Ethics Grand Rounds: “The Ethics of Medication Adherence Monitoring in the Age of AI: Patient-Centered, Not Device Centered”

Herald Schmidt, PhD, MA, is an Associate Professor of Medical Ethics and Health Policy, a Research Associate at the Center for Health Incentives and Behavioral Economics, and a Senior Fellow at the Leonard Davis Institute, all at the University of Pennsylvania. His research interests are centered around improving opportunity and reducing disadvantage for marginalized populations in health promotion and healthcare priority setting. Before coming to Penn, he was a Commonwealth Fund Harkness Fellow in Health Care Policy and Practice at the Harvard School of Public Health, and for seven years served as Assistant Director of the U.K.’s Nuffield Council on Bioethics in London.

Talk Description: For a number of reasons, patients do not take medications as prescribed. Currently, understanding of medication adherence is largely based on patient’s report, biochemical testing, or indirect measures such as prescription filling records. However, a new set of likely disruptive digital and AI-based technologies looks set to profoundly challenge the existing paradigm, by enabling remote monitoring of adherence in real-time. This talk outlines the main rationales underlying adherence monitoring, and describes a central range of novel technological approaches. Key ethical issues are discussed, focusing on the concepts of preference sensitivity, proportionality, and the least restrictive alternative, especially as they apply to monitoring adherence in Tuberculosis treatment.