From General Principles to Procedural Values: Responsible Digital Health Meets Public Health Ethics

Abstract

Most existing work in digital ethics is modeled on the “principlist” approach to medical ethics, seeking to articulate a small set of general principles to guide ethical decision-making. Critics have highlighted several limitations of such principles, including (1) that they mask ethical disagreements between and within stakeholder communities, and (2) that they provide little guidance for how to resolve trade-offs between different values. This paper argues that efforts to develop responsible digital health practices could benefit from paying closer attention to a different branch of medical ethics, namely public health ethics. In particular, I argue that the influential “accountability for reasonableness” (A4R) approach to public health ethics can help overcome some of the limitations of existing digital ethics principles. A4R seeks to resolve trade-offs through decision-procedures designed according to certain shared procedural values. This allows stakeholders to recognize decisions reached through these procedures as legitimate, despite their underlying disagreements. I discuss the prospects for adapting A4R to the context of responsible digital health and suggest questions for further research.

Stuck in translation: Stakeholder perspectives on impediments to responsible digital health

“…As a result, trust among patients and clinicians is often missing. This aligns widely with the literature ( 12 , 28 ). Like other technologies, the success of digital health ultimately depends upon widespread adoption.…”

“…Responsible digital health has been defined as “any intentional systematic effort designed to increase the likelihood of a digital health technology developed through ethical decision making, being socially responsible and aligned with the values and well-being, of those impacted by it” ( 18 ). Parallels are frequently drawn between responsible digital health technologies and the responsibilities of healthcare practitioners (HCPs) ( 18 – 20 ). HCPs are accountable for protecting patients' rights and welfare.…”

You Can’t Have AI Both Ways: Balancing Health Data Privacy and Access Fairly

“…Decision-makers in EU countries should structurally engage an inclusive group of researchers, data subjects, clinicians, and other relevant stakeholders, to deliberate the trade-offs between data privacy and the value of AI. We want to emphasize we do not suggest favouring any of the two approaches but propose that inclusive engagement or “data democracy” is needed to ensure that decisions empower affected communities and are sensitive to their specific needs, which in turn may help to promote public trust ( Ienca et al, 2018 ; Kalluri, 2020 ; Nyrup, 2021 ). Ethicists may join the process to help explain and clarify complex moral questions ( McLennan et al, 2022b ).…”

AI and We in the Future in the Light of the Ouroboros Model: A Plea for Plurality

“…Employing AI for the first time in times of crisis, such as for dealing with the COVID-19 pandemic, has in particular been considered ethically delicate and demanding [5]. "Accountability for Reasonableness" is a recently coined catchphrase describing health ethics that can be aptly generalized to a principle of validity [6]. Beyond the context of biomedical ethics, the basic values of beneficence, non-maleficence, autonomy, and justice matter; for engineers, very much the same should be demanded, such as adherence to a precautionary principle, i.e., avoiding unnecessary risks [7].…”