Aging 4.0? Rethinking the ethical framing of technology-assisted eldercare

Silke Schicktanz, Mark Schweda, Silke Schicktanz, Mark Schweda

Abstract

Technological approaches are increasingly discussed as a solution for the provision of support in activities of daily living as well as in medical and nursing care for older people. The development and implementation of such assistive technologies for eldercare raise manifold ethical, legal, and social questions. The discussion of these questions is influenced by theoretical perspectives and approaches from medical and nursing ethics, especially the principlist framework of autonomy, non-maleficence, beneficence, and justice. Tying in with previous criticism, the present contribution is taking these principles as a starting point and as a frame of reference to be critically re-examined. It thus aims to outline how existing ethical frameworks need to be extended or reconsidered to capture the ethical issues posed by technological developments regarding care for older people. In a first step, we provide a brief overview of assistive technologies in eldercare according to their purposes and functions. In the next step, we discuss how the questions and problems raised by new technologies in eldercare call for an expansion, re-interpretation, and revision of the principlist framework. We underline that the inclusion of ethical perspectives from engineering and computer science as well as a closer consideration of socio-political dimensions and fundamental anthropological and praxeological questions are needed.

Keywords: Aging; Empowerment; Ethics; Justice; Liability; Privacy; Technology assisted care.

Conflict of interest statement

The author declare no conflict of interest.

© 2021. The Author(s).

References

    1. Ammicht Quinn R, Beimborn M, Kadi S, Köberer N, Mühleck M, Spindler M, Tulatz K. Alter Ein Fragen- und Kriterienkatalog. Universitätsbibliothek Tübingen; 2015.
    1. Anderson, M., & Anderson, S. L. (2008). ETHEL: Toward a principled ethical eldercare robot. In AAAI fall symposium: AI in eldercare: New solutions to old problems. Retrieved June 10, 2020, from .
    1. Arnold, D. G. (Ed.) (2009). Ethics and the business of biomedicine. Cambridge University Press.
    1. Aujoulat I, Marcolongo R, Bonadiman L, Deccache A. Reconsidering patient empowerment in chronic illness: A critique of models of self-efficacy and bodily control. Social Science & Medicine. 2008;66(5):1228–1239. doi: 10.1016/j.socscimed.2007.11.034.
    1. Beauchamp T, Childress JF. Principles of biomedical ethics. 7. Oxford University Press; 2013.
    1. Bergemann, L., & Frewer, A. (Eds.) (2018). Autonomie und Vulnerabilität in der Medizin. Menschenrechte-Ethik-Empowerment. Transcript.
    1. Brown I, Adams AA. The ethical challenges of ubiquitous healthcare. The International Review of Information Ethics. 2007;8:53–60. doi: 10.29173/irie98.
    1. Burrell J. How the machine ‘thinks’: Understanding opacity in machine learning algorithms. Big Data & Society. 2016;3(1):1–12. doi: 10.1177/2053951715622512.
    1. Byrne CA, Collier R, O’Hare GM. A review and classification of assisted living systems. Information. 2018;9(7):2078–2489. doi: 10.3390/info9070182.
    1. Callahan Jr, J. J. (Ed.) (2019). Aging in place. Routledge.
    1. Castro EM, Van Regenmortel T, Vanhaecht K, Sermeus W, Van Hecke A. Patient empowerment, patient participation and patient-centeredness in hospital care: A concept analysis based on a literature review. Patient Education and Counseling. 2016;99(12):1923–1939. doi: 10.1016/j.pec.2016.07.026.
    1. Cavoukian A, Fisher A, Killen S, Hoffman DA. Remote home health care technologies: How to ensure privacy? Build it in: Privacy by design. Identity in the Information Society. 2010;3(2):363–378. doi: 10.1007/s12394-010-0054-y.
    1. Chiapperino L, Tengland PA. Empowerment in healthcare policy making: Three domains of substantive controversy. Health Promotion Journal of Australia. 2015;26(3):210–215. doi: 10.1071/HE15035.
    1. Clegg SR. Frameworks of power. Sage; 1989.
    1. Cook AM, Polgar JM, Livingston NJ. Need-and task-based design and evaluation. In: Oishi M, Mitschell I, Van der Loos H, editors. Design and use of assistive technology. Springer; 2010. pp. 41–48.
    1. Daniels N. Just health care. Cambridge University Press; 1985.
    1. Daniels N. Just health: Meeting health needs fairly. Cambridge University Press; 2008.
    1. Durocher E, Wang RH, Bickenbach J, Schreiber D, Wilson MG. “Just access”? Questions of equity in access and funding for assistive technology. Ethics & Behavior. 2019;29(3):172–191. doi: 10.1080/10508422.2017.1396461.
    1. Elder A. False friends and false coinage: A tool for navigating the ethics of sociable robots. ACM SIGCAS Computers and Society. 2016;45(3):248–254. doi: 10.1145/2874239.2874274.
    1. Feil-Seifer D, Matarić MJ. Socially assistive robotics. IEEE Robotics & Automation Magazine. 2011;18(1):24–31. doi: 10.1109/MRA.2010.940150.
    1. Feste C, Anderson RM. Empowerment: From philosophy to practice. Patient Education and Counseling. 1995;26(1–3):139–144. doi: 10.1016/0738-3991(95)00730-N.
    1. Folbre N. Nursebots to the rescue? Immigration, automation, and care. Globalizations. 2006;3(3):349–360. doi: 10.1080/14747730600870217.
    1. Harris CE. The good engineer: Giving virtue its due in engineering ethics. Science and Engineering Ethics. 2008;14(2):153–164. doi: 10.1007/s11948-008-9068-3.
    1. Hauggard M. Power: A reader. Manchester University Press; 2002.
    1. Hofmann B. Ethical challenges with welfare technology: A review of the literature. Science and Engineering Ethics. 2013;19(2):389–406. doi: 10.1007/s11948-011-9348-1.
    1. Ienca M, Wangmo T, Jotterand F, Kressig RW, Elger B. Ethical design of intelligent assistive technologies for dementia: A descriptive review. Science and Engineering Ethics. 2018;24(4):1035–1055. doi: 10.1007/s11948-017-9976-1.
    1. Ienca M, Jotterand F, Vică C, Elger B. Social and assistive robotics in dementia care: Ethical recommendations for research and practice. International Journal of Social Robotics. 2016;8(4):565–573. doi: 10.1007/s12369-016-0366-7.
    1. Kaber DB. Issues in human-automation interaction modeling: Presumptive aspects of frameworks of types and levels of automation. Journal of Cognitive Engineering and Decision Making. 2018;12(1):7–24. doi: 10.1177/1555343417737203.
    1. Kachouie R, Sedighadeli S, Khosla R, Chu MT. Socially assistive robots in elderly care: A mixed-method systematic literature review. International Journal of Human-Computer Interaction. 2014;30(5):369–393. doi: 10.1080/10447318.2013.873278.
    1. Kayser L, Karnoe A, Duminski E, Somekh D, Vera-Muñoz C. A new understanding of health related empowerment in the context of an active and healthy ageing. BMC Health Services Research. 2019;19:242. doi: 10.1186/s12913-019-4082-5.
    1. Kenner AM. Securing the elderly body: Dementia, surveillance, and the politics of “aging in place“. Surveillance & Society. 2008;5(3):252–269. doi: 10.24908/ss.v5i3.3423.
    1. Kolkowska, E., & Kajtazi, M. (2015). Privacy dimensions in design of smart home systems for elderly people. WISP 2015 Proceedings, 17. Conference Paper. Retrieved June 10, 2020, from .
    1. Körtner T. Ethical challenges in the use of social service robots for elderly people. Zeitschrift Für Gerontologie Und Geriatrie. 2016;49(4):303–307. doi: 10.1007/s00391-016-1066-5.
    1. Krenn B. Robot: Multiuse tool and ethical agent. In: Trappl R, editor. A construction manual for robots' ethical systems. Springer; 2015. pp. 11–29.
    1. Ladner RE. Accessible technology and models of disability. In: Oishi M, Mitschell I, Van der Loos H, editors. Design and use of assistive technology. Springer; 2010. pp. 25–31.
    1. Lasi H, Fettke P, Kemper HG, Feld T, Hoffmann M. Industry 4.0. Business & Information Systems Engineering. 2014;6(4):239–242. doi: 10.1007/s12599-014-0334-4.
    1. Link BG, Phelan JC. Conceptualizing stigma. Annual Review of Sociology. 2001;27(1):363–385. doi: 10.1146/annurev.soc.27.1.363.
    1. Liu L, Stroulia E, Nikolaidis I, Miguel-Cruz A, Rios Rincon A. Smart homes and home health monitoring technologies for older adults: A systematic review. International Journal of Medical Informatics. 2016;91:44–59. doi: 10.1016/j.ijmedinf.2016.04.007.
    1. Liu Z, Wang J. Human-cyber-physical systems: Concepts, challenges, and research opportunities. Frontiers of Information Technology & Electronic Engineering. 2020;21(11):1535–1553. doi: 10.1631/FITEE.2000537.
    1. Manzeschke, A., Weber, K., Rother, E., & Fangerau, H. (2015). Ethical questions in the area of age appropriate assisting systems. German Federal Ministry of Education and Research, VDI/VDE Innvation + Technik GmbH.
    1. Martinez-Martin E, Del Pobil AP. Personal robot assistants for elderly care: An overview. In: Costas A, Julian V, Novais P, editors. Personal assistants: Emerging computational technologies. Berlin: Springer; 2018. pp. 77–91.
    1. McAllister M, Dunn G, Payne K, Davies L, Todd C. Patient empowerment: The need to consider it as a measurable patient-reported outcome for chronic conditions. BMC Health Services Research. 2012;12:157. doi: 10.1186/1472-6963-12-157.
    1. McConnell T, Sturm T, Stevenson M, McCorry N, Donnelly M, Taylor BJ, Best P. Co-producing a shared understanding and definition of empowerment with people with dementia. Research Involvement and Engagement. 2019;5:19. doi: 10.1186/s40900-019-0154-2.
    1. McWilliam CL. Patients, persons or partners? Involving those with chronic disease in their care. Chronic Illness. 2009;5(4):277–292. doi: 10.1177/1742395309349315.
    1. Merkel S, Kucharski A. Participatory design in gerontechnology: A systematic literature review. The Gerontologist. 2019;59(1):e16–e25. doi: 10.1093/geront/gny034.
    1. Miller, C. A., Haigh, K., & Dewing, W. (2002). First, cause no harm: Issues in building safe, reliable and trustworthy elder care systems. Paper presented at the Working Notes of the AAAI 2002 Workshop on Elder Care. Retrieved June 10, 2020, from .
    1. Morris ME, Adair B, Miller K, Ozanne E, Hansen R, Pearce AJ, Santamaria N, Viega L, Long M, Said CM. Smart-home technologies to assist older people to live well at home. Journal of Aging Science. 2013;1:101. doi: 10.4172/2329-8847.1000101.
    1. Morte-Ferrer, R., Toboso-Martín, M., Aparicio Payá, M., Ausín Díez, T., Monasterio Astobiza, A., & López Castro, D. (2020). Personal autonomy in elderly and disabled: How assistive technologies impact on it. In J. Haltaufderheide, J. Hovemann & J. Vollmann (Eds.), Aging between participation and simulation: Ethical dimensions of socially assistive technologies in elderly care (pp. 185–198). De Gruyter.
    1. Neven L, Peine A. From triple win to triple sin: How a problematic future discourse is shaping the way people age with technology. Societies. 2017;7(3):26. doi: 10.3390/soc7030026.
    1. Parent WA. Recent work on the concept of privacy. American Philosophical Quarterly. 1983;20(4):341–355.
    1. Pellegrino ED. For the patient’s good: The restoration of beneficence in health care. Oxford: Oxford University Press; 1988.
    1. Preuβ D, Legal F. Living with the animals: Animal or robotic companions for the elderly in smart homes? Journal of Medical Ethics. 2017;43(6):351–352. doi: 10.1136/medethics-2016-103603.
    1. Raz A, Schicktanz S. Comparative empirical bioethics: Dilemmas of genetic testing and euthanasia in Israel and Germany. Berlin: Springer; 2016.
    1. Rose SM. Advocacy/empowerment: An approach to clinical practice for social work. Journal for Sociology & Social Welfare. 1990;17(2):41–51.
    1. Salge C, Polani D. Empowerment as replacement for the three laws of robotics. Frontiers in Robotic and AI. 2017;4:25. doi: 10.3389/frobt.2017.00025.
    1. Schecter D. The critique of instrumental reason from Weber to Habermas. Continuum; 2010.
    1. Schicktanz S, Schweda M, Wynne B. The ethics of ‘public understanding of ethics’: Why and how bioethics expertise should include public and patients' voices. Medicine, Health Care and Philosophy. 2012;15(2):129–139. doi: 10.1007/s11019-011-9321-4.
    1. Schicktanz S, Amelung T, Rieger J. Qualitative assessment of patients' attitudes and expectations toward BCIs and implications for future technology development. Frontiers in Systems Neuroscience. 2015;9:64. doi: 10.3389/fnsys.2015.00064.
    1. Schlager, N. (Ed.) (1994). When technology fails: Significant technological disasters, accidents, and failures of the twentieth century. Gale Research.
    1. Schmietow, B. (2020). Reconfigurations of autonomy in digital health and the ethics of (socially) assistive technologies. In J. Haltaufderheide, J. Hovemann & J. Vollmann (Eds.) Aging between participation and simulation (pp. 171–183). De Gruyter.
    1. Schulz R, Wahl HW, Matthews JT, De Vito Dabbs A, Beach SR, Czaja SJ. Advancing the aging and technology agenda in gerontology. The Gerontologist. 2015;55(5):724–734. doi: 10.1093/geront/gnu071.
    1. Schweda, M. (2017). “A season to everything“? Considering life-course perspectives in bioethical and public-health discussions on ageing. In M. Schweda, L. Pfaller, K. Brauer, F. Adloff & S. Schicktanz (Eds.), Planning later life: Bioethics and public health in ageing societies (pp. 11–30). Routledge.
    1. Schweda M, Kirste T, Hein A, Teipel S, Schicktanz S. The emergence of co-intelligent monitoring and assistive technologies in dementia care-an outline of technological trends and ethical aspects. Bioethica Forum. 2020;12:29–37.
    1. Sharkey A, Sharkey N. Granny and the robots: Ethical issues in robot care for the elderly. Ethics and Information Technology. 2012;14(1):27–40. doi: 10.1007/s10676-010-9234-6.
    1. Silvers A. Better than new! Ethics for assistive technologists. In: Oishi M, Mitchell I, Van der Loos H, editors. Design and use of assistive technology. Berlin: Springer; 2010. pp. 3–15.
    1. Small N, Bower P, Chew-Graham CA, Whalley D, Protheroe J. Patient empowerment in long-term conditions: Development and preliminary testing of a new measure. Health Services Research. 2013;13:263. doi: 10.1186/1472-6963-13-263.
    1. Sorell T, Draper H. Robot carers, ethics, and older people. Ethics and Information Technology. 2014;16(3):183–195. doi: 10.1007/s10676-014-9344-7.
    1. Sparrow R, Sparrow L. In the hands of machines? The future of aged care. Minds and Machines. 2006;16(2):141–161. doi: 10.1007/s11023-006-9030-6.
    1. Stavropoulos TG, Papastergiou A, Mpaltadoros L, Nikolopoulos S, Kompatsiaris I. IoT wearable sensors and devices in elderly care: A literature review. Sensors. 2020;20:2826. doi: 10.3390/s20102826.
    1. Thompson IE. The nature of confidentiality. Journal of Medical Ethics. 1979;5(2):57–64. doi: 10.1136/jme.5.2.57.
    1. Vallor S. Carebots and caregivers: Sustaining the ethical ideal of care in the twenty-first century. Philosophy & Technology. 2011;24(3):251–268. doi: 10.1007/s13347-011-0015-x.
    1. Van Wynsberghe A. Designing robots for care: Care centered value-sensitive design. Science and Engineering Ethics. 2013;19(2):407–433. doi: 10.1007/s11948-011-9343-6.
    1. Vandemeulebroucke T, Dierckx de Casterlé B, Gastmans C. The use of care robots in aged care: A systematic review of argument-based ethics literature. Archives of Gerontology and Geriatrics. 2018;74:15–25. doi: 10.1016/j.archger.2017.08.014.
    1. Wagner F, Basran J, Dal Bello-Haas V. A review of monitoring technology for use with older adults. Journal of Geriatric Physical Therapy. 2012;35(1):28–34. doi: 10.1519/JPT.0b013e318224aa23.
    1. Wang Z, Yang Z, Dong T. A review of wearable technologies for elderly care that can accurately track indoor position, recognize physical activities and monitor vital signs in real time. Sensors. 2017;17(2):341. doi: 10.3390/s17020341.
    1. Weber LJ. Profits before people? Indiana University Press; 2006.
    1. Winfield AF, Jirotka M. Ethical governance is essential to building trust in robotics and artificial intelligence systems. Philosophical Transactions of The Royal Society A Mathematical Physical and Engineering Sciences. 2018;376(2133):163. doi: 10.1098/rsta.2018.0085.
    1. World Health Organization (WHO). (1998). Empowerment for health. In WHO (Ed.), Health promotion glossary. Geneva. Retrieved June 10, 2020, from .
    1. Yusif S, Soar J, Hafeez-Baig A. Older people, assistive technologies, and the barriers to adoption: A systematic review. International Journal of Medical Informatics. 2016;94(1):112–116. doi: 10.1016/j.ijmedinf.2016.07.004.
    1. Zwijsen SA, Niemeijer AR, Hertogh CM. Ethics of using assistive technology in the care for community-dwelling elderly people: An overview of the literature. Aging & Mental Health. 2011;15(4):419–427. doi: 10.1080/13607863.2010.543662.

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