What ethical dilemmas are experienced by a practicing medical technologist?
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“First, do no harm.” The seemingly simple maxim of healthcare proves far more complex when considered in the context of rapidly advancing medical technology, constant budget constraints, and new health threats. At a time when emerging technologies such as big data and artificial intelligence (AI) are challenging the fundamental notion of what a healthcare provider is, the battle to stop a worldwide pandemic reveals just how difficult ethical issues in healthcare can become when resources are strained. Show
How do you test the efficacy of a new medical technology without harming patients? Who gets care when the number of patients exceeds a hospital’s capacity? What organizations should have access to data that can predict a patient’s future health issues? Deliberating such complex practical and moral issues is a constant challenge in healthcare administration, and medical professionals can benefit greatly from training in ethical issues and public policy. Here are just six of the major ethical issues facing the healthcare industry in 2020. Each issued-based section includes related questions that highlight specific challenges that leaders face when making day-to-day medical decisions and far-reaching policies that affect patient health. Taking Advantage of Big Data Without Dehumanizing PatientsMedical professionals routinely make difficult decisions, including life-or-death calls, for patients and their families. They rely on extensive scientific training and increasingly sophisticated technology to do so, but their experience, instincts, and knowledge of individual patients also guide them. The increasing role of big data and predictive analytics in medical decision-making raises questions about the ethics of big data in healthcare — specifically whether data-driven decisions risk dehumanizing patients. The term “big data” refers to the proliferation of digital information in the modern age. Advances in data storage and processing technology have dramatically changed the speed and volume of data analysis capabilities and given rise to predictive analytics. Such analysis promises more accurate diagnostic and therapeutic assessments, but assessments based purely on technology and data, no matter how accurate, lack an essential human touch. Imagine, for example, a decision to end treatment of a loved one’s terminal illness based solely on a predictive score produced by an algorithm. As healthcare data collection technology advances, the industry faces questions about how to handle automatically collected data. Many modern medical devices are capable of reporting an incredible variety of health information, with or without a patient’s knowledge. For example, digital pills, also known as smart pills, are pharmaceuticals that contain an ingestible sensor that transmits data after the pill is consumed. The first digital pill to be approved in the United States was a form of the antipsychotic medication aripiprazole (sold under the trade name Abilify) in 2017. A digital sensor in the pills is activated by the patient’s stomach acid and generates an electrical signal that’s picked up by a patch on the rib cage and then transmitted to a smartphone app. The technology offers a promising benefit for treating patients who struggle with medication adherence, but critics cite concerns about who should have access to such data and how it can be protected. The advent of predictive and prescriptive algorithms that can analyze large amounts of data also increases the potential privacy risks associated with stored medical specimens. Medical researchers have long collected and stored blood and tissue samples for future research, but the value of biological samples has increased as advances have been made in genetics, genomics, and biotechnology. Reusing stored biological samples and data collected from research participants in past studies, as well as samples collected from patients for clinical or diagnostic purposes, raises new issues about the responsibility of healthcare providers to obtain informed consent. A patient may give permission to a healthcare provider or clinical researcher to use a tissue sample for one test, for example, but have no control over its use in future projects. Ethical Considerations
Safeguarding Patient Privacy When Using Population Health DataThe digitization of patient information provides enormous benefits. Electronic health records (EHRs) create a centralized, shareable record of a patient’s entire medical history; allow for the automation of healthcare provider workflows; and enable advanced medical assessment tools. Because they hold large amounts of very personal data, they also carry the risk of privacy violation. Protecting patient data is a core responsibility of healthcare providers, and the federal law restricting release of medical information strictly regulates the handling of sensitive patient health information, but the field of population health complicates issues of patient privacy. Population health is the analysis of health outcomes of large groups of people. The use and effectiveness of population health is increasing in the era of big data, which can be used to find links between diseases and specific environments or socioeconomic groups. Population health can discover widespread health problems or locate segments of the population that have a particularly high occurrence of a disease, for example. Sharing patient data for secondary purposes, such as population health programs, requires either consent from the patient or anonymization of the data. However, even anonymized data can be misused. Through the practice of de-anonymization, or data re-identification, anonymous data can be compared with publicly available information and matched to an individual. The same information that public health officials use to diagnose, treat, and promote public policies could potentially be used by insurance companies, lenders, marketers, landlords, and employers. Whether population health information is matched to an individual or applied in aggregate to a population, if it’s used for purposes other than promoting health, it has the potential to negatively impact those who supplied the data. An analysis that reveals a high rate of a disease in a given population could be used to focus education and treatment efforts; it could also be used to adjust insurance coverage. Ethical Considerations
Ensuring Equal Access to Customized MedicineCustomized medicine refers to the creation of bioidentical limbs and organs to replace injured or missing ones. Biological 3D printers can create limbs and organs customized for a patient’s body, and scientists use DNA mapping to “grow” organs that are genetically identical to a patient’s own cells, according to Electronic Health Reporter. The related field of precision medicine, or personalized medicine, also uses genomic data. Precision medicine doesn’t describe drugs or medical devices designed specifically for unique patients, but rather the tailoring of treatments to the individual characteristics of patients that have been classified using big data analytics and population health. Enabled by advances in the understanding of how unique molecular and genetic profiles make an individual susceptible to a particular disease, personalized medicine has applications in risk assessment, prevention, detection, diagnosis, treatment, and management of diseases. Customized medicine and other advanced treatments raise issues of income inequality and equal access to healthcare. Advances such as DNA mapping and bioidentical organs hold the potential to lengthen lives dramatically, but treatments that are prohibitively expensive for many or most patients violate the tenets of health equity. Ethical Considerations
Reconciling Patient Care Decisions with Financial ManagementOne of the constant ethical challenges facing healthcare administrators is how to make capital allocations that strike a balance between patients’ medical needs and fiscal responsibility. Health administrators responsible for healthcare finance management decisions may be put in a position to question, for example, whether a drug needs to be prescribed or an imaging test needs to be done. Even efforts to reduce waste and inappropriate use of resources, critical aspects of responsible fiscal stewardship, can unintentionally impinge on patients’ best interests. The sometimes conflicting responsibilities of supporting optimal patient outcomes and fiscal responsibility can lead to a state of “moral injury.” Describing the injury of a person’s moral conscience and values resulting from the experience of committing a moral transgression, moral injury results in feelings of shame and guilt. The risk of moral injury can be particularly high in a profit-driven healthcare environment where multiple factors other than patient care influence treatment decisions. Ethical Considerations
Implementing Artificial Intelligence and Robotics EthicallyThe growing use of AI and robotics also raises issues of healthcare technology ethics. AI refers to the ability of computers to mimic human intelligence and learning. Potential medical applications include analysis of radiologic images. AI used for health-related predictive analysis relies on large, diverse datasets, including EHRs. However, the ability of AI-powered tools to analyze virtually any dataset, from income data to criminal records, raises concerns about its potential for abuse. The Genetic Information Nondiscrimination Act of 2008 prohibits employers and health insurers from considering genetic information when making decisions such as hiring and firing or health insurance eligibility. However, the law doesn’t apply to nongenetic predictive data. Robotics are already heavily used in healthcare; robot-assisted surgeries are now commonplace, and robotic prosthetics are advancing rapidly. However, some see a future where robots care for the sick and elderly and robotic enhancements provide patients with superhuman capabilities — applications with more problematic implications. Robotic health workers offer a potential answer to labor shortages, but their use could dehumanize those they’re meant to serve and those they replace. The evolution of robotics in healthcare beyond compensatory measures and into human enhancements raises issues of access and fairness for patients and challenges the definition of a healthcare provider. Ethical Considerations
Devising Ethical Responses to Pandemics and Other Widespread Medical EmergenciesThe outbreak of the COVID-19 virus provides a grim illustration of ethical issues in pandemic planning and response. When the World Health Organization (WHO) declared COVID-19 a pandemic in March 2020, tens of thousands of cases had been confirmed across more than 100 countries. The daily loss of life caused by the virus created an immediate healthcare crisis, prompting a rush to develop a vaccine and the enactment of social distancing measures in countries around the world. A rapid response during pandemics is crucial, but rushing healthcare efforts can add risk to processes such as drug trials. Deciding how much risk is justified under the circumstances is an ongoing debate. Lacking a vaccine, public health officials have fought the outbreak with social distancing measures that slow the spread of the disease, helping to mitigate outbreak spikes that overwhelm medical facilities and ultimately result in more lives lost. When determining how strict such measures should be, lawmakers and public health officials must balance the good of communities against individual liberties, a literal life-and-death decision with substantial financial, political, and social ramifications. When pandemics and other widespread medical emergencies do overwhelm the capacity of medical facilities, even starker ethical questions arise. Healthcare professionals, who are themselves at risk of infection, may be forced to decide which patients should receive treatment or access to lifesaving equipment and treatment when need exceeds capacity. Ethical Considerations
Combining the Science of Health with the World of BusinessAddressing the difficult ethical issues influencing the science and business of healthcare requires leaders with exceptional knowledge and skills. Whether forming technology ethics committees, fostering greater collaboration between healthcare administrators and clinicians, or influencing regulations that protect the use of personal information and predictive data, such leaders support ethical healthcare while balancing medical and financial responsibilities. With courses in innovation, strategy, and ethical issues and public policy, AdventHealth University Online’s Master of Healthcare Administration in Strategy and Innovation and Master of Business Administration (MHA/MBA) Dual Degree program develops strategic thinkers and leaders capable of making significant impacts and initiating positive change. Find out more about how this unique program offered through a partnership between AdventHealth University Online and Stetson University is creating leaders to shape the future of the healthcare industry. Recommended Readings AdventHealth University and Stetson University Announce Partnership and MHA/MBA Dual-Degree Healthcare Administration: Salary, Careers, and Education MHA vs. MBA: What Are the Differences?
Sources: American Medical Association, The Top 10 Ethical Issues Medical Students Should Be Taught BMC Medical Ethics, “Addressing Harm in Moral Case Deliberation: The Views and Experiences of Facilitators” BMC Medical Ethics, “Broad Consent for Biobanks Is Best — Provided It Is Also Deep” BMC Medical Ethics, “Digital Pills: A Scoping Review of the Empirical Literature and Analysis of the Ethical Aspects” BMC Medical Ethics, “Do Patients and Research Subjects Have a Right to Receive Their Genomic Raw Data? An Ethical and Legal Analysis” Deloitte Insights, “Using Predictive Analytics in Health Care” Electronic Health Reporter, “First Do No Harm: The Ethics of Healthcare in 2020” GINAhelp.org, Genetic Information Nondiscrimination Act Healthcare Financial Management Association, “Beyond Compliance: Healthcare CFOs Face Many Situations in Which Ethics Can Guide Decision-making” HealthITAnalytics, “What Are Precision Medicine and Personalized Medicine?” HealthTech, “How Predictive Analytics in Healthcare Is Improving Patient Care” Medical Xpress, “Artificial Intelligence in Medicine Raises Legal and Ethical Concerns” National Center for Biotechnology Information, “Considerations for Ethics Review of Big Data Health Research: A Scoping Review” RoboticsBiz, “8 Ethical Issues in the Use of Robotics in Healthcare” STAT, “Research in the Time of Coronavirus: Keep It Ethical” The Conversation, “The Coronavirus Pandemic Is Forcing Us to Ask Some Very Hard Questions. But Are We Ready for the Answers?” The Hasting Center, “Why Health Care Organizations Need Technology Ethics Committees” The Medical Futurist, “The Most Pressing Issues in Bioethics” The New York Times, “First Digital Pill Approved to Worries About Biomedical ‘Big Brother’” The Washington Post, “Too Many Tests, Too Little Time: Doctors Say They Face ‘Moral Injury’ Because of a Business Model That Interferes with Patient Care” The Washington Post, “U.S. Hospitals May Have to Ration Care During the Pandemic. Here’s One Approach.” U.S. News & World Report, “Why Will It Take So Long for a COVID-19 Vaccine?”
Blog What Is Health Data Management? December 29, 2021 Blog Nurse Staffing and Patient Outcomes: Strategies for Improvement December 29, 2021 Blog Religion and Healthcare: The Importance of Cultural Sensitivity December 29, 2020 Blog AdventHealth University’s Master of Science in Spiritual Care Gains Important Accreditation Affirmation What are ethical issues in medical technology?Those issues include concerns that technology is biased, increases wealth and power inequalities, and erodes the human bonds that create a worthwhile life. The impact of technology is not limited to patients.
What are some examples of a medical ethics dilemma?Common Examples of Ethical Dilemma in Nursing. Pro-life vs. pro-choice.. Empirical knowledge vs. religious beliefs.. Autonomy vs. beneficence.. Parent refuses to vaccinate their child.. Being honest vs. withholding information.. Healthcare needs vs. resource allocation.. What are the ethical issues in medical laboratory?Clinical laboratories have some unique ethical concerns, such as collecting specimens, retaining medical records, using leftover “remnant” specimens, making incidental findings, and biobanking specimens.
What are some ethical dilemmas with technology?Most Important Ethical Issues in Technology. Misuse of Personal Information. ... . Misinformation and Deep Fakes. ... . Lack of Oversight and Acceptance of Responsibility. ... . Use of AI. ... . Autonomous Technology. ... . Respect for Employees and Customers. ... . Moral Use of Data and Resources. ... . Responsible Adoption of Disruptive Tech.. |
