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Health as the Moral Principle of Post-Genomic Society: Data-Driven Arguments Against Privacy and Autonomy

Published online by Cambridge University Press:  22 May 2019

Abstract:

In Finland, as well as all over the globe, great weight is put on the possibilities of large data collections and ‘big data’ for generating economic growth, enhancing medical research, and boosting health and wellbeing in totally new ways. This massive data gathering and usage is justified by the moral principle of improving health. The imperative of health thus legitimizes data collection, new infrastructures and innovation policy. It is also supported by the rhetoric of health promotion. New arrangements in health research and innovations in the health sector are justified, as they produce health, while the moral principle of health also obligates individual persons to pursue healthy lifestyles and become healthy citizens. I examine how, in this context of Finnish data-driven medicine, arguments related to privacy and autonomy become silenced when contrasted with the moral principle of health.

Type
Special Section: Health, Morality, and Moralism
Copyright
Copyright © Cambridge University Press 2019 

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References

Notes

1. The Organization for Economic Cooperation and Development. Data-driven Innovation for Growth and Well-being. Interim synthesis report. Paris: OECD Publications; 2014.Google Scholar

2. European Commission. Communication on enabling the digital transformation of health and care in the Digital Single Market; empowering citizens and building a healthier society. COM(2018)233. 2018 at 3.Google Scholar

3. Juengst, ET, Settersten, RA, Fishman, JR, McGowan, ML. After the revolution? Ethical and social challenges in ‘personalized genomic medicine’. Personalized Medicine 2012;9(4):429–39.CrossRefGoogle ScholarPubMed

4. Tutton, R. Genomics and the Reimagining of Personalized Medicine. Farnham: Ashgate; 2014.Google Scholar

5. Topol, E. The Patient Will See You Now: The Future of Medicine Is in Your Hands. New York: Basic Books; 2015.Google Scholar

6. Ministry of Social Affairs and Health. Improving Health through the Use of Genomic Data. Finland’s Genome Strategy. Working Group Proposal; 2015.Google Scholar

7. Hood, L. Auffray, C. Participatory medicine: a driving force for revolutionizing healthcare. Genome Medicine 2013;5:110.CrossRefGoogle ScholarPubMed

8. See note 5, Topol 2015.

9. Topol, E. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books; 2012.Google Scholar

10. See note 3, Juengst et al. 2012.

11. See note 7, Hood and Auffray 2013.

12. See note 4, Tutton 2014.

13. Hedgecoe, A. Terminology and the Construction of Scientific Disciplines: The Case of Pharmacogenomics. Science, Technology, & Human Values 2003;28(4):513–37.CrossRefGoogle Scholar

14. Hoeyer, K. Denmark at a crossroad? Intensified data sourcing in a research radical country. In Mittelstadt, B. Floridi, L., eds. The Ethics of Biomedical Big Data. Springer; 2016:7393.CrossRefGoogle Scholar

15. Lupton, D. The Imperative of Health. Public Health and the Regulated Body. London: SAGE; 1995.Google Scholar

16. Fitzpatrick, K, Tinning, R. Health education’s fascist tendencies: A cautionary exposition. Critical Public Health 2014;24(2)132–42.CrossRefGoogle Scholar

17. Solove, DJ. Nothing to Hide. The False Tradeoff between Privacy and Security. New Haven: Yale University Press; 2011.Google Scholar

18. Dickenson, D. Me Medicine vs We Medicine. Reclaiming biotechnology for the common good. New York: Columbia University Press; 2013.CrossRefGoogle Scholar

19. König, PD. The place of conditionality and individual responsibility in a “data-driven economy.” Big Data & Society 2017; July-Dec:1–14.CrossRefGoogle Scholar

20. Sharon, T. Healthy citizenship beyond autonomy and discipline: Tactical engagements with genetic testing. BioSocieties 2015;10(3):295316.CrossRefGoogle Scholar

21. See note 18, Dickenson 2013 and note 14, Hoeyer 2016.

22. Prainsack, B, Buyx, A. Solidarity in Biomedicine and Beyond. Cambridge: Cambridge University Press; 2017.CrossRefGoogle Scholar

23. Widdows, H. Between the individual and the community: The impact of genetics on ethical models. New Genetics and Society 2009;28(2):173–88.CrossRefGoogle Scholar

24. Sharon, T. Self-tracking for health and the quantified self: Re-articulating autonomy, solidarity, and authenticity in an age of personalized healthcare. Philosophy & Technology 2017;30:93121.CrossRefGoogle Scholar

25. Woods, S. Big Data Governance: Solidarity and the Patient Voice. In Mittelstadt, B. Floridi, L., ed. The Ethics of Biomedical Big Data. Springer, 2016:221–38.CrossRefGoogle Scholar

26. Biobank Act (688/2012)

27. Soini, S. Finland on a Road towards a Modern Legal Biobanking Infrastructure. European Journal of Health Law 2013;20(3):289–94.CrossRefGoogle ScholarPubMed

28. Rothstein, MA Knoppers, BA. Harrell, HL. Comparative Approaches to Biobanks and Privacy. Journal of Law, Medicine and Ethics 2016;44(1):161–72.CrossRefGoogle ScholarPubMed

29. Tupasela A, Snell K, Cañada J. Patients, business and the state – translating health information into sustainable benefits. Policy brief for engagement practices in Canada, Finland, Iceland, Spain, UK and the US. Tekes Review 322. Helsinki: Tekes; 2015.

30. See note 6, Ministry of Social Affairs and Health 2015.

31. See note 6, Ministry of Social Affairs and Health 2015 at 15.

32. Ministry of Social Affairs and Health. Tieto hyvinvoinnin ja uudistuvien palvelujen tukena. Sote-tieto hyötykäyttöön -strategia. 2014Google Scholar

33. Tarkkala, H, Hélen, I, Snell, K. From Health to Wealth: The Future of Personalized Medicine in the Making. Futures 2018; available at https://doi.org/10.1016/j.futures.2018.06.004 (last accessed 6 Nov 2018)Google Scholar

34. Bourret, P, Keating, P, Cambrosio, A. Regulating diagnosis in post-genomic medicine: Re-aligning clinical judgment? Social Science & Medicine 2011;73(6):816–24.CrossRefGoogle ScholarPubMed

35. Chiapperino, L, Testa, G. The epigenomic self in personalized medicine: between responsibility and empowerment. Sociological Review Monograph Series: Biosocial Matters: Rethinking Sociology-Biology Relations in the Twenty-First Century 2016;64(1):201–20.Google Scholar

36. Lupton, D. Digital Health: Critical and Cross-Disciplinary Perspectives. Oxon: Routledge; 2018Google Scholar

37. See note 33, Tarkkala et al. 2018.

38. Gaskell, G, Gottweis, H. Starkbaum, J. Broerse, J. Helén, I. Hobbes, A. et al. Publics and biobanks: Pan-European diversity and the challenge of responsible innovation. European Journal of Human Genetics 2013;21(1):1420.CrossRefGoogle ScholarPubMed

39. Snell, K, Starkbaum, J, Lauß, G, Vermeer, A, Helén, I. From protection of privacy to control of data streams: A focus group study on biobanks in the information society. Public Health Genomics 2012;15(5):293302.CrossRefGoogle Scholar

40. Ministry of Economic Affairs and Employment. Innovating together. Growth Strategy for Health Sector Research and Innovation Activities: The Roadmap for 2016-2018 . 2016.Google Scholar

41. See note 6, Ministry of Social Affairs and Health 2015 at 31.

42. See note 20, Sharon 2015.

43. See note 19, König 2017.

44. See note 36, Lupton 2018.

45. Crawford, R. Healthism and the medicalization of everyday life. International Journal of Health Services 1980;19:365–88.CrossRefGoogle Scholar

46. See note 15, Lupton 1995.

47. Flores, M, Glusman, G, Brogaard, K, Price, ND, Hood, L. P4 medicine: How systems medicine will transform the healthcare sector and society. Personalized Medicine 2013; 10(6):565–76, at 565.CrossRefGoogle ScholarPubMed

48. See note 17, Solove 2011.

49. Forsberg, JS, Hansson, MG, Eriksson, S. Changing perspectives in biobank research: from individual rights to concerns about public health regarding the return of results. European Journal of Human Genetics 2009;17:1544–49.CrossRefGoogle ScholarPubMed

50. Tinetti, ME, Basch, E. Patients’ Responsibility to Participate in Decision Making and Research. JAMA 2013;309(22):2331–32.CrossRefGoogle ScholarPubMed

51. See note 33, Tarkkala et al. 2018.

52. See note 17, Solove 2011.

53. See note 20, Sharon 2015.

54. See note 23, Widdows 2009.

55. See note 17, Solove 2011, at 34.

56. See note 18, Dickenson 2013, at 27.

57. See note 17, Solove 2011, at 22.

58. See note 39, Snell et al. 2012.

59. See note 17, Solove 2011

60. Burkart, PA, Andersson Schwarz J. Post-privacy and ideology: A question of doxa and praxis. In Christensen, M. Jansson, A., ed. Media, surveillance and identity: A social perspective . New York: Peter Lang. 2014:218–37.Google Scholar

61. Maj, A., ed. Post-Privacy Culture: Gaining Social Power in Cyber-Democracy. Inter-Disciplinary Press;2014.Google Scholar

62. For an analysis of PatientsLikeMe see Prainsack, B. Personalized Medicine: Empowered Patients in the 21st Century? New York: New York University Press;2017.CrossRefGoogle Scholar

63. Evans, BJ. Power to the people: Data citizens in the age of precision medicine. Vanderbilt Journal of Entertainment & Technology Law 2017;19(2)243–65.Google ScholarPubMed

64. See note 22, Prainsack and Buyx 2017.

65. Solove DJ. Understanding Privacy. Cambridge: Harvard University Press;2008 at 113.

66. Nissenbaum, H. Privacy as contextual integrity. Washington Law Review 2004;79(1):119–58.Google Scholar

67. For analysis of other reforms related to electronic health records see Garrety, K, McLoughlin, I. Wilson, R, Zelle, G, Martin, M. National electronic health records and the digital disruption of moral orders. Social Science and Medicine 2014;101:70-77. andCrossRefGoogle ScholarPubMedVezyridis, P. Timmons, S. Understanding the care.data conundrum: New information flows for economic growth. Big Data & Society 2017;1–12.Google Scholar

68. See note 29, Tupasela et al. 2015.

69. Glass, DC, Kelsall, HL, Slegers, C, Forbes, AB, Loff, B, Zion, D, Fritschi, L. A telephone survey of factors affecting willingness to participate in health research surveys. BMC Public Health 2015;15:1017.CrossRefGoogle ScholarPubMed

70. Ministry of Social Affairs and Health. Report of the expert group appointed to evaluate the integration of Finnish biobanks. A report to the Ministry of Social Affairs and Health. 2016Google Scholar

71. Palotie, A. Onko monimutkainen suostumusjärjestelmä uhka koko suomalaisen biopankkitoiminnan toteutumiselle? 2016; available at https://www.auria.fi/biopankki/blogit/index.php (last accessed 6 Nov 2018).Google Scholar

72. Launis, V. Biopankkitutkimus on läpikotaisin eettistä! 2016; available at https://www.auria.fi/biopankki/blogit/index.php (last accessed 6 Nov 2018).Google Scholar

73. See note 26, Biobank Act.

74. See note 15, Lupton 1995.

75. See note 23, Widdows 2009.

76. See note 2, European Commission 2018.

77. See note 18, Dickenson 2013.

78. Mol, A. The logic of care. Health and the problem of patient choice. Oxon: Routledge; 2008.CrossRefGoogle Scholar

79. See note 35, Chiapperino and Testa

80. See note 18, Dickenson 2013 and note 20, Sharon 2015.

81. See note 14 Hoeyer 2016 and note 23, Widdows 2009.

82. See note 22, Prainsack B, Buyx A 2017.

83. See note 25, Woods 2016.