The Sociotechnical Ethics of Digital Health: A Critique and Extension of Approaches From Bioethics

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.

The Impact of Artificial Intelligence on Health Equity in Oncology: Scoping Review

“…When such a collaboration occurred, AI technologies were primarily designed in HICs and implemented in LMICs. This divide between the location of development and location of the implementation of AI in global oncology can pose a barrier to integration in LMICs due to costs [ 102 ] and infrastructural considerations [ 88 ], thereby suggesting a need for greater attention to co-design, which refers to the involvement of end users in the design process of AI technologies [ 159 ]. Moreover, it is important to recognize that the inclusion of researchers from LMICs in the design of AI technologies alone does not guarantee widespread improvements in health for patients in these countries.…”

“…For example, treatment patterns produced by Watson for Oncology, an AI decision support system trained by data and experts from the Memorial Sloan Kettering Cancer Center, may be inapplicable to many LMICs [ 173 ]. In previous studies investigating this issue, some researchers have argued for the co-design of AI technologies, which requires the involvement of end users—and specifically marginalized groups—in AI research and development to ensure the equitable distribution of the benefits of these technologies [ 159 , 174 ].…”

Using COMPASS (Context Optimisation Model for Person-Centred Analysis and Systematic Solutions) Theory to Augment Implementation of Digital Health Solutions

“…There is a need for a mutually agreeable health and social care theory that supports ethical research in digital technology [ 5 ]. However, an ethical perspective limited to technology functions is insufficient to assess the broader impact of technology adoption in a person centred, health and social care environment, and the larger health-related ecosystem of which it is a part of [ 6 , 7 ].…”

Examining how Ethics in Relation to Health Technology is Described in the Research Literature: Scoping Review

“…Furthermore, technology’s mediation of human-to-human relations may result in ethical dilemmas [ 8 ]. Therefore, a broader perspective is needed where both the context and future implications for human life are considered [ 9 ].…”