Meier E, Rigter T, Schijven M P, van den Hoven M, Bak M A R
Department of Ethics, Law & Humanities, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands.
Amsterdam Public Health, Digital Health, Amsterdam, The Netherlands.
Med Health Care Philos. 2025 Mar;28(1):17-31. doi: 10.1007/s11019-024-10238-3. Epub 2024 Nov 30.
Recent publications on digital health technologies highlight the importance of 'responsible' use. References to the concept of responsibility are, however, frequently made without providing clear definitions of responsibility, thus leaving room for ambiguities. Addressing these uncertainties is critical since they might lead to misunderstandings, impacting the quality and safety of healthcare delivery. Therefore, this study investigates how responsibility is interpreted in the context of using digital health technologies, including artificial intelligence (AI), telemonitoring, wearables and mobile apps. We conducted a scoping review with a systematic search in PubMed, Web of Science, Embase, CINAHL and Philosopher's Index. A total of 34 articles were included and categorized using a theoretical framework of responsibility aspects, and revealed two main findings. First, we found that digital health technologies can expand and shift existing 'role responsibilities' among caregivers, patients and technology. Second, moral responsibility is often equated with liability or accountability, without clear justification. Articles describe new ways in which physicians can be held accountable, particularly in the context of AI, and discuss the emergence of a 'responsibility gap' where no-one can be fully responsible for AI-generated outcomes. The literature also shows that m-Health technologies can increase patients' accountability for their own health. However, there was limited discussion in the reviewed literature on whether these attributions of accountability are appropriate. We conclude with implications for practice and suggestions for expanding the theoretical framework of moral responsibility, recommending further study on responsibility of collectives and artificial entities, and on the role of virtue in digital health.
近期关于数字健康技术的出版物强调了“负责任”使用的重要性。然而，在提及责任概念时，往往没有对责任给出明确的定义，从而留下了模糊不清的空间。解决这些不确定性至关重要，因为它们可能导致误解，影响医疗服务的质量和安全。因此，本研究调查了在使用数字健康技术（包括人工智能、远程监测、可穿戴设备和移动应用程序）的背景下，责任是如何被解读的。我们在PubMed、科学网、Embase、CINAHL和《哲学家索引》中进行了系统检索，开展了一项范围综述。共纳入34篇文章，并使用责任方面的理论框架进行分类，得出了两个主要发现。首先，我们发现数字健康技术可以扩大并转移护理人员、患者和技术之间现有的“角色责任”。其次，道德责任常常被等同于责任或问责，但却没有明确的依据。文章描述了医生可能被追究责任的新方式，尤其是在人工智能背景下，并讨论了“责任缺口”的出现，即在这种情况下，没有人能对人工智能产生的结果完全负责。文献还表明，移动健康技术可以增强患者对自身健康的问责。然而，在所审查的文献中，对于这些问责归属是否恰当的讨论有限。我们最后提出了对实践的启示以及扩展道德责任理论框架的建议，建议进一步研究集体和人工实体的责任，以及美德在数字健康中的作用。
