Bioethics Digest

In this feature, our team provides you with an overview of the most recent publications in the field of bioethics, with a particular focus on contributions coming from (or having relevance for) Switzerland.

Buona lettura! Bonne lecture! Viel Spass beim Lesen! Enjoy your reading!

The editors: Andrea Martani and Maddalena Favaretto

AI ETHICS

AI ETHICS

“Machine learning applications in healthcare and the role of informed consent: Ethical and practical considerations”

In the bioethical and medical literature, it is increasingly debated whether Machine Learning (ML) tools used by healthcare professionals generate specific duties of disclosure towards the patients, since such tools have often a bearing on clinical decisions. Would – for example – patients need to be informed (and provide consent) every time ML is used as part of their treatment? Lorenzini and colleague discuss this issue and take stock of the existing gap between theoretical and practical considerations pro or contra the implementation of informed consent in this context. They show that such a gap is undesirable, since in the clinical context practical and theoretical considerations are intertwined and interdependent. Finally, they argue that requiring patients’ informed consent for ML use is ethically desirable particularly in those circumstances where it supports shared decision making.

Lorenzini G, Shaw DM, Arbelaez Ossa L, Elger BS. Machine learning applications in healthcare and the role of informed consent: Ethical and practical considerations. Clinical Ethics. April 2022. doi:10.1177/14777509221094476

 

“A Systemic Approach to the Oversight of Machine Learning Clinical Translation”

More and more tools based on Machine Learning (ML) are being introduced in the healthcare setting. This has raised several questions on what standards should these satisfy to enter the market, and what kind of oversight should be exercised to ensure their ethical, medical and societal acceptability. In their contribution, Vayena and Blasimme argue for the introduction of a systemic approach in the oversight of these new type of medical technologies, in particular by the involvement of Ethics Committee or Institutional Review Boards that should possess a broader expertise (e.g. including computer scientists) and also consider new issues (beyond the mere protection of participants in clinical research and addressing ethical dilemmas in clinical decision making). The authors also point at a few new national and international guidelines for regulatory agencies on how to approve ML and they underline the importance of patient involvement.

Vayena E, Blasimme A. A Systemic Approach to the Oversight of Machine Learning Clinical Translation. Am J Bioeth. 2022 May;22(5):23-25. doi: 10.1080/15265161.2022.2055216

THEORETICAL BIOETHICS

theoretical bioethics

“Revisiting respect for persons: conceptual analysis and implications for clinical practice”

Respect for persons in the medical context is undoubtedly one of the most discussed concepts in bioethics. However, its understanding is often tied with the idea of autonomy and its concrete implications for critical practice are less commonly addressed. In this article Subramani and Biller-Andorno propose to expand the understanding of respect, and underline that it requires not only to let patients decide autonomously, but also “avoiding disrespectful behaviors and actions and practicing respect guided by self-reflection on social and moral norms that show moral attitude and act respectfully towards persons, i.e., patients and family members”. They then also reflect on how this conception of respect can be promoted by changing medical education on ethics, and “introducing self-reflection and mindfulness about one's attitudes, actions, bias, and language into their curriculum”.

 Subramani S, Biller-Andorno N. Revisiting respect for persons: conceptual analysis and implications for clinical practice. Med Health Care and Philos 2022. doi: 10.1007/s11019-022-10079-y