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Authored by:
- AdventHealth University
“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.
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 Patients
Medical 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
- What is the best way to acquire a patient’s informed consent to the use of predictive analytics and other advanced analyses techniques that are based on the patient’s private data?
- What are the ethical limitations on the use of data that is collected automatically by digital pills and other medical devices and technologies that report sensitive data, sometimes without the patient’s knowledge?
- Do current policies and regulations related to biospecimens offer adequate privacy protection to patients?
Safeguarding Patient Privacy When Using Population Health Data
The 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
- What protections could be put in place to safeguard the de-anonymization of patient data?
- How can patients be protected from the negative effects of inherent bias in the algorithms used to analyze public health data?
- What level of control should individual patients have over the use of their private health information that becomes part of public health databases?
Ensuring Equal Access to Customized Medicine
Customized 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
- How can healthcare providers ensure equitable access to expensive technologies that not only treat illnesses but also promise to promote longevity and enhance patients’ quality of life?
- What are the ethics of cost/benefit analyses when human lives are at stake?
- What policies could help avoid “genetic discrimination” when medical test results reveal conditions or genetic susceptibilities to specific diseases that weren’t the subject of the original tests?
Reconciling Patient Care Decisions with Financial Management
One 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
- What is the right balance between meeting the medical needs of patients and maintaining fiscal responsibility when making decisions about capital allocation?
- How can healthcare administrators address waste and inappropriate use of resources without impinging on the medical decisions made by healthcare providers in the best interests of their patients?
- What steps can be taken to address the moral injury that many healthcare providers feel when they’re forced by economic considerations to make decisions that go against their moral beliefs and their own expectations?
- How can a sense of ethics be instilled in the day-to-day decision-making of healthcare workers in medical departments and in administrative roles?
Implementing Artificial Intelligence and Robotics Ethically
The 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
- What procedures are in place to ensure that AI, robotics, and other advanced technologies are adopted only after they’re proven to be effective in meeting the healthcare needs of patients?
- How much say should patients have in the use of advanced technologies as part of their medical treatment?
- Will predictions about a patient’s future health generated by AI systems be made available to insurance companies and other third parties?
- What effect will AI-based medical care have on the relationship between patients and their doctors and other healthcare providers?
Devising Ethical Responses to Pandemics and Other Widespread Medical Emergencies
The 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
- How should healthcare providers decide who gets treated when the demand for their services outstrips their capacity to supply them to all patients who are in need?
- How can healthcare professionals protect against age bias and other forms of discrimination when making these decisions?
- In the race to develop vaccines and treatments for deadly diseases, such as COVID-19, how does the healthcare industry ensure that the potential risks to patients and caregivers of these new treatments are properly balanced with the potential rewards they promise?
- What role do healthcare providers play in devising and enforcing policies, such as social distancing measures, that restrict the freedoms of their patients?
Combining the Science of Health with the World of Business
Addressing 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, “Broad Consent for Biobanks Is Best — Provided It Is Also Deep”
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
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”
RoboticsBiz, “8 Ethical Issues in the Use of Robotics in Healthcare”
STAT, “Research in the Time of Coronavirus: Keep It Ethical”
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?”
