Abstract
The ubiquity of mobile applications makes it difficult to weigh up opportunities and potential risks. One significant aspect of an ethical assessment regarding the development and use of health and medical apps is the lack of clear and consistent guidelines and measures of value. Aim: The aim of this paper was to identify the main ethical determinants associated in the context of health and medical apps and develop a framework for ethical reflection. Methods: A systematic literature search in the database PubMed was undertaken and the journal Biomed Central Medical Ethics was hand searched and 32 met the review criteria. On this basis of the review an interview guide was developed and five purposively selected experts on the field of payers, science, consumers, medical ethics and society were interviewed regarding health and medical apps. Results: There is a lack of consistent and clear guidelines regarding the use of health and medical apps in literature. Indeed, findings refer to established biomedical principles. The interviews identified that several insecurities related to legal and regulatory issues are common. On the other hand, many advantages of the use of health and medical apps have been pointed out by experts. Conclusion: Debates on ethics and the use of health and medical apps should play a significant role in public discussion. Ethical endpoints cannot be considered isolated from each other, and must be regarded as a complex network of aspects connected with each other. Further research should concentrate on the development of consistent guidelines and a framework for reflection of occurring ethical concerns.
Highlights
Digitalisation is currently having an increasing impact on the health sector.[1]
The aim of this study is to develop a framework that shows the current state of discussion and expand it empirically, to provide a base for ethical reflection in the field of health and medical apps
Additional ethical aspects discussed in literature, such as privacy, regulation, transparency, access, control, social inequalities and discrimination, have been subsumed under these main categories. (Table 1) All references emphasise the use of health and medical apps from an additional ethical perspective, but with differences in application context
Summary
Digitalisation is currently having an increasing impact on the health sector.[1] In healthcare, the term "digitalisation" refers to eHealth and mHealth applications.[2] The use of modern information and communication technologies in the context of health and disease is summarised under the term eHealth.[3] As a part of this, health and medical apps become more important. Due to the high usage rates of new media and the associated simple accessibility for users, the range and possibilities of using health and medical apps is steadily growing.[4]. Medical apps could be helpful for selfmanagement through knowledge transfer or for promoting the motivational components, as well as being used as an application in therapy and diagnostics (e.g. monitoring of disease-relevant vital parameters). A strict differentiation of usage context is not entirely possible, since e.g. applications used to monitor certain parameters can be used in the field of treatment or research.[6]
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