Is There a Technological Imperative in Health Care?

Hofmann, Bjørn

doi:10.1017/s0266462302000491

Cited by 80 publications

(17 citation statements)

References 26 publications

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“…Another force is the continuous comparison of survival statistics between NICUs that may lead to a "benchmarking effect," making doctors favor continuation of life support in the gray zone. The technology itself can also become a self-perpetuating force, referred to as the "technological imperative" (Hofmann 2002).…”

Section: Critical Discussion Of the Ppwh-approachmentioning

confidence: 99%

Postponed Withholding: Balanced Decision-Making at the Margins of Viability

Syltern

Ursin

Solberg

et al. 2021

The American Journal of Bioethics

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Advances in neonatology have led to improved survival for periviable infants. Immaturity still carries a high risk of short-and long-term harms, and uncertainty turns provision of life support into an ethical dilemma. Shared decision-making with parents has gained ground. However, the need to start immediate life support and the ensuing difficulty of withdrawing treatment stands in tension with the possibility of a fair decision-making process. Both the parental "instinct of saving" and "withdrawal resistance" involved can preclude shared decision-making. To help health care personnel and empower parents, we propose a novel approach labeled "postponed withholding." In the absence of a prenatal advance directive, life support is started at birth, followed by planned redirection to palliative care after one week, unless parents, after a thorough counseling process, actively ask for continued life support. Despite the emotional challenges, this approach can facilitate ethically balanced decision-making processes in the gray zone.

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Section: Critical Discussion Of the Ppwh-approachmentioning

confidence: 99%

Postponed Withholding: Balanced Decision-Making at the Margins of Viability

Syltern

Ursin

Solberg

et al. 2021

The American Journal of Bioethics

View full text Add to dashboard Cite

show abstract

“…For example, imperatives may be classified, analyzed and explained in a wide range of other ways, e.g. as inertia (Okonofua et al ., 2006; Cooke et al ., 2012; Reach et al ., 2017; Saposnik and Montalban, 2018), human deficiencies (Cassell, 1993) or more specific forms of technological imperatives (Wolf and Berle, 1981; Mandell, 1983; Barger-Lux and Heaney, 1986; Hofmann, 2002a, 2002b, 2002c). Correspondingly, the loss aversion effect here classified as an affective bias may well be classified as a cognitive bias.…”

Section: Discussionmentioning

confidence: 99%

“…One important imperative is the imperative of possibility (Hofmann, 2002a, 2002b, 2002c): because something is possible, it ought to be implemented, or as they say in radiology: ‘we scan because we can’. This is closely related to Roemer's law: ‘A built bed is a filled bed’ (Shain and Roemer, 1959).…”

Section: Mechanisms That Hamper Disinvestmentmentioning

confidence: 99%

“…This phenomenon can be connected to the tendency to use technology as a placebo (Einvik et al ., 2002; Saririan and Eisenberg, 2003; Harris, 2016). For example, diagnostic technology that is developed to detect somatic disease is used to treat mental conditions (anxiety) or to ascertain health (Hofmann, 2002a, 2002b, 2002c, 2006). This sometimes is called ‘technology creep’ (Gelijns and Halm, 1991; Hobson, 2009).…”

Section: Mechanisms That Hamper Disinvestmentmentioning

confidence: 99%

“…After a while, the discarded machine enters the daily practice again, for example due to high demand. After some time, it is argued again that it is ‘provides low quality images,’, ‘is dangerous’ or ‘outdated’ and needs replacement again (Hofmann, 2002a, 2002b, 2002c). Accordingly, disinvestment counters these types of ingrained practice partly driven by imperatives.…”

Section: Mechanisms That Hamper Disinvestmentmentioning

confidence: 99%

See 2 more Smart Citations

Internal barriers to efficiency: why disinvestments are so difficult. Identifying and addressing internal barriers to disinvestment of health technologies

Hofmann

2021

HEPL

Self Cite

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Although efficiency is a core concept in health economics, its impact on health care practice still is modest. Despite an increased pressure on resource allocation, a widespread use of low-value care is identified. Nonetheless, disinvestments are rare. Why is this so? This is the key question of this paper: why are disinvestments not more prevalent and improving the efficiency of the health care system, given their sound foundation in health economics, their morally important rationale, the significant evidence for a long list of low-value care and available alternatives? Although several external barriers to disinvestments have been identified, this paper looks inside us for mental mechanisms that hamper rational assessment, implementation, use and disinvestment of health technologies. Critically identifying and assessing internal inclinations, such as cognitive biases, affective biases and imperatives, is the first step toward a more rational handling of health technologies. In order to provide accountable and efficient care we must engage in the quest against the figments of our minds; to disinvest in low-value care in order to provide high-value health care.

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Actions and Uncertainty: How Prenatally Diagnosed Variants of Uncertain Significance Become Actionable

Werner‐Lin¹,

McCoyd²,

Bernhardt³

2019

Hastings Center Report

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The development of genomic technologies has seemed almost magical. Excitement about it, both in medicine and among the public, stems from the belief that genomic techniques will illuminate the causes of health and disease, will lead to effective interventions for both rare and common genetic conditions, and will inform reproductive decision‐making. Novel diagnostic tools, however, are often deployed before targeted therapies are developed, tested, or available and before their psychosocial implications are explored. Newer technologies such as prenatal whole exome screening are seen as offering “decisional autonomy” to expectant parents, although such technologies identify information about genetic sequencing that may not have clear meaning. The “therapeutic gap” between the ability to conduct genetic sequencing and the ability to fully understand what the test results mean, much less what treatments to offer, leaves families with complex and unclear information they cannot act upon with confidence during pregnancy. In this essay, we will consider the psychosocial and ethical implications of such assumptions—and of the uncertain information produced by these technologies—for individuals and families and for societal aspects such as medical service usage and demographic inequities.

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Is There a Technological Imperative in Health Care?

Cited by 80 publications

References 26 publications

Postponed Withholding: Balanced Decision-Making at the Margins of Viability

Postponed Withholding: Balanced Decision-Making at the Margins of Viability

Internal barriers to efficiency: why disinvestments are so difficult. Identifying and addressing internal barriers to disinvestment of health technologies

Actions and Uncertainty: How Prenatally Diagnosed Variants of Uncertain Significance Become Actionable

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