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Abstract
Most existing work in digital ethics is modeled on the “principlist” approach to medical ethics, seeking to articulate a small set of general principles to guide ethical decision-making. Critics have highlighted several limitations of such principles, including (1) that they mask ethical disagreements between and within stakeholder communities, and (2) that they provide little guidance for how to resolve trade-offs between different values. This paper argues that efforts to develop responsible digital health practices could benefit from paying closer attention to a different branch of medical ethics, namely public health ethics. In particular, I argue that the influential “accountability for reasonableness” (A4R) approach to public health ethics can help overcome some of the limitations of existing digital ethics principles. A4R seeks to resolve trade-offs through decision-procedures designed according to certain shared procedural values. This allows stakeholders to recognize decisions reached through these procedures as legitimate, despite their underlying disagreements. I discuss the prospects for adapting A4R to the context of responsible digital health and suggest questions for further research.
Highlights
Recent years have seen a proliferation of digital ethics guidelines
Many seeking to bring analytical clarity to this panoply have looked to medical ethics for inspiration [3, 4]
The rest of this paper will focus on how insights from public health ethics can help overcome the two limitations of purely principlist approaches to digital ethics I highlighted in the introduction, i.e., that they mask disagreements between and within different stakeholder communities and provide little guidance for how to resolve trade-offs
Summary
Recent years have seen a proliferation of digital ethics guidelines. There exist more than 160 such guidelines, the vast majority published within the last 5 years by a wide range of institutions, including governments, legislative bodies, technology companies, and academic and professional organizations [1]. Due to its focus on population/institution-level interventions, public health ethics mainly addresses questions of political morality rather than the ethics of the individual patient-clinician relationship [20] It provides a promising resource for addressing important political issues that arise from digital health. Public health ethics is a well-developed literature addressing practical political issues in healthcare, often closely informed by the empirical realities of healthcare policy and decision-making It can help broaden the range of questions digital health ethics addresses. The rest of this paper will focus on how insights from public health ethics can help overcome the two limitations of purely principlist approaches to digital ethics I highlighted in the introduction, i.e., that they mask disagreements between and within different stakeholder communities and provide little guidance for how to resolve trade-offs. Daniels and Sabin propose four conditions for legitimate decision-procedures [44, 45]: 1. Publicity: The rationale for a given decision must be publicly accessible
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