The lifecycle of algorithmic decision-making systems: Organizational choices and ethical challenges

2021 ◽  
Vol 30 (3) ◽  
pp. 101683
Author(s):  
Marco Marabelli ◽  
Sue Newell ◽  
Valerie Handunge
Keyword(s):  
Decision Making ◽  
Ethical Challenges

Military health outreach on Exercise ASKARI SERPENT: a discussion of clinical and ethical challenges

2018 ◽  
Vol 165 (5) ◽  
pp. 346-350 ◽  
Author(s):  
Luke John Turner ◽  
D Wilkins ◽  
J I J A Woodhouse
Keyword(s):  
Decision Making ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Ethical Challenges ◽  
Military Health ◽  
Post Hoc Analysis ◽  
Rural Kenya ◽  
Four Quadrant ◽  
Post Hoc ◽  
Universal Nature

Exercise ASKARI SERPENT (Ex AS) is an annual British Army medical exercise that sees the deployment of a medical regiment to rural Kenya. The exercise involves the delivery of health outreach clinics and health education to the civilian population alongside Kenyan governmental and non-governmental organisations. This article includes a post hoc analysis of the ethical and clinical challenges that clinicians faced during Ex AS, applying a four-quadrant approach to ethical decision-making. This article intends to stimulate further debate and discussion on how to best prepare clinicians for clinical challenges and ethical decision-making on future exercises and operations. We conclude that our experiences on Ex AS can provide an insight on how to develop predeployment training for clinicians. Furthermore, the universal nature of the challenges faced on Ex AS can be applied to training for future contingency operations.

scholarly journals Evaluating underpinning, complexity and implications of ethical situations in humanitarian operations: qualitative study through the lens of career humanitarian workers

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e039463
Author(s):  
Ramin Asgary ◽  
Katharine Lawrence
Keyword(s):  
Decision Making ◽  
Social Constructivism ◽  
Moral Distress ◽  
Unintended Consequences ◽  
Aid Effectiveness ◽  
International Agency ◽  
Negative Consequences ◽  
Ethical Challenges ◽  
Ethical Frameworks ◽  
Humanitarian Operations

IntroductionData regarding underpinning and implications of ethical challenges faced by humanitarian workers and their organisations in humanitarian operations are limited.MethodsWe conducted comprehensive, semistructured interviews with 44 experienced humanitarian aid workers, from the field to headquarters, to evaluate and describe ethical conditions in humanitarian situations.Results61% were female; average age was 41.8 years; 500 collective years of humanitarian experience (11.8 average) working with diverse major international non-governmental organisations. Important themes included; allocation schemes and integrity of the humanitarian industry, including resource allocation and fair access to and use of services; staff or organisational competencies and aid quality; humanitarian process and unintended consequences; corruption, diversion, complicity and competing interests, and intentions versus outcomes; professionalism and interpersonal and institutional responses; and exposure to extreme inequities and emotional and moral distress. Related concepts included broader industry context and allocations; decision-making, values, roles and sustainability; resource misuse at programme, government and international agency levels; aid effectiveness and utility versus futility, and negative consequences. Multiple contributing, confounding and contradictory factors were identified, including context complexity and multiple decision-making levels; limited input from beneficiaries of aid; different or competing social constructs, values or sociocultural differences; and shortcomings, impracticality, or competing philosophical theories or ethical frameworks.ConclusionsEthical situations are overarching and often present themselves outside the exclusive scope of moral reasoning, philosophical views, professional codes, ethical or legal frameworks, humanitarian principles or social constructivism. This study helped identify a common instinct to uphold fairness and justice as an underlying drive to maintain humanity through proximity, solidarity, transparency and accountability.

scholarly journals Balancing health worker well-being and duty to care: an ethical approach to staff safety in COVID-19 and beyond

2020 ◽  
pp. medethics-2020-106557 ◽  
Author(s):  
Rosalind J McDougall ◽  
Lynn Gillam ◽  
Danielle Ko ◽  
Isabella Holmes ◽  
Clare Delany
Keyword(s):  
Decision Making ◽  
Clinical Work ◽  
Well Being ◽  
Decision Makers ◽  
Ethical Challenges ◽  
Healthcare Staff ◽  
Front Line ◽  
Specific Setting ◽  
Healthcare Work ◽  
Staff Protection

The COVID-19 pandemic has highlighted the risks that can be involved in healthcare work. In this paper, we explore the issue of staff safety in clinical work using the example of personal protective equipment (PPE) in the COVID-19 crisis. We articulate some of the specific ethical challenges around PPE currently being faced by front-line clinicians, and develop an approach to staff safety that involves balancing duty to care and personal well-being. We describe each of these values, and present a decision-making framework that integrates the two. The aim of the framework is to guide the process of balancing these two values when staff safety is at stake, by facilitating ethical reflection and/or decision-making that is systematic, specific and transparent. It provides a structure for individual reflection, collaborative staff discussion, and decision-making by those responsible for teams, departments and other groups of healthcare staff. Overall the framework guides the decision maker to characterise the degree of risk to staff, articulate feasible options for staff protection in that specific setting and identify the option that ensures any decrease in patient care is proportionate to the increase in staff well-being. It applies specifically to issues of PPE in COVID-19, and also has potential to assist decision makers in other situations involving protection of healthcare staff.

Ethical and Cultural Considerations in Informed Consent in Botswana

2007 ◽  
Vol 14 (4) ◽  
pp. 503-509 ◽  
Author(s):  
Sheila Shaibu
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Nurse Educators ◽  
Cultural Practices ◽  
Culturally Sensitive ◽  
Ethical Challenges ◽  
Research Participants ◽  
Cultural Considerations ◽  
Conducting Research

Reflections on my experience of conducting research in Botswana are used to highlight tensions and conflicts that arise from adhering to the western conceptualization of bioethics and the need to be culturally sensitive when carrying out research in one's own culture. Cultural practices required the need to exercise discretionary judgement guided by respect for the culture and decision-making protocols of the research participants. Ethical challenges that arose are discussed. The brokerage role of nurse educators and leaders in contextualizing western bioethics is emphasized.

scholarly journals Person and Family Centeredness in Ethiopian Cancer Care: Proposal for a Project for Improving Communication, Ethics, Decision Making, and Health (Preprint)

2019 ◽  
Author(s):  
Nataliya Berbyuk Lindström ◽  
Aynalem Abraha Woldemariam ◽  
Abebe Bekele ◽  
Christian Munthe ◽  
Rune Andersson ◽  
...  
Keyword(s):  
Decision Making ◽  
Cancer Care ◽  
Research Collaboration ◽  
Addis Ababa ◽  
Educational Interventions ◽  
Medical Attention ◽  
Health Care Ethics ◽  
Ethical Challenges ◽  
Multiple Sources ◽  
Cancer Awareness

BACKGROUND Cancer is a major burden in Ethiopia. The Oncology Department of Tikur Anbessa (Black Lion) Specialized Hospital in Addis Ababa is the sole specialist unit for cancer care in the country. With only a handful of oncologists, a lack of resources, and a huge patient load, the work is challenging, especially in terms of achieving effective and ethical patient consultations. Patients, usually accompanied by family members, often wait for a long time to receive medical attention and frequently depart without treatment. Handling consultations effectively is essential to help patients as much as possible within such limitations. OBJECTIVE The project has the following three main aims: (1) to enhance and expand the understanding of communicative and associated ethical challenges in Ethiopian cancer care; (2) to enhance and expand the understanding of the implications and use of person- and family-centered solutions to address such communicative challenges in practice; and (3) to plan and evaluate interventions in this area. METHODS This project develops and consolidates a research collaboration to better understand and mitigate the communicative challenges in Ethiopian cancer care, with a focus on the handling and sharing of decision making and ethical tension among patients, staff, and family. Using theoretical models from linguistics, health communication, and health care ethics, multiple sources of data will be analyzed. Data sources currently include semistructured interviews with Ethiopian staff (n= 16), patients (n= 54), and family caregivers (n= 22); survey data on cancer awareness (n=150) and attitudes toward breaking bad news (n=450); and video recordings of medical consultations (n=45). In addition, we will develop clinical and methodological solutions to formulate educational interventions. RESULTS The project was awarded funding by the Swedish Research Council in December 2017 for the period 2018 to 2021. The research ethics boards in Sweden and Ethiopia approved the project in May 2018. The results of the studies will be published in 2020 and 2021. CONCLUSIONS The project is the first step toward providing unique and seminal knowledge for the specific context of Ethiopia in the areas of physician-patient communication research and ethics. It contributes to the understanding of the complexity of the role of family and ethical challenges in relation to patient involvement and decision making in Ethiopia. Improved knowledge in this area can provide a fundamental model for ways to improve cancer care in many other low-resource settings in Africa and the Middle East, which share central cultural prerequisites, such as a strong patriarchal family structure, along with strong and devout religiosity. The project will also serve to develop greater understanding about the current challenges in Western health systems associated with greater family and patient participation in decision making. In addition, the project will contribute to improving the education of Ethiopian health professionals working in cancer care by developing a training program to help them better understand and respond to identified challenges associated with communication. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/16493

scholarly journals ASSESSING ETHICAL AI-BASED DECISION-MAKING: TOWARDS AN APPLIED ANALYTICAL FRAMEWORK

2019 ◽  
Vol 2019 ◽  
Author(s):  
Paul Henman
Keyword(s):  
Artificial Intelligence ◽  
Decision Making ◽  
Analytical Framework ◽  
Government Accountability ◽  
Ethical Challenges ◽  
Government Decision ◽  
Policy Work ◽  
Key Questions

Globally there is strong enthusiasm for using Artificial Intelligence (AI) in government decision making, yet this technocratic approach is not without significant downsides including bias, exacerbating discrimination and inequalities, and reducing government accountability and transparency. A flurry of analytical and policy work has recently sought to identify principles, policies, regulations and institutions for enacting ethical AI. Yet, what is lacking is a practical framework and means by which AI can be assessed as un/ethical. This paper provides an overview of an applied analytical framework for assessing the ethics of AI. It notes that AI (or algorithmic) decision-making is an outcome of data, code, context and use. Using these four categories, the paper articulates key questions necessary to determine the potential ethical challenges of using an AI/algorithm in decision making, and provides the basis for their articulation within a practical toolkit that can be demonstrated against known AI decision-making tools.

scholarly journals Analytical study of care quality and moral distress in clinical situations and patient care

2019 ◽  
Vol 6 (4) ◽  
pp. 327-334
Author(s):  
Masoumeh Hasanlo ◽  
Arezo Azarm ◽  
Parvaneh Asadi ◽  
Kourosh Amini ◽  
Hossein Ebrahimi ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Analytical Study ◽  
Moral Distress ◽  
Professional Competence ◽  
Care Quality ◽  
Nursing Profession ◽  
Ethical Challenges ◽  
Significant Difference ◽  
Distress Scale

Abstract Objective Nursing profession conventionally meets a high standard of ethical behavior and action. One of the ethical challenges in nursing profession is moral distress. Nurses frequently expose to this phenomenon which leads to different consequences such as being bored by delivering patient care that decline care quality and make it challenging to achieve health purposes. This study was conducted to investigate the association between the aspects of moral distress and care quality. Methods In this descriptive–analytical study, 545 nurses of intensive and cardiac care units and dialysis and psychiatric wards were recruited by census sampling. Three questionnaires, Sociodemographics, Moral Distress Scale, and Quality Patient Care Scale, were distributed among the participants and collected within 9 months. Data analysis was conducted by descriptive statistics, analysis of variance, and the least significant difference in SPSS 13. Results Investigating moral distress domains (ignoring patient, decision-making power, and professional competence) and care quality domains (psychosocial, physical, and communicational) demonstrated that in being exposed to moral distress, ignoring patient had no effect on psychosocial domain (P=0.056), but decision-making and professional competence of moral distress had positive effect on psychosocial, physical (bodily), and communication domains of care quality. Conclusions Because moral distress domains are effective on patient care quality, it is recommended to enhance the knowledge of nurses, especially beginners, about moral distress, increase their strength alongside standardizing nursing services in decision-making domains, improve the professional competence, and pay attention to patients.

scholarly journals Informed Consent and Decision Making Among Participants in Novel-Design Phase I Oncology Trials

2017 ◽  
Vol 13 (10) ◽  
pp. e863-e873 ◽  
Author(s):  
Katherine E. Reeder-Hayes ◽  
Megan C. Roberts ◽  
Gail E. Henderson ◽  
Elizabeth C. Dees
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Phase I ◽  
Treatment Options ◽  
Research Participation ◽  
Predictive Biomarker ◽  
Ethical Challenges ◽  
Phase I Clinical Trials ◽  
Standard Drug ◽  
Experimental Drugs

Background: Although phase I clinical trials are the gateway to progress in cancer therapies, this setting poses ethical challenges to ensure that patients provide consent free from misunderstandings of therapeutic intent or unrealistic expectations of benefit. The design of phase I oncology trials has evolved rapidly over time and today includes more targeted agents and combinations of experimental drugs with standard drugs, which may further complicate how patients understand phase I research participation. Methods: We conducted semistructured interviews regarding motivations, decision making, and understanding of trial purpose nested within a phase I clinical trial of a novel PI3kinase inhibitor combined with a standard oral chemotherapy in 18 participants. Results: Fewer than half of patients correctly identified the safety and dosing objectives. The inclusion of a targeted agent was attractive to participants and was perceived as an indicator of less toxic or more efficacious therapy, with less appreciation for added risks. The significance of a cellular drug target, without a known predictive biomarker of response, was unclear to patients. The inclusion of a standard drug in the regimen attracted patients with more treatment options than traditional first-in-human participants. Patients frequently expressed a realistic understanding of prognosis and uncertainty of benefit, but simultaneous hopes for extraordinary outcomes. Conclusion: Novel phase I oncology trial designs may attract patients with less constrained treatment options, but the inclusion of targeted drugs and combinations including standard chemotherapies is likely to complicate understanding of safety and dosing objectives and likelihood of personal benefit for purposes of informed consent.

Too close for comfort: journalists’ ethical challenges in regional Australia

2020 ◽  
pp. 1329878X2096746
Author(s):  
Jane Stephens (Fynes-Clinton) ◽  
Rosanna Natoli ◽  
Michele Gilchrist
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Professional Practice ◽  
News Media ◽  
New South ◽  
Ethical Challenges ◽  
Remote Areas ◽  
South Wales ◽  
Story Writing ◽  
Regional Australia

Staff and budget cutbacks and systemic changes in news media have been widely documented by journalists and scholars, and this qualitative study aims to understand the empirical experience of journalists outside the cities, where isolation, small staff, tight budgets and close communities are the rule. This article reports on part of a study that investigated the experience of journalists in remote and regional media outlets in Queensland and New South Wales. This article explores the more pointed ethical difficulties journalists experience in regional areas, finding these conundrums add layers to decision-making and complexity in the source–journalist relationships. Journalists in regional and remote areas report feeling pressure to take shortcuts in their story writing due to time restraints, to sensationalise or angle stories to suit management agendas, or to write clickbait headlines. They identified these as challenges to their professional practice.

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