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Terranova C, Cestonaro C, Fava L, Cinquetti A. AI and professional liability assessment in healthcare. A revolution in legal medicine? Front Med (Lausanne) 2024; 10:1337335. [PMID: 38259835 PMCID: PMC10800912 DOI: 10.3389/fmed.2023.1337335] [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: 11/12/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
The adoption of advanced artificial intelligence (AI) systems in healthcare is transforming the healthcare-delivery landscape. Artificial intelligence may enhance patient safety and improve healthcare outcomes, but it presents notable ethical and legal dilemmas. Moreover, as AI streamlines the analysis of the multitude of factors relevant to malpractice claims, including informed consent, adherence to standards of care, and causation, the evaluation of professional liability might also benefit from its use. Beginning with an analysis of the basic steps in assessing professional liability, this article examines the potential new medical-legal issues that an expert witness may encounter when analyzing malpractice cases and the potential integration of AI in this context. These changes related to the use of integrated AI, will necessitate efforts on the part of judges, experts, and clinicians, and may require new legislative regulations. A new expert witness will be likely necessary in the evaluation of professional liability cases. On the one hand, artificial intelligence will support the expert witness; however, on the other hand, it will introduce specific elements into the activities of healthcare workers. These elements will necessitate an expert witness with a specialized cultural background. Examining the steps of professional liability assessment indicates that the likely path for AI in legal medicine involves its role as a collaborative and integrated tool. The combination of AI with human judgment in these assessments can enhance comprehensiveness and fairness. However, it is imperative to adopt a cautious and balanced approach to prevent complete automation in this field.
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Affiliation(s)
- Claudio Terranova
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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2
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Hachem LD, Bernstein M. Ethical issues in geriatric cranial neurosurgery. Neurosurg Focus 2020; 49:E3. [PMID: 33002872 DOI: 10.3171/2020.7.focus20447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/17/2020] [Indexed: 11/06/2022]
Abstract
The global demographic shift to an older population has led to the emergence of the new field of geriatric neurosurgery. Beyond the complexities of disease states and multimorbidity, advanced age brings with it intricate ethical issues pertaining to both the practice and provision of medical and surgical care. In this paper, the authors describe the central ethical themes seen across the spectrum of common neurosurgical conditions in the elderly and highlight the use of foundational ethical principles to help guide treatment decision-making.
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Affiliation(s)
- Laureen D Hachem
- 1Division of Neurosurgery, Department of Surgery, University of Toronto; and
| | - Mark Bernstein
- 1Division of Neurosurgery, Department of Surgery, University of Toronto; and.,2Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Zietlow KE, Oyeyemi DM, Cook SE, Hardy M, McDonald SR, Lagoo-Deenadayalan S, Heflin MT, Whitson HE. RESEARCHCognition and Capacity to Consent for Elective Surgery. J Am Geriatr Soc 2020; 68:2694-2696. [PMID: 33460037 DOI: 10.1111/jgs.16786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/18/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Kahli E Zietlow
- Division of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Deborah M Oyeyemi
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sarah E Cook
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Margaret Hardy
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Shelley R McDonald
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Mitchell T Heflin
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA.,Durham Veterans Affairs Geriatrics Research Education and Clinical Center, Durham, North Carolina, USA
| | - Heather E Whitson
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA.,Durham Veterans Affairs Geriatrics Research Education and Clinical Center, Durham, North Carolina, USA
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John S, Rowley J, Bartlett K. Assessing patients decision‐making capacity in the hospital setting: A literature review. Aust J Rural Health 2020; 28:141-148. [DOI: 10.1111/ajr.12592] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 10/20/2019] [Accepted: 10/21/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Shibu John
- Coffs Harbour Health Campus Mid North Coast Local Health District Coffs Harbour NSW Australia
| | - Joanne Rowley
- Coffs Harbour Health Campus Coffs Harbour NSW Australia
| | - Kerry Bartlett
- Coffs Harbour Health Campus Mid North Coast Local Health District Coffs Harbour NSW Australia
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Mandarelli G, Parmigiani G, Carabellese F, Codella S, Roma P, Brancadoro D, Ferretti A, Alessandro L, Pinto G, Ferracuti S. Decisional capacity to consent to treatment and anaesthesia in patients over the age of 60 undergoing major orthopaedic surgery. MEDICINE, SCIENCE, AND THE LAW 2019; 59:247-254. [PMID: 31366276 DOI: 10.1177/0025802419865854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Despite growing attention to the ability of patients to provide informed consent to treatment in different medical settings, few studies have dealt with the issue of informed consent to major orthopaedic surgery in those over the age of 60. This population is at risk of impaired decision-making capacity (DMC) because older age is often associated with a decline in cognitive function, and they often present with anxiety and depressive symptoms, which could also affect their capacity to consent to treatment. Consent to major orthopaedic surgery requires the patient to understand, retain and reason about complex procedures. This study was undertaken to extend the literature on decisional capacity to consent to surgery and anaesthesia of patients over the age of 60 undergoing major orthopaedic surgery. Recruited patients ( N=83) were evaluated using the Aid to Capacity Evaluation, the Beck Depression Inventory, the State–Trait Anxiety Inventory Y, the Mini-Mental State Examination and a visual analogue scale for measuring pain symptomatology. Impairment of medical DMC was common in the overall sample, with about 50% of the recruited patients showing a doubtful ability, or overt inability, to provide informed consent. Poor cognitive functioning was associated with reduced medical DMC, although no association was found between decisional capacity and depressive, anxiety and pain symptoms. These findings underline the need of an in-depth assessment of capacity in older patients undergoing major orthopaedic surgery.
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Affiliation(s)
| | | | - Felice Carabellese
- Section of Criminology and Forensic Psychiatry, Department of Interdisciplinary Medicine, University of Bari, Italy
| | - Silvia Codella
- Anesthesiology Department, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy
| | - Paolo Roma
- Department of Human Neurosciences, 'Sapienza' University of Rome, Italy
| | - Domitilla Brancadoro
- Anesthesiology Department, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy
| | - Andrea Ferretti
- Orthopaedic Unit, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy
| | | | - Giovanni Pinto
- Anesthesiology Department, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy
| | - Stefano Ferracuti
- Department of Human Neurosciences, 'Sapienza' University of Rome, Italy
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Bolger JC, Zaidi A, Fuentes-Bonachera A, Kelly ME, Abbas A, Rogers A, McCormack T, Waldron B, Murray KP. Emergency surgery in octogenarians: Outcomes and factors affecting mortality in the general hospital setting. Geriatr Gerontol Int 2018; 18:1211-1214. [PMID: 29897164 DOI: 10.1111/ggi.13456] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 03/28/2018] [Accepted: 04/16/2018] [Indexed: 11/26/2022]
Abstract
AIM The Western world has an expanding older population, who are living longer with increasing numbers of comorbidities. In addition, expectations of patients and relatives are increasing. As a general hospital operating in a rural setting, our University Hospital Kerry, Tralee, Ireland, deals with a significant number of emergency presentations to the acute surgical service. The aim of the present study was to examine outcomes for patients in the extremes of age who present requiring emergency surgical procedures. METHODS A retrospective review of theater and admission logs was carried out to identify all emergency surgeries from January 2008 to December 2015. All patients aged >80 years at the time of surgery were identified. Details of surgery were recorded, in addition to biochemical and hematological data, use of intensive care unit, length of stay and mortality. RESULTS In total, 128 octogenarians underwent an emergency surgery. The average patient age was 84.3 years (range 80-94 years). The commonest procedures were laparotomy (65%, n = 84), repair of strangulated/incarcerated hernia (18%, n = 23) and laparoscopic procedures (16%, n = 21). The 30-day all-cause mortality was 22.6%. On multivariate analysis, American Society of Anesthesia status and intensive care unit utilization predicted mortality (P = 0.04 and 0.05, respectively). A total of 82 patients required intensive care unit admission, with an average length of stay of 4.8 days, using 484 bed days in total. CONCLUSIONS Emergency surgery in octogenarians is a significant part of the workload of general surgeons. Poor baseline status is associated with an increased risk of mortality. Emergency surgery in older adults only utilizes a fraction of available intensive care unit resources. Geriatr Gerontol Int 2018; 18: 1211-1214.
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Affiliation(s)
- Jarlath C Bolger
- Department of Surgery, University Hospital Kerry, Tralee, Ireland
| | - Akif Zaidi
- Department of Surgery, University Hospital Kerry, Tralee, Ireland
| | | | - Michael E Kelly
- Department of Surgery, University Hospital Kerry, Tralee, Ireland
| | - Aqeel Abbas
- Department of Surgery, University Hospital Kerry, Tralee, Ireland
| | - Ailin Rogers
- Department of Surgery, University Hospital Kerry, Tralee, Ireland
| | - Tom McCormack
- Department of Surgery, University Hospital Kerry, Tralee, Ireland
| | - Brian Waldron
- Department of Surgery, University Hospital Kerry, Tralee, Ireland
| | - Kevin P Murray
- Department of Surgery, University Hospital Kerry, Tralee, Ireland
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Mozer AB, Speicher JE, Anciano CJ. Thoracic Surgery Considerations in the Mentally Ill or Handicapped Patient. Thorac Surg Clin 2017; 28:59-68. [PMID: 29150038 DOI: 10.1016/j.thorsurg.2017.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Increasing prevalence of mentally ill and handicapped populations requiring surgical thoracic interventions has brought to light their worse associated morbidity and mortality. Baseline functional status, caretaker environment, and mental limitations in day to day life have an impact in the short and long term from these interventions. Aggressive perioperative care, multispecialty approach, technical aspects, palliative procedures, and ethical considerations all play a part in improving outcomes. In this article real cases are presented illustrating points of care and situations for discussion.
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Affiliation(s)
- Anthony B Mozer
- General Surgery Resident, Department of Surgery, East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA
| | - James E Speicher
- Thoracic and Foregut Surgery, Department of Cardiovascular Sciences, East Carolina University, 115 Heart Drive, Greenville, NC 27834, USA
| | - Carlos J Anciano
- Thoracic and Foregut Surgery, Department of Cardiovascular Sciences, East Carolina University, 115 Heart Drive, Greenville, NC 27834, USA; Minimally Invasive Thoracic Surgery, Department of Cardiovascular Sciences, East Carolina University, 115 Heart Drive, Greenville, NC 27834, USA.
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Mukherjee A, Livinski AA, Millum J, Chamut S, Boroumand S, Iafolla TJ, Adesanya MR, Dye BA. Informed consent in dental care and research for the older adult population: A systematic review. J Am Dent Assoc 2017; 148:211-220. [PMID: 28065430 DOI: 10.1016/j.adaj.2016.11.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/19/2016] [Accepted: 11/28/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ethics in health care and research is based on the fundamental principle of informed consent. However, informed consent in geriatric dentistry is not well documented. Poor health, cognitive decline, and the passive nature of many geriatric patients complicate this issue. METHODS The authors completed this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors searched the PubMed (MEDLINE), Web of Science, PsycINFO, and Cochrane Library databases. The authors included studies if they involved participants 65 years or older and discussed topics related to informed consent beyond obtaining consent for health care. The authors explored informed consent issues in dentistry and other biomedical care and research. RESULTS The authors included 80 full-text articles on the basis of the inclusion criteria. Of these studies, 33 were conducted in the United States, 29 addressed consent issues in patients with cognitive impairment, 29 were conducted in patients with medical conditions, and only 3 involved consent related to dental care or research. CONCLUSIONS Informed consent is a neglected topic in geriatric dental care and research. Substantial knowledge gaps exist between the understanding and implementation of consent procedures. Additional research in this area could help address contemporary consent issues typically encountered by dental practitioners and to increase active participation from the geriatric population in dental care and research. PRACTICAL IMPLICATIONS This review is the first attempt, to the authors' knowledge, to identify informed consent issues comprehensively in geriatric dentistry. There is limited information in the informed consent literature covering key concepts applicable to geriatric dentistry. Addressing these gaps could assist dental health care professionals in managing complex ethical issues associated with geriatric dental patients.
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Søreide K, Wijnhoven BPL. Surgery for an ageing population. Br J Surg 2016; 103:e7-9. [DOI: 10.1002/bjs.10071] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 06/11/2015] [Accepted: 10/27/2015] [Indexed: 01/18/2023]
Abstract
The greatest surgical challenge
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Affiliation(s)
- K Søreide
- Department of Gastrointestinal Surgery, PO Box 8100, Stavanger University Hospital, N-4068 Stavanger, Norway (e-mail: )
| | - B P L Wijnhoven
- Department of Surgery, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
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A case-control study investigating factors of preoperative delay in emergency laparotomy. Int J Surg 2015; 22:131-5. [PMID: 26318501 DOI: 10.1016/j.ijsu.2015.08.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/03/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Emergency laparotomy (EL) is a procedure that puts a strain on healthcare resources and is associated with a significant morbidity and mortality. Despite these implications little improvement in the outcome of patients undergoing this procedure has been made in the UK over the last few decades. A delay in transferring patients to theatre has been shown to negatively affect outcome of EL. A prospective case-control study was carried out to evaluate which preoperative factors may contribute towards a delay in theatre transfer. METHODS The time between decision to operate and anaesthetic start time was recorded for all patients undergoing EL between April and September 2013 at Gloucestershire Royal Infirmary. Patient selection criteria were based on the National Emergency Laparotomy Audit guidelines. Patients were divided into two groups depending on whether the transfer to theatre was delayed or not. Binary logistic regression analysis was performed on perioperative factors to determine independent predictors of delay. RESULTS A total of 84 EL were included for analyses with 31 classified as delayed. In the delayed group time for theatre transfer was increased at 6.9 vs. 2.3 h (p < 0.005) respectively. Unavailability of emergency theatres due to other cases taking priority was the most frequent cause for delay (n = 24). On binary logistic regression analysis, indication for laparotomy (OR 4.96, CI 1.4-17.6, p < 0.05), patient age (OR 1.04, CI 1.00-1.07, p < 0.04) and presence of a consultant surgeon (OR 0.16, CI 0.03-0.79, p < 0.03) were found to be independent predictors of delay in EL. CONCLUSION In this study, factors that were associated with a delay in commencing EL were operative indication and patient age whereas the presence of a consultant surgeon made a delay less likely. These findings may highlight points of interest for researchers analysing and auditing the provision of EL in the UK.
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