Regina Müller

BackgroundThe West African Ebola virus epidemic from 2014 to 2016 is unprecedented in its scale, surpassing all previous and subsequent Ebola outbreaks since 1976. This epidemic provoked a humanitarian emergency that extended to different spheres of life, making visible ethical challenges in addition to medical, economic, and social ones. The present article aims to identify and differentiate the scope of ethical issues associated with the Ebola epidemic.MethodsAn online media analysis was performed on articles published from March 2014 to September 2015 in ten preselected academic journals (scientific press) and two online newspapers (lay press). Two methodological approaches were combined: a systematic literature search and a qualitative content analysis. An additional keyword search was conducted on the PubMed database for the period after the end of the Ebola epidemic (2016-2020) to obtain an overview of research dealing with medical ethics due to the epidemic and to compare these results with the identified ethical challenges.ResultsA total of 389 articles dealing with the subject fields “Ebola epidemic” and “ethics” were researched. For qualitative content analysis, the time span with the highest article density was selected and a total of 64 articles were included (15 scientific articles, 49 popular articles). Five core ethical challenges of the Ebola epidemic emerged: 1. Responsibility and Accountability, 2. Spillover Effects, 3. Research and Development, 4. Health Communication, and 5. Resource Allocation. Articles in academic journals were dominated by the discussion of normative aspects in the area of “research and development”, while newspaper articles focused on aspects of “responsibility and accountability”.ConclusionAn ethical discussion of the Ebola epidemic requires an examination of as many of the ethical dimensions involved as possible. The presented investigation of the two types of media with regard to the Ebola epidemic offers this possibility of a more comprehensive insight into this diversity as a basis for ethical discussions.

Definition of the problem Digital health technologies have gained significant importance in recent years. These technologies include symptom checker apps which use algorithms or artificial intelligence to provide users with analyses and recommendations based on their symptom input. Despite their widespread recognition, research shows mixed results regarding the accuracy of these apps, thus, limiting their current utility. The interdisciplinary CHECK.APP project examined the ethical, legal, and social aspects associated with symptom checker apps. Arguments The resulting recommendations presented here are directed towards various stakeholders, including users, physicians, developers, and public institutions. It is crucial to adopt a critical stance towards the use of symptom checker apps, promote health literacy and eHealth literacy, and ensure transparency regarding the data basis and user experiences. Moreover, there is a need for reliable and independent information sources that allow users and physicians to stay informed about current developments in the digitalization of healthcare. At the same time, developers are encouraged to follow clear guidelines on transparency, quality assurance, and accessibility. Additionally, policymakers are recommended to ensure the voluntary use of symptom checker apps and to create conditions that strengthen the health literacy of the population. Conclusion The recommendations presented here outline how symptom checker apps can be used responsibly to maximize potential benefits and minimize risks.

Definition of the problem Digital health technologies have gained significant importance in recent years. These technologies include symptom checker apps which use algorithms or artificial intelligence to provide users with analyses and recommendations based on their symptom input. Despite their widespread recognition, research shows mixed results regarding the accuracy of these apps, thus, limiting their current utility. The interdisciplinary CHECK.APP project examined the ethical, legal, and social aspects associated with symptom checker apps. Arguments The resulting recommendations presented here are directed towards various stakeholders, including users, physicians, developers, and public institutions. It is crucial to adopt a critical stance towards the use of symptom checker apps, promote health literacy and eHealth literacy, and ensure transparency regarding the data basis and user experiences. Moreover, there is a need for reliable and independent information sources that allow users and physicians to stay informed about current developments in the digitalization of healthcare. At the same time, developers are encouraged to follow clear guidelines on transparency, quality assurance, and accessibility. Additionally, policymakers are recommended to ensure the voluntary use of symptom checker apps and to create conditions that strengthen the health literacy of the population. Conclusion The recommendations presented here outline how symptom checker apps can be used responsibly to maximize potential benefits and minimize risks.

Definition of the problem In Germany, there is currently a significant gap in the care of persons affected by obesity due to the absence of a standardized therapy path, regional variations in health services, and case-by-case decisions for approval. This situation prompts the discussion of integrating digital obesity applications into the existing care framework. Arguments The analysis presents an ethical reflection on the use of digital health applications for obesity treatment, examining their suitability for this complex chronic condition, which has multifactorial causes and a heterogeneous patient group. We evaluate the social, advisory, and organizational aspects required to meet the diverse needs of those affected. The study highlights key ethical challenges such as avoiding stigmatization and discrimination, acknowledging the diversity of patient groups, and integrating holistic therapeutic approaches. The article also emphasizes the importance of participatory research methods to incorporate the perspectives and experiences of patients systematically. Conclusion Digital health applications hold potential to significantly improve obesity care in Germany, especially in regions with limited access to traditional therapy options. Successful implementation, however, requires careful ethical reflection and empirical research. It is crucial that these applications address the diversity and complexity of the patient population and their specific needs, which will contribute to a reduction of the care gap.

Definition of the problem In Germany, there is currently a significant gap in the care of persons affected by obesity due to the absence of a standardized therapy path, regional variations in health services, and case-by-case decisions for approval. This situation prompts the discussion of integrating digital obesity applications into the existing care framework. Arguments The analysis presents an ethical reflection on the use of digital health applications for obesity treatment, examining their suitability for this complex chronic condition, which has multifactorial causes and a heterogeneous patient group. We evaluate the social, advisory, and organizational aspects required to meet the diverse needs of those affected. The study highlights key ethical challenges such as avoiding stigmatization and discrimination, acknowledging the diversity of patient groups, and integrating holistic therapeutic approaches. The article also emphasizes the importance of participatory research methods to incorporate the perspectives and experiences of patients systematically. Conclusion Digital health applications hold potential to significantly improve obesity care in Germany, especially in regions with limited access to traditional therapy options. Successful implementation, however, requires careful ethical reflection and empirical research. It is crucial that these applications address the diversity and complexity of the patient population and their specific needs, which will contribute to a reduction of the care gap.

Self-tracking-technologies can serve as a prominent example of how digital technologies put to test established practices, institutions, and structures of medicine and healthcare. While proponents emphasize the potentials, e.g., for individualized healthcare and new research data, opponents stress the risk that these technologies will reinforce gender-related inequalities. While this has been made clear from—often intersectional—feminist perspectives since the introduction of such technologies, we aim to provide a queer-feminist perspective on self-tracking applications in healthcare by analyzing three concrete cases. In this way, we want to show why such a perspective is helpful in assessing self-tracking technologies and how such a perspective might contribute to a queering of healthcare. After a short introduction to self-tracking in healthcare and the corresponding risks of reproducing gender-related inequalities, we introduce queer bioethics as a methodology to examine structural discrimination and marginalization in bioethical research. We apply this framework in the analysis of three exemplary self-tracking applications from the areas of nutrition/fitness, reproductive health, and mental health. In the subsequent discussion of these results against the backdrop of already existing queer-sensitive technologies, we identify an equal access, a subversive design, an inclusive database, and a diversity-sensitive and discriminatory-critical definition of purposes as well as individualized usage possibilities as first possible starting points for a queering of self-tracking applications. Finally, we draw conclusions, how such a critical perspective on self-tracking applications might also contribute to a queering of the healthcare system at a structural level.

_A comprehensive guide to AI's ethical, epistemological, and legal impacts through applied philosophy_ Inartificial intelligence (AI) influences nearly every aspect of society. _A Companion to Applied Philosophy of AI_ provides a critical philosophical framework for understanding and addressing its complexities. Edited by Martin Hähnel and Regina Müller, this volume explores AI's practical implications in epistemology, ethics, politics, and law. Moving beyond a narrow ethical perspective, the authors advocate for a multi-faceted approach that synthesizes diverse disciplines and perspectives, offering readers a nuanced and integrative understanding of AI's transformative role. The Companion explores a broad range of topics, from issues of transparency and expertise in AI-driven systems to discussions of ethical theories and their relevance to AI, such as consequentialism, deontology, and virtue ethics. Filling a significant gap in the current academic literature, this groundbreaking volume also addresses AI's broader social, political, and legal dimensions, equipping readers with practical frameworks to navigate this rapidly evolving field. Offering fresh and invaluable insights into the interplay between philosophical thought and technological innovation, A Companion to Applied Philosophy of AI: Features contributions from leading philosophers and interdisciplinary experts Offers a unique applied philosophy perspective on artificial intelligence Covers diverse topics including ethics, epistemology, politics, and law Encourages interdisciplinary dialogue to better understand AI's profound implications for humanity _A Companion to Applied Philosophy of AI_ is ideal for undergraduate and graduate courses in applied philosophy, AI ethics, political theory, and legal philosophy. It is also a vital reference for those working in areas including AI policy, governance, and interdisciplinary research.

Bioethics has developed approaches to address ethical issues in health care, similar to how technology ethics provides guidelines for ethical research on artificial intelligence, big data, and robotic applications. As these digital technologies are increasingly used in medicine, health care and public health, thus, it is plausible that the approaches of technology ethics have influenced bioethical research. Similar to the “empirical turn” in bioethics, which led to intense debates about appropriate moral theories, ethical frameworks and meta-ethics due to the increased use of empirical methodologies from social sciences, the proliferation of health-related subtypes of technology ethics might have a comparable impact on current bioethical research. This systematic journal review analyses the reporting of ethical frameworks and non-empirical methods in argument-based research articles on digital technologies in medicine, health care and public health that have been published in high-impact bioethics journals. We focus on articles reporting non-empirical research in original contributions. Our aim is to describe currently used methods for the ethical analysis of ethical issues regarding the application of digital technologies in medicine, health care and public health. We confine our analysis to non-empirical methods because empirical methods have been well-researched elsewhere. Finally, we discuss our findings against the background of established methods for health technology assessment, the lack of a typology for non-empirical methods as well as conceptual and methodical change in bioethics. Our descriptive results may serve as a starting point for reflecting on whether current ethical frameworks and non-empirical methods are appropriate to research ethical issues deriving from the application of digital technologies in medicine, health care and public health.

In October 2022, the International Association of Bioethics announced that the 17th World Congress of Bioethics (WCB) 2024 would be held in Doha, Qatar. The International Network on Feminist Approaches to Bioethics (FAB) traditionally holds its World Congress jointly with the WCB. As part of the ongoing debate about the ethics of bioethics conferencing, the FAB provided a detailed statement discussing concerns about choosing Qatar as the site for a feminist bioethics conference. In order to explore possible approaches towards the FABs decision, the German Feminist Perspectives in Medical Ethics and Bioethics working group (FME) dedicated one of its meetings to the topic. In this commentary, we present two aspects that we consider particularly important for this current debate: (1) the participation of LGBTQIA+ people in the conference and (2) the possibility of racist and anti-Muslim bias in the evaluation of Qatar as the site for the WCB 2024. As members of the FME, we aim to contribute to an exchange of various perspectives within the international feminist bioethics community.

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.

Background Symptom checker apps (SCAs) are mobile or online applications for lay people that usually have two main functions: symptom analysis and recommendations. SCAs ask users questions about their symptoms via a chatbot, give a list with possible causes, and provide a recommendation, such as seeing a physician. However, it is unclear whether the actual performance of a SCA corresponds to the users’ experiences. This qualitative study investigates the subjective perspectives of SCA users to close the empirical gap identified in the literature and answers the following main research question: How do individuals (healthy users and patients) experience the usage of SCA, including their attitudes, expectations, motivations, and concerns regarding their SCA use? Methods A qualitative interview study was chosen to clarify the relatively unknown experience of SCA use. Semi-structured qualitative interviews with SCA users were carried out by two researchers in tandem via video call. Qualitative content analysis was selected as methodology for the data analysis. Results Fifteen interviews with SCA users were conducted and seven main categories identified: (1) Attitudes towards findings and recommendations, (2) Communication, (3) Contact with physicians, (4) Expectations (prior to use), (5) Motivations, (6) Risks, and (7) SCA-use for others. Conclusions The aspects identified in the analysis emphasise the specific perspective of SCA users and, at the same time, the immense scope of different experiences. Moreover, the study reveals ethical issues, such as relational aspects, that are often overlooked in debates on mHealth. Both empirical and ethical research is more needed, as the awareness of the subjective experience of those affected is an essential component in the responsible development and implementation of health apps such as SCA. Trial registration German Clinical Trials Register (DRKS): DRKS00022465. 07/08/2020.

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.

The development of artificial intelligence (AI) in medicine raises fundamental ethical issues. As one example, AI systems in the field of mental health successfully detect signs of mental disorders, such as depression, by using data from social media. These AI depression detectors (AIDDs) identify users who are at risk of depression prior to any contact with the healthcare system. The article focuses on the ethical implications of AIDDs regarding affected users’ health-related autonomy. Firstly, it presents the (ethical) discussion of AI in medicine and, specifically, in mental health. Secondly, two models of AIDDs using social media data and different usage scenarios are introduced. Thirdly, the concept of patient autonomy, according to Beauchamp and Childress, is critically discussed. Since this concept does not encompass the specific challenges linked with the digital context of AIDDs in social media sufficiently, the current analysis suggests, finally, an extended concept of health-related digital autonomy.

Definition of the problemFeminist approaches to medical ethics are well established in international discourses. By contrast, in the German-speaking medical ethical discourse, they still seem to be rather marginal. In this article, we analyze which feminist perspectives are prominent in German medical ethics and suggest new approaches.ArgumentsWe present our results from a systematized review of the literature, in which we identify existing feminist approaches within the German-speaking medical ethics discourse as well as research gaps. Based on the review, our preliminary research and discussions in the working group “Feminist perspectives in bio and medical ethics”, we defend three hypotheses aimed at advancing the German feminist medical ethical discourse. We posit that (1) feminist medical ethics aim at (epistemic) justice, (2) feminist medical ethics are critical and context-sensitive, and (3) intersectional and postcolonial approaches within feminist medical ethics may contribute to epistemically just, critical, and context-sensitive medical ethics.ConclusionWe argue that feminist perspectives should be implemented as a fundamental perspective in medical ethics because they can bring together key dimensions such as epistemically just, critical, context-sensitive, intersectional, and postcolonial thinking.

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.

BackgroundPatient advocacy organizations (PAOs) have an increasing influence on health policy and biomedical research, therefore, questions about the specific character of their responsibility arise: Can PAOs bear moral responsibility and, if so, to whom are they responsible, for what and on which normative basis? Although the concept of responsibility in healthcare is strongly discussed, PAOs particularly have rarely been systematically analyzed as morally responsible agents. The aim of the current paper is to analyze the character of PAOs’ responsibility to provide guidance to themselves and to other stakeholders in healthcare.MethodsResponsibility is presented as a concept with four reference points: (1) The subject, (2) the object, (3) the addressee and (4) the underlying normative standard. This four-point relationship is applied to PAOs and the dimensions of collectivity and prospectivity are analyzed in each reference point.ResultsUnderstood as collectives, PAOs are, in principle, capable of intentionality and able to act and, thus, fulfill one prerequisite for the attribution of moral responsibility. Given their common mission to represent those affected, PAOs can be seen as responsible for patients’ representation and advocacy, primarily towards a certain group but secondarily in a broader social context. Various legal and political statements and the bioethical principles of justice, beneficence and empowerment can be used as a normative basis for attributing responsibility to PAOs.ConclusionsThe understanding of responsibility as a four-point relation incorporating collective and forward-looking dimensions helps one to understand the PAOs’ roles and responsibilities better. The analysis, thus, provides a basis for the debate about PAOs’ contribution and cooperation in the healthcare sector.

BackgroundThe West African Ebola virus epidemic from 2014 to 2016 is unprecedented in its scale, surpassing all previous and subsequent Ebola outbreaks since 1976. This epidemic provoked a humanitarian emergency that extended to different spheres of life, making visible ethical challenges in addition to medical, economic, and social ones. The present article aims to identify and differentiate the scope of ethical issues associated with the Ebola epidemic.MethodsAn online media analysis was performed on articles published from March 2014 to September 2015 in ten preselected academic journals (scientific press) and two online newspapers (lay press). Two methodological approaches were combined: a systematic literature search and a qualitative content analysis. An additional keyword search was conducted on the PubMed database for the period after the end of the Ebola epidemic (2016-2020) to obtain an overview of research dealing with medical ethics due to the epidemic and to compare these results with the identified ethical challenges.ResultsA total of 389 articles dealing with the subject fields “Ebola epidemic” and “ethics” were researched. For qualitative content analysis, the time span with the highest article density was selected and a total of 64 articles were included (15 scientific articles, 49 popular articles). Five core ethical challenges of the Ebola epidemic emerged: 1. Responsibility and Accountability, 2. Spillover Effects, 3. Research and Development, 4. Health Communication, and 5. Resource Allocation. Articles in academic journals were dominated by the discussion of normative aspects in the area of “research and development”, while newspaper articles focused on aspects of “responsibility and accountability”.ConclusionAn ethical discussion of the Ebola epidemic requires an examination of as many of the ethical dimensions involved as possible. The presented investigation of the two types of media with regard to the Ebola epidemic offers this possibility of a more comprehensive insight into this diversity as a basis for ethical discussions.

Symptom Checker Applications (SCA) are mobile applications often designed for the end-user to assist with symptom assessment and self-triage. SCA are meant to provide the user with easily accessible information about their own health conditions. However, SCA raise questions regarding ethical, legal, and social aspects (ELSA), for example, regarding fair access to this new technology. The aim of this scoping review is to identify the ELSA of SCA in the scientific literature. A scoping review was conducted to identify the ELSA of SCA. Ten databases (e.g., Web of Science and PubMed) were used. Studies on SCA that address ELSA, written in English or German, were included in the review. The ELSA of SCA were extracted and synthesized using qualitative content analysis. A total of 25,061 references were identified, of which 39 were included in the analysis. The identified aspects were allotted to three main categories: (1) Technology; (2) Individual Level; and (3) Healthcare system. The results show that there are controversial debates in the literature on the ethical and social challenges of SCA usage. Furthermore, the debates are characterised by a lack of a specific legal perspective and empirical data. The review provides an overview on the spectrum of ELSA regarding SCA. It offers guidance to stakeholders in the healthcare system, for example, patients, healthcare professionals, and insurance providers and could be used in future empirical research to investigate the perspectives of those affected, such as users.