Socio-ethical challenges and opportunities to advance diversity, equity, and inclusion in digital medicine: Narrative Review#

Authors#

Ivana Paccoud, Anja K. Leist, Isabel Schwaninger, R. Van Kessel, Jochen Klucken

Abstract#

Digitalization in medicine offers a significant opportunity to transform healthcare systems by providing novel digital tools and services to guide personalized prevention, prediction, diagnosis, treatment and disease management. This transformation raises a number of novel socio-ethical considerations for individuals and society as a whole, which need to be appropriately addressed to ensure that digital medical devices (DMDs) are widely adopted and benefit all patients as well as healthcare service providers. In this narrative review, we outline five core socio-ethical considerations in digital medicine that intersect with the notions of equity and digital inclusion: (i) access, use and engagement with DMDs, (ii) inclusiveness in DMD clinical trials, (iii) algorithm fairness, (iv) surveillance and datafication, and (v) data privacy and trust. By integrating literature from multidisciplinary fields, including social, medical, and computer sciences, we shed light on concerns and opportunities related to the development and adoption of DMDs. We begin with an overview of the different types of DMDs, followed by in-depth discussions of five socio-ethical implications related to them. Finally, we offer evidence-based multilevel recommendations aimed at fostering a more inclusive digital landscape to ensure that the development and integration of DMDs in healthcare mitigate rather than create, maintain or exacerbate health inequalities.