The promise of mobile health (mHealth) may be overly positive, and mHealth must be considered in the light of bioethical concerns, according to an article published in the Journal of Medical Ethics.
With the ubiquitous availability of digital technology such as smartphones, smart watches, health-related apps, and patient monitoring devices, the era of mHealth is upon us. Wearable devices capture workouts, calorie intake, and medication adherence. In 2018, 485 million wearable devices are expected to be sold; 52% of smartphone owners have looked up health or medical information on their smartphone, and 19% have downloaded a health-related app. This technology promises to revolutionize healthcare, making it more broadly available and fostering self-management and patient empowerment.
Federica Lucivero, PhD, from the Wellcome Centre for Ethics and Humanities, Big Data Institute, University of Oxford, United Kingdom, and Karin R. Jongsma, PhD, from the University Medical Center Utrecht, The Netherlands, examine the ethical issues involved in mHealth, as well as its promises and challenges.
One of the promises offered by mHealth is efficient, cost-effective solutions for disease prevention, monitoring, and management. One example offered by the authors is that of a mobile melanoma skin check app that uses the smartphone’s camera to check on moles. This app offers inexpensive early self-assessment of moles that will prompt users to see a dermatologist for questionable lesions. However, an app that inaccurately identifies an early melanoma as benign would do considerable harm by reassuring the user and preventing an early intervention.
mHealth also promises to improve patient self-management and increase patient empowerment. Apps and wearable sensors will allow health-conscious individuals to track and improve their health without having to refer to physicians as regularly. But the authors contend that this technology may have more of a Big Brother effect, indirectly disciplining individuals to maintain certain diet and exercise goals rather than increasing their autonomy. Another concern is the security of the data: third-party access to data could be harmful to individual app users if they result in discrimination by insurance providers or employers.
The final concern raised by the authors is regarding accessibility to healthcare and social justice. They raise the possibility that not all will have equal access to this technology and the healthcare improvements it may offer. Lack of literacy or fluency in the official language or poverty may limit participation in the benefits offered by the technology. The elderly may have more difficulty accessing the technology. In Western countries, users of some of these technologies such as iPhones and Fitbit are on average younger, more educated, and wealthier. This raises the question as to whether mHealth exacerbates health discrepancies or mitigates them.
The authors argue that for mHealth to be implemented in an ethically sound way, ethical reflection should be involved from the early developmental stages of these devices.
Lucivero F, Jongsma KR. A mobile revolution for healthcare? Seeing the agenda for bioethics [published online June 15, 2018]. J Med Ethics. doi: 10.1136/medethics.2017.104741