Ethical considerations for the development of Decision Support Systems

Alan J Green

Centre for Professional Ethics, Keele University, England

Published 2006 on OpenClinical (based on a 2004 paper)

This paper, commissioned by OpenClinical, is a short version of a dissertation submitted as part of the MA in Medical Ethics at Keele University 2004. The dissertation, entitled "Ethical implications of the introduction of computer-based knowledge management systems into medical practice", can be requested directly from the author.

"Decision Support Systems can have both positive and negative effects on ethical medical practice. The increase in the doctor’s and the patient’s knowledge have a positive effect on autonomy; in contrast where knowledge is withheld, either by not being presented by the DSS, or by the doctor not passing on all the knowledge imparted by the DSS autonomy may be reduced; where this is thought to be in the patient’s best interest there will be an increase in paternalism.

"The incorporation of such systems into the healthcare process brings ethical considerations that extend the features of the doctor-patient relationship to non-medical professionals. I have introduced the concept of chains of duty and shown how trustworthiness and duty of care propagate along the chain of people involved in the development and maintenance of the systems. I have indicated that knowledge of eventual use provides a good end point for these chains.

"The eventual incorporation of DSSs into normal practice will depend on many factors. Education of doctors in the use (and abuse) of the systems will play a part in this process (the Royal College of General Practitioners run many continuing professional development and other courses and publish a number of information guides for GPs; these could offer a conduit for knowledge of the use of DSSs to be given to GPs). Availability of funding and the recommendations of National Institute for Clinical Excellence will play a part as will the attitude of the courts if, for example, the use of DSSs forms part of any case of negligence. However the attitude of the public will also have a strong influence on the acceptance of such systems; in order that the public see the systems as offering a benefit the systems must be seen as trustworthy; the use of open methods of control of the systems will play a crucial role in this."

The complete dissertation includes a much fuller discussion of the ethical and legal implications for clinicians, software designers, developers, maintainers, knowledge suppliers, manufacturers and patients of using electronic clinical decision support systems in clinical practice. Extra sections include a discussion of ethical practice in medicine and the philosophical principles underpinning use of DSS in clinical practice.

E:  ethicsalan-j-green.me.uk

   Complete paper (156KB) [OC]    Centre for Professional Ethics, Keele University    Quality, Safety and Ethics in the use of computers to advise on patient care [OC]    OpenClinical Green Paper (2002): Quality, Safety and Ethics in the use of computers to advise on patient care [OC]