Addressing the Ethical, Legal, and Social Issues of Healthtech in Education: Insights From Japan

The increasing application of health technology (healthtech) in educational settings, particularly for monitoring students' mental health, has garnered significant attention. These technologies, which range from wearable devices to digital mental health screenings, offer new opportunities for enhancing student well-being and strengthening support systems. Numerous studies have explored the ethical, legal, and social issues (ELSIs) of healthtech in the field of psychiatry, highlighting its potential benefits while also acknowledging the inherent complexities and risks that demand careful consideration. However, the ELSIs related to the use of healthtech in educational settings remain largely overlooked and insufficiently addressed. This study provides an overview of items that should be considered by researchers, teachers, and education boards or committees to promote healthtech in the educational context. By adapting existing ELSI frameworks from educational technology and digital health, this study systematically reviews ethical concerns surrounding healthtech in schools. Expert consultations were conducted through a project consisting of members with expertise related to healthtech, including developers, a teacher, a school counselor, and university researchers, leading to the identification of 52 ELSI concerns categorized into 8 domains: consent, rights and privacy, algorithms, information management, evaluation, use, role of public institutions, and relationships with private companies. Using Japan as a case study, we examine regulatory and cultural factors affecting healthtech adoption in schools. The findings reveal critical challenges, such as ensuring informed consent for minors, protecting student privacy, preventing biased algorithmic decision-making, and maintaining transparency in data management. In addition, institutional factors, including the role of public education policies and private-sector involvement, shape the ethical landscape of healthtech implementation. This study highlights the need for multistakeholder collaboration to establish guidelines that balance innovation with ethical responsibility. The study underscores the need for a multifaceted approach to mitigate risks such as data misuse, inequitable access, and algorithmic bias, ensuring the ethical and effective use of healthtech in education. The fundamental ELSI framework for healthtech, including privacy, consent, and algorithms, can be applied to educational systems worldwide, while aspects related to public education policies should be considered in accordance with the specific context of each country and culture. Incorporating healthtech into the educational system helps address the barriers associated with traditional approaches, including limited resources, cost constraints, and logistical challenges. Researchers from universities and healthtech companies, along with educators and other stakeholders, should ensure that healthtech projects consider diverse ELSI concerns at every stage before and during implementation.