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The regulation of health data sharing in Africa: a comparative study. 非洲健康数据共享监管:比较研究。
IF 3.4 2区 哲学 Q1 ETHICS Pub Date : 2024-01-18 eCollection Date: 2024-01-01 DOI: 10.1093/jlb/lsad035
Annelize G Nienaber McKay, Dirk Brand, Marietjie Botes, Nezerith Cengiz, Marno Swart

The sharing of health data is an essential component in the provision of healthcare, in medical research, and disease surveillance. Health data sharing is subject to regulatory frameworks that vary across jurisdictions. In Africa, numerous factors complicate the regulation of health data sharing, including technological, motivational, economic, and political barriers, as well as ethical and legal challenges. This comparative study examines the regulation of health data sharing in Africa by comparing and contrasting the legal and policy frameworks of five African countries. The study identifies gaps and inconsistencies in the current regulatory regimes and provides recommendations for improving the regulation of health data sharing in Africa.

共享健康数据是提供医疗保健、医学研究和疾病监测的重要组成部分。健康数据共享受制于各辖区不同的监管框架。在非洲,众多因素使健康数据共享的监管变得复杂,包括技术、动机、经济和政治障碍,以及伦理和法律挑战。本比较研究通过对五个非洲国家的法律和政策框架进行比较和对比,探讨了非洲健康数据共享的监管问题。研究指出了当前监管制度中的差距和不一致之处,并为改善非洲健康数据共享的监管提出了建议。
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引用次数: 0
Defusing the legal and ethical minefield of epigenetic applications in the military, defense, and security context. 化解军事、国防和安全领域应用表观遗传学的法律和伦理雷区。
IF 3.4 2区 哲学 Q1 ETHICS Pub Date : 2023-12-13 eCollection Date: 2023-07-01 DOI: 10.1093/jlb/lsad034
Gratien Dalpé, Katherine Huerne, Charles Dupras, Katherine Cheung, Nicole Palmour, Eva Winkler, Karla Alex, Maxwell Mehlman, John W Holloway, Eline Bunnik, Harald König, Isabelle M Mansuy, Marianne G Rots, Cheryl Erwin, Alexandre Erler, Emanuele Libertini, Yann Joly

Epigenetic research has brought several important technological achievements, including identifying epigenetic clocks and signatures, and developing epigenetic editing. The potential military applications of such technologies we discuss are stratifying soldiers' health, exposure to trauma using epigenetic testing, information about biological clocks, confirming child soldiers' minor status using epigenetic clocks, and inducing epigenetic modifications in soldiers. These uses could become a reality. This article presents a comprehensive literature review, and analysis by interdisciplinary experts of the scientific, legal, ethical, and societal issues surrounding epigenetics and the military. Notwithstanding the potential benefit from these applications, our findings indicate that the current lack of scientific validation for epigenetic technologies suggests a careful scientific review and the establishment of a robust governance framework before consideration for use in the military. In this article, we highlight general concerns about the application of epigenetic technologies in the military context, especially discrimination and data privacy issues if soldiers are used as research subjects. We also highlight the potential of epigenetic clocks to support child soldiers' rights and ethical questions about using epigenetic engineering for soldiers' enhancement and conclude with considerations for an ethical framework for epigenetic applications in the military, defense, and security contexts.

表观遗传学研究带来了多项重要的技术成果,包括确定表观遗传时钟和特征以及开发表观遗传编辑技术。我们讨论的这些技术的潜在军事应用包括:利用表观遗传检测对士兵的健康状况进行分层、暴露于创伤、生物钟信息、利用表观遗传钟确认儿童兵的未成年状况,以及诱导士兵进行表观遗传修饰。这些用途都有可能成为现实。本文介绍了全面的文献综述,以及跨学科专家对围绕表观遗传学和军事的科学、法律、伦理和社会问题的分析。尽管这些应用可能带来益处,但我们的研究结果表明,目前的表观遗传学技术缺乏科学验证,因此在考虑用于军事之前,需要进行仔细的科学审查并建立健全的管理框架。在这篇文章中,我们强调了在军事领域应用表观遗传学技术的普遍担忧,特别是如果士兵被用作研究对象,会产生歧视和数据隐私问题。我们还强调了表观遗传学时钟在支持儿童兵权利方面的潜力,以及利用表观遗传工程提高士兵素质的伦理问题,最后提出了在军事、国防和安全领域应用表观遗传学的伦理框架。
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引用次数: 0
The AI cycle of health inequity and digital ageism: mitigating biases through the EU regulatory framework on medical devices 健康不公平和数字时代歧视的人工智能循环:通过欧盟医疗设备监管框架减少偏见
IF 3.4 2区 哲学 Q1 ETHICS Pub Date : 2023-12-07 DOI: 10.1093/jlb/lsad031
Hannah van Kolfschooten
Abstract The use of Artificial Intelligence (AI) medical devices is rapidly growing. Although AI may benefit the quality and safety of healthcare for older adults, it simultaneously introduces new ethical and legal issues. Many AI medical devices exhibit age-related biases. The first part of this paper explains how ‘digital ageism’ is produced throughout the entire lifecycle of medical AI and may lead to health inequity for older people: systemic, avoidable differences in the health status of different population groups. This paper takes digital ageism as a use case to show the potential inequitable effects of AI, conceptualized as the ‘AI cycle of health inequity’. The second part of this paper explores how the European Union (EU) regulatory framework addresses the issue of digital ageism. It argues that the negative effects of age-related bias in AI medical devices are insufficiently recognized within the regulatory framework of the EU Medical Devices Regulation and the new AI Act. It concludes that while the EU framework does address some of the key issues related to technical biases in AI medical devices by stipulating rules for performance and data quality, it does not account for contextual biases, therefore neglecting part of the AI cycle of health inequity.
人工智能(AI)医疗设备的使用正在迅速增长。虽然人工智能可能有利于老年人医疗保健的质量和安全,但它同时引入了新的伦理和法律问题。许多人工智能医疗设备表现出与年龄相关的偏见。本文的第一部分解释了“数字年龄歧视”是如何在医疗人工智能的整个生命周期中产生的,并可能导致老年人的健康不平等:不同人群健康状况的系统性、可避免的差异。本文以数字年龄歧视为用例,展示了人工智能的潜在不公平影响,概念为“人工智能健康不平等周期”。本文的第二部分探讨了欧盟(EU)监管框架如何解决数字年龄歧视问题。它认为,在《欧盟医疗器械条例》和新的《人工智能法案》的监管框架内,人工智能医疗器械中与年龄相关的偏见的负面影响没有得到充分认识。它的结论是,虽然欧盟框架确实通过规定性能和数据质量规则解决了与人工智能医疗设备中的技术偏差相关的一些关键问题,但它没有考虑到情境偏差,因此忽略了人工智能健康不平等周期的一部分。
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引用次数: 0
Cryopreservation and current legal problems: seeking and selling immortality. 低温保存和当前的法律问题:寻求和出售不朽。
IF 3.4 2区 哲学 Q1 ETHICS Pub Date : 2023-11-09 eCollection Date: 2023-07-01 DOI: 10.1093/jlb/lsad028
Alexandra Mullock, Elizabeth Chloe Romanis

Cryonics, the 'freezing' of the human body after death in the hope of reanimation in the future, remains a remote possibility, and yet it is becoming a more popular choice. There has been much academic discussion of the ethics of cryopreservation; however, the legal problems have received little attention. There are, however, several potential current conflicts that might arise, as was illustrated by the case of JS in England, in which a 14-year-old girl who sought cryopreservation against her father's wishes. In the USA, there have been disputes within families about cryonic preservation, and between cryonics organizations and loved ones of the deceased when there is negligent preservation. Cryopreservation raises questions concerning the law on death and posthumous interests, property in the body, contract law, and (potentially) negligence. We argue that, in the absence of proper regulation, cryonics organizations may be able to exploit the dying and dead. The potential legal problems that we have identified in relation to the law in England and Wales demonstrate that the law is ill-equipped to protect the interests of the dead and their next of kin.

人体冷冻技术,即在人死后将人体“冷冻”起来,以期在未来复活的技术,仍然是一种遥远的可能性,但它正成为一种越来越受欢迎的选择。关于冷冻保存的伦理问题,学术界有很多讨论;然而,法律问题却很少受到关注。然而,目前可能会出现一些潜在的冲突,正如英国JS的案例所说明的那样,一名14岁的女孩违背父亲的意愿寻求冷冻保存。在美国,家庭内部对人体冷冻保存存在争议,当存在疏忽保存时,人体冷冻组织与死者家属之间也存在争议。低温保存提出了有关死亡和死后利益、身体财产、合同法和(潜在的)疏忽的法律问题。我们认为,在缺乏适当监管的情况下,人体冷冻组织可能会利用濒死者和死者。我们在英格兰和威尔士发现的与法律相关的潜在法律问题表明,法律在保护死者及其近亲的利益方面能力不足。
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引用次数: 0
'The law is very, very outdated and not keeping up with the technology': novel forms of assisted gestation, legal challenges, and perspectives of reproductive rights advocates in England and Wales. “这项法律非常、非常过时,跟不上技术”:新型的辅助妊娠、法律挑战以及英格兰和威尔士生殖权利倡导者的观点。
IF 3.4 2区 哲学 Q1 ETHICS Pub Date : 2023-11-01 eCollection Date: 2023-07-01 DOI: 10.1093/jlb/lsad027
Elizabeth Chloe Romanis

A growing body of literature examines the ethico-legal challenges resulting from novel forms of assisted gestation like uterus transplantation and artificial placentas (also known as 'artificial wombs'). However, there has not yet been consideration of reproductive rights organizations/advocates' understandings of novel forms of assisted gestation and their challenges. These perspectives provide critical insight into how novel procreative practices are understood and the problems and pressures that might arise from their use. This is the first legal article to engage with reproductive rights organizations/advocates and thus it provides important contextual grounding to existing scholarship about assisted gestation. Focus group discussion epitomized the need for legal reform in key areas surrounding reproduction. Themes were constructed that exemplify what participants highlighted as critical: the need to re-evaluate the fundamentals of legal parenthood, consideration of how novel technologies could further enable the policing of gestation, and the space and time needed for law-making.

越来越多的文献研究了子宫移植和人造胎盘(也称为“人造子宫”)等新型辅助妊娠形式所带来的伦理法律挑战。然而,尚未考虑生殖权利组织/倡导者对新型辅助妊娠及其挑战的理解。这些观点提供了对如何理解新的生育实践以及使用这些实践可能产生的问题和压力的批判性见解。这是第一篇与生殖权利组织/倡导者接触的法律文章,因此它为现有的辅助妊娠学术提供了重要的背景基础。焦点小组讨论集中体现了围绕生殖的关键领域进行法律改革的必要性。构建的主题体现了与会者强调的关键内容:需要重新评估合法父母的基本原则,考虑新技术如何进一步促进妊娠监管,以及立法所需的空间和时间。
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引用次数: 0
Neuroethics guidance documents: principles, analysis, and implementation strategies. 神经伦理学指导文件:原则、分析和实施策略。
IF 3.4 2区 哲学 Q1 ETHICS Pub Date : 2023-10-26 eCollection Date: 2023-07-01 DOI: 10.1093/jlb/lsad025
Matthew R O'Shaughnessy, Walter G Johnson, Lucille Nalbach Tournas, Christopher J Rozell, Karen S Rommelfanger

Innovations in neurotechnologies have ignited conversations about ethics around the world, with implications for researchers, policymakers, and the private sector. The human rights impacts of neurotechnologies have drawn the attention of United Nations bodies; nearly 40 states are tasked with implementing the Organization for Economic Co-operation and Development's principles for responsible innovation in neurotechnology; and the United States is considering placing export controls on brain-computer interfaces. Against this backdrop, we offer the first review and analysis of neuroethics guidance documents recently issued by prominent government, private, and academic groups, focusing on commonalities and divergences in articulated goals; envisioned roles and responsibilities of different stakeholder groups; and the suggested role of the public. Drawing on lessons from the governance of other emerging technologies, we suggest implementation and evaluation strategies to guide practitioners and policymakers in operationalizing these ethical norms in research, business, and policy settings.

神经技术的创新引发了世界各地关于伦理的讨论,对研究人员、政策制定者和私营部门都有影响。神经技术对人权的影响引起了联合国各机构的注意;近40个州的任务是执行经济合作与发展组织关于负责任的神经技术创新的原则;美国正在考虑对脑机接口实施出口管制。在此背景下,我们首次回顾和分析了著名政府、私人和学术团体最近发布的神经伦理学指导文件,重点关注明确目标的共性和差异;设想不同利益攸关方群体的作用和责任;以及建议公众发挥的作用。借鉴其他新兴技术治理的经验教训,我们提出了实施和评估战略,以指导从业者和决策者在研究、商业和政策环境中实施这些道德规范。
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引用次数: 0
Implementing the human right to science in the regulatory governance of artificial intelligence in healthcare. 在医疗保健人工智能监管治理中落实科学人权。
IF 3.4 2区 哲学 Q1 ETHICS Pub Date : 2023-10-14 eCollection Date: 2023-07-01 DOI: 10.1093/jlb/lsad026
Calvin W L Ho

Artificial intelligence (AI) enables a medical device to optimize its performance through machine learning (ML), including the ability to learn from past experiences. In healthcare, ML is currently applied within controlled settings in devices to diagnose conditions like diabetic retinopathy without clinician input, for instance. In order to allow AI-based medical devices (AIMDs) to adapt actively to its data environment through ML, the current risk-based regulatory approaches are inadequate in facilitating this technological progression. Recent and innovative regulatory changes introduced to regulate AIMDs as a software, or 'software as a medical device' (SaMD), and the adoption of a total device/product-specific lifecycle approach (rather than one that is point-in-time) reflect a shift away from the strictly risk-based approach to one that is more collaborative and participatory in nature, and anticipatory in character. These features are better explained by a rights-based approach and consistent with the human right to science (HRS). With reference to the recent explication of the normative content of HRS by the Committee on Economic, Social and Cultural Rights of the United Nations, this paper explains why a rights-based approach that is centred on HRS could be a more effective response to the regulatory challenges posed by AIMDs. The paper also considers how such a rights-based approach could be implemented in the form of a regulatory network that draws on a 'common fund of knowledges' to formulate anticipatory responses to adaptive AIMDs. In essence, the HRS provides both the mandate and the obligation for states to ensure that regulatory governance of high connectivity AIMDs become increasingly collaborative and participatory in approach and pluralistic in substance.

人工智能(AI)使医疗设备能够通过机器学习(ML)优化其性能,包括从过去的经验中学习的能力。例如,在医疗保健领域,ML目前在无需临床医生输入的情况下,在可控环境下应用于诊断糖尿病视网膜病变等疾病的设备中。为了让基于人工智能的医疗设备(AIMD)能够通过ML积极适应其数据环境,目前基于风险的监管方法不足以促进这一技术进步。最近为将AIMD作为一种软件或“软件作为一种医疗器械”(SaMD)进行监管而引入的创新性监管变化,以及对特定设备/产品的全生命周期方法(而不是时间点方法)的采用,反映出从严格基于风险的方法向更具协作性和参与性、前瞻性的方法的转变。这些特征可以通过基于权利的方法得到更好的解释,并与科学人权相一致。关于联合国经济、社会和文化权利委员会最近对人权标准规范内容的解释,本文解释了为什么以人权标准为中心的基于权利的方法可以更有效地应对AIMD带来的监管挑战。该文件还考虑了如何以监管网络的形式实施这种基于权利的方法,该网络利用“共同知识基金”来制定对适应性AIMD的预期反应。从本质上讲,HRS为各国提供了授权和义务,以确保高连通性AIMD的监管治理在方法上越来越具有协作性和参与性,在实质上也越来越多元化。
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引用次数: 0
Doctors’ duty to provide abortion information 医生提供堕胎信息的义务
IF 3.4 2区 哲学 Q1 ETHICS Pub Date : 2023-09-01 DOI: 10.2139/ssrn.4430194
M. Oberman, Lisa Soleymani Lehmann
Abstract With abortion remaining legal in over half of the country and a proliferation of websites offering information on how to access abortion medications, for those who know where to look, there are sound options for safely ending an unwanted early-stage pregnancy. But not all patients have equal access to reliable information. This Article addresses the urgent downstream harms caused by the lack of access to abortion information, and argues that in view of these consequences, regardless of abortion’s legal status, clinicians have a duty to provide their patients with abortion information. We begin by documenting clinicians’ hesitation to share abortion information, drawing on our interviews with 25 doctors practicing medicine in a state where abortion is criminalized. Next, we explain why clinicians are duty-bound to provide all-options counseling. We then consider whether such duties shift where abortion is criminalized. After identifying the limited legal risks associated with supplying abortion information, and showing how, by requiring all-options counseling, professional societies might reduce risks to patients and clinicians, we conclude that, regardless of the legal status of abortion, clinicians have a professional responsibility to share basic abortion information – including treatment options and how to access those options.
摘要随着堕胎在全国一半以上的地区仍然是合法的,以及提供如何获得堕胎药物信息的网站的激增,对于那些知道去哪里寻找的人来说,安全结束意外的早期妊娠有着合理的选择。但并非所有患者都能平等地获得可靠的信息。这篇文章论述了缺乏堕胎信息所造成的紧急下游危害,并认为鉴于这些后果,无论堕胎的法律地位如何,临床医生都有义务向患者提供堕胎信息。我们首先记录了临床医生在分享堕胎信息时的犹豫,我们采访了25名在堕胎被定罪的州行医的医生。接下来,我们解释为什么临床医生有义务提供各种选择的咨询。然后,我们考虑在堕胎被定为犯罪的情况下,这些职责是否会发生变化。在确定了与提供堕胎信息相关的有限法律风险,并展示了专业协会如何通过要求所有选项咨询来降低患者和临床医生的风险后,我们得出结论,无论堕胎的法律地位如何,临床医生有专业责任分享基本的堕胎信息,包括治疗选择和如何获得这些选择。
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引用次数: 0
Genetic data are not always personal-disaggregating the identifiability and sensitivity of genetic data. 遗传数据并不总是个人的——分解了遗传数据的可识别性和敏感性。
IF 3.4 2区 哲学 Q1 ETHICS Pub Date : 2023-07-24 eCollection Date: 2023-07-01 DOI: 10.1093/jlb/lsad029
Johanna Rahnasto

In both the EU and USA, genetic data are recognized as a special category of data that requires heightened privacy protection. Identifiability and sensitivity are central pillars of the regulatory framework in both jurisdictions: the privacy concerns stem from the assumption that genetic data are capable of identifying the individual and reveals sensitive information about them. But not all genetic data are identifiable and sensitive, nor are genetic data necessarily different from other types of big data in terms of these issues. This article argues that a more nuanced approach is needed to assess the threat to privacy interests posed by uses of genetic data. The privacy interests involved should be distinguished in terms of proposed use, the amount of data in question, and its uniqueness and informational content. When these factors are disaggregated, it is clear that both regulatory schemes could better achieve their goals by focusing more on the ways genetic data can be used rather than on their status as a special category of data.

在欧盟和美国,基因数据被认为是一种特殊类型的数据,需要加强隐私保护。可识别性和敏感性是这两个司法管辖区监管框架的核心支柱:隐私问题源于基因数据能够识别个人并揭示有关个人的敏感信息的假设。但并非所有的基因数据都是可识别和敏感的,基因数据在这些问题上也不一定与其他类型的大数据不同。本文认为,需要一种更细致入微的方法来评估基因数据使用对隐私利益构成的威胁。所涉及的隐私利益应根据拟议的用途、所涉数据的数量、其独特性和信息内容加以区分。当这些因素被分解后,很明显,通过更多地关注基因数据的使用方式,而不是关注它们作为一种特殊数据类别的地位,这两种监管方案都可以更好地实现它们的目标。
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引用次数: 0
Open science in play and in tension with patent protections. 开放科学正在发挥作用,与专利保护关系紧张。
IF 3.4 2区 哲学 Q1 ETHICS Pub Date : 2023-07-19 eCollection Date: 2023-07-01 DOI: 10.1093/jlb/lsad016
Anna Nuechterlein, Ari Rotenberg, Jeff LeDue, Paul Pavlidis, Judy Illes

The open science (OS) movement has garnered increasing support in academia alongside continued financial and reputational incentives to obtain intellectual property (IP) protections over research outputs. Here, we explore stakeholder perspectives about intersections between OS and IP to inform the development of institutional OS guidelines for the neurosciences in Canada. We held six focus groups and three interviews with 29 faculty members from a major research and clinical center in Canada. The semi-structured interview guide probed perspectives on the respective roles of patents and OS in neuroscience-related research. We applied thematic content analysis to the transcript data, and extracted 12 major themes and 30 subthemes. Participants perceived a conflict between OS ideologies and the inherently restrictive nature of patents, and highlighted the importance of autonomy, justice, and respectful, culturally safe research practices in any future adoption of OS. Overall, the data suggest that a hybrid OS-IP policy model supported by local expertise may be best suited to meet the priorities and values of the community while mitigating perceived threats. This model includes expanded education about patenting, incentivized data sharing and collaboration, and tangible resources to support implementation of OS that includes skilled support in digital research infrastructures.

开放科学(OS)运动在学术界获得了越来越多的支持,同时持续的财政和声誉激励措施,以获得对研究成果的知识产权保护。在这里,我们探讨了利益相关者对OS和IP交叉点的看法,为加拿大神经科学机构OS指南的制定提供信息。我们举办了六个焦点小组,并对来自加拿大一个主要研究和临床中心的29名教员进行了三次采访。半结构化访谈指南探讨了专利和OS在神经科学相关研究中各自作用的观点。我们将主题内容分析应用于成绩单数据,提取了12个主要主题和30个子主题。与会者认为OS意识形态与专利固有的限制性之间存在冲突,并强调了自主性、公正性以及在未来采用OS时尊重、文化安全的研究实践的重要性。总体而言,数据表明,由当地专业知识支持的混合OS-IP政策模型可能最适合满足社区的优先事项和价值观,同时减轻感知到的威胁。该模式包括扩大专利教育,激励数据共享和协作,以及支持操作系统实施的有形资源,包括数字研究基础设施中的技术支持。
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引用次数: 0
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