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Disclosure of true medical information: the case of Bangladesh. 披露真实医疗信息:孟加拉国的案例。
IF 3 1区 哲学 Q1 ETHICS Pub Date : 2024-10-17 DOI: 10.1186/s12910-024-01115-y
Sanwar Siraj, Kristien Hens, Yousuf Ali

Background: Truth-telling in health care is about providing patients with accurate information about their diagnoses and prognoses to enable them to make decisions that can benefit their overall health. Physicians worldwide, especially in the United Kingdom (U.K.) and the United States (U.S.), openly share such medical information. Bangladesh, however, is a Muslim-majority society with different social norms than Western societies. Therefore, we examined whether Muslim culture supports truth disclosure for patients, particularly how and to what extent medical information about life-threatening diseases is provided to patients in Bangladesh.

Methods: This was a phenomenological qualitative study. We conducted thirty in-depth interviews with clinicians, nurses, patients and their relatives at Shaheed Suhrawardy Medical College Hospital in Dhaka, Bangladesh. We also used observations to explore interactions between patients, families and healthcare professionals regarding their involvement in medical decisions and truth disclosure issues. NVivo software was used to identify common themes, and a thematic analysis method was utilised to analyse the datasets.

Results: This study identified three recurring themes relevant to the ethics and practice of truth disclosure: best interest rather than autonomy, the ambivalent value of deception and who understands what. The participants revealed that physicians often withhold fatal medical prognoses from terminally ill patients to ensure the best healthcare outcomes. The results indicate that deception towards patients is commonly accepted as a means of reducing burden and providing comfort. The participants opined that true medical information should be withheld from some patients, assuming that such disclosures may create a severe burden on them. Whether or to what extent medical information is disclosed primarily depends on a family's wishes and preferences.

Conclusions: While truth disclosure to patients is considered an ethical norm in many cultures, such as in the U.K. and the U.S., the practice of concealing or partially revealing severe medical prognoses to patients is an actual medical practice in Bangladeshi society. This study emphasises the importance of recognising a patient's active involvement and respecting the cultural values that shape family involvement in medical decision-making. These findings may have significant policy and practical implications for promoting patient autonomy within Bangladeshi family dynamics and religious-based cultural values.

背景:医疗保健中的实话实说是指为患者提供有关其诊断和预后的准确信息,使他们能够做出有利于其整体健康的决定。全世界的医生,尤其是英国和美国的医生,都公开分享此类医疗信息。然而,孟加拉国是一个穆斯林占多数的社会,其社会规范与西方社会不同。因此,我们研究了穆斯林文化是否支持向患者披露真相,特别是在孟加拉国,如何以及在多大程度上向患者提供有关危及生命的疾病的医疗信息:这是一项现象学定性研究。我们对孟加拉国达卡 Shaheed Suhrawardy 医学院医院的临床医生、护士、患者及其亲属进行了 30 次深入访谈。我们还通过观察探讨了患者、家属和医护人员之间在参与医疗决策和披露真相问题上的互动。我们使用 NVivo 软件确定共同主题,并采用主题分析方法对数据集进行分析:本研究发现了与披露真相的伦理和实践相关的三个重复出现的主题:最佳利益而非自主权、欺骗的矛盾价值以及谁能理解什么。参与者发现,医生经常对临终病人隐瞒致命的医疗预后,以确保最佳的医疗效果。研究结果表明,作为减轻负担和提供安慰的一种手段,对病人的欺骗被普遍接受。与会者认为,应该对某些病人隐瞒真实的医疗信息,因为披露这些信息可能会给他们造成严重的负担。是否披露医疗信息或披露的程度主要取决于家属的意愿和偏好:虽然在许多文化中,如在英国和美国,向病人披露真相被认为是一种道德规范,但在孟加拉社会,向病人隐瞒或部分披露严重医疗预后的做法却是一种实际的医疗行为。本研究强调了承认病人积极参与和尊重形成家庭参与医疗决策的文化价值观的重要性。这些发现可能对在孟加拉国家庭动态和基于宗教的文化价值观中促进患者自主权具有重要的政策和实践意义。
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引用次数: 0
Ethical constraints and dilemmas in the provision of in-vitro fertilization treatment in Ghana: from the perspectives of experts. 加纳在提供体外受精治疗方面的伦理限制和困境:从专家的角度。
IF 3 1区 哲学 Q1 ETHICS Pub Date : 2024-10-17 DOI: 10.1186/s12910-024-01113-0
David Appiah, John K Ganle

Background: Infertility presents both medical and public health challenges, with in vitro fertilization (IVF) emerging as a prominent solution, particularly when other alternatives are exhausted. However, IVF treatment raises significant ethical questions that have been under explored in the Ghanaian context. This study aimed to explore ethical constraints and dilemmas in the provision of in vitro fertilization (IVF) treatment in Ghana.

Methods: A descriptive phenomenological qualitative design was employed. Purposive sampling techniques were used to recruit 12 participants including ART experts from three in vitro fertilization (IVF) centres, ethicists and a legal practitioner. In-depth face-to-face interviews guided by an open-ended interview guide were conducted. Thematic analysis of the interviews was performed to identify major themes.

Results: Providing IVF treatment in Ghana raises several ethical issues, including inequitable access due to high costs and limited availability, which favour wealthier individuals and leave marginalized populations with fewer options. There are significant ethical considerations in balancing the potential benefits of successful IVF treatment outcomes against the health risks and emotional tolls on patients. Decisions about the fate of surplus embryos present moral dilemmas, including whether to preserve, donate, or discard them. Differing personal beliefs about the moral status of the embryo further complicate the ethical landscape. Ensuring informed consent is challenging due to the complex medical, ethical, and emotional implications of IVF treatment, potentially leading to compromised consent. Additionally, there are ongoing risks of breaches in confidentiality, given the sensitive nature of reproductive health data and the importance of protecting patient privacy.

Conclusion: This study revealed that several ethical dilemmas confront both healthcare providers and couples in the process of IVF. There is an urgent need for the development of clear and uniform regulations to govern the practice of IVF treatment in Ghana, with further attention given to mitigating financial barriers and enhancing support systems for couples considering IVF treatment.

背景:不孕不育症给医疗和公共卫生都带来了挑战,体外受精(IVF)成为一种重要的解决方案,尤其是在用尽其他替代方法的情况下。然而,体外受精治疗引发了重大的伦理问题,而在加纳,对这些问题的探讨还很不够。本研究旨在探讨在加纳提供体外受精(IVF)治疗过程中的伦理限制和困境:采用描述性现象学定性设计。采用有目的的抽样技术招募了 12 名参与者,包括来自三个体外受精(IVF)中心的 ART 专家、伦理学家和一名法律从业人员。在开放式访谈指南的指导下,进行了面对面的深入访谈。对访谈进行了主题分析,以确定主要主题:在加纳提供体外受精治疗会引发一些伦理问题,包括由于费用高昂和可用性有限而造成的不公平,这有利于富裕人群,而使边缘化人群的选择更少。在平衡试管婴儿成功治疗的潜在益处与健康风险和对患者造成的情感伤害之间,存在着重大的伦理考虑。决定剩余胚胎的命运也是一个道德难题,包括是保存、捐赠还是丢弃。对胚胎道德地位的不同个人信仰使伦理问题更加复杂。由于试管婴儿治疗涉及复杂的医学、伦理和情感问题,确保知情同意具有挑战性,可能会导致知情同意受到影响。此外,鉴于生殖健康数据的敏感性和保护患者隐私的重要性,保密性被破坏的风险一直存在:这项研究表明,在试管婴儿过程中,医疗服务提供者和夫妇都面临着一些伦理困境。迫切需要制定明确、统一的法规来规范加纳的体外受精治疗实践,并进一步关注减少财务障碍和加强对考虑接受体外受精治疗的夫妇的支持系统。
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引用次数: 0
Exploring bias risks in artificial intelligence and targeted medicines manufacturing. 探索人工智能和靶向药物制造中的偏差风险。
IF 3 1区 哲学 Q1 ETHICS Pub Date : 2024-10-17 DOI: 10.1186/s12910-024-01112-1
Ngozi Nwebonyi, Francis McKay

Background: Though artificial intelligence holds great value for healthcare, it may also amplify health inequalities through risks of bias. In this paper, we explore bias risks in targeted medicines manufacturing. Targeted medicines manufacturing refers to the act of making medicines targeted to individual patients or to subpopulations of patients within a general group, which can be achieved, for example, by means of cell and gene therapies. These manufacturing processes are increasingly reliant on digitalised systems which can be controlled by artificial intelligence algorithms. Whether and how bias might turn up in the process, however, is uncertain due to the novelty of the development.

Methods: Examining stakeholder views across bioethics, precision medicine, and artificial intelligence, we document a range of opinions from eleven semi-structured interviews about the possibility of bias in AI-driven targeted therapies manufacturing.

Result: Findings show that bias can emerge in upstream (research and development) and downstream (medicine production) processes when manufacturing targeted medicines. However, interviewees emphasized that downstream processes, particularly those not relying on patient or population data, may have lower bias risks. The study also identified a spectrum of bias meanings ranging from negative and ambivalent to positive and productive. Notably, some participants highlighted the potential for certain biases to have productive moral value in correcting health inequalities. This idea of "corrective bias" problematizes the conventional understanding of bias as primarily a negative concept defined by systematic error or unfair outcomes and suggests potential value in capitalizing on biases to help address health inequalities. Our analysis also indicates, however, that the concept of "corrective bias" requires further critical reflection before they can be used to this end.

背景:尽管人工智能在医疗保健领域具有巨大价值,但它也可能因存在偏见风险而扩大健康不平等。本文探讨了靶向药物生产中的偏差风险。靶向药物生产是指针对个体患者或群体中的亚群患者生产药物的行为,例如,可以通过细胞和基因疗法来实现。这些制造过程越来越依赖于可由人工智能算法控制的数字化系统。然而,由于开发的新颖性,这一过程中是否会出现偏差以及如何出现偏差尚不确定:我们研究了利益相关者在生物伦理、精准医疗和人工智能方面的观点,记录了 11 个半结构式访谈中关于人工智能驱动的靶向疗法制造过程中可能存在偏见的一系列观点:结果:研究结果表明,在制造靶向药物时,上游(研发)和下游(药品生产)流程都可能出现偏差。然而,受访者强调,下游流程,尤其是那些不依赖患者或人群数据的流程,可能存在较低的偏差风险。研究还发现了一系列偏差含义,从消极、矛盾到积极、富有成效。值得注意的是,一些参与者强调了某些偏差在纠正健康不平等方面具有生产性道德价值的潜力。这种 "纠正性偏见 "的观点打破了偏见主要是由系统性错误或不公平结果所定义的负面概念的传统理解,并提出了利用偏见来帮助解决健康不平等问题的潜在价值。然而,我们的分析也表明,"纠正偏差 "的概念需要进一步的批判性反思,然后才能用于这一目的。
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引用次数: 0
Nurses' experience of nasogastric tube feeding under restraint for Anorexia Nervosa in a psychiatric hospital. 精神病院护士在束缚下为厌食症患者进行鼻胃管喂食的经验。
IF 3 1区 哲学 Q1 ETHICS Pub Date : 2024-10-10 DOI: 10.1186/s12910-024-01108-x
Berit Støre Brinchmann, Mette Spliid Ludvigsen, Tove Godskesen

Background: Anorexia nervosa is a complex mental disorder that has severe physical and psychological consequences, often requiring hospitalisation, and in the most severe cases, patients receive coercive treatment. Among the various nursing tasks associated with encountering these patients, the administration of nasogastric tube feeding under restraint stands out. It is crucial to recognise and address the unique practical and ethical challenges nurses face when caring for adults struggling with severe anorexia nervosa. The aim of the study was to gain a deeper understanding of registered nurses' experience of nasogastric tube feeding under restraint in hospitalised patients with severe anorexia nervosa.

Methods: A naturalistic design guided this study. Narrative interview data were analysed using reflexive thematic analysis. The participants were twelve registered nurses recruited from an inpatient ward for adult patients with an eating disorder in a Norwegian psychiatric hospital.

Results: Three main themes were developed: providing good nursing care during coercive treatment; having ethical concerns about nasogastric tube feeding under restraint when the patient reaches a body mass index that is not immediately life-threatening; and having concerns about involving personnel from another ward in the nasogastric tube feeding under restraint procedure.

Conclusions: Nurses find nasogastric tube feeding under restraint to be part of life-saving nursing for patients with severe anorexia nervosa. It raises ethical concerns, especially with patients with a body mass index that is no longer life-threatening. Our results demonstrate the vulnerability of nurses as well as the difficulties and ethical dilemmas of nursing during nasogastric tube feeding under restraint.

背景:神经性厌食症是一种复杂的精神障碍,会对患者的生理和心理造成严重影响,通常需要住院治疗,在最严重的情况下,患者会接受强制治疗。在与这些患者相关的各种护理任务中,在约束下实施鼻胃管喂食的任务尤为突出。认识并解决护士在护理患有严重厌食症的成人时所面临的独特的实际和伦理挑战至关重要。本研究旨在深入了解注册护士在约束下对住院的重度神经性厌食症患者进行鼻胃管喂食的经验:本研究采用自然主义设计。采用反思性主题分析法对叙述性访谈数据进行分析。研究对象是从挪威一家精神病医院的成人饮食失调症住院病房招募的12名注册护士:结果:形成了三大主题:在强制治疗期间提供良好的护理;当患者的体重指数达到不会立即威胁生命的程度时,对在限制条件下进行鼻胃管喂食存在伦理顾虑;对让其他病房的人员参与限制条件下的鼻胃管喂食程序存在顾虑:护士们认为,在限制条件下进行鼻胃管喂食是严重厌食症患者救生护理的一部分。这引起了伦理方面的关注,尤其是对体重指数已不再危及生命的患者。我们的研究结果表明了护士的脆弱性,以及在束缚状态下进行鼻胃管喂食时的护理困难和伦理困境。
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引用次数: 0
Tensions between end-of-life care and organ donation in controlled donation after circulatory death: ICU healthcare professionals experiences. 循环死亡后控制性捐献中临终关怀与器官捐献之间的紧张关系:ICU医护人员的经验。
IF 3 1区 哲学 Q1 ETHICS Pub Date : 2024-10-09 DOI: 10.1186/s12910-024-01093-1
Matthieu Le Dorze, Romain Barthélémy, Olivier Lesieur, Gérard Audibert, Marie-Ange Azais, Dorothée Carpentier, Charles Cerf, Gaëlle Cheisson, Renaud Chouquer, Vincent Degos, Marion Fresco, Fabien Lambiotte, Emmanuelle Mercier, Jérôme Morel, Laurent Muller, Erika Parmentier-Decrucq, Sébastien Prin, Armine Rouhani, France Roussin, Jean-Christophe Venhard, Mathieu Willig, Catherine Vernay, Benjamin Chousterman, Nancy Kentish-Barnes

Background: The development of controlled donation after circulatory death (cDCD) is both important and challenging. The tension between end-of-life care and organ donation raises significant ethical issues for healthcare professionals in the intensive care unit (ICU). The aim of this prospective, multicenter, observational study is to better understand ICU physicians' and nurses' experiences with cDCD.

Methods: In 32 ICUs in France, ICU physicians and nurses were invited to complete a questionnaire after the death of end-of-life ICU patients identified as potential cDCD donors who had either experienced the withdrawal of life-sustaining therapies alone or with planned organ donation (OD(-) and OD( +) groups). The primary objective was to assess their anxiety (State Anxiety Inventory STAI Y-A) following the death of a potential cDCD donor. Secondary objectives were to explore potential tensions experienced between end-of-life care and organ donation.

Results: Two hundred six ICU healthcare professionals (79 physicians and 127 nurses) were included in the course of 79 potential cDCD donor situations. STAI Y-A did not differ between the OD(-) and OD( +) groups for either physicians or nurses (STAI Y-A were 34 (27-38) in OD(-) vs. 32 (27-40) in OD( +), p = 0.911, for physicians and 32 (25-37) in OD(-) vs. 39 (26-37) in OD( +), p = 0.875, for nurses). The possibility of organ donation was a factor influencing the WLST decision for nurses only, and a factor influencing the WLST implementation for both nurses and physicians. cDCD experience is perceived positively by ICU healthcare professionals overall.

Conclusions: cDCD does not increase anxiety in ICU healthcare professionals compared to other situations of WLST. WLST and cDCD procedures could further be improved by supporting professionals in making their intentions clear between end-of-life support and the success of organ donation, and when needed, by enhancing communication between ICU physician and nurses.

Trial registration: This research was registered in ClinicalTrials.gov (Identifier: NCT05041023, September 10, 2021).

背景:循环死亡后控制性捐献(cDCD)的发展既重要又具有挑战性。临终关怀与器官捐献之间的矛盾给重症监护室(ICU)的医护人员带来了重大的伦理问题。这项前瞻性、多中心、观察性研究旨在更好地了解重症监护室医生和护士在 cDCD 方面的经验:在法国的 32 个 ICU 中,ICU 的医生和护士受邀在被确定为潜在 cDCD 捐赠者的 ICU 临终患者死亡后填写一份调查问卷,这些患者要么经历了单独的生命维持疗法的撤消,要么经历了有计划的器官捐赠(OD(-) 组和 OD( +) 组)。首要目标是评估潜在 cDCD 捐赠者死亡后他们的焦虑程度(国家焦虑量表 STAI Y-A)。次要目标是探讨临终关怀与器官捐献之间可能存在的紧张关系:共有 26 名 ICU 医护人员(79 名医生和 127 名护士)参与了 79 例潜在 cDCD 捐献者的研究。医生和护士的STAI Y-A在OD(-)组和OD(+)组之间没有差异(医生的STAI Y-A在OD(-)组为34(27-38),在OD(+)组为32(27-40),P = 0.911;护士的STAI Y-A在OD(-)组为32(25-37),在OD(+)组为39(26-37),P = 0.875)。器官捐献的可能性仅是影响护士做出 WLST 决定的一个因素,也是影响护士和医生实施 WLST 的一个因素。ICU 医护人员总体上对 cDCD 体验持积极态度。WLST和cDCD程序可通过支持专业人员明确其在生命末期支持和器官捐献成功之间的意图,以及在必要时通过加强ICU医生和护士之间的沟通来进一步改善:本研究已在ClinicalTrials.gov注册(标识符:NCT05041023,2021年9月10日)。
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引用次数: 0
Ethical self-efficacy among healthcare professionals caring for people with dementia: a brief pre- and post-report on the CARE intervention. 护理痴呆症患者的医护人员的伦理自我效能感:CARE 干预前后的简要报告。
IF 3 1区 哲学 Q1 ETHICS Pub Date : 2024-10-09 DOI: 10.1186/s12910-024-01106-z
Frederik Schou-Juul, Lucca-Mathilde Thorup Ferm, Simon Kinch, Sofie Smedegaard Skov, Christian Ritz, Sigurd Lauridsen

Background: Interventions targeting healthcare professionals' confidence in managing ethical issues in dementia care are limited despite documented positive effects of educational programs on staff knowledge and self-efficacy. However, inconsistencies in the literature regarding the impact of educational programs underscore the need for targeted interventions. The CARE intervention, specifically designed to enhance confidence in ethical decision-making, aims to address this gap. This study evaluates the effectiveness of the CARE intervention in enhancing the ethical self-efficacy of healthcare professionals caring for people with dementia, particularly those with initially low levels of self-efficacy.

Methods: Using a non-experimental pre-post evaluation design, the CARE intervention was administered to healthcare professionals (n = 86), measuring ethical self-efficacy pre-and post-intervention. We hypothesized significant differences in ethical self-efficacy mean scores pre- and post-intervention for all participants, particularly those with low pre-measurement scores, whom we expected to benefit most from the intervention. Statistical analysis included paired t-tests and Wilcoxon tests for the low pre-measurement subgroup analysis.

Results: While no significant change was observed in the entire sample, participants with low initial self-efficacy showed a statistically significant improvement post-intervention.

Conclusions: The CARE intervention holds promise in improving ethical self-efficacy among healthcare professionals with initial low confidence levels. Targeted interventions are essential in addressing confidence gaps in managing ethical challenges in dementia care, with implications for professional well-being and quality of care. Further research should explore long-term effects and expand sample size to enhance generalizability and sustainability of findings.

背景:尽管有文献记载教育项目对员工的知识和自我效能有积极影响,但针对医护人员在处理痴呆症护理中的伦理问题时的信心的干预措施却很有限。然而,有关教育项目影响的文献并不一致,这凸显了有针对性干预的必要性。CARE 干预方案专门用于增强道德决策的信心,旨在弥补这一不足。本研究评估了 CARE 干预在提高医护人员护理痴呆症患者(尤其是最初自我效能水平较低者)的伦理自我效能方面的有效性:采用非实验性的前后评估设计,对医护专业人员(n = 86)实施 CARE 干预,测量干预前后的伦理自我效能。我们假设所有参与者在干预前和干预后的道德自我效能感平均得分存在显著差异,尤其是那些干预前得分较低的参与者,我们预计他们将从干预中获益最多。统计分析包括配对 t 检验和 Wilcoxon 检验,用于对测量前得分低的亚组进行分析:结果:虽然在整个样本中没有观察到明显的变化,但初始自我效能感低的参与者在干预后有了统计学意义上的明显改善:CARE干预有望提高最初自信水平较低的医护人员的道德自我效能感。有针对性的干预措施对于解决在应对痴呆症护理中的伦理挑战方面存在的信心差距至关重要,这将对专业人员的福祉和护理质量产生影响。进一步的研究应探讨长期效果并扩大样本量,以提高研究结果的普遍性和可持续性。
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引用次数: 0
Capacity to consent: a scoping review of youth decision-making capacity for gender-affirming care. 同意的能力:对青少年性别确认护理决策能力的范围审查。
IF 3 1区 哲学 Q1 ETHICS Pub Date : 2024-10-08 DOI: 10.1186/s12910-024-01107-y
Loren G Marino, Katherine E Boguszewski, Haley F Stephens, Julia F Taylor

Background: Transgender and gender expansive (TGE) youth often seek a variety of gender-affirming healthcare services, including pubertal suppression and hormone therapy requiring that TGE youth and their parents participate in informed consent and decision making. While youth must demonstrate the ability to understand and appreciate treatment options, risks, benefits, and alternatives as well as make and express a treatment choice, standardized approaches to assess the capacity of TGE youth to consent or assent in clinical practice are not routinely used. This scoping review identified the currently available data regarding adolescent capacity to consent to gender-affirming medical treatments.

Methods: Articles relevant to assessing adolescent capacity for clinical decision-making were identified using OVID Medline, Web of Science, and PubMed. Articles were reviewed and thematically analyzed.

Results: Eight relevant articles were identified using three tools for measuring adolescent clinical decision-making capacity: Measure of Understanding, Measure of Competence, and MacArthur Competence Assessment Tool (MacCAT). These studies explored hypothetical treatment decisions, mental health treatment decisions, HIV treatment decisions, genetic testing decisions, and gender-affirming medical decisions. Only one study specifically examines the capacity of TGE youth to consent to medical treatments. Age was correlated with capacity in most, but not all studies. Other studies found cognitive measures (IQ, literacy, numeracy) may impact important aspects of capacity (understanding and reasoning).

Conclusions: For clinicians caring for TGE youth, tools such as the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) may prove useful, in conjunction with consideration of youth developmental abilities and utilization of shared decision-making practices. A standardized, collaborative approach to assessing TGE youth capacity would benefit TGE youth and their parents, and allow clinicians to more easily resolve ethical concerns.

背景:变性和性别扩张(TGE)青少年经常寻求各种性别确认医疗服务,包括青春期抑制和激素治疗,这要求 TGE 青少年及其父母参与知情同意和决策。虽然青少年必须证明自己有能力理解和认识治疗方案、风险、益处和替代方案,并做出和表达治疗选择,但在临床实践中并没有常规使用标准化方法来评估 TGE 青少年的同意能力。本范围界定综述确定了有关青少年同意接受性别确认医疗的能力的现有数据:使用 OVID Medline、Web of Science 和 PubMed 查找了与评估青少年临床决策能力相关的文章。对文章进行了审阅和专题分析:结果:使用三种衡量青少年临床决策能力的工具,确定了八篇相关文章:这些研究探讨了假定的治疗方案和治疗方法。这些研究探讨了假设性治疗决策、心理健康治疗决策、艾滋病治疗决策、基因检测决策和性别确认医疗决策。只有一项研究专门探讨了 TGE 青少年同意医疗的能力。在大多数研究中,年龄与能力相关,但并非所有研究都是如此。其他研究发现,认知能力(智商、读写能力、计算能力)可能会影响能力的重要方面(理解和推理):对于照顾 TGE 青少年的临床医生来说,麦克阿瑟治疗能力评估工具(MacCAT-T)等工具可能会被证明是有用的,同时还要考虑到青少年的发展能力,并采用共同决策的做法。采用标准化的合作方法来评估 TGE 青少年的能力将使 TGE 青少年及其家长受益,并使临床医生更容易解决伦理问题。
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引用次数: 0
Clinicians' roles and necessary levels of understanding in the use of artificial intelligence: A qualitative interview study with German medical students. 临床医生在人工智能应用中的角色和必要的理解水平:对德国医科学生的定性访谈研究。
IF 3 1区 哲学 Q1 ETHICS Pub Date : 2024-10-07 DOI: 10.1186/s12910-024-01109-w
F Funer, S Tinnemeyer, W Liedtke, S Salloch
<p><strong>Background: </strong>Artificial intelligence-driven Clinical Decision Support Systems (AI-CDSS) are being increasingly introduced into various domains of health care for diagnostic, prognostic, therapeutic and other purposes. A significant part of the discourse on ethically appropriate conditions relate to the levels of understanding and explicability needed for ensuring responsible clinical decision-making when using AI-CDSS. Empirical evidence on stakeholders' viewpoints on these issues is scarce so far. The present study complements the empirical-ethical body of research by, on the one hand, investigating the requirements for understanding and explicability in depth with regard to the rationale behind them. On the other hand, it surveys medical students at the end of their studies as stakeholders, of whom little data is available so far, but for whom AI-CDSS will be an important part of their medical practice.</p><p><strong>Methods: </strong>Fifteen semi-structured qualitative interviews (each lasting an average of 56 min) were conducted with German medical students to investigate their perspectives and attitudes on the use of AI-CDSS. The problem-centred interviews draw on two hypothetical case vignettes of AI-CDSS employed in nephrology and surgery. Interviewees' perceptions and convictions of their own clinical role and responsibilities in dealing with AI-CDSS were elicited as well as viewpoints on explicability as well as the necessary level of understanding and competencies needed on the clinicians' side. The qualitative data were analysed according to key principles of qualitative content analysis (Kuckartz).</p><p><strong>Results: </strong>In response to the central question about the necessary understanding of AI-CDSS tools and the emergence of their outputs as well as the reasons for the requirements placed on them, two types of argumentation could be differentiated inductively from the interviewees' statements: the first type, the clinician as a systemic trustee (or "the one relying"), highlights that there needs to be empirical evidence and adequate approval processes that guarantee minimised harm and a clinical benefit from the employment of an AI-CDSS. Based on proof of these requirements, the use of an AI-CDSS would be appropriate, as according to "the one relying", clinicians should choose those measures that statistically cause the least harm. The second type, the clinician as an individual expert (or "the one controlling"), sets higher prerequisites that go beyond ensuring empirical evidence and adequate approval processes. These higher prerequisites relate to the clinician's necessary level of competence and understanding of how a specific AI-CDSS works and how to use it properly in order to evaluate its outputs and to mitigate potential risks for the individual patient. Both types are unified in their high esteem of evidence-based clinical practice and the need to communicate with the patient on the use of medical
背景:人工智能驱动的临床决策支持系统(AI-CDSS)正被越来越多地引入医疗保健的各个领域,用于诊断、预后、治疗和其他目的。关于伦理适宜性条件的讨论,很大一部分涉及使用 AI-CDSS 时确保负责任的临床决策所需的理解程度和可解释性。迄今为止,有关利益相关者对这些问题看法的经验证据还很少。本研究一方面通过深入调查对理解和可解释性的要求及其背后的理论依据,对实证伦理研究进行了补充。另一方面,本研究还对即将毕业的医学生进行了调查,他们是研究的利益相关者,迄今为止,关于他们的数据很少,但对他们来说,AI-CDSS 将是其医疗实践的重要组成部分:对德国医科学生进行了 15 次半结构式定性访谈(每次平均 56 分钟),调查他们对使用 AI-CDSS 的看法和态度。以问题为中心的访谈以肾脏内科和外科使用人工智能数据采集系统的两个假设案例为基础。访谈内容包括受访者对自己在处理人工智能数据采集与分析系统时的临床角色和责任的看法和信念,以及对可解释性的观点和临床医生所需的理解和能力水平。根据定性内容分析的主要原则(Kuckartz)对定性数据进行了分析:在回答关于对人工智能 CDSS 工具的必要了解、其产出的出现以及对其提出要求的原因这一核心问题时,可以从受访者的陈述中归纳出两类论点:第一类是临床医生作为系统受托人(或 "依赖者"),强调需要有实证证据和适当的审批程序,以保证人工智能 CDSS 的使用能将危害降至最低并带来临床效益。根据 "依赖者 "的观点,临床医生应该选择那些从统计学角度来看伤害最小的措施。第二种类型是临床医生作为个人专家(或称 "控制者"),他们设定了更高的先决条件,这些先决条件超出了确保经验证据和适当审批程序的范围。这些更高的先决条件涉及临床医生的必要能力水平,以及对特定 AI-CDSS 如何工作和如何正确使用它的理解,以便评估其输出结果并降低对患者个人的潜在风险。这两类受访者都非常推崇循证临床实践,并认为有必要就医疗人工智能的使用与患者进行沟通。然而,受访者对临床医生角色和责任的不同理解,导致他们对临床医生对人工智能-CDSS的理解和可解释性有着不同的要求,而不仅仅是证明其益处:研究结果凸显了(未来)临床医生对必要的理解和能力水平的两种不同看法。这些研究结果应为有关适当的培训计划和专业标准(如临床实践指南)的讨论提供信息,以便在不同的临床领域安全有效地使用人工智能数据采集系统。虽然目前的方法是寻找适当的必要理解和能力的最低要求,但本文所描述的(未来)临床医生在信息和理解需求方面的差异可以导致更有区别的解决方案。
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引用次数: 0
Practices and attitudes of herbalists regarding informed consent in Uganda: a qualitative study. 乌干达草药医生对知情同意的做法和态度:一项定性研究。
IF 3 1区 哲学 Q1 ETHICS Pub Date : 2024-10-04 DOI: 10.1186/s12910-024-01104-1
Sumayiya Nalubega, Paul Kutyabami, Adelline Twimukye, David Kaawa-Mafigiri, Nelson K Sewankambo

Background: Informed consent (IC) is a fundamental principle in medical ethics that upholds respect for patient autonomy. Although widely applied in healthcare, its feasibility and implementation in herbal medicine have been underexplored. This study therefore aimed to explore the practices and attitudes of herbalists regarding informed consent.

Methods: To achieve these objectives, a qualitative cross-sectional study was conducted from June to December 2020. Twenty-one in-depth interviews with herbalists and four key informant interviews with leaders of the different traditional medicine organizations were conducted. The data were analyzed thematically using NVivo version 12 software.

Results: Sixteen of the twenty-one participants acquired oral herbal medicine knowledge from their relatives. Although a positive inclination toward obtaining IC was evident, the focus was on disclosing basic information. Discussions of alternative treatments and herbal specifics were less frequent. Disease management decisions often involve shared responsibility within families or societies. Documented IC procedures are rare among herbalists, who deem consent forms unnecessary, although they recognize the potential benefits of IC in fostering trust and professionalism. Challenges hindering IC implementation included regulatory gaps, inadequate skills, and the absence of mechanisms to protect the intellectual property rights of herbal medicine.

Conclusion: This study illuminates how educational, cultural, familial, and regulatory factors influence herbalists' practices and attitudes toward informed consent.

背景:知情同意(IC)是医学伦理的一项基本原则,它坚持尊重患者的自主权。虽然知情同意被广泛应用于医疗保健领域,但其在中草药领域的可行性和实施情况尚未得到充分探索。因此,本研究旨在探讨草药医生在知情同意方面的做法和态度:为实现上述目标,我们在 2020 年 6 月至 12 月期间开展了一项横断面定性研究。对草药医生进行了 21 次深入访谈,对不同传统医药组织的领导人进行了 4 次关键信息提供者访谈。研究使用 NVivo 第 12 版软件对数据进行了专题分析:结果:21 名参与者中有 16 人从亲戚那里获得了口服草药知识。虽然获取集成电路的积极倾向是显而易见的,但重点是披露基本信息。关于替代疗法和草药具体内容的讨论并不频繁。疾病管理决策往往涉及家庭或社会的共同责任。草药医生中很少有记录在案的 IC 程序,他们认为没有必要填写同意书,尽管他们认识到 IC 在促进信任和专业性方面的潜在益处。阻碍实施整合疗法的挑战包括监管空白、技能不足以及缺乏保护草药知识产权的机制:本研究揭示了教育、文化、家庭和监管因素如何影响草药医生对知情同意的实践和态度。
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引用次数: 0
Speculation fit for a king? Medical announcements from the British royal family and the recurring ethical complexities of personal privacy and public commentary from physicians. 适合国王的猜测?英国王室的医疗公告以及医生在个人隐私和公开评论方面反复出现的复杂伦理问题。
IF 3 1区 哲学 Q1 ETHICS Pub Date : 2024-10-04 DOI: 10.1186/s12910-024-01105-0
Alexander Smith, Dinesh Bhugra, Antonio Ventriglio, Michael Liebrenz

This article explores the ethical complexities of openly-expressed medical commentary using recent cancer diagnoses within the British monarchy as illustrative cases. Specifically, it examines tensions between public interest, personal privacy, and professional standards, underlining the adverse implications of conjectural discourse, alongside the role of physicians in enhancing wider medical understanding.

本文以英国王室最近的癌症诊断为例,探讨了公开发表医学评论在伦理方面的复杂性。具体而言,文章探讨了公众利益、个人隐私和专业标准之间的紧张关系,强调了猜测性言论的负面影响,以及医生在增进更广泛医学理解方面的作用。
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引用次数: 0
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BMC Medical Ethics
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