Explore the vast range of titles available.

Despite the advances made in the development of ethical frameworks for health technology assessment (HTA), there is no clear agreement on the scope and details of a practical approach to address ethical aspects in HTA. This systematic review aimed to identify existing guidance documents for incorporation of ethics in HTA to provide an overview of their methodological features. The review identified 43 conceptual frameworks or practical guidelines, varying in their philosophical approach, structure, and comprehensiveness. They were designed for different purposes throughout the HTA process, ranging from helping HTA-producers in identification, appraisal and analysis of ethical data to supporting decision-makers in making value-sensitive decisions. They frequently promoted using analytical methods that combined normative reflection with participatory approaches. The choice of a method for collection and analysis of ethical data seems to depend on the context in which technology is being assessed, the purpose of analysis, and availability of required resources.

An exploration of the moral and ethical implications of new biotechnologies Many of the ethical issues raised by new technologies have not been widely examined, discussed, or indeed settled. For example, robotics technology challenges the notion of personhood. Should a robot, capable of making what humans would call ethical decisions, be held responsible for those decisions and the resultant actions? Should society reward and punish robots in the same way that it does humans? Likewise, issues of safety, environmental concerns, and distributive justice arise with the increasing acceptance of genetically modified organisms (GMOs) in food production nanotechnology in engineering and medicine, and human gene therapy and enhancement. The problem of dual-use—when a technology can be used both to benefit and to harm—exists with virtually all new technologies but is central in the context of emerging 21st century technologies ranging from artificial intelligence and robotics to human gene-editing and brain-computer interfacing. In Re-Creating Nature: Science, Technology, and Human Values in the Twenty-First Century , James T. Bradley addresses emerging biotechnologies with prodigious potential to benefit humankind but that are also fraught with ethical consequences. Some actually possess the power to directly alter the evolution of life on earth including human. Specifically, these topics include stem cells, synthetic biology, GMOs in agriculture, nanotechnology, bioterrorism, CRISPR gene-editing technology, three-parent babies, robotics and roboethics, artificial intelligence, and human brain research and neurotechnologies. Offering clear explanations of these various technologies, a pragmatic presentation of the conundrums involved, and questions that illuminate hypothetical situations, Bradley guides discussions of these and other thorny issues resulting from the development of new biotechnologies. He also highlights the responsibilities of scientists to conduct research in an ethical manner and the responsibilities of nonscientists to become “science literate” in the twenty-first century.

Winner of an Honorable Mention in the Clinical Medicine category of the Professional and Scholarly Publishing Awards given by the Association of American Publishers At a time when medical technologies make it ever easier to enhance our minds and bodies, a debate has arisen about whether such efforts promote a process of \"normalization, \" which makes it ever harder to tolerate the natural anatomical differences among us. The debate becomes especially complicated when it addresses the surgical alteration, or \"shaping, \" of children. This volume explores the ethical and social issues raised by the recent proliferation of surgeries designed to make children born with physical differences look more normal. Using three cases—surgeries to eliminate craniofacial abnormalities such as cleft lip and palate, surgeries to correct ambiguous genitalia, and surgeries to lengthen the limbs of children born with dwarfism—the contributors consider the tensions parents experience when making such life-altering decisions on behalf of or with their children. The essays in this volume offer in-depth examinations of the significance and limits of surgical alteration through personal narratives, theoretical reflections, and concrete suggestions about how to improve the decision-making process. Written from the perspectives of affected children and their parents, health care providers, and leading scholars in philosophy, sociology, history, law, and medicine, this collection provides an integrated and comprehensive foundation from which to consider a complex and controversial issue. It takes the reader on a journey from reflections on the particulars of current medical practices to reflections on one of the deepest and most complex of human desires: the desire for normality. Contributors Priscilla Alderson, Adrienne Asch, Cassandra Aspinall, Alice Domurat Dreger, James C. Edwards, Todd C. Edwards, Ellen K. Feder, Arthur W. Frank, Lisa Abelow Hedley, Eva Fedder Kittay, Hilde Lindemann, Jeffery L. Marsh, Paul Steven Miller, Sherri G. Morris, Wendy E. Mouradian, Donald L. Patrick, Nichola Rumsey, Emily Sullivan Sanford, Tari D. Topolski

Although it is now generally acknowledged that new biomedical technologies often produce new definitions and sometimes even new concepts of disease, this observation is rarely used in research that anticipates potential ethical issues in emerging technologies. This article argues that it is useful to start with an analysis of implied concepts of disease when anticipating ethical issues of biomedical technologies. It shows, moreover, that it is possible to do so at an early stage, i.e. when a technology is only just emerging. The specific case analysed here is that of ‘molecular medicine’. This group of emerging technologies combines a ‘cascade model’ of disease processes with a ‘personal pattern’ model of bodily functioning. Whereas the ethical implications of the first are partly familiar from earlier—albeit controversial—forms of preventive and predictive medicine, those of the second are quite novel and potentially far-reaching.

Children dependent on life-prolonging medical technology are often subject to a constant background risk of sudden death or catastrophic complications. Such children can be cared for in hospital, in an intensive care environment with highly trained nurses and doctors able to deliver specialised, life-saving care immediately. However, remaining in hospital, when life expectancy is limited, can considered to be a harm in of itself. Discharge home offers the possibility for an improved quality of life for the child and their family but comes with significant medical risks.When making decisions for children, two ethical models predominate, the promotion of the child’s best interests or the avoidance of harm. However, in some circumstances, particularly for children with life-limiting and/or life-threatening illness, all options may be associated with risk. There are no good options, only potentially harmful choices.In this paper, we explore decisions made by one family in such circumstances. We describe a model adopted from risk management programmes beyond medicine, which offers a potential framework for identifying risks to the child that are morally permissible. Some risks and harms to a child, not ordinarily permitted, may be acceptable when undertaken in the pursuit of a specified desired good, so long as they are as low as reasonably practicable.

Recent publications on digital health technologies highlight the importance of ‘responsible’ use. References to the concept of responsibility are, however, frequently made without providing clear definitions of responsibility, thus leaving room for ambiguities. Addressing these uncertainties is critical since they might lead to misunderstandings, impacting the quality and safety of healthcare delivery. Therefore, this study investigates how responsibility is interpreted in the context of using digital health technologies, including artificial intelligence (AI), telemonitoring, wearables and mobile apps. We conducted a scoping review with a systematic search in PubMed, Web of Science, Embase, CINAHL and Philosopher’s Index. A total of 34 articles were included and categorized using a theoretical framework of responsibility aspects, and revealed two main findings. First, we found that digital health technologies can expand and shift existing ‘role responsibilities’ among caregivers, patients and technology. Second, moral responsibility is often equated with liability or accountability, without clear justification. Articles describe new ways in which physicians can be held accountable, particularly in the context of AI, and discuss the emergence of a ‘responsibility gap’ where no-one can be fully responsible for AI-generated outcomes. The literature also shows that m-Health technologies can increase patients’ accountability for their own health. However, there was limited discussion in the reviewed literature on whether these attributions of accountability are appropriate. We conclude with implications for practice and suggestions for expanding the theoretical framework of moral responsibility, recommending further study on responsibility of collectives and artificial entities, and on the role of virtue in digital health.

Prenatal/preconceptional and newborn screening programs have been a focus of recent policy debates that have included attention to ethical, legal, and social issues (ELSIs). In parallel, there has been an ongoing discussion about whether and how ELSIs may be addressed in health technology assessment (HTA). We conducted a knowledge synthesis study to explore both guidance and current practice regarding the consideration of ELSIs in HTA for prenatal/preconceptional and newborn screening. As the concluding activity for this project, we held a Canadian workshop to discuss the issues with a diverse group of stakeholders. Based on key workshop themes integrated with our study results, we suggest that population-based genetic screening programs may present particular types of ELSIs and that a public health ethics perspective is potentially highly relevant when considering them. We also suggest that approaches to addressing ELSIs in HTA for prenatal/preconceptional and newborn screening may need to be flexible enough to respond to diversity in HTA organizations, cultural values, stakeholder communities, and contextual factors. Finally, we highlight a need for transparency in the way that HTA producers move from evidence to conclusions and the ways in which screening policy decisions are made.

Only recently, the exponential growth of technology has facilitated the widespread integration of computers into the biomedical domain from electronization of medical data analysis to automated detection of biomedical images [2–3]. The lack of understanding around AI and the tantalizing benefits of this new wave of technology suggest the need for professionals in biomedical fields to acquire a basic understanding of AI and its medical applications in order to understand its clinical utility and engage with cutting-edge research. The importance of biomedical involvement in emerging technology is highlighted in the flaws of contemporary electronic medical records (EMR) that are widely used across the healthcare system. The ideal AI adaptation of EMR would be able to facilitate patient care through a variety of features like tracking changes in medical history of a patient and alerting caretakers of concerning health patterns; however, with the current state of EMR, tasks as simple as sharing medical records between healthcare facilities are burdensome.

Background Home-based health technologies for paediatric palliative care have great potential to improve care for children, caregivers, healthcare professionals, and health systems. However, no systematic reviews have directly addressed the intersections among the ethical, legal, and social aspects of these technologies for paediatric palliative care. The objective of this systematic review was to identify and analyse the ethical, legal, and social aspects of health technologies for home-based paediatric palliative care. Methods We have conducted a systematic review, inspired by the framework suggested by McCullough. We registered the review protocol in PROSPERO (CRD42024496034) and conducted a systematic search in six databases (ASSIA, Cinahl, Embase, Medline, PsycInfo, and Web of Science) on 27 November 2023 to identify relevant studies. Pairs of authors independently assessed the eligibility of the studies and extracted data. The eligible studies employed a range of different methods from randomised controlled trials to usability studies. We then synthesised the data according to the ethical, legal and social aspects of the technologies. Results Overall, our search resulted in 9,545 reports, which were screened after deduplication. The quality of the reports was assessed according to being published in peer reviewed journals. Fifteen reports were included, which showed that the main ethical issues are harm reduction, improved services, agency and autonomy, trust and empowerment. The main legal aspects are privacy equal access to care, participation in decisions and standardisation. The main social issues are cost reduction, transformation of family relations and novel modes of communication. Health technologies have the potential to alleviate burdens and improve the quality of care for children in paediatric palliative care and their families, but they also create novel burdens through constant reporting requirements and the vulnerability of some health technologies to technological malfunction. Nevertheless, they can increase family inclusion and children’s autonomy and participation, thus empowering children, particularly through co-development of solutions. Furthermore, studies have indicated that health technologies themselves may have positive effects on children’s health. The legal aspects of health technologies pertain to privacy and control over one’s health information and equitable access to care and participation in care, while social issues can potentially reduce costs for health systems but also involve novel costs. Conclusion The reviewed studies concerning the co-development of health technologies reported increased benefits in terms of health, agency, well-being, and strengthened children’s rights in home-based paediatric palliative care. However, the social dimensions of such technologies can lead to both public savings and reconfiguration of family constellations. We recommend that future researchers consider privacy, the formal dimensions of apps and smartphones, and their impacts on families. PROSPERO reference CRD42024496034.