15th February 2021

Author: Joan Cornet Prat

The advent of the car brought with it many advantages, but also inconveniences. The main one was to regulate circulation to improve safety. So in the early 20th century, William Phelps Eno created the first traffic rules.

Eno, born in New York in 1858, studied Engineering at Yale University, graduating in 1882. Focused on real estate businesses that were the family’s professional core, he warned of the chaos that was beginning to generated in New York traffic. In fact, one of the first traffic jams he had a chance to meet was with horse carriages, in 1867, with no agreement to fix it. Faced with the growth of the automobile, in 1900 he published the work ‘Reform in Our Street Traffic Urgently Needed’, considered a first regulation of circulation. (1)

Igual que en el caso del tráfico de vehículos, la aparición de nuevas herramientas y nuevas máquinas tarde o temprano es necesario tener una regulación para su uso y en general un código ético o código de conducta. La Enciclopedia Britanica define “Ethics, also called moral philosophy, the discipline concerned with what is morally good and bad and morally right and wrong. The term is also applied to any system or theory of moral values or principles” and “Generally, the terms ethics and morality are used interchangeably, although a few different communities (academic, legal, or religious, for example) will occasionally make a distinction… Generally, the terms ethics and morality are used interchangeably, although a few different communities (academic, legal, or religious, for example) will occasionally make a distinction (2)(3).

In the field of health, there are numerous regulations and ethical codes, starting with The Hippocratic Oath (Ορκος)which is perhaps the most widely known of Greek medical texts. It requires a new physician to swear upon a number of healing gods that he will uphold a number of professional ethical standards. It also strongly binds the student to his teacher and the greater community of physicians with responsibilities similar to that of a family member. In fact, the creation of the Oath may have marked the early stages of medical training to those outside the first families of Hippocratic medicine, the Asclepiads of Kos, by requiring strict loyalty.

In the face of advances in the digital world and the emergence of Big Data and Analytics, Articificial Intelligence, Deep learning etc, is a new stage in the world of health. The activity of health professionals, especially doctors and nurses are no longer limited to their relationship with the patient, data, information, diagnostic images, etc. They circulate, are digitally archived and can be used for research. The European Union approved in 2016 The General Data Protection Regulation (GDPR) with regard to the right to privacy and data protection for all types of activities, including health.(4)

On 8 April 2019, the High-Level Expert Group on AI presented Ethics Guidelines for Trustworthy Artificial Intelligence. This followed the publication of the guidelines’ first draft in December 2018 on which more than 500 comments were received through an open consultation. (5)
According to the Guidelines, trustworthy AI should be:

(1) lawful – respecting all applicable laws and regulations

(2) ethical – respecting ethical principles and values

(3) robust – both from a technical perspective while taking into account its social environmen


  1. Human factor and human control: it means that artificial intelligence systems must be vectors for an egalitarian society, existing at the service of social and fundamental rights, without, however, restricting human autonomy.
  2. Robustness and security: an artificial intelligence system considered to be trustworthy requires that its algorithms are sufficiently safe, reliable, and robust to manage errors and inconsistencies in all phases of a system’s life cycle.
  3. Respect for privacy and data governance: it is essential that citizens know and be fully aware of their data and that this data is not used against themselves in a way that generates harm or discrimination.
  4. Transparency: the possibility of tracing and retracing the artificial intelligence systems must be ensured.
  5. Diversity, non-discrimination, and equity: artificial intelligence systems must take into account a whole range of human capacities, skills, and needs, accessibility to this diversity and plurality must be guaranteed when the system is operable.
  6. Social and environmental well-being: AI systems should be used to sustain and support positive social developments and reinforce durability and ecological responsibility.
  7. Accountability: it is appropriate to give applicability to mechanisms to guarantee human responsibility concerning AI systems and their results, and subject them to an accountability obligation.

The debate has only just begun. In the field of health, patient data and information are key and both can and should be digitized. The following table shows the areas of data that can be generated in clinical practice. We need to add the data that is generated with the use of Smartphones or wearables that a person can use to take care of their health or their illness.


Developing IoT technologies in health will further increase the volume of data. As is the case, technological advances create new paradigms and new challenges for legislators, policy makers and country governments. The European Union is aware of this and is working with high-level expert groups to address these challenges, especially ethical ones.

However, guidelines and laws are not enough, citizens, health professionals and technology companies must have a code of personal ethics beyond the laws that is to act morally. Let’s remember that the Oath written by Hippocrates is still held sacred by physicians: to treat the ill to the best of one’s ability, to preserve a patient’s privacy, to teach the secrets of medicine to the next generation, and so on.

  1. https://en.wikipedia.org/wiki/William_Phelps_Eno
  2. https://www.britannica.com/topic/ethics-philosophy
  3. https://www.britannica.com/story/whats-the-difference-between-morality-and-ethics
  4. https://ec.europa.eu/info/law/law-topic/data-protection/data-protection-eu_en
  5. https://ec.europa.eu/digital-single-market/en/news/ethics-guidelines-trustworthy-ai
  6. https://www.ncbi.nlm.nih.gov/books/NBK493822/
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