Healthcare Ethics in the Information Age

Healthcare Ethics in the Information Age

Keith Bauer (Marquette University, USA)
Copyright: © 2009 |Pages: 16
DOI: 10.4018/978-1-60566-022-6.ch012
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Abstract

This chapter reviews key debates about the meaning of telehealth and also considers how new and emerging systems in telehealth work to protect patient confidentiality, improve healthcare relationships, and diminish instances of compromised access and equity in the healthcare system. This chapter also looks at how these same telehealth systems could undermine those goals, making it important to assess the way in which these emerging technologies are implemented. Various technologies are examined to show how their implementation can ensure that their benefits outweigh their risks.
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Introduction

The growing use of information and communication technology (ICT) is producing widespread changes in society. One area in particular that is quickly being transformed by ICT is the field of healthcare. This is evident in the relatively new field of telehealth, which utilizes the Internet, electronic patient records systems, hand-held computers, among other types of ICT. Telehealth has great potential to improve the quality and provision of healthcare services, but there are a number of subtle ethical issues that should be considered as society moves forward with its use. The aim of this chapter is, therefore, to provide an ethical assessment of telehealth. The specific questions this chapter addresses are as follows:

  • 1.

    What are the distributive justice implications of telehealth? Will medically underserved populations gain greater access to healthcare services? If so, what sorts of tradeoffs, if any, between access and quality will be required?

  • 2.

    What are the implications of telehealth for provider-patient relationships? For example, will an increase in the quantity of provider-patient interactions lead to a corresponding increase or reduction in the quality of those interactions?

  • 3.

    What are the implications of telehealth for medical privacy and patient confidentiality?

  • 4.

    What are the future trends in telehealth and how will they affect patient care and the healthcare system in general?

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Background

In order to understand what telehealth is, it is necessary to understand its history and its meanings. The literal meaning of the word telehealth is health from a distance. Combining the word health with the Greek prefix tele, which means end, far off, or distance, produces this definition. We see similar combinations in the words telephone, which literally means, sound from a distance, and telegraph, which literally means writing from a distance.

Various definitions of telehealth are currently in circulation within the healthcare community. One common view of telehealth makes it synonymous with two-way audio-video systems that allow for interactive consults between patients and healthcare professionals. However, other definitions are equally common and may include the use of ICTs (e.g., computers) that capture, store, manipulate, and display medical data but not include the use of interactive communications between patients and healthcare providers. Consequently, a fax machine used to transmit patient medical information or the telemonitoring of a cardiac patient would not count as telehealth under the first definition but would under the second definition (Denton, 1993; Preston, 1994).

Although no universally accepted definition of telehealth exists, there is agreement that any definition of it must include at least three elements: (1) the use of ICT, (2) geographic distance between the participants, and (3) health or medical uses. On the basis of these three characteristics, the Institute of Medicine (IOM) defines telehealth/telemedicine in the following manner:

Telemedicine [telehealth] is the use of telecommunications and information technologies to share and to maintain patient health information and to provide clinical care and health education to patients and professionals when distance separates the participants. (Field, 1996, p. 27)

The IOM’s definition can be made more specific, depending on whether (a) emphasis is given to a particular technology (e.g., video conferencing or Internet) (b) a distinction is made between clinical and non-clinical applications, and (c) whether telehealth is conceived of as an integrated system of healthcare delivery rather than a mere collection of electronic tools.

Key Terms in this Chapter

Modernity: The social, economic, and technological forces that have shaped the contemporary provider-patient relationship.

Implantable Biosensors: Sensors that are directly embedding into the human body to monitor vital signs and to provide prosthetic functions, often in concert with smart home technology and larger telehealth networks.

Distributive Justice: A sub-field of ethics that deals with questions about access and the fair allocation of healthcare benefits and burdens among populations. More specifically, distributive justice in healthcare requires the application of fair standards that make quality healthcare available and accessibl e to persons in an efficient manner.

Physical Privacy: Refers to the restricted access that others have to our bodies, relationships, and living spaces.

Telehealth/Telemedicine: The use of ICT to share and to maintain patient health information and to provide clinical care and health education to patients and professionals when distance separates the participants.

Technological Fix: The temptation to employ technology as a panacea rather than to give oneself as a person in the process of healing patients.

Science of Healthcare: Standardized clinical practice guidelines, automated procedures, scientific evidence, and the employment of medical technology.

Smart Homes: The use of ITC to augment the range of services that homes can provide for their occupants without human assistance, for example, monitoring the time, frequency, and variety of a person’s activities, including how often a person is waking up and walking, using the toilet, or opening his medicine cabinet to take medication.

Art of Healthcare: Individual clinical judgements and intuitions of healthcare providers.

Confidentiality: The protection of private information, once it has been disclosed by a patient to a healthcare professional (e.g., during a medical examination or taking of a medical history). Confidentiality requires patients to give up their informational privacy.

Informational Privacy: Refers to the security of identifiable patient health information and clinical data found in patient records and in communications among healthcare professionals and patients.

Interconnectedness and Social Presence: The quality and feeling of communication exchange with other persons, with or without ITC.

Ethics: The descriptive and prescriptive study of what is right, wrong, good, and bad, of what ought and out not be done.

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Table of Contents
Preface
Rocci Luppicini, Rebecca Adell
Acknowledgment
Rocci Luppicini, Rebecca Adell
Chapter 1
Rocci Luppicini
Over the last 30 years, an amassing body of work has focused on ethical dimensions of technology in a variety of contexts impacting society. This... Sample PDF
The Emerging Field of Technoethics
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Chapter 2
Marc J. de Vries
In this chapter it is argued that a multidisciplinary approach to technoethics is necessary to do justice to the complexity of technology.... Sample PDF
A Multi-Disciplinary Approach to Technoethics
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Chapter 3
Daniela Cerqui, Kevin Warwick
Common ethical issues related to technology are formulated in terms of impact. With an anthropological approach, every technological device is... Sample PDF
Technoethics: An Anthropological Approach
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Chapter 4
Michael S. Billinger
Despite the fact that analyses of biological populations within species have become increasing sophisticated in recent years, the language used to... Sample PDF
A Technoethical Approach to the Race Problem in Anthropology
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Chapter 5
Andy Miah
This chapter outlines a technoethics for sport by addressing the relationship between sport ethics and bioethics. The purpose of this chapter is to... Sample PDF
The Ethics of Human Enhancement in Sport
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Chapter 6
Darryl Macer
This chapter examines some of the cultural variation in the ethical factors associated with the use of science and technology. The issues discussed... Sample PDF
Education of Ethics of Science and Technology Across Cultures
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Chapter 7
Seppo Visala
Within the organisational development people’s arguments rise from their personal or group interests, which in turn are based on the systemic... Sample PDF
Planning, Interests, and Argumentation
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Chapter 8
Alireza Bagheri
This chapter elaborates on some of the existing concerns and ethical issues that may arise when biomedical research protocols are proposed or funded... Sample PDF
Ethics Review on Externally- Sponsored Research in Developing Countries
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Chapter 9
Gerrhard Fortwengel
At the beginning of this section the authors provide a definition of biomedical research and an interpretation of the meaning of ethics and social... Sample PDF
Social and Ethical Aspects of Biomedical Research
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Chapter 10
Stefano Fait
In assessing the ethical implications of genomics and biotechnology, it is important to acknowledge that science, technology, and bioethics do not... Sample PDF
Ethical Aspects of Genetic Engineering and Biotechnology
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Chapter 11
Timothy F. Murphy
Military researchers are working to exploit advances in nanoscale research for military uniforms, medical diagnosis and treatment, enhanced soldier... Sample PDF
Nanoscale Research, Ethics, and the Military
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Chapter 12
Keith Bauer
This chapter reviews key debates about the meaning of telehealth and also considers how new and emerging systems in telehealth work to protect... Sample PDF
Healthcare Ethics in the Information Age
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Chapter 13
Matthew Charlesworth, David Sewry
The development of cybernetics and digital computers prompted the need for a greater exploration of computer ethics. Information ethics, as... Sample PDF
Ethical Theories and Computer Ethics
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Chapter 14
John P. Sullins
This chapter will argue that artificial agents created or synthesized by technologies such as artificial life (ALife), artificial intelligence (AI)... Sample PDF
Artificial Moral Agency in Technoethics
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Chapter 15
Pilar Alejandra Cortés Pascual
‘What positive and negative aspects are perceived of Information and Communications Technologies (ICT)?’ and ‘What dilemmas arise regarding these... Sample PDF
Ethical Controversy over Information and Communication Technology
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Chapter 16
Martin Ryder
This chapter provides a brief summary of the technical and social hurdles that define the so-called ‘digital divide’ and it considers the celebrated... Sample PDF
The Cyborg and the Noble Savage: Ethics in the War on Information Poverty
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Chapter 17
Mike Ribble
In todays changing global society, digital technology users need to be prepared to interact and work with users from around the world. Digital... Sample PDF
Becoming a Digital Citizen in a Technological World
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Chapter 18
Deb Gearhart
Are we developing a (global) society where our youth think it is ok to copy and paste whatever they see on the Internet and turn it in for homework;... Sample PDF
Technoethics in Education for the Twenty-First Century
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Chapter 19
May Thorseth
The purpose of this chapter is to discuss important ethical aspects of online communication of global scope. We focus particularly on procedural... Sample PDF
The Ethics of Global Communication Online
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Chapter 20
Cameron Norman, Adrian Guta, Sarah Flicker
New information technologies are creating virtual spaces that allow youth to network and express themselves with unprecedented freedom and... Sample PDF
Engaging Youth in Health Promotion Using Multimedia Technologies: Reflecting on 10 Years of TeenNet Research Ethics and Practice
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Chapter 21
Samantha Mei-che Pang
In Hong Kong, end-of-life practice ideally adheres to values that include respect for the patient’s selfdetermination and an understanding shared by... Sample PDF
Ethical Challenges of Engaging Chinese in End-of-Life Talk
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Chapter 22
Busi Nkala
An estimated 39.5 million people are living with HIV worldwide. There were 4.3 million new infections in 2006 with 2.8 million (65%) of these... Sample PDF
Community Education in New HIV Prevention Technologies Research
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Chapter 23
Makoto Nakada, Rafael Capurro
In this article we give an overview of the range and characteristics of intercultural information ethics (IIE) focusing on the public/private debate... Sample PDF
The Public / Private Debate: A Contribution to Intercultural Information Ethics
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Chapter 24
Arsalan Butt
Consumer software piracy is widespread in many parts of the world. P2P based websites have made it easier to access pirated software, which has... Sample PDF
Ethical, Cultural and Socio- Economic Factors of Software Piracy Determinants in a Developing Country: Comparative Analysis of Pakistani and Canadian University Students
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Chapter 25
A. Anderson, S. Allan, A. Petersen, C. Wilkinson
Recent evidence on genetically modified crops, cloning and stem cell research suggests that the news media play a significant role in shaping wider... Sample PDF
Nanoethics: The Role of News Media in Shaping Debate
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Chapter 26
Russell W. Robbins, Kenneth R. Fleischmann, William A. Wallace
This chapter explains and integrates new approaches to teaching computing and information ethics (CIE) and researching CIE education. We first... Sample PDF
Computing and Information Ethics Education Research
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Chapter 27
Jennifer Candor
The allocation of resources for assistive technology does not have to result in a gap between general and special education. This case study... Sample PDF
The Ethical Dilemma over Money in Special Education
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Chapter 28
Pilar Alejandra Cortés Pascual
Educational orientation should be set within a specific socio-historical context, which is nowadays characterized by the Society of Information.... Sample PDF
Educational Technoethics Applied to Career Guidance
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Chapter 29
A.K. Haghi
In this book chapter, the authors summarize their retrospections as an engineering educator for more than 20 years. Consideration is given to a... Sample PDF
The Scholarship of Teaching Engineering: Some Fundamental Issues
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Chapter 30
Antoinette Rouvroy
The aim of the present chapter is to elucidate the paradoxical position of the individual legal subject in the context of human genetics. It first... Sample PDF
Which Rights for Which Subjects? Genetic Confidentiality and Privacy in the Post-Genomic Era
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Chapter 31
Eduardo A. Rueda
This chapter focuses on showing legitimate ways for coping with uncertainties within the informed consent process of predictive genetic testing. It... Sample PDF
Predictive Genetic Testing,Uncertainty, and Informed Consent
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Chapter 32
Soraj Hongladarom
The chapter argues that there is a way to justify privacy without relying on the metaphysical assumption of an independently existing self or... Sample PDF
Privacy, Contingency, Identity, and the Group
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Chapter 33
Y. Ibrahim
This chapter situates the current debates on pornography in the virtual realm and its ethical and legal implications for users and researchers. It... Sample PDF
The Ethics of Gazing: The Politics of Online Pornography
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Chapter 34
Neil C. Rowe
We examine the main ethical issues concerning deception in cyberspace. We first discuss the concept of deception and survey ethical theories... Sample PDF
The Ethics of Deception in Cyberspace
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Chapter 35
Cyber Identity Theft  (pages 542-557)
Lynne D. Roberts
Information and communication technologies (ICTs) provide substantial benefits to governments, organizations and individuals through providing low... Sample PDF
Cyber Identity Theft
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Chapter 36
A. Pablo Iannone
This chapter asks: What is information overload? At what levels of existence does it occur? Are there any features common to information overload at... Sample PDF
Walking the Information Overload Tightrope
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Chapter 37
Cyber-Victimization  (pages 575-592)
Lynne D. Roberts
Information and communication technologies (ICTs); while providing a range of benefits to individuals, organisations and governments; also provide... Sample PDF
Cyber-Victimization
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Chapter 38
Spyware  (pages 593-608)
Mathias Klang
It is well known that technology can be use as to effectively monitor the behavior of crows and individuals and in many cases this knowledge may b... Sample PDF
Spyware
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Chapter 39
D. Gareth Jones
The advent of in vitro fertilization (IVF) marked a watershed in the scientific understanding of the human embryo. This, in turn, led to a... Sample PDF
In Vitro Fertilization and the Embryonic Revolution
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Chapter 40
Joyce Yi- Hui Lee
In this chapter we argue that even though conflict has been explored at an intra-organizational level, its effect and role at an... Sample PDF
Inter-Organizational Conflicts in Virtual Alliances
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Chapter 41
Andreas Matthias
Creation of autonomously acting, learning artifacts has reached a point where humans cannot any more be justly held responsible for the actions of... Sample PDF
From Coder to Creator: Responsibility Issues in Intelligent Artifact Design
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Chapter 42
J. José Cortez
Fundamental democratic principles and values that guide our social relationships have been important concerns in the evolution of this nation’s... Sample PDF
Historical Perspective of Technoethics in Education
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Chapter 43
Heidi L. Schnackenberg
On the cutting edge of current technologies are portable media, where users can download information and take it with them to digest it anytime... Sample PDF
Podcasting and Vodcasting in Education and Training
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Chapter 44
Technoethics in Schools  (pages 680-699)
Darren Pullen
School students are used to digital technology-they blog, create movies for public viewing on the web, create and download music and use instant... Sample PDF
Technoethics in Schools
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Chapter 45
Charles R Crowell
This chapter discusses the ways in which moral psychology can inform information ethics. A “Four Component Model” of moral behavior is described... Sample PDF
Moral Psychology and Information Ethics: Psychological Distance and the Components of Moral Behavior in a Digital World
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Chapter 46
José-Rodrigo Córdoba
Current developments in information systems (IS) evaluation emphasise stakeholder participation in order to ensure adequate and beneficial IS... Sample PDF
A Critical Systems View of Power-Ethics Interactions in Information Systems Evaluation
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Chapter 47
Joan D. McMahon
If you were to survey course syllabi on your campus, you would probably find the standard syllabi to include: • Course title and number •... Sample PDF
Ethical Issues in Web-Based Learning
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Chapter 48
Barbara Paterson
Computer ethicists foresee that as information and communication technology (ICT) increasingly pervades more and more aspects of life, ethical... Sample PDF
We Cannot Eat Data: The Need for Computer Ethics to Address the Cultural and Ecological Impacts of Computing
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Chapter 49
Bernd Carsten Stahl, Simon Rogerson
The ever-changing face of ICT can render its deployment rather problematic in sensitive areas of applications, such as healthcare. The ethical... Sample PDF
Current and Future State of ICT Deployment and Utilization in Healthcare: An Analysis of Cross-Cultural Ethical Issues
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Chapter 50
Sue Conger
With each new technology, new ethical issues emerge that threaten both individual and household privacy. This chapter investigates issues relating... Sample PDF
Emerging Technologies, Emerging Privacy Issues
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Chapter 51
Robert N. Barger
This chapter discusses the ethics of a proof-of-concept demonstration of “parasitic computing.” A “parasite” computer attempts to solve a complex... Sample PDF
Ethics of "Parasitic Computing": Fair Use or Abuse of TCP/IP Over the Internet?
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Chapter 52
Cecilia Andrews
“Counter-terrorism refers to the practices, tactics and strategies that governments, militaries and other groups adopt in order to fight terrorism.”... Sample PDF
Simulating Complexity-Based Ethics for Crucial Decision Making in Counter Terrorism
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Chapter 53
Gundars Kaupins
This article summarizes the legal and ethical implications associated with employee location monitoring. It states that few international laws and... Sample PDF
Legal and Ethical Implications of Employee Location Monitoring
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Chapter 54
Fjodor Ruzic
In today’s dynamic e-business environment where fast time to market is imperative, where information and telecommunications technology is costly and... Sample PDF
New Ethics for E-Business Offshore Outsourcing
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About the Contributors