Ethics

伦理学
  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    在美国,临床知情同意的实践受超过100年的判例法管辖。尽管行为分析师的主要伦理资源为提供临床知情同意提供了一些指导,这种指导仍然有限。因此,本文的目的是通过提供相关判例法的历史和当代指南,扩展有关行为分析中临床知情同意的当代文献。本文将重点介绍有关临床知情同意的判例法历史上的开创性时刻,讨论它们在行为分析中对临床知情同意过程的适用性,并加强对治疗背景下与知情同意相关的伦理和法律义务的理解。
    在线版本包含补充材料,可在10.1007/s40617-023-00902-0获得。
    The practice of clinical informed consent in America is governed by over 100 years of case law. Although predominant ethics resources for behavior analysts offer some guidance regarding the provision of clinical informed consent, such guidance remains limited. The goal of this article is thus to expand the contemporary literature on clinical informed consent in behavior analysis by providing a historical and contemporary guide to relevant case law. The article will highlight seminal moments in the history of case law regarding clinical informed consent, discuss their applicability to the process of clinical informed consent in behavior analysis, and provide an enhanced understanding of the ethical and legal obligations related to informed consent in the therapeutic context.
    UNASSIGNED: The online version contains supplementary material available at 10.1007/s40617-023-00902-0.
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  • 文章类型: Journal Article
    人体组织的敏感性和以前的误用情况,理所当然,导致引入了影响深远的监督和监管机制,存储和共享样品。然而,这些限制,与更广泛的隐私法规相结合,产生了阻碍合法医疗材料请求的意外后果。这确实不利于生物医学研究的雄心,最引人注目的是精准医学议程。因此,本文为促进授权研究人员沿着实际的医学伦理路线访问人体组织和相关数据提供了理由,详细说明如何将样本从不合适的法规中解放出来,重新评估生物银行,多样化考虑捐助者的利益-风险,与目前相比,未来证明捐赠者的同意和扁平化的捐赠可接受性等级等同于管理生物样本和信息的更有凝聚力和尊重的手段。
    The sensitivity of human tissue and previous instances of misuse have, rightfully, led to the introduction of far-reaching oversight and regulatory mechanisms for accessing, storing and sharing samples. However, these restrictions, in tandem with more broad-based privacy regulations, have had the unintended consequence of obstructing legitimate requests for medical materials. This is of real detriment to ambitions for biomedical research, most notably the precision medicine agenda. As such, this paper makes the case for facilitating authorised researcher access to human tissue and associated data along practical medical ethics lines, detailing how liberating samples from unfit regulations, re-evaluating biobanks, diversifying considerations for donor benefit-risk, future proofing donor consent and flattening hierarchies of donation acceptability equate to a more cohesive and respectful means of managing biological samples and information than is achieved at present.
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  • 文章类型: Journal Article
    目标:人工智能(AI)正在重塑健康和医学,特别是通过其解决低收入和中等收入国家(LMICs)健康差距的潜力。然而,与使用AI相关的几个问题可能会减少其影响,并可能加剧全球健康差异。本研究提出了LMIC在AI部署中面临的关键问题。
    方法:主题分析。
    方法:PubMed,Scopus,搜索了Embase和WebofScience数据库,从成立之日起至2023年9月,使用术语“人工智能”,\"LMIC\",“道德*”和“全球健康”。在主要搜索之前和之后,通过滚雪球参考进行了其他搜索。最终的研究是根据它们与本文主题的相关性选择的。
    结果:在回顾了378篇文章之后,14项研究纳入最终分析。引入了一个名为“AI部署悖论”的概念,以关注使用AI解决LMIC健康差距的挑战。并确定了以下三个类别:(1)数据贫困和背景变化;(2)成本效益和健康公平性;(3)新技术殖民和潜在开发。
    结论:全球健康之间的关系,人工智能和道德考虑是一个需要系统调查的领域。依赖具有结构性偏见的健康数据,以及在没有系统伦理考虑的情况下部署人工智能,可能会加剧全球健康不平等。应对这些挑战需要细致入微的社会政治理解,本地化的利益相关者参与,以及深思熟虑的道德和监管框架。
    OBJECTIVE: Artificial intelligence (AI) is reshaping health and medicine, especially through its potential to address health disparities in low- and middle-income countries (LMICs). However, there are several issues associated with the use of AI that may reduce its impact and potentially exacerbate global health disparities. This study presents the key issues in AI deployment faced by LMICs.
    METHODS: Thematic analysis.
    METHODS: PubMed, Scopus, Embase and the Web of Science databases were searched, from the date of their inception until September 2023, using the terms \"artificial intelligence\", \"LMICs\", \"ethic∗\" and \"global health\". Additional searches were conducted by snowballing references before and after the primary search. The final studies were chosen based on their relevance to the topic of this article.
    RESULTS: After reviewing 378 articles, 14 studies were included in the final analysis. A concept named the \'AI Deployment Paradox\' was introduced to focus on the challenges of using AI to address health disparities in LMICs, and the following three categories were identified: (1) data poverty and contextual shifts; (2) cost-effectiveness and health equity; and (3) new technological colonisation and potential exploitation.
    CONCLUSIONS: The relationship between global health, AI and ethical considerations is an area that requires systematic investigation. Relying on health data inherent with structural biases and deploying AI without systematic ethical considerations may exacerbate global health inequalities. Addressing these challenges requires nuanced socio-political comprehension, localised stakeholder engagement, and well-considered ethical and regulatory frameworks.
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    文章类型: Journal Article
    本节探讨了将基因组研究转化为基因组医学所涉及的挑战。在澳大利亚国家健康基因组学框架中已经确定了许多优先事项来应对这些挑战。负责收集,storage,基因组数据的使用和管理是这些优先事项之一,是本节的主要主题。最近发布的Genomical,澳大利亚的数据共享平台,被用作案例研究,以说明在解决这一优先事项时可以向卫生保健部门提供的援助类型。本节首先介绍了国家框架和其他涉及基因组医学发展的驱动因素。然后,本节将检查关键的道德,基因组学中的法律和社会因素,特别关注隐私和同意。最后,该部分检查了如何使用Genomical来帮助确保向基因组医学的转变是道德上的,在法律和社会上都是合理的,它优化了基因组和信息技术的进步。
    This section explores the challenges involved in translating genomic research into genomic medicine. A number of priorities have been identified in the Australian National Health Genomics Framework for addressing these challenges. Responsible collection, storage, use and management of genomic data is one of these priorities, and is the primary theme of this section. The recent release of Genomical, an Australian data-sharing platform, is used as a case study to illustrate the type of assistance that can be provided to the health care sector in addressing this priority. The section first describes the National Framework and other drivers involved in the move towards genomic medicine. The section then examines key ethical, legal and social factors at play in genomics, with particular focus on privacy and consent. Finally, the section examines how Genomical is being used to help ensure that the move towards genomic medicine is ethically, legally and socially sound and that it optimises advances in both genomic and information technology.
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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
    本文有助于越来越多的关于如何减轻药品污染的讨论,这是对人类的威胁,动物,和环境健康以及抗生素耐药性的潜在驱动因素。它将药品的市场批准确定为塑造生产者行为的最有力方法之一,并强调应用该工具会引发道德问题,因为它可能会影响患者获得药物。该文件确定了七种不同的政策选择,这些政策选择在批准过程中逐步将环境考虑因素放在首位,确定受此类政策影响的伦理相关利益,并在这些利益之间进行明确的紧张关系和必要的权衡。虽然认为当前的欧洲法规对环境考虑的重视不够,该文件强调了对最强有力的政策选择的担忧,理由是这些很可能危及患者获得有效药物。
    This paper contributes to the growing discussion about how to mitigate pharmaceutical pollution, which is a threat to human, animal, and environmental health as well as a potential driver of antimicrobial resistance. It identifies market approval of pharmaceuticals as one of the most powerful ways to shape producer behavior and highlights that applying this tool raises ethical issues given that it might impact patients\' access to medicines. The paper identifies seven different policy options that progressively give environmental considerations increased priority in the approval process, identifies ethically relevant interests affected by such policies, and makes explicit tensions and necessary tradeoffs between these interests. While arguing that the current European regulation gives insufficient weight to environmental considerations, the paper highlights concerns with the strongest policy options, on the grounds that these may very well endanger patients\' access to effective medication.
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  • 文章类型: Journal Article
    大型语言模型(LLM)支持的服务由于在许多任务中的出色性能而在各种应用程序中越来越受欢迎,如情绪分析和回答问题。最近,研究一直在探索它们在数字健康环境中的潜在用途,特别是在心理健康领域。然而,实施LLM增强的会话人工智能(CAI)提出了重要的道德,技术,和临床挑战。在这篇观点论文中,我们讨论了2个挑战,这些挑战会影响LLM增强的CAI对于有心理健康问题的个人的使用,专注于抑郁症患者的用例:将LLM增强的CAI人性化的趋势以及他们缺乏情境化的鲁棒性。我们的方法是跨学科的,依靠哲学的考虑,心理学,和计算机科学。我们认为,LLM增强的CAI的人性化取决于对使用LLM模拟“类似人类”特征的含义的反映,以及这些系统在与人类的互动中应该扮演什么角色。Further,确保LLM稳健性的情境化需要考虑抑郁症患者语言产生的特殊性,以及它随时间的演变。最后,我们提供了一系列建议,以促进负责任的设计和部署LLM增强的CAI,为抑郁症患者提供治疗支持.
    UNASSIGNED: Large language model (LLM)-powered services are gaining popularity in various applications due to their exceptional performance in many tasks, such as sentiment analysis and answering questions. Recently, research has been exploring their potential use in digital health contexts, particularly in the mental health domain. However, implementing LLM-enhanced conversational artificial intelligence (CAI) presents significant ethical, technical, and clinical challenges. In this viewpoint paper, we discuss 2 challenges that affect the use of LLM-enhanced CAI for individuals with mental health issues, focusing on the use case of patients with depression: the tendency to humanize LLM-enhanced CAI and their lack of contextualized robustness. Our approach is interdisciplinary, relying on considerations from philosophy, psychology, and computer science. We argue that the humanization of LLM-enhanced CAI hinges on the reflection of what it means to simulate \"human-like\" features with LLMs and what role these systems should play in interactions with humans. Further, ensuring the contextualization of the robustness of LLMs requires considering the specificities of language production in individuals with depression, as well as its evolution over time. Finally, we provide a series of recommendations to foster the responsible design and deployment of LLM-enhanced CAI for the therapeutic support of individuals with depression.
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  • 文章类型: Editorial
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  • 文章类型: Journal Article
    人均无(NPO),也被称为NilbyMouth(NBM),是一种与健康相关的干预措施,包括扣留食物和液体。当在吞咽困难的人的情况下实施时,非营利组织旨在减轻愿望风险。然而,缺乏证据表明NPO作为吞咽困难患者的干预措施是有益的。本文探讨了与NPO的潜在益处和不利影响有关的理论和经验证据,并断言NPO不是良性干预措施。本文主张在做出有关使用NPO作为吞咽困难干预措施的决策时应用道德框架,特别是涉及知情同意和一个人的自决权。
    Nil per os (NPO), also referred to as Nil by Mouth (NBM), is a health-related intervention of withholding food and fluids. When implemented in the context of a person with dysphagia, NPO aims to mitigate risks of aspiration. However, evidence demonstrating that NPO is beneficial as an intervention for people with dysphagia is lacking. This paper explores the theoretical and empirical evidence relating to the potential benefits and adverse effects of NPO and asserts that NPO is not a benign intervention. This paper argues for applying an ethics framework when making decisions relating to the use of NPO as an intervention for dysphagia, in particular addressing informed consent and a person\'s right to self-determination.
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