Informed consent

知情同意
  • 文章类型: Journal Article
    亨德里克斯怀孕救援案(PRC)试图表明堕胎在道德上通常是错误的。我在这里认为,中国的堕胎与典型的堕胎之间至少存在两个道德上相关的差异,因此即使前者在道德上是错误的,后者在道德上也不是错误的。我对PRC进行了五项修改,以表明这两个差异在道德上很重要。首先,在中国,我们不知道该人是否知情同意堕胎,进行堕胎的医疗专业人员也没有,因此不能进行堕胎,因为患者给予了知情同意。第二,在中国不阻止胎儿死亡会导致另一个怀孕的胎儿死亡,而大多数堕胎并不意味着终止另一个人的妊娠。
    Hendricks\' pregnancy rescue case (PRC) tries to show that abortion is typically morally wrong. I argue here that there are at least two morally relevant differences between the abortion in PRC and the typical abortion so that the latter isn\'t morally wrong even if the former is morally wrong. I develop five modifications to PRC to show that these two differences are morally important. First, in PRC we don\'t know whether the person gives informed consent to the abortion, nor does the medical professional who will perform the abortion, and so the abortion can\'t be performed because the patient gives informed consent to it. Second, not preventing the death of the fetus in PRC brings about the death of an additional fetus gestating in a separate pregnant person, whereas most abortions don\'t entail the termination of another\'s pregnancy.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    个人健康数据的广泛利用是现代医学研究的关键成功因素之一。在临床护理期间获得对此类数据使用的同意,然而,承担低和不平等的批准率的风险,以及在科学使用数据时随之而来的方法问题的风险。鉴于这些缺点,以及人们通过共享个人健康数据为医学研究做出贡献的事实证明,知情同意的范式需要重新考虑.《欧洲通用数据保护条例》在允许未经同意使用健康数据的研究方面给予了欧洲成员国相当大的回旋余地。然而,遵循这种方法将需要提供替代信息,以弥补医疗期间缺乏与专家的直接沟通。因此,我们引入了“健康数据素养”的概念,\"定义为查找的能力,理解,并评估有关个人健康数据研究使用的风险和收益的信息,并采取相应行动。具体来说,健康数据素养包括有关数据丰富的医学研究的目标和方法以及数据保护的可能性和局限性的基本知识。尽管开发必要资源的责任主要在于那些直接参与数据丰富的医学研究的人,提高健康数据素养最终应该是每个对此类研究成功感兴趣的人都关心的问题。
    UNASSIGNED: The extensive utilization of personal health data is one of the key success factors of modern medical research. Obtaining consent to the use of such data during clinical care, however, bears the risk of low and unequal approval rates and risk of consequent methodological problems in the scientific use of the data. In view of these shortcomings, and of the proven willingness of people to contribute to medical research by sharing personal health data, the paradigm of informed consent needs to be reconsidered. The European General Data Protection Regulation gives the European member states considerable leeway with regard to permitting the research use of health data without consent. Following this approach would however require alternative offers of information that compensate for the lack of direct communication with experts during medical care. We therefore introduce the concept of \"health data literacy,\" defined as the capacity to find, understand, and evaluate information about the risks and benefits of the research use of personal health data and to act accordingly. Specifically, health data literacy includes basic knowledge about the goals and methods of data-rich medical research and about the possibilities and limits of data protection. Although the responsibility for developing the necessary resources lies primarily with those directly involved in data-rich medical research, improving health data literacy should ultimately be of concern to everyone interested in the success of this type of research.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    医学伦理指南要求临床试验研究者和申办者告知前瞻性试验参与者与研究医疗产品相关的所有已知和潜在风险。并获得他们的自由知情同意。这些指南还要求临床研究的设计应尽量减少危害并最大化收益。
    研究默克公司在GardasilHPV疫苗许可前临床试验中使用含反应性铝的“安慰剂”的科学原理。
    我们检查了在丹麦进行的FUTUREIIGardasil疫苗试验的知情同意书和招募手册;我们采访了几位FUTUREII试验参与者及其治疗医生。我们还审查了与Gardasil疫苗批准过程相关的监管文件以及关于评估人类疫苗中使用的佐剂的指南。
    发现疫苗制造商默克公司向试验参与者做出了一些不准确的陈述,损害了他们的知情同意权。首先,尽管研究方案将安全性测试列为研究的主要目标之一,招聘手册强调FUTUREII不是一项安全研究,疫苗已经被证明是安全的。第二,试验的广告材料和知情同意书指出安慰剂是盐水或非活性物质,when,事实上,它含有默克公司专有的高反应性铝佐剂,该佐剂似乎没有经过适当的安全性评估。几个试验参与者经历了慢性致残症状,包括一些随机分配到佐剂“安慰剂”组。
    在我们看来,在Gardasil临床试验中使用反应性安慰剂没有任何可能的益处,不必要地将研究对象暴露在风险中,因此违反了医学伦理。在疫苗临床试验中常规使用铝佐剂作为“安慰剂”是不合适的,因为它阻碍了疫苗相关安全信号的发现。
    UNASSIGNED: Medical ethics guidelines require of clinical trial investigators and sponsors to inform prospective trial participants of all known and potential risks associated with investigational medical products, and to obtain their free informed consent. These guidelines also require that clinical research be so designed as to minimize harms and maximize benefits.
    UNASSIGNED: To examine Merck\'s scientific rationale for using a reactogenic aluminum-containing \"placebo\" in Gardasil HPV vaccine pre-licensure clinical trials.
    UNASSIGNED: We examined the informed consent form and the recruitment brochure for the FUTURE II Gardasil vaccine trial conducted in Denmark; and we interviewed several FUTURE II trial participants and their treating physicians. We also reviewed regulatory documentation related to Gardasil vaccine approval process and the guidelines on evaluation of adjuvants used in human vaccines.
    UNASSIGNED: It was found that the vaccine manufacturer Merck made several inaccurate statements to trial participants that compromised their right to informed consent. First, even though the study protocol listed safety testing as one of the study\'s primary objectives, the recruitment brochure emphasized that FUTURE II was not a safety study, and that the vaccine had already been proven safe. Second, the advertising material for the trial and the informed consent forms stated that the placebo was saline or an inactive substance, when, in fact, it contained Merck\'s proprietary highly reactogenic aluminum adjuvant which does not appear to have been properly evaluated for safety. Several trial participants experienced chronic disabling symptoms, including some randomized to the adjuvant \"placebo\" group.
    UNASSIGNED: In our view, the administration of a reactive placebo in Gardasil clinical trials was without any possible benefit, needlessly exposed study subjects to risks, and was therefore a violation of medical ethics. The routine use of aluminum adjuvants as \"placebos\" in vaccine clinical trials is inappropriate as it hinders the discovery of vaccine-related safety signals.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    以前没有研究评估患者对纳入正在进行的心脏骤停临床试验的态度。这项研究的目的是评估患者参与正在进行的随机对照药物试验的意愿和动机,“在心脏骤停(IHCA)的情况下,除肾上腺素外,血管加压素和类固醇”(VAST-A试验)。
    住院患者,男性≥18岁,女性≥50岁,在IHCA的情况下,被要求知情同意纳入VAST-A审判,批准或拒绝纳入试验的原因和基线特征.
    入院的患者被要求在住院期间接受IHCA的情况下同意纳入VAST-A。患者还被问及为什么他们批准或拒绝纳入以及基线特征问题。
    1,064名患者被问及参与VAST-A试验的意愿,这902例(84.8%)患者批准纳入.411名患者的亚组,除了意愿,还询问了参与与否的动机和基本特征。批准纳入的主要原因是为研究做出贡献(n=328,83.9%)。减少纳入的主要原因是对药物治疗测试的担忧(n=6,30%)。
    在住院患者中,绝大多数患者知情同意纳入正在进行的随机心脏骤停药物试验。批准纳入的主要原因是为研究做出贡献。
    UNASSIGNED: No previous study has evaluated patients attitudes towards inclusion in an ongoing cardiac arrest clinical trial. The aim of this study was to assess patientś willingness and motives to participate in the ongoing randomized controlled drug trial \"Vasopressin and Steroids in addition to Adrenaline in cardiac arrest\" (VAST-A trial) in case of an in-hospital cardiac arrest (IHCA).
    UNASSIGNED: Hospitalized patients, men ≥ 18 and women ≥ 50 years, were asked for informed consent for inclusion in the VAST-A trial in case of an IHCA, the reason for approving or declining inclusion in the trial and baseline characteristics.
    UNASSIGNED: Patients admitted to hospital were asked to give informed consent of inclusion in VAST-A in case of an IHCA during their hospital stay. Patients were also asked why they approved or declined inclusion as well as baseline characteristics questions.
    UNASSIGNED: 1,064 patients were asked about willingness to participate in the VAST-A trial, of these 902 (84.8%) patients approved inclusion. A subgroup of 411 patients were, except willingness, also asked about motives to participate or not and basic characteristics. The main reason for approving inclusion was to contribute to research (n = 328, 83.9%). The main reason for declining inclusion was concerns regarding testing the drug treatment (n = 6, 30%).
    UNASSIGNED: Among hospitalized patients the vast majority gave informed consent to inclusion in an ongoing randomized cardiac arrest drug trial. The main reason for approving inclusion was to contribute to research.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    背景:机构审查委员会(IRB)因IRB工作人员不足或缺乏经验而延误批准研究提案而受到批评。人工智能(AI)特别是大型语言模型(LLM),在协助IRB成员进行迅速有效的审查过程方面具有巨大的潜力。
    方法:在七个经过验证的案例研究中,评估了四个LLM是否可以识别潜在的伦理问题。LLM被提示与研究参与者的拟议资格标准相关的查询,脆弱性问题,在知情同意书(ICD)中披露的信息,风险-效益评估和使用安慰剂的理由。向LLM发出了另一个查询,以针对这些情况生成ICD。
    结果:所有四个LLM都能够为与所有七个案例相关的查询提供答案。总的来说,对于大多数元素,响应是均匀的。LLM在识别安慰剂组的适用性方面表现欠佳,风险缓解策略和潜在风险在某些案例研究中研究参与者,只有一个提示。然而,多个提示导致更好的输出在所有这些领域。每个LLM都包含所有情况下ICD的所有基本要素。使用行话,在AI生成的ICD中,低估收益和未能陈述潜在风险是关键的观察结果。
    结论:LLM可能可以增强对临床研究中潜在伦理问题的识别,它们可以用作辅助工具,以预先筛选研究提案并提高IRB的效率。
    BACKGROUND: Institutional review boards (IRBs) have been criticised for delays in approvals for research proposals due to inadequate or inexperienced IRB staff. Artificial intelligence (AI), particularly large language models (LLMs), has significant potential to assist IRB members in a prompt and efficient reviewing process.
    METHODS: Four LLMs were evaluated on whether they could identify potential ethical issues in seven validated case studies. The LLMs were prompted with queries related to the proposed eligibility criteria of the study participants, vulnerability issues, information to be disclosed in the informed consent document (ICD), risk-benefit assessment and justification of the use of a placebo. Another query was issued to the LLMs to generate ICDs for these case scenarios.
    RESULTS: All four LLMs were able to provide answers to the queries related to all seven cases. In general, the responses were homogeneous with respect to most elements. LLMs performed suboptimally in identifying the suitability of the placebo arm, risk mitigation strategies and potential risks to study participants in certain case studies with a single prompt. However, multiple prompts led to better outputs in all of these domains. Each of the LLMs included all of the fundamental elements of the ICD for all case scenarios. Use of jargon, understatement of benefits and failure to state potential risks were the key observations in the AI-generated ICD.
    CONCLUSIONS: It is likely that LLMs can enhance the identification of potential ethical issues in clinical research, and they can be used as an adjunct tool to prescreen research proposals and enhance the efficiency of an IRB.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    大型语言模型的最新进展(LMM;例如,ChatGPT(OpenAI,旧金山,加州,美国))已经在各个领域得到了广泛的使用,包括医疗保健。本案例研究报告了在预处理讨论中首次使用LMM并获得放射肿瘤学治疗的知情同意。Further,分析了ChatGPT3.5回复的可重复性.一个乳腺癌患者,经过法律咨询,与ChatGPT3.5就她的放射治疗进行了交谈。病人提出了关于副作用的问题,预防,活动,药物,和后期效果。虽然有些答案不准确,回答与医生的回答非常相似。在最后的评估讨论中,病人,然而,她说,她更喜欢医生在场,并对所提供信息的来源表示担忧。在十次迭代中测试再现性。在放射肿瘤学中使用此类模型的未来指南应由医学专业人员推动。虽然人工智能(AI)支持基本任务,人类互动仍然至关重要。
    Recent advancements in large language models (LMM; e.g., ChatGPT (OpenAI, San Francisco, California, USA)) have seen widespread use in various fields, including healthcare. This case study reports on the first use of LMM in a pretreatment discussion and in obtaining informed consent for a radiation oncology treatment. Further, the reproducibility of the replies by ChatGPT 3.5 was analyzed. A breast cancer patient, following legal consultation, engaged in a conversation with ChatGPT 3.5 regarding her radiotherapy treatment. The patient posed questions about side effects, prevention, activities, medications, and late effects. While some answers contained inaccuracies, responses closely resembled doctors\' replies. In a final evaluation discussion, the patient, however, stated that she preferred the presence of a physician and expressed concerns about the source of the provided information. The reproducibility was tested in ten iterations. Future guidelines for using such models in radiation oncology should be driven by medical professionals. While artificial intelligence (AI) supports essential tasks, human interaction remains crucial.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    最近,新南威尔士州神经外科医生的备受瞩目的案例强调了执业范围(SOP)的监管问题,CharlesTeo先生,特别是新南威尔士州医疗保健投诉委员会(HCCC)在Teo发现的“不满意的专业行为”,查尔斯(2023)NSWMPSC2(2023年7月12日)。HCCC的决定涉及Teo实践中的两个问题:(1)他决定不在其专业的SOP范围内进行手术[238];(2)他未能获得患者对该手术的知情同意[245]。本文探讨了针对Teo在SOP方面的发现,并建议了一种细致入微的方法来调节临床创新和SOP的演变。
    The issue of regulation of scope of practice (SOP) has recently been highlighted through the high-profile case of New South Wales-based neurosurgeon, Mr Charles Teo and specifically the finding of \'unsatisfactory professional conduct\' by the NSW Health Care Complaints Commission (HCCC) in Teo, Charles (2023) NSWMPSC 2 (12 July 2023). The HCCC decision went to two issues in Teo\'s practice: (1) his decision to perform a surgery not within the SOP of his profession [at 238]; and (2) his failure to gain patient informed consent for that surgery [at 245]. This paper explores the findings against Teo with respect to SOP and recommends a nuanced approach to the regulation of clinical innovation and SOP evolution.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    阻碍医学生谈论道德状况的一个因素是缺乏解决冲突的足够知识和技能。这也可能影响学生的决策和干预时机。本文将提供实用的方法,以有效地解决8月A.Culbert等人提出的医学生的道德案例。在手术中浏览知情同意和患者安全:医学生和初级学员的课程。\"
    AbstractOne factor that impedes medical students from speaking up about ethical situations is the lack of sufficient knowledge and skills in conflict resolution. This may also affect students\' decision and timing to intervene. This article will provide practical ways to effectively and efficiently address the medical student\'s ethical case presented in August A. Culbert et al.\'s \"Navigating Informed Consent and Patient Safety in Surgery: Lessons for Medical Students and Junior Trainees.\"
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Letter
    暂无摘要。
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    疫苗授权可以采取多种形式,不同类型的任务可以以不同的方式暗示一系列的价值观。因此,关于特定疫苗授权的良好道德论点将涉及各个政策的细节。此外,注意特定的任务政策,以及他们旨在治理的社区的属性,也可以阐明哪些道德论点在特定情况下可能更加突出。如果伦理学家希望他们的论点在政策上有所作为,他们应该注意这些经验性的考虑。本文重点介绍了当代美国最常见和最具争议的疫苗授权改革:取消学校和日托疫苗授权的非医疗豁免(NME)。它突出了,特别是,关于加州参议院第277号法案(SB277)的辩论,这是该国最近首次成功消除NME的努力。我们使用媒体,次要来源,以及对政策制定者和活动家的原始访谈,以确定和评估SB277批评者提供的三个道德论点:父母自由,知情同意,以及儿童受照料和教育的权利。然后,我们转向SB277倡导者经常提出的一种道德论点:预防伤害。我们注意到,然而,免疫伦理文献中常见的三个关于授权的论点——公平/搭便车,儿童接种疫苗的权利,和功利主义-在关于SB277的辩论中没有发挥作用。
    Vaccine mandates can take many forms, and different kinds of mandates can implicate an array of values in diverse ways. It follows that good ethics arguments about particular vaccine mandates will attend to the details of individual policies. Furthermore, attention to particular mandate policies-and to attributes of the communities they aim to govern-can also illuminate which ethics arguments may be more salient in particular contexts. If ethicists want their arguments to make a difference in policy, they should attend to these kinds of empirical considerations. This paper focuses on the most common and contentious vaccine mandate reform in the contemporary United States: the elimination of nonmedical exemptions (NMEs) to school and daycare vaccine mandates. It highlights, in particular, debates about California\'s Senate Bill 277 (SB277), which was the first successful recent effort to eliminate NMEs in that country. We use media, secondary sources, and original interviews with policymakers and activists to identify and evaluate three ethics arguments offered by critics of SB277: parental freedom, informed consent, and children\'s rights to care and education. We then turn to one ethics argument often offered by advocates of SB277: harm prevention. We note, however, that three arguments for mandates that are common in the immunization ethics literature-fairness/free-riding, children\'s rights to vaccination, and utilitarianism-did not play a role in debates about SB277.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

公众号