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Therac-25 scenario: are operators between a rock and a hard place?
- You have been operating a Therac-25 unit for several months now. Even though the machine is new, rumors of problems have started to flow in from other places. From your standpoint, the machine is quite nice. For example, you are able to treat patients faster because the machine’s software automatically aligns the machine’s magnets and beams to produce the right kind of radiation treatment. One machine combines three functions: x-ray treatment, electron treatment, and a harmless beam that lets you target the machine on exactly the right place on the patient.
- Four issues concern you. First, the newest Therac machine has dismantled many hardware safety controls and replaced them with software controls. AECL assures you that this is safer because hardware is more reliable. But, as a hands-on kind of person, you like to have more control over the configuration and operation of the machine.
- Second, the patient and the machine are located in one room, but you carry out the radiation treatment from another room. This is for your safety, since you would be over exposed to radiation if you were to stay with all of your patients during their treatment. But your ability to monitor the treatment and the patient’s health depends on the audio and video monitoring systems. You know from past experience at the hospital, that these systems break down and the hospital maintenance staff is sometimes slow in getting around to repairs. You should decline to treat patients when these monitoring systems are not functioning but it is difficult for an operator to press this point with supervisors.
- Third, while initially the quicker patient turnover time allowed you to spend more time with each patient, there is now subtle but increasing pressure to fill in the additional time by treating more patients. You understand the hospital’s concern to carry out treatments as efficiently and economically as possible. But what kind of arguments can you give to your supervisors for treating fewer patients and spending more time with each? Is it your job to advocate for patient interests in this context?
- Finally, the computer interface with the operator simply provides inadequate information. When a treatment pause occurs, only a generic error message flashes on the screen. It would, in your opinion, be better if you knew the specific reason for the treatment pause. Furthermore, many of your counterparts have found ways to override the pauses. This saves time and money since resetting the machine and reentering the data takes up valuable time. Nevertheless, since you do not know the reason behind the pause, how do you know that the pause is not due to some dangerous machine state like an inadequate focusing of the photon beam? Is this a problem you need to bring to the attention of your supervisors?
- Your hospital administration is holding a meeting. Fifteen minutes has been allocated for a report from you and the other Therac-25 operators on how the machine has been performing to date. Prepare a short informal presentation that makes these concerns known to the administrators. Be sure to deal with the problems mentioned above but also take care to define your problems in terms your administrators would find clear and persuasive. For each problem suggest some solutions, say 2 or 3. Evaluate these solutions in ethical and non-ethical terms. Rank them.
Source:
OpenStax, Using the ethics bowl to integrate ethics into the business and professional curriculum. OpenStax CNX. Dec 20, 2009 Download for free at http://legacy.cnx.org/content/col10411/1.2
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