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Biomedical subjects

Eike-Henner W Kluge

Publications and source records attributed to Eike-Henner W Kluge.

16 recordsLinked to original sources
PubMed2006

Secure e-Health: managing risks to patient health data.

e-Health, as an inter-jurisdictional enterprise, presents risks to patient health data that involve not only technology and professional protocols but also laws, regulations and professional security cultures. The USA Patriot Act is one example of how national laws can shape these concerns. Secure e-Health therefore requires not only national standardization of professional education and protocols but also global interoperability of regulations and laws. Some progress in this regard has been made in the European context; however, even here developments are incomplete, and nothing similar has been accomplished on a global scale. Professional health information organizations must take the lead in developing appropriate high-level principles for professional certification and security protocols and in harmonizing these on a global basis, so that they can provide a firm and consistent foundation for international treaties. Such developments should occur in concert with other health professions, so that coordinated requirements are integrated into revisions of the relevant codes of ethics. This presentation identifies and addresses some of the ethical and legal issues and proposes a series of recommendations.

Computer Security↗
PubMed2005

Competence, capacity, and informed consent: beyond the cognitive-competence model.

Only competent persons can give informed consent to health care. Current approaches define competence in essentially cognitive terms, thereby ignoring the fact that someone may be cognitively competent yet lack the capacity to give a valid consent. I outline a more robust theory of competence that includes not only cognitive but also emotional and valuational parameters. I then distinguish competence from capacity, and indicate the role this distinction can usefully play in the extended and continuing care setting. I also show how this distinction is consistent with several recent Canadian legal decisions, and outline its usefulness in interpreting and applying relevant provincial statutes.

Comprehension↗
PubMed2004

Informed consent and the security of the electronic health record (EHR): some policy considerations.

Various codes of ethics, and in particular the IMIA Code of Ethics for Health Information Professionals (HIPs), stipulate that the subject of an electronic health record (EHR) has a series of security rights with respect to her/his EHR, and that to some degree these rights center in the notion of informed consent. This paper examines the ethical basis of this position, outlines its implications for professionals, institutions and society in general, and identifies its limits. Further issues that will be discussed include who carries the responsibility for informed consent, what nature it should take, whether web-based EHRs present ethically unique problems, and related security implications.

Computer Security↗
PubMed2004

Informed consent to the secondary use of EHRs: informatic rights and their limitations.

It is frequently asserted that the secondary use of data contained in electronic health records (EHRs) requires the informed consent of the subjects of these records. This paper argues that while correct in principle, this has four important ethically based limitations: when it seriously threatens the equal and competing right of others, when it undermines the ability of health care providers to carry out their mandates, when it imperils the possibility of establishing and maintaining a health care system in the first place, and when it makes bona fide research impossible. Nevertheless, as a general rule, when consent can be had, it should be had. This paper provides a theoretical basis for these claims by looking at the nature and role of EHRs and provides some possible approaches for incorporating them into the health care delivery process.

Confidentiality↗
PubMed2003

Patenting human genes: when economic interests trump logic and ethics.

To date, over 5,000 applications have been filed with United States Patent Office for patents on human genes. More than 1,500 of these applications have been granted. Other jurisdictions are experiencing a similar rush to mine and protect genomic gold. This paper argues that although many jurisdictions allow the patenting of human genes, this is ethically indefensible and amounts to an unjustified appropriation of a general human heritage. Economic and legal arguments in favour of patenting are considered and rejected. Reference is made to the Wellcome Trust Consortium's initiative and the Merck Gene Index Project, which place patented genetic information into the public domain.

Biotechnology↗
PubMed2003

Security and privacy of EHR systems--ethical, social and legal requirements.

This paper addresses social, ethical and legal concerns about security and privacy that arise in the development of international interoperable health information systems. The paper deals with these concerns under four rubrics: the ethical status of electronic health records, the social and legal embedding of interoperable health information systems, the overall information-requirements healthcare as such, and the role of health information professionals as facilitators. It argues that the concerns that arise can be met if the development of interoperability protocols is guided by the seven basic principles of information ethics that have been enunciated in the IMIA Code of Ethics for Health Information Professionals and that are central to the ethical treatment of electronic health records.

Computer Security↗
PubMed2002

Health care resource allocation: complicating ethical factors at the macro-allocation level.

It is generally assumed that allocation problems in a socialized health care system result from limited resources and too much demand. Attempts at solutions have therefore centered in increasing efficiency, using evidence-based decision-making and on developing ways of balancing competing demands within the existing resource limitation. This article suggests that some of the difficulties in macro-allocation decision-making may result from the use of conflicting ethical perspectives by decision-makers. It presents evidence from a preliminary Canadian study to this effect.

Canada↗
PubMed2002

Ethical issues in geriatric medicine: a unique problematic?

It is commonly believed that geriatric medicine generates a distinctive set of ethical problems. Implicated are such issues as resource allocation, competence and consent, advance directives, medical futility and deliberate death. It is also argued that it would be unjust to allow the elderly to compete with younger populations for expensive and scarce healthcare resources because the elderly "have already lived," and that treating them the same as these other populations would diminish the available resources unfairly, prolong a life of inevitably failing health and result in increased health care expenditures. In fact, however, this perception of ethical uniqueness is mistaken. Differences in medical conditions, demographics and aetiology should not be allowed to obscure the fact that ethical issues in geriatric medicine are essentially the same as those faced in any other area of health care, and that the solutions that are adopted in the geriatric context must be consistent with the ethical principles that are followed elsewhere. The paper argues that the root of the mistaken perception lies in the abandonment of the Hippocratic mandate of medicine and in an unreflective adherence to the belief that medical advances are inevitably beneficial. It is suggested that a return to patient-centred medicine and the use of ethics impact analyses before introducing medical advances may be ethically appropriate.

Aged↗
PubMed2000

Elective, non-therapeutic ventilation: a reply to Browne et al., "The ethics of elective (non-therapeutic) ventilation.

Browne, Gillett and Tweeddale propose that the use of non-therapeutic elective ventilation (EV) to secure transplantable organs is ethically indefensible. Their argument centres around several propositions: that explicit patient consent for EV is essential, but since it is not included in the consent process for donation from the patient, using it constitutes assault; that inferring consent for EV from the consent to donate itself is ethically and logically indefensible; and that explicit consent from next-of-kin should neither be sought nor honoured in view of the stress EV may cause to staff and families. This article examines their reasoning and suggests that it is fatally flawed. It argues further that in most cases of donation, not using EV may itself be unethical.

Disclosure↗