Technology and Ethics in Health Care FINAL

Technology and Ethics in Health Care 1

Technology and Ethics in Health Care

Amanda K. Romano-Kwan

California State University of Long Beach

TECHNOLOGY AND ETHICS IN HEALTH CARE 2

Abstract

Advancements in health care technology have revolutionized the medical industry for many

years. The evolving industry has become heavily dependent on these new technologies, and

requires that hospitals and other medical centers adjust to these changes in order to meet the

quality demands and needs of patients and consumers, as well as other state and federal

regulatory requirements. Health information technology, along with medical technology, aims to

advance patient care and improve the medical field through the constant delivery of safe, quality

care. Although these changes in technology aim to benefit the overall health of the population,

there are a series of ethical issues that follow each new technological development. The health

care field operates within a series of procedures, principles, and standards that make various

aspects of medical technology morally and ethically questionable. This paper will discuss the

technological advances in health care and the potential pitfalls that may occur without the proper,

ethical use of technology. It will also outline the basic moral obligations required of all health

care professionals.


Technology and Ethics in Health Care

Medical and health information technology has become increasingly prevalent within all

health care organizations. Advancements in technology over time have continued to evolve the

medical field into the system that is used today. The growth of these resources has allowed the

improved treatment of medical ailments and diseases across the world at a more efficient level.

Nevertheless, each new development has the potential to negate various core principles of the

health care industry. The medical field has become “dependent on technological developments to

ensure organizational success” (Morrison & Furlong, 2014) due to its need to meet the high

demands of quality care. It is important for health care providers to understand and properly

evaluate the potential ethical implications of their use of medical and health information

technology in order to maintain a high standard of care.

Ethics

Every individual has their own set of beliefs, morals, and values that they uphold in their

daily lives. The term ‘ethics’ usually refers to moral principles and “matters of social policy

involving issues of morality” (American Medical Association, 1996). Therefore, medical ethics

is the application of ethical principles in the medical field. Each health care professional has the

moral duty and obligation to comply with the proper behavior in order to maintain the best

possible relationship with their patients. The guidelines provided for medical professionals

include core principles designed to put the patient first. Autonomy is one of the most important

basic moral obligations involved in health care. Autonomy focuses on the individual and their

right to make their own decisions. Beneficence, or the duty to operate within the patient’s best

interests, is another fundamental idea in the principles of medical ethics. Unfortunately, the

medical field is still a business entity and largely focuses on the monetary profit that health care


provides. Therefore, it is important for medical professionals to remain ethical and overlook

greed so as to avoid creating barriers to accessibility and affordability. Non-maleficence is the

commitment to do no harm. The health and well-being of all people is the primary goal of health

care services, making non-maleficence an integral principle of medical ethics. Other important

qualities of ethical practices in health care include justice and honesty. Justice relates to the

fairness and equality of all patients. Issues involving justice usually revolve around concerns

about the lack of resources and decisions of priority treatment. The truth is essential in health

care; without honest communication between a doctor and their patient, the medical procedures

may not be what is best for the individual. Furthermore, all medical professionals have the moral

obligation to respect all cultures and religious backgrounds of their patients. The failure to

comply with these core principles translates to unethical conduct, and usually results in censure,

suspension, or expulsion from medical practices. It is important to note, however, that no ethical

principle is more right or wrong than the other. Each principle can be weighed and judged

differently depending on each situation. The values outlined do not provide answers to unethical

dilemmas, but rather provide a framework for understanding conflicts and give insight on how to

handle difficult situations.

Technology

Medical technology aims to advance patient care, increase the efficiency of the health

care industry, and further the quality of medical care. The advancement of medical equipment,

products, and procedures allows patients a wider variety of treatment options to better suit their

individual needs. The development of these new resources require the quality, efficiency, and

safety of the research and implementation process of each new invention. Several regulations and

license requirements are in place to ensure patient safety and test the overall effectiveness of the


technology. Unfortunately, past innovations show that there is a lack of focus on medical ethics

and the intended outcomes or benefits of new technology.

Research and development have been important parts in the advancement of medical

technology. Regrettably, the increasing dependence on technology allows researchers to focus on

outcomes for only those that directly benefit from the study. It is important that the methods of

research remain ethical throughout the entire study. One well-known example of unethical

medical research was the Tuskegee Syphilis Study, which involved a study on humans. The

ethical issues involved in this study revolve around the lack of patient autonomy and informed

consent. The research participants included 400 African American males split evenly into either a

control or experimental group. The experimental group was purposely exposed to active syphilis,

and then told that the medication they were receiving was treatment for a rare, deadly blood

disease. In return for their participation, the men were given food, medical care, and burial

insurance as compensation (Tuskegee University, 2016). The study lacked autonomy due to the

failure of the researchers to properly obtain informed consent from their participants. There are

four elements needed in order to gain informed consent: the patient must be competent, meaning

that they understand the treatment involved in the study, including potential outcomes and side

effects; the patient must be volunteering and given the opportunity to say no, allowing them the

opportunity to decide on their participation based on their own terms and free from outside

influences; the patient must have full disclosure or knowledge of all features of the research,

including legal and ethical aspects; and the patient must give their authorization, or agreement, to

the research and understand that they are part of a scientific study (Morrison & Furlong, 2014).

Unfortunately, none of the four elements were met in this study, as none were addressed or

followed before the participants entered the study. Furthermore, offering compensation that was


specifically appealing to the disadvantaged African American population was highly unethical.

Scientific progress is enlightening and beneficial, but it is vital for researchers to adhere to the

outlined ethical guidelines.

Individuals must analyze the new technological innovations that are created every day

and the potential future benefits or consequences that it may have. The development of a new

medical technology may have a myriad of positive effects that help improve the efficiency and

accessibility of the health care system. However, no new scientific finding becomes widely

accepted or integrated into every day society without previous scrutinization and criticism from

fellow research experts in the field. The same critique is applied to new advancements of medical

technology. For instance, the recent innovations in the field of synthetic biology raise a series of

ethical concerns and mixed opinions. Synthetic biology is a genetics-related science that allows

scientists to replace natural genetic material with synthetic, or human-made, genetic material.

The synthetic copied material has the ability to self-replicate, opening doors for the substitution

of raw materials in place of genetic materials inside living organisms. This breakthrough in

science is largely accredited to rapid advancements in technologies relating to DNA synthesis

and molecular biology (Newson, 2015). This field of research allows for the potential creation of

“organisms with novel or enhanced characteristics or traits” (Guttman, 2011), which can lead to

new discoveries that may greatly benefit the medical field. However, the creation of genetic

materials from natural resources is still a new and developing field of research, and therefore the

practices involved undergo much speculation. The Presidential Commission for the Study of

Bioethical Issues, under special request from President Barack Obama in 2010, investigated the

field and determined the ethical boundaries in order to maximize the potential benefits for the

public and minimize the risks (U.S. Department of Health and Human Services, 2010). President


Obama recognized the potential of the developing field, but was also aware of the ethical

challenges presented and the unknown consequences that society may face without proper

evaluation. In response to the President, the Commission identified five ethical principles to be

used in the consideration of the social implications of synthetic biology: public beneficence, to

maximize public benefits and minimize public harm; responsible stewardship, to ensure

consideration to those who are unable to represent themselves for the benefits of the research,

and to the environment for future generations; intellectual freedom, which allows individuals to

responsibly use their studies in morally accountable ways through the implementation of periodic

assessments and regulations; democratic deliberation, to ensure representation from all groups of

society and allow for respectful debate and active participation for all citizens; and justice and

fairness to guarantee the even distribution of benefits and risks associated with the study across

society (Presidential Commission for the Study of Bioethical Issues, 2010). These ethical

principles provided a guideline to analyze synthetic biology and ensure that its discoveries are

used for society’s best interests. It can also be applied to other fields of science and research in

the medical field. Medical technology should be easily accessible to all members of society and

used for public benefit with minimized risks. The research performed must follow state and

federal regulations, as well as the moral guidelines outlined to guarantee the ethical treatment of

all participants. Individuals are obligated to understand the ethical concerns that arise with each

new unknown innovation and critically consider the future applications and consequences that

can occur.

Health information technology refers to the use of computer systems and software in the

medical field to provide quality care through the use of electronic medical records. This includes

all computer-assisted management-of-care products and other database platforms (Morrison &


Furlong, 2014). The use of health information technology has become increasingly prevalent

with the evolving digital age. Although the use of such technology is not mandatory, medical

hardware and software increases productivity, improves quality outcomes, and makes reporting

mechanisms much easier for medical professionals at a much quicker rate. Due to the rapid

development of new technologies, health information technology can become outdated or

obsolete within a few months, making the adaptation to this digital change difficult to

implement. Electronic health records (EHRs), or certified technology used to exchange health

information, have become one of the most controversial topics in the health care industry. The

transfer from paper records to electronic medical records offers a wide selection of benefits

through improved legibility and communication of records, verifiability of documents, and the

standardization of data. Just like all other aspects of medical technology, the ethical concern is

the use of EHRs and how they can most benefit the patients. The American Recovery and

Reinvestment Act (ARRA) of 2009 aimed to accelerate the implementation of EHRs among

health care providers. The Health Information Technology for Economic and Clinical Health

(HITECH) Act was a part of the ARRA, and provided a wider range of privacy and security

enforcements, as well as insisted on the ‘meaningful use’ of EHRs amongst medical

professionals (Leyva & Leyva , 2016). Meaningful use is defined as the use of EHR technology

to: improve quality, safety, efficiency, and reduce health disparities; to engage patients and

family; to improve care coordination, and population and public health; and to maintain privacy

and security of patient health information” (National Coordinator for Health Information

Technology, 2015). This is to ensure the proper demonstration of their applicable use as

mandated by the ARRA of 2009. The pressure to EHR technology was strong, however this push

to digitalize medical records and information raises ethical concerns regarding beneficence—not


for the patients, but for medical organizations. The HITECH Act provided a series of financial

incentives to encourage health care organizations to implement EHR technology within a

specific timeframe. However, the application of this technology comes with much risk, and

without the safe and diligent transfer from paper to computer, the success of EHR technology

becomes seriously flawed. Promoting timelines on the incorporation of EHRs to medical

providers threatens the quality of care to patients. Small and medium-sized healthcare

organizations may not have the financial resources to properly implement EHR technology

within the dictated timeline. The confidentiality and accuracy of patient data is extremely

valuable, and without the careful transfer of this data, various medical and ethical issues arise.

Furthermore, the proper education on the use and function of new EHR technology must be

provided for all stakeholders, including the medical providers and the patients. Health care

organizations have a moral obligation to act in the patient’s best interests and maintain their well-

being. By letting financial concerns influence the decisions and implementation of electronic

health records, health care organizations fail to maintain the highest standard of quality care (de

Ruiter, Liaschenko, & Angus, 2016).

It is important to note, however, that EHRs are not required, and many providers have

made the decision to opt-out and remain using paper medical records regardless of the financial

outcomes. The decision to reject electronic documentation is not without concern, as people

question the ability of medical providers to match the efficiency of EHRs in accessing,

organizing, documenting, and reporting on patient care quality. Patient information becomes less

accessible and more likely to be overlooked, which can lead to the prescription of incorrect or

contradicting medications. The illegibility of physician handwriting is also a major concern, as a

misunderstanding of orders can lead to serious dosing errors or other medical complications. The


principle of non-maleficence is called into question, as patients may be at risk for unnecessary

harm due to the mentioned errors. Negligence on behalf of the provider may also be considered,

as the benefits of EHRs have been proven to increase the quality of care, and the decision to

forego the digital transition can be viewed as the denial for better care for their patients (de

Ruiter, Liaschenko, & Angus, 2016).

Despite the usefulness of electronic medical records, the use of this technology can still

have unintended ethical consequences. Patient confidentiality is of upmost importance in the

medical field. Laws have been created to secure more patient protection rights. The Health

Information Portability and Accountability Act (HIPAA) outlines national standards to “protect

individual’s medical records and other personal health information and applies to…health care

providers that conduct certain health care transactions electronically… [And] also gives patients’

rights over their health information, including rights to examine and obtain a copy of their health

records, and to request corrections” (U.S. Department of Health and Human Services, 2016). The

American Medical Association created a standard Code of Medical Ethics which states that “the

information disclosed to a physician or clinician during the course of the patient-physician

relationship is confidential to the utmost degree” (American Medical Association, 2016). This

assurance of confidentiality allows the patient to safely disclose their personal medical

information to ensure that they receive the care best suited to their individual needs. Electronic

health records largely increase the accessibility of this patient information due to its ability to be

retrieved through several information technology resources, such as laptops and smart phones.

Although this data is protected through a series of security measures, the increased risk is large

enough to constitute cautious observation of EHRs. Breaches of data have occurred several

times, allowing the inappropriate and illegal access to private health information of multiple


individuals. Patients should not have to be concerned about the security of their medical

information. The medical history of an individual is highly sensitive and should be limited to

those who need to know of their medical needs. It is the duty of all health care organizations to

uphold the highest possible security precautions, as well as to educate all medical professionals

of the HIPAA requirements for patient protection and confidentiality. Additionally, the transfer

from paper to digital does not negate the possibility of error, as technological mistakes can be

made and easily multiplied throughout the systems database. Other pitfalls of EHRs include the

potential to “misrepresent service, render authorship ambiguous, and divert attention from the

patient” (Cheshire, 2013). The careless use of electronic medical records can lead to numerous

legal complications and ethical concerns, therefore it is vital for health care providers to remain

vigilant in their efforts to use EHRs responsibly and for the benefits of the patient. There are

many debates on the use electronic health records, however this constant battle of pros and cons

can be found with every new technological development in the medical field. It is impossible to

weigh the concerns of one group over another, as each perspective offers valuable insight to the

potential benefits and consequences that EHRs offer. The best solution is to act foremost with the

needs of the patient in mind and to provide the highest possible quality care, whilst adhering to

the suggested ethical guidelines for proper use and implementation. Consequently, health care

organizations “should welcome electronic medical record systems that add value and safety to

clinical care as long as they do not displace the individual responsibility of the ethical physician”

(Cheshire, 2013).

Modern medical ethics demands the proper use of developing technology across the

world. Advancements in technological resources have improved the medical industry by

countless bounds for hundreds of years and have allowed for the improved treatment of patients


at a more effective level. The overall benefits that medical and health information technology

provide easily overshadow the disadvantages, however the use of these technologies have not

been without the disregard of various moral principles. History teaches an invaluable lesson in

the appropriate treatment and use of medical technology, and it is crucial for health care

providers to learn from these past mistakes in order to properly respect basic medical values and

treat patients with respect. Those in the medical profession have an obligation to remain honest

and to preserve the ideals of patient autonomy, beneficence, non-maleficence, and justice, as well

as maintaining the proper respect for all individuals and cultures. Following a system of core

values such as trustworthiness, fairness, responsibility, and respect can provide guidance for the

correct and ethical use of technological advances that are not accompanied with a set of moral

guidelines specific to their use. Medical and health information technology is the future of

medical care, and health care organizations must analyze and confront the ethical concerns that

arise before, during, and after the implementation of advanced technology in order to provide

patients with the best possible quality of care.


References

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