On November 10, Â鶹AV Desautels Dean Yolande E. Chan kicked off the Laidley Centre for Business Ethics (LCBE)’s inaugural business ethics conference, focused on ethical management in healthcare. Over a hundred community members, including academics, students, healthcare practitioners, bioethics and health technology researchers, and startups gathered to discuss the topic, particularly timely in a world still grappling with the aftermath of a global pandemic and adapting to the systemic challenges brought to light.
The first panel, “Ethics and Innovation in Healthcare,” addressed the tensions between patient-centered innovation and profitability. , Professor and Director of Clinical Performance, Transformation, and Innovation at the Â鶹AV Health Centre (MUHC), posited that researchers’ focus on patient well-being, paired with companies' focus on profitability, minimizes the necessary trust and collaboration to advance patient-centered technology. For example, , Co-Founder and CTO of FemTherapeutics Inc., explained that to lower competition, big companies will acquire smaller companies and the patient-centered innovations that their researchers spent years developing. In these cases, the bigger companies will often shelf those very innovations, ultimately sacrificing patient needs for profitability.
President and CEO of CIUSSS West-Central Montreal, suggested that “money isn’t the issue.” According to data from the , Canada spends more money per capita on healthcare than most other countries with public healthcare systems yet has one of the lowest numbers of doctors and hospital beds per capita, highlighting the need for equity-based policies to more effectively distribute healthcare.
Dr. Rosenberg also argued that while people think innovation equals technology, he sees it as a response to unmet needs, meaning that innovation does not necessarily refer to technology, but can also entail process or regulatory innovations. As Dr. Forster said, “Often innovation stumbles because we don’t have the rules.” Dr. Laurette DubĂ©, Chair and Scientific Director of Â鶹AV Centre for the Convergence of Health and Economics (MCCHE), maintained that we can’t look at the healthcare industry in isolation – we need to consider the laws and socioeconomic factors that underlie it. She suggests that using a convergence approach would create more synergy between healthcare and socioeconomics and help to address the costs and social determents of the healthcare industry.
Diving deeper into the socioeconomic factors that shape the industry, the second panel addressed inclusion and equity in healthcare. , Vice-Dean of Indigenous Health, Social Justice and Anti-Racism at the University of Manitoba, advocated for centering healthcare around marginalized communities, citing the impact of colonially-based education and income gaps on Indigenous health. “When we see these patterns, we have to remember that this could have been different. We have created these conditions through repeated policy choices.” Dr. Anderson’s groundbreaking work includes spearheading a first-of-its-kind to collect race-based data in Manitoba’s hospitals, informing policies that allocated additional resources to high-risk communities. When Indigenous people in Manitoba were given the earliest access to the rollout of a COVID-19 vaccine, she explained, it saved lives. When this equity-based decision was not made for off-reserve First Nations, there were higher rates of severe illness at younger ages.
Richard Budgell from Â鶹AV’s Department of Family Medicine also spoke about policy choices and health gaps, highlighting that Inuit People must travel huge distances to access healthcare. He suggested redirecting millions spent on medical transportation toward bolstering local healthcare capacity for Inuit communities. Associate Director of Â鶹AV’s Faculty of Medicine and Health Sciences (FMHS)’s Social Accountability and Community Engagement (SACE) Office, described research supporting the idea that having sociocultural representation on your healthcare team leads to better health outcomes. “It’s only meaningful when an organization does this kind of research if they are going to make policy decisions informed by it,” she cautions. Moreover, she emphasized the need to go to the communities we are researching (rather than simply sending surveys) and interviewing people in their own environments, thereby learning much about their lived experience and gaining a fuller picture of the inequities in healthcare accessibility they face.
Concluding the panel, Dr. Timothy Evans, Executive Director of the COVID-19 Immunity Task Force and Director of Â鶹AV’s School of Population and Global Health, suggested that equity-based policy must begin in the academy. He proposed instructional reform to teach future healthcare practitioners to become agents of ethical change and encouraged the investment in new institutions. “We need to double the amount of institutions to meet the needs of the people,” he argues, “changing the curriculum is not enough.” Additionally, he calls on institutions like Â鶹AV to rethink admissions policies and select medical students who better reflect the populations they will serve. Moreover, he argues, such institutions should be partnering with those in poorer regions—rather than only institutions in equally developed nations and of similar calibre—if we want to make a real difference in global health.
The final panel discussed ethical management of AI in healthcare. Dr. Samer Faraj, Professor in Strategy and Organization at Â鶹AV Desautels and Canada Research Chair in Technology, Innovation and Organizing, highlighted that AI development involves critical organizational choices. He stressed the importance of examining the composition of identities and professions in the room during development. , CEO of VitalTracer, discussed how used in US hospitals during COVID-19 contributed to a higher loss of life among Latin American and Black communities. The pulse oximeter was almost exclusively tested on white people, resulting in a product that on dark skin. Dastmalchi is currently creating a watch designed for all skin tones, using sensors and AI to measure bio-signals in real time. However, due to the historical mistreatment of people of colour in healthcare, recruiting willing participants for product testing poses a challenge.
This example illuminates that solutions must be based on representative populations, and safe and inclusive environments must be created to encourage participation in AI research. Because health data is so personal, Dr. Ignacio Cofone, Associate Professor and Canada Research Chair in Artificial Intelligence Law and Data Governance at Â鶹AV, advocated for data protection by design through the creation of systemic protections.
Healthcare System Partner at Roche Canada, explained that AI in healthcare is progressing more slowly due to heavy regulations. While AI regulations are still evolving, the need to consider ethics was reiterated. Panel moderator Dr. Nicholas King emphasized that much of what people think of as technical choices are actually ethical ones. Recalling the example of the pulse oximeter, he asserts that practitioners need to be trained to recognize the ethical aspects of technical decisions. This training, he contended, could shift the focus from profit to equity when developing products.
The conference sparked questions from participants, leading to insightful conversations. Audience member and medical education champion Richard Cruess suggested that institutionalizing bioethics principles could help renegotiate the contract between the patient and the healthcare system, potentially resolving many obstacles.
The conference concluded with remarks from Dr. Daniel Ding, Associate Professor in Operations Management at Â鶹AV, and Dr. Lindsay Holmgren, Director of the Laidley Centre for Business Ethics and Associate Professor in Strategy & Organization at Â鶹AV, who reaffirmed a collective commitment to incorporating ethical principles into the systems and institutions in which we all live and work.
Finally, thanks were given to (MBA’82), whose recent $4 million donation to the Laidley Centre will fund a lifetime position for a Chair in Business Ethics. His generous gift will enable the Centre to recruit a globally influential business ethics professor who will work to enhance the research component of the Centre’s mission as the Centre continues to bolster the dissemination of our business ethics research.
Ěý
