While the continuing discussion on vaccine mandates is most welcome, one thing that struck me as needing more attention being dedicate to is how do we cater to workers vaccine preferences and what are the corresponding duties of employers to provide such vaccines. As I have argued elsewhere (https://www.tandfonline.com/doi/full/10.1080/20502877.2021.1959789) there is a part of the population that is not in principle opposed to vaccination in general, but might have objections to specific vaccines. Whether or not we accept vaccine mandates as ethical perhaps we need to discuss what employers should be doing to promote vaccination. While some of the authors of this paper have argued elsewhere (https://academic.oup.com/phe/article/14/3/242/6324053?login=true) that the only thing that matters is that the vaccine given is effective, particularly when a vaccine mandate is being put in place there seems to be an obligation to reduce the burden of that mandate on the workers. What I would wish to see is more debate on the obligations of employers (and the wider health service) to provide vaccines that staff deem personally acceptable. Even if there are no mandates, this might increase vaccination uptake. To return to the article at hand, it would be good if we had alternatives to influenza vaccines that were not made in he...
While the continuing discussion on vaccine mandates is most welcome, one thing that struck me as needing more attention being dedicate to is how do we cater to workers vaccine preferences and what are the corresponding duties of employers to provide such vaccines. As I have argued elsewhere (https://www.tandfonline.com/doi/full/10.1080/20502877.2021.1959789) there is a part of the population that is not in principle opposed to vaccination in general, but might have objections to specific vaccines. Whether or not we accept vaccine mandates as ethical perhaps we need to discuss what employers should be doing to promote vaccination. While some of the authors of this paper have argued elsewhere (https://academic.oup.com/phe/article/14/3/242/6324053?login=true) that the only thing that matters is that the vaccine given is effective, particularly when a vaccine mandate is being put in place there seems to be an obligation to reduce the burden of that mandate on the workers. What I would wish to see is more debate on the obligations of employers (and the wider health service) to provide vaccines that staff deem personally acceptable. Even if there are no mandates, this might increase vaccination uptake. To return to the article at hand, it would be good if we had alternatives to influenza vaccines that were not made in hen's eggs so as to cater to vegan staff and it would be good to have vaccines not developed with HEK293 (or other similar cell lines) for whatever disease will come next to cater for staff who believe the use of such cell lines to be morally dubious.
The article on the ethics of generative AI should be read in tandem with the recommendations on “Chatbots, ChatGPT, and Scholarly Manuscripts” issued by the World Association of Medical Editors (https://wame.org/page3.php?id=106).
While acknowledging the positive contribution chatbots can make to the development of texts on ethics and other academic fields, I would cite a few key negatives:
1) Chatbots like ChatGPT appear to be biased in favour of what they are proposing. This bias is evidenced in the references they provide, which uniformly support the point of view expressed by the chatbot. References opposing the point of view are not provided. This is probably inherent in the instructions in the algorithms applied by a chatbot, which must be along the lines of “provide an argument and supporting evidence”. No doubt this tendency to bias can be cured in future editions of the chatbot.
2) Chatbots have been found to invent references where there are none. This is puzzling. Why did the programmers allow that? This should be an easy fix.
3) Chatbots are only as up to date in their references as their programming (their “training”). For ChatGPT, the cut-off date is sometime in mid-2021 – anything that appeared later than their training material that is simply not in their universe. In fast-moving fields, thus, there is a strong risk that what is asserted in the chatbot’s output has been superseded by...
The article on the ethics of generative AI should be read in tandem with the recommendations on “Chatbots, ChatGPT, and Scholarly Manuscripts” issued by the World Association of Medical Editors (https://wame.org/page3.php?id=106).
While acknowledging the positive contribution chatbots can make to the development of texts on ethics and other academic fields, I would cite a few key negatives:
1) Chatbots like ChatGPT appear to be biased in favour of what they are proposing. This bias is evidenced in the references they provide, which uniformly support the point of view expressed by the chatbot. References opposing the point of view are not provided. This is probably inherent in the instructions in the algorithms applied by a chatbot, which must be along the lines of “provide an argument and supporting evidence”. No doubt this tendency to bias can be cured in future editions of the chatbot.
2) Chatbots have been found to invent references where there are none. This is puzzling. Why did the programmers allow that? This should be an easy fix.
3) Chatbots are only as up to date in their references as their programming (their “training”). For ChatGPT, the cut-off date is sometime in mid-2021 – anything that appeared later than their training material that is simply not in their universe. In fast-moving fields, thus, there is a strong risk that what is asserted in the chatbot’s output has been superseded by later evidence or discussion. But perhaps ethics is not particularly fast-moving.
4) Chatbots are plagiarists: everything they say has been said before, every idea they report has been thought already. Of course, they can be creative by mistake, along the probability lines of monkeys typing out Shakespeare. While it can be argued that this is true of many humans as well, it will take humans to recognize when a chatbot has done something original, and when you should just feed it a banana.
Murdoch et al. give an excellent account of the law in Canada relating to consent to research in children when they mature. Laws must be based on moral principles, which always have a beneficial intention and are everywhere similar for both treatment and research, for both adults and children and for the publication of identifying data.
A competent adult can accept,reject or discontinue treatment. But a doctor must only provide treatment, which is beneficial physically or emotionally. In a publicly funded service she may need to balance the benefit to the individual against the needs of the community. The .patient is always free to consult a different doctor. A patient's personal details must not be revealed without express permission.
An adult can also accept, reject or stop participation in research intended to benefit others. Again he must not be identified without permission. He cannot require the eradication of data obtained because that would harm others.
A guardian, on behalf of a child, consents to treatment or research with the same rights and restrictions. As far as possible the informed consent of the child should be obtained.. When the child reaches maturity he must be fully informed and assumes responsibility for his own care. He can discontinue beneficial treatment but cannot demand that the doctor reverses it, because that would require her to cause harm. He can change doctors. He can stop participation in research but he cannot hav...
Murdoch et al. give an excellent account of the law in Canada relating to consent to research in children when they mature. Laws must be based on moral principles, which always have a beneficial intention and are everywhere similar for both treatment and research, for both adults and children and for the publication of identifying data.
A competent adult can accept,reject or discontinue treatment. But a doctor must only provide treatment, which is beneficial physically or emotionally. In a publicly funded service she may need to balance the benefit to the individual against the needs of the community. The .patient is always free to consult a different doctor. A patient's personal details must not be revealed without express permission.
An adult can also accept, reject or stop participation in research intended to benefit others. Again he must not be identified without permission. He cannot require the eradication of data obtained because that would harm others.
A guardian, on behalf of a child, consents to treatment or research with the same rights and restrictions. As far as possible the informed consent of the child should be obtained.. When the child reaches maturity he must be fully informed and assumes responsibility for his own care. He can discontinue beneficial treatment but cannot demand that the doctor reverses it, because that would require her to cause harm. He can change doctors. He can stop participation in research but he cannot have existing data eradicated, because that would harm others..
Jurisdictions differ about the age at which children should assume adult responsibility. They may depute to ethics committees decisions about research and to the Courts other problems, such as the competence of a particular individual to make a specific decision. The Courts may adjudicate when treatment is demanded, which doctors see as harmful, unhelpful or an unfair use of resources.
Dahlquist and Kugelberg (2021) correctly notice as the many non-pharmaceutical interventions (NPIs) which have been introduced to stop or slow down the COVID-19 pandemic through coercion are not publicly justified through a scientific consensus on the factual propositions that are used to support the policies, and as such, they would be illegitimate. It has been an unfortunate circumstance of this pandemic, that not only the NPIs but also the therapeutic approaches have been the subject of media misinterpretation, at the expense of a correct debate in between the scientific community, with scientists expressing opinions not welcomed by the media routinely abused for doing their work. Examples of policies lacking every scientific support, but still approved by the media, are everywhere. To find a working solution to the pandemic, definitively we do need free science “on the top”, rather than “on the tap” or even “on a leash”, limiting the interference by governments and corporations directly and through the media serving their interests. Misinformation by media is what has made the response to COVID-19 less effective than what could have been listening to the majority of the scientists. The response to COVID-19 of many countries has been dictated so far by the media, or better by those who control the media, rather than the scientists. To find a solution, scientists should be free of this conditioning.
REFERENCES
1. Dahlquist M, Kugelberg HD. (2021). Public j...
Dahlquist and Kugelberg (2021) correctly notice as the many non-pharmaceutical interventions (NPIs) which have been introduced to stop or slow down the COVID-19 pandemic through coercion are not publicly justified through a scientific consensus on the factual propositions that are used to support the policies, and as such, they would be illegitimate. It has been an unfortunate circumstance of this pandemic, that not only the NPIs but also the therapeutic approaches have been the subject of media misinterpretation, at the expense of a correct debate in between the scientific community, with scientists expressing opinions not welcomed by the media routinely abused for doing their work. Examples of policies lacking every scientific support, but still approved by the media, are everywhere. To find a working solution to the pandemic, definitively we do need free science “on the top”, rather than “on the tap” or even “on a leash”, limiting the interference by governments and corporations directly and through the media serving their interests. Misinformation by media is what has made the response to COVID-19 less effective than what could have been listening to the majority of the scientists. The response to COVID-19 of many countries has been dictated so far by the media, or better by those who control the media, rather than the scientists. To find a solution, scientists should be free of this conditioning.
REFERENCES
1. Dahlquist M, Kugelberg HD. (2021). Public justification and expert disagreement over non-pharmaceutical interventions for the COVID-19 pandemic. J. Med. Ethics, Published Online First: 12 October 2021. doi: 10.1136/medethics-2021-107671
We should be careful of the way we talk. Human society can be described as a long conversation about what matters. In this conversation, the language we use to describe our healthcare and social care practices not only reveals our attitudes and virtues, it shapes them. In order to promote self-worth and respect for individuals who use professional services there must be an understanding of how the language used in a profession influences professionals and the individuals with whom professionals work. The term ‘ service user’ or ‘client’ may be one reluctantly used by many healthcare professionals. The language of ‘service user’ or ‘client’ is acceptable at the political level. However it may be potentially detrimental to those it labels in healthcare and may also be damaging to the underlying ethical practices of many healthcare professions.
Language is a means of communication in healthcare, it can indicate attitudes and it is an integral part of social and professional life and behaviour. The particular meaning we attach to words reveal the underlying values and attitudes we hold about the people or things to which we are referring. Language exerts hidden power as our words may be simple descriptions or they may change lives. This power may not be detected by the vulnerable/underserved in society and by those with less power . Power and status in healthcare and social care interactions determine how each party behaves e.g. The term ‘service user’ or ‘cl...
We should be careful of the way we talk. Human society can be described as a long conversation about what matters. In this conversation, the language we use to describe our healthcare and social care practices not only reveals our attitudes and virtues, it shapes them. In order to promote self-worth and respect for individuals who use professional services there must be an understanding of how the language used in a profession influences professionals and the individuals with whom professionals work. The term ‘ service user’ or ‘client’ may be one reluctantly used by many healthcare professionals. The language of ‘service user’ or ‘client’ is acceptable at the political level. However it may be potentially detrimental to those it labels in healthcare and may also be damaging to the underlying ethical practices of many healthcare professions.
Language is a means of communication in healthcare, it can indicate attitudes and it is an integral part of social and professional life and behaviour. The particular meaning we attach to words reveal the underlying values and attitudes we hold about the people or things to which we are referring. Language exerts hidden power as our words may be simple descriptions or they may change lives. This power may not be detected by the vulnerable/underserved in society and by those with less power . Power and status in healthcare and social care interactions determine how each party behaves e.g. The term ‘service user’ or ‘client’ may be described as ‘depersonalising’.
Care of people who are unable to care for themselves and compassion towards people who are vulnerable has been a basic tenet of medicine since ancient times . We need to be aware of our own language, values and attitudes to enable us to create a collaborative relationship with people that is person centred, respectful, non-judgmental, encourages personal responsibility and takes into account ethical and professional considerations.
We need to be particularly careful of language in the care of the dying. Euphemisms are place-holders for important concepts. They may disguise a practice which one might abhor if it were given another name.
Those who use the phrase ‘dying with dignity’, by avoiding the negative connotations of suicide and euthanasia /intentional killing , expect that it will be perceived as less alarming than euthanasia and assisted suicide, and that there is a problem with people being treated with ‘dignity. The use of the term ‘dying with dignity’ creates a halo of benignity and generates greater support for and muted opposition to any proposed law. Similarly, the euphemisms ‘physician assisted suicide’ , ‘medical assistance in dying’ or ‘assistance with dying’ are meant to be reassuring.
The use of ‘detoxifying language’ can lead to a situation where physicians, pharmacists, nurses and others can turn from healers/those who maintain or improve health, to those who intentionally take human life. In Nazi Germany during World War II, euphemisms were used to desensitize physicians, pharmacists, nurses and society to the horrors of a program of intentional killing /euthanasia .
The consistent application of euphemisms for medicalized killing significantly weakens arguments against assisted intentional killing of a human being.
Reference:
Mitchell CB. Of Euphemisms and Euthanasia: The Language Games of the Nazi Doctors and Some Implications for the Modern Euthanasia Movement. OMEGA - Journal of Death and Dying. 2000;40(1):255-265. doi:10.2190/K68E-
Pharmacists are essential healthcare professionals and are critical members of the whole healthcare team. Pharmacists work in varied settings such as community and hospital, hospice/palliative care industry and regulatory affairs. Regardless of where pharmacists work, and whether their roles provide direct or indirect patient care, all pharmacists contribute to safe and quality health care. Pharmacists may hold roles in many specialty areas of a healthcare system including the emergency department, infectious disease, oncology, pain management and anticoagulation management (1).
Although effective, medicines are often challenging to manage and use appropriately. This is due to a number of factors, such as increasingly complex pharmacotherapies, polypharmacy, ageing populations with multiple diseases, and limited, or inadequately coordinated resources in healthcare systems. While performing a medication review, many pharmacists work together with GPs/consultants to optimise the patient's pharmacotherapy and reduce the potential risks of polypharmacy. An example of an expected health related goal suggested by a patient during a medication review could be a desire to reduce pain. During the medication review, the patient’s pain medication could be optimised by a pharmacist to achieve this goal (1).
Pharmacists are pivotal in the lethal drug medication use process. Assisted suicide(i.e. physician assisted) will not take place without the use of medicat...
Pharmacists are essential healthcare professionals and are critical members of the whole healthcare team. Pharmacists work in varied settings such as community and hospital, hospice/palliative care industry and regulatory affairs. Regardless of where pharmacists work, and whether their roles provide direct or indirect patient care, all pharmacists contribute to safe and quality health care. Pharmacists may hold roles in many specialty areas of a healthcare system including the emergency department, infectious disease, oncology, pain management and anticoagulation management (1).
Although effective, medicines are often challenging to manage and use appropriately. This is due to a number of factors, such as increasingly complex pharmacotherapies, polypharmacy, ageing populations with multiple diseases, and limited, or inadequately coordinated resources in healthcare systems. While performing a medication review, many pharmacists work together with GPs/consultants to optimise the patient's pharmacotherapy and reduce the potential risks of polypharmacy. An example of an expected health related goal suggested by a patient during a medication review could be a desire to reduce pain. During the medication review, the patient’s pain medication could be optimised by a pharmacist to achieve this goal (1).
Pharmacists are pivotal in the lethal drug medication use process. Assisted suicide(i.e. physician assisted) will not take place without the use of medications dispensed by pharmacists.
Prescribing > Dispensing > Administration
The two quotes below ( (a.) and (b.)) taken from Professor Urban Wiesin’s very stimulating article (2) will be of interest to pharmacists worldwide.
a. “Nobody can be forced to assist with suicide, this is also the case for physicians”.
b. “Doctors ought to have a role in assisted suicide, simply on considering the facts. No other profession can ………. recognise inadequate pain therapy better. No other profession can provide more adequate information about the options for medical treatment of an illness”.
The pharmacy profession worldwide is regularly excluded from conscientious objection provisions in legislation. This exclusion denies the dignity of pharmacists as human beings and their central role in medication use.
The following questions must be asked
• Are pharmacists less dignified/ less free than doctors?
• Are pharmacists lacking in a conscience/ are they robots?
• Is the complex role of pharmacists in assisted suicide not understood / purposely ignored / not visible?
• Are conscientious pharmacists valued by society / health systems/ other professions?
Pharmacists will be at the vortex of some of society’s most controversial moral dilemmas. Pharmacist are highly trained professionals with moral, ethical and legal accountability. The human rights and dignity of pharmacists must be recognised and protected.
(1) www.fip.org/file/4757 Patient safety .Pharmacists’ role in “Medication without harm” 2020. FIP. International Pharmaceutical Federation.
(2) Wiesing U The Judgment of the German Federal Constitutional Court regarding assisted suicide: a template for pluralistic states?Journal of Medical Ethics Published Online First: 11 June 2021. doi: 10.1136/medethics-2021-107233
This article addresses a critically important topic, but I would not classify it as a 'current controversy'. The UK Animal Welfare and Ethical Review Body (AWERB) task of 'helping to promote a culture of care within the establishment and, as appropriate, the wider community' includes supporting the wellbeing of animal technologists and care staff. There is a good level of understanding that the culture of care includes caring for staff, in the belief that people who are cared for will behave more compassionately towards animals, and that science, animal welfare and staff morale will all benefit [see references in 1]. The AWERB task of 'supporting named persons, and other staff dealing with animals, on animal welfare, ethical issues and provision of appropriate training' can also be interpreted as providing emotional support and ensuring staff feel competent, capable and confident with respect to humane killing.
Outside the UK, the European Union working document on Animal Welfare Bodies and National Committees also discusses the importance of supporting staff and ensuring mutual respect as part of a good culture of care, including encouraging scientists to work with (and value the contribution of) animal technologists and care staff [2].
In my experience of working with AWERBs, many of these were (and are) very mindful of the emotional loading exterted on staff who had to humanely kill animals because of the pandemic [3]. The i...
This article addresses a critically important topic, but I would not classify it as a 'current controversy'. The UK Animal Welfare and Ethical Review Body (AWERB) task of 'helping to promote a culture of care within the establishment and, as appropriate, the wider community' includes supporting the wellbeing of animal technologists and care staff. There is a good level of understanding that the culture of care includes caring for staff, in the belief that people who are cared for will behave more compassionately towards animals, and that science, animal welfare and staff morale will all benefit [see references in 1]. The AWERB task of 'supporting named persons, and other staff dealing with animals, on animal welfare, ethical issues and provision of appropriate training' can also be interpreted as providing emotional support and ensuring staff feel competent, capable and confident with respect to humane killing.
Outside the UK, the European Union working document on Animal Welfare Bodies and National Committees also discusses the importance of supporting staff and ensuring mutual respect as part of a good culture of care, including encouraging scientists to work with (and value the contribution of) animal technologists and care staff [2].
In my experience of working with AWERBs, many of these were (and are) very mindful of the emotional loading exterted on staff who had to humanely kill animals because of the pandemic [3]. The issue of potential staff distress around using particular killing techniques, especially physical methods, is also frequently discussed by AWERBs. Further support for staff is forthcoming from the UK Institute of Animal Technology, which frequently produces materials and holds meetings and workshops to help its members develop resilience and deal with AUB.
However, I can believe that not all AECs, IACUCs etc worldwide are concerned with staff mental health (practice can also vary regarding achieving all the tasks between different AWERBs and AWBs), and it is a shame to think that mitigating AUB might be viewed as controversial by some.
One of the most enlightening statements for me from the report of the WISH patient safety forum 2015 is, "The idea that saving patients’
lives demands heroism is a harmful misconception about health and medicine seen in popular culture. In the real-world, the true heroes are not just rescuing patients, they are voicing their concerns and taking proactive measures to reduce the risks, before a patient is potentially put in harm’s way".
We shouldn't need to rely on heroic rescue or expect it to be a normal part of our every day clinical practice. The idolisation of heroism damages attempts to improve systemic approaches to improving patient care because it neglects and belittles the under-appreciated grind of change to reduce the underlying risk of patient harm. Heroism should be less of an aspiration and more of a flag highlighting the need for organisational improvement.
I read with great attention and not a little emotion the short article of Clinical Ethics by SDTR [1]. The narrative and flat form fails to hide the author's strong ethical commitment. Few points, in my view, deserve a greater focus in the challenging and highly contributing considerations.
The core of this contribution is the question: “when as a hospitalised medically qualified patient, one sees fellow patients in difficulty, or deteriorating clinically, unnoticed by medical staff, the question of whether it is ethical to intervene arises”.[1]
The issue is complex and is very much about the mutual assistance that patients (may) give each other, as have often given each other, when confined to a hospital ward, on a desert island, in a prison, in a concentration camp, in a college. This aspect of natural solidarity, observable also in ethology in many animal species, even in captivity, can come into brutal contrast not so much with "education", which concerns cultural and social aspects of shared ethics, but more with "instruction", also intended as training and usual professional activity. Actually, impact of curricular studies of medicine on youngsters is complex, but seems to modify only some and limited aspects of previously acquired thoughts and feelings on health and disease. [2] Are there deontological appropriate rules of conduct for doctors that can be immediately contrary to elementary ethics? Regretfully yes, and without dist...
I read with great attention and not a little emotion the short article of Clinical Ethics by SDTR [1]. The narrative and flat form fails to hide the author's strong ethical commitment. Few points, in my view, deserve a greater focus in the challenging and highly contributing considerations.
The core of this contribution is the question: “when as a hospitalised medically qualified patient, one sees fellow patients in difficulty, or deteriorating clinically, unnoticed by medical staff, the question of whether it is ethical to intervene arises”.[1]
The issue is complex and is very much about the mutual assistance that patients (may) give each other, as have often given each other, when confined to a hospital ward, on a desert island, in a prison, in a concentration camp, in a college. This aspect of natural solidarity, observable also in ethology in many animal species, even in captivity, can come into brutal contrast not so much with "education", which concerns cultural and social aspects of shared ethics, but more with "instruction", also intended as training and usual professional activity. Actually, impact of curricular studies of medicine on youngsters is complex, but seems to modify only some and limited aspects of previously acquired thoughts and feelings on health and disease. [2] Are there deontological appropriate rules of conduct for doctors that can be immediately contrary to elementary ethics? Regretfully yes, and without disturbing the best systems with our considerations. The recent year 2020, and the current 2021, however, is placing us in front of problems related to the confinement of entire populations, with extreme isolation both for hospitalized patients and for patients in home quarantine. Actually, even patients with COVID-19 are never completely alone, but those who have the fortune, or misfortune, of having to stay in the hospital in recent months find around them as the only possible friends, to watch and, hopefully, to talk to, other equally unhappy patients. Relatives, friends and even the personal doctor, if there is one, are not allowed in for visiting and even for contributing, as more or less was usual everywhere. The patient's only connection with the outside world is a functioning smartphone.
Patients with COVID-19, or non-COVID-19 under current COVID-19 protective measures, stay alone in the hospital, and, at worst, die alone there. I do not want to talk about personal experiences, but I will only talk about the feelings of loved ones, or known ones or, simply, of my patients. The acute sense of injustice that patients and relatives feel concerns precisely this prolonged obligation to suffer and die alone.
The most directly related issue is that younger doctors are trained to proceed along stranded guidelines, which do not at all include interference from other patients, however much they are medically qualified. In general, it can also be justified, by medico-legal considerations: but what leaps to the eye is the annoyance of many doctors in having a patient who is too aware, and sometimes too impatient or with excessive demands for attention. All this seems to be tolerated, and not always, if the concerns and requests, or suggestions, refer to the patient himself: less so if they concern other patients. Perhaps it is an anthropological problem, or perhaps something else, but this situation is at least unusual in the hospitals that I know. Here, as an unwritten rule, nurses and doctors often if not always ask for the collaboration of the concurrently hospitalized health professional to monitor, as possible, on other patients. As always, it is requested to the more lucid and attentive patients in the same ward. Intervening in the diagnostic reasoning, even in urgency, of those who are on-duty is, of course, quite another thing. However, it must be done, without hesitation, gracefully and promptly. Usually our trainees learn to appreciate this real world school. If all this sounds excessive and difficult to implement in a context of ethical directives, it could be better received within a strategy of clinical risk analysis and management, with a focus to processes.
Guglielmo M. Trovato, MD
Professor of Medicine at the School of Medicine of the University of Catania (Italy)
References
1) Taylor-Robinson SD. Personal perspectives: having the time to observe the patient. J Med Ethics Epub ahead of print: [please include Day Month Year]. doi:10.1136/medethics-2020-107041
2) Trovato GM, Catalano D, Di Nuovo S, Di Corrado D. Perception of cultural correlates of medicine: a comparison between medical and non-medical students--the authoritarian health. Eur Rev Med Pharmacol Sci. 2004; 8:59-68. PMID: 15267119.
The argument Jecker and Au mount against an elimination strategy for Covid-19 fails to account for the New Zealand experience. They discuss the question of excess mortality and suggest that tactics to reduce Covid-19 related deaths inadvertently increase deaths from other causes. Whilst this is intuitively true actual country wide data undermines their argument: https://blogs.otago.ac.nz/pubhealthexpert/mortality-declines-in-aotearoa... New Zealand experienced negative excess deaths for the years 2020-21 as did Australia and Taiwan. Had New Zealand experienced the same rate of excess deaths as the USA we could have expected 19,900 deaths which would have disproportionately affected ethnic minorities and the vulnerable. The elimination strategy in New Zealand was by far the best strategy to address health disparities, without it many more of those suffering disparities would have died.
While the continuing discussion on vaccine mandates is most welcome, one thing that struck me as needing more attention being dedicate to is how do we cater to workers vaccine preferences and what are the corresponding duties of employers to provide such vaccines. As I have argued elsewhere (https://www.tandfonline.com/doi/full/10.1080/20502877.2021.1959789) there is a part of the population that is not in principle opposed to vaccination in general, but might have objections to specific vaccines. Whether or not we accept vaccine mandates as ethical perhaps we need to discuss what employers should be doing to promote vaccination. While some of the authors of this paper have argued elsewhere (https://academic.oup.com/phe/article/14/3/242/6324053?login=true) that the only thing that matters is that the vaccine given is effective, particularly when a vaccine mandate is being put in place there seems to be an obligation to reduce the burden of that mandate on the workers. What I would wish to see is more debate on the obligations of employers (and the wider health service) to provide vaccines that staff deem personally acceptable. Even if there are no mandates, this might increase vaccination uptake. To return to the article at hand, it would be good if we had alternatives to influenza vaccines that were not made in he...
Show MoreThe article on the ethics of generative AI should be read in tandem with the recommendations on “Chatbots, ChatGPT, and Scholarly Manuscripts” issued by the World Association of Medical Editors (https://wame.org/page3.php?id=106).
While acknowledging the positive contribution chatbots can make to the development of texts on ethics and other academic fields, I would cite a few key negatives:
1) Chatbots like ChatGPT appear to be biased in favour of what they are proposing. This bias is evidenced in the references they provide, which uniformly support the point of view expressed by the chatbot. References opposing the point of view are not provided. This is probably inherent in the instructions in the algorithms applied by a chatbot, which must be along the lines of “provide an argument and supporting evidence”. No doubt this tendency to bias can be cured in future editions of the chatbot.
Show More2) Chatbots have been found to invent references where there are none. This is puzzling. Why did the programmers allow that? This should be an easy fix.
3) Chatbots are only as up to date in their references as their programming (their “training”). For ChatGPT, the cut-off date is sometime in mid-2021 – anything that appeared later than their training material that is simply not in their universe. In fast-moving fields, thus, there is a strong risk that what is asserted in the chatbot’s output has been superseded by...
Murdoch et al. give an excellent account of the law in Canada relating to consent to research in children when they mature. Laws must be based on moral principles, which always have a beneficial intention and are everywhere similar for both treatment and research, for both adults and children and for the publication of identifying data.
A competent adult can accept,reject or discontinue treatment. But a doctor must only provide treatment, which is beneficial physically or emotionally. In a publicly funded service she may need to balance the benefit to the individual against the needs of the community. The .patient is always free to consult a different doctor. A patient's personal details must not be revealed without express permission.
An adult can also accept, reject or stop participation in research intended to benefit others. Again he must not be identified without permission. He cannot require the eradication of data obtained because that would harm others.
A guardian, on behalf of a child, consents to treatment or research with the same rights and restrictions. As far as possible the informed consent of the child should be obtained.. When the child reaches maturity he must be fully informed and assumes responsibility for his own care. He can discontinue beneficial treatment but cannot demand that the doctor reverses it, because that would require her to cause harm. He can change doctors. He can stop participation in research but he cannot hav...
Show MoreDahlquist and Kugelberg (2021) correctly notice as the many non-pharmaceutical interventions (NPIs) which have been introduced to stop or slow down the COVID-19 pandemic through coercion are not publicly justified through a scientific consensus on the factual propositions that are used to support the policies, and as such, they would be illegitimate. It has been an unfortunate circumstance of this pandemic, that not only the NPIs but also the therapeutic approaches have been the subject of media misinterpretation, at the expense of a correct debate in between the scientific community, with scientists expressing opinions not welcomed by the media routinely abused for doing their work. Examples of policies lacking every scientific support, but still approved by the media, are everywhere. To find a working solution to the pandemic, definitively we do need free science “on the top”, rather than “on the tap” or even “on a leash”, limiting the interference by governments and corporations directly and through the media serving their interests. Misinformation by media is what has made the response to COVID-19 less effective than what could have been listening to the majority of the scientists. The response to COVID-19 of many countries has been dictated so far by the media, or better by those who control the media, rather than the scientists. To find a solution, scientists should be free of this conditioning.
REFERENCES
Show More1. Dahlquist M, Kugelberg HD. (2021). Public j...
We should be careful of the way we talk. Human society can be described as a long conversation about what matters. In this conversation, the language we use to describe our healthcare and social care practices not only reveals our attitudes and virtues, it shapes them. In order to promote self-worth and respect for individuals who use professional services there must be an understanding of how the language used in a profession influences professionals and the individuals with whom professionals work. The term ‘ service user’ or ‘client’ may be one reluctantly used by many healthcare professionals. The language of ‘service user’ or ‘client’ is acceptable at the political level. However it may be potentially detrimental to those it labels in healthcare and may also be damaging to the underlying ethical practices of many healthcare professions.
Language is a means of communication in healthcare, it can indicate attitudes and it is an integral part of social and professional life and behaviour. The particular meaning we attach to words reveal the underlying values and attitudes we hold about the people or things to which we are referring. Language exerts hidden power as our words may be simple descriptions or they may change lives. This power may not be detected by the vulnerable/underserved in society and by those with less power . Power and status in healthcare and social care interactions determine how each party behaves e.g. The term ‘service user’ or ‘cl...
Show MorePharmacists are essential healthcare professionals and are critical members of the whole healthcare team. Pharmacists work in varied settings such as community and hospital, hospice/palliative care industry and regulatory affairs. Regardless of where pharmacists work, and whether their roles provide direct or indirect patient care, all pharmacists contribute to safe and quality health care. Pharmacists may hold roles in many specialty areas of a healthcare system including the emergency department, infectious disease, oncology, pain management and anticoagulation management (1).
Although effective, medicines are often challenging to manage and use appropriately. This is due to a number of factors, such as increasingly complex pharmacotherapies, polypharmacy, ageing populations with multiple diseases, and limited, or inadequately coordinated resources in healthcare systems. While performing a medication review, many pharmacists work together with GPs/consultants to optimise the patient's pharmacotherapy and reduce the potential risks of polypharmacy. An example of an expected health related goal suggested by a patient during a medication review could be a desire to reduce pain. During the medication review, the patient’s pain medication could be optimised by a pharmacist to achieve this goal (1).
Pharmacists are pivotal in the lethal drug medication use process. Assisted suicide(i.e. physician assisted) will not take place without the use of medicat...
Show MoreThis article addresses a critically important topic, but I would not classify it as a 'current controversy'. The UK Animal Welfare and Ethical Review Body (AWERB) task of 'helping to promote a culture of care within the establishment and, as appropriate, the wider community' includes supporting the wellbeing of animal technologists and care staff. There is a good level of understanding that the culture of care includes caring for staff, in the belief that people who are cared for will behave more compassionately towards animals, and that science, animal welfare and staff morale will all benefit [see references in 1]. The AWERB task of 'supporting named persons, and other staff dealing with animals, on animal welfare, ethical issues and provision of appropriate training' can also be interpreted as providing emotional support and ensuring staff feel competent, capable and confident with respect to humane killing.
Outside the UK, the European Union working document on Animal Welfare Bodies and National Committees also discusses the importance of supporting staff and ensuring mutual respect as part of a good culture of care, including encouraging scientists to work with (and value the contribution of) animal technologists and care staff [2].
In my experience of working with AWERBs, many of these were (and are) very mindful of the emotional loading exterted on staff who had to humanely kill animals because of the pandemic [3]. The i...
Show MoreOne of the most enlightening statements for me from the report of the WISH patient safety forum 2015 is, "The idea that saving patients’
lives demands heroism is a harmful misconception about health and medicine seen in popular culture. In the real-world, the true heroes are not just rescuing patients, they are voicing their concerns and taking proactive measures to reduce the risks, before a patient is potentially put in harm’s way".
We shouldn't need to rely on heroic rescue or expect it to be a normal part of our every day clinical practice. The idolisation of heroism damages attempts to improve systemic approaches to improving patient care because it neglects and belittles the under-appreciated grind of change to reduce the underlying risk of patient harm. Heroism should be less of an aspiration and more of a flag highlighting the need for organisational improvement.
I read with great attention and not a little emotion the short article of Clinical Ethics by SDTR [1]. The narrative and flat form fails to hide the author's strong ethical commitment. Few points, in my view, deserve a greater focus in the challenging and highly contributing considerations.
Show MoreThe core of this contribution is the question: “when as a hospitalised medically qualified patient, one sees fellow patients in difficulty, or deteriorating clinically, unnoticed by medical staff, the question of whether it is ethical to intervene arises”.[1]
The issue is complex and is very much about the mutual assistance that patients (may) give each other, as have often given each other, when confined to a hospital ward, on a desert island, in a prison, in a concentration camp, in a college. This aspect of natural solidarity, observable also in ethology in many animal species, even in captivity, can come into brutal contrast not so much with "education", which concerns cultural and social aspects of shared ethics, but more with "instruction", also intended as training and usual professional activity. Actually, impact of curricular studies of medicine on youngsters is complex, but seems to modify only some and limited aspects of previously acquired thoughts and feelings on health and disease. [2] Are there deontological appropriate rules of conduct for doctors that can be immediately contrary to elementary ethics? Regretfully yes, and without dist...
The argument Jecker and Au mount against an elimination strategy for Covid-19 fails to account for the New Zealand experience. They discuss the question of excess mortality and suggest that tactics to reduce Covid-19 related deaths inadvertently increase deaths from other causes. Whilst this is intuitively true actual country wide data undermines their argument: https://blogs.otago.ac.nz/pubhealthexpert/mortality-declines-in-aotearoa... New Zealand experienced negative excess deaths for the years 2020-21 as did Australia and Taiwan. Had New Zealand experienced the same rate of excess deaths as the USA we could have expected 19,900 deaths which would have disproportionately affected ethnic minorities and the vulnerable. The elimination strategy in New Zealand was by far the best strategy to address health disparities, without it many more of those suffering disparities would have died.
Pages