Blockchain in Healthcare: Ethical Considerations

Blockchain in Healthcare: Ethical Considerations

by Leo Petersen-Khmelnitski

This text is based on the report “Blockchain Applications in the Healthcare Sector” by the EU Blockchain Observatory and Forum, and represents its key takeaways in the section on the ethical aspects.

In the healthcare sector, blockchain adoption is growing rapidly, that is why it is important to consider potential consequences and moral aspects of such adoption. Decentralised technologies, just as other high tech in healthcare, such as AI, machine learning, robotics, present complex ethical questions. Why is it important? First, blockchain based platforms that interconnect healthcare stakeholders must be aware of these ethical issues. Second, blockchain in the healthcare sector can be designed to offer healthcare stakeholders special privacy and security incentives. We will start with the latter.


According to its name, “Ethics by Design” examines how ethical considerations are incorporated into design. To make sure that a healthcare provider respects a patient and considers seriously her or his individual preferences, it is important to focus on an ethical approach that goes beyond regulations. To identify ethical design features of healthcare blockchains, we may need to review ethical design frameworks.

An ethical design framework usually includes ethical principles, organisational values, risk mitigation strategies, policies on privacy and security, a policy on sustainability. Creating a blockchain ethical design framework for healthcare may be inspired on principles of open architecture if it is a public blockchain, or on Hyperledger standards for permissioned blockchains. It may also be based on a guiding principle to respect individual interests, however, it has to be developed, in accordance with ethical principles and recommendations adopted by your national healthcare.

When integrating healthcare technology, design and programming with values of a healthcare provider, you may find useful to have a look at those elements and methods that improve accessibility of the provided technology. For healthcare blockchains to have the intended impact on the healthcare ecosystem, a review of ethical frameworks that govern them may be required.

To make informed decisions how blockchains will impact the EU’s healthcare ecosystem, legislators and regulators in Europe are encouraged to review ethical design frameworks for healthcare blockchains. Without ethical considerations, leadership may not understand how blockchain technology can aid in achieving specific healthcare goals such as improving treatment efficiency, reducing costs, and maintaining quality care.


To ensure high quality decision-making process, developing scenario-based ethical dilemmas may be adopted. These value chain scenarios may be applied across blockchain applications and across diverse healthcare stakeholders. To integrate all blockchain attributes, these ethical considerations should be holistic. Creating ethical frameworks will allow legislators and regulators to incorporate ethical decisions into their regulatory, legal, technical, and financial decisions regarding healthcare blockchains.

In its origins, blockchain is an open-source technology that works with a wide range of technologies, such as big data, cloud computing, and artificial intelligence. Interaction between technologies complicates the analysis of ecosystems because each application has its own ethical implications.


Distributed ledger technology may be applied in many ways within the healthcare industry. Blockchain technology can be used to track the provenance within the supply chain in the pharma industry. Here issues pertaining to individual privacy and especially the right to be forgotten may present a problem, as it is impossible to remove anything from a blockchain. Due to the add-only nature of the ledger, blockchain technology makes it impossible to delete the data in the ledger.

Researchers and practitioners point out that even though blockchain technology has various applications in healthcare, it’s important to focus on ethical considerations associated with the technology as well as artificial intelligence, since both technologies offer some of the most promising technological synergies. It is not accidental that federated learning gained traction during the pandemic, as it signifies those similar models are being used in a collaborative manner.


Algocracy, defined as the use of algorithms to decide on decisions, is a concern. There is a belief that moving decision making away from humans and into the machine-learning black box is the solution to many of our problems. Algocracy draws on automated advice that is based on the algorithmic analysis of data to coordinate social action.

A host of ethical issues is yet to be addressed with spread of AI and blockchain adoption to medical decision making. To facilitate the development of ethical guidelines for blockchain when used in combination with AI, we have to study already established guidelines and recommendations in the field of AI.

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