Philip C Hébert | University of Toronto (original) (raw)

Papers by Philip C Hébert

Journal of Medical Ethics

Integrating large language models (LLMs) like GPT-4 into medical ethics is a novel concept, and u... more Integrating large language models (LLMs) like GPT-4 into medical ethics is a novel concept, and understanding the effectiveness of these models in aiding ethicists with decision-making can have significant implications for the healthcare sector. Thus, the objective of this study was to evaluate the performance of GPT-4 in responding to complex medical ethical vignettes and to gauge its utility and limitations for aiding medical ethicists. Using a mixed-methods, cross-sectional survey approach, a panel of six ethicists assessed LLM-generated responses to eight ethical vignettes.The main outcomes measured were relevance, reasoning, depth, technical and non-technical clarity, as well as acceptability of GPT-4’s responses. The readability of the responses was also assessed. Of the six metrics evaluating the effectiveness of GPT-4’s responses, the overall mean score was 4.1/5. GPT-4 was rated highest in providing technical (4.7/5) and non-technical clarity (4.4/5), whereas the lowest rat...

Canadian Medical Association Journal, Feb 15, 1993

Page 1. prevention and treatment of dis-ease. The extent of the misuse will depend on the quality... more Page 1. prevention and treatment of dis-ease. The extent of the misuse will depend on the quality of the pub-lic debate on the use of genetic information. The medical profes-sion will be expected to provide informed opinion ...

Http Www Libreriasaulamedica Com, 2008

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 15, 1993

This study examined the views and experiences of 20 physicians and 20 nurses at a major Canadian ... more This study examined the views and experiences of 20 physicians and 20 nurses at a major Canadian teaching hospital regarding the use of advance directives in clinical care. The participants were purposively drawn from four clinical specialties: family and community medicine, oncology, intensive care and geriatrics. Detailed interviews were conducted in person. Content analysis was used to code the data, which were further analysed with both quantitative and qualitative techniques. Thirty-nine of the 40 participants favoured the use of advance directives in clinical care; physicians had somewhat less positive attitudes than nurses toward such directives. Advance directives were thought by participants to be helpful in resolving disagreements between patients and their families about treatment options; in making patients more comfortable, both physically and psychologically, during the process of dying; and in opening up communication and trust among patients, their families and healt...

The Laryngoscope, 2013

Resource allocation decisions have become increasingly necessary as the cost of health care habit... more Resource allocation decisions have become increasingly necessary as the cost of health care habitually increases. Bilateral (second side) adult cochlear implantation (CI) is an example of a novel technology with accruing evidence of benefit, yet expense has limited universal employ. Currently at our centers, bilateral implantation is only provided under research protocol. In this article, we discuss the need for a principled approach concerning the distribution of a second device, both during this period of investigation and if ultimately an insured service. Allocation strategies, while extensively addressed in some arenas, have yet to be developed for second‐side sequential adult CI. We advocate that physicians must assume an explicit role when both caring for individual patients as well as administering health care programs. We review social justice theories that inform resource allocation macrodecisions, and include a defence of age‐based considerations. Our approach to patient s...

Journal of Perinatology, 2004

Recruiting patients for studies in the Neonatal Intensive Care Unit is a complex endeavour. Much ... more Recruiting patients for studies in the Neonatal Intensive Care Unit is a complex endeavour. Much discussion has occurred regarding the optimal recruitment ''model'' for this environment. This paper discusses current and suggested recruitment models for the NICU setting and presents a systematic approach to the consent process that focuses on the protection and promotion of parental autonomy. The proposed model incorporates several key considerations for an ethically optimal approach to the inclusion of neonates in research: informing parents about research and their rights prior to any solicitation, asking parents if they wish to be approached for research, approaching for one study at a time, assuring the study is relevant to the infants' current clinical status, minimising information overload, allowing parents appropriate time (which will vary from study to study) to consider their choice, and providing a waiting period between subsequent approaches. It is argued that parental ability to make a truly informed choice may be improved when following the proposed model.

Journal of Medical Ethics, 1992

An instrument to assess 'ethical sensitivity' has been developed. The instrument presents four cl... more An instrument to assess 'ethical sensitivity' has been developed. The instrument presents four clinical vignettes and the respondent is asked to list the ethical issues related to each vignette. The responses are classified, post hoc, into the domains ofautonomy, beneficence andjustice. This instrument was used in 1990 to assess the ethical sensitivity ofstudents in allfour medical classes at the University of Toronto. Ethical sensitivity, as measured by this instrument, is not related to age or grade-point average. Sensitivity increases between the Ist and 2ndyear and then decreases throughout the rest of undergraduate medical training, such that the 4th-year students identify fewer issues than those entering medical school. Students expressing a career choice offamily medicine identify more issues than theirpeers. Several problems with the use ofthe instrument and the interpretation ofthe data were found. Nonetheless, these findings, ifreproducible, are important and their meaning needs further discussion.

Canadian Medical Association Journal, 2011

Palliative Care and Social Practice

Since 2016, when medical assistance in dying (MAiD) became legal in Canada, healthcare profession... more Since 2016, when medical assistance in dying (MAiD) became legal in Canada, healthcare professionals (HCPs) have become familiar with exploring and acting upon patients’ wishes to hasten death (WTHD). In contrast to MAiD, the literature on the voluntary stopping of eating and drinking (VSED) is very limited and there are no standards of practice or legal guidance to support HCPs. In this article, the legal and ethical literature as regards VSED is critically reviewed and new standards of practice are proposed.

BMJ, 1999

Expansion in consultant numbers is needed Editor-Forgacs's review provides an excellent picture o... more Expansion in consultant numbers is needed Editor-Forgacs's review provides an excellent picture of the unpleasant reality of acute medicine, as practised at present. 1 The Royal College of Physicians is well aware of the need to cost future improvements in increasing the number of hospital doctors and to provide evidence of the likely benefits. The latter will be a difficult task but must be tackled. Indeed, a working group of the three Royal Colleges of Physicians is currently reviewing all aspects of the problems regarding acute medicine. As chairman of the group which produced the document "Consultant physicians working for patients" and main author, 2 I (JDW) can assure readers that I have had experience, on many occasions, of handling more than 20 acutely ill patients during a 24 hour period of acute medicine as a general physician in Sheffield. Our working group realises that hundreds more consultants tomorrow and much smaller numbers of "take patients" is unrealistic. We do know from several sources that doctors are working 14-16 sessions per week and close to a 60 hour week. We know that consultation times in outpatient departments have been pared to the bone. We know that clinical governance in all its guises will place further demands on consultants. If we do not state our requirements now for an expansion in the number of consultants we will never achieve improvements.

Journal of Medical Ethics, 2005

he important point about creating an ethical environment within an organisation is that the propo... more he important point about creating an ethical environment within an organisation is that the proposed structures are multiple, interconnected with one another, and diffused throughout the organisation.'' 1

Introductory Series in Medicine, 2015

CMAJ: Canadian Medical Association Journal, 1991

Page 1. BOOKS * LIVRES The teaching of ethics Medical Ethics for Undergraduate Medical Students. ... more Page 1. BOOKS * LIVRES The teaching of ethics Medical Ethics for Undergraduate Medical Students. Symposium '89 Proceedings. Edited by Francoise Baylis and Jocelyn Downie. 180 pp. Westminster Institute for Eth-ics and Human Values, London, Ont. 1990. $8.95. ...

Canadian Medical Association Journal, 2017

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 15, 1991

G uidelines for withholding forced nutrition and hydration have applied largely to patients who a... more G uidelines for withholding forced nutrition and hydration have applied largely to patients who are terminally ill'-who, in Ramsey's words,2 are already "in the article of death"-and, more recently, to those who exhibit marked incompetence, such as the demented elderly.3-6 Patients in the advanced stages of anorexia nervosa are more difficult to categorize. Their competence may be subtly impaired,7 and although their lack of nutrition may be life-threatening they are not thought of as terminally ill. As a result they normally receive some form of involuntary feeding.8-'0 We present a case in which a patient with anorexia nervosa was not force-fed and died shortly afterward. Although in some ways an exceptional case it leads us to two general conclusions. First, our standards for making decisions on behalf of incompetent patients are not easily applied to patients with anorexia nervosa. Second, "difflcult and burdensome" patients, such as those who vigorously resist strenuous efforts to prevent them from dying, can arouse powerful negative feelings in caregivers. These feelings can affect judgement about life-saving care and require exploration before such care is withheld. Case report A 22-year-old woman with an 8-year history of anorexia nervosa was admitted to hospital stuporous and in a state of cardiovascular collapse. She appeared cachectic. She was 158 cm tall and weighed

Journal of Law Medicine & Ethics, Jan 9, 2016

Canadian Journal of Gastroenterology, 2004

BACKGROUND: Helicobacter pylori is an important cause of stomach cancer that infects a substantia... more BACKGROUND: Helicobacter pylori is an important cause of stomach cancer that infects a substantial proportion of the Canadian adult population. H pylori can be detected by noninvasive tests and effectively eradicated by medical treatment. Screening for and treatment of H pylori may represent a significant opportunity for preventive oncology.METHODS: Cancer Care Ontario organized a workshop held in Toronto, Ontario, on October 24 and 25, 2002, to: review the current state of knowledge regarding H pylori treatment and cancer prevention; determine if there is currently sufficient evidence to consider the promotion of H pylori treatment for the purpose of cancer prevention; identify critical areas for research; and advise Cancer Care Ontario on H pylori and cancer prevention.RESULTS: Workshop participants developed a number of recommendations for research into the relationship between H pylori and stomach cancer, including determining the prevalence of infection in different regions of ...

Ubc Medical Journal, Oct 21, 2014