Hasil untuk "Medical philosophy. Medical ethics"

Dilza Teresinha Ambrós Ribeiro

Francisco Javier Aznar Sala, Ángel Garrido Vila, Paula Cano Molla

El presente artículo se centra en el análisis bioético y científico de la eutanasia, con especial atención al caso español. Se aborda el fenómeno de la posible pendiente resbaladiza en aquellos países donde ha sido implementada en el marco de una comparativa global que nos permita establecer pautas y sinergias sinónimas en los distintos lugares desde su desarrollo. El análisis ha sido trabajado desde fuentes primigenias que nos permiten recoger los últimos datos.

Anuradha Sharma, Anupriya Wadhwa, Nupur Gupta

Cristian Moyano-Fernández, Jon Rueda, Janet Delgado et al.

The application of Artificial Intelligence (AI) in healthcare and epidemiology undoubtedly has many benefits for the population. However, due to its environmental impact, the use of AI can produce social inequalities and long-term environmental damages that may not be thoroughly contemplated. In this paper, we propose to consider the impacts of AI applications in medical care from the One Health paradigm and long-term global health. From health and environmental justice, rather than settling for a short and fleeting green honeymoon between health and sustainability caused by AI, it should aim for a lasting marriage. To this end, we conclude by proposing that, in the upcoming years, it could be valuable and necessary to promote more interconnected health, call for environmental cost transparency, and increase green responsibility.Highlights Using AI in medicine and epidemiology has some benefits in the short term.AI usage may cause social inequalities and environmental damage in the long term.Health justice should be rethought from the One Health perspective.Going beyond anthropocentric and myopic cost–benefit analysis would expand health justice to include an environmental dimension.Greening AI would help to reconcile public and global health measures.

Jin Shi, David Bendig, Horst Christian Vollmar et al.

BackgroundArtificial intelligence (AI), conceived in the 1950s, has permeated numerous industries, intensifying in tandem with advancements in computing power. Despite the widespread adoption of AI, its integration into medicine trails other sectors. However, medical AI research has experienced substantial growth, attracting considerable attention from researchers and practitioners. ObjectiveIn the absence of an existing framework, this study aims to outline the current landscape of medical AI research and provide insights into its future developments by examining all AI-related studies within PubMed over the past 2 decades. We also propose potential data acquisition and analysis methods, developed using Python (version 3.11) and to be executed in Spyder IDE (version 5.4.3), for future analogous research. MethodsOur dual-pronged approach involved (1) retrieving publication metadata related to AI from PubMed (spanning 2000-2022) via Python, including titles, abstracts, authors, journals, country, and publishing years, followed by keyword frequency analysis and (2) classifying relevant topics using latent Dirichlet allocation, an unsupervised machine learning approach, and defining the research scope of AI in medicine. In the absence of a universal medical AI taxonomy, we used an AI dictionary based on the European Commission Joint Research Centre AI Watch report, which emphasizes 8 domains: reasoning, planning, learning, perception, communication, integration and interaction, service, and AI ethics and philosophy. ResultsFrom 2000 to 2022, a comprehensive analysis of 307,701 AI-related publications from PubMed highlighted a 36-fold increase. The United States emerged as a clear frontrunner, producing 68,502 of these articles. Despite its substantial contribution in terms of volume, China lagged in terms of citation impact. Diving into specific AI domains, as the Joint Research Centre AI Watch report categorized, the learning domain emerged dominant. Our classification analysis meticulously traced the nuanced research trajectories across each domain, revealing the multifaceted and evolving nature of AI’s application in the realm of medicine. ConclusionsThe research topics have evolved as the volume of AI studies increases annually. Machine learning remains central to medical AI research, with deep learning expected to maintain its fundamental role. Empowered by predictive algorithms, pattern recognition, and imaging analysis capabilities, the future of AI research in medicine is anticipated to concentrate on medical diagnosis, robotic intervention, and disease management. Our topic modeling outcomes provide a clear insight into the focus of AI research in medicine over the past decades and lay the groundwork for predicting future directions. The domains that have attracted considerable research attention, primarily the learning domain, will continue to shape the trajectory of AI in medicine. Given the observed growing interest, the domain of AI ethics and philosophy also stands out as a prospective area of increased focus.

Johannes J. Rasker, Suzanne P. Linn-Rasker

We hypothesise that MMR vaccination is possibly a safe, cheap, effective and readily available method to reduce the severity of COVID-19 disease course in health care workers, elderly patients and other people at risk. The evidence is based on relevant literature.  Suggestions for further studies are given.

Stefan F. Vermeulen, Marjolijn Hordijk, Nikkie Aarts et al.

Abstract Seriously ill patients who have exhausted all approved treatment regimens and who cannot be enrolled in clinical trials may resort to expanded access programmes in order to gain access to unapproved, investigational drugs. It seems that in some countries, expanded access to investigational drugs is offered in clinical practice on a more routine basis than in other countries. This study is the first to investigate the experiences of physicians with expanded access to investigational drugs in different healthcare systems, with a focus on factors that facilitate or hinder expanded access. Semi-structured interviews (n = 36) were carried out with medical specialists in the Netherlands (n = 14), Turkey (n = 9) and the United States of America (n = 13), and analysed thematically. This study identifies five sets of factors pointed out by physicians that determine the degree to which expanded access to investigational drugs is deemed feasible in clinical practice: the suitability of investigational treatments, the application process, hospital policies, support by pharmaceutical companies, and funding and reimbursement arrangements. Based on the interviews conducted, we conclude that, while legally allowed and technically possible, expanded access is not always feasible for—and not always considered an option by—treating physicians. This is mainly due to lack of familiarity with expanded access, the extensive time and effort required for the application process, willingness or ability of pharmaceutical companies to supply the drugs, and funding issues.

Pankti Mehta, Sakir Ahmed

Medicine as a field is unique in the sense that the skill to relate to people weighs heavier on the doctor than the skill required to practise it. Medical humanities is an interdisciplinary field that considers issues of health in the context of history, philosophy, social studies, and anthropology among others, enabling students to change their practice from “looking” to “seeing” the patient as a whole. Unfortunately, current medical training is focused on academics with students left on their own to acquire communication and ancillary skills. In the core medical curriculum, a structured training in medical humanities remains lacking. Herein, we discuss the need, student’s perspectives, and the approach going forward in the inculcation of medical humanities in the medical training with a particular focus on medical ethics.

Thabang Excellent Mofokeng

The issue regarding the transition of members from their current medical schemes to the National Health Insurance (NHI) in South Africa has erupted in much debate. This study, modelled on enlightened marketing philosophy concepts, measures the effects of the perceived costs classified by type (procedural, financial, and relational) and direction (positive and negative) of this switch in terms of Customer Satisfaction. It also measures the impact on the perceived marketing ethics of current medical schemes in South Africa. Data were collected using a face-to-face survey from 250 consumers of medical schemes in South Africa. An 83.2% response rate was entered into SPSS Version 26, and AMOS Version 26 to test a two-step modelling approach (SEM). The results reveal positive significant effects of personal relational loss costs and benefit loss costs on Customer Satisfaction, which in turn, negatively affects currently perceived marketing ethics of medical schemes. For customers paying high and medium medical scheme contributions, and those who have prior switching experience, the results show that the costs of increasing benefit loss enhance Customer Satisfaction. Increasing satisfaction then enhances perceptions of marketing ethics for customers who do not have switching experience. The practical implications and recommendations explain marketing strategies to medical scheme practitioners to enable the enhancement of personal relationships with customers and increase the service benefits, which in turn, removes the current negatively perceived marketing ethics. This paper, therefore, links articulation of the disconfirmation Expectation Theory and the General Theory of Marketing Ethics in the context of medical schemes in South Africa. Limitations and relevant future research avenues conclude the discussion of the research study.

Akankshya Kashyap

Mario Souza y Machorro

El vínculo postmodernidad tecnológica/comunicación humana tiene en los mass-media, la TV, el cine, el internet y sus derivados; en las publicaciones sin censura y en la publicidad, herramientas de distorsión educativa y de salud comunitarias. La postmodernidad impacta en la organización social y en la cultura con su dicotomía de racionalismo vs. irracionalismo. La visión kantiana de la ciencia, la moral y el arte en pro de una sociedad más justa, libre y feliz, se desmorona en el intento de «superar la modernidad». La sociedad cibernética burocratiza e impide la libertad del hombre. Los mass media y la sociedad de la comunicación no han generado una sociedad más «transparente» o consciente de sí misma, sino más compleja y caótica. Las dicotomías sujeto-objeto y público-privado hacen al individuo ajeno a su vida, un elemento de ciencia ficción, inmerso en un proceso virtual que lo desplaza a mundos electrónicos. En el éxtasis de la comunicación el medio predomina con su dispersión sobre el mensaje; el saber científico se orienta al desarrollo tecnológico y al poder, destacando su aspecto lingüístico, que no impide que cada vez más se hable y se escriba peor. El impacto de los mass media impulsa conductas antisociales y una «búsqueda de sensaciones intensas», para aplacar estados emocionales derivados del vacío existencial, de la frustración e insatisfacción vital de ciertas poblaciones. La persistencia de la divulgación enajenante, alienadora de la autoconciencia y falseadora de la realidad, no fomenta el desarrollo de una función personal, vincular y social saludables.

S. Gregory, E. M. Bunnik, A. B. Callado et al.

Abstract Background Including participants in patient and public involvement activities is increasingly acknowledged as a key pillar of successful research activity. Such activities can influence recruitment and retention, as well as researcher experience and contribute to decision making in research studies. However, there are few established methodologies of how to set up and manage participant involvement activities. Further, there is little discussion of how to do so when dealing with collaborative projects that run across countries and operate in multiple linguistic and regulatory contexts. Methods In this paper we describe the set-up, running and experiences of the EPAD participant panel. The EPAD study was a pan-European cohort study with the aim to understand risks for developing Alzheimer’s disease and build a readiness cohort for Phase 2 clinical trials. Due to the longitudinal nature of this study, combined with the enrolment of healthy volunteers and those with mild cognitive impairments, the EPAD team highlighted participant involvement as crucial to the success of this project. The EPAD project employed a nested model, with local panels meeting in England, France, Scotland, Spain and The Netherlands, and feeding into a central study panel. The local panels were governed by terms of reference which were adaptable to local needs. Results The impact of the panels has been widespread, and varies from feedback on documentation, to supporting with design of media materials and representation of the project at national and international meetings. Conclusions The EPAD panels have contributed to the success of the project and the model established is easily transferable to other disease areas investigating healthy or at-risk populations.

Juan María Cuevas Silva, Giovane Mendieta Izquierdo

Mahmood Mosavinezhad, Maryam Safara, Sadegh Kasir et al.

Background and Objectives: Social anxiety disorder is one of the most important psychological disorders that has appeared concurrently with social changes. The present study aimed at evaluating the role of spiritual intelligence and personal beliefs in social anxiety among students at Azad University, Ferdows Branch, South Khorasan Province, Iran. Methods: The study population of this analytical cross-sectional study was all students at the Faculty of Psychology and Educational Sciences affiliated to Azad University, Ferdows Branch, South Khorasan, Iran. In total, 300 students were selected through stratified random sampling in the 2017-2018 academic year. Data were collected using the social anxiety scale by Connor et al. (2000), King's spiritual intelligence scale (2008), and personal beliefs questionnaire by Ellis (1978). Moreover, data analysis was performed utilizing inferential statistics (Pearson correlation and multiple regression). The significance level was considered 0.01 in this study. Results: The results showed that spiritual intelligence correlated significantly with social anxiety (r=-0.651, P<0.001), and there was a remarkable association between personal beliefs and social anxiety (r=0.335, P<0.001). Moreover, according to the obtained results, spiritual intelligence (42.9) and irrational personal beliefs (11.2) predicted social anxiety (P<0.01). Conclusion: According to the role of spiritual intelligence and personal beliefs in reducing social anxiety, it can be concluded that strengthening the components of these two factors can be effective in reducing the social anxiety among students which improve their mental health.

Beatriz Sanabria Barradas, Pascual Linares Márquez, Dora Elizabeth Granados Ramos

El presente artículo muestra la importancia que tiene el consentimiento informado en los procesos de investigación científica y, por ende, la vulnerabilidad que enfrentan ante este procedimiento las personas con discapacidad. Se presenta la evolución del concepto del consentimiento informado en diferentes países de Iberoamérica y Estados Unidos. De igual manera, se abordan los diversos criterios que deben considerarse dentro del consentimiento informado, así como los tratados y declaraciones que deben tomarse en cuenta para no vulnerar los derechos humanos de los participantes en investigaciones científicas. Además, dentro de este dilema ético en nuestros tiempos, se aborda el trastorno del espectro autista (TEA), un trastorno del neurodesarrollo que, al presentar diversos grados de severidad, no permite que las personas con TEA puedan dar su opinión, aunado a esto que sean menores de edad, aspectos que los pone en condición de vulnerabilidad.

Kristina Würth, Wolf Langewitz, Stella Reiter-Theil et al.

Abstract Background In todays’ super-diverse societies, communication and interaction in clinical encounters are increasingly shaped by linguistic, cultural, social and ethnic complexities. It is crucial to better understand the difficulties patients with migration background and healthcare professionals experience in their shared clinical encounters and to explore ethical aspects involved. Methods We accompanied 32 migrant patients (16 of Albanian and Turkish origin each) during their medical encounters at two outpatient clinics using an ethnographic approach (participant observation and semi-structured interviews with patients and healthcare professionals). Overall, data of 34 interviews with patients and physicians on how they perceived their encounter and which difficulties they experienced are presented. We contrasted the perspectives on the difficult aspects and explore ethical questions surrounding the involved issues. Results Patients and physicians describe similar problem areas, but they have diverging perspectives on them. Two main themes were identified by both patients and physicians: >patients’ behaviour in relation to doctors’ advice< and > relationship issues<. Conclusions A deeper understanding of the difficulties and challenges that can arise in cross-cultural settings could be provided by bringing together healthcare professionals’ and patients’ perspectives on how a cross- cultural clinical encounter is perceived. Ethical aspects surrounding some of the difficulties could be highlighted and should get more attention in clinical practice and research.

H. Namazi, K. Aramesh, B. Larijani

The nature of the doctor-patient relationship as a keystone of care necessitates philosophical, psychological and sociological considerations. The present study investigates concepts related to these three critical views considered especially important. From the philosophical viewpoint, the three concepts of "the demands of ethics “,” ethical phenomenology and "the philosophy of the relationship" are of particular importance. From a psychological point of view, the five concepts of "communication behavior patterns" (including submissiveness, dominance, aggression, and assertiveness), "psychic distance", "emotional quotient", "conflict between pain relief and truth-telling", and "body language" have received specific emphasis. Lastly, from the sociological perspective, the three notions of "instrumental action", "communicative action", and "reaching agreement in the light of communicative action" are the most significant concepts to reconsider in the doctor-patient relationship. It should be added, however, that from the sociological point of view, the doctor-patient relationship goes beyond a two-person interaction, as the moral principles of doctors and patients depend on medical and patient ethics respectively. The theoretical foundations of the doctor-patient relationship will finally help establish the different dimensions of medical interactions. This can contribute to the development of principles and multidisciplinary bases for establishing practical ethical codes and will eventually result in a more effective doctor-patient relationship.

Maryam Aghabarary, Nahid Dehghan Nayeri

Concerns over limited medical equipment and resources, particularly in intensive care units (ICUs), have raised the issue of medical futility. Medical futility draws a contrast between physician’s authority and patients’ autonomy and it is one of the major issues of end-of-life ethical decision-making. The aim of this study was to review medical futility and its challenges. In this systematized review study, a comprehensive search of the existing literature was performed using an internet search with broad keywords to access related articles in both Persian and English databases. Finally, 89 articles were selected and surveyed. Medical futility is a complex, ambiguous, subjective, situation-specific, value-laden, and goal-dependent concept which is almost always surrounded by some degrees of uncertainty; hence, there is no objective and valid criterion for its determination. This concept is affected by many different factors such as physicians’ and patients’ value systems, medical goals, and sociocultural and religious context, and individuals’ emotions and personal characteristics. It is difficult to achieve a clear consensus over the concept of medical futility; hence, it should be defined and determined at an individual level and based on the unique condition of each patient.

Florencia Luna

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M. Shakour, A. Yousefi, L. Bazrafkan et al.