Ethical Ergonomics: Telehealth in Context
TimeThursday, April 152:15pm - 2:16pm EDT
The Human Factors and Ergonomics Society promotes a code of ethics and consists of members trained in human subjects research; however, in the context of human factors work, there are gaps in the literature on the ethical considerations behind designing and implementing health technologies. To address these gaps and mitigate unintended consequences, our team composed of an ethicist, human factors psychologist, and health informatician propose a framework to highlight and analyze ethical considerations when using telehealth.
Recent policy changes due to COVID-19 have prompted a substantial increase in the adoption of telehealth as an alternative to in-person care. Medical societies such as the American Medical Association, American Academy of Pediatrics, and American Association of Nurse Practitioners have given their input, guidance, and endorsement for telehealth (Centers for Disease Control and Prevention, 2020). As a result, telehealth has grown into a multi-billion dollar industry, generating $3.2 billion in 2020 for its annual revenue (Arcieri, 2021). However, embracing these new technologies has created its own minefield of ethical challenges. The hasty adoption of remote medical care by clinicians, hospitals, and employers during COVID-19 has exposed multiple weaknesses with human factors relevance. A gap assessment of how clinicians and organizations have adapted to using telehealth during COVID-19 shows that clinicians and organizations need to re-evaluate their guidelines for ethical use of these services (Kaplan, 2020). These gaps, including quality of care, access, consent, and privacy, can be addressed with a systematic approach to ethical medical practices in a remote healthcare environment.
In response to this challenge, our proposed framework (a) focuses on the user narrative to identify ethical considerations in human factors work related to designing and implementing telehealth services; (b) systematically analyzes ethical considerations through the lens of four principles of medical ethics; (c) organizes and analyzes this information for overarching patterns and trends using artificial intelligence; (d) engage with diverse and relevant stakeholders to refine the telehealth solution. The framework will then represent an ongoing feedback loop between human factors in telehealth, ethical considerations, and artificial intelligence.
We propose a framework of four principles of medical ethics--respect of persons, beneficence and non-maleficence, distributive justice, and utility--that can be used to outline the ethical ergonomics of clinical and organizational operations in a Western context. A large range of telehealth services are delivered in a doctor and patient relationship and services provided in non-traditional formats are in high demand during the pandemic. For example, instructor Dr. Kanojia uses the world’s leading live streaming and digital distribution platforms to engage in conversation with an audience of thousands on mental health topics (Limbong, 2021).
By utilizing these open-access platforms that were unintended for the delivery of healthcare, a growing community of over 400,000 can benefit from Dr. Kanojia's advice and support another in a digital space during a time in which we are more isolated than ever before (Limbong, 2021). However, creating and regulating this space is complex to consider through the lens of medical ethics. Can autonomy be preserved while community members publicly discuss personal mental health issues? Can beneficence and non-maleficence be regulated in an online community of over 400,000? Can there be an equitable distribution of resources and support in a large and diverse community that is still growing? Can free, open-access media platforms be utilized to bring benefit to as many people possible? For complex examples that use telehealth, our ethical analysis framework aims to keep up in pace with the rapidly changing ecosystem in remote healthcare.
Our proposed areas of ethical concern cover the principles of respect for persons, beneficence and non-maleficence, distributive justice, and utility. This list is an amalgamation of ethical principles found in human subjects research (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1979) and is reflected in the Human Factors and Ergonomics Society’s Code of Ethics (Human Factors and Ergonomics Society, 2020).
Respect for persons addresses a range of ethical issues that attend to human dignity, such as informed consent and privacy in which people are treated as autonomous agents capable of making their own judgements and decisions. This principle is upheld by making truthful and accurate information accessible and transparent, or maintaining confidence and fidelity with duties to withhold information. Beneficence and nonmaleficence address ethical issues involving user risk, liability, and the protection and prioritization of life by focusing on efforts to secure a person’s well-being, doing no harm in the process, and removing the possibilities of harmful effects. Distributive
justice addresses access to care and ensures equitable distribution of resources; when there is inequity, it is necessary to offer acceptable justification for differential treatment. Lastly, utility aims to bring as much benefit to as many people possible while also addressing the previous moral principles (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1979).
While ethical challenges in the remote healthcare setting are complex and at times competing, they can be analyzed through the lenses of these four overarching principles. Our recommended response to these challenges is guided by the areas of psychiatry in conjunction with telemedicine due to their continued leadership and growth in cultivating a remote healthcare ecosystem before and during the pandemic and beyond.
Overview of Presentation
The proposed presentation will cover our telehealth framework which incorporates the disciplines of human factors, ethics, and artificial intelligence.
Centers for Disease Control and Prevention. (2020). Using telehealth to expand access to essential health services during the COVID-19 pandemic. U.S. Department of Health and Human Services. https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html
Kaplan B. (2020). Revisiting health information technology ethical, lega, and social issues and evaluation: Telehealth/telemedicine and COVID-19. International journal of medical informatics, 143, 104239. https://doi.org/10.1016/j.ijmedinf.2020.104239
Limbong, Andrew. (2021, January 13). To help gamers on Twitch, Dr. K balances mental health advice with medical ethics. National Public Radio. https://www.npr.org/2021/01/13/956315576/psychiatrist-criticized-for-addressing-mental-health-issues-on-twitch
Arcieri, Katie. (2021, January 12). Amazon is likely to boost its own healthcare ambitions after exiting. Haven JV. S&P Global. https://www.spglobal.com/marketintelligence/en/news-insights/latest-news-headlines/amazon-is-likely-to-boost-its-own-healthcare-ambitions-after-exiting-haven-jv-62000298
National Commision for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. U.S. Department of Health and Human Services. https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html
Human Factors and Ergonomics Society. (2020). Code of Ethics. https://www.hfes.org/About-HFES/Code-of-Ethics