(Part 2 of an ongoing series)
As a healthcare ethics speaker, consultant and book author, one concern I frequently encounter revolves not about technology, AI or various managed care modules, but of a more basic concern: dehumanization.
Sooner or later, all of us become patients. That is a given. What is not always clear, is how the healthcare system will treat us. For, there is a great deal of unevenness in application. How does the system see us and how do we respond to “them.”
Ethics is a human thing
To answer the question of ethical based healthcare, it is necessary to pose questions borne out of recent challenges and technologies. Again, I want to think of these issues in the light of ethics and avoiding the tendency of social institutions to dehumanize.
COVID-19 and the future of pandemics
Ethical based healthcare was challenged in a myriad of ways when a heretofore unknown virus spread across the world. Many critics of healthcare and Big Pharma point to a woefully inadequate response. In many cases, the effects of the disease were mitigated but not contained. The disease became unreasonably politicized; communities were torn apart; and worse, healthcare providers were often forced to decide who got treated – and who didn’t in a super-strained system. The question of what is ethical-based healthcare was not answered in what seemed to be two-years’ worth of indecision and panic. Healthcare systems must solve how it will respond to future pandemics from an ethical point-of-view in order to disseminate information and save lives.
We know everything about you
At what point do our digital medical records go from being a positive, sharable tool and devolve into a loss of privacy? Who maintains the guardrails? Ethically, how does the healthcare system regulate the differences between the important medical aspects of Big Data and its protection in clinical settings, to our personal data suddenly landing in the digital files of rental agencies or banks; supermarket chains and pharmacies? Are we, as patients anonymous or are we heading toward a state of affairs where we suddenly receive coupons for vitamins, adult diapers or asthma inhalers? It is not a medical question so much as an ethical examination.
Who helps us stay human and not digital?
As an adjunct to the section above, is the reality that the healthcare system is at an understandable, though digital cross road. Through the use of AI and data, patients are becoming more data-driven decisions than human. Clearly, the analysis of patient data vis-à-vis the subset of similar patients potentially provides better assessments. On the other hand, what happens when the human element escapes us? Does a patient’s data represent all likely health outcomes or can there be extenuating circumstances? Will these trends lead to patients not having a say in their treatment? It raises more issues that an ethical based healthcare model will have to answer.
Who has the access?
We have experienced, for far too long, many inequities in the healthcare system. And, while healthcare can boast of technologies from DNA-driven miracles to customized drugs and tailored treatments there are a lack of answers that deeply concern me as a healthcare ethics speaker, consultant and book author.
Then there is the area of robotics and highly sophisticated surgical techniques.
Who has access to these medical marvels? Is it the rich, the entitled, the young, the “preferred,” the intelligent, the captains of industry?
Before these ethical concerns are considered absurd, I can clearly point to numerous historical examples where patient care has been exactly doled out based on those parameters plus to race, geographic area and those with “conditions.” For example, I am pleased the customizable technology around artificial limbs has become so sophisticated but I fear those advanced technologies will come to the white CEO of a bank and not an immigrant production worker in an automobile plant.
Who has the money?
Ethically-based healthcare must provide a balance between what is prescribed or tested or deemed profitable versus patient need and the patients’ best interests. How does the healthcare industry best become good agents of patients and their rights to treatment? How will capital expenditures be distributed in the years ahead?
Ethical based healthcare is critical, and without the considerations raised above, I am afraid our humanity could get lost under piles of data and lost promises. It is critical ethics wins.
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