Für eine ethische Beurteilung des Einsatzes moderner Informations- und Kommunikationstechnologien sowie autonomer Assistenzsysteme im Berufsfeld Pflege empfiehlt es sich zunächst, empirische Informationen über Wirkungen und Folgen dieser Technologien aus unterschiedlichen Perspektiven einzuholen. Allerdings ist die Studienlage erweiterungsbedürftig. Auch wenn die Diskussion eher tentativ auf der Grundlage von vorsichtigen Annahmen geführt werden kann, so schälen sich dennoch in der internationalen pflegewissenschaftlichen Debatte sehr ambivalente Bewertungen heraus. Eine der Kontroversen betrifft die Frage, inwieweit und in welchem Maße Pflege als Beziehungsarbeit technisch substituiert (...) werden kann oder darf; inwieweit sich dadurch nicht nur Strukturen der Wahrnehmung und Aufmerksamkeit wandeln, sondern soziokulturelle Bedingungen von Hilfe, Unterstützung und Befähigung grundlegend verändern. Assistenztechnologien werden nicht nur das widersprüchliche Verhältnis von Sicherheit, Überwachung, Kontrolle und Entmündigung verschärfen. Unter dem Einfluss moderner Informationstechnologien wird sich auch der Status professionellen Wissens wandeln. Von erheblichem Gewicht ist schließlich, ob möglicherweise sozialanthropologische Grundannahmen wie beispielsweise die der leiblichen Responsivität und personalen Authentizität obsolet werden. Die ethische Beurteilung erfolgt aus verschiedenen Bewertungsperspektiven. Aus deontologischer Sicht hat sich die Akzeptanz neuer Technologien daran zu bemessen, inwieweit deren Wirkungen mit normativen Ansprüchen und Integritätsinteressen betroffener Personen vereinbar sind. Aus Sicht einer Ethics of Care wird es darum gehen, inwieweit durch den Einsatz von Assistenztechnologien nicht nur psychophysische Entlastungen, nicht nur bessere Informationsflüsse bewirkt werden können. Nicht weniger bedeutsam ist die Frage, ob soziale Netzwerke entwickelt, Möglichkeiten der Teilhabe verbessert und kreative Potenziale der Selbstorganisation und der Selbstwirksamkeit gefördert werden können. (shrink)

Für eine ethische Beurteilung des Einsatzes moderner Informations- und Kommunikationstechnologien sowie autonomer Assistenzsysteme im Berufsfeld Pflege empfiehlt es sich zunächst, empirische Informationen über Wirkungen und Folgen dieser Technologien aus unterschiedlichen Perspektiven einzuholen. Allerdings ist die Studienlage erweiterungsbedürftig. Auch wenn die Diskussion eher tentativ auf der Grundlage von vorsichtigen Annahmen geführt werden kann, so schälen sich dennoch in der internationalen pflegewissenschaftlichen Debatte sehr ambivalente Bewertungen heraus. Eine der Kontroversen betrifft die Frage, inwieweit und in welchem Maße Pflege als Beziehungsarbeit technisch substituiert (...) werden kann oder darf; inwieweit sich dadurch nicht nur Strukturen der Wahrnehmung und Aufmerksamkeit wandeln, sondern soziokulturelle Bedingungen von Hilfe, Unterstützung und Befähigung grundlegend verändern. Assistenztechnologien werden nicht nur das widersprüchliche Verhältnis von Sicherheit, Überwachung, Kontrolle und Entmündigung verschärfen. Unter dem Einfluss moderner Informationstechnologien wird sich auch der Status professionellen Wissens wandeln. Von erheblichem Gewicht ist schließlich, ob möglicherweise sozialanthropologische Grundannahmen wie beispielsweise die der leiblichen Responsivität und personalen Authentizität obsolet werden. Die ethische Beurteilung erfolgt aus verschiedenen Bewertungsperspektiven. Aus deontologischer Sicht hat sich die Akzeptanz neuer Technologien daran zu bemessen, inwieweit deren Wirkungen mit normativen Ansprüchen und Integritätsinteressen (Selbstbestimmung, Sicherheit) betroffener Personen vereinbar sind. Aus Sicht einer Ethics of Care wird es darum gehen, inwieweit durch den Einsatz von Assistenztechnologien nicht nur psychophysische Entlastungen (Pflegepersonal, Patient*innen, ältere Menschen), nicht nur bessere Informationsflüsse bewirkt werden können. Nicht weniger bedeutsam ist die Frage, ob soziale Netzwerke entwickelt, Möglichkeiten der Teilhabe verbessert und kreative Potenziale der Selbstorganisation und der Selbstwirksamkeit gefördert werden können. (shrink)

Use of electronic health records within clinical encounters is increasingly pervasive. The digital record allows for data storage and sharing to facilitate patient care, billing, research, patient communication and quality-of-care improvement—all at once. However, this multifunctionality is also one of the main reasons care providers struggle with the EHR. These problems have often been described but are rarely approached from a philosophical point of view. We argue that a postphenomenological case study of the EHR could lead to more in-depth insights. (...) We will focus on two concepts—transparency and multistability—and translate them to the specific situation of the EHR. Transparency is closely related to an embodiment relation in which the user becomes less aware of the technology: it fades into the background, becoming a means of experience. A second key concept is that of multistability, referring to how a technology can serve multiple purposes or can have different meanings in different contexts. The EHR in this sense is multistable by design. Future EHR design could incorporate multistable information differently, allowing the provider to focus on patient care when interacting with the EHR. Moreover we argue that the use of the EHR in the daily workflow should become more transparent, while awareness of the computer in the specific context of the patient-provider relationship should increase. (shrink)

BackgroundThis manuscript presents a framework to guide the identification and assessment of ethical opportunities and challenges associated with electronic patient records (EPR). The framework is intended to support designers, software engineers, health service managers, and end-users to realise a responsible, robust and reliable EPR-enabled healthcare system that delivers safe, quality assured, value conscious care.MethodsDevelopment of the EPR applied ethics framework was preceded by a scoping review which mapped the literature related to the ethics of EPR technology. The underlying assumption behind (...) the framework presented in this manuscript is that ethical values can inform all stages of the EPR-lifecycle from design, through development, implementation, and practical application.ResultsThe framework is divided into two parts: context and core functions. The first part ‘context’ entails clarifying: the purpose(s) within which the EPR exists or will exist; the interested parties and their relationships; and the regulatory, codes of professional conduct and organisational policy frame of reference. Understanding the context is required before addressing the second part of the framework which focuses on EPR ‘core functions’ of data collection, data access, and digitally-enabled healthcare.ConclusionsThe primary objective of the EPR Applied Ethics Framework is to help identify and create value and benefits rather than to merely prevent risks. It should therefore be used to steer an EPR project to success rather than be seen as a set of inhibitory rules. The framework is adaptable to a wide range of EPR categories and can cater for new and evolving EPR-enabled healthcare priorities. It is therefore an iterative tool that should be revisited as new EPR-related state-of-affairs, capabilities or activities emerge. (shrink)

BackgroundElectronic patient record (EPR) technology is a key enabler for improvements to healthcare service and management. To ensure these improvements and the means to achieve them are socially and ethically desirable, careful consideration of the ethical implications of EPRs is indicated. The purpose of this scoping review was to map the literature related to the ethics of EPR technology. The literature review was conducted to catalogue the prevalent ethical terms, to describe the associated ethical challenges and opportunities, and to identify (...) the actors involved. By doing so, it aimed to support the future development of ethics guidance in the EPR domain.MethodsTo identify journal articles debating the ethics of EPRs, Scopus, Web of Science, and PubMed academic databases were queried and yielded 123 eligible articles. The following inclusion criteria were applied: articles need to be in the English language; present normative arguments and not solely empirical research; include an abstract for software analysis; and discuss EPR technology.ResultsThe medical specialty, type of information captured and stored in EPRs, their use and functionality varied widely across the included articles. Ethical terms extracted were categorised into clusters ‘privacy’, ‘autonomy’, ‘risk/benefit’, ‘human relationships’, and ‘responsibility’. The literature shows that EPR-related ethical concerns can have both positive and negative implications, and that a wide variety of actors with rights and/or responsibilities regarding the safe and ethical adoption of the technology are involved.ConclusionsWhile there is considerable consensus in the literature regarding EPR-related ethical principles, some of the associated challenges and opportunities remain underdiscussed. For example, much of the debate is presented in a manner more in keeping with a traditional model of healthcare and fails to take account of the multidimensional ensemble of factors at play in the EPR era and the consequent need to redefine/modify ethical norms to align with a digitally-enabled health service. Similarly, the academic discussion focuses predominantly on bioethical values. However, approaches from digital ethics may also be helpful to identify and deliberate about current and emerging EPR-related ethical concerns. (shrink)

The specific arrangements of power/knowledge that characterize nurse interactions with the electronic health record form a panopticon. As health care moves into the 21st century, sophisticated technologies like the electronic health record shape the terrain of professional possibilities. The longer it is in use, the more it is possible to excavate the inherent disciplinary function of electronic health record. A panopticon is a generalizable, replicable apparatus of power that cultivates discipline when similar behaviours are desired from a group of people. (...) This paper traces the arrangements of power/knowledge that characterize nurse interactions with the electronic health record rooted in a trauma critical care setting. Examining the apparatuses of power/knowledge enforced through panopticism in nursing makes the invisible visible. This in turn enables nurses to address the intended and unintended consequences of the electronic health record. If nurses are to effectively shape the direction of their own futures and the future of health care, nurses will need to unpack the invisible techniques of power such as the electronic health record as a panopticon. In the process of building a visible identity, contextualizing nursing knowledge to better care for patients on the one hand and understand the relationships of power that limit us on the other, nurses are neither apolitical nor powerless. Considering the dialectic of power/knowledge in the healthcare setting helps to illuminate spaces to recharacterize nursing, reveal the contributions and knowledge of nurses, and consolidate the professional power of nurses to affect meaningful change and self‐governance in the healthcare setting. (shrink)

What Ivan Illich regarded in his Medical Nemesis as the ‘expropriation of health’ takes place on the surfaces and in the spaces of the screens all around us, including our cell phones but also the patient monitors and (increasingly) the iPads that intervene between nurse and patient. To explore what Illich called the ‘age of the show’, this essay uses film examples, like Creed and the controversial documentary Vaxxed, and the television series Nurse Jackie. Rocky’s cancer in his last film (...) (submitting to chemo to ‘fight’ cancer) highlights what Illich along with Petr Skrabanek called the ‘expropriation of death’. In contrast to what Illich denotes as ‘Umsonstigkeit’ – i.e., a free gift, given undeservedly, i.e., gratuitously – medical science tends to be tempted by what Illich terms scientistic ‘black magic’, taking over (expropriating) the life and the death of the patient in increasingly technological ways, a point underscored in the concluding section on the commercial prospects of xenotransplants using factory farm or mass-produced (and already for some time) human-pig mosaics or chimeras. (shrink)