scholarly journals Ethical issues in geriatric cranial neurosurgery

2020 ◽  
Vol 49 (4) ◽  
pp. E3
Author(s):  
Laureen D. Hachem ◽  
Mark Bernstein
Keyword(s):  
Decision Making ◽  
Ethical Issues ◽  
Surgical Care ◽  
Treatment Decision ◽  
The Elderly ◽  
Demographic Shift ◽  
Older Population ◽  
Treatment Decision Making ◽  
Disease States ◽  
Guide Treatment Decision

The global demographic shift to an older population has led to the emergence of the new field of geriatric neurosurgery. Beyond the complexities of disease states and multimorbidity, advanced age brings with it intricate ethical issues pertaining to both the practice and provision of medical and surgical care. In this paper, the authors describe the central ethical themes seen across the spectrum of common neurosurgical conditions in the elderly and highlight the use of foundational ethical principles to help guide treatment decision-making.

scholarly journals Computer knows best? The need for value-flexibility in medical AI

2018 ◽  
Vol 45 (3) ◽  
pp. 156-160 ◽  
Author(s):  
Rosalind J McDougall
Keyword(s):  
Decision Making ◽  
Medical Treatment ◽  
Shared Decision Making ◽  
Patient Autonomy ◽  
Ethical Issues ◽  
Treatment Decision ◽  
Shared Decision ◽  
Treatment Decision Making ◽  
Value Judgements ◽  
The Relationship

Artificial intelligence (AI) is increasingly being developed for use in medicine, including for diagnosis and in treatment decision making. The use of AI in medical treatment raises many ethical issues that are yet to be explored in depth by bioethicists. In this paper, I focus specifically on the relationship between the ethical ideal of shared decision making and AI systems that generate treatment recommendations, using the example of IBM’s Watson for Oncology. I argue that use of this type of system creates both important risks and significant opportunities for promoting shared decision making. If value judgements are fixed and covert in AI systems, then we risk a shift back to more paternalistic medical care. However, if designed and used in an ethically informed way, AI could offer a potentially powerful way of supporting shared decision making. It could be used to incorporate explicit value reflection, promoting patient autonomy. In the context of medical treatment, we need value-flexible AI that can both respond to the values and treatment goals of individual patients and support clinicians to engage in shared decision making.

scholarly journals Infused Chemotherapy Use in the Elderly After Patent Expiration

2012 ◽  
Vol 8 (3S) ◽  
pp. e18s-e23s ◽  
Author(s):  
Rena M. Conti ◽  
Meredith B. Rosenthal ◽  
Blase N. Polite ◽  
Peter B. Bach ◽  
Ya-Chen Tina Shih
Keyword(s):  
Decision Making ◽  
Cost Efficiency ◽  
Empirical Work ◽  
Treatment Decision ◽  
The Elderly ◽  
Patent Expiration ◽  
Treatment Decision Making

As calls for improving the quality and cost efficiency of oncology increase, future empirical work is needed to examine the responsiveness of oncologists' treatment decision making to incentives among patients of all ages and insurance types.

Ethical Issues in Adult Cognitive Disorders

2019 ◽  
pp. 864-880
Author(s):  
Andrea Horwege ◽  
Thomas Hammek ◽  
Anita Sue Jwa ◽  
Allyson C. Rosen
Keyword(s):  
Decision Making ◽  
Incidental Findings ◽  
Ethical Issues ◽  
Cognitive Disorders ◽  
Research Participation ◽  
Treatment Decision ◽  
Treatment Decision Making ◽  
The Past ◽  
Effort Testing ◽  
Tremendous Progress

During the past few decades, there has been tremendous progress in the diagnosis and treatment of cognitive disorders. With these opportunities to advance diagnosis and care, there are new ethical and practical concerns. This chapter provides a general overview of ethical issues related to patients with diminished cognitive functioning. It describes essential concepts and issues that clinicians must know, such as treatment decision-making, limitations on independence, protection from harm, and interpretive issues surrounding effort testing. It then describes ethical issues related to clinical research, such as informed consent and assent for research participation, and considerations when conducting clinical trials. Finally, the chapter describes some issues surrounding neuroethics, such as preparing for and dealing with incidental findings, early detection of disorders, neuroenhancement, and the use of deception.

scholarly journals Tumor Treating Fields for Glioblastoma Therapy During the COVID-19 Pandemic

2021 ◽  
Vol 11 ◽  
Author(s):  
Na Tosha N. Gatson ◽  
Jill Barnholtz-Sloan ◽  
Jan Drappatz ◽  
Roger Henriksson ◽  
Andreas F. Hottinger ◽  
...  
Keyword(s):  
Decision Making ◽  
Elderly Patients ◽  
Health Care Systems ◽  
Panel Discussion ◽  
Treatment Decision ◽  
The Elderly ◽  
Tumor Patients ◽  
Treatment Decision Making ◽  
Tumor Treating Fields ◽  
Care Systems

BackgroundThe COVID-19 pandemic has placed excessive strain on health care systems and is especially evident in treatment decision-making for cancer patients. Glioblastoma (GBM) patients are among the most vulnerable due to increased incidence in the elderly and the short survival time. A virtual meeting was convened on May 9, 2020 with a panel of neuro-oncology experts with experience using Tumor Treating Fields (TTFields). The objective was to assess the risk-to-benefit ratio and provide guidance for using TTFields in GBM during the COVID-19 pandemic.Panel DiscussionTopics discussed included support and delivery of TTFields during the COVID-19 pandemic, concomitant use of TTFields with chemotherapy, and any potential impact of TTFields on the immune system in an intrinsically immunosuppressed GBM population. Special consideration was given to TTFields' use in elderly patients and in combination with radiotherapy regimens. Finally, the panel discussed the need to better capture data on COVID-19–positive brain tumor patients to analyze longitudinal outcomes and changes in treatment decision-making during the pandemic.Expert OpinionTTFields is a portable home-use device which can be managed via telemedicine and safely used in GBM patients during the COVID-19 pandemic. TTFields has no known immunosuppressive effects which is important during a crisis where other treatment methods might be limited, especially for elderly patients with multiple co-morbidities. It is too early to estimate the full impact of COVID-19 on the global healthcare system and on patient outcomes and the panel strongly recommended collaboration with existing cancer COVID-19 registries to follow CNS tumor patients.

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