=Paper=
{{Paper
|id=Vol-3191/paper08
|storemode=property
|title=Innovative Information Technologies in Medicine, the Ethical Aspects – Medical Students’ Opinion (short paper)
|pdfUrl=https://ceur-ws.org/Vol-3191/paper08.pdf
|volume=Vol-3191
|authors=Alexandrina Vodenitcharova,Nikoleta Leventi,Kristina Popova
|dblpUrl=https://dblp.org/rec/conf/isgt2/VodenitcharovaL22
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==Innovative Information Technologies in Medicine, the Ethical Aspects – Medical Students’ Opinion (short paper)==
https://ceur-ws.org/Vol-3191/paper08.pdf
Innovative Information Technologies in Medicine,
the Ethical Aspects – Medical Students’ Opinion
Alexandrina Vodenitcharova 1, Nikoleta Leventi 1 and Kristina Popova 2
1
MU – Sofia, FPH “Prof. Dr. Tzecomir Vodenicharov”, Dept. Bioethics, Bialo more str. 8,
BG-1527 Sofia, Bulgaria
2
MU – Sofia, FPH “Prof. Dr. Tzecomir Vodenicharov”, Dept. Social Medicine, Bialo
more str. 8, BG-1527 Sofia, Bulgaria
Abstract
The aim of this paper is to explore medical students’ opinion on the role
of medical ethics course for their future practice and professionalism.
Furthermore the research focuses on the usage of innovative information
technologies such as artificial intelligence (AI), big data, etc., in medicine
and the ethical implications that arise when they are applied. In modern
medicine, innovative information technologies hold promise to help
medical professionals to solve problems within their every day clinical
practice, to improve health care delivery as well as to provide optimal
outcomes to patients. A survey was conducted among first academic year
medical students in the Faculty of Medicine in Medical University – Sofia in
Bulgaria. To achieve the purpose of the study a web-based questionnaire was
distributed to students after the end of their course in medical ethics. From
data collected students believe that ethical knowledge would contribute to
their professionalism. The subject is actual, thus the authors will further
continue the research. Any comparison results will be provided in a more
detailed analysis also in the future. The current results show that according
to the students, the incorporation of innovative information technologies in
medical practice poses new challenges regarding compliance with ethical
principles and norms. In addition guidelines ensuring an appropriate ethical
framework to strengthen values, are necessary.
Keywords
Innovative information technologies, artificial intelligence, medical ethics,
students’ opinion
Information Systems & Grid Technologies: Fifteenth International Conference ISGT’2022, May 27–28, 2022, Sofia, Bulgaria
EMAIL: a.vodenicharova@foz.mu-sofia.bg (A. Vodenitcharova); n.leventi@foz.mu-sofia.bg (N. Leventi); k.popova@foz.
mu-sofia.bg (K. Popova)
ORCID: 0000-0002-5801-980X (N. Leventi)
© 2022 Copyright for this paper by its authors.
Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0).
CEUR Workshop Proceedings (CEUR-WS.org)
1. Introduction
Medical ethics is a form of applied, normative ethics, which include the
application of the universal ethical principles and norms when specific moral
dilemmas arise in medical practice, when provided medical care, and in bio-
medical research [1]. The main purpose of the medical ethics course is to famil-
iarize the students with the four fundamental biomedical principles namely the
principle of [2]:
• respect to patient autonomy,
• beneficence,
• non-maleficence, and
• justice.
Medical ethics is a course incorporated in the educational program for medi-
cal students in the first semester in first academic year in the Faculty of Medicine
in Medical University – Sofia, (МU-Sofia). Ethical knowledge is a tool provided
to future medical professionals, in order to help them in dealing with the ethi-
cal issues arising in clinical practice. Thus after the end of the respective course
students are able to reflect, and identify ethical issues in medicine, apply the prin-
ciples in order to make moral decisions, and provide optimal care to the patient.
Our curriculum integrate the knowledge of the fifteen bioethical principles
of the UNESCO Universal Declaration on Bioethics and Human Rights [3], and
the respective methodology:
1. Human dignity and human rights;
2. Benefit and harm;
3. Autonomy and individual responsibility;
4. Consent;
5. Persons without the capacity to consent;
6. Respect for human vulnerability and personal integrity;
7. Privacy and confidentiality;
8. Equality, justice and equity;
9. Non-discrimination and non-stigmatization;
10. Respect for cultural diversity and pluralism;
11. Solidarity and cooperation;
12. Social responsibility and health;
13. Sharing of benefits;
14. Protecting future generations;
15. Protection of the environment, the biosphere and biodiversity.
In addition, innovative information technologies and more specifically tech-
nologies such as AI, big data, etc. are widely used in medicine, but their applica-
tion raises social, legal and ethical issues.
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A concrete example of initiative in this direction is focused on AI systems,
and is applicable also in the case of medical applications, and the usage of such
systems in medicine, as systems that should improve individual and collective
wellbeing [4, 5]. It was in June 2018 when the European Commission set up the
High Level Expert Group on AI [6], to offer guidance on a comprehensive frame-
work for trustworthy AI. Three are the components of trustworthy AI, which
should be met throughout the system’s entire life cycle:
1. should be lawful,
2. should be ethical, and
3. should be robust.
In order to ensure that AI systems are developed, deployed and used in a
trustworthy way, four ethical principles, which are specified as ethical impera-
tives, must be respected. These principles rooted in fundamental rights and are
follow:
1. respect for human autonomy,
2. prevention of harm,
3. fairness, and
4. explicability.
Aiming to provide with detailed guidance on how trustworthy AI can be real-
ized, seven requirements that AI systems should meet were listed. It was proposed
that both technical and non-technical methods could be used for their implemen-
tation. The main advice, regarding the seven key requirements for trustworthy AI
is to ensure that the development, deployment and use of AI systems meet them:
• human agency and oversight,
• technical robustness and safety,
• privacy and data governance,
• transparency,
• diversity, non-discrimination and fairness,
• environmental and societal well-being and
• accountability.
In medicine physicians make clinical decisions based on evidences and val-
ues. Following the fundamental principles ensures that the decision was on ethi-
cal basis.
In conclusion this is the medical ethics course focus and this is our research
approach, and of course the respective results that will be presented in the current
paper.
2. Methodology
Herein we analyze medical students’ opinion on the role of medical ethics
education for their future clinical practice and professionalism, as well as stu-
91
dents’ views on the application of AI, big data and other innovative information
technologies, in medicine and the related ethical considerations that arise.
To achieve the purpose of the study a web-based questionnaire was distrib-
uted among 244 first academic year medical students in the Faculty of Medicine
from Medical University – Sofia in Bulgaria. The data was collected during Janu-
ary 2022, after the end of the course on medical ethics. Completed questionnaires
were received from 191 students (78.3% of the students). All of them participated
anonymously and voluntarily.
The questionnaire consisted of 10 questions related to students attitude to-
wards medical ethics education, the role of ethical knowledge into their future
practice, ethical issues addressed during the pandemic, preferred teaching meth-
ods during the course in medical ethics. In addition questions related to the use
of AI, big data and etc. in medicine and the ethical problems that arise with this
application, were asked. A descriptive statistical method was used to analyze the
data collected.
The majority of the questions were developed as closed and if only they
answered “other“ or “yes” in a question, students had to specify their answer.
Statements related to closed questions were given a range for the answer like:
• Yes / No
• Yes, No, “I cannot evaluate”
As we focused to achieve the best participation rates from the respondents,
the questionnaire was developed by flowing the questions from the more general
to the more specific, from the least sensitive to the most sensitive one.
Herein we will demonstrate partially the results of our survey, related to
students’ attitude towards medical ethics education and the students’ views in the
application of innovative information technologies, including AI, big data and
others in medicine
3. Results
A total amount of respondents in this survey was 191 medical students from
the Faculty of Medicine in Medical University – Sofia in Bulgaria.
We divided the answers into two parts. First we analyze some of the ques-
tions related to student’s attitude towards medical ethics education, following by
students’ views on the incorporation of innovative informational technologies in
medicine and their ethical implications.
3.1. Students’ attitude towards medical ethics education
To the question “Do you think that ethical knowledge will help your reason-
ing in making decisions and applying them in your future medical practice?”, the
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majority (90,5%) of the respondents answered “yes”, 6,3% answered “I can not
evaluate”, and only 3,2% of the students respond “no” (see Figure 1).
Further question, asked to survey participants, concerned the principles of
the UNESCO Declaration on Bioethics and Human Rights. The participants
were asked to evaluate, for which of the principles, they need more in-depth
knowledge, in order to deal more effectively with ethical issues in their clinical
practice.
Data show that medical students need more in-depth knowledge in order to
deal more effectively with ethical issues in their clinical practice, in principles
related to “people without the capacity to give consent” (48,7%), “human dignity
and human rights” (45,5%), “autonomy and personal responsibility” (42,4%),
and “consent” (37,7%).
Figure 1: “Do you think that ethical knowledge will help your reasoning in mak-
ing decisions and applying them in your future medical practice?”
The list is followed by the “equality, justice and equity” (37,2%), “social
responsibility and health” (36,6%,), “respect for human vulnerability and per-
sonal integrity” (34,6%), “non-discrimination and non-stigmatization” (30,9%),
“protecting future generations” (27,7%), “solidarity and cooperation” (27,2%),
“protection of the environment, the biosphere and biodiversity” (26,7%), “respect
for cultural diversity and pluralism, and principle sharing of benefits” (25,1%),
and finally on the principle related to “privacy and confidentiality” (24,6%). A
detailed distribution of results is demonstrated below (see Figure 2).
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Figure 2: “In which of the principles of the UNESCO Declaration on Bioethics
and Human Rights / 2005 / do you think you need more in-depth knowledge in
order to deal more effectively with ethical issues in your clinical practice”
It is worth mentioning that regarding the answer to the question “Which of
the following ethical interventions and institutions do you think will contribute
to dealing with ethical issues in modern medical practice?” the majority (64%)
of the respondents indicated “the procedures for informed consent”, 56,6% an-
swered “the guidelines for good medical practice”, 56,1% “the ethics commit-
tees”, 28% “the principle of publicity and dialogue”, and 19% “the professional
organizations” (Figure 3).
Figure 3: “Which of the following ethical interventions and institutions do you
think will contribute to dealing with ethical issues in modern medical practice?”
94
3.2. Students’ views on the incorporation of innovative informational
technologies in medicine and their ethical implications
The next figure shows the percentage distribution to the question “Do you
think that with the application of innovative information technologies, such as
artificial intelligence, big data analysis, etc. in medicine, ethical dilemmas could
arise in medical practice?“ (see Figure 4). Here we see that most of the future
physicians (67%) answered, “Yes”, 23,6% answered they cannot evaluate, and
9.4% answered “No”.
Figure 4: “Do you think that with the application of innovative information
technologies, such as artificial intelligence, big data analysis, etc. could arise
ethical dilemmas in medical practice?“
When a positive answer received to the previous question we asked the par-
ticipants to indicate in which field. The data presented (see Figure 5) shows that
the majority of the respondents (65,7%) focus on the protection of personal data,
57,5% on confidentiality, 55,2% on privacy, 38,1% on justice, 32,1% on transpar-
ency, 29,9% on social and environmental well-being, 22,4% on discrimination,
17,2% on accountability, 15,7% on diversity, and 0,7% indicated others fields.
95
Figure 5: If “Yes” (meaning, agree that with the application of innovative infor-
mation technologies, such as artificial intelligence, big data analysis, etc. could
arise ethical dilemmas in medical practice) please indicate in which field
4. Conclusions
The main goals of this survey were to present medical students’ attitude to-
wards medical ethics education as well as their views on the ethical implications
after the incorporation of innovative informational technologies in medicine. The
authors intend to conduct further research, and provide comparison results, but
also consider a more detailed analysis of the results in the future. From data ob-
tained a positive attitude towards medical ethics education is supported by the
participants. However further efforts to promote trust in innovative information
technologies as AI, big data, etc. in medicine are necessary to avoid discrimina-
tion and protect the most vulnerable populations. Meanwhile there is a lack of
in-depth education on the application of digital technologies in medical practice.
To cover this need multidisciplinary courses should be added in student programs
to improve future medical professionals opinion, and develop trust with the in-
novative information technologies.
5. References
[1] Vodenitcharova A., and Popova K. (2019). Medical Ethics. FPH Press, So-
fia. ISBN 978-619-7452-13-6.
[2] Beauchamp L., and Childress F., (2013), Principles of Biomedical Ethics,
7th Edition, Oxford University Press, ISBN: 978-0-19-992458-5.
[3] UNESCO, (2005). Universal Declaration on Bioethics and Human Rights.
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The General Conference of UNESCO. Retrieved from http://portal.unes-
co.org/en/ev.php-URL_ID=31058&URL_DO=DO_TOPIC&URL_SEC-
TION=201.html.
[4] Ioannis Patias, Vasil Georgiev (2020), Mobile Medical Applications and
Cloud Federation Challenges, 16th World Congress on Public Health 2020,
editor/s: Walter Ricciardi and Carlo Signorelli, Publisher: WCPH 2020 –
European Journal of Public Health, 2020, pages: 5-0, ISSN (print): 1101-
1262, ISSN (online):1464-360X, doi:https://doi.org/10.1093/eurpub/
ckaa165.1029.
[5] I. Patias, V. Georgiev (2020), The Use of Big Data in Medicine and Pub-
lic Health Policy-Making: Opportunities and Challenges, Proceedings of
the thirteenth International Conference on Information Systems and Grid
Technologies (ISGT’2020), Sofia, Bulgaria, May 29 – 30, 2020, Publisher:
CEUR Workshop Proceedings (CEUR-WS.org vol. 2656), 2020, pages:
7-13, ISSN (online): 1613-0073, http://ceur-ws.org/Vol-2656/paper1.pdf.
[6] Artificial Intelligence, High-Level Expert Group on (AI HLEG), (2018).
Ethics Guidelines for Trustworthy AI. Retrieved from https://ec.europa.eu/
futurium/en/ai-alliance-consultation/guidelines#Top.
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