Cybersecurity in health - disentangling value tensions

Cybersecurity in healthcare has become an urgent matter in recent years due to various malicious attacks on hospitals and other parts of the healthcare infrastructure. The purpose of this paper is to provide an outline of how core values of the health systems, such as the principles of biomedical ethics, are in a supportive or conflicting relation to cybersecurity.,This paper claims that it is possible to map the desiderata relevant to cybersecurity onto the four principles of medical ethics, i.e. beneficence, non-maleficence, autonomy and justice, and explore value conflicts in that way.,With respect to the question of how these principles should be balanced, there are reasons to think that the priority of autonomy relative to beneficence and non-maleficence in contemporary medical ethics could be extended to value conflicts in health-related cybersecurity.,However, the tension between autonomy and justice, which relates to the desideratum of usability of information and communication technology systems, cannot be ignored even if one assumes that respect for autonomy should take priority over other moral concerns.,In terms of value conflicts, most discussions in healthcare deal with the conflict of balancing efficiency and privacy given the sensible nature of health information. In this paper, the authors provide a broader and more detailed outline.

[1]  Vivian Genaro Motti,et al.  Users' Privacy Concerns About Wearables - Impact of Form Factor, Sensors and Type of Data Collected , 2015, Financial Cryptography Workshops.

[2]  M. Aanestad,et al.  eRegistries: governance for electronic maternal and child health registries , 2016, BMC Pregnancy and Childbirth.

[3]  Urmimala Sarkar,et al.  Barriers and Facilitators to Online Portal Use Among Patients and Caregivers in a Safety Net Health Care System: A Qualitative Study , 2015, Journal of medical Internet research.

[4]  Dipak Kalra,et al.  Inter-organizational future proof EHR systems: A review of the security and privacy related issues , 2009, Int. J. Medical Informatics.

[5]  R. Rawbone,et al.  Principles of Biomedical Ethics, 7th Edition , 2015 .

[6]  D. McGraw,et al.  Privacy as an enabler, not an impediment: building trust into health information exchange. , 2009, Health affairs.

[7]  Willem F. G. Haselager,et al.  Hacking the brain: brain–computer interfacing technology and the ethics of neurosecurity , 2016, Ethics and Information Technology.

[8]  P. Aggarwal,et al.  Ethical issues in electronic health records: A general overview , 2015, Perspectives in clinical research.

[9]  Karsten Weber,et al.  Methods for Practising Ethics in Research and Innovation: A Literature Review, Critical Analysis and Recommendations , 2017, Science and Engineering Ethics.

[10]  Mary Barros-Bailey,et al.  Ethics and the Use of Technology in Rehabilitation Counseling , 2010, Journal of Applied Rehabilitation Counseling.

[11]  Charles Fried,et al.  An Anatomy of Values: Problems of Personal and Social Choice , 1970 .

[12]  Deborah Lupton Quantified sex: a critical analysis of sexual and reproductive self-tracking using apps , 2015, Culture, health & sexuality.

[13]  Eric M Meslin,et al.  Research Ethics Recommendations for Whole-Genome Research: Consensus Statement , 2008, PLoS biology.

[14]  A. Adeyemo,et al.  Ethical and legal implications of whole genome and whole exome sequencing in African populations , 2013, BMC medical ethics.

[15]  Stefan Fischer,et al.  Privacy Concerns in a Remote Monitoring and Social Networking Platform for Assisted Living , 2010, PrimeLife.

[16]  Ilse M Wallace Is Patient Confidentiality Compromised With the Electronic Health Record?: A Position Paper , 2015, Computers, informatics, nursing : CIN.

[17]  Patricia A. H. Williams In a 'trusting' environment, everyone is responsible for information security , 2008, Inf. Secur. Tech. Rep..

[18]  Bonnie Kaplan,et al.  Ethical Challenges of Telemedicine and Telehealth , 2008, Cambridge Quarterly of Healthcare Ethics.

[19]  Matthias Wjst,et al.  Caught you: threats to confidentiality due to the public release of large-scale genetic data sets , 2010, BMC medical ethics.

[20]  P Knaup,et al.  Potential and Requirements of IT for Ambient Assisted Living Technologies , 2013, Methods of Information in Medicine.

[21]  Eike-Henner W. Kluge e-Health Promises and Challenges: Some Ethical Considerations , 2011, ITCH.

[22]  B. Knoppers,et al.  Trends in ethical and legal frameworks for the use of human biobanks , 2007, European Respiratory Journal.

[23]  Edward J. Bloustein Individual and Group Privacy , 2002 .

[24]  Mark Gerstein,et al.  Genomics and Privacy: Implications of the New Reality of Closed Data for the Field , 2011, PLoS Comput. Biol..

[25]  Nathalie Devillier Ageing, well-being and technology: From quality of life improvement to digital rights management a French perspective , 2016, 2016 ITU Kaleidoscope: ICTs for a Sustainable World (ITU WT).

[26]  B. Gordijn,et al.  Solidarity and Justice as Guiding Principles in Genomic Research , 2007, Bioethics.

[27]  Nathalie Devillier Aging, Well-Being, and Technology: From Quality of Life Improvement to Digital Rights Management — A French and European Perspective , 2017, IEEE Communications Standards Magazine.

[28]  B. Gordijn,et al.  Canvas White Paper 1 – Cybersecurity and Ethics , 2017 .

[29]  Robin Mackenzie,et al.  Challenges of ethical and legal responsibilities when technologies’ uses and users change: social networking sites, decision-making capacity and dementia , 2012, Ethics and Information Technology.

[30]  S. Nepal,et al.  Facilitating Secure Sharing of Personal Health Data in the Cloud , 2016, JMIR medical informatics.

[31]  Juan E. Tapiador,et al.  Security and privacy issues in implantable medical devices: A comprehensive survey , 2015, J. Biomed. Informatics.

[32]  Paulo Rodrigues,et al.  Health users' perception of biometric authentication technologies , 2013, Proceedings of the 26th IEEE International Symposium on Computer-Based Medical Systems.

[33]  Amr M. Youssef,et al.  Security Tradeoffs in Cyber Physical Systems: A Case Study Survey on Implantable Medical Devices , 2016, IEEE Access.

[34]  Liang Xiao,et al.  Developing a security protocol for a distributed decision support system in a healthcare environment , 2008, 2008 ACM/IEEE 30th International Conference on Software Engineering.

[35]  Glen T. Cameron,et al.  “Willing but Unwilling”: Attitudinal barriers to adoption of home-based health information technology among older adults , 2014, Health Informatics J..

[36]  Deirdre K. Mulligan,et al.  Doctrine for Cybersecurity , 2011, Daedalus.

[37]  Charles Safran,et al.  Informatics as a Strategy for Reducing Health Disparities in Underserved Populations , 2004 .

[38]  James J. Heckman,et al.  The American Family in Black & White: A Post-Racial Strategy for Improving Skills to Promote Equality , 2011, Daedalus.

[39]  P. Clayton,et al.  Privacy, confidentiality, and electronic medical records. , 1996, Journal of the American Medical Informatics Association : JAMIA.

[40]  Jun Pang,et al.  Challenges in eHealth: From Enabling to Enforcing Privacy , 2011, FHIES.

[41]  Veikko Ikonen,et al.  Ethical Assessment in the Design of Ambient Assisted Living , 2007, Assisted Living Systems - Models, Architectures and Engineering Approaches.

[42]  David J. Danelski,et al.  Privacy and Freedom , 1968 .

[43]  Anastasia Kotsopoulou,et al.  E-therapy: The Ethics Behind the Process☆ , 2015 .

[44]  Jessica S. Ancker,et al.  Navigation in the electronic health record: A review of the safety and usability literature , 2017, J. Biomed. Informatics.

[45]  John Leubsdorf,et al.  Privacy and Freedom , 1968 .

[46]  James P. Anderson,et al.  Information Security in a Multi-User Computer Environment , 1972, Adv. Comput..

[47]  K. Dierickx,et al.  Children and biobanks: a review of the ethical and legal discussion , 2011, Human Genetics.

[48]  P. Bath,et al.  Accessibility versus confidentiality of information in the emergency department , 2009, Emergency Medicine Journal.

[49]  B. Knoppers,et al.  International Charter of principles for sharing bio-specimens and data , 2016, European Journal of Human Genetics.

[50]  Stephen T. Kent,et al.  Security Mechanisms in High-Level Network Protocols , 1983, CSUR.

[51]  Annie I. Antón,et al.  Balancing Good Intentions : Protecting the Privacy of Electronic Health Information , 2010 .

[52]  Yue Yin,et al.  A Research on Security and Privacy Issues for Patient related Data in Medical Organization System , 2013 .

[53]  Urs Gasser,et al.  Elements of a new ethical framework for big data research , 2016 .

[54]  Mark Christopher Shaw,et al.  Critical Theory as an Approach to the Ethics of Information Security , 2013, Science and Engineering Ethics.

[55]  Joan Torrent-Sellens,et al.  DETERMINANTS OF THE INTENTION TO USE TELEMEDICINE: EVIDENCE FROM PRIMARY CARE PHYSICIANS , 2016, International Journal of Technology Assessment in Health Care.

[56]  Toomas Timpka,et al.  Ethical issues in public health informatics: implications for system design when sharing geographic information , 2002, J. Biomed. Informatics.

[57]  K. Hine What is the outcome of applying principlism? , 2011, Theoretical medicine and bioethics.

[58]  Julia Lane,et al.  Balancing access to health data and privacy: a review of the issues and approaches for the future. , 2010, Health services research.

[59]  Fiza Abdul Rahim,et al.  Information privacy concerns in electronic healthcare records: A systematic literature review , 2013, 2013 International Conference on Research and Innovation in Information Systems (ICRIIS).

[60]  M. C. Roberts,et al.  Critical incidents in the marriage of psychology and technology: A discussion of potential ethical issues in practice, education, and policy. , 2011 .

[61]  T. Beauchamp,et al.  A History and Theory of Informed Consent , 1986, American Political Science Review.

[62]  Yuying Zhang,et al.  What consumers want in personal health applications: findings from Project HealthDesign , 2014, Personal and Ubiquitous Computing.

[63]  B. Gert,et al.  A critique of principlism. , 1990, The Journal of medicine and philosophy.

[64]  Suzy A. Buckovich,et al.  Viewpoint: Driving Toward Guiding Principles: A Goal for Privacy, Confidentiality, and Security of Health Information , 1999, J. Am. Medical Informatics Assoc..