Computerprognose - Ärztliche Entscheidung zwischen Statistik und Intuition

Weber, Ralph; Vogt-Weber, Beate

doi:10.1007/s003500050242

Cited by 4 publications

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“…Following the introduction of the Riyadh algorithm in German ICUs, a debate among physicians, professional societies, ethicists and politicians about the “death computer” ensued. The program was widely critiqued, especially for including economic rationale into the decisions to withdraw treatment [ 35 , 36 ]. The authors themselves recognized the dangers, and warned: “We consider that the data on outcome predictions with the Riyadh Intensive Care Program have always been presented in a responsible manner.…”

Section: Ethical Aspects Of Applying Scoring Systems To Clinical Carementioning

confidence: 99%

Clinical decision-making and secondary findings in systems medicine

Fischer

Erdmann²,

Langanke

2016

BMC Med Ethics

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BackgroundSystems medicine is the name for an assemblage of scientific strategies and practices that include bioinformatics approaches to human biology (especially systems biology); “big data” statistical analysis; and medical informatics tools. Whereas personalized and precision medicine involve similar analytical methods applied to genomic and medical record data, systems medicine draws on these as well as other sources of data. Given this distinction, the clinical translation of systems medicine poses a number of important ethical and epistemological challenges for researchers working to generate systems medicine knowledge and clinicians working to apply it.DiscussionThis article focuses on three key challenges: First, we will discuss the conflicts in decision-making that can arise when healthcare providers committed to principles of experimental medicine or evidence-based medicine encounter individualized recommendations derived from computer algorithms. We will explore in particular whether controlled experiments, such as comparative effectiveness trials, should mediate the translation of systems medicine, or if instead individualized findings generated through “big data” approaches can be applied directly in clinical decision-making. Second, we will examine the case of the Riyadh Intensive Care Program Mortality Prediction Algorithm, pejoratively referred to as the “death computer,” to demonstrate the ethical challenges that can arise when big-data-driven scoring systems are applied in clinical contexts. We argue that the uncritical use of predictive clinical algorithms, including those envisioned for systems medicine, challenge basic understandings of the doctor-patient relationship. Third, we will build on the recent discourse on secondary findings in genomics and imaging to draw attention to the important implications of secondary findings derived from the joint analysis of data from diverse sources, including data recorded by patients in an attempt to realize their “quantified self.”SummaryThis paper examines possible ethical challenges that are likely to be raised as systems medicine to be translated into clinical medicine. These include the epistemological challenges for clinical decision-making, the use of scoring systems optimized by big data techniques and the risk that incidental and secondary findings will significantly increase. While some ethical implications remain still hypothetical we should use the opportunity to prospectively identify challenges to avoid making foreseeable mistakes when systems medicine inevitably arrives in routine care.

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Section: Ethical Aspects Of Applying Scoring Systems To Clinical Carementioning

confidence: 99%

Clinical decision-making and secondary findings in systems medicine

Fischer

Erdmann²,

Langanke

2016

BMC Med Ethics

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“…1013 Um es auf den Punkt zu bringen, entscheidend gegen ein derartiges Verständnis von "Lebensunfähigkeit" spricht, dass der Lebensschutz die absolute Gleichwertigkeit allen menschlichen Lebens fordert, was es sowohl verbietet, eine bestimmte Zeitspanne im Leben eines Neugeborenen weniger zu schützen als eine andere, als auch das Leben eines Neugeborenen im Vergleich zum Erwachsenen für weniger schützenswert zu halten. 1014 Das erstmalige Verhelfen zur eigenen Existenz bei Neugeborenen anders zu beurteilen ist als deren Aufrechterhaltung und Wiederherstellung in einer späteren Altersstufe. Das (zu frühe) Neugeborene ist nicht weniger Mensch oder ein weniger wertvoller Mensch als der Erwachsene.…”

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Computerprognose - Ärztliche Entscheidung zwischen Statistik und Intuition

Cited by 4 publications

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Clinical decision-making and secondary findings in systems medicine

Clinical decision-making and secondary findings in systems medicine

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