Ontology is currently perceived as the solution of first resort for all problems related to biomedical terminology, and the use of description logics is seen as a minimal requirement on adequate ontology-based systems. Contrary to common conceptions, however, description logics alone are not able to prevent incorrect representations; this is because they do not come with a theory indicating what is computed by using them, just as classical arithmetic does not tell us anything about the entities that are added (...) or subtracted. In this paper we shall show that ontology is indeed an essential part of any solution to the problems of medical terminology – but only if it is understood in the right sort of way. Ontological engineering, we shall argue, should in every case go hand in hand with a sound ontological theory. (shrink)

Medical terminology collects and organizes the many different kinds of terms employed in the biomedical domain both by practitioners and also in the course of biomedical research. In addition to serving as labels for biomedical classes, these names reflect the organizational principles of biomedical vocabularies and ontologies. Some names represent invariant features (classes, universals) of biomedical reality (i.e., they are a matter for ontology). Other names, however, convey also how this reality is perceived, measured, and understood by health (...) professionals (i.e., they belong to the domain of epistemology). We analyze terms from several biomedical vocabularies in order to throw light on the interactions between ontological and epistemological components of these terminologies. We identify four cases: 1) terms containing classification criteria, 2) terms reflecting detectability, modality, uncertainty, and vagueness, 3) terms created in order to obtain a complete partition of a given domain, and 4) terms reflecting mere fiat boundaries. We show that epistemology-loaded terms are pervasive in biomedical vocabularies, that the “classes” they name often do not comply with sound classification principles, and that they are therefore likely to cause problems in the evolution and alignment of terminologies and associated ontologies. (shrink)

Medical practitioners of the sixteenth century had their own body of special terms, just like the doctors of this century. McConchie examines medical terminology used in a selection of thirteen medical works published between 1547 and 1612, and compares it with treatment of these words in the Oxford English Dictionary and other dictionaries of today, showing how well - or ill - the specialist terminology of sixteenth-century medical practitioners has been recorded. He compiles a (...) corpus of new data from a selection of medical texts ranging from scholarly tomes to homely handbooks. The study of this corpus reveals errors, omissions, and biases which raise questions for lexicographical tools in general. Are existing dictionaries adequate in their investigation of Renaissance English? Has current understanding been more biased and more deficient than we thought? If so, how are we to redress the problem? This book uses a specialist semantic domain to raise important issues for lexicographers, and historians of early modern English and medicine. (shrink)

Not the least noticeable is the fact that the ancient Greek compound euthanasia, formed by Francis Bacon, has retained its original terminological form since it was first used in the 17th century. Among all other controversial ethical issues, however, the conceptual notion of euthanasia categorically evokes rather important controversies. The questions that arise in this context are whether there is a definition, or at least a determination, of the term euthanasia and whether we are aware of its use in scientific (...) discourse, what exactly is euthanasia. The paper offers a terminological elaboration of the term euthanasia in a linguistic, but mainly legal and medical-procedural context, in order to examine the coherence in defining the term between these categories and, consequently, to determine the key determinants of euthanasia according to categorical sections. The key facts stated are the primary determination or the possible definition of the term for any further scientific study of euthanasia as one of the most controversial issues within bioethical doctrine. (shrink)

Advance directives are specific competent consumers’ wishes about future medical plans in the event that they become incompetent. Awareness of a patient’s autonomy particularly, in relation to their right to refuse or withdraw treatment, a right for the patient to die from natural causes and interest in end of life issues were among the main reasons for developing and legalizing advance medical directives in developed countries. However, in many circumstances cultural and religious aspects are among many factors that (...) can hamper implementation of advance directives. Islam and Muslims in general have a good understanding of death and dying. Islam allows the withholding or withdrawal of treatments in some cases where the intervention is considered futile. However, there is lack of literature and debate about such issues from an Islamic point of view. This article provides the Islamic perspective with regards to advance medical directive with the hope that it will generate more thoughts and evoke further discussion on this important topic. (shrink)

One of the ethical principles of medical research involving human subjects is obtaining proper informed consent (IC). However, if the participants’ actual awareness of medical research terminology is lower than the researchers’ prediction of that awareness, it may cause difficulty obtaining proper IC. Therefore, this study aims to clarify the presence of “perception gaps” and then discuss IC-related issues and measures based on the insights obtained. We conducted two online surveys: a “public survey” to understand the Japanese (...) public’s awareness of 11 medical research terms and a “physicians’ survey” to investigate physicians’ predictions regarding public awareness. In the “public survey,” for each term, respondents were instructed to select their situation from “understand,” “have heard,” or “have never heard.” In the “physicians’ survey,” respondents were asked to estimate the proportions of the general public who would “have understood,” “have heard,” or “have never heard” by using an 11-step scale. We analyzed separately in two age groups to understand the age-related difference. We received 1002 valid responses for the “public survey” and 275 for the “physicians’ survey.” Of the public respondents, more than 80% had never heard of terms such as interventional study, prospective clinical study, cohort study, Phase I clinical trial, or double-blind study. Concurrently, physicians overestimated general public awareness of the terms placebo, cohort study, double-blind study, and randomized clinical trial (in the group of people under 60). The results revealed the perception gap between the general public and physicians which raise serious concerns about obtaining proper IC from clinical research participants. (shrink)

March 2020 has become a moment of change in communication mode and quality. Previously, the media paid attention to the current affairs, however, never earlier the journalistic discourse has been so influentially affected by the ongoing phenomenon as in the case of COVID-19. Almost overnight the new terminological phenomena with specific legal or medical reference were introduced into everyday language mainly via mass media and become an important part of a pandemic related narration. The strong influence on the shape (...) of the mentioned linguistic changes has mainly the adoption of new legal regulations due to the unexpected outbreak of the pandemic. The aim of the following paper is to investigate how COVID-19 pandemic affected the specialisation of the journalistic discourse and how different domains are being influenced by new terminology and in other way round, how for example law and medicine influence new “COVID language”. In order to take the interdisciplinary nature of the issue into account, the degree of hybridity of the selected texts will be examined by means of selected material analysis. The methodology applied in the paper uses an empirical approach and comparative analysis. The material used for the analysis comes from the selected Polish quality and boulevard press. The paper concerns the linguistic influence of the “invisible enemy” on the language presented in press. The main findings reveal the intense use of neologisms, borrowings, and it shows that the discourse was changed linguistically thanks to Student’s t-test. (shrink)

The paper by Bowman-Smart et al. (2023) on noninvasive prenatal genetic testing (NIPT) for non-medical traits aims to set out the case for and the case against such testing. In response to their pa...

Linguistics, in general, is the basic science of all language studies. It is concerned with the nature and structure of language and with the role it plays in human communication. Medical linguistics uses some methods of general linguistics and also creates additional ones. This is motivated by the following practical needs: Computer-aided data record, storage, and retrieval in medical practice and research require that medical data be stored in such a manner that enables their computational processing. However, (...) databases written in natural medical language cannot be easily processed. To enable efficient natural language processing, medical terms and sentences used in them must be made amenable to syntactic and semantic operations by computer programs. Medical linguistics is an ill-defined, interdisciplinary branch of medical informatics and medical information and library sciences concerned with methods and problems of natural language processing in medicine. (shrink)

Several fields contributing to psychiatric advances, such as psychology, biology, and the humanities, have not yet met to produce a cohesive and integrated picture of human function and dysfunction, strength and vulnerability, etc., despite advances in their own areas. The failure may have its roots in a disagreement on what we mean by the human person and his or her relationship with the world, for which the incommensurate language of these disciplines may be partly to blame. Turns taken by western (...) philosophy over the past 400 years may help to explain this. Language is such an important tool for psychiatrists, that examination of it may afford an insight into the reasons for divisions in the field. This paper aims to examine and compare psychologies (and hence psychiatries) derived from modern western philosophy, with similar concepts in other cultures, through the study of developments in terminology, in terms of the simplest facts about what it means to be human. Terminology used in mental health in western cultures is examined, with particular consideration of the term “self” as it has come to be used in a technical sense. Analogous terms from non-English speaking European languages, and some non-western cultures are studied. Western philosophy and psychology have evolved a meaning for the term “self” which is quite different from equivalent terms in non-western cultures. It is a moot point whether or not the development in western psychiatry of what are now technical terms to describe normal human experience has become needlessly obscure and ambiguous. It is not evident that this “new” language represents a genuine advance in understanding; it distances mental health professionals from those who are not familiar with it; and it makes transcultural dialogue difficult. (shrink)

Philosophers have long recognized that the unique values of the individual physician effect medical-ethical decision-making. While not taking issue with this basic assumption, this article critically examines one discussion of how different philosophies (existential, utilitarian, and value realist) can influence a neurosurgeon's decision to operate upon a person having a malignant brain tumor. It also delineates and discusses a fund of ‘medical wisdom’ commonly available to any neurosurgeon and easily obtainable by both researcher and patient. The article suggests (...) that those in the humanities interested in studying the ethical decision-making process in a medical subspecialty become familiar with this fund of knowledge. It can provide a base for evaluating when and how individual medical decisions vary. In this specific instance, the medical knowledge base was used to direct attention to when and how ethical issues are identified and resolved within the staff clinical neurosurgical setting. An informal survey among resident and staff neurosurgeons supported the conclusion that philosophical analyses of medical-ethical decision-making are appreciated when case examples are carefully and accurately documented, when medical terminology is used correctly and when recognition of the practical limits placed on medical decision-making is given. CiteULike Connotea Del.icio.us What's this? (shrink)

Ukrainian science and its terminology in the nineteenth century experienced a number of twists and turns. Divided between two empires, it lacked institutions, scholars pursuing it, and a unified literary language. One could even say that until the late nineteenth century there was a possibility for two communities with two literary languages to emerge – Ruthenian and Ukrainian. Eventually, both communities and languages merged. This article tracks the meanderings of this process, arguing that scholarly publications played a crucial role (...) in shaping the standard for the scientific language. The article follows the biography of the naturalist Ivan Verhrats’kyi, the author of the first dictionaries of naturalist terminology in Ruthenian in 1860, a translator and author of textbooks, and the head of the Mathematical–Naturalist–Medical Section of the Shevchenko Society in L’viv. He thus shaped many Ruthenian, and then Ruthenian–Ukrainian scholarly projects. Initially successful with his approach to making the Ruthenian scientific language vernacular, in the 1890s his approach was losing ground to the internationalization of vocabulary and to the growing pressure toward the unification of Ruthenian and Ukrainian. Finally, in the beginning of the twentieth century, Verhrats’kyi became marginalized within the Ukrainian scholarly community. By discussing the history of a minority language within imperial structures, I argue that the media in which scholarly work was published requires special attention. In the Ruthenin–Ukrainian case, they determined the standard for scientific language. Lacking professional journals, Ruthenian scholars published in the 1860s–late 1880s in popular newspapers and in school textbooks, requiring them to use a language that was near to the spoken tongue of the Habsburg province. Once the political situation changed, favoring Ruthenian–Ukrainian unification, and scholarly journals appeared and transgressed the imperial boundary, the favored language had to be transimperial, ousting out the vernacular. (shrink)

The idea of personalised medicine (PM) has gathered momentum recently, attracting funding and generating hopes as well as scepticism. As PM gives rise to differing interpretations, there have been several attempts to clarify the concept. In an influential paper published in this journal, Schleidgen and colleagues have proposed a precise and narrow definition of PM on the basis of a systematic literature review. Given that their conclusion is at odds with those of other recent attempts to understand PM, we consider (...) whether their systematic review gives them an edge over competing interpretations. We have found some methodological weaknesses and questionable assumptions in Schleidgen and colleagues’ attempt to provide a more specific definition of PM. Our perplexities concern the lack of criteria for assessing the epistemic strength of the definitions that they consider, as well as the logical principles used to extract a more precise definition, the narrowness of the pool from which they have drawn their empirical data, and finally their overlooking the fact that definitions depend on the context of use. We are also worried that their ethical assumption that only patients’ interests are legitimate is too simplistic and drives all other stakeholders’ interests—including those that are justifiable—underground, thus compromising any hope of a transparent and fair negotiation among a plurality of actors and interests. As an alternative to the shortcomings of attempting a semantic disciplining of the concept we propose a pragmatic approach. Rather than considering PM to be a scientific concept in need of precise demarcation, we look at it as an open and negotiable concept used in a variety of contexts including at the level of orienting research goals and policy objectives. We believe that since PM is still more an ideal than an achieved reality, a plurality of visions is to be expected and we need to pay attention to the people, reasons and interests behind these alternative conceptions. In other words, the logic and politics of PM cannot be disentangled and disagreements need to be tackled addressing the normative and strategic conflicts behind them. (shrink)

Medicine is the art of healing, aesthetics the study of our response to art and beauty. What happens when the two come together in the practice of cosmetic surgery? This is my question, a foray into what I will call "medical aesthetics." In what follows, I examine how practitioners of cosmetic surgery and related specialties have appropriated the language of medicine and healthcare to reframe and legitimize various nonmusical elective procedures designed to modify appearance. I being with a short (...) discussion of the history and terminology of cosmetic surgery. Against this background, I critically assess the claim that cosmetic surgery qualifies as a form of healthcare, and hence a legitimate branch of medicine . . . In pressuring medical professionals to place beauty above health, cosmetic surgery and related specialties such as cosmetic dentistry unavoidably raise questions about the definition of medicine itself. In particular, patient demand for what I am labeling "medical aesthetics" may collide with the Hippocratic requirement that physicians "do no harm." It is to those harms and related concerns that I turn in the final section. (shrink)

We present the details of a methodology for quality assurance in large medical terminologies and describe three algorithms that can help terminology developers and users to identify potential mistakes. The methodology is based in part on linguistic criteria and in part on logical and ontological principles governing sound classifications. We conclude by outlining the results of applying the methodology in the form of a taxonomy different types of errors and potential errors detected in SNOMED-CT.

The relation between the notions of (medical) invasiveness and (actual or potential) harm has not been systematically discussed nor theoretically grounded, despite its importance to clinical-ethical practice. This paper aims to clarify the notion of invasiveness beyond the traditional notion of invasiveness as breaking skin or inserting mechanical objects into the body. The traditional notion of invasiveness is challenged by counterexamples. Three approaches to the notion of disorder applied here are: deviation from what is common; deviation from what is (...) considered ideal; and disruption of self-organization. Assuming that more extreme measures are related to more harm, all three approaches to the notion of disorder suggest that invasiveness is proportional if not identical to harm, and show no clear relation to the traditional notion of invasiveness. In conclusion, the notion of invasiveness may best be eliminated from medical terminology, replacing it with a detailed understanding of the notion of harm. (shrink)

This is a practical introduction to the range of ethical questions which doctors and other health-care professionals may be expected to encounter in practice. The books covers both the traditional "end of life" issues and also deals with medical research and consent issues, confidentiality and AIDS, resource allocation, care of the mentally ill, and the doctor/patient relationship. Each chapter canvasses a range of ethical views, drawing both from traditional philosophical responses and the most recent contemporary responses. Theoretical discussion is (...) extended and enlivened by the use of hypothetical and actual examples, suitable both for private study or group discussion. While the needs of medical students for a non-technical guide to ethics have been kept firmly in mind, the clarity of writing and avoidance of specialist medical and philosophical terminology ensure that it will be of value to students of nursing and related disciplines, and accessible to the lay reader. (shrink)

Despite extensive research and a multitude of computer systems, there is no viable computerized system that is even remotely capable of approaching the skill of an expert human physician. Minor obstacles in the design of a practical system include imprecise medical terminology, the use of nonindependent clinical parameters, incorrect or inaccurate information supplied to the computer, and static representation of a patient's medical history. Major problems that go beyond computer manipulation of data include the requirement for a (...) massive data base, representation of medical knowledge in general rather than specific terms, and physician fallibility in the design of a computer system. CiteULike Connotea Del.icio.us What's this? (shrink)

Why do we persist in the relentless pursuit of artificial nourishment and other treatments to maintain a permanently unconscious existence? In facing the future, if not the present world-wide reality of a huge number of persistent vegetative state (PVS) patients, will they be treated because of our ethical commitment to their humanity, or because of an ethical paralysis in the face of biotechnical progress? The PVS patient is cut off from the normal patterns of human connection and communication, with a (...) life unlike other forms of human existence. Why the struggle to justify ending a life which, it is said, has suffered an irreversible loss of the content of consciousness? Elsewhere, the authors have addressed the ethical controversies and confusion engendered by ambiguous terminology, misuse of medical facts and the differing interpretations of what constitutes 'effective' treatment: in particular, the issue of whether in fact artificial nutrition and hydration is a medical treatment, or simply part of the obligatory care owed to all patients, permanently unconscious or not. In this paper, we intend to argue that recent analyses of medical futility, its meaning and ethical implications, despite an absence of public consensus, permit some tentative re-evaluation of our ethical obligations to the PVS patient. (shrink)

Medical assistance in dying (MAiD) is scheduled to be legalized in Canada as of March 2024 for individuals with mental disorder/illness as their sole underlying medical condition (MAiD MD-SUMC). As guidelines are being developed for the safe and consistent provision of MAiD MD-SUMC, sufficient consideration must be given to the interpretation of ambiguous terminology in current legislation, and to ensuring sound use of acceptable ethics principles in these interpretations.

The usage, derivation, and psychological, ethical, and legal aspects of slang terminology in medicine are discussed. The colloquial vocabulary is further described and a comprehensive glossary of common UK terms provided in the appendix. This forms the first list of slang terms currently in use throughout the British medical establishment.

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)

The Unified Medical Language System and the Gene Ontology are among the most widely used terminology resources in the biomedical domain. However, when we evaluate them in the light of simple principles for wellconstructed ontologies we find a number of characteristic inadequacies. Employing the theory of granular partitions, a new approach to the understanding of ontologies and of the relationships ontologies bear to instances in reality, we provide an application of this theory in relation to an example drawn (...) from the context of the pathophysiology of hypertension. This exercise is designed to demonstrate how, by taking ontological principles into account we can create more realistic biomedical ontologies which will also bring advantages in terms of efficiency and robustness of associated software applications. (shrink)

Background: Systematized Nomenclature of Medicine—Clinical Terms (SNOMED CT, hereafter abbreviated SCT) is acomprehensive medical terminology used for standardizing the storage, retrieval, and exchange of electronic healthdata. Some efforts have been made to capture the contents of SCT as Web Ontology Language (OWL), but theseefforts have been hampered by the size and complexity of SCT. Method: Our proposal here is to develop an upper-level ontology and to use it as the basis for defining the termsin SCT in a way (...) that will support quality assurance of SCT, for example, by allowing consistency checks ofdefinitions and the identification and elimination of redundancies in the SCT vocabulary. Our proposed upper-levelSCT ontology (SCTO) is based on the Ontology for General Medical Science (OGMS). Results: The SCTO is implemented in OWL 2, to support automatic inference and consistency checking. Theapproach will allow integration of SCT data with data annotated using Open Biomedical Ontologies (OBO) Foundryontologies, since the use of OGMS will ensure consistency with the Basic Formal Ontology, which is the top-levelontology of the OBO Foundry. Currently, the SCTO contains 304 classes, 28 properties, 2400 axioms, and 1555annotations. It is publicly available through the bioportal athttp://bioportal.bioontology.org/ontologies/SCTO/. Conclusion: The resulting ontology can enhance the semantics of clinical decision support systems and semanticinteroperability among distributed electronic health records. In addition, the populated ontology can be used forthe automation of mobile health applications. (shrink)

U.S. politicians and policymakers have been preoccupied with how to pay for health care. Hardly any thought has been given to what should be paid for—as though health care is a commodity that needs no examination—or what health outcomes should receive priority in a just society, i.e., rationing. I present a rationing proposal, consistent with U.S. culture and traditions, that deals not with “health care,” the terminology used in the current debate, but with the more modest and limited topic (...) of medical care. Integral to this rationing proposal—which allows scope to individual choice and at the same time recognizes the interdependence of the individual and society—is a definition of a “decent minimum,” the basic package of medical treatments everyone should have access to in a just society. I apply it to a specific example, diabetes mellitus, and track it through a person's life span. (shrink)

Over the past 50 years, technical advances have taken place in medicine that have greatly increased the possibilities of life-prolonging intervention. The increased possibilities of intervening have brought along new ethical questions. Not everything that is technically possible is appropriate in a specific case: not everything that could be done should be done. In the 1980s, a new term was coined to indicate a class of inappropriate interventions: “medically futile treatment”. A debate followed, with contributions from the USA and several (...) western European countries. A similar debate later took place in Mediterranean countries, although with a different terminology. The purpose of this article is to provide an up-to-date and systematic analysis of the concept of futility, and to draw some conclusions on its operationalisation in medical practice. While the concept of “medical futility” in theory applies to all kinds of medical intervention that might be performed without being medically indicated—things such as certain medical screenings and cosmetic surgery—in practice the literature on “futility” deals only with life-saving and life-sustaining medical interventions. This article deals with this more limited application of the concept of “futility”. (shrink)

Biomedical terminologies are focused on what is general, Electronic Health Records (EHRs) on what is particular, and it is commonly assumed that the step from the one to the other is unproblematic. We argue that this is not so, and that, if the EHR of the future is to fulfill its promise, then the foundations of both EHR architectures and biomedical terminologies need to be reconceived. We accordingly describe a new framework for the treatment of both generals and particulars in (...) biomedical information systems that is designed: 1) to provide new opportunities for the sharing and management of data within and between healthcare institutions, 2) to facilitate interoperability among different terminology and record systems, and thereby 3) to allow new kinds of reasoning with biomedical data. (shrink)

Technology and terminology often detract from a reasoned appraisal of the euthanasia option, especially in those discussions that argue for euthanasia's incorporation into a beneficence-based medical model. “Beneficent euthanasia,” assuming there is such a thing, poses special challenges to the traditional provider-patient relationship. These challenges argue for well-defined limits of beneficence and a more equitable distribution of responsibility between participants. We should not allow technology and terminology to generate an unrealistic portrayal of patient death and its ramifications. (...) Participants need to acknowledge their roles in the decision to kill and the obligations that those roles entail. Perhaps we can reach ethical consensus concerning euthanasia by first reasserting our span of control over the technology that can extend the near-death period and by openly discussing euthanasia's implications. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 11.2 (2001) 115-116 [Access article in PDF] The Ethics of Medical Mistakes: Historical, Legal, and Institutional Perspectives Introduction In late 1999, the Institute of Medicine (IOM) released its report on medical errors, To Err is Human: Building a Safer Health System. The report estimated almost 50,000 deaths per year nationally due to medical mistakes, making it a leading cause of death. (...) IOM speculated that more than half of the deaths related to medical error are preventable. The IOM report shocked the public and medical professionals alike, sparking a national discussion of how to make the health care system safer. This multifaceted issue has profound implications for all aspects of health care, from the very personal--e.g., the relationship of caregiver and patient--to the societal--e.g., a nation's responsibility to its citizens.On 15 May 2000, the University of Pittsburgh Medical Center hosted an ethics conference devoted to the topic of medical mistakes. The goal was to bring together experts from various disciplines, before an audience of both providers and patients, to discuss medical mistakes and their implications. In this issue of the Kennedy Institute of Ethics Journal, we present selected papers resulting from that conference. These papers reflect not only the original oral presentations, but also much of the discussion those presentations generated. Three key perspectives on the ethics of medical mistakes are offered: historical, legal, and institutional.Rosa Lynn Pinkus offers a revealing historical perspective on the ethics of medical mistakes. In analyzing the history of mistake reporting in neurosurgery, she shows how the notion of a mistake developed only as the notion of a standard of practice emerged. Although much of managed care is directed toward systematically fostering a standard of care, this pursuit is relatively new in health care. One might speculate that as more standards are created, mistakes--defined as deviations from standard practice--must increase. If deviation from standard practice is overly castigated, however, then needed innovation in practice may be stifled. Interestingly, as Pinkus discusses, medical malpractice suits quickly followed the emergence of practice standards, driving the initial open reporting of mistakes underground. [End Page 115]Taking up the issue of medical malpractice, Thomas May and Mark Aulisio consider the ramifications of the current malpractice system for mistake prevention. The current system, they argue, while failing to adequately achieve its purported goals of deterring medical mistakes and compensating victims, itself creates a climate that deters the open reporting of mistakes by engendering fear and shame in clinicians. According to May and Aulisio, this failure to report medical mistakes openly has serious ramifications. Chief among these is the inability to do root cause analysis of mistakes, and then, where possible, to implement safeguards to minimize the occurrence of future mistakes. Ultimately, both the prevention of medical mistakes and the goals of malpractice litigation itself will be better served if substantial malpractice reform is undertaken.Andy Thurman argues that even in the current climate institutions ought to have a policy (and practice) of admitting to and openly reporting medical mistakes. Thurman argues that doing so not only is the right thing to do, but is also in the interest of institutions. Interestingly, he contends that failing to admit and openly report mistakes is both at odds with the mission of health care institutions and puts them at higher risk of litigation, and liability. In light of this, Thurman then suggests an institutional process for handling medical mistakes.Michael DeVita concedes that disclosing mistakes is widely supported by the health professionals' principles of ethics, but argues that there are a number of factors that conspire to make doing so a very difficult task. In analyzing an index case, DeVita contends that platitudes about being honest are not nearly enough to foster honest behavior and that policies that offer specific guidance on handling unfavorable events are needed in health care institutions.Finally, we conclude with the policy on disclosure of unfavorable events (this terminology is chosen because it includes both iatrogenic and natural diseases and conditions) that resulted from... (shrink)

This volume reprints in a scholar's edition the first English-language texts on bioethics, John Gregory's (1724-1773) Observations on the Duties and Offices of a Physician and on the Method of Prosecuting Enquiries in Philosophy (London, 1770) and Lectures on the Duties and Qualifications of a Physician (London, 1772). Five previously unpublished manuscripts of Gregory's lectures are also included. An introduction places Gregory's medical ethics and philosophy of medicine in their eighteenth-century contexts of Scottish Enlightenment history and culture, Baconian science (...) and philosophy of medicine, medical practice, the feminine and feminist philosophy of the Bluestocking Circle, and moral sense philosophy, particularly David Hume's concept of sympathy, and provides a bibliography of primary and secondary sources as an aid to teaching and future scholarship. The book's index provides access to Gregory's texts, by using both historical terms and current terminology of bioethics. A volume in the subseries Classics of Medical Ethics. (shrink)

Race and ethnicity are commonly reported variables in biomedical research, but how they were determined is often not described and the rationale for analyzing them is often not provided. JAMA improved the reporting of these factors by implementing a policy and procedure. However, still lacking are careful consideration of what is actually being measured when race/ethnicity is described, consistent terminology, hypothesis-driven justification for analyzing race/ethnicity, and a consistent and generalizable measurement of socioeconomic status. Furthermore, some studies continue to use (...) race/ethnicity as a proxy for genetics. Research into appropriate measures of race/ethnicity and socioeconomic factors, as well as education of researchers regarding issues of race/ethnicity, is necessary to clarify the meaning of race/ethnicity in the biomedical literature. (shrink)

Over recent years, the research community has been increasingly using preprint servers to share manuscripts that are not yet peer-reviewed. Even if it enables quick dissemination of research findings, this practice raises several challenges in publication ethics and integrity. In particular, preprints have become an important source of information for stakeholders interested in COVID19 research developments, including traditional media, social media, and policy makers. Despite caveats about their nature, many users can still confuse pre-prints with peer-reviewed manuscripts. If unconfirmed but (...) already widely shared first-draft results later prove wrong or misinterpreted, it can be very difficult to “unlearn” what we thought was true. Complexity further increases if unconfirmed findings have been used to inform guidelines. To help achieve a balance between early access to research findings and its negative consequences, we formulated five recommendations: (a) consensus should be sought on a term clearer than ‘pre-print’, such as ‘Unrefereed manuscript’, “Manuscript awaiting peer review” or ‘’Non-reviewed manuscript”; (b) Caveats about unrefereed manuscripts should be prominent on their first page, and each page should include a red watermark stating ‘Caution—Not Peer Reviewed’; (c) pre-print authors should certify that their manuscript will be submitted to a peer-review journal, and should regularly update the manuscript status; (d) high level consultations should be convened, to formulate clear principles and policies for the publication and dissemination of non-peer reviewed research results; (e) in the longer term, an international initiative to certify servers that comply with good practices could be envisaged. (shrink)

The use of artificial intelligence (AI) in healthcare comes with opportunities but also numerous challenges. A specific challenge that remains underexplored is the lack of clear and distinct definitions of the concepts used in and/or produced by these algorithms, and how their real world meaning is translated into machine language and vice versa, how their output is understood by the end user. This “semantic” black box adds to the “mathematical” black box present in many AI systems in which the underlying (...) “reasoning” process is often opaque. In this way, whereas it is often claimed that the use of AI in medical applications will deliver “objective” information, the true relevance or meaning to the end‐user is frequently obscured. This is highly problematic as AI devices are used not only for diagnostic and decision support by healthcare professionals, but also can be used to deliver information to patients, for example to create visual aids for use in shared decision‐making. This paper provides an examination of the range and extent of this problem and its implications, on the basis of cases from the field of intensive care nephrology. We explore how the problematic terminology used in human communication about the detection, diagnosis, treatment, and prognosis of concepts of intensive care nephrology becomes a much more complicated affair when deployed in the form of algorithmic automation, with implications extending throughout clinical care, affecting norms and practices long considered fundamental to good clinical care. (shrink)

This brief report presents the global problem of the shortfall of donor corneal tissue for transplantation, a potential root cause (‘ick factor’ language), and a potential solution (modification of ‘ick factor’ language). Specifically, use of the term ‘eye donation’ is a potential hurdle to ocular tissue donation as it can stimulate the ‘ick factor.’ Verbiage such as ‘ocular (eye tissue)’ could be a method of providing terminology that is less emotive than ‘eye donor’ or ‘eye donation.’ The field of (...) transplantation has experienced terminology shifts over time; for example, ‘cadaver’ has been replaced with ‘deceased donor,’ ‘harvest’ has been replaced with ‘recover,’ and ‘life support’ has been replaced with ‘ventilated.’ Notably, only a small number of regions worldwide are using ‘ocular’ terminology, yet it could be an important step to enhancing the informed consent process and improving donation rates, potentially increasing transplant and optimising patient quality of life for those with treatable blindness. (shrink)

Incompletely understood medical texts, like other kinds of technical writing, pose problems that require a multi-disciplinary approach. In addition, the etymological writings of ancient commentators hint at their own cultures priorities and limitations. Progress today, therefore, also depends partly upon how well we can harmonize our own thinking with the beliefs and practices of an alien culture, whose medicine may overlap with culinary and other social uses. A puzzling word may have been reshaped to reflect the supposed properties of (...) the entity denoted or the use made of it. Plant names, which figure strongly in such texts, are particularly liable to be passed from language to language as ‘culture borrowings’ and are thus especially vulnerable to this false rationalization process, commonly known as ‘folk etymology’. In a personal exploration I analyse some modern vocabulary and identify several varieties of the process and then illustrate its effects by means of toponyms and medicinal plant names from mediaeval Italy and ancient Mesopotamia, Anatolia, Greece and Italy. Since no known language seems immune from etymologizing, the generic points that emerge are offered as a contribution to the decipherers craft. (shrink)

Race and ethnicity are commonly reported variables in biomedical research, but how they were initially determined is often not described and the rationale for analyzing them is often not provided. JAMA improved the reporting of these factors by implementing a policy and procedure for doing so. However, still lacking are careful consideration of what is actually being measured when race/ethnicity is described, consistent terminology, hypothesis-driven justification for analyzing race/ethnicity, and a consistent and generalizable measurement of socioeconomic status. Furthermore, some (...) studies continue to use race/ethnicity as a proxy for genetics. Research into appropriate measures of race/ethnicity and socioeconomic factors, as well as education of researchers regarding issues of race/ethnicity, is necessary to clarify the meaning of race/ethnicity in the biomedical literature. (shrink)

Background: Medical tourism, thought of as patients seeking non-emergency medical care outside of their home countries, is a growing industry worldwide. Canadians are amongst those engaging in medical tourism, and many are helped in the process of accessing care abroad by medical tourism brokers - agents who specialize in making international medical care arrangements for patients. As a key source of information for these patients, brokers are likely to play an important role in communicating the (...) risks and benefits of undergoing surgery or other procedures abroad to their clientele. This raises important ethical concerns regarding processes such as informed consent and the liability of brokers in the event that complications arise from procedures. The purpose of this article is to examine the language, information, and online marketing of Canadian medical tourism brokers' websites in light of such ethical concerns. Methods: An exhaustive online search using multiple search engines and keywords was performed to compile a comprehensive directory of English-language Canadian medical tourism brokerage websites. These websites were examined using thematic content analysis, which included identifying informational themes, generating frequency counts of these themes, and comparing trends in these counts to the established literature. Results: Seventeen websites were identified for inclusion in this study. It was found that Canadian medical tourism broker websites varied widely in scope, content, professionalism and depth of information. Three themes emerged from the thematic content analysis: training and accreditation, risk communication, and business dimensions. Third party accreditation bodies of debatable regulatory value were regularly mentioned on the reviewed websites, and discussion of surgical risk was absent on 47% of the websites reviewed, with limited discussion of risk on the remaining ones. Terminology describing brokers' roles was somewhat inconsistent across the websites. Finally, brokers' roles in follow up care, their prices, and the speed of surgery were the most commonly included business dimensions on the reviewed websites. Conclusion: Canadian medical tourism brokers currently lack a common standard of care and accreditation, and are widely lacking in providing adequate risk communication for potential medical tourists. This has implications for the informed consent and consequent safety of Canadian medical tourists. (shrink)

In the tradition of Western medicine that goes back to Hippocrates, we teach medical students to see beyond the disease and to consider the patient as a whole—to take into account the broader context of family, lifestyle, and environmental exposures. For instance, when measuring blood pressure to diagnose hypertension, family history and situational stress must be considered. Moreover, repeated measurements at multiple time points must be performed to avoid a false-positive diagnosis due to temporary fluctuations of blood pressure. The (...) diagnosis then provides, in adherence to standard-of-care guidelines, the indication for antihypertensive therapy. The recommendations have been... (shrink)

As medical professionals, we outline the science underlying disorders or differences of sexual development (DSD), discuss the nuances of sex and gender and how terminology can differ based on medical vs. non-medical context, briefly review the evidence of the ergogenic effects of hyperandrogenism, and discuss the medical complications with the hormonal contraceptive use currently dictated by World Athletics to allow DSD athletes to compete in the female category.

Translational research is a buzzword which dominates discussions about the quality, the utilization, and the benefits of medical research. Yet, although translational research has become a prominent topic, no commonly agreed definition of this terminology exists. Instead, experts from different contexts such as biomedical research, clinical practice or nursing discuss translational research in multiple ways depending on how they define the problem that translational research is supposed to be the solution to. In this paper, we do not seek (...) to find a ‘correct’ definition of translational research, but instead ask how actors using this terminology for describing their own research make sense of it. To do so, we asked three questions: Which actors are engaged in the debate about translational research? What kind of different meanings of translational research exist? And, which actors refer to which meaning of translational research when using the term? In answering these questions, we highlight the role this terminology plays in defining what medical science is about today. (shrink)

Translational research is a buzzword which dominates discussions about the quality, the utilization, and the benefits of medical research. Yet, although translational research has become a prominent topic, no commonly agreed definition of this terminology exists. Instead, experts from different contexts such as biomedical research, clinical practice or nursing discuss translational research in multiple ways depending on how they define the problem that translational research is supposed to be the solution to. In this paper, we do not seek (...) to find a ‘correct’ definition of translational research, but instead ask how actors using this terminology for describing their own research make sense of it. To do so, we asked three questions: Which actors are engaged in the debate about translational research? What kind of different meanings of translational research exist? And, which actors refer to which meaning of translational research when using the term? In answering these questions, we highlight the role this terminology plays in defining what medical science is about today. (shrink)

Translational research is a buzzword which dominates discussions about the quality, the utilization, and the benefits of medical research. Yet, although translational research has become a prominent topic, no commonly agreed definition of this terminology exists. Instead, experts from different contexts such as biomedical research, clinical practice or nursing discuss translational research in multiple ways depending on how they define the problem that translational research is supposed to be the solution to. In this paper, we do not seek (...) to find a ‘correct’ definition of translational research, but instead ask how actors using this terminology for describing their own research make sense of it. To do so, we asked three questions: Which actors are engaged in the debate about translational research? What kind of different meanings of translational research exist? And, which actors refer to which meaning of translational research when using the term? In answering these questions, we highlight the role this terminology plays in defining what medical science is about today. (shrink)

BackgroundCORE (Clarity and Openness in Reporting: E3-based) Reference (released May 2016 by the European Medical Writers Association [EMWA] and the American Medical Writers Association [AMWA]) is a complete and authoritative open-access user’s guide to support the authoring of clinical study reports (CSRs) for current industry-standard-design interventional studies. CORE Reference is a content guidance resource and is not a CSR Template.TransCelerate Biopharma Inc., an alliance of biopharmaceutical companies, released a CSR Template in November 2018 and recognised CORE Reference as (...) one of two principal sources used in its development.MethodsThe regulatory medical writing and statistical professionals who developed CORE Reference conducted a critical review of the TransCelerate CSR Template. We summarise our major findings and recommendations in this communication. We also re-examined and edited the Version 1 CORE Reference Terminology Table that we first published in 2016, and we present this as Version 2 in this communication.ResultsOur major critical review findings indicate that opportunities remain to refine the CSR Template structure and instructional text, enhance content clarity, add web links to referenced guidance documents, improve transparency to support the broad readership of CSRs, and develop supporting resources.The CORE Reference ‘Terminology Table’ Version 2 includes estimand as a defined term and an adaptation of the original ‘worked study example’ to incorporate the recently evolved concept of ‘estimands’.ConclusionsAs TransCelerate’s CSR Template represents an important milestone in authoring CSRs, we offer CSR authors advice and recommendations on its use, similarities, and differences with CORE Reference and advise them to consider shared interpretations between the two.RegistrationCORE Reference is registered with the EQUATOR Network. The TransCelerate CSR Template is not registered with any external organisation to the knowledge of the authors of this paper. (shrink)