Tabea Ott

Background: Mobile health (mHealth) apps promise to enhance patient empowerment, enable real-time health monitoring, and support self-management. Patients with breast cancer stand to benefit particularly from these capabilities, given the demanding pre- and posttreatment procedures they face. However, the effective adoption of these tools is challenged by issues including accessibility, usability limitations, and privacy concerns. Objective: This study aimed to investigate the current usage behavior and attitudes toward mHealth apps among patients with breast cancer in Germany, focusing on acceptance, usefulness, empowerment, and data-sharing. Specifically, we aimed to identify the incentives and barriers influencing use and the intention to use mHealth apps at the time of this writing to guide their further implementation and use. Methods: A cross-sectional online survey was conducted between November 2023 and June 2024 using a structured questionnaire developed in German. Participants with a self-reported breast cancer diagnosis were recruited via university hospital channels, patient associations, and social media. Topics included technology and health app usage, perceived usefulness, personal empowerment, and attitudes toward data sharing. The survey comprised both closed- and open-ended questions to capture quantitative patterns and qualitative insights into participants’ experiences and perspectives. Results: We collected responses from 90 participants with breast cancer. Participants demonstrated high engagement with digital technology; 97% (87/90) reported daily smartphone use, and 70% (63/90) owned a smartwatch or fitness tracker. Approximately 67% (60/90) of respondents had used health apps in the past year, with many relying on general fitness and lifestyle apps to support their health management. Most participants (62/90, 69%) indicated that health apps contribute to a better understanding of their personal health. Health apps were generally perceived as useful, with users highlighting their ability to provide continuous support and timely, reliable health information (n=31). This, in turn, was seen as instrumental in promoting self-management and empowerment. Respondents also showed a conditional willingness to share personal health data for research, particularly when clear benefits for treatment advancements were evident (n=82). Nonetheless, concerns were raised regarding data privacy, app usability, the need for multiple apps to cover all necessary features, and the potential increase in fear of illness (cyberchondria). Conclusions: The findings underscore the potential of mHealth apps to empower patients with breast cancer by improving health literacy and supporting self-management. To maximize their impact, future digital health tools must align closely with patient needs by incorporating adaptive, interactive features and integrating seamlessly with clinical care. Addressing key barriers—particularly data privacy and usability issues—is essential for broader adoption. Longitudinal studies are warranted to evaluate the long-term effects of health app usage on patient empowerment, quality of life, and clinical outcomes.

Misinformation, disinformation, and malinformation pose a challenge to health risk communication. These information disorders can be amplified and altered by AI. In this article, we compare governance approaches from Germany and Brazil to understand how these two democracies address the role of AI in both exacerbating and mitigating health information disorders. Drawing on document analysis of hard and soft law governance approaches, the study shows that both countries frame AI as an ambivalent tool: While AI enables large-scale production and spread of misleading content, it also provides mechanisms for detection and monitoring of this content, and allows tailored communication. In Germany, information disorders are addressed through a multi-level governance strategy that combines national regulation with international frameworks. At the same time, independent fact-checking organizations and individual actors play a complementary role by monitoring public discourse, verifying claims, and fostering media literacy. In Brazil, efforts include legislative proposals on AI, the National AI Plan, and fact-checking services, though implementation is complicated by political and economic dynamics. Across both contexts, governance measures emphasize individual and organizational responsibilities, particularly through platform regulation, transparency, and digital literacy, but often underplay broader societal and interactional factors such as political structures, trust, and post-truth dynamics.

Wie nehmen wir einander wahr? Und was beeinflusst diese Wahrnehmung? Tabea Ott stellt nach einer phänomenologischen Einführung den Begriff der Visibilität als einen ethischen Topos vor, der mit Anerkennung, Handlungsfähigkeit und Vulnerabilität verbunden ist. Sie fragt nach den Möglichkeiten der Gestaltung gerechten Sehens (nicht nur) angesichts digitaler Datenbilder und führt am hochaktuellen Beispiel des digitalisierten Gesundheitssystems vor, was es heißt, unsichtbar und exponiert zu sein. In der Perspektive einer theologischen Ethik, die immer wieder Bezug auf den Blickaustausch zwischen Gott und Mensch in der alttestamentlichen Hagar-Geschichte nimmt, skizziert die Autorin schließlich Grundlinien einer Ethik der Aufmerksamkeit, die ganz konkrete Governance-Maßnahmen für den Umgang mit digitalen Datenbildern liefert.

This paper investigates the underlying structural logics of purity cultures from a theological-ethical perspective, highlighting how the regulation of bodies within the framework of purity cultures can be understood as a form of sexual violence. Often associated with conservative religious ideologies, purity cultures impose strict norms and expectations on individual's sexual behavior and expression. Although they claim to promote moral virtue and purity, this paper argues that they can have detrimental consequences for individuals, particularly those who deviate from the prescribed norms. By examining the dynamics of purity cultures and their impact on diverse communities, this paper seeks to shed light on the multifaceted nature of sexual violence and the often overseen way it is enacted by establishing a belief system of ‘bodies as property’.

Ist Denken Reflexion "auf der Grenze" (Paul Tillich), so ist Kommunikation eigenen Denkens Vermittlung dieser Grenzerfahrung, die selbst an Grenzen stößt. Dies gilt erst recht in einer Gegenwart, in der durch Polarisierung, Propaganda und Hassreden elementare Bedingungen von Verständigungs- und Vermittlungsbemühungen nicht mehr anerkannt sind. Dabei stellt die Digitalisierung von Kommunikation eine zusätzliche Herausforderung dar, die sogar die Grundlagen einer liberal-rechtsstaatlichen Demokratie untergraben kann. Vor diesem Hintergrund bieten in diesem Band herausragende DenkerInnen aus ihrer jeweiligen Fachperspektive Grenzreflexionen rund um das Verhältnis von Theologie, Philosophie und Ethik im Kontext von Kirche, Politik und Öffentlichkeit.

Der Artikel nimmt die Berichte und Studien zu gewaltvollen Erfahrungen unter der Geburt zum Anlass, um das relationale Spannungsfeld zu analysieren, in das sich Schwangere, Ungeborenes und Geburtshelferinnen unter der Geburt gestellt sehen. Unter Berücksichtigung des mehrdimensionalen Verantwortungsverhältnisses wird der Autonomiebegriff sozialanthropologisch als relationaler entfaltet, anhand dessen gezeigt werden soll, wannin der Geburtshilfe von der Anwendung ‚wohltätigen‘ Zwanges gesprochen werden kann, wie er etwa auch im Kontext psychischer Devianz diskutiert wird.

Der Artikel nimmt die Berichte und Studien zu gewaltvollen Erfahrungen unter der Geburt zum Anlass, um das relationale Spannungsfeld zu analysieren, in das sich Schwangere, Ungeborenes und Geburtshelferinnen unter der Geburt gestellt sehen. Unter Berücksichtigung des mehrdimensionalen Verantwortungsverhältnisses wird der Autonomiebegriff sozialanthropologisch als relationaler entfaltet, anhand dessen gezeigt werden soll, wann in der Geburtshilfe von der Anwendung ‚wohltätigen‘ Zwanges gesprochen werden kann, wie er etwa auch im Kontext psychischer Devianz diskutiert wird. The article takes the reports and studies on violent experiences during childbirth as a reason to analyse the relational field of tension in which pregnant women, the unborn and obstetricians find themselves during childbirth. Taking into account the multidimensional relationship of responsibility, the concept of autonomy is presented in social anthropological terms as a relational one, which is used to show when it is possible to speak of ‘benevolent’ coercion in obstetrics, as it is also discussed, for example, in the context of psychological deviance.

Intersectionality has become a buzzword in the humanities, yet it often remains ill-defined or is used inconsistently depending on the subject area. On the one hand, intersectionality still needs refinement and lacks scientific acknowledgement. Particularly in German-speaking theological ethics, intersectionality has been little discussed. On the other hand, intersectionality seems to be so established, especially in the Anglo-American context, that the intersection of gender and race is far from questioned anymore. However, both stances overlook the inherent dimensions of intersectionality, failing to effectively tackle the challenges posed by algorithmic classification. These challenges stem from the ongoing creation of new intersections and the superimposition or obscuration of existing ones. However, intersectionality understood as a knowledge project promises to address the challenges effectively. Therefore, the paper identifies key dimensions of what constitutes intersectionality. First, intersectional theories aim to de-marginalize the intersection where discrimination and injustice occur. Second, intersectional theories identify the intersections as multiple, non-hierarchical, and dynamic entanglements. Third, intersectional theories are often misunderstood as identity politics. However, they function as a critique of power and the pursuit of justice. From these three dimensions of intersectional theories, the paper draws socio-ethical implications for algorithmic classification. The in-depth analysis shows that intersectional theory is able to expose the difficulties of using categories and classifiers as well as aggregating and disaggregating data in the context of Artificial Intelligence. The paper points out that the disaggregation of data and fine-grained analysis can only take place where political protection mechanisms ensure that individuals and groups are not harmed.

Der Sammelband beleuchtet die vielfältigen Facetten von Solidarität in einer digital vernetzten und krisengeprägten Welt. Er untersucht, wie neue Technologien und soziale Netzwerke Solidaritätspraktiken verändern und welche Potentiale und Herausforderungen sich daraus ergeben. Durch die Verknüpfungen von Traditionen der protestantischen Ethik, der Befreiungstheologie und Black Theology mit intersektional-feministischen Theorien zeigt der Sammelband auf, welche Rolle Solidarität in emanzipatorischen Bewegungen spielt und wie diese aktuelle Definitionen informieren können. Ziel ist es, die Debatte um Solidarität anzuregen sowie neue Impulse für theologisch-ethische und soziale Diskurse zu setzen.

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.

Since uncertainty is a major challenge in medicine and bears the risk of causing incorrect diagnoses and harmful treatment, there are many efforts to tackle it. For some time, AI technologies have been increasingly implemented in medicine and used to reduce medical uncertainties. What initially seems desirable, however, poses challenges. We use a multimethod approach that combines philosophical inquiry, conceptual analysis, and ethical considerations to identify key challenges that arise when AI is used for medical certainty purposes. We identify several challenges. Where AI is used to reduce medical uncertainties, it is likely to result in (a) patients being stripped down to their measurable data points, and being made disambiguous. Additionally, the widespread use of AI technologies in health care bears the risk of (b) human physicians being pushed out of the medical decision-making process, and patient participation being more and more limited. Further, the successful use of AI requires extensive and invasive monitoring of patients, which raises (c) questions about surveillance as well as privacy and security issues. We outline these several challenges and show that they are immediate consequences of AI-driven security efforts. If not addressed, they could entail unfavorable consequences. We contend that diminishing medical uncertainties through AI involves a tradeoff. The advantages, including enhanced precision, personalization, and overall improvement in medicine, are accompanied by several novel challenges. This paper addresses them and gives suggestions about how to use AI for certainty purposes without causing harm to patients.

This paper presents a social-theologically informed interpretation of the term integrity, as it occurs in fundamental law. It explores the manifestations of integrity violations and proceeds to draw an inference: an integrity violation can directly emanate from a misconception regarding integrity itself, as well as the implementation of protective measures that follow it. Integrity in its wholeness dimension is understood as open-endedness and non-seclusion rather than as a substantial, clearly definable characteristic of a person. This open-endedness and non-seclusion results from the relational constitution of an individual. Consequently, it follows that a violation of integrity occurs when the open-endedness and non-seclusion of a person and their relational Becoming is hindered. The new definition of integrity is particularly important when it comes to the governance of new health technologies, especially Digital Twins that can become representatives of a person. Human integrity is non-violated only when it is understood as open to relational Becoming and this Becoming shows its expression in the mutual enabling and support of self-articulation.

Background Palliative care is an integral part of health care, which in term has become increasingly technologized in recent decades. Lately, innovative smart sensors combined with artificial intelligence promise better diagnosis and treatment. But to date, it is unclear: how are palliative care concepts and their underlying assumptions about humans challenged by smart sensor technologies (SST) and how can care benefit from SST? Aims The paper aims to identify changes and challenges in palliative care due to the use of SST. In addition, normative guiding criteria for the use of SST are developed. Methods The principle of Total Care used by the European Association for Palliative Care (EAPC) forms the basis for the ethical analysis. Drawing on this, its underlying conceptions of the human and its socio-ethical aspects are examined with a phenomenological focus. In the second step, the advantages, limitations, and socio-ethical challenges of using SST with respect to the Total Care principle are explored. Finally, ethical-normative requirements for the application of SST are derived. Results and Conclusion First, SST are limited in their measurement capabilities. Second, SST have an impact on human agency and autonomy. This concerns both the patient and the caregiver. Third, some aspects of the Total Care principle are likely to be marginalized due to the use of SST. The paper formulates normative requirements for using SST to serve human flourishing. It unfolds three criteria according to which SST must be aligned: (1) evidence and purposefulness, (2) autonomy, and (3) Total Care.

The use of Artificial Intelligence and Big Data in health care opens up new opportunities for the measurement of the human. Their application aims not only at gathering more and better data points but also at doing it less invasive. With this change in health care towards its extension to almost all areas of life and its increasing invisibility and opacity, new questions of transparency arise. While the complex human-machine interactions involved in deploying and using AI tend to become non-transparent, the use of these technologies makes the patient seemingly transparent. Papers on the ethical implementation of AI plead for transparency but neglect the factor of the “transparent patient” as intertwined with AI. Transparency in this regard appears to be Janus-faced: The precondition for receiving help - e.g., treatment advice regarding the own health - is to become transparent for the digitized health care system. That is, for instance, to donate data and become visible to the AI and its operators. The paper reflects on this entanglement of transparent patients and (non-) transparent technology. It argues that transparency regarding both AI and humans is not an ethical principle per se but an infraethical concept. Further, it is no sufficient basis for avoiding harm and human dignity violations. Rather, transparency must be enriched by intelligibility following Judith Butler’s use of the term. Intelligibility is understood as an epistemological presupposition for recognition and the ensuing humane treatment. Finally, the paper highlights ways to testify intelligibility in dealing with AI in health care ex ante, ex post, and continuously.