Browsing by Subject "Disclosure"
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Item Addressing privacy challenges in healthcare through the lens of contextual integrity(2023-02-14) Nissenbaum, Helen[Note: The slide presentation is not available from this event.] In healthcare, as in other social spheres, digital technology has posed dire challenges to entrenched approaches to privacy. Yet, as a fundamental cornerstone of ethical healthcare, privacy cannot be allowed to erode. The theory of contextual integrity (CI), which defines privacy as appropriate flow of personal information answers the need for a meaningful concept of privacy that, simultaneously explains its value to individuals and to societies. CI requires that we bend away from one-dimensional ideas, which for decades have gripped the privacy domain, namely, control over information about ourselves, stoppage of flow, or fetishization of specific, "sensitive" attributes (e.g., identity, health). This lecture will review key ideas behind CI, contrast it with alternative accounts, and apply these ideas to the domain of intensive health care and health research domains, distinctive not only for their societal importance but for their ages-long attentiveness to privacy.Item The disclosure dilemma: when adverse events affect multiple patients(2015-01-13) Dudzinski, Denise M.Imagine that endoscopes had not been properly processed for a period of several months. Once discovered, the problem is immediately corrected, but patients scoped during those months are more likely to even though the majority are unlikely to have been harmed? This presentation will explore the ethical and practical dimensions of this question by examining several cases.Item Ethical implications of public disclosure of Medicare payments to individual physicians(2015-03-10) Steinbrook, RobertIn the spring of 2014, the Centers for Medicare & Medicaid Services, in response to a court decision and the requirements of the Freedom of Information Act, began to publicly disclose the amounts and reasons for Medicare payments to individual physicians. The disclosures have attracted broad interest in the news media and shone a bright light on patterns of physician billing and utilization that were previously hidden from public view. The disclosures, however, have also raised questions about what the data means, how useful they will be to patients, and how the data can best be used to improve the quality and values of medical care. This grand rounds will discuss salient examples from the first year of the new policy that highlight the ethical implications of the public disclosure of physician payment data.Item Institutional corruption & off-label drug use(2015-04-14) Rodwin, Marc A.Although sometimes reasonable, off-label drug use typically is unsupported by substantial evidence of effectiveness and safety. At the root of inappropriate off-label drug use lies institutional corruption of pharmaceutical practice. Institutional corruption involves perverse incentives for pharmaceutical firms, the lack of evaluation of off-label prescribing and conflicts of interest in the design, oversight, and reporting of clinical trials. Typical reform proposals such as increased sanctions for manufacturers, education for physicians, registration of clinical trials, and disclosure of conflicts of interest do not remove the source of the problem. The speaker explores alternative reform options. These include: 1) tracking off-label prescriptions to monitor the risks and benefits of off-label uses and the manufacturers' conduct; 2) changing pharmaceutical firm reimbursement to remove incentives to encourage off-label prescribing; and 3) independent clinical trials to evaluate drugs.Item Talking with patients and families about medical error(2016-04-12) Truog, Robert D.Until fairly recently, clinicians were routinely told never to admit to a medical error. But patients and society have come to expect and demand more openness and transparency around adverse events and errors, and the medical profession is slowly changing its approach. Not only is an honest approach "the right thing to do," but it has other benefits as well. First, only by acknowledging and analyzing our errors can we take steps to make sure they don't happen again. Second, clinicians often suffer from the silence that surrounds medical errors, and opportunities to disclose and apologize have turned out to be enormously healing for many clinicians. Third, we have learned that empathic disclosure of errors may actually decrease the risk of malpractice litigation, making it possible for patients to be justly compensated for errors without the need to embark upon the costly process of litigation.