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Medical Ethics and Artificial Intelligence - Can Blockchain Help?
Short Answer: Yes
In everyday medical practice, specialists are faced with not only medical but ethical questions as well. Solving ethical problems is not a prerequisite for acquiring an excellent MD qualification, yet nevertheless, an incorrect decision can oftentimes drastically impact the treatment a patient receives.
Imagine you are a doctor and are faced with a decision: what treatment should be given to an oncology patient with a positive COVID-19 PCR test. You see that the COVID-19 virus is not yet impacting them severely, and interrupting their anticancer therapy will worsen their cancer prognosis. It’s your job to choose - either stop the anticancer therapy and move the patient from your department, or continue the therapy but move him to a separate ward and look on. In scenario one - you increase the risk of the cancer getting worse and thereby, the risk of death from its complications. In the second - you give a card-blanche to the infectious agent. In terms of guidelines, in either case you have no right option because of the many nuances you can’t account for yourself. It seems that you need the most objective, unbiased, collegial decision. How can you reach it? The easiest way is to increase the number of MDs participating in decision making.
Why are these problems arising today, in our modern reality with increased reliance on hi-tech in medicine? The main answer lies in an MD’s personality: in moments such choices must be made, he or she is more biased than usual, and it’s not only their qualification that plays a role, but also the person's character and the peculiarities of their social portrait. In such critical moments for patients, a doctor acts alone because she is in the position of undivided responsibility: as a duty doctor, family therapist, or chief of the department. It should be noted that MDs in more midpoint positions also meet ethical issues daily and weekly.
That’s exactly the problem Israeli doctors Ruth Skvortsov, Andrey Skvortsov, Oksana Stanevich, and biostatistician Evgeny Bakin are looking to solve on GOSH. They propose the creation of a network that lets physicians from all over the world consult with their confreres on ethical questions and reach decisions through voting, as an alternative approach for division of responsibility.
Because GOSH is built to reach consensus around the code and securing the Software Supply Chain, the same decision-making mechanisms can be applied for myriad different purposes; in this case, ‘Medical Consensus,’ with SMV Smart Contracts offering doctors a convenient way to vote, all while maintaining privacy by patient data encryption, transparency, the immutability of every log, and a security guarantee.
The structure used for storing git on-chain is perfectly suited for this use case, which can perhaps be described as a ‘Public Health Repository.’
In general, this will be a blockchain service for doctors, who exchange their professional opinions on different ethical requests from all over the world. Different specialists will have a different weight in each process depending on their clinical experience and area of expertise.
According to the laws of probability when many confident specialists consult each other, the risk of wrong decisions naturally decreases. MDs who ask a question can expand their thinking by being offered many opinions. And patients can, hopefully, feel more confident in the treatment they receive.
Some doctors already use social networks, many of which are not private, may not quantify qualifications, and certainly don’t have immutable records of information; therefore, the use of current such services in the medical process is dubious. This is not the case here.
Undoubtedly, any ethical-decision-supporting network cannot replace the individual judgment of the physician. But it could give them additional insight. Moreover, it can demonstrate the wide spectrum of ethical problems in medicine that should be accounted for by the World Health Organization.
The technology this network relies on is not, however, only the blockchain. The ethical voting method will also be used to train AI. The presence of neural networks will mean the progressive learning and better understanding of MD’s answers to ethical questions. Later, there arises the additional ability to see the probabilities of particular answers for different ethical quandaries; classes of ethical problems; and even degrees of uncertainty in particular cases within the network's past and present information.
GOSH’s core principles can be applied to any chain; actions, reactions, and decisions. In this case, medical decision making could well be improved through intelligent use of this powerful technology. If even a few MDs can better inform their decisions through input from other professionals in their field, if even a few patients can get better treatment, if even a few lives can be saved, then we can say everything we do is worthwhile.
About The Founders
Oksana V. Stanevich - MD, 7-year' specialist in infectious diseases. For the past six months, she has been involved in the UK-based Bionabu charity initiative dedicated to telemedicine consulting of Ukrainian residents and refugees with infections. Having a Master's degree in Public Health Sciences (PHS), she was involved in Decentralized Science discourse and created “PHS DAO: Decentralized Public Health” initiatives. She is the author of several research papers in recognized scientific journals such as BMC Infectious diseases, Frontiers in Medicine, Health Information Science and Systems. She was one of the first specialists to describe and publish a study of prolonged (318-days) COVID-19 in a B-cell lymphoma patient.
Evgeny A. Bakin - PhD, biostatistician, bioinformatician and data scientist with 15+ years experience. He specializes in the processing of complex biomedical real-world data. He is the author of research papers and patents devoted to clinical decision support algorithms, analysis of prognostic factors for survival in oncohematology and digital signals processing. He also leads an educational program titled “Biostatistics and medical data analysis” at the Boston Institute of Bioinformatics.
Andrey Skvortsov - MD, PhD. Cardiosurgeon, transplant surgeon. Since 2009, he has been developing and implementing medical perfusion devices for resuscitation and organ transplantation, as well as medical information systems for organ donation to hospitals. From 2012 to 2022 he was CEO of a company dealing with research and development of medical devices. He is co-author of 8 patents. And a co-creator of the device for ECMO perfusion.
Ruth Skvortsov - MD, Cardiologist, respiratory therapist. Since 2013, she has worked with patients in terminal stages of heart and respiratory failure, as well as patients at high perioperative risk. From 2020-2022 she was the organizer and head of the then new Respiratory Care Service for patients with an acute respiratory failure due to COVID-19 in a hospital setting. She is co-author of a patent dealing with assessing patients before surgery, and is co-author of various research papers in the field of internal medicine. She is also a regular participant in various international medical conferences.