ORCID Profile
0000-0001-9186-870X
Current Organisation
Macquarie University
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Applied Ethics | Bioethics (human and animal) | Human Bioethics | Professional Ethics (incl. police and research ethics) | Law And Society | Law and Society | Feminist Theory | Philosophy | Biochemistry and Cell Biology | Public Health and Health Services | Language In Culture And Society (Sociolinguistics) | Applied Ethics (Incl. Bioethics And Environmental Ethics) | Synthetic Biology | Human Rights | Microbial Genetics | Law | Ethical Theory | Medical Ethics | Public Health And Health Services Not Elsewhere Classified | Law Not Elsewhere Classified |
ANZSRC Socio-Economic Objective (SEO)
Bioethics | Law, Politics and Community Services not elsewhere classified | Health policy evaluation | Justice and the law not elsewhere classified | Bioethics | Gender | Public Health (excl. Specific Population Health) not elsewhere classified | Social Ethics | Women’s health | Health education and promotion | Organic Industrial Chemicals (excl. Resins, Rubber and Plastics) | Human Pharmaceutical Treatments (e.g. Antibiotics) | Public health not elsewhere classified | Expanding Knowledge in the Biological Sciences | Health not elsewhere classified | Treatments (e.g. chemicals, antibiotics) | Social structure and health
Related Links
Publications
Guidance offers little in the way of ethics or transparency
Publisher: BMJ
Date: 24-04-2012
DOI: 10.1136/BMJ.E2910
Consent to the publication of patient information: More on confidentiality and case material
Publisher: BMJ
Date: 14-10-2004
Including the public in pandemic planning: a deliberative approach
Publisher: Springer Science and Business Media LLC
Date: 19-08-2010
Evidence-Based Medicine and Women: Do the Principles and Practice of EBM Further Women's Health?
Publisher: Wiley
Date: 02-2004
DOI: 10.1111/J.1467-8519.2004.00378.X
Abstract: Clinicians and policy makers the world over are embracing evidence-based medicine (EBM). The promise of EBM is to use summaries of research evidence to determine which healthcare interventions are effective and which are not, so that patients may benefit from effective interventions and be protected from useless or harmful ones. EBM provides an ostensibly rational objective means of deciding whether or not an intervention should be provided on the basis of its effectiveness, in theory leading to fair and effective healthcare for all. In this paper I closely examine these claims from the perspective of healthcare for women, using relevant ex les. I argue that the current processes of evidence-based medicine contain a number of biases against women. These biases occur in the production of research that informs evidence-based medicine, in the methods used to analyse and synthesise the evidence, and in the application of EBM through the use of guidelines. Finally, the biomedical model of health that underpins most of the medical research used by EBM ignores the social and political context which contributes so much to the ill-health of women.
Introduction
Publisher: University of Toronto Press Inc. (UTPress)
Date: 2012
Evidence-Based Medicine in Theory and Practice: Epistemological and Normative Issues
Publisher: Springer Netherlands
Date: 06-06-2015
Innovative surgery: the ethical challenges
Publisher: BMJ
Date: 22-06-2011
Abstract: Innovative surgery raises four kinds of ethical challenges: potential harms to patients compromised informed consent unfair allocation of healthcare resources and conflicts of interest. Lack of adequate data on innovations and lack of regulatory oversight contribute to these ethical challenges. In this paper these issues and the extent to which problems may be resolved by better evidence-gathering and more comprehensive regulation are explored. It is suggested that some ethical issues will be more resistant to resolution than others, owing to special features of both surgery and innovation.
Defining disease in the context of overdiagnosis
Publisher: Springer Science and Business Media LLC
Date: 15-11-2016
DOI: 10.1007/S11019-016-9748-8
Abstract: Recently, concerns have been raised about the phenomenon of 'overdiagnosis', the diagnosis of a condition that is not causing harm, and will not come to cause harm. Along with practical, ethical, and scientific questions, overdiagnosis raises questions about our concept of disease. In this paper, we analyse overdiagnosis as an epistemic problem and show how it challenges many existing accounts of disease. In particular, it raises questions about conceptual links drawn between disease and dysfunction, harm, and risk. We argue that 'disease' should be considered a vague concept with a non-classical structure. On this view, overdiagnosed cases are 'borderline' cases of disease, falling in the zone between cases that are clearly disease, and cases that are clearly not disease. We then develop a précising definition of disease designed to provide practical help in preventing and limiting overdiagnosis. We argue that for this purpose, we can define disease as dysfunction that has a significant risk of causing severe harm to the patient.
Health Inequities and the Social Determinants of Health
Publisher: Wiley
Date: 15-06-2006
We still need to ask 'what is disease?'
Publisher: SAGE Publications
Date: 10-2003
Response to Comment on “Ethical Issues Across the IDEAL Stages of Surgical Innovation”
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2019
The Routledge Handbook of Feminist Bioethics
Publisher: Routledge
Date: 24-06-2022
Reframing the Debate Around State Responses to Infertility: Considering the Harms of Subfertility and Involuntary Childlessness
Publisher: Oxford University Press (OUP)
Date: 08-03-2016
DOI: 10.1093/PHE/PHW005
Risk, Overdiagnosis and Ethical Justifications
Publisher: Springer Science and Business Media LLC
Date: 04-05-2019
DOI: 10.1007/S10728-019-00369-7
Abstract: Many healthcare practices expose people to risks of harmful outcomes. However, the major theories of moral philosophy struggle to assess whether, when and why it is ethically justifiable to expose in iduals to risks, as opposed to actually harming them. Sven Ove Hansson has proposed an approach to the ethical assessment of risk imposition that encourages attention to factors including questions of justice in the distribution of advantage and risk, people's acceptance or otherwise of risks, and the scope in iduals have to influence the practices that generate risk. This paper investigates the ethical justifiability of preventive healthcare practices that expose people to risks including overdiagnosis. We applied Hansson's framework to three such practices: an 'ideal' breast screening service, a commercial personal genome testing service, and a guideline that lowers the diagnostic threshold for hypertension. The framework was challenging to apply, not least because healthcare has unclear boundaries and involves highly complex practices. Nonetheless, the framework encouraged attention to issues that would be widely recognised as morally pertinent. Our assessment supports the view that at least some preventive healthcare practices that impose risks including that of overdiagnosis are not ethically justifiable. Further work is however needed to develop and/or test refined assessment criteria and guidance for applying them.
Pregnancy, Vulnerability, and the Risk of Exploitation in Clinical Research
Publisher: Springer International Publishing
Date: 2016
Credit where credit is due? Regulation, research integrity and the attribution of authorship in the health sciences
Publisher: Elsevier BV
Date: 05-2010
DOI: 10.1016/J.SOCSCIMED.2010.01.013
Abstract: Despite attempts at clear direction in international, national and journal guidelines, attribution of authorship can be a confusing area for both new and established researchers. As journal articles are valuable intellectual property, authorship can be hotly contested. In idual authors' responsibilities for the integrity of article content have not been well explored. Semi-structured interviews (n = 17) were conducted with staff, student advocates and doctoral candidates working in health research in two universities in Australia. Stratified s ling ensured participants reflected a range of experience across biomedical, clinical and social science disciplines. Participants were asked about their experience with research publication and their views on the responsibilities of authorship. Participants gave a variety of reasons for attribution of authorship including: writing the paper seniority and student supervision. Gift authorship was seen by some participants as: a way of maintaining relationships a reward a means to increase a paper's credibility or a demonstration of collaboration between authors. Norms and beliefs differed markedly between disciplines for authorship attribution and, to a lesser extent, for authors' responsibility for content integrity. Discussions about the effect of power differentials on authorship were common across disciplines. This paper describes a broad range of beliefs, values and practice norms held by health science researchers with respect to attribution of authorship and author responsibility for scientific publications. The findings support the need for clarity in relation to authorship, and a research environment which is supportive of ethical behaviour in the publication of research.
Audit or research: the ethics of publication
Publisher: Wiley
Date: 06-2006
Ethical and regulatory implications of the COVID-19 pandemic for the medical devices industry and its representatives
Publisher: Springer Science and Business Media LLC
Date: 23-03-2022
DOI: 10.1186/S12910-022-00771-2
Abstract: The development and deployment of medical devices, along with most areas of healthcare, has been significantly impacted by the COVID-19 pandemic. This has had variable ethical implications, two of which we will focus on here. First, medical device regulations have been rapidly amended to expedite approvals of devices ranging from face masks to ventilators. Although some regulators have issued cessation dates, there is inadequate discussion of triggers for exiting these crisis standards, and evidence that this may not be feasible. Given the relatively low evidence standards currently required for regulatory approval of devices, this further indefinite reduction in standards raises serious ethical issues. Second, the pandemic has disrupted the usual operations of device representatives in hospitals, providing an opportunity to examine and refine this potentially ethically problematic practice. In this paper we explain and critically analyse the ethical implications of these two pandemic-related impacts on medical devices and propose suggestions for their management. These include an endpoint for pandemic-related adjustments to device regulation or a mechanism for continued refinement over time, together with a review of device research conducted under crisis conditions, support for the removal and replacement of emergency approved devices, and a review of device representative credentialling.
Ethical issues in public health: a qualitative study of public health practice in Scotland
Publisher: BMJ
Date: 06-2004
Abstract: To identify ethical issues encountered by staff in the development and implementation of public health activities at two sites in Scotland. Qualitative research study involving face to face semi-structured interviews with participants. A public health directorate in a National Health Service Trust, and a public health demonstration project in child health. Health promotion specialists, managers, nurses, public health consultants and specialists, researchers, trainees, and other public health staff. Three main categories of ethical issues were identified: paternalism, responsibilities, and ethical decision making. Consulting with the community and sharing information raised issues of paternalism and honesty. Participants identified multiple and sometimes conflicting responsibilities. Barriers to fulfilling responsibilities included meeting targets, working with partners, and political influences. Defining the limits of responsibilities posed challenges. Participants identified values for ideal decision making, but lack of time often led to a more pragmatic approach. These empirical findings complement and extend existing discussions of public health ethics, emphasising the complex nature of ethical issues in public health. The implications for public health policy and future research are discussed.
Response to Bjorn Hofmann: Clarifying overdiagnosis without losing conceptual complexity
Publisher: Wiley
Date: 15-12-2016
DOI: 10.1111/JEP.12682
Authors’ reply to Grundtvig Gram et al.
Publisher: Springer Science and Business Media LLC
Date: 06-2021
The challenges of systematically reviewing public health interventions
Publisher: Oxford University Press (OUP)
Date: 09-2004
Pressures on confidentiality
Publisher: Elsevier BV
Date: 02-2006
Density and visco-elasticity of Natrosol 250 HH solutions: Determining their suitability for experimental tectonics
Publisher: Elsevier BV
Date: 05-2016
Macquarie Surgical Innovation Identification Tool (MSIIT): a study protocol for a usability and pilot test
Publisher: BMJ
Date: 11-2016
Industry and Bioethics: What Price the Relationship?
Publisher: Public Library of Science (PLoS)
Date: 27-06-2006
Evidence-Based Medicine in Theory and Practice: Epistemological and Normative Issues
Publisher: Springer Netherlands
Date: 2017
Smoke and mirrors: unanswered questions and misleading statements obscure the truth about organ sources in China.
Publisher: BMJ
Date: 04-05-2016
DOI: 10.1136/MEDETHICS-2016-103533
Abstract: This response refutes the claim made in a recent article that organs for transplantation in China will no longer be sourced from executed prisoners. We identify ongoing ethical problems due to the lack of transparent data on current numbers of transplants in China implausible and conflicting claims about voluntary donations and obfuscation about who counts as a voluntary donor. The big unanswered question in Chinese transplant ethics is the source of organs, and until there is an open and independently audited system in China, legitimate concerns remain about organ harvesting from prisoners of conscience.
Response to Brodersen et al’ s ‘Overdiagnosis: what it is and what it isn’t’
Publisher: BMJ
Date: 29-03-2018
No Surgical Innovation Without Evaluation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2019
Is there a tension between doctors' duty of care and evidence-based medicine?
Publisher: Springer Science and Business Media LLC
Date: 2002
Research fraud and its combat: what can a journal do?
Publisher: Wiley
Date: 09-06-2013
DOI: 10.1111/MEDU.12197
Testing relationships: ethical arguments for screening for type 2 diabetes mellitus with HbA1C
Publisher: BMJ
Date: 04-10-2011
DOI: 10.1136/MEDETHICS-2011-100086
Abstract: Since the 1990s, glycated haemoglobin (HbA1C) has been the gold standard for monitoring glycaemic control in people diagnosed as having either type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM). Discussions are underway about diagnosing diabetes mellitus on the basis of HbA1C titres and using HbA1C tests to screen for T2DM. These discussions have focused on the relative benefits for in idual patients, with some attention directed towards reduced costs to healthcare systems and benefits to society. We argue that there are strong ethical reasons for adopting HbA1C-based diagnosis and T2DM screening that have not yet been articulated. The rationale includes the differential impact of HbA1C-based diabetic testing on disadvantaged groups, and what we are beginning to learn about HbA1C vis-à-vis population health. Although it is arguable that screening must primarily benefit the in idual, using HbA1C to diagnose and screen for T2DM may promote a more just distribution of health resources and lead to advances in investigating, monitoring and tackling the social determinants of health.
The Ethics of Surgical Research and Innovation
Publisher: Springer International Publishing
Date: 2023
Reports of new healthcare AI interventions should include systematic ethical evaluations
Publisher: Wiley
Date: 10-05-2022
DOI: 10.1111/BIOE.13051
Ethical Guidance for Hard Decisions: A Critical Review of Early International COVID-19 ICU Triage Guidelines
Publisher: Springer Science and Business Media LLC
Date: 26-10-2021
DOI: 10.1007/S10728-021-00442-0
Abstract: This article provides a critical comparative analysis of the substantive and procedural values and ethical concepts articulated in guidelines for allocating scarce resources in the COVID-19 pandemic. We identified 21 local and national guidelines written in English, Spanish, German and French applicable to specific and identifiable jurisdictions and providing guidance to clinicians for decision making when allocating critical care resources during the COVID-19 pandemic. US guidelines were not included, as these had recently been reviewed elsewhere. Information was extracted from each guideline on: 1) the development process 2) the presence and nature of ethical, medical and social criteria for allocating critical care resources and 3) the membership of and decision-making procedure of any triage committees. Results of our analysis show the majority appealed primarily to consequentialist reasoning in making allocation decisions, tempered by a largely pluralistic approach to other substantive and procedural values and ethical concepts. Medical and social criteria included medical need, co-morbidities, prognosis, age, disability and other factors, with a focus on seemingly objective medical criteria. There was little or no guidance on how to reconcile competing criteria, and little attention to internal contradictions within in idual guidelines. Our analysis reveals the challenges in developing sound ethical guidance for allocating scarce medical resources, highlighting problems in operationalising ethical concepts and principles, ergence between guidelines, unresolved contradictions within the same guideline, and use of naïve objectivism in employing widely used medical criteria for allocating ICU resources.
Virtue ethics and public health: A practice-based analysis
Publisher: Springer Science and Business Media LLC
Date: 2004
DOI: 10.1007/BF03351406
Activism and Bioethics: Taking a Stand on Things That Matter
Publisher: Wiley
Date: 07-2021
DOI: 10.1002/HAST.1270
Abstract: The question of whether activism should be overtly embraced as part of the bioethicist's role deserves serious consideration. Like others, we agree that bioethics is inescapably partisan bioethical deliberation is based on trying to determine morally relevant features of situations and morally justifiable outcomes. Where disagreement arises is over the degree to which bioethicists should be activists. Meyers argues for a somewhat circumscribed role, limited to action on ethically concerning institutional matters, for those who are financially independent of the institutions. We take a broader view, arguing that some issues are so morally egregious that there is a duty to take a stand against them, even if the prospects of success are dim. There is a need for further debate, sharing of experiences, and analysis of case studies, to support bioethicists who take a stand .
Exclusion of Women From Clinical Research: Myth or Reality?
Publisher: Elsevier BV
Date: 05-2008
DOI: 10.4065/83.5.536
Abstract: To determine the proportion of male and female research participants and rates of sex-based analysis and sex-specific reporting in published Australian clinical research. We assessed 400 clinical studies involving Australian-only participants, published in journals between January 1, 2003, and May 31, 2006 (100 per year). Numbers of male and female participants in each study and presence or absence of analysis by sex (covariate adjustment, subgroup analysis, or sex-specific reporting) were recorded. Sex-specific studies were evaluated to determine whether the exclusion of one sex was biologically necessary. The total s le comprised 546,824 participants, of whom 73% were female 36 studies were male-only, 78 were female-only. Of the participants in 286 studies that were not sex-specific, 56% were female. Of 114 sex-specific studies, the segregation by sex was deemed to be biologically necessary in 62%, ie, the research related directly to male or female biological function. More than one-quarter (28%) of studies with 30 participants or more published covariate adjustment or subgroup analysis by sex 7% included sex-specific reporting of results. We found no routine exclusion of women however, few publications analyzed results by sex. Some studies excluded women or men for apparently arbitrary reasons. Research performed with male-only participants differed in nature and size from that performed with female-only participants. These data indicate the need to track the sex of research participants. In addition, they provide the basis for assessing appropriate inclusion of men and women in research and for comparing any relationship between different international regulatory models and the rates of female participation in research.
Engaging with China on organ transplantation
Publisher: BMJ
Date: 07-02-2017
DOI: 10.1136/BMJ.J665
Responding to unethical research: the importance of transparency
Publisher: BMJ
Date: 14-09-2020
What Can Feminist Epistemology Do for Surgery?
Publisher: Cambridge University Press (CUP)
Date: 2014
DOI: 10.1111/HYPA.12052
Abstract: Surgery is an important part of contemporary health care, but currently much of surgery lacks a strong evidence base. Uptake of evidence‐based medicine (EBM) methods within surgical research and among practitioners has been slow compared with other areas of medicine. Although this is often viewed as arising from practical and cultural barriers, it also reflects a lack of epistemic fit between EBM research methods and surgical practice. In this paper we discuss some epistemic challenges in surgery relating to this lack of fit, and investigate how resources from feminist epistemology can help to characterize them. We point to ways in which these epistemic challenges may be addressed by gathering and disseminating evidence about what works in surgery using methods that are contextual, pluralistic, and sensitive to hierarchies.
Potential Conflict of Interest and Bias in the RACGP's Smoking Cessation Guidelines: Are GPs Provided with the Best Advice on Smoking Cessation for their Patients?
Publisher: Oxford University Press (OUP)
Date: 20-04-2015
DOI: 10.1093/PHE/PHV010
Pandemic influenza communication: views from a deliberative forum
Publisher: Wiley
Date: 09-2009
Introduction: The Boundaries of Disease
Publisher: Oxford University Press (OUP)
Date: 14-07-2017
DOI: 10.1093/JMP/JHX014
An ethical justification for the Chronic Care Model (CCM)
Publisher: Wiley
Date: 17-02-2010
Dollars, debts and duties: lessons from funding Australian general practice
Publisher: Hindawi Limited
Date: 09-2000
Reproductive Ethics: Ethical Issues and Menopause
Publisher: Elsevier
Date: 2008
Problems, Policies and Ethics in Health Care
Publisher: Oxford University Press (OUP)
Date: 2007
DOI: 10.1016/S1449-4035(07)70114-5
Abstract: There are three factors necessary for the successful implementation of a policy. First, a problem has to be identified in a way that invites action. Second, there must be a policy that fits the problem in question. And third, there must be the political will to tackle the problem with the policy. Each of these factors is necessary but not sufficient for policy development implementation requires a happy conjunction of all three. To date there has been little overt ethical analysis in relation to policy development by those identifying as ethicists. This paper describes three potential roles for ethics analysis in the problem-policy-politics nexus, arguing that ethicists have a role to play in the identification of problems and in the substantive and procedural evaluation of policies. In addition, wherever ethics language is used overtly, ethicists have a duty to investigate and offer critiques of the notions in question, both on their own merits and against accepted usage and normative frameworks.
Beyond the RCT: When are Randomized Trials Unnecessary for New Therapeutic Devices, and What Should We Do Instead?
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-07-2021
Understanding Corporate Responsibility: Culture and Complicity
Publisher: Informa UK Limited
Date: 09-2011
Donation after Cardiac Death: Community Views about ‘Decent’ Intervals
Publisher: Elsevier BV
Date: 03-2011
DOI: 10.1111/J.1600-6143.2010.03432.X
Abstract: Donation after cardiac death (DCD) offers an alternative pathway to donation for some donors. Successful recovery of organs for transplantation following DCD requires that organ recovery surgery commence as soon as possible after death has occurred. This limits the amount of time that family and friends can spend with the donor prior to surgery. The aim of this study was to identify community views about the timing of organ recovery in DCD. Data were collected from two sources in South Australia: 32 members of the public participated in four focus groups, and 2693 adults participated in a representative population survey. Respondents were asked their views about a decent interval to wait after death prior to organ recovery surgery. Focus group participants identified a tension between preserving organ viability and allowing families time with the deceased. Of the survey respondents, 45.2% selected a timeframe compatible with potentially viable donations 34.1% selected a timeframe incompatible with viable donations and 20.8% gave an indeterminate answer. These findings provide information about public perceptions of DCD, can be used to inform educational c aigns about DCD and serve as a baseline for evaluating such c aigns, and identify a number of areas for further investigation.
Reporting conflicts of interest: clarifying the grey areas
Publisher: Wiley
Date: 07-2008
IS SEX-SELECTIVE ABORTION MORALLY JUSTIFIED AND SHOULD IT BE PROHIBITED?
Publisher: Wiley
Date: 11-2007
DOI: 10.1111/J.1467-8519.2007.00599.X
Abstract: In this paper we argue that sex-selective abortion (SSA) cannot be morally justified and that it should be prohibited. We present two main arguments against SSA. First, we present reasons why the decision for a woman to seek SSA in cultures with strong son-preference cannot be regarded as autonomous on either a narrow or a broad account of autonomy. Second, we identify serious harms associated with SSA including perpetuation of discrimination against women, disruption to social and familial networks, and increased violence against women. For these reasons, SSA should be prohibited by law, and such laws should be enforced. Finally, we describe additional strategies for decreasing son-preference. Some of these strategies rely upon highlighting the disadvantages of women becoming scarce, such as lack of brides and daughters-in-law to care for elderly parents. We should, however, be cautious not to perpetuate the view that the purpose of women is to be the consorts for, and carers of, men, and the providers of children. Arguments against SSA should be located within a concerted effort to ensure greater, deeper social and cultural equality between the sexes.
Moral responsibility in medicine: where are the boundaries?
Publisher: Elsevier BV
Date: 08-2020
Planning older people's discharge from acute hospital care: linking risk management and patient participation in decision-making
Publisher: Informa UK Limited
Date: 06-2004
Habitus and responsible dog-ownership: reconsidering the health promotion implications of ‘dog-shaped’ holes in people’s lives
Publisher: Informa UK Limited
Date: 04-2015
The Line-drawing Problem in Disease Definition
Publisher: Oxford University Press (OUP)
Date: 21-04-2017
DOI: 10.1093/JMP/JHX010
Abstract: Biological dysfunction is regarded, in many accounts, as necessary and perhaps sufficient for disease. But although disease is conceptualized as all-or-nothing, biological functions often differ by degree. A tension is created by attempting to use a continuous variable as the basis for a categorical definition, raising questions about how we are to pinpoint the boundary between health and disease. This is the line-drawing problem. In this paper, we show how the line-drawing problem arises within "dysfunction-requiring" accounts of disease, such as those of Christopher Boorse and Jerome Wakefield. We then provide several detailed ex les to establish that biological dysfunction cannot provide a boundary. We examine potential ways of resolving the line-drawing problem, either by dropping one of the claims that generates it, or by appealing to additional criteria. We argue that two of these options are plausible, and that each of these can be applied with regard to different diseases.
Identifying Surgical Innovation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2014
Diagnosis, narrative identity, and asymptomatic disease
Publisher: Springer Science and Business Media LLC
Date: 05-07-2017
DOI: 10.1007/S11017-017-9412-1
Abstract: An increasing number of patients receive diagnoses of disease without having any symptoms. These include diseases detected through screening programs, as incidental findings from unrelated investigations, or via routine checks of various biological variables like blood pressure or cholesterol. In this article, we draw on narrative identity theory to examine how the process of making sense of being diagnosed with asymptomatic disease can trigger certain overlooked forms of harm for patients. We show that the experience of asymptomatic disease can involve 'mismatches' between one's beliefs about one's health status on the one hand, and bodily sensations or past experience on the other. Patients' attempts to integrate these diagnoses into their self-narratives often involve either forming inaccurate beliefs about bodily sensations and/or past experience, or coming to believe that feelings and experience do not necessarily track or predict health status, leading to an ongoing sense of vulnerability to ill health. These resulting alterations in self-understanding can sometimes be considered harmful, in view of their implications for ascriptions of responsibility and ongoing anxiety.
Device representatives in hospitals: Are commercial imperatives driving clinical decision-making?
Publisher: BMJ
Date: 04-07-2018
DOI: 10.1136/MEDETHICS-2018-104804
Abstract: Despite concerns about the relationships between health professionals and the medical device industry, the issue has received relatively little attention. Prevalence data are lacking however, qualitative and survey research suggest device industry representatives, who are commonly present in clinical settings, play a key role in these relationships. Representatives, who are technical product specialists and not necessarily medically trained, may attend surgeries on a daily basis and be available to health professionals 24 hours a day, 7 days a week, to provide advice. However, device representatives have a dual role: functioning as commissioned sales representatives at the same time as providing advice on approaches to treatment. This duality raises the concern that clinical decision-making may be unduly influenced by commercial imperatives. In this paper, we identify three key ethical concerns raised by the relationship between device representatives and health professionals: (1) impacts on healthcare costs, (2) the outsourcing of expertise and (3) issues of accountability and informed consent. These ethical concerns can be addressed in part through clarifying the boundary between the support and sales aspects of the roles of device representatives and developing clear guidelines for device representatives providing support in clinical spaces. We suggest several policy options including hospital provision of expert support, formalising clinician conduct to eschew receipt of meals and payments from industry and establishing device registries.
Evidence‐based medicine in practice: limiting or facilitating patient choice?
Publisher: Wiley
Date: 28-05-2002
DOI: 10.1046/J.1369-6513.2002.00168.X
Abstract: Facilitating patient choice is an important element in respecting the autonomy of patients. Evidence-based medicine has the potential to contribute to this process by the provision of high quality research-based information, for use by patients and clinicians. In this paper, I analyse the processes of evidence-based medicine in order to identify the ways in which patient choice is affected by decisions made in the development and use of evidence-based guidelines. I argue that despite the potential contribution, the current methods and techniques of guideline production limit rather than facilitate patient choice.
Avoiding the trap of overtreatment
Publisher: Wiley
Date: 11-12-2013
DOI: 10.1111/MEDU.12371
Getting clearer on overdiagnosis
Publisher: Wiley
Date: 06-05-2016
DOI: 10.1111/JEP.12556
Abstract: Overdiagnosis refers to diagnosis that does not benefit patients because the diagnosed condition is not a harmful disease in those in iduals. Overdiagnosis has been identified as a problem in cancer screening, diseases such as chronic kidney disease and diabetes, and a range of mental illnesses including depression and attention deficit hyperactivity disorder. In this paper, we describe overdiagnosis, investigate reasons why it occurs, and propose two different types. Misclassification overdiagnosis arises because the diagnostic threshold for the disease in question has been set at a level where many people without harmful disease are nonetheless diagnosed. We illustrate misclassification overdiagnosis using the ex le of chronic kidney disease. Misclassification occurs in diseases diagnosed using biomarkers or based on patient reported phenomena. Maldetection overdiagnosis arises because, at the time the diagnosis is made and despite the presence of a ‘gold standard’ diagnostic test, it is not possible to discriminate between harmful and non‐harmful cases of the index disease. We illustrate maldetection overdiagnosis using the ex le of thyroid cancer. While there is some overlap between misclassification and maldetection overdiagnosis, this conceptual analysis helps to clarify the phenomenon of overdiagnosis and is a necessary first step in developing strategies to address the problem.
Practical, epistemic and normative implications of algorithmic bias in healthcare artificial intelligence: a qualitative study of multidisciplinary expert perspectives
Publisher: BMJ
Date: 23-02-2023
Abstract: There is a growing concern about artificial intelligence (AI) applications in healthcare that can disadvantage already under-represented and marginalised groups (eg, based on gender or race). Our objectives are to canvas the range of strategies stakeholders endorse in attempting to mitigate algorithmic bias, and to consider the ethical question of responsibility for algorithmic bias. The study involves in-depth, semistructured interviews with healthcare workers, screening programme managers, consumer health representatives, regulators, data scientists and developers. Findings reveal considerable ergent views on three key issues. First, views on whether bias is a problem in healthcare AI varied, with most participants agreeing bias is a problem (which we call the bias-critical view), a small number believing the opposite (the bias-denial view), and some arguing that the benefits of AI outweigh any harms or wrongs arising from the bias problem (the bias-apologist view). Second, there was a disagreement on the strategies to mitigate bias, and who is responsible for such strategies. Finally, there were ergent views on whether to include or exclude sociocultural identifiers (eg, race, ethnicity or gender- erse identities) in the development of AI as a way to mitigate bias. Based on the views of participants, we set out responses that stakeholders might pursue, including greater interdisciplinary collaboration, tailored stakeholder engagement activities, empirical studies to understand algorithmic bias and strategies to modify dominant approaches in AI development such as the use of participatory methods, and increased ersity and inclusion in research teams and research participant recruitment and selection.
The Regulation of Medical Device Representatives: A Question of Trust?
Publisher: Queensland University of Technology
Date: 24-05-2022
DOI: 10.5204/LTHJ.2281
Abstract: The introduction of new technologies in medical treatment has led to innovation in medical devices that are highly technical in their application and operation. The medical technology landscape is changeable and healthcare providers often turn to the medical device representatives (MDRs), employed by device manufacturers to help navigate the shifts and uncertainties. While the relationship between MDRs and healthcare providers can be a positive one focusing on appropriate use, selection and safety of devices, it is one that has evolved over time and is not independently regulated. In addition, patients, for the most part, are usually unaware of the involvement of MDRs in their healthcare. It is this knowledge gap with regard to the role of MDRs that is the focus of this paper. We argue that trust is at the heart of healthcare relationships and explore the nature of trust alongside the models of regulation of the medical device industry. We argue that MDRs may currently present a threat to both the interpersonal and the institutional trust of patients, and that regulation and policy responses are appropriate ways to address this risk. We consider potential regulatory frameworks and identify transparency and communication as the crucial characteristics of an appropriate response. We recommend that the polycentric nature of Australian healthcare regulation be cultivated through a multilayered approach, and that a positive obligation to inform the patient of the role of MDRs in their clinical care be established.
The controversy over vertebroplasty: An analysis of the debate and proposals for a way forward
Publisher: Wiley
Date: 08-07-2012
Utopia versus dystopia: Professional perspectives on the impact of healthcare artificial intelligence on clinical roles and skills
Publisher: Elsevier BV
Date: 2023
DOI: 10.1016/J.IJMEDINF.2022.104903
Abstract: Alongside the promise of improving clinical work, advances in healthcare artificial intelligence (AI) raise concerns about the risk of deskilling clinicians. This purpose of this study is to examine the issue of deskilling from the perspective of erse group of professional stakeholders with knowledge and/or experiences in the development, deployment and regulation of healthcare AI. We conducted qualitative, semi-structured interviews with 72 professionals with AI expertise and/or professional or clinical expertise who were involved in development, deployment and/or regulation of healthcare AI. Data analysis using combined constructivist grounded theory and framework approach was performed concurrently with data collection. Our analysis showed participants had erse views on three contentious issues regarding AI and deskilling. The first involved competing views about the proper extent of AI-enabled automation in healthcare work, and which clinical tasks should or should not be automated. We identified a cluster of characteristics of tasks that were considered more suitable for automation. The second involved expectations about the impact of AI on clinical skills, and whether AI-enabled automation would lead to worse or better quality of healthcare. The third tension implicitly contrasted two models of healthcare work: a human-centric model and a technology-centric model. These models assumed different values and priorities for healthcare work and its relationship to AI-enabled automation. Our study shows that a erse group of professional stakeholders involved in healthcare AI development, acquisition, deployment and regulation are attentive to the potential impact of healthcare AI on clinical skills, but have different views about the nature and valence (positive or negative) of this impact. Detailed engagement with different types of professional stakeholders allowed us to identify relevant concepts and values that could guide decisions about AI algorithm development and deployment.
Evidence-Based Medicine
Publisher: Elsevier
Date: 2012
Special Access Programs Warrant Further Critical Attention: Authors’ Response to Open Peer Commentaries on “Ethical Justifications for Access to Unapproved Medical Interventions: An Argument for (Limi
Publisher: Informa UK Limited
Date: 17-10-2014
Current Dilemmas in Defining the Boundaries of Disease
Publisher: Oxford University Press (OUP)
Date: 21-04-2017
DOI: 10.1093/JMP/JHX009
Abstract: Boorse's biostatistical theory states that diseases should be defined in ways that reflect disturbances of biological function and that are objective and value free. We use three ex les from contemporary medicine that demonstrate the complex issues that arise when defining the boundaries of disease: polycystic ovary syndrome, chronic kidney disease, and myocardial infarction. We argue that the biostatistical theory fails to provide sufficient guidance on where the boundaries of disease should be drawn, contains ambiguities relating to choice of reference class, and is out of step with medical processes for identifying disease boundaries. Although proponents of the biostatistical theory might regard these practical issues as irrelevant to the aim of providing a theoretical account of disease, we take them to indicate the need for a theoretical account that is adequate for current needs-including limiting new forms of medicalization that are driven by the identification of disease based on dysfunction. Our processes for determining the boundaries for disease need to recognize that there is no value-free method for making these decisions.
Details Matter—Definitions and Context Can’t Be Glossed Over When Managing Innovation
Publisher: Informa UK Limited
Date: 28-05-2019
Papers based on data concerning organs from executed prisoners should not be published: Response to Zheng and Yan
Publisher: Wiley
Date: 28-04-2017
DOI: 10.1111/LIV.13366
Strengthening the ethical assessment of placebo-controlled surgical trials: three proposals
Publisher: Springer Science and Business Media LLC
Date: 23-10-2014
Whistle-blowing in the medical curriculum: A response to Faunce
Publisher: Springer Science and Business Media LLC
Date: 2005
DOI: 10.1007/BF03351428
Against the use and publication of contemporary unethical research: the case of Chinese transplant research
Publisher: BMJ
Date: 07-2020
DOI: 10.1136/MEDETHICS-2019-106044
Abstract: Recent calls for retraction of a large body of Chinese transplant research and of Dr Jiankui He’s gene editing research has led to renewed interest in the question of publication, retraction and use of unethical biomedical research. In Part 1 of this paper, we briefly review the now well-established consequentialist and deontological arguments for and against the use of unethical research. We argue that, while there are potentially compelling justifications for use under some circumstances, these justifications fail when unethical practices are ongoing—as in the case of research involving transplantations in which organs have been procured unethically from executed prisoners. Use of such research displays a lack of respect and concern for the victims and undermines efforts to deter unethical practices. Such use also creates moral taint and renders those who use the research complicit in continuing harm. In Part 2, we distinguish three dimensions of ‘non-use’ of unethical research: non-use of published unethical research, non-publication, and retraction and argue that all three types of non-use should be upheld in the case of Chinese transplant research. Publishers have responsibilities to not publish contemporary unethical biomedical research, and where this has occurred, to retract publications. Failure to retract the papers implicitly condones the research, while uptake of the research through citations rewards researchers and ongoing circulation of the data in the literature facilitates subsequent use by researchers, policymakers and clinicians.
Is there a moral duty for doctors to trust patients?
Publisher: BMJ
Date: 04-2002
DOI: 10.1136/JME.28.2.77
Abstract: In this paper I argue that it is morally important for doctors to trust patients. Doctors' trust of patients lays the foundation for medical relationships which support the exercise of patient autonomy, and which lead to an enriched understanding of patients' interests. Despite the moral and practical desirability of trust, distrust may occur for reasons relating to the nature of medicine, and the social and cultural context within which medical care is provided. Whilst it may not be possible to trust at will, the conscious adoption of a trusting stance is both possible and warranted as the burdens of misplaced trust fall more heavily upon patients than doctors.
The ethical and epistemic roles of narrative in person-centred healthcare
Publisher: University of Buckingham Press
Date: 21-10-2020
Abstract: Positive claims about narrative approaches to healthcare suggest they could have many benefits, including supporting person-centred healthcare (PCH). Narrative approaches have also been criticised, however, on both theoretical and practical grounds. In this paper we draw on epistemological work on narrative and knowledge to develop a conception of narrative that responds to these concerns. We make a case for understanding narratives as accounts of events in which the way each event is described as influenced by the ways other events in the narrative are described. This view of narratives recognises that they can contribute knowledge of different kinds of connections between events: not just causal, and not just of patient’s perspectives. Additionally, narratives can add further epistemic value by suggesting potentially useful lines of inquiry. We take narrative approaches to healthcare to include clinicians considering both patients’ informational offerings and their own professional understandings as narratives. On this understanding, our account is able to overcome the major theoretical and practical criticisms that have been levelled against the use of narrative approaches in healthcare, and can help to explain why and how narrative approaches are consistent with PCH.
Increased prescribing of psychotropic medication for children and adolescents during the COVID ‐19 pandemic: no cause for alarm
Publisher: Wiley
Date: 08-08-2023
DOI: 10.5694/MJA2.52071
The challenge of overdiagnosis begins with its definition
Publisher: BMJ
Date: 04-03-2015
DOI: 10.1136/BMJ.H869
Reasonableness, Credibility, and Clinical Disagreement
Publisher: American Medical Association (AMA)
Date: 02-2017
DOI: 10.1001/JOURNALOFETHICS.2017.19.2.STAS1-1702
Abstract: Evidence in medicine can come from more or less trustworthy sources and be produced by more or less reliable methods, and its interpretation can be disputed. As such, it can be unclear when disagreements in medicine result from different, but reasonable, interpretations of the available evidence and when they result from unreasonable refusals to consider legitimate evidence. In this article, we seek to show how assessments of the relevance and implications of evidence are typically affected by factors beyond that evidence itself, such as our beliefs about the credibility of the speaker or source of the evidence. In evaluating evidence, there is thus a need for reflective awareness about why we accept or dismiss particular claims.
Evaluation framework to guide implementation of AI systems into healthcare settings
Publisher: BMJ
Date: 10-2021
DOI: 10.1136/BMJHCI-2021-100444
Abstract: To date, many artificial intelligence (AI) systems have been developed in healthcare, but adoption has been limited. This may be due to inappropriate or incomplete evaluation and a lack of internationally recognised AI standards on evaluation. To have confidence in the generalisability of AI systems in healthcare and to enable their integration into workflows, there is a need for a practical yet comprehensive instrument to assess the translational aspects of the available AI systems. Currently available evaluation frameworks for AI in healthcare focus on the reporting and regulatory aspects but have little guidance regarding assessment of the translational aspects of the AI systems like the functional, utility and ethical components. To address this gap and create a framework that assesses real-world systems, an international team has developed a translationally focused evaluation framework termed ‘Translational Evaluation of Healthcare AI (TEHAI)’. A critical review of literature assessed existing evaluation and reporting frameworks and gaps. Next, using health technology evaluation and translational principles, reporting components were identified for consideration. These were independently reviewed for consensus inclusion in a final framework by an international panel of eight expert. TEHAI includes three main components: capability, utility and adoption. The emphasis on translational and ethical features of the model development and deployment distinguishes TEHAI from other evaluation instruments. In specific, the evaluation components can be applied at any stage of the development and deployment of the AI system. One major limitation of existing reporting or evaluation frameworks is their narrow focus. TEHAI, because of its strong foundation in translation research models and an emphasis on safety, translational value and generalisability, not only has a theoretical basis but also practical application to assessing real-world systems. The translational research theoretic approach used to develop TEHAI should see it having application not just for evaluation of clinical AI in research settings, but more broadly to guide evaluation of working clinical systems.
A Book of Its Time
Publisher: Springer Science and Business Media LLC
Date: 03-2007
Seeking Community Views on Allocation of Scarce Resources in a Pandemic in Australia: Two Methods, Two Answers
Publisher: Springer International Publishing
Date: 2016
Conflict of interest guidelines for clinical guidelines
Publisher: AMPCo
Date: 03-2012
DOI: 10.5694/MJA11.11371
Reducing health inequalities: Ethical issues in a Scottish child health home visiting program
Publisher: CSIRO Publishing
Date: 2004
DOI: 10.1071/PY04044
Abstract: Childhood inequalities have far-reaching consequences throughout the life cycle. Reducing health inequalities for children is an important goal for health policy, grounded in justice and the desire to prevent avoidable ill health. The purpose of this article is to report and discuss the results of a qualitative study into the ethical issues identified by staff involved in a paediatric home visiting program in Scotland. One of the major aims of the visiting program was to reduce health inequalities. The results presented here relate to two issues identified by study participants: conflicting responsibilities, and ethical tensions inherent in the very task of reducing inequalities. The requirement for evaluation, meeting targets and working with partners led to conflicting responsibilities for some participants. Working to reduce health inequalities led to some paradoxical effects, and a fear that root causes of inequality were not being addressed. These results suggest that programs aimed at reducing inequalities may lead to unexpected ethical tensions. Policy-makers and those implementing such programs need to be aware of possible unintended effects and tensions experienced by staff.
Gender Inequities in Health Research: An Australian Perspective
Publisher: Oxford University Press
Date: 02-10-2008
Sex Bias in Studies Selected for Clinical Guidelines
Publisher: Mary Ann Liebert Inc
Date: 09-2011
Abstract: To determine the proportions of female participants in research studies selected to inform the development of national clinical guidelines and to assess these against the proportions of women affected by the conditions. We assessed 392 published articles, involving a total of 5.2 million participants, cited as references in five influential clinical guidelines addressing the use of antiarrhythmics, chronic fatigue, depression, diabetes, and colorectal cancer. For each article, we extracted the number of female participants to determine any discrepancies in the sex of participants and if the proportion of female participants as research subjects reflected the sex distribution of patients affected by the condition. The overall and median percentages (per study) of females per guideline were: use of antiarrhythmics (35%, median 38%), chronic fatigue (70%, median 73%), colorectal cancer (67%, median 46%), depression (66%, median 66%), and diabetes (63%, median 50%). The baseline prevalence rates used for comparison purposes were (percentage female): antiarrhythmics (60% of patients 75(+) years) chronic fatigue (66%), colorectal cancer (46%), depression (66%), and diabetes (46%). The colorectal cancer, depression, and chronic fatigue guidelines were based on research populations that accurately reflected the sex distribution of the condition in the general population. Women were slightly overrepresented in the research studies supporting the diabetes guidelines and were significantly underrepresented in the research studies supporting the guidelines on the use of antiarrhythmics. Guideline developers should be aware of and comment on the potential impact of sex. Where the evidence base is lacking, guideline developers should highlight this and, where necessary, limit their specific conclusions to populations on whom the research was performed.
Vulnerability in Research Ethics: a Way Forward
Publisher: Wiley
Date: 30-05-2013
DOI: 10.1111/BIOE.12032
Abstract: Several foundational documents of bioethics mention the special obligation researchers have to vulnerable research participants. However, the treatment of vulnerability offered by these documents often relies on enumeration of vulnerable groups rather than an analysis of the features that make such groups vulnerable. Recent attempts in the scholarly literature to lend philosophical weight to the concept of vulnerability are offered by Luna and Hurst. Luna suggests that vulnerability is irreducibly contextual and that Institutional Review Boards (Research Ethics Committees) can only identify vulnerable participants by carefully examining the details of the proposed research. Hurst, in contrast, defines the vulnerable as those especially at risk of incurring the wrongs to which all research ethics participants are exposed. We offer a more substantive conception of vulnerability than Luna but one that gives rise to a different rubric of responsibilities from Hurst's. While we understand vulnerability to be an ontological condition of human existence, in the context of research ethics, we take the vulnerable to be research subjects who are especially prone to harm or exploitation. Our analysis rests on developing a typology of sources of vulnerability and showing how distinct sources generate distinct obligations on the part of the researcher. Our account emphasizes that the researcher's first obligation is not to make the research participant even more vulnerable than they already are. To illustrate our framework, we consider two cases: that of a vulnerable population involved in international research and that of a domestic population of people with diminished capacity.
Re-evaluating confidentiality: using patient information in teaching and publications
Publisher: Cambridge University Press (CUP)
Date: 03-2005
DOI: 10.1192/APT.11.2.115
Abstract: Case studies used in psychiatry for teaching and learning can include large amounts of personal information, and most medical journals refuse to publish case material without patient consent. However, not all patients are capable of consenting and maintaining anonymity is not always successful. Disclosure of personal information without consent can cause a sense of violation, but a principle of non-violation rigorously applied would prohibit the use of such material without consent, even if the patient is completely unidentifiable. A public interest argument can be made for using patient information for teaching purposes. Furthermore, a limited case can be made for using, and even publishing, some cases without consent, e.g. those requiring urgent public discussion or concerning people who are incapable of giving consent. Thus, an argument can be put forward for relaxing to this limited degree the demand for patient consent to publish case material.
Bioethics and activism: A natural fit?
Publisher: Wiley
Date: 08-02-2019
DOI: 10.1111/BIOE.12558
Abstract: Bioethics is a practically oriented discipline that developed to address pressing ethical issues arising from developments in the life sciences. Given this inherent practical bent, some form of advocacy or activism seems inherent to the nature of bioethics. However, there are potential tensions between being a bioethics activist, and academic ideals. In academic bioethics, scholarship involves reflection, rigour and the embrace of complexity and uncertainty. These values of scholarship seem to be in tension with being an activist, which requires pragmatism, simplicity, certainty and, above all, action. In this paper I explore this apparent dichotomy, using the case ex le of my own involvement in international efforts to end forced organ harvesting from prisoners of conscience in China. I conclude that these tensions can be managed and that academic bioethics requires a willingness to be activist.
Conflicts of interest in divisions of general practice
Publisher: BMJ
Date: 12-2006
Evidence-based Medicine and Equity: The Exclusion of Disadvantaged Groups
Publisher: Springer Berlin Heidelberg
Date: 2005
Analysing the ethics of breast cancer overdiagnosis: a pathogenic vulnerability
Publisher: Springer Science and Business Media LLC
Date: 20-07-2018
DOI: 10.1007/S11019-018-9852-Z
Abstract: Breast cancer screening aims to help women by early identification and treatment of cancers that might otherwise be life-threatening. However, breast cancer screening also leads to the detection of some cancers that, if left undetected and untreated, would not have damaged the health of the women concerned. At the time of diagnosis, harmless cancers cannot be identified as non-threatening, therefore women are offered invasive breast cancer treatment. This phenomenon of identifying (and treating) non-harmful cancers is called overdiagnosis. Overdiagnosis is morally problematic as it leads to overall patient harm rather than benefit. Further, breast cancer screening is offered in a context that exaggerates cancer risk and screening benefit, minimises risk of harm and impedes informed choice. These factors combine to create pathogenic vulnerability. That is, breast cancer screening exacerbates rather than reduces women's vulnerability and undermines women's agency. This paper provides an original way of conceptualising agency-supporting responses to the harms of breast cancer overdiagnosis through application of the concept of pathogenic vulnerability.
Hips, Knees, and Hernia Mesh: When Does Gender Matter in Surgery?
Publisher: University of Toronto Press Inc. (UTPress)
Date: 02-2017
Abstract: This paper draws attention to gendered dimensions of surgical device failure, focusing on two case studies—hernia repair mesh for pelvic organ prolapse, and metal-on-metal hip implants. We explore possible reasons for higher rates of harms to women, including systematic biases in health research and device regulation. Given that these factors are readily identifiable, we look to feminist scholarship to understand what might maintain them, including the role of cultural factors within surgery, such as gendered communication patterns and sexism. We then canvas potential measures to mitigate the increased risk of harms faced by women who use implanted devices.
New insights into smoking cessation question the effectiveness of nicotine replacement therapy
Publisher: Elsevier BV
Date: 11-2016
Beneficence in general practice: an empirical investigation.
Publisher: BMJ
Date: 10-1999
DOI: 10.1136/JME.25.5.388
Abstract: To study and report the attitudes of patients and general practitioners (GPs) concerning the obligation of doctors to act for the good of their patients, and to provide a practical account of beneficence in general practice. Semi-structured interviews administered to GPs and patients. Participants randomly recruited from an age and gender stratified list of GPs in a geographically defined region of South Australia. The s le comprised twenty-one general practitioners and seventeen patients recruited by participating GPs. In practice, acting for the good of the patient not only accommodates the views of patients and GPs on expertise and knowing best, but also responds to the particular details of the clinical situation. Patients had a complex understanding of the expertise necessary for medical practice, describing a contextual domain in which they were expert, and which complemented the scientific expertise of their GPs. General practitioners identified multiple sources for their expertise, of which experience was the most significant. The role of the GP included responding to in idual patients and particular clinical problems and ranged from the assumption of responsibility through to the proffering of medical advice. This study found that GPs acting for the good of their patients covered a variety of GP actions and patient preferences. Beneficence was not justified by presumed patient vulnerability or the inability of patients to understand medical problems, but furthered through a recognition of the different areas of expertise contributed by both parties to the consultation.
Addressing Deficits and Injustices: The Potential Epistemic Contributions of Patients to Research
Publisher: Springer Science and Business Media LLC
Date: 08-06-2016
DOI: 10.1007/S10728-016-0323-5
Abstract: Patient or public involvement (PPI) in health research is increasingly expected as a matter of policy. In theory, PPI can contribute both to the epistemic aims intrinsic to research (generating knowledge), and to extrinsically valued features of research such as social inclusion and transparency. In practice, the aims of PPI have not always been clear, although there has been a tendency to encourage the involvement of so-called ordinary people who are regarded as representative of an assumed patient perspective. In this paper we focus on the epistemic potential of PPI, using theoretical work in epistemology to develop a nuanced account of patients' experiential knowledge and how this might contribute directly to conceptual development, hypothesis generation and data interpretation. We also consider how some features of health research pose barriers to this kind of epistemic contribution. Drawing on Miranda Fricker's idea of testimonial injustice, we explore how disciplinary indicators of credibility in clinical and academic health research contexts might be wrongly applied to those involved in PPI, undermining their potential to contribute. Finally we argue for a range of strategies to maximize opportunities for patients to engage with research teams and make epistemologically significant contributions to research.
Slab breakoff: Insights from 3D thermo-mechanical analogue modelling experiments
Publisher: Elsevier BV
Date: 2017
Reply to Chen et al.
Publisher: Frontiers Media SA
Date: 27-06-2020
DOI: 10.1111/TRI.13632
Addressing Within-Role Conflicts of Interest in Surgery
Publisher: Springer Science and Business Media LLC
Date: 22-03-2013
DOI: 10.1007/S11673-013-9431-1
Abstract: In this paper we argue that surgeons face a particular kind of within-role conflict of interests, related to innovation. Within-role conflicts occur when the conflicting interests are both legitimate goals of professional activity. Innovation is an integral part of surgical practice but can create within-role conflicts of interest when innovation compromises patient care in various ways, such as by extending indications for innovative procedures or by failures of informed consent. The standard remedies for conflicts of interest are transparency and recusal, which are unlikely to address this conflict, in part because of unconscious bias. Alternative systemic measures may be more effective, but these require changes in the culture of surgery and accurate identification of surgical innovation.
Challenging the epistemological foundations of EBM : what kind of knowledge does clinical practice require?
Publisher: Wiley
Date: 21-09-2012
DOI: 10.1111/J.1365-2753.2012.01905.X
Abstract: This paper raises questions about the epistemological foundations of evidence-based medicine (EBM). We argue that EBM is based upon reliabilist epistemological assumptions, and that this is appropriate - we should focus on identifying the most reliable processes for generating and collecting medical knowledge. However, we note that this should not be reduced to narrow questions about which research methodologies are the best for gathering evidence. Reliable processes for generating medical evidence might lie outside of formal research methods. We also question the notion of the knower that is assumed by EBM. We argue that EBM assumes an enlightenment conception of knowers as autonomous, substitutable in iduals. This conception is troubled by the way that clinicians learn the role of anecdote in health care and the role of patient choice, all of which bring into play features of clinicians and patients as situated in iduals with particular backgrounds and experiences. EBM's enlightenment conception of the knower is also troubled by aspects of the way evidence is produced. Given these limitations, we argue that EBM should retain its reliabilist bent, but should look beyond formal research methodologies in identifying processes that yield reliable evidence for clinical practice. We suggest looking to feminist epistemology, with its focus on the standpoints of in idual situated knowers, and the role of social context in determining what counts as knowledge.
Perceptions of embryo status and embryo use in an Australian community
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.RBMO.2012.01.014
Abstract: Increasingly, important areas of medical therapy and research rely on the donation and use of human embryos. Yet their use is commonly determined by community tolerance and ethico-legal regulation. The aim of this study was to explore the views of an Australian community about what an embryo is, how it should be used and who should make disposition decisions. The findings of a large representative population survey showed that most participants thought of an embryo as human or potentially human but that this did not affect a majority community view that embryos should be used rather than discarded. This study also found ergent views about what the community perceived to be acceptable uses of embryos. The majority perceived the couple as having the authority to make a disposition decision. Women held different views to men across all three questions. The way an embryo was perceived related significantly to how it should be used and who should decide its disposition. These differences and relationships should be considered when developing clinic practices and ethico-legal frameworks to regulate embryo use in science or treatment.
Evidence based medicine and justice: a framework for looking at the impact of EBM upon vulnerable or disadvantaged groups
Publisher: BMJ
Date: 04-2004
Abstract: This article examines the implicit promises of fairness in evidence based medicine (EBM), namely to avoid discrimination through objective processes, and to distribute effective treatments fairly. The relationship between EBM and vulnerable groups (such as those disadvantaged by virtue of poverty, ethnicity, age, gender, mental health problems or similar) is examined. Several aspects of EBM are explored: the way evidence is created (commissioning and design of, and participation in research), and the way evidence is applied in clinical care and health policy. This analysis suggests that EBM turns our attention away from social and cultural factors that influence health and focuses on a narrow biomedical and in idualistic model of health. Those with the greatest burden of ill health are left disenfranchised, as there is little research that is relevant to them, there is poor access to treatments, and attention is erted away from activities that might have a much greater impact on their health.
Gender agenda: let's track women's trial participation
Publisher: Springer Science and Business Media LLC
Date: 06-2010
DOI: 10.1038/4651005D
Lightweight and efficient octave convolutional neural network for fire recognition
Publisher: IEEE
Date: 11-2019
Revisiting the equity debate in COVID-19: ICU is no panacea
Publisher: BMJ
Date: 22-06-2020
DOI: 10.1136/MEDETHICS-2020-106460
Abstract: Throughout March and April 2020, debate raged about how best to allocate limited intensive care unit (ICU) resources in the face of a growing COVID-19 pandemic. The debate was dominated by utility-based arguments for saving the most lives or life-years. These arguments were tempered by equity-based concerns that triage based solely on prognosis would exacerbate existing health inequities, leaving disadvantaged patients worse off. Central to this debate was the assumption that ICU admission is a valuable but scarce resource in the pandemic context. In this paper, we argue that the concern about achieving equity in ICU triage is problematic for two reasons. First, ICU can be futile and prolong or exacerbate suffering rather than ameliorate it. This may be especially true in patients with COVID-19 with emerging data showing that most who receive access to a ventilator will still die. There is no value in admitting patients with poor prognostic indicators to ICU to meet an equity target when intensive critical care is contrary to their best interests. Second, the focus on ICU admission shifts focus away from important aspects of COVID-19 care where there is greater opportunity for mitigating suffering and enhancing equitable care. We propose that the focus on equity concerns during the pandemic should broaden to include providing all people who need it with access to the highest possible standard of end-of-life care. This requires attention to culturally safe care in the following interlinked areas: palliative care, communication and decision support and advanced care planning.
The ethical, legal and social implications of using artificial intelligence systems in breast cancer care
Publisher: Elsevier BV
Date: 02-2020
Defining, Estimating, and Communicating Overdiagnosis in Cancer Screening
Publisher: American College of Physicians
Date: 20-11-2018
DOI: 10.7326/L18-0513
Comment on “Lung Transplantation for Elderly Patients With End-stage COVID–19 Pneumonia”
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-10-2020
The Oxford textbook of clinical research ethics Ezekiel Emanuel, Christine Grady, Robert Crouch, Reidar Lie, Franklin Miller, David Wendler, Oxford University Press, 2008. No. of pages: 848. Price: $1
Publisher: Wiley
Date: 02-01-2021
DOI: 10.1002/SIM.4221
Rethinking the Vulnerability of Minority Populations in Research
Publisher: American Public Health Association
Date: 12-2013
Abstract: The Belmont Report, produced in 1979 by a United States government commission, includes minority populations among its list of vulnerable research participants. In this article, we consider some previous attempts to understand the vulnerability of minorities in research, and then provide our own account. First we examine the question of the representation of minorities in research. Then we argue that the best understanding of minorities, vulnerability, and research will begin with a broad understanding of the risk of in idual members of minority groups to poor health outcomes. We offer a typology of vulnerability to help with this task. Finally, we show how researchers should be guided by this broad analysis in the design and execution of their research.
Papers based on data concerning organs from executed prisoners should not be published
Publisher: Wiley
Date: 30-01-2017
DOI: 10.1111/LIV.13348
Joint issues – conflicts of interest, the ASR hip and suggestions for managing surgical conflicts of interest
Publisher: Springer Science and Business Media LLC
Date: 15-08-2014
Whose autonomy? Which choice? A study of GPs' attitudes towards patient autonomy in the management of low back pain
Publisher: Oxford University Press (OUP)
Date: 04-2002
Abstract: Respect for patient autonomy is an important ethical principle for medical practitioners however, previous investigators have reported inconsistent attitudes amongst practitioners towards respect for patient autonomy. This study in empirical ethics used qualitative methods to investigate GPs' attitudes towards respect for patient autonomy in consultations for low back pain. The aim of this study was to explore GPs' attitudes towards respect for patient autonomy by analysing attitudes towards four issues in the management of low back pain which raise ethical and practical dilemmas. Participants were 21 GPs selected from general practice in South Australia by stratified, purposive s ling aimed at maximizing ersity. Semi-structured interviews were tape-recorded, transcribed and analysed using codes developed from the transcripts, with additional theoretical codes. In the analysis, attitudes towards patient autonomy in the four issues were characterized as autonomy-respecting, intermediate or controlling. The results showed in idual inconsistencies in GPs' attitudes towards respect for patient autonomy. For ex le, the majority of GPs accepted patient autonomy in the use of complementary therapies, but were controlling with regard to the use of analgesics. Attitudes to duration of time off work were spread evenly, whilst controlling attitudes towards use of X-rays were modified by patient requests for X-rays. These results suggest that GP attitudes towards patient autonomy are modified by ethical and pragmatic factors, and vary depending upon the nature of the issue in question.
Evaluation of artificial intelligence clinical applications: Detailed case analyses show value of healthcare ethics approach in identifying patient care issues
Publisher: Wiley
Date: 28-05-2021
DOI: 10.1111/BIOE.12885
Abstract: This paper is one of the first to analyse the ethical implications of specific healthcare artificial intelligence (AI) applications, and the first to provide a detailed analysis of AI‐based systems for clinical decision support. AI is increasingly being deployed across multiple domains. In response, a plethora of ethical guidelines and principles for general AI use have been published, with some convergence about which ethical concepts are relevant to this new technology. However, few of these frameworks are healthcare‐specific, and there has been limited examination of actual AI applications in healthcare. Our ethical evaluation identifies context‐ and case‐specific healthcare ethical issues for two applications, and investigates the extent to which the general ethical principles for AI‐assisted healthcare expressed in existing frameworks capture what is most ethically relevant from the perspective of healthcare ethics. We provide a detailed description and analysis of two AI‐based systems for clinical decision support (Painchek ® and IDx‐DR). Our results identify ethical challenges associated with potentially deceptive promissory claims, lack of patient and public involvement in healthcare AI development and deployment, and lack of attention to the impact of AIs on healthcare relationships. Our analysis also highlights the close connection between evaluation and technical development and reporting. Critical appraisal frameworks for healthcare AIs should include explicit ethical evaluation with benchmarks. However, each application will require scrutiny across the AI life‐cycle to identify ethical issues specific to healthcare. This level of analysis requires more attention to detail than is suggested by current ethical guidance or frameworks.
Populações especiais: vulnerabilidade e proteção
Publisher: Fundacao Oswaldo Cruz
Date: 08-12-2008
The tangled web of medical and commercial interests
Publisher: Wiley
Date: 26-02-2007
Vulnerability
Publisher: Cambridge University Press
Date: 24-06-2021
Ethical Justifications for Access to Unapproved Medical Interventions: An Argument for (Limited) Patient Obligations
Publisher: Informa UK Limited
Date: 17-10-2014
DOI: 10.1080/15265161.2014.957416
Abstract: Many health care systems include programs that allow patients in exceptional circumstances to access medical interventions of as yet unproven benefit. In this article we consider the ethical justifications for-and demands on-these special access programs (SAPs). SAPs have a compassionate basis: They give patients with limited options the opportunity to try interventions that are not yet approved by standard regulatory processes. But while they signal that health care systems can and will respond to in idual suffering, SAPs have several disadvantages, including the potential to undermine regulatory and knowledge-generation structures that constitute significant public goods. The "balance" between these considerations depends in part on how broadly SAPs are used, but also on whether SAPs can be made to contribute to the generation of knowledge about the effects of health interventions. We argue that patients should usually be required to contribute outcome data while using SAPs.
Compliance with ethical standards in the reporting of donor sources and ethics review in peer-reviewed publications involving organ transplantation in China: a scoping review
Publisher: BMJ
Date: 02-2019
DOI: 10.1136/BMJOPEN-2018-024473
Abstract: The objective of this study is to investigate whether papers reporting research on Chinese transplant recipients comply with international professional standards aimed at excluding publication of research that: (1) involves any biological material from executed prisoners (2) lacks Institutional Review Board (IRB) approval and (3) lacks consent of donors. Scoping review based on Arksey and O’Mallee’s methodological framework. Medline, Scopus and Embase were searched from January 2000 to April 2017. We included research papers published in peer-reviewed English-language journals reporting on outcomes of research involving recipients of transplanted hearts, livers or lungs in mainland China. Data were extracted by in idual authors working independently following training and benchmarking. Descriptive statistics were compiled using Excel. 445 included studies reported on outcomes of 85 477 transplants. 412 (92.5%) failed to report whether or not organs were sourced from executed prisoners and 439 (99%) failed to report that organ sources gave consent for transplantation. In contrast, 324 (73%) reported approval from an IRB. Of the papers claiming that no prisoners’ organs were involved in the transplants, 19 of them involved 2688 transplants that took place prior to 2010, when there was no volunteer donor programme in China. The transplant research community has failed to implement ethical standards banning publication of research using material from executed prisoners. As a result, a large body of unethical research now exists, raising issues of complicity and moral hazard to the extent that the transplant community uses and benefits from the results of this research. We call for retraction of this literature pending investigation of in idual papers.
Advancing Health Promotion in Australian General Practice
Publisher: SAGE Publications
Date: 06-2001
DOI: 10.1177/109019810102800309
Abstract: Health promotion activities, while having the potential to prevent disease and decrease the burden of ill health, often play a minor role in the health care offered by general practitioners. There are several identified barriers to the involvement of Australian general practitioners in health promotion. These include structural barriers and barriers within the practice setting, in idual practitioner and patient factors, and difficulties in evaluating the outcomes of health promotion activities. This article explores the barriers to the engagement of Australian general practice with health promotion and reviews several recent initiatives that have the potential to increase the health promotion activities of general practitioners. These initiatives act at the level of the in idual practitioner, the practice, and in the community. Despite the lack of a coordinated national approach, these strategies form an important development in general practice.
Confidentiality and the ethics of medical ethics
Publisher: BMJ
Date: 08-2003
DOI: 10.1136/JME.29.4.220
Abstract: In this paper we consider the use of cases in medical ethics research and teaching. To date, there has been little discussion about the consent or confidentiality requirements that ought to govern the use of cases in these areas. This is in marked contrast to the requirements for consent to publish cases in clinical journals, or to use personal information in research. There are a number of reasons why it might be difficult to obtain consent to use cases in ethics. Many cases concern people who are incompetent, and thus unable to give consent. Often the material is of a sensitive nature, it is not clear who should give consent, or the ethicist has no access to those involved. We argue that the use of cases in ethics research and teaching can be justified by appeal to the public interest argument, and suggest a number of areas for discussion and clarification.
Overdiagnosis: one concept, three perspectives, and a model
Publisher: Springer Science and Business Media LLC
Date: 11-01-2021
Reducing Shared Vulnerabilities to Data Misuse
Publisher: Cambridge University Press
Date: 30-09-2019
Sex and gender in health research: updating policy to reflect evidence
Publisher: AMPCo
Date: 24-11-2020
DOI: 10.5694/MJA2.50426
Requiring influenza vaccination for health care workers
Publisher: American Public Health Association
Date: 2009
Abstract: Annual influenza vaccination for health care workers has the potential to benefit health care professionals, their patients, and their families by reducing the transmission of influenza in the health care setting. Furthermore, staff vaccination programs are cost-effective for health care institutions because of reduced staff illness and absenteeism. Despite international recommendations and strong ethical arguments for annual influenza immunization for health care professionals, staff utilization of vaccination remains low. We have analyzed the ethical implications of a variety of efforts to increase vaccination rates, including mandatory influenza vaccination. A program of incentives and sanctions may increase health care worker compliance with fewer ethical impediments than mandatory vaccination.
Letter to the Editor: New Study Raises Questions about Effectiveness of Nicotine Replacement Therapy
Publisher: Oxford University Press (OUP)
Date: 12-06-2016
DOI: 10.1093/PHE/PHW027
Medical AI and human dignity: Contrasting perceptions of human and artificially intelligent (AI) decision making in diagnostic and medical resource allocation contexts
Publisher: Elsevier BV
Date: 08-2022
Autonomy, vulnerability and capacity: a philosophical appraisal of the Mental Capacity Act
Publisher: Cambridge University Press (CUP)
Date: 19-02-2013
DOI: 10.1017/S174455231200047X
Abstract: The UK Mental Capacity Act provides an important legislative framework for protecting persons who are vulnerable, by virtue of partial or total lack of capacity, from abuse, coercion, exploitation, disrespect or unwarranted intrusions on their privacy and liberty. In this article we argue, however, that in order to effectively implement the Act's governing principles and promote the autonomy of persons whose capacities are impaired, health and social welfare professionals must go beyond a primarily cognitive approach to capacity assessment and refer to a range of more demanding autonomy conditions relating to authenticity, diachronic coherence and consistency, accountability to others, and affective attitudes towards oneself. We suggest that these conditions are in fact implicit in the guidelines, scenarios and practical advice contained in the Act's accompanying Code of Practice . To ground our analysis, we discuss two cases of end-of-life decision-making, and consider how these cases might have been assessed had the Mental Capacity Act been applied. We also address the question of whether the conditions for autonomy we identify raise the bar too high to be met by persons who are vulnerable because their capacity is partially compromised.
Physicians and the pharmaceutical industry
Publisher: Wiley
Date: 22-12-2005
Getting Clearer About Surgical Innovation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2015
COVID-19 and transplant research from China: An ethical dilemma
Publisher: Elsevier BV
Date: 06-2020
THE ETHICS OF UTERUS TRANSPLANTATION
Publisher: Wiley
Date: 04-07-2011
DOI: 10.1111/J.1467-8519.2011.01897.X
Abstract: Human uterus transplantation (UTx) is currently under investigation as a treatment for uterine infertility. Without a uterus transplant, the options available to women with uterine infertility are adoption or surrogacy only the latter has the potential for a genetically related child. UTx will offer recipients the chance of having their own pregnancy. This procedure occurs at the intersection of two ethically contentious areas: assisted reproductive technologies (ART) and organ transplantation. In relation to organ transplantation, UTx lies with composite tissue transplants such as face and limb grafts, and shares some of the ethical concerns raised by these non-life saving procedures. In relation to ART, UTx represents one more avenue by which a woman may seek to meet her reproductive goals, and as with other ART procedures, raises questions about the limits of reproductive autonomy. This paper explores the ethical issues raised by UTx with a focus on the potential gap between women's desires and aspirations about pregnancy and the likely functional outcomes of successful UTx.
Fragility, uncertainty, and healthcare
Publisher: Springer Science and Business Media LLC
Date: 02-2016
DOI: 10.1007/S11017-016-9350-3
Abstract: Medicine seeks to overcome one of the most fundamental fragilities of being human, the fragility of good health. No matter how robust our current state of health, we are inevitably susceptible to future illness and disease, while current disease serves to remind us of various frailties inherent in the human condition. This article examines the relationship between fragility and uncertainty with regard to health, and argues that there are reasons to accept rather than deny at least some forms of uncertainty. In situations of current ill health, both patients and doctors seek to manage this fragility through diagnoses that explain suffering and provide some certainty about prognosis as well as treatment. However, both diagnosis and prognosis are inevitably uncertain to some degree, leading to questions about how much uncertainty health professionals should disclose, and how to manage when diagnosis is elusive, leaving patients in uncertainty. We argue that patients can benefit when they are able to acknowledge, and appropriately accept, some uncertainty. Healthy people may seek to protect the fragility of their good health by undertaking preventative measures including various tests and screenings. However, these attempts to secure oneself against the onset of biological fragility can cause harm by creating rather than eliminating uncertainty. Finally, we argue that there are good reasons for accepting the fragility of health, along with the associated uncertainties.
Gender inequities in organ donation and transplantation
Publisher: Routledge
Date: 24-06-2022
Reporting guideline for the early-stage clinical evaluation of decision support systems driven by artificial intelligence: DECIDE-AI
Publisher: Springer Science and Business Media LLC
Date: 05-2022
DOI: 10.1038/S41591-022-01772-9
Abstract: A growing number of artificial intelligence (AI)-based clinical decision support systems are showing promising performance in preclinical, in silico evaluation, but few have yet demonstrated real benefit to patient care. Early-stage clinical evaluation is important to assess an AI system's actual clinical performance at small scale, ensure its safety, evaluate the human factors surrounding its use and pave the way to further large-scale trials. However, the reporting of these early studies remains inadequate. The present statement provides a multi-stakeholder, consensus-based reporting guideline for the Developmental and Exploratory Clinical Investigations of DEcision support systems driven by Artificial Intelligence (DECIDE-AI). We conducted a two-round, modified Delphi process to collect and analyze expert opinion on the reporting of early clinical evaluation of AI systems. Experts were recruited from 20 pre-defined stakeholder categories. The final composition and wording of the guideline was determined at a virtual consensus meeting. The checklist and the Explanation & Elaboration (E&E) sections were refined based on feedback from a qualitative evaluation process. In total, 123 experts participated in the first round of Delphi, 138 in the second round, 16 in the consensus meeting and 16 in the qualitative evaluation. The DECIDE-AI reporting guideline comprises 17 AI-specific reporting items (made of 28 subitems) and ten generic reporting items, with an E&E paragraph provided for each. Through consultation and consensus with a range of stakeholders, we developed a guideline comprising key items that should be reported in early-stage clinical studies of AI-based decision support systems in healthcare. By providing an actionable checklist of minimal reporting items, the DECIDE-AI guideline will facilitate the appraisal of these studies and replicability of their findings.
Feminism and public health ethics
Publisher: BMJ
Date: 06-2006
Précising definitions as a way to combat overdiagnosis
Publisher: Wiley
Date: 30-03-2018
DOI: 10.1111/JEP.12909
Abstract: Roughly, overdiagnosis (ODx) occurs when people are harmed by receiving diagnoses (often accompanied by interventions) that do not benefit them, usually because the diagnosed conditions do not pose a threat to their health. ODx is a theoretical as well as a practical problem as it relates to definitions of disease. Elsewhere, it has been argued that disease is a vague concept and that this vagueness may contribute to ODx. In response, we develop a stipulative or précising definition of disease, for the specific purpose of decreasing or preventing ODx. We call this disease
Partnerships between academic psychiatry and the pharmaceutical industry (multiple letters) [1]
Publisher: SAGE Publications
Date: 03-2005
Social Justice and Pandemic Influenza Planning: The Role of Communication Strategies
Publisher: Oxford University Press (OUP)
Date: 11-2008
DOI: 10.1093/PHE/PHN031
Confidentiality
Publisher: Wiley
Date: 02-2013
DOI: 10.1002/9781444367072.WBIEE546
Abstract: “Confidentiality” refers to the duty not to disclose private information to other people. It is often associated with healthcare professionals’ duty to safeguard patient information, but confidentiality extends to all personal information provided in circumstances or relationships which imply that the information will not be disclosed to others. In some relationships the duty to maintain confidentiality is regarded as absolute (priests in the confessional, for ex le). In others, although the duty is a strong one, it is not absolute and some disclosures may be required (e.g., by law) or justified with reference to other duties (e.g., protection of the public interest). This essay will concentrate on confidentiality as it applies to healthcare practice. It will look at why there is a duty, various justifications for breaking confidentiality, and difficult cases.
Ethics, Pandemic Planning and Communications
Publisher: Springer Science and Business Media LLC
Date: 10-2006
DOI: 10.1007/BF03351458
Justice in Health Research: What is the Role of Evidence-Based Medicine?
Publisher: Project MUSE
Date: 2009
DOI: 10.1353/PBM.0.0082
Abstract: Evidence-based medicine (EBM) aims to facilitate access to up-to-date, accurate information about the effectiveness of medical interventions, in order to improve human health. The quality of the research results available for EBM processes of synthesis and meta-analysis is critical to this process. If there are distortions or corruptions in the research process, EBM becomes a false prophet, collecting and propagating unreliable results. This article examines flaws in the current processes of research production and the implications of these for justice and for vulnerable patients, and explores possible solutions.
Trust in the health system: An analysis and extension of the social theories of Giddens and Luhmann
Publisher: Informa UK Limited
Date: 08-2008
Reply to Ackermann
Publisher: Oxford University Press (OUP)
Date: 14-01-2016
DOI: 10.1093/PHE/PHV039
Casting the net too wide on overdiagnosis: benefits, burdens and non-harmful disease
Publisher: BMJ
Date: 08-08-2002
Equity Under the Knife: Justice and Evidence in Surgery
Publisher: Wiley
Date: 10-06-2012
DOI: 10.1111/J.1467-8519.2012.01980.X
Abstract: Surgery is an increasingly common and expensive mode of medical intervention. The ethical dimensions of the surgeon-patient relationship, including respect for personal autonomy and informed consent, are much discussed but broader equity issues have not received the same attention. This paper extends the understanding of surgical ethics by considering the nature of evidence in surgery and its relationship to a just provision of healthcare for in iduals and their populations.
Ethical Issues Across the IDEAL Stages of Surgical Innovation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2019
Open access as a requirement for research ethics committee approval
Publisher: BMJ
Date: 14-10-2015
DOI: 10.1136/BMJ.H5299
A New Approach to Defining Disease
Publisher: Oxford University Press (OUP)
Date: 09-07-2018
DOI: 10.1093/JMP/JHY014
Abstract: In this paper, we examine recent critiques of the debate about defining disease, which claim that its use of conceptual analysis embeds the problematic assumption that the concept is classically structured. These critiques suggest, instead, developing plural stipulative definitions. Although we substantially agree with these critiques, we resist their implication that no general definition of "disease" is possible. We offer an alternative, inductive argument that disease cannot be classically defined and that the best explanation for this is that the concept is structured as a cluster. We further argue that we do not need to reject the possibility of defining the general concept "disease" to legitimate developing stipulative definitions of disease that are relative to particular purposes. A cluster definition of disease is compatible with contextually motivated definitions, which may be considered précisifications of the more general cluster concept.
The Ethics of Uterus Transplantation
Publisher: Routledge
Date: 09-09-2020
Towards a practical definition of professional behaviour
Publisher: BMJ
Date: 25-03-2010
Abstract: Professionalism remains a challenging part of the medical curriculum to define, teach and evaluate. We suggest that one way to meet these challenges is to clarify the definition of professionalism and distinguish this from medical ethics. Our analysis is two staged. First, we reviewed influential definitions of professionalism and separated elements relating to (a) ethico-legal competencies, (b) clinical competence and (c) professionalism. In reference to professionalism, we then distinguished between aspirational virtues/values and specific behaviours. From these, we develop a working definition of medical professional behaviour consisting of six domains of behaviour: responsibility relationships with and respect for patients probity and honesty self awareness and capacity for reflection collaboration and team work and care of colleagues. Second, we tested this working definition against empirical data concerning disciplinary action against practising doctors using (a) sources in the literature and (b) an original analysis of complaints received by the Medical Board of South Australia. Our empirical analysis supports the relevance of four of the six potential domains: responsibility relationships with and respect for patients probity and honesty self awareness and capacity for reflection. There are additional reasons for retaining 'collaboration and team work' in the medical professional behaviour curriculum but 'care of colleagues' may be better addressed in the ethico-legal curriculum. Our definition of professional behaviour is consistent with the theoretical literature, captures behaviours that predict future complaints against practitioners and is consistent with current complaints about professionalism in South Australian practitioners. This definition can further the teaching and assessing of professional behaviour in medical schools.
Are the Ethics of Synthetic Biology Fit for Purpose? A Case Study of Artemisinin [Point of View]
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 05-2022
Ethical issues raised by thyroid cancer overdiagnosis: A matter for public health?
Publisher: Wiley
Date: 13-09-2017
DOI: 10.1111/BIOE.12383
Abstract: Current practices of identifying and treating small indolent thyroid cancers constitute an important but in some ways unusual form of overdiagnosis. Overdiagnosis refers to diagnoses that generally harm rather than benefit patients, primarily because the diagnosed condition is not a harmful form of disease. Patients who are overdiagnosed with thyroid cancer are harmed by the psycho-social impact of a cancer diagnosis, as well as treatment interventions such partial or total thyroidectomy, lifelong thyroid replacement hormone, monitoring, surgical complications and other side effects. These harms seem to outweigh any putative benefit of knowing about a cancer that would not have caused problems if left undiscovered. In addition to harms to patients, thyroid cancer overdiagnosis leads to significant opportunity costs at a societal level, due to costs of diagnosis and treatment. Unlike many other overdiagnosed cancers, accurate risk stratification is possible with thyroid cancer. At the in idual patient level, use of this risk information might support informed choice and/or shared decision-making, as mandated by clinical ethics frameworks. And this approach might, to some extent, help to reduce rates of diagnosis and intervention. In practice, however, it is unlikely to stem the rising incidence and associated harms and costs of overdiagnosed thyroid cancer, especially in situations where health professionals have conflicts of interest. We argue in this article that thyroid cancer overdiagnosis may be usefully understood as a public health problem, and that some public health approaches will be readily justifiable and are more likely to be effective in minimising its harms.
Ethical challenges of innovative surgery: a response to the IDEAL recommendations
Publisher: Elsevier BV
Date: 09-2010
Australian women's judgements about using artificial intelligence to read mammograms in breast cancer screening
Publisher: SAGE Publications
Date: 2023
DOI: 10.1177/20552076231191057
Abstract: Mammographic screening for breast cancer is an early use case for artificial intelligence (AI) in healthcare. This is an active area of research, mostly focused on the development and evaluation of in idual algorithms. A growing normative literature argues that AI systems should reflect human values, but it is unclear what this requires in specific AI implementation scenarios. Our objective was to understand women's values regarding the use of AI to read mammograms in breast cancer screening. We ran eight online discussion groups with a total of 50 women, focused on their expectations and normative judgements regarding the use of AI in breast screening. Although women were positive about the potential of breast screening AI, they argued strongly that humans must remain as central actors in breast screening systems and consistently expressed high expectations of the performance of breast screening AI. Women expected clear lines of responsibility for decision-making, to be able to contest decisions, and for AI to perform equally well for all programme participants. Women often imagined both that AI might replace radiographers and that AI implementation might allow more women to be screened: screening programmes will need to communicate carefully about these issues. To meet women's expectations, screening programmes should delay implementation until there is strong evidence that the use of AI systems improves screening performance, should ensure that human expertise and responsibility remain central in screening programmes, and should avoid using AI in ways that exacerbate inequities.
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