201,593 research outputs found
The four principles: Can they be measured and do they predict ethical decision making?
Background The four principles of Beauchamp and Childress - autonomy, non-maleficence, beneficence and justice - have been extremely influential in the field of medical ethics, and are fundamental for understanding the current approach to ethical assessment in health care. This study tests whether these principles can be quantitatively measured on an individual level, and then subsequently if they are used in the decision making process when individuals are faced with ethical dilemmas. Methods The Analytic Hierarchy Process was used as a tool for the measurement of the principles. Four scenarios, which involved conflicts between the medical ethical principles, were presented to participants and they made judgments about the ethicality of the action in the scenario, and their intentions to act in the same manner if they were in the situation. Results Individual preferences for these medical ethical principles can be measured using the Analytic Hierarchy Process. This technique provides a useful tool in which to highlight individual medical ethical values. On average individuals have a significant preference for non-maleficence over the other principles, however, and perhaps counter-intuitively, this preference does not seem to relate to applied ethical judgements in specific ethical dilemmas. Conclusions People state they value these medical ethical principles but they do not actually seem to use them directly in the decision making process. The reasons for this are explained through the lack of a behavioural model to account for the relevant situational factors not captured by the principles. The limitations of the principles in predicting ethical decision making are discussed
Information and participation in decision-making about treatment: a qualitative study of the perceptions and preferences of patients with rheumatoid arthritis.
Objectives: To elicit the perceptions and preferences of
patients with rheumatoid arthritis regarding information
and participation in treatment decision-making. To analyse
the patientsâ narratives on the background of the ethical
discourse on various approaches to treatment decisionmaking.
Design: In-depth interviews with themes identified using
principles of grounded theory.
Participants: 22 patients with long-standing rheumatoid
arthritis.
Main outcome measures: Qualitative data on patientsâ
perceptions and preferences regarding information and
participation in decision-making about treatment.
Results: Decision-making about treatment has been
described by the patients as a process consisting of
different stages with shifting loci of control and
responsibility. Patients initially received one treatment
recommendation and were not aware of alternative
treatment options. Those participants in this study who
wanted information about negative effects of a treatment
cited ââinterest in oneâs own healthââ and the potential ââuse
of informationââ as reasons for their preference. The
physiciansâ expert knowledge and clinical experience
regarding the effects of medication were cited as
arguments by patients for a treatment recommendation.
Conclusions: The patientsâ accounts of decision-making
about treatment differ from models of physicianâpatient
relationship that have been put forward in ethical
discourse. These differences may be relevant with respect
to the starting point of an ethical analysis of treatment
decision-making. Patientsâ accounts with respect to a lack
of information on treatment alternatives point to ethically
relevant challenges regarding treatment decision-making
in clinical practice
The horns of dilemma: Life or sovereignty
Death and dying are the bitter truth that is faced by every person inevitably. Paying respect to the decision of a patient in a hospital setting is always a challenging task. In eastern countries, family plays an important role in decision making. But it always overrides the preferences and wishes of the patient and this leads to violation of ethical principles such as autonomy, informed consent and veracity. Looking a situation from different paradigms and deciding the best solution on the ground of ethical principles should be the utmost priority of the healthcare provider
Building Ethically Bounded AI
The more AI agents are deployed in scenarios with possibly unexpected
situations, the more they need to be flexible, adaptive, and creative in
achieving the goal we have given them. Thus, a certain level of freedom to
choose the best path to the goal is inherent in making AI robust and flexible
enough. At the same time, however, the pervasive deployment of AI in our life,
whether AI is autonomous or collaborating with humans, raises several ethical
challenges. AI agents should be aware and follow appropriate ethical principles
and should thus exhibit properties such as fairness or other virtues. These
ethical principles should define the boundaries of AI's freedom and creativity.
However, it is still a challenge to understand how to specify and reason with
ethical boundaries in AI agents and how to combine them appropriately with
subjective preferences and goal specifications. Some initial attempts employ
either a data-driven example-based approach for both, or a symbolic rule-based
approach for both. We envision a modular approach where any AI technique can be
used for any of these essential ingredients in decision making or decision
support systems, paired with a contextual approach to define their combination
and relative weight. In a world where neither humans nor AI systems work in
isolation, but are tightly interconnected, e.g., the Internet of Things, we
also envision a compositional approach to building ethically bounded AI, where
the ethical properties of each component can be fruitfully exploited to derive
those of the overall system. In this paper we define and motivate the notion of
ethically-bounded AI, we describe two concrete examples, and we outline some
outstanding challenges.Comment: Published at AAAI Blue Sky Track, winner of Blue Sky Awar
Farewell to Prognosis in Shared Decision-Making
Whether because of a cultural pattern or personal preference, palliative care clinicians encounter persons approaching the end of life who wish to limit or forego prognostic information relating to their situation. This scenario has received attention in a recent motion picture as well as a newly available advance directive modificationâthe Prognosis Declaration form. The ordinary expectation for end-of-life shared decision-making with a capable person is clinician disclosure of the best effort at prognostic assessment. The optimal match between the expressed values, goals, and preferences of the person with available clinician expertise is hopefully achieved. For the clinician, a personâs choice to modify information disclosure and participation in shared decision-making represents a significant challenge of balancing key ethical principles of intervention with tolerance and compassion for these different preferences. Attention to communication strategies that elicit and appropriately reassess individual information and decision-making wishes, flexibility in information disclosure patterns with capable persons and their representatives, and recognition that a respect for autonomy includes the choice to opt out can approach this challenge while providing compassionate and ethical end-of-life care
Ethical issues in dysphagia management
Dysphagia management is complex and requires balancing individualsâ preferences, quality of life, and medical consequences. Ethical challenges are not uncommon given the complexity of dysphagia. Professionals must engage in ethical reflection and shared decision-making when managing dysphagia. Recognizing oneâs own presuppositions and beliefs may be fundamental to ensuring an ethical approach.
The goal of this article is to apply principles of ethics using hypothetical case studies of dysphagia. To this end, we will describe the challenges of working with the disorder of dysphagia, the influence of culture on decision-making about eating and feeding, the importance of information disclosure and respect for individualsâ refusal of recommendations, and the
interplay of ethical reflection, evidence, and clinical judgment when making complex dysphagia management decisions. These concepts should be kept in mind ensure compassionate and competent care of the person with eating, drinking or swallowing problems and their family caregivers
Reconsidering prenatal screening: an empirical-ethical approach to understand moral dilemmas as a question of personal preferences
In contrast to most Western countries, routine offer of prenatal screening is considered problematic in the Netherlands. The main argument against offering it to every pregnant woman is that women would be brought into a moral dilemma when deciding whether to use screening or not. This paper explores whether the active offer of a prenatal screening test indeed confronts women with a moral dilemma. A qualitative study was developed, based on a randomised controlled trial that aimed to assess the decision-making process of women when confronted with a test offer. A sample of 59 women was interviewed about the different factors balanced in decision-making. Participants felt themselves caught between a need for knowledge and their unwillingness to take on responsibility. Conflict was reported between wishes, preferences and ethical views regarding parenthood; however, women did not seem to be caught in a choice between two or more ethical principles. Participants balanced the interests of the family against that of the fetus in line with their values and their personal circumstances. Therefore, we conclude that they are not so much faced with an ethical dilemma as conflicting interests. We propose that caregivers should provide the opportunity for the woman to discuss her wishes and doubts to facilitate her decision. This approach would help women to assess the meaning of testing within their parental duties towards their unborn child and their current offsprin
Veterinariansâ role in clientsâ decisionâmaking regarding seriously ill companion animal patients
BACKGROUND: When companion animals become seriously ill clients may have doubts about treatment choices, if any, and turn to veterinarians for help. But how should veterinarians reply? Influence on clientsâ decision-making may or may not be acceptableâdepending on oneâs attitude to principles such as âpaternalismâ, ârespect for autonomyâ and âshared decision-makingâ. This study takes as a starting point a situation where the animal is chronically ill, or aged, with potentially reduced animal welfare and client quality of life, and thus where clients need to consider treatment options or euthanasia. It is assumed throughout that both veterinarians and clients have the animalsâ best interest at heart. The purpose of the study was to explore the challenges these situations hold and to investigate how clients experience veterinary influence. A second aim was to reflect on the ethical implications of the role of veterinarians in these situations. Qualitative interviews were conducted with 12 dog owners considering treatment or euthanasia of their chronically ill or aged dogs. RESULTS: Challenges relating to the dog and to the client were identified. Some situations left the interviewees hesitant, e.g. if lacking a clear cut-off point, the dog appeared normal, the interviewee felt uncertain about treatments or animal welfare, or experienced conflicting concerns. Some interviewees found that veterinarians could influence their decisions. Such influence was received in different ways by the interviewees. Some interviewees wanted active involvement of the veterinarian in the decision-making process, and this may challenge a veterinarianâs wish to respect client autonomy. CONCLUSIONS: Different preferences are likely to exist amongst both veterinarians and clients about veterinary involvement in clientsâ decision-making, and such preferences may vary according to the situation. It is suggested, that one way to handle this challenge is to include respect for client preference on veterinary involvement under a wider understanding of respect for autonomy, and to apply models of shared decision-making to veterinary practice. In any case there is a need to further explore the challenges these situations raise, and for the veterinary profession to engage in more formal and structured deliberation over the role of veterinarians in relation to clientsâ decision-making. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13028-016-0211-x) contains supplementary material, which is available to authorized users
How Bioethics Principles Can Aid Design of Electronic Health Records to Accommodate Patient Granular Control
Ethics should guide the design of electronic health records (EHR), and recognized
principles of bioethics can play an important role. This approach was adopted recently by a team of informaticists designing and testing a system where patients exert granular control over who views their personal health information. While this method of building ethics in from the start of the design process has significant benefits, questions remain about how useful the application of bioethics principles can be in this process, especially when principles conflict. For instance, while the ethical principle of respect for autonomy supports a robust system of granular control, the principles of beneficence and non-maleficence counsel restraint due to the danger of patients being harmed by restrictions on provider access to data. Conflict between principles has long been recognized by ethicists and has even motivated attacks on approaches that state and apply principles. In this paper we show how using ethical principles can help in the design of EHRs by first, explaining how ethical principles can and should be used generally, and then by, discuss how attention to details in specific cases can show that the tension between principles is not as bad as it initially appeared. We conclude by suggesting further ways in which the application of these (and other) principles can add value to the ongoing discussion of patient involvement in their health care. This is a new approach to linking principles to informatics design that we expect will stimulate further interest
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