Professor Eike-Henner Kluge 2003
A personal review by Rod Ward - 15.7.03
This is a useful book for anyone interested in health informatics, as it sets out many of the principles and problems of this rapidly expanding field, putting them into an ethical context.
Those working in this area need to discuss the issues raised and make absolutely clear the functions of health informatics and the roles and responsibilities of various staff. The book will contribute to this debate which is focusing in the UK on the formation of the UK Council for Health Informatics Professions (UKCHIP).
The different position of IT in healthcare from other IT sectors, and the potential risks to individuals and society, makes the publication of this book necessary. As the book is published by the British Computer Society, through its health informatics committee, I suspect that other sectors in corporate IT may eventually follow the lead of health informatics towards a more professional status.
I am sure that the exact terminology used in the rules will change over time however many of the principles expressed are timeless. The ideas are generally clearly stated and argued, however I found the use of HIP, as an abbreviation for "Health Informatics Professional" a little off putting. I'm not sure that health informatics has reached professional status, although this book may provide a step along the way.
The book is divided into 3 major sections; an introduction, the rules of ethical conduct for HIPs and some explanation.
The first section sets out very brief descriptions of fundamental ethical principles and then goes on to general principles of information ethics. My very limited formal training in ethics was a few lectures many years ago, however I do feel reasonably aware of the issues around patient rights, security and confidentiality etc. With this background I was interested to note a "fundamental ethical principle" which I'd not encountered before - The Principle of Impossibility - "All rights and duties hold subject to the condition that it is possible to meet them under the circumstances that obtain." I have some worries that this will be used as a "cop out" for failed IT projects in the future.
The second section, rules of ethical conduct for HIPs, puts forward a list of duties towards the subject area, towards health care professionals and towards institutions/employers. These lay down what "should be done" however many of them require further exploration and explanation, which is undertaken in the third section of the book. This section explores what it means to be a professional, the fiduciary (trust) relationships with patients and some of the implications, before detailing the rationale for some of the specific duties set out in the previous section. I felt that further examples related to day to day practice and decision making in health informatics would be helpful.
Clinical staff, whose professions are already covered by codes of ethics (such as doctors and nurses), will find much that is familiar, particularly those examples which relate to patient safety, however the application of these to the information environment will help them to think through many of the issues. Any potential conflicts between codes, e.g. a nurse registered with the Nursing & Midwifery Council and working in health informatics, need to be further explored.
The book is generally easy to read and has a clear structure. The glossary could be useful to readers with little previous knowledge of ethics, but does not cover all of the potentially unclear terms in the book. A fairly comprehensive contents page goes some way to making up for the absence of an index.
This book will appeal to an international audience, and has been endorsed by the International Medical Information Association (IMIA), as this principles set out will apply to anyone working in the field. However, as the forward points out, the prime audience will be in the UK as current key policy initiatives in the NHS affect every one who works in healthcare and health informatics struggles towards the status of a profession.
Title: A handbook of Ethics for Health Information Professionals
Author: Eike-Henner Kluge
Publishers: British Computer Society, Health informatics Committee
No of pages: 73
Price: £not known
The full text of this publication is available at: http://www.health-informatics.org/hic/ethicsbk/index.htm
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Page Created: 15.7.2003
Last Updated: 30.10.2005