Regulatory and Ethical Considerations on Artificial Intelligence for Occupational Medicine

Generative artificial intelligence and Large Language Models are reshaping labor dynamics and occupational health practices. As AI continues to evolve, there's a critical need to customize ethical considerations for its specific impacts on occupational health. Recognizing potential ethical challenges and dilemmas, stakeholders and physicians are urged to proactively adjust the practice of occupational medicine in response to shifting ethical paradigms. By advocating for a comprehensive review of the International Commission on Occupational Health ICOH code of Ethics, we can ensure responsible medical AI deployment, safeguarding the well-being of workers amidst the transformative effects of automation in healthcare.

[ICOH International Code of Ethics for Occupational Health Professionals: Historical fortune and future perspectives in Italy]

The Working Group responsible for the Italian translation of the third edition of the International Code of Ethics, appointed by the President of the International Commission on Occupational Health (ICOH), Dr. Jukka Takala, completed last April the revision work. The final text, already available on the ICOH website, has been printed and distributed by the Italian National Institute for Insurance against Accidents at Work (INAIL) at the 79th National Congress of the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII), in Rome. The curators of this third Italian edition have accomplished the delicate task of adaptation in Italian, taking into account the specificities of the practice of medicine in the Italian work environment. It involves many professionals with diverse roles and responsibilities in the public and private sectors for safety, hygiene, health and environment in relation to work. More than twenty years after the first Italian edition, we trace the evolution of the ICOH International Code of Ethics, in order to focus its birth, national and international distribution, and continuous improvement as well as its ability to direct the stakeholders towards a participatory prevention model, in a legislative framework that has seen over the past two decades a radical change in the Italian world of work.

Ethics in occupational health and safety: case studies from Gujarat

Rapid industrialisation in India is giving employment to millions of people in the formal sector, and many more in the unorganised sector. However, the absence of clear policies, poorly enforced regulations, lack of systematic reporting of occupational diseases, lamentable socioeconomic conditions of the workers and their limited access to healthcare make occupational health and safety (OHS) a critical area.

[Ethics, medical ethics, and occupational medicine: is their dialogue possible?]

Today's medicine faces some critical moral challenges, yet the medical class suffers from an increasingly evident malaise: a growing dissatisfaction with an ethical demand often perceived as a cumbersome burden of rules and prohibitions, which risk to erode the fiduciary relations with patients. Such a negative appraisal is partly due to a narrow interpretation of the meaning of ethics, a misconception whose roots are in the positivistic stance that permeates our culture, and in its almost exclusively technological bent. This radical orientation of our culture shows itself in the vanishing of the idea of an intrinsic ethical dimension of medicine and consequent eclipse of traditional medical ethics, currently all but assimilated by bioethics. Maintaining a clear distinction between medical ethics and bioethics is a fundamental condition for guaranteeing an original ethical reflection in medicine, thereby fostering a constructive dialogue between philosophical and medical ethics. In this sense, occupational medicine holds a very propitious position, at the cross-roads to some of the most important dimensions in human life and society: health, work, environment. In a milieu which is too often inclined to efface the living human being and the deepest needs of humanity, the moral commitment of medical profession to the care of the integral reality of the embodied human person is one of the most important ethical challenges facing occupational medicine and a most valuable contribution to the current ethical debate.

[Ethical problems of hygienic tests in occupational medicine]

The authors discuss bioethical problems appearing in usage of genetic tests as a technology of personalized medicine for prevention and early diagnosis of occupational diseases, and connected with question "Who has a right to know results of genetic test?". Analysis covered principles and legal norms, regulating human rights for security of health information, and causes of anxiety about workers' discrimination due to genetic test results. The authors necessitate differentiation between discrimination and reasonable restrictions favorable for workers in cases when work conditions can be a health hazard for person due to genetic predisposition.

The Bioethics of Music, the Music of Bioethics

Bioethics is rarely referenced in the scholarship of performing arts medicine (PAM). This essay argues that bioethical concerns loom far larger in the care of PAM patients than might typically be understood. This essay presents Beauchamp and Childress's four principles of bioethics, with examples pertinent to PAM, drawn from the author's research and personal experience.

[Ethical values and virtues of the Diatriba. A tribute to Bernardino Ramazzini on the tercentenary of his death (1714)]

Based on Hyppocratic values of ancient medicine, Ramazzini's way of thinking prefigures the social medicine that was to be an achievement of the Enlightenment. This contribution aims at analyzing the ethical aspects of the Diatriba. The preface already contains elements that constitute the ethical manifesto of Ramazzini. He shows compassion ("...we must admit that the workers in certain arts and crafts sometimes derive from them grave injuries"), expresses gratitude ("we owe this to the wretched condition of the workers from whose manual toil...so many benefits accrue"), demonstrates a sense of justice ("...in our own time also laws have been passed in well-ordered cities to secure good conditions for the workers; so it is only right that the art of medicine should contribute its portion for the benefit and relief of those for whom the law has shown such foresight") and demonstrates his willingness to be helpful to workers ("...I have tried to unearth in the shops of craftsmen...to suggest medical precautions for the prevention and treatment of such diseases as usually affect the workers"). The ethical contribution of Ramazzini, however, goes far beyond these noble and heartfelt words, demonstrating his intellectual and moral depth. In fact, alongside comments and suggestions, quotations and proposals, information and warnings, the Magister offers a framework for his beliefs on the attitude that the physician should adopt. Prudence and moderation inspire his recommendations when he speaks directly and indirectly to workers; irony and sarcasm pervade his thoughts when he talks to his colleagues, fairness and integrity inspire his remarks to authorities. Although current practice is based on ethical rules dating back to more recent times, the ethical vision of the Magister, that is admirable for its honesty, originality and depth, is in some respects still relevant today.

Models of occupational medicine practice: an approach to understanding moral conflict in "dual obligation" doctors

In the United Kingdom (UK), ethical guidance for doctors assumes a therapeutic setting and a normal doctor-patient relationship. However, doctors with dual obligations may not always operate on the basis of these assumptions in all aspects of their role. In this paper, the situation of UK occupational physicians is described, and a set of models to characterise their different practices is proposed. The interaction between doctor and worker in each of these models is compared with the normal doctor-patient relationship, focusing on the different levels of trust required, the possible power imbalance and the fiduciary obligations that apply. This approach highlights discrepancies between what the UK General Medical Council guidance requires and what is required of a doctor in certain roles or functions. It is suggested that using this modelling approach could also help in clarifying the sources of moral conflict for other doctors with "dual obligations" in their various roles.

Health protection of health care workers from the prospective of ethics, science and good medical practice. Opinions from stakeholders in health care settings

Fitness for work (FFW) in health care workers poses multidisciplinary challenges because of management problems scientific and ethical implications and the implementation of preventive interventions in health care settings. All the relevant stakeholders, including the General Manager, Medical Director, worker's representative, the person responsible for prevention and protection, forensic medicine expert, the person responsible for prevention and health safety at public administration level, commented on: danger to third parties; FFW formulation; human resource management; stress; professional independence; role of the person responsible for prevention and protection and of the person responsible for prevention at public administration level; professional responsibilities. Opinions are reported regarding the main problems related to the role of the Occupational Physician in FFW formulation, such as the difficult balance between autonomy and independence, limited turnover and aging of workforce, need of confidentiality and respect for professional status of the HCW prevalence of susceptibility conditions, rights and duties of stakeholders. The most significant result was the request by the Lombardy Region for more quality in risk assessment and health surveillance; to maintain uniform conduct over all the local health authorities, to allow the board in charge of examining appeals against FFW to fully cooperate with the occupational physician; due attention to the person/worker; the opportunity to convene referral boards for complex FFW management; the challenge of stress management and the need for an observatory for psychological discomforts; the importance of the ICOH Code of Ethics and avoidance of conflicts of interests; the need for individual risk assessment and risk management; the concept of sharing responsibilities and of a real multidisciplinary approach.

The differing perspectives of workers and occupational medicine physicians on the ethical, legal and social issues of genetic testing in the workplace

Genetic testing in the workplace holds the promise of improving worker health but also raises ethical, legal, and social issues. In considering such testing, it is critical to understand the perspectives of workers, who are most directly affected by it, and occupational health professionals, who are often directly involved in its implementation. Therefore, a series of focus groups of unionized workers (n=25) and occupational medicine physicians (n=23) was conducted. The results demonstrated strikingly different perspectives of workers and physicians in several key areas, including the goals and appropriateness of genetic testing, and methods to minimize its risks. In general, workers were guided by a profound mistrust of the employer, physician, and government, while physicians were guided primarily by scientific and medical concerns, and, in many cases, by the business concerns distrusted by the workers.

[The health and welfare of migrant workers as a factor in business competitiveness]

The role of the enterprises in tackling the immigration theme was significant in the last few years, though within a context of tensions, necessity of flexible approaches, and swaying feelings. However, the world of the entrepreneurs has certainly contributed to the promotion of quality of life and to the process of integration, through a few actions, such as education, the use of mediators for culture, cooperation with projects aimed at family conjunctions, regularizations, code of ethics. The acknowledgement that the immigrant workers is more prone to acquire health and safety culture is a step forward, as well as the co-existence of cultures is per se a positive factor toward behavioral changes. An industrial policy favoring work for itself, equity and merit, while creating moments of encounter, certainly facilitates good organization and integration, and delineates pathways for responsibility for immigrant workers as well. The occupational plant physician can proactively play a fundamental role for safety and health promotion for immigrant workers, considering the special relationship based on trust and the moments of encounter within the workplace, clear occasion "to treat every patient with the same care and diligence, regardless of ethnicity, religion, nationality, social condition", as the Hyppocrates oath states.

[Bioethical aspects of epidemiologic research concerning occupational risk]

The author analysed peculiarities of ethic examination for occupational risk research in industrial medicine. Findings are that occupational risk research involving humans as examinees have significant social and individual value, therefore ethically justified. The article covers the most important points of the study design, possible sources of preference conflicts in industrial medicine. The study results are important for ethic committees, when considering the studies connected with examination of occupational populations.

Occupational health practice and exposure to nanoparticles: reconciling scientific evidence, ethical aspects, and legal requirements

The paper aims at focusing the relationship between scientific evidence and ethical values' issues of occupational health practice according to the new Italian law 81/2008 stating that the occupational health physician (OHP) is required to act according to the Code of Ethics of the International Commission on Occupational Health. The code itself emphasizes that (i) the practice should be relevant, knowledge-based, sound, and appropriate to the occupational risks and (ii) the objectives and methods of health surveillance must be clearly defined. Because exposure to nanoparticles involves several uncertainties about health effects and may limit the effectiveness of workers' health surveillance, OHPs face a several ethical dilemmas, involving different stakeholders. The dilemmas arising from the practice should be dealt with according to the ethical principles of beneficence, autonomy, and justice in order to take a decision.

[Occupational health practice among law, evidence and ethics: a field study]

BACKGROUND

Quality in health care is defined as the degree to which health services increase the likelihood of desired health outcomes and are consistent with the law, the evidence and the ethical values.

MATERIALS AND METHODS

The paper aims at providing a framework in which the concept of quality is applied in the field of occupational health by analysing real-life decisions.

RESULTS

The Italian law states that the practice must be evidence-based and respectful of the code of ethics, emphasizeing that the practice should be relevant, knowledge-based, sound and appropriate. Any dilemma should be dealt according to the ethical principles of beneficience, autonomy and justice. Both the law and the code require that the practice is based on the available evidence. Results show that decisions in selected cases can be made according the above mentioned criteria. CONCLUSION; Decisions made on the basis of a process founded on scientific evidence result in effective and high-quality outcomes respectful of both law and ethics.

[Role of the occupational physician in occupational injuries prevention: across ethics, science and good practices]

Occupational injuries (OI) are a relevant issue in workplaces, being responsible for a range of individual and socio-economic consequences, with an enormous toll paid by workers, enterprises and society. Despite all these issues, OI prevention has not received significant field research attention, with studies mainly addressed to reporting data a posteriori instead of evaluating the effectiveness of prevention programs. In addition, the role of occupational physician (OP) seems to be largely underplayed. OP may and should be involved in OI prevention and control, in respect of codes of ethics, current legislation and scientific evidence. A multifaceted intervention in foundries, which showed effectiveness in reducing OI rates and improving quantitative and qualitative outcomes, gave us the opportunity to highlight OP's key role in implementing good occupational health and safety practices in workplaces.

[The ICOH International Code of Ethics for Occupational Health Professionals]

In the paper all the steps are described which are followed by ICOH to finalize the International Code of Ethics for Occupational Health Professionals (OHP). The Code is composed by a "Preface" in which is explained why the Occupational Health Professionals need a specific Code different from other Codes built up for general practitioners or other specializations, followed by an "Introduction" where the targets of Occupational Health are underlined and which professionals contribute to achieve the defined target. These two parts are followed by a more substantial description of the tasks and duties of the OHP. In the last part of the Code it is illustrated how to carry out the above mentioned duties. The principles inserted in the ICOH Code of Ethics have been worldwide accepted by the OHP and particularly in Italy where they have been included in the Legislative Decree 81/08.

The ethical challenges of the occupational physician in our time

An increasing interest in professional ethics is observed among occupational health professionals. To this may contribute the ongoing financial crisis of world economy. The moral development, induced i.a. by the Nuremberg trials in 1947 has probably contributed to a changing moral landscape. Within health professions, including many categories of occupational health professionals there is an increasing awareness of the needs to revisit points of departure in building up ethical competence to and prepare their members for tasks in the Labour market. Selected topics will be commented on in respect to their challenges to occupational professional health ethics. Widening of perspectives of Ethics in traditional Hippocratic medical ethics issues related to requirements of confidentiality and informed consent.

Illicit drugs, testing, prevention and work in France: ethical and legal issues

The use of illicit drugs in the workplace raises issues pertaining to prevention and safety and the responsibility of the various members of staff. It also brings into question the interface between work and private life. If employees are in theory responsible for their own safety and risk heavy penalties in the event of the consumption of illicit drugs in the workplace, such behaviour has to be proved. In reality, the worker can only be partially and marginally held liable, given the fact that the employer is prohibited from infringing on their rights and liberties (restrictions on the searching of their personal belongings and lockers as well as on the carrying out of breath testing and saliva testing under restrictive conditions). Employers have for their part a broader range of responsibilities and, above all, an absolute obligation to achieve specific goals in terms of health and safety resulting in the need to take action. In accordance with the International Labour Organization recommendations, European and national legislation, the employer has to implement a suitable preventive policy. However, where is the balance between prevention and repression? Very few studies have raised these issues and our aim is to precisely situate the place of drug testing in the employer's repressive arsenal in France and to try to answer the legal and ethical issues raised. Thus, for example, repression can only be acceptable when it deals with moderate and non-addicted users, or it could be tantamount to discrimination.

[Consent and confidentiality in occupational health practice: balance between legal requirements and ethical values]

INTRODUCTION

The recently introduced Italian law on the protection of workers' health states that the occupational health physician (competent physician) is required to act according to the Code of Ethics of the International Commission on Occupational Health (ICOH).

AIM

This paper aims at examining the articles of legislative decree 81/2008 dealing with informed consent and confidentiality compared with the corresponding points of the ICOH Ethics Code.

RESULTS

Analysis of the relationship between articles 25 and 39 (informed consent) and 18, 20 and 39 (confidentiality) of the decree shows that there are some points of disagreement between the legal requirements and the Code of Ethics, in particular concerning prescribed health surveillance, consent based on appropriate information (points 8, 10 and 12 of the Code) and some aspects of confidentiality (points 10, 20, 21, 22 and 23 of the Code).

CONCLUSION

Although the competent physician is required to act according to the law, the decisional process could lead to a violation of workers' autonomy.

[Sickness absence certification from the medical perspective]

Sickness absence certification is a medical task with important clinical, social, occupational and ethical implications, in addition to economic consequences for the worker, the employers and social security institutions. In 2007, IMSS affiliated workers received certifications for 65,384,690 days of absence, with cash benefits for 8.1 billion pesos. The duration of return to work depends on the efficiency of health care team as well as factors associated to the worker and the occupational environment. The correct management of sickness absence certification requires adequate disease diagnosis, regulatory knowledge and adequate communication with the patient. The purpose of control and auditing is to make sure that the certification is adequate in the indication and the optimal length, in order to warrant a responsible and sustainable management of this resource of social protection. If expenditure reduction is not possible, the objective is to avoid inefficient or irrational management. Treating physicians, with proper information, can contribute to optimize the provision of this benefit to those who need it.

[Occupational physician's decisions on the basis of legislation, ethics and scientific evidence]

BACKGROUND

In the dynamic context of occupational medicine an increasing number of occupational health problems requires a high-quality standard practice supported by decisions consistent both with ethics and legislation.

OBJECTIVES

This paper examines the relationship between legal requirements, ethical values and scientific evidence issues in occupational health practice.

RESULTS

i) Legal requirements. Italian law states that practice must be evidence-based and comply with the code of ethics for occupational health professionals of the ICOH. ii) Ethical values. The code itself emphasizes that practice should be relevant, knowledge-based, sound and appropriate to occupational risks. Furthermore, the objectives and methods of health surveillance and biological monitoring must be clearly defined and indicator must be chosen according to their relevance and predictive value. Any dilemma arising from the practice should be dealt with according to the ethical principles of health benefit, independence and justice. iii) Scientific evidence. Both the law and the code of ethics require that practice be based on available evidence.

CONCLUSIONS

Decisions made on the basis of a comprehensive process founded on scientific evidence should result in effective and high-quality outcomes that respect both the law and the rights of individuals and society.

[Occupational medicine: practice and ethical requirements of the new law on health and safety in the workplace (legislative decree 81/2008)]

Decisions in occupational health may involve ethical conflicts arising from conflicts between stakeholders' interests. Codes of ethics can provide a practical guide to solve dilemmas. The new law on health and safety in the workplace in Italy (decree 81/2008) states that occupational health practice must comply with the code of ethics of the International Commission on Occupational Health. The universally acknowledged ethical principles of beneficience/nonmaleficience, autonomy and justice, which are the basis of the Charter of fundamental rights of the European Union, inspired this code. Although the code is not a systematic textbook of occupational health ethics and does not cover all possible aspects arising from the practice, making decisions based on it will assure their effectiveness and compliance with ethical principles, besides the formal respect of the law.

[Comparative analysis of occupational health physician's duties based upon legislative decree 81/2008 art. 25 and upon the Ethics Code of the International Commission on Occupational Health]

INTRODUCTION

Ethical behaviour consists ofindividual choices inspired by knowledge and professional experience derived from the universally acknowledged ethical principles of beneficience/nonmaleficience, autonomy and justice. However, in spite of the unanimous consent on their universal importance, such principles do not usually have the strength of a law.

AIM

The recently introduced Italian law on the protection of workers' health represents a novelty because it gives the Ethics Code of the International Commission on Occupational Health legal strength. This paper aims at examining article 25 of legislative decree 81/2008 by comparing the points of the Ethics Code and the Deontology Code of the Italian medical profession.

RESULTS

The relationships between the 12 points of paragraph 1 of article 25, the 26 points ofthe Code ofEthics and the 75 articles of the Deontology Code are described with regard to the occupational health physician's duties (i) of collaboration with other occupational health professionals, (ii) of organization and execution of health surveillance, (iii) of recording, securing, transmitting of medical files on workers' health and (iv) of employee and employer information on the importance and meaning of health surveillance.

[Physicians' duty to inform about the presence of health contraindications to driving motor vehicles]

BACKGROUND

The issue concerning the duty of physicians to inform about health problems, which could be a contraindication to driving a motor vehicle, give in practice rise to many questions. Existing regulations do not apply to this issue directly, and the available literature lacks a definite stand on this matter. Information collected by the competent authorities about health problems, which may be a contraindication to driving a motor vehicle could contribute enormously to reducing or eliminating health risks among drivers and other potential road users.

MATERIAL AND METHODS

Current legislation that could in any way refer to the discussed problem were subjected to a thorough analysis and interpretation. with reference to the existing case law.

RESULTS

Despite the lack of clear regulations, physicians are obliged to provide the authorized agencies with the information about health problems, which could be a contraindication to driving a motor vehicle. The transfer of this kind of information is a legitimate exemption from doctor-patient confidentiality, therefore, physicians who transfer it do not expose themselves to bearing the responsibility. In the absence of clear standards governing the scope of information that physicians should make available for relevant authorities, the information does not need, but may include a specific medical diagnosis.

CONCLUSIONS

This article presents first comprehensive approach to the exchange of information between physicians and the body entitled to obtain information on medical unfit to drive motor vehicle, which is a helpful guide in daily practice.

Bioethical committees and data protection issues in Poland

In Poland there are only Regional Bioethical Committees. Unlike most EU countries Poland has no coordinating centre on bioethics for human research. However, the Ministry of Health and Welfare has established a Bioethics Appeals Committee.The functioning of the Bioethical Committees in Poland is regulated in detail by the Regulation of the Ministry of Health and Welfare of 1999. All regulations comply with important guidelines such as: the Helsinki Declaration, The Rules of Good Clinical Practice, EU Directives and legal regulations binding in Poland, mainly the Act of the Medical Doctor Profession and the Dentist Profession, as well as the Act of Pharmaceutical Law.In the framework of the Human Biomonitoring Programme, the application for bioethical evaluation will be submitted to the Bioethical Committee at the Nofer Institute of Occupational Medicine in Lodz.The data protection legislation in Poland according to the Act of the Protection of Personal Data of 29th of August 1997 with latest amendments fulfils EU regulations. The Act also contains detailed provisions regarding the duties of the Inspector General for Data Protection. The paper presents data on the activities of the Bureau of the Inspector General for Personal Data Protection in 2005, 2006 and 2007.

[Efficiency of the patient's signature in examinations performed by the occupational medicine doctor]

BACKGROUND

A special relationship occurring between the doctor and the patient, besides many stipulations of the ethical nature, is controlled by numerous legal regulations. In the Polish legislative system, there are no clear and unequivocal regulations that would precisely define the diagnostic-therapeutic process. Communication, namely the exchange of information between the doctor and the patient plays a particular role in this process in which the doctor bears much greater responsibility than the patient, and thus is obliged to provide the patient with the comprehensible information presented in such a way that he or she would be able to interpret it properly.

MATERIAL AND METHODS

The analysis comprised the binding legislation concerning prophylactic examination as well as drivers examination. The problem was discussed taking into account the current court judgments.

RESULTS

The doctor should pay particular attention to adjusting the quality, quantity and way of conveying the information to the patient's ability to acquire and interpret it properly. This ability is associated with the patient's personal traits. There are no algorithms for the doctor-patient communication. The occupational medicine doctors are in a better situation as legislative regulations pertaining to specificity of their health services may indicate proper communication between the doctor and the patient.

CONCLUSIONS

The importance of this communication has been notified in the legislative doctrine, where the idea of informative mistake has been formed. Such a mistake may have significant consequences especially for the occupational medicine doctors due to the specificity of performed functions. The article discusses legislative aspects concerning the exchange of information at the doctor-patient level, and presents some examples of judgments of Polish courts as well as numerous indications useful in everyday practice.

Difficult reputations and the social reality of occupational medicine

This response to Tee Guidotti's (2008) critique of Elaine Draper's 'The Company Doctor: Risk, Responsibility, and Corporate Professionalism' (2003) argues that a forthright examination of the conflicts of those working in the field of occupational medicine is essential to maintaining the health of the profession and to promoting constructive policies. Research for 'The Company Doctor' reveals how doctors walk a tightrope of professional demands on them. The author describes how corporate employment affects medicine and science and how professionals working in corporations are subject to the decisions of company managers and to economic and legal imperatives stemming from their status as corporate employees. Analyzing company doctors' role in confronting toxics and responding to liability fears in corporations, the author argues that problems of lost credibility, stigmatization, and tarnished reputation that company doctors describe largely stem from the organizational constraints, economic interests, and other aspects of the social context of their work. These social forces exert powerful pressure on the ethical framework and daily work lives of these professionals as well as on the reputation of their field. The author discusses ways in which the conflicting demands from being both a corporate employee and a physician are a social and structural problem beyond individual ethics.

Occupational medicine and the construction of "difficult reputations"

The creation of "difficult reputations" is a collective act of disparagement often undertaken to diminish the influence of the target individual or group for political reasons. This process can be observed in efforts to discredit the field of occupational medicine and the American College of Occupational and Environmental Medicine (ACOEM) by revising its history. Examples are given from Draper's 'The Company Doctor: Risk, Responsibility, and Corporate Professionalism' and LaDou, in which new sources of historical information do not support the allegations or impressions conveyed. This tendency is inimical to progress in occupational health in general and may be highly destructive to the field if not recognized and discouraged.

[Alcohol and work: ethical-deontological and medico-legal remark upon the recent set of rules]

BACKGROUND AND OBJECTIVES

The Disposition of the Permanent Conference for the relation among the State, the Regions and the Autonomous Provinces of Trento and Bolzano, published in Gazzetta Ufficiale n. 75 on the 30th March 2006 the list of high-risk occupations under the influence of alcohol, activating de facto a previous law (Legge n. 125, 3017 march 2001, "Legge quadro in materia di alcol e di problemi alcolcorrelati"). We here present some ethical-deontological and medical-juridical profiles on the contents of this law and some consideration about its application.

RESULTS AND CONCLUSIONS

Particular attention is dedicated to deontological aspects about industrial safety rules and to medico-legal aspects about occupation under the influence of alcohol, with references to complex relations among worker's discretion right, employer's right to the protection of his own interests and qualified doctor's (or someone to him comparable) right to the respect for the deontological code, with regard to benefit recipient information before the medical treatment. Authors'purpose is to evidence critical points and interpretative ambiguities of a regulation lacking in its practical applications, to provide further proposals of consideration, available to revalue a thematic rich in questions and with a significant social impact.

Ethics in sports medicine

Physicians have struggled with the medical ramifications of athletic competition since ancient Greece, where rational medicine and organized athletics originated. Historically, the relationship between sport and medicine was adversarial because of conflicts between health and sport. However, modern sports medicine has emerged with the goal of improving performance and preventing injury, and the concept of the "team physician" has become an integral part of athletic culture. With this distinction come unique ethical challenges because the customary ethical norms for most forms of clinical practice, such as confidentiality and patient autonomy, cannot be translated easily into sports medicine. The particular areas of medical ethics that present unique challenges in sports medicine are informed consent, third parties, advertising, confidentiality, drug use, and innovative technology. Unfortunately, there is no widely accepted code of sports medicine ethics that adequately addresses these issues.

The acceptability of waiting times for elective general surgery and the appropriateness of prioritising patients

Background

Problematic waiting lists in public health care threaten the equity and timeliness of care provision in several countries. This study assesses different stakeholders' views on the acceptability of waiting lists in health care, their preferences for priority care of patients, and their judgements on acceptable waiting times for surgical patients.

Methods

A questionnaire survey was conducted among 257 former patients (82 with varicose veins, 86 with inguinal hernia, and 89 with gallstones), 101 surgeons, 95 occupational physicians, and 65 GPs. Judgements on acceptable waiting times were assessed using vignettes of patients with varicose veins, inguinal hernia, and gallstones.

Results

Participants endorsed the prioritisation of patients based on clinical need, but not on ability to benefit. The groups had significantly different opinions (p < 0.05) on the use of non-clinical priority criteria and on the need for uniformity in the prioritisation process.

Acceptable waiting times ranged between 2 and 25 weeks depending on the type of disorder (p < 0.001) and the severity of physical and psychosocial problems of patients (p < 0.001). Judgements were similar between the survey groups (p = 0.3) but responses varied considerably within each group depending on the individual's attitude towards waiting lists in health care (p < 0.001).

Conclusion

The explicit prioritisation of patients seems an accepted means for reducing the overall burden from waiting lists. The disagreement about appropriate prioritisation criteria and the need for uniformity, however, raises concern about equity when implementing prioritisation in daily practice.

Single factor waiting time thresholds seem insufficient for securing timely care provision in the presence of long waiting lists as they do not account for the different consequences of waiting between patients.

Ethical considerations in testing workers for the -Glu69 marker of genetic susceptibility to chronic beryllium disease

OBJECTIVE

The most compelling real-world example of genetic testing for susceptibility to a workplace exposure involves those industries that process or fabricate beryllium. We examined ethical issues associated with testing for susceptibility to chronic beryllium disease.

METHODS

Using ethical and clinical criteria, we examined voluntary employer-sponsored testing programs in which individual results are reported directly to workers in a confidential manner.

RESULTS

Under reasonable assumptions, the longitudinal positive predictive value of the HLA-DPB1-Glu69 marker of susceptibility to beryllium disease is 12%. Interpretive challenges further limit the utility of the test and may inadvertently suggest a false sense of safety among workers. Concerns about confidential participation and pressures to be tested also must be addressed.

CONCLUSIONS

Difficulties surrounding the interpretation of the HLA-DPB1-Glu69 marker, lack of assurance regarding the protection of worker confidentiality, and the potential lowering of social barriers to the implementation of mandatory worker screening combine to make testing beryllium workers inappropriate at this time.

Protection of third parties in current legislation and preventive practice

The problem of safety and the management of risks to third parties, which may be caused by a change in the mental or physical health of an employee, is one which affects a number of different areas (infectious diseases, psychiatric illnesses, conditions of drug and alcohol abuse, etc.). Italian legislation deals with the issue of fitness for work through a variety of laws, decrees and regulations which, because many of them were issued in different historical circumstances, are not always mutually harmonized. The growing complexity of the workplace makes the role of the Occupational Physician more complex, and to this person the law assigns the exclusive task of monitoring the health of employees in the cases covered by the current regulations. In our opinion, the Occupational Physician, to the best of his knowledge and conscience, having taken into consideration all the aforementioned factors, must take each case on its merits, in the most responsible manner possible, weighing up the complexity and delicacy of the aspects discussed earlier, and decide to deliver a verdict of fitness and/or to break or not to break the obligation of confidentiality, tending, in our view, to favour the need to safeguard collective health, or that of third parties, should there be a conflict of interest.

Is globalisation outpacing ethics and social responsibility in occupational health?

INTRODUCTION

The definition of globalisation is varied. However, one certainty is that in a globalised world the borders are porous in many aspects; people movement, goods exchange, knowledge sharing and redistribution of labour. The concept of globalisation, its impact on society, and its direction leads to a two-sided argument. Could this be the effect of globalisation on ethics and social responsibility, as it is perceived? This paper endeavours to further our understanding of the dynamic relationship of globalisation, ethics and social responsibility in occupational health.

METHOD

The multidisciplinary activity approach to occupational health was used. The globalisation, ethical and social responsibility relationship of the activities in occupational health was analysed using a schematic map of the direct and indirect influences.

RESULTS

The analysis revealed areas that can be clustered to address the interaction between driving forces in occupational health ethics and social responsibility for a healthy workforce.

DISCUSSION

Each cluster is discussed highlighting areas of concern. In the discussion proposals are made on how we can modify the way we think in order to avoid repeating mistakes. Suggestion is made of using an innovative method borrowed from other disciplines and adopted for use in occupational health. A partnership approach is proposed and explored on how it will be applied in situations of unequal balance of power.

Framework for considering genetics in the workplace

There has been aproliferation of genetic information in the last 25 years resulting in a spectrum of existing and potential uses in the workplace. These uses of have different issues and implications which may be more clearly considered in a framework that identifies three distinct uses (research, practice, and regulation/litigation) for inherited genetic factors and acquired genetic effects. Inherited genetic factors pertain to the characteristics of the genes, and acquired genetic effects to the impact on genes and chromosomes of environmental and constitutional factors. Critical in assessing the issues involving genetics in the workplace is attention on the rights of workers, validity and clinical utility of genetic information, cost pressures on employers, and societal implications. Genetic information may provide mechanistic and diagnostic insight into occupational diseases and allow for targeting high-risk groups, improving risk assessments, and providing early indicators of risk. However, these benefits are more likely to be realized and problems avoided when the different uses are considered in a framework that distinguishes them by type and content. The application of such a framework makes it easier to assess whether there is a sufficient evidence base and worker safeguards in place for any particular use of genetic information.

The threat to scientific integrity in environmental and occupational medicine

Over the last century, environmental and occupational medicine has played a significant role in the protection and improvement of public health. However, scientific integrity in this field has been increasingly threatened by pressure from some industries and governments. For example, it has been reported that the tobacco industry manipulated eminent scientists to legitimise their industrial positions, irresponsibly distorted risk and deliberately subverted scientific processes, and influenced many organisations in receipt of tobacco funding. Many environmental whistleblowers were sued and encountered numerous personal attacks. In some countries, scientific findings have been suppressed and distorted, and scientific advisory committees manipulated for political purposes by government agencies. How to respond to these threats is an important challenge for environmental and occupational medicine professionals and their societies. The authors recommend that professional organisations adopt a code of ethics that requires openness from public health professionals; that they not undertake research or use data where they do not have freedom to publish their results if these data have public health implications; that they disclose all possible conflicts; that the veracity of their research results should not be compromised; and that their research independence be protected through professional and legal support. The authors furthermore recommend that research funding for public health not be directly from the industry to the researcher. An independent, intermediate funding scheme should be established to ensure that there is no pressure to analyse data and publish results in bad faith. Such a funding system should also provide equal competition for funds and selection of the best proposals according to standard scientific criteria.

[Occupational selection in industrial medicine]

The article deals with contemporary state of occupational selection (educational, social and psychologic, medical) in Russia, its importance in industrial medicine and connection with ethic problems. The author defined topical directions in research of occupational selection and occupational fitness examination.