Abstract
The widespread adoption of digital technologies raises important ethical issues in health care and public health. In our view, understanding these ethical issues demands a perspective that looks beyond the technology itself to include the sociotechnical system in which it is situated. In this sense, a sociotechnical system refers to the broader collection of material devices, interpersonal relationships, organizational policies, corporate contracts, and government regulations that shape the ways in which digital health technologies are adopted and used. Bioethical approaches to the assessment of digital health technologies are typically confined to ethical issues raised by features of the technology itself. We suggest that an ethical perspective confined to functions of the technology is insufficient to assess the broader impact of the adoption of technologies on the care environment and the broader health-related ecosystem of which it is a part. In this paper we review existing approaches to the bioethics of digital health, and draw on concepts from design ethics and science & technology studies (STS) to critique a narrow view of the bioethics of digital health. We then describe the sociotechnical system produced by digital health technologies when adopted in health care environments, and outline the various considerations that demand attention for a comprehensive ethical analysis of digital health technologies in this broad perspective. We conclude by outlining the importance of social justice for ethical analysis from a sociotechnical perspective.
Highlights
Hope in the promise of digital technologies to contribute to better health and health care continues to grow among many policymakers, health care providers, researchers and technology users around the world [1, 2]
There are alternative perspectives in the broad field of applied health ethics on which we could focus in our critique, such as public health ethics [19], we focus on bioethics because it is the dominant approach to ethical analysis for issues in health care and medicine [20]
The sociotechnical ethics of digital health we propose in this paper is based on a critique of the epistemic and normative foundations of much work done on digital health from within the field of bioethics
Summary
Hope in the promise of digital technologies to contribute to better health and health care continues to grow among many policymakers, health care providers, researchers and technology users around the world [1, 2]. We present a typology of domains in which ethical harms can be considered in an ethical analysis of digital health technologies from a sociotechnical perspective The purpose of this framework is to provide structure to a sociotechnical ethics approach to digital health, wherein the analyst can develop a sense of where one might look to identify the broader range of ethical issues we have referred to. A sociotechnical approach encourages the ethical analyst to engage in the work necessary to develop a clearer understanding of the ethical issues presented by a given application of digital health in these various domains Such an effort might require a review of social science literature on these topics, or new empirical research to uncover the implications of a particular technology and the ways in which it is produced and distributed. The broader view we articulate in this paper, and the practical implications we introduce here, help to promote the sustainable and ethical adoption of digital health technologies into the future
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