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Vakili-Ojarood M, Naseri A, Shirinzadeh-Dastgiri A, Saberi A, HaghighiKian SM, Rahmani A, Farnoush N, Nafissi N, Heiranizadeh N, Antikchi MH, Narimani N, Atarod MM, Yeganegi M, Neamatzadeh H. Ethical Considerations and Equipoise in Cancer Surgery. Indian J Surg Oncol 2024; 15:363-373. [PMID: 39328740 PMCID: PMC11422545 DOI: 10.1007/s13193-024-02023-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 07/02/2024] [Indexed: 09/28/2024] Open
Abstract
The changing landscape of cancer surgery requires ongoing consideration of ethical issues to ensure patient-centered care and fair access to treatments. With technological advancements and the global expansion of surgical interventions, healthcare professionals must navigate complex ethical dilemmas related to patient autonomy, informed consent, and the impact of new technologies on the physician-patient relationship. Additionally, ethical principles and decision-making in oncology, especially in the context of genetic predisposition to breast cancer, highlight the importance of integrating patient knowledge, preferences, and alignment between goals and treatments. As global surgery continues to grow, addressing ethical considerations becomes crucial to reduce disparities in access to surgical interventions and uphold ethical duties in patient care. Furthermore, the rise of digital applications in healthcare, such as digital surgery, requires heightened awareness of the unique ethical issues in this domain. The ethical implications of using artificial intelligence (AI) in robotic surgical training have drawn attention to the challenges of protecting patient and surgeon data, as well as the ethical boundaries that innovation may encounter. These discussions collectively emphasize the complex ethical issues associated with surgical innovation and underscore the importance of upholding ethical standards in the pursuit of progress in the field. In this study, we thoroughly analyzed previous scholarly works on ethical considerations and equipoise in the field of oncological surgery. Our main focus was on the use of AI in this specific context.
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Affiliation(s)
- Mohammad Vakili-Ojarood
- Department of Surgery, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Amirhosein Naseri
- Department of Colorectal Surgery, Imam Reza Hospital, AJA University of Medical Sciences, Tehran, Iran
| | - Ahmad Shirinzadeh-Dastgiri
- Department of Surgery, School of Medicine, Shohadaye Haft-E Tir Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Saberi
- Department of General Surgery, School of Medicine Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Masoud HaghighiKian
- Department of General Surgery, School of Medicine Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Rahmani
- Department of Plastic Surgery, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Nazila Farnoush
- Department of General Surgery, Babol University of Medical Sciences, Babol, Iran
| | - Nahid Nafissi
- Breast Surgery Department, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Naeimeh Heiranizadeh
- Breast Surgery Department, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of Surgery, School of Medicine, Shahid Sadoughi General Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Nima Narimani
- Department of Urology, Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Atarod
- Department of Urology, Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Yeganegi
- Department of Obstetrics and Gynecology, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Hossein Neamatzadeh
- Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Grynberg M, Sermondade N. Fertility preservation before cancer treatment: the dilemma of saying 'no' as the price of glory. Hum Reprod 2024:deae110. [PMID: 38794911 DOI: 10.1093/humrep/deae110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 04/28/2024] [Indexed: 05/26/2024] Open
Abstract
A great deal of work has been carried out by professionals in reproductive medicine in order to raise awareness about fertility preservation (FP) techniques, particularly for women, and to ensure that FP is included in the care of young adults treated for cancer or a pathology requiring gonadotoxic treatment. If the importance of the development of our discipline is obvious, our militancy in favour of FP and our emotional projections must not make us forget that medical thinking must be carried out not only on a case-by-case basis, weighing up the benefit-risk balance, but also without losing sight that conceiving a child with one's own gametes is not a vital issue. The cultural importance given to the genetic link with offspring may bias patients' and physicians' decisions, while other ways of achieving parenthood exist, and are often more effective. Systematic information should be provided on the existence of FP techniques, but this should not lead to their systematic implementation, nor should it obscure that early information will also allow patients to begin projecting themselves in alternative options to become parents.
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Affiliation(s)
- Michaël Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris Sud, Assistance Publique-Hôpitaux de Paris, Clamart, France
- Université Paris-Sud, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Nathalie Sermondade
- Department of Reproductive Biology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Recherche Saint Antoine, Sorbonne Universités, UPMC Université Paris 6, INSERM UMRS_938, Paris, France
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Pressman SM, Borna S, Gomez-Cabello CA, Haider SA, Haider C, Forte AJ. AI and Ethics: A Systematic Review of the Ethical Considerations of Large Language Model Use in Surgery Research. Healthcare (Basel) 2024; 12:825. [PMID: 38667587 PMCID: PMC11050155 DOI: 10.3390/healthcare12080825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION As large language models receive greater attention in medical research, the investigation of ethical considerations is warranted. This review aims to explore surgery literature to identify ethical concerns surrounding these artificial intelligence models and evaluate how autonomy, beneficence, nonmaleficence, and justice are represented within these ethical discussions to provide insights in order to guide further research and practice. METHODS A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Five electronic databases were searched in October 2023. Eligible studies included surgery-related articles that focused on large language models and contained adequate ethical discussion. Study details, including specialty and ethical concerns, were collected. RESULTS The literature search yielded 1179 articles, with 53 meeting the inclusion criteria. Plastic surgery, orthopedic surgery, and neurosurgery were the most represented surgical specialties. Autonomy was the most explicitly cited ethical principle. The most frequently discussed ethical concern was accuracy (n = 45, 84.9%), followed by bias, patient confidentiality, and responsibility. CONCLUSION The ethical implications of using large language models in surgery are complex and evolving. The integration of these models into surgery necessitates continuous ethical discourse to ensure responsible and ethical use, balancing technological advancement with human dignity and safety.
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Affiliation(s)
| | - Sahar Borna
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Syed A. Haider
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Clifton Haider
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Antonio J. Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
- Center for Digital Health, Mayo Clinic, Rochester, MN 55905, USA
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Hofmann B. Surgery beyond bodies: Soul surgery and social surgery. Front Surg 2022; 9:950172. [PMID: 36157420 PMCID: PMC9489933 DOI: 10.3389/fsurg.2022.950172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bjørn Hofmann
- Centre of Medical Ethics, The University of Oslo, Oslo, Norway.,Institute of the Health Sciences, The Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
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Allam O, Gudbranson E, Long AS, Alperovich M, Avraham T. Prophylactic Desexualizing Mastectomy for an Intellectually Disabled Woman: Protective Measure or Disregard for Autonomy? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4347. [PMID: 35620504 PMCID: PMC9126510 DOI: 10.1097/gox.0000000000004347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Abstract
Historically, sterilization of the so-called feeble-minded has been advocated in the name of eugenics. Surrogate decision-making that impacts sexuality of the intellectually disabled presents significant ethical dilemmas. We describe a 19-year-old intellectually disabled woman who presented with her legal decision-maker for surgical correction of her asymmetric chest and hypoplastic breast. The decision-maker requested a mastectomy to make the patient's breasts as inconspicuous as possible, and to reduce the risk of sexual assault and pregnancy. This case covers the ethical considerations on whether or not to prophylactically desexualize an intellectually disabled woman.
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Affiliation(s)
- Omar Allam
- Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Emily Gudbranson
- Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Aaron S Long
- Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Michael Alperovich
- Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Tomer Avraham
- Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
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