Department of Ethics, Law and Humanities, Amsterdam UMC, location VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands.
Defence Healthcare Organisation, Ministry of Defence, Utrecht, The Netherlands.
BMC Med Ethics. 2023 Mar 9;24(1):21. doi: 10.1186/s12910-023-00899-9.
The field of personal health monitoring (PHM) develops rapidly in different contexts, including the armed forces. Understanding the ethical dimension of this type of monitoring is key to a morally responsible development, implementation and usage of PHM within the armed forces. Research on the ethics of PHM has primarily been carried out in civilian settings, while the ethical dimension of PHM in the armed forces remains understudied. Yet, PHM of military personnel by design takes place in a different setting than PHM of civilians, because of their tasks and the context in which they operate. This case study therefore focusses on obtaining insights into the experiences and related values of different stakeholders regarding an existing form of PHM, the Covid-19 Radar app, in the Netherlands Armed Forces.
We carried out an exploratory qualitative study, using semi-structured interviews with twelve stakeholders in the Netherlands Armed Forces. We focussed on participation in the use of PHM, reflections on the practical use and use of data, moral dilemmas and the need for ethics support, all in regard to PHM. The data was analysed using an inductive thematic approach.
Three interlinking categories reflecting ethical dimensions of PHM emerged: (1) values, (2) moral dilemmas, and (3) external norms. The main values identified were: security (in relation to data), trust and hierarchy. Multiple related values were found. Some, but no broadly shared, moral dilemmas were identified and no strong need for ethics support was expressed.
This study shed light on key values, provide insights in the experienced and presumed moral dilemmas and bring to mind ethics support considerations when looking at PHM in the armed forces. Some values bring a certain vulnerability to military users when personal and organisational interests are not aligned. Furthermore, some identified values may hinder a careful consideration of PHM because they potentially conceal parts of ethical dimensions of PHM. Ethics support can assist in uncovering and addressing these concealed parts. The findings highlight a moral responsibility for the armed forces to devote attention to the ethical dimensions of PHM.
个人健康监测（PHM）领域在不同背景下迅速发展，包括武装部队。了解这种监测类型的伦理维度是在武装部队中对 PHM 进行负责任的开发、实施和使用的关键。对 PHM 的伦理研究主要在民用环境中进行，而武装部队中 PHM 的伦理维度仍未得到充分研究。然而，由于军人的任务和所处的环境，对军人的 PHM 设计与对平民的 PHM 不同。因此，本案例研究侧重于了解不同利益相关者对荷兰武装部队中现有的 PHM 形式（即 Covid-19 雷达应用程序）的经验和相关价值观。
我们进行了一项探索性定性研究，对荷兰武装部队的 12 名利益相关者进行了半结构化访谈。我们重点关注参与 PHM 的使用、对实际使用和数据使用的反思、道德困境以及对伦理支持的需求，所有这些都与 PHM 有关。使用归纳主题方法分析数据。
出现了三个相互关联的类别，反映了 PHM 的伦理维度：（1）价值观，（2）道德困境，和（3）外部规范。确定的主要价值观包括：安全（与数据有关）、信任和层级。还发现了一些相关的价值观。确定了一些但不是广泛共享的道德困境，并且没有强烈表达对伦理支持的需求。
本研究阐明了关键价值观，深入了解了经验和假定的道德困境，并在考虑武装部队中的 PHM 时引起了对伦理支持考虑的关注。当个人和组织利益不一致时，一些价值观会给军人用户带来一定的脆弱性。此外，一些确定的价值观可能会阻碍对 PHM 的仔细考虑，因为它们可能掩盖了 PHM 的某些伦理维度。伦理支持可以帮助揭示和解决这些隐藏的部分。研究结果强调了武装部队对 PHM 的伦理维度负有道德责任。
