he goal of the First Graded Discussion is to make
sure each student is able to prepare and post a
short PowerPoint presentation of 3-5 slides with
accompanying notes about a current health
The PowerPoint will need to describe and explain
what the selected health information technology
does and then analyze how it might improve quality,
increase access, and/or reduce the cost of
healthcare services in the US.
Now Do this
As we prepare our slide presentations about health
information technology (see below for that Forum), 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
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
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
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
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 EHTICS 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 their own 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?
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