Shaw James A, Donia Joseph
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Women's College Hospital, Toronto, ON, Canada.
Front Digit Health. 2021 Sep 23;3:725088. doi: 10.3389/fdgth.2021.725088. eCollection 2021.
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.
数字技术的广泛应用在医疗保健和公共卫生领域引发了重要的伦理问题。在我们看来，理解这些伦理问题需要一种超越技术本身的视角，将其所处的社会技术系统纳入考量。从这个意义上讲，社会技术系统指的是更广泛的物质设备、人际关系、组织政策、公司合同以及政府法规的集合，这些因素塑造了数字健康技术的采用和使用方式。生物伦理方法对数字健康技术的评估通常局限于技术本身特性所引发的伦理问题。我们认为，仅局限于技术功能的伦理视角不足以评估技术采用对护理环境以及它所属的更广泛健康相关生态系统的更广泛影响。在本文中，我们回顾了数字健康生物伦理的现有方法，并借鉴设计伦理和科学技术研究（STS）的概念，对数字健康生物伦理的狭隘观点进行批判。然后，我们描述了数字健康技术在医疗保健环境中采用时所产生的社会技术系统，并概述了在这一广阔视角下对数字健康技术进行全面伦理分析时需要关注的各种考量因素。我们通过概述社会正义在从社会技术视角进行伦理分析中的重要性来得出结论。
