We argue that while digital health technologies (e.g. artificial intelligence, smartphones, and virtual reality) present significant opportunities for improving the delivery of healthcare, key concepts that are used to evaluate and understand their impact can obscure significant ethical issues related to patient engagement and experience. Specifically, we focus on the concept of empowerment and ask whether it is adequate for addressing some significant ethical concerns that relate to digital health technologies for mental healthcare. We frame these (...) concerns using five key ethical principles for AI ethics (i.e. autonomy, beneficence, non-maleficence, justice, and explicability), which have their roots in the bioethical literature, in order to critically evaluate the role that digital health technologies will have in the future of digital healthcare. (shrink)

Digital Health Tools (DHTs), also known as patient self-surveilling strategies, have increasingly been promoted by health-care policy makers as technologies that have the capacity to transform patients’ lives. At the heart of the debate is the notion of empowerment. In this paper, we argue that what is required is not so much empowerment but rather a shift to enabling DHTs as digital companions. This will enable policy makers and health-care system designers to provide a more (...) balanced view—one that capitalises on the benefits of DHTs, while minimising the risks of potential harms. -/- . (shrink)

The proposition that digital innovations can put people in charge of their health has been accompanied by prolific talk of empowerment. In this paper we consider ethical challenges and opportunities of trying to achieve justice and empowerment using digital health initiatives. The language of empowerment can misleadingly suggest that by using technology, people can control their health and take responsibility for health outcomes to a greater degree than is realistic or fair. Also, digital (...) health empowerment often primarily reaches people who already have high technological and health literacy, leaving others behind. We critically investigate whether the concept of health empowerment could be re-engineered to mean something different, namely the process of improving the health literacy and access of those who least possess it, in line with recent proposals for conceptual engineering in the service of justice. We settle on the weaker conclusion that underlying ethical values including justice should be used to interpret the existing concept of empowerment. To conclude, we take a high-level view of various strategies for achieving the ethical value associated with digital health empowerment. (shrink)

Wearable devices are increasingly present in the health context, as tools for biomedical research and clinical care. In this context, wearables are considered key tools for a more digital, personalised, preventive medicine. At the same time, wearables have also been associated with issues and risks, such as those connected to privacy and data sharing. Yet, discussions in the literature have mostly focused on either technical or ethical considerations, framing these as largely separate areas of discussion, and the contribution (...) of wearables to the collection, development, application of biomedical knowledge has only partially been discussed. To fill in these gaps, in this article we provide an epistemic (knowledgerelated) overview of the main functions of wearable technology for health: monitoring, screening, detection, and prediction. On this basis, we identify 4 areas of concern in the application of wearables for these functions: data quality, balanced estimations, health equity, and fairness. To move the field forward in an effective and beneficial direction, we present recommendations for the 4 areas: local standards of quality, interoperability, access, and representativity. (shrink)

In exploring the intra-active, relational and material connections between humans and non- humans, proponents of posthumanism advocate a questioning of the ‘human’ beyond its traditional anthropocentric conceptualization. By referring specifically to controversial developments in mHealth applications, this paper critically diverges from posthuman accounts of human/non-human assemblages. Indeed, we argue that, rather than ‘dissolving’ the human subject, the power of assemblages lie in their capacity to highlight the antagonisms and contradictions that inherently affirm the importance of the subject. In outlining this (...) claim, we propose a turn from the posthuman to the inhuman as a way of understanding the contemporary landscape of (digital) health. (shrink)

It has been suggested that to overcome the challenges facing the UK’s National Health Service (NHS) of an ageing population and reduced available funding, the NHS should be transformed into a more informationally mature and heterogeneous organisation, reliant on data-based and algorithmically-driven interactions between human, artificial, and hybrid (semi-artificial) agents. This transformation process would offer significant benefit to patients, clinicians, and the overall system, but it would also rely on a fundamental transformation of the healthcare system in a way (...) that poses significant governance challenges. In this article, we argue that a fruitful way to overcome these challenges is by adopting a pro-ethical approach to design that analyses the system as a whole, keeps society-in-the-loop throughout the process, and distributes responsibility evenly across all nodes in the system. (shrink)

Common mental health disorders are rising globally, creating a strain on public healthcare systems. This has led to a renewed interest in the role that digital technologies may have for improving mental health outcomes. One result of this interest is the development and use of artificial intelligence for assessing, diagnosing, and treating mental health issues, which we refer to as ‘digital psychiatry’. This article focuses on the increasing use of digital psychiatry outside of clinical (...) settings, in the following sectors: education, employment, financial services, social media, and the digital well-being industry. We analyse the ethical risks of deploying digital psychiatry in these sectors, emphasising key problems and opportunities for public health, and offer recommendations for protecting and promoting public health and well-being in information societies. (shrink)

At the beginning of the COVID-19 pandemic, high hopes were placed on digital contact tracing. Digital contact tracing apps can now be downloaded in many countries, but as further waves of COVID-19 tear through much of the northern hemisphere, these apps are playing a less important role in interrupting chains of infection than anticipated. We argue that one of the reasons for this is that most countries have opted for decentralised apps, which cannot provide a means of rapidly (...) informing users of likely infections while avoiding too many false positive reports. Centralised apps, in contrast, have the potential to do this. But policy making was influenced by public debates about the right app configuration, which have tended to focus heavily on privacy, and are driven by the assumption that decentralised apps are “privacy preserving by design”. We show that both types of apps are in fact vulnerable to privacy breaches, and, drawing on principles from safety engineering and risk analysis, compare the risks of centralised and decentralised systems along two dimensions, namely the probability of possible breaches and their severity. We conclude that a centralised app may in fact minimise overall ethical risk, and contend that we must reassess our approach to digital contact tracing, and should, more generally, be cautious about a myopic focus on privacy when conducting ethical assessments of data technologies. (shrink)

As COVID-19 spread, clinicians warned of mental illness epidemics within the coronavirus pandemic. Funding for digital mental health is surging and researchers are calling for widespread adoption to address the mental health sequalae of COVID-19. -/- We consider whether these technologies improve mental health outcomes and whether they exacerbate existing health inequalities laid bare by the pandemic. We argue the evidence for efficacy is weak and the likelihood of increasing inequalities is high. -/- First, we (...) review recent trends in digital mental health. Next, we turn to the clinical literature to show that many technologies proposed as a response to COVID-19 are unlikely to improve outcomes. Then, we argue that even evidence-based technologies run the risk of increasing health disparities. We conclude by suggesting that policymakers should not allocate limited resources to the development of many digital mental health tools and should focus instead on evidence-based solutions to address mental health inequalities. (shrink)

Public health scholars and public health officials increasingly worry about health-related misinformation online, and they are searching for ways to mitigate it. Some have suggested that the tools of digital influence are themselves a possible answer: we can use targeted, automated digital messaging to counter health-related misinformation and promote accurate information. In this commentary, I raise a number of ethical questions prompted by such proposals—and familiar from the ethics of influence and ethics of AI—highlighting (...) hidden costs of targeted digital messaging that ought to be weighed against the health benefits they promise. (shrink)

Can we identify potential long-term consequences of digitalisation on public health? Environmental studies, metabolic research, and state of the art research in neurobiology point towards the reduced amount of natural day and sunlight exposure of the developing child, as a consequence of increasingly long hours spent indoors online, as the single unifying source of a whole set of health risks identified worldwide, as is made clear in this review of currently available literature. Over exposure to digital environments, (...) from abuse to addiction, now concerns even the youngest (ages 0 to 2) and triggers, as argued on the basis of clear examples herein, a chain of interdependent negative and potentially long-term metabolic changes. This leads to a deregulation of the serotonin and dopamine neurotransmitter pathways in the developing brain, currently associated with online activity abuse and/or internet addiction, and akin to that found in severe substance abuse syndromes. A general functional working model is proposed under the light of evidence brought to the forefront in this review. (shrink)

Well before the COVID-19 pandemic, proponents of digital psychiatry were touting the promise of various digital tools and techniques to revolutionize mental healthcare. As social distancing and its knock-on effects have strained existing mental health infrastructures, calls have grown louder for implementing various digital mental health solutions at scale. Decisions made today will shape the future of mental healthcare for the foreseeable future. We argue that bioethicists are uniquely positioned to cut through the hype surrounding (...) digital mental health, which can obscure crucial ethical and epistemic gaps that ought to be considered by policymakers before committing to a digital psychiatric future. Here, we describe four such gaps: The evidence gap, the inequality gap, the prediction-intervention gap, and the safety gap. (shrink)

Low back pain (LBP) carries a high risk of chronicization and disability, greatly impacting the overall demand for care and costs, and its treatment is at risk of scarce adherence. This work introduces a new scenario based on the use of a mobile health tool, the Dress-KINESIS, to support the traditional rehabilitation approach. The tool proposes targeted self-manageable exercise plans for improving pain and disability, but it also monitors their efficacy. Since LBP prevention is the key strategy, the tool (...) also collects real-patient syndromic information, shares valid educational messages and fosters self-determined motivation to exercise. Our analysis is based on a comparison of the performance of the traditional rehabilitation process for non-specific LBP patients and some different scenarios, designed by including the Dress-KINESIS’s support in the original process. The results of the simulations show that the integrated approach leads to a better capacity for taking on patients while maintaining the same physiotherapists’ effort and costs, and it decreases healthcare costs during the two years following LBP onset. These findings suggest that the healthcare system should shift the paradigm towards citizens’ participation and the digital support, with the aim of improving its efficiency and citizens’ quality of life. (shrink)

Digital COVID certificates are a novel public health policy to tackle the COVID-19 pandemic. These immunity certificates aim to incentivize vaccination and to deny international travel or access to essential spaces to those who are unable to prove that they are not infectious. In this article, we start by describing immunity certificates and highlighting their differences from vaccination certificates. Then, we focus on the ethical, legal, and social issues involved in their use, namely autonomy and consent, data protection, (...) equity, and international mobility from a global fairness perspective. The main conclusion of our analysis is that digital COVID certificates are only acceptable if they meet certain conditions: that they should not process personal data beyond what is strictly necessary for the aimed goals, that equal access to them should be guaranteed, and that they should not restrict people’s autonomy to access places where contagion is unlikely. We conclude that, if such conditions are guaranteed, digital COVID certificates could contribute to mitigating some of the most severe socioeconomic consequences of the pandemic. (shrink)

Alongside the increasing popularity of digital, ‘social’ media platforms, has been the emergence of self-styled digital life-coaches, many of whom seek to propagate their knowledge of and interests in a variety of topics through online social networks (such as, Facebook, Youtube, Instagram, etc.). With many of these ‘social influencers’ garnering a large online following, their popularity, social significance and cultural impact offers important insights into the place and purpose of the subject in our digital media environment. Accordingly, (...) this chapter will examine the proliferation of digital media technologies, which, on the one hand, propose the dissolution of the subject (wearable technology, technological singularity, etc.), while on the other, provide new opportunities for discovering, ‘sharing’ and/or improving one’s ‘inner-Self’ (digital media gurus, online health and fitness regimes, etc.). It is in considering how the effects of this ‘digital subject’ redefines traditional (Cartesian) conceptions, that the relative significance of ‘Digital Guru Media’ (DGM) can be drawn. In particular, explicit attention is given to examining how our engagements with social media can be considered in relation to Lacan’s (2002) notion of the big Other and its relevance in introducing, examining and, possibly, subverting, the digital media guru. (shrink)

Online therapy sessions and other forms of digital mental health services (DMH) have seen a sharp spike in new users since the start of the COVID-19 pandemic. Having little access to their social networks and support systems, people have had to turn to digital tools and spaces to cope with their experiences of anxiety and loss. With no clear end to the pandemic in sight, many of us are likely to remain reliant upon DMH for the foreseeable (...) future. As such, it is important to articulate some of the specific ways in which the pandemic is affecting our self and world-relation, such that we can identify how DMH services are best able to accommodate some of the newly emerging needs of their users. In this paper I will identify a specific type of loss brought about by the COVID-19 pandemic and present it as an important concept for DMH. I refer to this loss as loss of perceptual world-familiarity. Loss of perceptual world-familiarity entails a breakdown in the ongoing effortless responsiveness to our perceptual environment that characterizes much of our everyday lives. To cash this out I will turn to insights from the phenomenological tradition. Initially, my project is descriptive. I aim to bring out how loss of perceptual world-familiarity is a distinctive form of loss that is deeply pervasive yet easily overlooked-hence the relevance of explicating it for DMH purposes. But I will also venture into the space of the normative, offering some reasons for seeing perceptual world-familiarity as a component of well-being. I conclude the paper with a discussion of how loss of perceptual world-familiarity affects the therapeutic setting now that most if not all therapeutic interactions have transitioned to online spaces and I explore the potential to augment these spaces with social interaction technologies. Throughout, my discussion aims to do justice to the reality that perceptual world-familiarity is not an evenly distributed phenomenon, that factors like disability, gender and race affect its robustness, and that this ought to be reckoned with when seeking to incorporate the phenomenon into or mitigate it through DMH services. (shrink)

The technological revolution and appropriation of internet tools began to reshape the material basis of society and the urban space in collaborative, grassroots, leaderless, and participatory actions. The protest squares’ representation on Television screens and mainstream media has been broad. Various health, governmental, societal, and urban challenges have marked the advent of the Covid-19 virus. Inequalities have become more salient as poor people and minorities are more affected by the virus. Social distancing makes the typical forms of protest impossible (...) to carry out. Under social distancing, some state-led policies took advantage of social media to focus on the Covid-19 pandemic to silence social and political activities, censor criticism, and control the press. However, during the pandemic era, the movements for social justice have been particularly active, focusing on defending workers’ rights, mutual aid and solidarity, monitoring policymakers, and popular education. These progressive movements combined concrete practices and experiences to confront the reactionary, capitalist, and governmental actors that sought to shape and envision the world. Through different case studies of protest movements during the pandemic in Europe, the UK, and Asia, this paper argues that at the time of rising racial, social, and economic inequalities, the social activities adapted to the circumstances determined by the social distancing and the impossibility of people gathering in physical spaces. Subsequently, the people in different countries had various individual and collective responses to the support of health workers, systemic inequalities, loss of jobs, and other societal and financial challenges imposed by the governments. It means that, rather than disappearing, the social movements have adapted to the unexpected situations during the pandemic outbreak. The pandemic broke the new digital global wave of protests in this sense. (shrink)

Health data processing fields face ethical and legal problems regarding fundamental rights. As we know, patients can benefit in the Digital Era from having health or medical information available, and medical decisions can be more effective with a better understanding of clinical histories, medical and health data thanks to the development of Artificial Intelligence, Internet of Things and other Digital technologies. However, at the same time, we need to guarantee fundamental rights, including privacy ones. The (...) complaint about ethical and legal requirements – including constitutional ones – is particularly relevant in the processing of health data. This paper is focused on the problem of the consent required to the processing of health data and the exceptions established in the new European Union General Data Regulation, which cover the processing of this special data -within other aims- for scientific, historical and statistical research as legitimate purposes, which include biomedical research. The conclusion is that these open concepts are problematic both for the protection of privacy rights and for the legal security/certainty of research. On one hand there are several interpretation problems, regarding the processing of health data and the protection of information privacy. On the other hand, professionals must follow the Multilevel legal framework and to guarantee fundamental rights in the processing of health data, so there are also problems of interpretation for researchers. Therefore, we need a clearer legal framework for biomedical research. (shrink)

Through this contribution I aim to explore the horizons and limits of digital medicine in light of an embodied approach to the issue of care. I will sketch the historical background of digital medicine and show the contemporary status of this interdisciplinary field, as well as its applications and outcomes. Then, I will address a critique of the computational theory of mind (CTM) upon which many contemporary mental health apps are designed. This approach to the mind is (...) inscribed into the modern trend of neuromania, which conceives the embodied, living human being as a mere series of data analyses and algorithms, with the brain as the seat of the person. Drawing on continental philosophy and classical phenomenology I will develop a notion of health conceived as a moral enterprise, showing how wellbeing and vitality are not reducible to a product made by technologies or doctors, but rather they are the results of an embodied encounter. As such, empathy and person-centered care cannot be achieved by digital medicine. They are the result of a journey into the regions of recognition, embodied presence and the aliveness constituting the person. Finally, I will show how the issue of care cannot be separated from an embodied encounter between people, especially in case of dementia. (shrink)

Background: The concept of digital twins has great potential for transforming the existing health care system by making it more personalized. As a convergence of health care, artificial intelligence, and information and communication technologies, personalized health care services that are developed under the concept of digital twins raise a myriad of ethical issues. Although some of the ethical issues are known to researchers working on digital health and personalized medicine, currently, there is no (...) comprehensive review that maps the major ethical risks of digital twins for personalized health care services. Objective: This study aims to fill the research gap by identifying the major ethical risks of digital twins for personalized health care services. We first propose a working definition for digital twins for personalized health care services to facilitate future discussions on the ethical issues related to these emerging digital health services. We then develop a process-oriented ethical map to identify the major ethical risks in each of the different data processing phases. Methods: We resorted to the literature on eHealth, personalized medicine, precision medicine, and information engineering to identify potential issues and developed a process-oriented ethical map to structure the inquiry in a more systematic way. The ethical map allows us to see how each of the major ethical concerns emerges during the process of transforming raw data into valuable information. Developers of a digital twin for personalized health care service may use this map to identify ethical risks during the development stage in a more systematic way and can proactively address them. Results: This paper provides a working definition of digital twins for personalized health care services by identifying 3 features that distinguish the new application from other eHealth services. On the basis of the working definition, this paper further layouts 10 major operational problems and the corresponding ethical risks. Conclusions: It is challenging to address all the major ethical risks that a digital twin for a personalized health care service might encounter proactively without a conceptual map at hand. The process-oriented ethical map we propose here can assist the developers of digital twins for personalized health care services in analyzing ethical risks in a more systematic manner. (shrink)

Purpose. The purpose of this study is to investigate how professionals learn from varying experiences with errors in health-care digitalization and develop and use negative knowledge and digital ignorance in efforts to improve digitalized health care. Design/methodology/approach. A two-year qualitative field study was conducted in the context of a public health-care organization working with digital patient communication. The data consisted of participant observation, semistructured interviews and document data. Inductive coding and a theoretically informed generation of (...) themes were applied. Findings. The findings show that both health-care and digital communication professionals learn through experiences with digital “rule-” and “knowledge-based” errors in patient communication and develop negative knowledge and awareness of digital ignorance. In their joint efforts, they use negative knowledge to “bend the rules” and to explore digital ignorance in efforts to improve patient communication. Originality/value. This study provides insight into the importance of collaboration between professionals with varying experience of errors in digitalizing patient communication. Such collaboration is required to acknowledge own shortcomings and create complementary negative knowledge to improve digital patient communication. This is particularly important when working with innovative digitalization in health care. (shrink)

This chapter serves as an introduction to the edited collection of the same name, which includes chapters that explore digital well-being from a range of disciplinary perspectives, including philosophy, psychology, economics, health care, and education. The purpose of this introductory chapter is to provide a short primer on the different disciplinary approaches to the study of well-being. To supplement this primer, we also invited key experts from several disciplines—philosophy, psychology, public policy, and health care—to share their thoughts (...) on what they believe are the most important open questions and ethical issues for the multi-disciplinary study of digital well-being. We also introduce and discuss several themes that we believe will be fundamental to the ongoing study of digital well-being: digital gratitude, automated interventions, and sustainable co-well-being. (shrink)

This chapter serves as an introduction to the edited collection of the same name, which includes chapters that explore digital well-being from a range of disciplinary perspectives, including philosophy, psychology, economics, health care, and education. The purpose of this introductory chapter is to provide a short primer on the different disciplinary approaches to the study of well-being. To supplement this primer, we also invited key experts from several disciplines—philosophy, psychology, public policy, and health care—to share their thoughts (...) on what they believe are the most important open questions and ethical issues for the multi-disciplinary study of digital well-being. We also introduce and discuss several themes that we believe will be fundamental to the ongoing study of digital well-being: digital gratitude, automated interventions, and sustainable co-well-being. (shrink)

Growing demand for broadly accessible mental health care, together with the rapid development of new technologies, trigger discussions about the feasibility of psychotherapeutic interventions based on interactions with Conversational Artificial Intelligence (CAI). Many authors argue that while currently available CAI can be a useful supplement for human-delivered psychotherapy, it is not yet capable of delivering fully fledged psychotherapy on its own. The goal of this paper is to investigate what are the most important obstacles on our way to developing (...) CAI systems capable of delivering psychotherapy in the future. To this end, we formulate and discuss three challenges central to this quest. Firstly, we might not be able to develop effective AI-based psychotherapy unless we deepen our understanding of what makes human-delivered psychotherapy effective. Secondly, assuming that it requires building a therapeutic relationship, it is not clear whether psychotherapy can be delivered by non-human agents. Thirdly, conducting psychotherapy might be a problem too complicated for narrow AI, i.e., AI proficient in dealing with only relatively simple and well-delineated tasks. If this is the case, we should not expect CAI to be capable of delivering fully-fledged psychotherapy until the so-called “general” or “human-like” AI is developed. While we believe that all these challenges can ultimately be overcome, we think that being mindful of them is crucial to ensure well-balanced and steady progress on our path to AI-based psychotherapy. (shrink)

Introduction: How enterprises should practice digitalization transformation to effectively improve green innovation performance is related to the sustainable development of enterprises and the economy, which is an important issue that needs to be clarified. -/- Methods: This research uses the perspective of production and operation to deconstruct the digitalization of industrial listed enterprises from 2016 to 2020 into six features. A variety of machine learning methods are used, including DBSCAN, CART and other algorithms, to specifically explore the complex impact of (...) enterprise digitalization feature configuration on green innovation performance. -/- Conclusions: (1) The more advanced digitalization transformation the enterprises have, the more possibly the high green innovation performance can be achieved. (2) Digitalization innovation is the digitalization element with the strongest influence ability on green innovation performance. (3) As the advancement of digitalization transformation, enterprises should also focus on digitalization innovation input and digitalization operation output, otherwise they should pay attention to digitalization management and digitalization operation output. -/- Discussion: The conclusions of this research will help enterprises understand their digitalization competitiveness and how to practice digitalization transformation to enhance green innovation performance, and also help the government to formulate policies to promote the development of green innovation in the digital economy era. (shrink)

Digital phenotyping will potentially enable earlier detection and prediction of mental illness by monitoring human interaction with and through digital devices. Notwithstanding its promises, it is certain that a person’s digital phenotype will at times be at odds with their first-person testimony of their psychological states. In this paper, we argue that there are features of digital phenotyping in the context of psychiatry which have the potential to exacerbate the tendency to dismiss patients’ testimony and treatment (...) preferences, which can be instances of epistemic injustice. We first explain what epistemic injustice is, and why it is argued to be an extensive problem in health and disability settings. We then explain why epistemic injustice is more likely to apply with even greater force in psychiatric contexts, and especially where digital phenotyping may be involved. Finally, we offer some tentative suggestions of how epistemic injustice can be minimised in digital psychiatry. (shrink)

Innovation is progressively needed in responding to global challenges. Moreover, the increasing complexity of challenges implies demand for the usage of multisectoral and policy mix approaches. Wicked problems can be tackled by "integrated innovation" that combines the coordinated implementation of social, technological, and health innovation co-created by entities of the public sector, the private sector, the non-governmental sector, and the informal sector. This Research Topic focuses on filling the knowledge gaps about the selected types of innovation. First, regarding social (...) innovation that can be understood as new strategies, concepts, products, services, and organizational forms that allow the satisfaction of human needs. Second, a technological innovation that refers to new or remarkably improved products, goods, or services in terms of their technical specifications, components, materials, software, design, or other functional features. Third, health innovation that focuses on novel or enhanced health policies, systems, products, technologies, services, and care delivery schemes to improve people’s health. Finally, this Research Topic highlights attempts to develop integrated innovation that can add value to social policy, health policy, and environmental policy by improving efficiency, effectiveness, quality, sustainability, safety, and affordability. (shrink)

The growth and development of children are closely related to the role of a mother, not a few mothers, and having the task of caring for children and working women, which will lead to suboptimal childcare. At this time, many android-based information system facilities that can be used to streamline child care for a mother who is a working woman. This study aimed to provide an overview and ideas of using android-based digital media in childcare to maximize children's growth (...) and development for working mothers with a literature review method. From the study results and review of 10 selected journals, it was concluded that for parents of workers who cannot maximize childcare time or parenting time, many applications could facilitate parents to monitor the child's growth and development safely. The development of a child health nursing management information system can include healthy children, sick children, education, environment, and parenting patterns. The implication of developing a child health nursing management information system during parenting is very useful ad preventive and promotive action in children’s health. Child nurses can effectively, efficiently, quickly, and accurately identify problems that arise in the preventive process so that they are expected to make nursing interventions that are also right on target. (shrink)

Recent years have seen growing public concern about the effects of persuasive digital technologies on public mental health and well-being. As the draws on our attention reach such staggering scales and as our ability to focus our attention on our own considered ends erodes ever further, the need to understand and articulate what is at stake has become pressing. In this ethical viewpoint, we explore the concept of attentional harms and emphasize their potential seriousness. We further argue that (...) the acknowledgment of these harms has relevance for evolving debates on digital inequalities. An underdiscussed aspect of web-based inequality concerns the persuasions, and even the manipulations, that help to generate sustained attentional loss. These inequalities are poised to grow, and as they do, so will concerns about justice with regard to the psychological and self-regulatory burdens of web-based participation for different internet users. In line with calls for multidimensional approaches to digital inequalities, it is important to recognize these potential harms as well as to empower internet users against them even while expanding high-quality access. (shrink)

This paper focuses on Precision Public Health (PPH), described in the scientific literature as an effort to broaden the scope of precision medicine by extrap- olating it towards public health. By means of the “All of Us” (AoU) research pro- gram, launched by the National Institutes of Health in the U.S., PPH is being devel- oped based on health data shared through a broad range of digital tools. PPH is an emerging idea to harness the (...) data collected for precision medicine to be able to tai- lor preventive interventions for at-risk groups. The character of these data concern genetic identity, lifestyle and overall health and therefore affect the ‘intimacy’ of personhood. Through the concept of biological citizenship, we elucidate how AoU and its recruitment tactics, by resonating ‘diversity’, at the same time appeal to and constitute identity, defining individuals as ‘data sharing subjects’. Although PPH is called for; the type of bio-citizenship that is enacted here, has a particular definition, where participant recruitment focuses on ‘citizenship’ in terms of empowerment (front), it is the ‘bio’ prefix that has become the main focus in terms of research. i.e. biosubjectivities vs biocapital. This raises the question whether the societal chal- lenges that often underlie public health issues can be sufficiently dealt with based on the way ‘diversity’ is accounted for in the program. We suggest that the AoU still risks of harming underrepresented groups based on the preconditions and the design of the program. (shrink)

This chapter provides a high-level overview of key ethical issues raised by the use of surveillance technologies, such as digital contact tracing, disease surveillance, and vaccine passports, to combat the COVID-19 pandemic. To some extent, these issues are entirely familiar. I argue that they raise old questions in new form and with new urgency, at the intersection of information ethics, research ethics, and public health. Whenever we deal with data-driven technologies, we have to ask how they fare in (...) relation to important values like privacy, fairness, transparency, and accountability—values emphasized by information ethics scholars. Likewise, when such technologies put individuals at risk in order to drive scientific research and knowledge construction, we have to ask how they implicate values such as autonomy, beneficence and non-maleficence, and justice—values central to research ethics. And as researchers focusing on health information have long argued, when the data collected by these technologies pertain to individuals and public health, these ethical issues take on a special cast. -/- It is also true, however, that the pandemic has placed these questions in a new and revealing light. I highlight three insights from information ethics and research ethics that can help us navigate this difficult terrain. First, the value of privacy is instrumental, not absolute—there is nothing wrong with asking how to balance privacy against other important values. Second, privacy has both individual and social importance. Weighing privacy, on one hand, and public health, on the other, is not, therefore, a contest between individual and collective interests. Rather, it is an attempt to balance disparate public goods. Third, we ought to put these kinds of ethical decisions in the hands of third parties, rather than leaving them up to those who directly stand to benefit from them. In the case of pandemic surveillance technologies, this should mean more public, democratic oversight. (shrink)

In December 2019 an infectious coronavirus disease, commonly known as COVID-19, was identified in Wuhan, China. The disease spread rapidly and became a global pandemic. New Zealand’s first COVID-19 case was confirmed on 28 February 2020, after which the number of cases began to rise significantly, prompting the New Zealand Government to introduce a nationwide lockdown on 25 March 2020. This factsheet reports early findings from a quantitative study with adult New Zealanders. It explores how prevalent the experiences of unwanted (...) digital communication were in the last 12 months, before, during, and just after the nationwide COVID 19 lockdown. This study found a higher prevalence of unwanted digital communications around the time of the nationwide COVID-19 lockdown. This study’s findings suggest that unexpected health and social events, such as the COVID-19 pandemic and compulsory lockdown, are factors that can trigger changes in people’s experiences of online risk from unwanted digital communications. (shrink)

Defining Ecosophy (ecological wisdom) like a contemporary philosophy of survival, security and a sustainable Human Development, terrestrial nature and society, the author of this article approaches the correlation between it and the digital version of security in the context of new technologies. Human survival is in connection with the protection, optimal functioning of the natural environment and the development of human society. Human evolution, physical and psychological (the issues of Anthropoecology, a medical-biological science, deals with them), depends on the (...) natural and social environment, on the development of new techniques and technologies. New technologies (nano-, bio-, info-, socio-technologies) can ensure the security and the increasing development of the human being, but they can threaten it too. The author does not deny behaviours, the possibility that human intellect could be non-biological. Moreover, the author believes if it comes to it, that we will not be able to speak about the human species. New technologies like the traditional and less new, are intended to help in solving various problems related to health, society interactions with nature, human society and diverse cultures, societies and states. The philosophy of security and the digital one, like the components of Ecosophy, along with philosophical aspects of Anthropoecology, General Ecology and Social Ecology, needs like any other science or philosophy to elaborate systems of concepts, principles and laws. (shrink)

Traditional medical practices and relationships are changing given the widespread adoption of AI-driven technologies across the various domains of health and healthcare. In many cases, these new technologies are not specific to the field of healthcare. Still, they are existent, ubiquitous, and commercially available systems upskilled to integrate these novel care practices. Given the widespread adoption, coupled with the dramatic changes in practices, new ethical and social issues emerge due to how these systems nudge users into making decisions and (...) changing behaviours. This article discusses how these AI-driven systems pose particular ethical challenges with regards to nudging. To confront these issues, the value sensitive design approach is adopted as a principled methodology that designers can adopt to design these systems to avoid harming and contribute to the social good. The AI for Social Good factors are adopted as the norms constraining maleficence. In contrast, higher-order values specific to AI, such as those from the EU High-Level Expert Group on AI and the United Nations Sustainable Development Goals, are adopted as the values to be promoted as much as possible in design. The use case of Amazon Alexa's Healthcare Skills is used to illustrate this design approach. It provides an exemplar of how designers and engineers can begin to orientate their design programs of these technologies towards the social good. (shrink)

This edited volume is designed to explore different perspectives of culture, identity and social development using the impact of the digital age as a common thread, aiming at interdisciplinary audiences. Cases of communities and individuals using new technology as a tool to preserve and explore their cultural heritage alongside new media as a source for social orientation ranging from language acquisition to health-related issues will be covered. Therefore, aspects such as Art and Cultural Studies, Media and Communication, Behavioral (...) Science, Psychology, Philosophy and innovative approaches used by creative individuals are included. From the Aboriginal tribes of Australia, to the Maoris of New Zealand, to the mystical teachings of Sufi brotherhoods, the significance of the oral and written traditions and their current relation to online activities shall be discussed in the opening article. The book continues with a closer look at obesity awareness support groups and their impact on social media, Facebook usage in language learning context, smartphone addiction and internet dependency, as well as online media reporting of controversial ethical issues. The Digital progress has already left its dominating mark as the world entered the 21st century. Without a doubt, as technology continues its ascent, society will be faced with new and altering values in an effort to catch-up with this extraordinary Digitization, adapt satisfactorily in order to utilize these strong developments in everyday life. (shrink)

Abstract: The field of life extension is full of ideas but they are unstructured. Here we suggest a comprehensive strategy for reaching personal immortality based on the idea of multilevel defense, where the next life-preserving plan is implemented if the previous one fails, but all plans need to be prepared simultaneously in advance. The first plan, plan A, is the surviving until advanced AI creation via fighting aging and other causes of death and extending one’s life. Plan B is cryonics, (...) which starts if plan A fails, and assumes cryopreservation of the brain until technical capabilities to return it to life appear. Plan C is digital immortality in the sense of collecting data about the person now so future AI will be able to recreate a model of a person. Plan D is the hope based on some unlikely scenarios of infinite survival, like so-called “quantum immortality”. All these plans have personal and social perspective. The personal aspect means efforts of the increasing chances of personal survival via taking care about one’s own health, signing cryocontract or collecting digital immortality data. The social aspect means the participation in collective work towards creation and increase of the availability of life extension technologies, which includes funding scientific research, promotion of life extension value and direct performing of research and implementation, as well as preventing global catastrophic risk. All plans converge at the end, as their result is the indefinite survival as an uploaded mind inside an ecosystem, created by a superintelligent AI. (shrink)

For many employees, ‘work’ is no longer something performed while sitting at a computer in an office. Employees in a growing number of industries are expected to carry mobile devices and be available for work-related interactions even when beyond the workplace and outside of normal business hours. In this article it is argued that a future step will increasingly be to move work-related information and communication technology (ICT) inside the human body through the use of neuroprosthetics, to create employees who (...) are always ‘online’ and connected to their workplace’s digital ecosystems. At present, neural implants are used primarily to restore abilities lost through injury or illness, however their use for augmentative purposes is expected to grow, resulting in populations of human beings who possess technologically altered capacities for perception, memory, imagination, and the manipulation of physical environments and virtual cyberspace. Such workers may exchange thoughts and share knowledge within posthuman cybernetic networks that are inaccessible to unaugmented human beings. Scholars note that despite their potential benefits, such neuroprosthetic devices may create numerous problems for their users, including a sense of alienation, the threat of computer viruses and hacking, financial burdens, and legal questions surrounding ownership of intellectual property produced while using such implants. Moreover, different populations of human beings may eventually come to occupy irreconcilable digital ecosystems as some persons embrace neuroprosthetic technology, others feel coerced into augmenting their brains to compete within the economy, others might reject such technology, and still others will simply be unable to afford it. In this text we propose a model for analyzing how particular neuroprosthetic devices will either facilitate human beings’ participation in new forms of socioeconomic interaction and digital workplace ecosystems – or undermine their mental and physical health, privacy, autonomy, and authenticity. We then show how such a model can be used to create device ontologies and typologies that help us classify and understand different kinds of advanced neuroprosthetic devices according to the impact that they will have on individual human beings. (shrink)

Objectives: In recent years, adolescents spend increasingly more time on technologic devices such as smartphones, televisions, computers, and tablets. The aim of the present study was to investigate the relationship between the usage of digital technology and health-related problems among adolescents. -/- Methods: A cross-sectional exploratory study was conducted by using a face-to-face survey administered to a sample of students studying at 4 randomly chosen public middle school and 4 randomly chosen public high school in the city of (...) Istanbul. In this study recruited 1147 volunteer adolescents. All participants were answered a questionnaire regarding the demographic characteristics, technological devices useage patterns and health-related problems. -/- Results: Most of the adolescents had smartphones (99.4%) and the fewest had game consoles (18.2%). The rate of using television and smartphone for more than two hours a day among adolescents was 13.1% and 28.4%, respectively. A decrease in sleep duration, increase in falling asleep time, distraction, fatigue, eating disorders and psychological symptoms were significantly more present for individuals using smartphone more than two hours. A positive and very weak relationship was detected between the duration of smartphone use and neck (r=0.096; p=0.002), wrist (r=0.079; p=0.008) and shoulder (r=0.069; p=0.021) pain. Also, positive and very weak relationship was detected between the duration of computer use and upper back (r=0.102; p=0.001), lower back (r=0.078; p=0.011) and shoulder (r=0.069; p=0.041) pain. -/- Conclusion: This study showed the most widely used technological device among adolescents is smartphones and it was observed that the excessive use of this device among adolescents is more associated with many different health-related problems than other technological devices. (shrink)

This article addresses the general ethical issues of accessing online personal data for research purposes. The authors discuss the practical aspects of online research with a specific case study that illustrates the ethical challenges encountered when accessing data from Kooth, an online youth web-counselling service. This paper firstly highlights the relevance of a process-based approach to ethics when accessing highly sensitive data and then discusses the ethical considerations and potential challenges regarding the accessing of public data from Digital Mental (...) Health services. It presents solutions that aim to protect young DMH service users as well as the DMH providers and researchers mining such data. Special consideration is given to service users’ expectations of what their data might be used for, as well as their perceptions of whether the data they post is public, private or open. We provide recommendations for planning and designing online research in an ethical manner that includes vulnerable young people as research participants. We emphasise the distinction between public, private and open data, which is crucial to comprehend the ethical challenges in accessing DMH data. Among our key recommendations, we foreground the need to consider a collaborative approach with the DMH providers while respecting service users’ control over personal data, and we propose the implementation of digital solutions embedded within the platform for explicit opt-out/opt-in recruitment strategies and ‘read more’ options. (shrink)

This article argues that personal medical data should be made available for scientific research, by enabling and encouraging individuals to donate their medical records once deceased, similar to the way in which they can already donate organs or bodies. This research is part of a project on posthumous medical data donation developed by the Digital Ethics Lab at the Oxford Internet Institute at the University of Oxford. Ten arguments are provided to support the need to foster posthumous medical data (...) donation. Two major risks are also identified—harm to others, and lack of control over the use of data—which could follow from unregulated donation of medical data. The argument that record-based medical research should proceed without the need to secure informed consent is rejected, and instead a voluntary and participatory approach to using personal medical data should be followed. The analysis concludes by stressing the need to develop an ethical code for data donation to minimise the risks, and offers five foundational principles for ethical medical data donation suggested as a draft code. (shrink)

This article argues that personal medical data should be made available for scientific research, by enabling and encouraging individuals to donate their medical records once deceased, in a way similar to how they can already donate organs or bodies. This research is part of a project on posthumous medical data donation developed by the Digital Ethics Lab at the Oxford Internet Institute. Ten arguments are provided to support the need to foster posthumous medical data donation. Two major risks are (...) also identified—harm to others, and lack of control over the use of data—which could follow from unregulated donation of medical data. The argument that record-based medical research should proceed without the need to ask for informed consent is rejected, and it instead a voluntary and participatory approach to using personal medical data should be followed. The analysis concludes by stressing the need to develop an ethical code for data donation to minimise the risks providing five foundational principles for ethical medical data donation; and suggesting a draft for such a code. (shrink)

Digital technologies hold promise to modernize healthcare. Such opportunity should be leveraged also to address the needs of rapidly ageing populations. Against this backdrop, this paper examines the use of wearable devices for promoting healthy ageing. Previous work has assessed the prospects of digital technologies for health promotion and disease prevention in older adults. However, to our knowledge, ours is one of the first attempts to specifically address the use of wearables for healthy ageing, and to offer (...) ethical insights for assessing the prospects of leveraging wearable devices in this context. We provide an analysis of the considerable opportunities associated with the use of wearables for healthy ageing, with a focus on the five domains of intrinsic capacity: locomotion, sensory functions, psychological aspects, cognition, and vitality. We then highlight current limitations and ethical challenges of such approach to healthy ageing, including issues related to access, inclusion, privacy, surveillance, autonomy, and regulation. We conclude by discussing the implications of our analysis in light of current debates on the ethics of digital health, and suggest measures to address the identified challenges. (shrink)

Universal health coverage (UHC) is at the center of current efforts to strengthen health systems and improve the level and distribution of health and health services. This document is the final report of the WHO Consultative Group on Equity and Universal Health Coverage. The report addresses the key issues of fairness and equity that arise on the path to UHC. As such, the report is relevant for every actor that affects that path and governments in (...) particular, as they are in charge of overseeing and guiding the progress toward UHC. (shrink)

This article highlights the limitations of the tendency to frame health- and wellbeing-related digital tools (mHealth technologies) as empowering devices, especially as they play an increasingly important role in the National Health Service (NHS) in the UK. It argues that mHealth technologies should instead be framed as digital companions. This shift from empowerment to companionship is advocated by showing the conceptual, ethical, and methodological issues challenging the narrative of empowerment, and by arguing that such challenges, as (...) well as the risk of medical paternalism, can be overcome by focusing on the potential for mHealth tools to mediate the relationship between recipients of clinical advice and givers of clinical advice, in ways that allow for contextual flexibility in the balance between patiency and agency. The article concludes by stressing that reframing the narrative cannot be the only means for avoiding harm caused to the NHS as a healthcare system by the introduction of mHealth tools. Future discussion will be needed on the overarching role of responsible design. (shrink)

On 8th August 2019, Secretary of State for Health and Social Care, Matt Hancock, announced the creation of a £250 million NHS AI Lab. This significant investment is justified on the belief that transforming the UK’s National Health Service (NHS) into a more informationally mature and heterogeneous organisation, reliant on data-based and algorithmically-driven interactions, will offer significant benefit to patients, clinicians, and the overall system. These opportunities are realistic and should not be wasted. However, they may be missed (...) (one may recall the troubled Care.data programme) if the ethical challenges posed by this transformation are not carefully considered from the start, and then addressed thoroughly, systematically, and in a socially participatory way. To deal with this serious risk, the NHS AI Lab should create an Ethics Advisory Board and monitor, analyse, and address the normative and overarching ethical issues that arise at the individual, interpersonal, group, institutional and societal levels in AI for healthcare. (shrink)

Much of the discussion of the role of emerging technologies associated with AI, machine learning, digital simulacra, and relevant ethical considerations such as those discussed in the target article, take a relatively narrow and episodic view of a person’s healthcare needs. There is much speculation about diagnostic, treatment, and predictive applications but relatively little consideration of how such technologies might be used to address a person’s lived experience of illness and ongoing care needs. This is likely due to the (...) greater weight or priority given to acute care needs and the role of medical treatment in care provision, but it may also reflect the limitations of current technologies and our limited vision of their potential application. Such limitations are not surprising given that we are still grappling with the complexities and nuances of achieving the ethical and humanistic ideals of care, namely, care that addresses the hermeneutical, relational, contextual, temporal, and agential dimensions of a person’s health and wellbeing. (shrink)

Social media has transformed how individuals handle their illnesses. While many patients increasingly use these online platforms to understand embodied information surrounding their conditions, healthcare professionals often frame these practices as negative and do not consider the expertise that patients generate through social media. Through a combination of insights from social epistemology and ignorance studies, this paper problematizes the distinctive understandings of social media between patients and healthcare professionals from a different perspective. A total of four ideas are introduced: (1) (...) healthcare professionals see embodied knowledge that arises from patients’ social media practices as uncomfortable knowledge; (2) healthcare professionals engage in several behaviours to preserve their authority and power in front of embodied knowledge created through these online platforms; (3) failing to consider embodied knowledge can have consequences not only in terms of trust between patients and healthcare professionals but also in connection with epistemological populism and the transition towards patient-centred care; and (4) media and digital health literacy could help healthcare professionals enhance the uses of social media in healthcare. Adopting this framework allows not only to offer valuable insights into how healthcare professionals manage patients’ social media practices, but also opens new avenues to improve healthcare digitisation. (shrink)

Braun explores the use of digital twin technology in medicine with a particular emphasis on the question of how such simulations can represent a person.1 In defining some first conditions for ethically justifiable forms of representation of digital twins, he argues that digital twins do not threaten an embodied person, as long as that person retains control over their simulated representation via dynamic consent, and ideally with the option to choose both form and usage of the simulation. (...) His thoughtful elaboration provides insight into the challenges inherent in interactions between a person and their digital twin, emphasising the modes of control required to respect personal modes of freedom. This individual-centric approach to the question of representation leaves out the important ethical consideration of ensuring that all, not merely some, can be represented. Braun describes dynamic consent as a necessary mode of control, arguing that where a person is unable to give consent, ‘such simulations threaten to become illegitimate representations. They would then shift the kind of interaction from representation to illegitimate forms of prediction or surveillance and thereby could lead to infringements to individual modes of freedom.’ Consequently, the implementation of digital twin technology in healthcare would seem to exclude the most vulnerable members of society from participation in and benefiting from medical innovation, …. (shrink)

A novel coronavirus in 2019 took the life of ‘patient zero’ and then millions of others alerting nation states to protect and secure the lives of their citizens. The coronavirus known as SARS-CoV-2 caused the ‘COVID-19’ disease which had governments impose restrictions on the freedom of movement or the right to travel in the form of ‘community quarantines.’ The serious adverse effects of these on the world and national economies moved the governments to loosen the quarantines and implement versions of (...) so-called ‘vaccine passport,’ an international digital health certificate proving COVID-19 vaccination status. One of the uses of the vaccine passport is to expedite the safe and orderly passage of people in airports which extends to other travel terminals, essential and commercial establishments, and facilities. There are ethical concerns, however, such as the inequitable distribution of the scarce supply of vaccines, among others. In this article, I briefly describe the vaccine passport idea, its uses, and ethical concerns, and then apply these concerns in a national context through the pending bills that aim to legitimize a Vaccine Passport System in the Philippines. In the end, I recommend that lawmakers (who represent the moral interest of Filipinos) consider such concerns before they cast their votes. (shrink)

At the beginning of the COVID-19 pandemic, high hopes were put on digital contact tracing, using mobile phone apps to record and immediately notify contacts when a user reports as infected. Such apps can now be downloaded in many countries, but as second waves of COVID-19 are raging, these apps are playing a less important role than anticipated. We argue that this is because most countries have opted for app configurations that cannot provide a means of rapidly informing users (...) of likely infections while avoiding too many false positive reports. Mathematical modelling suggests that differently configured apps have the potential to do this. These require, however, that some pseudonymised data be stored on a central server, which privacy advocates have cautioned against. We contend that their influential arguments are subject to two fallacies. First, they have tended to one-sidedly focus on the risks that centralised data storage entails for privacy, while paying insufficient attention to the fact that inefficient contact tracing involves ethical risks too. Second, while the envisioned system does entail risks of breaches, such risks are also present in decentralised systems, which have been falsely presented as ‘privacy preserving by design’. When these points are understood, it becomes clear that we must rethink our approach to digital contact tracing in our fight against COVID-19. There are no data in this work. (shrink)