Ethical perspectives on recommending digital technology for patients with mental illness

Abstract

The digital revolution in medicine not only offers exciting new directions for the treatment of mental illness, but also presents challenges to patient privacy and security. Changes in medicine are part of the complex digital economy based on creating value from analysis of behavioral data acquired by the tracking of daily digital activities. Without an understanding of the digital economy, recommending the use of technology to patients with mental illness can inadvertently lead to harm. Behavioral data are sold in the secondary data market, combined with other data from many sources, and used in algorithms that automatically classify people. These classifications are used in commerce and government, may be discriminatory, and result in non-medical harm to patients with mental illness. There is also potential for medical harm related to poor quality online information, self-diagnosis and self-treatment, passive monitoring, and the use of unvalidated smartphone apps. The goal of this paper is to increase awareness and foster discussion of the new ethical issues. To maximize the potential of technology to help patients with mental illness, physicians need education about the digital economy, and patients need help understanding the appropriate use and limitations of online websites and smartphone apps.

Smartphones in mental health: a critical review of background issues, current status and future concerns

“…People have varied attitudes towards the use of apps and wearables. Many people with chronic medical illness reject self-monitoring, finding it annoying, depressing, a burden, or prefer to forget they are ill (Lupton 2013;Bauer et al 2017). The very process of measurement may hinder enjoyment of physical activities and decrease wellbeing (Toner 2018;Etkin 2016).…”

Development and Presentation of an Ethical Framework for Health and Medical Apps

“…A total of 32 references has been included in this review. (Figure 1) Of these, 18 references were journal articles, [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] seven reviews, [27][28][29][30][31][32][33] three systematic reviews, [34][35][36] two survey results from Australia 37 and the USA, 38 one study report from Germany 6 and one qualitative study from Australia. 39 For further discourse, the principles of biomedical ethics defined by Beauchamp and Childress function as ethical endpoints.…”

“…Mobile applications become even more apparent being used to prevent and treat diseases, such as chronic alcohol abuse, HIV or the use in routine psychiatric care. 10,19,24,25,27,28 Furthermore, publications address the use of health and medical apps designed for specific indications, for example in the field of dermatology, pain management or Parkinson's disease. 12,35,37 One reference examined the use of mobile applications against the background of different social circumstances and settings and two publications address the ethical challenges linked with health and medical apps in aging societies.…”

“…It occurs essential to upgrade and constantly evaluate security certifications as well as the requirements for recertifications and data ownership policy. 27 Besides, there are uncertainties regarding a distinction between specific medical devices and those applications that do not meet the necessary requirements. 6 A balance between personal interests and market-based interests are strongly demanded.…”

“…11 Nevertheless, constant development can also facilitate disparities in the adaption and use of health and medical apps. 27…”