Defense Date


Graduation Date

Fall 12-16-2022


One-year Embargo

Submission Type


Degree Name



Health Care Ethics


McAnulty College and Graduate School of Liberal Arts

Committee Chair

Gerard Magill

Committee Member

Joris Gielen

Committee Member

Peter Ikechukwu Osuji


healthcare ethics, governance ethics, digital health, telemedicine, telehealth, digital equity


The COVID-19 pandemic revealed the harm of digital health exclusion. Excluded groups could not benefit from virtual care due to device access gaps, broadband connectivity, and digital and language literacy levels. A lack of engagement with historically excluded populations in digital health innovation is an ethical harm and a maleficent form of social exclusion. Digital tools in healthcare delivery represent more than just a strategy for promoting health equity; they signify an opportunity to address health inequities in the health technology design process.

The historical focus of healthcare ethics on bedside decision-making issues largely explains why the field lacks concerted scholarship in the ethical dimensions of health equity. This dissertation examines the ethical implications of structural exclusion from healthcare innovation. Specifically, it scrutinizes the reciprocal relationship between digital inequality and social inequality in healthcare. The dissertation introduces a normative argument for including historically excluded voices in digital health innovation with the explicit goal of mitigating and preventing health inequities. By introducing a normatively defensible ethical imperative of inclusion, innovators and healthcare leaders can work to develop systems-level solutions for systems-level inequities in care mediated by digital health technologies. This work employs a governance ethics approach by defending the role of healthcare leaders in ensuring beneficent and equitable digital health innovation. By bridging healthcare ethics and communications discourse, this dissertation convenes previously siloed scholarship to advance a multi-stakeholder approach for scaling and sustaining digital health equity at the meso or organizational level of ethics governance.