The Alice Books, full of illogical thoughts, words, and contradictions, were unrivaled entertainment until the publication of the medical literature promoting electronic fetal monitoring for every pregnancy. The modern-day EFM advocates acknowledge EFM’s decades long failure but simultaneously recommend EFM use for lawsuit protection and because the profession has used EFM for every pregnancy for fifty years, therefore, it must be efficacious. These self-indulgent, illogical rationalizations ignore the half century of evidence-based scientific research proving that EFM is (...) a complete failure as well as ignoring the fact that continued EFM use violates the fundamental principles of modern bioethics. This blind advocacy perpetuates four pernicious EFM harms occurring to mothers, babies, and the medical profession itself. This article sets out these four EFM harms with the goal of abolishing the misguided, illogical, contradictory, arguments used by the twenty-first century EFM Lewis Carroll mimics. (shrink)

A half century ago electronic fetal monitoring was rushed into clinical use with the promise that the secrets of fetal heart rate decelerations had been discovered and that the newly discovered knowledge would prevent cerebral palsy with just in time cesarean sections preventing babies from experiencing asphyxia, which was thought to be the primary cause of cerebral palsy. In the years since electronic fetal monitoring’s debut, it has been discovered that asphyxia is a (...) rare cause of cerebral palsy. At the same time electronic fetal monitoring use increased to 85% of all labors, the C-section rate increased to 33% without an attributable decrease in the rate of cerebral palsy. What went wrong with electronic fetal monitoring? The answer lies in a new analysis of the physiologic theories concerning fetal heart rate decelerations, demonstrating that the earlier electronic fetal monitoring theories were wrong. This revelation is only the latest evidence that electronic fetal monitoring use today... (shrink)

In recent years there has been an explosion of interest in Artificial Intelligence (AI) both in health care and academic philosophy. This has been due mainly to the rise of effective machine learning and deep learning algorithms, together with increases in data collection and processing power, which have made rapid progress in many areas. However, use of this technology has brought with it philosophical issues and practical problems, in particular, epistemic and ethical. In this paper the authors, with backgrounds in (...) philosophy, maternity care practice and clinical research, draw upon and extend a recent framework for shared decision-making (SDM) that identified a duty of care to the client's knowledge as a necessary condition for SDM. This duty entails the responsibility to acknowledge and overcome epistemic defeaters. This framework is applied to the use of AI in maternity care, in particular, the use of machine learning and deep learning technology to attempt to enhance electronic fetal monitoring (EFM). In doing so, various sub-kinds of epistemic defeater, namely, transparent, opaque, underdetermined, and inherited defeaters are taxonomized and discussed. The authors argue that, although effective current or future AI-enhanced EFM may impose an epistemic obligation on the part of clinicians to rely on such systems' predictions or diagnoses as input to SDM, such obligations may be overridden by inherited defeaters, caused by a form of algorithmic bias. The existence of inherited defeaters implies that the duty of care to the client's knowledge extends to any situation in which a clinician (or anyone else) is involved in producing training data for a system that will be used in SDM. Any future AI must be capable of assessing women individually, taking into account a wide range of factors including women's preferences, to provide a holistic range of evidence for clinical decision-making. (shrink)

The rise of digital and interconnected technology within the workplace, including programs that facilitate monitoring and surveillance of employees is unstoppable. The COVID-19-induced lockdowns and the resulting increase in home office adoption even increased this trend. Apart from major benefits that may come along with such information and communication technologies (e.g., productivity increases, better resource planning, and increased worker safety), they also enable comprehensive Electronic Performance Monitoring (EPM) which may also have negative effects (e.g., increased stress and (...) a reduction in job satisfaction). This conceptual article investigates EPM to better understand the development, adoption, and impact of EPM systems in organizations. The EPM literature published since the 1980s constitutes the basis for this conceptual article. We present a framework which is intended to serve as foundation for future studies. Moreover, we reviewed more than three decades of empirical EPM research and identified six major outcomes that are influenced by the use of an EPM system, as well as a large number of moderator variables. Based on our conceptual analyses and the resulting insights, which also include privacy, ethical, and cultural considerations, we discuss future research opportunities where we also refer to design implications for EPM systems. (shrink)

Near ubiquitous use of electronic fetal monitoring (EFM) during low-risk childbirth constrains both maternal agency and maternal autonomy. An analysis of interdisciplinary literature about EFM reveals that its use cannot be understood apart from broader norms and values that have significant implications for the agency and autonomy of laboring women. Overreliance on EFM use for low-risk women threatens their autonomy in several ways: by privileging the status of the fetal patient, by delegitimizing women’s embodied experience of (...) childbirth, and by constructing EFM data as objective science despite evidence to the contrary. In birth situations defined as high-risk, however, EFM may lead to greater maternal agency by enabling women to choose vaginal over cesarean birth. Viewing doctor-patient interactions as a co-construction in the context of an understanding that sees EFM as a social as well as technological construction may improve autonomy in childbirth. (shrink)

Extensive and growing use of electronic performance monitoring in organizations has resulted in considerable debate. Advocates of electronic monitoring approach the debate in teleological terms arguing that monitoring benefits organizations, customers, and society. Its critics approach the issue in deontological terms countering that monitoring is dehumanizing, invades worker privacy, increases stress and worsens health, and decreases work-life quality. In contrast to this win-lose approach, this paper argues that an approach which emphasizes communication in the (...) design and implementation of monitoring systems offers a win-win solution that should satisfy both deontological and teleological ethicists. (shrink)

The “best interests of the patient” standard—a complex balance between the principles of beneficence and autonomy—is the driving force of ethical clinical care. Clinicians’ fear of litigation is a challenge to that ethical paradigm. But is it ever ethically appropriate for clinicians to undertake a procedure with the primary goal of protecting themselves from potential legal action? Complicating that question is the fact that tort liability is adjudicated based on what most clinicians are doing, not the scientific basis of whether (...) they should be doing it in the first place. In a court of law, clinicians are generally judged based on the “reasonably prudent” standard: what a reasonably prudent practitioner in a similar situation would do. But this legal standard can have the effect of shifting the medical standard of care—enabling a standard‐of‐care sprawl where actions undertaken for the primary purpose of avoiding liability reset the standard of care against which clinicians will be adjudicated. While this problem has been recognized in the legal literature, neither current ethical models of care nor legal theory offer workable solutions.One of the best examples of the conflict between evidence‐based medicine and common clinical practice is the use of electronic fetal monitoring. Despite strong evidence and professional guidelines that argue against the use of EFM for healthy pregnancies, the practice persists. One of the main reasons for this is often assumed to be physicians’ concerns about liability. (shrink)

The “best interests of the patient” standard—a complex balance between the principles of beneficence and autonomy—is the driving force of ethical clinical care. Clinicians’ fear of litigation is a challenge to that ethical paradigm. But is it ever ethically appropriate for clinicians to undertake a procedure with the primary goal of protecting themselves from potential legal action? Complicating that question is the fact that tort liability is adjudicated based on what most clinicians are doing, not the scientific basis of whether (...) they should be doing it in the first place. In a court of law, clinicians are generally judged based on the “reasonably prudent” standard: what a reasonably prudent practitioner in a similar situation would do. But this legal standard can have the effect of shifting the medical standard of care—enabling a standard-of-care sprawl where actions undertaken for the primary purpose of avoiding liability reset the standard of care against which clinicians will be adjudicated. While this problem has been recognized in the legal literature, neither current ethical models of care nor legal theory offer workable solutions. One of the best examples of the conflict between evidence-based medicine and common clinical practice is the use of electronic fetal monitoring. Despite strong evidence and professional guidelines that argue against the use of EFM for healthy pregnancies, the practice persists. One of the main reasons for this is often assumed to be physicians’ concerns about liability. (shrink)

The problem at the heart of “Stemming the Standard-of-Care Sprawl: Clinician Self-Interest and the Case of Electronic Fetal Monitoring,” an article by Kayte Spector-Bagdady and colleagues in the November-December 2017 issue of the Hastings Center Report, is the persistence of a suboptimal standard of care long after evidence-driven approaches would dictate a change. That problem is not simply defensive medicine, or what the authors call “standard-of-care sprawl.” Instead, it is that, in some cases, the standard of care (...) lags behind best practices. It gets stuck. The authors point to the genesis of the stickiness problem in their passing reference to a core truth: “The problem is that standard of care is not synonymous with best or evidence-based medicine.” In my view, we might best understand the persistence of ineffective and even harmful medical interventions by acknowledging the regulatory vacuum in which such practices thrive. It is by default, not by design, that the profession relies on medical malpractice law to set the boundaries on acceptable practice. (shrink)

In maternity care, costly high-technology interventions that have never been shown to be clinically effective continue to be used in the United States, while inexpensive and effective low-technology interventions continue to be underused. Three high-technology approaches to risk reduction—electronic fetal monitoring, cesarean section, and home uterine activity monitoring are contrasted with three low-technology approaches—prenatal care, smoking cessation, and nutrition supplementation. These technologies are examined in terms of current controversies over their safety, efficacy, and cost-effectiveness. Examination of (...) these controversies illustrates how the medical technology industry, the regulatory process, and systems of social stratification contribute to social and cultural constructions of what are regarded as reducible birth risks. (shrink)

Purpose Advances in electronic performance monitoring have raised employees’ concerns regarding the invasion of privacy and erosion of trust. On the other hand, EPM promises to improve performance and processes. This paper aims to focus on how the alignment of EPM design and organizational culture through effective organizational mechanisms can address privacy concerns, and, hence, positively affect employees’ perception toward technology. Design/methodology/approach Based on a theoretical lens extending two conceptual frameworks, a qualitative approach was used to analyze interview (...) data collected from a comparative case study of two organizations in the USA and Qatar within the oil and gas sector. These two contexts were selected to emphasize the cross-cultural and organizational differences in employees’ acceptance of EPM. Findings The study revealed that national and corporate cultures affected employees’ perception and acceptance of monitoring in both countries. Because of diversity, though EPM was better accepted in Qatar, as they are an easy way to enforce standardization and to push employees to adapt to a dominating corporate culture. Conversely, in the USA where culture is more innovation-oriented, organizational mechanisms shifted the perceptions of EPM to being mean to obtain feedback rather than to impose standards. Research limitations/implications This qualitative study is based on a descriptive comparative case study of two organizations with two cultural contexts. The limited sample size and cross-sectional nature of data may need to be extended to a larger cultural scope that is observed over a longer period to safely generalize the findings. Practical implications Decision-makers in multinational corporations with different cultural backgrounds may benefit of this study’s outcomes, as it emphasizes the importance of the fit between EPM designs and the cultural settings. Furthermore, organizations aiming to conduct analytics on EPM data have to justify and prove its benefits to employees to facilitate acceptance. Social implications The study shows that employees in Qatar have a different cultural frame of reference in their perception of fairness and ethics than their counterparts in the USA because of changes in the meaning of social relations, personal goals and behavioral norms. Originality/value The originality of this study lays in its empirical validation of a composite framework examining both national and corporate cultures on employees’ reactions to EPM systems. It also proves the critical importance of organizational mechanisms to align the EPM design with the organization cultural settings. (shrink)

There is general agreement that the “principle of balance” should guide controlled substance policy and regulation in the United States. Although the diversion of controlled substances from medical to nonmedical purposes is a significant public health problem, overly aggressive controlled substance regulation has been shown to have an unintended deterrent effect on appropriate controlled substance use, including pain management with opioid analgesics. The promotion of effective pain management and the reduction of substance abuse are equally important regulatory objectives. Neither regulatory (...) objective need be sacrificed to achieve the other. Rather, the two objectives must be balanced with each other to assure that necessary pain management is encouraged while drug abuse is curtailed.Approximately 75 million people in the United States suffer from severe pain. Fifty million of these suffer chronic pain, and 25 million suffer acute pain from trauma or surgery. Pain is not merely an uncomfortable symptom. (shrink)

There is general agreement that the “principle of balance” should guide controlled substance policy and regulation in the United States. Although the diversion of controlled substances from medical to nonmedical purposes is a significant public health problem, overly aggressive controlled substance regulation has been shown to have an unintended deterrent effect on appropriate controlled substance use, including pain management with opioid analgesics. The promotion of effective pain management and the reduction of substance abuse are equally important regulatory objectives. Neither regulatory (...) objective need be sacrificed to achieve the other. Rather, the two objectives must be balanced with each other to assure that necessary pain management is encouraged while drug abuse is curtailed.Approximately 75 million people in the United States suffer from severe pain. Fifty million of these suffer chronic pain, and 25 million suffer acute pain from trauma or surgery. Pain is not merely an uncomfortable symptom. (shrink)

This paper considers electronic monitoring (EM) a promising alternative to imprisonment as a criminal sanction for a series of criminal offenses. However, little has been said about EM from an ethical perspective. To evaluate EM from an ethical perspective, six initial ethical challenges are addressed and discussed. It is argued that since EM is developing as a technology and a punitive means, it is urgent to discuss its ethical implications and incorporate moral values into its design and development.

The paper examines the ethics of electronic monitoring for advertising purposes and the implications for Internet user privacy using as a backdrop DoubleClick Incs recent controversy over matching previously anonymous user profiles with personally identifiable information. It explores various ethical theories that are applicable to understand privacy issues in electronic monitoring. It is argued that, despite the fact that electronic monitoring always constitutes an invasion of privacy, it can still be ethically justified on both (...) Utilitarian and Kantian grounds. From a Utilitarian perspective the emphasis must be on minimizing potential harms. From a Kantian perspective the emphasis must be on giving users complete information so that they can make informed decisions as to whether they are willing to be monitored. Considering the Internet advertising industrys current actions, computer users and government regulators would be well advised, both practically and ethically, to move to a user control model in electronic monitoring. (shrink)

The incidence of elder abuse has led to a growing trend of states taking various methods to regulate the use of electronic monitoring in institutional settings through programs, guidelines, regulations, and laws. This article attempts evaluate how the regulation of electronic monitoring has evolved and may be advanced in the future with the anticipated increase of elder abuse.

This paper examines ethical, legal and economic dimensions of the decision facing employers regarding whether it is appropriate to monitor the electronic mail (e-mail) communications of its employees. We review the question of whether such monitoring is lawful. Recent e-mail monitoring cases are viewed as a progression from cases involving more established technologies (i.e., phone calls, internal memoranda, faxes and voice mail).The central focus of the paper is on the extent to which employer monitoring of employee (...) e-mail presents a structure of costs and benefits to the employer which are unlikely to make such a practice profitable or practical to the employer. The practice of employer monitoring to detect illicit employee behavior (e.g., fraud, harassment of fellow employees, industrial espionage) is considered. (shrink)

Abstract:Open neural tube defects or myelomeningoceles are a common congenital condition caused by failure of closure of the neural tube early in gestation, leading to a number of neurologic sequelae including paralysis, hindbrain herniation, hydrocephalus and neurogenic bowel and bladder dysfunction. Traditionally, the condition was treated by closure of the defect postnatally but a recently completed randomized controlled trial of prenatal versus postnatal closure demonstrated improved neurologic outcomes in the prenatal closure group. Fetal surgery, or more precisely maternal-fetal (...) surgery, raises a number of ethical issues that we address including who the patient is, informed consent, surgical innovation and equipoise as well maternal assumption of risk. As the procedure becomes more widely adopted into practice, we suggest close monitoring of new fetal surgery centers, in order to ensure that the positive results of the trial are maintained without increased risk to both the mother and fetus. (shrink)

The effective collection and management of personal data of rapidly migrating populations is important for ensuring adequate healthcare and monitoring of a displaced peoples’ health status. With developments in ICT data sharing capabilities, electronic personal health records (ePHRs) are increasingly replacing less transportable paper records. ePHRs offer further advantages of improving accuracy and completeness of information and seem tailored for rapidly displaced and mobile populations. Various emerging initiatives in Europe are seeking to develop migrant‐centric ePHR responses. This paper (...) highlights their importance and benefits, but also identifies a number of significant ethical, legal and social issues (ELSI) and challenges to their design and implementation, regarding (1) the kind of information that should be stored, (2) who should have access to information, and (3) potential misuse of information. These challenges need to be urgently addressed to make possible the beneficial use of ePHRs for vulnerable migrants in Europe. (shrink)

One of the most significant changes in modern healthcare delivery has been the evolution of the paper record to the electronic health record (EHR). In this paper we argue that the primary change has been a shift in the focus of documentation from monitoring individual patient progress to recording data pertinent to Institutional Priorities (IPs). The specific IPs to which we refer include: finance/reimbursement; risk management/legal considerations; quality improvement/safety initiatives; meeting regulatory and accreditation standards; and patient care delivery/evidence (...) based practice. Following a brief history of the transition from the paper record to the EHR, the authors discuss unintended or contested consequences resulting from this change. These changes primarily reflect changes in the organization and amount of clinician work and clinician‐patient relationships. The paper is not a research report but was informed by an institutional ethnography the aim of which was to understand how the EHR impacted clinicians and administrators in a large, urban hospital in the United States. The paper was also informed by other sources, including the philosophies of Jacques Ellul, Don Idhe, and Langdon Winner. (shrink)

The behaviour of autonomous agents may deviate from that deemed to be for the good of the societal systems of which they are a part. Norms have therefore been proposed as a means to regulate agent behaviours in open and dynamic systems, where these norms specify the obliged, permitted and prohibited behaviours of agents. Regulation can effectively be achieved through use of enforcement mechanisms that result in a net loss of utility for an agent in cases where the agent’s behaviour (...) fails to comply with the norms. Recognition of compliance is thus crucial for achieving regulation. In this paper, we propose a general framework for observation of agents’ behaviour, and recognition of this behaviour as constituting, or counting as, compliance or violation. The framework deploys monitors that receive inputs from trusted observers, and processes these inputs together with transition network representations of individual norms. In this way, monitors determine the fulfillment or violation status of norms. The paper also describes a proof of concept implementation of the framework, and its deployment in electronic contracting environments. (shrink)

Research to improve the health of pregnant and fetal patients presents ethical challenges to clinical investigators, institutional review boards, funding agencies, and data safety and monitoring boards. The Common Rule sets out requirements that such research must satisfy but no ethical framework to guide their application. We provide such an ethical framework, based on the ethical concept of the fetus as a patient. We offer criteria for innovation and for Phase I and II and then for Phase III (...) clinical trials to improve the health of pregnant patients and of fetal patients and also criteria to responsibly manage the transition from investigation to clinical practice. Basing ethical criteria for research involving pregnant women on the ethical concept of the fetus as a patient insulates the proposed ethical framework and therefore research on pregnant women from the divisive and politicized concepts and discourses of personhood, fetal rights, and unborn child. (shrink)

The regulation of the activity of multiple autonomous entities represented in a multi-agent system, in environments with no central design (and thus with no cooperative assumption), is gaining much attention in the research community. Approaches to this concern include the use of norms in so-called normative multi-agent systems and the development of electronic institution frameworks. In this paper we describe our approach towards the development of an electronic institution providing an enforceable normative environment. Within this environment, institutional services (...) are provided that assist agents in forming cooperative structures whose commitments are made explicit through contracts. Our normative framework borrows some concepts from contract law theory. Contracts are formalized using norms which are used by the institution while monitoring agents’ activities, thus making our normative environment dynamic. We regard the electronic institution as a means to facilitate both the creation and the enforcement of contracts between agents. A model of “institutional reality” is presented that allows for monitoring the fulfillment of norms. The paper also distinguishes our approach from other developments of the electronic institution concept. We address the application of our proposal in the B2B field, namely regarding the formation of Virtual Organizations. (shrink)

Research to improve the health of pregnant and fetal patients presents ethical challenges to clinical investigators, institutional review boards, funding agencies, and data safety and monitoring boards. The Common Rule sets out requirements that such research must satisfy but no ethical framework to guide their application. We provide such an ethical framework, based on the ethical concept of the fetus as a patient. We offer criteria for innovation and for Phase I and II and then for Phase III (...) clinical trials to improve the health of pregnant patients and of fetal patients and also criteria to responsibly manage the transition from investigation to clinical practice. Basing ethical criteria for research involving pregnant women on the ethical concept of the fetus as a patient insulates the proposed ethical framework and therefore research on pregnant women from the divisive and politicized concepts and discourses of personhood, fetal rights, and unborn child. (shrink)

Unlike sonographic examinations, sonic fetal heartbeat monitoring has received relatively little attention from scholars in the social sciences. Using the case of fetal heartbeat monitoring as part of midwifery prenatal care in Germany, this contribution introduces music as an analytical tool for exploring the aesthetic dimensions of obstetrical surveillance practices. Based on ethnographic stories, three orchestrations are compared in which three different instruments help audiences to listen to what becomes fetal heartbeat music and to qualify (...) fetal and pregnant lives in relation to each other. In the Doppler-based orchestration, audible heartbeat music is taken as a sign of a child in need of parental love and care cultivated to listen. The Pinard horn makes esoteric fetal music that can be appreciated by the midwife as a skilled instrumentalist alone and helps to enact a child hidden in the belly. The cardiotocograph brings about soothing music and a reassuring relationship with a child but also durable scripts of juridical beauty. This material-semiotic analysis amplifies how well-being is shaped in midwifery prenatal care practices. (shrink)

Personal Health Monitoring (PHM) uses electronic devices which monitor and record health-related data outside a hospital, usually within the home. This paper examines the ethical issues raised by PHM. Eight themes describing the ethical implications of PHM are identified through a review of 68 academic articles concerning PHM. The identified themes include privacy, autonomy, obtrusiveness and visibility, stigma and identity, medicalisation, social isolation, delivery of care, and safety and technological need. The issues around each of these are discussed. (...) The system / lifeworld perspective of Habermas is applied to develop an understanding of the role of PHMs as mediators of communication between the institutional and the domestic environment. Furthermore, links are established between the ethical issues to demonstrate that the ethics of PHM involves a complex network of ethical interactions. The paper extends the discussion of the critical effect PHMs have on the patient’s identity and concludes that a holistic understanding of the ethical issues surrounding PHMs will help both researchers and practitioners in developing effective PHM implementations. (shrink)

The Medication Event Monitoring System (MEMS) is a relatively new device designed to overcome some of the disadvantages of traditional adherence-measuring techniques. MEMS has also been found useful in tracking adherence behaviour without the need to visit patients frequently. In this study each patient was given a pre-filled, labelled MEMS bottle and cap. Patients were monitored for 24 weeks. For patients specifically studied, there were periods when drug levels may have been low and some exhibited erratic medication-taking behaviour. It (...) is concluded that MEMS can measure adherence behaviour objectively, and so might be used to improve prescribing decisions, identify drug wastage and improve carer support. Further research is needed before the routine use of electronic medication monitoring can be recommended. (shrink)

System Requirements System requirements Minimum 80486, 66MHz IBM PC or full compatible ; Minimum 16MB RAM 177MB hard disk space to store and run the Nachlass, an extra 12MB in addition to this should be available during installation. SVGA monitor set to 800x600 pixels, 16-bit colour, or higher setting recommended to use and display the transcription text and facsimiles; Quad-speed CD-ROM drive or higher; Windows 3.1, 3.11; Windows 95/98; Windows NT 4.0; Windows 2000. Microsoft mouse or compatible Network versions Windows (...) NT 4, and Novell networks. Customers with Wide Area Networks should ring Customer Services to discuss specific requirements. Customer Service Contact: Customer Services, Electronic Publishing Tel: +44 1865 267979 Fax: +44 1865 267990 Email: [email protected]. (shrink)

While electronic mail has enjoyed rapid growth in the workplace, many companies have failed to establish clear expectations among employees about their e-mail privacy rights. This has resulted in controversy and even lawsuits against employers where employees later learned that management personnel monitored or read their electronic communications. It has been speculated that most employees underestimate the legal right of their employer to engage in e-mail monitoring activities. However, this issue has been virtually unexplored from a research (...) perspective. Consequently, the purpose of this study is to assess individuals'' ethical beliefs and perceptions about electronic mail privacy. This study of more than 200 e-mail users reveals that there is significant resistance to e-mail monitoring, and that many individuals have a relatively poor understanding of their e-mail privacy rights. The results also suggest that companies need to develop and communicate a policy to employees that addresses this issue. Finally, this study suggests several possibilities for further research. Building a greater body of knowledge of this domain should assist business leaders and lawmakers as they work to formulate an effective response to this workplace challenge that will equitably balance the rights of employees and employers. (shrink)

Implementation of guidelines regarding breaches of electronic health information requires an anticipatory stance and physician and patient education regarding security and monitoring measures and methods of redress. Adopting a preventive ethics, rather than a crisis management, model may also increase physician awareness of how the information they choose to include and privilege within the health record may expose patients to added harms if not done mindfully.

Since the attack on the World Trade Center in New York, and on the Pentagon in the United States, concerns over security issues have been at an all-time high in this country. Both state and federal governments continue to discuss legislation on these issues amid much controversy. One key concern of both employers and employees is the extent that employers, espousing a "need to know" mentality, continue to expand their capability and implementation of surveillance of employees in the workplace. With (...) the technology typically growing faster than the speed of legislation, protective or permissive, the management and legal issues involved in electronic monitoring of employee communications in the workplace, are and well should be on the agenda for discussion of every management and legal team in American business today. Companies have a legitimate right to protect their trade secrets from disclosure by disgruntled employees. Similarly, companies also have a duty to protect their good names and reputations from unauthorized employee communications with outside parties, and even other employees, that may damage them. It is also a prime duty of management to ensure, in their direction of their workforces, that the employees execute their responsibilities by working full time on their stated objectives. In this regard, any management that fails to oversee its workforce to ensure that employees are not expending valuable company time, for which they are being compensated, on personal business, including unauthorized communications, is remiss in its responsibilities to its shareholders. The company may see a reduction of the price of its shares in the marketplace if it does not protect the economic interests of its shareholders. (shrink)

In recent years, artificial intelligence (AI) has garnered tremendous attention across a range of sectors, including health care. AI is a comprehensive term, broadly defined as computational machines making decisions and performing tasks that previously required human intelligence or cognition. There are high expectations of what AI can do; enthusiasts sometimes refer to it as a central pillar of the Fourth Industrial Revolution, with an impact on humanity as profound as that of the steam power engine or electricity. Building on (...) the Third Industrial Revolution (or Digital Revolution) that began in the middle of the twentieth century and was characterized by the spread of automation and digitization through the use of electronics, computers, and communication technologies (e.g., the internet), the Fourth Industrial Revolution is characterized by a fusion of advancing technologies in AI, robotics, the Internet of Things (IoT), genetic engineering, and quantum computing. These technologies blend physical production and operations with smart digital technologies, promising to transform the operation, management, and governance of every industry, including health care. (shrink)

The extant clinical literature indicates profound problems in the assessment, monitoring, and documentation of care in long-term care facilities. The lack of adequate resources to accommodate higher staff-to-resident ratios adds additional urgency to the goal of identifying more costeffective mechanisms to provide care oversight. The ever expanding array of electronic monitoring technologies in the clinical research arena demands a conceptual and pragmatic framework for the resolution of ethical tensions inherent in the use of such innovative tools. CareMedia (...) is a project that explores the utility of video, audio and sensor technologies as a continuous real-time assessment and outcomes measurement tool. In this paper, the authors describe the seminal ethical challenges encountered during the implementation phase of this project, namely privacy and confidentiality protection, and the strategies employed to resolve the ethical tensions by applying principles of the interest theory of rights. (shrink)

Many office workers use computers and the Internet not only to get their daily jobs done but also to deal with their personal businesses. Therefore employers nowadays monitor their employees electronically to prevent the misuse of the company resources. The use of electronic monitoring in organizations causes issues of trust and privacy. This study is dedicated to developing a conceptual model on the two issues under electronic monitoring. Control, considered as the essence of the definition of (...) privacy as well as the foundation of the control model in the theory of procedural justice, plays an important role to people’s privacy concerns and trust. People’s perceived‐self, as essential in the group‐value model in the theory of procedural justice and in the cultural studies, also plays an important role to people’s privacy concerns and trust. This study presents research hypotheses on trust and privacy under electronic surveillance based on the two models of the theory of procedural justice, social identity theory, and cultural studies. (shrink)

Following the widespread occurrence of birth defects from the use of thalidomide to treat nausea during pregnancy in the 1960s and 1970s, the Food and Drug Administration became particularly vigilant about the use of therapeutic agents during pregnancy and in women of childbearing potential. The FDA developed a list that categorizes an agent according to the known risks to a fetus. The drug thalidomide falls into Category X: agents that have demonstrated clear risk of fetal abnormalities and whose risks (...) outweigh the benefits of use during pregnancy.Another Category X drug is isotretinoin, commonly known by its trade name Accutane. Isotretinoin is an oral medication prescribed for severe recalcitrant, nodular acne in patients who are unresponsive to conventional therapy. Isotretinoin has been available since 1982, and it remains the only effective treatment for this condition. (shrink)

The United States Food and Drug Administration , in collaboration with pharmaceutical manufacturers, have recently implemented a heavily revised risk-management program for patients on isotretinoin , a drug with known and pronounced teratogenic effects. This revised risk management plan places significant burdens on both providers and patients in the hopes of achieving its goal of reducing fetal exposure to isotretinoin. The main focus of this paper is to discuss the burdens of various aspects of the program in relationship to (...) potential corresponding benefits. In particular, we evaluate the pregnancy rates of women on isotretinoin therapy compared with that of the general population and the rate changes based on the risk management programs. Additionally, we investigate whether the benefits of the program for women have increased as the benefits have risen. We devote special attention to the ethical implications of the intent of the program and to an analysis of the ethical justification of the restrictions placed on women of childbearing potential as it compares to the risk-benefit relationship of using isotretinoin. (shrink)

A vigorous debate has developed surrounding electronic surveillance in the workplace. This controversial practice is one element of the more general issues of employee dignity and management control, revolving around the use of polygraph and drug testing, integrity exams, and the like. Managers, under pressure from competitors, are making greater use of technologically advanced employee monitoring methods because they are available, and hold the promise of productivity improvement. In this paper, the context of electronic surveillance is described (...) and analyzed from the perspectives of ethics, public policy, and managerial behavior. (shrink)