From implicit assumptions to explicit ethics: assessment of normative frameworks in digitalization recommendations in rheumatology
7 affiliations
- 1FOM University of Applied Sciences, Cologne, Germany
- 2Department of Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- 3Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- 4Center for Digital Medicine, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- 5Institute of IT Management and Digitization Research (ifid), FOM University of Applied Sciences, Düsseldorf, Germany
- 6Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany
- 7Competence Center for Medical Economics, FOM University of Applied Sciences, Cologne, Germany
Abstract
Background: The digital transformation of rheumatology offers significant potential but introduces complex ethical challenges.
Objectives: This study investigates whether current guidelines and recommendations from leading international rheumatology societies provide a systematically reasoned ethical framework.
Methods: We conducted a qualitative document analysis of digitalization-related publications from the American College of Rheumatology (ACR), Asia Pacific League of Associations for Rheumatology (APLAR), and European Alliance of Associations for Rheumatology (EULAR). A systematic search (2019–2025) identified five core documents. Using deductive content analysis guided by Beauchamp and Childress’ principlism and three major normative theories (utilitarianism, deontology, virtue ethics), we analyzed the presence and depth of ethical reasoning.
Results: All documents acknowledge practical benefits and mention concepts like data protection and patient-centeredness. However, systematic engagement with normative ethical theories is absent. Ethical terms are used sporadically without definition, and fundamental tensions (e.g., efficiency vs. equitable access) remain invisible. A utilitarian perspective appears implicit in the prioritization of aggregate benefits, but this is not explicitly acknowledged or balanced against alternative frameworks.
Discussion: Current digitalization guidelines in rheumatology exhibit a critical gap in explicit ethical scaffolding. To ensure responsible innovation, future guideline development should integrate multidisciplinary expertise and systematically apply diverse ethical frameworks, moving from implicit assumptions to transparent value deliberation.
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BibTeX
@article{drexler2026from,
title = {{From implicit assumptions to explicit ethics: assessment of normative frameworks in digitalization recommendations in rheumatology}},
author = {Joanne Drexler and Jutta G. Richter and Rüdiger Buchkremer and Gamal Chehab and Birgitt Killersreiter and Christian Thielscher},
journal = {Frontiers in Digital Health},
year = {2026},
month = oct,
doi = {10.3389/fdgth.2026.1928292},
url = {https://doi.org/10.3389/fdgth.2026.1928292},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - From implicit assumptions to explicit ethics: assessment of normative frameworks in digitalization recommendations in rheumatology
AU - Joanne Drexler
AU - Jutta G. Richter
AU - Rüdiger Buchkremer
AU - Gamal Chehab
AU - Birgitt Killersreiter
AU - Christian Thielscher
PY - 2026
DA - 2026/10/21
JO - Frontiers in Digital Health
DO - 10.3389/fdgth.2026.1928292
UR - https://doi.org/10.3389/fdgth.2026.1928292
AB - Background: The digital transformation of rheumatology offers significant potential but introduces complex ethical challenges. Objectives: This study investigates whether current guidelines and recommendations from leading international rheumatology societies provide a systematically reasoned ethical framework. Methods: We conducted a qualitative document analysis of digitalization-related publications from the American College of Rheumatology (ACR), Asia Pacific League of Associations for Rheumatology (APLAR), and European Alliance of Associations for Rheumatology (EULAR). A systematic search (2019–2025) identified five core documents. Using deductive content analysis guided by Beauchamp and Childress’ principlism and three major normative theories (utilitarianism, deontology, virtue ethics), we analyzed the presence and depth of ethical reasoning. Results: All documents acknowledge practical benefits and mention concepts like data protection and patient-centeredness. However, systematic engagement with normative ethical theories is absent. Ethical terms are used sporadically without definition, and fundamental tensions (e.g., efficiency vs. equitable access) remain invisible. A utilitarian perspective appears implicit in the prioritization of aggregate benefits, but this is not explicitly acknowledged or balanced against alternative frameworks. Discussion: Current digitalization guidelines in rheumatology exhibit a critical gap in explicit ethical scaffolding. To ensure responsible innovation, future guideline development should integrate multidisciplinary expertise and systematically apply diverse ethical frameworks, moving from implicit assumptions to transparent value deliberation.
SN - 2673-253X
ER -