Older LGBT+ and Blockchain in Healthcare: A Value Sensitive Design Perspective

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 are LGBT+ older adults, which has traditionally been under-surveyed in healthcare and technology design. This paper investigates the implications of missing gender and sex considerations in distributed ledger technologies for LGBT+ older adults. By using the value sensitive design methodology, our contribution shows that many value meanings dear to marginalized communities are not considered in the design of the blockchain, such as LGBT+ older adults' interpretations of trust, privacy, and security. By highlighting the LGBT+ 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 - LGBT+ older adults - we emphasize the need for a holistic, value sensitive design approach for the development of ledger technologies for healthcare, including the values of everyone within the healthcare ecosystem.