The following is a case study of the ethical issues surrounding a premature software release. All characters, as well as the organisations, Footech and Dunidin City hospital, are fictional.
In October 2008, Dunidin City Hospital (DCH) commissioned bespoke development of an upgrade to the hospital’s information management system, Foobar. A contract was signed with Footech Software Ltd to complete the Foobar 3.0 upgrade project by 19 August 2009, at the cost of $450,000. This report was written in response to the request from the Lead Engineer, Ms. Jane Doe, at Footech to investigate the ethicality of the upcoming release of the Foobar software.
The report firstly analyses the situation and identifies the ethical issues and stakeholders involved. It then discusses the ethicality of releasing the Foobar software from a consequentialist viewpoint, evaluating under the following criteria: resulting harm, benefits, disrespect and treatment of stakeholders. Thirdly, the deontological approach to ethics is applied to determine the whether the release abridges rights of DCH or is a neglect of Footech’s duties. Conclusions are then drawn from these findings and recommendations of actions to be taken are given.
2.1 Situation analysis
In order to determine whether the upcoming release of Foobar 3.0 is ethical or not, the underlying situation must firstly be fully understood. This includes identifying which of the relevant facts raise an ethical issue and what harm could potentially result.
2.1.1 Relevant facts
The following facts are important for consideration:
- The Foobar information management software coordinates crucial hospital events from admission to discharge, so is high reliability software with safety concerns. The influence of the software on the wider community is substantial.
- On 8 August 2009, Dunidin City Hospital representatives were informed by the project manager at Footech, Mr. Donald Johnson that the Foobar system upgrade development is on schedule.
- Footech Ltd. warrants the Foobar software and is subject to liability should it malfunction.
- DHC only outsources software development projects to organizations in the software industry that have an excellent reputation and sufficient experience in the related field.
- Before accepting an outsourcer, DHC must firstly approve the organizations official code of conduct, or requires the organization to belong to a recognized professional society.
- Footech Software Ltd is a member of the corporate partnership program of the New Zealand Computer Society and conforms to the society’s Code of Ethics.
- On 10 August 2009, senior developer for Footech, Ms. Jane Doe, received indications from her line manager, Mr. John Smithers, that the Foobar software system should be released immediately.
- Footech Ltd implements a rigorous quality assurance program to uncover defects whereby software engineers sign-off modules of a project to upper management. All released software products should conform to ISO 9000 standards.
- Release criteria are used in the quality assurance program to determine whether or not a system is fit for release. It is a list of measurable, achievable, trackable criteria. Mr. Johnson has decided that all criteria have been met.
- Ms. Doe believes the module she has developed for the system is not sufficiently reliable and should not be released in its current state.
2.1.2 Ethical issues
There are two actions performed by the management of the Foobar upgrade project that raise ethical issues and will be investigated further. They are:
- Falsely indicating that the system development is on schedule, and,
- Ordering the release of a system that is known to have deficiencies.
Both of these actions could lead to harm for the stakeholders of the software, with the second action potentially leading to disastrous consequences. The resulting harm is discussed further in section 3.2.
There are a number of people and groups of people that have an interest or stake in the Foobar system. These stakeholders can be categorized into two groups – investors and participants. Investors in the system are stakeholders that risk financial loss, whereas participants are those who deal with, or have previously had dealings with, the software. Investors in the Foobar software system include Footech Ltd shareholders, Dunidin City Hospital and third-party suppliers. Participants include DCH board members, cardiologists and nurses. Patients whose information is already managed by the software or whose might be managed in the future, as well as family, friends, and caregivers of patients are also participants. The most direct participants are the management and software developers at Footech Ltd.
2.2 Isolation of ethical dilemma
The software engineer, Ms. Doe, is caught between the performance targets of her employers and the expectations of the client. The major ethical dilemma to be resolved now is whether or not Ms. Doe should attempt to prevent the release of the Foobar information management software to Dunidin City Hospital, or whether she should allow the release whilst believing it is deficient.
2.3 Consequences of actions
“Consequentialism refers to those moral theories which hold that the consequences of a particular action form the basis for any valid moral judgment about that action”. (2009, “Consequentialism”) Consequentalist principles require a tally of the good and bad outcomes of an action, then a determination of whether the good actions outweigh the bad. From a consequentialist standpoint, predictions of the outcome of the release of the Foobar software system and its effects on the stakeholders can help determine whether or not it is a morally right action. Adhering to the principle of utilitarianism, a form of consequentialism, outcomes must be considered for both the provider of the service, Footech, and the customer, Dunidin City Hospital.
2.3.1 Resulting harm
Because the Foobar software is used to streamline patient care processes at DHC and reliability of the system is critical to patient safety, in the event that Foobar 3.0 were released in a deficient state, the resulting harm could be widespread. Making matters worse, if harm does occur, the damage could take a long time to fully reveal itself because divulging details publicly is troubling to all those who are associated with a faulty system. This harm would come in the form of physical and emotional suffering, damage to jobs and reputations, and financial liability.
In a worst-case scenario, the Foobar software could fail so disastrously that patients could be hurt or killed. The Foobar software is responsible for delivering a vast amount of information to physicians or nurses, such as reason for admission, patient history, and results from clinical laboratory and radiology examinations. If this information is not timely, up-to date, and valid, patient health is at risk as physicians are more likely to make erroneous or harmful treatment decisions.
Reputations would be harmed – from the cardiologists and hospital at large, to all those involved with the development of the software. This would include the Footech company as a whole, and the individuals directly involved: the project manager, the line manager, and the software engineers. The reputation of third party suppliers and customers with previous dealings with Footech would also be indirectly harmed. Disciplinary or, possibly, job action may be taken against all those involved. The bug that caused the harm could be directly traced back to the software engineer who designed the code, so as a personal consideration, this is an especially important point for Ms. Doe.
If patients were found to be mistreated by the Footech software, financial harm would probably result. Public trust in the company would be diminished and customers would be more reluctant to use Footech’s services. Withdrawal of the software would mean loss of revenue, and if the deficiencies were considered serious enough, Footech may be removed from the project, or the project may be terminated altogether. Between 1985 and 1987, the Therac series of radiation treatment machines’ software failure caused massive overdoses to patients, and the manufacturer of the machines and software was sued successfully for damages. This case provides ample incentive for software developers for health institutions, such as Footech, to ensure products are fully tested before being released, as admission of failing software due to unethical behavior could lead to a direct financial loss through subsequent lawsuits.
A properly functioning information management system is essential for the competitiveness of any hospital. Dunidin City Hospital would also suffer financially if the information management system functioned improperly. For example, if the information flow is too slow, bills cannot be sent out in a timely manner, and if information becomes irretrievable, payable services cannot be billed.
On the other hand, if Ms. Doe decides to refrain from signing-off the software, harm would come to Footech’s reputation in the fact that the software was not completed on time and, consequently, to budget. If word of this spread, it could make future prospective clients reluctant to use Foobar’s services. However, due to the risks involved, high-reliability bespoke projects with safety concerns projects, such as the Foobar 3.0 upgrade, tend to have a reputation for costing more and going over budget. Therefore, the Foobar project should be less time-critical and receive more leniencies from the client to ensure product meets specifications and is of sufficient quality. Overall, given the severity of the risks involved, the option of halting the release of the impaired Foobar software would create significantly less harm for stakeholders.
2.3.2 Resulting benefits
If Ms. Doe agrees to sign-off on her module of the project, the major benefit would be that the Foobar project meets all project milestones and the project is completed on time and on budget. At any rate, Ms. Doe’s concerns about system deficiencies may be unfounded or the deficiencies may not be serious enough to affect the overall operation of the system. It may be possible to simply make a note of the defect and monitor it closely through the maintenance and evolution phase of the software life cycle. However, choosing this option would only be morally correct if the defect would not detrimentally affect the performance of the product according to the requirements of the client. If this is the case, a benefit of not attempting to halt the release would be the avoidance of harm to Footech’s professional record and the penalties associated with exceeding time taken and budget. In this case, Ms. Doe would also benefit from not burdening management by ‘holding up the project’, keeping in tact her reputation for efficiency and prospects for promotion. Obviously, Dunidin City Hospital would also benefit by receiving the upgrade on time without the need to pay extra.