Sunday, March 19, 2006

E-Pathfinder: Information Ethics in Healthcare

Scope: This e-pathfinder is designed for use by

healthcare professionals, medical students, and
patients who are seeking information about ethical
issues in the healthcare field. It may also be used
by librarians who are assisting library patrons who
are doing research in this area. Privacy of healthcare
data and medical ethics are addressed. Resources
include print materials, such as books and journals,
and healthcare organizations. They can be used
by both inexperienced users and those who are more
familiar with the subject. Many of the links include
introductory information and also offer a breadth of
knowledge for those interested in further research.

Search terms: health information ethics, medical ethics,

patient records

Resources:


Books:

Amatayakul, M. (2004). Electronic health records: a

practical guide for professionals and organizations.
Chicago, IL: AHIMA.
Addresses electronic healthcare records and how

privacy and security are affected.

Anderson, J.G. & Goodman, K. (2002). Ethics and

information technology. New York, NY: Springer.
This book includes case studies concerning ethical

issues that exist because of the use of computers
for the distribution of healthcare information.

Chapman, A. (1997). Health care and information

ethics: protecting fundamental human rights.
Lanham, MD: Sheed & Ward.
Discusses how computer technology has changed

access to information in healthcare and discusses
the challenges of electronic information in the field.

Freeman, L. & Pearce, A.G. (2005). Information

ethics: privacy and intellectual property.
Hershey, PA: Idea Group Publishing.
Shows the effects of information technology on

healthcare information and discusses patient rights
and access to information.

Fremgen, B.F. (2005). Medical law and ethics.

Upper Saddle River, NJ: Prentice Hall.
Discusses ethical issues involved in patient

confidentiality and medical records.

Garwood-Gowers, A., Tingle, J. & Wheat, K. (2005).

Contemporary issues in healthcare law and ethics.
Phiadelphia, PA: Elsevier Health Sciences.
Written for healthcare professionals, this book

addresses current ethical issues that healthcare
professionals are facing such as healthcare security
and aspects of healthcare law.

Kluge, E.W. (2001). The ethics of electronic patient

records. New York: P. Lang.
Discusses ethical problems concerning healthcare

professionals such as access to patient records,
security, and confidentiality.

Loewy, E.H., Loewy, R.S. (2004). Textbook of

healthcare ethics. Boston: Academic Publishers.
A book written specifically for professionals in the

healthcare field. Ethical concerns regarding healthcare
information are addressed. Useful for both those with
little knowledge and more experienced professionals
in the field.

Journals:


Cambridge Quarterly of Healthcare Ethics
http://journals.cambridge.org/action/displayIssue?jid=CQH&amp
;amp;amp;volumeId=14&issueId=01
A journal useful for professionals who serve on
healthcare ethics committees in healthcare centers.

Ethics and Medicine
http://www.ethicsandmedicine.com/about.htm
This publication addresses ethical issues that
affect medical professionals.

Health Information Management Journal
http://www.himaa.org.au/HIMJ/journal.html
This journal covers topics such as confidentiality
of healthcare information and issues concerning
electronic patient records.

International Review of Information Ethics
http://www.i-r-i-e.net/
This journal includes articles about the concerns
of the delivery of healthcare information.
This topic will be specifically addressed in the

August, 2006 issue.

Journal of American Health Information Management

Association
http://www.ahima.org/journal/
Includes information about ethical
concerns regarding electronic patient records

Journal of Medical Internet Research

http://www.jmir.org
Addresses issues such as how the Internet is
used for medical research and distribution of
health information and how this technology
is changing the healthcare field.

New England Journal of Medicine
http://content.nejm.org
Includes articles regarding privacy and
healthcare and how health information, such as
computer records can be protected.

Associations and Information Centers:

American Health Information Management Association
http://www.ahima.org
Professionals who belong to this association are involved
in learning about ethical practices concerning healthcare
information including disclosure and how to protect patron
privacy.

American Medical Association
http://www.ama-assn.org/

Dedicated to assisting healthcare providers with professional
issues such as the distribution of healthcare information.

Center for Ethics in Healthcare
http://www.ohsu.edu/ethics/descr.htm
An organization that performs research to explore
answers to questions about ethical issues facing
healthcare information professionals.

Center for Healthcare Ethics, St. Louis University
http://www.slu.edu/centers/chce/
Provides professsional education courses including
a program for health information management.

Health Privacy Project, Georgetown University
http://www.healthprivacy.org
A project dedicated to issues in healthcare privacy
and information access.

Internet Healthcare Coalition
http://www.ihealthcoalition.org
This coalition works to inform healthcare
professionals about the delivery of healthcare
information, particularly on the Internet.

Medical Library Association
http://www.mlanet.org/
Has links to medical libraries and includes
resources for library professionals to help them
distribute
healthcare information.

National Institutes of Health
http://www.nih.gov/about
A medical research organization and provider
of health information. Supports ethical practices
in the distibution of this information.


National Network of Libraries of Medicine
http://nnlm.gov/
Supports health professionals and the public in
their access to information. Has information about
ethical issues involved in the sharing of this information.
Includes links to medical libraries.

United States Department of Health and Human Services
http://www.hhs.gov/ocr/hipaa
Supports improvement of healthcare programs and
the protection of healthcare information.

Codes of Ethics:

The following codes created by these healthcare

organizations provide guidelines for ethical decision
making and distribution of healthcare information.

American Medical Association-Ethics Standards
http://ama-assn.org/ama/pub/category/2416.html

Medical Library Association Code of Ethics
http://www.mlanet.org/about/ethics.html

International Medical Informatics Association
http://www.imia.org/English_code_of_ethics.html

Internet Healthcare Coalition
http://www.ihealthcoalition.org/ethics/ehealthcode0524.html



Sunday, March 12, 2006

What is Information Ethics?
In the Information Ethics class we put together a detailed definition that is posted on Wikipedia.
http://en.wikipedia.org/wiki/Information_ethics

Saturday, March 11, 2006

Blog 5: Information Professionals and Public Policy Issues Access, Ownership, Privacy, Security, and Community
Part 1: The Role of the Professional
In the area of healthcare, information professionals have an important role in disseminating information to the public while trying to make ethical decisions. Librarians working in a medical library have the responsibility of fulfilling patrons’ requests for information in a responsible way. These information professionals must put their personal biases and preferences aside when performing their job duties. When asked for information by an inquiring patient, for example, the librarian is expected to direct the patient toward the materials that he or she needs. The librarian is to go about this transaction without asking personal questions of the patient or offering advice to that individual. Codes of ethics that have been established within a medical library may be used as a point of reference in serving library patrons within the library. Ethical decision making, however, is neither straightforward nor predictable, and codes can not foresee every situation (Elrod & Smith, 2005). The issue of privacy is often addressed in codes of ethics of associations which support libraries, such as the Medical Library Association. The MLA’s Code of Ethics states that the health sciences librarian is to “respect the privacy of clients and protect the confidentiality of the client relationship”. Librarians serving in the area of healthcare are expected to respect patron privacy and treat patron requests with confidentiality. The issue of access is also important since information professionals working in a healthcare environment may have to put personal preferences aside when deciding which materials to keep available. While an information professional working in a medical library may prefer to withhold materials about sensitive topics such as abortion and human cloning from the collection, that individual needs to consider individuals’ rights to access this information. Because of personal biases a librarian may feel conflicted about what information should be publicly available (Elrod & Smith, 2005). Codes of ethics established by associations such as the MLA can provide guidance and make suggestions about the expected responsibilities of information professionals in the medical field. But there will always be questions about policy issues that may not be so easy to answer such as who should have access to what information, how privacy can be protected while providing healthcare, and how information professionals can provide the best and fairest balance between access and protection (Carbo, 2003).

Part 2: The Role of Associations
Professional library organizations such as the Medical Library Association have great influence on the professional activities and decision making that take place in libraries. With their established values, objectives and codes of ethics, these associations provide a model for its members to follow, and information professionals may choose to abide by these guidelines when performing their work responsibilities. Professional codes are often designed to motivate members of an association to behave in certain ways and provide advice for individual members when they confront situations that are morally complex (Tavani, 2004). The associations do not express their opinions about the specific types of information that should be made available to the public and seem to take a neutral stance about public policy issues such as privacy and confidentiality. In the American Health Information Management Association’s code of ethics it states that the “ethical obligations of the health information management professional include the protection of patient privacy and confidential information” but it does not include specific directions about the actions that information professionals should take to follow the code. The code is general and shows that the information professionals need look within themselves when performing their responsibilities as librarians. Equally important is the need for information professionals to explore their relationships between themselves, technology and the world around them especially since technology is evolving at a rapid rate (Capurro, 1992). While associations’ codes mention issues that are global concerns such as privacy and confidentiality they do not address the relationships between information professionals and the world around them. Information ethics will continue to be put through new tests as technologies race ahead of many social and cultural conventions and norms (Spinello & Tavani, 2004). Perhaps in the future professional associations should consider these issues as they update their codes especially since information professionals often look to such conventions for guidance and direction.

American Health Information Management Association (2004). Retrieved February 26, 2006 from
http://www.ahima.org/

Capurro, R. (1992). Information technology and technologies of the self. Journal of Information Ethics, 5(2), 19-28. Retrieved February 26, 2006 from
http://www.capurro.de/self.htm

Carbo, T. (2003). Challenges for libraries creating one world: information ethics and policy issues for medical librarians. Journal of the Medical Library Association, 91(3), 281-285.

Elrod, E. & Smith, M. (2005). Information Ethics. Encyclopedia of Science, 2, 1004-1011. Retrived February 26, 2006 from
http://findgalegroup.com/

Medical Library Association (2000). Retrieved February 26, 2006 from
http://www.mlanet.org/

Spinello, R.A. & Tavani, H.T. (2004). Readings in Cyberethics. Massachusetts: Jones and Bartlett Publishers Inc.

Tavani, H.T. (2004). Ethics & Technology. New Jersey: John Wiley & Sons, Inc.

Saturday, February 25, 2006

Blog 4: Professional Codes: Traditions and Guidance for the Future
Select one of the popular codes in the information professions broadly speaking:
I selected the ACM Code of Ethics and Professional Conduct. The ACM is the Association for Computing Machinery.

Does the code reflect a foundation in utilitarianism or deontology? Other ethical traditions? Describe.

The code reflects a foundation in deontology. The guidelines in the code point to members taking actions based on doing what is right. ACM’s code includes directives regarding individuals being “honest” and “fair”, “respecting privacy” and “honoring confidentiality”. It also addresses “professional responsibilities” such as “striving to achieve the highest quality in professional work” and “knowing and respecting existing laws pertaining to professional work”. Members are expected to adhere to the rules of the code while respecting the rights of others. The code includes specific steps that individuals should take to abide by these rules as both members and computing professionals.

Does the code address individual members, the profession at large, and/or the public? Are there enforcement provisions?

The code addresses the individual members of the ACM. Each section begins with the phrase “as an ACM member”, and this phrase precedes each of the requirements that people agree to as members of the association. ACM’s code contains general statements about what is expected and in some cases what is required to be a member in good standing (Tavani, 2004). However, the Organizational Leadership Imperatives portion in Section 3 is slightly broader and indirectly addresses the profession at large since it refers to members utilizing the code in their individual work in organizations that they are involved in outside of the ACM such as their “employers” or “volunteer professional organizations”. It applies to individuals who have a leadership role in the workplace (Tavani, 2004). The code can help guide members when they confront situations that are morally complex, but it probably can not address every situation as it contains many, but not all, issues that professionals are likely to face (Spinello & Tavani, 2004). In Section 4 of the code there is an enforcement provision. It states that if an “ACM member does not follow this code by engaging in gross misconduct, membership in ACM may be terminated”. This shows that ACM members are expected to abide by the code. It appears that violations of the code will be taken seriously. However, the ACM code does not necessarily threaten the employment of those who violate them (Tavani, 2004). It is also unclear if there would be some kind of review process, when a violation takes place, before it is determined whether the member is to be dismissed from the association and/or if his or her employer would be notified.

Is the code a useful document to present the profession to a national or international audience?

The code is a useful document to present the profession to a national or international audience. It gives a clear understanding about the ethical professional conduct that is expected of every member of the ACM (Spinello & Tavani, 2004). The code provides a thorough list of principles that computer professionals should adhere to in their work, and these principles could be applied to the same profession in any location. ACM’s Code of Ethics contains many issues that professionals are likely to face (Tavani, 2004). It is comprehensive, organized, and useful to individuals in the profession or to those individuals eager to learn more about a career as a computer professional and the expectations that are involved.

What current public policy issues are noted or implied?

One of the public policy issues that is implied is civil rights. This is evident in the code’s mention that “discrimination on the basis of race, sex, religion, age, disability, and national origin will not be tolerated.” The issue of the environment is addressed in the area of the code that states that members “must be alert to, and make others aware of, any potential damage to the local or global environment.” Education is implied in the section that discusses “professional competence” where members can enhance their knowledge by doing “independent study, attending seminars, conferences or courses”. Additionally, the issue of anti-piracy is addressed where the code specifically states that “property rights” including “copyrights and patents” are to be “honored”.

If you were to update the code, what would you include? For example, does the code discuss the Intenet or electronic resources? What about workplace surveillance of employees? Ethnic diversity? Civil liberties? Other topics?

If I were to update the ACM code I would add guidelines about workplace surveillance of employees. It is not clear how the association would know whether its members are abiding by the code or violating it in some way. This code seems to imply that members are on their honor to follow the rules. I would also add some information about how members are expected to treat their clients or employers (Tavani, 2004). Perhaps there could also be a section about objectivity where it would be clear that personal judgment should not affect decision-making in professional activities.

Association of Computing Machinery (1992). Retrieved February 11, 2006 from
http://www.acm.org/constitution/code.html

Spinello, R.A. & Tavani, H.T. (2004). Readings in Cyberethics. Massachusetts: Jones and Bartlett Publishers Inc.

Tavani, H.T. (2004). Ethics & Technology. New Jersey: John Wiley & Sons, Inc.

Sunday, February 05, 2006

Blog 3: Just Consequentialism and the Potter Box in Information Ethics

You are planning to make a job change in the next two years. Although you are happy enough with where you are working, you are now in school and expect to look for something better when you graduate. How can just consequentialism and the Potter Box inform your decision-making? Are you received time-off or tuition assistance from your workplace? When should you inform your employers that you are looking for other opportunities? What else should you consider?

I am applying the Potter Box Model to my plans to make a job change in the next two years.

Empirical Definition - Define the situation objectively:
I am currently working in a sales capacity for a rep firm for public broadcasting. Even though I like my coworkers and I enjoy my job responsibilities, the work is not where my true interest is. In my position I am raising funds by selling corporate sponsorships for public broadcasting stations, and this effort supports the stations' activities and a good cause. Although I am assisting clients and potential clients and providing them with information, I decided that I would like to help people on a broader scale. Last year I began the program at Drexel to pursue my master's degree in library science to fulfill this desire. After completing my degree next year I will look for a job in the library field. At this time my employer is not aware of my plans.

Identifying Values - State and compare the merits of differing values:
My employer values hard work, client and station relations, customer service, income, attaining new business, and team work. I value helping others, hard work, relationships with clients and coworkers, income, benefits, access to information, and fair treatment. My employer and I have some similar values but also some that differ. The primary value of the company is to make money. While earning a salary is a top priority for me, I also highly value helping others and gain personal satisfaction from assisting people with successfully finding information.

Principles - State a principal that each value honors. Consider and compare other ethical values:
My employer supports the principles of service, loyalty, leadership, maximizing earnings, and respect for employees. I support the principles of making a contribution to society, earning a good living, the importance of relationships, and respect for people. Other ethical values that my employer and I share are honesty, integrity, and presenting unbiased information to clients.

Loyalties - Decide to whom I am being loyal. Evaluate the presence of others deserving loyalty. Select a course of action embracing the most important values, principles, and loyalties. Evaluate the impact of your decision.
I am loyal to my employer, coworkers and clients. Each day I report to work on time and get my tasks done so that deadlines are met. Outside of work I am also loyal to my family, friends and my work towards my master's degree in library science. I plan to stay at my job until I complete the program, and I will continue to fulfill my employer's expectations for the work that is required of me. However, my future plans to have a career as a librarian will not be known to them until I give notice. As long as I am employed there I will continue to assist clients, help the company make money, and try to increase my own income. I don't feel that by pursuing this degree that I am being disloyal to my employer because I am still committed to my job and working hard for the company. I also know that at any time they could become disloyal to me and eliminate my position. I feel that I am justified in seeking ways to improve my skills and completing this program to do work that fulfills my career goals. It is sometimes frustrating to me that my employer offers tuition reimbursement that I am unable to use. I realize though that this benefit is only for those employees who are looking to improve their skills for sales oriented positions. I could inform my employer that I am pursuing this program to enhance my searching skills to improve my job duties but it would be dishonest. I will not tell my employer that I am seeking other opportunities until I have completed my degree and I am offered a position elsewhere. When I first began work at the company I was provided with a policy that stated that the company can terminate my job at any time for any reason. With this in mind I sometimes question loyalty and I feel that I have the right to resign at any time. The only requirement that the employer asks of the employee is to give two weeks notice prior to leaving the firm. I plan to do so and if time allows I will give them more time so that they can prepare to find a replacement for me. It is not my intention to hurt my employer or to leave them in the difficult position of being short-staffed, and I will not withhold information from them longer than necessary once I complete my degree and find a new job. I think that it will be difficult to resign since I have been working at the company for a long time. I feel a sense of loyalty but I realize that I need to put myself first when it comes to my career and my future goals. I know that when I do finally leave and find a job as a librarian it will be in my best interest.

Backus, N. & Ferraris, C. (2004). Theory meets practice: Using the Potter Box to Teach Business Communication Ethics. Association for Business Communication. Western Oregon University.

Moor, J.H. (2004). Just Consequentialism and Computing. In Readings in Cyberethics. Massachusetts: Jones and Bartlett Publishers, Inc.

Tavani, H.T. (2004). Ethics & Technology. New Jersey: John Wiley & Sons, Inc.

Blog 2: Artifacts and Politics: Technologies of the Self

Due to the advent of the Internet and the stock market boom of the late 1990's, many people became wealthy and focused on money. Dot com companies created a frenzy where individuals started their own businesses for the purpose of creating wealth. After reading about all of the Internet based companies that failed I learned that while money is important, it is not what I value the most. I began to look within myself to see what my priorities were, and I discovered that my passion was to help others. About ten years ago I worked part time in the circulation department of a public library and at that time I observed reference librarians helping other people. The transactions between the librarians and patrons there inspired me to eventually pursue a career serving others. After working at the library I was employed in publishing and sales oriented jobs. However the responsibilities of these positions did not include many duties of service to others. I made up my mind last year to go into the information profession. Although I may not be able to get a full time job as a librarian until after I receive my degree, I take much satisfaction in the meantime with helping family and friends who need assistance with finding information. I love the challenge of information seeking and I find it stimulating to try to retrieve information that is difficult to access. It is very rewarding for me to help others and I crave a position of service as a librarian.

The Internet has had a big influence on me in my life both personally and professionally because of easier access to information. However I sometimes feel that I am experiencing communication overload because of the constant influx of e-mail and voice mail messages at home, at work, and at school. I think that this excess of information has helped me focus on what really matters to me in my life and has enabled me to become more organized since I need to prioritize which messages are the most important. Over the past several years people like myself have been busier than ever with working more hours at their jobs and trying to juggle responsibilities. The value system in society of having work dominate one's life has led people to become overwhelmed and have less time for family and personal goals such as furthering their education. Technological advancements such as online degree programs have really opened the door for my pursuit of graduate education. Without the option to work toward a degree online, it would be very difficult for me to take classes since I am not able to attend on-campus sessions due to lack of time to travel to school. I do not take for granted the opportunity to study and learn in an online environment especially since not everyone has access to such innovations. Technology influences the extent of how people can work and communicate (Winner, 1986). Less economically advantaged individuals may not have access to communication technology that would assist and enhance their learning. The benefits of information technology are not always equally distributed (Capurro, 1992). I realize how privileged I am to have access to information right at my fingertips. It will be interesting to see what future information and communication technologies are developed, and I look forward to seeing how they influence society and the information profession. Hopefully such technologies will help me improve my service to others when I become a librarian.

Capurro, R. (1996). Information technology and technologies of the self. Journal of Information Ethics, 5(2), 19-28.

Winner, L. (1986). Do artifacts have politics? Chicago: The University of Chicago Press.

Blog 1: Defining Information Ethics for Today

There are a number of information ethics issues that are prevalent in today's society. Because of the increased dependency on computers to retrieve and exchange information, concerns about privacy and confidentiality are being addressed in organizations such as libraries and healthcare facilities. Cybertechnology-related issues involving privacy, security, and free speech can affect everyone including individuals who have never even used a computer (Tavani, 2004).

Librarians are faced with several ethical issues during their day-to-day interactions with and observations of library patrons. If a librarian is asked for information from a patron that could potentially be used to harm others, then that individual needs to consider the privacy of the information seeker. It is a librarian's responsibility to maintain the confidentiality of the patron. However, an information professional needs to make judgments when deciding whether information sought by a patron may cause danger to society or to a specific individual. Privacy concerns have increased because of terrorist activities both nationally and internationally. Furthermore, there is current controversy because of recent legislation known as the USA Patriot Act which gives the government access to library records of those individuals who are potentially involved in terrorist behavior. Some librarians believe that this act violates library patrons' rights to privacy.

Librarians involved in collection development experience the ethical dilemma of determining which materials to keep accessible to the public. The question of whether information professionals should remove controversial books from the shelves (Elrod & Smith, 2005) is and will continue to be a sensitive issue. Librarians need to decide whether to eliminate information from libraries that may have the potential to offend individuals or that would encourage harmful behavior.

Healthcare facilities such as hospitals also have information ethics issues to consider in terms of protecting the privacy of patients. The question of who should have access to patient records is an ongoing controversy. Currently patients are able to obtain their own records but they can not always control who will be able to review them and how that information might be used for marketing purposes. Patient confidentiality is protected in instances even when family members attempt to find out information over the telephone about the condition of a relative in the hospital. A medical facility will not reveal any personal information in order to protect the privacy of the patient. However, since medical information is now available electronically there is the potential that personal data may be accessible to people trying to intercept such information for personal gain or theft.

Internet ethics is another issue that is a current concern. The Amy Boyer murder case mentioned in the Tavani reading is an example of how personal privacy can be violated when one uses the Internet to find out information about an individual to intentionally harm that person (Tavani, 2004). Because information is readily accessible in online searches (Tavani, 2004), personal privacy can be compromised. File sharing that occurs on the Internet brings about ethical concerns as well. If people choose to exchange and download music files, this activity can infringe upon copyright issues and bring about questions of ownership. However, such incidents can be difficult to monitor.

Privacy is the freedom granted to individuals to control their exposure to others (Spinello & Tavani, 2004), but there is no guarantee that people will have their personal information protected. Individuals like librarians and healthcare providers who have access to personal information need to be ethical when it comes to protecting the privacy of those they serve. This will continue to be a challenging effort especially due to the increased amount of information that is available online and not always easy to control.

Elrod, E. & Smith, M. (2005). Information Ethics. Encyclopedia of Science, 2, 1004-1011. Retrieved January 12, 2006, from
http://findgalegroup.com

Tavani, H.T. (2004). Ethics & Technology. New Jersey: John Wiley & Sons, Inc.

Spinello, R.A. & Tavani, H.T. (2004). Readings in Cyberethics. Massachusetts, Jones and Bartlett Publishers, Inc.

Friday, February 03, 2006

Introduction:

Welcome to my blog that I have created for my course in information ethics. More posts to follow soon.