1,721,290 research outputs found
Spiritual Help During Detention: Specific Responses to Different Stages and Types of Imprisonment
No full textThe provision of spiritual advice in prisons must be adapted to a number of factors and, hence, cannot be reduced to a one-fits-all strategy for prisoners in various settings. This chapter describes the major topics and issues arising when providing spiritual advice. Two variables are of particular importance and must be taken into account by spiritual advisors: the type of facility in which the person is imprisoned and the duration of the imprisonment. After presenting an overview of the main issues encountered by those who provide spiritual advice in modern correctional institutions, the authors discuss possible solutions to existing problems. They argue that spiritual help in the correctional context should be understood within a wide context that cannot be reduced exclusively to religious ritualism but must also take into account other cultural and psychological considerations. An interdisciplinary approach for spiritual advice is proposed that combines more specifically spiritual or religious communication strategies and care solutions with those from other humanistic and care-providing disciplines
La confidentialité dans un contexte pénitentiaire: une étude à base de vignettes portant sur les attitudes des professionnels médicaux et juridiques
No full textObjectif : Dans cette étude, nous avons cherché à comprendre, comment les professionnels médicaux et légaux géraient des situations portant sur la confidentialité en médecine pénitentiaire. Méthodes : Nous avons mené auprès de professionnels médicaux et légaux suisses une enquête postale consistant en cinq vignettes. Pour chaque cas, les participants devaient indiquer comment ils agiraient et justifier leur réponse. Résultats : Un total de 147 questionnaires a été analysé. Dans l'ensemble, les professionnels légaux avaient tendance à révéler plus facilement des informations à un tiers que les professionnels médicaux. Conclusion: Les attitudes rapportées par des professionnels médicaux et légaux à propos de la confidentialité envers des patients potentiellement dangereux diffèrent de façon significative. Des discussions partagées portant sur des situations cliniques pourraient réduire ces différences entre les groupes professionnels
Medical error communication : policy and practice
Get PDFThe issue of medical errors and patient safety has been a central concern to health systems around the world since alarming statistics relating to the frequency, harm, and costs of medical errors were published in the United States in 2000. Subsequent research has made it clear that this is a worldwide issue, with available data suggests that medical errors cause disabling injuries or death to nearly one in ten patients. In recent decades there has been a dramatic change internationally in the approach to medical errors, with a new ethic of transparency replacing the traditional customs of secrecy and denial. It is seen as important that medical errors are reported within the hospital so that opportunities for systems improvements can be identified and addressed. Clinicians are also now widely considered internationally to have an ethical, professional and legal obligation to disclose medical errors to patients. There remains, however, a large communication ‘gap’ between expected practice and what is actually being done, with research indicating that errors are often not reported within hospitals or disclosed to patients. This thesis examines a number of important research gaps concerning medical error communication, particularly regarding the disclosure of errors to patients, in Switzerland and internationally
Obstacles in accessing dementia care for people with a migration background in Basel. A qualitative interview study with professionals
Get PDFIntroduction: As our population is aging, age-related medical issues including mild
and major cognitive impairments are becoming more and more common. Literature
shows concerns related to access to health care for people with a migration
background in western countries. The connection between dementia and migration
and the access to dementia care for people with a migration background has not yet
been widely explored. Especially, in Switzerland, there are only a few studies on the
subject. The canton (federal state) of Basel-Stadt has a high percentage of people with
a migration background compared to the rest of Switzerland. This study aimed to
explore the care situation for people with a migration background and dementia living
in Basel-Stadt and to elaborate on the obstacles they might face to access dementia
care services compared to their local counterparts, causing inequalities in access to
dementia care, by interviewing professionals working in the thematic field.
Methods: Participants were acquired via online research and supplemented with
personal contacts and recommendations of other participants. Therefore, the sampling
strategy was both purposive and snowball. Interviews were performed via Zoom
following a semi-structured interview guide. The interviews concentrated on
differences in access to dementia care during different stages of the disease from a
professional view. Data analysis was performed using MAXQDA 2020.
Results: Sixteen professionals were interviewed belonging to different professions
such as general practitioner, hospital doctor, politicians, and those working in dementia
support services, ambulant care, home care, and nursing homes. We found that the
migrant population was underrepresented in the participating services, which lead to
in-depth exchange about obstacles that could potentially burden their access to the
available services. These challenges were grouped into four themes: (1) Delayed
diagnosis and lack of diagnostic tools and scores; (2) Obstacles to seeking help; (3)
Lack of migration sensitivity in dementia care services; and (4) Administrative and
financial obstacles.
Discussion and Conclusion: Our findings are in line with literature from other
countries. The interviewed services reported an underrepresentation of people with a
migration background compared to the demographic numbers, especially in postdiagnostic services. During our interviews and in context with the actual literature from
other countries it became clear that despite our broad and specialized health care
system we have not yet reached a point of equal access for people with a migration
background. To even out inequalities we suggest different measures including
adapting the diagnostic process and existing dementia care services with a focus on
migrant sensitivity in regard to language, culture, religion, and socio-economic aspects.
We also touch upon legal and political changes necessary to advance migration
sensitivity in dementia care. And finally, we want to encourage further research on a
national basis and explore the needs of the migrant community directly with the
affected population itself
Medical Artificial Intelligence and related ethics issues
Get PDFChapter 1 introduces the topics and concepts discussed in the following Chapters of this thesis.
In particular, it presents medical artificial intelligence (MAI) and it argues that it bears the potential to
affect the doctor-patient relationship, both doctors’ and patients’ autonomy, patients’ safety,
cybersecurity, and shared decision-making (SDM). It concludes by highlighting the importance of a
reflection on how we talk about MAI since our narratives have a performative power and can therefore
influence its uptake and development.
Chapter 2 gives an overview of the methodologies used for the present research. It also aims to
explain how theoretical and empirical research can be combined in bioethics while showing the benefits
of this approach. Eventually, this thesis is based on what is known as empirical bioethics, although
theoretical work is prevalent.
Chapter 3 analyses the role of AI-based clinical decision support systems (CDSS) for shared
decision-making (SDM) to better comprehend its promise and associated ethical issues. Artificial
intelligence (AI) based CDSS are becoming ever more widespread in healthcare and could play an
important role in diagnostic and treatment processes. For this reason, AI-based CDSS has an impact on
the doctor-patient relationship, shaping their decisions with its suggestions. We may be on the verge of
a paradigm shift, where the doctor-patient relationship is no longer a dual relationship, but a triad.
Moreover, Chapter 3 investigates how certain AI implementations may instead foster the inappropriate
paradigm of paternalism. Understanding how AI relates to doctors and influences doctor-patient
communication is essential to promoting more ethical medical practice. Both doctors’ and patients’
autonomy need to be considered in the light of AI.
Informed consent is at the core of the clinical relationship. With the introduction of machine
learning (ML) in healthcare, the role of informed consent is challenged. Chapter 4 addresses the issue
of whether patients must be informed about medical ML applications and asked for consent. It aims to
expose the discrepancy between ethical and practical considerations while arguing that this polarization
is a false dichotomy: in reality, ethics is applied to specific contexts and situations. Bridging this gap
and considering the whole picture is essential for advancing the debate. In light of the possible future
developments of the situation and the technologies, as well as the benefits that informed consent for ML
can bring to shared decision-making, Chapter 4 concludes that it is necessary to prepare the ground for
a future requirement of informed consent for medical ML.
Healthcare cybersecurity is increasingly targeted by malicious hackers. This sector has many
vulnerabilities and health data is very sensitive and valuable. Consequently, any damage caused by
malicious intrusions is particularly alarming. The consequences of these attacks can be enormous and
endanger patient care. Amongst the already-implemented cybersecurity measures and the ones that need to be further improved, Chapter 5 aims to demonstrate how penetration tests can greatly benefit
healthcare cybersecurity. It is already proven that this approach has enforced cybersecurity in other
sectors. However, it is not popular in healthcare since many prejudices still surround the hacking practice
and there is a lack of education on hackers’ categories and their ethics. Chapter 5 analyses hacker ethics
to comprehend who ethical hackers are. Currently, hacker ethics has the status of personal ethics;
however, to employ penetration testers in healthcare, it is recommended to draft an official code of
ethics, comprising principles, standards, expectations, and best practices. Additionally, it is important
to distinguish between malicious hackers and ethical hackers. Amongst the latter, penetration testers are
only a sub-category. Acknowledging the subtle differences between ethical hackers and penetration
testers allows to better understand why and how the latter can offer their services to healthcare facilities.
The discourse surrounding medical artificial intelligence (AI) often focuses on narratives that
either hype the technology's potential or predict dystopian futures. AI narratives have a significant
influence on the direction of research, funding, and public opinion and thus shape the future of medicine.
Chapter 6 aims to offer critical reflections on AI narratives, with a specific focus on medical AI. This
Chapter raises awareness as to how people working with medical AI talk about AI and discharge their
‘narrative responsibility’. Qualitative semi-structured interviews were conducted with participants from
different disciplines who were exposed to medical AI. The research represents a secondary analysis of
data using a thematic narrative approach. Stories about the AI-doctor interaction depicted either a
competitive or collaborative relationship. Some participants argued that AI might replace doctors as it
performs better than physicians. However, others believed that doctors should not be replaced and that
AI should rather assist and support physicians. The idea of excessive technological deferral and
automation bias was discussed, highlighting the risk of ‘losing’ decisional power. The possibility that
AI could relieve doctors from burnout and allow them to spend more time with patients was also
considered. Finally, a few participants reported an extremely optimistic account of medical AI while the
majority criticized this type of story. The latter lamented the existence of a ‘magical theory’ of medical
AI, identified with techno-solutionist positions. The majority of the participants reported a nuanced view
of technology, recognizing both its benefits and challenges, and avoiding polarized narratives. However,
some participants did contribute to the hype surrounding medical AI, comparing it to human capabilities
and depicting it as superior. Overall, the majority agreed that medical AI should assist rather than replace
clinicians. Chapter 6 concludes that a balanced narrative (that focuses on the technology's present
capabilities and limitations) is necessary to fully realize the potential of medical AI while avoiding
unrealistic expectations and hype.
Finally, Chapter 7 provides a summary of the recommendations and conclusions presented in
the previous chapters. It indicates further research directions and limitations while concisely
recommending the next steps for ethically implementing MAI. The final considerations centre on
patients’ safety and rights, which should always be prioritised
Les facteurs associés aux ordres "Do not attempt resuscitation" et "Cardiopulmonary resuscitation" dans un service de médecine interne générale en Suisse
No full textLa majorité des patients qui décèdent en milieu hospitalier font l'objet d'un ordre DNAR (Do-Not-Attempt-Resuscitation) avant leur décès, et les médecins prennent quotidiennement des décisions concernant ce type d'ordres. Nous avons conduit une étude prospective dans le Service de Médecine Interne Générale des Hôpitaux Universitaires de Genève afin d'analyser les facteurs associés à la prescription d'un ordre DNAR. 21,2% des patients ont un ordre DNAR. Le pronostic et la qualité de vie sont les paramètres le plus fortement associés aux ordres DNAR, mais le pronostic est évalué par les médecins uniquement de manière intuitive, et la qualité de vie sans la contribution des patients. L'âge, certains diagnostics et l'absence de capacité de discernement sont également associés aux ordres DNAR. La distinction entre l'ordre DNAR et les objectifs de soins n'est pas claire pour les médecins. Ces résultats confirment la nécessité de former les médecins à cette prise de décision difficile
Ageing prisoners and ethics behind bars : law, human rights and health care - old (age) problems and new challenges
Get PDFThe structure of penal institutions and their impact on inmates raises complex ethical and human rights issues. The circumstance that the number of prisoners who are older and/or suffer from mental disorders is steadily growing in Switzerland and worldwide in general, creates additional problems. Therefore, the aims of this thesis are to provide information on the current health care situation of ageing prisoners in Switzerland, to better understand the legal and practical settings of health care provision for ageing prisoners and to analyse the ethical issues that arise from the need to provide adequate health care to inmates in the context of an increasingly ageing prison population.
This thesis is divided in a general introduction, seven chapters and a general discussion. The introduction provides general information on institutions and their characteristics, the role of punishment in institutions and the numerical changes of the prison population in the correctional system. Furthermore, an overview of possible reasons for the tremendous growth of the prison population is given. Special focus is put on the sub-group of ageing prisoners and their features. Their needs in accommodation and health care are presented in detail. The introduction then proceeds with a brief description of the ethical issues in relation to the health care for ageing prisoners and continues with an overview about project details of the “Agequake in Prisons” project.
A first theoretical overview about the challenges that the prison system has to face with the growing number of ageing prisoners and their special needs is given in Chapter 1. Special emphasis is put on the accommodation of older prisoners and the end-of-life care and death in prison. The principle of equivalence of care is used as a framework.
Chapter 2 contains a review of national and international guidelines, legal frameworks and other documents relating to the health care needs of ageing prisoners. The results on the existence or non-existence of regulations that address the health care of ageing prisoners are critically examined. In this analysis focus is particularly put on Europe and the United States of America (USA).
Chapter 3 explores current expert perspectives on Western European prison health care services and investigates if ageing prisoners receive equivalent care. Here, the difficulties of providing equivalent health care to ageing prisoners are described in detail. The factors that contribute to these difficulties are looked at. Possible solutions for the described problems are provided which shall give guidance to people working in correctional facilities.
Chapter 4 reflects on the disease burden of ageing prisoners and the different impact that age and length of imprisonment have on their health.
The topic of end-of-life in prison is covered in Chapter 5. More and more prisoners grow old in prison and are likely to die there. Non-physician assisted suicide is under certain conditions available to the public in Switzerland. In this chapter it is argued that it should be made available for prisoners, too.
Chapter 6 and Chapter 7 give an insight into the topic of restraint measures. While Chapter 6 addresses restraint measures in hospitals in Germany, Chapter 7 explores the new legal regulation of restraint measures in Switzerland.
The last part of this thesis contains a general discussion of the presented work and summarises its findings. Furthermore, the implications of this study for research and practice in correctional facilities are described. It should be noted that Chapters 1, 2, 3, 4, 5, 6 and 7 have been published in different European and American journals; therefore it is possible that there is an overlap between the description of the background, ethical issues and methods used.
Although, the delivery of health care for ageing prisoners does meet the standard of equivalent health care in certain prisons, it is of great concern that it is not achieved in every Swiss prison according to the Stakeholders that were interviewed. This thesis provides an insight into some of the most challenging aspects of old age inside prisons such as the provision of equivalent health care and contributes to the understanding of how the health care provision for ageing prisoners could be made more effective
Intelligent Assistive Technologies for Dementia: Clinical, Ethical, Social and Regulatory Implications
No full textThe development and implementation of intelligent assistive technologies (IATs) to compensate for the specific physical and cognitive deficits of older adults with dementia have been recognized by many as one of the most promising approaches to this emerging financial and caregiving burden. In the past 15 years, advancements in artificial intelligence (AI), pervasive and ubiquitous computing (PUC), and other advanced trends in software and hardware technology have led to the development and design of a wide range of IATs to help older people compensate for the physical and sensory deficits that may accompany dementia and age-related cognitive decline. These technologies are designed to support impaired older adults in the completion of activities of daily living, assist them in the prevention or management of risk, and/or maintain their recreational and social environment. The widespread implementation and use of assistive technologies is a very rapid process, which is reshaping dementia care and producing constantly changing strategies. This volume aims at providing an up-to-date overview of the current state of the art of assistive technologies for dementia care and an examination of their implications at the medical level, including psychological and clinical issues and their ethical and regulatory challenges. The overall goal of this book is to raise societal awareness on the use of IATs for dementia care and take a first step into developing an international regulatory and policy framework
Ethical and legal perspectives on big data in research
Get PDFThis PhD thesis focuses on the legal and ethical aspects of Big Data in general and in research. Big Data holds the promise of resolving many pressing questions in commercial and research settings. In fact, the use of Big Data to reveal individual or group patterns and the use of predictive analysis are already effective in several areas ranging from building smart hospitals and cities to fighting climate change and to predict individual health related topics. Big Data thus touches the core of today’s massively interlinked and connected society; this omnipresent use raises societal questions and also affects individual rights, raising many issues for regulators. To assess issues in regulation and identify ethical challenges with the use of Big Data, interviews were conducted in Switzerland and the USA. In Switzerland we interviewed Data-Protection-Officers of all cantons with Universities and University hospitals) and hospital lawyers. The US sample consisted of lawyers with a connection to Big Data or dealing with medical Big Data. The publications that arose from the project can be grouped into the following categories. A first group of publications deals with the relationship between tech companies and their users and explores how to build a “trusted partnership”. A second group has the focus on health data in general and the fact that the distinction between health and non-health data gets more and more blurry. A third group of publications based on the results of our interviews deals with legal and ethical issues on the use of big Data ranging from special hands on topics of for example data sharing (Social Messaging) in the hospital to discussing the building blocks of data protection law and ownership
Ethical Concerns About the Use of Assistive Technologies: How to Balance Beneficence and Respect for Autonomy in the Care of Dementia Patients
No full text- …
