Ethical challenges in clinical decision-making in the era of new technologies: Experiences from low income countries

New technologies have remarkably changed the healthcare field over the last three decades by improving the functionality and efficiency of health care systems and patient outcomes. However, if not well managed, new technologies present ethical challenges to clinicians globally but more so in low income countries (LICs) where there is lack of resources and the technologies may serve to increase existing health inequities. There is paucity of literature exploring the ethical challenges faced by clinicians in LICs in this era of new technologies. Objective: To discuss the ethical (and other) challenges clinicians in LICs face in this new technology era. Methods: (i) The author's personal experiences (As a clinician and researcher working in LICs), (ii) empirical research findings from interviews with 44 doctors and 16 nurses working in a LIC hospital,and 2 policy makers and (iii) relevant literature. Patient related challenges included; inappropriate demand, ability to make informed decisions and balancing self-interest vs. public interest. Clinician related challenges included; the use of unfair criteria, lack of explicit criteria and processes, lack of evidence, potential for abuse, physicians' dual role, autonomy and moral distress. Most of these were directly influenced by the extreme lack of resources, and decisions made at the meso- macro and global levels with regards to research and development and investing in new technologies for LICs. Hence addressing these challenges require concerted efforts at all levels, ensuring that decisions are guided by ethical values; and not only the clinicians' duty. (C) 2015 Published by Elsevier Ltd. on behalf of Fellowship of Postgraduate Medicine.