Race and ethics in the design of biomedical technologies: the pulse oximeter as a case in point (The Daniel W. Foster, M.D., Visiting Lectureship in Medical Ethics)
There were clear indications from studies done in 2005 and 2007 that pulse oximeters overestimate arterial oxygen saturation during hypoxia in dark-skinned individuals. And yet, years later, the device remains essentially unaltered. This disregard has been particularly significant during the coronavirus pandemic. Patients diagnosed with COVID-19 who present with silent hypoxemia, but are not sick enough to warrant hospital admission, have been guided to monitor their arterial oxygenation by pulse oximetry at home, and present for care when they show evidence of hypoxemia. Others in the general public have used the device simply for personal assurance. Whether or not these uses are appropriate is debatable. Nevertheless, that a racial bias is embedded in this technology is indisputable. The pulse oximeter serves as a timely case in point of how race can become a matter of ethics in the design of biomedical devices.