Wearable Technologies and Stress: Toward an Ethically Grounded Approach

Ethical and legal implications of health monitoring wearable devices: A scoping review

BACKGROUND

health monitoring wearable devices (HMWDs) are increasingly implemented for personalized and preventive care. This review aims to summarize the existing literature on the ethical and legal implications of HMWDs in healthcare.

METHODS

the study design is a scoping review and narrative synthesis of scientific literature. The literature search was conducted in May 2023, and updated on March 15th, 2024, from the following databases: PubMed, EBSCO (including CINAHL, PsycInfo, Index to Legal Periodicals & Books, Philosopher's Index), HeinOnline, Engineering Village, Nexis Uni and Cochrane Library. Pairs of blinded authors independently screened articles using Rayyan software, and manually checked reference lists of included articles. Peer-reviewed articles in English discussing ethical and/or legal implications of HMWDs in healthcare were included. A thematic synthesis approach was used to identify and summarize ethical and legal issues and recommendations.

PROTOCOL REGISTRATION

https://osf.io/kfuh4/.

FINDINGS

overall, out of 7767 records retrieved, 405 full texts were assessed, and 12 articles, published between 2017 and 2024, were included. We identified 6 main themes: the use of HMWDs may adversely affect and reshape care relationships and the healthcare system; the use of HMWDs raises a variety of justice-related concerns; there are ethical issues related to personal data; HMWDs present several risks but the benefits are still uncertain; there are ethical issues regarding clinical research on HMWDs; and the current regulatory framework is inadequate.

INTERPRETATION

the use of HMWDs in clinical and research settings raises several ethical and legal concerns, ranging from patient safety to autonomy, justice, and data protection. Implementing HMWDs without addressing these concerns may lead to dehumanization and datafication of care relationships and further marginalization of vulnerable populations.

Modern Smart Gadgets and Wearables for Diagnosis and Management of Stress, Wellness, and Anxiety: A Comprehensive Review

The increasing development of gadgets to evaluate stress, wellness, and anxiety has garnered significant attention in recent years. These technological advancements aim to expedite the identification and subsequent treatment of these prevalent conditions. This study endeavors to critically examine the latest smart gadgets and portable techniques utilized for diagnosing depression, stress, and emotional trauma while also exploring the underlying biochemical processes associated with their identification. Integrating various detectors within smartphones and smart bands enables continuous monitoring and recording of user activities. Given their widespread use, smartphones, smartwatches, and smart wristbands have become indispensable in our daily lives, prompting the exploration of their potential in stress detection and prevention. When individuals experience stress, their nervous system responds by releasing stress hormones, which can be easily identified and quantified by smartphones and smart bands. The study in this paper focused on the examination of anxiety and stress and consistently employed "heart rate variability" (HRV) characteristics for diagnostic purposes, with superior outcomes observed when HRV was combined with "electroencephalogram" (EEG) analysis. Recent research indicates that electrodermal activity (EDA) demonstrates remarkable precision in identifying anxiety. Comparisons with HRV, EDA, and breathing rate reveal that the mean heart rate employed by several commercial wearable products is less accurate in identifying anxiety and stress. This comprehensive review article provides an evidence-based evaluation of intelligent gadgets and wearable sensors, highlighting their potential to accurately assess stress, wellness, and anxiety. It also identifies areas for further research and development.

Ethics of Wearable-Based Out-of-Hospital Cardiac Arrest Detection

Out-of-hospital cardiac arrest is a major health problem, and immediate treatment is essential for improving the chances of survival. The development of technological solutions to detect out-of-hospital cardiac arrest and alert emergency responders is gaining momentum; multiple research consortia are currently developing wearable technology for this purpose. For the responsible design and implementation of this technology, it is necessary to attend to the ethical implications. This review identifies relevant ethical aspects of wearable-based out-of-hospital cardiac arrest detection according to four key principles of medical ethics. First, aspects related to beneficence concern the effectiveness of the technology. Second, nonmaleficence requires preventing psychological distress associated with wearing the device and raises questions about the desirability of screening. Third, grounded in autonomy are empowerment, the potential reidentification from continuously collected data, issues of data access, bystander privacy, and informed consent. Finally, justice concerns include the risks of algorithmic bias and unequal technology access. Based on this overview and relevant legislation, we formulate design recommendations. We suggest that key elements are device accuracy and reliability, dynamic consent, purpose limitation, and personalization. Further empirical research is needed into the perspectives of stakeholders, including people at risk of out-of-hospital cardiac arrest and their next-of-kin, to achieve a successful and ethically balanced integration of this technology in society.

Digital technologies for step counting: between promises of reliability and risks of reductionism

Step counting is among the fundamental features of wearable technology, as it grounds several uses of wearables in biomedical research and clinical care, is at the center of emerging public health interventions and recommendations, and is gaining increasing scientific and political importance. This paper provides a perspective of step counting in wearable technology, identifying some limitations to the ways in which wearable technology measures steps and indicating caution in current uses of step counting as a proxy for physical activity. Based on an overview of the current state of the art of technologies and approaches to step counting in digital wearable technologies, we discuss limitations that are methodological as well as epistemic and ethical-limitations to the use of step counting as a basis to build scientific knowledge on physical activity (epistemic limitations) as well as limitations to the accessibility and representativity of these tools (ethical limitations). As such, using step counting as a proxy for physical activity should be considered a form of reductionism. This is not per se problematic, but there is a need for critical appreciation and awareness of the limitations of reductionistic approaches. Perspective research should focus on holistic approaches for better representation of physical activity levels and inclusivity of different user populations.