Biomedical Ethics: Assignment Week 4

Chapter 16

Technological Advances in Health Care: Blessing or Ethics Nightmare?

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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.

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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).

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Ethics Obligations

• The healthcare field is becoming more dependent on technology.

• Innovation in technology requires due diligence.

• Patient safety and effectiveness is being considered.

• Attention needs to be paid to overall benefits.

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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.

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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.

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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 populations, but they thought they were being ethical.

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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.

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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.

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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.

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Recent Innovations

• Synthetic biology shows both promise and concern.

• Ethics questions are many 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.

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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.

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Ethics Principles

• Freedom of intellectual efforts balances total freedom for study with a 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.

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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.

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Computer–Assisted Robotic Surgery

• Ethics issue 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.

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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.

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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.

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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.

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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.

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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.

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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 issue with this decision (nonmaleficence).

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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.

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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.

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In Summary…

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