Medical Ethics in Terminal Patients: Dilemmas in the Use of AI for End-of-Life Decisions
DOI:
https://doi.org/10.56294/ai202222Keywords:
Medical ethics, Artificial intelligence, Palliative care, Patient autonomy, End-of-life decisionsAbstract
Medical ethics in terminal patients faces unprecedented challenges with the integration of artificial intelligence (AI) in end-of-life decision-making. This article aims to analyze the ethical dilemmas arising from the use of AI in this context by exploring its implications for autonomy, dignity, and the humanization of palliative care. To this end, a literature review was conducted of articles in Spanish and English indexed in Scopus between 2018 and 2022, selecting studies that addressed the intersection of AI, bioethics, and palliative medicine. The results were organized into four thematic axes: patient autonomy and informed consent, algorithmic biases and equity in recommendations, dehumanization versus optimization of care, and legal and moral responsibility in automated decisions. It was identified that, although AI can improve the accuracy of forecasts and treatments, its implementation requires ethical safeguards to prevent the reduction of the doctor-patient relationship to a technical process. The conclusions highlight the need for regulatory frameworks that balance technological innovation with bioethical principles, prioritizing human dignity and the active participation of patients and families in end-of-life decisions.
References
Garetto F, Cancelli F, Rossi R, Maltoni M. Palliative Sedation for the Terminally Ill Patient. CNS Drugs 2018;32(10):951-961. https://doi.org/10.1007/s40263-018-0576-7
Tatum P, Mills S. Hospice and Palliative Care: An Overview. Medical Clinics of North America 2020;104(3):359-373. https://doi.org/10.1016/j.mcna.2020.01.001
Rosenberg L, Fishel A, Harley R, Stern T, Emanuel L, Cohen J. Psychological Dimensions of Palliative Care Consultation: Approaches to Seriously Ill Patients at the End of Life. Journal of Clinical Psychiatry 2022;83(2):22ct14391. https://doi.org/10.4088/JCP.22ct14391
Gómez Cano CM, Valencia Arias JA. Mechanisms used to measure technological innovation capabilities in organizations: results from a bibliometric analysis. Revista Guillermo de Ockham 2020;18(1):69-79. https://doi.org/10.21500/22563202.4550
Quinn K, Wegier P, Stukel T, Huang A, Bell C, Tanuseputro P. Comparison of Palliative Care Delivery in the Last Year of Life Between Adults With Terminal Noncancer Illness or Cancer. JAMA Network Open 2021;4(3):e210677. https://doi.org/10.1001/jamanetworkopen.2021.0677
Heydari H, Hojjat-Assari S, Almasian M, Pirjani P. Exploring health care providers' perceptions about home-based palliative care in terminally ill cancer patients. BMC Palliative Care 2019;18:66. https://doi.org/10.1186/s12904-019-0452-3
Gómez CA, Sánchez V, Fajardo MY. Projects and their dimensions: a conceptual approach. Contexto 2018;7:57-64. http://contexto.ugca.edu.co
Anandarajah G, Mennillo H, Rachu G, Harder T, Ghosh J. Lifestyle Medicine Interventions in Patients With Advanced Disease Receiving Palliative or Hospice Care. American Journal of Lifestyle Medicine 2019;14(3):243-257. https://doi.org/10.1177/1559827619830049
Gómez-Cano C, Sánchez V, Tovar G. Endogenous factors causing irregular permanence: a reading from teaching practice. Educación y Humanismo 2018;20(35):96-112. http://dx.10.17081/eduhum.20.35.3030
Coeckelbergh M. AI for climate: freedom, justice, and other ethical and political challenges. AI and Ethics 2020;1(1):67-72. https://doi.org/10.1007/s43681-020-00007-2
Simon S, Pralong A, Radbruch L, Bausewein C, Voltz R. The Palliative Care of Patients With Incurable Cancer. Deutsches Ärzteblatt International 2020;116(7):108-115. https://doi.org/10.3238/arztebl.2020.0108
Frasca M, Galvin A, Raherison C, Soubeyran P, Burucoa B, Bellera C, Mathoulin-Pélissier S. Palliative versus hospice care in patients with cancer: a systematic review. BMJ Supportive & Palliative Care 2020;11(2):188-199. https://doi.org/10.1136/bmjspcare-2020-002195
Kim C, Kim S, Lee K, Choi J, Kim S. Palliative Care for Patients With Heart Failure. Journal of Hospice and Palliative Nursing 2022;24(3):E151-E158. https://doi.org/10.1097/NJH.0000000000000869
Gómez-Monroy CA, Cuesta-Ramírez DH, Gómez-Cano CA. Analysis of the perception of tax on the consumption of plastic bags charged in large and medium-sized establishments from the center of Florence. LOGINN Investigación Científica y Tecnológica 2021;5(1). https://dx.doi.org/10.23850/25907441.4320
Areia N, Gongóra J, Major S, Oliveira V, Relvas A. Support interventions for families of people with terminal cancer in palliative care. Palliative and Supportive Care 2020;18(5):580-588. https://doi.org/10.1017/S1478951520000127
Zeng Y, Wang C, Ward K, Hume A. Complementary and Alternative Medicine in Hospice and Palliative Care: A Systematic Review. Journal of Pain and Symptom Management 2018;56(5):781-794.e4. https://doi.org/10.1016/j.jpainsymman.2018.07.016
Strang P. Palliative oncology and palliative care. Molecular Oncology 2022;16(19):3399-3409. https://doi.org/10.1002/1878-0261.13278
Guayara Cuéllar CT, Millán Rojas EE, Gómez Cano CA. Design of a virtual digital literacy course for teachers at the University of Amazonia. Revista Científica 2019;(34):34-48. https://doi.org/10.14483/23448350.13314
Hui D, Bruera E. Models of Palliative Care Delivery for Patients With Cancer. Journal of Clinical Oncology 2020;38(9):852-865. https://doi.org/10.1200/JCO.18.02123
Rigue A, Monteiro D. Difficulties of nursing professionals in the care management of cancer patients in palliative care. Research, Society and Development 2020;9(10):e9109073. https://doi.org/10.33448/rsd-v9i10.9073
Gómez-Cano C, Sánchez-Castillo V. Evaluation of the maturity level in project management of a public services company. Económicas CUC 2021;42(2):133-144. https://doi.org/10.17981/econcuc.42.2.2021.Org.7
Wong-Parodi G, Mach K, Jagannathan K, Sjostrom K. Insights for developing effective decision support tools for environmental sustainability. Current Opinion in Environmental Sustainability 2020;42:52-59. https://doi.org/10.1016/j.cosust.2020.01.005
Lanini I, Samoni S, Husain-Syed F, Fabbri S, Canzani F, Messeri A, et al. Palliative Care for Patients with Kidney Disease. Journal of Clinical Medicine 2022;11(13):3923. https://doi.org/10.3390/jcm11133923
Pickering J. Trust, but Verify: Informed Consent, AI Technologies, and Public Health Emergencies. Future Internet 2021;13(5):132. https://doi.org/10.3390/fi13050132
Shlobin N, Sheldon M, Lam S. Informed consent in neurosurgery: a systematic review. Neurosurgical Focus 2020;49(5):E6. https://doi.org/10.3171/2020.8.FOCUS20611
Mena-Vázquez N, Gomez-Cano C, Perez-Albaladejo L, Manrique-Arija S, Romero-Barco C, Aguilar-Hurtado C, et al. Prospective follow-up of a cohort of patients with interstitial lung disease associated with rheumatoid arthritis in treatment with DMARD. Annals of the Rheumatic Diseases 2018;77(Suppl 2):585. https://doi.org/10.1136/annrheumdis-2018-eular.1935
Glaser J, Nouri S, Fernández A, Sudore R, Schillinger D, Klein-Fedyshin M, Schenker Y. Interventions to Improve Patient Comprehension in Informed Consent for Medical and Surgical Procedures: An Updated Systematic Review. Medical Decision Making 2020;40(2):119-143. https://doi.org/10.1177/0272989X19896348
Resnik D. Informed Consent, Understanding, and Trust. American Journal of Bioethics 2021;21(5):61-63. https://doi.org/10.1080/15265161.2021.1906987
Ulibarri N, Ajibade I, Galappaththi E, Joe E, Lesnikowski A, Mach K, et al. A global assessment of policy tools to support climate adaptation. Climate Policy 2022;22(1):77-96. https://doi.org/10.1080/14693062.2021.2002251
Rodríguez-Torres E, Gómez-Cano C, Sánchez-Castillo V. Management information systems and their impact on business decision making. Data and Metadata 2022;1:21. https://doi.org/10.56294/dm202221
Sherman K, Kilby C, Pehlivan M, Smith B. Adequacy of measures of informed consent in medical practice: A systematic review. PLoS ONE 2021;16(5):e0251485. https://doi.org/10.1371/journal.pone.0251485
Convie L, Carson E, McCusker D, McCain R, McKinley N, Campbell W, et al. The patient and clinician experience of informed consent for surgery: a systematic review of the qualitative evidence. BMC Medical Ethics 2020;21:58. https://doi.org/10.1186/s12910-020-00501-6
Algu K. Denied the right to comfort: Racial inequities in palliative care provision. EClinicalMedicine 2021;34:100833. https://doi.org/10.1016/j.eclinm.2021.100833
Cloyes K, Candrian C. Palliative and End-of-Life Care for Sexual and Gender Minority Cancer Survivors: a Review of Current Research and Recommendations. Current Oncology Reports 2021;23:146. https://doi.org/10.1007/s11912-021-01034-w
Berkman C, Stein G. Experiences of LGBT Patients and Families With Hospice and Palliative Care: Perspectives of the Palliative Care Team. Innovation in Aging 2020;4(Suppl 1):67. https://doi.org/10.1093/geroni/igaa057.218
Koffman J, Bajwah S, Davies J, Hussain J. Researching minoritised communities in palliative care: An agenda for change. Palliative Medicine 2022;36(4):530-542. https://doi.org/10.1177/02692163221132091
De Panfilis L, Peruselli C, Tanzi S, Botrugno C. AI-based clinical decision-making systems in palliative medicine: ethical challenges. BMJ Supportive & Palliative Care 2023;13(2):183-189. https://doi.org/10.1136/bmjspcare-2021-002948
Gajra A, Zettler M, Miller K, Frownfelter J, Showalter J, Valley A, et al. Impact of Augmented Intelligence on Utilization of Palliative Care Services in a Real-World Oncology Setting. JCO Oncology Practice 2022;18(2):e80-e88. https://doi.org/10.1200/OP.21.00179
Guzmán DL, Gómez-Cano C, Sánchez-Castillo V. State building through citizen participation. Revista Academia & Derecho 2022;14(25). https://doi.org/10.18041/2215-8944/academia.25.10601
Greer J, Moy B, El-Jawahri A, Jackson V, Kamdar M, Jacobsen J, et al. Randomized Trial of a Palliative Care Intervention to Improve End-of-Life Care Discussions in Patients With Metastatic Breast Cancer. Journal of the National Comprehensive Cancer Network 2022;20(2):136-143. https://doi.org/10.6004/jnccn.2021.7040
Harasym P, Brisbin S, Afzaal M, Sinnarajah A, Venturato L, Quail P, et al. Barriers and facilitators to optimal supportive end-of-life palliative care in long-term care facilities: a qualitative descriptive study of community-based and specialist palliative care physicians' experiences, perceptions and perspectives. BMJ Open 2020;10(8):e037466. https://doi.org/10.1136/bmjopen-2020-037466
Pérez-Gamboa AJ, Gómez-Cano C, Sánchez-Castillo V. Decision making in university contexts based on knowledge management systems. Data and Metadata 2022;2:92. https://doi.org/10.56294/dm202292
Ziegler L, Craigs C, West R, Carder P, Hurlow A, Millares-Martin P, et al. Is palliative care support associated with better quality end-of-life care indicators for patients with advanced cancer? A retrospective cohort study. BMJ Open 2018;8(1):e018284. https://doi.org/10.1136/bmjopen-2017-018284
Sleeman K, Timms A, Gillam J, Anderson J, Harding R, Sampson E, Evans C. Priorities and opportunities for palliative and end of life care in United Kingdom health policies: a national documentary analysis. BMC Palliative Care 2021;20:171. https://doi.org/10.1186/s12904-021-00802-6
Evans C, Ison L, Ellis-Smith C, Nicholson C, Costa A, Oluyase A, et al. Service Delivery Models to Maximize Quality of Life for Older People at the End of Life: A Rapid Review. Milbank Quarterly 2019;97(1):113-175. https://doi.org/10.1111/1468-0009.12373
Parviainen J, Rantala J. Chatbot breakthrough in the 2020s? An ethical reflection on the trend of automated consultations in health care. Medicine, Health Care and Philosophy 2022;25(1):61-71. https://doi.org/10.1007/s11019-021-10049-w
Verdicchio M, Perin A. When Doctors and AI Interact: on Human Responsibility for Artificial Risks. Philosophy & Technology 2022;35:11. https://doi.org/10.1007/s13347-022-00506-6
Mykhailov D. A moral analysis of intelligent decision-support systems in diagnostics through the lens of Luciano Floridi's information ethics. Human Affairs 2021;31(2):149-164. https://doi.org/10.1515/humaff-2021-0013
Erkal E, Akpınar A, Erkal H. Ethical evaluation of artificial intelligence applications in radiotherapy using the Four Topics Approach. Artificial Intelligence in Medicine 2021;115:102055. https://doi.org/10.1016/J.ARTMED.2021.102055
Pérez Gamboa AJ, García Acevedo Y, García Batán J. Life project and university training process: an exploratory study at the University of Camagüey. Transformación 2019;15(3):280-296. http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S2077-29552019000300280
Lang B. Are physicians requesting a second opinion really engaging in a reason-giving dialectic? Normative questions on the standards for second opinions and AI. Journal of Medical Ethics 2022;48(4):234-235. https://doi.org/10.1136/medethics-2022-108246
Naik N, Hameed B, Shetty D, Swain D, Shah M, Paul R, et al. Legal and Ethical Consideration in Artificial Intelligence in Healthcare: Who Takes Responsibility? Frontiers in Surgery 2022;9:862322. https://doi.org/10.3389/fsurg.2022.862322
McDonald J, Graves J, Abrahams N, Thorneycroft R, Hegazi I. Moral judgement development during medical student clinical training. BMC Medical Education 2021;21:585. https://doi.org/10.1186/s12909-021-02572-4
De Campos Freitas C, Osório F. Moral judgment and hormones: A systematic literature review. PLoS ONE 2022;17(4):e0265693. https://doi.org/10.1371/journal.pone.0265693
Quek C, Ong R, Wong R, Chan S, Chok A, Shen G, et al. Systematic scoping review on moral distress among physicians. BMJ Open 2022;12(8):e064029. https://doi.org/10.1136/bmjopen-2022-064029
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