Mariacarla Gadebusch Bondio

Background: The ethical, legal, and social issues accompanying the latest advancements in digital health technologies highlight the need to involve the public in their design, development, and deployment to align with societal values and needs. For public engagement to be meaningful, it should be participatory, inclusive, and scalable. However, studies in participatory digital health do not characterize public engagement strategies in terms of scalability, representativeness, and the extent of participation. Moreover, no reviews have examined how ethical debates shape the design and implementation of public engagement strategies in digital health ethics. Objective: The objectives of the planned study based on this protocol are to (1) identify approaches used to engage the public in digital health ethics; (2) characterize approaches used in digital health ethics in terms of scalability, representativeness, and extent of participation; and (3) explore the role of ethics in the design and implementation of participatory methods. Methods: The research will be undertaken using the Joanna Briggs Institute scoping review method. To identify relevant literature, the academic databases PubMed, ScienceDirect, IEEE Xplore, and Web of Science will be searched for articles published from January 1, 2015, to November 30, 2025. All retrieved papers will be uploaded to the Rayyan software. Duplicates will be removed, and subsequently, 2 reviewers will independently screen titles and abstracts, followed by full-text screening using a hybrid verification model. Data will be extracted on a spreadsheet, with rows representing individual studies and columns capturing categories of extracted information. Results: Currently, the search has yielded 1352 articles; at the title and abstract screening phase, 1291 (95.5%) articles have been excluded and 61 (4.5%) have been included. Anticipated results are the number of studies, bibliographic details of the studies (ie, author, publication year, journal, and country), participant characteristics, digital health technology type, participatory methods, and media, as well as the embodiment of participatory, representative, and scalable characteristics in engagement methods and how ethical debates influence the design of public engagement strategies. Conclusions: This protocol outlines methodology for a scoping review mapping the characteristics and ethics of public engagement methods to improve participatory and ethically responsible innovation in digital health.

BACKGROUND Advances in digital health and artificial intelligence promise transformative impacts on healthcare but also raise significant ethical, legal, and social (ELSA) issues. Addressing these challenges requires meaningful public engagement to ensure that technological innovation aligns with societal values and needs. However, current studies in participatory digital health rarely characterize engagement strategies in terms of their scalability, representativeness, or degree of participation, and no reviews have examined how ethical debates inform these approaches. OBJECTIVE This scoping review aims to (1) identify methods and media used to engage the public in digital health ethics; (2) characterize these approaches regarding scalability, representativeness, and participatory depth; and (3) explore how ethical considerations shape the design and implementation of participatory strategies in digital health. METHODS The review will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews and adhere to the PRISMA-ScR reporting guidelines. Academic databases, including PubMed, ScienceDirect, Scopus, IEEE Xplore, and Web of Science will be searched for studies published between January 2015 and August 2025. All identified papers will be imported into Rayyan for duplicate removal and independent screening by two reviewers. Data will be extracted using a structured spreadsheet capturing bibliographic details, study characteristics, engagement methods, media, and ethical dimensions relevant to the research questions. RESULTS We anticipate identifying and summarizing studies according to engagement method, country, and technology type. Expected outputs include descriptive tables and thematic syntheses mapping the degree of participation, scalability, and representativeness of engagement methods, as well as the ethical rationales underlying their design and implementation. CONCLUSIONS This protocol outlines a systematic approach to mapping public engagement strategies in digital health ethics. The anticipated findings will contribute to improving participatory and ethically responsible innovation practices in digital health. CLINICALTRIAL Not applicable.

Zusammenfassung: Praktiken der weiblichen Genitalverstümmelung bzw. -beschneidung konfrontieren Ärzt*innen auch in Deutschland mit zahlreichen Herausforderungen. Eine mögliche Interventionsmöglichkeit ist die elektiven Klitorisrekonstruktion zur ästhetischen und physiologischen Rehabilitation nach weiblicher Genitalverstümmelung bzw. -beschneidung. Auch wenn die Studienlage bezüglich der durch Klitorisrekonstruktion erzielten Ergebnisse kontrovers diskutiert wird, steigt das Angebot an Rekonstruktionsoptionen an.Die vorliegende Arbeit zielt darauf ab, die epistemischen und ethischen Dimensionen der in den letzten 20 Jahren entstandenen und interdisziplinär geführten Debatte über die Klitorisrekonstruktion kritisch zu beleuchten. Sie soll eine Orientierung in dem komplexen Feld bieten, in dem kulturelle, geschlechtsspezifische, sexuelle und psychosoziale Faktoren mit anatomisch-physiologischem (Un)Wissen interagieren. Die Analyse zeigt die ambivalente Rolle von Evidenz und Evidenzansprüchen in Bezug auf das chirurgische Verfahren der Klitorisrekonstruktion.Schwierigkeiten bei Prüfung und Vergleich der bestehenden chirurgischen Verfahren und bei der Anwendung standardisierter Befragungstools belegen, wie essentiell kulturelle Kompetenz und Diversitätsbewusstsein im Umgang mit Betroffenen sind. Das prima facie korrekte Argument der unzureichenden Evidenz zu Wirkung, Vergleichbarkeit und Langzeitfolgen der Rekonstruktionsverfahren erweist sich aus ethischen und epistemischen Gründen als problematisch. Für die Erzeugung valider und brauchbarer Daten zu Sexualität, Körperwahrnehmung, Schmerz- und Lustempfinden vor und nach einer Klitorisrekonstruktion sind Befragungsmodi nötig, die die kulturell heterogene Zielgruppe der Frauen mit FGM/C adressieren. Auch für eine zielgruppengerechte Aufklärung und Beratung als Bedingung selbstbestimmter Entscheidungen für/gegen eine Klitorisrekonstruktion sind kulturelle Kompetenz und Sensibilität in der Medizin dringend nötig.

In times of ongoing resource shortages, appropriate evaluation criteria are crucial for the ethical prioritization of medical care. While the use of scoring models as tools for prioritization is widespread, they are barely discussed in the medical‐ethical discourse in the context of the COVID‐19 pandemic. During this time, the challenge of providing care for patients in need has promoted consequentialist reasoning. In this light, we advocate for the integration of time‐ and context‐sensitive scoring (TCsS) models in prioritization policies that foster treatment opportunities for patients with subacute and chronic conditions. We argue, first, that TCsSs enable a more efficient use of resources, reducing avoidable harm to patients by preventing arbitrary postponement of necessary but nonurgent interventions. Second, we contend that on an interrelational level, TCsSs render decision‐making pathways more transparent, which promotes the information requirement of patient autonomy and raises confidence in the resulting prioritization decision. Third, we claim that TCsS contributes to distributive justice by reallocating available resources to the benefit of elective patients. We conclude that TCsSs promote anticipatory measures that extend the timeframe for responsible action into the future. This strengthens patients' ability to exercise their right to healthcare—primarily during times of crisis, but ultimately in the longer term too.

In this chapter, Jukola and Gadebusch Bondio analyze the so-called bouffant scandal, a debate which erupted in 2014 after the Association of periOperative Registered Nurses (AORN) issued new guidelines for surgical attire in the perioperative setting. The AORN recommendation to cover all hair in operating room sparked a reaction from the community of surgeons, as it would effectively ban the use of the traditional surgical skull cap. A central question in the debate that followed was what type of evidence is needed for issuing new policies and practices in the clinical hygienic setting. By drawing on philosophy of science, Jukola and Gadebusch Bondio illustrate how different epistemic and non-epistemic (e.g., ethical) values and background assumptions can lead to disagreements concerning evidence and guidelines. In particular, they show that the participants in the discussion had divergent ideals concerning adequate evidence and relied on different understandings of the goal of the preventative guidelines. By comparing the US discussion with the reception of the perioperative hygiene guidelines in Germany, they suggest that different professional or interprofessional constellations of experts and decision makers may influence how claims about evidence and critique are formulated in debates. Their analysis of the bouffant scandal demonstrates how philosophical tools can be used for identifying argumentative patterns in disputes over evidence.

Evidence is not only an extremely important but also highly contested resource in democratically constituted knowledge societies. As a constitutive basis of knowledge and a guarantor of credibility and validity, evidence serves to justify knowledge claims and decisions. However, the flipside of its rise in importance is the phenomenon of increasing evidence contestation which is the focus of this book. In the Introduction, the editors lay some conceptual groundwork and outline how processes of evidence criticism have emerged. In this context, evidence and its contestation are discussed as contested concepts in themselves. Commonalities, differences and consequences of evidence criticism and contestation in academia and society are among the important questions that the authors address. Referring to the individual chapters, the Introduction outlines how actors in both, science and society at large, contribute to and deal with dissent and what this means for knowledge societies.

Hospital acquired infections (HAIs) are a major threat to patient safety. This paper addresses the following question: given what is known about the causes of and possible interventions on HAIs, to whom or what should the moral responsibility for preventing these infections be attributed? First, we show how generating robust evidence on the effectiveness of preventive hygiene measures is a complex endeavour and review the existing evidence on the causes of HAIs. Second, we demonstrate that the existing literature on the ethical aspects of infection control has focused on responsibility at the individual-level. Thirdly, we argue that these accounts do not accommodate systemic factors relevant for HAI prevention. We show that the notion of collective responsibility is useful for making understandable how systemic factors, such as employment conditions in hospitals, are both causally and ethically relevant in infection control.

Der Beitrag stellt Gedächtnisformen und Bilder, die im Zusam­menhang mit der Coronavirus-Pandemie entstanden sind, in den Mittelpunkt. Im ersten Teil widmet sich Mariacarla Gadebusch Bondio den Gedächtnisformen. Birgit Ulrike Münch befasst sich im Anschluss mit der Ikonographie zentraler Bilder von COVID-19. Am Fallbeispiel ›Long COVID‹ problematisieren die Autorinnen zudem Symptomatik und Folgen einer schwer objektivierbaren, unsichtbaren Krankheit. ›Long COVID‹ – so kann Birgit Ulrike Münch am Ende des Beitrags zeigen – hat bereits ein Bildarchiv an Visualisierungen des ›(In)visiblen‹ generiert, welches von ihr charakterisiert und anhand von Fallbeispielen besprochen wird. The paper focuses on forms of memory and images that emerged in the context of the coronavirus pandemic. In the first part, Mariacarla Gadebusch Bondio focuses on the forms of memory. Birgit Ulrike Münch then deals with the iconography of central images of COVID-19. Using the case study ›Long COVID‹, the authors also problematize the symptoms and consequences of an invisible disease that is difficult to objectify ›Long COVID‹ - as Birgit Ulrike Münch shows at the end of the article - has already generated an image archive of visualizations of the ›(in)visible‹, which she characterizes and discusses on the basis of case studies.

Medical knowledge about female genital mutilation, a practice still widespread today, dates back to antiquity. Coinciding with the “rediscovery” of female genitalia, information about clitoridectomy and infibulation began circulating in anatomical texts from around 1550 onwards. In addition to classical sources, traveller’s reports are also carefully consulted here. Terminological ambiguities typify these descriptions of the morphology and physiology of the pudenda. This study discloses and pieces together sources and discourses that have previously only been studied as fragments, thereby tracing the prevailing acceptance among physicians of mutilating ‘corrections’ of the pudenda. It concludes that medically and morally based criticism of such practices was an exception that by the 17th century had been all but forgotten