The Patient preference predictor and the objection from higher-order preferences
Recently, Jardas et al have convincingly defended the patient preference predictor (PPP) against a range of autonomy-based objections. In this response, I propose a new autonomy-based objection to the PPP that is not explicitly discussed by Jardas et al. I call it the ‘objection from higher-order preferences’. Even if this objection is not sufficient reason to reject the PPP, the objection constitutes a pro tanto reason that is at least as powerful as the ones discussed by Jardas et al. (Source: Journal of Medical Ethics)
Source: Journal of Medical Ethics - February 21, 2023 Category: Medical Ethics Authors: Mainz, J. T. Tags: Response Source Type: research
Vaccine mandates for healthcare workers beyond COVID-19
We provide ethical criteria to establish when vaccine mandates for healthcare workers are ethically justifiable. The relevant criteria are the utility of the vaccine for healthcare workers, the utility for patients (both in terms of prevention of transmission of infection and reduction in staff shortage), and the existence of less restrictive alternatives that can achieve comparable benefits. Healthcare workers have professional obligations to promote the interests of patients that entail exposure to greater risks or infringement of autonomy than ordinary members of the public. Thus, we argue that when vaccine mandates are...
Source: Journal of Medical Ethics - February 21, 2023 Category: Medical Ethics Authors: Giubilini, A., Savulescu, J., Pugh, J., Wilkinson, D. Tags: Open access, Press releases, COVID-19 Extended essay Source Type: research
'Climate change mitigation is a hot topic, but not when it comes to hospitals: a qualitative study on hospital stakeholders perception and sense of responsibility for greenhouse gas emissions
Conclusion
Perceptions of most important emission sources did not coincide with those in literature, highlighting the need to inform stakeholders, for instance, about pharmaceuticals as important emission source. A frequently perceived conflict between reducing emissions and providing high-quality medical care could be eased, if reducing emissions would not only be justified as a contribution to mitigation, but also as a contribution to preventing ill health—a basic principle of medical ethics. (Source: Journal of Medical Ethics)
Source: Journal of Medical Ethics - February 21, 2023 Category: Medical Ethics Authors: Quitmann, C., Sauerborn, R., Danquah, I., Herrmann, A. Tags: Open access, Editor's choice Original research Source Type: research
Diversity in clinical research: public health and social justice imperatives
This article aims to both provide the missing arguments for why adequate representation of racial and ethnic minorities in clinical research is essential and to articulate a number of recommendations for improving diversity going forward.
Appropriate racial and ethnic representation and fair inclusion help (1) increase the generalisability of clinical trial results, (2) equitably distribute any benefits of clinical research and (3) enable trust in the research enterprise. (Source: Journal of Medical Ethics)
Source: Journal of Medical Ethics - February 21, 2023 Category: Medical Ethics Authors: Varma, T., Jones, C. P., Oladele, C., Miller, J. Tags: Original research Source Type: research
Surrogacy: beyond the commercial/altruistic distinction
In this article, I critique the commonly accepted distinction between commercial and altruistic surrogacy arrangements. The moral legitimacy of surrogacy, I claim, does not hinge on whether it is paid (‘commercial’) or unpaid (‘altruistic’); rather, it is best determined by appraisal of virtue-abiding conditions constitutive of the surrogacy arrangement. I begin my article by problematising the prevailing commercial/altruistic distinction; next, I demonstrate that an assessment of the virtue-abiding or non-virtue-abiding features of a surrogacy is crucial to navigating questions about the moral legi...
Source: Journal of Medical Ethics - February 21, 2023 Category: Medical Ethics Authors: Lee, J. Y. Tags: Original research Source Type: research
Conscientious objection and the referral requirement as morally permissible moral mistakes
Some contributions to the current literature on conscience objection in healthcare posit the notion that the requirement to refer patients to a non-objecting provider is a morally questionable undertaking in need of explanation. The issue is that providing a referral renders those who conscientiously object to being involved in a particular intervention complicit in its provision. This essay seeks to engage with such claims and argues that referrals can be construed in terms of what Harman calls morally permissible moral mistakes. I go on to suggest that one might frame the (in)actions of those who exercise the right of no...
Source: Journal of Medical Ethics - February 21, 2023 Category: Medical Ethics Authors: Emmerich, N. Tags: Original research Source Type: research
The scope of patient, healthcare professional and healthcare systems responsibilities to reduce the carbon footprint of inhalers: a response to commentaries
I am grateful for these four wide-ranging and incisive commentaries on my paper discussing the ethical issues that arise when we consider the carbon footprint of inhalers.1 As I am unable to address every point raised, instead I focus on what I take to be the common thread running through these papers. Each response has something to say regarding the scope of healthcare’s responsibility to mitigate climate change. This can be explored at the intuitional or structural level, or at the individual patient and practitioner level leading to a further issue of the relationship between these perspectives. Coverdale argues f...
Source: Journal of Medical Ethics - February 21, 2023 Category: Medical Ethics Authors: Parker, J. Tags: Commentary Source Type: research
AI knows best? Avoiding the traps of paternalism and other pitfalls of AI-based patient preference prediction
In our recent article ‘The Ethics of the Algorithmic Prediction of Goal of Care Preferences: From Theory to Practice’1, we aimed to ignite a critical discussion on why and how to design artificial intelligence (AI) systems assisting clinicians and next-of-kin by predicting goal of care preferences for incapacitated patients. Here, we would like to thank the commentators for their valuable responses to our work. We identified three core themes in their commentaries: (1) the risks of AI paternalism, (2) worries about attacks to our humanity stemming from the use of AI and (3) the possibility of designing AI syste...
Source: Journal of Medical Ethics - February 21, 2023 Category: Medical Ethics Authors: Ferrario, A., Gloeckler, S., Biller-Andorno, N. Tags: Commentary Source Type: research
Artificial intelligence paternalism
In response to Ferrario et al’s1 work entitled ‘Ethics of the algorithmic prediction of goal of care preferences: from theory to practice’, we would like to point out an area of concern: the risk of artificial intelligence (AI) paternalism in their proposed framework. Accordingly, in this commentary, we underscore the importance of the implementation of safeguards for AI algorithms before they are deployed in clinical practice. The goal of documenting a living will and advanced directives is to convey personal preferences regarding the acceptance of therapies, including life support, for future use in cas...
Source: Journal of Medical Ethics - February 21, 2023 Category: Medical Ethics Authors: Diaz Milian, R., Bhattacharyya, A. Tags: Commentary Source Type: research
Fracking our humanity
Nietzche claimed that once we know why to live, we’ll suffer almost any how.1 Artificial intelligence (AI) is used widely for the how, but Ferrario et al now advocate using AI for the why.2 Here, I offer my doubts on practical grounds but foremost on ethical ones. Practically, individuals already vacillate over the why, wavering with time and circumstance. That AI could provide prosthetics (or orthotics) for human agency feels unrealistic here, not least because ‘answers’ would be largely unverifiable. Ethically, the concern is that AI stands to frack our humanity. We form a fragile ecosystem of ethical s...
Source: Journal of Medical Ethics - February 21, 2023 Category: Medical Ethics Authors: Jesudason, E. Tags: Commentary Source Type: research
Artificial Intelligence algorithms cannot recommend a best interests decision but could help by improving prognostication
Introduction Most jurisdictions require a patient to consent to any medical intervention. Clinicians ask a patient, ‘Given the pain and distress associated with our intervention and the predicted likelihood of this best-case outcome, do you want to accept the treatment?’ When a patient is incapable of deciding, clinicians may ask people who know the patient to say what the patient would decide; this is substituted judgement. In contrast, asking the same people to say how the person would make the decision is substituted interests.1 The UK Mental Capacity Act 2005 uses the latter approach, and my comments appert...
Source: Journal of Medical Ethics - February 21, 2023 Category: Medical Ethics Authors: Wade, D. Tags: Commentary Source Type: research
What you believe you want, may not be what the algorithm knows
Tensions between respect for autonomy and paternalism loom large in Ferrario et al’s discussion of artificial intelligence (AI)-based preference predictors.1 To be sure, their analysis (rightfully) brings out the moral matter of respecting patient preferences. My point here, however, is that their consideration of AI-based preference predictors in treatment of incapacitated patients opens more fundamental moral questions about the desirability of over-ruling considered patient preferences, not only if these are disclosed by surrogates, but possibly also in treating competent patients. I do not advocate such an evolut...
Source: Journal of Medical Ethics - February 21, 2023 Category: Medical Ethics Authors: Segers, S. Tags: Commentary Source Type: research
For the sake of multifacetedness. Why artificial intelligence patient preference prediction systems shouldnt be for next of kin
Introduction In their contribution ‘Ethics of the algorithmic prediction of goal of care preferences’1 Ferrario et al elaborate a from theory to practice contribution concerning the realisation of artificial intelligence (AI)-based patient preference prediction (PPP) systems. Such systems are intended to help find the treatment that the patient would have chosen in clinical situations—especially in the intensive care or emergency units—where the patient is no longer capable of making that decision herself. The authors identify several challenges that complicate their effective development, applicati...
Source: Journal of Medical Ethics - February 21, 2023 Category: Medical Ethics Authors: Tretter, M., Samhammer, D. Tags: Commentary Source Type: research
Ethics of the algorithmic prediction of goal of care preferences: from theory to practice
Artificial intelligence (AI) systems are quickly gaining ground in healthcare and clinical decision-making. However, it is still unclear in what way AI can or should support decision-making that is based on incapacitated patients’ values and goals of care, which often requires input from clinicians and loved ones. Although the use of algorithms to predict patients’ most likely preferred treatment has been discussed in the medical ethics literature, no example has been realised in clinical practice. This is due, arguably, to the lack of a structured approach to the epistemological, ethical and pragmatic challeng...
Source: Journal of Medical Ethics - February 21, 2023 Category: Medical Ethics Authors: Ferrario, A., Gloeckler, S., Biller-Andorno, N. Tags: Open access Feature article Source Type: research
'VaxTax: a follow-up proposal for a global vaccine pandemic response fund
We present our ‘VaxTax model’ and explore its comparative advantages and disadvantages while considering other possible measures to address the global vaccine access problem, also in view of future pandemics and disease outbreaks. (Source: Journal of Medical Ethics)
Source: Journal of Medical Ethics - February 21, 2023 Category: Medical Ethics Authors: Germani, F., Holzer, F., Ortiz, I., Biller-Andorno, N., März, J. W. Tags: Open access Current controversy Source Type: research
