Calvin Ho on Generative AI and the Foregrounding of Epistemic Injustice in Bioethics (The American Journal of Bioethics)

"Generative AI and the Foregrounding of Epistemic Injustice in Bioethics"
Calvin Ho
The American Journal of Bioethics
Volume 23, 2023 - Issue 10
Published online: October 2023

Introduction: OpenAI’s Chat Generative Pre-training Transformer (ChatGPT), Google’s Bard and other generative artificial intelligence (GenAI) technologies can greatly enhance the capability of healthcare professionals to interpret data across different data sources and locations with a simple query, as well as advance medical research through its ability to generate synthetic data (The Lancet Regional Health-Europe 2023). However, the performance of these technologies depends on the data they are trained on. Existing data may be seriously biased due to a lack of gender, ethnic, racial, social and/or religious diversity, and is a concern that the Global Alliance for Genomics & Health (2023) seeks to address in a recent initiative to promote global diversity in datasets within genomic research. If used in clinical medicine, the results from GenAI technologies present serious normative challenges that Cohen (2023) has clearly and succinctly set out, quite aside from the direct impact that they could have on human health and wellbeing.

    While it should come as no surprise to anyone that emerging health technologies tend to present normative and regulatory challenges, many of the “new-ish” problems that are anticipated to arise from the use of GenAI technologies in healthcare and research foreground intransigent concerns with epistemic injustice. I provide three reasons why GenAI’s clinical use is a big deal in bioethics. First, it highlights that bioethics does not adequately account for the impact that power dynamics and system biases have in knowledge production and dissemination. Marginalized individuals and communities still lack the capability to participate…Click here to read the full text. 

Calvin Ho et al on Streamlining Ethics Review for International Health Research (Science)

"Streamlining ethics review for international health research"
Mark A Rothstein, Ma'n H Zawati, Adrian Thorogood, Michael J S Beauvais, Yann Joly, Kyle B Brothers, Michael Lang, Pamela Andanda, Calvin Ho, Rosario Isasi, Jane Kaye, Won Bok Lee, Obiajulu Nnamuchi, Andrea Saltzman, Bartha Maria Knoppers
Science - National Library of Medicine: National Center for Biotechnology Information

Published on 24 February 2022

Abstract: International biomedical research, in which projects span borders and engage participants from multiple countries, has increased substantially during the last several decades. Despite the proven value of large, geographically, and ethnically diverse studies, further advancements are being impeded by the burden of submitting separate, and often numerous, applications for research ethics approval in compliance with country-specific laws or varied policy frameworks. To address this, we see promise in applying the international concept of “adequacy,” contained in the European Union (EU) General Data Protection Regulation (GDPR) (1), to ethics review of international health research. We advocate for countries to publish their prior determinations about the adequacy of ethics review requirements in other countries to enable review by one institutional review board (IRB) or comparable body (“single-site” review) in the researcher’s country, streamlining ethics review while safeguarding the welfare of local research participants.

Stephen Thomson, Eric Ip & Shing Fung Lee on Comparisons of COVID-19 Data and the Effectiveness of Non-pharmaceutical Interventions (Journal of Biosocial Science)

"International comparisons of COVID-19 case and mortality data and the effectiveness of non-pharmaceutical interventions: a plea for reconsideration"
Stephen Thomson, Eric Ip and Shing Fung Lee
Journal of Biosocial Science

Published online on 27 October 2021

Abstract: International comparisons of the effectiveness of coronavirus disease 2019 (COVID-19) non-pharmaceutical interventions (NPIs) based on national case and mortality data are fraught with underestimated complexity. This article calls for stronger attention to just how extensive is the multifactorial nature of national case and mortality data, and argues that, unless a globally consistent benchmark of measurement can be devised, such comparisons are facile, if not misleading. This can lead to policy decisions and public support for the adoption of potentially harmful NPIs that are ineffective in combating the COVID-19 pandemic and damaging to mental health, social cohesion, human rights and economic development. The unscientific use of international comparisons of case and mortality data in public discourse, media reporting and policymaking on NPI effectiveness should be subject to greater scrutiny.

Cedric Tang (PCLL 2021, JD 2020) on Liability for Dispensing Errors in Hong Kong (Asian Bioethics Review)

"Liability for Dispensing Errors in Hong Kong"

Cedric Tang (PCLL 2021, JD 2020)

Asian Bioethics Review

Published on 28 May 2021

Abstract: The United Kingdom (UK) case R v Lee (2010) EWCA Crim 1404 resulted in a pharmacist being convicted for an inadvertent dispensing error and paved way for the decriminalisation of such errors by way of a due diligence defence enacted in 2018. In relation to Hong Kong (HK), what is its legal position for dispensing errors, and can it follow the decriminalising steps of UK? The primary objective of this paper is to explore whether and how HK can reach the normative position for a dispensing error legal regime: (1) I posit that the normative position for healthcare professional (HCP) liability for dispensing errors should prioritise the public interest of minimisation of future dispensing errors over the retribution of past wrongs; (2) I illustrate HK’s current position for the liabilities of HCPs on dispensing errors, focusing analysis on the relatively controversial aspects of HK’s criminal liability, referencing the landmark cases Hin Lin Yee v HKSAR (2009) 13 HKCFAR 142 and Kulemesin v HKSAR (2013) 16 HKCFAR 195 to assist my analysis of the requisite mental element for relevant statutory offences; (3) through comparison with UK’s development post-R v Lee and application of Rule of Law principles, HK’s current position is critiqued, coming to the conclusion that while there are compelling reasons for the decriminalisation of dispensing errors in HK, the prerequisite for this to happen is an overhaul of regulatory frameworks by significantly increasing levels of accountability.

Calvin Ho et al on Ethical Governance Policies on Sharing of Biological Materials for Biomedical Research (Wellcome Open Research)

"Diffusion of ethical governance policy on sharing of biological materials and related data for biomedical research"

Manjulika Vaz1, Ana G. Palmero, Wongani Nyangulu, Alpha A. Diallo, Calvin W. L. Ho 

Wellcome Open Research online
First published: 12 Nov 2019

Abstract: This paper considers how ethical norms on sharing of human biological materials and related data in international policy documents diffuse from global forums to national policies and practices. With focus on the domestic policies of four countries (i.e. Guinea, Argentina, India and Malawi), this paper seeks to explain policy diffusion by broadly applying an analytical framework wherein policy learning is one of four theories used to explain how countries learn policy norms from expert epistemic communities and international organizations. While the governance structures of all four countries broadly incorporate key ethical provisions in international policy documents on sharing of biological materials and related data for biomedical research, relative emphasis on certain provisions differ among them. In three of these countries (i.e. Guinea, Argentina and India), international ethical norms have had direct influence over their domestic governance policies. Their impact has been greatest for Guinea and Argentina, whose governance policies had to be adapted in response to the Ebola virus epidemic in West Africa and the Zika virus epidemic in Latin America. In both countries, sharing of biological materials and related data with international organisations increased significantly to meet therapeutic and research needs during the outbreaks. International organisations have had a comparatively greater role in bringing about policy change in Guinea when compared with Argentina, mainly due to the fragility of the health system in Guinea in 2014. In contrast, policy in India and in Malawi occurred under less strenuous conditions. This may account for the relatively greater emphasis on control and limits to cross-border transferability in their policies when compared with those of Guinea and Argentina. While all four countries have made significant progress in establishing accountable governance arrangements, still more needs to be done to ensure that the ethical goal of equitable sharing of benefits is realised.