The ethics of artificial intelligence in healthcare: From hands-on care to policy-making.

Contemporary healthcare at all levels increasingly uses Artificial Intelligence (AI). However, since the various levels involve different tasks, have different data needs, and different ethical obligations, the AIs that are used have to be differently structured. Also, since healthcare construed as a commodity involves different ethical parameters from healthcare construed as a right, and different ethical systems entail logically distinct considerations, this also necessitates the need for differently structured AIs. What follows sketches how and why this is the case. It concludes with a brief look at why AIs programmed into quantum computers would not change this.

Big Data, Information Technology and Information Professionals: Some Considerations for Digital Ethics.

It is generally accepted that the global evolution of health information technology, both in design and usage, raises ethical issues that should be addressed. However, the terms in which this concern is expressed are shrouded in ambiguity. Even what constitutes an ethical issue itself is never clearly defined. The present discussion attempts to clarify the landscape and suggests how the concern should be addressed.

Expression of catalase, alcohol dehydrogenase, and malate dehydrogenase in rot grains upon fungicide use on maize hybrids grown at different spacings.

In this study, we evaluated the fungicide effect on the incidence of rot grains and expression of catalase (CAT), alcohol dehydrogenase (ADH), and malate dehydrogenase (MDH) enzymes in commercial maize hybrids grown with conventional and reduced spacing in Guarapuava, PR, Brazil. The experiment was designed in random blocks with a 3 × 8-factorial scheme, totaling 24 treatments. The first factor constituted three levels, the first with foliar fungicide application [150.0 g/L trifloxystrobin (15.0%, w/v) + 175.0 g/L prothioconazole (17.5%, w/v)] at a dose of 0.4 L/ha at V8-stage eight expanded leaves and the second with an application of 0.5 L/ha at VT-tasseling and check (no fungicide application) stage. The second factor comprised eight maize hybrids that were divided into two groups, complex (AG 9045PRO, AG 8041PRO, DKB245PRO2, and 2B707PW) and susceptible (P 32R48H, DKB390PRO, P 30F53H, and P 30R50H), according to their reaction to the causative fungus, totaling 72 plots at each site in the crop of 2013/2014. The percentage of rot grains and the expression of CAT, ADH, and MDH were evaluated for each hybrid. The percentage of rot grains was influenced by the hybrid and fungicide used. The (trifloxystrobin + prothioconazole) reduced the incidence of rot grains, with relatively higher reduction in the hybrids considered susceptible. The higher expression of CAT enzyme was related to the higher incidence of rot grains because of grain deterioration, depending on the hybrids evaluated. A higher expression of ADH and MDH enzymes was observed in the maize hybrids belonging to the group considered tolerant.

Info-vigilance or safety in health information systems.

The paper examines the issues of security and safety in Health Information Systems and focuses the need for the development of appropriate Guidelines for the effective use of IEC 61508 standard.

Expert systems, security and quality assurance: implications of patient records as data-space.

The concept of data-space is fruitful in trying to understand the ethical rights and duties that surround the treatment of patient records. However, it also provides a solution to three apparently unconnected problems: the construction of expert diagnostic systems, the development of an internal security element within the sphere of permitted data-access for health care professionals, and the development of a professional quality assurance mechanism. This paper presents a model of how these diverse aims may be achieved. It does so by developing the notion of the logical form of data within a data-space and by showing how the path taken by a health care professional through a profession-relative data-space can provide checks for the security, quality and appropriateness of the path itself. The result is important in that it provides an integrated method for information specialists to meet their fiduciary obligations towards the patients whose records are in their care, and towards the institutions that employ them.

Breaking strength of native and sutured trachea. An experimental study on sheep trachea.

Tracheal anastomoses are, even more so than other sutures, often only possible to prepare under tension and thus in danger of breakage. No information is available regarding native tracheae and freshly sutured tracheae. For this reason, our objective was to examine the tensile strength of native tracheae and compare it with freshly sutured specimens. Fresh tracheae were collected from the local slaughterhouse within 30 min of slaughter. With the help of a suitable holding device, 24 fresh tracheae were mounted on a material testing machine and stretched to breaking point, during which the force and distance required were recorded. The same study was carried out on each 10 freshly anastomosed tracheae using three different suturing techniques. The mean value of the maximum force required for native tracheae was 198 N. With continuous suturing (polypropylene), a mean value of 171 N was attained, and with single interrupted suturing (polydioxanone and polyglactin 910), 123 N, respectively, 108 N. Differences between the groups proved to be highly significant. With respect to the mechanical strain from traction, the continuous suture proved to be statistically identical to native tracheae, whereas single interrupted sutures revealed a considerably lower stability under burden. Therefore, the continuous suture is of advantage in respect of the mechanical strain from traction and the suture protection of tracheal anastomoses. Further studies with differing survival times in vivo with this method provide insight into the stability of tracheal anastomoses during the healing process.

Physicians' practice profiles and the patient's right to know.

Recent legislation has made physician practice profiles publicly available in many states of the United States. This paper examines the ethical reasoning underlying such a move. It concludes that, on balance, such an initiative is ethically appropriate and should be followed by other jurisdictions.

Professional codes for electronic HC record protection: ethical, legal, economic and structural issues.

Guidelines for the protection of electronic health care data frequently stipulate that national laws should be followed. This stipulation is subjected to analysis and critique. It is argued that it commits the fallacy of nationality, and suggests that appropriately constructed ethical guidelines for the protection of electronic health care data must focus solely on fundamental ethical principles as these are applied to the types of situations in which such electronic data are generated, used and ultimately disposed of. The relevance of economic considerations is also be addressed. An attempt is made to sketch a general ethical framework within which data protection guidelines could be situated.

Improving organ retrieval rates: various proposals and their ethical validity.

The current global shortage of organs has prompted a series of proposals for improving organ retrieval rates. They include preferred recipient status for registered organ donors, payment for organs, presumed consent and required response. This paper examines the tenability of these proposals and points out their shortcomings. Taking the Canadian situation as an example, it argues further that the shortage is exacerbated by unethical and essentially illegal retrieval protocols that flout the law of informed consent. It is suggested that before any redrafting of laws and regulations is undertaken, these protocols should be revised.

Medical narratives and patient analogs: the ethical implications of electronic patient records.

An electronic patient record consists of electronically stored data about a specific patient. It therefore constitutes a data-space. The data may be combined into a patient profile which is relative to a particular specialty as well as phenomenologically unique to the specific professional who constructs the profile. Further, a diagnosis may be interpreted as a path taken by a health care professional with a certain specialty through the data-space relative to the patient profile constructed by that professional. This way of looking at electronic patient records entails certain ethical implications about privacy and accessibility. However, it also permits the construction of artificial intelligence and competence algorithms for health care professionals relative to their specialties.

The Canadian health care system. An analytical perspective.

The Canadian health care system is a publicly funded system based on the philosophy that health is a right, not a commodity. The implementation of this perspective is hampered by the fact that the Canadian Constitution makes health care a matter of provincial jurisdiction, while most taxing powers lie in the hands of the federal government. Further problems arise because of Canada's geographic nature and a move to regionalization of provincial health care administration. The issue is compounded by recent developments in reproductive technologies, aboriginal health, changes in consent law, etc.

Macro allocation in health: an ethically based model.

We propose an approach to macro allocation of health care resources that is compatible with the principles of the Canada Health Act. The approach is equitable and just and takes public support into account. It hinges on the provision of data on disease prevalence and incidence, on data on the effectiveness of intervention measures and of their cost. It is therefore a proposal that may be important as a direction for ongoing research even if it is not immediately feasible. The approach is analyzed with respect to selected related approaches.

Professional ethics as basis for legal control of health care information.

The development of uniform, ethical and internationally enforceable standards for handling computerised electronic patient records is a major requirement for the implementation of the next generation of health information systems. This paper develops a model code of ethics to address this issue.