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Tian YJA, Felber NA, Pageau F, Schwab DR, Wangmo T. Benefits and barriers associated with the use of smart home health technologies in the care of older persons: a systematic review. BMC Geriatr 2024; 24:152. [PMID: 38355464 PMCID: PMC10865618 DOI: 10.1186/s12877-024-04702-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Smart home health technologies (SHHTs) have been discussed in the frame of caregiving to enable aging-in-place and independence. A systematic review was conducted in accordance with the PRISMA guidelines to gather the up-to-date knowledge on the benefits and barriers of using SHHTs in the care of older persons from the perspective of older persons and their caregivers. METHODS Ten electronic databases were reviewed for empirical peer-reviewed literature published from 01.01.2000 to 31.12.2021 in English, German, and French reporting on experimental, qualitative, quantitative, and other empirical study designs were included. Included studies contained user-feedback from older persons over 65 years of age or their caregivers (formal and informal). We used an extraction document to collect relevant data from all included studies and applied narrative synthesis to analyze data related to benefits and barriers of SHHTs. RESULTS 163 empirical peer-reviewed articles were included, the majority of those published between 2014 and 2021. Five first-order categories of benefits and five of barriers were found with individual sub-themes. SHHTs could be useful in the care context where continuous monitoring is needed. They improve self-management and independent living of older persons. Barriers currently exist with respect to ease of usability, social acceptance, and cost. CONCLUSIONS SHHTs could be useful in the care context but are not without concerns. Researchers and policy makers can use the information as a starting point to better understand how the roles and outcomes of SHHTs could be improved for the care of older persons, while caregivers of older adults could use our findings to comprehend the scope of SHHTs and to decide when and where such technology could best address their individual family needs. Limitations lie in the possible exclusion of relevant articles published outside the inclusion criteria as well as the fact that due to digital divide, our review represents opinions of those who could and wanted to participate in the included 163 studies. TRIAL REGISTRATION This review has been registered as PROSPERO CRD42021248543. A protocol was completed in March 2021 with the PRISMA-P guidance. We have extended the review period from 2000 to 2020 since the registration of the protocol to 2000-2021.
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Affiliation(s)
| | | | - Félix Pageau
- Centre d'excellence sur le vieillissement de Québec, VITAM- Research Center on Sustainable Health, Laval University, Quebec City, QC, Canada
- Division of Geriatrics, Department of Medicine, Laval University, Quebec City, QC, Canada
| | - Delphine Roulet Schwab
- School of nursing sciences, La Source, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, 4056, Switzerland
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AboJabel H, Welsch J, Schicktanz S. Cross-cultural perspectives on intelligent assistive technology in dementia care: comparing Israeli and German experts' attitudes. BMC Med Ethics 2024; 25:15. [PMID: 38326778 PMCID: PMC10848426 DOI: 10.1186/s12910-024-01010-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 02/01/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Despite the great benefits of intelligent assistive technology (IAT) for dementia care - for example, the enhanced safety and increased independence of people with dementia and their caregivers - its practical adoption is still limited. The social and ethical issues pertaining to IAT in dementia care, shaped by factors such as culture, may explain these limitations. However, most studies have focused on understanding these issues within one cultural setting only. Therefore, the aim of this study was to explore and compare the attitudes of Israeli and German dementia experts toward IAT in dementia care, to contribute to a more cultural-comparative perspective. METHODS Semi-structured interviews were conducted with 35 experts (15 Israelis and 20 Germans) in key roles in health and community services for people with dementia as well as in the fields of dementia and IAT (e.g., computer science, electrical/biomedical engineering, ethics, nursing, and gerontology). Thematic content analysis was used to analyze the data. FINDINGS Israeli and German experts identified the same social accelerators in the development and implementation of IAT in dementia care (i.e., changes in family structure and social digitization) and benefits of adopting IAT (e.g., enhancing the safety of people with dementia and increasing their independence). However, there were differences in inhibitor/risk assessments between the two groups. Namely, economic considerations and the cognitive capacity of people with dementia were identified by both groups as inhibitors, while Israeli experts additionally reported stigma and ageism. Whereas both groups agreed that IAT might reduce human connection, and that the technology is not yet reliable enough, German experts highlighted concerns regarding privacy; in contrast, Israeli experts prioritized safety over privacy. CONCLUSIONS Our research findings allow for the identification of relevant similarities but also important differences between German and Israeli experts' perspectives. As such, an important basis has been provided for a more in-depth discussion regarding where, why, and how culturally-sensitive technology development is needed.
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Affiliation(s)
- Hanan AboJabel
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany.
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Johannes Welsch
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany
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Esmaeilzadeh P. Older Adults' Perceptions About Using Intelligent Toilet Seats Beyond Traditional Care: Web-Based Interview Survey. JMIR Mhealth Uhealth 2023; 11:e46430. [PMID: 38039065 PMCID: PMC10724815 DOI: 10.2196/46430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 10/19/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND In contemporary society, age tech (age technology) represents a significant advancement in health care aimed at enhancing patient engagement, ensuring sustained independence, and promoting quality of life for older people. One innovative form of age tech is the intelligent toilet seat, which is designed to collect, analyze, and provide insights based on toileting logs and excreta data. Understanding how older people perceive and interact with such technology can offer invaluable insights to researchers, technology developers, and vendors. OBJECTIVE This study examined older adults' perspectives regarding the use of intelligent toilet seats. Through a qualitative methodology, this research aims to unearth the nuances of older people's opinions, shedding light on their preferences, concerns, and potential barriers to adoption. METHODS Data were collected using a web-based interview survey distributed on Amazon Mechanical Turk. The analyzed data set comprised 174 US-based individuals aged ≥65 years who voluntarily participated in this study. The qualitative data were carefully analyzed using NVivo (Lumivero) based on detailed content analysis, ensuring that emerging themes were coded and classified based on the conceptual similarities in the respondents' narratives. RESULTS The analysis revealed 5 dominant themes encompassing the opinions of aging adults. The perceived benefits and advantages of using the intelligent toilet seat were grouped into 3 primary themes: health-related benefits including the potential for early disease detection, continuous health monitoring, and seamless connection to health care insights. Technology-related advantages include the noninvasive nature of smart toilet seats and leveraging unique and innovative data collection and analysis technology. Use-related benefits include ease of use, potential for multiple users, and cost reduction owing to the reduced need for frequent clinical visits. Conversely, the concerns and perceived risks were classified into 2 significant themes: psychological concerns, which included concerns about embarrassment and aging-related stereotypes, and the potential emotional impact of constant health monitoring. Technical performance risks include concerns centered on privacy and security, device reliability, data accuracy, potential malfunctions, and the implications of false positives or negatives. CONCLUSIONS The decision of older adults to incorporate intelligent toilet seats into their daily lives depends on myriad factors. Although the potential health and technological benefits are evident, valid concerns that need to be addressed remain. To foster widespread adoption, it is imperative to enhance the advantages while simultaneously addressing and mitigating the identified risks. This balanced approach will pave the way for a more holistic integration of smart health care devices into the routines of the older population, ensuring that they reap the full benefits of age tech advancements.
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Affiliation(s)
- Pouyan Esmaeilzadeh
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, United States
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Haltaufderheide J, Lucht A, Strünck C, Vollmann J. Increasing efficiency and well-being? a systematic review of the empirical claims of the double-benefit argument in socially assistive devices. BMC Med Ethics 2023; 24:106. [PMID: 38037080 PMCID: PMC10687833 DOI: 10.1186/s12910-023-00984-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Socially assistive devices (care robots, companions, smart screen assistants) have been advocated as a promising tool in elderly care in Western healthcare systems. Ethical debates indicate various challenges. One of the most prevalent arguments in the debate is the double-benefit argument claiming that socially assistive devices may not only provide benefits for autonomy and well-being of their users but might also be more efficient than other caring practices and might help to mitigate scarce resources in healthcare. Against this background, we used a subset of comparative empirical studies from a comprehensive systematic review on effects and perceptions of human-machine interaction with socially assistive devices to gather and appraise all available evidence supporting this argument from the empirical side. METHODS Electronic databases and additional sources were queried using a comprehensive search strategy which generated 9851 records. Studies were screened independently by two authors. Methodological quality of studies was assessed. For 39 reports using a comparative study design, a narrative synthesis was performed. RESULTS The data shows positive evidential support to claim that some socially assistive devices (Paro) might be able to contribute to the well-being and autonomy of their users. However, results also indicate that these positive findings may be heavily dependent on the context of use and the population. In addition, we found evidence that socially assistive devices can have negative effects on certain populations. Evidence regarding the claim of efficiency is scarce. Existing results indicate that socially assistive devices can be more effective than standard of care but are far less effective than plush toys or placebo devices. DISCUSSION We suggest using the double-benefit argument with great caution as it is not supported by the currently available evidence. The occurrence of potentially negative effects of socially assistive devices requires more research and indicates a more complex ethical calculus than suggested by the double-benefit argument.
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Affiliation(s)
- Joschka Haltaufderheide
- Medical Ethics with a Focus on Digitization, Joint Faculty for Health Sciences Brandenburg, University of Potsdam, Am Mühlenberg 9, 14476, Potsdam, Germany.
- Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Bochum, Germany.
| | - Annika Lucht
- Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Christoph Strünck
- School of Life Sciences, University of Siegen, Siegen, Germany
- Institute of Gerontology at Technical University Dortmund, Dortmund, Germany
| | - Jochen Vollmann
- Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Bochum, Germany
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Leibing A, Lazzaroni C, Petersen N. Emerging Technologies for Preventing the 'New' Dementia: Ambiguous Optimism in the Canadian Context. Med Anthropol 2023; 42:607-622. [PMID: 37552820 DOI: 10.1080/01459740.2023.2244649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Experts' views on the use of mostly digital technologies for dementia prevention are characterized by a simultaneity of "gerontechnological optimism" and skeptical hesitancy. Despite the hope for progress in dementia prevention through preventive technologies, experts also point to the complexity of prevention, the importance of environmental factors and public health policies, and the danger of an excessive focus on individual interventions. Without questioning the positive impact such technologies can have on many people, we claim that the experts' ambiguity reveals a deeper concern, a kind of "cruel optimism" that is based on a fantasy of "supported autonomy".
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Affiliation(s)
- Annette Leibing
- Faculty of Nursing, University of Montreal, Montreal, Canada
| | - Cynthia Lazzaroni
- Department Social Studies of Medicine, McGill University, Montreal, Canada
| | - Niklas Petersen
- Institute of Medical Ethics and History of Medicine, University of Göttingen, Gottingen, Germany
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Tian YJ(A, Jotterand F, Wangmo T. Remote Technologies and Filial Obligations at a Distance: New Opportunities and Ethical Challenges. Asian Bioeth Rev 2023; 15:479-504. [PMID: 37808448 PMCID: PMC10555987 DOI: 10.1007/s41649-023-00256-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 10/10/2023] Open
Abstract
The coupled growth of population aging and international migration warrants attention on the methods and solutions available to adult children living overseas to provide distance caregiving for their aging parents. Despite living apart from their parents, the transnational informal care literature has indicated that first-generation immigrants remain committed to carry out their filial caregiving obligations in extensive and creative ways. With functions to remotely access health information enabled by emergency, wearable, motion, and video sensors, remote monitoring technologies (RMTs) may thus also allow these international migrants to be alerted in sudden changes and remain informed of their parent's state of health. As technological solutions for caregiving, RMTs could allow independent living for older persons while any unusual deviations from normal health patterns are detected and appropriately supported. With a vignette of a distance care arrangement, we engage with concepts such as filial piety, in-absentia caregiving distress, and the social exchange theory, as well as the upholding of shifting cultural ideals to illustrate the complex dynamic of the satisfaction and quality of the informal caregiving relationship. This paper extends the traditional ethical issues in technology-aided caregiving, such as autonomy, privacy, and justice, to be considered within the context of distance care. We also posit newer ethical considerations such as consent in power imbalances, harm to caregivers, and stigma. These known and new ethical issues aim to encourage further ethically conscious design and use of RMTs to support distance care for older persons.
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Affiliation(s)
| | - Fabrice Jotterand
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, USA
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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Schicktanz S, Welsch J, Schweda M, Hein A, Rieger JW, Kirste T. AI-assisted ethics? considerations of AI simulation for the ethical assessment and design of assistive technologies. Front Genet 2023; 14:1039839. [PMID: 37434952 PMCID: PMC10331421 DOI: 10.3389/fgene.2023.1039839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 05/23/2023] [Indexed: 07/13/2023] Open
Abstract
Current ethical debates on the use of artificial intelligence (AI) in healthcare treat AI as a product of technology in three ways. First, by assessing risks and potential benefits of currently developed AI-enabled products with ethical checklists; second, by proposing ex ante lists of ethical values seen as relevant for the design and development of assistive technology, and third, by promoting AI technology to use moral reasoning as part of the automation process. The dominance of these three perspectives in the discourse is demonstrated by a brief summary of the literature. Subsequently, we propose a fourth approach to AI, namely, as a methodological tool to assist ethical reflection. We provide a concept of an AI-simulation informed by three separate elements: 1) stochastic human behavior models based on behavioral data for simulating realistic settings, 2) qualitative empirical data on value statements regarding internal policy, and 3) visualization components that aid in understanding the impact of changes in these variables. The potential of this approach is to inform an interdisciplinary field about anticipated ethical challenges or ethical trade-offs in concrete settings and, hence, to spark a re-evaluation of design and implementation plans. This may be particularly useful for applications that deal with extremely complex values and behavior or with limitations on the communication resources of affected persons (e.g., persons with dementia care or for care of persons with cognitive impairment). Simulation does not replace ethical reflection but does allow for detailed, context-sensitive analysis during the design process and prior to implementation. Finally, we discuss the inherently quantitative methods of analysis afforded by stochastic simulations as well as the potential for ethical discussions and how simulations with AI can improve traditional forms of thought experiments and future-oriented technology assessment.
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Affiliation(s)
- Silke Schicktanz
- University Medical Center Göttingen, Department for Medical Ethics and History of Medicine, Göttingen, Germany
- Hanse-Wissenschaftskolleg, Institute of Advance Studies, Delmenhorst, Germany
| | - Johannes Welsch
- University Medical Center Göttingen, Department for Medical Ethics and History of Medicine, Göttingen, Germany
| | - Mark Schweda
- University of Oldenburg, Department of Health Services Research, Division for Ethics in Medicine, Oldenburg, Germany
| | - Andreas Hein
- University of Oldenburg, Department of Health Services Research, Division Assistance Systems and Medical Device Technology, Oldenburg, Germany
| | - Jochem W. Rieger
- University of Oldenburg, Applied Neurocognitive Psychology Lab, Oldenburg, Germany
| | - Thomas Kirste
- University of Rostock, Institute for Visual and Analytic Computing, Rostock, Germany
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Fasoli A, Beretta G, Pravettoni G, Sanchini V. Mapping emerging technologies in aged care: results from an in-depth online research. BMC Health Serv Res 2023; 23:528. [PMID: 37221528 PMCID: PMC10204691 DOI: 10.1186/s12913-023-09513-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/08/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Emerging Technologies (ETs) have recently acquired great relevance in elderly care. The exceptional experience with SARS-CoV-2 pandemic has emphasized the usefulness of ETs in the assistance and remote monitoring of older adults. Technological devices have also contributed to the preservation of social interactions, thus reducing isolation and loneliness. The general purpose of this work is to provide a comprehensive and updated overview of the technologies currently employed in elderly care. This objective was achieved firstly, by mapping and classifying the ETs currently available on the market and, secondly, by assessing the impact of such ETs on elderly care, exploring the ethical values promoted, as well as potential ethical threats. METHODS An in-depth search was carried out on Google search engine, by using specific keywords (e.g. technology, monitoring techniques, ambient intelligence; elderly, older adults; care and assistance). Three hundred and twenty-eight technologies were originally identified. Then, based on a predetermined set of inclusion-exclusion criteria, two hundreds and twenty-two technologies were selected. RESULTS A comprehensive database was elaborated, where the two hundred and twenty-two ETs selected were classified as follows: category; developmental stage; companies and/or partners; functions; location of development; time of development; impact on elderly care; target; website. From an in-depth qualitative analysis, some ethically-related contents and themes emerged, namely: questions related to safety, independence and active aging, connectedness, empowerment and dignity, cost and efficiency. Although not reported by developers, a close analysis of website contents highlights that positive values are often associated with potential risks, notably privacy threats, deception, dehumanization of care. CONCLUSIONS Research findings may ultimately lead to a better understanding of the impact of ETs on elderly people.
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Affiliation(s)
- Annachiara Fasoli
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, MI, Italy
| | - Giorgia Beretta
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, MI, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, MI, Italy
- Psycho-Oncology Division, European Institute of Oncology, Milan, 20141, MI, Italy
| | - Virginia Sanchini
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, MI, Italy.
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, 3000, Belgium.
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Wang RH, Tannou T, Bier N, Couture M, Aubry R. Proactive and Ongoing Analysis and Management of Ethical Concerns in the Development, Evaluation, and Implementation of Smart Homes for Older Adults With Frailty. JMIR Aging 2023; 6:e41322. [PMID: 36892912 PMCID: PMC10037176 DOI: 10.2196/41322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 03/10/2023] Open
Abstract
Successful adoption and sustained use of smart home technology can support the aging in place of older adults with frailty. However, the expansion of this technology has been limited, particularly by a lack of ethical considerations surrounding its application. This can ultimately prevent older adults and members of their support ecosystems from benefiting from the technology. This paper has 2 aims in the effort to facilitate adoption and sustained use: to assert that proactive and ongoing analysis and management of ethical concerns are crucial to the successful development, evaluation, and implementation of smart homes for older adults with frailty and to present recommendations to create a framework, resources, and tools to manage ethical concerns with the collaboration of older adults; members of their support ecosystems; and the research, technical development, clinical, and industry communities. To support our assertion, we reviewed intersecting concepts from bioethics, specifically principlism and ethics of care, and from technology ethics that are salient to smart homes in the management of frailty in older adults. We focused on 6 conceptual domains that can lead to ethical tensions and of which proper analysis is essential: privacy and security, individual and relational autonomy, informed consent and supported decision-making, social inclusion and isolation, stigma and discrimination, and equity of access. To facilitate the proactive and ongoing analysis and management of ethical concerns, we recommended collaboration to develop a framework with 4 proposed elements: a set of conceptual domains as discussed in this paper, along with a tool consisting of reflective questions to guide ethical deliberation throughout the project phases; resources comprising strategies and guidance for the planning and reporting of ethical analysis throughout the project phases; training resources to support leadership, literacy, and competency in project teams for the analysis and management of ethical concerns; and training resources for older adults with frailty, their support ecosystems, and the public to support their awareness and participation in teams and ethical analysis processes. Older adults with frailty require nuanced consideration when incorporating technology into their care because of their complex health and social status and vulnerability. Smart homes may have a greater likelihood of accommodating users and their contexts with committed and comprehensive analysis, anticipation, and management of ethical concerns that reflect the unique circumstances of these users. Smart home technology may then achieve its desired individual, societal, and economic outcomes and serve as a solution to support health; well-being; and responsible, high-quality care.
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Affiliation(s)
- Rosalie H Wang
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Thomas Tannou
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) - Centre-Sud-de-l'île-de-Montréal, Montréal, QC, Canada
- Centre d'Investigation Clinique de l'Institut National de la Santé et de la Recherche Médicale (INSERM CIC) 1431, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Nathalie Bier
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) - Centre-Sud-de-l'île-de-Montréal, Montréal, QC, Canada
- Programme d'ergothérapie, École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Mélanie Couture
- École de Travail social, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Régis Aubry
- Centre d'Investigation Clinique de l'Institut National de la Santé et de la Recherche Médicale (INSERM CIC) 1431, Centre Hospitalier Universitaire de Besançon, Besançon, France
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Gender Stereotyping of Robotic Systems in Eldercare: An Exploratory Analysis of Ethical Problems and Possible Solutions. Int J Soc Robot 2021. [DOI: 10.1007/s12369-021-00854-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AbstractSocio psychological studies show that gender stereotypes play an important role in human-robot interaction. However, they may have various morally problematic implications and consequences that need ethical consideration, especially in a sensitive field like eldercare. Against this backdrop, we conduct an exploratory ethical analysis of moral issues of gender stereotyping in robotics for eldercare. The leading question is what moral problems and conflicts can arise from gender stereotypes in care robots for older people and how we should deal with them. We first provide an overview on the state of empirical research regarding gender stereotyping in human-robot interaction and the special field of care robotics for older people. Starting from a principlist approach, we then map possible moral problems and conflicts with regard to common ethical principles of autonomy, care, and justice. We subsequently consider possible solutions for the development and implementation of morally acceptable robots for eldercare, focusing on three different strategies: explanation, neutralization, and queering of care robots. Finally, we discuss potentials and problems associated with these three strategies and conclude that especially the queering of robotics and the idea of a gender-fluid robot offers an innovative outlook that deserves closer ethical, social, and technological examination.
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Timmermann C, Ursin F, Predel C, Steger F. Aligning Patient's Ideas of a Good Life with Medically Indicated Therapies in Geriatric Rehabilitation Using Smart Sensors. SENSORS 2021; 21:s21248479. [PMID: 34960570 PMCID: PMC8709340 DOI: 10.3390/s21248479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022]
Abstract
New technologies such as smart sensors improve rehabilitation processes and thereby increase older adults’ capabilities to participate in social life, leading to direct physical and mental health benefits. Wearable smart sensors for home use have the additional advantage of monitoring day-to-day activities and thereby identifying rehabilitation progress and needs. However, identifying and selecting rehabilitation priorities is ethically challenging because physicians, therapists, and caregivers may impose their own personal values leading to paternalism. Therefore, we develop a discussion template consisting of a series of adaptable questions for the patient–physician encounter based on the capability approach. The goal is to improve geriatric rehabilitation and thereby increase participation in social life and well-being. To achieve this goal, we first analyzed what is considered important for participation on basis of the capability approach, human rights, and ethics of care. Second, we conducted an ethical analysis of each of the four identified dimensions of participation: political, economic, socio-cultural, and care. To improve compliance with rehabilitation measures, health professionals must align rehabilitation measures in an open dialogue with the patient’s aspiration for participation in each dimension. A discussion template based on the capability approach allows for a proactive approach in patient information and stimulates a critical assessment of treatment alternatives while reducing the risk of imposing personal values.
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Affiliation(s)
- Cristian Timmermann
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89073 Ulm, Germany; (C.P.); (F.S.)
- Correspondence:
| | - Frank Ursin
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, 30167 Hannover, Germany;
| | - Christopher Predel
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89073 Ulm, Germany; (C.P.); (F.S.)
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89073 Ulm, Germany; (C.P.); (F.S.)
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