Ethics

伦理学
  • 文章类型: Journal Article
    3D扫描和打印技术正在迅速发展,并为在大体解剖学教育中使用提供了巨大的潜力。使用人体捐赠者创建数字扫描和3D打印模型引起了人们对捐赠者知情同意的道德担忧。潜在的商品化,以及获取和存储潜在可识别的解剖复制品。本文回顾了现有文献,描述了这些新兴技术应用的伦理意义,现有已发布的管理和共享2D成像的最佳实践,以及目前学术界捐赠计划对这些最佳实践的坚持。我们得出的结论是,知情同意对于人类供体和人类供体衍生材料的所有用途至关重要,并且目前在遵守已建立的管理和共享来自人类供体的3D数字内容的最佳实践方面存在相当大的差异。我们提出了一个新的简化框架,用于对捐赠者衍生的教材以及数字共享所需的相应同意级别进行分类。该框架提出了相对于广义的人类捐赠者和人类捐赠者来源材料的同等最低程度的特定同意,不同的教材(即人造塑料模型)。同样,我们建议,集体前进的道路应该包括建立一个集中的,数字人类捐赠者3D内容的安全存储库,作为一种积累机制,调节,并控制适当同意的人类捐赠者衍生的3D数字内容的分发,这也将增加道德创造的人类衍生教材的可用性,同时阻止商品化。
    3D scanning and printing technologies are quickly evolving and offer great potential for use in gross anatomical education. The use of human body donors to create digital scans and 3D printed models raises ethical concerns about donor informed consent, potential commodification, and access to and storage of potentially identifiable anatomical reproductions. This paper reviews available literature describing ethical implications for the application of these emerging technologies, existing published best practices for managing and sharing 2D imaging, and current adherence to these best practices by academic body donation programs. We conclude that informed consent is paramount for all uses of human donor and human donor-derived materials and that currently there is considerable diversity in adherence to established best practices for the management and sharing of 3D digital content derived from human donors. We propose a new and simplified framework for categorizing donor-derived teaching materials and the corresponding level of consent required for digital sharing. This framework proposes an equivalent minimum level of specific consent for human donor and human donor-derived materials relative to generalized, nonidentical teaching materials (i.e., artificial plastic models). Likewise, we propose that the collective path forward should involve the creation of a centralized, secure repository for digital human donor 3D content as a mechanism for accumulating, regulating, and controlling the distribution of properly consented human donor-derived 3D digital content that will also increase the availability of ethically created human-derived teaching materials while discouraging commodification.
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  • 文章类型: Journal Article
    近年来,在帕金森病前驱阶段识别个体的能力有所提高,提出了一个问题,即是否以及如何向受影响的人通报未来疾病的风险。几项研究调查了患有孤立性REM睡眠行为障碍的个体的预后咨询,并表明大多数患者希望获得有关预后的信息。但是必须尊重自主权和个人偏好。然而,关于PD的风险披露或早期诊断仍有许多悬而未决的问题,包括对个人情况的影响,文化偏好和与前驱症状的不同特征相关的具体挑战,基因测试或生物标志物评估。这篇叙述性综述旨在总结目前有关PD预后咨询和风险披露的文献,以及强调随着新生物标志物的开发可能出现的未来观点及其对PD定义的预期影响。
    帕金森病研究的一个重要目标是在早期诊断疾病,甚至在典型的运动症状出现之前,在所谓的“前驱阶段”。目前,在这个早期阶段,没有可用的治疗方法可以减缓或预防疾病的进展,尽管许多早期症状是可以治疗的。这引发了道德问题,即人们是否想知道他们未来患帕金森病的风险,如果是,如何提供这些信息。本文总结了当前的知识状态,但也公开了有关帕金森病前驱阶段风险披露的问题。以前的研究表明,许多有帕金森病早期症状的人都想知道他们的风险,但是,必须首先确定和尊重个人想要知道(或不知道)的愿望。未来的研究需要找出帕金森病的早期诊断是否会对患者产生影响。例如在心理压力或焦虑方面,以及文化背景是否会影响对风险披露的态度。此外,预计未来将有可能使用特定的新技术对帕金森病进行早期诊断,例如,通过测试脊髓液。最重要的是找出这些新技术的测试结果是否以及如何传达给患者,即使它们不会导致直接的医疗。
    The ability to identify individuals in the prodromal phase of Parkinson\'s disease has improved in recent years, raising the question of whether and how those affected should be informed about the risk of future disease. Several studies investigated prognostic counselling for individuals with isolated REM sleep behavior disorder and have shown that most patients want to receive information about prognosis, but autonomy and individual preferences must be respected. However, there are still many unanswered questions about risk disclosure or early diagnosis of PD, including the impact on personal circumstances, cultural preferences and specific challenges associated with different profiles of prodromal symptoms, genetic testing or biomarker assessments. This narrative review aims to summarize the current literature on prognostic counselling and risk disclosure in PD, as well as highlight future perspectives that may emerge with the development of new biomarkers and their anticipated impact on the definition of PD.
    An important goal of Parkinson’s disease research is to diagnose the disease at an earlier stage, even before the typical motor symptoms appear, in the so-called ‘prodromal phase’. Currently, there are no treatments available that can slow down or prevent disease progression in this early phase, even though many of the early symptoms are treatable. This raises ethical questions about whether people want to know their future risk of Parkinson’s and, if so, how this information should be given. This article summarizes the current state of knowledge, but also open questions about risk disclosure in the prodromal phase of Parkinson’s. Previous studies have shown that many people with early symptoms of Parkinson’s would like to know their risk, but that the individual’s wish to know (or not to know) must first be ascertained and respected. Future studies need to find out whether very early diagnosis of Parkinson’s might have an impact on people affected, for example in terms of psychological stress or anxiety, and whether cultural background might influence attitudes to risk disclosure. Furthermore, it is expected that in the future it will be possible to make an early diagnosis of Parkinson’s using specific new techniques, e.g., by testing spinal fluid. It is of utmost importance to find out if and how test results of these new techniques should be communicated to patients, even if they do not lead to direct medical treatment.
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  • 文章类型: Journal Article
    2018年,国际放射防护委员会(ICRP)发布了第138号出版物,强调了放射防护系统的道德价值观。额外的工作,ICRP内外,提出或推荐了与系统在不同领域的应用相关的道德价值观,也许最值得注意的是在医学上,兽医,和环境放射防护。还有一些与放射保护没有具体关系的现有道德框架,但与放射保护的实践相关;例如,当涉及到辐射和放射性的医学用途时,生物医学伦理学的Beauchamp和Childress原则具有特别重要的意义。乍一看,似乎有独特或孤立的道德价值观,需要根据具体情况应用。然而,尽管每个应用领域确实都有其独特的方面和相关的价值判断,这些伦理价值观之间存在着一致和互补的关系。本文回顾了ICRP与伦理学相关的工作,包括简短的历史背景,并强调了一系列以医学为重点的伦理价值观之间的异同,兽医,辐射防护的环境应用。
    In 2018, the International Commission on Radiological Protection (ICRP) released Publication 138, which highlights the ethical values foundational to the system of radiological protection. Additional work, both within and beyond the ICRP, has proposed or recommended ethical values associated with applications of the system in different areas, perhaps most notably in medical, veterinary, and environmental radiological protection. There are also existing ethical frameworks not specifically related to radiological protection that are nonetheless relevant to its practice; for example, the Beauchamp and Childress principles of biomedical ethics are of particular significance when it comes to medical uses of radiation and radioactivity. At first glance, it may seem as if there are unique or isolated sets of ethical values that need to be applied depending on the circumstance. Yet while each area of application will indeed have its own unique aspects and associated value judgements, there are consistent and complementary relationships between these ethical values. This paper reviews the work of the ICRP related to ethics, including brief historical context, and highlights the similarities and differences between sets of ethical values with emphasis on medical, veterinary, and environmental applications of radiological protection.
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  • 文章类型: Journal Article
    有大量关于学者使用第三方服务(TPS)的科学文献,以协助学术出版中的“出版顾问”。TPS为缺乏设备的研究团队提供广泛的学术服务,技能,动机,或者在没有外部援助的情况下生产纸张的时间。虽然语言编辑等服务,统计支持,或图形设计是常见的,通常是合法的,一些TPS还提供非法服务,并向提供这些服务的学者发送未经请求的电子邮件(垃圾邮件)。这种非法类型的TPS有可能威胁到同行评审的科学文献的完整性。在极端情况下,被称为“造纸厂”的营利性机构甚至提供虚假的科学出版物或作者身份出售。使用这种非法服务以及不承认其使用是学术出版的道德违反,而未能声明对TPS的支持可被视为合同欺诈的一种形式。我们讨论了一些关于TPS的文献,重点介绍目前由10家最大的商业出版商提供的服务,并期望作者对在其出版物中使用这些服务保持透明。从伦理/道德(即,非商业)观点,这是编辑的责任,期刊,和出版商,确保识别和禁止非法的TPS应该符合他们的最大利益,而出版商采用的TPS应在其出版物中适当披露。
    There is a substantial body of scientific literature on the use of third-party services (TPS) by academics to assist as \"publication consultants\" in scholarly publishing. TPS provide a wide range of scholarly services to research teams that lack the equipment, skills, motivation, or time to produce a paper without external assistance. While services such as language editing, statistical support, or graphic design are common and often legitimate, some TPS also provide illegitimate services and send unsolicited e-mails (spam) to academics offering these services. Such illegitimate types of TPS have the potential to threaten the integrity of the peer-reviewed scientific literature. In extreme cases, for-profit agencies known as \"paper mills\" even offer fake scientific publications or authorship slots for sale. The use of such illegitimate services as well as the failure to acknowledge their use is an ethical violation in academic publishing, while the failure to declare support for a TPS can be considered a form of contract fraud. We discuss some literature on TPS, highlight services currently offered by ten of the largest commercial publishers and expect authors to be transparent about the use of these services in their publications. From an ethical/moral (i.e., non-commercial) point of view, it is the responsibility of editors, journals, and publishers, and it should be in their best interest to ensure that illegitimate TPS are identified and prohibited, while publisher-employed TPS should be properly disclosed in their publications.
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  • 文章类型: Journal Article
    这篇叙述性评论旨在描述学术文献中有关道德和健康研究优先级设置的当前实践和正在进行的讨论。首先是关于研究优先级设置类型的一些初步区别。然后给出了一些关于正式研究优先级设置练习的当前实践的背景,包括卫生研究方法特设委员会的摘要,儿童健康与营养研究倡议(CHNRI)方法,组合方法矩阵(CAM),德尔菲法,基本国家健康研究(ENHR)优先事项设定战略,和詹姆斯·林德联盟(JLA)框架。该论文的大部分报告了文献综述的结果,具体涵盖了过程标准主题标题下的道德问题,实质性标准,全球正义,特定行为者的义务,和研究课题。它以一些关于明显差距和未来调查方向的总结思考结束。
    需要更多的健康研究来为许多疾病开发新的治疗和预防方案。但是支持健康研究的资源有限。这意味着必须就如何在相互竞争的重要项目中分配这些资源做出艰难的决定。做出这些决定称为优先级设置。JosephMillum博士回顾了已发表的关于健康研究优先事项设定的伦理学的内容。首先,他比较了已经开发的帮助组织和政府确定优先事项的不同方法。第二,他确定了当前有关道德和优先级设置的讨论中的主题。一些重要主题包括:应如何将利益攸关方纳入确定优先事项的工作;什么是公平分配研究资源;卫生研究的全球差异;以及不同类型的资助者应如何考虑其义务。这项审查的结果将为世界卫生组织提供有关如何将伦理学纳入健康研究重点设置的指导。
    This narrative review aims to describe current practice and ongoing discussions in the academic literature regarding ethics and health research priority setting. It begins with some preliminary distinctions regarding types of research priority setting. It then gives some background on current practice with respect to formal research priority setting exercises, including summaries of The Ad Hoc Committee on Health Research method, the Child Health and Nutrition Research Initiative (CHNRI) method, the Combined Approach Matrix (CAM), the Delphi method, the Essential National Health Research (ENHR) strategy for priority setting, and the James Lind Alliance (JLA) framework. The majority of the paper reports the results of a literature review covering specifically ethical issues under the thematic headings of process criteria, substantive criteria, global justice, the obligations of specific actors, and research topics. It closes with some summary thoughts about apparent gaps and directions for future investigation.
    More health research is needed to develop new treatment and prevention options for many diseases. But there are limited resources available to support health research. This means that difficult decisions must be made about how to allocate those resources among competing important projects. Making these decisions is called priority setting. Dr. Joseph Millum reviewed what has been published on the ethics of health research priority setting. First, he compared different methods that have already been developed to help organizations and governments set priorities. Second, he identified themes in the current discussions about ethics and priority setting. Some important themes included: how stakeholders should be included in priority setting exercises; what would be a fair allocation of research resources; global disparities in health research; and how different types of funder should think about their obligations. The results of this review will inform guidance from the World Health Organization on how to incorporate ethics into health research priority setting.
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  • 文章类型: Journal Article
    背景:本范围审查旨在综合与使用电和磁神经调节技术有关的伦理问题的零散证据,以及增强健康人大脑功能的脑机接口,解决快速的技术进步和正在进行的道德辩论所激发的理解差距。
    方法:查询了以下数据库和接口:MEDLINE(通过PubMed),WebofScience,PhilPapers,谷歌学者。通过所包括的引文的参考书目确定了其他参考文献。参考文献包括实验研究,reviews,意见文件,以及在同行评审的期刊上发表的致编辑的信,探讨了电和磁神经调节技术以及脑机接口对增强健康成人或儿科人群脑功能的伦理意义。
    结果:共有23篇文章被纳入综述,其中大多数以定性研究或调查以及审查的形式探讨了专家意见。两项研究探讨了外行人对该主题的看法。大多数证据表明,这些新技术缺乏足够的有效性和安全性数据,侵入性手术的风险可能超过收益。此外,有人提出了对潜在社会经济后果的担忧,这些后果可能进一步加剧现有的社会经济不平等,以及改变人和环境的风险。
    结论:这项范围审查强调了在电和磁神经调节技术以及脑-计算机接口方面增强健康人脑功能的伦理研究的严重不足。关于安全的关键问题,功效,以及神经调节技术的社会经济影响。它强调迫切需要将伦理考虑纳入神经科学研究,以解决重大差距并确保公平的获取和结果。
    BACKGROUND: This scoping review aimed to synthesize the fragmented evidence on ethical concerns related to the use of electrical and magnetic neuromodulation technologies, as well as brain-computer interfaces for enhancing brain function in healthy individuals, addressing the gaps in understanding spurred by rapid technological advancements and ongoing ethical debates.
    METHODS: The following databases and interfaces were queried: MEDLINE (via PubMed), Web of Science, PhilPapers, and Google Scholar. Additional references were identified via bibliographies of included citations. References included experimental studies, reviews, opinion papers, and letters to editors published in peer-reviewed journals that explored the ethical implications of electrical and magnetic neuromodulation technologies and brain-computer interfaces for enhancement of brain function in healthy adult or pediatric populations.
    RESULTS: A total of 23 articles were included in the review, of which the majority explored expert opinions in the form of qualitative studies or surveys as well as reviews. Two studies explored the view of laypersons on the topic. The majority of evidence pointed to ethical concerns relating to a lack of sufficient efficacy and safety data for these new technologies, with the risks of invasive procedures potentially outweighing the benefits. Additionally, concerns about potential socioeconomic consequences were raised that could further exacerbate existing socioeconomic inequalities, as well as the risk of changes to person and environment.
    CONCLUSIONS: This scoping review highlights a critical shortage of ethical research on electrical and magnetic neuromodulation technologies and brain-computer interfaces for enhancement of brain function in healthy individuals, with key concerns regarding the safety, efficacy, and socioeconomic impacts of neuromodulation technologies. It underscores the urgent need for integrating ethical considerations into neuroscientific research to address significant gaps and ensure equitable access and outcomes.
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  • 文章类型: Journal Article
    本EBCOG指南回顾了胎儿和母体医学中基因组学的当前和未来状况。本文件介绍了基因检测在产前筛查和诊断测试中的临床应用。描述了基因组学在胎儿和母体医学中的作用。基因检测的研究和未来的意义以及教育,讨论了基因组学的伦理和经济意义。
    This EBCOG guidance reviews the current and future status of genomics within fetal and maternal medicine. This document addresses the clinical uses of genetic testing in both screening and diagnostic testing prenatally. The role of genomics within fetal and maternal medicine is described. The research and future implications of genetic testing as well as the educational, ethical and economic implications of genomics are discussed.
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  • 文章类型: Journal Article
    背景:在新兴的AI技术中,ChatGPT(聊天生成预训练变压器)作为一种著名的语言模型出现,通过人工智能研究独特地发展起来。它在各个领域的多功能性,从语言翻译到医疗数据处理,强调了它在医疗文件中的承诺,诊断,研究,和教育。当前的全面审查旨在研究ChatGPT在泌尿外科教育和实践中的实用性,并强调其潜在的局限性。方法:作者对ChatGPT的使用及其在泌尿外科教育中的应用进行了全面的文献综述,研究和实践。通过对文献的系统回顾,使用PubMed等数据库的搜索策略,和Embase,我们分析了在泌尿外科使用ChatGPT的优势和局限性,并评估了其潜在影响.结果:共有78条记录符合纳入条件。ChatGPT的好处经常在各种情况下被引用。在21条记录(87.5%)中提到的教育/学术福利中,ChatGPT通过提供准确的信息和响应来自患者数据分析的查询来协助泌尿科医生的能力,从而支持决策,在18条记录(75%)中,优势包括个性化医疗,疾病风险和结果的预测能力,简化临床工作流程,改进诊断。然而,有人对潜在的错误信息表示担忧,强调人类监督的必要性,以保证患者的安全和解决伦理问题结论:潜在的应用ChatGPT持有的能力,带来的变革在泌尿外科教育,研究,和实践。人工智能技术可以作为增强人类智能的有用工具;然而,以负责任和道德的方式使用它是至关重要的。
    Background: Among emerging AI technologies, Chat-Generative Pre-Trained Transformer (ChatGPT) emerges as a notable language model, uniquely developed through artificial intelligence research. Its proven versatility across various domains, from language translation to healthcare data processing, underscores its promise within medical documentation, diagnostics, research, and education. The current comprehensive review aimed to investigate the utility of ChatGPT in urology education and practice and to highlight its potential limitations. Methods: The authors conducted a comprehensive literature review of the use of ChatGPT and its applications in urology education, research, and practice. Through a systematic review of the literature, with a search strategy using databases, such as PubMed and Embase, we analyzed the advantages and limitations of using ChatGPT in urology and evaluated its potential impact. Results: A total of 78 records were eligible for inclusion. The benefits of ChatGPT were frequently cited across various contexts. In educational/academic benefits mentioned in 21 records (87.5%), ChatGPT showed the ability to assist urologists by offering precise information and responding to inquiries derived from patient data analysis, thereby supporting decision making; in 18 records (75%), advantages comprised personalized medicine, predictive capabilities for disease risks and outcomes, streamlining clinical workflows and improved diagnostics. Nevertheless, apprehensions were expressed regarding potential misinformation, underscoring the necessity for human supervision to guarantee patient safety and address ethical concerns. Conclusion: The potential applications of ChatGPT hold the capacity to bring about transformative changes in urology education, research, and practice. AI technology can serve as a useful tool to augment human intelligence; however, it is essential to use it in a responsible and ethical manner.
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  • 文章类型: Journal Article
    合成生物学是为有用的目的设计和创建生物工具和系统。它利用生物学知识,比如生物技术,分子生物学,生物物理学,生物化学,生物信息学,和其他学科,比如工程学,数学,计算机科学,电气工程。它被认为是科学和技术的一个分支。合成生物学的范围从修饰现有的生物体以获得新的特性到从非生物成分创造活的生物体。合成生物学在能源等重要领域有许多应用,化学,医学,环境,农业,国家安全,和纳米技术。合成生物学的发展也引发了伦理和社会辩论。本文旨在确定伦理学在合成生物学中的地位。在这种情况下,关于合成生物学的理论伦理辩论从2000年到2020年,当时合成生物学的发展相对较快,采用系统综述的方法进行了分析。根据分析结果,与该领域相关的主要道德问题,可能出现的问题,并提出了解决这些问题的建议。研究的数据收集阶段包括根据协议进行的文献综述,包括规划,筛选,选择和评价。在下一阶段进行了分析和合成过程,并确定了与合成生物学和伦理学相关的主要主题。搜索是在WebofScience中进行的,Scopus,PhilPapers和MEDLINE数据库。该研究包括在2020年底之前在同行评审期刊上发表的理论研究文章和评论。出版物的语言是英语。根据初步数据,从四个数据库中检索了1,453种出版物。考虑到纳入和排除标准,在研究中分析了58篇出版物。关于合成生物学的伦理辩论已经在各种问题上进行。在这种情况下,本文在五个主题下研究了伦理辩论:合成生物学产品的道德地位,合成生物学和生命的意义,合成生物学和隐喻,合成生物学和知识,和期望,关注,和解决问题:风险与谨慎。
    Synthetic biology is designing and creating biological tools and systems for useful purposes. It uses knowledge from biology, such as biotechnology, molecular biology, biophysics, biochemistry, bioinformatics, and other disciplines, such as engineering, mathematics, computer science, and electrical engineering. It is recognized as both a branch of science and technology. The scope of synthetic biology ranges from modifying existing organisms to gain new properties to creating a living organism from non-living components. Synthetic biology has many applications in important fields such as energy, chemistry, medicine, environment, agriculture, national security, and nanotechnology. The development of synthetic biology also raises ethical and social debates. This article aims to identify the place of ethics in synthetic biology. In this context, the theoretical ethical debates on synthetic biology from the 2000s to 2020, when the development of synthetic biology was relatively faster, were analyzed using the systematic review method. Based on the results of the analysis, the main ethical problems related to the field, problems that are likely to arise, and suggestions for solutions to these problems are included. The data collection phase of the study included a literature review conducted according to protocols, including planning, screening, selection and evaluation. The analysis and synthesis process was carried out in the next stage, and the main themes related to synthetic biology and ethics were identified. Searches were conducted in Web of Science, Scopus, PhilPapers and MEDLINE databases. Theoretical research articles and reviews published in peer-reviewed journals until the end of 2020 were included in the study. The language of publications was English. According to preliminary data, 1,453 publications were retrieved from the four databases. Considering the inclusion and exclusion criteria, 58 publications were analyzed in the study. Ethical debates on synthetic biology have been conducted on various issues. In this context, the ethical debates in this article were examined under five themes: the moral status of synthetic biology products, synthetic biology and the meaning of life, synthetic biology and metaphors, synthetic biology and knowledge, and expectations, concerns, and problem solving: risk versus caution.
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  • 文章类型: Journal Article
    临床研究领域不断进步,以及研究的伦理行为,研究人员需要在良好的临床实践(GCP)中拥有坚实的基础。GCP指南是国际公认的规范临床试验的标准,确保保护人类主体和生成可靠的数据。然而,研究活动的新手研究人员或研究生医学生可能会面临难以获得GCP培训的途径。因此,在这篇简短的评论文章中,我们通过对其历史的一瞥来讨论GCP在临床研究领域的意义,发展,和关键原则。我们提供在线课程列表,好处,以及这些课程的缺点,以及在印度举办GCP研讨会或继续医学教育计划的组织名单。
    The field of clinical research continues to advance, and for ethical conduct of research, researchers need to have a strong foundation in good clinical practice (GCP). GCP guidelines are internationally recognized standards that govern the conduct of clinical trials, ensuring the protection of human subjects and the generation of reliable data. However, novice researchers or postgraduate medical students who would delve into research activities may face difficulty getting avenues for GCP training. Hence, in this brief review article, we discuss the significance of GCP in the field of clinical research with a glimpse of its history, development, and key principles. We provide a list of online courses, benefits, and disadvantages of those courses, and a list of organizations that conduct GCP workshops or continued medical education programs in India.
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