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Mobile health ethics and the expanding role of autonomy

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Abstract

Mhealth technology is mushrooming world-wide and, in a variety of forms, reaches increasing numbers of users in ever-widening contexts and virtually independent from standard medical evidence assessment. Yet, debate on the broader societal impact including in particular mapping and classification of ethical issues raised has been limited. This article, as part of an ongoing empirically informed ethical research project, provides an overview of ethical issues of mhealth applications with a specific focus on implications on autonomy as a key notion in the debate. A multi-stage model of references to the potential of mhealth use for strengthening some or other form of self-determination will be proposed as a descriptive tool. It illustrates an assumed continuum of enhanced autonomy via mhealth broadly conceived: from patient to user autonomy, to improved health literacy, and finally to the vision of supra-individual empowerment and democratised, participatory health and medicine as a whole. On closer examination, however, these references are frequently ambivalent or vague, perpetuating the at times uncritical use of established autonomy concepts in medical ethics. The article suggests zooming in on the range of autonomy-related aspects against the backdrop of digital innovation and datafied health more generally, and on this basis add to existing frameworks for the ethical evaluation of mhealth more specifically.

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Notes

  1. ‘Datafication’ may also be used prescriptively. Couldry and Yu refer to “the process whereby life-processes must be converted into streams of data inputs for computer-based processing” which “is deemed a natural stage of development” (Couldry and Yu 2018: 4473).

  2. These perspectives highlight, for example, the effort to create a “culture of transparency” (Smith et al. 2016), questions concerning ownership and data access, and the trade-off between accelerated innovation, ethics and regulation (cf. Dorn 2015; Mittelstadt 2017; Torous and Roberts 2017).

  3. These kinds of enhanced autonomy, however, in turn raise new questions as regards the applicability of professional norms and responsibilities such as when lay persons are involved in mobile care offers that blur the boundary to regular psychotherapy (Kreitmair and Cho 2017).

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Funding

This article is part of the research project “Medicine 4.0—the ethical basis of digitalised healthcare” funded by the German Ministry of Health.

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  1. Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-Universität München, Lessingstraße 2, 80336, Munich, Germany

    Bettina Schmietow & Georg Marckmann

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  1. Bettina Schmietow
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  2. Georg Marckmann
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Correspondence to Bettina Schmietow.

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Schmietow, B., Marckmann, G. Mobile health ethics and the expanding role of autonomy. Med Health Care and Philos 22, 623–630 (2019). https://doi.org/10.1007/s11019-019-09900-y

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