Beyond Principlism: A Cosmopolitan and Care Ethics Approach to One Digital Health

This article examines the limitations of principlism in addressing the ethical challenges posed by One Digital Health. While principlism remains influential in bioethics, digital health, and global health policy, we argue that it is insufficient to capture the relational, data infrastructural, and multispecies dynamics shaping the threats to One Health. Using antimicrobial resistance as a paradigmatic case, we show that One Digital Health governance is shaped not only by distributive ethical concerns but also by structural asymmetries in data visibility, digital infrastructure, and epistemic inclusion across human, animal, and environmental domains. These asymmetries reveal a key limitation of principlism: although it articulates abstract commitments to justice and equity, it lacks the conceptual and operational resources to explain how inequalities are produced and reproduced in digital systems. To address this gap, we propose an integrated framework that combines the ethics of care, cosmopolitanism, and a FAIRER-based account of data governance. Ethics of care foregrounds situated vulnerability and relational interdependence; cosmopolitanism extends moral responsibility across global and multispecies scales; and FAIRER operationalizes these commitments within digital infrastructures and data systems. The antimicrobial resistance case study shows that this approach provides a more comprehensive account of One Digital Health governance by linking lived practices, global responsibilities, and data infrastructures. We conclude that addressing One Health threats through digital transformation requires moving beyond principle-based reasoning toward relational frameworks that integrate global commitments with contextual sensitivity.