1
|
Kumfor F, Wei G, Ries N, Bennett H, D'Mello M, Kaizik C, Piguet O, Hodges JR. Examining the propensity and nature of criminal risk behaviours in frontotemporal dementia syndromes and Alzheimer's disease. Alzheimers Dement (Amst) 2024; 16:e12577. [PMID: 38605995 PMCID: PMC11007792 DOI: 10.1002/dad2.12577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/14/2024] [Accepted: 02/18/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Some people with dementia develop changes in behaviour and cognition that may lead to interactions with police or the legal system. However, large, prospective case-control studies examining these behaviours are lacking. METHODS One hundred and forty-four people with dementia and 53 controls completed the Misdemeanours and Transgressions Screener. RESULTS Criminal risk behaviours were reported in: 65.6% of behavioural-variant frontotemporal dementia, 46.2% of right-lateralised semantic dementia, and 27.0% of Alzheimer's disease patients. In 19.1% of patients these behaviours led to contact with police or authority figures. Compared to controls, people with dementia showed higher rates of physical assault (p = 0.024), financial/professional recklessness (p = 0.009), and inappropriate behaviours (p = 0.052). DISCUSSION Criminal risk behaviours are common across dementia subtypes and may be one of the first clinical signs of frontotemporal dementia. Further research to understand how to balance risk minimisation with an individual's liberties as well as the inappropriate criminalisation of people with dementia is needed. Highlights The Misdemeanours and Transgressions Screener is a new tool to assess criminal risk behaviours.Forty-seven percent of patients with dementia show criminal risk behaviour after dementia onset.Behaviours included verbal abuse, traffic violations, physical assault.New onset of criminal risk behaviours >50 years is a clinical sign for frontotemporal dementia.
Collapse
Affiliation(s)
- Fiona Kumfor
- School of PsychologyUniversity of SydneySydneyNew South WalesAustralia
- Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia
| | - Grace Wei
- School of PsychologyUniversity of SydneySydneyNew South WalesAustralia
- Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia
| | - Nola Ries
- Law Health Justice Research CentreUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Hayley Bennett
- Neuroscience Research AustraliaRandwickNew South WalesAustralia
| | - Mirelle D'Mello
- School of PsychologyUniversity of SydneySydneyNew South WalesAustralia
- Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia
| | - Cassandra Kaizik
- School of PsychologyUniversity of SydneySydneyNew South WalesAustralia
- Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia
| | - Olivier Piguet
- School of PsychologyUniversity of SydneySydneyNew South WalesAustralia
- Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia
| | - John R. Hodges
- Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia
- Central Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia
| |
Collapse
|
2
|
Levy MJ, Wend CM, Flemming WP, Lazieh A, Rosenblum AJ, Pineda CM, Wolfberg DM, Jenkins JL, Goolsby CA, Margolis AM. Bleeding Control Protections Within US Good Samaritan Laws. Prehosp Disaster Med 2024; 39:156-162. [PMID: 38572644 DOI: 10.1017/s1049023x24000268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
INTRODUCTION In the United States, all 50 states and the District of Columbia have Good Samaritan Laws (GSLs). Designed to encourage bystanders to aid at the scene of an emergency, GSLs generally limit the risk of civil tort liability if the care is rendered in good faith. Nation-wide, a leading cause of preventable death is uncontrolled external hemorrhage. Public bleeding control initiatives aim to train the public to recognize life-threatening external bleeding, perform life-sustaining interventions (including direct pressure, tourniquet application, and wound packing), and to promote access to bleeding control equipment to ensure a rapid response from bystanders. METHODS This study sought to identify the GSLs in each state and the District of Columbia to identify what type of responder is covered by the law (eg, all laypersons, only trained individuals, or only licensed health care providers) and if bleeding control is explicitly included or excluded in their Good Samaritan coverage. RESULTS Good Samaritan Laws providing civil liability qualified immunity were identified in all 50 states and the District of Columbia. One state, Oklahoma, specifically includes bleeding control in its GSLs. Six states - Connecticut, Illinois, Kansas, Kentucky, Michigan, and Missouri - have laws that define those covered under Good Samaritan immunity, generally limiting protection to individuals trained in a standard first aid or resuscitation course or health care clinicians. No state explicitly excludes bleeding control from their GSLs, and one state expressly includes it. CONCLUSION Nation-wide across the United States, most states have broad bystander coverage within GSLs for emergency medical conditions of all types, including bleeding emergencies, and no state explicitly excludes bleeding control interventions. Some states restrict coverage to those health care personnel or bystanders who have completed a specific training program. Opportunity exists for additional research into those states whose GSLs may not be inclusive of bleeding control interventions.
Collapse
Affiliation(s)
- Matthew J Levy
- Johns Hopkins School of Medicine, Baltimore, MarylandUSA
| | | | | | - Antoin Lazieh
- Rutgers New Jersey Medical School, Newark, New JerseyUSA
| | | | | | | | | | | | - Asa M Margolis
- Johns Hopkins School of Medicine, Baltimore, MarylandUSA
| |
Collapse
|
3
|
Khan A, Garg T, Khunte M, Bajaj S, Wu X, Mezrich J, Malhotra A. Analysis of Medical Malpractice Claims Involving Interventional Radiologists: A Comprehensive Analysis From Two National Legal Databases. J Am Coll Radiol 2024; 21:656-662. [PMID: 37769859 DOI: 10.1016/j.jacr.2023.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE The nature of lawsuits involving interventional radiologists (IRs) is not well understood. The purposes of this article are to provide an overview of the causes of action underlying medical malpractice lawsuits related to IRs and to characterize the associated factors and outcomes. METHODS Two large legal databases were used to search for US legal cases in which there were jury awards and settlements involving IRs in the United States. Cases were screened to include only those cases in which the cause of action involved negligence on the part of IRs. RESULTS A total of 389 published case summaries were identified, of which 93 were eligible to be included in the analysis. In 46% of the cases (43 of 93), medical malpractice was alleged against an individual IR, whereas in 43% (40 of 93), it was alleged against both an individual IR and a health care institution. Thirty-five percent of IR malpractice cases (33 of 93) involved the performance of a vascular procedure, most commonly embolization procedures (30% [n = 10]), stenting or angioplasty (21% [n = 7]), and diagnostic arteriography and angiography (18% [n = 6]). Twenty-six percent of cases (24 of 93) involved IR performance of a biopsy. Eighteen percent of cases (17 of 93) involved a failure to gain informed consent in addition to an allegation of medical negligence during treatment. Eleven percent of cases (10 of 93) were resolved by settlement, with an average settlement amount of $877,500 (range, $200,000-$2,700,000). Among the 72 cases that went to trial, 74% (53 of 72) resulted in judgments for the defendants, and 26% (19 of 72) resulted in judgements for the plaintiffs, with an average award of $2,012,243 (range, $101,667-$6,400,000). CONCLUSIONS Vascular procedures and biopsies were the most frequent reasons for malpractice lawsuits involving IRs. Failure to gain informed consent in addition to an allegation of medical negligence during treatment was not infrequent. Although the majority of published medical malpractice claims involving IRs resulted in judgments in favor of the defendants, the average amount awarded to plaintiffs was higher compared with previous data reported for all physicians.
Collapse
Affiliation(s)
- Amin Khan
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mihir Khunte
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Suryansh Bajaj
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Xiao Wu
- Department of Radiology, University of California, San Francisco, San Francisco, California
| | - Jonathan Mezrich
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.
| |
Collapse
|
4
|
Bente BE, Van Dongen A, Verdaasdonk R, van Gemert-Pijnen L. eHealth implementation in Europe: a scoping review on legal, ethical, financial, and technological aspects. Front Digit Health 2024; 6:1332707. [PMID: 38524249 PMCID: PMC10957613 DOI: 10.3389/fdgth.2024.1332707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/12/2024] [Indexed: 03/26/2024] Open
Abstract
Background The evolution of eHealth development has shifted from standalone tools to comprehensive digital health environments, fostering data exchange among diverse stakeholders and systems. Nevertheless, existing research and implementation frameworks have primarily emphasized technological and organizational aspects of eHealth implementation, overlooking the intricate legal, ethical, and financial considerations. It is essential to discover what legal, ethical, financial, and technological challenges should be considered to ensure successful and sustainable implementation of eHealth. Objective This review aims to provide insights into barriers and facilitators of legal, ethical, financial, and technological aspects for successful implementation of complex eHealth technologies, which impacts multiple levels and multiple stakeholders. Methods A scoping review was conducted by querying PubMed, Scopus, Web of Science, and ACM Digital Library (2018-2023) for studies describing the implementation process of eHealth technologies that facilitate data exchange. Studies solely reporting clinical outcomes or conducted outside Europe were excluded. Two independent reviewers selected the studies. A conceptual framework was constructed through axial and inductive coding, extracting data from literature on legal, ethical, financial, and technological aspects of eHealth implementation. This framework guided systematic extraction and interpretation. Results The search resulted in 7.308 studies that were screened for eligibility, of which 35 (0.48%) were included. Legal barriers revolve around data confidentiality and security, necessitating clear regulatory guidelines. Ethical barriers span consent, responsibility, liability, and validation complexities, necessitating robust frameworks. Financial barriers stem from inadequate funding, requiring (commercial) partnerships and business models. Technological issues include interoperability, integration, and malfunctioning, necessitating strategies for enhancing data reliability, improving accessibility, and aligning eHealth technology with existing systems for smoother integration. Conclusions This research highlights the multifaceted nature of eHealth implementation, encompassing legal, ethical, financial, and technological considerations. Collaborative stakeholder engagement is paramount for effective decision-making and aligns with the transition from standalone eHealth tools to integrated digital health environments. Identifying suitable stakeholders and recognizing their stakes and values enriches implementation strategies with expertise and guidance across all aspects. Future research should explore the timing of these considerations and practical solutions for regulatory compliance, funding, navigation of responsibility and liability, and business models for reimbursement strategies.
Collapse
Affiliation(s)
- Britt E. Bente
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Esnchede, Netherlands
| | - Anne Van Dongen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Esnchede, Netherlands
| | - Ruud Verdaasdonk
- Section of Health, Technology and Implementation, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Lisette van Gemert-Pijnen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Esnchede, Netherlands
| |
Collapse
|
5
|
Datta V, Blum AW. Forensic assessment of somatoform and functional neurological disorders. Behav Sci Law 2024. [PMID: 38450761 DOI: 10.1002/bsl.2651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 03/08/2024]
Abstract
Functional neurological disorders (FND) and somatization are common in clinical practice and medicolegal settings. These conditions are frequently disabling and, if arising following an accident, may lead to claims for legal compensation or occupational disability (such as social security disability insurance). However, distinguishing FND and somatization from symptoms that are intentionally produced (i.e., malingered or factitious) may pose a major forensic psychiatric challenge. In this article, we describe how somatoform disorders and FND lie along a spectrum of abnormal illness-related behaviors, including factitious disorder, compensation neurosis, and malingering. We provide a systematic approach to the forensic assessment of FND and conclude by describing common litigation scenarios in which FND may be at issue. Forensic testimony may play an important role in the resolution of such cases.
Collapse
Affiliation(s)
- Vivek Datta
- Private Practice, San Francisco, California, USA
| | - Austin W Blum
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| |
Collapse
|
6
|
Sangari A, Sood A, Stoff BK. What to do when you are curbsided by your patient's plus one. J Am Acad Dermatol 2024; 90:671-672. [PMID: 36029913 DOI: 10.1016/j.jaad.2022.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/20/2022] [Accepted: 08/21/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Ayush Sangari
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Aditya Sood
- Department of Dermatology, Emory University School of Medicine, Druid Hills, Georgia.
| | - Benjamin K Stoff
- Department of Dermatology, Emory University School of Medicine, Druid Hills, Georgia; Emory Center for Ethics, Druid Hills, Georgia
| |
Collapse
|
7
|
Zandesh Z. Privacy, Security, and Legal Issues in the Health Cloud: Structured Review for Taxonomy Development. JMIR Form Res 2024; 8:e38372. [PMID: 38345858 PMCID: PMC10897789 DOI: 10.2196/38372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 01/01/2023] [Accepted: 01/24/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Privacy in our digital world is a very complicated topic, especially when meeting cloud computing technological achievements with its multidimensional context. Here, privacy is an extended concept that is sometimes referred to as legal, philosophical, or even technical. Consequently, there is a need to harmonize it with other aspects in health care in order to provide a new ecosystem. This new ecosystem can lead to a paradigm shift involving the reconstruction and redesign of some of the most important and essential requirements like privacy concepts, legal issues, and security services. Cloud computing in the health domain has markedly contributed to other technologies, such as mobile health, health Internet of Things, and wireless body area networks, with their increasing numbers of embedded applications. Other dependent applications, which are usually used in health businesses like social networks, or some newly introduced applications have issues regarding privacy transparency boundaries and privacy-preserving principles, which have made policy making difficult in the field. OBJECTIVE One way to overcome this challenge is to develop a taxonomy to identify all relevant factors. A taxonomy serves to bring conceptual clarity to the set of alternatives in in-person health care delivery. This study aimed to construct a comprehensive taxonomy for privacy in the health cloud, which also provides a prospective landscape for privacy in related technologies. METHODS A search was performed for relevant published English papers in databases, including Web of Science, IEEE Digital Library, Google Scholar, Scopus, and PubMed. A total of 2042 papers were related to the health cloud privacy concept according to predefined keywords and search strings. Taxonomy designing was performed using the deductive methodology. RESULTS This taxonomy has 3 layers. The first layer has 4 main dimensions, including cloud, data, device, and legal. The second layer has 15 components, and the final layer has related subcategories (n=57). This taxonomy covers some related concepts, such as privacy, security, confidentiality, and legal issues, which are categorized here and defined by their expansion and distinctive boundaries. The main merits of this taxonomy are its ability to clarify privacy terms for different scenarios and signalize the privacy multidisciplinary objectification in eHealth. CONCLUSIONS This taxonomy can cover health industry requirements with its specifications like health data and scenarios, which are considered as the most complicated among businesses and industries. Therefore, the use of this taxonomy could be generalized and customized to other domains and businesses that have less complications. Moreover, this taxonomy has different stockholders, including people, organizations, and systems. If the antecedent effort in the taxonomy is proven, subject matter experts could enhance the extent of privacy in the health cloud by verifying, evaluating, and revising this taxonomy.
Collapse
Affiliation(s)
- Zahra Zandesh
- Information Technology and Statistics Department, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
8
|
Zasler ND. Medico legal issues and disorders of consciousness. NeuroRehabilitation 2024; 54:149-165. [PMID: 38217622 DOI: 10.3233/nre-230242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
BACKGROUND The tasks and responsibilities that come with clinician involvement in medicolegal proceedings can be daunting and particularly so in challenging areas such as provision of medicolegal opinions in cases involving disorders of consciousness (DoC). OBJECTIVE The aim of this narrative review was to provide education and advice to healthcare practitioners who by choice or circumstance are asked and/or required to provide medicolegal opinions in cases involving patients with DoC. METHODS A literature search was conducted using PubMed Central and MedlinePlus for articles dealing with clinician involvement in medicolegal cases involving persons with DoC. The information provided also integrates the authors' nearly 40 years of clinical experience, brain injury medicine practice and "trials and tribulations" associated with medicolegal involvement in such cases. RESULTS The literature was found to be replete with articles on brain death and withdrawal/withholding of care (which are not the focus of this review). The extant medical literature in brain injury medicine on the other hand is currently lacking in practical information for clinicians working "in the trenches" regarding the challenges and caveats of medicolegal involvement in such cases. CONCLUSION This review provides the reader with a big picture overview of the most pertinent medicolegal topics inherent in clinical work with patients with DOC including pertinent nomenclature, caveats regarding forensic consultation including independent medical examinations, testimony tips, discussion of life expectancy/median survival concepts, prognostication in a medicolegal context, documentation and record keeping as well as some of the specific challenges pertinent to these types of brain injury cases that are not per se relevant in less severe injuries.
Collapse
Affiliation(s)
- Nathan D Zasler
- Concussion Care Centre of Virginia, Ltd., Richmond, VA, USA
- Tree of Life, Richmond, VA, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
- Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
9
|
Greely HT. Science fiction and ELSI: three thoughts. Front Genet 2023; 14:1270590. [PMID: 38148977 PMCID: PMC10750382 DOI: 10.3389/fgene.2023.1270590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023] Open
Abstract
Science fiction can be useful to those who analyze ethical, legal, and social issues (ELSI) in genetics and the biosciences more broadly. It can provide examples of possible technological changes, which are occasionally valuable as predictions of the future but more often helpful as indicators of the likely social consequences of such technologies. This "what-if" approach to science fiction can also provide a good pathway to exploring such issues. Science fiction can also allow a more distant, less realistic, and non-culture-specific context for exploring deep questions about humanity, ethics, and other major issues. At the same time, science fiction also has some negative effects on such analysis or its reception as a result of the need for fiction to hold its audience by providing drama through conflict. This necessity for successful fiction often leads to technological or cultural changes being portrayed as catastrophic and dystopian, much more often than beneficial or utopian. This imbalance can predispose public opinion against innovations unfairly, in part by providing "examples" from fiction of similar innovations, leading to bad outcomes. ELSI researchers should keep this fiction-induced bias in mind in their work.
Collapse
Affiliation(s)
- Henry T. Greely
- Stanford Law School, Stanford University, Stanford, CA, United States
- Center for Law and the Biosciences, Stanford, CA, United States
| |
Collapse
|
10
|
Abstract
As winter draws on it is timely to look at ways in which nurses in the community may be faced with problems, expected and unexpected, when their patients are particularly affected by cold conditions and at the precautions which need to be taken to avoid or lessen adverse effects on their health. As in the case of heat-related risks to health, examined in an earlier article, so too in the case of cold those most at risk are elderly patients and those who are vulnerable due to a pre-existing condition affecting health even in a more clement climate. Cold weather attracts extra legal responsibilities which are examined in this article.
Collapse
Affiliation(s)
- John Finch
- Freelance journalist specialising in law and ethics relating to healthcare
| |
Collapse
|
11
|
Sato K, Hida A, Niimi Y, Iwata A, Iwatsubo T. [Survey on the Current Advertising and Sales of Mucuna pruriens in Consumer-to-consumer Internet Trading in Japan]. YAKUGAKU ZASSHI 2023; 143:1057-1067. [PMID: 37839871 DOI: 10.1248/yakushi.23-00145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Mucuna pruriens (MP) is leguminous plant which contains 5% of L-3,4-dihydroxyphenylalanine (levodopa) in its seeds. It may have a potential to be used as an alternative therapy for Parkinson's disease (PD). Meanwhile, there is a concern in terms of public health that MP products can be overused by patients with PD. As an entry for patients with PD to acquire MP products in Japan, they are often purchased via internet auctions or free markets. MP products are not reagrded as 'pharmatheutical' by Japanese law as long as the specific legal requirements on advertisements are met, so that the MP products can be advertised or sold without any permission from the authorities. In this study, we aimed to conduct internet survey as to the complianse status of these legal requirements. Several major internet auction or free market websites in Japan were surveyed in May-June 2023 by the authors, and 1157 MP product pages were examined. We found approximately 30-40% of the MP products were suspected to have potential legal risks in terms of their advertisements in their website descriptions, such as claiming pharmatheutical efficacy or describing pharmatheutical-like dosages. In addition, approximately 30-40% of the MP products also did not refer to cautions not to take MP products excessively because of the levodopa ingredients. Current study suggested the need of careful description of the MP products in the auction or free market websites for the MP products exhibitors or sellers, in order to fullfill legal requirements as well as to prevent MP abuse.
Collapse
Affiliation(s)
- Kenichiro Sato
- Unit for Early and Exploratory Development, The University of Tokyo Hospital
- Department of Neuropathology, Graduate School of Medicine, The University of Tokyo
| | - Ayumi Hida
- Department of Neurology, Meirikai Tokyo Yamato Hospital
- Daiichi Tokyo Bar Association, Japan
| | - Yoshiki Niimi
- Unit for Early and Exploratory Development, The University of Tokyo Hospital
| | - Atsushi Iwata
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital
| | - Takeshi Iwatsubo
- Unit for Early and Exploratory Development, The University of Tokyo Hospital
- Department of Neuropathology, Graduate School of Medicine, The University of Tokyo
| |
Collapse
|
12
|
Koenig LR, Becker A, Ko J, Upadhyay UD. The Role of Telehealth in Promoting Equitable Abortion Access in the United States: Spatial Analysis. JMIR Public Health Surveill 2023; 9:e45671. [PMID: 37934583 PMCID: PMC10664017 DOI: 10.2196/45671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/05/2023] [Accepted: 09/26/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Even preceding the Supreme Court's 2022 Dobbs v. Jackson Women's Health Organization decision, patients in the United States faced exceptional barriers to reach abortion providers. Abortion restrictions disproportionately limited abortion access among people of color, young people, and those living on low incomes. Presently, clinics in states where abortion remains legal are experiencing an influx of out-of-state patients and wait times for in-person appointments are increasing. Direct-to-patient telehealth for abortion care has expanded since its introduction in the United States in 2020. However, the role of this telehealth model in addressing geographic barriers to and inequities in abortion access remains unclear. OBJECTIVE We sought to examine the amount of travel that patients averted by using telehealth for abortion care, and the role of telehealth in mitigating inequities in abortion access by race or ethnicity, age, pregnancy duration, socioeconomic status, rural residence, and distance to a facility. METHODS We used geospatial analyses and data from patients in the California Home Abortion by Telehealth Study, residing in 31 states and Washington DC, who obtained telehealth abortion care at 1 of 3 virtual abortion clinics. We used patients' residential ZIP code data and data from US abortion facility locations to document the round-trip driving distance in miles, driving time, and public transit time to the nearest abortion facility that patients averted by using telehealth abortion services from April 2021 to January 2022, before the Dobbs decision. We used binomial regression to assess whether patients reported that telehealth was more likely to make it possible to access a timely abortion among patients of color, those experiencing food insecurity, younger patients, those with longer pregnancy durations, rural patients, and those residing further from their closest abortion facility. RESULTS The 6027 patients averted a median of 10 (IQR 5-26) miles and 25 (IQR 14-46) minutes of round-trip driving, and 1 hour 25 minutes (IQR 46 minutes to 2 hours 30 minutes) of round-trip public transit time. Among a subsample of 1586 patients surveyed, 43% (n=683) reported that telehealth made it possible to obtain timely abortion care. Telehealth was most likely to make it possible to have a timely abortion for younger patients (prevalence ratio [PR] 1.4, 95% CI 1.2-1.6) for patients younger than 25 years of age compared to those 35 years of age or older), rural patients (PR 1.4, 95% CI 1.2-1.6), those experiencing food insecurity (PR 1.3, 95% CI 1.1-1.4), and those who averted over 100 miles of driving to their closest abortion facility (PR 1.6, 95% CI 1.3-1.9). CONCLUSIONS These findings support the role of telehealth in reducing abortion-related travel barriers in states where abortion remains legal, especially among patient populations who already face structural barriers to abortion care. Restrictions on telehealth abortion threaten health equity.
Collapse
Affiliation(s)
- Leah R Koenig
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
- Center for Gender and Health Justice, University of California Global Health Institute, Oakland, CA, United States
| | - Andréa Becker
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Jennifer Ko
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States
- Center for Gender and Health Justice, University of California Global Health Institute, Oakland, CA, United States
| | - Ushma D Upadhyay
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States
- Center for Gender and Health Justice, University of California Global Health Institute, Oakland, CA, United States
| |
Collapse
|
13
|
Magee DE, Bukavina L, Correa A. Taking a Stand: No Conferences in Anti-abortion States. J Urol 2023; 210:728-730. [PMID: 37643454 DOI: 10.1097/ju.0000000000003686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Diana E Magee
- Department of Urology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
| | - Laura Bukavina
- Department of Urology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
| | - Andres Correa
- Department of Urology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
| |
Collapse
|
14
|
Chan K, Hu Z, Bush LW, Cope H, Holm IA, Kingsmore SF, Wilhelm K, Scharfe C, Brower A. NBSTRN Tools to Advance Newborn Screening Research and Support Newborn Screening Stakeholders. Int J Neonatal Screen 2023; 9:63. [PMID: 37987476 PMCID: PMC10660757 DOI: 10.3390/ijns9040063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023] Open
Abstract
Rapid advances in the screening, diagnosis, and treatment of genetic disorders have increased the number of conditions that can be detected through universal newborn screening (NBS). However, the addition of conditions to the Recommended Uniform Screening Panel (RUSP) and the implementation of nationwide screening has been a slow process taking several years to accomplish for individual conditions. Here, we describe web-based tools and resources developed and implemented by the newborn screening translational research network (NBSTRN) to advance newborn screening research and support NBS stakeholders worldwide. The NBSTRN's tools include the Longitudinal Pediatric Data Resource (LPDR), the NBS Condition Resource (NBS-CR), the NBS Virtual Repository (NBS-VR), and the Ethical, Legal, and Social Issues (ELSI) Advantage. Research programs, including the Inborn Errors of Metabolism Information System (IBEM-IS), BabySeq, EarlyCheck, and Family Narratives Use Cases, have utilized NBSTRN's tools and, in turn, contributed research data to further expand and refine these resources. Additionally, we discuss ongoing tool development to facilitate the expansion of genetic disease screening in increasingly diverse populations. In conclusion, NBSTRN's tools and resources provide a trusted platform to enable NBS stakeholders to advance NBS research and improve clinical care for patients and their families.
Collapse
Affiliation(s)
- Kee Chan
- American College of Medical Genetics and Genomics, Bethesda, MD 20814, USA
| | - Zhanzhi Hu
- Department of Systems Biology, Columbia University, New York, NY 10032, USA
| | - Lynn W Bush
- Division Genetics and Genomics, Boston Children's Hospital Center, Boston, MA 02115, USA
- Department of Pediatrics and Center for Bioethics, Harvard Medical School, Boston, MA 02115, USA
| | - Heidi Cope
- GenOmics and Translational Research Center, RTI International, Research Triangle Park, NC 27709, USA
| | - Ingrid A Holm
- Division Genetics and Genomics, Boston Children's Hospital Center, Boston, MA 02115, USA
- Department of Pediatrics and Center for Bioethics, Harvard Medical School, Boston, MA 02115, USA
| | | | - Kevin Wilhelm
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Curt Scharfe
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA
| | - Amy Brower
- American College of Medical Genetics and Genomics, Bethesda, MD 20814, USA
| |
Collapse
|
15
|
Finch J. Legal responsibilities relating to isolation. Br J Community Nurs 2023; 28:510-512. [PMID: 37793106 DOI: 10.12968/bjcn.2023.28.10.510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Isolation can cause harm in everyday life, even in the most benign conditions. Taking on responsibility for a patient in the community who is isolated can entail a responsibility to steer them on a course, which they might otherwise not have taken and which might redound to their benefit. In this article, John Finch, a freelance journalist specialising in clinical law and ethics, examines some of the legal responsibilities which are added by the effects of isolation to the already heavy burden carried by community nurses.
Collapse
Affiliation(s)
- John Finch
- Freelance journalist specialising in legal and ethical aspects of clinical care
| |
Collapse
|
16
|
Buckley TA, Bryk KN, Hunzinger KJ, Costantini K. National Collegiate Athletic Association athletic trainers' response to the Arrington settlement: management, compliance, and practice patterns. PHYSICIAN SPORTSMED 2023; 51:427-433. [PMID: 36026565 DOI: 10.1080/00913847.2022.2118001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/23/2022] [Indexed: 10/15/2022]
Abstract
The primary purpose of this study was to assess Athletic Trainers' (ATs) report of NCAA member institution compliance with the Arrington settlement, the concussion lawsuit vs. the NCAA, and to elucidate compliance predictors. A secondary purpose was to provide a contemporary concussion management clinical practice pattern description among NCAA collegiate athletic trainers. Head Athletic Trainers from NCAA Division I, II, and III completed an electronic questionnaire in August 2020 regarding their institution's response to the Arrington Settlement and their current concussion management clinical practice patterns. The 37-item questionnaire included AT and institution demographics, current concussion management policies, and response to the Arrington settlement with a specific focus on the five settlement requirements. An overall compliance score on the five requirements, compliance on the individual requirements, and concussion management practices are reported with descriptives. Regression was used to identify specific predictors of both overall and individual settlement requirements. An ANOVA compared compliance by NCAA division level. Being pressured to be non-compliant was assessed between sexes by a chi-square. There were 223 respondents (21.8%), and overall compliance was high (4.1 ± 0.7) with the five required Arrington Settlement components. Settlement requirement 1, pre-season baseline testing, and requirement 5, presence of trained personnel at all contact sport practices, had the lowest compliance rates at 44.8% and 73.3%, respectively. The number of sports the institution offered was the only significant predictor of each requirement. There was no difference in compliance between NCAA divisions. Although the overall rate of being non-compliant pressure was low (13.8%), females were 3.28x more likely report being pressured than males. NCAA institutions are generally compliant with the Arrington settlement; however, lack of clarity in the requirements, particularly requirement 1, raises potential concerns. Concussion management practices continue to incorporate multifaceted approaches and are largely consistent with current best practices.
Collapse
Affiliation(s)
- Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
- Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, DE, USA
| | | | - Katherine J Hunzinger
- Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Katelyn Costantini
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| |
Collapse
|
17
|
Abstract
Health problems related to climate change are with us to stay, some say for a good while. The effect of excessive heat on the human frame are manifold and they are encountered first in the home. During hot weather, community nurses are likely to be faced with an array of health issues not encountered in more temperate conditions. Those very health issues can also impact on legal issues. John Finch, a freelance journalist specialising in clinical law and ethics, examines how.
Collapse
Affiliation(s)
- John Finch
- Freelance journalist specialising in clinical law and ethics
| |
Collapse
|
18
|
Lv LL, Zhang MM. Up-to-date literature review and issues of sedation during digestive endoscopy. Wideochir Inne Tech Maloinwazyjne 2023; 18:418-435. [PMID: 37868289 PMCID: PMC10585454 DOI: 10.5114/wiitm.2023.127854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/03/2023] [Indexed: 10/24/2023] Open
Abstract
Sedation is common during digestive endoscopy to provide comfort and pain relief for patients. However, the use of sedation in endoscopy also poses potential risks, and recent issues have been raised regarding its safety and administration. This literature review paper will discuss the most recent developments in the field of sedation in digestive endoscopy, including the adverse events that might be associated with sedation and how to manage it, the legal issues associated with administration, the impact of COVID-19 on sedation practices, and sedation in special situations. It will also touch upon the current guidelines and recommendations for sedation, including the importance of patient selection and monitoring and the need for training and certification for endoscopists administering sedation. The review will also analyse studies evaluating the safety and efficacy of various sedation techniques, including propofol, midazolam, and others. It will examine the benefits and drawbacks of these agents.
Collapse
Affiliation(s)
- Lu-Lu Lv
- Department of Gastroenterology, Shengzhou People’s Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shengzhou, Zhejiang Province, China
| | - Meng-Meng Zhang
- Hangzhou Shangcheng District People’s Hospital, Hangzhou, Zhejiang Province, China
| |
Collapse
|
19
|
Rivron NC, Martinez Arias A, Pera MF, Moris N, M'hamdi HI. An ethical framework for human embryology with embryo models. Cell 2023; 186:3548-3557. [PMID: 37595564 DOI: 10.1016/j.cell.2023.07.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/24/2023] [Accepted: 07/18/2023] [Indexed: 08/20/2023]
Abstract
A human embryo's legal definition and its entitlement to protection vary greatly worldwide. Recently, human pluripotent stem cells have been used to form in vitro models of early embryos that have challenged legal definitions and raised questions regarding their usage. In this light, we propose a refined legal definition of an embryo, suggest "tipping points" for when human embryo models could eventually be afforded similar protection to that of embryos, and then revisit basic ethical principles that might help to draft a roadmap for the gradual, justified usage of embryo models in a manner that aims to maximize benefits to society.
Collapse
Affiliation(s)
- Nicolas C Rivron
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences (IMBA), Vienna Biocenter (VBC), 1030 Vienna, Austria.
| | - Alfonso Martinez Arias
- Systems Bioengineering, DCEXS, Universidad Pompeu Fabra, Doctor Aiguader 88 ICREA (Institució Catalana de Recerca i Estudis Avançats), Barcelona, Spain
| | | | - Naomi Moris
- The Francis Crick Institute, 1 Midland Road, NW1 1AT London, UK
| | - Hafez Ismaili M'hamdi
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| |
Collapse
|
20
|
Barrett R. A cross-sectional study on substandard and falsified medicines (fake or counterfeit drugs) in UK pharmacies during the COVID-19 pandemic. Expert Opin Drug Saf 2023; 22:1289-1299. [PMID: 36374122 DOI: 10.1080/14740338.2023.2147922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Failure of the Falsified Medicines Directive (FMD) in the UK could mean that substandard and falsified medicines (SFs) enter the supply chain. Does this risk patients' health? Readiness to implement FMD, and prevalence of SFs vs. regulator detection were assessed. RESEARCH DESIGN AND METHODS A total of 12,040 primary care pharmacies across England were invited (April 2021-March 2022). Respondent postcodes were used to extract deprivation scores. Information request was placed with the medicine's agency. Survey findings were used to calculate probability and power of a simulated trial. RESULTS A total of 208 participants responded: Of the seven who identified SFs, all but one reported it; 61% were ready to implement FMD, 74.1% had adequate resources, 54.8% expected improved patient safety, and 17.8% had ever reported SFs. SFs were prevalent in deprived areas. Bayesian simulation shows 438 (p = 0.030) incidences with a 3% probability of SFs prevalence. The agency identified 15,238 SFs units in the supply chain (2019 and 2020). Results are credible, reliable, and generalisable, with corroborated longitudinal persistence. CONCLUSIONS FMD or equivalent processes need to be urgently reinstated. Deprived children may be more affected. Pharmacists are worried about liability. All health consultations should assess safety, and effectiveness of medicines. Findings should inform policy, systems planning, surveillance, and evaluations.
Collapse
Affiliation(s)
- Ravina Barrett
- Pharmacy Practice, School of Applied Sciences, Cockcroft Building, University of Brighton, Brighton, UK
| |
Collapse
|
21
|
Md Said MHB, Emmanuel Kaka G. Domestic Violence in Cross-Border Marriages: A Systematic Review. Trauma Violence Abuse 2023; 24:1483-1502. [PMID: 35232287 DOI: 10.1177/15248380221074321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Cross-border marriages have been found to be associated with domestic violence due to the migration experiences of the couples concerned and the stress experienced before, during, and after migration, despite local and international legislation on domestic violence. A systematic review using the PRISMA Statement was conducted to examine the relationship between domestic violence and cross-border marriages among cross-border wives from Asian countries. Six databases-Taylor & Francis Online, Wiley Online, Scopus, Web of Science, Sage Journals, and Springer Online library, were used in the research which found 179 articles for eligibility and 58 articles were finally used in the review. To be included, studies must have addressed domestic violence and cross-border marriage among Asians, report qualitative, quantitative, or mixed methods, addressed the RQs, been published in polished English between 2010 and 2020 and published in a reputable journal with high impact factor. The systematic review found that immigration status, citizenship, culture, language barrier, diversity/intersectionality, age, and economic dependence are the risk factors for domestic violence, which leads effects such as divorce or separation, racism, loneliness, loss of identity & inheritance, stigma, abandonment, and discrimination. Yet these cross-border wives resorted to NGOs, social & religious groups, and traditional beliefs as coping strategies. The review suggests that legislations on domestic violence should be amended to include a definition of the rights of immigrant women, and the plight of cross-border wives, which should be protected. It is also imperative to propose favorable laws and policies regarding immigration status and citizenship for these cross-border couples.
Collapse
|
22
|
Hrymak H, Hrymak C, Ratana P, Leeies M. Legal issues pertaining to the collection of sociodemographic data in emergency departments. Acad Emerg Med 2023; 30:760-764. [PMID: 36869627 DOI: 10.1111/acem.14709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Affiliation(s)
- Haley Hrymak
- Peter A. Allard School of Law, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carmen Hrymak
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Section of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Ratana
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Murdoch Leeies
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Section of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
23
|
Koralesky KE, Rankin JM, Fraser D. Using institutional ethnography to analyse animal sheltering and protection I: Animal protection work. Anim Welf 2023; 32:e44. [PMID: 38487424 PMCID: PMC10936383 DOI: 10.1017/awf.2023.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 03/17/2024]
Abstract
Animal protection laws exist at federal, provincial and municipal levels in Canada, with enforcement agencies relying largely upon citizens to report concerns. Existing research about animal protection law focuses on general approaches to enforcement and how legal terms function in the courts, but the actual work processes of animal law enforcement have received little study. We used institutional ethnography to explore the everyday work of Call Centre operators and Animal Protection Officers, and we map how this work is organised by laws and institutional polices. When receiving and responding to calls staff try to identify evidence of animal 'distress' as legally defined, because various interventions (writing orders, seizing animals) then become possible. However, many cases, such as animals living in deprived or isolated situations, fall short of constituting 'distress' and the legally mandated interventions cannot be used. Officers are also constrained by privacy and property law and by the need to record attempts to secure compliance in order to justify further action including obtaining search warrants. As a result, beneficial intervention can be delayed or prevented. Officers sometimes work strategically to advocate for animals when the available legal tools cannot resolve problems. Recommendations arising from this research include expanding the legal definition of 'distress' to better fit animals' needs, developing ways for officers to intervene in a broader range of situations, and more ethnographic research on enforcement work in jurisdictions with different legal systems to better understand how animal protection work is organised and constrained by laws and policies.
Collapse
Affiliation(s)
- Katherine E Koralesky
- Animal Welfare Program, 2357 Main Mall, University of British Columbia, Vancouver, BC, Canada V6T1Z4
| | - Janet M Rankin
- Faculty of Nursing, University of Calgary, 2500 University Drive NW Calgary, AB, Canada T2N1N4
| | - David Fraser
- Animal Welfare Program, 2357 Main Mall, University of British Columbia, Vancouver, BC, Canada V6T1Z4
| |
Collapse
|
24
|
Nguyen DD, Fellouah M, Nguyen ALV, Kazu DC, Baltzan I, Labban M, De S, Zorn KC, Chughtai B, Elterman DS, Trinh QD, Bhojani N. Litigation associated with 5-alpha-reductase-inhibitor use: A Canadian legal database review. Can J Urol 2023; 30:11546-11550. [PMID: 37344466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
INTRODUCTION 5α-reductase inhibitors (5ARI) are commonly prescribed medications. There is ongoing controversy about the adverse events of these medications. The aim of this study is to characterize lawsuits in Canada involving medical complications of 5ARIs use. MATERIALS AND METHODS Legal cases were queried from CanLII. Cases were included if they involved a party taking a 5ARI who alleged an adverse event. Relevant full cases were retained, and pertinent characteristics were extracted with the help of a legal expert. RESULTS Our deduplicated search yielded 67 unique legal documents from December 2013 to February 2019. Twelve of these documents met the inclusion criteria (representing 3 cases, considering each case had several hearings). The medical complaints filed by the plaintiffs were all related to medication side effects (n = 3, 100%). The plaintiffs were commonly patients themselves. Defendants were exclusively pharmaceutical companies. Persistent erectile dysfunction after stopping the medication was cited as a side effect in all complaints. The prescriptions were made for male pattern hair loss (n = 3, 100%) in all cases. All cases represent class actions brought by the plaintiffs, and they have been certified by their respective court. However, the cases are still ongoing. CONCLUSION While 5ARI use has been linked to undesired sexual side effects, there have been few litigations on this issue in Canada. Persisting sexual dysfunction after stopping the medication is the only complaint presented in legal action. To date, no judgment against a physician or pharmaceutical company was identified. Cases are still ongoing.
Collapse
Affiliation(s)
- David-Dan Nguyen
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Massine Fellouah
- Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Anna-Lisa V Nguyen
- Faculty of Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | | | - Isabel Baltzan
- Faculty of Law, McGill University, Montréal, Quebec, Canada
| | - Muhieddine Labban
- Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School Boston, Massachusetts, USA
| | - Shubha De
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Kevin C Zorn
- Division of Urology, Centre hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, Quebec, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College/New York-Presbyterian, New York, New York, USA
| | - Dean S Elterman
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Quoc-Dien Trinh
- Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School Boston, Massachusetts, USA
| | - Naeem Bhojani
- Division of Urology, Centre hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, Quebec, Canada
| |
Collapse
|
25
|
Kamat S, Agarwal A, Klufas T, Patel S, Lu J. Teledermatology Within Correctional Settings in the United States: A Narrative Review of the Literature. JMIR Dermatol 2023; 6:e47115. [PMID: 37632943 PMCID: PMC10335332 DOI: 10.2196/47115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/07/2023] [Accepted: 05/15/2023] [Indexed: 08/28/2023] Open
Affiliation(s)
- Samir Kamat
- Icahn School of Medicine at Mount Sinai, New York City, NJ, United States
| | - Aneesh Agarwal
- Icahn School of Medicine at Mount Sinai, New York City, NJ, United States
| | | | - Saahil Patel
- The College of New Jersey, Ewing, NJ, United States
| | - Jun Lu
- Department of Dermatology, University of Conneticut, Farmington, CT, United States
| |
Collapse
|
26
|
Pal S, Ramanathan S. Ethical Consideration in Dealing With Suicide in Different Populations. Focus (Am Psychiatr Publ) 2023; 21:173-177. [PMID: 37201150 PMCID: PMC10172560 DOI: 10.1176/appi.focus.20220082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Affiliation(s)
- Sutanaya Pal
- Department of Psychiatry and Behavioral Sciences, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York
| | - Seetha Ramanathan
- Department of Psychiatry and Behavioral Sciences, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York
| |
Collapse
|
27
|
Torres-Castaño A, Abt-Sacks A, Toledo-Chávarri A, Suarez-Herrera JC, Delgado-Rodríguez J, León-Salas B, González-Hernández Y, Carmona-Rodríguez M, Serrano-Aguilar P. Ethical, Legal, Organisational and Social Issues of Teleneurology: A Scoping Review. Int J Environ Res Public Health 2023; 20:3694. [PMID: 36834388 PMCID: PMC9962592 DOI: 10.3390/ijerph20043694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Neurological disorders are the leading cause of disability and the second leading cause of death worldwide. Teleneurology (TN) allows neurology to be applied when the doctor and patient are not present in the same place, and sometimes not at the same time. In February 2021, the Spanish Ministry of Health requested a health technology assessment report on the implementation of TN as a complement to face-to-face neurological care. METHODS A scoping review was conducted to answer the question on the ethical, legal, social, organisational, patient (ELSI) and environmental impact of TN. The assessment of these aspects was carried out by adapting the EUnetHTA Core Model 3.0 framework, the criteria established by the Spanish Network of Health Technology Assessment Agencies and the analysis criteria of the European Validate (VALues In Doing Assessments of healthcare TEchnologies) project. Key stakeholders were invited to discuss their concerns about TN in an online meeting. Subsequently, the following electronic databases were consulted from 2016 to 10 June 2021: MEDLINE and EMBASE. RESULTS 79 studies met the inclusion criteria. This scoping review includes 37 studies related to acceptability and equity, 15 studies developed during COVID and 1 study on environmental aspects. Overall, the reported results reaffirm the necessary complementarity of TN with the usual face-to-face care. CONCLUSIONS This need for complementarity relates to factors such as acceptability, feasibility, risk of dehumanisation and aspects related to privacy and the confidentiality of sensitive data.
Collapse
Affiliation(s)
- Alezandra Torres-Castaño
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - Analía Abt-Sacks
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - Ana Toledo-Chávarri
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - José Carlos Suarez-Herrera
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- UNITWIN/UNESCO Chair, Research, Planning and Development of Local Health Systems, Department of Clinical Sciences, University of Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain
| | - Janet Delgado-Rodríguez
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
- Department of Philosophy I, University of Granada, 18071 Granada, Spain
| | - Beatriz León-Salas
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - Yadira González-Hernández
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - Montserrat Carmona-Rodríguez
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
- Health Technology Assessment Agency, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Pedro Serrano-Aguilar
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Institute of Biomedical Technologies, University of La Laguna, 38200 Tenerife, Spain
| |
Collapse
|
28
|
Weil CJ. Ethical, Legal, and Policy Issues Surrounding Biospecimen Research Conducted or Supported in the USA. Biopreserv Biobank 2023; 21:14-22. [PMID: 35138936 DOI: 10.1089/bio.2021.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Rapid and dramatic advances in molecular sequencing technology, as well as medical discoveries from genome-wide association and other precision medicine studies, have highlighted the longstanding ethical and legal challenges research biobanks consistently face. Whose authority is needed to conduct research with excised tissue, and how that authority may be exercised with respect and transparency, are central questions. This review article explores how scholars have addressed ethical and legal controversies such as the proper breadth and scope of consent for collection and future research use of biological specimens and data, the importance of disclosing individual research results and secondary findings, and collecting cadaver tissue from deceased persons. This article focuses on the legal and regulatory environment for conducting and/or supporting biospecimen research in the United States of America. It takes the position that proper biobank governance strategies, which ensure accountability and model respect toward biospecimen contributors, as well as transparency in communications between participants and researchers, reduce the likelihood of downstream legal disputes.
Collapse
Affiliation(s)
- Carol J Weil
- Consultant, Human research protections and Bioethics, Bethesda, Maryland, USA
| |
Collapse
|
29
|
Wang S, Lädermann A, Chiu J, Nabergoj M, Ho SWL, Brigitte VR, Bothorel H, Lädermann L, Kolo F. Muscle Edema of Retraction and Pseudo-Fatty Infiltration After Traumatic Rotator Cuff Tears: An Experimental Model in Sheep. Orthop J Sports Med 2023; 11:23259671231154275. [PMID: 36874052 PMCID: PMC9982832 DOI: 10.1177/23259671231154275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/21/2022] [Indexed: 03/04/2023] Open
Abstract
Background Traumatic rotator cuff tears can result in retraction of the tendon and may be associated with muscle edema, which may be confused with fatty infiltration as seen on magnetic resonance imaging (MRI). Purpose To describe the characteristics of a type of edema associated with acute retraction of the rotator cuff tendon (termed "edema of retraction") and to highlight the risk of mistaking it with pseudo-fatty infiltration of the rotator cuff muscle. Study Design Descriptive laboratory study. Methods A total of 12 alpine sheep were used for analysis. On the right shoulder, osteotomy of the greater tuberosity was performed to release the infraspinatus tendon; the contralateral limb acted as the control. MRI was performed immediately after surgery (time zero) and at 2 and 4 weeks postoperatively. T1-weighted, T2-weighted, and Dixon pure-fat sequences were reviewed for hyperintense signals. Results Edema of retraction resulted in hyperintense signals around or within the retracted rotator cuff muscle on both T1- and T2-weighted imaging, but there was an absence of hyperintense signals on Dixon pure-fat imaging. This represented pseudo-fatty infiltration. Edema of retraction created a characteristic "ground glass" appearance of the muscle on T1-weighted sequences and was often found in either the perimuscular or intramuscular location of the rotator cuff muscle. Compared to time zero values, a decrease in the percentage of fatty infiltration was observed at 4 weeks postoperatively (16.5% ± 4.0% vs 13.8% ± 2.9%, respectively; P < .005). Conclusion The location of edema of retraction was often peri- or intramuscular. Edema of retraction presented as a characteristic "ground glass" appearance of the muscle on T1-weighted sequences and led to a decrease in the fat percentage because of a dilution effect. Clinical Relevance Physicians should be aware that this edema can result in a form of pseudo-fatty infiltration, as it is associated with hyperintense signals on both T1- and T2-weighted sequences, and it can be mistaken for fatty infiltration.
Collapse
Affiliation(s)
- Sidi Wang
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland.,Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Joe Chiu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan
| | - Marko Nabergoj
- Valdoltra Orthopedic Hospital, Ankaran, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Sean W L Ho
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - von Rechenberg Brigitte
- Musculoskeletal Research Unit, University of Zurich, Zurich, Switzerland.,Competence Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland
| | - Hugo Bothorel
- Research Department, La Tour Hospital, Meyrin, Switzerland
| | - Léo Lädermann
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Frank Kolo
- Rive Droite Radiology Center, Geneva, Switzerland
| |
Collapse
|
30
|
Pallocci M, Treglia M, Passalacqua P, Tittarelli R, Zanovello C, De Luca L, Caparrelli V, De Luna V, Cisterna AM, Quintavalle G, Marsella LT. Informed Consent: Legal Obligation or Cornerstone of the Care Relationship? Int J Environ Res Public Health 2023; 20:ijerph20032118. [PMID: 36767485 PMCID: PMC9915667 DOI: 10.3390/ijerph20032118] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 06/02/2023]
Abstract
The topic of informed consent has become increasingly important in recent decades, both in the ethical-deontological field and as a duty of law. The review covered all sentences issued by the 13th section of the Civil Court of Rome during the period January 2016-December 2020. During this period, 156 judgments were found in which a breach of consent was required; in 24 of these, specific liability was proven, and the corresponding compensation liquidated. Moreover, 80% of the cases concerned the lack of information provided. The most involved branches were those related to surgical areas: general surgery, plastic surgery and aesthetic medicine and orthopaedics. The total amount of compensation paid was EUR 287,144.59. The research carried out has highlighted how, in a broad jurisprudential context, the damage caused by the violation of the right related to informed consent is considered, and how it impacts on the economic compensation of damages. Additionally, it showed that the areas most affected by the information deficit are those related to the performance of surgical activities, which are characterized by greater invasiveness and a higher risk of adverse events. The data reported underline the exigency to consider informed consent not as a mere documentary allegation but as an essential moment in the construction of a valid therapeutic alliance, which is also useful for avoiding unnecessary litigation that is becoming increasingly burdensome for healthcare systems all over the world.
Collapse
Affiliation(s)
- Margherita Pallocci
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Michele Treglia
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Pierluigi Passalacqua
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Roberta Tittarelli
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Claudia Zanovello
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Lucilla De Luca
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Valentina Caparrelli
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Vincenzo De Luna
- Department of Clinical Science and Translational Medicine, Section of Orthopedics and Traumatology, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | | | | | - Luigi Tonino Marsella
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| |
Collapse
|
31
|
Zarchi G, Sherman M, Gady O, Herzig T, Idan Z, Greenbaum D. Blockchains as a means to promote privacy protecting, access availing, incentive increasing, ELSI lessening DNA databases. Front Digit Health 2023; 4:1028249. [PMID: 36703942 PMCID: PMC9871783 DOI: 10.3389/fdgth.2022.1028249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023] Open
Abstract
Not all blockchains are created equal, and many cannot accommodate all of the primary characteristics of big data: Variety, Velocity, Volume and Veracity. Currently, public blockchains are slow and clunky, it can be expensive to keep up with the velocity of genomic data production. Further, the transparent and universally accessible nature of public blockchain doesn't necessarily accommodate all of the variety of sequence data, including very private information. Bespoke private permissioned blockchains, however, can be created to optimally accommodate all of the big data features of genomic data. Further, private permissioned chains can be implemented to both protect the privacy and security of the genetic information therein, while also providing access to researchers. An NFT marketplace associated with that private chain can provide the discretized sale of anonymous and encrypted data sets while also incentivizing individuals to share their data through payments mediated by smart contracts. Private blockchains can provide a transparent chain of custody for each use of the customers' data, and validation that this data is not corrupted. However, even with all of these benefits there remain some concerns with the implementation of this new technology including the ethical, legal and social implications typically associated with DNA databases.
Collapse
Affiliation(s)
- Gal Zarchi
- Reichman University (IDC) Herzliya, Herzliya, Tel Aviv District, Israel,Zvi Meitar Institute for Legal Implications of Emerging Technologies, Herzliya, Tel Aviv District, Israel
| | - Maya Sherman
- Reichman University (IDC) Herzliya, Herzliya, Tel Aviv District, Israel,Zvi Meitar Institute for Legal Implications of Emerging Technologies, Herzliya, Tel Aviv District, Israel
| | - Omer Gady
- Reichman University (IDC) Herzliya, Herzliya, Tel Aviv District, Israel,Zvi Meitar Institute for Legal Implications of Emerging Technologies, Herzliya, Tel Aviv District, Israel
| | - Tomer Herzig
- Reichman University (IDC) Herzliya, Herzliya, Tel Aviv District, Israel,Zvi Meitar Institute for Legal Implications of Emerging Technologies, Herzliya, Tel Aviv District, Israel
| | - Ziv Idan
- Reichman University (IDC) Herzliya, Herzliya, Tel Aviv District, Israel,Zvi Meitar Institute for Legal Implications of Emerging Technologies, Herzliya, Tel Aviv District, Israel
| | - Dov Greenbaum
- Reichman University (IDC) Herzliya, Herzliya, Tel Aviv District, Israel,Zvi Meitar Institute for Legal Implications of Emerging Technologies, Herzliya, Tel Aviv District, Israel,Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, NY, United States,Harry Radzyner Law School, Reichman University (IDC Herzliya), Herzliya, Israel
| |
Collapse
|
32
|
Abstract
Machine learning systems have become integrated into some of the most vital decision-making aspects of humanity, including hiring decisions, loan applications, and automobile safety, to name just a few. As applications increase in both gravity and complexity, the data quality and algorithmic interpretability of the systems must rise to meet those challenges. This is especially vital for navigating the nuances of health care, particularly among the high stakes of surgical operations. In addition to inherent ethical challenges of enabling a "black box" system to influence decision-making in patient care, the creation of biased datasets leads to biased algorithms with the power to perpetuate discrimination and reinforce disparities. Transparency and responsibility are paramount to the implementation of artificial intelligence in surgical decision-making and autonomous robotic surgery. Machine learning has been permeating health care across diverse clinical and surgical contexts but continues to face sizable obstacles, including apprehension from patients and providers alike. To integrate the technology fully while upholding standard of care and patient-provider trust, one must acknowledge and address the ethical, financial, and legal implications of using artificial intelligence for patient care.
Collapse
Affiliation(s)
- Miranda X Morris
- 12277Duke University School of Medicine, Durham, NC, USA.,22957Duke Pratt School of Engineering, Durham, NC, USA
| | - Ethan Y Song
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, 14742Duke University Hospital, Durham, NC, USA
| | - Aashish Rajesh
- Department of Surgery, 571198University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Malke Asaad
- Department of Plastic Surgery, 22957University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Brett T Phillips
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, 14742Duke University Hospital, Durham, NC, USA
| |
Collapse
|
33
|
van der Velden PG, Contino C, Das M, Wittmann L. To what extent do post-traumatic mental health and other problems reflect pre-existing problems? Findings from the prospective comparative population-based VICTIMS-study. Int J Soc Psychiatry 2022:207640221140287. [PMID: 36464851 DOI: 10.1177/00207640221140287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
BACKGROUND Findings from prospective studies question the assumption that mental health problems observed in traumatized adults mainly reflect the effects of potentially traumatic events. AIMS Aim of the present comparative prospective study is to clarify the extent to which victims of potentially traumatic events with mental health, social, financial, and/or legal problems, already suffered from such problems before these events. METHOD Data was extracted from three surveys of the prospective VICTIMS-study (T1 = 2018, T2 = 2019, T3 = 2020), conducted with the population-based longitudinal LISS-panel. Differences between victims (n = 340, victimized by violence, accidents, and serious threats in the 12 months before T3) and nonvictims (n = 3,872, not victimized by such events in this period), were examined using multivariate logistic regression analyses. RESULTS The large majority of victims with current (at T3) anxiety and depression symptomatology (74%), general mental health problems (71%), partner/family (67%), financial (76%), and legal problems (58%), and lack of support (79%), already had these problems (at T1 and/or at T2). A similar pattern was observed among nonvictims. Of the victims with current probable PTSD (at T3), 87% already had any mental health problem. At T3, among both groups, the incidence of problems was substantially lower than their prevalence. The large majority of victims with post-event mental health, social, financial, and legal problems already suffered from these problems in the past. CONCLUSIONS When victims seek help for their problems, professional care providers should be aware that in most cases, as among nonvictims, these problems are chronic/re-current rather than new problems.
Collapse
Affiliation(s)
- Peter G van der Velden
- Centerdata, Tilburg, The Netherlands.,TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | | | - Marcel Das
- Centerdata, Tilburg, The Netherlands.,Tilburg School of Economics and Management, Tilburg University, Tilburg, The Netherlands
| | - Lutz Wittmann
- International Psychoanalytic University Berlin, Berlin, Germany
| |
Collapse
|
34
|
Morris C, Scott RE, Mars M. A Survey of Telemedicine Use by Doctors in District Hospitals in KwaZulu-Natal, South Africa. Int J Environ Res Public Health 2022; 19:13029. [PMID: 36293608 PMCID: PMC9602563 DOI: 10.3390/ijerph192013029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
There is anecdotal evidence of informal telemedicine activity in KwaZulu-Natal (KZ-N), South Africa. AIM To determine the current extent of telemedicine in district hospitals in KZ-N; the range of clinical activities and technologies used; additional services needed; current knowledge and practice regarding legal, ethical, and regulatory issues; and the need to formalise telemedicine activities. METHOD A cross-sectional survey of telemedicine use by 143 doctors working at 22 District hospitals in KZ-N. RESULTS Most doctors (96%) participated in some form of telemedicine across a spectrum of disciplines, but more than half did not consider their activities to constitute telemedicine. To meet their needs, doctors have started their own informal services with colleagues, using mostly instant messaging and chat groups (WhatsApp). Some doctors indicated the need to formalise these services and establish additional services. Few doctors were aware of the national telemedicine guidelines and the required written informed consent for telemedicine was seldom obtained. This could have serious legal, regulatory, and ethical implications. CONCLUSIONS Practical clinical and technical guidelines and standard operating procedures need to be developed with the active participation of the clinical workforce. These should encourage innovation and greater use of telemedicine, including the use of instant messaging apps.
Collapse
Affiliation(s)
- Christopher Morris
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Richard E. Scott
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Maurice Mars
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
- Department of Digital Health Systems, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia
| |
Collapse
|
35
|
Shakhatreh HJM, Salih AJ, Aldrou KKAR, Alazzam FAF, Issa MSB. Medico- Legal Aspects of Abortion: Updates of the Literature. Med Arch 2022; 76:373-376. [PMID: 36545456 PMCID: PMC9760240 DOI: 10.5455/medarh.2022.76.373-376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background Abortion is an increasingly important issue since it is discussed from multiple points of view including medical, social, religious, and legal aspects. Abortion is an old topic that is continuously discussed from various perspectives including medicine, laws, and society. Abortion is an illegal in general terms, but it can be carried out under certain medical conditions for the interest of pregnant woman, if the pregnancy is threatening her life. Objective The aim of this article is updates of the literature about medico-legal aspects of the abortion. Methods This is descriptive study about medico-legal aspects of the abortion based on searching this topic in the scientific literature deposited in on-line databases. Results and Discussion . At global level, more and more women are opting to terminate their pregnancies for societal reasons. It is estimated that 50 million unborn babies are terminated every year across the globe, causing the lives of 200,000 pregnant women and the agony of millions more people. It is a difficult decision to conduct abortion. In this study, a comprehensive review of the literature was made to discuss abortion from medical, legal, and cultural points of view. In general, abortion was legally discussed because legal aspects involve the various perspectives. Conclusion From religious points of view, abortion implies ending the life of the fetus. The right of life is to be kept. The international laws do not permit abortion and criminalize the parties involved in its existence unless it is recognized it is crucial to save the life of pregnant woman..
Collapse
|
36
|
Chen Z, Jiang W, Xu J, Jiang L, Wang G. Ethical, Legal, and Social Implications of Genomics in China: A Scoping Review and Implications for Precision Public Health. China CDC Wkly 2022; 4:706-710. [PMID: 36060445 PMCID: PMC9433758 DOI: 10.46234/ccdcw2022.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/04/2022] [Indexed: 11/17/2022] Open
Abstract
We conducted a scoping review of Chinese language studies on the ethical, legal, and social implications of genomics and identified four broad themes: ethical considerations, regulatory framework, perceptions of genomics and precision medicine, and future directions of genomics. Ethical, legal, and social implications of genomics are growing in importance and are highly relevant to public health in China.
Collapse
Affiliation(s)
- Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA.,School of Economics, Faculty of Humanities and Social Sciences, University of Nottingham Ningbo China, Ningbo City, Zhejiang Province, China
| | - Wei Jiang
- School of Economics, Faculty of Humanities and Social Sciences, University of Nottingham Ningbo China, Ningbo City, Zhejiang Province, China
| | - Jianhong Xu
- School of Economics, Faculty of Humanities and Social Sciences, University of Nottingham Ningbo China, Ningbo City, Zhejiang Province, China
| | - Lan Jiang
- School of Economics, Faculty of Humanities and Social Sciences, University of Nottingham Ningbo China, Ningbo City, Zhejiang Province, China
| | - Guoyu Wang
- School of Philosophy, Fudan University, Shanghai Municipality, China.,Center for Biomedical Ethics, Fudan University, Shanghai Municipality, China
| |
Collapse
|
37
|
Pellico-López A, Paz-Zulueta M, Manjón-Rodríguez JB, Sánchez Movellán M, Ajo Bolado P, García-Vázquez J, Cayón-De las Cuevas J, Ruiz-Azcona L. Evolution of Legislation and the Incidence of Elective Abortion in Spain: A Retrospective Observational Study (2011-2020). Int J Environ Res Public Health 2022; 19:9674. [PMID: 35955037 PMCID: PMC9368144 DOI: 10.3390/ijerph19159674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND According to the WHO, "unsafe abortion occurs when a pregnancy is terminated either by people lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both". AIM To review the legislation that ensures access to elective abortion and the main indicators of elective abortion in Spain. METHODS A retrospective observational study was conducted across all regions of Spain from 2011 to 2020. The regulations of each region on the creation of the clinical committee and the creation of the registry of conscientious objector professionals were identified. Data were collected on rates of elective abortions per 1000 women, type of health center where the intervention was performed, interval of weeks of gestation, and cause. RESULTS After Law 2/2010 entered into force, the Spanish regions created a clinical committee; however, very few regions have a registry of conscientious objectors. During the study period, the average annual rate in Spain was 11.10 elective abortions per 1000 women between 15 and 44 years of age, showing a decreasing trend (annual percentage change of -1.92%). Only 10.67% of abortions were performed at public centers. In 90.18% of the cases, abortions were performed at the woman's request. CONCLUSION Spain legislated late compared to most European Union countries. The current law is similar to that of other member states, allowing abortion at the woman's request in the first fourteen weeks and thereafter for medical reasons. Most abortions are performed at private centers, although many territorial inequalities are observed.
Collapse
Affiliation(s)
- Amada Pellico-López
- Departamento de Enfermería, Universidad de Cantabria, Avda. Valdecilla s/n, 39008 Santander, Spain
- Cantabria Health Service, Avda. Derechos de la Infancia 31, 39340 Cantabria, Spain
| | - María Paz-Zulueta
- Departamento de Enfermería, Universidad de Cantabria, Avda. Valdecilla s/n, 39008 Santander, Spain
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Grupo de Investigación en Derecho Sanitario y Bioética (GRIDES), C/Cardenal Herrera Oria s/n, 39011 Cantabria, Spain
| | | | - Mar Sánchez Movellán
- Sección de Programas de Salud de la Mujer, Dirección General de Salud Pública, Consejería de Sanidad, Gobierno de Cantabria, C/Federico Vial 13, 39009 Cantabria, Spain
| | - Purificación Ajo Bolado
- Sección de Programas de Salud de la Mujer, Dirección General de Salud Pública, Consejería de Sanidad, Gobierno de Cantabria, C/Federico Vial 13, 39009 Cantabria, Spain
| | - José García-Vázquez
- Consejería de Salud de Asturias, C/Ciriaco Miguel Vigil, 9, CP, 33005 Oviedo, Spain
| | - Joaquín Cayón-De las Cuevas
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Grupo de Investigación en Derecho Sanitario y Bioética (GRIDES), C/Cardenal Herrera Oria s/n, 39011 Cantabria, Spain
- Departamento de Derecho Privado, Universidad de Cantabria, Avda, de los Castros s/n, 39005 Santander, Spain
| | - Laura Ruiz-Azcona
- Departamento de Enfermería, Universidad de Cantabria, Avda. Valdecilla s/n, 39008 Santander, Spain
- Global Health Research Group, Universidad de Cantabria, Avda. Valdecilla, s/n, 39008 Santander, Spain
| |
Collapse
|
38
|
Armour M, Sinclair J, Cheng J, Davis P, Hameed A, Meegahapola H, Rajashekar K, Suresh S, Proudfoot A, Leonardi M. Endometriosis and Cannabis Consumption During the COVID-19 Pandemic: An International Cross-Sectional Survey. Cannabis Cannabinoid Res 2022; 7:473-481. [PMID: 35089093 PMCID: PMC9418353 DOI: 10.1089/can.2021.0162] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Introduction: Endometriosis affects 1 in 10 women worldwide, with most experiencing difficulties achieving adequate symptom control. These difficulties have been compounded by the onset of the COVID-19 pandemic due to worldwide shifts in health care resource allocation. As cannabis is a relatively common form of self-management in endometriosis, this study aims to explore the impact of the COVID-19 pandemic on cannabis consumption in those with endometriosis. Methods: An anonymous, cross-sectional online international survey was developed and promoted by endometriosis advocacy/support organizations worldwide. Respondents needed to have a diagnosis of endometriosis and be aged between 18 and 55. Results: A total of 1634 responses were received from 46 different countries. The average age of respondents was 30, with a mean diagnosis age of 25. Eight hundred forty-six respondents (51%) reported consuming cannabis in the past 3 months, with 55% of these reporting use for symptom management only. One in five respondents (20%) reported having consumed cannabis previously, the most common reason for discontinuation (65%) was access difficulties during COVID. Those who had legal access were more likely to consume cannabis than those without (p<0.0001) and were more likely to disclose usage to health care professionals (p<0.0001). The most common reasons for consuming cannabis during COVID was increased stress/anxiety (59%) and lack of access to normal medical care (48%). Pre-pandemic, cannabis was mostly consumed at least once a day (61%) and in inhaled forms (51.6%). Consumption increased for most people (57%) during the pandemic. During the pandemic just under a quarter (23%) of respondents changed their mode of consumption, with a reduction in inhaled forms (39.5%) and an increase in consumption of edibles (40%) or oil (25.2%). Conclusions: Cannabis consumption, especially for symptom relief, was relatively common among those with endometriosis, with some people starting their consumption of cannabis due to health care restrictions that occurred due to the COVID-19 pandemic. Difficulties accessing cannabis and unpleasant/unwanted side effects were the most common reasons for lack of current cannabis consumption in those who had previously consumed it. Cannabis consumption may form an important part of endometriosis management especially when access to routine medical care is restricted.
Collapse
Affiliation(s)
- Mike Armour
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- Medical Research Institute of New Zealand (MRINZ), Wellington, New Zealand
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, New South Wales, Australia
| | - Justin Sinclair
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Junipearl Cheng
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Preston Davis
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Aaish Hameed
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Harini Meegahapola
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Krithika Rajashekar
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Sunethra Suresh
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Andrew Proudfoot
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Mathew Leonardi
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
39
|
Morris C, Scott RE, Mars M. An Audit and Survey of Informal Use of Instant Messaging for Dermatology in District Hospitals in KwaZulu-Natal, South Africa. Int J Environ Res Public Health 2022; 19:7462. [PMID: 35742708 DOI: 10.3390/ijerph19127462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023]
Abstract
Background. In KwaZulu-Natal (KZ-N), South Africa, recent reports have indicated that spontaneous use of smartphones has occurred, providing access to specialist dermatological care to remote areas. This informal use has raised a number of practical, legal, regulatory, and ethical concerns. Aim. To assess the nature and content of WhatsApp messages sent to dermatologists, to determine the referring doctors’ reasons for, and satisfaction with, their interactions, as well as their knowledge of legal, regulatory, and ethical requirements. Methods. A retrospective study of WhatsApp messages between referring doctors and dermatologists, as well as a cross-sectional survey of doctors working at district hospitals in KZ-N who used IM for teledermatology. Results. Use of IM (primarily WhatsApp) for teledermatology was almost universal, but often not considered ‘telemedicine’. Few referring doctors were aware of South Africa’s ethical guidelines and their requirements, and few of those who did followed them, e.g., the stipulated and onerous consent process and existing privacy and security legislations. No secure methods for record keeping or data storage of WhatsApp content were used. A desire to formalize the service existed. Conclusions. Based upon these findings, it was proposed that a number of described steps be followed in order to formalize the use of IM for teledermatology.
Collapse
|
40
|
Ananthram H, Rane A. Head in the sand: Contemporary Australian attitudes towards induction of labour. Aust N Z J Obstet Gynaecol 2022; 62:483-486. [PMID: 35289394 PMCID: PMC9544769 DOI: 10.1111/ajo.13512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 11/29/2022]
Abstract
Ambivalence in Australian thought on induction of labour, despite recent evidence, stands out in contrast to ever-increasing rates of this intervention. As consent obligations on information provision have crystallised in maternity care, this article examines whether consumer-led expectations and legal obligations may precipitate change to end the cultural stigma around induction of labour.
Collapse
Affiliation(s)
- Harsha Ananthram
- College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia.,Obstetrics & Gynaecology, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Ajay Rane
- College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia
| |
Collapse
|
41
|
Fuller SJ, Chapman S, Cave E, Druce-Perkins J, Daniels P, Tan J. Nasogastric tube feeding under physical restraint on paediatric wards: ethical, legal and practical considerations regarding this lifesaving intervention. BJPsych Bull 2022; 47:105-110. [PMID: 35249576 PMCID: PMC10063984 DOI: 10.1192/bjb.2022.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Eating disorders have the highest mortality rate of any psychiatric condition. Since the COVID-19 pandemic, the number of patients who have required medical stabilisation on paediatric wards has increased significantly. Likewise, the number of patients who have required medical stabilisation against their will as a lifesaving intervention has increased. This paper highlights a fictional case study aiming to explore the legal, ethical and practical considerations a trainee should be aware of. By the end of this article, readers will be more aware of this complex issue and how it might be managed, as well as the impact it can have on the patient, their family and ward staff.
Collapse
Affiliation(s)
- Sarah J Fuller
- Advanced Specialist Eating Disorders Dietitian, East London NHS Foundation Trust and Child; and Child and Adolescent Mental Health Department, Imperial College London, UK
| | - Simon Chapman
- Consultant in Paediatric and Adolescent Medicine, Department of Paediatrics, King's College London, UK
| | - Emma Cave
- Professor of Healthcare Law, Department of Paediatrics, Durham University, UK
| | - James Druce-Perkins
- Highly Specialist Dietitian, Child and Adolescent Mental Health Department, Aneurin Bevan University Health Board
| | | | - Jacinta Tan
- Consultant Child and Adolescent Psychiatrist, Oxford Health NHS Foundation Trust; and Senior Clinical Research Fellow, Department of Psychiatry, Oxford University, UK
| |
Collapse
|
42
|
Coulter C, McKay F, Hallowell N, Browning L, Colling R, Macklin P, Sorell T, Aslam M, Bryson G, Treanor D, Verrill C. Understanding the ethical and legal considerations of Digital Pathology. J Pathol Clin Res 2022; 8:101-115. [PMID: 34796679 PMCID: PMC8822384 DOI: 10.1002/cjp2.251] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/12/2021] [Accepted: 10/12/2021] [Indexed: 12/21/2022]
Abstract
Digital Pathology (DP) is a platform which has the potential to develop a truly integrated and global pathology community. The generation of DP data at scale creates novel challenges for the histopathology community in managing, processing, and governing the use of these data. The current understanding of, and confidence in, the legal and ethical aspects of DP by pathologists is unknown. We developed an electronic survey (e-survey), comprising 22 questions, with input from the Royal College of Pathologists (RCPath) Digital Pathology Working Group. The e-survey was circulated via e-mail and social media (Twitter) through the RCPath Digital Pathology Working Group network, RCPath Trainee Committee network, the Pathology image data Lake for Analytics, Knowledge and Education (PathLAKE) digital pathology consortium, National Pathology Imaging Co-operative (NPIC), local contacts, and to the membership of both The Pathological Society of Great Britain and Ireland and the British Division of the International Academy of Pathology (BDIAP). Between 14 July 2020 and 6 September 2020, we collected 198 responses representing a cross section of histopathologists, including individuals with experience of DP research. We ascertained that, in the UK, DP is being used for diagnosis, research, and teaching, and that the platform is enabling data sharing. Our survey demonstrated that there is often a lack of confidence and understanding of the key issues of consent, legislation, and ethical guidelines. Of 198 respondents, 82 (41%) did not know when the use of digital scanned slide images would fall under the relevant legislation and 93 (47%) were 'Not confident at all' in their interpretation of consent for scanned slide images in research. With increasing uptake of DP, a working knowledge of these areas is essential but histopathologists often express a lack of confidence in these topics. The need for specific training in these areas is highlighted by the findings of this study.
Collapse
Affiliation(s)
- Cheryl Coulter
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.,Nuffield Division of Clinical Laboratory Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Francis McKay
- The Wellcome Centre for Ethics and Humanities and the Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nina Hallowell
- The Wellcome Centre for Ethics and Humanities and the Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Lisa Browning
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Richard Colling
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Philip Macklin
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Tom Sorell
- Department of Politics and International Studies, University of Warwick, Coventry, UK
| | - Muhammad Aslam
- Department of Histopathology, Glangwilli Hospital, Hywel Dda University Health Board, Carmarthen, Wales, UK
| | - Gareth Bryson
- Department of Pathology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Darren Treanor
- Department of Pathology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Clare Verrill
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| |
Collapse
|
43
|
Fukunaga H, Yokoya A, Prise KM. A Brief Overview of Radiation-Induced Effects on Spermatogenesis and Oncofertility. Cancers (Basel) 2022; 14:cancers14030805. [PMID: 35159072 PMCID: PMC8834293 DOI: 10.3390/cancers14030805] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Spermatogenesis is one of the most important processes for the propagation of life; however, the testes’ ability to form sperm via this differentiation process is highly radiosensitive and easily impacted by exposure to environmental, occupational, or therapeutic radiation. Furthermore, the possibility that radiation effects on the gonads can be passed on from generation to generation should not be overlooked. This review focuses on the radiation-induced effects on spermatogenesis and the transgenerational effects. We also explore the potential of novel radiobiological approaches to improve male fertility preservation during radiotherapy. Abstract The genotoxicity of radiation on germ cells may be passed on to the next generation, thus its elucidation is not only a scientific issue but also an ethical, legal, and social issue in modern society. In this article, we briefly overview the effects of radiation on spermatogenesis and its associated genotoxicity, including the latest findings in the field of radiobiology. The potential role of transgenerational effects is still poorly understood, and further research in this area is desirable. Furthermore, from the perspective of oncofertility, we discuss the historical background and clinical importance of preserving male fertility during radiation treatment and the potential of microbeam radiotherapy. We hope that this review will contribute to stimulating further discussions and investigations for therapies for pediatric and adolescent/young adult patients.
Collapse
Affiliation(s)
- Hisanori Fukunaga
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
- Correspondence:
| | - Akinari Yokoya
- Institute for Quantum Life Science, National Institutes for Quantum Science and Technology, Ibaraki 319-1106, Japan;
- Graduate School of Science and Engineering, Ibaraki University, Ibaraki 310-8512, Japan
| | - Kevin M. Prise
- Patrick G Johnstone Centre for Cancer Research, Queen’s University Belfast, Belfast BT9 7AE, UK;
| |
Collapse
|
44
|
Banja JD, Hollstein RD, Bruno MA. When Artificial Intelligence Models Surpass Physician Performance: Medical Malpractice Liability in an Era of Advanced Artificial Intelligence. J Am Coll Radiol 2022; 19:816-820. [PMID: 35120881 DOI: 10.1016/j.jacr.2021.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/26/2021] [Indexed: 10/19/2022]
Abstract
It seems inevitable that diagnostic and recommender artificial intelligence models will ultimately reach a point when they outperform human clinicians. Just as antibiotics displaced a host of medicinals for treating infections, the superior performance of such models will force their adoption. This article contemplates certain ethical and legal implications bearing on that adoption, especially as they involve a clinician's exposure to allegations of malpractice. The article discusses four relevant considerations: (1) the imperative of using explainable artificial intelligence models in clinical care, (2) specific strategies for diminishing liability when a clinician agrees or disagrees with a model's findings or recommendations but the patient nevertheless experiences a poor outcome, (3) relieving liability through legislation or regulation, and (4) comprehending such models as "persons" and therefore as potential defendants in legal proceedings. We conclude with observations on clinician-vendor relationships and argue that, although advanced artificial intelligence models have not yet arrived, clinicians must begin considering their implications now.
Collapse
Affiliation(s)
- John D Banja
- Professor and Director of the Center for Ethics, Center for Ethics and Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia.
| | - Rolf Dieter Hollstein
- President, Advanced Radiology Services Foundation, Clinical Assistant Professor, Michigan State University; Advanced Radiology Services, P.C., Grand Rapids, Michigan
| | - Michael A Bruno
- Professor, Radiology and Medicine, Vice Chair, Quality and Safety, and Chief, Emergency Radiology, Department Radiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| |
Collapse
|
45
|
Brown J, Jonason A, Asp E, McGinn V, Carter MN, Spiller V, Jozan A. Fetal alcohol spectrum disorder and confabulation in psycho legal settings: A beginner's guide for criminal justice, forensic mental health, and legal interviewers. Behav Sci Law 2022; 40:46-86. [PMID: 34689366 DOI: 10.1002/bsl.2540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 06/13/2023]
Abstract
Fetal alcohol spectrum disorders (FASD) are neurodevelopmental/neurobehavioral conditions caused by prenatal alcohol exposure (PAE). Impairments caused by PAE contribute to the over-representation of individuals with FASD in the United States juvenile and adult criminal justice systems. These same impairments can equally impact on individuals with FASD who are witnesses to or victims of crime who also have to navigate the complexities of the criminal justice system. Difficulties include increased susceptibility to confabulation throughout the legal process that, in turn, can contribute to increased rates of poor outcomes including false confessions and wrongful convictions. Individuals with FASD are particularity at risk of confabulation when they are subjected to tactics, such as stressful and anxiety-provoking situations, threats, and leading, suggestive, or coercive questioning. Many professionals in the forensic context are unfamiliar with FASD or related confabulation risk and may unintentionally utilize tactics that intensify impacts of pre-existing impairment. This article serves as a beginner's guide for professionals working in criminal justice settings by (a) providing research-based overviews of FASD and confabulation, (b) describing how FASD may lead to confabulation, and (c) suggesting ways that professionals can modify protocols when interacting with individuals with FASD. Suggestions in this article hold the potential to decrease the risk of confabulation in the criminal justice system and decrease problematic outcomes, such as false confessions and wrongful convictions among individuals with FASD.
Collapse
Affiliation(s)
- Jerrod Brown
- Pathways Counseling Center, Inc., St. Paul, Minnesota, USA
- Concordia University, St. Paul, Minnesota, USA
- American Institute for the Advancement of Forensic Studies, St. Paul, Minnesota, USA
| | - Alec Jonason
- Department of Psychology, Hamline University, St. Paul, Minnesota, USA
- Wesley & Lorene Artz Cognitive Neuroscience Research Center, Hamline University, St. Paul, Minnesota, USA
| | - Erik Asp
- Department of Psychology, Hamline University, St. Paul, Minnesota, USA
- Wesley & Lorene Artz Cognitive Neuroscience Research Center, Hamline University, St. Paul, Minnesota, USA
- Department of Neurology, University of Iowa, Iowa City, Iowa, USA
| | - Valerie McGinn
- The FASD Centre, Auckland, New Zealand
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Megan N Carter
- University of Washington, Seattle, Washington, USA
- Department of Social and Health Services, Special Commitment Center, Steilacoom, Washington, USA
| | | | - Amy Jozan
- American Institute for the Advancement of Forensic Studies, St. Paul, Minnesota, USA
| |
Collapse
|
46
|
Brown J, Madore E, Carter MN, Spiller V, Jozan A. Fetal alcohol spectrum disorder (FASD) and suggestibility: A survey of United States federal case law. Int J Law Psychiatry 2022; 80:101763. [PMID: 34902756 DOI: 10.1016/j.ijlp.2021.101763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/20/2021] [Accepted: 12/03/2021] [Indexed: 06/14/2023]
Abstract
This article summarizes four federal criminal cases that illustrate how suggestibility can impact defendants with FASD in the criminal justice system. Four cases were identified via a Google Scholar search of "suggestibility" and "fetal alcohol" in the federal case law database. These cases are illustrative of how FASD can affect legal defendants, including vulnerability to peer pressure, being easily manipulated, insufficient comprehension of legal proceedings, difficulty in assisting legal counsel, learning impairment, acquiescence or higher levels of suggestibility, and difficulty understanding consequences. The cases presented here provided the most comprehensive discussion of FASD and suggestibility issues but are by no means an exhaustive review of case law. Because defendants with FASD are the focal point of this article, we intentionally excluded cases involving eyewitness suggestibility, the suggestibility of child witnesses, and the suggestibility of those under hypnosis. Therefore, this review has been developed to explicate and illustrate problems common to FASD defendants within legal settings, especially regarding risk for suggestibility. The information provided from this discussion may better guide legal professionals who regularly come into contact with persons affected by FASD on how to more readily detect this neurodevelopmental condition and mitigate the likelihood of injustice during criminal proceedings. Additionally, we include suggestions on how to attenuate miscarriages of justice as a result of faulty confessions, wrongful convictions, and vulnerability of suggestibility in persons affected by FASD.
Collapse
Affiliation(s)
- Jerrod Brown
- Pathways Counseling Center, Inc., St. Paul, MN, USA; Concordia University, St. Paul, MN, USA; American Institute for the Advancement of Forensic Studies, St. Paul, MN, USA.
| | - Erica Madore
- American Institute for the Advancement of Forensic Studies, St. Paul, MN, USA
| | - Megan N Carter
- University of Washington, Seattle, WA, USA; Department of Social and Health Services, Special Commitment Center, Steilacoom, WA, USA
| | | | - Amy Jozan
- American Institute for the Advancement of Forensic Studies, St. Paul, MN, USA
| |
Collapse
|
47
|
De Hert M, Loos S, Sterckx S, Thys E, Van Assche K. Improving control over euthanasia of persons with psychiatric illness: Lessons from the first Belgian criminal court case concerning euthanasia. Front Psychiatry 2022; 13:933748. [PMID: 35928783 PMCID: PMC9343580 DOI: 10.3389/fpsyt.2022.933748] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/30/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Belgium is one of very few countries that legally allow euthanasia for suffering caused by psychiatric illness. In the first criminal trial in Belgium of physicians involved in euthanasia, three physicians recently faced the accusation of "murder by poisoning," for allegedly having failed to comply with several requirements of the Belgian Euthanasia Law in granting the euthanasia request a woman suffering from psychiatric illness. Although all three physicians were acquitted, the case generated much debate among policy makers, medical professionals, and the general public. METHOD We use this trial as the starting point for a critical analysis of the adequacy of the three-level control system established in the Euthanasia Law, as it is applied in the evaluation of euthanasia requests from persons who suffer unbearably from a psychiatric illness. This analysis is based on information presented during the criminal trial as well as information on the euthanasia that was published in the press. RESULTS Our analysis highlights substantial problems in the assessment and granting of the euthanasia request. The patient was euthanized without it having been substantiated that her psychiatric illness had no prospect of improvement and that her suffering could not be alleviated. The three-step control system enshrined in the Law and promoted by the Federal Control and Evaluation Commission for Euthanasia appears to have failed at each level. CONCLUSION To evaluate requests for euthanasia for mental suffering caused by psychiatric illness, the requirements of the Belgian Euthanasia Law should be complemented by mandating the advice of two psychiatrists, and face-to-face discussions between all physicians involved. In parallel with the process of evaluating the euthanasia request, a treatment track should be guaranteed where reasonable evidence-based treatments and recovery-oriented options are tried.
Collapse
Affiliation(s)
- Marc De Hert
- University Psychiatric Centre, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Neurosciences, Centre for Clinical Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Brain Institute, Katholieke Universiteit Leuven, Leuven, Belgium.,Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
| | - Sien Loos
- Research Group Personal Rights and Property Rights, Faculty of Law, University of Antwerp, Antwerp, Belgium.,Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sigrid Sterckx
- Bioethics Institute Ghent, Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
| | - Erik Thys
- University Psychiatric Centre, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Neurosciences, Centre for Clinical Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kristof Van Assche
- Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium.,Research Group Personal Rights and Property Rights, Faculty of Law, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
48
|
De Hert M, Thys E, Catthoor K, Van den Broeck K, Matthys F, Vansteelandt K, Detraux J. Media coverage of Belgium's first criminal case concerning euthanasia for psychiatric patients: A content analysis of Flemish newspapers and magazines. Front Psychiatry 2022; 13:1050086. [PMID: 36684025 PMCID: PMC9845880 DOI: 10.3389/fpsyt.2022.1050086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/05/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Belgium is one of the few countries worldwide where euthanasia on the grounds of unbearable suffering caused by a psychiatric disorder is legally possible. In April 2010 euthanasia was carried out on a 38-year-old Belgian woman with borderline personality disorder and/or autism. After a complaint by the family, three physicians were referred to the Court of Assizes on the charge of "murder by poisoning". METHODS A content analysis of print and online news coverage of the euthanasia case in a selected sample of Flemish newspapers and magazines, published between December 1, 2019 and March 1, 2020, was conducted to analyze the prominence and framing of the euthanasia case, as well as the portrayal of key figures in this case. A quantitative analysis, as well as an in-depth qualitative analysis (with the aid of NVivo 1.0 software) was performed. RESULTS One thousand two hundred fifteen news articles were identified through database searching. Of these, 789 articles were included after screening for relevance and eligibility. Mean prominence scores were moderate and did not statistically significantly differ between newspapers with a different historical ideological background or form (elite versus popular). The most frequent headline topics featured legal aspects (relating to the Belgian Euthanasia Law or the course of the trial). Headlines and content of most articles (90 and 89%, respectively) did not contain an essential standpoint on the euthanasia case itself or, if they did, were neutral. Historical ideological background, nor form of newspaper (elite versus popular) significantly influenced headline tone or article direction toward the euthanasia case. Despite this, our qualitative analysis showed some subtle differences in selection, statement or tonality of reports between certain newspapers with a different historical ideological background. CONCLUSION Although major Flemish newspapers and magazines generally were neutral in their coverage of the judicial case, major points of contention discussed were: the need for an evaluation and possible amendments to the existing Euthanasia Law, including a revision of the Belgian Control Commission and the system of penalties for physicians, and the absence of any consensus or guidance on how to define psychological suffering.
Collapse
Affiliation(s)
- Marc De Hert
- University Psychiatric Center KU Leuven, Leuven, Belgium.,Department of Biomedical Sciences, Research Group Psychiatry, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium.,Antwerp Health Law and Ethics Chair - AHLEC University Antwerpen, Antwerp, Belgium
| | - Erik Thys
- Psycho-Sociaal Centrum, St.-Alexius-Elsene Vzw, Ixelles, Belgium
| | - Kirsten Catthoor
- Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium.,The Collaborative Antwerp Psychiatric Research Institute (CAPRI) and Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium.,Flemish Psychiatric Association, Kortenberg, Belgium
| | - Kris Van den Broeck
- The Collaborative Antwerp Psychiatric Research Institute (CAPRI) and Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium.,Flemish Psychiatric Association, Kortenberg, Belgium
| | - Frieda Matthys
- Flemish Psychiatric Association, Kortenberg, Belgium.,Department of Psychiatry, University Hospital Brussels, Brussels, Belgium
| | - Kristof Vansteelandt
- Department of Biomedical Sciences, Research Group Psychiatry, KU Leuven, Leuven, Belgium
| | - Johan Detraux
- Department of Biomedical Sciences, Research Group Psychiatry, Public Health Psychiatry, KU Leuven, Leuven, Belgium
| |
Collapse
|
49
|
Mammen JJ, Asirvatham ES, Sarman CJ, Ranjan V, Charles B. A review of legal, regulatory, and policy aspects of blood transfusion services in India: Issues, challenges, and opportunities. Asian J Transfus Sci 2021; 15:204-211. [PMID: 34908756 PMCID: PMC8628249 DOI: 10.4103/ajts.ajts_65_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 01/10/2021] [Accepted: 02/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Blood transfusion services (BTS) in India have progressed significantly during the last three decades. However, there is still inequity in the availability and access to blood due to various demand and supply-side issues. Appropriate laws, regulations, policies, and guidelines are critical to ensure universal access to blood. Aims and Objectives: This article aims to review the evolution and current status of legal, regulatory, and policy framework and analyses the issues, challenges, and opportunities for improvement of BTS in India. Methods: This article is based on an extensive review of currently available literature and government documents. Results: The review highlights the gaps and challenges in terms of licensing, safety and quality, voluntary blood donations, the organization of BTS, access to services, and regulatory bodies. The findings emphasize the need for a coordinated response by either the National Blood Transfusion Council or a newly established autonomous “National Blood Authority” consisting of technical, administrative, and legal experts which must be exclusively responsible for regulating the BTS. As adherence to quality management systems in blood banks is not a mandatory requirement, it recommends a legal measure to ensure mandatory quality assurance in blood banks and storage centers. Towards ensuring efficiency and universal access to blood, this article recommends evidence-based criteria for establishing new blood banks to avoid skewed distribution of blood banks, component separation facilities, and blood storage centers. Conclusion: The review emphasizes the need for periodic reviews and updates of the legal, regulatory and policy framework, considering the rapid developments and technical advancements with increasingly complex systems and processes in transfusion medicine.
Collapse
Affiliation(s)
- Joy John Mammen
- Department of Transfusion Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | | | | | - Varsha Ranjan
- Christian Medical Association of India, New Delhi, India
| | - Bimal Charles
- Christian Medical Association of India, New Delhi, India
| |
Collapse
|
50
|
Belani S, Tiarks GC, Mookerjee N, Rajput V. "I Agree to Disagree": Comparative Ethical and Legal Analysis of Big Data and Genomics for Privacy, Consent, and Ownership. Cureus 2021; 13:e18736. [PMID: 34796049 PMCID: PMC8589338 DOI: 10.7759/cureus.18736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
Statement of Purpose: Digital healthcare, as it relates to big data and genomics, presents a real threat to privacy and ownership rights for individuals and society. Research Question/Hypothesis: Our experience with genomics provides a lens to facilitate the way we navigate toward a future health data space. Contemporary and innovative legal and ethical models can be applied to concepts of privacy, ownership, and consent in relation to big data. Significance: Technological innovation has transformed healthcare at a faster rate than legal reform, security measures, and consent policies can adapt. The Health Information Portability and Accountability Act (HIPAA) has been recognized as a work in progress, with respect to big data as it relates to healthcare and individual wellbeing. The shortcomings of HIPAA, and its application to big data, can be paralleled with its prior limitations surrounding genomics in the last two decades. The Genetic Information and Nondiscrimination Act (2008) and Genomic Data Sharing Policy (2015) were established to overcome HIPAA’s inadequacies concerning genetic discrimination and security. These policies can serve as a basic model for our approach to legislative reform as it relates to privacy risks with big data generated in healthcare and from healthy individuals in society who are not patients. In addition to notions of privacy, concepts of ownership and consent have become increasingly vague and opaque. The technological advancements have facilitated access and transmission of information, such that big data can be sold for financial gain for commercial enterprise. This applies to genomics, with companies like 23andMe, in addition to big data, as it relates to big tech giants like Apple or Google who oversee wearable and search term data. Clarity of ownership within a digital healthcare arena needs to be defined through ethical and legal frameworks at a global level. Approach: A narrative review of the literature published between 2010 and 2021 was performed using PubMed and Google Scholar. Articles discussing privacy, security, ownership, big data, and genomics were included as relevant literature. Importance: As a society, we are at a crossroads; we must determine the extent of privacy that we are willing to give for science and society. We cannot continue with the current status quo in hope that individual will be used for the greater good of society. We need to strive for a cohesive approach to combat privacy violations by encouraging legislative reform, ethical accountability, and individual responsibility.
Collapse
Affiliation(s)
- Seema Belani
- College of Allopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Georgina C Tiarks
- College of Allopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA
| | - Neil Mookerjee
- Medical Education, Cooper Medical School of Rowan University, Camden, USA
| | - Vijay Rajput
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| |
Collapse
|