Negotiating ethical approaches to product development
Key takeaways for digital health founders and product, design and clinical leaders
The accessibility improvements you’ve made a solid case for just got shelved, again, for a flashy new feature that promises to boost next quarter's sales. You know it's the wrong call, but you also know why it happened. Welcome to the daily reality of trying to build ethically in digital health.
This is a constant trade-off. Investing in the foundational pillars of quality vs revenue targets and surviving in the short term.
In January 2025 I spoke to Jess Morley, postdoc at Yale’s Digital Ethics Center on how we might negotiate this more robustly. In that episode we covered both the policy and vendor perspectives, but a lot of people contacted me afterwards around the challenges they have working in digital health companies, and much of it was a slightly different version of the quote at the start.
I thought it might be useful to break down the key takeaways from that conversation that apply specifically to digital health companies trying to balance this tension. I’ve also created a mini-episode that covers these sound bites specifically. I’ll add some of my own lens and experience where appropriate too.
Ethics 101
If law is defined as the rules of the game, ethics is how you win
Prof Luciano Floridi
Here’s a quick breakdown of some of the key principles, within the context of digital health
Beneficence : do good
Non maleficence: do no harm
Autonomy: protect the individuals right to determine their own life.
Justice: complicated, but can think as equity and equality
Explainability: do we understand what is going on
Accountability : who is taking responsibility for what happens
Transparency: making who is accountable clear for everyone, as well as the process and actions.
The problem
These principles might get embedded into a company’s culture and decision making. A product or clinical leader might be charged with ensuring these are lived every day.
Good intentions and check-boxes carry you some of the way at the start. But even when you have a great set of principles that people actually live, it becomes hard when these rub up against business realities.
Beyond nice to have
Jess made the point that often vendors get caught in the concern that investing in the ethical decision is usually harder and more expensive.
Instead, it might be more useful to remember that this does not have to be considered an ‘additional thing’.
Good software design, making the effort to curate a wider training data set, spending that extra sprint on that feature that improves accessibility. Including more than the easiest to access people for user research. These are pillars of quality.
Also another powerful part of any negotiation is pressing on the risk of not doing something. Discussing how this protects reputation or business risk can help bring colleagues out of short-term thinking.
And you’ll have many that want your organisation to live its principles, not just ‘talk’ about them. Each decision is part of that.
So the next time you find yourself negotiating that initiative that will improve one of the ethical principles listed above, consider how you’re framing it:
Not an extra thing, but part of how you build a high quality product.
Foundations, not decorations or optics.
As reducing the risk to a project and the business as a whole
Resources
There’s also not a whole load of resources out there to show us the way. In many ways, maybe that’s a good thing - there isn’t supposed to be ‘a one size fits every context and decision’, so it really is about how we adapt these to live them and shape building decent products.
The WHO created this which people might find helpful. I’ll post more as I come across them.
Here’s the mini episode with Jess
Here’s the full episode, that also gets into the political and procurement related determinants of ethical approaches.
What have you done that works? What do you struggle with? I’d be happy to read your thoughts.