Preamble
This project, a pilot study sponsored by the World Health Organization, addresses ethical issues that arise when computer programs, specifically decision support and prognostic scoring systems, are used for triage, allocation, and rationing of limited resources during COVID-19 and other public health emergencies. It is apparently one of the first, if not the first, of its kind to identify ethical issues and related best practices in the use of computers in public health emergencies. Its successful completion is hoped to support international and global capacity building to identify and guide appropriate uses and users of these technologies.
Background and Context
Public health informatics is the use of computers and other information and communication technologies to assess, study, and attempt to improve the health of populations. The growth of this technology has entailed that many traditional tasks in epidemiology and public health are now impossible without it. Surveillance is perhaps the best-known example of the use of information technology in epidemiology and public health.
Less-well analyzed and hence not clearly understood is the use of specific kinds of computer programs to make diagnoses and prognoses for various purposes during the COVID-19 pandemic. There are two tranches of such kind of decision support: seeking patterns across a population, for instance, (i) how many patients will die, given antecedent conditions; and (ii) will this patient die? Answering these questions accurately is important in cases in which there are or are expected to be inadequate resources to treat all patients either aggressively or appropriately.
Computer programs that render diagnoses and prognoses are among the functions of decision-support systems. In COVID-19, these programs were used to inform and guide resource allocation, including decisions about rationing and triage. This proposal is for a project to identify and analyze the use of such decision-support systems in a pandemic. Ethical issues associated with these tools and uses are in most respects independent of, and agnostic regarding, the kind of software in use. That is, similar ethical issues are raised by (i) basic statistical inferences, (ii) patterns found in simple relational databases, (iii) artificial intelligence algorithms.
This project includes an international survey of clinicians, and experts in information technology, ethics, and other fields, and an on-line repository of sources at the intersection of health information technology and ethics.
Methods
We crafted a 17-question Qualtrics survey with questions about respondent demographics and their views and familiarity about various aspects of prognostic scoring system use. We compiled an international list of 124 scholars and academics, clinicians, government employees, non-governmental organization employees, and others known or believed to have an interest in ethics and biomedical informatics to receive the survey. We tried to ensure geographic diversity, but available sources are from developed countries. Prospective respondents were emailed an invitation to complete the survey on December 28, 2020, with a subsequent reminder on January 6, 2021.
Only survey responses were recorded; that is, no identifying information about any respondent was collected.
