Regulatory and Ethical Considerations on Artificial Intelligence for Occupational Medicine.

Generative artificial intelligence and Large Language Models are reshaping labor dynamics and occupational health practices. As AI continues to evolve, there's a critical need to customize ethical considerations for its specific impacts on occupational health. Recognizing potential ethical challenges and dilemmas, stakeholders and physicians are urged to proactively adjust the practice of occupational medicine in response to shifting ethical paradigms. By advocating for a comprehensive review of the International Commission on Occupational Health ICOH code of Ethics, we can ensure responsible medical AI deployment, safeguarding the well-being of workers amidst the transformative effects of automation in healthcare.

Impacto ocupacional por cuarentena obligatoria: el caso de la región de Magallanes y Antártica Chilena / Occupational impact due to mandatory quarantine: the case of the Magallanes and Chilean Antarctic region

OBJETIVOS: describir el comportamiento ocupacional en tiempos de pandemia, específicamente durante el aislamiento social obligatorio, e identificar su impacto en el equilibrio ocupacional de la población estudiada. MÉTODOS: investigación de tipo cualitativa, con un diseño descriptivo exploratorio, se realizó entrevistas semiestructuradas a personas de diversos rangos etarios subdivididos en infancia, jóvenes, personas adultas y personas mayores, todas habitantes de la ciudad de Punta Arenas que estuvieron en cuarentena total obligatoria en los meses de abril y mayo de 2020. RESULTADOS: se identificaron dos grandes categorías: primero: Adaptación ocupacional/satisfacción y bienestar, a partir de las cuales se generaron las siguientes subcategorías: Exploración ocupacional, balance ocupacional, elección ocupacional, eficacia, calidad de vida y aprendizajes; la segunda categoría se denomina desequilibrio ocupacional/insatisfacción o ausencia de bienestar, que incluye subcategorías tales como: tipo y cantidad de ocupaciones, desestructuración de patrones de ejecución, deprivación ocupacional, infraocupación, sobreocupación. CONCLUSIÓN: frente a la situación de confinamiento en pandemia, las personas pueden tener una respuesta adaptativa o desadaptativa dependiendo de sus recursos personales, contextuales, sociales y emocionales. La terapia ocupacional puede aportar estrategias para mejorar la calidad de vida de las personas en crisis sanitarias como la que se vive en la actualidad

OBJECTIVE: To describe the occupational behavior in a time of pandemic, especially during compulsory social isolation, and to identify its impact on the occupational balance of the population under study. METHODS: Qualitative research with a descriptive exploratory design. Semi-structured interviews were carried out among people of different age ranges sub-divided into childhood, youth, adults and the elderly, all inhabitants of the city of Punta Arenas, who were in mandatory total quarantine during the months of April and May 2020. RESULTS: Two main categories were identified being the first one: occupational adaptation / satisfaction and well-being, from which the following subcategories were generated: occupational exploration, occupational balance, occupational choice, efficacy, quality of life and learning. The second category was called occupational imbalance / dissatisfaction or absence of well-being, which included subcategories such as: type and number of occupations, disruption of performance patterns, occupational deprivation, underemployment, over-employment. CONCLUSION: Faced with the confinement situation in a pandemic, people can have an adaptive or maladaptive response depending on their personal, contextual, social and emotional resources. Occupational therapy can provide strategies to improve the quality of life of people in health crisis like the one we are living today

Trasplantes de órganos y su incidencia sobre la relación laboral. Especial referencia a la situación de Incapacidad Permanente de las personas trasplantadas / Organ transplantation and its impact on employment. Special reference to the situation of permanent disability of transplanted people

Muy pocas veces se han analizado desde un punto de vista jurídico los efectos que el trasplante de órganos puede desplegar en el ámbito del Derecho del Trabajo y de la Seguridad Social. En el presente trabajo se exponen las principales medidas de contenido socio-laboral actualmente vigentes destinadas a ofrecer una protección especial a este tipo de pacientes, a través de las que se trata de evitar que esta situación desencadene el abandono prematuro e involuntario de la vida activa (AU)

The effects of organ transplantation have been rarely addressed from a legal perspective in the Labor and Social Security Law. This paper analyzes the current, main social and labor regulations, designed to provide special protection to transplanted patients, which prevent the premature and involuntary abandonment of working life (AU)

ICOH International Code of Ethics for Occupational Health Professionals: Historical fortune and future perspectives in Italy. / I1 Codice Internazionale di Etica ICOH per gli operatori di Medicina del Lvoro: fortuna storica e prospettive future in Italia.

The Working Group responsible for the Italian translation of the third edition of the International Code of Ethics, appointed by the President of the International Commission on Occupational Health (ICOH), Dr. Jukka Takala, completed last April the revision work. The final text, already available on the ICOH website, has been printed and distributed by the Italian National Institute for Insurance against Accidents at Work (INAIL) at the 79th National Congress of the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII), in Rome. The curators of this third Italian edition have accomplished the delicate task of adaptation in Italian, taking into account the specificities of the practice of medicine in the Italian work environment. It involves many professionals with diverse roles and responsibilities in the public and private sectors for safety, hygiene, health and environment in relation to work. More than twenty years after the first Italian edition, we trace the evolution of the ICOH International Code of Ethics, in order to focus its birth, national and international distribution, and continuous improvement as well as its ability to direct the stakeholders towards a participatory prevention model, in a legislative framework that has seen over the past two decades a radical change in the Italian world of work.

Ethics in occupational health and safety: case studies from Gujarat.

Rapid industrialisation in India is giving employment to millions of people in the formal sector, and many more in the unorganised sector. However, the absence of clear policies, poorly enforced regulations, lack of systematic reporting of occupational diseases, lamentable socioeconomic conditions of the workers and their limited access to healthcare make occupational health and safety (OHS) a critical area.

[Ethical problems of hygienic tests in occupational medicine].

The authors discuss bioethical problems appearing in usage of genetic tests as a technology of personalized medicine for prevention and early diagnosis of occupational diseases, and connected with question "Who has a right to know results of genetic test?". Analysis covered principles and legal norms, regulating human rights for security of health information, and causes of anxiety about workers' discrimination due to genetic test results. The authors necessitate differentiation between discrimination and reasonable restrictions favorable for workers in cases when work conditions can be a health hazard for person due to genetic predisposition.

The ethics of occupational health and safety in Turkey: responsibility and consent to risk / La ética de la salud ocupacional y temas de seguridad en Turquía: responsabilidad y consentimiento al riesgo / A ética da saúde e segurança ocupacionais na Turquia: responsabilidade e consentimento para o risco

Work-related diseases, injuries, risks and deaths are the issues that have been recently gaining importance especially in developing countries. The ethical dimensions of occupational health and safety have remained as relatively understudied areas. Concepts such as responsibility, consent, autonomy, paternalism, choice, and certain values or justifications that are used in medical ethics and bioethics are also applicable to occupational health and safety. This article examines the ethical issues of responsibility and consent to occupational risk. It will first define the concepts of consent and risk, and then different views on responsibility and consent to risk will be discussed. The article will also examine the responsibility of the society and government regarding these concepts.

Enfermedades relacionadas con el trabajo, lesiones, riesgos y muertes son temas de mayor importancia, especialmente en países en desarrollo. Las dimensiones éticas de la salud ocupacional y los temas de seguridad han sido relativamente menos examinados. La responsabilidad, el consentimiento, la autonomía, el paternalismo, la elección y otros conceptos, como valores y justificaciones usados en ética médica y bioética, son también aplicables al ámbito de la salud ocupacional y seguridad. Este artículo examina los temas éticos de responsabilidad y consentimiento relativos a riesgo ocupacional. En este artículo, primero, se definen los conceptos de consentimiento y riesgo, entonces se discuten puntos de vista diferentes sobre responsabilidad y consentimiento al riesgo y finalmente se examina la responsabilidad de la sociedad y el gobierno.

Doenças relacionadas com o trabalho, lesões, riscos e mortes são temas que ganham importância, especialmente nos países em desenvolvimento. As dimensões éticas de questões de saúde e segurança no trabalho têm sido relativamente pouco examinadas. Responsabilidade, consentimento, autonomia, paternalismo, escolha e outros conceitos, valores ou justificativas usadas em ética médica e bioética são também aplicáveis ao domínio da saúde e segurança ocupacionais. Este artigo examina as questões de ética da responsabilidade e o consentimento ao risco ocupacional. Neste artigo, em primeiro lugar, os conceitos de consentimento e de risco são definidos; em seguida, diferentes pontos de vista sobre a responsabilidade e consentimento ao risco são discutidos e, finalmente, a responsabilidade da sociedade e do governo são examinados.

[Ethics, medical ethics, and occupational medicine: is their dialogue possible?]. / Etica, etica medica e medicina del lavoro: un dialogo possibile.

Today's medicine faces some critical moral challenges, yet the medical class suffers from an increasingly evident malaise: a growing dissatisfaction with an ethical demand often perceived as a cumbersome burden of rules and prohibitions, which risk to erode the fiduciary relations with patients. Such a negative appraisal is partly due to a narrow interpretation of the meaning of ethics, a misconception whose roots are in the positivistic stance that permeates our culture, and in its almost exclusively technological bent. This radical orientation of our culture shows itself in the vanishing of the idea of an intrinsic ethical dimension of medicine and consequent eclipse of traditional medical ethics, currently all but assimilated by bioethics. Maintaining a clear distinction between medical ethics and bioethics is a fundamental condition for guaranteeing an original ethical reflection in medicine, thereby fostering a constructive dialogue between philosophical and medical ethics. In this sense, occupational medicine holds a very propitious position, at the cross-roads to some of the most important dimensions in human life and society: health, work, environment. In a milieu which is too often inclined to efface the living human being and the deepest needs of humanity, the moral commitment of medical profession to the care of the integral reality of the embodied human person is one of the most important ethical challenges facing occupational medicine and a most valuable contribution to the current ethical debate.

The Bioethics of Music, the Music of Bioethics.

Bioethics is rarely referenced in the scholarship of performing arts medicine (PAM). This essay argues that bioethical concerns loom far larger in the care of PAM patients than might typically be understood. This essay presents Beauchamp and Childress's four principles of bioethics, with examples pertinent to PAM, drawn from the author's research and personal experience.

Ethics education: a priority for general practitioners in occupational medicine.

General practitioners (GPs) who work in occupational medicine (OM) should be trained continuously. However, it seems that ethical issues have been neglected. This cross-sectional study aimed to determine educational priorities for GPs working in OM. A total of 410 GPs who participated in OM seminars were asked to answer a number of questions related to items that they usually come across in their work. The respondents were given scores on 15 items, which pertained to their frequency of experience in OM, their felt needs regarding education in the field, and their knowledge and skills. Ethical issues were the most frequently utilised item and the area in which the felt need for education was the greatest. The knowledge of and skills in ethical issues and matters were the poorest. Ethical principles and confidentiality had the highest calculated educational priority scores. It is necessary to consider ethical issues as an educational priority for GPs working in the field of OM.

La Medicina del Trabajo y la valoración de la capacidad laboral / Occupational Medicine and evaluación of work ability

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Investigación y divulgación científica en Medicina del Trabajo / Investigation in Occupational Medicine

No disponible

[Ethical values and virtues of the Diatriba. A tribute to Bernardino Ramazzini on the tercentenary of his death (1714)]. / Virtù e valori etici della Diatriba. Un tributo a Bernardino Ramazzini in occasione del trecentesimo anniversario della morte (1714).

Based on Hyppocratic values of ancient medicine, Ramazzini's way of thinking prefigures the social medicine that was to be an achievement of the Enlightenment. This contribution aims at analyzing the ethical aspects of the Diatriba. The preface already contains elements that constitute the ethical manifesto of Ramazzini. He shows compassion ("...we must admit that the workers in certain arts and crafts sometimes derive from them grave injuries"), expresses gratitude ("we owe this to the wretched condition of the workers from whose manual toil...so many benefits accrue"), demonstrates a sense of justice ("...in our own time also laws have been passed in well-ordered cities to secure good conditions for the workers; so it is only right that the art of medicine should contribute its portion for the benefit and relief of those for whom the law has shown such foresight") and demonstrates his willingness to be helpful to workers ("...I have tried to unearth in the shops of craftsmen...to suggest medical precautions for the prevention and treatment of such diseases as usually affect the workers"). The ethical contribution of Ramazzini, however, goes far beyond these noble and heartfelt words, demonstrating his intellectual and moral depth. In fact, alongside comments and suggestions, quotations and proposals, information and warnings, the Magister offers a framework for his beliefs on the attitude that the physician should adopt. Prudence and moderation inspire his recommendations when he speaks directly and indirectly to workers; irony and sarcasm pervade his thoughts when he talks to his colleagues, fairness and integrity inspire his remarks to authorities. Although current practice is based on ethical rules dating back to more recent times, the ethical vision of the Magister, that is admirable for its honesty, originality and depth, is in some respects still relevant today.

Models of occupational medicine practice: an approach to understanding moral conflict in "dual obligation" doctors.

In the United Kingdom (UK), ethical guidance for doctors assumes a therapeutic setting and a normal doctor-patient relationship. However, doctors with dual obligations may not always operate on the basis of these assumptions in all aspects of their role. In this paper, the situation of UK occupational physicians is described, and a set of models to characterise their different practices is proposed. The interaction between doctor and worker in each of these models is compared with the normal doctor-patient relationship, focusing on the different levels of trust required, the possible power imbalance and the fiduciary obligations that apply. This approach highlights discrepancies between what the UK General Medical Council guidance requires and what is required of a doctor in certain roles or functions. It is suggested that using this modelling approach could also help in clarifying the sources of moral conflict for other doctors with "dual obligations" in their various roles.

Pre-employment medical testing in Brazil: ethical challenges.

Pre-employment medical tests, considered to be a practice within the subspecialty of occupational medicine, are ordered by physicians on behalf of employers. Candidates for a job may be rejected if they are found to suffer from a condition that can be worsened by the job, or one that may put other workers at risk. As the physician who orders pre-employment tests is chosen by the employer, pre-employment tests can violate both the autonomy and the privacy of the individual. This paper discusses ethical conflicts inherent in pre-employment medical testing.

Grounded for an ethical dilemma: disequilibrium in a commercial airline pilot.

This article presents the case of a 41-year-old airline pilot with benign paroxysmal positional vertigo who requests that his diagnosis not be disclosed to his commercial airline employer or his aviation medical examiner because it may result in the suspension of medical certification. The legal and ethical requirements for physicians reporting impaired pilots are discussed as well as practical recommendations for handling such situations. The argument is made that a physician's obligation to honor patient confidentiality should not take precedence over his or her duty to protect the safety and well-being of the airplane passengers and the general public. If the patient chooses not to self-report, a physician has an ethical obligation to report the patient's medical condition to the Federal Aviation Administration.

Occupational physicians' perceptions and impact of 2009 GMC consent guidelines.

BACKGROUND: In 2009, the General Medical Council (GMC) updated its guidance on consent, introducing a new statement that employees should be offered the opportunity to view reports, before the reports are sent to the employer. AIMS: To investigate the effects of this change on the perceptions and practice of occupational physicians. METHODS: A cross-sectional survey of UK occupational physicians via the Society of Occupational Medicine e-newsletter, seeking their opinions of the anticipated and actual effects of the guidance on employers, employees, occupational physicians and occupational health services. RESULTS: Two hundred and ninety-five completed questionnaires were returned (estimated response rate 30%). Respondents included 25% of accredited UK specialists. Some reported improved standards and greater transparency, however the change was generally perceived as unfavourable, with employee and employer losses: 50% reported delay providing timely advice to employers and 35% reported delays in employees returning to work. Significant variation in practice and increased costs were reported, with variable effects on different services. Difficulties in areas such as pensions and health surveillance were reported. Some occupational physicians had moved to instant reporting; others had moved away from this to allow more care with wording of reports. CONCLUSIONS: We found significant variations in practice between occupational physicians and concerns of employee and employer losses as a result of changes to the GMC consent guidance. Clearer guidance on practical implementation was desired. The background ethical reasoning should be stated so that the parameters of the guidance are delineated and its reach should be clarified.