This paper examines ethical issues arising from the use of information technology in health care, with a focus on knowledge management ethics. Drawing primarily on Marckmann and Goodman (2006), it reviews how computer-based technologies have transformed health care delivery while introducing novel ethical dilemmas. Topics covered include constructive imaging technologies such as MRI and PET, ICT implants and brain-computer interfaces, deep brain stimulation and its effects on patient personality, and the ethical management of genetic information. The paper also considers legislative responses such as the Genetic Information Nondiscrimination Act and calls for ongoing interdisciplinary collaboration between health professionals and patients to address emerging ethical concerns.
The purpose of this paper is to increase understanding of knowledge management (KM) ethics and to identify, examine, and analyze concepts, principles, and practices related to KM ethics and health care information technology. The paper additionally examines appropriate methods for responsibly addressing ethical dilemmas and promoting ethical standards and practices in the use of health care information technology.
Health care services have been transformed over the past two decades by the increasing use of information technology; however, ethical issues have arisen in relation to health care IT, generating many studies as well as serious debates. These debates have resulted in the proposal of practical solutions and guidelines for health care professions. The push for conversion of the record-keeping system from paper medical records to an electronic system has further driven debate around the ethical issues of this topic.
Gould and Younkins (1992), in their work "Guidelines Help Managers Deal with Ethical Issues — Healthcare Financial Managers," state that ethical issues exist in financial management techniques in the field of healthcare. Written approximately sixteen years prior to this paper, their work highlighted the significant time that financial management required and noted that ethical problems arising from wrongly coded expenses and patient diagnosis information had triggered ethics violations. While some of these problems have been mitigated through information technology, other ethical issues have arisen. Information technology applications serve efficiency and effectiveness in today's medical field, yet the use of these technologies is creating new and previously unimagined ethical concerns for practitioners.
Marckmann and Goodman (2006) state that computer-based information and communication technologies have not only transformed health care delivery but have also transformed "the conception and scientific understanding of the human body and the diseases that afflict it" (p. 1). They further note that medical informatics has experienced an evolution as rapid as "any science in history, paralleling and relying on extraordinary advances in information collection, storage, analysis and transmission." Like sciences and technologies that preceded it — biochemistry, microbiology, genetics, cell biology, pharmacology, and so on — medical informatics is changing the standard of care. It is no longer unreasonable to consider whether a physician or allied health professional might be remiss in failing to use intelligent machines or their applications in clinical practice and research (Marckmann & Goodman, 2006, p. 3).
Marckmann and Goodman (2006) also relate that information and computer technology in medicine not only stores and processes patient data but may also be used to create virtual realities for teaching and training. One example cited is the work of Janne Lahtiranta and Kimppa, who employed virtual reality in the form of "anthropomorphized, human-like artefacts" (p. 4).
The Institute of Medicine (IOM), in its landmark report To Err is Human: Building a Safer Health System, found that approximately 44,000 to 98,000 people die in hospitals each year as a result of preventable medical errors (cited in Marckmann & Goodman, 2006, p. 4). The IOM states that simulation is best practice in teaching institutions for training novice practitioners. It cautions, however, that medical students "should be aware of these limitations and enjoy sufficient opportunity to interact with the complexity of real-world patients. Computer-based simulation can be a valuable supplement, but should never be a substitute for conventional bedside teaching" (Marckmann & Goodman, 2006, p. 4).
One ethical challenge presented by information technology in medicine concerns moral problems created by constructive technologies. Modern imaging technologies such as magnetic resonance imaging (MRI), positron emission tomography (PET), and functional MRI provide new and apparently realistic insights into the human body. However, these images are highly constructed artifacts resulting from extremely complicated model-driven algorithms, computations, and visualizations. These epistemic observations become ethically relevant when the images are used without reflection on their production process. Rather than depicting the world as it is, the images are heavily loaded with interpretation and create new meanings for concepts such as "health," "disease," "normality," and "gender." Developing standardized atlases of the brain also raises ethical issues, given the plasticity and inter- and intra-individual variability of cerebral structure and functioning (Marckmann & Goodman, 2006, p. 4).
Because these images appear realistic, they "create the illusory impression that certain differences between groups and populations are biologically fixed within the human brain. This can promote stereotypes and false dichotomies that are embedded in the seemingly 'objective' results of scientific imaging techniques" (Marckmann & Goodman, 2006, p. 4).
Marckmann and Goodman (2006) also address ethical concerns related to information and communication technologies when these are used innovatively in computer integration processes, modeling, and transmission of patient data — particularly in the form of implants. Medical science and health care practice have entered a new dimension in this area, and questions arise regarding the ethical aspects of neuronal motor prostheses. Advances in neuroscience and microsystem technology provide the potential to connect computer systems with the human brain via brain-computer interfaces, offering new therapeutic perspectives especially for paralyzed patients. The goal is to bridge interrupted nerve fibers with micro-technical devices and connect the cortex to an artificial limb — or, ideally, with the patient's own paralyzed limb.
On one hand, brain-computer interfaces raise general ethical issues related to the protection of human subjects and the limits of human-machine integration. On the other, neuronal motor prostheses raise ethical issues attributable to the technological components themselves: "Will the implanted electrodes of the input component that registers the cortical field potentials alter the patient's personality traits in an unacceptable way?" (Marckmann & Goodman, 2006, p. 4).
Ethical concerns in this area require that the following questions be addressed:
(1) Who bears responsibility for actions of the artificial limb that result from an indissoluble interaction between the patient's brain and the decoding algorithm?
(2) Will the wireless output component allow unwanted external control or interference?
Marckmann and Goodman note that patient risk must be "balanced against the benefits of restored limb function" (2006, p. 5).
Elizabeth Hildt discusses another application of ICT implants in the neurosciences that presents ethical concerns: the implantation of electrodes in the brain for the treatment of tremors in patients with Parkinson's disease. Such neurostimulation treatments may affect the individual's personality and character traits. Specific concerns include whether the patient will experience irreversible changes. It is concluded that "deep brain stimulation should be restricted to severe disorders with a well-known pathophysiological basis for which there are no other less invasive treatments with comparable effectiveness" (Marckmann & Goodman, 2006, p. 5).
"Genetic data privacy, access, ownership, and GINA legislation"
"Ongoing ethical challenges and call for collaboration"
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