From implicit assumptions to explicit ethics: assessment of normative frameworks in digitalization recommendations in rheumatology

The digital transformation of rheumatology offers significant potential but introduces complex ethical challenges.

This study investigates whether current guidelines and recommendations from leading international rheumatology societies provide a systematically reasoned ethical framework.

We conducted a qualitative document analysis of digitalization-related publications from the American College of Rheumatology (ACR), Asia Pacific League of Associations for Rheumatology (APLAR), and European Alliance of Associations for Rheumatology (EULAR). A systematic search (2019-2025) identified five core documents. Using deductive content analysis guided by Beauchamp and Childress' principlism and three major normative theories (utilitarianism, deontology, virtue ethics), we analyzed the presence and depth of ethical reasoning.

All documents acknowledge practical benefits and mention concepts like data protection and patient-centeredness. However, systematic engagement with normative ethical theories is absent. Ethical terms are used sporadically without definition, and fundamental tensions (e.g., efficiency vs. equitable access) remain invisible. A utilitarian perspective appears implicit in the prioritization of aggregate benefits, but this is not explicitly acknowledged or balanced against alternative frameworks.

Current digitalization guidelines in rheumatology exhibit a critical gap in explicit ethical scaffolding. To ensure responsible innovation, future guideline development should integrate multidisciplinary expertise and systematically apply diverse ethical frameworks, moving from implicit assumptions to transparent value deliberation.