Abstract
Background eHealth promises to increase self-management and personalised medicine and improve cost-effectiveness in primary care. Paired with these promises are ethical implications, as eHealth will affect patients’ and primary care professionals’ (PCPs) experiences, values, norms, and relationships. Objectives We argue what ethical implications related to the impact of eHealth on four vital aspects of primary care could (and should) be anticipated. Discussion (1) EHealth influences dealing with predictive and diagnostic uncertainty. Machine-learning based clinical decision support systems offer (seemingly) objective, quantified, and personalised outcomes. However, they also introduce new loci of uncertainty and subjectivity. The decision-making process becomes opaque, and algorithms can be invalid, biased, or even discriminatory. This has implications for professional responsibilities and judgments, justice, autonomy, and trust. (2) EHealth affects the roles and responsibilities of patients because it can stimulate self-management and autonomy. However, autonomy can also be compromised, e.g. in cases of persuasive technologies and eHealth can increase existing health disparities. (3) The delegation of tasks to a network of technologies and stakeholders requires attention for responsibility gaps and new responsibilities. (4) The triangulate relationship: patient–eHealth–PCP requires a reconsideration of the role of human interaction and ‘humanness’ in primary care as well as of shaping Shared Decision Making. Conclusion Our analysis is an essential first step towards setting up a dedicated ethics research agenda that should be examined in parallel to the development and implementation of eHealth. The ultimate goal is to inspire the development of practice-specific ethical recommendations.
Highlights
Information and Communication Technologies (ICT) are increasingly permeating every aspect of our lives
We have made the first step towards morally responsible use of eHealth in primary care by providing an exploration of its ethical implications in primary care practice
EHealth may not necessarily revolutionise primary care, but it does bring about necessary reconfigurations of the practice
Summary
Information and Communication Technologies (ICT) are increasingly permeating every aspect of our lives. As new health technologies affect users’ experiences, values, norms, and relationships [19,20], the increasing use of digital technologies in primary care can be expected to profoundly affect professionals and patients in- and outside of the consultation room. These changes can affect day-to-day primary care practice and raise ethical questions that require attention.
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