7 Using MEESTAR for early evaluation of ethical, legal and social implications of a socio-technical support system for mechanically ventilated patients

In intensive care units (ICU), mechanically ventilated patients undergoing weaning from the respirator represent a highly vulnerable population. To support their early re-orientation and participation, the ACTIVATE project aims to develop and pilot a socio-technical system that facilitates the communication between these patients and the ICU health care team. Such digital health technologies (DHT) need to be assessed in terms of ethical, legal and social implications (ELSI) before they can be introduced in health care practice. In the ACTIVATE project we chose the Model for Ethical Evaluation of Socio-Technical Arrangements (MEESTAR) as guiding theoretical framework to assess relevant ELSI. Based on our intermediate findings and experiences, the objective of this article is to reflect on the applicability of MEESTAR to the assessment of ELSI of support systems targeting the acute care for critically ill patients. Following the Socratic approach, various data sources and research methods are iteratively applied for the ELSI assessment of the ACTIVATE system under development. Numerous positive implications and potential challenges, varying with the perspectives of patients and health professionals, especially nurses, were identified. Based on the preliminary findings and experiences, we expect that the implementation of the Socratic approach in combination with MEESTAR will ensure that relevant ELSI of the ACTIVATE system will be early detected and taken into account in the development and adaptation of this support system.