ABSTRACT
Patient self-management of disease is increasingly supported by technologies that can monitor a wide range of behavioural and biomedical parameters. Incorporated into everyday devices such as cell phones and clothes, these technologies become integral to the psychosocial aspects of everyday life. Many technologies are likely to be marketed directly to families with ill members, and families may enlist the support of clinicians in shaping use. Current ethical frameworks are mainly conceptualised from the perspective of caregivers, researchers, developers and regulators in order to ensure the ethics of their own practices. This paper focuses on families as autonomous decision-makers outside the regulated context of healthcare. We discuss some morally relevant issues facing families in their decisions to monitor the health-related behaviours of loved ones. An example - remote parental monitoring of adolescent blood glucose - is presented and discussed through the lens of two contrasting accounts of ethics; one reflecting the predominant focus on health outcomes within the health technology assessment (HTA) framework and the other that attends to the broader sociocultural contexts shaping technologies and their implications. Issues discussed include the focus of assessments, informed consent and child assent, and family co-creation of system characteristics and implications. The parents' decisions to remotely monitor their child has relational implications that are likely to influence conflict levels and thus also health outcomes. Current efforts to better integrate outcome assessments with social and ethical assessments are particularly relevant for informed decision-making about health monitoring technologies in families.
Subject(s)
Caregivers/psychology , Diabetes Mellitus, Type 1/psychology , Health Behavior , Monitoring, Ambulatory/methods , Patient Acceptance of Health Care/psychology , Adolescent , Adult , Age Factors , Blood Glucose/analysis , Blood Glucose Self-Monitoring , Child , Diabetes Mellitus, Type 1/blood , Female , Humans , Male , Monitoring, Ambulatory/psychology , Morals , Parent-Child Relations , Quality of Life/psychology , Self Care , Young AdultABSTRACT
Patients with multivessel coronary atherosclerosis and stable angina pectoris were examined by outpatient testing and admitted to a staging area with their families on the morning of coronary bypass surgery. This experimental group was not hospitalized before surgery. Their hospital charges were compared with those of cohorts of coronary artery surgery patients from 1977 to 1981 who met the same entrance criteria. Length of stay in the hospital was reduced by two days. A 10% savings in hospital charges was realized in the 1981 experimental group as compared with the 1981 control group. A comparison of total hospital charges, adjusted for inflation, shows that 1981 experimental group patients paid 35% less for their hospital room, 45% less for their intensive care period, and 17% less in total charges than the 1977 control group. Interviews indicated that these patients with stable cardiac conditions preferred to stay with their families or friends before surgery.
