Ethical Applications in Informatics Objectives

Chapter 5

Ethical Applications in Informatics


Recognize ethical dilemmas in nursing informatics.

Examine ethical implications of nursing informatics.

Evaluate professional responsibilities for the ethical use of healthcare informatics technology.

Explore the ethical model for ethical decision making.

Analyze practical ways of applying the ethical model for ethical decision making to manage ethical dilemmas in nursing informatics.




Introduction (1 of 2)

The Knowledge Age is changing health care in ways that will not be fully recognized and understood for years.

The change is paradigmatic and every expert who addresses this change reminds healthcare professionals of the need to “go with the flow” of rapid change or be left behind.




Introduction (2 of 2)

As with any paradigm shift, a new way of viewing the world brings with it enduring values of the previous worldview.

Ethical decision-making frameworks will remain constant, but the context for examining these moral issues or ethical dilemmas will become increasingly complex.




A process of systematically examining varying viewpoints related to moral questions of right and wrong

Ethics is a dialectical, goal-oriented approach to answering questions that have the potential of multiple acceptable answers.





The study and formulation of healthcare ethics

Bioethics takes on ethical problems experienced by healthcare providers.

Technology advances require recognition and acknowledgment of rights and needs of individuals and groups receiving this high-tech care.



Technology Developments Create Ethics Concerns

Smartphone apps to direct, interact with, and monitor patient status and behaviors

Example: Google Glass for “secretive” photos and videos

Social media such as Facebook, Twitter, LinkedIn, and YouTube

Mobile device use by healthcare providers

Ethical Dilemmas and Morals

Ethical dilemmas arise when moral issues raise questions that cannot be answered with a simple, clearly defined rule, fact, or authoritative view.

Moral dilemmas occur when some evidence indicates that an act is morally right and some evidence indicates the act is morally wrong; yet the evidence on both sides is inconclusive; or an individual believes that on moral grounds, he or she cannot commit an act (Beauchamp and Childress, p. 11).




Ethical Decision Making

The process of making informed choices about ethical dilemmas based on a set of standards differentiating right from wrong

The changing meaning of  “communication” alone will bring with it new concerns by healthcare professionals for protecting patients’ rights of confidentiality, privacy, and autonomy.



Theoretical Approaches to Healthcare Ethics

Theoretical approaches to healthcare ethics have evolved in response to societal changes.

The Hippocratic tradition emerged from relatively homogenous societies where beliefs were similar and the majority of societal members shared common values.



Principlism (1 of 2)

Principlism arose as societies became more heterogeneous and members began experiencing a diversity of incompatible beliefs and values.

Principles were expansive enough to be shared by all rational individuals, regardless of their background and individual beliefs.



Principlism (2 of 2)

Basis of principlism:

Autonomy: free-will or agency

Beneficence: desire to do good

Nonmaleficence: desire not to harm

Justice: social distribution of benefits and burdens





Prompted by expansive technological changes and associated ethical dilemmas

Opponents of principlism claim principles:

Are too conceptual, intangible, or abstract

Do not consider a person’s psychological factors, personality, life history, sexual orientation, or religious, ethnic, and cultural background




A case-based ethical reasoning method that analyzes the facts of a case in a sound, logical, and ordered or structured manner

Grew out of the concern for more concrete methods of examining ethical dilemmas

The facts are compared to the decisions arising out of consensus in previous paradigmatic or model cases.



Bioethical Decision Making

The Husted bioethical decision-making model centers on the healthcare professional’s implicit agreement with patient/client

Based on six contemporary bioethical standards: autonomy, freedom, veracity, privacy, beneficence, and fidelity




Contemporary Bioethical Standards (1 of 2)

Autonomy: Right of individual to choose for self

Freedom: Ability and right to make choices

Veracity: Right to truth/truthfulness



Contemporary Bioethical Standards (2 of 2)

Privacy: Relates to personal information and rules that restrict access to this personal information

Beneficence: Actions performed that contribute to the welfare of others

Fidelity: Faithfulness to what has been promised



Virtue Ethics

The virtue ethics approach emphasizes the virtuous character of individuals who make the choices.

Suggests that individuals use power to bring about human benefit

One must consider the needs of others and the responsibility to meet those needs.

Virtue ethics has seen a resurgence in the last 30 years.




Care Ethics

Responsiveness to the needs of others dictates providing care, preventing harm, and maintaining relationships.

Care ethicists are less guided by rules.

Focus is on the needs of others and one’s responsibility to meet those needs.




Theoretical Approaches to Healthcare Ethics

Each method reflects an important aspect of ethical experience, adds to the others, and enriches the ethical imagination.

Diverse ethical insights can be integrated to support a particular bioethical decision, and that decision can be understood as a new, ethical whole.




Applying Ethics to Informatics (1 of 6)

With the knowledge age has come global closeness or the ability to reach around the globe instantaneously through technology.

Language barriers are being broken through technological translators to enhance our interaction and exchange of data and information.



Applying Ethics to Informatics (2 of 6)

Informatics practitioners are bridging continents, and international panels, committees, and organizations are establishing standards and rules for the implementation of informatics.

The ethical approaches can be used to help healthcare professionals make ethical decisions in all areas of practice.



Applying Ethics to Informatics (3 of 6)

Typically situations are analyzed using our past experience and in collaboration with others.

The use of expert systems, decision support tools, evidence-based practice and artificial intelligence in patient care provides challenges:

Who should use these tools?

How they are implemented?

How they are tempered with clinical judgment?



Applying Ethics to Informatics (4 of 6)

Facing ethical dilemmas on a daily basis and struggling with unique client situations cause clinicians to question their own actions and actions of colleagues and patients.

The goal of any ethical system should be to reach a rational, justifiable decision.



Applying Ethics to Informatics (5 of 6)

To be useful, the information concerning an ethical dilemma must remain in the context of the dilemma.

Bioinformatics could gather, manipulate, classify, analyze, synthesize, retrieve, and maintain databases related to ethical cases.



Applying Ethics to Informatics (6 of 6)

To make ethical decisions about informatics technologies and patients’ intimate healthcare data and information, we must be informatics competent.

Just as we use processes and models to diagnose and treat patients in practice, we can apply a model in the analysis and synthesis of ethical dilemmas or cases.





ETHICAL Model for Decision Making

Examine the ethical dilemma

Thoroughly comprehend the possible alternatives

Hypothesize ethical arguments

Investigate, compare, and evaluate the arguments for each alternative

Choose the alternative you would recommend

Act on your chosen alternative

Look at the ethical dilemma and examine the

outcomes while reflecting on the ethical decision









Nursing Code of Ethics

The International Council of Nurses code of ethics states that “The nurse holds in confidence personal information and uses judgment in sharing this information.”




New Challenges (1 of 2)

Patients and healthcare providers no longer have to be in the same place for a quality interaction.

How then does one deal with licensing issues if the electronic consultation takes place across a state line?



New Challenges (2 of 2)

Consider the ethical issues created by genomic databases or by sharing information in a health information exchange to promote population health.

Does public good outweigh individual interests in data collection and data mining?



Conclusion (1 of 2)

As advances in science and technology and policy makers and healthcare providers continue to shape healthcare practices, ethical decisions must be made.

The healthcare professional cannot allow conflicting loyalties to interfere with judicious, ethical decision making.



Conclusion (2 of 2)

In an ideal world, healthcare professionals must not be affected by conflicting loyalties; nothing should interfere with judicious, ethical decision making. As the technologically charged waters of health care are navigated, one must hone a solid foundation of ethical decision making and practice it consistently.




Thought-Provoking Questions (1 of 3)

Identify moral dilemmas in healthcare informatics that would best be approached with the use of an ethical decision-making framework.

Discuss the evolving healthcare ethics traditions within their social and historical contexts.



Thought-Provoking Questions (2 of 3)

Differentiate among the theoretical approaches to healthcare ethics as they relate to the theorists’ perspectives of individuals and their relationships.

Select one of the healthcare ethics theories and support its use in examining ethical issues in healthcare informatics.




Thought-Provoking Questions (3 of 3)

Select one of the healthcare ethics theories and argue against its use in examining ethical issues in healthcare informatics.



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