Can health technologies be "care optimizers"? A normative evaluation of digital health technologies in light of postphenomenological reflections.

The integration of new technologies such as artificial intelligence (AI) into healthcare has initiated profound changes in clinical practice, reshaping not only clinical workflows but the relational structure of care itself. Among the most significant developments is the transformation of the traditional doctor–patient dyad into a doctor–patient–technology triad. Philosophical studies of technology, especially postphenomenological research, argue that technologies should not be understood as neutral tools but as mediators of perception and action. Building on this perspective, we argue that ethical evaluation must move beyond description toward a normative orientation for understanding how such mediation reshapes care relations. To this end, we draw on postphenomenological theory of technological mediation in relation to contemporary clinical practices and develop a normative evaluative framework grounded in patient wellbeing, understood as an emergent, relational quality of care. Rather than deriving evaluative categories from a single tradition, the framework integrates insights from quality-of-care scholarship and care-ethical perspectives, informed by relational accounts of clinical practice. It operationalizes this orientation across five domains (care quality, patient-centeredness, decision-making, access and communication, and care practices) understood as relational sites where technological mediation can enhance or compromise care. Using clinical decision support systems (CDSS) as an analytically demanding test case, we introduce the concept of the care optimizer as a descriptive-normative category identifying technologies that structure the conditions under which care unfolds. By anchoring evaluation in patient wellbeing and situating technological mediation within a normative horizon, the framework translates postphenomenological insights into ethically actionable guidance and aims to ensure that digital health innovations reinforce, rather than undermine, the moral commitments of medicine.