Cyber-bioethics: the new ethical discipline for digital health

摘要

Bioethics, a term coined by Van Rensselaer Potter in his 1970 work "Bioethics, the Science of Survival", is conceived as a bridge between “bios” and “ethos”. The word “bios” encompasses the totality of life, both somatic and rational, and represents biological knowledge. Meanwhile, “ethos” alludes both to the environment and to ethics, integrating knowledge of the human values which enable us to survive the challenges threatening environment survival. Potter aspired to a "global ethics" based on this knowledge, and saw bioethics as a newly emerging discipline which would forge a link between science and the humanities, or to be more exact, a bridge between the biological sciences and ethics. Bioethics was also a bridge to a peaceful, ecologically sustainable and socially equitable future(1). In 1971, the Joseph and Rose Kennedy Institute for the Study of Human Reproduction and Bioethics popularised this term(2).While Potter saw bioethics as a new discipline, the philosophers and theologians of Georgetown considered it a branch of applied ethics. However, the events of the 1960s and 70s, such as the revelations in the press of experiments on uninformed patients and the civil rights and feminist movements, among other political, social and economic events, paved the way for the empowerment of "bioethicists" to advise on the ethical limits of medicine and biotechnology(3). At this time bioethics acquired the philosophical basis of principlism, which seeks to resolve bioethical problems with four principles, derived from the prima facie duties theory of WD Ross, as described in “The Principles of Biomedical Ethics” by Tom Beauchamp and James Childress: the principles of respect for autonomy, beneficence, non-maleficence, and justice(2,4).The Encyclopedia of Bioethics defines bioethics as the moral analysis of life and health. Applied ethics, which is interdisciplinary, encompasses such diverse spheres as medical bioethics, business ethics, and information ethics, among others. Potter highlighted the need to control technology and the importance of interdisciplinary collaboration(2).Technologies like Artificial Intelligence (AI), mobile applications, wearables, and the Internet of Things are becoming integrated in what we know as Digital Health. Digital health promises countless benefits, but also throws up significant ethical challenges(5) which will affect how we live and coexist with others in the world(6), such as the dilemma of cybersecurity, data privacy(5), and the transformation of the doctor-patient-machine relationship. Society stands at the crossroads of adapting bioethics to the 21st century in order to avoid the mistakes of the past. By adopting an ethical approach, society can move forward to a digital future which more equitable, more secure, and centred on the well-being of individuals(5). As in the 1960s and 70s, we believe that the rapid evolution in which we are immersed in the digital will bring with it the empowerment of a new discipline within bioethics. We know the biotechnology which Potter described and the ethics of AI, but we do not have a name to define the new bioethical discipline we propose, this new branch of bioethics in the digital era(5).As well as digital health, AI is also receiving more attention, making it even more urgent and important to rise to the ethical and social challenges posed by AI. This has generated an avalanche of initiatives and documents relating to policies for action which not only identify ethical problems in AI, but also seek to provide guidance for such policies. In fact, many actors have proposed policies responding to AI from an ethical perspective, including governments and public bodies such as national ethics committees; technology companies like Google; engineers and their professional organisations such as the IEEE (Institute of Electrical and Electronics Engineers); intergovernmental organisations like the EU, with its Artificial Intel