Abstract
Digital health is transforming healthcare systems worldwide. It promises benefits for population health but might also lead to health inequities. From an ethical perspective, it is hence much needed to adopt a fair approach. This article aims at outlining chances and challenges from an ethical perspective, focusing especially on the dimension of justice—a value, which has been described as the core value for public health. Analysed through the lenses of a standard approach for health justice—Norman Daniels’ account of just health and accountability for reasonableness—most recent and relevant literature was reviewed and challenges from a justice point of view were identified. Among them are challenges with regard to digital illiteracy, resulting inequities in access to healthcare, truthful information sharing to end users demanding fully informed consent, dignity and fairness in storage, access, sharing and ownership of data. All stakeholders involved bear responsibilities to shape digital health in an ethical and fair way. When all stakeholders, especially digital health providers and regulators, ensure that digital health interventions are designed and set up in an ethical and fair way and foster health equity for all population groups, there is a chance for this transformation resulting in a fair approach to digital health.
Highlights
Digital technology is already part of our daily lives
This article aims at outlining chances and challenges from an ethical perspective, focusing especially on the dimension of justice—a value, which has been described as the core value for public health
Especially digital health providers and regulators, ensure that digital health interventions are designed and set up in an ethical and fair way and foster health equity for all population groups, there is a chance for this transformation resulting in a fair approach to digital health
Summary
Digital technology is already part of our daily lives. We use smartphones to navigate our routes and order our purchases. Daniels argues that justice describes the social obligations to promote and restore health as a means to achieve individual opportunities and exercise individual autonomy.[10] He specifies that everyone should have fair access to public health and healthcare to have fair equality of opportunities in society, resulting in health equity.[5] Daniels states that fair processes are needed to ensure legitimacy and fairness His concept of accountability for reasonableness declares that policies should be made in a transparent way, based on reasonable arguments and with the option of being revised.[6] Such a public health justice approach towards the implications—the chances and challenges—of digital health can uncover what is ethically at stake, where responsibilities lie for those involved, and can guide and justify resulting policy choices. They are tied to aspects related to general governance (as for instance accountability and transparency) Besides these challenges, which can even result in physical, psychological or social harms to individuals,[11] there are chances for using digital health to establish fairer health systems. There is a benefit in terms of welfare for the public
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