Applying ethical guidelines to ubiquitous health care in China

Applying Ethical Guidelines to Ubiquitous Health Care in China I. Jantunen , X. Wang, M. Pekkola, and T. Korhonen Comnet / Aalto University http://www.ubi-serv.org

Ethical assessment (MINAmI) From results of MINAmI project. V. Ikonen, E. Kaasinen, M. Niemelä, and J. Leikas, Ethical Guidelines for Mobile-Centric Ambient Intelligence , 2008. http://www.fp6-minami.org/uploads/media/MINAmI_WP1_D14_EthicalguidelinesforAmI_v12.pdf

China-specific issues in ubiquitous health services TCM = Traditional Chinese Medicine

Elderly in the society: West and East Li Yang: Ost trifft West

Ethical guidelines for the East
Group orientation vs. individualism
Privacy
Benefit to the society
Medical paternalism
Traditional Chinese Medicine (TCM)

Group orientation vs. individualism
Ubiquitous health care and welfare services for the Chinese should include the patient’s family in discussing the patient’s needs.
In general, the family's role as the main authority for medical decision-making in China is strikingly different to the Western approach where the patient's family is involved in the decision-making only with the consent of the patient.

Privacy
Protection of privacy is usually not of top priority for Chinese patients. The information, on the contrary, can be circulated within the close people or relevant health care professionals.
In some extreme cases (terminal illness), the information should typically be known first by people close to the patient, who bear the responsibility of deciding whether to conceal potentially upsetting information from the patient.

Privacy
Protection of privacy is usually not of top priority for Chinese patients. The information, on the contrary, can be circulated within the close people or relevant health care professionals.
In some extreme cases (terminal illness), the information should typically be known first by people close to the patient, who bear the responsibility of deciding whether to conceal potentially upsetting information from the patient.
Information disclosure without authorization from the care-givers to the patient could even result in a court judgment

Ubiquitous health care and welfare services should not be only for the rich.
In China, of the most reported ethical issues are uncontrolled levels of medical fees and refusal to treat patients who could not show evidence of their ability to pay.

Ubiquitous health care and welfare services should not be only for the rich.
In China, of the most reported ethical issues are uncontrolled levels of medical fees and refusal to treat patients who could not show evidence of their ability to pay.
In a health care system based on private health care insurances there is also a risk that ambient intelligence applications restrict the life of the patient , e.g., to the area covered by mobile phone network.

Medical paternalism
An example of medical paternalism is a physician withholding relevant information about a terminal illness of a patient to protect him/her from psychological stress.
Chinese elders tend to prefer the passive role, and enjoy the care and support from their relatives as well as physicians.

Medical paternalism
An example of medical paternalism is a physician withholding relevant information about a terminal illness of a patient to protect him/her from psychological stress.
Chinese elders tend to prefer the passive role, and enjoy the care and support from their relatives as well as physicians.
Due to tremendous gap between supply and demand, some claim that doctor’s time is better spent on deciding and applying treatments than explaining complicated processes and consequences.

Traditional Chinese Medicine vs. Western Medicine
Traditional Chinese Medicine
inductive and synthetic
individualized
experience-based
summary of clinical observations
emphasizes the role of the body in healing
herbs and natural agents
behavior of the system as a whole
works to maintain health
Western Medicine
reductive and analytical
standardized
evidence-based
result of laboratory experimentations
mainly relies on medication and procedures
pure chemical compounds
structure and function of the parts
manages disease

Unidirectional computer interfaces
Chinese characters are basically ideograms
Chinese character input not based in characters assigned to keys on keyboards
Most used input system for computers, Pinyin, is based on phonetics of Mandarin Chinese
Very many elderly people are uneducated on Pinyin and their native Chinese dialect has little resemblance to the phonetics of Mandarin
E-inclusion issues, push for medical paternalism

Conclusions 1
Ubiquitous health care and welfare services must take into account the culture on the target market.
Political and economical differences, infrastructure
Ethical issues may differ between different cultures
China compared to Europe: the main differences on ethical issues were identified to relate to autonomy and privacy of the user.
In a collectivist culture the privacy and autonomy of an individual is not regarded as important as in the West.
Solid connection between the elderly and in-group members

Conclusions 2
Benefits of new technology to the society must be taken into account.
The income level of the Chinese is still lower than in the West and the income differences are high within China.
AmI technologies for health care & welfare offer a promise of cheaper services , but the cost may still be too high for the poor majority.
Younger family members often play a significant role in the adoption of ICT by the elderly people.

Recommendations
AmI-based home healthcare and assisted living services or applications in China be marketed first and foremost to the younger generations
Any AmI applications, offering seamless connections between the elderly and their families should be treated as important as providing functionalities which assist the elders’ daily life.
AmI applications for Chinese elderly could adopt medical paternalism, leaving only a few control-related options to user oneself.

Acknowledgements
MIMOSA & MINAmI project partners, especially Eija Kaasinen , Head of MIMOSA&MINAmI WP1
UBI-SERV project partners in Finland and China
Aalto University, Peking University, Fudan University
Li Yang for Ost trifft West

Applying ethical guidelines to ubiquitous health care in China

by Iiro Jantunen on Apr 22, 2010

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Applying ethical guidelines to ubiquitous health care in China — Presentation Transcript