professional obligation

  • 文章类型: Journal Article
    人工智能(AI)在移动健康(mHealth)中的日益突出已经产生了一个不同的应用程序子集,这些应用程序使用用户输入的健康状况和症状信息为用户提供诊断信息-AI支持的症状检查器应用程序(AIShycheck)。虽然这些应用程序可能会增加获得医疗保健的机会,他们提出了相应的道德和法律问题。本文将强调人工智能在医疗保健系统中的使用值得注意的问题,进一步巩固医疗保健系统中现有的偏见和专业问责制问题。对专业义务和责任的偏见和复杂性问题进行深入分析,我们专注于2mHealth应用程序作为例子-巴比伦和阿达。我们选择了这两个应用程序,因为它们在COVID-19大流行期间都广泛分发,并对它们使用人工智能来评估用户症状做出了突出的声明。首先,偏见根深蒂固通常源于用于训练人工智能系统的数据,让人工智能通过垃圾复制这些不平等,“垃圾出”现象。这些应用程序的用户也不太可能在人口统计上代表更大的人口,导致扭曲的结果。第二,鉴于AISymCheck应用程序可靠性的巨大多样性和缺乏监管,专业问责制构成了重大挑战。目前还不清楚这些应用程序是否应该接受安全审查。负责应用介导的误诊,以及这些应用程序是否应该由医生推荐。随着应用程序数量的迅速增加,对卫生专业人员的指导仍然很少。专业机构和宣传组织在解决这些道德和法律差距方面可以发挥特别重要的作用。在这些应用程序中实施技术保障措施可以减轻偏见,人工智能可以主要用中性数据进行训练,应用程序可能会受到监管系统的约束,以允许用户做出明智的决定。在我们看来,至关重要的是,在这些潜在破坏性技术的设计和实施过程中,必须考虑这些法律问题。根深蒂固的偏见和职业责任,在以不同方式操作时,最终加剧了mHealth的不受管制的性质。
    The growing prominence of artificial intelligence (AI) in mobile health (mHealth) has given rise to a distinct subset of apps that provide users with diagnostic information using their inputted health status and symptom information-AI-powered symptom checker apps (AISympCheck). While these apps may potentially increase access to health care, they raise consequential ethical and legal questions. This paper will highlight notable concerns with AI usage in the health care system, further entrenchment of preexisting biases in the health care system and issues with professional accountability. To provide an in-depth analysis of the issues of bias and complications of professional obligations and liability, we focus on 2 mHealth apps as examples-Babylon and Ada. We selected these 2 apps as they were both widely distributed during the COVID-19 pandemic and make prominent claims about their use of AI for the purpose of assessing user symptoms. First, bias entrenchment often originates from the data used to train AI systems, causing the AI to replicate these inequalities through a \"garbage in, garbage out\" phenomenon. Users of these apps are also unlikely to be demographically representative of the larger population, leading to distorted results. Second, professional accountability poses a substantial challenge given the vast diversity and lack of regulation surrounding the reliability of AISympCheck apps. It is unclear whether these apps should be subject to safety reviews, who is responsible for app-mediated misdiagnosis, and whether these apps ought to be recommended by physicians. With the rapidly increasing number of apps, there remains little guidance available for health professionals. Professional bodies and advocacy organizations have a particularly important role to play in addressing these ethical and legal gaps. Implementing technical safeguards within these apps could mitigate bias, AIs could be trained with primarily neutral data, and apps could be subject to a system of regulation to allow users to make informed decisions. In our view, it is critical that these legal concerns are considered throughout the design and implementation of these potentially disruptive technologies. Entrenched bias and professional responsibility, while operating in different ways, are ultimately exacerbated by the unregulated nature of mHealth.
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  • 文章类型: Journal Article
    在文化和政治理想的背景下,本文强调了心理健康护理在满足人群需求方面的重要性,以及可能阻碍其充分实现这一目标的监管障碍。具体来说,我们考虑监管机构规定的护士教育中的“熟练程度”概念如何影响未来心理健康护士的发展及其心理健康护理身份。心理健康实践中的一个关键紧张关系是受制裁的权力在限制患者自由的同时,以及促进患者自主康复的愿望(和义务)所带来的道德法律挑战。英国未来护士标准的普遍性对心理健康护士做好准备,以应对随之而来的紧张局势。这对护士和病人都有影响,因为这两种风险都经历了给予或接受不良护理的痛苦和不和谐。我们认为,需要做更多的工作来使心理健康护士能够定义和阐明职业的细微差别,作为成为关键的一部分,有思想和自信的从业者。教育工作者可以通过调整课程来为这一使命做出贡献,教学方法和评估,为心理健康护理学生创造有意义的机会,以参与复杂的心理健康护理实践。没有这个,该行业的可信度将继续受到质疑;它的未来不确定。
    Against the backdrop of cultural and political ideals, this article highlights both the significance of mental health nursing in meeting population needs and the regulatory barriers that may be impeding its ability to adequately do so. Specifically, we consider how ambiguous notions of \'proficiency\' in nurse education-prescribed by the regulator-impact the development of future mental health nurses and their mental health nursing identity. A key tension in mental health practice is the ethical-legal challenges posed by sanctioned powers to restrict patients\' freedom at the same time as the desire (and obligation) to promote patients\' self-determined recovery. The genericism of the UK\'s Future Nurse Standards do little to prepare mental health nurses to navigate the tensions that ensue. This has consequences for nurses and patients alike, as both risk experiencing the distress and dissonance that attends giving or receiving poor care. We argue that more needs to be done to enable mental health nurses to define and articulate the nuances of the profession as part of becoming critical, thoughtful and confident practitioners. Educators can contribute to this mission by aligning curriculum, pedagogy and assessment to create meaningful opportunities for mental health nursing students to engage with the complexities of mental health nursing practice. Without this, the credibility of the profession will continue to be questioned; its future uncertain.
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  • 文章类型: Journal Article
    Informed consent is the cornerstone of the doctor-patient relationship. At least this is how it is presented in theory. In practice, doctors struggle with their obligation to inform their patient before obtaining their approval prior to a medical intervention. In Taiwan, the culture is often mentioned to justify the doctor\'s reluctance to speak openly with their patient. Invoking the importance of the family in the society, doctors tend to rely less on their patients and more on their relatives to make important decisions. Yet, the cultural argument for not seeking the patients\' informed consent sounds more like a mere excuse than the real cause of the difficulties doctors face today in obtaining their patients\' consent. This paper argues that today the doctors in Taiwan are mostly governed by the same fear that was the rule in the USA and Europe until the 1980s. It may be time for changing the paradigm, admitting that patients are able to handle even the most dramatic diagnosis. It seems also important to get away from the sterile opposition of doctor\'s paternalism versus patient\'s autonomy and to introduce a true partnership between doctors and patients.
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