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Issue No 005

Vol. 5 - September 2006
Ethics of Information Technology
in Medicine and Health Care

Have you seen a doctor lately? We hope not (at least not in an unpleasant matter). Anyway, if so you could have seen for yourself that modern medicine has become almost inconceivable without the use of information technology: from getting an appointment in the first place up to the making of a diagnosis, the treatment and not to forget all the accounting and necessary archiving. In fact it radically changed the delivery of health care in various aspects. And even more fundamentally – at least that is what some authors of this issue argue – information technology has transformed the medical construction of the human body and the scientific understanding of disease itself. No one can deny the great improvements that have been made possible by these developments. Being aware of this massive further research and devel-opment is undertaken in the field. Not less important it is then to be aware of the ethical issues raised: the benefits and risks for the patient, the practitioner and the society thus developing guide lines for an appropriate use of information technology in medicine and health care. Any normative analysis in this field has to be based on a thorough factual understanding of the techno-logical developments, their medical applications and qualified philosophical interpretations. Therefore, we are very thankful that this issue is once again co-edited by two very experienced experts in the field: Georg Marckmann, Dept. of Medical Ethics at the University of Tübingen, Germany, and Kenneth W. Goodman, Director of the Bioethics Program and Co-Director, Ethics Program, at Miami University, USA. Due to their excellent piece of work, we can publish six very profound contributions to the subject in this issue ranging from an analysis of the role of software in the patient care process up to questions on property and availability of genetic information. For an overview of the different contributions see the very compound and well informed introduction Georg Marckmann and Kenneth Goodman wrote at the beginning of this volume. We therefore are convinced that this issue of IRIE provides a most welcome forum to analyse and discuss the ethical and social issues raised by the various applications of information and communica-tion technology in medicine and health care. May it lead to deeper insights, open controversies and new perspectives for scholars and practitioners all over the world.


Rafael Capurro, Thomas Hausmanninger, Karsten Weber and Felix Weil, the Editors.

Full Journal
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Editorial: On IRIE Vol. 5
Language: English
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Introduction: Ethics of Information Technology in Health Care
by Georg Marckmann and Kenneth W. Goodman
Language: English
abstract:   Computer-based information and communication technologies continue to transform the delivery of health care and the conception and scientific understanding of the human body and the diseases that afflict it. While information technology has the potential to improve the quality and efficiency of patient care, it also raises important ethical and social issues. This IRIE theme issue seeks to provide a forum to identify, analyse and discuss the ethical and social issues raised by various applications of information and communication technology in medicine and health care. The contributions give a flavour of the extraordinarily broad landscape shaped by the intersection of medicine, computing and ethics. In fact, their diversity suggests that much more work is needed to clarify issues and approaches, and to provide practical tools for clinicians.
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“Software must not manipulate the physicians:” The IT Challenge to Patient Care
by Dirk Thomas Hagemeister
Language: English
abstract:   Information technology plays an increasingly important role in the medical working environment. Besides facilitating improvements in the quality of health care, it might also bear some unwished effects. Examining the ‘making’ of a diagnosis and the role it plays in modern medicine leads to the question how far this process of ‘diagnosing’ might be affected by the ‘technical surroundings’. A number of examples from clinical medicine in the hospital and the ambulatory sector illustrate the way IT is being utilised in modern medicine. A twofold negative effect could result from this ‘computerisation’: Firstly, the technical requirements for the use of IT might force the process of diagnosing to be adapted with subsequent wrong or altered diagnoses. Secondly, constraints like cost control might be facilitated by IT and thus its application might cause the doctors trying to avoid such pressures by modifying the diagnosis and potentially worsening treatment and outcome.
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The Use of Extremely Anthropomorphized Artefacts in Medicine
by J. Lahtiranta and K. K. Kimppa
Language: English
abstract:   Anthropomorphized, or human-like artefacts, have been used in teaching and training of medical skills for a long time. The most famous artefact used today is probably the Resusci ® Anne CPR training manikin, which is used for training of resuscitation skills. However, what has changed over the lifespan of these artefacts is the level of human-like features in them. All around the globe, highly anthropomorphized ICT artefacts are used in training of medical skills. Amongst others, the UNAM University in Mexico City and Royal North Shore Hospital in New South Wales use artefacts, which are closer to human-like robots than traditional manikins in teaching. The purpose of this article is to look deeper into this phenomenon, consider its potential implications for the patient-physician relationship and quality of patient care, and to propose some practical methods for minimizing the possible risks emerging from the use of these extremely anthropomorphized artefacts.
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Gender and ethically relevant issues of visualizations in the life sciences
by Britta Schinzel
Language: English
abstract:   Here moral problems created by the use of constructive imaging technologies within the life sciences are discussed. It specifically deals with the creation of dichotomies, such as gender, race and other differences, created and manifested through the contingent use of scientific and computational models and methods, channelling the production process of scientific results and images. Gender in technology studies has been concerned with destabilizing essentialist and dichotomous co-constructions of gender and technology. In the technological construction process gendered social constructions of stereotypes and inequalities both of the technological models and of the presumptions in life sciences become structural properties of the artefacts, again flowing back into the seemingly objective results and knowledge of the life sciences. Here we will deal with the construction of gender differences via biomedical imaging and the creation of norms in atlases. Additionally, the de-contextualized images, showing idiosyncratic selections and reducing complexity are used to popularize gendered assumptions about biological facts.
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Ethische Aspekte von Gehirn-Computer-Schnittstellen in motorischen Neuroprothesen
by Jens Clausen
Language: German
abstract:   Brain-Computer interfacing is a highly promising and fast developing field of modern life sciences. Recent advances in neuroscience together with progressing miniaturization in micro systems provide insights in structure and functioning of the human brain and enable connections of technical components to neuronal structures as well. This possibly offers a future therapy for paralysed patients through neuronal motor pros-theses. This paper identifies central ethical aspects which have to be considered in further progressing research in this scientific field and the development of neuronal motor prostheses.
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Electrodes in the brain: Some anthropological and ethical aspects of deep brain stimulation
by Elisabeth Hildt
Language: English
abstract:   In the following text, medical, anthropological and ethical issues of deep brain stimulation, a medical technology in which electrodes implanted in the human brain electrically influence specified brain regions, will be discussed. After a brief account of the deep brain stimulation procedure and its chances and risks, anthropological and ethical aspects of the approach will be discussed. These relate to the reversibility of the procedure and to the patient’s capacity to control the effects it exerts in the brain, to modifications and fluctuations in a person’s character traits and individuality brought about by neurostimulation, and to the range of legitimate, adequate uses of the deep brain stimulation approach. The paper concludes that deep brain stimulation should be confined to therapeutic contexts and to severe, otherwise treatment-refractory disorders in which the aim is to normalize brain functioning. Apart from this, it should not be used to modify a person’s individual character traits and behaviour or to enhance human traits.
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Genetische Informationen: Eigentumsansprüche und Verfügbarkeit
by Michael Nagenborg and Mahha El-Faddagh
Language: German
abstract:   The use of genetic information about a patient may cause serious concern within the discourse on informa¬tional privacy. In our article we would like to discuss a positive example of a diagnostic use of genetic infor¬mation in the field of molecular genetics. With regard to this example we will discuss the question who owns the genetic information to determine who should decide which data is to be stored or deleted. We will use a Kantian concept of property in order to show that the genetic information in the example given is to be considered the property of the patient. We shall argue, that the information should be considered as a part of the medical sphere, which is to be informationally sealed. Although we present hereby a theoretical frame¬work for a design of an appropriate information infrastructure, we will finally point out to the high costs of such an infrastructure.
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The Myth of Automated Meaning
by James Caufield
Language: English
abstract:   Most discussions of search engines focus on technology or user experience. By contrast, this paper asks about those who produce the recommendations that search engines gather. How are these people and institutions affected when search engines incorporate their work into search results, but no credit is given? The paper argues that the lack of attribution encourages the myth of automated meaning, the false belief that computers and algorithms have created rather than simply gathered these recommendations. It further argues that by concealing the role of these producers, search engines undermine public support for the individuals and institutions that create trustworthy recommendations, especially libraries. Because search engines borrow so extensively from public institutions and the public at large, their ethical obligations are far greater than previously recognized. The paper concludes with some comparisons between the ethical practices of libraries and those of search engines.
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