A look at ethical problems in Virtual Reality

Dr. Philipp Kellmeyer, a researcher at the Freiburg University Hospital (Germany), calls for more sensitive use of virtual realities in medicine and nursing.

A shift from developer-driven to patient-driven innovations is desirable

Dr. Philipp Kellmeyer, a researcher at the Freiburg University Hospital (Germany), calls for more sensitive use of virtual realities in medicine and nursing.

Dementia, anxiety disorders, stroke: the spectrum of possible applications of virtual reality (VR) is growing rapidly. For example, a simulation of their original environment can have a calming effect on dementia patients in nursing homes. "In principle, virtual reality can have positive effects," said neurologist Dr. Philipp Kellmeyer from the Department of Neurosurgery at the Freiburg University Medical Centre and the Freiburg Institute of Advanced Studies (FRIAS). But he also warns: "The special needs of patients are often insufficiently taken into account. If dementia patients are no longer able to distinguish between reality and fiction, for example, this is a serious intervention in their autonomy. Together with colleagues from the Netherlands and Switzerland, he has published an article on this subject in the journal Nature Medicine.

"The border between reality and VR is becoming more and more blurred"

VR applications are also being tested in the treatment of eating disorders, attention deficit hyperactivity syndrome (ADHD) and forensic psychiatry. "It is valid to say that VR applications have very positive effects. But how virtual reality cognitively and emotionally affects its users and patients has hardly been investigated. And the boundary between reality and VR is becoming increasingly blurred," says Kellmeyer. 

The neurologist sees three central risks in the application of VR:

  1. The persuasiveness of VR simulation can be used for therapeutic purposes that are ultimately based on deception or illusion. This instrumentalization restricts the autonomy of patients and is also problematic with regard to human dignity.
  2. The application of VR aims at a change in behavior that users cannot escape. This endangers autonomous decision-making.
  3. Users build emotional ties to virtual figures, avatars, and accept them as supposed real people. This could result in a social withdrawal from the real world.

Involving patients in VR development at an early stage

These problems can be solved in different ways. "Technological solutions should only be used where the problems cannot be solved politically or socially," says Kellmeyer. To make new applications more user-centric, Kellmeyer and colleagues suggest involving patients in development at an early stage. "We should move away from developer-driven to patient-driven innovations”, Kellmeyer suggests.

Ethical tensions of virtual reality treatment in vulnerable patients
Philipp Kellmeyer, Nikola Biller-Andorno & Gerben Meynen 
Nature Medicine (2019)
DOI: 10.1038/s41591-019-0543-y

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