Anita Ho

• PhD (U of Alberta), MPH (UC Berkeley)
• Professor (Associate) at UBC and UCSF

Background: This debate article explores how smart technologies may create a double-edged sword for patient safety and effective therapeutic relationships. Increasing utilization of health monitoring devices by patients will likely become an important aspect of self-care and preventive medicine. It may also help to enhance accurate symptom reports...

From predicting medical conditions to administering health behavior interventions, artificial intelligence technologies are being developed to enhance patient care and outcomes. However, as Mélanie Terrasse and coauthors caution in an article in this issue of the Hastings Center Report, an overreliance on virtual technologies may depersonalize medi...

Background: Concerns regarding personal, professional, administrative, and institutional implications of medical assistance in dying (MAiD) are of particular interest to palliative and hospice care providers (PHCPs), who may encounter additional moral distress and professional challenges in providing end-of-life (EOL) care in the new legislative an...

Background: The world is experiencing a dramatic increase in the aging population, challenging the sustainability of traditional care models that have relied on in-person monitoring. This debate article discusses whether artificial intelligence health monitoring may be suitable enhancement or replacement for elder care. Main text: Internationall...

Background Radiotherapy is an essential component of cancer treatment, yet many countries do not have adequate capacity to serve all patients who would benefit from it. Allocation systems are needed to guide patient prioritization for radiotherapy in resource-limited contexts. These systems should be informed by allocation principles deemed relevan...

Artificial intelligence (AI) technologies in medicine are gradually changing biomedical research and patient care. High expectations and promises from novel AI applications aiming to positively impact society raise new ethical considerations for patients and caregivers who use these technologies. Based on a qualitative content analysis of semi-stru...

Informed consent is a cornerstone of ethical human research. However, as cluster randomized trials (CRTs) are increasingly popular to evaluate health service interventions, especially as health systems aspire toward the learning health system, questions abound how research teams and research ethics boards (REBs) should navigate intertwining consent...

Artificial intelligence (AI) has garnered tremendous attention in health care, and many hope that AI can enhance our health system's ability to care for people with chronic and degenerative conditions, including Parkinson's Disease (PD). This paper reports the themes and lessons derived from a qualitative study with people living with PD, family ca...

Objectives Research on medical assistance in dying (MAiD) decision-making indicates that family members and close friends are often involved in making decisions with patients and their care providers. This decision-making model comprising patients, family members, and palliative care providers (PCPs) has been described as a triad. The objective of...

Objectives: There is little research on moral uncertainties and distress of palliative and hospice care providers (PHCPs) working in jurisdictions anticipating legalising voluntary assisted dying (VAD). This study examines the perception and anticipated concerns of PHCPs in providing VAD in the State of Queensland, Australia prior to legalisation...

Respect for patient autonomy and data privacy is generally accepted as one of the foundational Western bioethical values. Nonetheless, as our society embraces expanding forms of personal and health monitoring, particularly in the context of an aging population and the increasing prevalence of chronic diseases, questions abound how artificial intell...

Respect for patient autonomy and data privacy is generally accepted as one of the foundational Western bioethical values. Nonetheless, as our society embraces expanding forms of personal and health monitoring, particularly in the context of an aging population and the increasing prevalence of chronic diseases, questions abound how artificial intell...

Respect for patient autonomy and data privacy is generally accepted as one of the foundational Western bioethical values. Nonetheless, as our society embraces expanding forms of personal and health monitoring, particularly in the context of an aging population and the increasing prevalence of chronic diseases, questions abound how artificial intell...

Respect for patient autonomy and data privacy is generally accepted as one of the foundational Western bioethical values. Nonetheless, as our society embraces expanding forms of personal and health monitoring, particularly in the context of an aging population and the increasing prevalence of chronic diseases, questions abound how artificial intell...

Respect for patient autonomy and data privacy is generally accepted as one of the foundational Western bioethical values. Nonetheless, as our society embraces expanding forms of personal and health monitoring, particularly in the context of an aging population and the increasing prevalence of chronic diseases, questions abound how artificial intell...

Respect for patient autonomy and data privacy is generally accepted as one of the foundational Western bioethical values. Nonetheless, as our society embraces expanding forms of personal and health monitoring, particularly in the context of an aging population and the increasing prevalence of chronic diseases, questions abound how artificial intell...

Uncertainty is inherent in new and unexpected viral outbreaks such as the current COVID-19 pandemic. It imposes challenges for health officials in soliciting cooperative behavioural changes based on incomplete information. In this paper, we use evolving mask recommendations in the United States as an example to analyse the ethical importance and pr...

Background: More than a dozen countries have now legalized some form of assisted dying, and additional jurisdictions are considering similar legislations or expanding eligibility criteria. Despite the persistent controversies about the relationship between medicine, palliative care, and assisted dying, many people are interested in assisted dying....

Background After over 4 years since medical assistance in dying legalization in Canada, there is still much uncertainty about how this ruling has affected Canadian society. Objective To describe the positive aspects of medical assistance in dying legalization from the perspectives of hospice palliative care providers engaging in medical assistance...

Radiotherapy is an essential component of cancer treatment, yet many countries do not have adequate capacity to serve their populations. This mismatch between demand and supply creates the need for priority setting. There is no widely accepted system to guide patient prioritization for radiotherapy in a low resource context. In the absence of conse...

p>Purpose: Treatment decision-making in the setting of advanced cancer is often complex and culturally embedded. Potential benefits of treatment must be weighed against toxicities, economic burden, and social consequences. The standard of shared decision-making (SDM) between doctor and patient, rooted in the Western principle of patient autonomy, m...

Purpose: Caring for patients with advanced cancer involves complex patient-provider communication (PPC), including disclosure of diagnosis, discussion of prognosis, decision-making about treatment, delivery of bad news, and transitions in goals of care. Values and norms that influence PPC differ across diverse cultural and socioeconomic contexts. W...

Background: Moral distress and burnout are highly prevalent among oncology clinicians. Research is needed to better understand how resource constraints and systemic inequalities contribute to moral distress in order to develop effective mitigation strategies. Oncology providers in low- and middle-income countries (LMICs) are well positioned to pro...

While the effects of COVID-19 are being felt globally, the pandemic disproportionately affects lower- and middle-income countries (LMICs) by exacerbating existing global health disparities. In this article, we illustrate how intersecting upstream social determinants of global health form a disparity pathway that compromises LMICs’ ability to respon...

Background Serious Illness Conversations aim to discuss patient goals. However, on acute medicine units, seriously ill patients may undergo distressing interventions until death. Objectives To investigate the feasibility of using the Surprise Question, “Would you be surprised if this patient died within the next year?” to identify patients who wou...

Evidence of health disparity and systemic barriers for Indigenous people as compared to non-Indigenous people in Canada is well documented. Nonetheless, the intersection of Indigenous patients’, family members’, and health service providers’ experiences of (dis)trust, cultural safety, and health care decision-making is not well understood. This...

: There has been growing investment in artificial intelligence (AI) interventions to combat the opioid-driven overdose epidemic plaguing North America. Although the evidence for the use of technology and AI in medicine is mounting, there are a number of ethical, social, and political implications that need to be considered when designing AI interve...

While the domestic effect of structural racism and other social vulnerabilities on Covid‐19 mortality in the United States has received some attention, there has been much less discussion (with some notable exceptions) of how structural global inequalities will further exacerbate Covid‐related health disparity across the world. This may be partiall...

Background Perspectives of clinical trial (CT) personnel on accrual to oncology CTs are relatively absent from the literature. This study explores CT personnel's experience recruiting patients to oncology CTs. Methods A qualitative study design was utilized. In‐depth, individual interviews with 12 oncology CT personnel were conducted, including si...

As the leading health economics and out comesresearch(HEOR) professional society,ISPOR has a responsibility to establish a uniform, harmonized international code for ethical conduct.ISPOR has updated its 2008 Code of Ethics to reflect the current research environment. This code addresses what is acceptable and un acceptable in research, from incept...

As the leading health economics and outcomes research (HEOR) professional society, ISPOR has a responsibility to establish a uniform, harmonized international code for ethical conduct. ISPOR has updated its 2008 Code of Ethics to reflect the current research environment. This code addresses what is acceptable and unacceptable in research, from ince...

In recent years, many medical schools around the world have formally established professionalism education as part of their standard curriculum. While the call to prepare future doctors to behave ethically and professionally is not new, what is new is the emphasis on identity formation in the context of the expanding online universe. Nonetheless, r...

In this issue of the Hastings Center Report, Joshua Rager and Peter Schwartz suggest using opioid treatment agreements as public health monitoring tools to inform patients about “the requirements entailed by undergoing opioid therapy,” rather than as contractual agreements to alter patients’ individual behavior or to benefit them directly. Because...

This chapter critically explores the extent to which pharmaceutical companies have a moral obligation to assist poor patients in least developed countries (LDCs) who currently have no or inadequate access to lifesaving medications. Focusing on the ongoing HIV/AIDS epidemic in LDCs, the first section of this essay begins with some background informa...

Describing a long-term community-based action research project on improving health conditions for displaced persons in Rwanda and South Sudan, this practice note discusses human rights as a framework for improving people’s health. In the course of researching women’s health concerns, researchers learned that human rights violations were a major roo...

Trust is central to the therapeutic relationship, but the epistemic asymmetries between the expert healthcare provider and the patient make the patient, the trustor, vulnerable to the provider, the trustee. The narratives of pain sufferers provide helpful insights into the experience of pain at the juncture of trust, expert knowledge, and the thera...

This qualitative study explored the current practice that nurses use to assess capacity to consent to health care (CTC-HC) in street outreach settings. Key informant interviews were conducted with a purposive sample of nurses from each of British Columbia’s five regional health authorities, allowing nurses to describe their lived experiences with a...

As healthcare delivery becomes increasingly interprofessional, it is imperative to identify opportunities for effective collaboration and coordination of care. Drawing on a Canadian qualitative study that adopted a constant comparative method based on the grounded theory approach, we report how healthcare providers' (HCPs) personal experiences and...

This commentary presents an ethical argument and practical suggestions for holding health administrators accountable for quality improvement efforts and results. Using hockey analogies and drawing on evidence from various studies and literature in organizational ethics, it argues that health leaders must promote system performance by ensuring that...

Objective: . Past research has demonstrated that trust is central to an effective therapeutic relationship, but the role of trust in chronic pain management is not well understood. The objective of this study was to provide an in-depth examination of how adults living with chronic pain negotiate trust and demonstrate trustworthiness with clinician...

Dans le milieu de la santé, le leadership éthique classique est axé sur la supervision de la relation entre le professionnel de la santé et le patient. Cependant, puisque la prestation des soins dépend désormais essentiellement d'une équipe et qu'elle est intégrée entre organisations de la santé, ces cadres éthiques doivent tenir compte de facteurs...

Traditional ethical leadership in healthcare concentrated on the oversight of the individual provider-patient relationship. However, as care delivery becomes predominantly team-based and integrated across provider organizations, these ethical frameworks also need to consider meso- and macro-factors within the system. These broader issues require ma...

Background Advance care planning (ACP) has been shown to support patients in making future healthcare decisions and lower healthcare costs at end-of-life (EOL). Nonetheless, recent studies indicate that communication of ACP and implementation within the Canadian healthcare system remains inadequate. Aim This presentation discusses healthcare provid...

In the age of person-centered care, there is an emphasis on promoting patient autonomy and surrogate decision maker authority in making treatment decisions that are aligned with the patient's priorities and values. As technological advances offer multiple clinical options with various levels and types of risks and benefits, person-centered clinical...

Health insurance is one of the ways that people in various countries finance their medical needs. It is estimated that out-of-pocket expenditure of over 15–20 % of total health expenditure or 40 % of household net income of subsistence needs can lead to financial catastrophe. When people on low incomes with no financial risk protection fall ill, th...

Pain is a subjective experience, albeit common to all human beings. Undertreated pain is a major contributor to suffering worldwide, although disproportionately burdening the global South, which has limited infrastructure and medications for pain control. Even in countries where opioid analgesics are available, regulations for procuring, stocking,...

Healthcare institutions have been making increasing efforts to standardize consultation methodology and to accredit both bioethics training programs and the consultants accordingly. The focus has traditionally been on the ethics consultation as the relevant unit of ethics intervention. Outcome measures are studied in relation to consultations, and...

Mrs. A is a pleasant seventy-seven-year-old widow with an increasingly symptomatic right knee that has markedly limited her activities in the past year. Mrs. A's daughter, who lives in town, urged her to seek treatment. History, physical examination, and radiographs confirmed the diagnosis of end-stage knee arthritis. Dr. Z, the orthopaedic surgeon...

Regarding end-of-life discussions, many have argued that a commitment to respect autonomy requires health-care professionals to facilitate the peaceful death of competent patients who find their terminal or disabling conditions intolerable. Informed by feminist accounts of relational autonomy, and focusing on medically-assisted death, physician-ass...

This chapter argues that independence and interdependence come in degrees and can change according to the context. Acknowledging that some patients may identify themselves as part of a larger familial unit rather than an isolated individual unit, this paper contends that a soft proxy approach may be appropriate when we have patients’ explicit conse...

Prescription opioid abuse (POA) is an escalating clinical and public health problem. Physician worries about iatrogenic addiction and whether patients are ‘drug seeking’, ‘abusing’ and ‘diverting’ prescription opioids exist against a backdrop of professional and legal consequences of prescribing that have created a climate of distrust in chronic pa...

Background Public health care increasingly uses outreach models to engage individuals who are marginalized, many of whom misuse substances. Problematic substance use, together with marginalization from the health care system, among homeless adults makes it difficult to assess their capacity to consent to medical care. Tools have been developed to a...

Predictive testing (PT) for Huntington disease (HD) usually requires several in-person appointments; which acts as a barrier to testing for those from remote regions. This pilot study reports the use of telehealth PT to examine whether such testing improves access to HD PT while maintaining quality of care and support. Individuals underwent PT via...

Working at the bedside and within communities as patient advocates, nurses frequently intervene to advance individuals’ health and well-being. However, the International Council of Nurses’ Code of Ethics asserts that nurses should expand beyond the individual model and also promote a rights-enabling environment where respect for human dignity is pa...

Over the last several years, direct to consumer(DTC) genetic testing has received increasing attention in the public, healthcare and academic realms. DTC genetic testing companies face considerable criticism and scepticism,particularly from the medical and genetic counseling community. This raises the question of what specific aspects of DTC geneti...

The assessment and management of behavioral and psychological symptoms of dementia (BPSD) in moderate to severe Alzheimer's disease (AD) can be challenging, and ethical dilemmas often arise. Clinicians often perceive a disconnect between evidence-based guidelines and the challenges of treating BPSD in moderate to severe AD. Reconciliation of salien...

It is generally accepted that the therapeutic relationship between professionals and patients is one of trust. Nonetheless, some patient groups carry certain social vulnerabilities that can be exacerbated when they extend trust to health-care professionals. In exploring the epistemic and ethical implications of expert status, this paper examines ho...

The availability of predictive genetic tests has rapidly expanded in the last two decades. We can now provide testing for a range of adult onset conditions including certain cancers, cardiac diseases, and neurological disorders. These developments have recognised benefit including determining the necessity of additional screening or preventive opti...

There is a growing demand for educating future physicians to be socially responsible. It is not clear, however, how social responsibility is understood and acted on in medical education and practice, particularly within the context of a growing desire to improve health care through an equitable and sustainable delivery system. The authors conduct a...

Cure rates of paediatric malignancies have dramatically improved with therapy intensification, at the cost of late treatment side effects. A survey was developed, centred around medulloblastoma scenarios, in order to explore paediatric oncology physicians' views on discussing late effects and involving parents in treatment decisions. Participants w...

Informed by the capabilities approach and our own ethnographic research study conducted in collaboration with an international non-governmental organization that manages a Rwandan refugee camp, this article argues that accountability and empowerment play a dual and conditional relationship in human rights protection. On the one hand, accountability...

Many have argued that Kant’s direct statements on the prohibition of suicide imply that medically-assisted deaths are impermissible, since they destroy one’s personhood and contradictorily will to end a moral being’s reasoning. Exploring various texts, this essay argues that Kant’s writings do not clearly prohibit all hastened deaths. While Kant’s...

A human rights framework has become more important in advancing equitable health and development opportunities. However, in post-conflict settings, human rights violations persist. Women and girls are especially vulnerable to discrimination and violence. To deepen understanding about the social context that influences human rights experiences and g...

The notions of "expert" and "expertise" imply that some people have more credibility than others on certain matters. While expert authority is often taken for granted, there are questions as to whether expert power in some cases can be a form of epistemic oppression. Informed by bedside disagreements between family and clinicians as well as feminis...

Gender-based violence persists in postconflict settings. Implementing an ethnographic study with Congolese refugees in Rwanda, we investigated community perspectives on justice and human rights. As core concepts, participants described the right to equal value as human beings and the corresponding responsibility to respect human rights as the basis...

This community-based research explores community perspectives on human rights barriers that women encounter in a postconflict setting of southern Sudan. An ethnographic design was used to guide data collection in five focus groups with community members and during in-depth interviews with nine key informants. A constant comparison method of data an...

In recent decades, the intertwining ideas of self-determination and well-being have received tremendous support in bioethics. Discussions regarding self-determination, or autonomy, often focus on two dimensions—the capacity of the patient and the freedom from external coercion. The practice of obtaining informed consent, for example, has become a s...

The therapeutic misconception has been seen as presenting an ethical problem because failure to distinguish the aims of research participation from those receiving ordinary treatment may seriously undermine the informed consent of research subjects. Hence, most theoretical and empirical work on the problems of the therapeutic misconception has been...

The intertwining ideas of self-determination and well-being have received tremendous support in western bioethics. They have been used to reject medical paternalism and to justify patients’ rights to give informed consent (or refusal) and execute advanced directives. It is frequently argued that everyone is thoroughly unique, and as patients are mo...

While disability has emerged as a major theme in academic and political discourses, a perusal of many bioethics textbooks reveals that most editors and philosophers still do not consider disability to be central to developing either critical perspective or social conscience in addressing the core questions in bioethics. This essay explores how disa...

• ‘Learning disability’ label establishes accommodation eligibility and civil rights protection but provides an excuse for school officials and legislators to adopt a medical model of learning disabilities and ignore other problems in the educational and social systems. • A commitment to inclusion and equality requires an acknowledgement of various...