Ethics and ethical considerations feature prominently in every area of healthcare from clinical practice to caregiving. In general, healthcare ethics canvass the day to day handling of patients and the specific measure to be taken when an issue or problem arises during the handling of patients. The entry and proliferation of technology in the healthcare profession have exponentially altered the scope of applicable ethics (Pelland, Baier, & Gardner, 2017). The healthcare profession includes a wide variety of different professionals who include physicians, nurses, advanced practice nurses, specialists and in the current regimen, administrators, management, and technicians. All these professionals have different professional codes of ethics that may, to some extent vary from one another. However, the general thread in all clinical ethics has two main provisions. The first is Primum non nocere which translates to first do no harm (Jagger, 2018). The second is absolute confidentiality for all patients (Redekop & Singer, 2017). As clinical systems continue to change due to the adoption of technology, ethics may either be diluted or overtaken by events; hence the need to keep adjusting them, as ethics are indispensable in healthcare.
Based on the World Health Organization’s definition of technology in healthcare, it would be safe to say that technology has not only permeated but also transformed modern clinical practice. WHO defines technology in healthcare as the application of organized knowledge and skills in all areas of clinical practice, in order to solve health problems or improve quality of life (Redekop & Singer, 2017). As per the definition, technology in healthcare is exponentially wide and includes the use of equipment and machinery, information technologyz and the concepts and principles developed for use in healthcare such as diagnostics and triage. In layman’s language, the application of technology can be considered as the shift from personalized healthcare to a healthcare system based on systems (Pelland, Baier, & Gardner, 2017). Clinical ethics were primarily based on the professionals involved in healthcare, who mainly included doctors and nurses.
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Among the areas of ethics in clinical practice most affected by the advent of technology is patient confidentiality with regard to health information technology (HIT). HIT began as a tool for use in the betterment of clinical practices but it has risen to become the avenue through which almost all clinical activities are carried out (Jonsen, Siegler, & Winslade, 2010). Due to the high prominence that HIT has been given in clinical practice, it has exponentially changed the concept of patient technology. In current clinical practice, almost all information about a patient is placed in the computer network of the hospital. The information is not only saved in a retrieval system but also made available from different nodes at the same time. To increase efficacy in handling patients, the concept of data interoperability has also been included in HIT (Jonsen, Siegler, & Winslade, 2010). For example, data about a patient is placed in a way that it can be useful to the physician, surgeon, nurse, and accountant, all at the same time. The storage of data in a retrieval system makes it susceptible to exposure to unauthorized third parties, which amounts to the ethical breach of confidentiality. Secondly, availing the data in different nodes under the concept of data interoperability is also a major potential ethics breach. The data is always exposed to third parties such as IT experts who may even be outside contractors, insurance adjustors, accountants and other professionals who may never have taken an oath to ensure confidentiality (Jonsen, Siegler, & Winslade, 2010). HIT is thus a major threat to clinical ethics from the perspective of confidentiality.
Other than confidentiality, HIT is also an ethical threat from the perspective of Primum non nocere as it interferes with the clinician-patient relationship. Under clinical ethics, it is evil to treat patients as anything but a human being who not only deserves dignity and respect but also one that the clinician ought to develop an interpersonal relationship with (Nakrem et al., 2018). HIT has dehumanized patients and reduced them into a sequence of zeroes and ones as produced by highly specialized data interoperability algorithms. Due to HIT, a patient can go through the entire process of being received at the emergency room, going through triage, getting treatment and being released without developing a single relationship with a single clinical professional. Details about the patient are collected in bits and pieces at different locations and fed into a highly specialized HIT system. Decisions are then made by clinicians, some of whom may never even meet with the patient. The clinicians who meet with the patient have already learned what they need from the computer entries of other professionals hence the patients become an item going through a conveyor belt (Pelland, Baier, & Gardner, 2017). In this regard, the taking over of HIT in the clinical practice has killed clinical ethics.
As HIT and other forms of technology continue to make work easier in clinical practice, they also exponentially increase the propensity for error, thus creating a new avenue of ethical issues as under the concept of Primum non nocere (Jagger, 2018). Many clinical processes that used to be done manually by clinicians have now been partially or fully automated, including diagnosis and prescription. The increase in use of technology in clinical care has increased the propensity for making mistakes and the potential impact of such mistakes to the safety of patients (Sulmasy, López, & Horwitch, 2017). For example, a simple typing error can lead to the death of a patient either through misdiagnosis or wrongful prescription. A computerized application that assists in word processing can lead to an erroneous entry in a patient’s data chart. Data interoperability will not only hide but also augment the error thus compromising the safety of the patient further. Some studies have revealed that as many as 250,000 Americans die annually due to errors by clinicians (Sulmasy, López, & Horwitch, 2017). The rate of the propensity for errors seems to be increasing just as the level of technological advancement in healthcare rises making technology an active threat to ethics in clinical practice.
Based on the discussion above, knowing the right thing and doing it is no longer enough to ensure adherence of ethics in a clinical setting. A doctor or nurse who has a full understanding of, and commitment to professional and clinical ethics can still be a part of massive ethical breaches due to the impact of technology in modern clinical practice. For a start, technology has placed a wedge between the patient and the clinician, in the form of a computer so that the clinician relates with the computer instead of the patient. Handling a patient without having an interpersonal relationship with the patient is a breach of ethics. Secondly, the use of technology has exponentially increased the propensity for errors of commission and omission, all of which relate to ethics. A simple mistake such as a typing error can have massive ramifications on a patient and the clinician may never even know that a mistake was made until it is too late. The most sensitive area, however, relates to patient confidentiality due to the concept of HIT in general and particularly data interoperability. The sanctity of patient information has been compromised by having it stored in retrieval systems and having it accessible to non-clinical staff. It is now incumbent upon clinical staff, such as doctors and nurses to establish evidence-based best practices to ensure that the proliferation of technology in healthcare does not come at the expense of clinical ethics since these ethics are essentially indispensable.
References
Jaggers, J. (2018). “Primum Non Nocere” When the treatment is worse than the disease. J Thorac Cardiovasc Surg, 155 (4), 1769-1770 .doi: https://doi.org/10.1016/j.jtcvs.2017.12.106 .
Jonsen, A. R., Siegler, M., & Winslade, W. J. (2010). Clinical ethics: A practical approach to ethical decisions in clinical medicine . New York: McGraw-Hill Medical.
Nakrem, S., Solbjør, M., Pettersen, I. N., & Kleiven, H. H. (2018). Care relationships at stake? Home healthcare professionals’ experiences with digital medicine dispensers–a qualitative study. BMC Health Services Research , 18 (1), 26 https://doi.org/10.1186/s12913-018-2835-1
Pelland, K. D., Baier, R. R., & Gardner, R. L. (2017). “It’s like texting at the dinner table”: A qualitative analysis of the impact of electronic health records on patient-physician interaction in hospitals. Journal of Innovation in Health Informatics , 24 (2), 216-223. doi: 10.14236/jhi.v24i2.894
Redekop, W. K., & Singer, D. R. (2017). Mapping the dimensions of Health Policy and Technology. Health Policy and Technology , 6 (2), 121-123. Doi: https://doi.org/10.1016/j.hlpt.2017.05.001
Sulmasy, L. S., López, A. M., & Horwitch, C. A., . (2017). Ethical implications of the electronic health record: In the service of the patient. Journal of General Internal Medicine , 32 (8), 935-939. doi: 10.1007/s11606-017-4030-1.
