Prospects for Thought Communication

In this chapter, we take a look at the realistic future possibility of thought communication— brain to machine and brain to brain. Technical details are presented on experimentation carried out thus far using implant technology and the route ahead involving brain-computer interfaces is described. Some of the social issues raised by such a novel technological development are also developed. Of importance is the fact that, once a new technology is globally accepted, its use tends to be considered as the normal way of being, which may lead to the creation of new disabilities for people unable to use the technology. The two authors agree about the analysis, but, as a result of their two completely different backgrounds, they disagree about how much benefit thought communication can bring to human beings.

Biometrics, Human Body, and Medicine

Identity is important when it is weak. This apparent paradox is the core of the current debate on identity. Traditionally, verification of identity has been based upon authentication of attributed and biographical characteristics. After small scale societies and large scale, industrial societies, globalisation represents the third period of personal identification. The human body lies at the heart of all strategies for identity management. The tension between human body and personal identity is critical in the health care sector. The health care sector is second only to the financial sector in term of the number of biometric users. Many hospitals and healthcare organisations are in progress to deploy biometric security architecture. Secure identification is critical in the health care system, both to control logic access to centralized archives of digitized patients’ data, and to limit physical access to buildings and hospital wards, and to authenticate medical and social support personnel. There is also an increasing need to identify patients with a high degree of certainty. Finally, there is the risk that biometric authentication devices can significantly reveal any health information. All these issues require a careful ethical and political scrutiny.

Compiling Medical Data into National Medical Databases

In recent years, various national medical databases have been set up in the EU from disparate local databases and file systems. Medical records contain personal data and are as such protected by EU and member states’ legislation. Medical data, in addition to being personal data, is also defined in the EU legislation as being especially sensitive and warrants special measures to protect it. It therefore follows that various legal issues and concerns arise in connection with these processes. Such issues relate to the merits of compiling a nationwide database, deciding on who has access to such a database, legitimate uses of medical data held, protection of medical data, and subject access rights amongst others. This chapter examines some of these issues and argues that such databases are inevitable due to technological change; however there are major legal and information security caveats that have to be addressed. Many of these caveats have not yet been resolved satisfactorily, hence making medical databases that already exist problematic.

Clinical Safety and Quality Management in Health IT

This chapter describes the principle risks that are associated with the supply of healthcare information systems, services, and technologies and the emerging best clinical safety and quality management practices that are being adopted by both users and suppliers in order to mitigate or remove these risks. It states that there are two principle sources of risk: one derived from the potential harm that could be caused to patients and users in a care environment and the other derived from possible failures to achieve the specifications and service levels demanded by a buyer. It argues that for a health IT supplier, implementing industry best practices in an effective way not only provides a high level of protection from both sources of risk but has in any event now become a minimum expectation on the part of users such as the NHS Connecting for Health programme. The chapter concludes that although quality, safety and performance standards in health IT still lag behind other, more established sectors of healthcare innovation—such as pharmaceuticals and medical devices—new standards for clinical safety and quality management are rapidly emerging, introducing a new dimension into informatics standardisation and substantially but necessarily raising the barriers to entry into the health IT market place.

Responsibility in Electronic Health

In this chapter, we look into the potential problems arising from the use of information and communication technology (ICT) artifacts in electronic health. We focus on issues such as liabilities and responsibilities and discuss these issues on the basis of patient-physician relationship, negligence, agentization, and anthropomorphism. We conclude the chapter with recommendations originating from different fields of industry. These recommendations are applied to the field of electronic health in order to make users more aware of the nature and use of ICT artifacts in various health care situations.

Applied Ethics and ICT-Systems in Healthcare

What are the ethical implications of information and communication technology in healthcare and how can new ICT-systems fit in an ethically based healthcare system? In this chapter, new ICT-applications in healthcare are assessed from an ethical perspective. The first application assessed is a system making patient information accessible for all healthcare units at a district, county or even national level. The second application, the so-called patient portal, is a system for patient Internet access to his or her medical record. The third application is the use of the Internet as a source of medical information, a means for medical consultation and for marketing of drugs. The systems are primarily assessed by the following ethical principles; the principle of doctor-patient relationship, the principle of responsibility and the principle of autonomy.

Trust and Clinical Information Systems

Our study of the use of clinical decision support systems by general practitioners in New Zealand reveals the pervasive nature of the issue of trust. “Trust” was a term that spontaneously arose in interviews with end users, technical support personnel, and system suppliers. Technical definitions of reliability are discussed in our chapter, but the very human dimension of trust seems at least as significant, and we examine what is bound up in this concept. The various parties adopted different means of handling the trust question, and we explain these. Some paradoxical aspects emerge in the context of modern information systems, both with the question of trust and with the provision of technical or organisational solutions in response to the existence of trust. We conclude by considering what lessons may be drawn, both in terms of the nature of trust and what this might mean in the context of information systems.

Are Agency and Responsibility Still Solely Ascribable to Humans? The Case of Medical Decision Support Systems

Are agency and responsibility solely ascribable to humans? This chapter explores the question from legal and ethical perspectives. In addition to presenting important theories, the chapter uses arguments, counterarguments, and scenarios to clarify both the actual and the hypothetical ethical and legal situations governing a very particular type of advanced computer system: medical decision support systems (MDSS) that feature AI in their system design. The author argues that today’s MDSS must be categorized by more than just type and function even to begin ascribing some level of moral or legal responsibility. As the scenarios demonstrate, various U.S. and UK legal doctrines appear to allow for the possibility of assigning specific types of agency—and thus specific types of legal responsibility—to some types of MDSS. The author concludes that strong arguments for assigning moral agency and responsibility are still lacking, however.

Online Medical Consultations

The growth of the Internet over the last 10 years as a medium of information and as a communication technology has provided the opportunity for selling medical products and services online directly to the public. This chapter investigates online medical consultations used for the purpose of prescribing and hence selling prescription drugs via the Internet. With consumers in mind, this chapter takes a critical look at this growing phenomenon from three perspectives—legal, ethical, and social—as a basis for discussion and to illustrate the problems raised by using the Internet in this way. The chapter concludes that online medical consultations pose greater dangers to patients compared to traditional off-line consultations. The chapter also concludes that while new technologies may aid doctors in making better diagnoses at a distance, they often bring new concerns. Finally, the chapter gives suggestions on safeguarding online consumers.

Compliance and Creativity in Grid Computing

Grid computing is a new technology enhancing services already offered by the Internet offering rapid computation, large-scale data storage, and flexible collaboration by harnessing together the power of a large number of commodity computers or clusters of basic machines. The grid has been used in a number of ambitious medical and healthcare applications. While these have been restricted to the research domain, there is a great deal of interest in real applications. There is some tension between the spirit of the grid paradigm and the requirements of healthcare applications. The grid maximises its flexibility and minimises its overheads by requesting computations to be carried out at the most appropriate node in the network; it stores data at the most convenient node according to performance criteria. A healthcare organization is required to maintain control of its patient data and be accountable for its use at all times. Despite this apparent conflict, certain characteristics of grids help to resolve the problem: “grid services” may provide a solution by negotiating ethical, legal, and regulatory compliance according to agreed policy.