Chasing Certainty After Cardiac Arrest: Can a Technological Innovation Solve a Moral Dilemma?

Mertens, Mayli; Til, Janine Astrid van; Bouwers-Beens, Eline; Boenink, Marianne

doi:10.1007/s12152-021-09473-9

Cited by 2 publications

(3 citation statements)

References 56 publications

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“…In the case of postanoxic coma, this may be a combination of continuous electroencephalogram (cEEG) monitoring with machine learning for data analysis. 22 Unknown to the treating clinician, who is kept blinded from the new test, the new test outputs a prognosis for a particular patient. Yet care for this patient proceeds not according to the deliverances of this novel test, but according to a series of established testing methods, perhaps including a somatosensory evoked potentials (SSEP) test.…”

Section: Three Ways That the Sfp Distorts Prognostic Researchmentioning

confidence: 99%

“…So, even if the established prognostic test is SSEP, an electroencephalogram (EEG) machine that is part of a novel test may be present in the room with the patient and the physician. 22 This invites a natural form of confirmation bias. 24 Any hypothesis entertained about the evidential value of indicators in the new instrumentation affects not just the perceptions of the researchers but also the decision making of the clinician (who may well be one of the researchers).…”

Section: Three Ways That the Sfp Distorts Prognostic Researchmentioning

confidence: 99%

“…The accumulating data has exactly the right structure to serve as the training and testing datasets needed to refine prognostic algorithms through machine learning. 22 18 The problem is that, due to self-fulfilment of prognoses, the eventual outcomes will be poor whenever a poor outcome was predicted. As a result, new data for refining the test will contain uncorrected false positives.…”

Section: Three Ways That the Sfp Distorts Prognostic Researchmentioning

confidence: 99%

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Can we learn from hidden mistakes? Self-fulfilling prophecy and responsible neuroprognostic innovation

et al. 2021

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A self-fulfilling prophecy (SFP) in neuroprognostication occurs when a patient in coma is predicted to have a poor outcome, and life-sustaining treatment is withdrawn on the basis of that prediction, thus directly bringing about a poor outcome (viz. death) for that patient. In contrast to the predominant emphasis in the bioethics literature, we look beyond the moral issues raised by the possibility that an erroneous prediction might lead to the death of a patient who otherwise would have lived. Instead, we focus on the problematic epistemic consequences of neuroprognostic SFPs in settings where research and practice intersect. When this sort of SFP occurs, the problem is that physicians and researchers are never in a position to notice whether their original prognosis was correct or incorrect, since the patient dies anyway. Thus, SFPs keep us from discerning false positives from true positives, inhibiting proper assessment of novel prognostic tests. This epistemic problem of SFPs thus impedes learning, but ethical obligations of patient care make it difficult to avoid SFPs. We then show how the impediment to catching false positive indicators of poor outcome distorts research on novel techniques for neuroprognostication, allowing biases to persist in prognostic tests. We finally highlight a particular risk that a precautionary bias towards early withdrawal of life-sustaining treatment may be amplified. We conclude with guidelines about how researchers can mitigate the epistemic problems of SFPs, to achieve more responsible innovation of neuroprognostication for patients in coma.

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Section: Three Ways That the Sfp Distorts Prognostic Researchmentioning

confidence: 99%

Section: Three Ways That the Sfp Distorts Prognostic Researchmentioning

confidence: 99%

Section: Three Ways That the Sfp Distorts Prognostic Researchmentioning

confidence: 99%

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Can we learn from hidden mistakes? Self-fulfilling prophecy and responsible neuroprognostic innovation

et al. 2021

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The self-fulfilling prophecy in medicine

Mertens

2024

Theor Med Bioeth

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This article first describes the mechanism of any self-fulfilling prophecy through discussion of its four conditions: credibility, employment, employment sensitivity, and realization. Each condition is illustrated with examples specific to the medical context. The descriptive account ends with the definition of self-fulfilling prophecy and an expansion on collective self-fulfilling prophecies. Second, the normative account then discusses the moral relevance of self-fulfilling prophecies in medicine. A self-fulfilling prophecy is typically considered problematic when the prediction itself changes the predicted outcome to match the prediction (transformative self-fulfillment). I argue that also self-fulfilling prophecies that do not change the outcome but change the ways in which the outcome was realized (operative self-fulfillment), have significant ethical and epistemic ramifications. Because it is difficult to distinguish, retrospectively, between a transformative and an operative self-fulfilling prophecy, and thus between a false or true positive, it becomes equally difficult to catch mistakes. Moreover, since the prediction necessarily turns out true, there is never an error signal warning that a mistake might have been made. On the contrary, accuracy is seen as the standard for quality assurance. As such, self-fulfilling prophecies inhibit our ability to learn, inviting repetition and exacerbation of mistakes. With the rise of automated diagnostic and prognostic procedures and the increased use of machine learning and artificial intelligence for the development of predictive algorithms, attention to self-fulfilling feedback loops is especially warranted. This account of self-fulfilling prophecies is practically relevant for medical research and clinical practice. With it, researchers and practitioners can detect and analyze potential self-fulfilling mechanisms in any medical case and take responsibility for their ethical and epistemic implications.

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Chasing Certainty After Cardiac Arrest: Can a Technological Innovation Solve a Moral Dilemma?

Cited by 2 publications

References 56 publications

Can we learn from hidden mistakes? Self-fulfilling prophecy and responsible neuroprognostic innovation

Can we learn from hidden mistakes? Self-fulfilling prophecy and responsible neuroprognostic innovation

The self-fulfilling prophecy in medicine

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