PDMP causes more than just testimonial injustice
Introduction In the article ‘Testimonial injustice in medical machine learning’, Pozzi argues that the prescription drug monitoring programme (PDMP) leads to testimonial injustice as physicians are more inclined to trust the PDMP’s risk scores over the patient’s own account of their medication history.1 Pozzi further develops this argument by discussing how credibility shifts from patients to machine learning (ML) systems that are supposedly neutral. As a result, a sense of distrust is now formed between patients and physicians. While there are merits to Pozzi’s main argument of epistemic inju...
Source: Journal of Medical Ethics - July 24, 2023 Category: Medical Ethics Authors: Nguyen, T. Tags: Commentary Source Type: research
Epistemic virtues of harnessing rigorous machine learning systems in ethically sensitive domains
Some physicians, in their care of patients at risk of misusing opioids, use machine learning (ML)-based prediction drug monitoring programmes (PDMPs) to guide their decision making in the prescription of opioids. This can cause a conflict: a PDMP Score can indicate a patient is at a high risk of opioid abuse while a patient expressly reports oppositely. The prescriber is then left to balance the credibility and trust of the patient with the PDMP Score. Pozzi1 argues that a prescriber who downgrades the credibility of a patient’s testimony based on a low PDMP Score is epistemically and morally unjustified and contribu...
Source: Journal of Medical Ethics - July 24, 2023 Category: Medical Ethics Authors: Burns, T. F. Tags: Commentary Source Type: research
Ubuntu as a complementary perspective for addressing epistemic (in)justice in medical machine learning
Pozzi1 has thoroughly analysed testimonial injustices in the automated Prediction Drug Monitoring Programmes (PDMPs) case. Although Pozzi1 suggests that ‘the shift from an interpersonal to a structural dimension ... bears a significant moral component’, her topical investigation does not further conceptualise the type of collective knowledge practices necessary to achieve epistemic justice. As Pozzi1 concludes: ‘this paper shows the limitations of systems such as automated PDMPs, it does not provide possible solutions’. In this commentary, we propose that an Ubuntu perspective—which, so far, h...
Source: Journal of Medical Ethics - July 24, 2023 Category: Medical Ethics Authors: Ferlito, B., De Proost, M. Tags: Commentary Source Type: research
'Can I trust my patient? Machine Learning support for predicting patient behaviour
Giorgia Pozzi’s feature article1 on the risks of testimonial injustice when using automated prediction drug monitoring programmes (PDMPs) turns the spotlight on a pressing and well-known clinical problem: physicians’ challenges to predict patient behaviour, so that treatment decisions can be made based on this information, despite any fallibility. Currently, as one possible way to improve prognostic assessments of patient behaviour, Machine Learning-driven clinical decision support systems (ML-CDSS) are being developed and deployed. To make her point, Pozzi discusses ML-CDSSs that are supposed to deliver physic...
Source: Journal of Medical Ethics - July 24, 2023 Category: Medical Ethics Authors: Funer, F., Salloch, S. Tags: Commentary Source Type: research
Testimonial injustice in medical machine learning: a perspective from psychiatry
Pozzi provides a thought-provoking account of how machine-learning clinical prediction models (such as Prediction Drug Monitoring Programmes (PDMPs)) may exacerbate testimonial injustice.1 In this response, I generalise Pozzi’s concerns about PDMPs to traditional models of clinical practice and question the claim that inaccurate clinicians are necessarily preferential to inaccurate machine-learning models. I then explore Pozzi’s concern that such models may deprive patients of a right to ‘convey information’. I suggest that machine-learning tools may be used to enhance, rather than frustrate, this r...
Source: Journal of Medical Ethics - July 24, 2023 Category: Medical Ethics Authors: Gillett, G. Tags: Commentary Source Type: research
Testimonial injustice in medical machine learning
Machine learning (ML) systems play an increasingly relevant role in medicine and healthcare. As their applications move ever closer to patient care and cure in clinical settings, ethical concerns about the responsibility of their use come to the fore. I analyse an aspect of responsible ML use that bears not only an ethical but also a significant epistemic dimension. I focus on ML systems’ role in mediating patient–physician relations. I thereby consider how ML systems may silence patients’ voices and relativise the credibility of their opinions, which undermines their overall credibility status without va...
Source: Journal of Medical Ethics - July 24, 2023 Category: Medical Ethics Authors: Pozzi, G. Tags: Feature article Source Type: research
Using meconium to establish prenatal alcohol exposure in the UK: ethical, legal and social considerations
An expanding policy framework aimed at monitoring alcohol consumption during pregnancy has emerged. The primary justification is prevention of harm from what is termed ‘prenatal alcohol exposure’ (PAE), by enabling more extensive diagnosis of the disability labelled fetal alcohol spectrum disorder (FASD). Here we focus on proposals to include biomarkers as a PAE ‘screening tool’, specifically those found in meconium (the first newborn excrement), which are discussed as an ‘objective’ measure of PAE.
We ask the overarching question, ‘Can routine screening of meconium to establish PA...
Source: Journal of Medical Ethics - July 24, 2023 Category: Medical Ethics Authors: Arkell, R., Lee, E. Tags: Current controversy Source Type: research
Intimate relationships in residential aged care: what factors influence staff decisions to intervene?
This study provides insight into how residential aged care staff make decisions regarding the intimacy and sexuality of older people living in residential aged care and how personal views and values likely guide practice in the absence of formal policies. (Source: Journal of Medical Ethics)
Source: Journal of Medical Ethics - July 24, 2023 Category: Medical Ethics Authors: McAuliffe, L., Fetherstonhaugh, D., Syme, M. Tags: Clinical ethics Source Type: research
Ethics of speculation
In an April 2023 article in JAMA Pediatrics, ‘Life Support System for the Fetonate and the Ethics of Speculation’, authors De Bie, Flake and Feudtner critique bioethicists for practising what they call ‘speculative ethics’. The authors refer to a 2017 article that they published on the Extra-uterine Environment of Neonatal Development (EXTEND) system. This system was able to keep fetonatal (newborn, but in a fetal physiological state) lambs alive outside of the parent lamb’s womb for 4 weeks. The article has been accessed almost 300 000 times and received significant media attention. It also r...
Source: Journal of Medical Ethics - July 24, 2023 Category: Medical Ethics Authors: Blumenthal-Barby, J. Tags: Editorial Source Type: research
Care not criminalisation: reform of British abortion law is long overdue
Megan1 is a young teenage patient who suffered a stillbirth at 28 weeks, leading to a year long police investigation dropped only after postmortem tests found that her pregnancy was lost due to natural causes. The stress of the investigation and her isolation from friends and support network following the seizure of her mobile and laptop compounded the trauma of the stillbirth, leaving her requiring emergency psychiatric care. Aisha1 is a vulnerable patient who suffered a premature delivery, having experienced similar problems in earlier pregnancies. Things happened so quickly that Aisha delivered on her own at home, only ...
Source: Journal of Medical Ethics - July 24, 2023 Category: Medical Ethics Authors: Sheldon, S., Lord, J. Tags: Editorial Source Type: research
Data for sale: trust, confidence and sharing health data with commercial companies
Powered by ‘big health data’ and enormous gains in computing power, artificial intelligence and related technologies are already changing the healthcare landscape. Harnessing the potential of these technologies will necessitate partnerships between health institutions and commercial companies, particularly as it relates to sharing health data. The need for commercial companies to be trustworthy users of data has been argued to be critical to the success of this endeavour. I argue that this approach is mistaken. Our interactions with commercial companies need not, and should not, be based on trust. Rather, they ...
Source: Journal of Medical Ethics - June 22, 2023 Category: Medical Ethics Authors: Graham, M. Tags: Open access Extended essay Source Type: research
Unintentional deception still deceives
In my recent article, Pretending to care, I argue that a better understanding of non-doxastic attitudes could improve our understanding of deception in clinical practice. In an insightful and well-argued response, Colgrove highlights three problems with my account. For the sake of brevity, in this reply I focus on the first: that my definition of deception is implausible because it does not involve intention. Although I concede that my initial broad definition needs modification, I argue that it should not be modified by involving intention but by involving responsibility. (Source: Journal of Medical Ethics)
Source: Journal of Medical Ethics - June 22, 2023 Category: Medical Ethics Authors: Hardman, D. Tags: Response Source Type: research
Deception, intention and clinical practice
Regarding the appropriateness of deception in clinical practice, two (apparently conflicting) claims are often emphasised. First, that ‘clinicians should not deceive their patients.’ Second, that deception is sometimes ‘in a patient’s best interest.’ Recently, Hardman has worked towards resolving this conflict by exploring ways in which deceptive and non-deceptive practices extend beyond consideration of patients’ beliefs. In short, some practices only seem deceptive because of the (common) assumption that non-deceptive care is solely aimed at fostering true beliefs. Non-deceptive care, ...
Source: Journal of Medical Ethics - June 22, 2023 Category: Medical Ethics Authors: Colgrove, N. Tags: Response Source Type: research
Pretending to care
On one hand, it is commonly accepted that clinicians should not deceive their patients, yet on the other there are many instances in which deception could be in a patient’s best interest. In this paper, I propose that this conflict is in part driven by a narrow conception of deception as contingent on belief. I argue that we cannot equate non-deceptive care solely with introducing or sustaining a patient’s true belief about their condition or treatment, because there are many instances of clinical care which are non-doxastic and non-deceptive. Inasmuch as this is true, better understanding of non-doxastic attit...
Source: Journal of Medical Ethics - June 22, 2023 Category: Medical Ethics Authors: Hardman, D. Tags: Original research Source Type: research
Leveling (down) the playing field: performance diminishments and fairness in sport
The 2018 eligibility regulation for female competitors with differences of sexual development (DSD) issued by World Athletics requires competitors with DSD with blood testosterone levels at or above 5 nmol/L and sufficient androgen sensitivity to be excluded from competition in certain events unless they reduce the level of testosterone in their blood. This paper formalises and then critically assesses the fairness-based argument offered in support of this regulation by the federation. It argues that it is unclear how the biological advantage singled out by the regulation as an appropriate target for diminishment, is relev...
Source: Journal of Medical Ethics - June 22, 2023 Category: Medical Ethics Authors: Holmen, S. J., Petersen, T. S., Ryberg, J. Tags: Original research Source Type: research
