Innovations permeate healthcare settings on an ever-increasing scale. Health technology innovations impact our perceptions and experiences of health, care, disease, etc. Because of the fast pace these HTIs are being introduced in different healthcare settings, there is a growing societal consensus that these HTIs need to be governed by ethical reflection. This paper reports a systematic review of argument-based literature which focused on articles reporting on ethical frameworks to screen or evaluate HTIs. To do this a four step methodology was (...) followed: Literature search conducted in five electronic literature databases; Identification of relevant articles; Development of data-extraction tool to analyze the included articles; Analysis, synthesis of data and reporting of results. Fifty-seven articles were included, each reporting on a specific ethical framework. These ethical frameworks existed out of characteristics which were grouped into five common ones: Motivations for development and use of frameworks; Objectives of using frameworks; Specific characteristics of frameworks ; Ethical approaches and concepts used in the frameworks; Methods to use the frameworks. Although this multiplicity of ethical frameworks shows an increasing importance of ethically analyzing HTIs, it remains unclear what the specific role is of these analyses. An ethics of caution, on which ethical frameworks rely, guides HTIs in their design, development, implementation, without questioning their technological paradigm. An ethics of desirability questions this paradigm, without guiding HTIs. In the end, a place needs to be found in-between, to critically assess HTIs. (shrink)

Socially Assistive Robots are increasingly conceived as applicable tools to be used in aged care. However, the use carries many negative and positive connotations. Negative connotations come forth out of romanticized views of care practices, disregarding their already established technological nature. Positive connotations are formulated out of techno-deterministic views on SAR use, presenting it as an inevitable and necessary next step in technological development to guarantee aged care. Ethical guidance of SAR use inspired by negative connotations tends to be over-restrictive (...) whereas positive connotations tend to provide over-permissive guidance. To avoid these extremes, we report on the development and content of 21 ethical orientations regarding SAR use in aged care. These orientations resulted from a multi-phased project, which consisted of empirical-ethical research focusing on older adults’ intuitions regarding SAR use and philosophical-ethical research focusing on philosophical-ethical argumentations regarding SAR use. This project led to the Socio-historical contextualization of the ethics of SAR use, in which the ethical impact of SAR use is localized on three interrelated analysis levels: societal, organizational, and individual-relational. The 21 novel orientations regarding SAR use are structured according to these levels and further categorized into foundational and applied orientations. The first category leads to critical reflection on SAR use while the latter category inspires decision-making processes regarding this use. While going beyond the care-romantic and techno-deterministic gaze of SAR use in aged care, the described orientations balance themselves between their over-restrictiveness and over-permissiveness. (shrink)

Different embodiments of technology permeate all layers of public and private domains in society. In the public domain of aged care, attention is increasingly focused on the use of socially assistive robots supporting caregivers and older adults to guarantee that older adults receive care. The introduction of SARs in aged-care contexts is joint by intensive empirical and philosophical research. Although these efforts merit praise, current empirical and philosophical research are still too far separated. Strengthening the connection between these two fields (...) is crucial to have a full understanding of the ethical impact of these technological artefacts. To bridge this gap, we propose a philosophical-ethical framework for SAR use, one that is grounded in the dialogue between empirical-ethical knowledge about and philosophical-ethical reflection on SAR use. We highlight the importance of considering the intuitions of older adults and their caregivers in this framework. Grounding philosophical-ethical reflection in these intuitions opens the ethics of SAR use in aged care to its own socio-historical contextualisation. Referring to the work of Margaret Urban Walker, Joan Tronto and Andrew Feenberg, it is argued that this socio-historical contextualisation of the ethics of SAR use already has strong philosophical underpinnings. Moreover, this contextualisation enables us to formulate a rudimentary decision-making process about SAR use in aged care which rests on three pillars: stakeholders’ intuitions about SAR use as sources of knowledge; interpretative dialogues as democratic spaces to discuss the ethics of SAR use; the concretisation of ethics in SAR use. (shrink)

In this paper, we explore how the definition of life takes on an essential character in the ethical debates around health technologies, with life thus being manufactured in the tensions and conflicts around the use of such artefacts and devices. We introduce concepts from science and technology studies (STS) to approach bioethics, overcoming the dualistic conception that separates the natural and the technological and questioning the dominant rationality that divides life into dualities. Drawing on two research projects in which we (...) have been involved in recent years, one regarding biobanks and the other regarding social care robots, we explore how the ethical discussions about biobanks and robots imply particular notions of life. We argue that the contemporary epistemic category of life is a manufactured life in which various rationalities coexist: one rationality based on a separation between the technological and the human, focused on pragmatism and functionalities that tend towards a dualized notion of life divided into qualified and non-qualified life, and another rationality based on a non-essentialist ontology, focused on the mediating role of health technologies, that entails a distributed life appearing as a precarious effect of a network. Each of these rationalities allows the emergence of different issues and ethical concerns, thus enriching the bioethical debate. (shrink)

In the scenario of growing polarization of promises and dangers that surround artificial intelligence (AI), how to introduce responsible AI and robotics in healthcare? In this paper, we develop an ethical–political approach to introduce democratic mechanisms to technological development, what we call “Caring in the In-Between”. Focusing on the multiple possibilities for action that emerge in the realm of uncertainty, we propose an ethical and responsible framework focused on care actions in between fears and hopes. Using the theoretical perspective of (...) Science and Technology Studies and empirical research, “Caring in the In-Between” is based on three movements: the first is a change of focus from the world of promises and dangers to the world of uncertainties; the second is a conceptual shift from assuming a relationship with robotics based on a Human–Robot Interaction to another focused on the network in which the robot is embedded (the “Robot Embedded in a Network”); and the last is an ethical shift from a general normative framework to a discussion on the context of use. Based on these suggestions, “Caring in the In-Between” implies institutional challenges, as well as new practices in healthcare systems. It is articulated around three simultaneous processes, each of them related to practical actions in the “in-between” dimensions considered: monitoring relations and caring processes, through public engagement and institutional changes; including concerns and priorities of stakeholders, with the organization of participatory processes and alternative forms of representation; and making fears and hopes commensurable, through the choice of progressive and reversible actions. (shrink)

Design for Values (DfV) philosophies are a series of design approaches that aim to incorporate human values into the early phases of technological design to direct innovation into beneficial outcomes. The difficulty and necessity of directing advantageous futures for transformative technologies through the application and adoption of value-based design approaches are apparent. However, questions of whose values to design are of critical importance. DfV philosophies typically aim to enrol the stakeholders who may be affected by the emergence of such a (...) technology. However, regardless of which design approach is adopted, all enrolled stakeholders are human ones who propose human values. Contemporary scholarship on metahumanisms, particularly those on posthumanism, have decentred the human from its traditionally privileged position among other forms of life. Arguments that the humanist position is not (and has never been) tenable are persuasive. As such, scholarship has begun to provide a more encompassing ontology for the investigation of nonhuman values. Given the potentially transformative nature of future technologies as relates to the earth and its many assemblages, it is clear that the value investigations of these design approaches fail to account for all relevant stakeholders (i.e., nonhuman animals). This paper has two primary objectives: (1) to argue for the cogency of a posthuman ethics in the design of technologies; and (2) to describe how existing DfV approaches can begin to envision principled and methodological ways of incorporating non-human values into design. To do this, the paper provides a rudimentary outline of what constitutes DfV approaches. It then takes up a unique design approach called Value Sensitive Design (VSD) as an illustrative example. Out of all the other DfV frameworks, VSD most clearly illustrates a principled approach to the integration of values in design. (shrink)

With recent advancements in systems engineering and artificial intelligence, autonomous agents are increasingly being called upon to execute tasks that have normative relevance. These are tasks that directly—and potentially adversely—affect human well-being and demand of the agent a degree of normative-sensitivity and -compliance. Such norms and normative principles are typically of a social, legal, ethical, empathetic, or cultural nature. Whereas norms of this type are often framed in the abstract, or as high-level principles, addressing normative concerns in concrete applications of (...) autonomous agents requires the refinement of normative principles into explicitly formulated practical rules. This paper develops a process for deriving specification rules from a set of high-level norms, thereby bridging the gap between normative principles and operational practice. This enables autonomous agents to select and execute the most normatively favourable action in the intended context premised on a range of underlying relevant normative principles. In the translation and reduction of normative principles to SLEEC rules, we present an iterative process that uncovers normative principles, addresses SLEEC concerns, identifies and resolves SLEEC conflicts, and generates both preliminary and complex normatively-relevant rules, thereby guiding the development of autonomous agents and better positioning them as normatively SLEEC-sensitive or SLEEC-compliant. (shrink)

With recent advancements in systems engineering and artificial intelligence, autonomous agents are increasingly being called upon to execute tasks that have normative relevance. These are tasks that directly—and potentially adversely—affect human well-being and demand of the agent a degree of normative-sensitivity and -compliance. Such norms and normative principles are typically of a social, legal, ethical, empathetic, or cultural (‘SLEEC’) nature. Whereas norms of this type are often framed in the abstract, or as high-level principles, addressing normative concerns in concrete applications (...) of autonomous agents requires the refinement of normative principles into explicitly formulated practical rules. This paper develops a process for deriving specification rules from a set of high-level norms, thereby bridging the gap between normative principles and operational practice. This enables autonomous agents to select and execute the most normatively favourable action in the intended context premised on a range of underlying relevant normative principles. In the translation and reduction of normative principles to SLEEC rules, we present an iterative process that uncovers normative principles, addresses SLEEC concerns, identifies and resolves SLEEC conflicts, and generates both preliminary and complex normatively-relevant rules, thereby guiding the development of autonomous agents and better positioning them as normatively SLEEC-sensitive or SLEEC-compliant. (shrink)

The approach to innovations known as Responsible research and innovation aims to move the innovation system towards creating products that strive to realize social values along with economic benefits. This paper discusses the systematic assessment of assistive technologies in order for them to meet the aims expressed in RRI. A central issue in the discussion is how to facilitate an integration of insights from the discourse on RRI with more established assessment approaches such as Health Technology Assessment. Based on the (...) literature on existing socio-ethical assessment tools, I investigate how these tools can be combined with HTA and how they can add perspectives from RRI that might increase the socio-ethical value of assistive technologies. Through a discussion on how to understand RRI, HTA, assessment and integration, I suggest a list of four possible approaches that have the potential to be applied as assessment approaches that integrate insights from RRI and HTA. These are then evaluated on their ability to address issues that have emerged from a literature review on RRI and assistive technologies, on empirical studies in this technology field and on their product focus. In conclusion, I argue that the Ethical Impact Assessment, the Socratic approach, the Ethical Matrix, and the HTA Core Model seem to be the most promising methodologies, but that these need adjustments to cover substantive themes from RRI. _Keywords:_ energy scenarios, justice, future generations, capabilities approach. (shrink)

The ethics of artificial intelligence is a widely discussed topic. There are numerous initiatives that aim to develop the principles and guidance to ensure that the development, deployment and use of AI are ethically acceptable. What is generally unclear is how organisations that make use of AI understand and address these ethical issues in practice. While there is an abundance of conceptual work on AI ethics, empirical insights are rare and often anecdotal. This paper fills the gap in our current (...) understanding of how organisations deal with AI ethics by presenting empirical findings collected using a set of ten case studies and providing an account of the cross-case analysis. The paper reviews the discussion of ethical issues of AI as well as mitigation strategies that have been proposed in the literature. Using this background, the cross-case analysis categorises the organisational responses that were observed in practice. The discussion shows that organisations are highly aware of the AI ethics debate and keen to engage with ethical issues proactively. However, they make use of only a relatively small subsection of the mitigation strategies proposed in the literature. These insights are of importance to organisations deploying or using AI, to the academic AI ethics debate, but maybe most valuable to policymakers involved in the current debate about suitable policy developments to address the ethical issues raised by AI. (shrink)

Over the last 20 yr, neurosurgical robots have been increasingly assisting in neurosurgical procedures. Surgical robots are considered to have noticeable advantages over humans, such as reduction of procedure time, surgical dexterity, no experience of fatigue and improved healthcare outcomes. In recent years, neurosurgical robots have been developed to perform various procedures. Public demand is informing the direction of neurosurgery and placing greater pressure on neurosurgeons to use neurosurgical robots. The increasing diversity and sophistication of neurosurgical robots have received ethical (...) scrutiny due to the surgical complications that may arise as well as the role of robots in the future. In this paper, we address 3 ethical areas regarding neurosurgical robots: Loss of neurosurgical skills due to increasing dependency on robots; How far do we want to go with neurosurgical robots? Neurosurgical robots and conflict of interest and medical bias. (shrink)

Informed by scholarship in dance studies, this essay examines the popular phenomenon of the dancing robot. It begins with an analysis of social robotics experiments that use techniques of contemporary experimental theater to frame human–robot interactions. With elements of theater history in mind, it becomes evident that such experimental designs fruitfully destabilize common understandings of social robots, theatrical performance, and dance movement. This sets up a discussion of a co-creative approach to developing robot choreography which utilizes compositional techniques from experimental (...) dance to, among other things, avoid cultural appropriation. Taken together, these points show that, because dance movement is culturally laden, scholarship in dance studies should be considered when designing dancing robots. (shrink)

Wearable robots and exoskeletons are relatively new technologies designed for assisting and augmenting human motor functions. Due to their different possible design applications and their intimate connection to the human body, they come with specific ethical, legal, and social issues, which have not been much explored in the recent ELS literature. This paper draws on expert consultations and a literature review to provide a taxonomy of the most important ethical, legal, and social issues of wearable robots. These issues are categorized (...) in wearable robots and the self, wearable robots and the other, and wearable robots in society. (shrink)

A number of Artificial Intelligence (AI) ethics frameworks have been published in the last 6 years in response to the growing concerns posed by the adoption of AI in different sectors, including healthcare. While there is a strong culture of medical ethics in healthcare applications, AI-based Healthcare Applications (AIHA) are challenging the existing ethics and regulatory frameworks. This scoping review explores how ethics frameworks have been implemented in AIHA, how these implementations have been evaluated and whether they have been successful. (...) AI specific ethics frameworks in healthcare appear to have a limited adoption and they are mostly used in conjunction with other ethics frameworks. The operationalisation of ethics frameworks is a complex endeavour with challenges at different levels: ethics principles, design, technology, organisational, and regulatory. Strategies identified in this review are proactive, contextual, technological, checklist, organisational and/or evidence-based approaches. While interdisciplinary approaches show promises, how an ethics framework is implemented in an AI-based Healthcare Application is not widely reported, and there is a need for transparency for trustworthy AI. (shrink)

Artificial intelligence is increasingly inputting into various human resource management functions, such as sourcing job applicants and selecting staff, allocating work, and offering personalized career coaching. While the use of AI for such tasks can offer many benefits, evidence suggests that without careful and deliberate implementation its use also has the potential to generate significant harms. This raises several ethical concerns regarding the appropriateness of AI deployment to domains such as HRM, which directly deal with managing sometimes sensitive aspects of (...) individuals’ employment lifecycles. However, research at the intersection of HRM and technology continues to largely center on examining what AI can be used for, rather than focusing on the salient factors relevant to its ethical use and examining how to effectively engage human workers in its use. Conversely, the ethical AI literature offers excellent guiding principles for AI implementation broadly, but there remains much scope to explore how these principles can be enacted in specific contexts-of-use. By drawing on ethical AI and task-technology fit literature, this paper constructs a decision-making framework to support the ethical deployment of AI for HRM and guide determinations of the optimal mix of human and machine involvement for different HRM tasks. Doing so supports the deployment of AI for the betterment of work and workers and generates both scholarly and practical outcomes. (shrink)

The ethics of emerging forms of artificial intelligence has become a prolific subject in both academic and public spheres. A great deal of these concerns flow from the need to ensure that these technologies do not cause harm—physical, emotional or otherwise—to the human agents with which they will interact. In the literature, this challenge has been met with the creation of artificial moral agents: embodied or virtual forms of artificial intelligence whose decision procedures are constrained by explicit normative principles, requiring (...) the implementation of what is commonly called artificial morality into these agents. To date, the types of reasoning structures and principles which inform artificial morality have been of two kinds: first, an ethically maximal vision of artificial morality which relies on the strict implementation of traditional moral theories such as Kantian deontology or Utilitarianism, and second, a more minimalist vision which applies stochastic AI techniques to large data sets of human moral preferences so as to illicit or intuit general principles and preferences for the design of artificial morality. Taken individually, each approach is unable to fully answer the challenge of producing inoffensive behavior in artificial moral agents, most especially since both forms are unable to strike a balance between the ideal set of constraints which morality imposes on one hand, and the types of constraints public acceptability imposes, on the other. We provide an alternative approach to the design of artificial morality, the Ethical Valence Theory, whose purpose is to accommodate this balance, and apply this approach to the case of autonomous vehicles. (shrink)