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Big data refers to extremely large data generated at high volume, velocity, variety, and veracity. The nurse scientist is uniquely positioned to leverage big data to suggest novel hypotheses on patient care and the healthcare system. The purpose of this paper is to provide an introductory guide to understanding the use and capability of big data for nurse scientists. Herein, we discuss the practical, ethical, social, and educational implications of using big data in nursing research. Some practical challenges with the use of big data include data accessibility, data quality, missing data, variable data standards, fragmentation of health data, and software considerations. Opposing ethical positions arise with the use of big data, and arguments for and against the use of big data are underpinned by concerns about confidentiality, anonymity, and autonomy. The use of big data has health equity dimensions and addressing equity in data is an ethical imperative. There is a need to incorporate competencies needed to leverage big data for nursing research into advanced nursing educational curricula. Nursing science has a great opportunity to evolve and embrace the potential of big data. Nurse scientists should not be spectators but collaborators and drivers of policy change to better leverage and harness the potential of big data. [ABSTRACT FROM AUTHOR]

This study investigates the views of contemporary Muslim jurists about withdrawing treatment of the terminally ill. Its aim is threefold. Firstly, it analyses jurists' views concerning core themes within the process of withdrawing treatment. Secondly, it provides insight into fatwas about withdrawing treatment. Thirdly, it compares these views with current medical standards in Europe and the Atlantic world on withdrawing treatment. The data consisted of six papers by Muslim jurists presented at the conference of the Islamic Fiqh Council in 2015. We conducted a directed content analysis (DCA) through a predetermined framework and compiled an overview of all previous fatwas referred to in the papers, which are also analysed. The results show that the general consensus is that if health cannot be restored, treatment may be withdrawn at the request of the patient and/or his family or on the initiative of the doctor. The accompanying fatwa emphasizes the importance of life-prolonging treatment if this does not harm the patient. It becomes apparent in the fatwa that the doctor has the monopoly in decision-making, which is inconsistent with current medical standards in Europe. Managing disclosure in view of the importance of maintaining the hope of Muslim patients may challenge the doctor's obligation to share a diagnosis with them. [ABSTRACT FROM AUTHOR]

The aim of the paper is twofold: 1. To present observations based on first-year nursing students' narratives during clinical rotation in gerontological nursing care; and 2. Explore a nursing educator's reflections on these observations in relation to the didactic and ethical challenges that occurred. The teaching of ethics is included in nurse education worldwide. Students are in their first clinical placement in residential care of older persons confronted with the moral complexities of gerontological care, where they get little possibility to share emotions and thoughts about ethically challenging nursing situations with a supervising registered nurse. A critical discussion paper. The educator's reflections in this discussion paper are based on a narrative assignment in ethics where first-year nursing students reflect on and describe a nursing situation during their clinical rotation in the residential care of older persons. Most students were acting as mere spectators in the described nursing situation where an older person, ethical standards, or evidence-based care was violated. Some students acted as advocates to the older person and intervened in the situation and a few as inspirers showing alternative ways of handling ethically challenging situations. Educators in nursing programs at the undergraduate level require time for student-centered formative guidance to foster moral courage and practice. During first-year students' clinical rotation, the learning goals in long-term residential care of older persons are focused on evidence-based basic nursing care. In this, students are confronted with ethically challenging situations, where the possibility to learn from a critical reflective practice is rare. When observing situations where an older person is subjected to unethical or unsafe nursing care it is common that the students take the spectators' role, not knowing how to deal with what is observed. Some students are taking an intervening role by trying to alleviate the vulnerability of the older person. A few are showing moral courage by directly intervening when experiencing unethical or unsafe nursing care or conduct. In this the student can inspire fellow students or staff during their clinical rotation in alternative ways of handling ethically challenging situations. As older persons are the largest demographic group that nurses will experience, educators need a sound knowledge of ethics as well as gerontological care to be able to meet and nurture students' ethical reflections during clinical practice and to foster practical wisdom in nursing. [ABSTRACT FROM AUTHOR]

In this article, we explore ethical issues of Deaf people's engagement in research. To focus on the perspectives of Deaf people, we investigated existing qualitative and mixed methods research within a qualitative evidence synthesis. Our synthesis is based on a systematic database search (Scopus, PubMed) and reference check of included papers which resulted in 27 eligible papers. We analyzed the data using thematic synthesis and developed 5 analytical themes. The results present research as a struggle for Deaf people and emphasize the need for changes regarding recognition of Deaf research in a cross-cultural context, maintaining equal and partner relations, and provision of accessible communication. Our research contributes to understanding what the ethical inclusion of Deaf people in research implies. It may also support the development of evidence-based normative recommendations and scientific cooperation between Deaf and hearing people. [ABSTRACT FROM AUTHOR]

Introduction: In the big data era, where corporations commodify health data, non-fungible tokens (NFTs) present a transformative avenue for patient empowerment and control. NFTs are unique digital assets on the blockchain, representing ownership of digital objects, including health data. By minting their data as NFTs, patients can track access, monetize its use, and build secure, private health information systems. However, research on NFTs in healthcare is in its infancy, warranting a comprehensive review. Methods: This study conducted a systematic literature review and thematic analysis of NFTs in healthcare to identify use cases, design models, and key challenges. Five multidisciplinary research databases (Scopus, Web of Science, Google Scholar, IEEE Explore, Elsevier Science Direct) were searched. The approach involved four stages: paper collection, inclusion/exclusion criteria application, screening, full-text reading, and quality assessment. A classification and coding framework was employed. Thematic analysis followed six steps: data familiarization, initial code generation, theme searching, theme review, theme definition/naming, and report production. Results: Analysis of 19 selected papers revealed three primary use cases: patientcentric data management, supply chain management for data provenance, and digital twin development. Notably, most solutions were prototypes or frameworks without real-world implementations. Four overarching themes emerged: data governance (ownership, tracking, privacy), data monetization (commercialization, incentivization, sharing), data protection, and data storage. The focus lies on user-controlled, private, and secure health data solutions. Additionally, data commodification is explored, with mechanisms proposed to incentivize data maintenance and sharing. NFTs are also suggested for tracking medical products in supply chains, ensuring data integrity and provenance. Ethereum and similar platforms dominate NFT minting, while compact NFT storage options are being explored for faster data access. Conclusion: NFTs offer significant potential for secure, traceable, decentralized healthcare data exchange systems. However, challenges exist, including dependence on blockchain, interoperability issues, and associated costs. The review identified research gaps, such as developing dual ownership models and data pricing strategies. Building an open standard for interoperability and adoption is crucial. The scalability, security, and privacy of NFT-backed healthcare applications require further investigation. Thus, this study proposes a research agenda for adopting NFTs in healthcare, focusing on governance, storage models, and perceptions. [ABSTRACT FROM AUTHOR]

Big data analytics in medicine is driving significant change, as it offers vital information for improving functions, developing cutting-edge solutions and overcoming inefficiencies. With the right archiving and analysis tools, all players in the healthcare system, from hospitals to patients and from medical personnel to the pharmaceutical industry, can yield numerous benefits. Therefore, to analyze and interpret these analytics effectively, so that they can be useful for the advancement of scientific knowledge, we require information sharing, specific skills, training, integration between all system players, unique infrastructures and security. All these characteristics will make it possible to establish and harmonize real big data biobanks, for which it will be appropriate to consider new forms of governance compared to those traditionally conceived for large-sample biobanks. [ABSTRACT FROM AUTHOR]

This editorial examines the implications of artificial intelligence (AI), specifically large language models (LLMs) such as ChatGPT, on the authorship and authority of academic papers, and the potential ethical concerns and challenges in health professions education (HPE). [ABSTRACT FROM AUTHOR]

Simple Summary: Large datasets concerning childhood cancers are rare. Therefore, it is important to fully exploit all available data, which are distributed over several resources, including biomaterials, images, clinical trials, and registries. With privacy-preserving record linkage (PPRL), datasets can be merged, without disclosing the patients' identities. Although PPRL is already implemented or described in various settings, use case descriptions are fragmented and incomplete. The present paper gives an overview of current and future use cases of PPRL in childhood cancer. We screened the literature, projects, and trial protocols, analysed a hypothetical patient journey, and discussed use cases with experts. All the identified use cases were structured along six key dimensions. We conclude that PPRL is a key concept in childhood cancer. Therefore, PPRL strategies should already be considered when starting research projects, to avoid distributed data silos, to maximise the knowledge derived from collected data, and, ultimately, to improve outcomes for children with cancer. Large datasets in paediatric oncology are inherently rare. Therefore, it is paramount to fully exploit all available data, which are distributed over several resources, including biomaterials, images, clinical trials, and registries. With privacy-preserving record linkage (PPRL), personalised or pseudonymised datasets can be merged, without disclosing the patients' identities. Although PPRL is implemented in various settings, use case descriptions are currently fragmented and incomplete. The present paper provides a comprehensive overview of current and future use cases for PPRL in paediatric oncology. We analysed the literature, projects, and trial protocols, identified use cases along a hypothetical patient journey, and discussed use cases with paediatric oncology experts. To structure PPRL use cases, we defined six key dimensions: distributed personalised records, pseudonymisation, distributed pseudonymised records, record linkage, linked data, and data analysis. Selected use cases were described (a) per dimension and (b) on a multi-dimensional level. While focusing on paediatric oncology, most aspects are also applicable to other (particularly rare) diseases. We conclude that PPRL is a key concept in paediatric oncology. Therefore, PPRL strategies should already be considered when starting research projects, to avoid distributed data silos, to maximise the knowledge derived from collected data, and, ultimately, to improve outcomes for children with cancer. [ABSTRACT FROM AUTHOR]

Locally accepted moral standards shape healthcare legislation, yet such legislative decisions should not be insulated from scrutiny by non-local ethical theories. This paper aims to demonstrate the relevance and propriety of applying Western bioethical theories to healthcare scenarios beyond the Western cultural context. Western cultures place a strong emphasis on individualism, and value individuals' rights and liberties; in contrast, many non-Western cultures prioritise collectivist values, such as community wellbeing. These fundamental differences impact healthcare practice within a culture, including the way that a patient and their healthcare team make treatment decisions. A fair ethical analysis of healthcare practice must not involve axioms biased towards a particular cultural value for it is not possible to derive normative claims from cultural practices. This paper demonstrates that the three dominant theories in Western medical ethics-utilitarianism, deontology, and principlism-are not biased towards individualism, despite their origins in the Western cultural context. Each theory is assessed individually, paying particular mind to 'autonomy' and potential misinterpretations grounded in cultural biases. Additionally, this paper argues that to investigate a scenario in a non-Western culture using a Western theory of medial ethics is an opportunity to invite discussion between philosophers of different backgrounds, not an attempt to impose cultural norms upon others. Investigation of practices with non-local ethical theories fosters dialogues that can contribute to more robust ethical theories, better healthcare practices and, by extension, improved patient care. [ABSTRACT FROM AUTHOR]

Despite having worked in higher education for over twenty years, I am still, first and foremost, a practicing nurse. My employer requires me to be a nurse and my regulator regards what I do as nursing. My practice is regulated by the Code and informed by nursing ethics. If I am nurse, practicing nursing, does that mean that my students are my patients? This paper considers how the relationship that I have with my students can be informed by the ethics of the nurse/patient relationship. After some initial theoretical preparation concerning argument from analogy, the paper identifies some areas for comparison between the two relationships. Areas of similarity and difference identify two areas of concern: Nurse education and educators regularly engage in coercion and surveillance in an attempt to increase student success, both of which would be considered outside nursing ethics. It is concluded that these coercive practices are not conducive to an environment where character is cultivated. Despite current financial and workforce pressures, nurse lecturers and more especially their managers would do well to return to the professional ethics of nursing to question and guide their practice. [ABSTRACT FROM AUTHOR]

An earlier version of this paper was read at the Journal of Child Psychotherapy Symposium on Ethical Publishing, 2022. The question under discussion was: how can we write about our patients in a safe and respectful way, while making a contribution to the development of our field. The author describes her experience of sharing a draft paper with a young person towards the end of the treatment, with a view to submitting the paper for publication. Some thought is given to the clinical and ethical complexity of this process, and the questions that arose through the process are explored. The paper proposes that it might sometimes be possible to aim for a collaborative form of writing that involves children, young people and families in writing up their stories. [ABSTRACT FROM AUTHOR]

The steady growth of corporate interest and influence in the health care sector over the past few decades has created a more business-oriented health care system in the United States, helping to spur for-profit and private equity investment. Proponents say that this trend makes the health care system more efficient, encourages innovation, and provides financial stability to ensure access and improve care. Critics counter that such moves favor profit over care and erode the patient-physician relationship. American College of Physicians (ACP) underscores that physicians are permitted to earn a reasonable income as long as they are fulfilling their fiduciary responsibility to provide high-quality, appropriate care within the guardrails of medical professionalism and ethics. In this position paper, ACP considers the effect of mergers, integration, private equity investment, nonprofit hospital requirements, and conversions from nonprofit to for-profit status on patients, physicians, and the health care system. [ABSTRACT FROM AUTHOR]

The management and exchange of electronic health records (EHRs) remain critical challenges in healthcare, with fragmented systems, varied standards, and security concerns hindering seamless interoperability. These challenges compromise patient care and operational efficiency. This paper proposes a novel solution to address these issues by leveraging distributed ledger technology (DLT), including blockchain, to enhance data security, integrity, and transparency in healthcare systems. The decentralized and immutable nature of DLT enables more efficient and secure information exchange across platforms, improving decision-making and coordination of care. This paper outlines a strategic implementation approach, detailing timelines, resource requirements, and stakeholder involvement while addressing crucial privacy and security concerns like encryption and access control. In addition, it explores standards and protocols necessary for achieving interoperability, offering case studies that demonstrate the framework's effectiveness. This work contributes by introducing a DLT-based solution to the persistent issue of EHR interoperability, providing a novel pathway to secure and efficient health data exchanges. It also identifies the standards and protocols essential for integrating DLT with existing health information systems, thereby facilitating a smoother transition toward enhanced interoperability. [ABSTRACT FROM AUTHOR]

The current uses, potential risks, and practical recommendations for using chat generative pretrained transformers (ChatGPT) in systematic reviews (SRs) and meta-analyses (MAs) are reviewed in this article. The findings of prior research suggest that, for tasks such as literature screening and information extraction, ChatGPT can match or exceed the performance of human experts. However, for complex tasks such as risk of bias assessment, its performance remains significantly limited, underscoring the critical role of human expertise. The use of ChatGPT as an adjunct tool in SRs and MAs requires careful planning and the implementation of strict quality control and validation mechanisms to mitigate potential errors such as those arising from artificial intelligence (AI) 'hallucinations'. This paper also provides specific recommendations for optimizing human-AI collaboration in SRs and MAs. Assessing the specific context of each task and implementing the most appropriate strategies are critical when using ChatGPT in support of research goals. Furthermore, transparency regarding the use of ChatGPT in research reports is essential to maintaining research integrity. Close attention to ethical norms, including issues of privacy, bias, and fairness, is also imperative. Finally, from a human-centered perspective, this paper emphasizes the importance of researchers cultivating continuous self-iteration, prompt engineering skills, critical thinking, crossdisciplinary collaboration, and ethical awareness skills with the goals of: continuously optimizing human-AI collaboration models within reasonable and compliant norms, enhancing the complextask performance of AI tools such as ChatGPT, and, ultimately, achieving greater efficiency through technological innovative while upholding scientific rigor. [ABSTRACT FROM AUTHOR]

This paper provides the first comprehensive analysis of ethical issues raised by artificial intelligence (AI) in veterinary medicine for companion animals. Veterinary medicine is a socially valued service, which, like human medicine, will likely be significantly affected by AI. Veterinary AI raises some unique ethical issues because of the nature of the client–patient–practitioner relationship, society's relatively minimal valuation and protection of nonhuman animals and differences in opinion about responsibilities to animal patients and human clients. The paper examines how these distinctive features influence the ethics of AI systems that might benefit clients, veterinarians and animal patients—but also harm them. It offers practical ethical guidance that should interest ethicists, veterinarians, clinic owners, veterinary bodies and regulators, clients, technology developers and AI researchers. [ABSTRACT FROM AUTHOR]

Conducting research studies with vulnerable populations on sensitive topics such as adolescent pregnancy can be challenging depending on methodological approaches and ethical issues that may arise before, during, and after data collection. This methodological paper was developed based on experiences and lessons learned from a critical ethnographic study conducted to determine and understand the cultural and personal meaning of unintended adolescent pregnancy in the Rwandan context and to explore the perceived consequences and management of unintended adolescent pregnancy with and for single adolescent mothers. The purpose of this methodological paper is to discuss methodological and ethical challenges encountered while conducting this research, as well as various approaches used to overcome these challenges, and to provide guidance to researchers interested in conducting research about similar or other sensitive topics. Future researchers facing similar challenges should prioritize community engagement strategies, such as building strong relationships with gatekeepers and leaders, to facilitate access to potential participants. Additionally, researchers should engage in continuous ethical reflection and adaptation throughout the study, adjusting strategies if necessary to ensure the well-being and autonomy of participants. As a result of the practical and methodological strategies provided in this reflective paper, researchers could be able to navigate practical, methodological, and ethical challenges effectively while conducting sensitive studies on topics such as adolescent pregnancy. [ABSTRACT FROM AUTHOR]

EU-US data transfers for health research remain a particularly thorny issue in view of the stringent rules of the EU General Data Protection Regulation (GDPR) and the challenges related to US mass surveillance programs, particularly the manner in which US law enforcement and national security agencies can access personal data originating from the EU. Since the entry into force of the GDPR, evidence of impeded collaborations is increasing, particularly in the case of sharing data with US public institutions. The adoption of a new EU-US adequacy decision in July 2023 does not hold the promise for a long-lasting solution due to the risks of being challenged and invalidated – yet again – at the Court of Justice of the EU. As the research community is calling for answers, the new proposal for a European Health Data Space regulation may hold a key to solving some of the existing issues. In this paper, we critically discuss the current rules and outline a possible way forward for transfers between public bodies. [ABSTRACT FROM AUTHOR]

The essay outlines a four-phase triage process made by a fictive Talmudic rabbi working on an equally fictive hospital COVID-19 ward. The rabbi bases his decision on four different Talmudic texts, proceeding one by one, with each text building on the preceding one, until he is ready to allocate his scarce medical resources to one of the patients, thus being forced to deny them to others. Along the way, the paper will examine how this Talmudic reasoning can also be applied to the patient, or even a potential patient, clarifying the demands of the individual's ethical responsibility to avoid triage situations in the first place through social distancing and even more so through getting vaccinated. The paper argues that the rabbi has a number of Talmudic tools at hand that make his decision easier, not because he strictly follows Jewish law, but because of the rich experience standing behind Jewish legal traditions, making a universally valid ethical justification of difficult decisions possible. The essay proposes that including such theological material in triage guidelines would help make those decisions more acceptable in the long run, especially for societies in which religious traditions still play a certain role in the cultural consciousness. [ABSTRACT FROM AUTHOR]

This paper was written in the framework of my internship at the National Commission for Bioethics and Technoethics of the Hellenic Republic. It constitutes an attempt at exploring the ethical and legal dilemmas of the medical practice of telepsychiatry. Telepsychiatry, as well as other forms of telemedicine, has become a prevalent way through which patients gain access to healthcare and with many research papers reporting on its effectiveness and advantages, telepsychiatry has gained a lot of proponents in the scientific and healthcare community. However, several questions regarding the ethical and legal nature of the practice remain unanswered and this can put patients and other users of telemental health services under risk for basic rights violations. In this paper, at first the scientific data supporting the use of telepsychiatry will be cited. In addition to that, there will be discussion of several ethical dilemmas that have been reported concerning the use of telemedicine in psychiatry during the past few years and there will be reference to the medical code of ethics. Following that, there will be reference to the existing legislation for telepsychiatry in Greece and the legal issues that can arise will be analyzed. In spite of the fact that the advantages and ethical pitfalls of telepsychiatry are common in many countries, the focus of this paper will be on Greece’s code of medical ethics and legislation due to the lack of relevant bibliography on the matter, even though telepsychiatry is widely used by Greek patients. Finally some suggestions will be made on what ought to be ameliorated in regards to the current conditions, so as to make sure telepsychiatry is in line with the basic principles of bioethics. [ABSTRACT FROM AUTHOR]

The predominant position in the reproductive rights literature argues that access to assisted reproductive technologies (ART) forms part of an individual's right to reproduce. On this reasoning, refusal of treatment by clinicians (via provision) violates a hopeful parent's reproductive right and discriminates against the infertile. I reject these views and suggest they wrongly contort what reproductive freedom entitles individuals to do and demand of others. I suggest these views find their origin, at least in part, in the way we define "reproduction" itself. This paper critically analyses two widely accepted definitions of human reproduction and demonstrates that both are fundamentally flawed. While the process of reproduction includes the biological acts of begetting and bearing a child, I argue that it does not extend to include rearing. This reworked definition has little impact in the realm of sexual reproduction. However, it has significant ethical implications for the formulation and assignment of reproductive rights and responsibilities in the non-sexual realm in two important ways. First, a claim to access ART where one has an intention to rear a child (but does not beget or bear) cannot be grounded in reproductive rights. Second, lacking an intention to rear does not extinguish the reproductive rights and responsibilities for those who collaborate in the process. I conclude that clinicians collaborate in non-sexual reproduction at the point of triggering conception (begetting) and therefore have the right to refuse to be involved in non-sexual reproduction, in some instances, as do all reproductive collaborators. [ABSTRACT FROM AUTHOR]

In recent years, there has been a focus in social psychology on efforts to improve the robustness, rigour, transparency and openness of psychological research. This has led to a plethora of new tools, practices and initiatives that each aim to combat questionable research practices and improve the credibility of social psychological scholarship. However, the majority of these efforts derive from quantitative, deductive, hypothesis‐testing methodologies, and there has been a notable lack of in‐depth exploration about what the tools, practices and values may mean for research that uses qualitative methodologies. Here, we introduce a Special Section of BJSP: Open Science, Qualitative Methods and Social Psychology: Possibilities and Tensions. The authors critically discuss a range of issues, including authorship, data sharing and broader research practices. Taken together, these papers urge the discipline to carefully consider the ontological, epistemological and methodological underpinnings of efforts to improve psychological science, and advocate for a critical appreciation of how mainstream open science discourse may (or may not) be compatible with the goals of qualitative research. [ABSTRACT FROM AUTHOR]

A large proportion of hospital inpatients are affected by cognitive impairment, posing challenges in the provision of their care in busy, fast-paced acute wards. Signs and symbols, known as visual identifiers, are employed in many U.K. hospitals with the intention of helping healthcare professionals identify and respond to the needs of these patients. Although widely considered useful, these tools are used inconsistently, have not been subject to full evaluation, and attract criticism for acting as a shorthand for a routinized response. In order for visual identifiers to be used effectively in acute care settings, thorough consideration must be given to the ethical and legal issues that are engaged in this context, and their potential benefits and harms must be weighed and balanced. This paper proposes a set of legal and ethical principles that can be used to guide the implementation of visual identifiers. Together, these principles provide a framework applicable in the design and implementation phases to systematically identify relevant considerations arising from the use of these tools. We outline some tensions that arise between principles and conclude that selecting a preferred moral framework could help to guide decision-making, as does clarity around the purpose and objectives of the identifier. [ABSTRACT FROM AUTHOR]

Healthcare is a critical area where blockchain technology (BT) is being heralded as a potential game-changer for facilitating secure and efficient data sharing. The purpose of this review is to examine BT applications, performance challenges, and solutions in healthcare. To begin, This review paper explores popular blockchain networks for data exchange, encompassing both public and permissioned platforms, such as Ethereum and Hyperledger Fabric. This paper analyzes the potential applications of BT's decentralized, immutable, and smart contract capabilities in healthcare settings, including secure and interoperable health data exchange, patient consent management, drug supply chain oversight, and clinical trial management. The healthcare industry might greatly benefit from the increased privacy, transparency, and accessibility that these technologies provide. Despite BT's promising medical uses, the technology is not without its drawbacks. High energy consumption, throughput, and scalability are all concerns. We wrapped up by discussing the solutions that have been implemented, including consensus processes, scalability measures like sharding, and off-chain transactions that are designed to mitigate the drawbacks. [ABSTRACT FROM AUTHOR]

The difficulty of explaining the outputs of artificial intelligence (AI) models and what has led to them is a notorious ethical problem wherever these technologies are applied, including in the medical domain, and one that has no obvious solution. This paper examines the proposal, made by Luciano Floridi and colleagues, to include a new 'principle of explicability' alongside the traditional four principles of bioethics that make up the theory of 'principlism'. It specifically responds to a recent set of criticisms that challenge the supposed need for such a principle to perform an enabling role in relation to the traditional four principles and therefore suggest that these four are sufficient without the addition of explicability. The paper challenges the critics' premise that explicability cannot be an ethical principle like the classic four because it is explicitly subordinate to them. It argues instead that principlism in its original formulation locates the justification for ethical principles in a midlevel position such that they mediate between the most general moral norms and the contextual requirements of medicine. This conception of an ethical principle then provides a mold for an approach to explicability on which it functions as an enabling principle that unifies technical/epistemic demands on AI and the requirements of high-level ethical theories. The paper finishes by anticipating an objection that decision-making by clinicians and AI fall equally, but implausibly, under the principle of explicability's scope, which it rejects on the grounds that human decisions, unlike AI's, can be explained by their social environments. [ABSTRACT FROM AUTHOR]

Introduction: The emergence of artificial intelligence (AI) chat programs has opened two distinct paths, one enhancing interaction and another potentially replacing personal understanding. Ethical and legal concerns arise due to the rapid development of these programs. This paper investigates academic discussions on AI in medicine, analyzing the context, frequency, and reasons behind these conversations. Methods: The study collected data from the Web of Science database on articles containing the keyword "ChatGPT" published from January to September 2023, resulting in 786 medically related journal articles. The inclusion criteria were peer-reviewed articles in English related to medicine. Results: The United States led in publications (38.1%), followed by India (15.5%) and China (7.0%). Keywords such as "patient" (16.7%), "research" (12%), and "performance" (10.6%) were prevalent. The Cureus Journal of Medical Science (11.8%) had the most publications, followed by the Annals of Biomedical Engineering (8.3%). August 2023 had the highest number of publications (29.3%), with significant growth between February to March and April to May. Medical General Internal (21.0%) was the most common category, followed by Surgery (15.4%) and Radiology (7.9%). Discussion: The prominence of India in ChatGPT research, despite lower research funding, indicates the platform's popularity and highlights the importance of monitoring its use for potential medical misinformation. China's interest in ChatGPT research suggests a focus on Natural Language Processing (NLP) AI applications, despite public bans on the platform. Cureus' success in publishing ChatGPT articles can be attributed to its open-access, rapid publication model. The study identifies research trends in plastic surgery, radiology, and obstetric gynecology, emphasizing the need for ethical considerations and reliability assessments in the application of ChatGPT in medical practice. Conclusion: ChatGPT's presence in medical literature is growing rapidly across various specialties, but concerns related to safety, privacy, and accuracy persist. More research is needed to assess its suitability for patient care and implications for non-medical use. Skepticism and thorough review of research are essential, as current studies may face retraction as more information emerges. [ABSTRACT FROM AUTHOR]

The medical metaverse and digital twin are set to revolutionise healthcare. Like all emerging technologies their benefits must be weighed against their ethical and social, impacts. If we consider the advances of medical technology as an expression of our values, such as the pursuit of knowledge, cures and healing, an ethical study allows us to align our values and steer the technology towards an agreed goal. However, to appreciate the long-term consequents of a technology, those consequences must be considered in the context of a society already shaped by that technology. This paper identifies the technologies currently shaping society and considers the ethical, and social consequences of the medical metaverse and digital twin in that future society. [ABSTRACT FROM AUTHOR]

Nowadays, the Internet of Things (IoT) is used in every domain, especially in the healthcare system it plays a very important role in our life and made our life easier by providing various facilities in every area. On the Internet of Medical Things (IoMT), IoT devices collect real-time data from patients and send it to the cloud through the Internet. These gathered data are extorted to centralized processing and computational power. Centralization can lead to a single point of failure, data modification, snooping, security, and privacy evasion. Blockchain can resolve such issues by providing decentralized computational power and better storage capacity for IoT data. Therefore, integrating IoT and blockchain technologies can be an intelligent way to implement a decentralized IoT-based smart healthcare system. We find that integration of the blockchain and IoT is persuasive and can cause remarkable transformations across the healthcare system. We discussed blockchain and its applicability in the healthcare industry. The paper explores blockchain's dimensions, making the innovative healthcare system more secure and stable. We provide a comparative analysis of well-known recent research on IoT-based smart healthcare system security using blockchain based on different parameters such as architecture, data integrity, medical information sharing, distributed electronic health records, patient encryption key, access control, hardware implementation, etc. The paper focuses on the current security issues in IoT-based smart healthcare systems, architectures, taxonomy, and research gap and their possible solutions we point out various research challenges that should be considered before the deployment of a blockchain network in an IoT setting. This paper will be helpful to new researchers to get an overview of IoT-based healthcare system security. [ABSTRACT FROM AUTHOR]

Background: Online learning has grown significantly during the past two decades, and COVID‐19 pandemic has expedited this process. However, previous research has shown how academic dishonesty is more prevalent under these modalities. Therefore, there is the challenge of performing trustworthy remote assessments, in order to obtain valid and reliable measures of students' knowledge. Objectives: The research question that drove this research was: what actions have been proposed in contemporary research to improve remote assessment trustworthiness from a technological and pedagogical perspective? Methods: We analysed the papers accepted for the special issue titled 'Trustworthy Assessment and Academic Integrity in Remote Learning' following a deductive qualitative category coding methodology to find the main approaches. Results and conclusions: We identified eight approaches to improve trustworthiness in remote assessment: four for exams and high‐stake tests, one exclusively for performance‐based assessments, and three for any type of assessment. Our findings shift attention from academic dishonesty to trustworthy assessment, integrating recent findings of papers accepted to this special issue. Implications: Our findings deepen current understanding of trustworthy remote assessments, inviting practitioners and researchers to explore different types of assessment methods and different moments related to assessing learning. Lay Description: What is already known about this topic?: Online learning has grown significantly during the last decade.This growth increases the need for online assessment methods that can provide a valid, reliable, and fair measure of student knowledge.Research demonstrated the prevalence of academic dishonesty in online learning.There is a timely need to research and develop methods for trustworthy online assessment, as well as to raise the awareness of researchers, practitioners, and administrators, to the topic and to the solutions at hand. What this paper adds?: A review of the state‐of‐the‐art with respect to trustworthy assessment in online learning.A typology of strategies to improve trustworthy assessment, characterizing the pedagogical approach, technological method, context, and type of assessment.An analysis of different solutions, approaches, and case studies, with respect to the proposed typology.A novel approach to inform the design and implementation of valid and reliable online assessment. The implications for practitioners: The paper presents strategies and approaches for implementing trustworthy assessment in online learning.The paper provides a conceptual framework that can inform the design of valid and reliable assessments methods, and analyse both existing and newly proposed onesHighlighting the importance of including the assessment as an integral part of the instructional design phase of online learning offerings. [ABSTRACT FROM AUTHOR]

Robust data privacy regulations hinder the exchange of healthcare data among institutions, crucial for global insights and developing generalised clinical models. Federated learning (FL) is ideal for training global models using datasets from different institutions without compromising privacy. However, disparities in electronic healthcare records (EHRs) lead to inconsistencies in ML-ready data views, making FL challenging without extensive preprocessing and information loss. These differences arise from variations in services, care standards, and record-keeping practices. This paper addresses data view heterogeneity by introducing a knowledge abstraction and filtering-based FL framework that allows FL over heterogeneous data views without manual alignment or information loss. The knowledge abstraction and filtering mechanism maps raw input representations to a unified, semantically rich shared space for effective global model training. Experiments on three healthcare datasets demonstrate the framework's effectiveness in overcoming data view heterogeneity and facilitating information sharing in a federated setup. [ABSTRACT FROM AUTHOR]

Purpose: Throughout the world, mobility devices are usually distributed using product-based business models, where a device is provided to a user, and serviced or replaced when the user returns to the clinic with an issue. Moving to a service-based business model can provide continuous and customised support for the user, and provide the clinicians and manufacturers with better data to base their decisions on. This study reviews papers on assistive technology service-based business models and considerations in designing such a model to optimise economic and social value. It then applies the findings to the mobility device space. Method: A systematic literature search was undertaken in PubMed, Web of Science, and OVID databases to analyse studies that discuss service delivery models used to provide assistive products. Inductive thematic analysis determined the themes, facilitators and barriers associated with providing a service. Findings were applied to mobility device service provision. Results and conclusion: Themes from the 29 relevant papers were grouped into four categories: Access (affordability/availability/education), Utility (customisability/usability/adaptability), Integrity (quality/sustainability/impact), and Compliance (policy/privacy/security). The most common themes were customisability, affordability, availability, and education. There is a need for service-based delivery models to replace conventional product-based models, and many considerations to optimise their design. No publications discussed the design and implementation of a service-based model for mobility device provision that uses modern sensors, software and other digital technologies to optimise the service. Service-based models that use modern digital technologies are new for the mobility device field, but much can be learnt from other fields. IMPLICATIONS FOR REHABILITATION: Service-based business models that make use of modern digital technologies are likely to improve ongoing individual rehabilitation, but they are new for the mobility device field and currently lack research and evidence-based practice. The systematic review found that modern digital technologies like sensors, apps, and AI might be useful for providing ongoing support and more personalised rehabilitation for users of assistive products. To provide ongoing support for end-users, a successful design of service-based business model for assistive products should be accessible, both physically and financially, as well as easy to customise and adapt over time. [ABSTRACT FROM AUTHOR]

This paper examines the integration of artificial intelligence (AI) in radiotherapy for cancer treatment. The importance of radiotherapy in cancer management and its time-intensive planning process make AI adoption appealing especially with the escalating demand for radiotherapy. This review highlights the efficacy of AI across medical domains, where it surpasses human capabilities in areas such as cardiology and dermatology. Focusing on radiotherapy, the paper details AI's applications in target segmentation, dose optimization, and outcome prediction. It discusses adaptive radiotherapy's benefits and AI's potential to enhance patient outcomes with much improved treatment accuracy. The paper explores ethical concerns, including data privacy and bias, stressing the need for robust guidelines. Educating healthcare professionals and patients about AI's role is crucial as it acknowledges potential job-role changes and concerns about patients' trust in the use of AI. Overall, the integration of AI in radiotherapy holds transformative potential in streamlining processes, improving outcomes, and reducing costs. AI's potential to reduce healthcare costs underscores its significance with impactful change globally. However, successful implementation hinges on addressing ethical and logistical challenges and fostering collaboration among healthcare professionals and patient population data sets for its optimal utilization. Rigorous education, collaborative efforts, and global data sharing will be the compass guiding its' success in radiotherapy and healthcare. [ABSTRACT FROM AUTHOR]

Gestational surrogacy is ethically complex, generating very different responses in law and policy worldwide. This paper argues that contemporary surrogacy law and policy, across many jurisdictions, fail to give sufficient attention to the significance of the relationship between the child and the gestational surrogate. This failure risks repeating the mistakes of historical, discredited approaches to adoption and donor‐assisted conception. This paper argues that proper recognition of the significance of gestation must be an organising principle in surrogacy law and policy. The paper begins by pointing to examples of surrogacy law and practice where the role of the gestator is unacceptably minimised, most notably the framing of the surrogate as a mere 'carrier'. It goes on to examine the nature of gestation, including consideration of contemporary scholarship on the metaphysics of pregnancy and emerging work in epigenetics, and argues that current evidence supports the view that the gestational relationship must be taken more seriously than it currently is. The paper then draws analogies with parenthood in donor‐assisted conception and adoption to argue that approaches to parental status in novel family formations that fail to promote transparency and seek to deny the truth of familial relationships are doomed to fail. The paper concludes by suggesting some implications for law and policy that flow from placing sufficient emphasis on the gestational role. The overarching thesis of this paper is that gestational surrogacy is ethically permissible when these fundamental requirements are adhered to, and that surrogacy law should proceed on this basis. [ABSTRACT FROM AUTHOR]

Rapport is generally considered an essential component of successful interviewing, where participants are willing to share and divulge information. The present paper contributes to the research on rapport in qualitative interviewing by exploring ethical tensions that researchers may experience when conducting qualitative interviews with vulnerable participants. The analysis is based on semi-structured interviews with nine researchers from various fields within social sciences who had extensive experience in doing research with diverse vulnerable groups. We identified six ethical tensions related to building rapport with people in vulnerable life situations that cover issues concerning both too little and too much rapport. Findings illustrate that rapport as the 'ideal' for the researcher-participant relationship may need nuancing. The study concludes that researchers undertaking qualitative interviews on sensitive topics need to have a conscious awareness of ethical tensions that may arise when building rapport with their participants [ABSTRACT FROM AUTHOR]

Background: In the years to come, artificial intelligence will become an indispensable tool in medical practice. The digital transformation will undoubtedly affect today's medical students. This study focuses on trust from the perspective of three groups of medical students - students from Croatia, students from Slovakia, and international students studying in Slovakia. Methods: A paper-pen survey was conducted using a non-probabilistic convenience sample. In the second half of 2022, 1715 students were surveyed at five faculties in Croatia and three in Slovakia. Results: Specifically, 38.2% of students indicated familiarity with the concept of AI, while 44.8% believed they would use AI in the future. Patient readiness for the implementation of technologies was mostly assessed as being low. More than half of the students, 59.1%, believe that the implementation of digital technology (AI) will negatively impact the patient-physician relationship and 51,3% of students believe that patients will trust physicians less. The least agreement with the statement was observed among international students, while a higher agreement was expressed by Slovak and Croatian students 40.9% of Croatian students believe that users do not trust the healthcare system, 56.9% of Slovak students agree with this view, while only 17.3% of international students share this opinion. The ability to explain to patients how AI works if they were asked was statistically significantly different for the different student groups, international students expressed the lowest agreement, while the Slovak and Croatian students showed a higher agreement. Conclusion: This study provides insight into medical students' attitudes from Croatia, Slovakia, and international students regarding the role of artificial intelligence (AI) in the future healthcare system, with a particular emphasis on the concept of trust. A notable difference was observed between the three groups of students, with international students differing from their Croatian and Slovak colleagues. This study also highlights the importance of integrating AI topics into the medical curriculum, taking into account national social & cultural specificities that could negatively impact AI implementation if not carefully addressed. [ABSTRACT FROM AUTHOR]

Nonhuman animal research has contributed to human health advancements but raises questions about the extent to which humans protect nonhuman animals during such endeavors. This series of drawings explores several ethics and empirical questions from a visual point of view. [ABSTRACT FROM AUTHOR]

Rationale Aims and Objectives Method Results and Conclusion The Joint Commission emphasizes the importance of cultural competence and effective communication in quality medical care, particularly during end‐of‐life (EOL), when decisions are influenced by diverse cultural and religious backgrounds. For Orthodox Jewish patients, the philosophical framework used for EOL decision‐making may conflict with that used in traditional Western medical ethics. In this paper, we explore the complexities of EOL decision‐making for devout Jewish patients and highlight how approaches may differ from a Western ethical framework.This paper aims to familiarize clinicians with EOL preferences of Orthodox Jewish patients, organized into an ethical framework called ‘casuistic deontology’. Leading with an open‐minded approach emphasizing cultural humility, we explore ways in which integrating this perspective can allow for culturally appropriate and compassionate EOL care.Using a case study methodology, we focus on a 79‐year‐old Orthodox Jewish male hospitalized with severe injuries. The patient's medical course is analyzed, highlighting how the decisions made by his family in consultation with their Rabbi may differ from the decisions made with a philosophy of a Western ethical framework.This case illustrates the ethical tensions that may arise when Western medical practices intersect with Orthodox Jewish beliefs, particularly regarding brain death, resuscitation, and artificial nutrition. We underscore the need for cultural sensitivity when approaching EOL decision‐making, allowing for compassionate and comprehensive care that respects religious perspectives. This paper helps provide a structure for clinicians to navigate the complex EOL care needs for the devout Jewish patient in a manner consistent with their cultural and religious identity. [ABSTRACT FROM AUTHOR]

The rapid advancements in artificial intelligence (AI) have led to the development of sophisticated large language models (LLMs) such as GPT-4 and Bard. The potential implementation of LLMs in healthcare settings has already garnered considerable attention because of their diverse applications that include facilitating clinical documentation, obtaining insurance pre-authorization, summarizing research papers, or working as a chatbot to answer questions for patients about their specific data and concerns. While offering transformative potential, LLMs warrant a very cautious approach since these models are trained differently from AI-based medical technologies that are regulated already, especially within the critical context of caring for patients. The newest version, GPT-4, that was released in March, 2023, brings the potentials of this technology to support multiple medical tasks; and risks from mishandling results it provides to varying reliability to a new level. Besides being an advanced LLM, it will be able to read texts on images and analyze the context of those images. The regulation of GPT-4 and generative AI in medicine and healthcare without damaging their exciting and transformative potential is a timely and critical challenge to ensure safety, maintain ethical standards, and protect patient privacy. We argue that regulatory oversight should assure medical professionals and patients can use LLMs without causing harm or compromising their data or privacy. This paper summarizes our practical recommendations for what we can expect from regulators to bring this vision to reality. [ABSTRACT FROM AUTHOR]