Table of Contents 2. Biomedical and Electronic skin patch 2 Motivation behind the Technology 5 Applications 6 Drug delivery system 6 Health monitoring 8 Medium of Communication 11 Human Computer Interaction Interface 12 Stakeholders 12 3. Ethical and Legal Concerns with the technology 14 3.1 Legal Issues 14 Inconsistent Medication 14 Number of Impacts of Wireless Technology 15 Data Integrity and Hacking 16 3.2 Ethical dilemma 17 Cultural and religious criticism 17 Public Monitoring/privacy 19 Impact on people with disabilities 20 Cost issues 20 Social Issues/implications 20 Credibility of Source of Information 21 4. Resolutions for these dilemmas 22 4.1 Possible solution 22 Tackling health issues 22 Preventing leakage of personal information 23 Preventing Overuse of Skin Patch 24 Addressing cultural issues 24 Denying any form of tracking human information 25 4.2 Strategy for implementation 25 Conclusion 26 Reference List 26

1. Introduction The purpose of this report is to identify the legal and ethical issues related to electronic skin patch and provide a possible solution to tackle it. The limitations of current medical science lead to the advancement of biomedical science to resolve the gap. The report further deals with the new technology electronic skin patch that promises to overcome the potholes of the traditional medical science. It provides the detailed analysis of the technology and the strategy to provide a solution, when there is a dilemma in distinguishing the legal and ethical issues related to electronic skin patch.

2. Analysis Methodology

To effectively examining the technology and its impacts on internal and external entities, we use 4 steps analysis methodology to take an insight look into the technology. The diagram below represents our strategy to analyse the technology.

The first step is to analysing the fact. In this step, we will describe the technology and its application. We will also explain why and how it benefits different stakeholders as well as the downside of such applications.

The second step is to isolating ethical and legal issues. This step will be the main section because it is very important to know in what extent, an issue would be considered as a legal or ethical one or both. Moreover, we will identify what is major population affected by these issues.

The next step is to suggest possible solutions to resolve these issues. Based on analysis above, we will provide number of different solutions which could be effective to treat the issues.

The last step is to build a proper strategy how to implement the technology successfully to prevent or minimise occurrence of such issues.
3. Biomedical and Electronic skin patch
Since the day medical services have been introduced to mankind it has been developing constantly. Over the past years biomedical technology has made a huge advancement in the field of medical sciences. Biomedical is a broad area that combines engineering and other technology to innovate new solutions to solve medical problems relating to human beings. Biomedical involves thorough analysis, experimentation and observation. It is an approach of finding medical solutions to diseases that are still claiming the lives of millions of people.
A biomedical research is basically conducted in several steps:-

* Basic research: Basic research is a type of research conducted in order to understand the basic processes going through a living organism. This research is performed using animal specimens so that a better understanding of the process is gained. * Applied research: it is a research conducted on the basis of findings made by basic research. It specifically focuses on a particular target or area/goal. It is specific goal based research that is focusing on solving a particular medical condition or define a medical process in order to provide a solution to it. * In vitro research: it is derived from a Latin word which means within the glass. It is a research technique in which a research is conducted in order to define or expand the knowledge of processes and this research is conducted in an artificially created or controlled environment outside the living organism. * In vivo research: the term in vivo in Latin means within the living. This refers to a research conducted within a living organism. It is a research mostly practiced in comparison to in vitro research because it is conducted in living organisms and in vitro research they fail to replicate the cellular conditions of an organism. * Ex vivo research: it is derived from Latin which means outside a living organism. It is a research conducted on living cells or tissues taken from a living organism and cultured in a laboratory outside an organism. It reduces the need of in vivo research because the cells and tissues can be cultured in the laboratory and used for research. * Product Safety research: it is conducted in order to check if it is safe for consumption by human beings or animals. This takes place in two phases i.e. pre-clinical trial and clinical trial. * Pre-clinical trial: it involves living creatures other than humans. This helps the researchers to broaden their knowledge on the processes and health condition that they are working on. Humans have a complex body and nothing else could be as similar to experimenting on living organisms. Moreover, all livings are susceptible to the similar diseases. * Clinical trial: It involves human beings in this trials. It takes place in hospitals involving humans that are informed about the trials. The people involved in the trials are volunteers that have volunteered to allow the researchers test on them in order to check the safety and effectiveness of the drugs and medical tools.

Biomedical, skin patch and drug delivery system are interrelated to each other. Biomedical and ethics go hand in hand since the era of Hippocrates until the middle of twentieth century. The progress in biological science and health science lead to inadequacy for contemporary ethics(Beauchamp & Childress 2001). Biomedical is the application of biological science and technology to improve the quality of delivery of medical services.

Skin patch is biomedical advancement in the field of medical sciences facilitating health services. Skin patch is a medicated, adhesive patch that delivers a certain dose of the drug to the human body through the skin and then to the bloodstream.

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With time the skin patch has rapidly advanced from a bandage that just delivers drugs to the skin when there were minute cuts and burns. It is rooted deep in medical field. It’s implemented for test diagnosis purposes and a very vast area of drug delivery which is further discussed in the application section. Earle Dickson in 1921 invented a skin patch History of the Band-Aid - Earle Dickson Inventor ... - Inventors. When it was first started it was just an adhesive with gauze to protect the wounds from infections. But today with the advancement of biomedical, researchers have found a way to deliver drug to the human body with the help of a skin patch. These days nicotine patches are also available that delivers a certain amount of nicotine to your body to avoid the craving of nicotine in smokers. Furthermore, skin patches have reached to next level i.e. electronic skin patches. These skin patches consist of a microchip and an adhesive layer with the help of which it is attached to your skin.

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Dr. Donghee Son of South Korea and his colleagues have developed a prototype of a skin patch. It is not the first skin patch with a microchip but it is the first skin patch with memory and that stores data and deliver drugs. It is an electronic skin patch which is elastic in nature. This skin patch is 0.3 mm thick, 4 cm long and 2cm wide. It consists of tiny titanium-gold particles that are held in the inner side of the patch with the help of adhesive. These skin patches are very easy to wear and comfortable as a wrist band, tattoo or a nicotine patch. The heat sensors are placed on the top side and the drug delivering particles in the bottom side which are further activated with the help of micro heaters present in the inner part of the patch(Arpana Sagwal Chaudhary 2014).
Motivation behind the Technology
The motivation of this skin patch technology is that it is very easy to apply to skin and the user need not worry about regular timely medications. The dosage of medications can go wrong or the prescribed medicines itself can go wrong. A patient can possibly forget to take his or her pills and there can be chances of overdose, side effects and drug addiction of unmonitored medications. The sensors in the patch constantly monitor the patients’ health and give timely notifications about the medications.

There are several advantages over traditional way of delivering medications to the body. | Migration is a medical condition which needs constant medications and there is no proper cure for it. But skin patch promises to eradicate migration by monitoring health constantly and delivering it on requirement.

Today, skin patches are available which can be used by people to test for measuring effects to human health when experiments are conducted. These skin patches are an evolution in engineering which are used for testing the safety of cars. Automobile engineers use human dummies and attach these skin patches on them and put them in the driver’s seat. The engineers test the safety of the car by creating possible accidental conditions in a closed monitored environment. The skin patches that were attached in the human dummies indicate the damage that it could have caused in the human body. These is a boon in the automobile engineering because these skin patches help automobile engineer to find out the potholes and improve their shortcomings and strengthen the safety which further save lots of human beings when they get in any kind of accidents.

According to (Sumner 2014 ), researchers have been working on a new skin patch that can completely cure Parkinson’s disease. The patients can skip their medications and not worry about consuming their medications. It is not ready to a hit the market but a group of researchers are working on an adhesive stretchable patch consisting of sensors and micro heaters that can monitor the patients’ health and send the report to their respective doctors and administer the patient’s health remotely by providing required medications. As we all know Parkinson’s disease is a neurological impairment where the patient has body disorder such as tremors in the hand. The doctors prescribe them with medications which they need to consume every few hours in order to suppress it. But the excess amount of intake of medicine may have some side effects or chances of overdose and when the dose is lowered the tremors return. According to an article published in Nature Nanotechnology a team of researchers from Seoul National University lead by Dr. Hyeong Kim have developed a skin patch that detects the tremors and supply medications as requirement. Instead of using stiff built silicon they have developed this skin patch using flexible silicon wires and plastic making it wearable and skin friendly. They have used a new technology to detect the tremors called the resistive random access memory and porous silica Nano-particles that deliver drugs when the sensors detect tremors.

Henceforth, the skin patch has lot of other applications and benefits over the traditional way of drug delivery driving the biomedical researchers to strive to seek the better way of delivery of drugs to patients. Therefore skin patch is an opportunity that can bring a revolution to the field of medical science.
Applications
As explained in the previous section the electronic skin patch technology has lot of potential application along with its benefits. It includes applications that can be used for drug deliver, health monitoring, medium of communication and as a Human computer interaction interface.
Drug delivery system
Electronic skin patch or the epidermal skin patch or the Trans dermal skin patch developed by the researchers is a wearable patch that can monitor the health, store & transmit data and deliver the necessary drugs when required to the human body. The utmost need for personalized treatment and medication has lead to the invention of this device. The applications of this device are commendable. Such a device has almost instant applications for those suffering from health issues like heart related diseases, diabetes etc. however, the most fundamental & novel application of this device would be in tracking of human health (Chaudhary 2014).

Conventional devices have limitation when it comes to factors such as wear ability and constant monitoring and tracking of health. It becomes almost impossible to track and examine the details related to a human’s health without the physical presence or without having kept under observation in order to draw a conclusion on the patients’ conditions. In such cases, a device such as an electronic skin, that can be wearable and which can be monitored will prove highly beneficial (Saluja et al. 2013)

The main features of this patches are they are flexible devices which means they can withstand twisting, bending without losing their main functionality which is to store data and relevant information and also they are tiny in nature. The compactness of the device in integral part of its design and hence it makes it very simple for the patients to use it discreetly (Chaudhary 2014)

Nanotechnology has revolutionized almost every field in a huge possible way. The development of sensors, motors, actuators at nano scale and also integration of such devices in micro and nano scale has further led to increased applications of devices in various fields. These devices such as electronic skin patch as a matter of discussion consists of nano sensors, actuators and motors that are integrated on that flexible skin patch. The use of such nano devices in its fabrication makes this device a tiny one.(Saluja et al. 2013)

The electronic skin patch basically like an e-tattoo, it’s easy to be patched onto the skin and the small electronics (processors, memory, sensors etc) integrated in them makes them store information and also deliver drugs when needed into the human body through the skin-silicon membrane interface. The most attractive part is that it can be worn as a tattoo which also reduces social stigma (Chaudhary 2014). Some patches also contain healing elements which can be activated remotely in order to release drugs. Such devices can be effectively used to construct or build bio integrated devices which can be optimized to store, transmit, deliver prescribed amount of drugs in various situations (Talbot 2014)

These devices as mentioned previously are completely bio integrated circuits which have series of devices like the sensors, motors, processors, a very thin silicon membrane (serpentine shape) which act as an interface on the skin to deliver drugs, silica nanoparticles to release drugs. The silicon nano membrane sensors are used in order to detect the muscle activity of the person when the doctor has to identify the kind of movement of the arm & if or not the recorded movement is a normal one or any tremor. The memory system has in it memory cells that are of nanometre range. When any stretching activity takes place in the membrane, the changes observed in the resistance values will enable a doctor to determine the movement. The memory cells on the other hand record these changes in the resistance values due to the membrane movements (Talbot 2014)

These patches also contain certain heating elements that are activated remotely to release drugs by raising the patch temperature by certain degree which as a reverse reaction releases drugs by porous silica nanoparticles. On heating, the bond between the silica nanoparticles and the drugs basically breaks which ensures the release of drugs molecules into the skin like a diffusion-driven process. The membranes are equipped with Resistive random access memory (RRAM) for data & information storage purposes (Talbot 2014)

This device forms a part of wireless health monitoring system which sends the data’s to the phone or computers of the people (doctors or the patients). This obtained information in form of signals is studied by doctors to monitor and track the health of patients almost all the time.

However, these devices need external power supply and the data transmitter and independent powering capability of such devices is still a researched area. Nevertheless, these devices can be efficiently and effectively used to detect tremors associated with diseases such as epilepsy, Parkinson’s etc. it can also give doctors a brief knowledge and idea about what possibilities could further trigger tremors that might worsen health conditions.

Health monitoring
The concept of electronic skin in health monitoring systems can be a novel application in the field of medicine. Electronic skin patch or the Transdermal skin patch is a device which can be used to monitor and track a person’s health on a regular basis. It forms a part of wireless health monitoring system. This device is a stretchable device and its functionality is not lost due to turning or twisting of the device.

The skin patch is like a temporary tattoo, where the device is integrated with nano electronic components like the sensors, actuators, motors, particles etc. Conventional devices however have constraints when it comes to factors like flexibility and wear ability. The device is as soft as the skin of the human and can move as the arm moves. The device is real time and can also send high quality data to the systems that are monitoring or tracking these data.

Monitoring Heart Rhythm

It is important for the heart patients to monitor the rhythm of their heart on frequent intervals in order to keep their heart healthy. Normally the electrodes and bulky wires along with rashes make it tedious to constantly monitor the heart rhythms on frequent basis. On a positive note the epidermal electronic systems helps the medical professionals, in order to provide a reliable and uninterrupted monitoring of patients heart. It provides user benefits in two ways, first it provides the user with a convenient and frequent cardiac rhythm monitoring, and secondly it has proved to be feasible in cost to its users(Steffen 2011).

Monitoring the Brain Waves

The electronic skin patch simply attach to forehead can now help in monitoring the activities of the brain as precisely as the electro encephalogram by using flexible electronic circuits. Furthermore to enhance its activity over the complex brain waves, recently the system is optimized with electrodes. In order to measure that the patch is working properly or not, an experiment was conducted where individuals were shown pictures and they were asked to keep track of the repeated objects. In order to detect system efficiency P300 signals were monitored in brain, these signals do appear when one pays attention to stimulus. Whenever the participants in the experiment notice the same object, the electronic patch notifies a blip at P300 signal. This shows the proper functioning of the device, which somewhere counts similar to the electro encephalogram(Reardon 2013).
Fitness
The skin mounting device can provide information on fitness i.e. fitness tacking and hence enable the person with a detailed depiction of the fitness activity. These devices are said to give much more efficient data’ as against wristbands or clip-on devices. These devices are sort of coupled with the skin and if one can mount it on different body parts safely, then, it can provide rich necessary information about the body movements (Ahlberg 2014). The wearable device is more comfortable when mounted on the skin and can be sensed without the mess of wires attached to conventional tracking systems; this is more natural and hence can be tagged suitable and adjustable.

Tackle diseases
Diseases like Parkinson’s can be detected at much earlier stages in the patient, even before he/she realizes it. The potential application of this device lies in monitoring a patient’s health, in the release and delivery of drugs by thermal activation & also monitoring wounds. The patch is constructed with an envelope filled with fluid on which the nano components are suspended. The physiological health conditions can be effectively monitored by this device (Paddock 2014)

Temperature reading
The use of this device in order to study how the body regulates temperature can be a very interesting application. The precision temperature mapping of the human skin is basically a detailed study of the pathological conditions as to how exactly a human body regulated temperature. The main drawback of this device is that it suffers from high cost IR cameras and it is not possible for the camera to measure, image or detect surfaces of tissues under movement. In such cases, the electronic skin can be converted into an advantageous application. It contains micro/Nano scale temperature sensors(Berger 2013).

Premature baby health
Another application for electronic chip includes monitoring of the premature baby. Premature babies are weak and continuously required to be monitored. They have risk of having diseases and continuously require to be medicated. Until now the babies are generally connected with lot of machines through wires which looks uncomfortable at the most. These machines are used to monitor the health of the baby but may not be one of the best ways to go with it. Electronic chips provide us a better way to monitor the premature babies without use of big wires and connecting it to the baby.

The wireless e-tattoo or the epidermal electronic can be put on the premature babies to continuously monitor the health of the infant(Doss 2014). It can be used to monitor the heart rate, brain activity, breathing, respiration etc. without any problem. These are safer than the physical hard wires that would be connected to the babies. The wires can leave marks on the babies and may have other problems. These chips can be attached to the babies and with their lightweight the baby wouldn’t be uncomfortable and furthermore the doctors would find the wireless technology easy to use.

Physical Rehabilitation

The e-tattoos that are used are generally only considered to monitor the health or provide medicines to the person. However, these chips can also be used to person going through physical rehabilitation. People might be injured in accident or might be disable from birth. They go through physical rehabilitation which requires different medicines and techniques. The chip can be used as a way to monitor the process. However, this chip if built with specific functionalities can also be used as a device which can help in physical therapy. This device is directly monitoring the nervous and physiological system can be used to stimulate the muscle contractions. Therefore, there won't be any need more heavy exercise if the chip connected to the user itself is providing an exercise. Thus there won't be any restriction on the movement of the patient as they can do other stuff while the chip will be providing stimulation to muscle contractions helping in rehabilitation(Doss 2014).

Therefore, with a number of applications, this device can be extensively used in order to monitor the health of a patient by receiving constant signals from the integrated electronic circuitry which is the basic construction of the electronic skin device. The device monitors and tracks the health of an individual efficiently without affecting the person’s day to day activity.
Medium of Communication
The epidermal electronic system when placed on the throat, it helps the user to speak silently. Sub vocalization is a process which makes the person throat muscles move, when the person think of speaking. The epidermal electronic system when placed over throat it behaves as a sub vocal microphones and helps the user in speech silently and wirelessly. The epidermal electronic system consists of the sensors, which can easily pick up the muscle movements and helps its users to communicate just with the thought. It can also provide ninety percent accuracy in playing voice activated video games to its users(CHOI 2013).

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These chips that are used are thought to collect the electrophysiological information. This is the information that links the electrical activity in the circuit of the chip to the physiological activities of the body. This includes brain activities, heart rate, throat senses and other important things. Thus, these chips can understand the activities of the body convert it into data and saved the data into the memory. The data collected by the chip can be integrated in pattern recognition software which can be used to help people communicate. The software will have speech recognition and speakers integrated through which people can express their view without speaking. There are number of disabled people in the world with speech problems. These chips can assist the people for example suffering with larynx disorders(Doss 2014).
Human Computer Interaction Interface
Another application associated with the electronic chip is creating a user interface for different kind of people. There are number of ways to communicate with the computer such as keyboards mouse, voice recognition, motion sensors etc. All of these are effective, however, they are difficult to handle when the user involved is suffering from some kind of difficulty. The user might be suffering from problems such as muscular or neurological disorders which create a problem when using a computer as users are not able to use normal hardware components such as keyboards that are required for communication with the computer. The electronic chip becomes very handy here as it can be used here to sense the muscular and neurological activity within the user’s body and help it to communicate with the computer. These movements can be recorded and then translated into machine language which would be understood by the computer and the communication will become possible.

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Similarly, these chips can be used to play games on computers.AS the chip can read the muscle movement and the body movement; it can work similar to the way motion sensor works. The way the body is moving and the hand gestures can be read by the chip and then be translated into inputs for the game to play the game. One of the example presented in the article explained integration of the chip with a game called “Sokobon”.This game required simple inputs such as up, down, right and left to play it. The electronic chip could be mounted on the throat of the player who is playing the game. This chip will then sense the throat movement of the user and try to translate the movements into the inputs that are required for the game. This throat sensing technique does require training for the user using it but after a while it can become effective(Fellman 2013).It can be seen that the epidermal electronic system consists of the sensors that can easily pick up the muscle movements and helps its users to communicate just with the thought. It can also provide ninety percent of accuracy in playing voice activated video games to its users(CHOI 2013).

Stakeholders
The stakeholders of the technology include all the people that are involved with the technology in any way. This involves people who are making, distributing, selling and using the epidermal electronic technology. As this technology is related to the body, thus the main stakeholders involve doctors, medical practitioners, patients and health department. The other parts of the community such as sports players or even the developers of the technology are essential stakeholders. As this technology is yet to be properly developed; it can be assumed that more number of stakeholders will emerge in the near future.

Following are the number of stakeholders that are associated with the chip technology:-

1. General Users - General users will be the one that are directly using the chip technology. These could be patients that have been introduced to the technology by their doctors to help them fight diseases such as Parkinson’s disease etc. The users could be people who are trying to stay fit & healthy such as sports players and thus, using chip technology to monitor themselves. Users are the most important stakeholders as both positive and negative effects of the technology will be directly faced by them.

2. Medical Practitioners - These stakeholders involve doctors and health practitioners who will be recommending the patients or other people to actually use the technology. They are required to thoroughly research about the technology and then use it on patients to continuously monitor them to check on their health.

3. Health Department - Health departments who do not have the big costly machines available can benefit from using this lightweight chip technology on patients. However, if the technology doesn't work, it can cause a negative effect on health department’s image.

4. Developers - These are considered the stakeholders as they are the one that are innovating the technology and are finding ways to upgrade this technology. As the technology becomes more and more popular, developers can continuously work on the project to make it more helpful.

5. Manufacturers and Distributors - The chip technology will become popular day by day. This will lead to increase in popularity of the manufacturers who are actually making the chips from different components. They will have more buyers coming in which will increase profit for them. Similarly, the distributors will also profit from the increase in demand of the technology.

6. Regulators - These are ones define which manufacturers can be certified to produce electronic skin patch. Also define policies in which limit numbers of skin patch can be owned per user, how long is best to replace used patches, when to replace new patch, which patch is used for children and which for adult. There are enormous amount of effort that these regulators need to do to maintain feasibility and sustainability of the electronic skin patch. These are not developers, not in health department, but people understand both medical and technology work along with government to regulate the use of new technology.

7. Insurance Company - In Australia, when people go to doctor and receive medication. The cost later will be claimed for government (public health policy) or for insurance company ( private high quality services ). So if patient need to have skin patch, which will pay for it and depend on current patient health status, who will responsible if unexpected problem occur that might harm patients.
3. Ethical and Legal Concerns with the technology
Write something here before go to legal issue section. For example, how to define a issue is legal or ethical. It would be great!!!!!
3.1 Legal Issues

There is no doubt that the technology name electronic skin patch can be of tremendous help not only for the patients suffering from different diseases but it could be of great help to the doctors diagnosing those diseases. However, the technology itself consists of number of legal issues. These legal issues are generally related to the health of the patient or the user using it. Any effect on the health of the patient can leads to breach of faith, honesty and even the contract that the doctors and health department are bound to. This could lead to legal actions taken by the users or the patients. Following are the legal concerns related to the skin patch technology.
Inconsistent Medication

As we know electronic skin patch is the technology use to suppress several diseases like Parkinson's and epilepsy. It also can be used to monitor or measure the body movements, on its basis sometimes doctors give the prescription else the device diagnose the individual when any symptoms are observed.

In order to determine whether the electronic skin patch is working in an appropriate manner or not, it is important to perform some sort of experimentation. Suppose if the chip has malfunction in its reading of muscle contraction, there is a probability that diagnosis may lead to the over dosage of medication. Its effect may lead patient to suffer from other serious diseases, and the same issue may arise if the device is diagnosing the patient.

Furthermore, some of the skin patches that are developed do not check the current vitals of the patient. This means that they have the information when to release the drug but cannot take decisions based on the health of the patient. These patches provided a consistent amount of dose or medicine to the patient but they cannot know when the patient requires a strong dose and for how much time span. Similarly, the patch doesn't know when the patient is good and well and does not require the medication. It continuously provides the same flow of drugs the patient is on. Some of the companies have issues some patches with responsive capabilities but rest of the patches still possess this unethical problem

Another scenario can be the drug that is provided by the chip is having an adverse reaction on the patient. It could be skin irritation or even dizziness. What if the patient is not able to contact the doctor, for e.g., doctor is not available or is on leave. The patient would have to wait for a day or two and the chip will continuously pour the drug into the body which could work as a poison and could have lethal effect on the patient. Who is to blame in this situation; doctor who gave the technology, patient who took it or the chip manufacturer.

Number of Impacts of Wireless Technology

The electronic chip uses the wireless technology to transfer the report or to provide an interface on the computer. Furthermore this technology is planning to enhance the service of delivery by transferring the report on the patient mobile phone. However in terms of technology its progressing but somewhere it may arise major concerns in terms of health(Sage & Carpenter). Following are the problems that a wireless user may suffer with its service:-

Public Health Risk

The radio frequency technology used by the user not only affects him, but to the one in the surrounding the non-users. The study states that the radio frequency radiations can have both short term and long term effects on its users as well as its non-users. The short term effects can be disruption in sleep, hormone disruption etc. Whereas the long term effects can be psychological stress, damage of DNA, infertility etc. There are further scientific evidences that states the exposure of radio frequency waves leads to the change in cell membrane. Furthermore it also leads to the change between the signal communications between the cells. The use of electronic skin patch not only leads to future health issues for its user but for the environment where the technology is being used by the users.

Alteration of skin’s pH value

Due to exposure of chemicals/ drugs can alter skin’s pH value and reducing skin’s defence barrier mechanism against diseases. The skin is the largest organ of a human body; this is a well-known fact. This organ acts as a potential barrier to various external environmental factors and thereby protecting underlying muscles, tissues and the internal organs of the human body. The optimal pH value of a human skin is around 5.5 which is important to be maintained as this acts as a defence mechanism against various infections and diseases. Although the skin has an excellent capacity to act as a buffer medium, the constant exposure to drugs, the chemicals present in them might alter the pH value of the skin i.e. it might increase or decrease the pH value of the skin resulting in an altered defence mechanism. This could again lead to some associated skin irritation and infections in the human body due to prolonged exposure to chemicals in the drugs in the Transdermal drug delivery methods.

Malignant Brain tumour

The wireless service uses the radio frequency technology that is same as mobile phone. A study proved that there is an increase in the chances of an individual to suffer from malignant tumour, which uses the mobile phone for more than 10 years. And the study states that the side of head an individual most often use to receive or make calls, is the most prone head region of individual to be affected from tumour. On an average the latency for the occurrence of tumours normally is more than 20 years but the same study reveals that the occurrence of tumours from radio frequency wireless technology is less than twenty years. The electronic chip technology has not yet been properly used or implemented in most of the countries. There are chances of this technology to somewhere cause future health problems to its users, as this technology works on the principles of radio frequency wireless technology(Sage & Carpenter).

Data Integrity and Hacking

The skin patch technology is a very advanced wireless technology which uses small size circuits consisting of specific amount of data. It has memory which can store data about the person it is attached to. For example, if a patient is using skin patch for drug delivery, the memory contains private and essential information about the/ patient. This can be used not only for delivered drug or can be used by doctors to read the current status of patients. The patch uses the wireless technology to transmit data to doctors or whoever is monitoring the patient. With all the benefits of wireless technology, there are plenty of ways the information can be misused when accessing wirelessly.

Wireless technology is not directed towards a single point. It is sent in all directions or can be accessed by multiple devices making them vulnerable to the attack. If proper measures or security is not provided it is very easy to get access to the data inside the patch. Now this hacking of data can involve manipulation of data. For example, the patient is supposed to get drug at a specific time. Changing the time or the parameters to calculate the time can lead to either overdose or no dose at all. It would be unethical for anyone to manipulate the data to harm the person but it’s possible.

Some of the patches are created to monitor specific health problems. If the data collected by the patch is hacked and manipulated, it can provide wrong reading which could be misinterpreted by both doctor or the patient involved. Data is constantly updated real time to cell phones and computers. Incorrect data may cause the patient to go for expensive treatments which are not required and can also lead them to use cure methods that can harm them physically. Thus, it can have effect on both financial and health perspective.

Another ethical issue is how much responsibility is taken up by the manufacturers of the patches and drug delivery system. They are using wireless technology so it becomes an ethical decision whether they are taking full responsibility of the security of the personal information of the user. It should be noted that it is also the responsibility of the user that they are using this technology so their information is at risk. However, it would still be ethically wrong if the manufacturers of the patch don’t provide proper security measures.

3.2 Ethical dilemma
Write something here as well, what is ethical dilemma? Before go to each dilemma
Cultural and religious criticism
The emergence of microchip either as a skin tattoo or as an implant does raise various ethical implications in different cultures among the world. Furthermore, it has led to a lot of debate among the different academic groups, organizations of human rights and religious groups. The e-tattoo or implant involves temporary or permanent modification of the body which is not acceptable and is considered unethical in some cultures. Some culture believe that human body should remain in purest form which means the way it was at birth and making changes to the boys is against the will of god. However, some culture doesn’t mind these kinds of modifications until and unless it is improving human life.

In Christian mythology, any kind of tattoo or implant done on the body is not considered ethical by the religious groups. It is said that these kind of tattoos printed or implanted on the body signifies the “Mark of the Beast”. It is believed that this mark is given by the antichrist and thus should not be used to buy or even sell any kind of item. It is said that this mark should not be used for own profit as it is against god and thus is forbidden(McTernan 2013).

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It is believed now the mark will be in the form of tattoo or implant. The electronic chip called the “epidermal electronic” can be attached to the body of the person and can be used with Wi-Fi technology. It won’t be long before this technology will be used to buy and sell through internet and thus will represent the mark of the beast which will be unethical with respect to the Christian mythology.

Similarly, in culture of Islam, it is considered as unethical to modify the body in any kind of way whether it is a permanent or a temporary modification. The modifications as well as the problems associated with health due to the technology are considered impure and against the culture. It is believed that all those people that go for tattoos or piercing alter the creation of the god and should be cursed. Thus, usage of electronic skin patch will be an unethical issue with respect to the Islam.

However, in some other mythologies such as Hindu it is not unethical if ear piercing or tattoo is done. Even when a child is born in India, their name or the name of their father is printed on the hand with the help of a permanent ink. Therefore, the electronic epidermal that has so much benefits to human life will be welcomed in Hindu culture. This shows it depends on culture whether the chips used on the body will be consider ethical or unethical.

Public Monitoring/privacy
The technology can cause ethical and legal issues such as security and privacy concerns. This technology can be enhanced and can be used for the purpose of spying. As this system is as small as the human hair, and it can be attached in the form of a tattoo, therefore it is easy for an individual to attach this up to a person in a crowd without his knowledge. However it can help the attacker to monitor the victim’s heart rates, brain waves and it may also record everything whatever the victim says.

Furthermore in future this technology can be used with wireless fidelity access along with miniature cameras attached to it that can somewhere violate the privacy.
Although the epidermal electronic system gains an advantage to oppose electrodes in the field of engineering, but at the same time it generates a major issue in the field of engineering. To the skin the EES is a foreign body, now the question arises, whether the patch adheres the skin, if yes then the van der Waal forces adhere to skin at molecular level may raise the chances of toxicity. There can be preventive measures that can be taken into considerations to prevent toxicity; however there can be a probability of having drawbacks in context to the long-time exposure of EES to skin.

There number of other abuses of the technology especially with the wireless technology that is available in the chip. This chip is presently directed towards medical industry but if it’s successful it could be used by government as a way to monitor public. It can be used to check on the day to day activities of the citizens and monitor them closely which is not ethical. This technology if successful could lead to a law in which this chip or electronic tattoo have to be present on everyone for identification purposes. This can give the government a medium to control the citizens and the entire population .People could be forced to wear the tattoo which can lead to failure of democracy. Till now no one is physically connected to the internet but this electronic skin tattoo can give a way for the internet to connect to the person and thus it is easy to monitor and track them down which is breach of privacy as well as ethics.

Impact on people with disabilities
Certain drugs that are developed are injected into bodies of people prone to some kind of disability. People with such disabilities or abnormal thinking may not be in a position to know and understand the advantages and disadvantages associated with the injected drug. Also there may not be detailed studies as to if or not these people will be liable for certain drug injections, or if the process will work out positively. This case may be an ethical issue related to drug delivery, where in the patients is injected with a drug without a basic understanding and knowledge. If these drugs, in a scenario, are misused by any health authorities in forceful injection into a human who is affected psychologically (Autism, dementia etc.), then this becomes offensive and a strong ethical issue(Isaac 2013).

Cost issues

Transdermal drug delivery practices, even though prevalent from a long time, are in practice very expensive. The method, no doubt may deliver the desired results when carried out on a certain someone, but the cost associated with these drug injection methods may be highly expensive. It is important to consider whether or not people from different sections of society will be able to afford such expenses to get their diseases cured. A layman with a weak financial background would possibly not afford such high expenses and if the method doesn’t serve the needy then it might as well not be tagged as reliable method(Isaac 2013).

Social Issues/implications
This epidermal electronic system is a latest technology; it has not affected the social environment until now. However as we know the system is as thin as human hair, so therefore this technology can be enhanced in the future to generate social issues. For example this technology can be provided in the form of contact lenses, where the reports generated from the EES can be visible directly through human eyes. This can act as a source of distraction and can be something that will deviate people using this technology from social environment. Furthermore this technology may make video games look more interactive, it may make user view television more realistic, and its result will somewhere make its user more addicted to the technology. This will affect the user’s social interaction with the people.

Furthermore, as we know humans tend to shy from work and try to find shortcuts to complete tasks. Remembering the time to take medicine and the amount of dose is important but usually we tend to forget it. With the emergence of electronic skin delivery systems, it is possible for the system to provide drugs to the body from time to time and the patients don’t have to keep track of it. People have habit of not to worry about things that are automatic. For example, when people are using washing machine they just push the buttons and they believe it will clean the clothes properly. Similarly, people will believe the electronic chip will constantly deliver the drug and they will no longer feel accountable for it. If people are not paying attention, they doze off and will not worry about the thing. They may not give attention to the chip and in any case if the patches are not suitable to the patient, the patient will never know and until and unless they go to doctor it could create a problem for them. Will the people will be held accountable if they don’t keep track of the chip’s result if they were made to believe it works properly or the innovators of the technology who made them believe that this invention is very effective.

Credibility of Source of Information

The electronic chip was advertised by Discovery Channel in the month of April 2014. And as we know Discovery Channel is very popular brand among people. It is the only channel that has more than two billion subscribers from 220 countries. This channel was started by John Hendricks in the year 1982, and this channel has gained tremendous popularity since 80’s(Patel April 2014).

This channel holds a credible and honest source of information among the viewers. The benefits of the electronic chip are being advertised by this channel, however by any means if the product fails to prove the effectiveness to its users who will be held responsible. Is it ethical if an honest credible source of information somehow fails to provide correct information to its viewers? It will be unethical on part of viewers who are relying on this channel in order to fetch useful and correct information. As this channel in that scenario, be breaking up the trust of billions of its users
4. Resolutions for these dilemmas

As we can see, in spite of the benefits of the skin patch technology, there are lot of ethical and legal dilemmas that are associated with it. It was important to understand the dilemmas and thus present number of solutions to the problems. Number of major issues were analysed by the authors and then a number of solutions were presented that can help in tackling with the dilemmas that are present.
4.1 Possible solution
The number of solutions is presented to the major dilemmas that were identified with the skin patch technology.
Tackling health issues * Testing on Animals - The technology can have number of health issues for human body. Thus, it is essential that the technology can be tested somewhere else before being used by the humans. One example can be testing the chips on animals. Animals for years have been used for testing of different type of drugs and medicines. Testing has been done on animals such as rats, guinea pigs and monkeys. This is one of the effective methods to find out the success of bio related medicine and technology. Therefore, the skin patch can first be tested on animals to find out various side effects and health problems that are related to it. This way the legal problems caused by the patches can be tackled earlier.

* Standardised the manufacturing process - The skin patch chip is small and simple to use. However, as we know in technical world, “The smaller the things are, the more complex is its working. The chip contains lot of components that are required to be of very high quality. Thus, the manufacturing process becomes essential as if the components malfunction it can cause side effects. Thus, one way is to use standards for manufacturing the chip. High standards can be used which can make sure high quality components are being built. Furthermore, only those organizations that comply with the international standard of biomaterials will be allowed to produce skin patch or its components.

* Customer Oriented Skin Patch - As we know different people are allergic to different things. Same goes for the chip technology where the skin patch might be harmful for some or might cause harm to the skin of the user. It is important to understand why certain skins are not compatible with the technology. Through this, different type of chips can be built that suit different kind of people and their skins.

* Notifications To users - One of the problems faced by the patient or the user using the chip was that they could not be notified about any problems related to the chip and its working. One solution can be to provide notification to users when the patch detects abnormal reactions from the skin. Users can receive the notification on mobiles, laptops or anyway they want instead of going to doctor.IT is ethical to keep the user in the loop bout the working and efficiency of the technology. These way users have the control over the chip than the chip having control over them. By having this option, users will no longer be suffering from side effects.

* Wi-Fi signal effects will not be a major concern however, there is a need to improve or prove that the patch would not release bad impact to surrounding people.
Preventing leakage of personal information * Encryption - The data stored in the patch is personal data belonging to the user. This could be the data of a patient or some important private information. The data being accessible from Wi-Fi is easy to hack into. One way is to use encryption tools to encrypt the data. Encryption is the process of converting the data into some other form which is not related to the original data. This encrypted data cannot be understood and cannot be related to the original data until one has the key that is used to encrypt the data. The data can be encrypted in the database or while sending through Wi-Fi. Thus, the data even if hacked would not be understood by the hacker. The key to decrypt the data will only be available to user sending and receiving data.

* Predefined Channel Of Communication - Another way to prevent leaking of information can be the use of predefined channels and connections with rich privacy configuration to send information. These use proper security protocols and safety measures to make sure data is safe. These channels can also be used to define where the data needs to be sent so that data won't be sent anywhere else. It can also decide to whom the data needs to be sent and also record incoming requests for future inquiries.

* Use Of Registered Servers - One of solution to privacy can be use of encryption with registered servers. The registered servers are servers that are the ones that can only decrypt or decode the information that being sent or received. These servers can be personally selected certified by the manufacturers and can be then be used to help in keeping privacy.

* Information Records/Auditing - Auditing is done every place where data is exchanged. The chip technology can also use auditing to keep record of all the connections and different type of data that was accessed. This can be the time taken to access or the type of information that was retrieved. This can be a good way to notice any harmful activity that might be happening related to the privacy of information.
Preventing Overuse of Skin Patch * Available as prescription - The skin patch can be used as a drug delivery system. Therefore, it is possible if the chips are commercially available they can be overused by people. One way to handle this is to make skin patch a prescription medication. This means that only doctor or health practitioners can prescribe the medicine to the people. The patches will not be commercially available thus, preventing any overused of the technology.

* ID Authentication - To prevent any kind of misuse, each skin patch can be registered with an ID associated with manufacture and intended users. This way it can be kept in record how much patches are being used by a single user. Any user using the patches more than they need can be banned from using it or maybe kept under doctor’s watch for overdose.

* Recycling - Recycle program has to be considered every 1-2 months or recollect unused ones. This makes sure every individual only own 1 at all the time.

* Multifunctional Patches - Different side of skin patch will serve different type of users (Pain release Skin patch cannot be reused with Nicotine).
Addressing cultural issues * Research on culture - Cultural issues is very significant and it is important to be dealt with. There are many cultures that will have problem with a chip being planted on a human body. For this, it is important to research on different cultures and try to find the actual problem that they have with the skin patch technology. The problem can be with the design of the patch. The research can help in understand how the design of the patch should be so to not have conflict with cultures. Furthermore, there might be some misunderstanding such as Christians thinking it as a “mark of the beast”. After effective research, people can be made aware about the misunderstandings that this technology does not represent antichrist but something good for humankind.

* No Modified Tattoo style - Some of the culture or countries do not allow tattoos or any piercing on the body. Some do allow simple tattoos but are against any kind of modified tattoo style. Thus, it is important that when putting this technology on body and hiding it under a tattoo, the tattoo should not be a fancy one that can cause a number of social and even security issues later on. This technology is there to help and not to for showing off. Thus, it is important to stay away from modified tattoo style.
Denying any form of tracking human information * Removal of Tracking Capability - The skin patch has the ability to track and monitor the whereabouts of people wearing it. Although, it is useful in cases such as tracking soldiers, if applied on normal local people can be misused. Thus, the skin patch that is built should not have any kind of tracking capabilities. The skin patch will not have GPS or any other technology integrated which allow expose users location. This will help in denying any form of tracking human information. The army if requires the tracking patch can order it specifically but it should not be commercially available for companies or people. * No Remote Access - Another problem with skin patch is the ability to remotely access from third party. The skin patch create should only -work as users' direct commands and should not allow any remote access from third party. Proper measures can be taken so that there is no way the third parties can get access to the patch even if they are allowed to do it. As we can see a number of solutions are presented in the previous section to the major problems that were identified with the skin patch technology. It is important to understand that all the problems are high priority and thus making all the solutions presented necessary to implement. All the possible solutions presented have to be applied in order to ensure that the product created comply with both ethical and legal aspects.
4.2 Strategy for implementation
It can be seen that a proper strategy is required for the implementation of the skin patch technology. This strategy should keep in mind of all the ethical and legal aspects along with the solutions that were presented. So, a strategy was made by the authors that include a total of 10 steps that should be followed properly while implementing the technology. These are:-

1. Stage one: Certify technology patents for origin inventors that prevent commercialise product before completed experiments and satisfy all safety standard. 2. Stage two: Instead of Releasing the whole product to the public, only release the product specifications first. This will help in getting the feedback for the system. This was the company can evaluate the feasibility of the technology. 3. Stage three: Find out the companies who are capable enough to manufacture the technology or its components. It is important to find and certify the manufactures which has outstanding history in providing medical equipment to produce the products. 4. Stage four: Release Act and Policy which associate with the product to medical organisations. 5. Stage five: Training and workshops are to be conducted that will help people understand how to use the technology. It will be explained how the data or information can be read and how to use it effectively without any side effects. 6. Stage six: The organisation can then be provided with the products. Once the organization start using it, all the information related to the use of the product can then be recorded to monitor the efficiency. 7. Stage seven: Notify technology to users via all available media channels about their benefit and rights in relation to the technology. 8. Stage eight: Once everything before is done the skin patch can then be provided to normal users. These users can be normal people or patients. Constant user’s feedback will be taken to understand how successful the technology is. 9. Stage nine: Based on the user’s feedback, the technology can be upgraded and customized. 10. Stage ten: Revise act and policy based on future situation.

Conclusion

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