Smartphone apps might offer a low-threshold approach to the detection of mental health conditions, such as depression. Based on the gathering of ‘passive data,’ some apps generate a user’s ‘digital phenotype,’ compare it to those of users with clinically confirmed depression and issue a warning if a depressive episode is likely. These apps can, thus, serve as epistemic tools for affected users. From an ethical perspective, it is crucial to consider epistemic injustice to promote socially responsible innovations within digital mental (...) healthcare. In cases of epistemic injustice, people are wronged specifically as epistemic agents, i.e., agents of the production and distribution of knowledge. We suggest that epistemic agency relies on different resource- and uptake-related preconditions which can be impacted by the functionality of passive self-tracking apps. We consider how this can lead to different forms of epistemic injustice (testimonial, hermeneutical, and contributory injustice) and analyze the influence of the apps’ use on epistemic practices on an individual level, in mental healthcare settings, and on the structural level. (shrink)

The glaring lack of formal and informal caregivers in Germany has not only become apparent in hospitals and nursing homes but also in home care arrangements. One tension is particularly pertinent in such arrangements: a ‘family-oriented’ logic of the long-term care insurance and the individual wishes of those in need of care meet the actual possibilities of family carers. This care gap has been compensated for by 24-hour care workers, so-called ‘live-ins’, from Eastern Europe for some years. This contribution maps (...) the ‘live-ins’ situation comprehensively from an ethical perspective. Based on different constellations regarding the ‘live-ins’ status as a professional nurse or non-professional caregiver, which ethical principles and moral norms are affected by whom and potentially conflict with each other in such home care arrangements at a micro and meso level of care are outlined. Special attention is paid to the tension between self-care and care for others, and to questions of the shared responsibility in and social responsibility of those external services that are involved in home care in addition to the ‘live-in’. In order to uncover, understand and influence the current ethical problems, an ethical framework that considers both the divergent interests of all individuals involved in the home care arrangement and their mutual dependency and vulnerability is needed. (shrink)

Consumer-targeted sleep tracking applications (STA) that run on mobile devices (e.g., smartphones) promise to be useful tools for the individual user. Assisted by built-in and/or external sensors, these apps can analyze sleep data and generate assessment reports for the user on their sleep duration and quality. However, STA also raise ethical questions, for example, on the autonomy of the sleeping person, or potential effects on third parties. Nevertheless, a specific ethical analysis of the use of these technologies is still missing (...) so far. The aim of the current analysis is to identify the characteristics of sleep tracking apps and to explore the specific ethical aspects associated with this form of self-tracking. Firstly, the field of mobile health applications was screened for STA to explore their typical functions and target user groups. Secondly, an ethical analysis was conducted focusing on the three ethical dimensions: (1) medicalization, (2) vulnerability, and (3) relationality. The analysis indicates that these three normative dimensions are decisive for assessing STA and that the ethical profile of this technology varies greatly depending on the respective user group. As the three dimensions medicalization, vulnerability, and relationality play a distinguishing role in the use of STA, they should be especially addressed in responsible development and implementation of STA. In addition, the analysis helps to evaluate the use of STA, in terms of different risks for specific user groups, the sensitive contexts of usage, and potential interference with the intimacy of third parties. (shrink)

Trust and trustworthiness are essential for good healthcare, especially in mental healthcare. New technologies, such as mobile health apps, can affect trust relationships. In mental health, some apps need the trust of their users for therapeutic efficacy and explicitly ask for it, for example, through an avatar. Suppose an artificial character in an app delivers healthcare. In that case, the following questions arise: Whom does the user direct their trust to? Whether and when can an avatar be considered trustworthy? Our (...) study aims to analyze different dimensions of trustworthiness in the context of mobile health app use. We integrate O'Neill's account of autonomy, trust, and trustworthiness into a model of trustworthiness as a relational concept with four relata: B is trustworthy with respect to A regarding the performance of Z because of C. Together with O'Neill's criteria of trustworthiness (honesty, competence, and reliability), this four-sided model is used to analyze different dimensions of trustworthiness in an exemplary case of mobile health app use. Our example focuses on an app that uses an avatar and is intended to treat sleep difficulties. The conceptual analysis shows that interpreting trust and trustworthiness in health app use is multi-layered and involves a net of interwoven universal obligations. At the same time, O'Neill's approach to autonomy, trust, and trustworthiness offers a normative account to structure and analyze these complex relations of trust and trustworthiness using mobile health apps. (shrink)

BackgroundCritical Incident Reporting Systems (CIRS) provide a well-proven method to identify clinical risks in hospitals. All professions can report critical incidents anonymously, low-threshold, and without sanctions. Reported cases are processed to preventive measures that improve patient and staff safety. Clinical ethics consultations offer support for ethical conflicts but are dependent on the interaction with staff and management to be effective. The aim of this study was to investigate the rationale of integrating an ethical focus into CIRS.MethodsA six-step approach combined the (...) analysis of CIRS databases, potential cases, literature on clinical and organizational ethics, cases from ethics consultations, and experts’ experience to construct a framework for CIRS cases with ethical relevance and map the categories with principles of biomedical ethics.ResultsFour main categories of critical incidents with ethical relevance were derived: (1) patient-related communication; (2) consent, autonomy, and patient interest; (3) conflicting economic and medical interests; (4) staff communication and corporate culture. Each category was refined with different subcategories and mapped with case examples and exemplary related ethical principles to demonstrate ethical relevance.ConclusionThe developed framework for CIRS cases with its ethical dimensions demonstrates the relevance of integrating ethics into the concept of risk-, quality-, and organizational management. It may also support clinical ethics consultations’ presence and effectiveness. The proposed enhancement could contribute to hospitals’ ethical infrastructure and may increase ethical behavior, patient safety, and employee satisfaction. (shrink)

Background Migrant live-in care workers are a main pillar of long-term care in many countries, including Germany. Several studies examining their working and living conditions reveal serious problems. However, a key element of live-in arrangements, namely the relationship between the individuals involved, has not yet been systematically investigated from an ethical perspective. Aim Building on previous socioempirical work that explored and set out the meaning of “care networks”, we start from the premise that live-ins are embedded in a network of (...) relationships which are essential for their employment and living situation. Methods The theoretical analysis draws on a network approach that takes care–ethical considerations into account. Using Joan Tronto’s four care–ethical phases, existing dependencies are described and reflected upon using the corresponding four care–ethical dimensions. The central questions are how dependencies in the live-in arrangement can be characterised based on the existing body of empirical studies and with a focus on the elements of power, dependency and trust in the ethical reflection on care. Results Based on this analysis, it becomes apparent that the ambivalence resulting from the simultaneity of different forms of asymmetry and mutual dependence is omnipresent in live-in arrangements and gives rise to seemingly contradictory forms of relationships and emotions. Responsibilities are vague and are constantly renegotiated on the basis of implicit assumptions and problematic role expectations and are also assigned without negotiation. Conclusions In the future, it will not only be necessary to better understand and clarify responsibilities at the micro level of the individual care arrangement from the various positions and roles and with a view to the changing processes of caring for another, but also to address the pressing ethical questions and problems in live-in arrangements at the meso and macro levels—enriched by care–ethical perspectives. (shrink)

Companies increasingly offer their employees the opportunity to participate in voluntary Workplace Health Promotion programmes. Although such programmes have come into focus through national and regional regulation throughout much of the Western world, their ethical implications remain largely unexamined. This article maps the territory of the ethical issues that have arisen in relation to voluntary health promotion in the workplace against the background of asymmetric relationships between employers and employees. It addresses questions of autonomy and voluntariness, discrimination and distributive justice, (...) as well as privacy and responsibility. Following this analysis, we highlight the inadequacy of currently established ethical frameworks to sufficiently cover all aspects of workplace health promotion. Thus, we recommend the consideration of principles from all such frameworks in combination, in a joint reflection of an Ethics of Workplace Health Promotion. (shrink)

As occupational health management (OHM) and work health promotion (WHP) become increasingly prominent in companies worldwide, little is known about consumers' attitudes towards work health‐related issues. Do consumers consider the health of employees in German companies to be important? Do German companies consider consumers to be relevant stakeholders in voluntary occupational health (OH) and well‐being activities? In the first of two qualitative interview studies, German consumers were asked which actors they consider to be responsible in OH contexts and whether or (...) not they prefer OH‐related product attributes to other socially desirable ones. During a second qualitative interview study with representatives from German companies, suppliers, institutions, and organizations concerned with voluntary and legally mandatory OH, participants were asked about their expectations regarding whether or not consumers are interested in such OH activities. Both studies highlight the difference between the consumers' perspective on OH issues and responsibilities on the one hand and what companies and stakeholders believe consumers think about OH issues and responsibilities on the other. The findings show that consumers can recognize non‐mandatory OH and well‐being activities as elements of their own social responsibility (ConSR), while companies usually do not consider this perspective in their corporate social responsibility (CSR). (shrink)

Zusammenfassung Migrantische Pflege- und Betreuungskräfte, die zusammen mit pflegebedürftigen Menschen in ihren Haushalten leben (sog. migrantische Live-Ins), sind eine tragende Säule der ambulanten Langzeitpflege in zahlreichen Ländern – so auch in Deutschland. Zur Arbeits- und Lebenssituation der Live-Ins liegen inzwischen zahlreiche empirische Untersuchungen vor, die damit einhergehende Problemlagen offenbaren. Ein Schlüsselelement der Live-In Arrangements, nämlich die Beziehungen zwischen den Involvierten, wurde bislang jedoch aus ethischer Perspektive noch nicht systematisch untersucht. Aufbauend auf sozio-empirischen Arbeiten, die die Bedeutung von „Care-Networks“ dargelegt haben, (...) gehen wir von der Annahme aus, dass Live-Ins auf verschiedenen Ebenen in ein Netz von Beziehungen eingebettet sind, die für ihre Arbeits- und Lebenssituation wesentlich sind. Mit Hilfe der vier Care-Phasen Joan Trontos werden in diesem Beitrag bestehende Abhängigkeiten beschrieben und anhand der korrespondierenden vier ethischen Dimensionen reflektiert. Zentral sind die Fragen, wie sich die Abhängigkeiten im Live-In Arrangement auf der Basis des bisherigen Korpus empirischer Studien charakterisieren lassen und wie die Beziehungsstrukturen mit Fokus auf die Elemente Macht, Abhängigkeit und Vertrauen in der Care-ethischen Reflexion eingeordnet werden können. Auf der Basis dieser Analyse zeigt sich, dass die aus der Gleichzeitigkeit verschiedener Formen von Asymmetrie und gegenseitiger Abhängigkeit resultierende Ambivalenz in Live-In Arrangements allgegenwärtig ist und scheinbar widersprüchliche Beziehungsformen und Emotionen entstehen lässt. Die Verantwortlichkeiten der Beteiligten füreinander sind vage und werden auf der Grundlage impliziter Annahmen und problematischer Rollenerwartungen ständig neu ausgehandelt und auch ohne Aushandlung zugewiesen. Es gilt künftig, nicht nur auf der Mikroebene des einzelnen häuslichen Pflegearrangements Verantwortlichkeiten aus den unterschiedlichen Positionen und Rollen heraus und mit Blick auf die changierenden Prozesse der Sorgebeziehungen besser zu verstehen und zu klären, sondern sich ebenfalls auf der Meso- und Makroebene – bereichert durch Care-ethische Perspektiven – den drängenden ethischen Fragen und Problemen in Live-In Arrangements zu stellen. (shrink)

Definition of the problem The COVID-19 pandemic poses a considerable challenge to the capacity and functionality of intensive care. This concerns not only resources but, above all, the physical and psychological boundaries of nursing professionals. The question of how care for others and self-care of nurses in intensive care units are related to each other in the context of the COVID-19 pandemic has not been addressed in public and scientific discourse so far. Arguments The present contribution reflects this relationship with (...) reference to the Code of Ethics of the International Council of Nurses, particularly considering principlism and the Care Ethics according to Joan Tronto. As a result, it shows a corridor of ethically justifiable care with several borders, above all: self-care must not be given up completely for the benefit of care for others, and a categorical subordination of care for others to self-care is ethically not justifiable. Conclusion The article makes an important contribution to a differentiated ethical consideration of the rights and responsibilities of intensive care nurses as moral actors within the pandemic in Germany. It, thus, provides a first starting point for a broad social and political discourse which is urgently needed not only during but also after the pandemic in order to improve the situation of intensive care nurses and those who are cared for. (shrink)