Designing robots for care: care centered value-sensitive design

The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship--what I refer to as care robots--require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vulnerable and sensitive time in their lives. The ethical evaluation of care robots requires insight into the values at stake in the healthcare tradition. What's more, given the stage of their development and lack of standards provided by the International Organization for Standardization to guide their development, ethics ought to be included into the design process of such robots. The manner in which this may be accomplished, as presented here, uses the blueprint of the Value-sensitive design approach as a means for creating a framework tailored to care contexts. Using care values as the foundational values to be integrated into a technology and using the elements in care, from the care ethics perspective, as the normative criteria, the resulting approach may be referred to as care centered value-sensitive design. The framework proposed here allows for the ethical evaluation of care robots both retrospectively and prospectively. By evaluating care robots in this way, we may ultimately ask what kind of care we, as a society, want to provide in the future.

The Ethics of Medical AI and the Physician-Patient Relationship

This article considers recent ethical topics relating to medical AI. After a general discussion of recent medical AI innovations, and a more analytic look at related ethical issues such as data privacy, physician dependency on poorly understood AI helpware, bias in data used to create algorithms post-GDPR, and changes to the patient-physician relationship, the article examines the issue of so-called robot doctors. Whereas the so-called democratization of healthcare due to health wearables and increased access to medical information might suggest a positive shift in the patient-physician relationship, the physician's 'need to care' might be irreplaceable, and robot healthcare workers ('robot carers') might be seen as contributing to dehumanized healthcare practices.

Significant challenges when introducing care robots in Swedish elder care

Introduction: Care robots are machines, operating partly or completely autonomously, that are intended to assist older people and their caregivers. Care robots are seen as one part of the solution to the aging population, allowing fewer professional caregivers to provide the necessary assistance and care. Despite the potential benefits, the dissemination of care robots, and welfare technology in general, is limited in Swedish elder care.Purpose: To explore the challenges of introducing welfare technology, particularly care robots, in elder care.Materials and methods: Twenty-one individual interviews with key actors at the societal level, analysed by thematic analysis.Results: The challenges, from the societal actors' perspectives, were related to; the beliefs in technology, attitudes, ethics, collaboration, and the need for knowledge and skills regarding care robots (individual and group challenges). Challenges of a national character were: national governance, infrastructure, laws and regulations, economics, and procurement (systemic and societal challenges). In addition, the necessary preconditions for successful introduction were revealed as: the utility of the technology, implementation, evaluation and safety, security, and integrity (preconditional challenges).Conclusions: The introduction of care robots in elder care services seems to be more challenging than that of welfare technology in general, given the context and prevailing attitudes and preconceptions about robotics. Significant challenges need to be managed, at all levels of the society, before care robots can become an integral part of daily care and assist older people and their caregivers in activities and rehabilitation.IMPLICATION FOR REHABILITATIONThe challenges described by the societal actors', are partly similar to those of the end users', in terms of attitudes, ethics, knowledge and skills, and collaboration. This consensus should provide a solid foundation for the conceptualization and introduction of care robots in elderly care.The challenges follow the pattern of an ecosystem involving all sections of society, which are intertwined and require consideration before the expected benefits can be realised.A user-centred approach is necessary to support the design, implementation, and usefulness of care robots and their suitability for meeting the real needs of older persons and professional caregivers.

Robot Care Ethics Between Autonomy and Vulnerability: Coupling Principles and Practices in Autonomous Systems for Care

Technological developments involving robotics and artificial intelligence devices are being employed evermore in elderly care and the healthcare sector more generally, raising ethical issues and practical questions warranting closer considerations of what we mean by “care” and, subsequently, how to design such software coherently with the chosen definition. This paper starts by critically examining the existing approaches to the ethical design of care robots provided by Aimee van Wynsberghe, who relies on the work on the ethics of care by Joan Tronto. In doing so, it suggests an alternative to their non-principled approach, an alternative suited to tackling some of the issues raised by Tronto and van Wynsberghe, while allowing for the inclusion of two orientative principles. Our proposal centres on the principles of autonomy and vulnerability, whose joint adoption we deem able to constitute an original revision of a bottom-up approach in care ethics. Conclusively, the ethical framework introduced here integrates more traditional approaches in care ethics in view of enhancing the debate regarding the ethical design of care robots under a new lens.

Care robot research and development plan for disability and aged care in Korea: A mixed-methods user participation study

The population of Korea is aging rapidly, and this has led to a care burden for caregivers. Without adequate caregivers to address the increased burden, people with significant disabilities and older adults with disabilities who have greatly reduced mobility are at risk. The aim of this study was to determine suitable types of care robots for care applications in Korea and formulate a strategy for a future care robot R&D plan through a user participation study. We categorized nine types of care robots that are suitable for the care needs in Korea. By adopting a mixed research methodology involving user participation, we conducted discussions with caregivers, care receivers, and other stakeholders under a public-private-people partnership model. We also identified five primary strategies for care robot R&D: (1) intensive investment to match the needs of people with very severe disabilities to care robot technologies, particularly for transfer, repositioning, toileting, and feeding; (2) translational research and technology development; (3) realization of smart-care through fourth industrial revolution (i.e., digital) technologies; (4) user-centered research with stakeholders; and (5) building of a care robot ecosystem. The formulated plan would be shared with other developers and clinical experts to drive development of suitable care robots.

Trust as a Solution to Human Vulnerability: Ethical Considerations on Trust in Care Robots

In the care sector, professionals face numerous challenges, such as a lack of resources, overloaded wards, physical and psychological strain, stressful constellations with patients and cooperation with medical professionals. Care robots are therefore increasingly being used to provide relief or to test new forms of interaction. However, this also raises the question of trust in these technical companions and the potential vulnerability to which these people then expose themselves. This article deals with an ethical analysis of the two concepts of trust and vulnerability in the context of care robotics. The first step is to examine what can be understood by vulnerability, focusing specifically on Misztal's three proposed types (relationships, future anticipation, past experiences). This strategy is often used as a starting point by authors and also seems relevant for the connection to the concept of trust. In a second step, these three types of human vulnerability are examined on the basis of a technical concept of trust. It is shown that (1) relationships and thus also interdependence can create additional options, (2) the anticipation problem with regard to the actions of others also makes responsibility transferable and (3) an explication of freedom is also associated with potential traumatic experiences. The final step brings together the previous considerations and makes it clear once again that trust in a care robot need not only be associated with vulnerability, but that vulnerability can also potentially be reduced, transferred and overcome.

Social Values of Care Robots

Care robots have the potential to address the challenge of aging societies, such as labor shortages or the aging workforce. While previous studies have focused mainly on the productivity or workability of care robots, there has been an increasing need to understand the social value of care robots. This study attempted to identify the social values of care robots by conducting focus group interviews (FGIs) with twenty-four care recipients and caregivers and by using analytic hierarchy processes (AHPs) with thirteen individuals with expertise in the care service and care robot industries. Our results show that the labor- and health-related benefits, the technology innovation, and the provision of essential care work have the highest importance among the criteria of care robots' social values. The criteria that receive lowest priority are cost, the autonomy and needs of the care recipients, and the organizational innovation. Our study suggests that along with the private benefits and costs of care robots, their social values also need to be considered to improve the quality of care and to unlock the potential of the care robot industries.

The entwinement of policy, design and care scripts: Providing alternative choice-dependency situations with care robots

The use of robots to assist feeding has become important for people with an impaired arm function. Yet, despite large-scale dissemination strategies, it has proven difficult to sustain the use of this technology. This ethnographic study draws on the script approach to discuss the use of robots to assist feeding. The empirical work was done at locations in Denmark and Sweden. Drawing on document studies, interviews, observation of meals and video footage, we discuss (1) policy strategies promoting ideas such as self-reliance; (2) design visions promoting ideas such as empowerment; (3) and three scripts of care: (a) the script of choice, (b) the script of eating alone and (c) the script of eating together. We argue that scripts entwine and give rise to and prevent the use of robots. The study contributes to the script literature and the care robot literature by substantiating that care robots may generate choice-dependency situations for users. Rather than the somewhat overflowing 'self-reliance' and 'empowerment', alternative configurations of choice and dependency emerge, in which some situations fit users better than others. We conclude that although sustaining the use of feeding robots is difficult, in some cases, useful choices arise for both end-users and care providers.

Assessing Visitor Expectations of AI Nursing Robots in Hospital Settings: Cross-Sectional Study Using the Kano Model

Background

Globally, the rates at which the aging population and the prevalence of chronic diseases are increasing are substantial. With declining birth rates and a growing percentage of older individuals, the demand for nursing staff is steadily rising. However, the shortage of nursing personnel has been a long-standing issue. In recent years, numerous researchers have advocated for the implementation of nursing robots as a substitute for traditional human labor.

Objective

This study analyzes hospital visitors' attitudes and priorities regarding the functional areas of artificial intelligence (AI) nursing robots based on the Kano model. Building on this analysis, recommendations are provided for the functional optimization of AI nursing robots, aiming to facilitate their adoption in the nursing field.

Methods

Using a random sampling method, 457 hospital visitors were surveyed between December 2023 and March 2024 to compare the differences in demand for AI nursing robot functionalities among the visitors.

Results

A comparative analysis of the Kano attribute quadrant diagrams showed that visitors seeking hospitalization prioritized functional aspects that enhance medical activities. In contrast, visitors attending outpatient examinations focused more on functional points that assist in medical treatment. Additionally, visitors whose purpose was companionship and care emphasized functional aspects that offer psychological and life support to patients.

Conclusions

AI nursing robots serve various functional areas and cater to diverse audience groups. In the future, it is essential to thoroughly consider users' functional needs and implement targeted functional developments to maximize the effectiveness of AI nursing robots.

Analysis of Comfort during Transfer by a Dual-Arm Care Robot Based on Human Body Pressure and Surface Electromyographic Signals

In-home elderly care faces a crucial challenge regarding mobility among essential assistive devices, for which dual-arm care robots present a viable solution. However, ensuring human comfort in human-robot interactions necessitate quantifiable standards. Currently, the field lacks accurate biomechanical model solutions and objective comfort evaluation. In response to this need, this study proposes a method for solving human-robot statics models based on real-time pressure and position information. Employing the Optitrack motion capture system and Tekscan pressure sensors, we collect real-time positional and pressure data. This information is then incorporated into our human-robot statics model, facilitating the instantaneous calculation of forces and moments within the human body's sagittal plane. Building on this, comprehensive research literature review and meticulous questionnaire surveys are conducted to establish a comprehensive comfort evaluation function. To validate this function, experiments are performed to enable real-time assessment of comfort levels experienced during the process of transferring the human body. Additionally, the Noraxon surface electromyography (sEMG) sensors are utilized to capture real-time sEMG signals from the erector spinae, adductor muscles and quadratus lumborum, thereby providing objective validation for the comfort evaluation function. The experimental findings demonstrate that the proposed methodology for evaluating comfort achieves an accuracy rate of 85.1%.

No thank you to humanized robots: attitudes to care robots in elder care services

The growing older population will increase the demands on the health and welfare systems, including elder care services. One way of meeting these growing service needs is to shift from traditional care services to technologically oriented services. Robotic innovations are gradually being introduced to elder care services. The aim was to explore attitudes toward the use of care robots in elder care services - specifically focusing on situations and interaction, influence, and emotions in interaction with care robots. Data were obtained from visitors at a welfare technology fair (n = 124). The results show that the most negative attitudes concerned if the care robots were humanized and had emotions. The attitudes toward interacting with care robots in general were predominately positive. In conclusion, concrete usage scenarios in elder care services need to be detected, based both on users' needs, digital literacy and on the maturity of the technology itself.