Technology is developing rapidly and creates new potentials for better patient care. It also poses new challenges and ethical dilemmas. How do we cope with these?
Ethical dilemmas & technology
Many healthcare professionals have faced ethical dilemmas related to practicing medical or therapeutic work, as well as it might have been a part of their professional training. This module will dig into what ethical dilemmas are about and provide tools, cases and questions for reflection.
Introduction to the module
The aim of this module is to equip you, your colleagues and healthcare managers with an general approach and tools to breach a discussion on the ethical implications of technology.
In this module you will be introduced to the following tools, which can assist your discussion on how to approach ethics in digital health technologies:
- Questions for reflection – a simple tool.
- The Quick and Proper Ethical Assessment Model – a more complex model for more exhaustive ethical assessment.
- A vocabulary – definition of relevant ethical values.
Both the questions for reflection and the assessment model can be used individually, but are suited for a group based discussions among peers and colleagues.
Ethical dilemmas
By definition, an ethical dilemma involves the need to choose from among two or more morally acceptable options or between equally unacceptable courses of action, when one choice prevents selection of the other
Ethical dilemmas create a conflict between two courses of action that are both correct but represent different principles or values. If a situation involves doing something right and wrong at the same time and one of those actions negatively impacts the other action, this is what creates the dilemma.
Typically ethical dilemmas arise from conflicts among values, norms, and interests and can be understood as the tension of knowing the “right thing to do, but experiencing institutional or other constraints making it difficult to pursue the desired course of action” (Holm et al.*).
A common example of an ethical dilemma is between weighing the patient’s autonomy and self-determination and beneficence for a potential treatment. For example a patient has chosen not to have surgery to remove a malignant tumor, despite advice and information from the healthcare professionals. In this scenario the patient’s autonomy outweighs the beneficence.
However, with the advent of technology, the ethical dilemmas can appear different. An example is teleconsultations, where the communication is moved to a digital platform, where a digital device is required. Does it exclude a particular vulnerable patient group? Or are there some treatments that are not suitable for this kind of consultations.
The aim of the module is to give healthcare professional tools to find a balance in contradicting ethical values when discussing the compromises we sometime make when interacting with technology.
Ethics and healthcare technology
Technology in itself is not unethical, but it does possess certain options for different uses when it interacts with humans. The designer or developer most often did not intend for ethical dilemmas and unethical situations to occur. However, it is not always possible to predict exactly what might be the effects and consequences of the technology when it is being released and used in a real life setting.
Therefore, it is recommended to consider ethical perspectives as early as possible in the process. In some cases the technology is designed elsewhere, which makes it very difficult to affect the design phase. Yet, it is still as a healthcare manager as well as a healthcare professional important to consider ethical dilemmas or implications in the implementation process.
Source / References
Understanding data in a healthcare setting
With the huge amount of raw data being gathered across the entire healthcare sector, it is important to keep in mind, that data is nothing if it is not being used.
A data-driven healthcare system harnesses the data and makes it actionable. While a range of healthcare entities collect data, the data does not necessarily flow freely among these entities in a cohesive or standardized way. For example general practitioners might not be able to see citizen data from the hospital, or the citizen may not be able to access their own data. That is one of the main barriers in many countries, in particular due to the sectorial division of healthcare services. In many cases, this is addressed on a cross-sectorial level or on a national level. (SAM:BO, MedCom, Sundhed.dk).
European Health Data Space
In order to unleash the full potential of health data, the European Commission has presented the European Health Data Space (EHDS).
The European Health Data Space (EHDS) is the first common EU data space. It is a framework that covers a wide range of topics and aims to make data exchanges safe and secure between member states, as well as making it easier to use and reuse health data.
In order to unleash the full potential of health data, the European Commission has presented the European Health Data Space, which is the first common EU data space. It is a framework that covers a wide range of topics and aims to make data exchanges safe and secure between member states, as well as making it easier to use and reuse health data.
Data protection and information security
When using a digital platform it is important that it is compliant with data protection and ehealth regulations.
Artificial intelligence – harnessing the data
The use of artificial intelligence (AI) in healthcare is considered very promising and has the potential to disrupt the future healthcare system. A strength of AI is the ability to process huge amounts of data and based on different defined parameters develop algorithms that can discover patterns in data. Algorithms in the healthcare system are not limited to clinical use, but can also be used to predict administrative processes like patient turnout. At the forefront of the emerging AI-technology are radiology. Algorithms have been developed so they can process x-ray scans to detect, for example cancer tumors and bone fractures. However, the implementation of AI in a clinical settings is not without it’s barriers and demands a multi-disciplinary approach. For inspiration, check out MAS-AI, which is a health technology assessment-based framework to support the introduction of AI technologies into healthcare in medical imaging. Check it out here https://cimt.dk/gb/mas-ai/.
Dilemma: Home Measurement
In the following 3 ethical dilemmas arising from the use of new technology are presented. The stories are based on specific situations. If the situations are not immediately recognizable to you, try to relate them to your own practice.
Katrine is a nurse at the Heart Outpatient Clinic, where her task, among other things, is to to follow up on the patients’ values and general well-being when they have been sent home after heart surgery.
Karl, who is 72 years old, had a heart operation two weeks ago. He is attending a check-up at the outpatient clinic today. Katrine can see that Karl seems very nervous. He says that the grandson has helped download apps for the mobile so that Karl can keep an eye on his numbers himself.
Karl is now worried. because the blood pressure and pulse fluctuate a lot during the day, and he therefore fears that the operation has not helped. Karl feels tired and sad and does not dare to move away from the house as he is afraid of falling over.
Source / References
Questions for reflection
What does the situation mean for the patient’s vulnerability or sense of security?
Do you think that citizens should have full access to their own health data? Why/why not?
Which – if any – responsibility do healthcare professionals bear in educating citizens about their own health data?
How can the situation affect your daily workflow and task solving?
Dilemma: Night surveillance
Maria is healthcare social worker and works as a night watchman at a nursing home. Recently, the care home has installed a camera in Johannes’ room. Instead of Maria disturbing Johannes at night by opening the door and looking in on him, she can now take care of the night supervision virtually.
Maria can see on her screen whether Johannes is in bed. She doesn’t have to look all the time, but takes the agreed-upon looks several times during the night. Maria has heard from the day guards that Johannes has become healthier during the day after they introduced virtual night supervision. Maria also knows that in the past she often woke him up when she opened the door and looked in.
On the other hand, Maria feels a little strange about monitoring Johannes on a screen. She feels it is boundary crossing to look at someone who is sleeping, even though Johannes has given permission for the camera. Maria considers what she thinks about camera surveillance in general (e.g. in public spaces) and how her task here at the nursing home differs from it.
Source / References
Questions for reflection
Consider Maria’s situation of feeling that she is overstepping her own ethical boundaries simply by performing her work. What reflections do you have regarding this?
Should you disregard personal ethical boundaries in order to do your work? When – if ever – is a boundary okay to be disregarded?
How can the situation affect your daily workflow and task solving?
Dilemma: Breast screening
Fatima is a doctor in the oncology department, where, among other things, they work on automating X-rays from breast cancer screenings. Fatima uses a computer algorithm to help evaluate the many X-ray results. This means that a computer checks the images for irregularities and diagnoses through image recognition. In this way, Fatima and her colleagues can go through the images much faster.
Fatima can see that the use of computers will benefit many, as the patients get faster answers to their screening and therefore have a shorter waiting time before a possible treatment. However, Fatima is a little skeptical about a computer preparing decision support for health assessments. Wouldn’t it be safer with a personal and targeted medical assessment?
Fatima is worried that some patients will fail the algorithm and get a false-negative answer. They will then not be examined further by a doctor, even if they actually have symptoms of breast cancer.
Source / References
Questions for reflection
Consider the ethical pros and cons regarding automation of processes in the healthcare system. Are they the same for the healthcare professional and the citizen? Where do they differ?
How does the situation affect the trust and relation between the citizen and the healthcare professional?
What does the situation mean for the patient’s vulnerability or sense of security?
How can the situation affect your daily workflow and task solving?
How to assess technology in an ethical way
Two tools for reflection and ethical assessment
Questions for reflections
This tool is a set of questions, that can be useful to start a discussion among healthcare professionals. They can lead to key points in developing guidelines for treatment etc. It can also be used as an indicator, to asses whether or not there is a need to do a more in depth study of the technology.
The Quick and Proper Ethical Assessment Model
Some technologies are more complex and need a more thorough and exhaustive analysis. This model will guide and inspire reflections on some relevant aspects of ethics and technology.
The model is based on four steps. It guides you through a process of asking what might be beneficial about a technology and through a series of steps where issues can be discussed. Finally it guides you to a step where possible solutions can be proposed.
For whom
The model and material can be used for individual study and group sessions. We do recommend group sessions, since this can result in a more rewarding discussions and reflections.
Though all steps are relevant for both Healthcare professionals and healthcare managers, some questions are more suited towards a joint reflection with both groups present.
How to use the model
The model is generic and can be adjusted to the relevant technology.
The material consist of three parts:
- The model.
- Cards with questions and examples of answers. They can provide inspiration on how to work with the questions. They are based on both scientific literature and professional experiences.
- Vocabulary.
However, we encourage participants to use examples from their own daily practice.
Source / References
- Note: Holm et al. 13 highlight that ethical dilemmas arise from conflicts among values, norms,
and interests and can be understood as the tension of knowing the “right thing to do, but experiencing institutional or other constraints making it difficult to pursue the desired course of action” (p. 403) - https://www.karger.com/Article/Pdf/509119
- The Quick and Proper Ethical Assessment Model
developed at Aalborg University, Denmark
