Older LGBTQ+ and blockchain in healthcare: A value sensitive design perspective

Abstract

Abstract Most algorithms deployed in healthcare do not consider gender and sex despite the effect they have on individuals’ health differences. Missing these dimensions in healthcare information systems is a point of concern, as neglecting these aspects will inevitably perpetuate existing biases, produce far from optimal results, and may generate diagnosis errors. An often-overlooked community with distinct care values and needs is LGBTQ+ older adults, who have traditionally been under-surveyed in healthcare and technology design. This article investigates the implications of missing gender and sex considerations in distributed ledger technologies for LGBTQ+ older adults. By using the value sensitive design (VSD) methodology, our contribution shows that many value meanings dear to marginalized communities are not considered in the design of the blockchain, such as LGBTQ+ older adults’ interpretations of trust, privacy, and security. By highlighting the LGBTQ+ older population values, our contribution alerts us to the potential discriminatory implications of these technologies, which do not consider the gender and sex differences of marginalized, silent populations. Focusing on one community throughout, we emphasize the need for a holistic, VSD approach for the development of ledger technologies for healthcare, including the values of everyone within the healthcare ecosystem.