FEX A, FLENSNER G, EK A‐C and SÖDERHAMN O. Nursing Inquiry 2011; 18: 336–347 Living with an adult family member using advanced medical technology at homeAn increased number of chronically ill adults perform self‐care while using different sorts of advanced medical technology at home. This hermeneutical study aimed to gain a deeper understanding of the meaning of living with an adult family member using advanced medical technology at home. Eleven next of (...) kin to adults performing self‐care at home, either using long‐term oxygen from a cylinder or ventilator, or performing peritoneal or haemodialysis, were interviewed. The qualitative interviews were analysed using a Gadamerian methodology. The main interpretation explained the meaning as rhythmical patterns of connectedness versus separation, and of sorrow versus reconciliation. Dependence on others was shown in the need for support from healthcare professionals and significant others. In conclusion, next of kin took considerable responsibility for dependent‐care. All next of kin were positive to the idea of bringing the technology home, even though their own needs receded into the background, while focusing on the best for the patient. The results were discussed in relation to dependent‐care and transition, which may have an influence on the self‐care of next of kin and patients. The study revealed a need for further nursing attention to next of kin in this context. (shrink)

In 1997, after long social debates, the Japanese government enacted a law on organ transplantation from brain-dead bodies. Since 1993, on gene therapy, administrative agencies have issued a series of guidelines. This study seeks to elucidate when people became aware of the issues and when they formed their opinions on organ transplant and gene therapy. At the same time, it aims to examine at which point in time experts, those in university ethical committees and in academic societies, consider these technologies (...) became accepted among the public. A self-administered questionnaire was sent by mail to a stratified random sampling of 3000 people nationwide in Japan. Another questionnaire was sent both to the member societies of the Japanese Association of Medical Sciences and to the ethical committees of all the medical schools in Japan. Results of the surveys indicated that many of the public remained undecided on the desirability of organ transplant or gene therapy at the time of enactment of official guidelines. A substantial part of them formed their opinions in subsequent periods, especially around the time of first implementation and thereafter. Experts of the academic societies and of the university ethical committees regarded the time of implementation as an important factor in the acceptance of the technologies in society. Since many people formed their opinion during the period of technological implementation, communications efforts to facilitate public understanding of science and technology, as well as to advance practical discussion on policy alternatives in this period can play a key role in determining the fate of technological innovation and ethical debates in medicine. (shrink)

Embryo screening technologies offer important benefits to individuals who use them and society. These techniques can expand the reproductive options of many prospective parents and can contribute to reducing the burdens of disease and disability. Nonetheless, embryo screening techniques present individuals and societies with important ethical challenges. Here, I explore some of them. In particular, I discuss the costs for prospective parents of increased reproductive choices, as well as concerns about sanctioning problematic social norms, increasing social injustice, limiting the ways (...) societies can tackle diseases and disabilities, and promoting the commodification of children. (shrink)

The 2018 Varsity Medical Ethics debate convened upon the motion: “This house believes that the constant monitoring of our health does more harm than good”. This annual debate between students from the Universities of Oxford and Cambridge is now in its tenth year. This year’s debate was hosted at the Oxford Union on 8th of February 2018, with Oxford winning for the Opposition, and was the catalyst for the collation and expansion of ideas in this paper.New technological devices have (...) the potential to enhance patient autonomy, improve patient safety, simplify the management of chronic diseases, increase connectivity between patients and healthcare professionals and assist individuals to make lifestyle changes to improve their health. However, these are pitted against an encroachment of technology medicalising the individual and home, an exacerbation of health inequalities, a risk to the security of patient data, an alteration of the doctor-patient relationship dynamic and an infringement on individual self-identity. This paper will draw upon and develop these concepts, while contending arguments for and against constant health monitoring. This is not a review of medical devices and health monitoring, but a reflective development and more detailed elaboration of the main points highlighted in the 2018 Varsity Medical Ethics debate. (shrink)

The 2018 Varsity Medical Ethics debate convened upon the motion: “This house believes that the constant monitoring of our health does more harm than good”. This annual debate between students from the Universities of Oxford and Cambridge is now in its tenth year. This year’s debate was hosted at the Oxford Union on 8th of February 2018, with Oxford winning for the Opposition, and was the catalyst for the collation and expansion of ideas in this paper.New technological devices have (...) the potential to enhance patient autonomy, improve patient safety, simplify the management of chronic diseases, increase connectivity between patients and healthcare professionals and assist individuals to make lifestyle changes to improve their health. However, these are pitted against an encroachment of technology medicalising the individual and home, an exacerbation of health inequalities, a risk to the security of patient data, an alteration of the doctor-patient relationship dynamic and an infringement on individual self-identity. This paper will draw upon and develop these concepts, while contending arguments for and against constant health monitoring. This is not a review of medical devices and health monitoring, but a reflective development and more detailed elaboration of the main points highlighted in the 2018 Varsity Medical Ethics debate. (shrink)

Embodied cognition is an interpretative—or hermeneutical—cognition inherent in motor-sensory perception intrinsically informed by biological and sociocultural memory, a cognition embedded in the organism as well as the socio-cultural environment interacting with it (Ward et al. TOPOI 36:365–375, 2017), of which technologies are a part. Yet, smart machines are advancing on human abilities to perceive and interpret concerning the accuracy, quantity, and quality of the data processed. Machines process and categorize images, perform classification tasks, they calculate and perform pattern analysis, all (...) machine learning processes are task-specific. Machine learning processes resemble human interpretative processes; however, these are two very different ways of “dealing with something,” although both can be said to be hermeneutical, one enactive, the other material; the first is a meaning-generating interpretative process, the second a statistics-based information output. The information extracted from all the data fed into the computer is the end-product of machine learning, whereas human interpretative enactments are continuous and necessary for any application of the information output. (shrink)

Development-oriented funding schemes such as the UK Global Challenges Research Fund (GCRF) have opened up opportunities for collaborations between low-middle income countries (LMICs) and high-income country (HIC) researchers. In particular, funding for medical technology research has seen a rise in previously under-represented disciplines such as physics and engineering. These collaborations have considerable potential to advance healthcare in LMICs, yet can pose challenges experienced to researchers undertaking these collaborations. Key challenges include a lack of tradition of HIC/LMIC collaborations within (...) participating departments, lack of experience with development agendas, designing contextually-appropriate technologies and ensuring long-term viability of research outputs. This paper reflects on these key challenges, using the experiences of the authors on the Open Laboratory Instrumentation (OLI) project as a focalizing lens. This project was a GCRF-funded collaboration between physicists in the UK and engineers in Tanzania to develop an open-source, 3D-printed, fully-automated laboratory microscope. The paper highlights key ethics lessons learnt. (shrink)

Development-oriented funding schemes such as the UK Global Challenges Research Fund (GCRF) have opened up opportunities for collaborations between low-middle income countries (LMICs) and high-income country (HIC) researchers. In particular, funding for medical technology research has seen a rise in previously under-represented disciplines such as physics and engineering. These collaborations have considerable potential to advance healthcare in LMICs, yet can pose challenges experienced to researchers undertaking these collaborations. Key challenges include a lack of tradition of HIC/LMIC collaborations within (...) participating departments, lack of experience with development agendas, designing contextually-appropriate technologies and ensuring long-term viability of research outputs. This paper reflects on these key challenges, using the experiences of the authors on the Open Laboratory Instrumentation (OLI) project as a focalizing lens. This project was a GCRF-funded collaboration between physicists in the UK and engineers in Tanzania to develop an open-source, 3D-printed, fully-automated laboratory microscope. The paper highlights key ethics lessons learnt. (shrink)

Development-oriented funding schemes such as the UK Global Challenges Research Fund (GCRF) have opened up opportunities for collaborations between low-middle income countries (LMICs) and high-income country (HIC) researchers. In particular, funding for medical technology research has seen a rise in previously under-represented disciplines such as physics and engineering. These collaborations have considerable potential to advance healthcare in LMICs, yet can pose challenges experienced to researchers undertaking these collaborations. Key challenges include a lack of tradition of HIC/LMIC collaborations within (...) participating departments, lack of experience with development agendas, designing contextually-appropriate technologies and ensuring long-term viability of research outputs. This paper reflects on these key challenges, using the experiences of the authors on the Open Laboratory Instrumentation (OLI) project as a focalizing lens. This project was a GCRF-funded collaboration between physicists in the UK and engineers in Tanzania to develop an open-source, 3D-printed, fully-automated laboratory microscope. The paper highlights key ethics lessons learnt. (shrink)

Digital twinning in medicine refers to the idea of simulating a person’s organs, muscles or perhaps their entire body, in order to arrive more effectively at accurate diagnoses, to make treatment recommendations that reflect chances of success and possible side-effects, and to better understand the long-term trajectory of an individual’s overall condition. Digital twins, in these ways, build on the recent movement toward personalised medicine,1 and they undoubtedly present us with exciting opportunities to advance our health. Of course, the opportunities (...) are accompanied by newfound challenges—a common refrain in discussions surrounding emerging technologies. In a recent article, Matthias Braun surveys numerous problems, including the precision of simulations, ownership and consent to the use of digital models, and issues of justice in assuring equitable access to novel medical systems.2 In particular, he places special emphasis on the notion of representation. According to Braun, proper representation naturally calls for correspondence—namely a precise model offering dynamic, real-time feedback as well as transparency, both for the patient and the practitioner, in terms of the data being employed. While technical challenges remain, these goals are quite clear and relatively uncontroversial. Where a host of questions arise, however, is in the discussion on the interaction between the represented persons and their simulations. Alongside questions regarding ownership of one’s digital twin, Braun raises the concern that ‘giving …. (shrink)

Emerging technologies such as artificial intelligence are actively revolutionizing the healthcare industry. While there is widespread concern that these advances will displace human practitioners within the healthcare sector, there are several tasks – including original and nuanced ethical decision making – that they cannot replace. Further, the implementation of artificial intelligence in clinical practice can be anticipated to drive the production of novel ethical tensions surrounding its use, even while eliminating some of the technical tasks which currently compete with ethical (...) deliberation for clinicians’ limited time. A new argument therefore arises to suggest that although these disruptive technologies will change the face of medicine, they may also foster a revival of several fundamental components inherent to the role of healthcare professionals, chiefly, the principal activities of moral philosophy. Accordingly, “machine medicine” presents a vital opportunity to reinvigorate the field of bioethics, rather than withdraw from it. (shrink)

As the number of medical and health humanities degree programs in the United States rapidly increases, it is especially timely to consider the range of specific disciplinary perspectives that might benefit students enrolled in these programs. This paper discusses the inclusion of one such perspective from the field of Science and Technology Studies The author asserts that STS benefits students in the medical and health humanities in four particular ways, by: challenging the “progress narrative” around the advancement (...) of biomedicine as scientific practice, evaluating the meaning of technology, especially in how technology orients us towards sickness and how health technology is in turn shaped by social and cultural values, assessing the plurality of biomedical epistemologies, rather than assuming biomedicine is one, cohesive body of knowledge that does not differ across contexts, and critiquing bias in biomedical practice and science, especially in the marginalization of women’s voices and in the racial and postcolonial trajectories of contemporary biomedicine. The paper discusses the theoretical importance of these four trajectories to the medical and health humanities, as well as the venues for inclusion of STS within coursework and programming at Case Western Reserve University. The paper also comments on how programming at other institutions might be adapted to incorporate STS scholarship. By drawing on numerous examples of research in the anthropology, sociology, history, and the philosophy of science, this article seeks to open a conversation about the value of science and technology studies to health humanities pedagogy. (shrink)

As in other countries, the traditional doctor-patient relationship in the Japanese healthcare system has often been characterised as being of a paternalistic nature. However, in recent years there has been a gradual shift towards a more participatory-patient model in Japan. With advances in technology, the possibility to use digital technologies to improve patient interactions is growing and is in line with changing attitudes in the medical profession and society within Japan and elsewhere. The implementation of an online patient (...) engagement platform is being considered by the Myotonic Dystrophy Registry of Japan. The aim of this exploratory study was to understand patients’ views and attitudes to using digital tools in patient registries and engagement with medical research in Japan, prior to implementation of the digital platform. We conducted an exploratory, cross-sectional, self-completed questionnaire with a sample of myotonic dystrophy patients attending an Open Day at Osaka University, Japan. Patients were eligible for inclusion if they were 18 years or older, and were diagnosed with MD. A total of 68 patients and family members attended the Open Day and were invited to participate in the survey. Of those, 59 % submitted a completed questionnaire. The survey showed that the majority of patients felt that they were not receiving the information they wanted from their clinicians, which included recent medical research findings and opportunities to participate in clinical trials, and 88 % of patients indicated they would be willing to engage with digital technologies to receive relevant medical information. Patients also expressed an interest in having control over when and how they received this information, as well as being informed of how their data is used and shared with other researchers. Overall, the findings from this study suggest that there is scope to develop a digital platform to engage with patients so that they can receive information about medical care and research opportunities. While this study group is a small, self-selecting population, who suffer from a particular condition, the results suggest that there are interested populations within Japan that would appreciate enhanced communication and interaction with healthcare teams. (shrink)

Healthcare depends increasingly on advanced medical technology. In addition, other forms of technology contribute to determine how our lives are influenced by disease and disability. The extent to which persons with impaired bodily functions are forced to live their lives differently than other people depends to a large part on a variety of technologies, from wheelchairs to computer interfaces, from hearing aids to garage doors. This wide-ranging influence of technology has important ethical aspects, but has (...) seldom been discussed in bioethics, the ethics of technology, or other branches of applied ethics. (shrink)

Olaf has a theory about advancing technologies being both our saviour and our doom. While we ought to avoid over-analysing claims of fictitious snowmen, we can pause to consider whether it is possible for an advancing technology to be both our saviour and our doom. I will maintain that it is. But for now, note how it is tempting to resolve the overlap by thinking about advancing technologies and individuals. In a possible reformulation of Olaf’s claim, advancing technology (...) can be one person’s saviour, but in being so, is another person’s doom. This reformulation is a type of an ‘individualisation argument’ against advancing technology. Specifically, it is the claim that while an individual’s use of technology may solve their iteration of a problem, it may also undermine a societal response to the broader problem. Peterson, in this edition’s Feature Article, has this type of ‘individualisation argument’ in his sights when he considers its application to non-medical egg freezing. That is, freezing an egg for social reasons rather than medical reasons. Peterson formulates the ‘individualisation argument’ in the following way1: > P1: It is morally wrong to let individuals use technology X—in order to try to handle a problem that is social in nature—if the use of X will somehow work against a social solution to a social problem P. > > P2: If individuals make use of a technology like …. (shrink)

Giulia Cavaliere disagrees with claims that ectogenesis will increase equality and freedom for women, arguing that they often ignore social context and consequently fail to recognise that ectogenesis may not benefit women or it may only benefit a small subset of already privileged women. In this commentary, I will contextualise her argument within the broader cultural milieu to highlight the pattern of reproductive advancements and technologies, such as egg freezing and birth control, being presented as the panacea for women’s inequality. (...) While these advancements and technologies can benefit women, I argue medicine is not the best tool to ‘cure’ social problems and should not be co-opted as an agent of social change. Systemic social changes, not just technomedical approaches, are needed to address the root of gender inequality, which is social in nature, not medical. (shrink)

As medical technology has advanced, the question of medical futility has become a topic of intense debate both within the medical community and within society as a whole. However, a unanimous definition thereof is yet to be decided—some commentators are sceptical as to whether an agreement will ever be reached—and this continues to lead to difficulties, tension, and even legal action when a treating physician disagrees with a patient and/or a patient’s family regarding care and (...) treatment options. Although living in a pluralistic society presents one of the major reasons as to why, despite 30 years of intense discussion, no consensus has been made; the issue of medical futility will always be complex as it is, by nature, multifaceted, and numerous elements—including possible risks, evidence of the probability of benefit, the wishes of the patient (and family), professional standards, and cost—interact. Nevertheless, the global medical community has seen the development of two distinctly different approaches to medical futility: one in which the autonomy of patients is of paramount importance in the decision whether or not to pursue a treatment; and one in which beneficence and primum non nocere—first do no harm—are almost entirely the clinician’s prerogative, and whereby he/she has a duty to refuse any treatment for which the potential risks outweigh the potential benefits for the patient. Recently, however, there has been a rejection of this dichotomous view of medical futility and the apparent “power struggle” between physician and patient, and a positive movement towards a more collaborative decision-making process that highlights the necessity of communication, aiming to result in the obtainment of the best possible outcome for each patient as an individual. (shrink)

Few subjects provoke as much controversy or debate as that of medical care, and the law that governs such an emotive area finds itself with the near-impossible task of simultaneously trying to regulate the medical profession and healthcare provision whilst upholding the rights of the millions of people who use those services every year. Medical Law combines an accessible explanation of the complex and challenging legal rules of medical care in England and Wales with a stimulating (...) examination of the social, political and ethical arguments such care provokes. It examines a broad range of issues, from the structure and organisation of the NHS, through the rules of clinical negligence, as well as focussing on the legal and ethical concerns around such deeply contentious areas as surrogacy, organ donation, abortion and euthanasia. Written very much with newcomers to the area in mind, Leanne Bell lucidly outlines not just what the law is, but how it has developed over time and also provides insights as to how advances in medical technology and techniques may call for it to evolve in the future. (shrink)

A growing literature addresses the ethical implications of electronic surveillance at work, frequently assigning ethical priority to values such as the right to privacy. This paper suggests that, in practice, the issues are sociologically more complex than some accounts suggest. This is because many workplace electronic technologies not designed or deployed for surveillance purposes nevertheless embody surveillance capacity. This capacity may not be immediately obvious to participants or lend itself to simple deployment. Moreover, because of their primary functions, such systems (...) embody a range of other features which are potentially beneficial for those utilising them. As a result, more complex ethical dilemmas emerge as different desired goods compete for priority in the decision-making of individuals and groups. From a sociological point of view this raises interesting questions about the way ethical dilemmas arise in the context of the ongoing social relationships of work. The paper explores these issues using data from a study of the development and implementation of a computerised instructional package in a maternity setting. This medical setting illustrates clearly how seeking to assign ethical priority to a particular concern, such as the right to privacy, cannot but oversimplify the real day to day dilemmas encountered by participants. At the same time,the example of the instructional package demonstrates that it is difficult to predict in advance what ethical issues will be raised by technologies that almost always turn out to have a range of capabilities beyond those envisaged in their original design specification. (shrink)

Medical technology, specialization, and the corporatization of health delivery systems in the late twentieth century have all helped give birth to an unwelcome but unavoidable responsibility for individuals with family or friends—serving as a health care proxy. The responsibility comes without monetary compensation, is often involuntary, and lacks any real guidelines beyond the duty to make life-and-death decisions in circumstances over which the proxy has little control.The parameters of the proxy's job have evolved somewhat awkwardly in statutes and (...) case law, as lawmakers and judges have tried to apply conventional concepts to novel circumstances. This article examines the legal and functional status of the proxy, as well as the strengths and weaknesses of current public policy as reflected by state advance directive and surrogate decision-making laws. The first section of the article provides a historical perspective of our current notions of agency law as relevant to health care proxies. (shrink)

Medical technology, specialization, and the corporatization of health delivery systems in the late twentieth century have all helped give birth to an unwelcome but unavoidable responsibility for individuals with family or friends—serving as a health care proxy. The responsibility comes without monetary compensation, is often involuntary, and lacks any real guidelines beyond the duty to make life-and-death decisions in circumstances over which the proxy has little control.The parameters of the proxy's job have evolved somewhat awkwardly in statutes and (...) case law, as lawmakers and judges have tried to apply conventional concepts to novel circumstances. This article examines the legal and functional status of the proxy, as well as the strengths and weaknesses of current public policy as reflected by state advance directive and surrogate decision-making laws. The first section of the article provides a historical perspective of our current notions of agency law as relevant to health care proxies. (shrink)

Death determination has long been a topic of intensive technoscientific and medical involvement. Due to advances in twentieth-century medical technology, the distinction between life and death has become less evident. Ambiguities appear when we start to use life-support technologies in order to save lives, bringing about “tragic artifacts” such as brain death and persistent vegetative state. In this paper we ask how this technoscientific and medical involvement shapes our understanding of death. We provide an overview of (...) medical literature that has appeared on (brain) death determination, highlighting thereby the role that technologies played in its establishment. Subsequently, we develop three philosophical interpretations of technological death determination: With Agamben and Marcuse as the installation of political power; with Don Ihde as an existential choice for the inevitable; and with Jacques Derrida as an encounter with the ineradicable mystery of death. To conclude, we argue that technological death determination reveals an intrinsic, paradoxical connection between human’s technicity and its ignorance of death. (shrink)

Death determination has long been a topic of intensive technoscientific and medical involvement. Due to advances in twentieth-century medical technology, the distinction between life and death has become less evident. Ambiguities appear when we start to use life-support technologies in order to save lives, bringing about “tragic artifacts” such as brain death and persistent vegetative state. In this paper we ask how this technoscientific and medical involvement shapes our understanding of death. We provide an overview of (...) medical literature that has appeared on (brain) death determination, highlighting thereby the role that technologies played in its establishment. Subsequently, we develop three philosophical interpretations of technological death determination: With Agamben and Marcuse as the installation of political power; with Don Ihde as an existential choice for the inevitable; and with Jacques Derrida as an encounter with the ineradicable mystery of death. To conclude, we argue that technological death determination reveals an intrinsic, paradoxical connection between human’s technicity and its ignorance of death. (shrink)

Due to advancements in technology such as data science and artificial intelligence, healthcare research has gained momentum and is generating new findings and predictions on abnormalities leading to the diagnosis of diseases or disorders in human beings. On one hand, the extensive application of data science to healthcare research is progressing faster, while on the other hand, the ethical concerns and adjoining risks and legal hurdles those data scientists may face in the future slow down the progression of healthcare (...) research. Simply put, the application of data science to ethically guided healthcare research appears to be a dream come true. Hence, in this paper, we discuss the current practices, challenges, and limitations of the data collection process during medical image analysis (MIA) conducted as part of healthcare research and propose an ethical data collection framework to guide data scientists to address the possible ethical concerns before commencing data analytics over a medical dataset. (shrink)

Photo by Hannah Busing on Unsplash INTRODUCTION Religion has long provided guidance that has led to standards reflected in some aspects of medical practices and traditions. The recent bioethical literature addresses numerous new problems posed by advancing medical technology and demonstrates an erosion of standards rooted in religion and long widely accepted as almost axiomatic. In the deep soul-searching that pervades the publications on bioethics, several disturbing and dangerous trends neglect some basic lessons of philosophy, logic, and (...) history. The bioethics discourse on medical aid in dying emphasizes similarity over previously recognized important distinguishing features. For example, it overplays a likeness between assistance in dying and the withdrawal of life-saving technology. In many bioethics’ topics, arguments based on a logical continuum are used to question the lines demarcating important moral differences. l. The Line Between Ethical and Not: Logic Based on Continuum Careful case selection, often either end of a continuum, allows the tearing down or ridiculing of many rules and codes across most professions and fields of interest. This situation holds true for traffic laws as well as medical ethics guidelines. It is relatively simple for those who desire to attack a particular viewpoint by selecting a case that makes that position seem untenable. In the ethics realm, good and bad medicine exist at opposite ends of an ethical continuum, with many practices lying in between. For example, much of medical ethics exists between the Nazi criminal physicians and the most sainted nurse or physician. A gradual progression occurred over less than two decades from a utilitarian position that supported limited euthanasia for those with certain mental illnesses to genocide. German society embraced a utilitarian ethic in which the value of human life no longer was intrinsic but instrumental.[1] Many morally significant points on a continuum were then ignored as the misguided utilitarian policy rampantly continued. A point in the continuum to distinguish between ethically justifiable and that which is not can be difficult to identify compared to the two extremes. This continuum is not unique to ethics but can be applied to almost any other aspect of human life and endeavor. Between a severely ill schizophrenic person and a superbly well-adjusted individual, there is a continuum of mental and psychological function. The existence of a continuum should not paralyze thinking and prevent us from drawing lines and identifying moral differences based on objective criteria as well as moral philosophy. Yet, by focusing on a continuum, many bioethicists use logic to disregard dividing lines between an "ethical" and an "unethical" act. Unfortunately, sometimes bioethicists draw revolutionary conclusions that would change the scope of medical practices which is accepted as ethical. There are many examples of similar shifts on the continuum. Many authors argue for the ethical permissibility of abortion by pointing out that the human fetus is no different in various characteristics, one arguing it is as like an ape or chick as it is like a person,[2] and does not achieve unique human and individual characteristics until well into the first year of life.[3] While human fetuses arguably do not have certain distinctive qualities of personhood, most people shy away from the logical next conclusion: permitting infanticide. For example, Joshua Lederberg condemns infanticide, in the face of biological illogic, because of our emotional commitment to infants, to me, a relatively weak explanation. Sir Francis Crick suggests we might consider birth at two days of life in order to decide whether an infant is a "suitable" member of society.[4] Giublini and Minerva suggest that infanticide should be permissible since late pregnancy abortions are permissible, arguing there is no significant difference between a fetus just before birth and an infant just after birth.[5] Clearly the continuum approach would allow for subjective arguments in favor of later infanticide at other points many days post-birth. Years ago, with a cynical tone, I mentioned infanticide as a further step on the continuum beyond abortion, and I was rightly shouted down as being deliberately provocative to assert the logic would ever stretch so far. While it is not an accepted mainstream position, the movement in academic settings from widespread condemnation to limited possible acceptance of infanticide has taken place in an incredibly short time. Public opinion and medical opinion in these areas have shifted dramatically in a short time. In another area, from a biological and chemical point of view, there is a continuum from man down to a single carbon atom. Yet, it would not seem logical to ignore the emotional differences, the meaning of personhood, or the moral distinction between killing an insect and killing a person. ll. A False Continuum: Medical Aid in Dying I assert that there has been an erosion of ethical guidelines in recent years attributable to using continuums to camouflage important distinctions. James Rachels’ work on active and passive euthanasia, which contends that the two are ethically identical, exemplifies that logic.[6] He illustrates this thesis, using a continuum to compare different scenarios with like consequences as morally equivalent, by comparing the deliberate drowning of a child with a deliberate failure to rescue a drowning child when easily able to do so. The author's comparison proposes that since much of the medical profession has already made peace with withholding treatment in order to hasten death, consistency inexorably demands that we permit active euthanasia as well.[7] When permission for active euthanasia was first introduced, it was limited exclusively to patients suffering severely from an intractable, incurable, and irreversible disease. These guidelines have been continuously eroded. There is now a substantial serious consideration for permitting active euthanasia of healthy elderly individuals who feel that they have completed their lives and are "tired of living."[8] There are many moral and factual differences along the ethical continuum. In human life, there is a difference between a live baby and a fetus, between a viable fetus and one that is not, between a fetus and a zygote, and between a zygote and a sperm cell. Similarly, there is a difference between pulling a trigger to kill someone and not interfering in preventing his death, which is reprehensible though both may be. There is a difference between not resuscitating an 80-year-old man with cancer when his heart stops and injecting him with a fatal dose of potassium chloride. I argue that an overt act of taking life repels civilized human beings is to be commended and encouraged as the reverence for human life or even for just a moment of human life is one of the great contributions of our civilization. CONCLUSION As an orthodox Jew, I feel that divinely inspired guidelines that have stood the test of centuries shape my beliefs, and such guidelines contradict medical aid in dying. I cannot speak to the viewpoint of those who do not access religion in defining their moral stance, nor do I implicate them in the current bioethics' trends, as I am not aware of the personal role of religion in the lives of most such authors. While many nonreligious people have a firm philosophical grounding and oppose medical aid in dying, I suggest that in the absence of any religious or other absolute standards, developing logically defensible ethical guidelines may be challenging. At the least, religion may play a role in defining the points on the continuums that are ethically meaningful and refuting the trending beliefs that if the endpoint is the same, allowing different methods of arriving at that end are somehow ethically equal. The continuum of ways death may result does not negate analysis of whether death is brought about in ways that recognize the importance of life. The German philosopher Hans Jonas said, "It is a question whether without restoring the category of the sacred, the category most thoroughly destroyed by the scientific enlightenment, we can have an ethics able to cope with the extreme powers that we possess today and constantly increase and are compelled to use."[9] While countries vary on the role of religion in policy, with many emphasizing freedoms of religion, a recent position paper released by a group of Jewish, Christian, and Moslem leaders suggested the need for agreement on the unique sanctity of human life.[10] I would recommend that such a document serve as an example of consensus on critical foundational bioethical guidelines for democratic secular societies. - [1] Alexander L Medical science under dictatorship. New England Journal of Medicine, 241, p39-47 DOI10.1056/NEJM194907142410201 [2] Lederberg J. A geneticist looks at contraception and abortion, Annals of Internal Medicine 67, sup 2, 25-27. https:/doi.org/10.7326/0003-4819-67-3-25 [3] Ibid. [4] Editorial, Sociology: Logic of biology. Nature 220, 429 https://www.nature.com/articles/220429b0 [5] Giublini A Minerva F After-birth abortion: why should the baby live. J Med Ethics 39, 261- [6] Rachels J Active and passive euthanasia. New England Journal of Medicine 292, 78-80 [7] Ibid. [8] Cohen-Almagor R Euthanizing people who are "tired of life". in Euthanasia and Assisted Suicide-Lessons from Belgium. Ch 11 of Euthanasia and Assisted Suicide, Cambridge University Press pp173-187. 2017 and DOI; https://doi.org/10.1017/9781108182799.012 [9] Hans Jonas, Technology and Responsibility: Reflections on the New Tasks of Ethics, 1972, found as Chapter IX, Philosophical Essays, 1980. https://inters.org/jonas-technology-responsability [10] A position paper of the Abrahamic Monotheistic religions on matters concerning the end-of-life. Vatican Press 28 October 2019 https://press.vatican.va/content/salastampa/en/bollettino/pubblico/2019/10/28/191028f.html. (shrink)

In this extraordinary introduction to the study of the philosophy of technology, Andrew Feenberg argues that techonological design is central to the social and political structure of modern societies. Environmentalism, information technology, and medical advances testify to technology's crucial importance. In his lucid and engaging style, Feenberg shows that technology is the medium of daily life. Every major technical changes reverberates at countless levels: economic, political, and cultural. If we continue to see the social and (...) technical domains as being seperate, then we are essentially denying an integral part of our existence, and our place in a democratic society. Questioning Tecchnology convinces us that it is vital that we learn more about technology the better to live with it and to manage it. (shrink)

In medical settings, machines are in close proximity with human beings: with patients who are in vulnerable states of health, who have disabilities of various kinds, with the very young or very old, and with medical professionals. Machines in these contexts are undertaking important medical tasks that require emotional sensitivity, knowledge of medical codes, human dignity, and privacy. -/- As machine technology advances, ethical concerns become more urgent: should medical machines be programmed to follow (...) a code of medical ethics? What theory or theories should constrain medical machine conduct? What design features are required? Should machines share responsibility with humans for the ethical consequences of medical actions? How ought clinical relationships involving machines to be modeled? Is a capacity for empathy and emotion detection necessary? What about consciousness? -/- The essays in this collection by researchers from both humanities and science describe various theoretical and experimental approaches to adding medical ethics to a machine, what design features are necessary in order to achieve this, philosophical and practical questions concerning justice, rights, decision-making and responsibility, and accurately modeling essential physician-machine-patient relationships. -/- This collection is the first book to address these 21st-century concerns. (shrink)

The use of modern medical technologies and interventions involves ethical and legal dilemmas which are yet to be solved. For the religious Jews the answer lies in Halakhah. The objective of this paper is to unscramble the difficult conundrum possessed by the halakhalic standing concerning the use of human embryonic cell for research. It also aims to take contemporary ethical issues arising from the use of technologies and medical advances made in human reproduction and study them from an (...) abstract philosophical perspective. Instead of providing any Jewish practical ruling the paper have tried to incite, stimulate and encourage philosophical thoughts about the issue through the intensive understanding of traditional Jewish thoughts. In this paper, an objective as well as a deep-rooted study has been adopted about the use of human embryos for research and the Jewish adoption of assisted reproductive technologies through the prism of the knowledge of Halakhah, Torah and Talmud. The paper finds that the embryo research sits at the crossroads of many halakhalic issues. Judaism adopts the belief that God has created man in his own image. The Jews not being dogmatic decipher “the image” of the creator as the ability to discern and reason. It follows that Judaism does not subscribe to the notion that tampering with nature is prohibited. To the Jews the mitzvah for procreation is so great that they are open to reason and adopt newer medical advancement in procreation. The Jewish laws are not only for engagement in intellectual exercise or academic pursuit but subscribe to a higher order of moral conduct. The Jewish approach is not situational but also casuistic in resolving conflicting medical issues. (shrink)

As everybody knows, advances in medicine and medical technology have brought enormous benefits to, and created vexing choices for, us all – choices that can, and occasionally do, test the very limits of thinking itself. As everyone also knows, we live in the age of consultants, i.e., of professional experts who are ready, willing, and able to give us advice on any and every conceivable question. One such consultant is the medical ethics consultant, or the medical (...) ethicist who consults.Medical ethics consultants involve themselves in just about every aspect of health care decision making. They help legislators and judges determine law, hospitals formulate policies, medical schools develop curricula, etc. In addition to educating physicians, nurses, and lawyers, amongst others, including medical, nursing, and law students, they participate in clinical decision making at the bedside. (shrink)

As everybody knows, advances in medicine and medical technology have brought enormous benefits to, and created vexing choices for, us all – choices that can, and occasionally do, test the very limits of thinking itself. As everyone also knows, we live in the age of consultants, i.e., of professional experts who are ready, willing, and able to give us advice on any and every conceivable question. One such consultant is the medical ethics consultant, or the medical (...) ethicist who consults.Medical ethics consultants involve themselves in just about every aspect of health care decision making. They help legislators and judges determine law, hospitals formulate policies, medical schools develop curricula, etc. In addition to educating physicians, nurses, and lawyers, amongst others, including medical, nursing, and law students, they participate in clinical decision making at the bedside. (shrink)

In Western countries today, a growing number of women delay motherhood until their late 30s and even 40s, as they invest time in pursuing education and career goals before starting a family. This social trend results from greater gender equality and expanded opportunities for women and is influenced by the availability of contraception and assisted reproductive technologies. However, advanced maternal age is associated with increased health risks, including infertility. While individual medical solutions such as ART and elective egg (...) freezing can promote reproductive autonomy, they entail significant risks and limitations. We thus argue that women should be better informed regarding the risks of advanced maternal age and ART, and that these individual solutions need to be supplemented by a public health approach, including policy measures that provide women with the opportunity to start a family earlier in life without sacrificing personal career goals. (shrink)

Our lives are dominated by technology. We live with and through the achievements of technology. What is true of the rest of life is of course true of medicine. Many of us owe our existence and our continued vigour to some achievement of medical technology. And what is true in a major way of general medicine is to a significant degree true of psychiatry. Prozac has long since arrived, and in its wake an ever-growing armamentarium of (...) new psychotropics; beyond that, neuroscience promises ever more technological advances for the field. -/- However, the effect of technology on the field of psychiatry remains highly ambiguous. On the one hand there are the achievements, both in the science and practice of psychiatry; on the other hand technology's influence on the field threatens its identity as a humanistic practice. In this ambiguity psychiatry is not unique - major thinkers have for a long time been highly ambivalent and concerned about the technological order that now defines modern society. For the future, the danger is that the psychiatrically real becomes that which can be seen, the symptom, and especially that which can be measured. Disorders and treatments might become reduced to what can be defined by diagnostic criteria and what can be mapped out on a scale. -/- This book exams how technology has come to influence and drive psychiatry forward, and considers at just what cost these developments have been made. It includes a range of stimulating and thought-provoking chapters from a range of psychiatrists and philosophers. (shrink)

Technological advances in the field of medicine and health sciences not only manipulate the normal human body and sex but also provide for surgical and hormonal management of hermaphroditism. Consequently, sex assignment surgery has not only become a standard care for babies born with genital abnormalities in the West but even in some Muslim states. On the positive side, it goes a long way in saving children born with abnormal genitalia from numerous legal interdictions of the pre-sex corrective surgery. Nevertheless, (...) the larger ethical and legal questions that medical management of genital abnormality raises to some extent have not been adequately appreciated by contemporary Muslim responses. This article, therefore, in principle argues against surgical management of intersexuality during early infancy from the Islamic legal perspective. (shrink)

Advances in medicine have brought us the stethoscope, artificial kidneys, and computerized health records. They have also changed the doctor-patient relationship. This book explores how the technologies of medicine are created and how we respond to the problems and successes of their use. Stanley Joel Reiser, MD, walks us through the ways medical innovations exert their influence by discussing a number of selected technologies, including the X-ray, ultrasound, and respirator. Reiser creates a new understanding of thinking about how health (...) care is practiced in the United States and thereby suggests new methods to effectively meet the challenges of living with technological medicine. As healthcare reform continues to be an intensely debated topic in America, Technological Medicine shows us the pros and cons of applying technological solutions health and illness. (shrink)

Advanced therapy medicinal products (ATMP) offer hope for health benefits in all situations where traditional methods of therapy fail or cannot be used for various reasons. The main purpose of this article is to analyze the concept of innovation as applied to the biotechnologies employed in ATMP. In the analysis of the concept, five main contexts of meaning that contribute to its understanding will be distinguished: a change in the way of thinking about the available spectrum of medical (...) procedures, the short time of recognition of technologies in the experimental and theoretical models, lack of clinical data in advance of used technologies, increase of technologies’ complexity and diversity of substrates used in them. The conducted analysis indicates the need to adopt an attitude of far-reaching caution in the evaluation of the safety of ATMP therapies in which innovative biotechnologies are used. (shrink)

The central theme of this book is that technological advances in medicine have created a multitude of choices for each individual -- choices that can influence how we live and die. These choices are difficult ones, and the book provides a better understanding of the issues. Thus, the implications of each choice become clearer. Such decisions remain inherently very difficult and personal. Thoughtful, compassionate societies must consider these difficult problems. Can we develop mechanisms to assist in the medical choices (...) that will inevitably take place throughout each individual's life? Jane Stein makes a stimulating effort to clarify these subjects in this book. She calls to attention problems we would prefer to avoid, touches the untouchable, and in so doing contributes to a constructive debate on the future of human life. - Preface. (shrink)

How is the concept of patient care adapting in response to rapid changes in healthcare delivery and advances in medical technology? How are questions of ethical responsibility and social diversity shaping the definitions of healthcare? In this topical study, scholars in anthropology, nursing theory, law and ethics explore questions involving the changing relationship between patient care and medical ethics. Contributors address issues that challenge the boundaries of patient care, such as: · HIV-related care and research · the (...) impact of new reproductive technologies · preventative healthcare · technological breakthroughs that are changing personal-caring relationships. Chapters range from a consideration of the practicalities of nursing and family healthcare to a debate about ‘universal human needs’ and patients’ rights. This book is a provocative exploration of the ways in which healthcare models are socially constructed. It will be of interest to policy-makers, medical practitioners and administrators, as well as students of sociology, anthropology and social policy. (shrink)

The growing potential of biomedical technologies has increasingly been associated with discussions surrounding the ethical aspects of the new technologies in different societies. Advances in genetics, stem cell research and organ transplantation are some of the medical issues that have raised important ethical and social issues. Special attention has been paid towards moral ethics in Islam and medical and religious professions in Iran have voiced the requirement for an emphasis on ethics. In the last decade, great strides have (...) been made in biomedical ethics, especially in the field of education, research and legislation. In this article, contemporary medical ethics in Iran, and the related moral philosophy, have been reviewed in brief and we have discussed some of the activities in the field of medical ethics that have been carried out in our country within recent years. These activities have included the establishment of the National and Regional Committees for Medical Research Ethics and the production of national codes of ethics in biomedical research in the 1990s and the introduction of a comprehensive strategic plan for medical ethics at the national level in 2002. This paper will discuss these issues, along with the production, in 2005, of the Specific National Ethical Guidelines for Biomedical Research. (shrink)

Prenatal diagnostic technologies have been used for the purpose of detecting sex—leading to abortion of female fetuses—and have posed new challenges to the already difficult question of social justice for women in India. This article reports findings from a case study conducted with 25 women who had used prenatal diagnostic technologies for sex determination.Against the common belief that Indian society is “improving” because of 21st-century medical technology, this case study shows that the social context has given a patriarchal (...) value to such advanced technology in India. Furthermore, it sheds light on why prenatal diagnostic technologies have taken a different route in India.It shows that reasons for accepting the use of prenatal diagnostic technologies for sex determination by women are diverse and complex. (shrink)

Recent advances in medical and information technologies, the availability of new types of medical data, the requirement of increasing numbers of study participants, as well as difficulties in recruitment and retention, all present serious problems for traditional models of specific and informed consent to medical research. However, these advances also enable novel ways to securely share and analyse data. This paper introduces one of these advances—blockchain technologies—and argues that they can be used to share medical data (...) in a secure and auditable fashion. In addition, some aspects of consent and data collection, as well as data access management and analysis, can be automated using blockchain-based smart contracts. This paper demonstrates how blockchain technologies can be used to further all three of the bioethical principles underlying consent requirements: the autonomy of patients, by giving them much greater control over their data; beneficence, by greatly facilitating medical research efficiency and by reducing biases and opportunities for errors; and justice, by enabling patients with rare or under-researched conditions to pseudonymously aggregate their data for analysis. Finally, we coin and describe the novel concept of prosent, by which we mean the blockchain-enabled ability of all stakeholders in the research process to pseudonymously and proactively consent to data release or exchange under specific conditions, such as trial completion. (shrink)

Obstetric ultrasound is the well-recognized prenatal test used to visualize and determine the condition of a pregnant woman and her fetus. Apart from the clinical application, some businesses have started promoting the use of fetal ultrasound machines for nonmedical reasons. Non-medical fetal ultrasound (also known as ‘keepsake’ ultrasound) is defined as using ultrasound to view, take a picture, or determine the sex of a fetus without a medical indication. Notwithstanding the guidelines and warnings regarding ultrasound safety issued by (...) governments and professional bodies, the absence of scientifically proven physical harm to fetuses from this procedure seems to provide these businesses with grounds for rapid expansion. However, this argument is too simplistic because current epidemiological evidence is not synchronous with advancing ultrasound technology. As non-medical fetal ultrasound has aroused very significant public attention, a thorough ethical analysis of this topic is essential. Using a multifaceted approach, we analyse the ethical perspective of non-medical fetal ultrasound in terms of the expectant mother, the fetus and health professionals. After applying four major theories of ethics and principles (the precautionary principle; theories of consequentialism and impartiality; duty-based theory; and rights-based theories), we conclude that obstetric ultrasound practice is ethically justifiable only if the indication for its use is based on medical evidence. Non-medical fetal ultrasound can be considered ethically unjustifiable. Nevertheless, the ethical analysis of this issue is time dependent owing to rapid advancements in ultrasound technology and the safety issue. The role of health professionals in ensuring that obstetric ultrasound is an ethically justifiable practice is also discussed. (shrink)

Ugar and Malele write that generic machine learning (ML) technologies for mental health diagnosis would be challenging to implement in sub-Saharan Africa due to cultural specificities in how those conditions are diagnosed. For example, they say that in South Africa, the appearance of ‘schizophrenia’ might be understood as a type of spiritual possession, rather than a mental disorder caused by a brain dysfunction. Hence, a generic ML system is likely to ‘misdiagnose’ persons whose symptomatology matches that of schizophrenia in the (...) South African context. The authors thus claim that ‘a generic or universal design cannot be effective given the heterogeneity of value judgements in defining what mental health disorders are in different contexts’.1 Should we take this to mean that ML systems ‘should not be designed with a generalised perception of mental disorders,’1 as the authors suggest? On the contrary, my view is that generic ML can be useful, with the caveat that issues of cultural sensitivity may engender translational challenges in various national and cultural contexts. Yet, if it can be demonstrated that a generic ML system can reliably and accurately pick up on shared symptomatologies across cultures despite what any individual or community might believe about their actual causes, this aspect is surely the function and value of diagnostic ML which we should take to matter. Cultural gaps in aetiological understandings of mental health conditions make it all the more important to advance generic ML as a calibrating diagnostic tool. In this commentary, therefore, I will endeavour to make a case for generic ML in mental healthcare. ### Aetiological (mis)understanding across cultures The fundamental complexity to which Ugar and Malele direct our attention is the fact that mental health conditions are attributed to variable causal explanations, rather than a …. (shrink)

What is medical progress? The answer to this question is often associated with advances in diagnostic technology, with greater understanding of disease or pathological mechanisms particularly at the molecular level, or with the discovery of drugs and the developmental of surgical procedures to treat diseases. However, this facile answer can be problematic. In a New York Times Magazine article, for example, Lisa Sanders (2003) recounts a lecture delivered to her first-year class, at a "white-coat" ceremony, by the (...) class='Hi'>medical school dean. Half of what we—the faculty—teach you—the students—is nonsense, she was told, but we don't know which half. She illustrates what the dean said, with the following change in advice for .. (shrink)

The purpose of advance care planning is to allow an individual to maintain autonomy in end-of-life medical decision-making even when incapacitated by disease or terminal illness. The intersection of EOL medical technology, ethics of EOL care, and state and federal law has driven the development of the legal framework for advance directives. However, from an ethical perspective the current legal framework is inadequate to make ADs an effective EOL planning tool. One response to this flawed AD process (...) has been the development of Physician Orders for Life Sustaining Treatment. POLST has been described as a paradigm shift to address the inadequacies of ADs. However, POLST has failed to bridge the gap between patients and their autonomous, preferred EOL care decisions. Analysis of ADs and POLST reveals that future policy should focus on a communications-based approach to ACP that emphasizes ongoing interactions between healthcare providers and patients to optimize EOL medical care to the individual patient. (shrink)

In this article, we examine the emergence of a concept of medical feeding that emphasizes artificiality and medical technology. We discuss how this concept has been created in specific contrast to the daily provision of food and water; medical definitions retain clear disjunctures with cultural and religious beliefs surrounding food, gendered aspects of eating and feeding, and the everyday practices of social and family life in the United States. We begin with an examination of the historical (...) processes involved in creating artificial nutrition and hydration as a medical concept, including the evolution of terminology and practices in relation to technology advancement, legal cases, and public discourse. We.. (shrink)

Despite the recent advances in information and communication technology that have increased our ability to store and circulate information, the task of ensuring that the right sorts of information gets to the right sorts of people remains. We argue that the many efforts underway to develop efficient means for sharing information across healthcare systems and organizations would benefit from a careful analysis of human action in healthcare organizations. This in turn requires that the management of information and knowledge within (...) healthcare organizations be combined with models of resources and processes of patient care that are based on a general ontology of social interaction. The Health Level 7 (HL7) is one of several ANSI-accredited Standards Developing Organizations operating in the healthcare arena. HL7 has advanced a widely used messaging standard that enables healthcare applications to exchange clinical and administrative data in digital form. HL7 focuses on the interface requirements of the entire healthcare system and not exclusively on the requirements of one area of healthcare such as pharmacy, medical devices, imaging or insurance transactions. This has inspired the development of a powerful abstract model of patient care called the Reference Information Model (RIM). The present paper begins with an overview of the core classes of the HL7 (Version 3) RIM and a brief discussion of its “actcentered” view of healthcare. Central to this account is what is called the life cycle of events. A clinical action may progress from defined, through planned and ordered, to executed. These modalities of an action are represented as the mood of the act. We then outline the basis of an ontology of organizations, starting from the theory of speech Acts, and apply this ontology to the HL7 RIM. Special attention is given to the sorts of preconditions that must be satisfied for the successful performance of a speech act and to the sorts of entities to which speech acts give rise (e.g. obligations, claims, commitments, etc.). Finally we draw conclusions for the efficient communication and management of medical information and knowledge within and between healthcare organizations, paying special attention to the role that medical documents play in such organizations. (shrink)

Medicine has made great strides with advances in technology and outcomes. However, compassion is an element that often is missing from medical care and ethics. The paper discusses why compassion is the ideal physician and why it is important to medicine. The benefit of compassion in biomedical ethics by exploring three ethical frameworks is also explored. Compassion is an important concept that has a place in both medical care and ethical practice.

With widespread advances in the diffusion and application of medical technologies, the phenomena of misuse and overuse have become pervasive. These phenomena not only increase the cost of health care systems and deplete the accessibility and availability of health care services, they also jeopardize patient autonomy. From a literature review on this aspect of medical technology, an impact on patient autonomy is found in almost all cases, with the exception of philosophical or ethical writings, in which there (...) is not much practical application for health policy and law. In this article, the major finding is that in the area of patient autonomy, it does not matter much whether the “physician decides” or the “patient decides” in the current “disease care” health system, where most of the doctors focus only on disease treatment using aggressive medical technologies. It is also our “disease care” system that ensures that the patients, the health care professionals, or the health care management cannot safeguard their autonomy. Only when the genuine health care system is restored will patient autonomy be protected. (shrink)