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 doctorís and the patientís 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 patientís best interest there will be an increase in
"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
"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
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.
|Alan J Green, Keele University
Entry on OpenClinical: 10 March 2006|
Last main update: 15 March 2006