Ethical issues in direct-to-consumer healthcare: A scoping review

An increasing number of health products and services are being offered on a direct-to-consumer (DTC) basis. To date, however, scholarship on DTC healthcare products and services has largely proceeded in a domain-specific fashion, with discussions of relevant ethical challenges occurring within specific medical specialties. The present study therefore aimed to provide a scoping review of ethical issues raised in the academic literature across types of DTC healthcare products and services. A systematic search for relevant publications between 2011–2021 was conducted on PubMed and Google Scholar using iteratively developed search terms. The final sample included 86 publications that discussed ethical issues related to DTC healthcare products and services. All publications were coded for ethical issues mentioned, primary DTC product or service discussed, type of study, year of publication, and geographical context. We found that the types of DTC healthcare products and services mentioned in our sample spanned six categories: neurotechnology (34%), testing (20%), in-person services (17%), digital health tools (14%), telemedicine (13%), and physical interventions (2%). Ethical arguments in favor of DTC healthcare included improved access (e.g., financial, geographical; 31%), increased autonomy (29%), and enhanced convenience (16%). Commonly raised ethical concerns included insufficient regulation (72%), questionable efficacy and quality (70%), safety and physical harms (66%), misleading advertising claims (56%), and privacy (34%). Other frequently occurring ethical concerns pertained to financial costs, targeting vulnerable groups, informed consent, and potential burdens on healthcare providers, the healthcare system, and society. Our findings offer insights into the cross-cutting ethical issues associated with DTC healthcare and underscore the need for increased interdisciplinary communication to address the challenges they raise.Author summary: Health products and services are increasingly being sold directly to consumers (DTC). However, prior research in this area has remained limited to specific medical domains, and there has not been a comprehensive examination of ethical concerns. To address this gap, we conducted a review of ethical concerns raised in the academic literature across various types of DTC healthcare products and services. Our search on PubMed and Google Scholar for publications discussing the ethics of DTC healthcare yielded 86 publications that met our inclusion criteria. Articles centered on six main categories of DTC products and services: neurotechnology, testing, in-person services, digital health tools, telemedicine, and physical interventions. Arguments supporting DTC healthcare included that it could promote increased access, autonomy, and convenience. The most frequently highlighted concerns centered on insufficient regulation, unproven efficacy, safety risks, misleading marketing claims, and privacy issues. Other frequently occurring ethical concerns revolved around financial costs, targeting vulnerable groups, informed consent, and potential burdens on healthcare providers, the healthcare system, and society. Overall, enhanced communication across medical specialties may be beneficial for navigating the ethical challenges raised by DTC healthcare.