Digital technology is already a part of our daily lives. We use smartphones to navigate our routes and order our purchases6. Also in the field of health, the digital dimension is ever increasing, and in the last few years, digital health initiatives received much interest and increasing investments from public and private sources6. Digital technologies are getting priorities in all areas of the patient dealings, both within research area and the clinical sectors, throughout healthcare systems across the world5.
With this understanding of a public health justice approach, we discuss the ethical chances and challenges unfolding in digital health. The research question of the literature review was, What are the ethical issues in digital health care that health care professionals should consider? We base our analytic overview of these issues on a narrative review in order to obtain a broad perspective on recent and relevant literature on digital (public) health. We point out what ethical guidance is needed for health care proffesionals.
We searched two Databases that are Pubmed Advanced and Google Scholar for studies on ethics on digital health care that health care professionals should consider published between 2014 to 2020. Through database searching we found 339 relevant articles. After removal of duplicates, the remaining records were assessed for relevance based on abstracts. References of included studies were checked for other relevant studies. Total 114 records were identified, out of which 109 articles were excluded for main reasons and finally 7 articles matched the inclusion criteria and were included for this review. The process used to reduce and evaluate the records is illustrated in Prisma diagram (2009) (Appendix 1). The results of the included articles answering the research question were extracted (Appendix 2: Summary of the included articles) and analyzed (Appendix 3: Analysis) using qualitative content analysis.
In this literature review we revealed four categories of ethical issues that should be considered by health care professionals. These were Patients’ rights in digital health care, Responsible behavior of health care professionals in digital health care, Governance of health care data and Equity in digital heath care.
Patients’ rights in digital health care included patient security in digital health care and freedom of informed choice in digital health care.
Patient security in digital health care was described as patients being concerned about their confidentiality in digital communication and their privacy being a key element of trustworthy artificial intelligence [1,6,7]. Health care professionals should consider about patient safety and should prevent any kind of unintentional harm to them [3,7].
Freedom of informed choice in digital health care meant preservation of dignity and support of human autonomy in digital health care services [6,7]. In case of video visit clinician need to trust on patient’s judgement to avoid negative disturbances . Valid informed consent, an important value and part of ethics (1), should be taken from the patient considering long time data use and storing as well as technological and language difficulties, because it plays an important role to find out truthful information [4,6].
Responsible behavior of health care professionals in digital health care included Accountability in digital health care, Transparency in digital health care, Relation of trust in digital health care.
Accountability is important in procedural value for digital health which maintain trustworthiness of artificial intelligence [6,7]. In case of video visit sensibility of clinician is required to avoid negative disturbances . Human agency and oversight also have importance for trustworthiness of artificial intelligence .
Transparency in digital health care is another key element of trustworthy artificial intelligence which has important procedural value for digital health [6,7].
Relation of trust in digital health care is important in between service receiver and service provider to mitigate ethical risk [3,6,7]. By working together in relationships of trust patient safety can be maintain also .
Governance of health care data includes Safe accessibility of Digital health care data and Responsible Management of health care data
Most of the patients want to keep their data private and confidential . Important value in digital health is safety of information . So, data should be stored in a safe way to protect from unauthorized access [6,7]. Exploitation of data should be prevented carefully .
Responsible Management of health care data implies that trustworthy artificial intelligence should be robust, lawful and ethical , so governance to be considered in rollout of digital access between patient and clinicians . Data should not be used without any purpose . Awareness of data use and data ownership has important value in digital health care [6, 7].
Equity in digital heath care includes Individual equity in digital health care and Societal equity in digital health care
Individual Equity in digital health care means equity in empowerment, access, exclusion, inclusion and getting equal treatment in health care access [6, 7]. All kind of fairness and ethical issues to be considered in rollout of digital access between patient and clinicians [3, 7]
Societal equity in digital health care Non-discrimination, non-stigmatization, environmental and societal well-being are also the key element of digital health care [6, 7].
Figure showing the ethical issues in digital health care that health care professionals should consider at a glance:
Ethics is the most important issue which to be considered in digital health care system like all other types of services. Health care provider should be ethical in providing digital health care services. The ethical issues are to be considered under the four broad heading – Patients’ rights, Responsible behavior of health care professionals, Governance of health care data and equity in health care. Trustworthy and equitable access to digital health care and interventions offers chances to healthcare coverage, spread of health information and literacy, and potentially efficiency of care. Overall Regulations and policies focusing on ethical guidance are needed for fair, equitable and trustworthy digital health aiming to empower service reciever.
- Ignatowicz, A., Slowther, A. M., Elder, P., Bryce, C., Hamilton, K., Huxley, C., … & Griffiths, F. (2018). Ethical implications of digital communication for the patient-clinician relationship: analysis of interviews with clinicians and young adults with long term conditions (the LYNC study). BMC medical ethics, 19(1), 11.
- Sturesson, L., & Groth, K. (2018). Effects of the digital transformation: qualitative study on the disturbances and limitations of using video visits in outpatient care. Journal of medical Internet research, 20(6), e221.
- Griffiths, F., Bryce, C., Cave, J., Dritsaki, M., Fraser, J., Hamilton, K., … & Madan, J. (2017). Timely digital patient-clinician communication in specialist clinical services for young people: a mixed-methods study (the LYNC study). Journal of medical Internet research, 19(4), e102.
- Odhiambo, R., & Mars, M. (2018). Patients’ understanding of telemedicine terms required for informed consent when translated into Kiswahili. BMC public health, 18(1), 588.
- Coathup, V., Teare, H. J., Minari, J., Yoshizawa, G., Kaye, J., Takahashi, M. P., & Kato, K. (2016). Using digital technologies to engage with medical research: views of myotonic dystrophy patients in Japan. BMC medical ethics, 17(1), 51.
- Brall, C., Schröder-Bäck, P., & Maeckelberghe, E. (2019). Ethical aspects of digital health from a justice point of view. European journal of public health, 29(Supplement_3), 18-22.
- Koszegi, S. T. (2019). High-Level Expert Group on Artificial Intelligence.
Appendix 1. Prisma Chart