Ethical Considerations in the Use of Virtual Reality

Kenneth Goodman, Ph.D., Director, Institute for Bioethics and Health Policy, Professor of Medicine, University of Miami

No new technology escapes the interest, if not the grasp, of clinicians and biomedical researchers.  Because new technologies are often a source of ethical challenges, the study, adoption, and use of virtual reality tools should be accompanied by comprehensive ethical and policy analyses. These analyses may be guided in part by antecedent work in biomedical informatics. The ethical issues raised by the use of virtual reality include but are not limited to (i) the training of health professionals (e.g., percutaneous renal access, ultrasound-guided neuraxial anesthesia, responding to inappropriate patient requests), which raises concerns about the risk of clinical skill degradation; (ii) appropriate uses and users, or the challenges imposed when a new tool might be used without adequate research or training, when the uses themselves might be illicit or inappropriate, or when VR devices are used for recreational and other non-professional purposes; and (iii) alterations in the clinician-patient relationship with potentially adverse consequences, as might occur when VR modifications or enhancements of the treatment setting emerge as atherapeutic. These issues are lensed in behavioral health when, for instance, the use of avatars, distortions or enhancements do not function as anticipated or intended; and in circumstances in which intelligent virtual agents or robots are involved. Ethical issues in software engineering might also play a role. Moreover, it is not unreasonable to inquire after the effects of virtual reality on nothing less than human self-perception and identity. Some of the ethical issues arising in the use of VR technology are empirical in nature, or will be clarified by additional research which we should expect will raise new challenges for human-subject protection. The intersection of virtual reality, artificial intelligence and machine learning promises a new generation of ethical issues, issues perhaps best addressed by what has been called “progressive caution,” or the idea that even as we have duties to develop and explore new health sciences, we must do so deliberately, dispassionately and with careful regard to unintended consequences.


Kenneth GoodmanDr. Goodman received his Bachelors degree in Journalism from the University of Florida, a Masters degree in Theoretical Linguistics from the University of Essex in England, and PhD in Philosophy from the University of Miami. He was a research associate at the Carnegie Mellon University, Center for the Advancement of Applied Ethics, and participating faculty in the University of Pittsburgh School of Medicine Clinical Ethics Training Program. He then returned to Florida in the University of Miami School of Medicine, Health and Human Values Program, where he has climbed the faculty ranks to become Professor of Medicine, with secondary appointments in Philosophy, Nursing and Health Studies, Epidemiology and Public Health and Anesthesiology. Dr. Goodman is a leading bioethicist in the United States who focuses on biomedical informatics. His initial background in computational linguistics and machine translation, and in journalism, has fostered his understanding of, and interest in, ethical issues in informatics.