Chapter 10 by Kathleen Mastrian, Dee McGonigle, and Nedra Farcus Ethical Applications of Informatics

Key Terms Defined Alternatives Antiprincipilism Autonomy Beneficence Bio-Ethics Alternatives - Choice between two or more options. Antiprincipilism - Emerged with the expansive technological changes and the tremendous rise in ethical dilemmas accompanying these changes. Opponents of principlism include those who claim that its principles do not represent a theoretical approach and those who claim that its principles are too far removed from the concrete particularities of everyday human existence; the principles are too conceptual, intangible or abstract, disregard or do not take into account a person’s psychological factors, personality, life history, sexual orientation, religious, ethnic and cultural background. Autonomy - Right of individual to choose for her/himself. Beneficence - Refers to actions performed that contribute to the welfare of others. Bio-ethics - Is defined as the study and formulation of healthcare ethics. Bioethics takes on relevant ethical problems experienced by health care providers in the provision of care to individuals and groups.

Key Terms Defined Bio-Informatics Care Ethics Casuistry Approach Confidentiality Consequences Bio-Informatics - "and computational biology involve the use of techniques including applied mathematics, informatics, statistics, computer science, artificial intelligence, chemistry, and biochemistry to solve biological problems usually on the molecular level" (Wikipedia, 2008, ¶ 1). Care Ethics - Is responsiveness to the needs of others that dictates providing care, preventing harm and maintaining relationships. Benjamin and Curtis base their framework on "care ethics" (Goodman, 1998, p. 5) and propose that "critical reflection and inquiry in ethics involves the complex interplay of a variety of human faculties, ranging from empathy and moral imagination on the one hand to analytic precision and careful reasoning on the other" (Benjamen and Curtis, 1992). Care ethicists are less guided by rules and focus on the needs of others and one’s responsibility to meet those needs. Casuistry Approach - approach to ethical decision-making grew out of the concern for more concrete methods of examining ethical dilemmas.  Casuistry is a case based ethical reasoning method that analyzes the facts of a case in a sound, logical and ordered or structured manner. The facts are compared to the decisions arising out of consensus in previous paradigmatic or model cases. Confidentiality - Safeguarding all personal information by ensuring that access is limited to only those who are authorized. Consequences - Outcomes or products resulting from our decision choices.

Key Terms Defined Decision Making Decision Support Duty Ethical Decision Making Ethical Dilemma Decision making - Output of cognition; outcome of our intellectual processing. Decision Support - A single recommendation or series of recommendations implying next steps based on care protocols; the computer reminders and alerts to improve the diagnosis and care of a patient including screening for correct drug selection and dosing, medication interactions with other medications, preventive health reminders in areas such as vaccinations, health risk screening and detection and clinical guidelines for. Duty - One’s feeling of being bound or obligated to carry out specific tasks or roles based on one’s rank or position. Ethical Decision Making - Refers to the process of making informed choices about ethical dilemmas based on a set of standards differentiating right from wrong. The decision making reflects an understanding of the principles and standards of ethical decision making, as well as philosophical approaches to ethical decision making; requires a systematic framework for addressing the complex and often controversial moral questions. Ethical Dilemma - Difficult choices; issues that challenge us ethically.

Key Terms Defined Ethical, Social and Legal implications (ESLI) Ethicist Ethics Eudiamonistic Fidelity Ethical, Social and Legal implications (ESLI) - As dilemmas continue to arise, ethics, social and legal perspectives should be incorporated into all levels of professional education. Ethicist - Thought of as experts in the arbitrary, ambiguous and ungrounded judgments of other people. Ethicists know that they make the best decision they can based on the situation and stakeholders at hand. Just as we try to make the best decisions with and for our patients, ethically we must do the same. We must critically think through the situation to arrive at the best decision. Ethics - A process of systematically examining varying viewpoints related to moral questions of right and wrong. Eudiamonistic - Principles address the question, "What is it to be an excellent person?" For Aristotle this ultimately means acting in a temperate manner according to a rational mean between extreme possibilities. Fidelity - Right to what has been promised.

Key Terms Defined Good Harm Justice Liberty Moral Good - Favorable outcome in ethics. Harm - Physical or mental injury or damage; unfavorable outcome in ethics. Justice - Fairness; treat everyone in the same way. Liberty - The independence from controlling influences. Moral - Refer to social convention about right and wrong human conduct that are so widely shared that they form a stable (although usually incomplete) communal consensus (Beauchamp and Childress, p.4).

Key Terms Defined Moral Dilemmas Moral Rights Negligence Nicomachean Nonmaleficence 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). Moral Rights - Ethical privileges. Negligence - A departure from the standard of due care toward others, includes intentionally posing risks that are unreasonable as well as unintentionally, but carelessly, imposing risks. Nicomachean - Vocabulary of technical terms used in a particular field, subject, science, or art; terminology. Nonmaleficence - Do no harm.

Key Terms Defined Principlism Privacy Rights Security Self-control Principlism - arose as societies became more heterogeneous and members began experiencing a diversity of incompatible beliefs and values. Principlism emerged as a foundation for ethical decision-making. Principlism arose as societies became more heterogeneous and members began experiencing a diversity of incompatible beliefs and values. Principlism emerged as a foundation for ethical decision-making. Principles were expansive enough to be shared by all rational individuals, regardless of their background and individual beliefs. Privacy - An important issue related to personal information, about the owner or about other individuals, that is included for sharing with others electronically and the mechanisms that restrict access to this personal information. Rights - Privileges; right to privacy, confidentiality, etc. Security - Protection from danger or loss; in informatics, you must protect against unauthorized access, malicious damage, incidental and accidental damage, and enforce secure behavior and maintain security of computing, data, application, information and networks. Self-control - Self-discipline; strength of will.

Key Terms Defined Standard Truth Uncertainty Values Veracity Standard - Benchmark; criterion; rule; norm; principle. Truth - Fact; certainty; sincere action, character, fidelity. Key Terms Defined Uncertainty - Ambiguity; insecurity; vagueness. Values - Relative worth of an object or action such as aesthetic beauty or ethical value. Veracity - Right to truth.

Key Terms Defined Virtue Virtue Ethics Wisdom Virtue - Assumes there are certain ideals toward which we should strive which provide for the full development of our humanity. Virtues are attitudes or character traits that enable us to be and to act in ways that develop our highest potential; examples are honesty, courage, compassion, generosity, fidelity, integrity, fairness, self-control, prudence. Like habits they become a characteristic of the person. The virtuous person is the ethical person. Virtue Ethics - Suggests that individuals use power to bring about human benefit. One must consider the needs of others and the responsibility to meet those needs. Wisdom - Knowledge applied in a practical way or translated into actions; uses knowledge and experience to heighten common sense and insight to exercise sound judgment in practical matters; sometimes thought of as the highest form of common sense resulting from accumulated knowledge or erudition (deep thorough learning) or enlightenment (education that results in understanding and the dissemination of knowledge); it is the ability to apply valuable and viable knowledge, experience, understanding and insight while being prudent and sensible; is focused on our own minds; the synthesis of our experience, insight, understanding and knowledge; the appropriate use of knowledge to solve human problems.  It is knowing when and how to apply knowledge.

Ethical Decisions Ethics Bioethics Ethical Dilemmas Morals Ethical Decision Making Ethics is a process of systematically examining varying viewpoints related to moral questions of right and wrong. Regardless of the theoretical definition, common characteristics regarding ethics are its dialectical, goal-oriented approach to answering questions that have the potential of multiple acceptable answers. Bioethics is defined as the study and formulation of healthcare ethics. Bioethics takes on relevant ethical problems experienced by health care providers in the provision of care to individuals and groups. As technology advances increased, recognition and acknowledgment of rights and the needs of individuals and groups receiving this high tech care also increased. 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 refers to 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 Theoretical approaches and healthcare ethics The Hippocratic tradition Principlism Anti-Principlism 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 arose as societies became more heterogeneous and members began experiencing a diversity of incompatible beliefs and values. The anti-Principlism movement has emerged with the expansive technological changes and the tremendous rise in ethical dilemmas accompanying these changes.

Theoretical Approaches The Casuistry Approach  The Husted Bioethical decision-making Model The Virtue Ethics Approach Care Ethics The casuistry approach to ethical decision-making grew out of the concern for more concrete methods of examining ethical dilemmas.  The Husted Bioethical decision-making Model centers on the health care professional’s implicit agreement with patient/client (Husted and Husted, 1995, p. 19), and is based on six contemporary bioethical standards: autonomy, freedom, veracity, privacy, beneficence, and fidelity. The virtue ethics approach emphasizes the virtuous character of individuals who make the choices. Virtue ethics has seen a resurgence in the last thirty years. Goodman (1998) credits Pellegrino and Thomasma with the resurgence of virtue ethics in the field of bioethics. Pellegrino and Thomasma (1993) maintain that virtue theory should be related to other theories within comprehensive philosophy of the health professions. Care Ethics is responsiveness to the needs of others that dictates providing care, preventing harm and maintaining relationships.

Theoretical Approaches The consensus-based approach The value of different theoretical ethical methods The importance of diverse ethical insight The consensus-based approach to bioethics was proposed by Martin (1999). 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 The Information Age Language Barriers Informatics Practitioners Healthcare Professionals and Ethical Approaches With the information 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. Informatics practitioners are bridging continents and international panels, committees and organizations are beginning to establish 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 Analysis and Ethics The use of expert systems Facing Ethical Dilemmas The Goal of an Ethical System 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 the care of our patients provides challenges as to who should use these tools, how they are implemented and how they are tempered with clinical judgment. Facing ethical dilemmas on a daily basis and struggling with unique client situations cause many clinicians to question their own actions as well as the actions of their colleagues and patients. The goal of any ethical system should be that a rational, justifiable decision was reached.

Applying Ethics to Informatics An Ethical Dilemma Bio-informatics Making Ethical Decisions Practicing Ethics The information concerning an ethical dilemma must remain in the context of the dilemma in order to be useful. Bio-informatics could gather, manipulate, classify, analyze, synthesize, retrieve and maintain databases related to ethical cases, the effective reasoning applied to various ethical dilemmas and the resulting ethical decisions. In order 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 our patients in practice, we can also apply a model in the analysis and synthesis of ethical dilemmas or cases.

Applying Ethics to Informatics Virtue ethics The Responsibility of Ethics The International Council of Nurses Code of Ethics Science/Technology Advances and the future Virtue ethics suggests that individuals use power to bring about human benefit. One must consider the needs of others and the responsibility to meet those needs. The International Council of Nurses Code of Ethics states that "The nurse holds in confidence personal information and uses judgment in sharing this information.” As science and technology advances and policy makers and health care providers continue to shape healthcare practices including information management, it is paramount that ethical decisions are made. The healthcare professional cannot allow conflicting loyalties to interfere with judicious, ethical decision making.

Thought Provoking Questions Identify moral dilemmas in healthcare informatics that would best be approached with the use of an ethical decision making framework. Discuss the evolving health care ethics traditions within their social and historical context.

Thought Provoking Questions Differentiate among the theoretical approaches to health care 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 Select one of the healthcare ethics theories and argue against its use in examining ethical issues in healthcare informatics.