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Ethical Challenges With Smartwatch-Based Screening for Atrial Fibrillation: Putting Users at Risk for Marketing Purposes?

Background: Atrial fibrillation is the most common persistent arrhythmia. It is associated with increased mortality and morbidity such as stroke. The early detection of atrial fibrillation can significantly reduce the risk of stroke through preventive anticoagulation. Smartwatches offer the opportun...

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Autores principales: Predel, Christopher, Steger, Florian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843431/
https://www.ncbi.nlm.nih.gov/pubmed/33521064
http://dx.doi.org/10.3389/fcvm.2020.615927
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author Predel, Christopher
Steger, Florian
author_facet Predel, Christopher
Steger, Florian
author_sort Predel, Christopher
collection PubMed
description Background: Atrial fibrillation is the most common persistent arrhythmia. It is associated with increased mortality and morbidity such as stroke. The early detection of atrial fibrillation can significantly reduce the risk of stroke through preventive anticoagulation. Smartwatches offer the opportunity to screen for atrial fibrillation in the general population. This paper aims to analyze the ethical challenges associated with screening for atrial fibrillation using smartwatches. Methods: This is an ethical analysis. The methodology is based on the principle-orientated approach of Beauchamp and Childress. The principles of beneficence, non-maleficence, justice, and autonomy have to be guaranteed given the influence of private companies, privacy protection, liability and doctor-patient-relationship. The work is based on a systematic literature research. Results: There is currently no evidence that screening for atrial fibrillation with smartwatches improves the outcome and reduces the number of adverse events. The high number of false-positive results can lead to harm. The principle of non-maleficence is violated. The over-reliance on and the lack of adequate education by smartwatches can worsen the doctor-patient relationship. However, the relationship can also be improved by the proactive participation of the patient, which leads to greater autonomy, compliance and in the end beneficence. Since smartwatches are consumer goods, there is a risk for greater disparities in the poor and rich population. There is also a risk of discrimination against ethnic minorities due to underrepresentation in training data and study cohorts. The principle of justice is violated. The storage of sensitive medical data by private companies also raises many ethical and legal concerns. Conclusion: This analysis has shown that the use of smartwatches to detect atrial fibrillation is currently in an ethical perspective problematic. The lack of evidence and the high number of false-positive results can lead to harm. As smartwatches provide only little information about the possible consequences, informed consent cannot be assumed. Ethical implementation could be archived if doctors provide smartwatches to patients who have been shown to benefit from them. The implementation and education should be managed by the doctor.
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spelling pubmed-78434312021-01-30 Ethical Challenges With Smartwatch-Based Screening for Atrial Fibrillation: Putting Users at Risk for Marketing Purposes? Predel, Christopher Steger, Florian Front Cardiovasc Med Cardiovascular Medicine Background: Atrial fibrillation is the most common persistent arrhythmia. It is associated with increased mortality and morbidity such as stroke. The early detection of atrial fibrillation can significantly reduce the risk of stroke through preventive anticoagulation. Smartwatches offer the opportunity to screen for atrial fibrillation in the general population. This paper aims to analyze the ethical challenges associated with screening for atrial fibrillation using smartwatches. Methods: This is an ethical analysis. The methodology is based on the principle-orientated approach of Beauchamp and Childress. The principles of beneficence, non-maleficence, justice, and autonomy have to be guaranteed given the influence of private companies, privacy protection, liability and doctor-patient-relationship. The work is based on a systematic literature research. Results: There is currently no evidence that screening for atrial fibrillation with smartwatches improves the outcome and reduces the number of adverse events. The high number of false-positive results can lead to harm. The principle of non-maleficence is violated. The over-reliance on and the lack of adequate education by smartwatches can worsen the doctor-patient relationship. However, the relationship can also be improved by the proactive participation of the patient, which leads to greater autonomy, compliance and in the end beneficence. Since smartwatches are consumer goods, there is a risk for greater disparities in the poor and rich population. There is also a risk of discrimination against ethnic minorities due to underrepresentation in training data and study cohorts. The principle of justice is violated. The storage of sensitive medical data by private companies also raises many ethical and legal concerns. Conclusion: This analysis has shown that the use of smartwatches to detect atrial fibrillation is currently in an ethical perspective problematic. The lack of evidence and the high number of false-positive results can lead to harm. As smartwatches provide only little information about the possible consequences, informed consent cannot be assumed. Ethical implementation could be archived if doctors provide smartwatches to patients who have been shown to benefit from them. The implementation and education should be managed by the doctor. Frontiers Media S.A. 2021-01-15 /pmc/articles/PMC7843431/ /pubmed/33521064 http://dx.doi.org/10.3389/fcvm.2020.615927 Text en Copyright © 2021 Predel and Steger. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Predel, Christopher
Steger, Florian
Ethical Challenges With Smartwatch-Based Screening for Atrial Fibrillation: Putting Users at Risk for Marketing Purposes?
title Ethical Challenges With Smartwatch-Based Screening for Atrial Fibrillation: Putting Users at Risk for Marketing Purposes?
title_full Ethical Challenges With Smartwatch-Based Screening for Atrial Fibrillation: Putting Users at Risk for Marketing Purposes?
title_fullStr Ethical Challenges With Smartwatch-Based Screening for Atrial Fibrillation: Putting Users at Risk for Marketing Purposes?
title_full_unstemmed Ethical Challenges With Smartwatch-Based Screening for Atrial Fibrillation: Putting Users at Risk for Marketing Purposes?
title_short Ethical Challenges With Smartwatch-Based Screening for Atrial Fibrillation: Putting Users at Risk for Marketing Purposes?
title_sort ethical challenges with smartwatch-based screening for atrial fibrillation: putting users at risk for marketing purposes?
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843431/
https://www.ncbi.nlm.nih.gov/pubmed/33521064
http://dx.doi.org/10.3389/fcvm.2020.615927
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