Designing a medical ethics curriculum in ophthalmology

Ethical principles form a bedrock to medical practice in any specialty,guiding physicians to appropriate attitudes and behaviors.A formal ethics curriculum can be difficult to generate de novo in an ophthalmology training program.A number of barriers exist in most ophthalmology departments:trainees may think ethics is of secondary importance compared to core basic and clinical science topics;most ophthalmology faculty have no formal degree in medical ethics;there is limited didactic time with competing academic,clinical,and surgical priorities;work-hours regulations may limit the time available to deliver“para-professional”lectures;and there is a belief that the medical ethics lectures during medical school is a sufficient amount of coursework to last through a physician’s career with no need for continuing professional development.The four pillars of medical ethics are beneficence,non-maleficence,autonomy,and justice.In addition,morals,ethics,and professionalism are important aspects of sound medical practice.A curriculum specific to medical ethics in ophthalmology can be developed in any of our sub-specialties and include lectures,curated readings,case rounds,and clinic wrap-up sessions.Ethical considerations are part of everyday clinical practice,and a structured ethics curriculum can be incorporated into ophthalmology training programs.The concept of backward design can be used to structure the curriculum,starting with the expected outcome,then designing authentic assessments,and finally putting together a learning plan that has students actively involved in ethical discussions.This paper will provide a guide to developing an ethics curriculum for an ophthalmology training program utilizing the concept of backwards design and guide the reader through the process of developing expected learning outcomes,authentic assessments,and a unified learning plan.

Reading Toni Morrison’s Home From the Perspective of Medical Relationship Ethics

As the first black women Nobel laureate,Toni Morrison has drawn great attention with her fascinating and deep-thinking novels.Her 10th novel Home vividly shows the racial suffering and the post-war trauma of black veteran Frank,who has drawn critical attention from various perspectives.However,there is hardly any scholarly focus on another major character Cee,whose experience of medical and racial discrimination actually constitutes another important clue throughout the whole story.Therefore,this paper intends to analyze Home from the perspective of ethical relationship ethics,including doctor-patient relationship,doctor-society relationship,patient-society relationship,and patient-family relationship.The analysis indicates that Home not only reveals the history of medical racial discrimination and human experiment ethics problems under the rapid development of medical technology in the 1950s,but also inspire readers’thinking on the ethical problems and ethical dilemmas in the contemporary world.

Patients＇ Responsibilities in Medical Ethics

There has been a shift from the general presumption that ＂doctor knows best＂ to a heightened respect for patient autonomy. Medical ethics remains one-sided, however. It tends （incorrectly） to interpret patient autonomy as mere participation in decisions, rather than a willingness to take the consequences. In this respect, medical ethics remains largely paternalistic, requiring doctors to protect patients from the consequences of their decisions. This is reflected in a one-sided account of duties in medical ethics. Medical ethics may exempt patients from obligations because they are the weaker or more vulnerable party in the doctor-patient relationship. We argue that vulnerability does not exclude obligation. We also look at others ways in which patients＇ responsibilities flow from general ethics： for instance, from responsibilities to others and to the self, from duties of citizens, and from the responsibilities of those who solicit advice. Finally, we argue that certain duties of patients counterbalance an otherwise unfair captivity of doctors as helpers.

Medicine as Profession： An Overlooked Approach to Medical Ethics

This article begins with three problems of ＂dual loyalties＂ in medicine, the supposed fact that military physicians are, as medical officers, sometimes required to do what violates ordinary medical ethics--for example, ignore medical need in order to treat their own wounded before civilians or wounded enemy, help make chemical or biological weapons more deadly, or assist at a rough interrogation. These problems are analyzed as special cases of a problem that could arise in any profession, a problem easily resolved using a theory of professional ethics （more or less） absent from medical ethics until now though common outside. Employing a physician--rather than an ordinary officer, some other kind of healer, or scientist--is to enter a sort of ＂Ulysses contract＂ requiring the physician＇s professional standards to preempt obligations otherwise applying to an employee. In this way, the article also illustrates the benefits that might accrue to medical ethics from drawing （more than is now common） on other fields of practical ethics.

Medical ethics w.s.r to ayurveda

With nearly 5,000,000 Indians dying due to medical negligence every year.there is a circular relationship between nature and humankind because human concepts are nature’s concepts. Human technological and economic inventiveness is no more than nature’s way of acting upon itself and shaping its own future. The outcome could be glorious success or disastrous failure - in either case, nature acting through humankind bears partial responsibility for the outcome. A basic knowledge of how judicial forums deal with the cases relating to medical negligence is of absolute necessity for doctors. The need for such knowledge is more now than before in light of higher premium being placed by the Indian forums on the value of human life and su ffering, and perhaps rightly so. Judicial forums, while seeking to identify delinquents and delinquency in the cases of medical negligence, actually aim at striking a careful balance between the autonomy of a doctor to make judgments and the rights of a patient to be dealt with fairly.Agadatantra one among eight branches of ayurveda has given good references in regard to medcal ethics and also how to overcome the burden of medical negligence merely by identifying the treating doctor.

Rhazes’concepts on medical ethics

Ethics in any industry and profession,especially in medicine,is a matter of great concern and debatable.Ancient Persian Muslim doctors also did not neglect this issue,as they mentioned some points regarding the observance of medical ethics in most of their books.Rhazes'"Akhlaq al-Tabib"treatise is one of the most important manuscripts on medical ethics.Abu Bakr Muhammad ibn Zakariyya Razi,known in the west as Rhazes,was a great Persian scientist and physician who lived in the 9th and 10th centuries AD.In the"Akhlaq al-Tabib"treatise,he wrote a collection of his guidelines and ideas about medical ethics.In this manuscript,Rhazes first mentioned the ethical qualities that the physician must admire,and then pointed out the ethical standards regarding treatment and patient's rights.The study found that the principles of tenth-century medical ethics are very similar to what is being said today.

Artificial intelligence ecosystem for computational psychiatry:Ideas to practice

Computational psychiatry is an emerging field that not only explores the biological basis of mental illness but also considers the diagnoses and identifies the underlying mechanisms.One of the key strengths of computational psychiatry is that it may identify patterns in large datasets that are not easily identifiable.This may help researchers develop more effective treatments and interventions for mental health problems.This paper is a narrative review that reviews the literature and produces an artificial intelligence ecosystem for computational psychiatry.The artificial intelligence ecosystem for computational psychiatry includes data acquisition,preparation,modeling,application,and evaluation.This approach allows researchers to integrate data from a variety of sources,such as brain imaging,genetics,and behavioral experiments,to obtain a more complete understanding of mental health conditions.Through the process of data preprocessing,training,and testing,the data that are required for model building can be prepared.By using machine learning,neural networks,artificial intelligence,and other methods,researchers have been able to develop diagnostic tools that can accurately identify mental health conditions based on a patient’s symptoms and other factors.Despite the continuous development and breakthrough of computational psychiatry,it has not yet influenced routine clinical practice and still faces many challenges,such as data availability and quality,biological risks,equity,and data protection.As we move progress in this field,it is vital to ensure that computational psychiatry remains accessible and inclusive so that all researchers may contribute to this significant and exciting field.

Artificial intelligence-assisted psychosis risk screening in adolescents:Practices and challenges

Artificial intelligence-based technologies are gradually being applied to psychiatric research and practice.This paper reviews the primary literature concerning artificial intelligence-assisted psychosis risk screening in adolescents.In terms of the practice of psychosis risk screening,the application of two artificial intelligence-assisted screening methods,chatbot and large-scale social media data analysis,is summarized in detail.Regarding the challenges of psychiatric risk screening,ethical issues constitute the first challenge of psychiatric risk screening through artificial intelligence,which must comply with the four biomedical ethical principles of respect for autonomy,nonmaleficence,beneficence and impartiality such that the development of artificial intelligence can meet the moral and ethical requirements of human beings.By reviewing the pertinent literature concerning current artificial intelligence-assisted adolescent psychosis risk screens,we propose that assuming they meet ethical requirements,there are three directions worth considering in the future development of artificial intelligenceassisted psychosis risk screening in adolescents as follows:nonperceptual realtime artificial intelligence-assisted screening,further reducing the cost of artificial intelligence-assisted screening,and improving the ease of use of artificial intelligence-assisted screening techniques and tools.

In the Spirit of Benevolence:Taking Action to Fight Against the COVID-19 Pandemic

Confucian doctors are representative of traditional Chinese medicine(TCM)practitioners with excellent moral character and medical knowledge,they are not hidden in the depths of ancient documents but are a guiding inspiration for professional medical personnel today.Confucian doctors are representative group of benevolence in Confucian philosophy and demonstrate the scientific and humanistic spirit of Confucian philosophy and demonstrate the scientific and humanistic spirit of Confucianism in their medical practice.They are also leading medical practitioners who uphold professional ethics in their pursuits of scientific research,clinical diagnosis&treatment,and scholarship.Both TCM and Confucian doctors played important roles during the outbreak of the coronavirus disease 2019(COVID-19)pandemic in China.By virtue of the superb medical skills of Confucian doctors,integrated Chinese and Western medicine can quickly alleviate patients’symptoms,increase cure rates,reduce mortality rates,thus saving lives.Following the results of extensive clinical trials,this integrated therapy is now understood to be a beneficial treatment for COVID-19.The combination of TCM and Western medicine is a major feature of COVID-19 prevention and control in China.In particular,TCM plays a significant role in the fight against the COVID-19 pandemic with its unique advantages.

Two case reports of novel syndrome of bizarre performance of gastrointestinal endoscopy due to toxic encephalopathy of endoscopists among 181767 endoscopies in a 13-year-university hospital review: Endoscopists, first do no harm!

BACKGROUND Although deficient procedures performed by impaired physicians have been reported for many specialists,such as surgeons and anesthesiologists,systematic literature review failed to reveal any reported cases of deficient endoscopies performed by gastroenterologists due to toxic encephalopathy.Yet gastroenterologists,like any individual,can rarely suffer acute-changes-inmental-status from medical disorders,and these disorders may first manifest while performing gastrointestinal endoscopy because endoscopy comprises so much of their workday.CASE SUMMARIES Among 181767 endoscopies performed by gastroenterologists at William-Beaumont-Hospital at Royal-Oak,two endoscopies were performed by normally highly qualified endoscopists who manifested bizarre endoscopic interpretation and technique during these endoscopies due to toxic encephalopathy.Case-1-endoscopist repeatedly insisted that gastric polyps were colonic polyps,and absurdly“pressed”endoscopic steering dials to“take”endoscopic photographs;Case-2-endoscopist repeatedly insisted that had intubated duodenum when intubating antrum,and wildly turned steering dials and bumped endoscopic tip forcefully against antral wall.Endoscopy nurses recognized endoscopists as impaired and informed endoscopy-unit-nurse-manager.She called Chief-of-Gastroenterology who advised endoscopists to terminate their esophagogastroduodenoscopies(fulfilling ethical imperative of“physician,firstdo-no-harm”),and go to emergency room for medical evaluation.Both endoscopists complied.In-hospital-work-up revealed toxic encephalopathy in both from:case-1-urosepsis and left-ureteral-impacted-nephrolithiasis;and case-2-dehydration and accidental ingestion of suspected illicit drug given by unidentified stranger.Endoscopists rapidly recovered with medical therapy.CONCLUSION This rare syndrome(0.0011%of endoscopies)may manifest abruptly as bizarre endoscopic interpretation and technique due to impairment of endoscopists by toxic encephalopathy.Recommended management(followed in both cases):1-recognize incident as medical emergency demanding immediate action to prevent iatrogenic patient injury;2-inform Chief-of-Gastroenterology;and 3-immediately intervene to abort endoscopy to protect patient.Syndromic features require further study.

Continuous sedation until death:Therapeutically and ethically acceptable

If a patient is dying and still suffering great pain, what is the least harmful alternative? Here we prefer continuous sedation until death (CSD). CSD differs from physician-assisted death (PAD) in many aspects. Firstly, CSD is not used to shorten life or cause death, but instead its intention is to relieve suffering. Secondly, once CSD is associated with a reduction in or suspension of food intake, the duration of sedation is too short to have an impact on survival rate. Thirdly, CSD is titrated while PAD is often overdosed. Fourthly, the sanctity of life could be maintained since sedation is used merely as a means of quelling suffering. Last but no least, for unconscious patients, the same medicines are frequently used for both palliative sedation and standard surgical procedures.

Premodern Intercultural Communication by Reanalyzing the Phrase“Da Yi Jing Cheng(大医精诚)”

Culture is fluid,not static.When one culture meets and blends with another,Westerm academic circles tend to use cultural hybridity to express a mixed state of culture.By reanalyzing the classic texts in relation to“Da Yi Jing Cheng(大医精诚)”,tracing the evolution of traditional medical ethics in history,and combining the knowledge of cultural hybridity,this paper suggests that cultural hybridity is not applicable to the discussion on the phenomenon of intercultural communication in the era before the rise of national states and modernity.A new discourse is needed to express intercultural integration,one that breaks through Western values and embodies the characteristics of Asian civilization.Civilization exchange and mutual learning can become the ideal model of intercultural communication under the background of the“Belt and Road Initiative”.

The Conflict between Patient Autonomy and the Dying Patient Law in Israel

The Dying Patient Law is very controversial in Israel; there are opinions that the reason for the Law was to prevent the court from making decisions on the subject of end of life according to democratic principles. I decided to do this study because I wanted to know if the legal principles of the Law are democratic as were the court rulings or they are only, or mostly, Jewish principles and meant to prevent a democratic ruling in the courts. The work is a review of the Law and the Dying Patient Committee discussions as well as the chairman＇s writings on the Law, critique articles, and a review of democratic and bioethical principles. In this project, I have seen that the underlying basis of the Dying Patient Law is Jewish principles and not democratic principles, although Israel is a declared democratic state. This law illustrates the problem in Israel being both a democratic and a Jewish state. It raises the question： What can be done to resolve the conflict between the Jewish principles and democratic and/or bioethical principles？

The Right to Life, Voluntary Euthanasia, and Termination of Life on Request

In this article, the logical implications of a right to life are examined. It is first argued that the prohibition of Termination of life on request confers an inalienable right to life. A fight is inalienable if it cannot legitimately be waived or transferred. Since voluntary euthanasia entails waiver of the right to life, the inalienability yields that it cannot be justified. Therefore, any ethical position that is in favor of voluntary euthanasia has to argue that the right to life is an inalienable right and accept the conclusion that killing on request is justified.

Medical Ethics Vs. Journalistic Ethics

Substituting tea for urine samples has sparked off more than just a storm in a teacup.Hospitals in Hangzhou,Zhejiang Province,were recently left red-faced when they tested tea and pronounced prescriptions to

Ethical dilemma in Chinese prison hospital

Forensic medical workers are faced with unique ethical challenges in their attempt to deliver medical care in a custodial environment.We first figure out the reasons why the doctor is standing opposed to the patient through questionnaire and interview of the prison doctor in Shanghai,China,which turn to be a bilateral issue.Both sides should take more active approaches and put themselves to the right position to contribute to a better medical environment in the prison hospital,which can reduce medical tangles and help the criminals to accomplish their reform process.

Chinese Ethics Review System and Chinese Medicine Ethical Review:Past,Present,and Future

The Chinese medical ethics committee and the ethical review system have made the following achievements： （1） enabled the institutionalization of medical ethics, （2） carried out the ethics review of Chinese medicine （CM） and integrative medicine extensively, （3） trained a large number of ethical professionals, （4） supported and protected the interests of patients and subjects, and （5） ensured the correct direction of biological research and provided ethical defense for the publication of its results. However, at the same time, they are also faced with some new problems and difficulties that need to be resolved in the following ways： （1） to refine the relevant rules of ethical review, （2） to develop the relevant standards of the CM and integrative medicine ethical review, （3） to enhance the independence and authority of ethics committee, （4） to emphasize innovation and to discover and solve new problems, and （5） to increase international exchanges and improve relevant research.

Expert consensus on clinical trials of human xenotransplantation in China

The history of xenotransplantation started in the 19th century.After a few decades of investigation,significant breakthroughs and preclinical milestones have been achieved worldwide.With the recent transplantation of genetically modified porcine kidneys and heart into humans,these ground-breaking achievements have attracted great attention worldwide,in the hope that xenotransplantation might alleviate or even solve the problem of organ shortage.On January 20,2022,the China Organ Transplantation Development Foundation convened a symposium on“The History,Current Situation and Future of Human Xenotransplantation Clinical Trials,”where ways to promote the ethical and sustainable development of xenotransplantation in China were discussed among the participating experts.A formal consensus was reached as the product of the symposium,outlining the expert opinions on scientific,regulatory,and ethical issues of clinical trials of xenotransplantation in China.

The unregulated commercialization of stem cell treatments:a global perspective

Research into the biological properties and clinical potential of stem cells has spurred strong public investment,industry development,media coverage,and patient interest in recent years.To date,however,few clinical applications of demonstrated safety and efficacy have been developed with the exception of uses of hematopoietic stem cells in the treatment of diseases of the blood and immune systems.This lack of an evidence basis notwithstanding,hundreds of companies and private clinics around the world now sell putative stem cell treatments for an enormously broad range of medical and quality-of-life conditions.This represents a major challenge for legitimate scientists working in the field,for authorities seeking to protect their constituencies,and for patients and consumers targeted by such companies’marketing strategies.In this review,I provide an overview of the global industry in pseudomedical stem cell treatments,with an investigation of claims in a single disease area(amyotrophic lateral sclerosis),and make recommendations for the introduction and enforcement of appropriate regulatory responses to this problem.