Bioethics and Internet Research Paper

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Abstract

Bioethics not only becomes global but it also goes online. Here, the aim is to analyze the role of the Internet in global bioethics. The Internet and the information and communication technologies (ICT) become central instruments to exchange and to produce knowledge; but, are they only means to transmit and to get information? In fact, they are more than instruments backing the construction of a bioethical discourse for the world as a whole. There are complex issues to approach, such as long-term care for dementia, the problem of organ trafﬁcking, and environmental risks. Consequently, bioethics online or e-bioethics could be more than cyberethics or computer ethics; it displays a prospect of shared knowledge and international cooperation. However, there are some arguments still to ponder, because online interaction and actual interaction follow different rules. Networked bioethics puts forward normative and pragmatic questions.

Introduction

Bioethics not only becomes global but it also goes online. “Internet ethics” refers to computer ethics associated with the World Wide Web. “Bioethics online” or “e-bioethics” could represent more than computer ethics, because it displays a prospect of shared knowledge and cooperation beyond borders and conventional spaces, thanks to the information and communication technologies (ICT) and the Internet. Here, the aim is to analyze their role in bioethics with global perspective. In this sense, the new interconnectedness is an opportunity to face, with additional resources, difﬁcult cases in clinical practice and in scientiﬁc research. However, there are several arguments still to ponder, in favor and against, because online activities and ofﬂine activities usually follow different rules. How relevant could this difference be for health care and scientiﬁc research? Which consequences could we extract from the communication possibilities?

The idea is that they could be seen as more than instruments; they are actually backing the global processes and, for the same reason, the construction of a bioethical discourse for the world as a whole. Currently, could we talk about an online and networked bioethics or “e-bioethics”? This resdearch paper suggests that the interconnectedness through the ICT requires a reﬂective approach to its advantages and also to its ambivalence. (1) Three recent experiences speak for the constructive role of the ICT in initiatives to face public health challenges and to exchange relevant information for experts and nonexperts. At the same time, the intensive use of these technologies still has uncertain outcomes. (2) A preliminary analysis of global and networking processes presents the conﬂuence between the new interconnectedness and the expansion of bioethics around the world. (3) In fact, the use of the Internet and the ICT had raised many questions, technical, social, political, and ethical; the skeptical arguments usually magnify the risks; for this reason, they have to be balanced with arguments that emphasized the role of information and networking instruments in bioethics. (4) Still, the prospect of an entirely interconnected and networked bioethics (bioethics online, e-ethics, e-bioethics) puts forward additional normative and pragmatic questions (from principles to structured information, deliberation, and interaction).

Experiences And Questions

In April 2014, the World Dementia Council had its ﬁrst meeting in London. The main objective of this independent council is to stimulate innovation and the development of treatments and care for people with dementias. At the G8 Summit of 2013, the Ministers proposed an articulate international response to these diseases and more cooperation among countries, acknowledging the impact of the problem – including its economic impact; they insisted on the commitment across the world with research and health care. “Global level” was the key term to mark the actual dimension of the diseases’ challenges and, consequently, the level of the required interventions. Updated information and different documents about the topic, including the G8 Dementia Summit’s Declaration, are available on a special website (http://dementiachallenge.dh.gov.uk/cate gory/wdc/).

Before, the WHO Report of 2012 identiﬁed dementia as a threat for public health, with its global burden and its global prevalence. It is available in different languages on the WHO site. In 2010, the UNESCO created the Global Observatory (GEObs), a platform for applied ethics and bioethics, with freely accessible databases and information in six languages. The objectives were to offer some guidelines and, especially, to give support to the activities of experts and of bioethics committees and also to teaching programs.

These and similar projects demonstrate that bioethics not only is global but it expands online. Currently, there are several pressing and complex issues to approach in the ﬁeld, such as the long-term care of dementia and the problem of organ trafﬁcking, among many others, the fair distribution of health resources, the elimination of biases in scientiﬁc research and also of gender bias in both health care and research, and, of course, the environmental risks to be taken seriously. In this context and by expanding spaces to communicate and to interact, the Internet and, in general, the ICT become central instruments to exchange and to produce knowledge. But, are they only means to transmit and to get information? How neutral are these technologies?

The thesis is that they are crucial for a global bioethics. At the same time, how local has it to be? And inside the Web, how much regulation and governance do programs and initiatives admit? In practice, the distance between the online interaction and the ofﬂine one could inﬂuence the quality of health care and of research. For instance, which institution or agent would be in charge and take care of patients with dementia? Would the use of new technologies help them and how much? As usually happens in ethics and in bioethics, there are no deﬁnitive answers. But knowing how the Internet and the ICT improve interconnectedness could help to understand why bioethics becomes global, local, and networked.

Two Processes

Compression of the world “into a single place” was the basic deﬁnition offered in the 1990s by R. Robertson to explain the increase of global processes in contemporary societies (Robertson 1992, p. 166). Deep changes in structures and several developments have derived from this new condition of the world as a whole; but, which are its substantial outcomes? It is not only a complex and multidimensional process – rather a set of processes – but it also integrates two elements, the global and the local. Then, the world as a single place represents more than integration, internationalization, intersection, or interdependence; the general or universal and the particular developments overlap in this new order, because the processes are always twofold. In fact, both paths are entwined in the same trend toward a world as a single place. For this reason, they are challenging the standard explanations about social transformations, especially those theories that insist on homogeneity and one-dimensional process; they disregard the internal and relevant differences of the overall direction. Consequently, “globalization” could be the right term to make clear that the world as a whole is a blended process, where local and global conditions are simultaneous. In this twofold process, agents, societies, and humans in general have to adjust to their interdependence or, better, to their interconnectedness inside an order that requires, at the same time, “universalization of particularism” and “particularization of universalism” (Robertson 1992, pp. 183, 102).

In that year, 1992, the Association for Computing Machinery adopted the Code of Ethics and Professional Conduct to promote social responsibility and respect for human rights among computing professionals. They have to become aware of potential harms, including the risks for safety or for health derived from this technology; thus, the general moral imperatives, professional standards, and organizational obligations might contribute to face ethical dilemmas with responsibility. Not only responsibility but also honesty, integrity, respect for others, and fairness are desired for professionals of the ﬁeld. This Code speciﬁed that the responsible uses of computing systems could alert about possible damages to the social and to the global environment as well. Three years later and in connection with the emerging digital culture, the Internet was deﬁned as “network of networks” by N. Negroponte, a system of heterogeneous processors (Negroponte 1995, pp. 180–183, 193–195). It consists of ﬂexible and nonhierarchical net – or nets – of computers with protocols to provide information; this system also builds up a community, an entire social structure, new and global. In 1996, it was already evident that the Internet modiﬁes the scale of communication and, besides, the standard dimensions of social interaction. The network society – as M. Castells designated it (Castells 1996) – is an outcome of both the information technology and the global processes. In this new form of organizing social life, digital communication transforms space, time, and some aspects of identities.

In 1997, an article published in the Hastings Center Report mentioned the impressive display of online communication, networks, and the “World Wide Web” for medical ethics (Cummins 1997). The new formats to communicate and to interact bring many beneﬁts and, in addition, some potential dangers. Several opportunities have emerged from networks; many ideas and ample information could be exchanged around the world; yet, some crucial topics for bioethics, like guarantees for conﬁdentiality or credibility of unedited information, have not been resolved. On the Internet, data or even drugs are more available than before, but not without risks. A decade afterwards, the systematic use of the term “global bioethics” advanced the reﬂection about the interconnected and networking societies and their inﬂuence on bioethics. Currently, the arguments around this topic are expanding the previous suggestions of V. R. Potter about the merging of the medical and the ecological dimension of the discipline (Potter 1988, pp. 71–93). In this sense, the global perspective in bioethics could reinforce the place and even the language of human rights (Ten Have and Gordijn 2010; Fox and Swazey 2008, pp. 215–232), always with respect for cultural diversity and pluralism (Macklin 2014, pp. 153–167).

At this point, the new interconnectedness, its many implications, and the world’s contraction are plainly visible and central for the discipline; perhaps it is just the moment to make more visible how the horizontal networks and the Internet based communication are operating in bioethics. How much do these media inﬂuence practices and deliberation (Simonson 2002)? The World Dementia Council’s plans of 2014 might speak for improved interconnectedness, for the sake of patients, professionals, caregivers, researchers, and health-care institutions around the world. Since 2010, the UNESCO Global Observatory could exemplify how to give way in applied ethics and in bioethics to communication and networking activities, via the Internet.

The Web

Since 1948, the UNESCO is strongly committed with the protection of fundamental rights; since the 1990s, it also considers the ethical dimensions of information societies, including the Internet transformations and its potential effects on knowledge and values. International panels, workshops, and forums have been promoted by this organization to explore pressing questions, like respect for freedoms and for human rights in the networking societies. In that line, the document of 2010, Towards inclusive knowledge societies: A review of UNESCO’s action in implementing the WSIS outcomes, conﬁrmed that the new communication environment offers several opportunities; at the same time, it represents a general challenge. For instance, how could we deal with the digital divide? The access to information and knowledge, how universal and free is it? Equity is or should be an inescapable issue in this area, like freedom of expression and respect for diversity.

In 2011, the UNESCO Code of Ethics for the Information Society speciﬁed which values, rights, and obligations have to be observed in inclusive societies. In this sense, the Internet has to become an instrument for development and for increasing potentials for societies and individuals. Their freedoms of expression, interaction, and participation should not to be restricted; for the same reason, protection against possible abuses and intrusion through the ICT and the Internet has to be ensured. In sum, ethical principles and, moreover, human rights are central for every agent and, of course, for information societies. But the general concern for infringement of rights and loss of control, of some goals, and elements of identity had surfaced before.

In the 1980s, the inﬂuential analysis of M. MacLuhan and B. Powers signaled two opposite reactions, satisfaction and dissatisfaction in agents; both are provoked by the emerging “robotism,” the new technological or “electronic man,” computerized data transmission, and, in general, by the intensive use of computers that alter social environments. It was already happening in workplaces and with professionals (McLuhan and Powers 1986, pp. 92–129). According to this thesis, the interactive technologies will extend information at worldwide level and at the speed of light; but the new interconnections might destroy some objectives, several social rules, aspects of individual identities, specialism, and, eventually, the former ethos. As M. Castells stressed later, communication networks and the Internet had created not only a new technological context but also a social space for power relationships, in terms of social change and in terms of domination (Castells 2009). Indeed, elites, groups, social movements, and individuals are competing in the new space, rooted in communication, networked, and, certainly, shaped by social practices. Other recent analyses reveal this same fact, that every technological change converges with social, ethical, and political processes.

For this reason, enthusiast and skeptical or critical opinions usually pervade the basic arguments, in favor and against the intensive use of the ICT and the Internet. The terminology becomes remarkable as well. The main target of debates is the Internet, a computer network known as the Net or the World Wide Web; however, several arguments are more focused on “cyberspace,” a global environment for communication, transactions, and relationships over computers, and the “blogosphere,” an online universe of personal journals or weblogs with writers and readers and, mostly, without external editing. Occasionally, arguments concentrate on “computer ethics,” codes to promote good practices for informatics professionals, and on “cyberethics,” the ethical assessment of dilemmas and cases brought out on the Web. “Internet ethics” means computer ethics in the World Wide Web. This terminology reveals that potentialities and conﬂicts are already patent and that they will require proportional answers. Perhaps the idea is that ethics by itself could moderate bad practices or abuses, thanks to special codes for Web users; these are necessary but not enough to capture the developments of the Internet and its paradoxes.

Here, the suggestion is that a broader ethical perspective might better encompass the ubiquity and complexity of the new forms of interconnectedness. Actually, the arguments about real improvements and possible risks emphasize the question of rights, conﬁdentiality, security, etc; then, they could go beyond this discourse of rights and codes in order to explore wider areas. Do the ICT and the Internet really mold knowledge, spaces, and interactions? How inclusive are these open communication technologies? Who are able and would take effective decisions to protect individual rights in cyberspace?

Some Arguments

In 2011, the Code of Ethics for the Information Society, of the UNESCO, explicitly addressed to states and stakeholders to implement measures and policies for more inclusive and equitable information societies. The ethical point of view usually meets social and political arguments about promising outcomes and uncertainties in the Internet. On the one hand, online platforms, networks, virtual communities, and sites are valued for their potential to make information available and for opening spaces for exchanges. In bioethics, these resources have many advantages for agents and institutions engaged in good practices and in disseminating relevant information. On the other hand, the general use of the Internet and the participation in cyberspace require sound criteria and normative frameworks, to exclude bad practices and misleading information, spread throughout the Web. Again, institutions and states have a strategic position in the guidance – or noninterference, depending on the context – of the information societies. For instance, in 2009, the study of the United Nations and the Council of Europe Trafﬁcking in organs, tissues and cells and trafﬁcking in human beings for the purpose of the removal of organs questioned the “services” for transplant tourism, offered in equivocal websites

Information and transparency are the main arguments in favor of an unrestricted use of the Internet. Access to information and exchange of data are helpful and clear improvements for professionals, patients, stakeholders, and institutions. In clinical settings or in scientiﬁc research, reliable information becomes essential, especially in difﬁcult cases. Patients could know situations as their own; professionals could examine precedents or get information about good practices, in order to improve their own practices. Local ethics committees might obtain data about ethics consultation around the world, thanks to studies and reports, online and accessible, composed by national and international committees. In these areas, people have to take decisions in uncertain circumstances; so, the more information, the better assessment of the cases. For several reasons, openness is worthy for everyone involved in ethical issues, in theory and in practice. The Internet and its possibilities could be considered a gain, because online resources reinforce knowledge and transparency. The UNESCO Declaration on Bioethics and Human Rights mentioned it, the promotion of transparency in the decision-making (art. 18). The study Trafﬁcking in organs, tissues and cells and trafﬁcking in human beings for the purpose of the removal of organs insisted on the principle that condemned bad practices; for this, commercialization has to be prevented, because organ donation could not give rise to ﬁnancial gain. Coherently, it defended international standards and instruments against trafﬁcking in organs and in human beings; this document is accessible online, of course.
Fragmented information and regulation problems are the principal arguments against a nonregulated use of the Internet and the ICT. In fact, worldwide information and interaction beyond frontiers could support good practices, but, sometimes, they also stimulate the worst practices. Moreover, the open information comes through channels, portals, sites, servers, and companies on the Web. In consequence, this space is networked and more structured than it seems (Sunstein 2007, pp. 46–96). Information becomes more accessible, but where and how do we get it? The possibility of networking our activities represents an improvement, but it would suggest horizontal interaction; it is also a vertical and, sometimes, a polarized interaction. Perhaps cyberspace has been overestimated, since it is built in line with the market. Then, how close are free market and free space? This line of argumentation says that the Internet and the new spaces of exchange are basically centered on individuals and on commodities, rather than on public goods: in the ﬁrst place, because the aggregation of preferences in a shared space is quite different from a common or public space, with cooperation and integration as key factors, and, in the second place, because consumers do not behave as citizens do and, ﬁnally, because openness and democratic participation require some guarantees, equal rights, and some level of regulation. But, what kind of regulation is really suitable for the Internet (Sunstein 2007, pp. 151–164)? The document Trafﬁcking in organs, tissues and cells and trafﬁcking in human beings for the purpose of the removal of organs determined that selling and buying human beings for removing their organs violates human rights. The Council of Europe Convention against Trafﬁcking in Human Organs reafﬁrmed in 2014 that this threat is global, and, in consequence, international cooperation to combat it has to be encouraged.

So far and in this ﬁeld, there are more reasons against than in favor of the market practices. To summarize, the Internet singular structure should be examined from both angles. The Web and its wide domain require agents and institutions, able to enforce the rule of law and to guarantee individuals’ rights; these are essential elements in democratic systems. Consequently, the main issue is not only where but how online activities are performed. Cyberspace is a promising environment where space and time conventional limits have been removed; at the same time, it demands normative frameworks, in order to become a real public space – and a real democratic one – for citizens. In this domain, ethics has probably less to do with issues like possible deception in online exchanges and misuses or with the acceptance of speciﬁc codes than with practices, especially with prevention of bad ones. Information and communication online – with transparency – could back international cooperation in this area. Yet, nowadays expanded information and communication seem not enough to strengthen civic and moral practices on the Web.

Bioethics Online

In 2004, the UNESCO Universal Declaration on Bioethics and Human Rights associated bioethics with respect for principles and fundamental rights. In that year, the European Commission adopted an action plan for e-health, aiming to improve health care with fewer costs in every area, from prevention to diagnosis and treatment of patients. New services might be offered to citizens, through the new technologies; teleconsultation, telemonitoring, telecare, telemedicine, or cybermedicine would be available to them, at home or in some hospitals. Only in 2014, the NETmundial Multistakeholder Statement reports conﬁrmed that values and human rights should be respected in both spaces, ofﬂine and online; they recommended some general principles for the Internet, like freedom of expression, association, privacy, accessibility, freedom to access information, and development as well. In a similar line, several issues concerning e-health have still to be addressed, from an ethical and a bioethical perspective (Ten Have 2002). Thus, on the way to cybermedicine, e-health, e-governance, e-integration, e-learning, e-Europe, etc., a closer look at the situation of bioethics online might prove why every technical and social modiﬁcation has to be encompassed by a reﬂective attitude and, as the case may be, by critical thinking. Perhaps, the technical transformations have been so visible and people are so involved in this universe that innovations like these could be overshadowed.

Discussing bioethics and ethics online – e-ethics (Lopez de la Vieja 2011) – implies more than arguing in favor of some codes to regulate special activities on the Internet and to exclude possible manipulations or misuses. It is rather a reﬂective approach to instruments and practices that modify communication in many settings and, somehow, the construction of knowledge as such. In this sense, a critical approach has nothing in common with a reluctant attitude to the ICT; it does not endorse every skeptical argument either. It only invites to ponder several and opposite reasons, giving a second thought to every step that could lead bioethics outside the normative framework, the international framework that has been built for decades, aiming to prevent bad practices in clinical settings and in scientiﬁc research. Why rights and, in general, normative principles mean so much in this area? Precedents exist and are relevant; they still cast their dense shadow over technological advances, giving many elements to learn from the “negative lessons” of contemporary history (Habermas 1998).

Currently, global bioethics could reinforce the role and even the language of human rights (Ten Have and Gordijn 2010); but, how is this language placed in cyberspace? How much autonomy, justice, and beneﬁcence would integrate the online activities and interactions? For the moment, there are more questions than proper answers about bioethics online. At least, the new interconnectedness in this ﬁeld could be approached from two different angles, the normative perspective (principles, human rights, codes, etc.) and the pragmatic one (possible uses, forms of interaction, etc.). Feminist bioethics had and is still questioning autonomy as the core principle to face dilemmas in medical ethics and in bioethics. According to many feminist theories, a care ethics viewpoint might disclose signiﬁcant differences and real needs in these areas. In a global context, justice and universal rights are desirable, for sure; however, bioethical discourse has to be more focused on actual relationships – the power relationships (Tong 2001). Gender point of view reveals these and similar structural problems.

In general, the exact place of autonomy, justice, and beneﬁcence in a global world and, especially, in virtual environments seems still undecided. For instance, where are the limits of attitudes and practices of beneﬁcence in these expanded contexts? There are also substantial arguments about an equitable access to medical, scientiﬁc, and technological resources. And by invoking complementary normative principles, like responsibility, cooperation, and solidarity – as did the UNESCO Declaration on Bioethics and Human Rights of 2005 – agents are not able to leave behind fragmented spaces and the deep ﬁssures in local and global solidarity. Maybe a pragmatic view exposes more clearly to what extent new technologies and virtual spaces are modifying central bioethical issues. Two experiences with national commissions and a public health issue would illustrate the changing uses and styles of interaction online.

Uses

In 2008, the French authorities supported open debates about a new bioethics act. The legislation in force since 2004 had to be replaced; before bringing this issue to the Parliament, the Ethics National Committee launched several meetings, open debates, forums, and conferences where citizens had been invited to participate. In accordance to a civic idea of shared knowledge, the États Généraux de la Bioéthique promoted a wide discussion on scientiﬁc research, health care, respect for individuals, and the use of technologies. Coherently with the French republican political culture, experts and nonexperts had the occasion to participate in the process, with free and informed debates. In fact, the public had access to relevant information about these topics; conferences and meetings were open to citizens, and, moreover, online resources and, especially, a website offered ample information and a very suitable channel to communicate (http://www. etatsgenerauxdelabioethique.fr/).

Informed consent, the concern about future generations, vulnerable persons, the idea of common good, and similar topics motivated a democratic deliberation. It is true that professionals could always have the upper hand in a process like this one, because of their expertise; however, the États Généraux de la Bioéthique and the use of the Internet gave occasion of sharing knowledge and deliberating in common. In this case, a national or local decision about how to face bioethical issues demonstrated that, nowadays, deliberation and interaction could be more informed and more democratic as well.

The information argument has to consider both the positive and the controversial aspects of bioethics online. The French experience of 2008 and analogous cases have proved that online resources are quite indispensable to produce and to deliver knowledge. In a multidisciplinary ﬁeld like bioethics, the exchanges among professionals could go beyond frontiers and languages. In consequence, information has to be available online. At the same time, the access and the use of personal data have to be protected and restricted; obviously, unlawful storage, unauthorized disclosure, intrusions, or abuses should be banned in research and clinical practice. Conﬁdentiality is also essential. For good reasons, the use of information is or has to be regulated and restricted in these areas. Thus, openness and transparency in information should be balanced with respect for rights. For instance, several ethics committees – in clinical ethics and in research ethics – are using platforms to get and to discuss information. Procedures are more efﬁcient, communication becomes more ﬂuid; however, privacy, conﬁdentiality, property rights, and security have to be guaranteed (these principles have already been mentioned during the international congress, organized in 1998 by the UNESCO and several national organizations; INFOethics ´98, Ethical, legal and societal challenges of cyberspace). A possible conclusion is that institutions like clinical and research committees are able to structure information and their exchanges online to perform ethics consultation. For the same reason, the use of this sensitive data has to be regulated. Communication should be open, but structured.

The deliberation argument emphasizes the improvement of this complex activity – it precedes decision-making – thanks to the use of the ICT and the Internet. In bioethics, the analysis usually faces difﬁcult cases and moral dilemmas; there are no ﬁnal answers concerning health care and life; hence, decisions about hard cases could be only reasonable – not deﬁnitive – and prima facie. Thus, the pros and cons of a given course of action have to be appropriately weighed. The whole process will be more efﬁcient when communication is supported by technical means, like the Internet. However, asking and giving reasons online is not like arguing ofﬂine. Indeed, arguments “on the screen” and their language have their own form and time; somehow, they are structured on and by the Web. Again, many ethics committees have the possibility of expanding time and space for arguments thanks to platforms and online resources. It is a real improvement especially in a preliminary phase of debates; but the ICT and the Internet are complementary means, they could not replace deliberation face-to-face. Firstly, arguing is a form of interaction, not only communication. Secondly, conﬁdentiality, privacy, and security have to be preserved by committees, in every context or format. Finally, ethics consultation face-to-face gets a more complete picture of a problem than the online narrative of it. The experience of the US Presidential Commission for the Study of Bioethical Issues – with its ﬁrst report of 2010, The Ethics of Synthetic Biology and Emerging Technologies (Presidential Commision for the Study of Bioethical Issues, New Directions, 2010) – suggested that commissions’ and committees’ open deliberation and recommendations could encourage further public debates and, especially, a social perspective on bioethical issues. This case showed that citizens’ participation and openness would be enhanced by the use of blogs and websites, with debates in cyberspace; nevertheless, institutional deliberation is more formal and regulated than exchanges online.

In fact, the Presidential Commission organized public meetings to promote a democratic deliberation about synthetic biology; actually, its nineteenth meeting on the issue was conducted in 2014. Thus, these initiatives and the French precedent, the États Généraux de la Bioéthique of 2008, speak for complementary activities, ofﬂine and online. Ethics committees and their experiences with platforms and websites also indicate that bioethical analyses supported by the Internet might fulﬁll some good governance criteria, such as efﬁciency, openness, and participation. Accountability – explaining and taking responsibilities – is a different question, because some structure and several rules are necessary. Who would take decisions and be responsible of possible consequences? At this moment, the limits between actual and virtual spheres could become blurred; however, the distance between interaction ofﬂine and online is relevant in practice and, especially, for agents.

Interaction

According to the WHO Report of 2012, dementias are becoming real challenges for public health at the global level. National surveys and international data about aging problems and dementia’s prevalence on the population are very explicit about the present and, besides, about the prospects. For this reason, the progressive use of the ICT to a better assessment, to the monitoring of patients’ functioning, and also for international cooperation in research is more than welcome. Caregivers will obviously beneﬁt from new devices and technologies to attend to patients in their daily activities. But, at the moment, the expectations have to be moderated; technologies are only complementary resources. In fact, the needs and burden of dementia illnesses are huge; moreover, data from different countries reveal that the distribution of patients’ care is unbalanced, unequal. Care, especially the informal one, has been and is still mainly sustained by women. Gender bias is evident there. That is to say that dementia’s treatments demand medical, technical, legal, and also social interventions. Online assistance would be very helpful and interesting in the initial phases of these illnesses; on the contrary, with noncompetent patients, daily care and direct responsibility have to be assured to them and assumed by someone or by some people in particular.

The debate about real and virtual communities or about online and ofﬂine activities is well known in education, because in this ﬁeld, several programs and experiences have already been developed and evaluated. “Blended” learning and e-learning are standard practices in every educational level. Nowadays, pure online education seems still less efﬁcient than mixed systems or methodologies. So far, the main reason is that direct experience and real interaction are not easily translated in the Web world. Online communication has its distinctive form; it allows interaction with many agents; even so, virtual and real exchanges are dissimilar. In practice, the current experiences in ethics committees prove that deliberation about pros and cons is more than analysis; sometimes, it becomes a commitment. Cases would be hard and they involve many agents; thus, ethical deliberations online are possible, but, so far, direct exposure to dialogue and to dilemmas has been only partially replaced by new languages, new instruments, and virtual exchanges.

In sum, arguing and deliberating are forms of interaction, in every space and format. For the moment, distance activities could not replicate the environment of practical deliberation and of actual interventions. The Internet offers communication and a special form of dialogue, open and horizontal. Face-to-face interaction provides a horizontal and a vertical interaction, as it happens with common social experiences. This is the point, social interaction. In bioethics, it is always important to get reasonable conclusions and, in general, to deﬁne good practices for agents and situations – real agents and real situations. Therefore, the Internet and the ICT are welcome; with special websites, online journals, online libraries, and online projects for bioethics, there is no way back to standard communication and information. However, some reﬂections about devastating illnesses like Alzheimer’s disease make us understand the difference between ofﬂine and online interaction.

Conclusion

The World Dementia Council intends to promote international cooperation for innovating research and treating patients with Alzheimer’s disease and other dementias. Connecting institutions and professionals is vital. Networking is also the main purpose of the GEObs, the global observatory supported by the UNESCO. These and other recent experiences suggest that interconnectedness is decisive to expand information and multiply interventions. The Internet seems the right channel for these parallel processes, globalization and networking. However, the ICT are more than means to extend spaces and to connect agents. They construct – and deconstruct as well – spaces, identities, and social relationships; the consequences are still uncertain. Thus, there are many reasons to think about a global bioethics that is becoming also bioethics online.

The aim here has been the role of the Internet in the ﬁeld. In fact, bioethical discourse exempliﬁes the intersection of processes that modify knowledge and practices. For instance, in ethics committees, networking activities via the Internet are different from standard cooperation. The ICT advantages seem evident, because they support better communication and better exchanges for agents and for institutions. The recent expansion of bioethics, as multidisciplinary, multicultural, and global discourse, is clearly related to the new instruments of getting and delivering information beyond frontiers and languages. The debates about controversial questions go actually beyond frontiers, cultures, and languages; cyberspace offers the opportunity to know new regulations, reports, conventions, and every sort of documents that refer to topics concerning clinical practice, research on humans and on nonhumans, end-of-life treatments, and many relevant issues. At the same time, the Internet and the technological environment shape the styles of producing knowledge, with consequences for ethical analysis and, especially, for practical deliberation.

A plausible conclusion is, then, that a reﬂective approach is necessary, with arguments that insist on advantages and, of course, with critical arguments to identify limitations and biases of online interventions. Problems like organ trafﬁcking or long-term care for dementia patients demonstrate that globalization and interconnectedness have augmented the complexity. It is not only a question of quantity (more information, more exchanges, more spaces available, etc.) but of quality, the construction of different styles of communication and interaction. In any case, from tyranny of the principles or the priority of cases, schematic or non-nuanced arguments seem unsatisfactory in this ﬁeld; for the same reason, elementary assessments about the use of the Internet, the ICT sovereignty, and their possible beneﬁts and risks could be out of place in bioethics. Philosophy has a long tradition of articulating caveats around technical innovations, after Plato’s classical considerations about written knowledge displacing living discourses. But, since R. Descartes, philosophy also has a solid tradition of reasons based on method and on enough evidences.

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