Emerging ethical dilemmas in the use of intelligent computer programs in decision-making in health care: an exploratory study

Background: Medical professionals are under tremendous stress due to various occupational stressors, and Artificial Intelligence (AI) geared toward patient care might look like a preferable solution in alleviating some amount of stress. Hence, the study assessed the level of awareness and perception of the ethical dilemmas of health professionals on intelligent computer programs in independent healthcare decision-making. Materials and Methods: The present study is a cross-sectional, non-interventional, and questionnaire-based descriptive study. This study was done in a Deemed to be University Hospital, Karnataka, India. Of the total 96 participants, 30 were medical participants, 36 were dentists, and 30 were nurses. A pretested and validated questionnaire was used to collect the participants’ responses. Results: Medical and nursing participants opined that intelligent computer programs can take both major and minor independent decisions in inpatient care when the physician is unavailable. The majority of the participants felt that in the decisions made by the intelligent computer programs, patients’ rights and wishes might not be respected, compromising autonomy. The majority agreed that computer-assisted information extraction helps in better treatment of patients causing beneficence. Medical and dental participants thought that intelligent computer programs cannot communicate well with patients, do not have a conscience, and can be hacked causing maleficence. Participants opined that the use of intelligent computer programs could serve justice in the form of equity and equality in health care. Conclusion: Breach of patient autonomy due to data mining, loss of confidentiality, and disrespect for patients’ rights and wishes are major concerns when AI takes independent decisions in health care. One of the most desirable outcomes of AI in health care could be an increase in equity and equality of the reach in health care to the rural population.

Ethics-related guidelines for authors and article retractions: How do Indian biomedical journals measure up?

Background: There has been an increase in research output from India, which in turn has led to an increase in the number of Indian journals facilitating biomedical research. The instructions to authors in the websites of these journals should clearly display ethics-related guidelines for the ethical publication process. The present study did an objective assessment of “instructions to authors” on the websites of Indian biomedical journals in PubMed and IndMED and retractions in these journals from January 2012 to October 2017.Methods: A 14-point checklist based on previous studies and review of literature was used. A total of 110 journals were included in the study and their websites assessed.Results: A dedicated section on ethics was found in 56 (50.9%) journal websites, 42 (38.2%) did not mention any specific bioethics guidelines, animal ethics was mentioned in 65 (59%) of the journals, and an ethics committee approval was required by 65 (59%) of the journals. Sixty-four (58.2%) journals mentioned mandatory informed consent and 19 (17.3%) required assent. There were 22 (20%) journals that required neither Clinical Trial Registry of India (CTRI) registration nor Consolidated Standards of Reporting Trials (CONSORT) guidelines for reporting of clinical trials. There were 38 (34.5%) journals that actively looked for plagiarism. Most common reason for retraction was duplicate publication (23, 38.4%) followed by plagiarism (17,28.3%).Conclusion: The lacunae found in this survey indicate a need for strengthening of author instructions. The number of retractions in the last five years suggests that there are valid reasons to strengthen ethics in the publication process in India

Bridging the ethics gaps.

“Sir, I have already collected 15 cases in my research project, and have not taken consent from any of the participants. What should I do now?” asked a postgraduate student in an ethics committee meeting that I happened to be attending, several years ago. Promptly came the reply from the head of the institution, who also happened to be the chairperson of the ethics committee there: “No problem, just go to any patient who is admitted in the ward and take his thumb print on the consent form.” This encounter rudely awakened me to the huge gap between knowledge and practice in medical ethics.