Ethical evaluation of new ICT-systems in health care


Göran Collste


Since many years information technology is used in health care. However, lately one can notice a growing interest for different kinds of applications, partly explained by the need of a faltering IT-industry to find new markets. Naturally, ICT can in different ways enhance the practice of health care. However, it is necessary to examine the applications in the light of the ethical values of health care.

In this paper I will discuss the ethical implications of the introduction of two new computerised information- and communication systems in health care. One is a system for patient surveys. The system, named IRIS, is used in the public health system and makes patient information available to any authorised care provider irrespective of at what place in the organisation he or she works. The use of IRIS is so far limited to the regional health care organisation, but in principle it can have a broader application and be used even at a European level. The other system I will discuss is a system for patient Internet accesses to his/her own medical case sheet.

There are several good reasons for introducing the new systems. IRIS will make patient information more accessible for doctors and other health care professionals, it will speed up the treatment and it will decrease the number of medical specimens and examinations. The system that provides patient access to his/her own medical case sheet will probably make patients more informed about their medical condition. The potential of both systems has relevance from an ethical point of view, for instance with reference to the principles of beneficence, non-maleficence and autonomy.

However, there are also possible risks with the new ICT-systems. Both systems will process confidential patient information and thus there is a risk for privacy violations. Furthermore, this risk will eventually lead to mistrust among both care providers and patients. This could eventually lead to a “censuring” of information, which, in its turn, will decrease the reliability of the systems. It is not clear who shall have access to IRIS. At the moment, the access is limited to persons involved in a “relation of care” but that could be interpreted as everyone working at a caring unit. But with such a broad access the possibility of misuse will also increase.

In order to protect the patients, the systems will use the highest security technology. Further, the patient has to give his/her informed consent to the processing of information. However, how a practice of informed consent shall be implemented without too many practical problems is a question that yet has to be answered.

The decision to introduce systems of this kind implies difficult and some times controversial ethical balancing. There are different ways to proceed, and I will discuss some possible alternatives. One can here make a distinction between criteria and procedures: which norms and values have priority, and according to which procedures should the system be designed and introduced?

One may, in accordance with utilitarianism, follow a kind of cost/benefit methodology and transform the different values at stake to a common unit. Or one may, from a deontological point of view, identify the relevant moral principles and norms and then either balance them in order to be able to decide which principle takes precedence or specify the norms in order to bring them to bear on practice.

Procedures for a morally justified introduction of new technologies include “participatory design” and, in accordance with the method of reflective equilibrium, “interactive technology assessment” (Reuzel et al). Then, different stakeholders’ perspectives will be taken into account in the processes of design and assessment.

In this paper, I will first describe the system for patient survey and the “open medical case sheet”-system. I will then analyse the ethical problems associated with the systems and, finally, discuss different moral criteria and possible procedures in order to come to a justified decision.