Is it ethically permissible for GPs to promote non-directed altruistic kidney donation to healthy adults?

Doctors hold coexisting ethical duties to avoid causing deliberate harm to their patients (non-maleficence), to act in patients' best interests (beneficence), to respect patients' right to self-determination (autonomy) and to ensure that costs and benefits are fairly distributed among patients (justice). In the context of non-directed altruistic kidney donations (NDAKD), doctors' duties of autonomy and justice are in tension with those of non-maleficence and beneficence. This article examines these competing duties across three scenarios in which general practitioners (GPs) could promote NDAKD to healthy adults. In the first-when a healthy adult patient prompts the GP to discuss NDAKD-the GP is ethically obligated to counsel the patient about NDAKD to respect their autonomy, yet this does not constitute any form of promotion of NDAKD. In the remaining scenarios, healthy adult patients are unaware of the possibility of NDAKD. In the second, it is ethically permissible for GPs to indirectly raise awareness of NDAKD among healthy adults by displaying recruitment campaign material to non-specified groups of patients in their waiting rooms. In the third, it is ethically impermissible for GPs to directly promote NDAKD to individual healthy adults by raising the possibility of NDAKD with such individuals. The major counterarguments raised against this position are problems with kinds of counselling that fail to reach expected professional standards, rather than problems with the ethical claims made in this article.

Performance of GPT-4 in Membership of the Royal College of Paediatrics and Child Health-style examination questions.

The large language model (LLM) ChatGPT has been shown to have considerable utility across medicine and healthcare. This paper aims to explore the capabilities of GPT-4 (Generative Pre-trained Transformer 4) in answering Membership of the Royal College of Paediatrics and Child Health (MRCPCH) written paper-style questions. GPT-4 was subjected to four publicly available sample papers designed for those preparing to sit MRCPCH theory components. The model received no specialised training or reinforcement. The average score across all four papers was 78.1%. The model provided reasoning for its answers despite this not being required by the questions. This performance strengthens the case for incorporating LLMs into supporting roles for practising clinicians and medical education in paediatrics.

Digital health technologies: Compounding the existing ethical challenges of the 'right' not to know.

INTRODUCTION: Doctors hold a prima facie duty to respect the autonomy of their patients. This manifests as the patient's 'right' not to know when patients wish to remain unaware of medical information regarding their health, and poses ethical challenges for good medical practice. This paper explores how the emergence of digital health technologies might impact upon the patient's 'right' not to know. METHOD: The capabilities of digital health technologies are surveyed and ethical implications of their effects on the 'right' not to know are explored. FINDINGS: Digital health technologies are increasingly collecting, processing and presenting medical data as clinically useful information, which simultaneously presents large opportunities for improved health outcomes while compounding the existing ethical challenges generated by the patient's 'right' not to know. CONCLUSION: These digital tools should be designed to include functionality that mitigates these ethical challenges, and allows the preservation of their user's autonomy with regard to the medical information they wish to learn and not learn about.

The Extent to Which the Wish to Donate One's Organs After Death Contributes to Life-Extension Arguments in Favour of Voluntary Active Euthanasia in the Terminally Ill: An Ethical Analysis.

In terminally ill individuals who would otherwise end their own lives, active voluntary euthanasia (AVE) can be seen as life-extending rather than life-shortening. Accordingly, AVE supports key pro-euthanasia arguments (appeals to autonomy and beneficence) and meets certain sanctity of life objections. This paper examines the extent to which a terminally ill individual's wish to donate organs after death contributes to those life-extension arguments. It finds that, in a terminally ill individual who wishes to avoid experiencing life he considers to be not worth living, and who also wishes to donate organs after death, AVE maximizes the likelihood that such donations will occur. The paper finds that the wish to donate organs strengthens the appeals to autonomy and beneficence, and fortifies the meeting of certain sanctity of life objections, achieved by life-extension arguments, and also generates appeals to justice that form novel life-extension arguments in favour of AVE in this context.

Non-directed (altruistic) kidney donation: Altruism or insurance policy?

INTRODUCTION: Since non-directed (altruistic) kidney donors do not stand to benefit from the lengthening and strengthening of a relationship that they intrinsically value, their donations are considered to constitute the most altruistic variety of living kidney donation. METHODOLOGY: This paper uses publicly-available data to assess the expected value that accrues to the donor of altruistic kidney donation. FINDINGS: Compared to healthy non-donors, living kidney donors experience only marginally increased absolute risks of poor physical health outcomes, and no difference in important psychosocial health outcomes. Crucially, the chance of requiring a kidney donation is only marginally increased by becoming a living kidney donor. In the United Kingdom, previous living kidney donors that subsequently become in need of any organ donation (not only kidneys) themselves are considered priority patients for these donations. They consequently experience shorter waiting times for these organs and reduced exposure to the inherently harmful effects of dialysis therapy (if a kidney donation is required) compared to non-donors in need of organ donation. As such, while key data points required to compute an accurate and complete expected value calculation are unavailable, it is likely that the additional risk incurred by becoming a living kidney donor is outweighed by the benefit of being considered a priority patient for the donation of any type of organ in the event that this is needed. CONCLUSION: Accordingly, the expected value of becoming a living kidney donor is likely to be positive, meaning the act of doing so may be considered akin to the taking out of an insurance policy. In the context of non-directed (altruistic) kidney donation, this may diminish the extent to which such a donation is considered altruistic.

Infectious diseases during the Russian-Ukrainian war - Morbidity in the Transcarpathian region as a marker of epidemic danger on the EU border.

•The Transcarpathian region in Ukraine has received over 350,000 Internally Displaced Persons (IDPs) since the beginning of the invasion, making the region vulnerable to outbreaks of communicable diseases.•The coverage of vital vaccination programs has been substantially harmed since the invasion began, with many children displaced without documentation and their vaccination status unknown.•The conditions in which IDPs in Transcarpathia reside risk local outbreaks of infectious diseases and their transmission into EU countries, making it vital to continue supporting Ukrainian healthcare authorities on the pivotal issue of vaccination.

ChatGPT: the threats to medical education.

While it offers abundant advantages, ChatGPT threatens to significantly harm the educational attainment, and the intellectual life, of students of medicine and the subjects that compliment it. This technology poses a serious threat to the ability of such students to deliver safe and effective medical care once they graduate to clinical practice. Institutions that providemedical education must react to the existence, availability, and rapidly increasing competency of GPT models. This article suggests an intervention by which this could be, at least partially, achieved.

Conflict and natural disaster: the impacts on medical education in Ukraine and Türkiye.

In addition to causing enormous and enduring harms to the health of populations, the Russian invasion of Ukraine and the recent earthquakes in southeast Türkiye have greatly damaged the institutions of medical education at work in these countries. This paper explores these harms and encourages medical educationalists in unaffected countries to reflect on the virtues of their own educational institutions.