Assessment 4


Chapter Eight

Technological Advances in Health Care: Blessing or Ethics Nightmare?



Medical and Health Information Technology

Medical technology involves products, equipment, and processes that help to make diagnoses.

Health information technology (HIT) includes computer hardware, software, and databases that assist the providers in giving quality care.


Medical and Health Information Technology

HIT can include the electronic medical record (EHR).

It can also include support systems like physician order entry (CPOE) and clinical decision-support systems (CDSS).


Ethics Obligations

The healthcare field is becoming more dependent on technology.

Innovation in technology requires due diligence.

Patient safety and effectiveness are being considered.

Attention needs to be paid to overall benefits.


Ethical Issues in Research

Technology research allows for a disassociation between the researcher and the research.

The lack of focus on the bigger picture can cause ethics violations that have major impact.

History demonstrates this issue.


Unethical Medical Research

Evaluation of research studies needs to consider the right to autonomy.

Autonomy is demonstrated by informed consent.

Informed consent includes competence, voluntariness, disclosure, and authorization.


Research Studies and Ethics

Tuskegee Syphilis Study (1932-1972)

This study failed to meet the criteria for true informed consent.

There was manipulation of subjects by researchers.

The researchers took advantage of a disadvantaged population, but they thought they were being ethical.


Research Studies and Ethics

The Willowbrook Study (1963-1966)

This study used children who had various mental disabilities for testing the progression of hepatitis virus.

The researchers assumed that these subjects were competent.

Researchers in this study took advantage of a vulnerable population.


Research Studies and Ethics

Researchers can become so absorbed in the study that they fail to see the ethical implications.

Susan Reverby uncovered another example of this issue in the USPHS funded syphilis study in Guatemala.

Findings like this call for an ethics review and a third-party evaluation of research studies.


Recent Innovations

There are many innovations that involve technology that pose ethics concerns.

One example is synthetic biology.

Researchers can create non-genetic raw materials to substitute for genetic material.


Recent Innovations

Synthetic biology shows both promise and concern.

Ethics questions include concerns about usage and controls.

The Presidential Commission for the Study of Bioethical Issues was formed to study ethics principles as they relate to this field.


Ethics Principles

Public beneficence looks at gains or losses for the public populations affected by the new research.

Responsible stewardship asks researchers to consider those who cannot represent themselves in future studies and in the use of products of the studies.


Ethics Principles

Freedom of intellectual efforts balances total freedom for study with stopping research. It asks for ongoing accountability.

Justice and fairness asks researchers to not subject individual, groups, or communities to risks in an unfair manner.


Computer –Assisted Robotic Surgery

This area combines the use of computer imagery and robotic equipment to assist in surgical interventions.

It includes stereotatic radiosurgery, computer-aided maxillofacial surgery, and robotic-assisted visceral surgery.


Computer –Assisted Robotic Surgery

Ethics issues include the lack of resources for all facilities to have this level of technology, thereby affecting population beneficence.

In addition, the costs of the investment must be recovered and that cost is passed on to the patient.

Only patients with funds can benefit.


Magnetic Resonance Imaging

MRI now have increased field strength (signals).

MRI strengths may reach 7-9.4T; resulting in enhanced image quality.

Ethical issues arise with the increase in costs versus the overall increased patient benefit.



Magnetic Resonance Imaging

Marketing makes an investment in higher “T” for MRI machines.

Deontology is often used as an argument for purchasing the higher “T” machines.

However, the higher “T” machine can also generate lower “T” images.


Magnetic Resonance Imaging

Consideration is being given for reimbursement for MRIs by signal strength.

This action can increase ethics temptation to upcode.

There is also a temptation to order more 1.5T images on 3T machines.


IBM Watson an Cognitive Health Care

IBM Watson is a supercomputer that can change healthcare decision making.

There are ethics concerns including the replacement of physicians.

Autonomy issues need to be considered.


HIT and Medical Group Practice

HIT is expanding rapidly and there is a rush toward implementation.

The HITECH is an attempt to ensure adoption of the EHR.

Meaningful use is required including proof of application and certification.


HIT and Medical Group Practice

An ethical concern about beneficence can be found when looking at the need for speedy implementation of the EHR.

The quality of care for patients should be of concern regardless of the form of documentation. There is a moral obligation to act in their benefit.


HIT and Medical Group Practice

Providers may choose to opt-out of the incentive program for EHR adoption.

This decision may be based on excessive capital expense, costs of training, and other concerns.

Patient quality concerns are issues with this decision (nonmaleficence).


IT and Privacy

The benefits of the EHR can also be liabilities.

Patients are concerned that their medical records are not confidential.

HIPPA violations have occurred.

Security continues to be an issue in protecting patient information.


IT and Privacy

Ethics issues include the protection of confidentiality.

In addition, training needs to be ongoing.

Organizations have a fiduciary obligation to protect security.


Keeping Up with Regulations

Medical group practices also have increasing and changing funding issues and regulations.

There is a need to stay current with MACRA and other reimbursement changes.

Autonomy of medical providers and nonmaleficience are ethics issues.


In Summary…