Latest news with #MedicalEthics
Forbes
31-07-2025
- Health
- Forbes
As Shared Decision-Making Ails, AI May Save This Human Interaction
Shared decision-making between doctors and patients may be 'the pinnacle of patient-centered care,' but three new medical journal articles suggest it's encountering more problems than peaks. Yet counterintuitively, it may be artificial intelligence that rescues this intimately human interaction. 'Shared decision-making is at a crossroads,' declares a Perspective in the Journal of General Internal Medicine, 'Saving Shared Decision-Making.' Unfortunately, its more-research-and-education recommendations for 'advancing the science of SDM implementation,' seem more crossing guard than crisis management. Even a cursory historical perspective shows that SDM is suffering from a failure to flourish. Back in 1982, a report by a presidential commission on ethics in medicine declared SDM 'the appropriate ideal for patient-professional relationships' and called on doctors 'to respect and enhance their patients' capacities for wise exercise of their autonomy.' Yet 43 years later, the Perspective authors – 18 members of the Agency for Healthcare Research and Quality Shared Decision-Making Learning Community – acknowledged that while some doctors respectfully ask patients, 'What do you think you would like to do, given these options?' many others still believe that, 'Let's do this option, sound OK?' is a shared decision process. That attitude reminded me of a tongue-in-cheek comment by comedian Stephen Colbert. 'See what we can accomplish when we work together by you doing what I say?' he told a 2015 Colbert Nation audience. 'It's called a partnership.' Cancer Communication Curtailed In cancer, where patient-doctor interactions have the highest stakes, shared decision-making was named one of the central components of quality care in a 1999 report, Ensuring Quality Cancer Care, by the Institute of Medicine (now the National Academy of Medicine). Nonetheless, a review of SDM among cancer patients in the journal Psycho-Oncology found that for physicians, 'making decisions and taking responsibility for the decisions remain an important part of the physicians' professional identity.' The fear of losing this identity, the authors wrote, 'tends to hinder the patient involvement and implementation of SDM.' Not surprisingly, cancer patients who want to speak up feel as if they won't be listened to or can't really refuse whatever their oncologist considers clinically 'optimal.' And, it turns out, oncologists are actually less open to SDM if a patient does speak up and resists the recommendations they feel are in the patient's best interest. Meanwhile, for those hoping Gen Z doctors will naturally be more sensitive, a JAMA Perspective, 'When Patients Arrive With Answers, brought discouraging news. When the topic of patients bringing in a treatment recommendation from ChatGPT came up among a group of medical students in the Seattle area, these Internet-native physicians of tomorrow bristled with an old-fashioned dismissiveness of the patient who's 'going to tell us what to order.' There's an implicit message that 'we still know best,' lamented Dr. Kumara Raja Sundar. AI Addresses Chronic Problem When you take a hard look at SDM use, misuse and non-use, it's clear this is a chronic problem, not an acute one. Good intentions collide with cultural norms going back to Hippocrates. The idea of patient self-determination, writes medical ethicist Dr. Jay Katz in The Silent World of Doctor and Patient, represents 'a radical break with medical practices, as transmitted from teacher to student during more than two thousand years of recorded medical history.' Perhaps equally important individual physicians are increasingly less likely to control their own time. In the 1980s, 80% of physicians worked in practices of ten or fewer doctors, according to the American Medical Association, and the overwhelming percentage of those were in private practice. In 2024, for the first time, private practice doctors were a minority, at just 42%, and about one in five doctors worked in practices of 50 or more. Paradoxically, AI may push shared decision-making onto what is now often an extremely time-pressured agenda precisely because the detailed, personalized level of information that it's able to force a reassessment of physician professional identity. Similarly, the scale, scope and depth of the AI revolution will also compel the group practice leaders, health system executives, private equity satraps and all others who now pull the strings on so many physicians to adapt to the democratization of medical knowledge. There may be no other choice. Already, individuals with breast, lung or prostate cancer can go to a well-funded start-up that will help them transfer their medical record into a platform that compares their treatment plan to the clinical practice guidelines of the National Comprehensive Cancer Network. Separately, a cancer survivor and entrepreneur has launched an online platform to make personalized agentic AI, a sophisticated search of the medical literature, available to every cancer patient. And real-world evidence in cancer care, now being marketed to clinicians and researchers, will inevitably be available directly to patients. Meanwhile, online venues like the PatientsUseAI Substack help guide those who wish to be full partners in their care how to use the new tools. The question no longer will be whether there is shared decision-making, but how it takes place. Sundar, a family physician, suggests 'relational humility,' with doctors 'seeing AI-informed visits as opportunities for deeper dialogue rather than threats to clinical authority.' He adds, 'If patients are arming themselves with information to be heard, our task as clinicians is to meet them with recognition, not resistance.'
Medscape
30-06-2025
- Health
- Medscape
Death Clock App Not Ready for Prime Time, Says Ethicist
This transcript has been edited for clarity. Hi. I'm Art Caplan. I'm at NYU's Division of Medical Ethics at our medical school. I came across a really interesting app called the Death Clock. It is exactly what it sounds like. It basically is an app where you feed in all your health information, personal information, social information — any fact about you — and it promises to tell you your death basically is a forecaster of when you're going to die. You might say, some people might have an interest in that. What's the issue? Well, I think there are many issues. Should a patient come and ask you about this, I think you'd be wise to be ready to answer in case this app or others like it that are coming take first problem is, can we accurately predict your death date, even given a whole array of personal information? I still don't think so. Having worked now for a while on geroscience, meaning what factors cause senescence — not diseases in old age, like Alzheimer's disease or Lewy body dementia, but just aging — we don't really understand why some people age at different rates. There's a disease called progeria where a 10-year-old can go through aging and end up looking like a 90-year-old at the age of 11. Then, there are clearly differences in the rates at which people age from midlife to old age. We don't understand them well, but we're learning. I think an app that says it can tell you your death date is not accurate. Some people aren't going to want to know their death date without getting counseling. If someone asks if they should buy the app, I think either that company or you, as the doctor, had better be prepared to counsel them about what it would mean if it predicted an early death or a death that's coming soon. Aside from fear and worry, what plans should they make?Should they fill out advanced directives? Should they not retire to Arizona sooner? They're going to want information and counseling, and somebody has to provide it to them, and I don't see this company doing that yet. People need to at least try to cope with bad news. Another reason the company says the app is interesting is it'll push you to make lifestyle changes that will extend your death they offer — I think it was for $50 a year, if I remember right — a program to counsel you, claiming to be targeted to your particular situation, so that you can live longer. I doubt that is necessary either. We all know how to counsel patients in terms of wanting to live simple steps. I don't mean simple to do, but I mean five or six rules that hold up: lose weight, more exercise, moderate drinking, wear your seatbelt, don't use recreational drugs in excess. We know what the tricks are if you want to add lifespan. I don't think you need to sign up for anybody's program yet. Probably the biggest worry I have is, who's going to get all this information? I don't trust this company not to resell. I don't trust this company to protect individual identity. Even if they tried, with hackers and accidents, having this private company control identifiable information — boy, I think that's a much bigger risk than any benefit you might get from having the death clock. Overall, I'm still not ready. I did take a peek at my own prediction. I've got some time left, which is good to know, but that was just curiosity so that I could talk to you about it. In general, I don't think this is ready for prime time. I do think the downsides still outweigh the benefits, so I would be pretty cautious before I set the death clock with a patient. I'm Art Caplan, at the Division of Medical Ethics at NYU Langone. Thanks for watching.
Medscape
27-05-2025
- Business
- Medscape
Make America Healthy Again Through Prevention, Says Ethicist
This transcript has been edited for clarity. Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at NYU Grossman School of Medicine. There was an announcement I received February 13, establishing an order from the White House for a new commission. It's called the Make America Healthy Again Commission. I've got the order printed out in my hand. It's something that everyone watching this video needs to be aware of and attentive to. The commission is meant to advise the federal government, chaired by the new Department of Health and Human Services leader, Robert Jr, on all matters regarding health and disease. The executive order creating it begins with what I have to say is one of the toughest, meanest indictments of American healthcare, as it now exists, that I've read anywhere. This is not something that was cooked up by some sort of civil rights group or some kind of foundation fighting against corporate American healthcare. This is right out of the world of the president and his top health advisors. What they're saying is that American healthcare is a grim failure because of the mess that Americans are in with respect to their health. The highest cancer rates, double the next highest rates of comparable countries. Asthma is twice as common than in most of Europe, Asia, and Africa, and the same for autoimmune diseases like inflammatory bowel disease, psoriasis, and multiple sclerosis. It basically says the American people are on a trajectory, if we don't do something about the whole healthcare system, that is leading them to premature death and disability due to chronic illness. It also suggests that children, in particular, are at grave risk because of the way healthcare is organized and delivered now. This is one huge indictment, and what it says is that we want fresh thinking. The charge is what can we do about better nutrition, more physical activity, change to healthy lifestyles,get off medications, try to assess new technology habits — they're talking about cell phones, I presume — and food and drug quality and safety. It's hard to be against any of those bits of advice. I think, in many ways, what the commission is charged to do is come up with new ways to think about prevention as opposed to disease treatment. That won't come as a shock to many of you physicians watching. Many people would like to see our healthcare system pay for more prevention, which it doesn't, and see more resources devoted to counseling and supporting people with respect to maintaining their health. I have to say, I don't think there are any big mysteries that have to be examined creation of this commission hints that somehow there are secrets out there that we don't know about. I don't believe that. I think we know that lifestyle change is very important. We just don't know how to get it done. I think we know that better diet would be great. We just don't know how to get people to do it. There's a huge food industry in America that stands in the way of transitioning to healthier diets. Our agriculture is built around unhealthy foods, including sugar and everything. It's going to be very tough to move what I'll call a fast-food society over to healthy lifestyles. I don't agree with the rationale given here about the need for new thought completelybecause I think many people know that we are too oriented toward fixing, treating, and rescuing people who have diseases and not doing enough to preserve health. I don't think that's a mystery of poor or limited thinking. There are also some concerning aspects in this order to create the committee of what they want this commission to do. For example, they say pay attention to things like cell phone towers; toxic exposures, with the suggestion being perhaps vaccines; and worrying about what's going on with children with respect to too much exposure to nasty elements of the environment. Again, I think what's going on with children is pretty well understood: obesity. We've got a big obesity challenge, and I hope that this commission can think about ways to battle obesity. One of the things that the commission's chair, RFK Jr, wants to do is shift lifestyle. I think many of you who practice, regarding children and families, know that efforts to change lifestyle have not ended well. It's very difficult to do it in the climate and environment in which we live when we're bombarded with ads for unhealthy food and portion sizes that are far bigger than in the rest of the world and on and on. Getting lifestyle change is so tough that we're turning more and more to the injectable weight loss drugs.I don't think that's something that RFK Jr is going to be willing to support. I don't think we need novel thinking about how to solve it in terms of what the causes are. If we're going to make progress, my comment would be that we have to change reimbursement and what we pay for. We have to intervene earlier with people long before they're sick, with better wellness visits and better well-baby have to shift how the system delivers prevention. I'm not quite on board with new thinking. I'm on board with new modes of thinking about how to deliver prevention to the American people. I'm Art Caplan, at the Division of Medical Ethics at NYU Grossman School of Medicine. Thanks for watching.
