Cultural Implications Regarding Privacy in Digital Contact Tracing Algorithms: Method Development and Empirical Ethics Analysis of a German and a Japanese Approach to Contact Tracing

Background Digital contact tracing algorithms (DCTAs) have emerged as a means of supporting pandemic containment strategies and protecting populations from the adverse effects of COVID-19. However, the impact of DCTAs on users’ privacy and autonomy has been heavily debated. Although privacy is often viewed as the ability to control access to information, recent approaches consider it as a norm that structures social life. In this regard, cultural factors are crucial in evaluating the appropriateness of information flows in DCTAs. Hence, an important part of ethical evaluations of DCTAs is to develop an understanding of their information flow and their contextual situatedness to be able to adequately evaluate questions about privacy. However, only limited studies and conceptual approaches are currently available in this regard. Objective This study aimed to develop a case study methodology to include contextual cultural factors in ethical analysis and present exemplary results of a subsequent analysis of 2 different DCTAs following this approach. Methods We conducted a comparative qualitative case study of the algorithm of the Google Apple Exposure Notification Framework as exemplified in the German Corona Warn App and the Japanese approach of Computation of Infection Risk via Confidential Locational Entries (CIRCLE) method. The methodology was based on a postphenomenological perspective, combined with empirical investigations of the technological artifacts within their context of use. An ethics of disclosure approach was used to focus on the social ontologies created by the algorithms and highlight their connection to the question about privacy. Results Both algorithms use the idea of representing a social encounter of 2 subjects. These subjects gain significance in terms of risk against the background of a representation of their temporal and spatial properties. However, the comparative analysis reveals 2 major differences. Google Apple Exposure Notification Framework prioritizes temporality over spatiality. In contrast, the representation of spatiality is reduced to distance without any direction or orientation. However, the CIRCLE framework prioritizes spatiality over temporality. These different concepts and prioritizations can be seen to align with important cultural differences in considering basic concepts such as subject, time, and space in Eastern and Western thought. Conclusions The differences noted in this study essentially lead to 2 different ethical questions about privacy that are raised against the respective backgrounds. These findings have important implications for the ethical evaluation of DCTAs, suggesting that a culture-sensitive assessment is required to ensure that technologies fit into their context and create less concern regarding their ethical acceptability. Methodologically, our study provides a basis for an intercultural approach to the ethics of disclosure, allowing for cross-cultural dialogue that can overcome mutual implicit biases and blind spots based on cultural differences

Aging between Participation and Simulation. Ethical Dimensions of Socially Assistive Technologies in Elderly Care

This publication aims to initiate an interdisciplinary discourse on the ethical, legal, and social implications of socially assistive technologies in healthcare. It combines practically relevant insights and examples from current research and development with ethical analysis to uncover moral pitfalls at the intersection between the promotion of social participation and well-being, and risks that may diminish the achievement of these ends

Increasing efficiency and well-being? a systematic review of the empirical claims of the double-benefit argument in socially assistive devices

Abstract Background Socially assistive devices (care robots, companions, smart screen assistants) have been advocated as a promising tool in elderly care in Western healthcare systems. Ethical debates indicate various challenges. One of the most prevalent arguments in the debate is the double-benefit argument claiming that socially assistive devices may not only provide benefits for autonomy and well-being of their users but might also be more efficient than other caring practices and might help to mitigate scarce resources in healthcare. Against this background, we used a subset of comparative empirical studies from a comprehensive systematic review on effects and perceptions of human-machine interaction with socially assistive devices to gather and appraise all available evidence supporting this argument from the empirical side. Methods Electronic databases and additional sources were queried using a comprehensive search strategy which generated 9851 records. Studies were screened independently by two authors. Methodological quality of studies was assessed. For 39 reports using a comparative study design, a narrative synthesis was performed. Results The data shows positive evidential support to claim that some socially assistive devices (Paro) might be able to contribute to the well-being and autonomy of their users. However, results also indicate that these positive findings may be heavily dependent on the context of use and the population. In addition, we found evidence that socially assistive devices can have negative effects on certain populations. Evidence regarding the claim of efficiency is scarce. Existing results indicate that socially assistive devices can be more effective than standard of care but are far less effective than plush toys or placebo devices. Discussion We suggest using the double-benefit argument with great caution as it is not supported by the currently available evidence. The occurrence of potentially negative effects of socially assistive devices requires more research and indicates a more complex ethical calculus than suggested by the double-benefit argument

Rethinking consent in mHealth: (A) moment to process

The field of mobile health promises a transformation of the healthcare industry, by providing health-related information and services directly to individuals, through digital mobile devices. This presents society with new platforms for persuasive systems for healthy behavior change. Before such systems’ full potential can be utilized, however, the question of how to consent to their use needs to be addressed. In this paper, I argue that one-off all-encompassing consent moments at the start of use of persuasive mobile health services do not suffice, given the functions they present, and the context in which they are used. Persuasive mobile health services are not only data-intensive, they are also designed to influence the user’s behavior and health. Informed consent should be temporally distributed, in order to improve the quality of the user’s autonomous authorization, that this context requires

8 Challenges arising from the use of assistive technologies by people with dementia in home care arrangements

Palmdorf S, Dockweiler C. 8 Challenges arising from the use of assistive technologies by people with dementia in home care arrangements. In: Haltaufderheide J, Hovemann J, Vollmann J, eds. Aging between Participation and Simulation. Ethical dimensions of socially assistive technologies. Berlin: De Gruyter; 2020

Types of ethical problems and expertise in clinical ethics consultation in psychiatry

$\textbf {Background:}$ Ethics consultation has been advocated as a valuable tool in ethically challenging clinical situations in healthcare. It is paramount for the development and implementation of clinical ethics support services (CESS) in psychiatry that interventions can address the moral needs of mental health professionals adequately and communicate the nature of the services clearly. This study explores types of ethical problems and concepts of ethical expertise as core elements of CESS in mental healthcare with the aim of contributing to the further development of ethical support in psychiatry. $\textbf {Methods:}$ We conducted 13 semi-structured interviews with mental health professionals and CESS members and triangulated them with four non-participant observations of ethical case consultations in psychiatry. Data were analyzed according to principles of grounded theory and are discussed from a normative perspective. $\textbf {Results:}$ The analysis of the empirical data reveals a typology of three different ethical problems professionals want to refer to CESS: (1) Dyadic problems based on the relationship between patients and professionals, (2) triangular problems, where a third party is involved and affected as a side effect, and (3) problems on a systemic level. However, CESS members focus largely on types (1) and (2), while the third remains unrecognized or members do not feel responsible for these problems. Furthermore, they reflect a strong inner tension connected to their role as ethical experts which can be depicted as a dilemma. On the one hand, as ethically trained people, they reject the idea that their judgments have expert status. On the other hand, they feel that mental health professionals reach out for them to obtain guidance and that it is their responsibility to offer it. $\textbf {Conclusion:}$ CESS members and professionals in mental healthcare have different ideas of the scope of responsibility of CESS. This contains the risk of misunderstandings and misconceptions and may affect the quality of consultations. It is necessary to adapt concepts of problem solving to practitioners' needs to overcome these problems. Secondly, CESS members struggle with their role as ethical experts. CESS members in psychiatry need to develop a stable professional identity. Theoretical clarification and practical training are needed

Interaktives Lernen

Das Gebot des "Social Distancing" während der COVID-19-Pandemie hat eine Revision der bisherigen Lehr-Lern-Settings an Universitäten erforderlich gemacht. Als positiven Nebeneffekt hat die begegnungsarme Kommunikation einen Innovationsschub in puncto digitale Lehre ausgelöst und diente vielen Dozierenden als Anlass, neue Formate zu erproben. Vor diesem Hintergrund hat das Institut für Medizinische Ethik und Geschichte der Medizin der Medizinischen Fakultät der Ruhr-Universität Bochum ein neues Lehrkonzept für den Pflicht-Querschnittsbereich Geschichte, Theorie, Ethik der Medizin (GTE) im Studium der Humanmedizin entwickelt.$^{1}$ Im Folgenden geben wir einen Einblick in die Erwartungen des Teams, die Herausforderungen, die sich bei der Umsetzung gestellt haben, und die Resonanz der Studierenden. $^{1}$Unser Institut ist für die GTE-Lehre an den Medizinischen Fakultäten der Ruhr-Universität Bochum und der Universität Duisburg-Essen verantwortlich. Der neue GTE-Kurs wurde für die Lehre an der Medizinischen Fakultät der Universität Duisburg-Essen entwickelt und dort im Sommersemester 2021 erstmals eingesetzt