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Ethical Dilemma: A computer controlled medical linear accelerator for…
Ethical Dilemma: A computer controlled medical linear accelerator for treating cancer
Patient receives multiple exposures
Who could be harmed?
Patients
Patient's Family
Workers
Programmer
Pros
Can have controlled doses
More time to catch errors in the machine
Can easily track the patients health and different intervals of time
Can cater to difference in patients health needs
Workers can become more experienced with the machine
Cons
Rooms taken up for longer periods of time
More chances for machine failure
Costs more money for the hospital
Could cost the families/patients more money
Treatments could take too long for real progress to take affect
Who could benefit?
Patients
Workers
Family of Patients
What if everyone took this route?
What rights may be abridged?
In the U.S. it is widely agreed upon that in the medical field - patient rights have a clause of Nonmaleficence. This means "do no harm". In this case the patient has the right to ensure they will be better off physically, and/or emotionally than what they were before they sought out treatment. If the treatment goes poorly and leaves them in a worse state than what they were when they came in, their patients rights would be breached.
patient receives singular overdose
operator sets the dose limit too high
wrong dose limit prescribed
operator selects the wrong beam type
high power beam is activated
beam shield not in place
beam shield moved/not properly placed
system did not detect that it was out of position
the operator had to move the table manually
turntable did not position correctly
machine jammed
shield motor failed
software failed
Who could be harmed?
The healthcare workers
The Hospital
Patient
Programmer
Who could benefit?
Patient's Family
Health care workers
Patient
Pros
Less treatment time
gives hospital chance to get to more patients instead of having to wait weeks to finish dosage of one patient
Saves the patient/family more money than having to pay for multiple doses
Efficiency can lead to less material cost
Cons
Workers would have to be perfect with little experience
Could overdose a patient
No time to catch any errors in machine
A major error could occur with catastrophic results
What if everyone took this route?
What rights may be abridged?
In the United States you have the right to life as well as pursuit of happiness. If an error occurs due to the Therac-25, it has the potential to hinder the victim's right to life, and the pursuit of happiness.
Stakeholders
Healthcare workers
Programmer
Patients
Patient's family
Other workers at the hospital
Relevant Facts
The program was developed by one person. There was no peer review of the work being done.
Therac-25 relied on the machine's software for control which resulted in a compromise in its safety.
Programming errors don't explain all the problems with Therac-25
Physicians didn't agree that an accident had occurred, so nothing was reported to the AECL or FDA.
Therac-25 seemed to be error free, but it wasn't.
The programmer worked in assembly language which is a high level language. This could result in major errors. Due to complexity
Therac-25 was on real-time software, updates signal every 0.1 seconds
Future changes / Policy changes that could prevent this dilemma in the future?
Multiple programmers on the assignment with peer review
Law requires a set amount of testing days and benchmarks
Rigorous testing of the software and hardware
More testing by the programmers and better regulation by government agencies to prevent this kind of accident from happening.
We decided to go with the "patient receives multiple exposures" option as we believe this is the safest way to go for multiple reasons. Some of these reasons include the following: 1. If there is multiple exposures, the dose can be lowered to see gradual changes overtime, as opposed to needing a higher dose for just a single-time treatment which can lead to fatally high levels as a result of an error. 2. It provides more trial an error for the operating techs. This way problems can be found out sooner rather than later, and hopefully not be as fatal
What Could be Done Differently?
Decision: