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.