I introduce a distinction between health need and medical need, and raise several questions about their interaction. Health needs are needs that relate directly to our health condition. Medical needs are needs which bear some relation to medical institutions or processes. I suggest that the question of whether medical insurance or public care should cover medical needs, health needs, or only needs which fit both categories is a political question that cannot be resolved (...) definitionally. I also argue against an overly strict definition of medical need on the grounds that this presupposes, wrongly, that medical intervention should always be a last resort. (shrink)

Many hold that distributing healthcare according to medical need is a requirement of equality. Most egalitarians believe, however, that people ought to be equal on the whole, by some overall measure of well-being or life-prospects; it would be a massive coincidence if distributing healthcare according to medical need turned out to be an effective way of promoting equality overall. I argue that distributing healthcare according to medical need is important for reducing individuals' uncertainty surrounding (...) their future medical needs. In other words, distributing healthcare according to medical need is a natural feature of healthcare insurance; it is about indemnity, not equality. (shrink)

The notion of respect for autonomy dominates bioethical discussion, though what qualifies precisely as autonomous action is notoriously elusive. In recent decades, the notion of autonomy in medical contexts has often been defined in opposition to the notion of autonomy favoured by theoretical philosophers. Where many contemporary theoretical accounts of autonomy place emphasis on a condition of “authenticity”, the special relation a desire must have to the self, bioethicists often regard such a focus as irrelevant to the concerns of (...) medical ethics, and too stringent for use in practical contexts. I argue, however, that the very condition of authenticity that forms a focus in theoretical philosophy is also essential to autonomy and competence in medical ethics. After tracing the contours of contemporary authenticity-based theories of autonomy, I consider and respond to objections against the incorporation of a notion of authenticity into accounts of autonomy designed for use in medical contexts. By looking at the typical problems that arise when making judgments concerning autonomy or competence in a medical setting, I reveal the need for a condition of authenticity—as a means of protecting choices, particularly high-stakes choices, from being restricted or overridden on the basis of intersubjective disagreement. I then turn to the treatment of false and contestable beliefs, arguing that it is only through reference to authenticity that we can make important distinctions in this domain. Finally, I consider a potential problem with my proposed approach; its ability to deal with anorexic and depressive desires. (shrink)

Definition of the problem The umbrella term “explicability” refers to the reduction of opacity of artificial intelligence (AI) systems. These efforts are challenging for medical AI applications because higher accuracy often comes at the cost of increased opacity. This entails ethical tensions because physicians and patients desire to trace how results are produced without compromising the performance of AI systems. The centrality of explicability within the informed consent process for medical AI systems compels an ethical reflection on the (...) trade-offs. Which levels of explicability are needed to obtain informed consent when utilizing medical AI? Arguments We proceed in five steps: First, we map the terms commonly associated with explicability as described in the ethics and computer science literature, i.e., disclosure, intelligibility, interpretability, and explainability. Second, we conduct a conceptual analysis of the ethical requirements for explicability when it comes to informed consent. Third, we distinguish hurdles for explicability in terms of epistemic and explanatory opacity. Fourth, this then allows to conclude the level of explicability physicians must reach and what patients can expect. In a final step, we show how the identified levels of explicability can technically be met from the perspective of computer science. Throughout our work, we take diagnostic AI systems in radiology as an example. Conclusion We determined four levels of explicability that need to be distinguished for ethically defensible informed consent processes and showed how developers of medical AI can technically meet these requirements. (shrink)

Pharmaceuticals or other emerging technologies could be used to enhance (or diminish) feelings of lust, attraction, and attachment in adult romantic partnerships. While such interventions could conceivably be used to promote individual (and couple) well-being, their widespread development and/or adoption might lead to “medicalization” of human love and heartache—for some, a source of serious concern. In this essay, we argue that the “medicalization of love” need not necessarily be problematic, on balance, but could plausibly be expected to have either (...) good or bad consequences depending upon how it unfolds. By anticipating some of the specific ways in which these technologies could yield unwanted outcomes, bioethicists and others can help direct the course of love’s “medicalization”—should it happen to occur—more toward the “good” side than the “bad.”. (shrink)

Torture is unethical and usually counterproductive. It is prohibited by international and national laws. Yet it persists: according to Amnesty International, torture is widespread in more than a third of countries. Physicians and other medical professionals are frequently asked to assist with torture. -/- Medical complicity in torture, like other forms of involvement, is prohibited both by international law and by codes of professional ethics. However, when the victims of torture are also patients in need of treatment, (...) doctors can find themselves torn. To accede to the requests of the torturers may entail assisting or condoning terrible acts. But to refuse care to someone in medical need may seem like abandoning a patient and thereby fail to exhibit the beneficence expected of physicians. -/- In this paper, we argue that this dilemma is real and that sometimes the right thing for a doctor to do, overall, is to be complicit in torture. Though complicity in a wrongful act is itself prima facie wrongful, this judgment may be outweighed by other factors. We propose three criteria for analyzing how those factors apply to particular cases of medical complicity in torture. (shrink)

In contemporary healthcare, medical image categorization is essential for illness prediction, diagnosis, and therapy planning. The emergence of digital imaging technology has led to a significant increase in research into the use of machine learning (ML) techniques for the categorization of images in medical data. We provide a thorough summary of recent developments in this area in this review, using knowledge from the most recent research and cutting-edge methods.We begin by discussing the unique challenges and opportunities associated with (...) medical image classification, including the complexity of anatomical structures, variability in imaging modalities, and the need for interpretability and reliability in clinical settings. Subsequently, we survey a wide range of ML algorithms and techniques employed for medical image classification, including traditional methods such as support vector machines and k-nearest neighbors, as well as deep learning approaches like convolutional neural networks (CNNs) and recurrent neural networks (RNNs). Furthermore, we examine key considerations in dataset preparation, feature extraction, and model evaluation specific to medical image classification tasks. We highlight the importance of large, annotated datasets, transfer learning, and data augmentation techniques in enhancing model performance and generalization. (shrink)

Medical tourism can be defined as the process of travelling outside of an individual’s country to another to seek medical care. The current research studies medical tourism in Ghana historically, focusing on Korle Bu Teaching Hospital in Accra and Komfo Anokye Teaching Hospital in Kumase. Using a qualitative research approach, the study provides a historical argument on the continuities and discontinuities of medical tourism in Ghana. Indeed, medical tourism has undergone several transitions over time. To (...) emphasize, the current contribution has thoroughly discussed the evolution of medical tourism in Ghana, the pull and push factors of medical tourism, its impact on the local health systems and the need to further promote it. The study concludes among other things that the improvement of medical facilities, personnel and equipment, will enhance the medical tourism prospects of the country. (shrink)

Miracle Max, it seems, is the only remaining miracle worker in all of Florin. Among other things, this means that he (unlike anyone else) can resurrect the recently dead, at least in certain circumstances. Max’s peculiar talents come with significant perks (for example, he can basically set his own prices!), but they also raise a number of ethical dilemmas that range from the merely amusing to the truly perplexing: -/- How much about Max’s “methods” does he need to reveal (...) to his patients? Is it really OK for Max to lie about Valerie’s being a witch, even though she really isn’t? Just how much of the “truth” does Max have to tell his patients? -/- Let’s suppose that Humperdinck had offered Max his old job back. Would it have been OK for Max to accept this offer? What about if Humperdinck wanted him to do experiments at “the Zoo”? -/- Is Max obligated to offer his services to everyone who needs them, such as the (mostly) dead Westley and friends? Or is he free to pick and choose? -/- In this chapter, I’ll consider how these questions might be addressed using concepts of medical ethics. As it turns out, Max’s dilemmas are not too different from the sorts of dilemmas that many medical professionals encounter in their daily lives, and exploring how Max could (or should) respond to them can help us figure out what we can do here in the “real” world. (shrink)

Larry Temkin draws on the work of Angus Deaton to argue that countries with poor governance sometimes rely on charitable giving and foreign aid in ways that enable them to avoid relying on their own citizens; this can cause them to be unresponsive to their citizens’ needs and thus prevent the long-term alleviation of poverty and other social problems. I argue that the implications of this “lack of government responsiveness argument” (or LOGRA) are both broader and narrower than they might (...) first appear. I explore how LOGRA applies more broadly to certain types of charitable giving in developed countries, with a focus on medical crowdfunding. I then highlight how LOGRA does not apply to charitable giving aimed at alleviating the suffering of the absolutely politically marginalized, or those especially vulnerable people to whom governments are never responsive. (shrink)

There have recently been novel applications of medical systematic review guidelines to economic policy interventions which contain controversial methodological assumptions that require further scrutiny. A landmark 2017 Cochrane review of unconditional cash transfer (UCT) studies, based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE), exemplifies both the possibilities and limitations of applying medical systematic review guidelines to UCT and universal basic income (UBI) studies. Recognizing the need to upgrade GRADE to incorporate the differences between (...) class='Hi'>medical and policy interventions, the GRADE Public Health Project Group (PHPG) was convened to enumerate and address these methodological challenges. However, in light of our analysis of additional methodological challenges that arise for UCT and UBI studies, we argue that the adaptation of medical systematic review guidelines to economic methodology is far from straightforward and is in fact more challenging than claimed by the PHPG. (shrink)

Pain medication is one of the responses to the mercy argument that utilitarian ethicists use for justifying active euthanasia on the grounds of prevention of cruelty and appeal to beneficence. The researcher reinforces the significance of pain medication in meeting this challenge and considers it the most preferred response among various other responses. It is because of its realism and effectiveness. In exploring the mechanism and considerations related to pain medication, the researcher briefly touches the Catholic ethical position on the (...) issue, a position that cannot be ignored in the development of contemporary bioethics. The researcher particularly deliberates on the contemporary Islamic discourse on the issue; by furthering the debate in line with the Islamic legal maxims and general guidance from the primary sources of Islamic law and ethics. The resolution on the issue is sought by synthesizing the views and legal maxims (al-Qawaid al-Fiqhiyyah) on the issue, which in conclusion provide justification for pain medication by considerably regarding pain as necessity and pressing need. However, such resolution allows pain medication to the limit and proportion that removes the pain and prohibits overdosing the patient with medication that may directly cause the death. (shrink)

Background: Critically ill patients often require complex clinical care by highly trained staff within a specialized intensive care unit (ICU) with advanced equipment. There are currently limited data on the costs of critical care in low-and middle-income countries (LMICs). This study aims to investigate the direct-medical costs of key infectious disease (tetanus, sepsis, and dengue) patients admitted to ICU in a hospital in Ho Chi Minh City (HCMC), Vietnam, and explores how the costs and cost drivers can vary between (...) the different diseases. -/- Methods: We calculated the direct medical costs for patients requiring critical care for tetanus, dengue and sepsis. Costing data (stratified into different cost categories) were extracted from the bills of patients hospitalized to the adult ICU with a dengue, sepsis and tetanus diagnosis that were enrolled in three studies conducted at the Hospital for Tropical Diseases in HCMC from January 2017 to December 2019. The costs were considered from the health sector perspective. The total sample size in this study was 342 patients. -/- Results: ICU care was associated with significant direct medical costs. For patients that did not require mechanical ventilation, the median total ICU cost per patient varied between US$64.40 and US$675 for the different diseases. The costs were higher for patients that required mechanical ventilation, with the median total ICU cost per patient for the different diseases varying between US$2,590 and US$4,250. The main cost drivers varied according to disease and associated severity. -/- Conclusion: This study demonstrates the notable cost of ICU care in Vietnam and in similar LMIC settings. Future studies are needed to further evaluate the costs and economic burden incurred by ICU patients. The data also highlight the importance of evaluating novel critical care interventions that could reduce the costs of ICU care. (shrink)

This article argues that personal medical data should be made available for scientific research, by enabling and encouraging individuals to donate their medical records once deceased, similar to the way in which they can already donate organs or bodies. This research is part of a project on posthumous medical data donation developed by the Digital Ethics Lab at the Oxford Internet Institute at the University of Oxford. Ten arguments are provided to support the need to foster (...) posthumous medical data donation. Two major risks are also identified—harm to others, and lack of control over the use of data—which could follow from unregulated donation of medical data. The argument that record-based medical research should proceed without the need to secure informed consent is rejected, and instead a voluntary and participatory approach to using personal medical data should be followed. The analysis concludes by stressing the need to develop an ethical code for data donation to minimise the risks, and offers five foundational principles for ethical medical data donation suggested as a draft code. (shrink)

One of the ways in which transnational medical agencies (TMAs) such as Medicins Sans Frontieres aim to increase the access of the global poor to health services is by supplying medical aid to people who need it in developing countries. The moral imperative supporting such work is clear enough, but a variety of factors can make such work difficult. One of those factors is the wrongdoing of other agents and agencies. For as a result of such wrongdoing, (...) the attempt to supply medical aid can sometimes lead to significant negative effects. What should TMAs do in such situations? On one view, TMAs should take account of any negative effects arising from the wrongdoing of others in just the same way in which they take account of negative effects arising more directly from their own actions, or from natural forces. To many people, this view seems wrong. In this paper, I articulate and discuss several different reasons why one might think this. In doing so, I hope to contribute to a debate about the more general question of how TMAs should respond to the wrongdoing of others. (shrink)

This study attempts an exposition of different perceptions of obligation to medical treatment that have emerged from the Islamic theological understanding and how they contribute to diversity of options and flexibility in clinical practice. Particularly, an attempt is made to formulate an Islamic perspective on ordinary and extraordinary means of medical treatment. This distinction is of practical significance in clinical practice, and its right understanding is also important to public funded healthcare authorities, guardians of the patients, health and (...) life insurance institutions, and employers who provide health care coverage to their employees. Not only these parties, but also lawyers and justice administration functionaries such as public prosecutors and judges are in need of understanding this distinction to deal with relevant litigations. The distinction could be made regarding terminally ill patients and non-terminally ill patients separately. The essential factors that matter in making the distinction between ordinary and extraordinary means of treatment are: (1) patient capacity (2) expert advice, and (3) nature of medication. Regarding terminally ill patients, medical treatment can become extraordinary because of (1) patient capacity and (2) nature of medication. In both these case the deciding condition applies: the expert advice taken from a group of physicians. In regards to non- terminally ill patients, extraordinary medical treatment includes three cases: (1) treatment that is known to be useless and futile, (2) treatment that endangers the life or cause more harm than what it removes, and (3) useful treatment, but the patient is unable to bear the cost. (shrink)

Thesis --University of Stellenbosch, 2004 Acceptance of the concept of medical futility facilitates a paradigm shift from curative to palliative medicine, accommodating a more humane approach and avoiding unnecessary suffering in the course of the dying process. This should not be looked upon as abandoning the patient but rather as providing the patient and family with an opportunity to come to terms with the dying process. It also does not entail withdrawal or passivity on the part of the health (...) care professional. In addition to medical skills, the treating physician is responsible for guiding this process by demonstrating sensitivity and compassion, respecting the values of patients, their families and the medical staff. The need for training to equip medical staff to take responsibility as empathetic participants in end-of-life decision-making is underscored. S Afr Med J 2008; 98: 284-286. (shrink)

Residents' high medical expenses is the core challenge that needs to be solved urgently in China's medical reform for a long time. Based on the panel data of 30 provinces in Chinese Mainland during 2011–2019, we evaluate the impact of China's national comprehensive medical reform pilot policy on residents' medical expenses by using the difference-in-differences model. The results show that the pilot policy was generally conducive to reducing residents' medical expenses, resulting in a reduction of (...) 2.13% in per capita medical expenses for inpatients, but the effect on per capita medical expenses for outpatients was insignificant. Mechanism analysis shows that hospital competition and institutional environment played a moderating role in the effect of the pilot policy on residents' medical expenses reduction. The more intense the hospital competition and the better the institutional environment, the more significant of the reduction effect. In addition, the reduction effect of the pilot policy was greater in the central provinces, the provinces with poor medical infrastructure, and the provinces with strong financial strength. This study provides useful policy insights for deepening medical reform and reducing residents' medical expenses. (shrink)

I defend the feasibility of a medical conscience in the following sense: a medical professional can object to the prevailing medical norms because they are incorrect as medical norms. In other words, I provide an account of conscientious objection that makes use of the idea that the conscience can issue true normative claims, but the claims in question are claims about medical norms rather than about general moral norms. I further argue that in order for (...) this line of reasoning to succeed, there needs to be an internal morality of medicine that determines what medical professionals ought to do qua medical professionals. I utilize a constructivist approach to the internal morality of medicine and argue that medical professionals can conscientiously object to providing treatment X, if providing treatment X is not in accordance with norms that would have been constructed, in light of the end of medicine, by the appropriate agents under the appropriate conditions. (shrink)

Forms of Artificial Intelligence (AI) are already being deployed into clinical settings and research into its future healthcare uses is accelerating. Despite this trajectory, more research is needed regarding the impacts on patients of increasing AI decision making. In particular, the impersonal nature of AI means that its deployment in highly sensitive contexts-of-use, such as in healthcare, raises issues associated with patients’ perceptions of (un) dignified treatment. We explore this issue through an experimental vignette study comparing individuals’ perceptions of being (...) treated in a dignified and respectful way in various healthcare decision contexts. Participants were subject to a 2 (human or AI decision maker) x 2 (positive or negative decision outcome) x 2 (diagnostic or resource allocation healthcare scenario) factorial design. We found evidence of a “human bias” (i.e., a preference for human over AI decision makers) and an “outcome bias” (i.e., a preference for positive over negative outcomes). However, we found that for perceptions of respectful and dignified interpersonal treatment, it matters more who makes the decisions in diagnostic cases and it matters more what the outcomes are for resource allocation cases. We also found that humans were consistently viewed as appropriate decision makers and AI was viewed as dehumanizing, and that participants perceived they were treated better when subject to diagnostic as opposed to resource allocation decisions. Thematic coding of open-ended text responses supported these results. We also outline the theoretical and practical implications of these findings. (shrink)

While every health care system stakeholder would seem to be concerned with obtaining the greatest value from a given technology, there is often a disconnect in the perception of value between a technology’s promoters and those responsible for the ultimate decision as to whether or not to pay for it. Adopting an empirical ethics approach, this paper examines how five Canadian medical device manufacturers, via their websites, frame the corporate “value proposition” of their innovation and seek to respond to (...) what they consider the key expectations of their customers. Our analysis shows that the manufacturers’ framing strategies combine claims that relate to valuable socio-technical goals and features such as prevention, efficiency, sense of security, real-time feedback, ease of use and flexibility, all elements that likely resonate with a large spectrum of health care system stakeholders. The websites do not describe, however, how the innovations may impact health care delivery and tend to obfuscate the decisional trade-offs these innovations represent from a health care system perspective. Such framing strategies, we argue, tend to bolster physicians’ and patients’ expectations and provide a large set of stakeholders with powerful rhetorical tools that may influence the health policy arena. Because these strategies are difficult to counter given the paucity of evidence and its limited use in policymaking, establishing sound collective health care priorities will require solid critiques of how certain kinds of medical devices may provide a better (i.e., more valuable) response to health care needs when compared to others. (shrink)

Mitochondrial replacement therapy requires oocytes of women whose mitochondrial DNA will be transmitted to resultant children. These techniques are scientifically, ethically and socially controversial; it is likely that some women who donate their oocytes for general in vitro fertilisation usage would nevertheless oppose their genetic material being used in MRT. The possibility of oocytes being used in MRT is therefore relevant to oocyte donation and should be included in the consent process when applicable. In present circumstances, specific consent should be (...) obtained. However, once MRT becomes more routine, such consent could be incorporated into the general consent process for oocyte donation. The reported lack of proper consent for MRT from the oocyte donor in the first baby born via the technique is an ethical failing and should be corrected in any future practice of MRT. (shrink)

Integrating medical imaging with computing technologies, such as Artificial Intelligence (AI) and its subsets: Machine learning (ML) and Deep Learning (DL) has advanced into an essential facet of present-day medicine, signaling a pivotal role in diagnostic decision-making and treatment plans (Huang et al., 2023). The significance of medical imaging is escalated by its sustained growth within the realm of modern healthcare (Varoquaux and Cheplygina, 2022). Nevertheless, the ever-increasing volume of medical images compared to the availability of imaging (...) experts. Biomedical experts and radiologists have resulted in a widening disparity, causing an excess and overwhelming workload on these healthcare professionals (Chen et al., 2021). Several studies indicate that the present-day biomedical radiologist is now saddled with the daunting task of interpreting an image almost every 10 seconds to keep pace with the burgeoning clinical demands (McDonald et al., 2015; Hosny et al., 2018; Lantsman et al., 2022). This cognitive drain has invariably led to inevitable consequences such as delays in diagnosis and an amplified risk of diagnostic errors – thus, the biomedical imaging aspect is in dire need of methods that would aid accurate diagnostics and analytics for improved decision making. In this review, the importance of AI-related technologies such as ML and/or DL methods are reviewed in relation to the processing of medical or biomedical images along with their potentials, challenges, and possible suggestions for future studies in the health landscape. The focus will be on machine learning methods associated with the medical field of image classification. (shrink)

Some patients, following brain injury, do not outwardly respond to spoken commands, yet show patterns of brain activity that indicate responsiveness. This is “cognitive-motor dissociation” (CMD). Recent research has used machine learning to diagnose CMD from electroencephalogram (EEG) recordings. These techniques have high false discovery rates, raising a serious problem of inductive risk. It is no solution to communicate the false discovery rates directly to the patient’s family, because this information may confuse, alarm and mislead. Instead, we need a (...) procedure for generating case-specific probabilistic assessments that can be communicated clearly. This article constructs a possible procedure with three key elements: (1) a shift from categorical “responding or not” assessments to degrees of evidence; (2) the use of patient-centred priors to convert degrees of evidence to probabilistic assessments; and (3) the use of standardized probability yardsticks to convey those assessments as clearly as possible. (shrink)

Today's realities require medical institutions to take more careful account of intangible factors that make up an irreplaceable component of cultural characteristics. Changes in the socio-economic conditions of economic activity have led to increased attention of the management of medical institutions to the need to form a corporate style that will provide additional competitive advantages. The purpose of the study is to identify the functions and elements of the corporate style of a medical institution and its (...) subdivisions, to find out its impact on the collective consciousness and behavior of consumers of medical services and to establish requirements for its development. The methodological basis of the study is modern research on the formation of corporate style and its impact on the reputation and successful development of organizations. The main hypothesis of the study is the assumption that corporate style influences the level of recognition and authority of a medical institution. Summary of the main research material. It is proved that an authentic, working corporate style for a modern medical institution is a necessary element of its organizational culture. It is determined that the corporate style contributes to creating a positive image of a medical institution in the eyes of consumers; allows distinguishing a medical institution from other medical institutions with a similar range of services; strengthens the organizational spirit of medical staff; increases the effectiveness of advertising; and creates a favorable image of a medical institution. The originality and practical significance of the study lies in the fact that a comparative analysis of the elements of corporate style of city clinical hospitals in Dnipro, which are clearly implemented on the official pages on the Internet, was carried out. Conclusions and prospects for further research. The conducted research has made it possible to state that the considered medical institutions of the city of Dnipro do not pay the necessary attention to the formation of their own corporate style. Sporadic initiatives and events create the appearance of the existence of a corporate style of a medical institution, but do not ensure the existence of such a corporate style that would work to increase the recognition and authority of a medical institution. (shrink)

This paper aims to analyze the ethical challenges in experimental drug use during the early stage of the COVID-19 pandemic, using Germany as a case study. In Germany uniform ethical guidelines were available early on nationwide, which was considered as desirable by other states to reduce uncertainties and convey a message of unity. The purpose of this ethical analysis is to assist the preparation of future guidelines on the use of medicines during public health emergencies. The use of hydroxychloroquine, remdesivir (...) and COVID-19 convalescent plasma in clinical settings was analyzed from the perspective of the ethical principles of beneficence, non-maleficence, justice and autonomy. We observed that drug safety and drug distribution during the pandemic affects all four ethical principles. We therefore recommend to establish ethical guidelines (i) to discuss experimental treatment options with patients from all population groups who are in urgent need, (ii) to facilitate the recording of patient reactions to drugs in off-label use, (iii) to expand inclusion criteria for clinical studies to avoid missing potentially negative effects on excluded groups, and (iv) to maintain sufficient access to repurposed drugs for patients with prior conditions. (shrink)

Ontological principles are needed in order to bridge the gap between medical and biological information in a robust and computable fashion. This is essential in order to draw inferences across the levels of granularity which span medicine and biology, an example of which include the understanding of the roles of tumor markers in the development and progress of carcinoma. Such information integration is also important for the integration of genomics information with the information contained in the electronic patient records (...) in such a way that real time conclusions can be drawn. In this paper we describe a large multi-granular datasource built by using ontological principles and focusing on the case of colon carcinoma. (shrink)

This chapter provides an outline of consent in the history of medical ethics. In doing so, it ranges over attitudes towards consent in medicine in ancient Greece, medieval Europe and the Middle East, as well as the history of Western law and medical ethics from the early modern period onwards. It considers the relationship between consent and both the disclosure of information to patients and the need to indemnify physicians, while attempting to avoid an anachronistic projection of (...) concern with patient autonomy too far back into the historical record. The chapter also includes a survey of the development of the social and intellectual infrastructure that underpins modern medical consent. It concludes with a brief discussion of possible future directions for ethical approaches to medical consent and competence that would depart from the models that arose in the twentieth-century. (shrink)

Background: Besides regulatory learning skills, learning also requires students to relate to their social context and negotiate it as they transition and adjust to medical training. As such, there is a need to consider and explore the role of social and cultural aspects in student learning, particularly in problem-based learning, where the learning paradigm differs from what most students have previously experienced. In this article, we report on the findings of a study exploring first-year medical students’ experiences (...) during the first semester of an undergraduate problem-based learning medical program at an African medical school. Method: We employed a qualitative case study approach using in-depth interviews with 23 first-year medical students. Participants ranged in age from 18 to 25 years. All students were bi/multilingual (some spoke three to five languages), with English as the learning language. We conducted an inductive thematic analysis to systematically identify and analyze patterns in the data using the Braun and Clarke framework. Results: Before medical school, students worked hard to compete for admission to medical school, were primarily taught using a teacher-centered approach, and preferred working alone. At the beginning of medical school, students found it challenging to understand the problem-based learning process, the role of the case, speaking and working effectively in a group, managing a heavy workload, and taking increased responsibility for their learning. By the end of the first semester, most students were handling the workload better, were more comfortable with their peers and facilitators, and appreciated the value of the problem-based learning approach. Conclusions: Our study highlights the importance of interrogating contextual sociocultural factors that could cause tension when implementing problem-based learning in non-western medical schools. Adjustment to problem-based learning requires a conceptual and pedagogic shift towards learner-centered practice, particularly concerning self direction, the role of the case, and collaborative learning. As such, there is a need to develop and implement research informed learning development programs that enable students to reflect on their sociocultural beliefs and practices, and enhance their regulatory learning competence to optimize meaningful and early engagement with the problem based learning process. (shrink)

Background: Community-based education (CBE) involves educating the head (cognitive), heart (affective), and the hand (practical) by utilizing tools that enable us to broaden and interrogate our value systems. This article reports on the use of virtue ethics (VE) theory for understanding the principles that create, maintain and sustain a socially accountable community placement programme for undergraduate medical students. Our research questions driving this secondary analysis were; what are the goods which are internal to the successful practice of CBE in (...) medicine, and what are the virtues that are likely to promote and sustain them? -/- Methods: We conducted a secondary theoretically informed thematic analysis of the primary data based on MacIntyre’s virtue ethics theory as the conceptual framework. -/- Results: Virtue ethics is an ethical approach that emphasizes the role of character and virtue in shaping moral behavior; when individuals engage in practices (such as CBE), goods internal to those practices (such as a collaborative attitude) strengthen the practices themselves, but also augment those individuals’ virtues, and that of their community (such as empathy). We identified several goods that are internal to the practice of CBE and accompanying virtues as important for the development, implementation and sustainability of a socially accountable community placement programme. A service-oriented mind-set, a deep understanding of community needs, a transformed mind, and a collaborative approach emerged as goods internal to the practice of a socially accountable CBE. The virtues needed to sustain the identified internal goods included empathy and compassion, connectedness, accountability, engagement [sustained relationship], cooperation, perseverance, and willingness to be an agent of change. -/- Conclusion: This study found that MacIntyre’s virtue ethics theory provided a useful theoretical lens for understanding the principles that create, maintain and sustain CBE practice. (shrink)

In the present paper, we shall discuss the notion of prototype and show its benefits. First, we shall argue that the prototypes of common-sense concepts are necessary for making prompt and reliable categorisations and inferences. However, the features constituting the prototype of a particular concept are neither necessary nor sufficient conditions for determining category membership; in this sense, the prototype might lead to conclusions regarded as wrong from a theoretical perspective. That being said, the prototype remains essential to handling most (...) ordinary situations and helps us to perform important cognitive tasks. To exemplify this point, we shall focus on disease concepts. Our analysis concludes that the prototypical conception of disease is needed to make important inferences from a practical and clinical point of view. Moreover, it can still be compatible with a classical definition of disease, given in terms of necessary and sufficient conditions. In the first section, we shall compare the notion of stereotype, as it has been introduced in philosophy of language by Hilary Putnam, with the notion of prototype, as it has been developed in the cognitive sciences. In the second section, we shall discuss the general role of prototypical information in cognition and stress its centrality. In the third section, we shall apply our previous discussion to the specific case of medical concepts, before briefly summarising our conclusions in section four. (shrink)

Biomedical diagnostic science is a great deal less successful than we've been willing to acknowledge in bioethics, and this fact has far-reaching ethical implications. In this article I consider the surprising prevalence of medically unexplained symptoms, and the term's ambiguous meaning. Then I frame central questions that remain answered in this context with respect to informed consent, autonomy, and truth-telling. Finally, I show that while considerable attention in this area is given to making sure not to provide biological care to (...) patients without a need, comparatively little is given to the competing, ethically central task of making sure never to obstruct access to biological care for those with diagnostically confusing biological conditions. I suggest this problem arises from confusion about the philosophical value of vagueness when it comes to the line between biological and psychosocial needs. (shrink)

Some of the duties of individuals and organisations involve responsiveness to need. This requires knowledge of need, so the epistemology of need is relevant to practice. The prevailing contention among philosophers who have broached the topic is that one can know one’s own needs (as one can know some kinds of desires) by feeling them. The article argues against this view. The main positive claims made in the article are as follows. Knowledge of need, in both (...) first‐person and second‐person cases, is a type of knowledge‐that with no basic epistemological source. Needs, like medical conditions, have signs and symptoms. Knowledge of these, with inference, results in knowledge of need. Finally, it is argued that need is akin to, but not a special case of, metaphysical necessity de re. Some implications of this for the epistemology of need are explained. (shrink)

In the last two decades we have witnessed considerable efforts directed towards making electronic healthcare records comparable and interoperable through advances in record architectures and (bio)medical terminologies and coding systems. Deep semantic issues in general, and ontology in particular, have received some interest from the research communities. However, with the exception of work on so-called ‘controlled vocabularies’, ontology has thus far played little role in work on standardization. The prime focus has been rather the rapid population of terminologies at (...) the level of fine detail. In this paper, we argue that more efforts are needed on the side of both research and standardization to ensure that the coding systems used in electronic healthcare records enjoy a semantics that is coherent with the semantics of the record. We propose realist ontology as a method to bring about this coherence by means of a robust system of top-level ontological categories. (shrink)

In this article I clarify the relationship between the use of involuntary antipsychotic medication and a delusional person’s freedom of thought in the light of three different views of freedom, namely, freedom as negative freedom, freedom as having an autonomous mind and freedom as capability. It is not clear how freedom of thought as a psychotic person’s human right should be understood and protected in practice. Therefore, further discussion is needed. These different ways of understanding a patient’s freedom of thought (...) also encourages to consider individual situations, hear the patient’s voice and work both multiprofessionally and across disciplines. (shrink)

Introduction. The medical sphere is constantly evolving, requiring improved approaches to its organisation and functioning. Advances in medical technology, observable changes in patient needs and growing competition challenge medical institutions to improve their strategies and approaches. Marketing technologies are becoming one of the key tools for achieving strategic goals. Purpose. This article is aimed at studying the peculiarities of the use of marketing technologies in the medical field. The main purpose of the study is to analyse (...) the impact of marketing tools on the development and success of medical institutions. Method (methodology). The methodological approach involves the use of an analytical approach to studying current trends in marketing and their impact on the healthcare sector. The study uses methods of data analysis and comparative analysis of marketing practices in medical institutions. Results. The study found that the use of targeted marketing strategies allows healthcare facilities to attract more patients, increase customer satisfaction and ensure an excellent reputation. The results of the study show a positive impact of the use of marketing tools on changing the perception of medical services by patients. Conclusions. The scope of application of the results is the practical activities of medical institutions seeking to improve their strategy of promotion and interaction with customers. The findings of the study can be used by marketers and managers of healthcare organisations to develop and implement effective marketing strategies. In summary, this article reveals the importance of using marketing technologies in the healthcare sector and provides practical recommendations for their successful implementation. The study emphasises that marketing in the healthcare industry is necessary to increase competitiveness and ensure quality medical care. (shrink)

Lately, more and more authors have asserted their belief that one of the criteria which, together with the medical ones, can and should be applied in the policy of selecting and/or prioritizing the patients in need for the allocation of medical resources with limited availability, is the principle of individual responsibility for illness. My intention in this study is to highlight some very serious obstacles looming against the attempt to apply this principle in the distribution of the (...) medical services with limited availability. Although there are numerous such obstacles, I shall only discuss five of them (the most important, in my opinion). These are: 1) the impossibility to establish with certainty whether a patient got ill due to his lifestyle; 2) the lack of a feasible and reliable method of establishing an individual’s responsibility for his lifestyle; 3) a patient’s right to privacy; 4) some moral requirements and principles and, last but not least, 5) the ethics of the medical profession. (shrink)

Recent developments in the field of forensic medicine and the judicial practice are both factors influencing considerably toward an increasing role of toxicologists in court hearings and litigation processes. The role of forensic toxicologist has been until a few decennia before a prerogative of the medico-legal specialists, but meanwhile a subspecialty of the general toxicology seems to have been created. Vis-à-vis the increasing presence of toxicologists in penal procedures of poisoning and intoxications, Albanian courts have created their own precedents and (...) bylaws, regulating the presence, the opinion taking, and the relative importance such an expert opinion will have on the final sentence. Due to a multiplicity of factors, legal terminology with regard to drugs of abuse needs to be revised and parallel to such a revision a better defining of the role of expert toxicologist as a collector and interpreter of the scientific proofs seems necessary. Overlapping competencies with judicial bodies and confusing legislative measures will do nothing else but complicate issues that should be and can be easily resolved, through simple and appropriate interventions at different levels. (shrink)

The Catholic Church is a field hospital with medics that help to spiritually heal those who recognize that they are in need of healing and who are willing to accept the cure being offered. Many of the sick ask for closeness, proximity and compassion, realities that cannot be offered simply by promoting pastoral activities. For this reason, we highlight the work of the spiritual doctor as a key element for a Church on the way out; we describe its main (...) characteristics based on the work of St. John Climacus. His contributions are of great relevance because they are based on living the virtues in order to offer personalized care. -/- La Iglesia católica es un hospital de campaña con médicos que ayudan a sanar espiritualmente a quienes reconociéndose enfermos aceptan la cura ofrecida. Muchos de estos piden cercanía, proximidad y compasión, realidades que no se logran ofrecer simplemente impulsando la realización de actividades pastorales. Poresta razón, destacamos la labor del médico espiritual como pieza clave para unaIglesia en salida; describimos sus principales características apoyándonos en la obra de San Juan Clímaco. Sus aportes son de gran actualidad porque se apoyan en la vivencia de las virtudes con el fin de brindar una atención personalizada. (shrink)

David Braybrooke argues that meeting people’s needs ought to be the primary goal of social policy. But he then faces the problem of how to deal with the fact that our most pressing needs, needs to be kept alive with resource-draining medical technology, threaten to exhaust our resources for meeting all other needs. I consider several solutions to this problem, eventually suggesting that the need to be kept alive is no different in kind from needs to fulfill various (...) projects, and that needs may have a structure similar to rights, with people’s legitimate needs serving as constraints on each other’s entitlements to resources. This affords a set of axioms constraining possible needs. Further, if, as Braybrooke thinks, needs are created by communities approving projects, so that the means to prosecute the projects then come to count as needs, then communities are obliged to approve only projects that are co-feasible given the world’s finite resources. The result is that it can be legitimate not to funnel resources towards endless life-prolongation projects. (shrink)

Despite analgesic and emetogenic benefits, cannabis has been banned from prescription in a number of western countries. Although some benefits are shared by drugs already available, the options of prescription are limited to the physician. The negative side-effects of cannabis do not justify this limitation on freedom and autonomy. Recreational use warrants limitations, as the search for euphoria is regularly believed to be a non-autonomous behavior. Medical prescriptions serve an analgesic and emetogenic purpose comparable to other prescribed drugs. This (...) vindicates the right for a physician to prescribe cannabis to qualified patients. For a patient to be considered qualified, they must be an adult that does not drive often, is not pregnant, and not at risk of schizophrenia or cardiovascular disease. If possible, cannabis should be eaten in an effort to avoid smoke irritation in the lungs and aerodigestive tract. In the end, the question is not whether cannabis use is efficable, but rather is the limitation of medical treatments to patients in need ethical? In light of the medical benefits, the banning of cannabis is simply immoral. Keywords: cannabis, banned substance, prescription, analgesic, emetogenic Note. Authors did not receive any external funding, nor display conflict of interest. (shrink)

The study aimed to identify the sharing of information and its impact on the quality of health care in Al-Shifa Medical Complex in the southern Palestinian governorates. The study adopted the descriptive analytical approach. The number is 2150 employees, and the questionnaire was distributed to a stratified random sample of 330 employees, and 302 questionnaires were retrieved, with a rate of 91.5%. One of the most important results of the study was that there is a statistically significant effect at (...) the level (α≤0.05) of information sharing for the performance of the medical staff in the quality of health care in Al-Shifa Medical Complex in the southern Palestinian governorates. The axis of participation in information came with a relative weight (69.6%) and a high degree. The level of health care quality was high with a relative weight of (69.0%). One of the most important recommendations of the study was the need to pay attention to measuring patients' satisfaction levels, and to set up a box for complaints and suggestions for patients, and what are their suggestions and point of view for the service provided to them. (shrink)

Diagnoses in medicine are often taken to serve as explanations of patients’ symptoms and signs. This article examines how they do so. I begin by arguing that although some instances of diagnostic explanation can be formulated as covering law arguments, they are explanatory neither in virtue of their argumentative structures nor in virtue of general regularities between diagnoses and clinical presentations. I then consider the theory that medical diagnoses explain symptoms and signs by identifying their actual causes in particular (...) cases. While I take this to be largely correct, I argue that for a diagnosis to function as a satisfactory causal explanation of a patient’s symptoms and signs, it also needs to be supplemented by understanding the mechanisms by which the identified cause produces the symptoms and signs. This mechanistic understanding comes not from the diagnosis itself, but rather from the theoretical framework within which the physician operates. (shrink)

Nomophobia (no-mobile-phone phobia) is the fear and anxiety of being without a mobile phone. This study pioneers the investigation of nomophobia in Afghanistan using the Nomophobia Questionnaire (NMP-Q), addressing a crucial gap in the field. We collected statistical data from 754 undergraduate medical students, comprising men (56.50 %) and women (43.50 %), and analyzed the dimensions of nomophobia. While results revealed that all but two participants were nomophobic, they identified three significant dimensions affecting the level of nomophobia among participants: (...) (a) gender, (b) age, and (c) marital status. The study's contributions are precious, given the peculiarity of Afghan political turmoil, security, and human rights issues, especially for women. For example, the study's data collection was abruptly halted in December 2022 due to the Taliban regime's decision to make it illegal for women to enroll in universities as students. Therefore, while examining the characteristics of nomophobia across societies is imperative, it is also vital to investigate what is true of one society, Afghanistan, at one point in time and space. The study concludes by emphasizing the need to broaden participants' scope in future studies to better understand the prevalence of nomophobia across broader societal contexts and forces. (shrink)

Background: The internationalization of clinical studies requires a shared understanding of the fundamental ethical values guiding clinical studies. It is important that these values are not only embraced at the legal level but also adopted by clinicians themselves during clinical studies. Objective: Our goal is to provide an insight on how clinicians in Germany and Poland perceive and identify the different ethical issues regarding informed consent in clinical studies. Methods: To gain an understanding of how clinicians view clinical studies in (...) the countries they work in, we carried out semi-structured problem-centered interviews per telephone in Poland (n = 6) and Germany (n = 6). Our interviewees concentrated on three main topics: an appraisal of the normative framework, challenges in the information process and the protection of all participants in clinical studies. Results: Clinicians generally supported the normative framework, even though they considered it quite complex. In the two study countries, a widely noted dilemma in the information process was whether to overburden participants with extensive information or risking leaving out important facts. Clinicians were ready to exclude larger population groups from participating in clinical studies when the information process could not be carried out with standard procedures or when their inclusion was ethically sensitive. Conclusion: Clinicians need to gain a better understanding of the consequences of excluding larger population groups form participating in clinical studies. They should seek assistance in improving the information process for the inclusion of underrepresented groups in clinical studies. (shrink)

New technologies such as smart sensors improve rehabilitation processes and thereby increase older adults’ capabilities to participate in social life, leading to direct physical and mental health benefits. Wearable smart sensors for home use have the additional advantage of monitoring day-to-day activities and thereby identifying rehabilitation progress and needs. However, identifying and selecting rehabilitation priorities is ethically challenging because physicians, therapists, and caregivers may impose their own personal values leading to paternalism. Therefore, we develop a discussion template consisting of a (...) series of adaptable questions for the patient–physician encounter based on the capability approach. The goal is to improve geriatric rehabilitation and thereby increase participation in social life and well-being. To achieve this goal, we first analyzed what is considered important for participation on basis of the capability approach, human rights, and ethics of care. Second, we conducted an ethical analysis of each of the four identified dimensions of participation: political, economic, socio-cultural, and care. To improve compliance with rehabilitation measures, health professionals must align rehabilitation measures in an open dialogue with the patient’s aspiration for participation in each dimension. A discussion template based on the capability approach allows for a proactive approach in patient information and stimulates a critical assessment of treatment alternatives while reducing the risk of imposing personal values. (shrink)

Although policymakers and investigators still struggle to quantify and compare the effects of various Covid-related interventions, we are steadily amassing data that could help inform choices. The pandemic’s medical, social, and economic harms have been immense, and they warrant a continuous policy response. All decision makers use some type of mental model to weigh the pros and cons of various policy options. Rigorous economic evaluation formalizes this process. Value judgments will still be required, but economic evaluation can make the (...) decision-making process more systematic, comprehensive, and transparent. (shrink)

The article discusses the role and importance of storytelling in the context of creating and maintaining organisational culture in the healthcare sector. Medical institutions are constantly solving complex tasks related to the provision of high-quality medical care and interaction with patients and staff. In this regard, storytelling is an important tool, aimed at strengthening cultural values and adjusting goals. The study examines the nature of organisational culture, its main components and culture, its main components and the peculiarities of (...) its formation and maintenance in medical institutions. Organisational culture affects all aspects of business processes and is an important element of corporate identity, in particular in the healthcare sector. healthcare. The authors determine that storytelling as a communication tool has become an important part of business communication and management in recent decades part of business communication and management practice in recent decades. Storytelling can be used to form common values and create meaningful narratives that promote cultural change and support the organisational organisational identity of healthcare facilities. Stories in healthcare facilities reveal the specifics and uniqueness of the organisation, help to distinguish it from competitors from competitors and create a competitive advantage in the market. They form the organisation’s identity and the loyalty of employees and customers. Storytelling has an impact on on the organisational culture of a medical institution, promotes stability and highlights the unique character of the organisation character of the organisation; it allows to form values, beliefs and needs of of employees based on the institution’s mission. Storytelling is important for understanding medical discourse and the system of narratives in healthcare organisations. It supports or discredits official narratives or discredit them, depending on the perception of stakeholders. It is important that storytelling in healthcare facilities is accessible to all stakeholders and promote internal identification and loyalty to the institution. Thus, storytelling is an essential tool for building and maintaining organisational culture in healthcare facilities, helping to create a unique identity and competitive advantage. The article aims to stimulating discussion of the experience of using storytelling and further research of this important aspect of management in the healthcare sector. of healthcare enterprises. (shrink)

Monkeypox, an infectious disease caused by the Orthopoxvirus, was identified in humans in 1970. It has recently emerged as a global health concern due to outbreaks beyond its endemic regions in Central and West Africa. This review examines the current state of medical treatments for monkeypox as of 2024, focusing on antiviral agents, immunotherapies, and supportive care measures. Monkeypox manifests with symptoms including fever, rash, and lymphadenopathy, with severe cases more common in immunocompromised individuals. Antiviral therapies such as tecovirimat (...) and brincidofovir are central to treatment strategies, with tecovirimat demonstrating efficacy in alleviating symptoms and reducing viral shedding. Emerging treatment strategies involve novel lipid-based formulations and combination therapies that integrate antivirals with immune-modulating agents. Supportive care remains essential, involving analgesics and antibiotics for secondary infections, while the MVA-BN vaccine plays a critical role in prevention. Research emphasizes the need for a deeper understanding of viral pathogenesis and host immune responses to improve therapeutic and preventive measures. Despite significant advancements, challenges remain, including potential antiviral resistance, disparities in healthcare access, and the necessity for enhanced diagnostic and surveillance capabilities. This review highlights the imperative for ongoing research, international collaboration, and investment in healthcare infrastructure to advance the management and prevention of monkeypox and to prepare for future outbreaks. (shrink)