Integrating large language models (LLMs) like GPT-4 into medical ethics is a novel concept, and understanding the effectiveness of these models in aiding ethicists with decision-making can have significant implications for the healthcare... more
Integrating large language models (LLMs) like GPT-4 into medical ethics is a novel concept, and understanding the effectiveness of these models in aiding ethicists with decision-making can have significant implications for the healthcare sector. Thus, the objective of this study was to evaluate the performance of GPT-4 in responding to complex medical ethical vignettes and to gauge its utility and limitations for aiding medical ethicists. Using a mixed-methods, cross-sectional survey approach, a panel of six ethicists assessed LLM-generated responses to eight ethical vignettes.The main outcomes measured were relevance, reasoning, depth, technical and non-technical clarity, as well as acceptability of GPT-4’s responses. The readability of the responses was also assessed. Of the six metrics evaluating the effectiveness of GPT-4’s responses, the overall mean score was 4.1/5. GPT-4 was rated highest in providing technical (4.7/5) and non-technical clarity (4.4/5), whereas the lowest rat...
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Page 1. prevention and treatment of dis-ease. The extent of the misuse will depend on the quality of the pub-lic debate on the use of genetic information. The medical profes-sion will be expected to provide informed opinion ...
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This study examined the views and experiences of 20 physicians and 20 nurses at a major Canadian teaching hospital regarding the use of advance directives in clinical care. The participants were purposively drawn from four clinical... more
This study examined the views and experiences of 20 physicians and 20 nurses at a major Canadian teaching hospital regarding the use of advance directives in clinical care. The participants were purposively drawn from four clinical specialties: family and community medicine, oncology, intensive care and geriatrics. Detailed interviews were conducted in person. Content analysis was used to code the data, which were further analysed with both quantitative and qualitative techniques. Thirty-nine of the 40 participants favoured the use of advance directives in clinical care; physicians had somewhat less positive attitudes than nurses toward such directives. Advance directives were thought by participants to be helpful in resolving disagreements between patients and their families about treatment options; in making patients more comfortable, both physically and psychologically, during the process of dying; and in opening up communication and trust among patients, their families and healt...
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Resource allocation decisions have become increasingly necessary as the cost of health care habitually increases. Bilateral (second side) adult cochlear implantation (CI) is an example of a novel technology with accruing evidence of... more
Resource allocation decisions have become increasingly necessary as the cost of health care habitually increases. Bilateral (second side) adult cochlear implantation (CI) is an example of a novel technology with accruing evidence of benefit, yet expense has limited universal employ. Currently at our centers, bilateral implantation is only provided under research protocol. In this article, we discuss the need for a principled approach concerning the distribution of a second device, both during this period of investigation and if ultimately an insured service. Allocation strategies, while extensively addressed in some arenas, have yet to be developed for second‐side sequential adult CI. We advocate that physicians must assume an explicit role when both caring for individual patients as well as administering health care programs. We review social justice theories that inform resource allocation macrodecisions, and include a defence of age‐based considerations. Our approach to patient s...
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Research Interests: Algorithms, Decision Making, Informed Consent, Autonomy, Medicine, and 11 moreInformation Overload, Humans, Human Experimentation, Clinical Sciences, Newborn Infant, Theoretical Models, Perinatology, Neonatal Intensive Care Unit, parental consent, Patient selection, and Paediatrics and reproductive medicine
Research Interests: Applied Ethics, Family Medicine, Medical Education, Economic Justice, Medical Ethics, and 15 moreMoral Development, Autonomy, Family Practice, Medicine, Medical Students, Judgment, Ontario, Beneficence, Medical Training, Career Choice, Ethical Issues, Cross Sectional Studies, Bioethical Issues, Ethical Analysis, and Grade point average
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Since 2016, when medical assistance in dying (MAiD) became legal in Canada, healthcare professionals (HCPs) have become familiar with exploring and acting upon patients’ wishes to hasten death (WTHD). In contrast to MAiD, the literature... more
Since 2016, when medical assistance in dying (MAiD) became legal in Canada, healthcare professionals (HCPs) have become familiar with exploring and acting upon patients’ wishes to hasten death (WTHD). In contrast to MAiD, the literature on the voluntary stopping of eating and drinking (VSED) is very limited and there are no standards of practice or legal guidance to support HCPs. In this article, the legal and ethical literature as regards VSED is critically reviewed and new standards of practice are proposed.
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Page 1. BOOKS * LIVRES The teaching of ethics Medical Ethics for Undergraduate Medical Students. Symposium '89 Proceedings. Edited by Francoise Baylis and Jocelyn Downie. 180 pp. Westminster Institute for Eth-ics and Human Values,... more
Page 1. BOOKS * LIVRES The teaching of ethics Medical Ethics for Undergraduate Medical Students. Symposium '89 Proceedings. Edited by Francoise Baylis and Jocelyn Downie. 180 pp. Westminster Institute for Eth-ics and Human Values, London, Ont. 1990. $8.95. ...
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BACKGROUND: Helicobacter pylori is an important cause of stomach cancer that infects a substantial proportion of the Canadian adult population. H pylori can be detected by noninvasive tests and effectively eradicated by medical treatment.... more
BACKGROUND: Helicobacter pylori is an important cause of stomach cancer that infects a substantial proportion of the Canadian adult population. H pylori can be detected by noninvasive tests and effectively eradicated by medical treatment. Screening for and treatment of H pylori may represent a significant opportunity for preventive oncology.METHODS: Cancer Care Ontario organized a workshop held in Toronto, Ontario, on October 24 and 25, 2002, to: review the current state of knowledge regarding H pylori treatment and cancer prevention; determine if there is currently sufficient evidence to consider the promotion of H pylori treatment for the purpose of cancer prevention; identify critical areas for research; and advise Cancer Care Ontario on H pylori and cancer prevention.RESULTS: Workshop participants developed a number of recommendations for research into the relationship between H pylori and stomach cancer, including determining the prevalence of infection in different regions of ...
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Adverse events and medical errors are not uncommon. In this article we review the literature on such events and discuss the ethical, legal and practical aspects of whether and how they should be disclosed to patients. Ethics, professional... more
Adverse events and medical errors are not uncommon. In this article we review the literature on such events and discuss the ethical, legal and practical aspects of whether and how they should be disclosed to patients. Ethics, professional policy and the law, as well as the relevant empirical literature, suggest that timely and candid disclosure should be standard practice. Candour about error may lessen, rather than increase, the medicolegal liability of the health care professionals and may help to alleviate the patient's concerns. Guidelines for disclosure to patients, and their families if necessary, are proposed.
Research Interests: Communication, Bioethics, Health Care, Medical Ethics, Medicine, and 15 moreMedical errors, Canada, Humans, Medical Ethics & Law, Health Professionals, Legal Liability, Malpractice, Liability, Medical Error, Adverse Event, Truth Disclosure, attitude to health, guidelines as topic, Medical and Health Sciences, and Physician-Patient Relations
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To discuss the characteristics of incidents reported to the Medical Safety in Community Practice (MSCP) safety learning system. Members of family physician offices in the Alberta Health Services--Calgary zone, confidentially reported... more
To discuss the characteristics of incidents reported to the Medical Safety in Community Practice (MSCP) safety learning system. Members of family physician offices in the Alberta Health Services--Calgary zone, confidentially reported patient safety incidents via web or fax from September 2007 to August 2010. The incident reporting form contained both open-ended and closed questions. Incidents were reviewed for their characteristics. A total of 19 family practices participated in MSCP. A total of 264 useable reports were collected. Reporting was higher when practices first joined and then decreased. There was an average of 1.4 reports per month. Physicians submitted the majority of reports. Physicians and nurses were more likely to report an incident than office staff. The vast majority of reported incidents were judged to have 'virtually certain evidence of preventability' (93%). Harm was associated with 50% of incidents. Only 1% of the incidents had a severe impact. The top...
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some derangement of biophysical function; qua maladies, they alter in some way how a person experiences or lives his or her life. Comprehensive medical theories of disease try to encompass both perspectives. Oliver Sacks (1974), writing... more
some derangement of biophysical function; qua maladies, they alter in some way how a person experiences or lives his or her life. Comprehensive medical theories of disease try to encompass both perspectives. Oliver Sacks (1974), writing of Parkinson’s disease, suggests that &dquo;We are concerned not simply with a handful of ’symptoms’ but with a person and his changing relation to the world&dquo; (p. 198, emphasis in original). Comprehensive medical practice should replicate this duality of illness. The health care professional is interested not only in curing or ameliorating a disease process but in helping persons cope psychologically and socially with their maladies. Illnesses usually restrict-or threaten to do so-the physical and phenomenological scope of one’s lived relation to the world. This duality of illness is often reflected in conflicting perspectives of patients and practi-
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Nurses have an obligation to disclose an error when one occurs. This study explored 1180... more
Nurses have an obligation to disclose an error when one occurs. This study explored 1180 nurses' perceptions of error disclosure in the nursing home setting. Nurse respondents found disclosure to be a difficult process. Registered nurse respondents and nurses who had prior experience disclosing a serious error were more likely to disclose a serious error. The study has implications to improve nursing education, policy, and patient safety culture in the nursing home setting.
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Patricia Illingworth’s central thesis concerning acquired immuno-deficiency syndrome (AIDS) and the Good Society is that the occurrence of AIDS in gay males and intravenous drug users (IVDUs) creates special moral obligations. Our... more
Patricia Illingworth’s central thesis concerning acquired immuno-deficiency syndrome (AIDS) and the Good Society is that the occurrence of AIDS in gay males and intravenous drug users (IVDUs) creates special moral obligations. Our society, she believes, has harmed these individuals by forcing them to engage in behavior that causes them to become infected with the human immuno-deficiency virus (HIV) (p. 14). As a consequence, society, rather than trying to control the actions of gays and IVDUs, ought to compensate them financially for their illness (p. 17). Illingworth tries to show that acquiring HIV and AIDS is a form of self-inflicted harm (pp. 27 ff.) that nevertheless deserves compensation. In her view, gays and IVDUs consent to the high-risk actions (&dquo;fast-track&dquo; sex by gay men and the sharing of drug equipment by poor drug addicts) that lead to their harm (p. 30). However, our non-Good Society’s &dquo;repressive morality&dquo; causes these actions to be performed nonautonomously (pp. 62, 77). Thus, although self-directed, the actions that lead to harm are &dquo;unauthentic&dquo; (p. 63) on account of society’s baneful influence. The autonomy of gays and IVDUs can be reintroduced, and the risky behavior diminished, only by changing &dquo;the relevant social conditions&dquo; (p. 116). Their autonomy can be best enhanced
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Medical ethics is both a pedagogical tool and an educational component of postgraduate medical education. Residency ethics is not about ensuring trainees have the right answers. It is about encouraging self-reflection and an awareness of... more
Medical ethics is both a pedagogical tool and an educational component of postgraduate medical education. Residency ethics is not about ensuring trainees have the right answers. It is about encouraging self-reflection and an awareness of alternatives. This is the best preparation for independent professional practice. We examine four areas of specialization—Family Medicine, Psychiatry, Surgery, and Pediatrics—to illustrate how current standards and future directions in postgraduate training reflect this understanding of ethics. While we believe that the most appropriate preparation of residents for medical professionalism is the development of residency specific graduate ethics teaching, there is little reliable empirical evidence for the best approach to designing an ideal ethics curriculum. There is no one right way to do so. We provide an ethics decision-making tool and suggest steps that programmers might wish to take planning their postgraduate ethics teaching.
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Research Interests: Communication, Decision Making, Family, Risk, Risk assessment, and 15 moreFamily Practice, Hospitals, Canada, Emergency Medical Services, Humans, Physicians, Organizational Policy, Advance Directives, Patient Participation, Risk Assessment, Medical Records, Terminal care, Mental Competency, guidelines as topic, and medical futility
Journal of Critical Care, Volume 21, Issue 1, Pages 116, March 2006, Authors:Philip C. Hébert, MD, PhD, FCFPC.
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Little work has explored the disclosure of errors in nursing homes (NHs). This paper reports how nurses would disclose hypothetical errors that occur in NH settings. A cross-sectional survey was given to a randomly selected sample of... more
Little work has explored the disclosure of errors in nursing homes (NHs). This paper reports how nurses would disclose hypothetical errors that occur in NH settings. A cross-sectional survey was given to a randomly selected sample of registered nurses (RNs) and registered practical nurses (RPNs) working in Ontario, Canada NHs. Of 1,180 respondents, only half might provide full details and the cause of the error and provide steps in how the error would be prevented if they were in situations described by the hypothetical scenarios. Scenarios that were less serious had an almost 3 times higher likelihood of an explicit apology (OR 2.97; 95% CI 1.36-6.51; P = 0.007). Nurses who were RNs, had more education, had a prior history of disclosing a serious error, and agreed with full disclosure were more likely to respond to disclosing more information about the error. Nurses also reported numerous barriers to effective disclosure in their workplace. Improvements in NH safety culture are nec...
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Correspondence from The New England Journal of Medicine Quality of Care and Negligence Litigation in Nursing Homes.