Artificial Intelligence in Mental Health

Chatbots are programmed conversational agents that emulate communication systematically using natural language processing. They can be programmed to assume a range of roles where regular human interaction occurs. Within mental health services, they are not as well represented as in other areas of healthcare, with research suggesting that uptake has been hindered by concerns over the accuracy of the information they provide, undeveloped technology, lack of adherence to an ethical framework, and the unconvincing portrayal of human authenticity. Technological improvements have addressed some of these concerns, and as the resultant solution choice increases, the potential for chatbots within mental health is receiving greater attention. In this chapter, two novel uses for chatbots are showcased. Foxbot, a recovery friend, accessible at the point of need to help mitigate some of the common risk factors to sustaining addiction recovery; and ERIC, a counselling client who allows trainee counsellors to practise their counselling skills without having to enlist an actual client.

Initial drafting of telemedicine’s code of ethics through a stakeholders’ participatory process

Telemedicine can improve access to healthcare services; however, it has raised ethical concerns demanding special considerations. This study aimed at developing the codes of ethics for telemedicine, and hence several approved national and international ethical guidelines related to telemedicine practice were reviewed, and 48 semi-structured interviews were conducted with medical ethics and medical informatics experts as well as with physicians and patients who had telemedicine experiences. Content analysis was then performed on the interviews’ transcripts and a draft on code of ethics was prepared, which was further reviewed by the experts in the focus group meetings to reach a consensus on the final document. The final document consisted of a preface, five considerations, and 25 ethical statements. Considering the growing trend of adopting telemedicine worldwide, this document provides an ethical framework for those who use telemedicine in their medical practice.

Promise and peril-defining ethical telehealth practice from the clinician and patient perspective: A qualitative study

Objectives We undertook a qualitative study to examine and compare the experience of ethical principles by telehealth practitioners and patients in relation to service delivery theory. The study was conducted prior to and during the recent global increase in the use of telehealth services due to the COVID-19 pandemic, Methods We conducted semi-structured interviews with 20 telehealth practitioners and patients using constructionist grounded theory methods to collect and analyse data. Twenty-five axial coded data categories were then unified and aligned through selective coding with the Beauchamp and Childress (2013) framework of biomedical ethics. The groups were then compared. Results Thirteen categories aligned to the ethical framework were identified for practitioners and 12 for patients. Variance existed between the groups. Practitioner results were non-maleficence 4/13 or (31%), beneficence 4/13 (31%), professional–patient relationships 3/12 (22%), autonomy 1/13 (8%) and justice 1/13 (8%). Patient data results were non-maleficence 4/12 (33%), professional–patient relationships 3/12 (33%), autonomy 2/12 (18%), beneficence 1/12 (8%) and justice 1/12 (8%). Conclusions Ethical principles are experienced differently between telehealth practitioners and patients. These differences can impact the quality and safety of care. Practitioners feel telehealth provides better care overall than patients do. Patients felt telehealth may force a greater share of costs and burdens onto them and reduce equity. Both patients and practitioners felt telehealth can be more harmful than face-to-face service delivery when it creates new or increased risk of harms. Building sufficient trust and mutual understanding are equally important to patients as privacy and confidentiality.

Developing a Living Donor Ethics Framework

This chapter advances an ethical framework for living donor transplantation. Given the analogies between living donor transplantation and human subjects research, the three principles enumerated in the National Commission’s Belmont Report are adopted as the starting point: respect for persons, beneficence, and justice. Two additional principles are also adopted: the principle of vulnerability and the principle that special relationships create special obligations. Whereas the Belmont Report discussed vulnerable groups, vulnerability is more aptly understood as an assortment of vulnerabilities that may apply to different people in different circumstances at different times of their lives. Eight distinct but overlapping vulnerabilities are described: capacitational, juridic, deferential, social, medical, situational, allocational, and infrastructural. The living donor advocate team (LDAT) stands in special relationship with the potential living donor and supports living organ donation provided that the living donor successfully addresses the challenges to autonomy and voluntariness that these vulnerabilities pose.

Teaching Students How to Frame Human-Computer Interactions Using Instrumentalism, Technological Determinism, and a Quadrant Learning Activity

This paper describes an innovative learning activity for educating students about human-computer interaction. The goal of this learning activity is to familiarize students with the way instrumentalists on the one hand, and technological determinists on the other, conceive of human-technology interaction, and to assess which theory students favor. This paper describes and evaluates the efficacy of this learning activity and presents preliminary data on student responses. It also establishes a framework for understanding how students initially perceive human-technology interaction and how that understanding can be used to personalize and improve their learning. Instrumentalists believe that technology can be understood simply as a tool or neutral instrument that humans use to achieve their own ends. In contrast, technological determinists believe that technology is not fully under human control, that it has some degree of autonomy, and that it has its own ends. Exposing students to these two theories of human-technological interaction provides five benefits: First, the competing theories deepen students’ ability to describe how technology and humans interact. Second, they provide an ethical framework that students can use to describe how technology and humans should interact. Third, they provide students with a vocabulary that they can use to talk about human freedom and how the design of computing technology may constrain or expand that freedom. Fourth, by challenging students to articulate what theory they favor, the learning is personalized. Fifth, because the learning activity challenges students to express their personal beliefs about how humans and technology interact, the learning activity can help instructors develop a clearer understanding of those beliefs and whether they reinforce what Erin Cech has identified as a culture of depoliticization and disengagement in engineering culture.

Consumer Medicine’s Origins and Harms

Consumer medicine consists of medical interventions pursued for non–health-related goals with the locus of the goals residing solely with the patient. Currently, contraceptives, abortion, cosmetic procedures, and physician-assisted suicide (PAS)/euthanasia fall in this category. Consumer medicine originates from the fusion of expressive individualism with its sole focus on the subjective psychological well-being intersecting with an expansion of health now including well-being combined with an exaltation of autonomy. Expressive individualism is inward-focused and entirely subjective reducing the human to a psychologic self while instrumentalizing the biological and social dimensions and neglecting the spiritual dimension. Expressive individualism is currently manifested through economic activity (career and consumption) and particularly sexual expression. This contrasts with the holistic biopsychosocial-spiritual model of health with its deep inter-relationships and prioritization of the spiritual. Consumer medicine has damaged the profession of medicine. Physicians now have conflicting roles of healer versus body engineer, and conflicting obligations to do no harm while performing medical harms unrelated to objective health. There is now division within medicine and increasing external state regulations both seriously harming its professional status. The traditional teleologically driven ethical framework that is objectively disease-focused is now confused with a subjective list of non–health-related values as goals for medical interventions leading to an incoherent ethical framework. Biologic solutions best address biological problems and do not effectively address psychological, social, or even spiritual problems but rather make them worse. Medicine now reinforces and is complicit with expressive individualism and its attendant shallow and narrow understanding of what it means to be human with the current valuation of sexual expression and economic activity. Medical harms and social costs have resulted while challenging the value of those who are disabled, elderly, or marginalized. This shallow view has likely fueled the current existential crisis contributing to the marked increase in PAS/euthanasia in the West. Summary: Consumer medicine currently includes contraceptives, abortion, cosmetic procedures, and physician-assisted suicide (PAS)/euthanasia. These medical interventions are pursued for subjective non–health-related goals as opposed to the traditional goal of treating sick patients for their objective health. Consumer medicine’s origins lie in the intersection of expressive individualism, the exaltation of patient autonomy combined with health’s redefinition as subjective well-being. This has resulted in harms to the profession of medicine, ethical incoherence, and medical injury. Consumer medicine promotes a truncated understanding of the human at odds with the biopsychosocial-spiritual model and human flourishing. This has likely contributed to the rise of PAS/euthanasia.

Professional ethics of recommendations: implications for COVID-19 vaccination of women who are pregnant or planning to become pregnant

There has been changing guidance from national and international professional associations, national and international non-governmental organizations, and health officials in national governments for obstetrician-gynecologists about COVID-19 vaccination of pregnant women and women who are planning to become pregnant. in this paper, we provide an ethical framework that provides the needed guidance to decision making about recommending COVID-19 vaccination to these patients. the unique feature of this ethical framework is that it is based on professional ethics in obstetrics and gynecology. We begin with an account of three key components of professional ethics in obstetrics and gynecology and how they are pertinent to the ethics of making recommendations that should be understood in obstetric and gynecologic practice generally. We then identify the implications of this overview for the specific topic of the ethics of recommending COVID-19 vaccination.

COVID-19 and the Working Class: Harm, Resistance, and Solidarity in the United States

Compared to many other wealthy nations, the United States lacks a strong social safety net, has weak legal protections for workers, has suffered long-term declines in unionization, and has eroded the gains in prosperity achieved by the working class in the post-WWII era. Consequently, despite advancements in science and medicine, the U.S. working class has suffered great harms during the COVID-19 pandemic, from the direct effects of illness and mortality and from indirect familial, social, and economic impacts. The failure of the federal government to protect blue collar, service, and retail sales workers with strong mandatory worksite infection control regulations has further endangered working class communities. The dearth of federal leadership has been countered by solidarity and a diversified set of pandemic monitoring and mitigation efforts on the part of worker organizations (primarily labor unions), social service NGOs, Indigenous nations, and communities of color. Defeating the COVID-19 syndemic will require continued working class solidarity, an ethical framework for envisioning a future which prioritizes social and racial justice, and structural economic and sociopolitical transformations.