Week 6: Discussion:
Ethics and Healthcare Information Technology
Having examined health information technology, it is
important to also be thinking about the related ethical implications of these
innovations.
To begin this discussion, let’s first make a distinction
between morality and ethics.
When we talk about morality, we are talking about our
beliefs in right and wrong. So for example, most of us believe it is morally
right to give everyone a fair chance and it is wrong to discriminate based on
race, ethnicity, or gender.
But while ethics also deals in the realm of right and wrong,
it doesn’t really come up until I am asked precisely WHY I think it is morally
right to be fair.
In other words, whereas morality is all about right and
wrong, ethics is all about the underlying logical reasons why we should act in
a certain way.
Or: Ethics is the thinking behind our morality that gives us
the solid REASONS for believing our behavior is morally right.
So, with that distinction in mind, this week’s discussion is
asking us to do more than simply state our feelings about the rights and wrongs
of healthcare technology. Rather – We need to be looking at the underlying
ethical reasons for WHY we think that way.
As an example, consider the whole issue of personal privacy
and then ask whether the Government has the right to collect health-related
information about each of us through a special ID number issued at birth?
Off the top of your head, what do you think: Yes or no?
Your answer to that question reflects your moral sense about
the rights of the individual versus the rights of the government as a representative
of the larger society.
But now, let’s look at the “ethics” of your answer. To do
that, you must explain WHY you have come to your particular judgment about the
relative rights of the individual, the government, and the society as a whole.
Saying such things as “Because I think so,” or “Because it’s
obvious,” and “Because I don’t like the government mucking around with my
personal information” are all insufficient answers. We need to dig much deeper
to actually explain WHY we think that the centralized collection of health data
by the government is an ethically good or bad idea.
So how do we do that?
To start, we need to develop some basic rules of ethical
thinking.
The good news is that a lot of really thoughtful people have
already done a lot of work on developing these rules AND they had the good
graces to write them down for us to read.
The most general rules for ethical thinking in health are
called “Clinical Ethics.” There are four basic principles or pillars of
clinical ethics that you can learn about here: Clinical Ethics.
A more specific set of ethical principles designed just for
healthcare managers has been developed by the American College of Healthcare
Executives (ACHE). You can read about the specific ethics governing our
profession here: ACHE Ethics.
After reading both sets of ethical principles, let’s now
revisit the question about government collection of health information by
identifying why we think it is right or wrong BASED ON CLINCIAL ETHICS AND THE
ETHICAL CODE OF OUR PROFESSION. In other words, why do we think it is right or
wrong based on the application of clinical and ACHE ethics to this situation?
So that’s what this week’s discussion is all about – an
ethical discussion about health information technology.
Let’s discuss two ethical questions.
First, let’s continue our thinking about the government’s
right to healthcare information. More specifically, does the government have
the right to assign each person born in the US a unique health identifier and
then collect and store all your personal health information in a centralized
data base? To help your thinking, consider how useful such a data base could be
in determining the effectiveness of different clinical techniques, controlling
epidemics, and strategic planning to best meet a community’s healthcare needs.
On the other hand, are such benefits outweighed by the risk that such personal
information might be misused to discriminate against people who might have
cancer, HIV/AIDS, or a genetic disposition towards extremely high cost
illnesses?
After that, let’s shake the government out of our heads, and
think about a very different type of ethical issue – Mobile apps.
Apple has included a health app with its most recent iPhone
and operating system update. This means that in the not too distant future,
anyone with an iPhone will have the ability to monitor their own basic vital
signs like blood pressure and heart rate.
What if someone buys an iPhone in Nepal or Sierra Leone,
finds out they have dangerously high blood pressure, but does not have access
to medical treatment? Does Apple have an ethical responsibility to help arrange
treatment to that person? And further – since we now know about such a person,
do we also have an ethical responsibility to help provide treatment ourselves?
Or – are we are on ethically sound ground to stand back and just let that
person die?
