In this interview with MEDICA.de, Professor Wolfgang Rascher, Director of the Clinical Ethics Committee of the University Hospital Erlangen, Germany, talks about the legal constraints that need to be considered and in what way the increasing exposure to medical technology also affects the doctor-patient relationship.
Professor Rascher, what is the basic conflict between ethics and patient monitoring?
Wolfgang Rascher: The basic conflict lies in control or rather the extent of control, because it is often accompanied by a patient’s loss of autonomy and freedom. If monitoring becomes too intensive, if the patient needs to be restrained for example, it borders on and violates human dignity and human rights. All of this can only be accounted for when it is in the best interest of the patient. Of course, monitoring of bodily functions is beneficial for a sick person. Malfunctions of the body are detected in time. Nursing staff and physicians can respond quickly and avoid complications. The monitoring of bodily functions has helped medicine enormously.
It gets more difficult, when adolescents or dementia patients disappear without permission from the ward and abscond treatment. In the worst-case scenario, they are being confined or monitored via electronic surveillance. This is de facto deprivation of liberty. On the other hand, this electronic surveillance also means safety for the patient, family members, nursing staff and the physician in charge. The resulting side effect notably violates privacy rights. This is the point where monitoring becomes an ethical issue and is therefore also justiciable.
Another ethical conflict at this point is assistance systems for elderly people. Old people live in their homes and are being monitored at the same time. This is basically a good approach, because they are being looked after this way and don’t have to go to a nursing home. These systems, for instance reminder systems to consume fluids, are based on long-term development. Voluntary health data collection is entirely unproblematic, but there are limits when it pertains to human rights or deprivation of privacy.
What areas of the hospital and care sector are particularly affected by this?
Rascher: All medical areas are affected, but in particular patients at intensive care units and locked wards or if they are no longer of sound mind, as is the case with dementia. Patients walk away without permission and abscond from care. In this case, monitoring systems help and are beneficial.
When individual bodily functions are being monitored, such as blood pressure, blood glucose levels or heart rate for example, it does not present a problem. It only becomes highly problematic when the person as a whole is being monitored. At the end of the day, all areas of medicine monitor a patient. Laboratory values alone constitute monitoring. We accept this, because it benefits us. Conversely, we therefore have to ask ourselves how much monitoring we can tolerate and where the boundaries are.