Chapter 4 — Advanced risk and ethics

Lesson map

Lesson 04 published. Map, example, EX016.

flowchart TD
  N0["Learning outcomes"]
  N1["4.1 Risk with ranges"]
  N2["4.2 Patient safety and other harms"]
  N3["4.3 An ethical conflict"]
  N4["Synthesis"]
  N0 --> N1 --> N2 --> N3 --> N4
  N4 --> EX["Worked example"]
  EX --> Q["Exercise EX016"]

Logical drawing

flowchart LR
  N0["Learning outcomes"]
  N1["4.1 Risk with ranges"]
  N2["4.2 Patient safety and other harms"]
  N3["4.3 An ethical conflict"]
  N4["Synthesis"]
  N0 --> N1 --> N2 --> N3 --> N4 --> Q["EX016"]

[Learning outcomes]
    |
    v
[4.1 Risk with ranges]
    |
    v
[4.2 Patient safety and other harms]
    |
    v
[4.3 An ethical conflict]
    |
    v
[Synthesis]
    |
    v
[Worked example] --> [Exercise EX016]

Learning outcomes

You will (1) estimate risk with explicit uncertainty; (2) weigh patient safety against other harms; (3) handle an ethical conflict in architecture work.

4.1 Risk with ranges

Priya estimates the risk of a ransomware event reaching clinical devices. Rather than a single number, she gives ranges: a yearly likelihood between two and eight percent under current design, and impact from one to five days of clinic disruption. She explains each range by its sources, following NIST SP 800-30 Rev. 1. A Monte Carlo lab is not needed for the board; a simple low, likely and high case is clearer. Ranges show leaders how much is unknown and stop a precise-looking number from implying confidence that does not exist.

4.2 Patient safety and other harms

Health care adds a dimension most risk methods treat lightly: harm to patients. Priya separates three kinds of harm: patient safety, privacy and financial. She refuses to convert patient safety into money, because doing so hides an ethical judgement inside arithmetic. Instead she presents safety harm alongside the others and asks the clinical governance committee to weigh it. That committee, not the architecture team, holds authority over clinical risk. Placing decisions with the right body is part of the architect's ethical duty.

4.3 An ethical conflict

A vendor offers Corvane a discount if it delays segmentation by a year to align with the vendor's product release. The finance director favours accepting. Priya believes the delay exposes patients to avoidable risk. She documents her view, the risk ranges and the safety concern, and escalates to the clinical governance committee rather than overriding or silently accepting the decision. The committee rejects the delay. Priya reflects that professional ethics require making risk visible to those accountable, not deciding alone and not staying quiet.

Worked example

Priya gives risk ranges with sources, keeps patient safety separate from money and escalates a vendor-driven delay to the clinical governance committee.

Synthetic case. Figures, vendor and committees are synthetic; SP 800-30 Rev. 1 is real.

Errors and limits

Ranges can be too wide to guide action. Escalation without evidence can look like obstruction.

Exercises

• EX016 — Why ranges. Why give risk as ranges rather than single numbers?
  Show marking criteria

  Rubric: 3 = to show uncertainty and avoid false confidence;; 2 = uncertainty;; 1 = precision;; 0 = none.
• EX017 — Three harms. Which three kinds of harm did Priya separate?
  Show marking criteria

  Rubric: 3 = patient safety, privacy and financial;; 2 = two;; 1 = vague;; 0 = none.
• EX018 — Not monetising safety. Why not convert patient safety into money?
  Show marking criteria

  Rubric: 3 = it hides an ethical judgement inside arithmetic;; 2 = ethics;; 1 = easier;; 0 = none.
• EX019 — Right authority. Who holds authority over clinical risk at Corvane?
  Show marking criteria

  Rubric: 3 = the clinical governance committee;; 2 = committee;; 1 = architecture team;; 0 = none.
• EX020 — Handling the discount. How did Priya handle the vendor's delay offer?
  Show marking criteria

  Rubric: 3 = documented and escalated to the clinical governance committee;; 2 = escalated;; 1 = accepted;; 0 = none.

Synthesis

Advanced risk work states uncertainty honestly, keeps safety visible and places decisions with the accountable body.

Continue studying — chapter 04 of 12

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