Shifting responsibilities in healthcare due to disruptive innovation: ethical, legal, and social implications

Introduction :

The term “disruptive innovation”, as coined by Clayton Christensen, describes an innovation that upsets a market by offering “cheaper, simpler, more convenient products or services, that start by meeting the needs of less demanding customers”. Several recent digital innovations in healthcare, such as telemedicine, healthcare apps, mobile devices, clinical decision support systems and care robots match this description and it has not gone unnoticed that they may be the answer to the looming unaffordability of healthcare and to its limited accessibility.

The main drivers of these new innovations are large scale health information exchange, big data research and AI, enabling the creation of ever more sophisticated predictive algorithms with preventive, diagnostic and curative potential. This need for health data processing has caused new players from the tech and information technology industry to take up an increasingly prominent role in the healthcare landscape, diminishing the central role of the traditional players in the healthcare sector.

Many of these new disruptive healthcare innovations are framed within a discourse of patient empowerment, while obscuring that with power comes responsibility. As we are moving away from the traditional doctor-patient relationship, the locus of responsibility is shifting in several directions (most notably healthcare provider to patient, healthcare provider to tech companies and data collectors, specialized physician to general physician or nurse) and we are facing an increasing number of so-called responsibility gaps, meaning that oftentimes it is not obvious who is primarily responsible for adverse outcomes. The prototypical example here is how to handle cases in which a clinical decision support system steers the physician towards a wrong decision, for example because the data the system’s algorithm was trained on does not match the profile of a particular patient. Besides legal questions regarding liability, numerous ethical questions surface when trying to trace moral responsibility here, regarding, for example, the transparency and explainability of the algorithm and biases in the training data that may lead to harm for already underprivileged populations, which in turn, raises questions about social stratification.

This proposed workshop will gather distinguished researchers from ELSI-disciplines and from across the globe focusing specifically on how innovations in healthcare may induce shifts in responsibilities. Bringing together this diverse group of experts will enable a thorough mapping of the key ethical, legal and social issues that it raises.

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