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Ethics in HTM: Part I

Updated: Mar 25

Co-teaching Ethics in Healthcare Technology Management (HTM) with Dr. Richard Gonzales at the College of Biomedical Equipment Technology (CBET) has been a consistently rewarding and illuminating experience, not least in sharing in the recurrent participant consensus that: “Ethics are neither peripheral to core technical training nor a soft skill but are, rather, a hard skill and critical component of the HTM professional toolkit.”


That conclusion is in quotation marks but is really just a summary of the concurrence of course participants over the last year, and one that has been established throughout each iteration of the course, with participants ranging from high school graduates preparing to enter the field to seasoned HTM professionals as they engage with the materials and discussions. 


Using a dialectical approach, we are as consistently guided as much as our students towards assessing, questioning, and re-evaluating or validating instinctive responses (or perceived wisdom) in the consideration of case studies, as well a broad range of contemporary industry issues.  The former includes anonymized but actual case studies shared by industry partners, while the latter includes industry-wide issues, including the roles of organizational culture and leadership, the impact of sentinel events and megatrends in the field, and changing specializations, as well as the merits or otherwise of establishing a Code of Ethics specific to the industry. 


I would not be surprised if many who are reading this have thought through some or even all of the concepts to be discussed in this blog but would be disappointed if anyone thinks that the consideration and daily application of ethics in HTM is not a conversation worth having. 


Jim Doran delivering a presentation on the importance of ethics in Healthcare Technology Management.

What are Ethics?


To begin at the beginning, what are ethics?  We ask that question as a key Week 1 assignment, before any substantive attendant reading or case studies have been shared or worked through.  From the outset, it is a conversation with no wrong answers, only solutions and tools to be discovered. 


My old best friend, the Shorter Oxford English Dictionary, includes, among its many definitions, “the moral principles by which any particular person is guided” and “the rules of conduct recognized in a particular profession or area of human life,” both of which are pertinent to the course of study.  My new best friend, ChatGPT, is wordier, but does not stray too far from this dual definition.  Not all initial responses during course participation are quite as definitive, but they are all the more interesting for that as students apply their own principles and understanding of those that should be brought to the HTM field. 


A common response is to list a sound set of moral principles (say, “honesty, integrity, trustworthiness, industry, empathy, kindness, duty,” and so on) with the conclusion that “these are my ethics.”  Another common response might be something along the lines of the Golden Rule (“Do unto others as you would have them do unto you,” or, in its more prohibitive form, “Do not do unto others as you would not have them do unto you”).  All of which lead to an engaging, valuable, and collaborative conversation as we turn our attention towards case studies and other circumstances where such values have been challenged. 


There will also be a response or two that invite immediate further discussion, such as: “My ethics are integrity, duty, trustworthiness, and kindness, … but these can vary, depending on the circumstances,” or, “What may be perceived as the right (or preferable) thing to do by one person might be perceived as the wrong (or less preferable) thing to do by another.”  These are early prompts for the class to consider that professional ethics might be something more than the sum of the moral principles themselves, that an individual’s principles are not always rigid or frozen in their order of importance, and that a common ethical framework might be required for consistent professional application in the HTM field.


An Ethical Framework


Such an “ethical framework” can be characterized as fundamental components of ethical decision making.  The indefinite rather than the definite article for such a framework is preferred, because ethics can be a complex business and there are, no doubt, similar frameworks or rules of thumb, albeit without too many dissimilarities, that can be brought to the application of ethics in the HTM field, as in others, to assess and quickly take action to resolve ethical dilemmas or plan to avoid them. 


The framework we have discussed in teaching Ethics in HTM at CBET (although we always welcome other considered approaches) includes: a consideration of the principles or values involved; the information or the establishment of facts and circumstances required to make fully informed decisions; the stakeholders involved; and the potential consequences for those stakeholders in the short and longer term.  Such a framework invites a quick but thorough assessment of ethical issues to act, as necessary, based on an ethical analysis rather than instinct or how we personally feel about a situation where the organization’s Code of Conduct is silent.


A Sample Case Study


It would be a dull course that simply stated the case for or lectured upon the value of an ethical framework.  Therefore, we endeavor to establish an understanding of the importance of an ethical framework by means of collaborative case study analyses and consideration of ethical dilemmas.  An example would be the following, heavily anonymized but nevertheless true and recent sample case:


Apprentice BMET Luigi is shadowing the Senior BMET Mario who, for the last three years, has performed all of the PMs on the hospital’s contrast injectors used during CT-Scans.


During Mario’s absence, Luigi asks his manager if he can practice the PM.


Once he sets up the laptop, connects the cables, and launches the calibration software, an error pops up on the screen, saying “Software License Expired. Please contact your local sales representative.”


The sales representative is surprised when Luigi calls and mentions that he had been wondering who was performing the injector PMs since the license had been expired for quite some time. 


Every time a PM was performed, the sales representative explained, the software would not issue a passing result until it pinged their server with the serial number of the injector.  And the last serial number was recorded over five years ago.


Uncovering an Ethical Framework


What might seem a straightforward case of negligence, ignorance, or malfeasance on the part of Mario can quickly become one small component of what might be, in fact, a decidedly more complex ethical scenario if you bring the right questions to case.  Here are a few, some that we suggest to begin the discussion, others exemplars of the rigor our students quickly bring to the issue:


Why is this a big deal? What would you do if you were Luigi? What would you do if you were the manager and Luigi reported this to you? What is the difference between observing an action and hearing about it? How do you imagine it is possible that this has been going on for so long?  Why do you think the manager has not been aware of this?  What would you think and do if you were a new supervisor, and this issue was brought to you? How would you feel if you had been in your position for a while? What does it say about organizational integrity? Is it significant that Mario has been doing this for three years but that the problem has existed for over five years?  Who could be adversely affected by this issue? What other consequences could result?


The situation is far from simple and does indeed rapidly raise issues beyond Mario’s failure, for whatever reasons your inquiry may suggest, to properly perform critical preventative maintenance.  It’s worth noting that Luigi is a new technician who may not have the best grasp of the conclusions he’s jumping to, that we do not know anything of the manager’s tenure, the type of training and problematic procedure Mario inherited of a practice that has been going on two years longer than that, and so many other facts that could be pertinent this scenario.  And this paragraph could go on for three or four pages and we would likely still not tease out the questions that need to be addressed in an ethical consideration of this abbreviated case study. 


Nevertheless, in this field, we always have clear sight of the stakeholders, and, once the facts are established, the potential consequences for those stakeholders. And, with a pertinent ethical framework in place, an appropriate analysis can be completed with appropriate speed and rigor. 


An Ethical Framework


One key takeaway of the analysis, then, is not merely the common complexity of ethical dilemmas but also the rapid establishment of a framework to address ethical issues.  As the questions are asked and assessed, we are assessing the principles (who you are as an HTM professional and an organization?), the information (the who, what, when, where, and why needed to establish the underlying facts), the stakeholders involved (the technicians, manager, the organization, the hospitals involved, but also the quick realization that the patient is the ultimate stakeholder), as well as the consequences (now and in the longer term) of resolving the issue or sweeping it under the carpet. 


Instinctive responses and binary choices are rarely a sound currency for ethical analysis, but decision-making in the HTM field does not always have the luxury of extended consideration, given that life, health, and safety are at a premium.  A sound ethical framework can assist in rapidly surveying the ethical landscape in a manner that is both comprehensive and commensurate with the ethical integrity that HTM operations require.  

 

 


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