Health technologies for self-management : an ethical appraisal of the impact of self-management technologies on doctor-patient relationships.

This thesis contributes to our understanding of the moral dimensions of using self-management technologies in general practice. Through qualitative interviews with general practitioners (GPs) and patients with experience in home blood pressure monitoring (HBPM) utilization, it examines the influences of HBPM on the general practitioner-patient relationship, patient responsibility for their health and patient autonomy. The first part of this thesis provides an account of the ethical implications of self-management technologies and their related practices for the doctor-patient relationship (DPR), patients’ responsibility for their health and patient autonomy. This account is contrasted with models of the DPR drawn from the bioethics and clinical literature, and with the conceptions of patient responsibility and patient autonomy that inform these models. Self-management technologies and their related practices have the potential to be more ethically robust than ordinary care. They may be able to influence patients’ health agency by promoting their cognitive and emotional abilities and, through this, change health outcomes for chronically-ill patients. However, there are a number of pertinent ethical issues concerning mutual trust in the DPR, patient responsibility and patient autonomy that need further empirical clarification. Building upon the theoretical material covered in the first part of the thesis, the second half describes an empirical study, which consisted of a series of interviews with GPs (n = 13) and patients (n = 19). HBPM was used as a case study for self-management technologies. The interviews focused on participants’ experiences with HBPM as a means to collect experiential narrative material relevant to answer the research questions. The findings are presented across two domains: the GP-patient relationship and patients’ responsibility for their health. GPs’ and patients’ views of these ethical notions are presented comparatively. Mutual trust in the DPR plays an important role in promoting patients’ motivation to maintain their health, which in turn, underpins all dimensions of patients’ responsibility for their health. In the final part of the thesis, these two themes from the empirical findings are drawn together with the theoretical material. I emphasize the significance of these findings for the bioethics literature concerning the DPR, patient responsibility and patient autonomy and for the conceptual base of self-management technologies. The implications of these conclusions for bioethics, general practice and public health are then considered.Thesis (Ph.D.) -- University of Adelaide, School of Population Health and Clinical Practice, 201