from these experiences influences how physicians think, feel and act as professionals (professional identity formation or PIF). It also determines how they cope with their roles, care for patients and interact with other professionals. Timely, personalised and appropriate support is key as shaping how these physicians develop and contend with sometimes competing beliefs and roles. The Ring Theory of Personhood (RToP) and the Krishna-Pisupati Model (KPM) offer a means of mapping PIF and thus moulding, coping and meaning making. This study uses the RToP and KPM to explore how caring for end-of-life patients impacts the personhood of palliative care physicians. Semi-structured interviews with a purposive sample of 13 palliative care physicians—eleven females and two males aged between 35 and 50 years—at a cancer specialist centre were conducted. Transcripts of the audio-recorded interviews underwent content and thematic analysis where complementary themes and categories identified were combined to form domains that highlighted the physicians’ key experience of providing end-of-life care. The domains identified were (1) identity formation, (2) conflicts, (3) KPM elements and (4) support systems. Together, results revealed that palliative care physicians are driven by Innate, Individual, Relational and Societal belief systems that create an intertwined professional and personal identity, enabling them to find meaning in their experiences and adapt to present contexts within cultural norms and professional expectations. However, their failure to recognise their need for support when hampered by evolving personal, existential and clinical factors underlines the exigency for ongoing surveillance and a potential role for a RToP-based tool and portfolio system that can detect and direct timely, appropriate support to in-need physicians.

In the ever-evolving landscape of Artificial Intelligence in Healthcare (AIH), understanding the entities and legal frameworks governing its research and development is crucial. This report delves into the intricacies of AIH in Malaysia, undertaking a comprehensive literature search on scientific databases, government portals, and news sources. Additionally, bibliometric analysis has been concurrently conducted to discern trends and developments in AIH over the years. Notably, the interest in AIH has seen a consistent rise since 2017, marked by a growing number of use cases (25 reported here) developed by both local and foreign innovators and applicators. Despite this surge in research and adoption, Malaysia lacks direct legislation specifically addressing AIH technologies, leaving them subject to 11 existing laws. This lack of clear oversight is compounded by the insufficient expertise within local regulatory and ethical bodies to effectively assess AIH research and deployment. The resultant challenges include bureaucratic hurdles for AIH innovators and applicators, raising ethical concerns related to patient autonomy, privacy, data management, AI robustness, and liability. To address these issues, this paper recommends: (1) adopting international ethical guidelines for AIH, (2) enhancing public awareness and education on AI technologies, and (3) promoting AIH research through clinical or silent trials to improve oversight and foster innovation.