Received: 16 May 2022 | Revised: 22 July 2022 | Accepted: 17 September 2022

DOI: 10.1111/bioe.13099

ORIGINAL ARTICLE

The birth of the “digital turn” in bioethics?

Sabine Salloch | Frank Ursin

Hannover Medical School, Institute of Ethics,

History and Philosophy of Medicine,
Hannover, Germany
Correspondence
Sabine Salloch, Hannover Medical School,
Institute of Ethics, History and Philosophy
of Medicine, Carl‐Neuberg‐Str. 1,
Hannover 30625, Germany.
Email: salloch.sabine@mh-hannover.de
Abstract
The so‐called “empirical turn” in bioethics gave rise to extensive theoretical and
methodological debates and has significantly shaped the research landscape from two
decades ago until the present day. Attentive observers of the evolution of the bioethical
research field now notice a new trend towards the inclusion of data science methods for
the treatment of ethical research questions. This new research domain of “digital
bioethics” encompasses both studies replacing (or complementing) socio‐empirical
research on bioethical topics (“empirical digital bioethics”) and argumentative approaches
towards normative questions in the healthcare domain (“argumentative digital bioethics”).
This article draws on insights taken from the debate on the “empirical turn” for sounding
out perspectives for the newly developing field of “digital bioethics.” We particularly
discuss the disciplinary boundaries, chances and challenges, and potentially undesirable
developments of the research field. The article closes with concrete suggestions on which
debates need to be initiated and which measures need to be taken so that the path
forward of “digital bioethics” will be a scientific success.

KEYWORDS
digital bioethics, empirical bioethics, methodology, paradigm shift, scientific turn

1 | T HE “ EMPIRICAL T URN ” I N
BIOETHICS
“Turns” are announced repeatedly in the general progress of science;
they emerge, develop further, and are finally superseded by new
epistemological frameworks that serve as explanatory models.
Starting, more or less, with the “linguistic turn” in philosophy in the
early 20th century, other “turns” evolved in the social sciences and
humanities that were labeled according to key analytical categories,
such as “performance,” “material,” or “icon.” 1
The most prominent “turn” in the bioethical domain, still
remembered by many of us, was the shift towards “empirical
bioethics.” Starting as a discipline very dominated by philosophy,
1
Bachmann‐Medick, D. (2016). Cultural turns new orientations in the study of culture (p. 24).
De Gruyter.
law, and theology, bioethics scholars from the 2000s onwards
increasingly imported empirical methods from the social sciences and
conducted their research partly in close contact with empirical
disciplines, such as sociology, anthropology, or psychology.2 There
were scientific, pragmatic, and genuinely ethical reasons leading to
this “empirical turn” (as the shift is often described): The insight that
“top‐down” approaches to ethics do not satisfy the requirement of a
context‐sensitive analysis of the issues at stake served as a major
starting point.3 Furthermore, bioethicists' embeddedness in medical
faculties and the influence of Evidence‐Based Medicine played a
2
Ashcroft, R. E. (2003). Constructing empirical bioethics: Foucauldian reflections on the
empirical turn in bioethics research. Health Care Analysis, 11(1), 3–13. https://doi.org/10.
1023/A:1025329811812
3
Musschenga, A. W. (2005). Empirical ethics, context‐sensitivity, and contextualism. The
Journal of Medicine and Philosophy, 30(5), 467–490. https://doi.org/10.1080/
03605310500253030

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© 2022 The Authors. Bioethics published by John Wiley & Sons Ltd.

Bioethics. 2023;37:285–291. wileyonlinelibrary.com/journal/bioe | 285


286 | SALLOCH
major role in the increasing uptake of socio‐empirical methods.4
Finally, a participatory aim (not leaving ethical decision‐making to
academic experts) was a main driver for including the perspectives of
those who are most affected, such as patients, relatives, or healthcare
staff, in bioethical analyses. 5
From a philosophical point of view, the various ways in which
socio‐empirical research can contribute to normative argument are
manifold. According to the classification presented by Molewijk
et al. there are five approaches to the use of empirical data in
bioethical analyses that differ, for example, in the location of moral
authority, the goals of research and the interaction between
empirical data and moral theory.6 A thorough reflection on these
characteristics can support the effective planning of the
empirical–ethical research design. From a slightly different perspec-
tive, Davies et al. systematically collected empirical bioethics
methodologies and arranged them according to two extreme “poles”
of methodological orientation, which they described as dialogical
7
versus consultative approaches. They conclude that heterogeneity
in empirical bioethics methods should be welcomed but that
methodological processes and ways to normative justification need
to be made transparent. Also, in other publications, the complex
interplay between ethical theory and empirical data is analyzed, for
example, with respect to the selection of a normative background
for empirical–ethical research that needs to account for theoretical,
methodological, and pragmatic requirements.8 Whereas the poten-
tial of empirical research for strengthening ethical analyses has been
widely discussed and demonstrated in concrete studies, various
forms of critique have also been raised against the empirical
tendency in bioethics. They refer, for example, to philosophical
concerns or the supposed uncritical take‐up of (mainly statistical)
9
methodologies stemming from biomedical research. From the
beginning onwards, there has been an intensive debate on meta‐
ethical, theoretical, and normative aspects with the is‐ought
10
distinction being a prominent issue of concern. An increasing
number and variety of empirical research papers in bioethics,
however, have been documented in recent years, as well as the
4
Borry, P., Schotsmans, P., & Dierickx, K. (2005). The birth of the empirical turn in bioethics.
Bioethics. 19(1), 49–71. https://doi.org/10.1111/j.1467-8519.2005.00424.x; Goldenberg, M. J.
(2005). Evidence‐based ethics? On evidence‐based practice and the “empirical turn” from
normative bioethics. BMC Medical Ethics, 6(1), 11. https://doi.org/10.1186/1472-6939-6-11
5
Ashcroft, op. cit. note 2.
6
Molewijk, B., Stiggelbout, A. M., Otten, W., Dupuis, H. M., & Kievit, J. (2004). Empirical data
and moral theory. A plea for integrated empirical ethics. Medicine, Health Care and Philosophy,
7(1), 55–69. https://doi.org/10.1023/b:mhep.0000021848.75590.b0
7 11
Davies, R., Ives, J., & Dunn, M. (2015). A systematic review of empirical bioethics
methodologies. BMC Medical Ethics, 16, 15. https://doi.org/10.1186/s12910-015-0010-3
8
Salloch, S., Wäscher, S., Vollmann, J., & Schildmann, J. (2015). The normative background of
empirical‐ethical research: First steps towards a transparent and reasoned approach in the
selection of an ethical theory. BMC Medical Ethics, 16, 20.
9
Birchley, G., & Ives, J. (2022). Fallacious, misleading and unhelpful: The case for removing
‘systematic review' from bioethics nomenclature. Bioethics, 36(6), 635–647. https://doi.org/
10.1111/bioe.13024; de Vries, R., & Gordijn, B. (2009). Empirical ethics and its alleged
meta‐ethical fallacies. Bioethics, 23(4), 193–201. https://doi.org/10.1111/j.1467-8519.
2009.01710.x; Goldenberg, op. cit. note 4.
10
Leget, C., Borry, P., & de Vries, R. (2009). ‘Nobody tosses a dwarf!’ The relation between
the empirical and the normative reexamined. Bioethics, 23(4), 226–235. https://doi.org/10.
1111/j.1467-8519.2009.01711.x
14678519, 2023, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/bioe.13099 by Nat Prov Indonesia, Wiley Online Library on [13/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
AND URSIN
generally positive positioning of (European) researchers towards the
emerging field.11 A broad variety of empirical–ethical research
methodologies has been published and some of them have been
used in concrete studies.12
The designation of this so‐called “empirical turn” as a paradigm
shift, according to Thomas S. Kuhn, can be legitimately called into
question.13 According to the common interpretation of a scientific
“turn,” the dominant paradigm providing the basis for “normal
science” becomes incompatible with the new phenomena observed,
necessitating the adoption of a new paradigm as an explanatory
background. In bioethics, instead, a heterogeneous mélange of
reasons (methodological, pragmatic, normative) led to the adoption
of empirical methods (not so much theories) from other scientific
branches. In addition, certain specifics of the domain of bioethics
need to be taken into account. While a scientific paradigm represents
“what members of a scientific community, and they alone, share,”14
bioethics appears as an interdisciplinary endeavor in which research
objects and methods are manifold and do not change abruptly.
Speaking of a “paradigm shift,” thus, presupposes the idea of a
“normal science” that might not be perfectly fitting to bioethics
because no individual discipline can claim exclusive representation of
bioethical scholarship.15 As a discursive endeavor, there is no “normal
science” in bioethics that can be replaced by another research
paradigm, but it could, of course, be supplemented. The impact of the
“empirical turn” (or better: “methodological shift”) on the theory,
methodology, and practice of bioethical inquiry, however, undoubt-
edly remains immense.
2 | A “d i gi t al t u r n” IN BIOETHICS?
Attentive observers of the evolution of bioethics may have recently
noticed a new, dazzling phenomenon in terms of changing
methodologies. Browsing through the leading journals’ volumes of
2020, 2021, and 2022, one can hardly overlook that not only socio‐
empirical but also data science methods are increasingly applied for
the treatment of bioethical research questions. Just to mention a few
examples:
• In a recent article, Schneider, Vayena, and Blasimme coined the
term “digital bioethics” and impressively demonstrated how
empirical bioethics can benefit from digital research methods to
Wangmo, T., Hauri, S., Gennet, E., Anane‐Sarpong, E., Provoost, V., & Elger, B. S. (2018). An
update on the “empirical turn” in bioethics: Analysis of empirical research in nine bioethics
journals. BMC Medical Ethics, 19(1), 6. https://doi.org/10.1186/s12910-018-0246-9;
Wangmo, T., & Provoost, V. (2017). The use of empirical research in bioethics: A survey of
researchers in twelve European countries. BMC Medical Ethics, 18(1), 79. https://doi.org/10.
1186/s12910-017-0239-0
12
Davies, R., et al., op cit. note 7.
13
Kuhn, T. S. (2012). The structure of scientific revolutions. 50th anniversary edition (4th ed.).
The University of Chicago Press; Hurst, S. (2010). What ‘empirical turn in bioethics’?
Bioethics, 24(8), 439–444. https://doi.org/10.1111/j.1467-8519.2009.01720.x
14
Kuhn, T. S. (1977). The essential tension. Selected studies in scientific tradition and change
(p. 294). University of Chicago Press.
15
Bachmann‐Medick, op. cit. note 1, p. 9.

SALLOCH AND URSIN
investigate ethically relevant phenomena.16 In particular, they
advance “the use of computational techniques that treat online
content and the digital traces of online activities as sources of
knowledge and as the basis of knowledge claims important to the
advancement of normative insight and policy analysis.”17 Drawing
on such online data material, Schneider et al. conducted a
sentiment analysis with social media data from Twitter, a hashtag
frequency analysis to identify the main topics in online discussions,
a thematic probing to investigate the occurrence of predefined
ethical themes in online discussions and a policy landscape analysis
based on network analysis by identifying backlinks of online policy
documents.
• Pacyna and Sharp argued that bioethics scholarship needs to adapt
its methods to keep pace with the implementation of new data
technologies in patient care and clinical research.18 To wrap up
these efforts, they propose the term “Big Bioethics,” resembling
“Big Data,” as a paradigm that has changed data and information
science profoundly in recent decades. They define “Big Bioethics”
as “empirical bioethics research—often surveys or retrospective
reviews of patient outcomes—that collect and analyze data from
very large numbers of people.”19 Most likely, such Big Data
approaches to bioethics will draw on methods of automated data
processing that, for example, detect significant patterns of
correlation that have escaped the attention of the human
researcher so far.
• Pavarini and colleagues used an approach called “design bioethics”
to create a research‐based narrative game testing the moral
intuitions of young people in an immersive setting.20 They define
“design bioethics” as the “design and use of purpose‐built,
engineered tools for bioethics research, education and engage-
ment.”21 They highlight the potential of digital methods (and
gaming methods, in particular) for creating an immersive setting
that integrates context, narratives, and embodiment into moral
decision‐making.
• Meier and coworkers were (among) the first to present algorithm‐
based decision‐making for concrete cases from clinical ethics.
They trained a machine learning algorithm on the basis of fuzzy
cognitive maps as an advisory system that operationalizes
Beauchamp and Childress' prima facie principles (with the
exemption of justice) and discuss chances and limitations of the
use of computers for supporting clinical ethics consultations.22
16
Schneider, M., Vayena, E., & Blasimme, A. (2021). Digital bioethics: Introducing new
methods for the study of bioethical issues. Journal of Medical Ethics. https://doi.org/10.
1136/medethics-2021-107387
17
Ibid.
18
Pacyna, J. E., & Sharp, R. R. (2022). The need for “big bioethics” research. American Journal
of Bioethics, 22(1), 3–5. https://doi.org/10.1080/15265161.2022.2009701
19
Ibid.
20
Pavarini, G., McMillan, R., Robinson, A., & Singh, I. (2021). Design bioethics: A theoretical
framework and argument for innovation in bioethics research. The American Journal of
Bioethics, 21(6), 37–50.
21
Ibid: 37.
22
Meier, L. J., Hein, A., Diepold, K., & Buyx, A. (2022). Algorithms for ethical decision‐making
in the clinic: A proof of concept. American Journal of Bioethics, 22(7), 1–17. https://doi.org/
10.1080/15265161.2022.2040647
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| 287
In this article, we apply the term “digital bioethics” in a rather
generic sense for all attempts making use of advanced data
technology for addressing bioethical research questions. Such
research questions can have an empirical or a conceptual character
and often comprise (and integrate) both descriptive and normative
claims. What is not designated with the term “digital bioethics” here
are initiatives using more simple forms of digital technology for
addressing ethical issues in healthcare, such as telemedicine in
Clinical Ethics Consultation.23 Even if these conceptual boundaries
might be hard to determine for some technologies, we would like to
draw a line between machines (at least) partly taking over genuine
tasks of bioethical research and consultation as opposed to digital
technologies functioning as mere means for the transmission of
information relevant to ethics. According to this definition, also the
use of computers and software, for example, for data analysis, does
not suffice for designating a research project as “digital bioethics.”
What is also not addressed in this article are applications drawing on
digital technologies or data science methods for ethics teaching—
even if such systems have already been successfully implemented.24
As it becomes apparent from the list of examples displayed
above, the spectrum of methods applied within “digital bioethics” is
already considerably wide. Regarding its “academic ancestry,” the
new digital trend in bioethics can be linked to at least two branches
of research that have, so far, often been detached in their scientific
discourses and methodological development. On the one hand, there
is “empirical bioethics,” typically understood as an “interdisciplinary
activity in which empirical social scientific analysis is integrated with
ethical analysis in order to draw normative conclusions.”25 Social
science methods as applied in “empirical bioethics” usually include
quantitative surveys and qualitative methods of data collection such
as interviews or focus groups.26 Depending on the character of the
concrete project, the aim of empirical bioethics research often
consists of generating a better understanding of social reality and the
contexts in which ethical problems occur, including a rich description
of the attitudes, knowledge, and behavior of people who are
affected. On the other hand, experimental philosophy (x‐phi)27 has
been developed as an increasingly big and complex branch of
research that predominantly draws on methods from (moral)
psychology and cognitive sciences for making contributions to
conceptual analysis (positive x‐phi) or challenging intuitive assump-
tions about empirical facts that are referred to in traditional
23
Kon, A. A., & Garcia, M. (2015). Telemedicine as a tool to bring clinical ethics expertise to
remote locations. HEC Forum, 27(2), 189–199. https://doi.org/10.1007/s10730-015-9272-x
24
Schrier, K. (2019). Designing games for moral learning and knowledge building. Games and
Culture, 14(4), 306–343. https://doi.org/10.1177/1555412017711514; Katsarov, J.,
Biller‐Andorno, N., Eichinger, T., Schmocker, D., & Christen, M. (2020). uMed: Your Choice—
Conception of a digital game to enhance medical ethics training. In M. Groen, N. Kiel, A.
Tillmann, & A. Weßel (Hrsg.), Games and ethics (pp. 197–212). Springer.
25
Ives, J., Dunn, M., Molewijk, B., Schildmann, J., Bærøe, K., Frith, L., Huxtable, R., Landeweer,
E., Mertz, M., Provoost, V., Rid, A., Salloch, S., Sheehan, M., Strech, D., de Vries, M., &
Widdershoven, G. (2018). Standards of practice in empirical bioethics research: Towards a
consensus. BMC Medical Ethics, 19, 68. https://doi.org/10.1186/s12910-018-0304-3
26
Wangmo, T., Hauri, S., Gennet, E., Anane‐Sarpong, E., Provoost, V., & Elger, B. S. (2018). An
update on the “empirical turn” in bioethics: Analysis of empirical research in nine bioethics
journals. BMC Medical Ethics, 19, 6. https://doi.org/10.1186/s12910-018-0246-9
27
Knobe, J., & Nichols, S. (2008). Experimental philosophy. Oxford University Press.

288 | SALLOCH
philosophical arguments (negative x‐phi).28 In contrast to empirical
bioethics, experimental designs are dominating this field, which means
that data are collected in highly standardized settings that allow for
explaining underlying cognitive processes and quantifying factors
that shape people's judgments about moral dilemmas. The more
recent sub‐field “experimental philosophical bioethics” (bioxphi)
systematically integrates such empirical data in normative arguments
concerning bioethical issues.29 Interestingly, thus, both experimental
methods as well as rather explorative research designs have already
been applied within “digital bioethics” together with other methods
that are specific for the data science domain.
A link has also been drawn between “digital bioethics” and
“computational social science” or “social data science” as related
fields that could inspire empirical bioethics in the integration of digital
30
methods. In this, it seems very plausible to research Big Data
phenomena in, for example, Social Media with digital methods
derived from data science, because processing these data by hand
would be much too labor‐intensive. Regarding bioethics' normative
side, a “productive integration” of digital and normative methods has
been demanded and the need for appropriate empirical–ethical
methodologies has been highlighted.31
On closer inspection, the umbrella term “digital bioethics”
potentially unifies (at least) two emergent branches:
(1) digital methods augmenting or replacing the “empirical branch” of
bioethical research (socio‐empirical or empirical–ethical studies) and
(2) digital methods supporting theoretical and conceptual analyses
as a major domain of bioethics work.
In the following sections, we will tentatively sketch both of these
branches and highlight aspects that are potentially important to consider
in the further development of “digital bioethics.” We will try to refer to
both chances for scientific progress and a better and more effective
treatment of bioethical research questions, as well as some of the
limitations and potentially undesirable developments of the discipline. In
this, we are well aware of the fact that our analysis cannot be more than a
“snapshot in time” of this dynamically developing field that will most
probably make enormous progress within a few years.
3 | E M PI R I C A L D I G I T A L B I O E T H I C S
The delicate beginnings of “digital bioethics” that can currently be
observed focus predominantly on the supplementation and replace-
ment of socio‐empirical research methods in the bioethical domain.
28
Knobe, J. (2016). Experimental philosophy as cognitive science. In J. Sytsma & W.
Buckwalter (Eds.), A companion to experimental philosophy (pp. 37–52). Wiley‐Blackwell.
29
Earp, B. D., Lewis, J., Dranseika, V., & Hannikainen, I. R. (2021). Experimental philosophical
bioethics and normative inference. Theoretical Medicine and Bioethics, 42, 91–111.
30
Schneider, op. cit. note 16, p. 3.
31
Ibid: 5; Salloch, S., Schildmann, J., & Vollmann, J. (2012). Empirical research in medical
ethics: How conceptual accounts of normative‐empirical collaboration may improve research
practice. BMC Medical Ethics, 13, 5.
14678519, 2023, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/bioe.13099 by Nat Prov Indonesia, Wiley Online Library on [13/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
AND URSIN
Attitudes towards vaccination, for example, are ethically relevant,
especially in times of a pandemic. Müller and Salathé conducted a
sentiment analysis on social media data addressing attitudes towards
vaccination over time.32 They demonstrate that information influ-
ences attitudes and, therefore, conclude that having an early warning
system for misinformation is desirable from a Public Health ethics
perspective. To address this, the World Health Organization recently
developed an artificial intelligence (AI)‐supported social listening
program on the so‐called “infodemic,” that is, prevalent mis-
information during a disease outbreak.33 Another example of digitally
aided socio‐empirical methods is research on drug epidemics.
Balsamo and colleagues used data mining and automated content
analysis of Reddit discussions (an online forum) to explore the opioid
crisis in the United States.34 Even if this study does not label itself as
bioethical research, a better understanding of how addicts consume
opioid substances for non‐medical abuse helps to serve their
healthcare needs more efficiently and tailor programs for the
prevention, treatment, and control of Public Health effects.
These rather randomly chosen examples of studies built on
Social Media data show how ethically important results can be
generated effectively by using data science methods. The current
preponderance of using digital methods as a replacement (or
supplement) of empirical–ethical research (as opposed to argumen-
tative research) can be interpreted in light of the fact that (young)
scholars from the social sciences are regularly active in the
bioethical domain and fruitfully contribute their up‐to‐date meth-
odological competencies. Against this background, it becomes
obvious how social scientists (from fields such as psychology or
media science) introduce new digital methods that have already
been established in their fields but not yet in the bioethical domain.
It can be expected that the digital research tools that have already
been developed within the Digital Humanities will also be applied
eventually in bioethics.35
Against this background, two aspects are particularly remarkable:
First, as has already been discussed regarding the “empirical turn,” we
need to keep in mind that empirical research alone does not provide
answers to bioethical questions that have a genuinely normative
character. Evidence on people's attitudes, knowledge, and behavior
regarding ethically controversial practices, for example, does not
directly allow for a judgment about the moral legitimacy of these
practices.36 Instead, empirical insights need to be integrated into an
32
Müller, M. M., & Salathé, M. (2019). Crowdbreaks: Tracking health trends using public
social media data and crowdsourcing. Frontiers in Public Health, 7, 81. https://doi.org/10.
3389/fpubh.2019.00081
33
World Health Organization. (2022). Early AI‐supported response with social listening
COVID‐19 online conversations in 30 pilot countries. https://www.who-ears.com/
34
Balsamo, D., Bajardi, P., Salomone, A., & Schifanella, R. (2021). Patterns of routes of
administration and drug tampering for nonmedical opioid consumption: Data mining and
content analysis of Reddit discussions. Journal of Medical Internet Research, 23(1), e21212.
https://doi.org/10.2196/21212
35
Weingart, S. B., Grunewald, S., Lincoln, M. et al. (eds.). The digital humanities literacy
guidebook. Carnegie Mellon University, Updated April 3, 2022. https://cmu-lib.github.
io/dhlg/
36
Salloch, S., Vollmann, J., & Schildmann, J. (2014). Ethics by opinion poll? The functions of
attitudes research for normative deliberations in medical ethics. Journal of Medical Ethics,
40(9), 597–602.

SALLOCH AND URSIN
overall ethical evaluation that considers normative and empirical
aspects and their interdependency.37 This means, second, that—
similar to what has been debated for the “empirical turn”—bioethics
scholars need to apply empirical–ethical methodologies for making
the interaction between their data collection and their ethical
research question explicit on the theoretical and methodological
levels and with respect to research practice. Various forms of
interaction between the normative and the empirical side of
bioethical argument have been described in the literature,38 and
suggestions for their realization in concrete studies have been
made. 39
Currently, in some of the approaches towards “empirical
digital bioethics,” the function of the empirical insights gained with
respect to normative argument is not made explicit in detail.40 The
newly emerging field might thus profit from previous conceptual
accounts of normative–empirical collaboration as developed in
empirical bioethics.
Not only with respect to normative–empirical collaboration,
theoretical and methodological questions already known now
appear “in a new guise”: Which normative research concerns stand
behind the collection and analysis of the data? Does the data
analysis have an “explorative” character, for example, when
identifying or further characterizing potential ethical issues? How
is a symmetry or balance between the academic disciplines
(normative and empirical) and their research interests and standards
guaranteed? And which quality criteria need to be applied
particularly at the intersection between data science and normative
41
research interests? Further questions, more specific to the digital
domain, need to be identified without neglecting bioethics'
character as a normative discipline with deep roots in philosophical
theory and argumentation.
4 | ARGUMENTATIVE DIGITAL BIOETHICS
Whereas a noticeable number of studies have already been published
in “empirical digital bioethics,” the second “argumentative” branch
seems to be less developed so far. However, advanced data science
may also potentially provide “argumentative bioethics,” with a
plethora of techniques from various fields, such as automatic
information retrieval techniques, argumentation mining, automated
text generation, or natural language processing as a component of AI.
What they all have in common is that they process semantic entities
referred to as arguments in written or spoken text. As it is not even
trivial to identify and assess the quality of arguments by humans, the
advantage of computers is that they process quantities of texts that
are unmanageable for humans and, thereby, find, for example, a
37
Earp, B. D., et al., op. cit. note 29.
38
Leget, C., et al., op. cit. note 10; Molewijk, B., et al., op. cit. note 6.
39
Davies, R., et al., op. cit. note 7.
40
Salloch, S. (2021). Powers and Perils. American Journal of Bioethics, 21(6), 72–73.
41
Mertz, M., Marcel Mertz, Inthorn, J., Renz, G., Rothenberger, L. G., Salloch, S., Schildmann,
J., Wöhlke, S., & Schicktanz, S. (2014). Research across the disciplines: a road map for quality
criteria in empirical ethics research. BMC Medical Ethics, 15, 17.
14678519, 2023, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/bioe.13099 by Nat Prov Indonesia, Wiley Online Library on [13/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
| 289
proper counterargument if you are arguing with, for example, IBM's
AI‐powered debating system on bioethical issues.42 Therefore, these
methods could, for instance, not only enrich the methodological
procedure of systematic reviews, for example, of arguments, reasons,
or all ethical issues,43 but also serve for (at least) the preparation of
theory‐led conceptual analyses of emergent bioethical issues. To
exemplify the latter, Sleigh and coworkers visualized an ethics
framework from health policy documents on data processing in
personalized health research in an accessible way.44 We, therefore,
see a great potential in the further development of “argumentative
digital bioethics,” which needs to be explored in close cooperation
with data science and informatics specialists.
Currently, however, the cooperation between “theoretical” bioethics
and data science does not seem to be as easily established as within the
“empirical branch” of bioethics. The pilot study by Meier and colleagues
on algorithmic ethical decision‐making or the study by Odeh and
coworkers, who mapped the entire bioethics literature and identified over
700 concepts through text mining and machine learning, making the case
for “bioethics informatics,”45 are rare exceptions. More recently,
Bystranowski and colleagues focused on almost 100 topics in seven
bioethics journals, they deepened their approach of topic modeling by
adding the diachronic dimension and emphasized that the data does not
speak for itself but must be still be interpreted.46
The determining reasons behind keeping the distance between
(mostly) philosophers and computer scientists are not easy to identify
and could prompt further studies on the sociology of science and
social construction of knowledge. Taking into account Ludwik Fleck's
concept of thought collectives, that is, that scientific facts are
produced in a sociologically complex way, may serve as an aid to
reflect the current situation more properly.47 We would thus suggest
further (e.g., ethnographic) research analyzing why the (self‐
perceived) distance between “normative scholars” and computer
scientists remains considerably wide compared with the relationship
between “digital” and “non‐digital” social scientists within bioethics.
42
Slonim, N., Bilu, Y., Alzate, C., Bar‐Haim, R., Bogin, B., Bonin, F., Choshen, L., Cohen‐Karlik,
E., Dankin, L., Edelstein, L., Ein‐Dor, L., Friedman‐Melamed, R., Gavron, A., Gera, A., Gleize,
M., Gretz, S., Gutfreund, D., Halfon, A., Hershcovich, D., … Aharonov, R. (2021). An
autonomous debating system. Nature, 591(7850), 379–384. https://doi.org/10.1038/
s41586-021-03215-w
43
Parsons, J. A., & Johal, H. K. (2021). In defence of the bioethics scoping review: Largely
systematic literature reviewing with broad utility. Bioethics, 36(4), 423–433. https://doi.org/
10.1111/bioe.12991; Mertz, M. (2019). How to tackle the conundrum of quality appraisal in
systematic reviews of normative literature/information? Analysing the problems of three
possible strategies (translation of a German paper). BMC Medical Ethics 20:81. https://doi.
org/10.1186/s12910-019-0423-5
44
Sleigh, J., Schneider, M., Amann, J., & Vayena, E. (2020). Visualizing an ethics framework: A
method to create interactive knowledge visualizations from health policy documents. Journal
of Medical Internet Research, 22(1), e16249. https://doi.org/10.2196/16249; Health Ethics
and Policy Lab. (2021). Health data ethics map. ETH Zürich. Retrieved May 11, 2022, from
https://ethicalsystemsmap.hest.ethz.ch/map
45
Odeh, M., Kharbat, F. F., Yousef, R., Odeh, Y., Tbaishat, D., Hakooz, N., Dajani, R., &
Mansour, A. (2021). iOntoBioethics: A framework for the agile development of bioethics
ontologies in pandemics, applied to COVID‐19. Frontiers in Medicine, 8, 619978. https://doi.
org/10.3389/fmed.2021.619978; Meier, L. J., et al., op. cit. note 22.
46
Bystranowski, P., Dranseika, V., & Żuradzki, T. (2022). Half a century of bioethics and
philosophy of medicine: A topic‐modeling study. Bioethics. https://doi.org/10.1111/bioe.
13087
47
Fleck, L. (2008). Genesis and development of a scientific fact. University of Chicago Press.

290 | SALLOCH
TABLE 1 Methods from the Digital Humanities and their potential application in “argumentative digital bioethics”48
Methods from the Digital Examples of methodical procedures, analytical
Humanities categories, and tools
Enhanced Critical Digital collections, multimedia critical editions, object‐
Curation based argumentation, experiential and spatial,
mixed physical and digital
Augmented Editions and Structured mark‐up, natural language processing,
Fluid Textuality relational rhetoric, textual analysis, variants and
versions, mutability
Scale: The Law of Large Quantitative analysis, text mining, machine reading,
Numbers digital cultural record, algorithmic analysis
Distant /Close, Macro/ Large‐scale patterns, fine‐grained analysis, close
Micro, Surface/Depth reading, distant reading, differential geographies
Code, Software, and Narrative structures, code as text, computational
Platform Studies processes, software in a cultural context, encoding
practices
Source: Adopted selection from Burdick and colleagues.
Other reasons for the, as yet, reluctant uptake of data science
methods for argumentative analysis arise from the fact that (somewhat
different from “empirical digital bioethics”) the role and responsibility of
the individual scientist or author play a more prominent role when they
present their ethical analysis in a written form. Many people would agree
that the author's personal background (as well as the philosophical
traditions they feel committed to) have a major impact on the focus,
structure, and outcome of the analysis, together with stylistic and
language issues that are far away from being unambiguous in
argumentative papers. Others, however, could argue that the position
of an “ideal observer” also has its merits for philosophical (or bioethical)
analysis,49 for example, as it compensates for several limits of human
moral psychology. Impartiality, processing capacity, or endurance might
be some of the assets that machines can contribute to moral reasoning
and bioethical argumentation. A deeper analysis of technologies applied
within “argumentative digital bioethics” therefore also comes along with
the opportunity to discuss issues of scientific authorship, research
integrity, and good scientific practice from a fresh perspective.
Apart from such topics of interdisciplinary co‐work and
human–machine interaction, there are more points to consider if
“argumentative digital bioethics” is going to succeed as a scientific
enterprise: Technical issues relate, for example, to the necessities of
making academic publications better accessible for machines in terms
of interoperability, so that relevant literature can undergo (semi‐)
automated screening and further processing.50 A closer look at the
48
Burdick, A., et al., op. cit. note 35, pp. 32–60.
49
Giubilini, A., & Savulescu, J. (2018). The artificial moral advisor. The “ideal observer” meets
artificial intelligence. Philosophy and Technology, 31(2), 169–188. https://doi.org/10.1007/
s13347-017-0285-z
50
Van Meenen, J., Leysen, H., Chen, H., Baccarne, R., Walter, D., Martin, B., & Maudsley, S.
(2022). Making biomedical sciences publications more accessible for machines. Medicine,
Health Care and Philosophy. https://doi.org/10.1007/s11019-022-10069-0
14678519, 2023, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/bioe.13099 by Nat Prov Indonesia, Wiley Online Library on [13/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
AND URSIN
Examples of hypothetical applications in “argumentative
digital bioethics”
Casuistry could profit from accessible digital collections of
cases that are searchable by keywords of the case at hand
or identifying similar cases by smart comparison.
Methods and databases could be used to accessibly compare
and analyze ethical codes, frameworks, or policy documents.
Data science technology could allow the extraction and analysis
of arguments not only from a sample that humans can
oversee but also from all written or spoken digitized text.
Questions such as “How did one specific argument evolve over
time?” or “Who used it where and when and how was it
interpreted?” can be addressed.
Researchers will be able to examine and understand the code
of an algorithm and analyze the values or norms that are
coded into software.
digital humanities coupled with a bit of imagination opens up a wide
range of methodological options for “argumentative digital bioethics”
for research, development, and the application of tools (see Table 1).
Finally, the impact of “argumentative digital bioethics” on ethical
theory needs to be critically assessed regarding both its potential of
widening the scope and the risk of constraining the theoretical
landscape, for example, if predominantly “deductive,” principle‐led
approaches are applied. A lot can be learnt in this respect from
related debates on artificial moral agents and “machine metaethics,”51
which demonstrate, for example, that some ethical accounts (e.g.,
principlism) bear the potential of being—at least partially—
programmed, whereas other types of ethical theory (e.g., phenome-
nology) escape the scope of algorithms to a considerable extent.
Setting bioethics on a data science basis, thus, would certainly carry
the risk of neglecting some accounts that, so far, provide important
insights into the character of bioethical problems.
5 | CONCLUDING REMARKS
Digital approaches have already pervaded many of the major fields of
bioethical work, such as clinical ethics,52 research ethics,53 or Public
Health ethics.54 They contribute to both the generation of insights
into empirical facts and the processing of data, information, and
51
Cervantes, J.‐A., López, S., Rodríguez, L.‐F., Cervantes, S., Cervantes, F., & Ramos, F.
(2020). Artificial moral agents: A survey of the current status. Science and Engineering Ethics,
26(2), 501–532. https://doi.org/10.1007/s11948-019-00151-x; Wallach, W., & Allen, C.
(2009). Moral machines: Oxford University Press.
52
Meier, L. J., et al., op. cit. note 22; Pacyna & Sharp, op. cit. note 18.
53
Odeh, M., et al., op. cit. note 45; eTIC. (2022). Electronic tool for informed consent
documents. Retrieved May 11, 2022, from https://etic.med.tum.de/
54
Schneider, M., et al., op cit. note 16; Schneider, M. (2021). Digital bioethics: Contextualizing
digital technologies and introducing digital methods for empirical research [PhD]. ETH Zurich.

SALLOCH AND URSIN
knowledge for the sake of bioethical argumentation. If advanced data
science technologies are increasingly used to support bioethical
analyses, the limitations of such technologies already known from the
introduction of AI into other fields, such as healthcare, need to be
kept in sight.55 This means (as a form of “self‐application” of AI ethics)
that (semi‐)automated ethical analyses necessitate a continuous
evaluation regarding the well‐known (but not yet fully mitigated)
ethical implications of AI. It is crucial that such aspects as the
transparency that algorithms are applied at all and the (debatable)
explainability of automatically generated recommendations gain
increasing relevance, whereas accuracy is more important in some
scenarios than an explanation of how the recommendation came
about. There are the known risks of bias arising from the training data
for machine learning algorithms that can disadvantage certain groups
and lead to unjust discrimination. Furthermore, doubts can be raised
on the extrapolation of results drawn from training data (so far, often
ethically rather uncontroversial cases) to more complicated ethical
problems as occurring in clinical practice. 56
Only when the AI is more
accurate than humans, the quality of recommendations can be truly
improved by computational support. Furthermore, an appropriate
division of labor and responsibility between human and nonhuman
ethicists and programmers needs to be developed considering
potential long‐term effects of ethicists, such as de‐skilling or the
automation bias. While these risks are well known, novel approaches
need to be designed and integrated for their mitigation in the field of
“digital bioethics.”
Our comparative overview on empirical bioethics and the newly
developing “digital turn” of the discipline revealed that some
challenges such as methodological rigor, interdisciplinary communi-
cation, or clear concepts of normative–empirical interaction occur
similarly in both fields. However, there are also major differences:
Empirical bioethics in its origin was very much driven by a
participatory ideal and the intention to make ethics context‐
sensitive. “Digital bioethics,” by contrast, seems much more
technology‐driven in so far as technologies developed in other fields
are now tested for ethical research questions or (in particular
argumentative) technologies are specifically designed to meet the
needs of ethical analysis. Even today, in the early beginnings, the
methodological spectrum of “digital bioethics” seems much broader
than in the studies typically conducted in empirical bioethics. On the
one hand, these great technological opportunities come along with
remarkable chances for answering established bioethical research
questions (and discovering new ones). On the other hand, the “digital
turn” necessitates the bioethics community to constantly negotiate
55
Dubber, M. D., Pasquale, F., & Das, S. (Eds.). (2020). The Oxford handbook of ethics of AI.
Oxford University Press.
56
Demaree‐Cotton, J., Earp, B. D., & Savulescu, J. (2022). How to use AI ethically for ethical
decision‐making. American Journal of Bioethics, 22(7), 1–3. https://doi.org/10.1080/
15265161.2022.2075968
14678519, 2023, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/bioe.13099 by Nat Prov Indonesia, Wiley Online Library on [13/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
| 291
the boundaries of their own discipline and its relationship with other
(socio‐empirical, biomedical, engineering) academic branches.
Finally, it remains to be asked whether the “birth” of “digital
bioethics” will be an easy or a difficult one. The success of the new
research field clearly depends on whether the results of “digital
bioethics” actually have an added value compared to “man‐made”
bioethics. We need to acknowledge that the biggest obstacles for
“digital bioethics” lie in the lack of a “ground truth” and the “context”
for explanations of the results.57 While it is unquestionable that
explanations are desired in bioethics, for example, as a justification
for a normative claim, some may doubt that certain contexts of
deriving a normative claim (such as emotional or personal affection)
should play a role and, therefore, machines make better decisions
because they lack such contexts. While this is debatable, the lack of a
“ground truth” conceived as the correct answer to a normative
question can also be seen as characteristic for a society that is value
pluralistic. Finally, yet importantly, the success of “digital bioethics”
depends on the “digital openness” and the willingness of the research
community to acquire digital research competencies or buy them in
by cooperation with data specialists. We think that it is worth trying!
ORC I D
Sabine Salloch http://orcid.org/0000-0002-2987-2684
Frank Ursin https://orcid.org/0000-0002-9378-3811
AUTHOR BIOGRAPHIES
Sabine Salloch is a medical ethicist and head of the Institute of
Ethics, History and Philosophy of Medicine at Hannover Medical
School, Germany. She has academic backgrounds in medicine and
philosophy. Her main research focuses are on bioethical methodol-
ogy, ethics of digitization in healthcare, and medical professionalism.
Frank Ursin is a postdoctoral research fellow at the Institute of
Ethics, History and Philosophy of Medicine at Hannover Medical
School, Germany. His academic backgrounds are in history and
philosophy. His main research focuses are on ethics of digitiza-
tion in medicine and pre‐modern history of medicine.
How to cite this article: Salloch, S., & Ursin, F. (2023). The
birth of the “digital turn” in bioethics? Bioethics, 37, 285–291.
https://doi.org/10.1111/bioe.13099
57
Holzinger, A., Carrington, A., & Müller, H. (2020). Measuring the quality of explanations:
The System Causability Scale (SCS): Comparing human and machine explanations. Künstliche
Intelligenz, 34(2), 193–198. https://doi.org/10.1007/s13218-020-00636-z