LK 120The wizard behind the curtain: programmers as providers
It is almost universally accepted that traditional provider-patient relationships should be governed, at least in part, by the ethical principles set forth by Beauchamp and Childress. Recently, however, the nature of medial practice has changed. The pervasive presence of computer technology in medicine raises interesting ethical questions. In this paper we argue that some computer programmers should be considered health care providers and thus be subject to (at least a subset of) the principles of autonomy, beneficence, nonmaleficence, and justice.
A fundamental raison-d’etre of medical ethics is to protect the patient from the provider. While in the past the power to harm (and benefit) in a medical context has been limited to “healthcare professionals”, this power is no longer vested only in those with traditional roles. Certain programmers now have the ability to harm (and help) in a medical context. For example, code written for devices such as pacemakers and ventilators can have significant health consequences. Programmers are, in essence, making active changes to therapy based on changing patient parameters. Take for instance ventilator settings. In this context, the programmer is no different than the physical provider at the bedside ordering changes to ventilator settings based on patient parameters. Software reflects the same type of thinking/decision making as a bedside provider, albeit in a programmed format. Despite the physical absence of the programmer, the programmer-patient interaction is no less real from a consequentialist perspective. The potential harm here is not just theoretical; ventilators have been recalled based on faulty software.
Our second reason to consider a programmer as a provider relates to decision support software. Code written for such programs helps make patient diagnoses and may also direct treatment. While it is true that at this point in software development there is usually an intermediary human agent involved, the programmer’s code nevertheless directly affects patient diagnosis and therapy. Code will have an increasing impact as computers take on more of the tasks of diagnosis and therapy and become semiautonomous decision makers. Clinical decisions will directly reflect code developed by the programmer, essentially putting the programmer in direct control of patient diagnosis and treatment.
One can note that in some cases the programming may be overseen and directed by a traditional health care provider. Thus, one may argue, the programmer is merely carrying out orders. This changes nothing. We still expect health care providers acting as a proxy for another provider (for example some nurses) to be subject to the tenets of medical ethics.
It can be argued that programmers are already subject to a code of ethics. However, this generally applies to business practices rather than the programmer-as-a provider. The increasingly central role of programmers in the provision of patient care demands explicit acknowledgement of, and training in, bioethics to directly remind the programmer of her responsibility in patient care.