10 Bioethical Issues in the Future of Digital Health
I’m truly excited for the future of medicine – sometimes it feels like we’re living in a science -fiction novel. But genetic discrimination and the elimination of privacy are just some of the bioethical issues we’ll face if we let medical innovation run wild.
As The Medical Futurist, I’m constantly thinking about the ethical implications of disruptive technologies. I’m a born optimist. More people have access to better treatments than ever before. We have eradicated deadly diseases and turned others into manageable conditions. But there are signs of alarming trends that few take seriously. Countries globally face doctor shortages and the cost of delivering care is skyrocketing in developed countries.
I believe physicians, patients, regulators and all other stakeholders must prepare for the coming waves of change. To do that, we need to start talking openly about the dangers we face. To spark discourse, I made a list of the 10 most important ethical issues we will have to deal with.
Bioethical issues on the level of the individual
1) Hacking medical devices
It has already been proven that pacemakers and insulin pumps can be hacked. Security experts have warned that vulnerabilities could be used to murder patients on a massive scale – sometime soon. The question is – what can we do to protect wearable devices that are connected to our physiological system from being hacked and controlled from a distance? Companies developing such technologies should make sure they are safe and users should be as vigilant as possible when using them.
2) Loss of privacy
We share much more information about ourselves than we think. Check mypermissions.org to see what services and apps you have given permission to access your personal information already. What if, as augmented reality spreads, all this information will be easily available to someone you just met? Kids who are born now represent the first generation whose lives are logged in meticulous detail – either by themselves or well-meaning but clueless relations. While such big data could significantly improve healthcare, how can we prevent companies and governments from misusing these? What if you ate red meat and your insurance company immediately raised your insurance rates because you’re not eating healthy enough?
3) Patients diagnosing themselves at home
Physicians are worried because patients Google their symptoms and treatments, and they might take the misinformation they find more seriously than what their caregiver tells them. But patients will soon be able to scan themselves, do blood tests and even genetic analysis on demand with other, unregulated companies or at home, then use publicly available algorithms to analyse their data. This will open the way for even more serious cases of misinterpretation, maltreatment or self-medication. Will we able to persuade patients to turn to doctors with this wealth of data and improve their care, and not just put their trust into algorithms? If you think this sounds like science fiction, check the finalist of the Nokia Sensing XChallenge, who have developed just such scanners.
4) Healthy people switching to technology
A disruptive technology can provide an unforeseen advantage over others or augment certain human capabilities to an unprecedented level. As a consequence, what if people start asking their doctors to replace their healthy limbs for robotic ones because it would let them run faster? What if they start asking for brain chips to get smarter? If now you can get a new nose or larger breasts, what would prevent you from getting new muscles or brain implants?
5) Biological differences based on differences in wealth
Today, societies struggle to fight gender and financial inequality. But once technology can truly augment human capabilities, people will get smarter, healthier and faster only because they can afford to be augmented. What if I can buy an exoskeleton or a personalized drug to live longer and you cannot? How do we prepare society for a time when financial differences lead to biological ones?
6) Drastically prolonged lifespans
Longevity studies have been going on for decades. Several aspects of the secret of long life have been discovered. Sooner or later, we will be able to significantly prolong life. Developed countries with aging populations are already struggling to maintain their health. How will the basics of society shift if a majority of people start living for more than 100 years? Could we support this population financially and medically? Can we ensure that ageing doesn’t come with a severe decline in health?
In the wildest futuristic scenarios, tiny nanorobots in our bloodstream could detect diseases. These microscopic robots would send alerts to our smartphones or digital contact lenses before disease could develop in our body. When most human bodies will contain tiny robots, how can we prevent terrorists from hacking these devices to gain direct control over our health?
8) Technological developments vs. evidence based medicine
Evidence based medicine shapes how we deliver healthcare today. It is by definition a lengthy process. Certain solutions such as simulations with cognitive computers instead of long and expensive clinical trials might make them faster but even these won’t match the pace of technological development. Over the last few years, technological advances have become so fast, it’s really hard to keep track of them anymore. How will doctors be able to keep up to date? When patients start seeing the amazing innovations out there that aren’t accessible to them in everyday care, will they reach for them outside the healthcare system?
9) Transhumanism & Singularitarianism
There are movements and philosophies that highlight a narrow concept or approach even though it is highly unlikely that any one solution will lead to a prosperous future. Transhumanism focuses more on the future of science, medicine and technology than on the individuals. Singularitarians believe in a technological singularity but do not give people guidance about what to do. A network of interconnected people, devices, and concepts is the only way to solve global issues. It is advisable not to trust just one movement or philosophy such as transhumanism or singularitarians. The most plausible solution will be a mix of all the concepts trying to describe the coming decades. We should be skeptical and analytical before accepting one major philosophy about the future. The future is going to be interconnected and not a one way ride.
10) Sexuality becoming technological
A man named Davecat lives with his wife and mistress, both of whom are Synthetiks––specially designed, life–sized dolls. Accordingly, Davecat calls himself a technosexual. While some will not understand how Davecat thinks about his partners, his story heralds the diversity of concepts surrounding sexuality that will arise in the next couple of years. How can we prepare for all these if we cannot even solve today’s issues in sexuality? Our current concepts about sexuality are very much based on biology. But dealing with technology that sneaks into our private lives might be a bigger challenge for people than even the LGBT revolution.
Let’s start discussing these bioethical issues at home, at the workplace and on public forums. This way, we can prepare to exploit the advantages technology offers, while keeping the potential dangers at bay.
And we shall never forget: “Primum non nocere”!
This question was just one among the 40 most exciting, surprising and heartwarming ones I was asked about the future of medicine over the years. I’ve answered all in my book, My Health: Upgraded. Learn more on Amazon.