AUTHOR
Tony Cornford and Ela Klecun-Dabrowska

ABSTRACT

This paper discusses ethical aspects of different models of evaluation based upon different concepts of telehealth. The term telehealth is often used alongside or interchangeably with telemedicine and telecare. These terms refer to health and care services that can be provided at a distance over various telecommunications networks. Telemedicine facilitates remote patient care in an institutional setting, for example, linking hospitals with remote surgeries and enabling remote diagnosis. Telecare refers to services that provide care for people away from institutions, typically in their own homes, for example monitoring elderly people as they lead their normal lives. Telehealth is perhaps more encompassing, and includes opportunities for health promotion among a wide range of people including the young and healthy.

We take telehealth as covering a number of heterogeneous technologies and services that cut across boundaries between different professions, including medicine, health promotion, health administration, social services and information systems. We could envisage finding a conception of telehealth in a variety of contexts:

1. a ‘drug’ or a therapeutic agent in a medicine/health context
2. an information system – embedded in an institutional/organisational context
3. an information service – in a social/community context.

These different ways of conceptualising telehealth highlight different issues and suggest different approaches to evaluation and different ethical concerns.

Ethical concerns have a particularly strong position within the medical tradition. The primary ethical concern regarding the evaluation of a drug is ‘to do no harm’. However the ethics of drug prescription, medical treatments and technologies reflect a complex model that increasingly incorporates a variety of concerns, including humanity and acceptability, accessibility, health outcomes, quality of life, and in the case of health projects the impact on related socio-economic development as well as effectiveness and efficiency. Thus there is tension between a scientific approach, the search for the gold standard and a more qualitative approach to evaluation.

Efficiency as an ethical system is much more prominent in the information systems tradition. In contrast to the medical setting, efficiency is not seen as a need for a better use of scarce resources but as a legitimate goal of increasing profitability and organisational effectiveness. Thus, efficiency could be seen as a primary interest, although different concerns, e.g. the quality of working life and job satisfaction are also (but to a lesser extent) present in information systems literature.

Perhaps the overriding ethical concern behind the concept of information services is the idea of information as a right, i.e. citizens/humans have the right to information. Information is seen as a tool for self-empowerment. At the same time there is tension between the idea of universal access and the trend towards commodification of information. The literature on information society and the role of information and communication technologies (ICTs) delivers its own set of ethical concerns. Telehealth can be evaluated in terms of empowering patients and communities, contributing to social cohesion, and democratising health care structures and service delivery versus intensifying social exclusion (information rich and poor), alienation and de-personalisation of health services (providing treatment not care), and the emphasis on standardisation and control.

Conclusions

This conceptualisation of different traditions is simplistic and crude and merits more sophisticated analysis in a full size paper. But this simplification has also a purpose – to emphasise the conflicting ethical underpinning of varied concepts of appropriate evaluation approaches for telehealth.

As telehealth crosses the boundaries of different disciplines, its evaluation must draw on a variety of traditions. Certainly, treating telehealth as a drug and concentrating on randomised controlled trials is very limited and, in many cases, of doubtful benefits. Tension between the different traditions of diverse disciplines highlights the complexity of evaluating telehealth. This can also be taken as an illustration of the struggle to define the ethical underpinning of the evaluation of ICTs in the context of information society.

AUTHOR
Francesco Conti

ABSTRACT

Mobile computing technologies are nowadays so developed that they are becoming interesting for the entertainment industry. The broad/narrow casting of entertainment and multimedia contents to mobile terminals is technically feasible.

Every transmission from and to a mobile terminal relies on the availability of radio spectrum. Radio spectrum is a finite resource. This means that there is not, nor can ever be, any guarantee that such resource can be made available to all who may wish to use it. Therefore the necessity to regulate the use of such resource clearly arises.

Regulation of the use of radio spectrum is not only a technical matter. It involves for the body in charge of regulation many social, economical and policy aspects to consider. Such issues may, in some cases, be conflicting. For instance, and generally speaking, letting the market grow competitive and free is clearly in conflict with the necessity of avoiding monopolistic positions. So many implications require, to the body in charge of regulation, to formalize precise concepts on how to serve the public interest before taking any regulative action. This paper intends to build a framework that can help in such task. Some ideas are derived from the past experience with traditional tv broadcast. Specific policy implementation suggestions, where given, apply to the italian reality.

The concept of public interest needs to be defined. I assume that there are three key terms that, when associated, describe better than others the notion of public interest: social security (prevention of social and economical degradation), freedom of choice (the possibility of autonomously choosing among different alternatives) and democracy (enhancing people power).

Having defined the notion of public interest, several issues pertaining to the broadcasting of digital multimedia contents can be more confidently discussed.

Competition. It seems impossible for the ruling authorities to determine which services are to be offered from the providers to the public. The rapid advancements of technologies are difficult to follow for the authority. So, how has the usage of radio spectrum to be regulated to let market forces effectively work? Several scenarios of licensed vs. unlicensed spectrum are discussed. The paper concludes that the best alternative is to license blocks of spectrum to transmission service providers and to put content providers (unlicensed) in reciprocal competition for the use of such spectrum.

Flexibility. Flexibility means the possibility to substitute undemanded services with more appetible ones. Moreover, it means the possibility for the authority to impose technical standards to be used. Several scenarios of permitted vs. not permitted service substitution and of imposed vs. free technical standards are discussed. The paper concludes suggesting to permit service substitution and in some measure to regulate the standards (to grant access to resources and to fill cultural gaps in different geographical areas).

Spectrum assignment and/or fee imposition. How to assign spectrum to one or another contender? Several approaches are possible: spectrum auctioning, assignment by lottery, equal division between contenders, consideration of the social utility of intended use, etc. Moreover, authorities can imposed fixed or proportional fees on the usage of spectrum, in consideration of how it is used. The implications of each of this policy are discussed in the paper. The paper concludes in favour of spectrum auctioning and suggests a mechanism to obtain complementary licenses from different countries for the case of transnational services.

Several other minor aspects of spectrum assignment policies are discussed.

AUTHOR
Corrado Conti

ABSTRACT

The availability of ever more highly sofisticated technologies in the handling of the financial system constitutes a leading factor towards the carrying out of a “global” market, in which all interested people, from any place in the world, can operate with hardly any limitation.

Among the various sectors of the system, both the credit and the securities markets benefit from such globalization of the economy.

As far as the credit institutions are concerned, the utilization of modern technologies gave them the opportunity to widen the range of the products they offer their customers, so reducing the diseconomic effects of the bank’s disintermediation process typical of our times. At the same time bank customers obtain better conditions in terms of costs, as well as the availability of products tailored to match their specific needs.

The transformations which have occurred in this sector of the economic system have not created any specific problem of social order, thanks above all to the existence of intermediaries, such as the banks, whose activities and stability are under strict supervision in every legislation.

On the other hand, when we examine what happens in the securities markets under the impact of the technological innovations, it appears evident that the structure of these markets facilitates the insurgence of different risks for the integrity and stability of the same markets.

It is commonly agreed that the efficiency of each securities market is closely related to the degree of disclosure of the various kinds of information the dealings are based on. Any lack, or delay, or misrepresentation in the relevant information, which the market ought to be provided with, produces a distortion in the fixing of the prices for the negotiated securities. As a consequence, most brokers incline to quit that unsafe market.

The utilization of electronic tools for computing as well as for telematic purposes made it possible to build up connections through which information is disseminated and exchanged, in real time, within the financial community. The organization and the extension of the securities markets have greatly benefited from this opportunity.

More recently, it is the Internet which has been widely used for the dissemination of financial information, for the public soliciting of investments in securities, and for the conclusion of dealings on securities. A number of problems has arisen from this practice, some of which of social relevance.

Authorities in this field, whether individual experts of law and of computing, or institutional bodies responsible for regulation and supervision in the securities markets, have made public their observations on this topic and elaborated their own proposals for a global solution. Some national regulators adopted supervisory rules for the activities subject to their jurisdiction.

The release point of my remark is that Internet navigators become potential addressees of communications which may well influence their behaviour, meanwhile escaping all precautionary control, both of a political and legal nature.

Whenever the contents of a communication embody the hypothesis of a solicitation of public savings, the necessity arises to respond to the need of protection which most modern States grant their citizens through the National legislations.

Effective means are to be found to avoid that the new technologies for the dissemination of financial information – which in principle could result favourable to a better knowledge on the part of the investors – are misused in such a way as to create risky or even detrimental opportunities for the same investors. This is likely to happen when no supervision system is feasible or, in any way, enforceable.

It is high time to examine this matter carefully, with an interdisciplinary approach, in order to reach a common view on the possibility of finding a way to protect the citizens of a transnational society, where collective interests are no longer guaranteed by traditional legislations.

The possibility of achieving fairly good results in the aim of protecting the users of the “global financial markets” against attempts to the integrity of the same markets is based on the way the international cooperation is activated.

Only through this kind of cooperation can we hope to work out a project in order to prevent any attempt against the integrity of the global financial market, and to provide the mechanisms through which, in case of failure in the said prevention, the positions affected by illicit behaviour may be restored.

AUTHOR
Göran Collste

ALSO PRESENTED AT:
The Computer Ethics Conference, Linköping University, Sweden, 1997

ABSTRACT

A patient, suffering from an unusual eye inflammation, was treated with cortisone and cytotoxin. At the same time, via Internet she succeeds to get in contact with a famous American specialist. The American specialist gives advice as to treatment, type of medication and dosage, resulting in the patient, following the advice of the American specialist instead of the Swedish doctor, getting severely ill.

This case bring to the fore some new problems, caused by an increase in the use of IT. “Do it your-self” – health care and consultation via Internet, will in different ways affect the patient – doctor relationship. In this paper, the consequences of the new source of information and consultation is discussed from an ethical point of view.

One condition for realizing the principle of autonomy is well-informed patients. IT can provide the patient with information and, hence, improve the possibilities of realizing the principle. On the other hand, when using Internet as a source of information, there are as yet no reliable criteria for distinguishing fancy from facts. There are studies showing that many people have a false belief in computer mediated messages. As a consequence, the patient may, uncritically, accept the medical information and advice given on Internet. This will, in its turn, diminish her autonomy.

The possibility of an Internet- doctor will also affect the clinical encounter. The relation between the patient and the doctor can be described in different, complementary, ways. According to a, “garage-model”, the patient is an object for treatment. When viewed as a contract, the focus is on the rights and duties of the doctor and the patient, respectively. Seeing the encounter as a dialogue, the personal and existential aspects of the relation is focused and, finally, when focusing on fidelity and trust, the moral aspects are stressed. It is argued that the practice of an Internet-doctor will, in different ways, affect the relation between the patient and the doctor. It is also argued that a new kind of relation between the patient and the Internet- doctor is established.

Being responsible is an important moral imperative in health care. For the doctor to be responsible, she must be able to follow up the treatment. When the patient follows the advice of an Internet-doctor, this condition is not met. Besides, it is difficult to hold the Internet -doctor responsible.

In conclusion: The IT-revolution in health care will, in different ways, change the relation between doctor and patient. Some new rules are necessary: there should be some form of peer review or licensing for reliable Internet-sites. The doctor should inform the patient about reliable sites and, finally, there is a need for a more specified contract between the doctor and the patient, regulating the rights and duties on both sides.

AUTHOR
Kari Coleman

ABSTRACT

In the past two decades, numerous authors have investigated the question of responsibility for computer errors. One popular line of argument is that it is inappropriate to hold the computer responsible because, in addition to interfering with the identification of the human beings who are responsible for such errors, computers simply are not responsible beings. Because of their placement in three roles to which we traditionally look when assigning blame-advisor, decision-maker, and actor-I suggest that we should reconsider our aversion to blaming computers and seriously investigate whether it is possible to build responsible computers. I begin by arguing that the metaphor of computer-as-tool hinders our ability to even conceive of the possibility of building responsible computers, and suggest a shift to the metaphor of computer-as-child. Following, I present a brief account of moral responsibility in terms of the ability to respond to one’s environment and one’s peers. Drawing on this account I address objections to the possibility of responsible computers involving autonomy (suggesting an account of autonomy as competence rather than choice), freedom (suggesting an alternative interpretation of ‘could have done otherwise’), and intentionality (addressing intentionality as both meaning and purpose). In conclusion, I suggest that a computer endowed with learning algorithms and communication skills could, if designed correctly, be morally responsible.

AUTHOR
Dave Chadwick, Phil Clipsham, G. Windall and A. Stanley

ABSTRACT

With the growing usage of the internet for commerce and the expanding use of computers of all kinds in organisations in all countries, I.T professionals globally are becoming aware that maintaining the security of data and information systems is of paramount importance. The teaching of security issues at an early stage in the careers of I.T professionals is, therefore, presumably to be desired. However, much research on ethics amongst computing professionals has concluded that younger people are more inclined to have a differing set of ethical principles to those who are older. The young are more inclined to take risks, more inclined to occasionally ignore the law and to sometimes act for the benefit of their own careers rather than for the benefit of their client or employer. This becomes an issue at undergraduate level where studies particularly concern computer and information security. The research described in this paper concentrates on the particular ethical problems which have arisen during the four years of teaching Information Systems Security as a specific unit in undergraduate computing studies at the University of Greenwich.

The research looks into the central questions of how ethical behaviour and awareness develop amongst students and to what extent such behaviour is influenced by a student: forming his/her own code of ethical conduct in isolation, being given knowledge of how unethical acts could be perpetrated without detection, being told how unethical acts could be punished by society, being taught a code of conduct derived from professional bodies in the I.T industry.

The first question was approached by researching how students would react when personally confronted with a number of situations where ethical decisions were required. This further investigated how, if at all, students formed their own ethical standards based upon their own principles and possibly derived from their unique student viewpoint.

The second question involved the problem of the choice of topics that should be included as content of a taught unit on Information Systems Security. For instance : if students are taught how hacking and fraud incidents are perpetrated then is there not a possibility that they may do likewise? However, if they are not taught these things at all then is there not a danger that their usefulness as security professionals may be compromised? How much of what should be taught before behaviour is influenced?

To answer the third question, research was undertaken to determine whether , in order to promote behaviour that was ethically acceptable to society, it was sufficient to teach students solely about the legal penalties for acting unethically. This approach also begged the question of whether changing outward behaviour also changed thoughts and attitudes.

In answer to the last question, research was undertaken to determine whether the teaching of a set of ethics drawn from accepted codes of professional conduct had any effect on a students ethical stance.

This research at the University of Greenwich has attempted to answer these four very pertinent questions regarding the education of future I.T professionals. In may ways, the findings of this research are pertinent to how the teaching of computer security issues to young people is to be conducted.