Towards an Ethics for the Healthcare Metaverse

Abstract

Harnessing the metaverse for medical and healthcare purposes is currently heralded as the “next frontier in healthcare.” However, to ensure the “amazing possibilities” of the so-called “healthcare metaverse” can be fully realized, it’s vital to proactively identify and address potential challenges, especially those of an ethical nature. This paper aims to spotlight these ethical challenges within the healthcare metaverse and chart a course for confronting these issues and cultivating an ethics framework for this emerging field. We will demonstrate that the ethical quandaries within the healthcare metaverse bear striking similarities to those seen in digital medicine, an arena that grapples with vast quantities of data and the application of artificial intelligence. Reflecting on these parallels, we explore how six central ethical challenges in digital medicine – 1) accessibility, 2) fairness, 3) discrimination and bias, 4) responsibility, 5) privacy, data safety and security, and data ownership, as well as 6) environmental issues – unfold within the healthcare metaverse’s virtual boundaries and show that the metaverse’s immersive nature further intensifies these ethical challenges. In view of this, we advocate that the next phase in forging ethics for the healthcare metaverse involves a nuanced reconsideration of current ethical methods and principles in digital medicine, with an emphasis on the immersive element of the metaverse. We foresee the concept of embodiment within virtual settings to be at the heart of this immersion-focused reassessment.

Keywords

• Virtual Reality
• Medicine
• Bioethics
• Challenges
• Medical Ethics
• Artificial Intelligence

References

1. Chengoden, R., et al. (2023). Metaverse for healthcare: A survey on potential applications, challenges and future directions. IEEE Access, 11, 12765-12795. https://www.doi.org/10.1109/access.2023.3241628
2. Zabeu, S. (2022). Metaverse could be the next technological step in the healthcare sector. Network King. Retrieved July 13, 2022, from https://network-king.net/metaverse-could-be-the-next-technological-step-in-the-healthcare-sector/
3. Varhsneya, R. (2022). Metaverse: The next frontier in healthcare? Information Week. Retrieved June 21, 2023, from https://www.informationweek.com/big-data/metaverse-the-next-frontier-in-healthcare-
4. Marr, B. (2022). The amazing possibilities of healthcare in the metaverse. Forbes. Retrieved June 21, 2023 from https://www.forbes.com/sites/bernardmarr/2022/02/23/the-amazing-possibilities-of-healthcare-in-the-metaverse/
5. Song, Y.-T. & Qin, J. (2022). Metaverse and personal healthcare. Procedia Computer Science, 210, 189-197. https://www.doi.org/10.1016/j.procs.2022.10.136
6. Bock, A. (2022). Revolution des Gesundheitswesens – Healthcare Metaverse ist keine Zukunftsmusik mehr. BearingPoint. Retrieved February 13, 2023 from https://www.bearingpoint.com/de-de/ueber-uns/pressemitteilungen-und-medienberichte/pressemitteilungen/revolution-des-gesundheitswesens/
7. Ahmadi Marzaleh, M., Peyravi, M. & Shaygani, F. (2022). A revolution in health: Opportunities and challenges of the Metaverse. EXCLI Journal, 21, 791-792. https://doi.org/10.17179/excli2022-5017
8. Wang, G., et al. (2022). Development of metaverse for intelligent healthcare. Nature Machine Intelligence, 4 (11), 922-929, https://www.doi.org/10.1038/s42256-022-00549-6

9. Bansal, G. et al. (2022). Healthcare in Metaverse: A Survey on Current Metaverse Applications in Healthcare. IEEE Access, 10, 119914-119946, https://www.doi.org/10.1109/access.2022.3219845
10. Mozumder, M. A. I. et al. (2022). Overview: Technology Roadmap of the Future Trend of Metaverse based on IoT, Blockchain, AI Technique, and Medical Domain Metaverse Activity, in 24th International Conference on Advanced Communication Technology (ICACT), 256-261, https://www.doi.org/10.23919/ICACT53585.2022.9728808
11. Usmani, S. S., Sharath, M. & Mehendale, M. (2022). Future of mental health in the metaverse. General Psychiatrtry, 35 (4), e100825, https://www.doi.org/10.1136/gpsych-2022-100825
12. Cerasa, A., et al. (2022). The promise of the metaverse in mental health: the new era of MEDverse. Heliyon, 8 (11), e11762, https://www.doi.org/10.1016/j.heliyon.2022.e11762
13. Damar, M. (2022). What the Literature on Medicine, Nursing, Public Health, Midwifery, and Dentistry Reveals: An Overview of the Rapidly Approaching Metaverse. Journal of Metaverse, 2 (2), 62-70, https://www.doi.org/10.57019/jmv.1132962
14. Ahuja, A. S. et al. (2023). The Digital Metaverse: Applications in Artificial Intelligence, Medical Education, and Integrative Health. Integrative Medicine Research, 12 (1), 100917, https://www.doi.org/10.1016/j.imr.2022.100917
15. Suh, I., McKinney, T. & Siu, Ka-Chun (2023). Current Perspective of Metaverse Application in Medical Education, Research and Patient Care. Virtual Worlds, 2 (2), 115-128, https://www.doi.org/10.3390/virtualworlds2020007
16. Plechata, A., Makransky, G. & Bohm, R. (2022). Can extended reality in the metaverse revolutionise health communication? NPJ Digital Medicine, 5 (1), 132, https://www.doi.org/10.1038/s41746-022-00682-x
17. Jung, S. et al. (2019). Augmented Reality in the Health Domain: Projecting Spatial Augmented Reality Visualizations on a Perceiver's Body for Health Communication Effects. Cyberpsychology, Behavior, and Social Networking, 22 (2), 142-150, https://www.doi.org/10.1089/cyber.2018.0028
18. Dwivedi, Y. K. et al. (2022). Metaverse beyond the hype: Multidisciplinary perspectives on emerging challenges, opportunities, and agenda for research, practice and policy. International Journal of Information Management, 66, 102542, https://www.doi.org/10.1016/j.ijinfomgt.2022.102542
19. Spence, E. H. (2008). Meta Ethics for the Metaverse: The Ethics of Virtual Worlds, in Current Issues in Computing and Philosophy, Adam, B., Waelbers, K. & Brey, P. Eds., 3-12, Amsterdam: IOS Press.
20. Benjamins, R., Rubio Viñuela, Y. & Alonso, C. (2023). Social and ethical challenges of the metaverse. AI and Ethics, 3 (3), 689-697, https://www.doi.org/10.1007/s43681-023-00278-5
21. Bang, J. & Kim, J.-Y. (2023). Metaverse Ethics for Healthcare Using AI Technology: Challenges and Risks, in Culture and Computing, Rauterberg, M. Ed., 367-378, Cham: Springer Nature Switzerland.
22. Fernandez, C. B. & Hui, P. (2022). Life, the Metaverse and Everything: An Overview of Privacy, Ethics, and Governance in Metaverse, in 2022 IEEE 42nd International Conference on Distributed Computing Systems Workshops (ICDCSW), 272-277, Bologna, https://www.doi.org/10.1109/ICDCSW56584.2022.00058
23. Kostick-Quenet, K. & Rahimzadeh, V. (2023). Ethical hazards of health data governance in the metaverse. Nature Machine Intelligence, 5 (5), 480-482, https://www.doi.org/10.1038/s42256-023-00658-w
24. Curtis, C. & Brolan, C. E. (2023). Health care in the metaverse. The Medical Journal of Austalia, 218 (1), 46, https://www.doi.org/10.5694/mja2.51793
25. Li, F., Ruijs, N. & Lu, Y. (2022). Ethics & AI: A Systematic Review on Ethical Concerns and Related Strategies for Designing with AI in Healthcare. AI, 4 (1), 28-53, https://www.doi.org/10.3390/ai4010003
26. Morley, J. et al. (2020). The ethics of AI in health care. Social Science & Medicine, 260, 113172, https://www.doi.org/10.1016/j.socscimed.2020.113172
27. Karimian, G., Petelos, E. & Evers, S. M. A. A. (2022). The ethical issues of the application of artificial intelligence in healthcare: a systematic scoping review. AI and Ethics, 2 (4), 539-551, https://www.doi.org/10.1007/s43681-021-00131-7
28. Ball, M. (2022). The metaverse. And how it will revolutionize everything. New York: W.W. Norton.
29. Mystakidis, S. (2022). Metaverse. Encyclopedia, 2 (1), 486-497. https://www.doi.org/10.3390/encyclopedia2010031
30. Bowman, D. A. & McMahan, R.P. (2007). Virtual reality: How much immersion is enough? Computer, 40 (7), 36-43. https://www.doi.org/10.1109/mc.2007.257
31. Shugalo, I. (2022). Is a virtual hospital the new normal? IT Transition. Retrieved Febraury 13, 2023 from https://www.itransition.com/blog/virtual-hospital
32. Patel, K., et al. (2019). The virtual hospital. Future Healthcare Journal, 6, 83. https://www.doi.org/10.7861/futurehosp.6-1-s83
33. Jee, Y.-S. (2023). Application of metaverse technology to exercise rehabilitation: present and future. Journal of Exercise Rehabilitation, 19 (2), 93-94, https://www.doi.org/10.12965/jer.2346050.025
34. Musamih, A., et al. (2022). Metaverse in healthcare: applications, challenges, and future Directions. IEEE Consumer Electronics Magazine, https://www.doi.org/10.1109/mce.2022.3223522
35. Garavand, A. & Aslani, N. (2022). Metaverse phenomenon and its impact on health: A scoping review. Informatics in Medicine Unlocked, 32. https://www.doi.org/10.1016/j.imu.2022.101029
36. Bhattacharya, S., Varshney, S. & Tripathi, S. (2022). Harnessing public health with "metaverse" technology. Frontiers in Public Health, 10, 1030574. https://www.doi.org/10.3389/fpubh.2022.1030574
37. Sun, M., et al. (2022). The metaverse in current digital medicine. Clinical eHealth, 5, 52-57. https://www.doi.org/10.1016/j.ceh.2022.07.002
38. Greenwood, M. (2022). How could the metaverse transform healthcare? News Medical Life Sciences. Retrieved June 21, 2023 from https://www.news-medical.net/health/How-Could-the-Metaverse-Transform-Healthcare.aspx
39. Thomason, J. (2021). MetaHealth: How will the metaverse change. Journal of Metaverse, 1 (1), 13-16.
40. Holm-Hadulla, M., et al. (2022). Healthcare in the metaverse. The legal framework for medical treatment and the use of medical devices in the medical extended reality. Gleiss Lutz. Retrieved March 15, 2023 from https://www.gleisslutz.com/en/Healthcare_Metaverse.html
41. Petrigna, L., & Musumeci, G. (2022). The metaverse: A new challenge for the healthcare system: A scoping review. Journal of Functional Morphology and Kinesiology, 7 (3), https://www.doi.org/10.3390/jfmk7030063
42. Wachter, S., Mittelstadt, B. D. & Russell, B. (2021). Bias preservation in machine learning: The legality of fairness metrics under EU non-discrimination law. West Virginia Law Review, 123 (3).
43. DeCamp, M. & Lindvall, C. (2020). Latent bias and the implementation of artificial intelligence in medicine. Journal of the American Medical Informatics Association, 27 (12), 2020-2023, https://www.doi.org/10.1093/jamia/ocaa094
44. Ebrahim, S. (2022). Racial bias in healthcare AI applications. Delfina, Retrieved May 9, 2023 from https://www.delfina.com/post/racial-bias-in-healthcare-ai-applications
45. Groom, V., Bailenson, J. N. & Nass, C. (2009). The influence of racial embodiment on racial bias in immersive virtual environments. Social Influence, 4 (3), 231-248, https://www.doi.org/10.1080/15534510802643750
46. Coeckelbergh, M. (2020). Artificial intelligence, responsibility attribution, and a relational justification of explainability. Science and Engineering Ethics, 26 (4), 2051-2068, https://www.doi.org/10.1007/s11948-019-00146-8
47. Bleher, H. & Braun, M. (2022). Diffused responsibility: attributions of responsibility in the use of AI-driven clinical decision support systems. AI and Ethics, 2, 747-761, https://www.doi.org/10.1007/s43681-022-00135-x
48. Sand, M., J. M. Duran, and K. R. Jongsma (2022). Responsibility beyond design: Physicians' requirements for ethical medical AI. Bioethics, 36 (2), 162-169, https://www.doi.org/10.1111/bioe.12887
49. Huang, Y., Li, Y. J. & Cai, Z. (2023). Security and privacy in metaverse: A comprehensive survey. Big Data Mining and Analytics, 6 (2), 234-247, https://www.doi.org/10.26599/bdma.2022.9020047
50. Wang, Y., et al. (2023). A survey on metaverse: Fundamentals, security, and privacy. IEEE Communications Surveys & Tutorials, 25 (1), 319-352, https://www.doi.org/10.1109/comst.2022.3202047
51. Hummel, P., Braun, M. & Dabrock, P. (2020). Own data? Ethical reflections on data ownership. Philosophy & Technology, 34 (3), 545-572, https://www.doi.org/10.1007/s13347-020-00404-9
52. Hummel, P., & Braun, M. (2020). Just data? Solidarity and justice in data-driven medicine. Life Sciences, Society and Policy, 16 (1), https://www.doi.org/10.1186/s40504-020-00101-7
53. Wolf, R. M. et al. (2022). Potential reduction in healthcare carbon footprint by autonomous artificial intelligence. NPJ Digital Medicine, 5 (1), 62, https://www.doi.org/10.1038/s41746-022-00605-w
54. Zhao, N. & You, F. (2023). The growing metaverse sector can reduce greenhouse gas emissions by 10 Gt CO2e in the united states by 2050. Energy & Environmental Science, 16 (6), 2382-2397, https://www.doi.org/10.1039/d3ee00081h
55. Bloomfield, P. S. et al. (2021). Artificial Intelligence in the NHS: Climate and emissions. The Journal of Climate Change and Health, 4, 100056, https://www.doi.org/10.1016/j.joclim.2021.100056
56. Kshetri, N. & Dwivedi, Y. K. (2023). Pollution-reducing and pollution-generating effects of the metaverse. International Journal of Information Management, 69, https://www.doi.org/10.1016/j.ijinfomgt.2023.102620
57. Jauhiainen, J. S., Kohn, C. & Junnila, J. (2022). Metaverse and sustainability: Systematic review of scientific publications until 2022 and Beyond. Sustainability, 15 (1), 346-355, https://www.doi.org/10.3390/su15010346
58. Hummel P., et al. (2021). Data sovereignty: A review. Big Data & Society, 8 (1), https://www.doi.org/10.1177/2053951720982012
59. German Ethics Council (2018). Big data and health: Data sovereignty as the shaping of informational freedom. Opinion. Berlin: German Ethics Council.
60. Holzinger, A., et al. (2019). Causability and explainability of Artificial Intelligence in medicine. Wiley Interdisciplinary Review of Data Mining and Knowledge Discovery, 9 (4), e1312, https://www.doi.org/10.1002/widm.1312
61. Hille, E., Hummel, P. & Braun, M. (2023). Meaningful Human Control over AI for Health? A Review. Journal of Medical Ethics, http://doi.org/10.1136/jme-2023-109095
62. Robbins, S. (2023). The many meanings of meaningful human control. AI and Ethics, https://doi.org/10.1007/s43681-023-00320-6
63. Braun, M., et al. (2020). Primer on an ethics of AI-based decision support systems in the clinic. Journal of Medical Ethics, 47 (12), e3, https://www.doi.org/10.1136/medethics-2019-105860
64. Jarvis, L. (2019). Immersive embodiment. Theatres of mislocalized sensation. Cham: Palgrave Macmillan.
65. Mullis, E. C. (2023). Instruments of embodiment. Costuming in contemporary dance, London, New York: Routledge.
66. Rokotnitz, N. (2011). Trusting performance. A cognitive approach to embodiment in drama, New York: Palgrave Macmillan.
67. Wolf, J. P. & Perron, B. (2023)., The Routledge companion to video game studies, 2nd ed. New York: Routledge.
68. Keogh, B. (2018). A play of bodies. How we perceive videogames. Cambridge, London: The MIT Press.
69. Farmasi, L. (2023). Narrative, perception, and the embodied mind. Towards a neuro-narratology. New York, Milton Park: Routledge.
70. Shapiro, L. (2024). The Routledge handbook of embodied cognition. London, New York: Routledge.
71. Chalmers, D.J. (2022). Reality+. Virtual worlds and the problems of philosophy. New York: W.W. Norton.
72. Chouraqui, F. (2021). The body and embodiment. A philosophical guide. Lanham: Rowman & Littlefield.
73. Fingerhut, J., Hufendiek, R. & Wild, M. (2013). Philosophie der Verkörperung. Grundlagentexte zu einer aktuellen Debatte. Berlin: Suhrkamp.
74. Gorichanaz, T. (2022). Being at home in the metaverse? Prospectus for a social imaginary. AI and Ethics, 3 (2), 647-658, https://www.doi.org/10.1007/s43681-022-00198-w
75. Boero, N. & Mason, K. (2021). The Oxford handbook of the scoiology of body and embodiment. New York: Oxford University Press.
76. Pinn, A. B. (2010). Embodyment and the new shape of Black theological thought. New York, London: New York University Press.
77. Malatino, H. (2019). Queer embodiment. Monstrosity, medical violence, and intersex experience. Lincoln: University of Nebraska Press.
78. Blanco-Fernández, V. (2023). Queering the metaverse. Queer approaches to virtual reality in contemporary art, in The Future of Digital Communication. The Metaverse, Benítez Rojas, R. V. Ed., 91-104, Boca Raton: CRC Press.
79. Etzelmüller, G. & Weissenrieder, A. (2016). Verkörperung als Paradigma theologischer Anthropologie. Berlin, Boston: Walter de Gruyter.