Organization: Emory University - Atlanta, Georgia, USA
Newsgroups: bit.listserv.ethics-l
Date:         Wed, 29 Jul 1992 10:43:29 EDT
From:         Bert Bruner <OSAKB@EMUVM1.BITNET>
Subject:      Re: Ethics of Computer Use in Medicine

On Tue, 28 Jul 1992 23:29:00 EDT JOE TRANCE said:
>                                                                    If
>the  computer program  results  in a  "dismal"  prognosis, should  the
>doctor share  these results with  the patient based on  the computer's
>analysis alone?  Should he/she  not say anything?  Is it  the doctor's
>responsibility to  balance the  results of  this program  with "human"
>factors; such  as, the  ability of  the patient  to follow  a remedial
>course of action, and their "will" to live?

Why should  the doctor behave  any differently  when he uses  a computer
than when he relies only on his  own knowledge? There is a great deal of
variance in the way that doctors handle  these issue now. In fact, it is
this wide variance that leads to improvement.

I, personally, am  very uncomfortable unless the  doctor discusses every
detail of a procedure  or diagnosis with me, but my  wife prefers not to
know all  of the details.  We try to keep  this difference in  mind when
choosing doctors.  Sometimes, the doctor understands  this difference in
attitude and adjusts his style accordingly.

I am very concerned that the use of diagnostic computers will make these
kinds of decisions for the doctor  and, as a result, the "discretion" of
the doctor will decline. That, I  believe, will, very rapidly, lead to a
decline in the overall quality of medical practice.

Already, the "standardizing" influence of the AMA and the government has
lead many insurance companies to refuse to pay for treatments which have
obvious  and  significant benefits  for  certain  patients. If  not  for
doctors who  are willing  to think for  themselves, treatments  for such
ailments  as TMJ  (disfunction  of the  jaw joint  which  leads to  very
painful headaches and muscle problems) would not exist.

For this reason, I am concerned  that diagnostic computers will have the
effect of forcing standardization that may not be good.

>
>The second  question involves programs  that are designed  to diagnose
>and suggest treatments by answering a  series of questions. There is a
>commercial  program through  the phone  service which  does this.  The
>person calls  the service  and answers a  series of  questions through
>pushing certain  buttons on  their touch-tone  phone to  represent the
>desired response. When  the questioning is complete  the machine tells
>you what your ailment is "MOST LIKELY" to be. The machine then goes on
>to describe the  appropriate remedy. At the end it  states that if the
>condition  persists please  consult your  physician. Can  this program
>really evaluate  someone condition based upon  that persons evaluation
>of the symptoms? Doesn't the  complexity of our english language leave
>a wide area for misunderstanding terms? Such as "a severe rash"...that
>will mean one thing to the patient and it could mean something else to
>the computer.  Aren't these programs  leaving to much to  chance? Like
>what your family  history of illness has been,  the numerous allergies
>that could apply,  and sometimes as simple as what  was the last thing
>you ate. I am concern about  the value of these commercial programs to
>the patient.

To me, this issue is really one of how much responsibility should one be
allowed to  take with regard  to one's own  health. Such systems  can be
abused,  but they  can also  provide great  benefit for  someone who  is
willing to take the time and effort to be personally involved in his own
diagnosis and treatment. Being involved  means knowing enough about your
body to know  when the information provided by the  machine is likely to
be accurate  and when the  suggested treatment has  inappropriate risks.
Most of this knowledge is what I would term "common sense".

Your question  sounds as  though you may  be considering  proposing that
these machines be banned by government. I submit that such action is not
an appropriate  function of  government and that  even though  risks are
present, society is  ill served by not allowing such  choices to be made
by individuals.

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:: Bert Bruner                     BITNET: OSAKB@EMUVM1                ::
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