Digital health technologies: Compounding the existing ethical challenges of the 'right' not to know

INTRODUCTION

Doctors hold a prima facie duty to respect the autonomy of their patients. This manifests as the patient's 'right' not to know when patients wish to remain unaware of medical information regarding their health, and poses ethical challenges for good medical practice. This paper explores how the emergence of digital health technologies might impact upon the patient's 'right' not to know.

METHOD

The capabilities of digital health technologies are surveyed and ethical implications of their effects on the 'right' not to know are explored.

FINDINGS

Digital health technologies are increasingly collecting, processing and presenting medical data as clinically useful information, which simultaneously presents large opportunities for improved health outcomes while compounding the existing ethical challenges generated by the patient's 'right' not to know.

CONCLUSION

These digital tools should be designed to include functionality that mitigates these ethical challenges, and allows the preservation of their user's autonomy with regard to the medical information they wish to learn and not learn about.

The Extent to Which the Wish to Donate One's Organs After Death Contributes to Life-Extension Arguments in Favour of Voluntary Active Euthanasia in the Terminally Ill: An Ethical Analysis

In terminally ill individuals who would otherwise end their own lives, active voluntary euthanasia (AVE) can be seen as life-extending rather than life-shortening. Accordingly, AVE supports key pro-euthanasia arguments (appeals to autonomy and beneficence) and meets certain sanctity of life objections. This paper examines the extent to which a terminally ill individual's wish to donate organs after death contributes to those life-extension arguments. It finds that, in a terminally ill individual who wishes to avoid experiencing life he considers to be not worth living, and who also wishes to donate organs after death, AVE maximizes the likelihood that such donations will occur. The paper finds that the wish to donate organs strengthens the appeals to autonomy and beneficence, and fortifies the meeting of certain sanctity of life objections, achieved by life-extension arguments, and also generates appeals to justice that form novel life-extension arguments in favour of AVE in this context.

Conflict and natural disaster: the impacts on medical education in Ukraine and Türkiye

In addition to causing enormous and enduring harms to the health of populations, the Russian invasion of Ukraine and the recent earthquakes in southeast Türkiye have greatly damaged the institutions of medical education at work in these countries. This paper explores these harms and encourages medical educationalists in unaffected countries to reflect on the virtues of their own educational institutions.

Socially optimal dosing for scarce vaccines: Ethical analysis through the principlism framework

RATIONALE, AIMS, AND OBJECTIVES

Under conditions of vaccine scarcity, the socially optimal dosing (SOD) strategy administers a lower dose of vaccine to a larger number of people than the individually optimal dosing (IOD) strategy, which administers a higher dose of vaccine to a smaller number of people. In the context of vaccines that generate diminishing returns of effectiveness with each additional dose beyond the first, SOD therefore generates a greater total amount of vaccine-induced protection than IOD and, as such, constitutes the socially optimal strategy. While the clinical and public health arguments in favour of SOD have previously been outlined, this article conducts an ethical analysis of SOD for scarce vaccines through the ethical framework of principlism.

METHODS

SOD is examined with regard to each principle within the principlism framework-nonmaleficence, beneficence, autonomy, and justice.

RESULTS

SOD is found to satisfy each of the ethical requirements under examination. Regarding nonmaleficence, SOD induces less iatrogenic harm than IOD since the dose of vaccine administered to each individual is lower in the former than the latter. Furthermore, both the good and bad effects of SOD are foreseen while only the good effects are intended, meaning this strategy simultaneously satisfies the doctrine of double effect. Regarding autonomy, SOD makes vaccine-induced protection available to a greater number of individuals who wish to receive it, thereby respecting their capacity for self-determination and to make independent decisions. Regarding beneficence, SOD renders the good-namely the protection of health-more widely available to the individuals that constitute the population in question. Finally, SOD promotes theories of justice that treat individuals equally and is unlikely to reduce the effectiveness of other distribution policies that allocate scarce vaccines in a just manner.

CONCLUSION

In conditions of vaccine scarcity, SOD favourably satisfies the ethical framework of principlism.

Non-directed (altruistic) kidney donation: Altruism or insurance policy?

INTRODUCTION

Since non-directed (altruistic) kidney donors do not stand to benefit from the lengthening and strengthening of a relationship that they intrinsically value, their donations are considered to constitute the most altruistic variety of living kidney donation.

METHODOLOGY

This paper uses publicly-available data to assess the expected value that accrues to the donor of altruistic kidney donation.

FINDINGS

Compared to healthy non-donors, living kidney donors experience only marginally increased absolute risks of poor physical health outcomes, and no difference in important psychosocial health outcomes. Crucially, the chance of requiring a kidney donation is only marginally increased by becoming a living kidney donor. In the United Kingdom, previous living kidney donors that subsequently become in need of any organ donation (not only kidneys) themselves are considered priority patients for these donations. They consequently experience shorter waiting times for these organs and reduced exposure to the inherently harmful effects of dialysis therapy (if a kidney donation is required) compared to non-donors in need of organ donation. As such, while key data points required to compute an accurate and complete expected value calculation are unavailable, it is likely that the additional risk incurred by becoming a living kidney donor is outweighed by the benefit of being considered a priority patient for the donation of any type of organ in the event that this is needed.

CONCLUSION

Accordingly, the expected value of becoming a living kidney donor is likely to be positive, meaning the act of doing so may be considered akin to the taking out of an insurance policy. In the context of non-directed (altruistic) kidney donation, this may diminish the extent to which such a donation is considered altruistic.

ChatGPT: the threats to medical education

While it offers abundant advantages, ChatGPT threatens to significantly harm the educational attainment, and the intellectual life, of students of medicine and the subjects that compliment it. This technology poses a serious threat to the ability of such students to deliver safe and effective medical care once they graduate to clinical practice. Institutions that providemedical education must react to the existence, availability, and rapidly increasing competency of GPT models. This article suggests an intervention by which this could be, at least partially, achieved.

The impact of COVID-19 on national screening programmes in England

OBJECTIVES

This study aimed to review the trends in adult national screening programme performance in England before and during the COVID-19 pandemic and consider the future implications.

STUDY DESIGN

This was a quantitative, longitudinal study.

METHODS

Publicly available data on quarterly uptake of the five adult screening programmes in England were obtained from Public Health England. Trends from 2017 to 2021 were reviewed and discussed.

RESULTS

From 2019 to 2020 Q4, there were substantial reductions in performance in four of the five national screening programmes that were not in keeping with recent trends.

CONCLUSION

The reductions in screening performance coincide with the arrival of the COVID-19 pandemic in England and may be explained by the temporary suspension of national screening programmes, and the inability or unwillingness of invitees to partake in screening once the programmes had been restored. Because of the delay in publication of the analysed data, further COVID-19 lockdowns in recent months make it probable that the current true screening performance figures are substantially lower than those presented in this article. The impact on screening programme performance is likely to be detrimental to patient outcomes, meaning remedial action is urgently required.