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 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?