AUTHOR
Mike Bowern

ABSTRACT

The vast majority of contemporary liberal democratic states are representative democracies, meaning citizens choose people from the citizen body to represent them in a parliament. Candidates present their own, or their party’s, statement of policies and promises for what they would do if they were elected to govern the nation. Citizens consider these policies, and other information provided during the election campaign, and cast their votes for the candidate(s) of their choice. The party that has the most number of elected candidates forms a government.

The government claims that, by being elected, it has a mandate from the people to implement these policies and promises, and to enact the necessary laws. It assumes that it has the consent of citizens to do these things.

Some commentators have cast doubt on this assumption. “Voters rarely endorse the winning party’s manifesto because they don’t read it” Mclean (1989). Uhr (2005) considers the current situation is more one of assent – a nod of approval – than informed consent. Arblaster (2002) suggests “silence means consent”, hence tacit or implied consent.

An important point to consider in the matter of consent concerns events and issues which arise during the term of the parliament, which were unknown during the election. In these cases there could be occasions when the notion of implied consent was abused by the government.

In this paper the term “informed consent” is used to imply that there is a process of providing information to citizens before and during an election, to help them decide which candidate or party should receive their consent to govern.

It also applies to information being available to inform citizens of issues which arise during the life of the parliament. In this instance, some thought needs be given to the types of decisions that require consent, since this would not be required for every decision. The types of decisions which should have informed consent could be those where politicians are granted a conscience vote (as in Australia), on abortion reform or voluntary euthanasia for example; or on issues which have major impact on the majority of citizens, such as going to war.

A general principle is that citizens have the right to know about matters that concern them, and information on these matters should be freely available. The information to be provided will be different during an election from that required for specific matters during the term of the parliament.

Information during an election could cover such things as the parties’ manifestos, criticisms and commentaries on these manifestos, and profiles of candidates. The types of information required to cover matters arising during the life of the parliament would depend on the particular issue, but it could follow the model of the deliberative poll. In a deliberative poll the participants are provided with the arguments for both sides of the question, the levels of detail depending on the nature of the problem.

In our modern societies there would be no problem in providing enough information to citizens. This is not difficult to do with the traditional electronic and print media; and the use of information and communications technology (ICT), especially the internet and web sites, would provide other important means to deliver information. This would be one aspect of electronic democracy.

Whatever delivery method is used, the main problem would be the provision of complete, unbiased and relevant information. For example, public information currently provided by a government for community education is a good thing, but this must be distinguished from public opinion-forming material, which is more in the way of government propaganda, provided at taxpayers expense.

There will be some citizens who will wish to delve deeper into a particular issue, and investigate other government documents. Governments’ Freedom of Information (FoI) initiatives have a valuable role here, although the terms of exclusion of some documents may be rather detrimental to the spirit of FoI. Access to FoI services on-line would be another component of electronic democracy.

The parliamentary election process enables citizens to give their consent to the government. However, providing citizens with a means to exercise their power by giving consent for a particular course of action during the parliamentary term does raise some problems. Should the democratic system have some additional voting mechanism for citizens to express, or withhold, their consent on a particular matter. Perhaps an electronic voting system could provide this mechanism.

To require this consent to be provided on a regular basis is like conducting frequent referenda, and there are very few democracies which use referenda to this extent. Alternatively, the greater use of opinion polls to gain this consent could be considered, but there could always be the question as to whether the poll sample was big enough to be considered democratic, and such polls could always be open to challenge, eg. on the grounds that the people responding to the polls were not sufficiently informed of the issues. However, this type of challenge to opinion polls could lead to a greater use of deliberative polls. A more informed citizenry and the use of deliberative polling could be part of a bigger picture of participatory democracy.

The solutions to these problems will be related to the particular culture of the society in question. Each society has evolved its democratic processes over many years, and continues to do so. Future versions of democracy are likely to include solutions to this problem of providing citizens with greater power through informed consent. These solutions will probably include a version of electronic democracy.

REFERENCES

Arblaster, A, 2002, Democracy, Third Edition, Open University Press, Buckingham, UK.

McLean, I, 1989, Democracy and new technology, Blackwell Polity Press,
Cambridge, UK.

Uhr, J, 2005, Terms of Trust: Arguments over ethics in Australian Government, UNSW Press, Sydney.

AUTHOR
Thomas Blake

ABSTRACT

Enhancing oneself through the use of cybernetic technology is becoming a real possibility for humankind. Through advancements in cybernetics, one can potentially transform oneself into a different sort of being. But what are the ethical implications of such a transformation? If ethics is based on one’s nature, will post-human “cyborgs” operate under a different standard of ethics? Can one rationally choose to become a different sort of being? In this paper, I briefly examine the issue of whether post-human ethics is indeed possible, and also whether a human can rationally choose to become a cyborg.

I will begin by discussing the meaning of the word “cyborg”, which can be defined in many ways. The word is short for “cybernetic organism”, meaning a combination of information technology and living matter. In popular culture and science fiction, this can mean any living being that has been integrated with any sort of technology; for example, a computer containing microorganisms, a child with immunizations, or a man wearing glasses would count as a cyborg in this very broad sense. But, of course, “information technology” usually refers to computing devices, so these examples are not really cyborgs in the usual sense. In this essay, I will simply specify that a cyborg is a human who has undergone the physical addition of mechanical parts – whether computing parts or not – such that they are integrated with the human’s biological body. Thus, a human who has been augmented with computer technology is a cyborg in my sense, and so is a human with prosthetic limbs which he or she can control directly.

At first glance, it seems that the addition of mechanical parts to the human body will not result in a being with a different nature. For example, if I have my leg amputated and I wear a prosthetic leg, I doubt that anyone would consider me to be inhuman. I believe that this would still be true if I were to attach a prosthetic leg that I can control as if it were my original leg. When we see a cyborg in science fiction, however, with all robotic limbs and laser eyes, there seems to be something unnatural and even menacing about it. In fact, it seems better to call such a thing “it” rather than “him” or “her”. It seems important, therefore, to examine the extent or nature of the change that transforms a human into a cyborg in the ethically relevant sense.

The potential for a change in human nature is important to ethics, because ethics is relative to human nature. Aristotle, amongst others, has argued that ethics is intimately related to human nature, and this connection is apparent in almost any ethical theory. Both Kantians and Utilitarians, for instance, would generally agree that the way a human should act is not the same as the way a dog or an insect or a chair should “act” (or even whether it makes sense to say that such beings should act, ethically speaking, in any way at all). Thus, for any ethical theory, we must ask whether the way a human should act is the same as the way a cyborg should act. Since what one should do is relative to human nature, it seems that a change in one’s nature could necessitate a change in one’s ethics.

Of course, how one might transition from one sort of ethics to another is not obvious. In “Transcending Humanity”, Martha Nussbaum claims that a human cannot possibly choose to become nonhuman. Something that is not a human might not have the virtues of a human, and thus a new life as a different sort of thing cannot fit into the context of my life as a human. Suppose that I am a human who is courageous, loyal and physically powerful, and that for a cyborg these traits are not virtues. Can I then, as a human, choose to become such a thing? Would the prospect of living such a life have any meaning for me while I am still a human? What Nussbaum suggests is that if transcending humanity would cause one’s nature to change, then one would have no context within which to choose such a life.

So what reason could we possibly have to become “more than” human? In the article “Playing God: Technological Hubris in Literature and Philosophy”, Richard Volkman shows that we humans have an imperative to transcend our limits. He demonstrates that it is in our nature to try to become greater than we are, even to the extent of becoming godlike. This shows that we can have a reason, consistent with our nature, to become something other than human. He also shows that technology is the means by which we become greater than we are. This suggests that the use of cybernetic technology for transcendence of humanity is not just a possibility, but an inevitability.

It follows that ethics based upon human nature must be open to reasons for becoming something that is nonhuman. If becoming cyborgs is an inevitable part of our future, which will come about through human choices, then it is absurd to think that ethics will not apply to such choices. Even if the transition from human to cyborg is not inevitable, it seems to be a natural part of the human condition to desire such a transformation.

REFERENCES

Nussbaum, Martha. “Transcending Humanity”. In her book Love’s Knowledge: Essays on Philosophy and Literature. Oxford University Press, 1990.

Volkman, Richard. “Playing God: Technological Hubris in Literature and Philosophy”. Proceedings of ETHICOMP2001, Gdansk, Poland.

AUTHOR
Angel Luis Garcia Alvarez, Porfirio Barroso Asenjo, Rishwina Dookhony

ABSTRACT

ETHICOMP (Ethics and Computer) has become a reality nowadays. The registered trademark belonging to the Centre for Computing and Social Responsibility (CCSR) at the Leicester University (United Kingdom) has gradually reached maturity and, after eight editions, has reached a recognised position among the most important congresses in the world about Computer Ethics. This evolution had not gone unnoticed and, eleven years after holding the first edition in Leicester in 1995, we thought it was necessary to make a content analysis and a comparative analysis about the development of the congress during its first decade of existence, both of which had not been possible until today. In this paper we will get some ideas and we’ll arrive to some conclusions on the historical evolution and features of ETHICOMP.

The first purpose or goal of this research that we present in this paper is to observe how ETHICOMP has grown and developed throughout the first eight editions and which guidelines it has followed. Our work consists not only of an analysis of one congress but a general perspective of all the congresses up to the present time. Due to the importance and response that ETHICOMP has amongst scholars of Computer Ethics, the analysis of ETHICOMP will eventually become an analysis of the predominant trends in Computer Ethics among the most prestigious authors, professors, and researchers of Computer Ethics all over the world.

To carry out the mentioned analysis of ETHICOMP, the most obvious and logic way was to approach the congresses through the previous articles and papers presented to ETHICOMP itself. Thus, the title of this abstract “A short history of ETHICOMPs”, is due to the analysis of all conferences published in the Book of Proceedings, more than 800 documents have been studied in multiple ways in order to finally arrive to this work that enlightens past, present, and future trends of ETHICOMP.

After we achieved the first step of our research of getting all the Book of Proceedings of all the conferences held by ETHICOMP, we continued to the most arduous work of our research: reading, comprehension, and categorisation of all the presented articles, and so on. The next step was to develop a process with which to classify criteria at the moment of categorising the distinct papers to place them in similar levels. We created a classification of the articles according to its topics or themes presented in the lectures of the Book of Proceedings so we could discover the ETHICOMP trends, and in addition at the same time, to know whom the scholars of Computer Ethics were that presented the articles in the conferences. Once we classified the paper, we paid attention to other aspects of the articles such as who the authors were, the year of presentation of the papers, or their possible relationship in the historical context.

Once completed the classification of the topics, it was time to collect and present the results in a paper in which we carried out an analysis in two stages. First, we studied each ETHICOMP yearly conference individually in order to find out the trends that dominated each one of them, the most frequent themes or topics, their relationship between the general title requested by ETHICOMP, which varies every eighteen months when every conference is held, and the presented papers by the scholars in Computer Ethics. Once analysed individually, each of the articles of all of the eight editions of the ETHICOMP conferences, we achieved a global analysis, observing the total number of articles presented with the goal of reaching some general conclusions of the evolution and trends of these first ten years of ETHICOMP. To arrive to these conclusions we analysed these five factors:

1. Evolution of the most repeated or more frequent themes presented in ETHICOMP
2. The proposed ETHICOMP theme and its corresponding presented papers
3. The number of articles presented in each ETHICOMP
4. The total number of papers presented in each of the forty ETHICOMP categories studied
5. Features and profiles of the authors who presented papers in EHICOMP

Once this double analysis was completed, we arrived at some results and conclusion that we will present briefly in advance. First, we found three stages of different hegemony in ETHICOMP. The first stage, from 1995 to 1999, is under the domain of the “Necessity of the existence of some ethical aspects and deontological guidelines.” The second stage is marked by the “Academic preparation and continued education.” And a third stage started in 2002 and continues to the present time, dominated by the “Development, promotion, and access to Computer Science.” We have also seen articles sent to ETHICOMP unrelated to the proposed theme or topic for each ETHICOMP conference but, on the contrary, they corresponded to the broad proposition of the year-and-a-half conference more than the requested theme or topic by ETHICOMP. The number of presented papers of each edition of ETHICOMP is marked, in this first stage from 1995 to 1999, by an increased number of papers each year and culminated when ETHICOMP stabilises around 130 papers. We have seen that the most important topics regarding the total number of proposed papers corresponded with the three themes that have appeared along the eight ETHICOMPs. The first topic was “Development, promotion, and access to Computer Science” with a percentage of 11.56% of the total number of papers. The second was “Academic preparation and continued education” with 9.11%. And the third topic was “Necessity of the existence of some ethical aspects and deontological guidelines” with a percentage of 8.99%. Finally, we have also observed and analysed the profiles of the authors who have attended all the previously held conferences, resulting in only 2 authors, and those who have presented the highest number of papers in all eight ETHICOMPs.

A series of results and conclusions which point to a single direction: to analyse the evolution followed by ETHICOMP in its first eight editions, always correlated with the historical and social context in which it has developed, and, along with it, the entire field of Computer Ethics, which is so accurately represented by such prestigious congress.

AUTHOR
Teresa Torres-Coronas,  Leonor Gonzalez, Mar Souto,  Mario Arias-Oliva

ABSTRACT
Individuals and organizations have enhanced the use of Internet and web information services during the last decades. Web pages are increasing exponentially every day (Gullison et al, 1999). Internet is used by 70% of its user as an information source (Korman, 1998). But according to the research conducted by the “Environmental Systems Research Institute” (2005), only 40% of the users searching for information can find it. To improve access to information will be a key stone in a further development of the Information Society.

There are more important problems than searching the right information when accessing to web information services. Many web pages are not accessible or easy to use for any user. Most of web information services have been developed by computer science specialist, graphical design specialist, without taking into consideration quality or communication experts’ criteria (Murray and Costanzo, 1999).

According to Ivory and Heast (2002) most of web sites are not usable, and this problem will increase in the future.

As the World Wide Web Consortium points out, individuals that have no access to the right technology cannot access to information services. For instance, a web page that required broadband access will not be accessible for a 28.000 kb per second connection modem; or a computer that has not installed a very last version of browser software will not let access to certain information services (W3C, 2005). If organizations wish to ensure access to their web information services, web pages must be designed taking into consideration the specific user situation, including special requirements for handicap people. In US, 54 millions of persons can be considered handicappers (Jackson-Sanbon et al, 2002); and in the UK 11 million persons have legal consideration of handicap according to the “Labour Force Survey” (Grewal et al, 2002). Are web sites ready to be browse by people with disabilities such us blind, deaf, color-blind, or any other disabilities?.

Only developing accessible web sites for people with disabilities we will improve really access to the Information Society. There are rules to fulfil and to guaranty that web site can be accessible for everybody. The most well known is the AAA standard developed by the World Wide Web Consortium, the WAI – Web Accessibility Iniciative, WCAG – Web Content Accessibility Guidelines. Designing accessible web sites for everybody (including people with disabilities) must be an ethical imperative to guaranty access to the Information Society. Regulatory frameworks are including these aspects in order to avoid any kind of discrimination in the Information Society. For instance, in the United States the Section 508 Amendments make mandatory for all government webs to make their pages accessible for people with disabilities, and regarding the American with Disabilities Act we find a trend to apply the no discrimination principle to virtual environments as well (Sloan, 2001). It has no sense to take care of people with disabilities in the “real world”, but not in the “virtual world”.

But nevertheless, to have a usable and accessible web site is not enough. We must go forward and include other important social and ethical dimensions to achieve e-Quality. For instance, aspects such as offensive content should be considered as well to improve access to Information Society.

Our research focus is based on the general ideas described, and is as follows:

• To define main principles and variables that guaranties a proper access to information services.
• To determine certain usability principles that any web must fulfil in order to make sure that any user can find and access to information.
• To analyse accessibility principles for people with disabilities.
• To establish a broader framework to determine the e-Quality concept that let any user access to information in a proper way.

Within this theoretical framework, we will analyze a case study to determine the ethical attitudes in organizations regarding the access to web information services.

REFERENCES

Environmental Systems Research Institute (2005): “What Is Usability?”, http://www.esri.com/software/usability/whatisusability.html [accessed el 01/06/2005].

Grewal, I., Joy, S., Lewis, J., Swales, K., Woodfield, K. (2002): “Disabled for life? Attitudes towards, and experiences of disability in Britain”, National Centre for Social Research on behalf of the Department for Work and Pensions, HMSO.

Gullison S., Blades R., Bragdon M., McKibbob S., Sparling M., Toms E. (1999): “The impact of information architecture on academic web site usability”, The Electronic Library, 17 (5), pp. 293-304.

Ivory M.Y., Sinha R., Hearst M.A. (2002): “Imporving Web Design”, IEEE Internet Computing, March – April, pp. 56-63.

Jackson-Sanborn, E., Kerri Odess-Harnish, K., Warren, N. (2002): “Web site accessibility: A study of six genres”, Library HiTech, 20 (3), pp. 308–317.

Korman R. (1998): “Helping users find their way by making your site “smelly”, WEBREVIEW.COM, May 15th, http://Webreview.com/wr/pub/98/05/15 [accessed el 01/06/2005].

Sloan, M. (2001): “Web accessibility and the DDA”, The Journal of Information, Law and Technology (JILT), No. 2, http://elj.warwick.ac.uk/jilt/01-02/ [accessed 01/06/2005].

W3C (2005): World Wide Web Consortium, WAI – Web Accessibility Iniciative, WCAG – Web Content Accessibility Guidelines, http://www.w3c.org [accessed 01/06/2005].

AUTHOR
Ryoko Asai

ABSTRACT

Over the past few decades, a considerable number of studies have been conducted on the effects of information and communication technology (ICT) on gender or gender roles. Some of them have focused on the relation between women and development of ICT, and have revealed the existence of gender disparities or gender inequalities in the information societies. Moreover it has been proposed that the use of ICT plays a big part empowering women in many countries, especially in developing ones. In fact, this proposition is now widely accepted by governments of many countries, as well as international organizations such as United Nations. It is clear that women have often been the subject of the studies related to gender and ICT. However, it is plausible to expect that development and deployment of ICT have effects on men as well as on women. The purpose of this study is to examine what effects ICT have on men in Japan from the viewpoint of gender. In order to attain the purpose, this study attempts to illustrate what significance ICT has to Japanese men who enjoy their life with another gender in cyber space in which gender role is alleged to be reinforced more than in the real world.

Nowadays, various types of communication in cyber space are available on the Net. These can be classified into two types on the whole: “transient communication” and “continuing communication”. The former is defined as a single-shot or a few times communication; once-and-for-all chatting on BBSs is a typical example. The latter is communication that keeps relatively long-term relationship with certain people: giving an example, communication evolved around on-line games and social networking services (SNS). In on-line games or SNS, its users continuously communicate with other users by using characters and emoticon as if they got into discretionary roles or pre-selected characters.

Japan has had a huge number of people who enroll and join in on-line games or SNS as its popularity has already been statistically proven. According to the use of on-line games or/and SNS, we could recognize very interesting phenomenon in the communication in cyber space.

In one of the major on-line game sites in Japan, over 90% of the players are male and 9% are female. But more than half of players pose as female characters in appearing on its sites, and this is contrary to the population structure. Namely, this circumstance indicates that many male users are more likely to appear and play as females in the site. Besides, men do not only pose as female characters but also comport themselves as women when they communicate with other players. In other words, they use the feminine form of expression, choose the subject of the conversation which women is more likely to talk about, and dress their own characters and/or avatars in women’s clothing.

In Japan, there has been the talk “Nekama” that was introduced in the online service period, i.e. pre-WWW period (sometimes this term has been considered as Otaku’s one).This term explains a certain type of men’s behavior in on-line communication. To put it another way, almost “Nekama” naturally go about their own daily life as person who have a male gender identity and most of them are heterosexual in the real world, on the other hand they represent themselves as females on the Net. The purposes of doing “Nekama” can be largely divided into two categories. One is to elicit a positive response from other males and openly rally them on their credulity on the Net, while the other is to feel rejoiced and a sense of release by acting as a female. Some of male players acting as female characters on the Net given above fit the latter description of “Nekama”.

As many studies in linguistic sociology have been pointed out, gender is considered as the important element to facilitate communication in the real world. Thus, gender has a great influence on the underlying conditions for communication. Then what significance does doing “Nekama” have in continuous communication on the Net? Because there are little indexes which are available for the users to discern the other users’ sex and gender in communicating each other in cyber space.

One “Nekama” person has told me, in an interview, that he disengages himself from masculinity enforced socially in the real world by acting as a female on the Net. In other words, ICT has a possibility for people to extricate from enforced gender identity in the real world through a process of expressing one’s another gender identity in cyber space. And also it can be seen as a means for resetting one’s own gender role in the real world because of its anonymousness and invisibility. Furthermore, it may open up a possibility of forging certain identity in line with certain discourse because it increases the importance of the expression by using some letters in the communication in which gender index does not function effectively. On the basis of recognition above, this study present the viewpoint that looks on ICT as a tool of giving free to gender identity containing diverse aspects, and also explore the significance of gender in cyber space.

AUTHOR
Isabel Alvarez and Simon Rogerson

ABSTRACT

This paper reviews the Personal Electronic Health Card (PEHC) from a local Portuguese perspective. The ethical and social issues surrounding PEHCs are discussed and global implications summarised.

At the same time that political and sociological conditions are causing a revolution in health care, advance technologies promise to introduce changes even more radical. More recently, pressures to better manage rising costs have generated an intense interest from governments in how the latest computing technologies can assist in cutting health expenses and improve the flow of medical information.

PEHCs are virtual in the sense that they provide a view of data, possibly configured differently at different locations, but united together into a common format for viewing and updating at the required time. In this way, members of health care teams dealing with a patient are able to access relevant elements of the information recorded by his/ her colleagues. They are thus able to obtain a very wide view of the circumstances of an individual’s present and past medical problems, and the health care given to solve them. PEHCs provide a user with virtual access to data possibly scattered around the world. A shared PEHC potentially offers meaningful access to all data for inspection by all authorised users. This can be modified by establishing access barriers which require specific authorisation clearance before protected data subsets can be viewed. This aligns with commonly accepted view that each Health Care Practitioner should only be allowed to access information on a “need-to-know” basis.

Health care providers and payers have long realised the benefits computer-based health cards could provide. In an information age, some of the world’s best medical doctors are still reliant upon paper-based information systems that fail to deliver crucial timely information during the consultation process.

The more we turn our lives over to computers, the more computers represent potentially harmful threats to our lives. There is no doubt that health care plays a critical role in human culture. PEHCs can facilitate the doctor-patient relationship through use of computerised notes which the doctor and patient share and contribute to. However, PEHCs can harm the relationship and undermine trust.

The policy of the Portuguese government has promoted the implementation of a national Personal Electronic Health Card, for each citizen, containing a longitudinal patient record covering the individual complete medical history for his/her whole life. Such strategy raises a number of ethical issues.

It is argued that the PEHC should form the basis for a collaborative environment in which medical doctors, and ultimately the patient, should be able to engage in an interactive electronic discussion. Moreover, by including patients and allowing them not only to access their data, but also to post reports and queries, patients can become better educated and more empowered to manage their own health.

Highly intensive monitoring, collecting and mining of health data at an international level would better support public policy decisions. Additional information derived from such international data mining could be used to more quickly discover and analyse associations between diseases, or to study disease distributions across geographic regions.

The Government states that this electronic card being personal is always in the patient’s possession and that the information therein contained would be only read and updated at the time of visiting a hospital or a private medical centre. In no other situation could it be used. However, it might be difficult for a current patient with a previous unrelated health condition to exercise the right to decide whether or not the medical doctor dealing with the current condition should access information other than what could be related with her present health status.

Although the Government currently guarantees that the use of the PEHC will be restricted, there is the danger that it may become a standard and be required in the common situations in Portugal. These include; when asking for credit at a Bank, where a medical check-up in an insurance company is compulsory, or when entering a new job and a health check-up is asked for, or where the majority of the companies require their employees to do an yearly health check-up concerning present health conditions.

In the past, similar situations have already occurred, with the unique tax number that each citizen has to have. It was initially supposed to be used only for taxing purposes but is now a de facto standard required everywhere in Portugal, by banks, employers, hospitals, telephone companies, electricity, gas and water utilities, and even for the simplest transactions like buying a monthly bus pass. Through this unique number all information can be crossed referenced and checked.

There is clearly a tension and trade-off between the need-to-know and the right to confidentiality which must be addressed. This is an issue which has been exacerbated by computer technologies. Violations of medical confidentiality may appear to be easier because of the efficiency of computerised systems. The damage to the patient whose confidentiality is violated may be proportionately greater because of the amount of data held within the PEHC. Electronic access to medical information requires careful scrutiny. A patient’s right to informed consent should prevail. A patient should have control over her/his data preventing casual distribution that might be harmful. Furthermore, the movement of PEHCs over the computer networks raises concern on the great risk of inaccuracy, falsification, duplication, manipulation and unauthorised distribution.

In general, PEHC use should ideally promote and must certainly not be in conflict with the fundamental medical ethical principles of beneficence (a duty to promote good and act in the best interest of the patient and the health of society), nonmaleficence (a duty to do no harm to patients) and respect for patient autonomy (a duty to protect and foster a patient’s free, uncoerced choices).