Zusammenfassung Der Diskurs um emotions- und soziosensitive Roboter in der Pflege kann aktuell eher als Ausdruck eines technologischen Solutionismus interpretiert werden, denn als realitätsgerechte Beschreibung des pflegerischen Alltags. Aus ethischer Perspektive ist demnach weniger drängend die Frage zu beantworten, wie die Systeme bzw. deren Einsatz aktuell konkret bewertet werden können, sondern welche Rolle dieser KI-gestützten Systemart in den Technikvisionen und -fiktionen zugeschrieben wird und welche normativen Aspekte bei der Entwicklung und dem Einsatz zukünftig Beachtung finden sollten. Dazu werden Elemente eines (...) anthropologischen und ethischen Reflexionsraums skizziert, welcher Aspekte benennt, die bei der Entwicklung dieser Art von Technik zu bedenken sind. Um fundierte ethische Urteilsbildung zu ermöglichen, wird eine fünfdimensionale Heuristik präsentiert, die anhand der Dimensionen Emotion, Interaktion, Kontext, Akteur und Aktant eine konkrete Situationsanalyse gestattet. Auf dieser empirisch informierten Basis können implementierbare technische Lösungen entwickelt werden bzw. bereits entwickelte ethisch evaluiert werden. (shrink)

Current national and international guidelines for the ethical design and development of artificial intelligence (AI) and robotics emphasize ethical theory. Various governing and advisory bodies have generated sets of broad ethical principles, which institutional decisionmakers are encouraged to apply to particular practical decisions. Although much of this literature examines the ethics of designing and developing AI and robotics, medical institutions typically must make purchase and deployment decisions about technologies that have already been designed and developed. The primary problem facing medical (...) institutions is not one of ethical design but of ethical deployment. The purpose of this paper is to develop a practical model by which medical institutions may make ethical deployment decisions about ready-made advanced technologies. Our slogan is “more process, less principles.” Ethically sound decisionmaking requires that the process by which medical institutions make such decisions include participatory, deliberative, and conservative elements. We argue that our model preserves the strengths of existing frameworks, avoids their shortcomings, and delivers its own moral, practical, and epistemic advantages. (shrink)

Socially assistive devices such as care robots or companions have been advocated as a promising tool in elderly care in Western healthcare systems. Ethical debates indicate various challenges. An important part of the ethical evaluation is to understand how users interact with these devices and how interaction influences users’ perceptions and their ability to express themselves. In this review, we report and critically appraise findings of non-comparative empirical studies with regard to these effects from an ethical perspective.Electronic databases and other (...) sources were queried using a comprehensive search strategy generating 9851 records. Studies were screened independently by two authors. Methodological quality of studies was assessed. For 22 reports on 21 datasets using a non-comparative design a narrative synthesis was performed.Data shows positive findings in regard to attitudes and emotional reactions of users. Varying perception of a social relation and social presence are the most commonly observed traits of interaction. Users struggle with understanding technical complexities while functionality of the devices is limited. This leads to a behavioral alignment of users towards the requirements of the devices to be able to make use of them.This evidence adds to three important ethical debates on the use of socially assistive devices in healthcare in regard to (1) reliability of existing empirical evidence to inform normative judgements, (2) ethical significance of the social presence of devices and (3) user autonomy in regard to behavioral alignment. (shrink)

The implementation of care robotics in care settings is identified by some authors as a disruptive innovation, in the sense that it will upend the praxis of care. It is an open ethical question whether this alleged disruption will also have a transformative impact on established ethical concepts and principles. One prevalent worry is that the implementation of care robots will turn deception into a routine component of elderly care, at least to the extent that these robots will function as (...) simulacra for something that they are not (i.e. human caregivers). At face value, this may indeed seem to indicate a concern for how this technology may upend existing practices and relationships within a care setting. Yet, on closer inspection, this reaction may rather point to a rediscovery and a revaluation of a particularly well-entrenched value or virtue, i.e. veracity. The virtue of veracity is one of the values that is mobilized to argue against a substitution of human caregivers (while a combination of care robots and human caregivers is much more accepted). The subject of this paper is to explore how the moral panic surrounding care robots should not so much be interpreted as an anticipated and probable disruptor in a care setting, but rather as a sensitizing – in a way conservationist – argument that identifies veracity as an established value that is supposed to be protected and advanced in present day and future care settings. (shrink)

With robots being introduced into caregiving, particularly for older persons, various ethical concerns are raised. Among them is the fear of replacing human caregiving. While ethical concepts like well-being, autonomy, and capabilities are often used to discuss these concerns, this paper brings forth the concept of social dignity to further develop guidelines concerning the use of robots in caregiving. By social dignity, we mean that a person’s perceived dignity changes in response to certain interactions and experiences with other persons. In (...) this paper, we will first present the concept of social dignity, and then identify a niche where robots can be used in caregiving in an ethical manner. Specifically, we will argue that, because some activities of daily living are performed in solitude to maintain dignity, a care recipient will usually prefer robotic assistance instead of human assistance for these activities. Secondly, we will describe how other philosophical concepts, which have been commonly used to judge robotic assistance in caregiving for the elderly so far, such as well-being, autonomy, and capabilities, are less useful in determining whether robotic assistance in caregiving is ethically problematic or not. To conclude, we will argue that social dignity offers an advantage to the other concepts, as it allows to ask the most pressing questions in caregiving. (shrink)

BackgroundArtificial intelligence has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have potential for advancing health equity within and between countries, we must consider the ethical implications of its deployment in order to mitigate its potential harms, particularly for the most vulnerable. This scoping review addresses the following question: (...) What ethical issues have been identified in relation to AI in the field of health, including from a global health perspective?MethodsEight electronic databases were searched for peer reviewed and grey literature published before April 2018 using the concepts of health, ethics, and AI, and their related terms. Records were independently screened by two reviewers and were included if they reported on AI in relation to health and ethics and were written in the English language. Data was charted on a piloted data charting form, and a descriptive and thematic analysis was performed.ResultsUpon reviewing 12,722 articles, 103 met the predetermined inclusion criteria. The literature was primarily focused on the ethics of AI in health care, particularly on carer robots, diagnostics, and precision medicine, but was largely silent on ethics of AI in public and population health. The literature highlighted a number of common ethical concerns related to privacy, trust, accountability and responsibility, and bias. Largely missing from the literature was the ethics of AI in global health, particularly in the context of low- and middle-income countries.ConclusionsThe ethical issues surrounding AI in the field of health are both vast and complex. While AI holds the potential to improve health and health systems, our analysis suggests that its introduction should be approached with cautious optimism. The dearth of literature on the ethics of AI within LMICs, as well as in public health, also points to a critical need for further research into the ethical implications of AI within both global and public health, to ensure that its development and implementation is ethical for everyone, everywhere. (shrink)

As people grow old, many risk becoming chronically lonely which is associated with e.g. depression, dementia, and increased mortality. Whoever else should help to protect them from this risk, various philosophers have argued that any children that they might have will often be among them. Proceeding on this assumption, this article considers what filial duties to protect ageing parents from loneliness consist of, or might consist of. I develop my answer by showing that a view that may be intuitively plausible, (...) namely that they simply require children to visit their ageing parents regularly when they can do so at reasonable cost and call, text, and/or email them from time to time, is defective in three respects. First, it ignores children’s potential responsibilities to encourage and/or facilitate social interaction between their parents and third parties. Second, it ignores their potential responsibilities to help provide their parents with non-human companionship. Third, it elides over their duties to coordinate their efforts to offer loneliness protection with others. What I end up proposing instead, then, is an approach for protecting ageing parents from loneliness that is multi-faceted. (shrink)

Healthcare is becoming increasingly automated with the development and deployment of care robots. There are many benefits to care robots but they also pose many challenging ethical issues. This paper takes care robots for the elderly as the subject of analysis, building on previous literature in the domain of the ethics and design of care robots. Using the value sensitive design approach to technology design, this paper extends its application to care robots by integrating the values of care, values that (...) are specific to AI, and higher-scale values such as the United Nations Sustainable Development Goals. The ethical issues specific to care robots for the elderly are discussed at length alongside examples of specific design requirements that work to ameliorate these ethical concerns. (shrink)

ObjectiveTo present (1) the ethical concepts related to the debate on resuscitation of extremely premature infants (EPIs) as they are described in the ethical literature; and (2) the ethical arguments based on these concepts.DesignWe conducted a systematic review of the ethical literature. We selected articles based on the following predefined inclusion/exclusion criteria: (1) English language articles (2) presenting fully elaborated ethical arguments (3) on resuscitation (4) of EPIs, that is, infants born before 28 weeks of gestation.AnalysisAfter repeated reading of articles, (...) we developed individual summaries, conceptual schemes and an overall conceptual scheme. Ethical arguments and concepts were identified and analysed.ResultsForty articles were included out of 4709 screened. Personhood, best interest, autonomy and justice were concepts grounding the various arguments. Regarding these concepts, included authors agreed that the best interest principle should guide resuscitation decisions, whereas justice seemed the least important concept. The arguments addressed two questions: Should we resuscitate EPIs? Who should decide? Included authors agreed that not all EPIs should be resuscitated but disagreed on what criteria should ground this decision. Overall, included authors agreed that both parents and physicians should contribute to the decision.ConclusionsThe included publications suggest that while the best interest is the main concept guiding resuscitation decisions, justice is the least important. The included authors also agree that both parents and physicians should be actively involved in resuscitation decisions for EPIs. However, our results suggest that parents’ decision should be over-ridden when in contrast with the EPI’s best interest. (shrink)

There is an urge to introduce high technology and robotics in care settings. Assisted living (AL) is the fastest growing form of older adults’ long-term care. Resident autonomy has become the watchword for good care. This article sheds light on the potential effects of care robotics on the sense of autonomy of older people in AL. Three aspects of the residents’ sense of autonomy are of particular interest: (a) interaction-based sense of autonomy, (b) coping-based sense of autonomy, and (c) potential-based (...) sense of autonomy. Ethnographical data on resident autonomy in an AL facility and existing literature on care robots are utilized in studying what kind of assurances different types of robots would provide to maintain the sense of autonomy in AL. Robots could strengthen the different types of sense of autonomy in multiple ways. Different types of robots could widen the residents’ space of daily movements, sustain their capacities, and help them maintain and even create future expectations. Robots may strengthen the sense of autonomy of older persons in AL; however, they may simultaneously pose a threat. Multi-professional discussions are needed on whether robots are welcomed in care, and if they are, how, for whom, and in what areas. (shrink)

Background: The debate over the ethical implications of care robots has raised a range of concerns, including the possibility that such technologies could disrupt caregiving as a core human moral activity. At the same time, academics in information ethics have argued that we should extend our ideas of moral agency and rights to include intelligent machines. Research objectives: This article explores issues of the moral status and limitations of machines in the context of care. Design: A conceptual argument is developed, (...) through a four-part scheme derived from the work of Alasdair MacIntyre. No empirical data are used. Ethical consideration: No primary data were gathered for this study. Secondary sources and authorship have been acknowledged throughout. Findings / discussion: Certain kinds of social experience, including the narrative unity of a life, and the giving and receiving of care, are essential for moral development. Machines, no matter how advanced, cannot participate in such experiences in key respects, and thus cannot develop as practical reasoners. Conclusion: It follows that they cannot be moral agents and that they cannot care. There are, it seems, no such things as care robots. In view of the institutional power of tech companies and commissioning bodies, care practitioners need to take more of a lead in developing new assistive technologies which are appropriate to their practice. (shrink)

A large share of countries is struggling to provide adequate care to their older populations. To deal with this challenge, philosopher Ingrid Robeyns has advocated legislation that requires (most) citizens to spend 1 year of their life providing dependency care. My aim of this contribution is to strengthen the case for this proposal, which I will refer to as a ‘universal care conscription’. I do so by defending this type of conscription against various alternative ways of addressing care-deficits that have (...) been proposed. As I show, not only is it doubtful whether pursuing these alternatives will always, or even generally, suffice to prevent and/or alleviate care-deficits at reasonable financial and moral cost, a universal care conscription has significant civic benefits in an age of polarization that count strongly in its favour. (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)

Healthcare robots enable practices that seemed far-fetched in the past. Robots might be the solution to bridge the loneliness that the elderly often experience; they may help wheelchair users walk again, or may help navigate the blind. European Institutions, however, acknowledge that human contact is an essential aspect of personal care and that the insertion of robots could dehumanize caring practices. Such instances of human–robot interactions raise the question to what extent the use and development of robots for healthcare applications (...) can challenge the dignity of users. In this article, therefore, we explore how different robot applications in the healthcare domain support individuals in achieving ‘dignity’ or pressure it. We argue that since healthcare robot applications are novel, their associated risks and impacts may be unprecedented and unknown, thus triggering the need for a conceptual instrument that is binding and remains flexible at the same time. In this respect, as safety rules and data protection are often criticized to lack flexibility, and technology ethics to lack enforceability, we suggest human dignity as the overarching governance instrument for robotics, which is the inviolable value upon which all fundamental rights are grounded. (shrink)

Background Advances in artificial intelligence, robotics and wearable computing are creating novel technological opportunities for mitigating the global burden of population ageing and improving the quality of care for older adults with dementia and/or age-related disability. Intelligent assistive technology is the umbrella term defining this ever-evolving spectrum of intelligent applications for the older and disabled population. However, the implementation of IATs has been observed to be sub-optimal due to a number of barriers in the translation of novel applications from the (...) designing labs to the bedside. Furthermore, since these technologies are designed to be used by vulnerable individuals with age- and multi-morbidity-related frailty and cognitive disability, they are perceived to raise important ethical challenges, especially when they involve machine intelligence, collect sensitive data or operate in close proximity to the human body. Thus, the goal of this paper is to explore and assess the ethical issues that professional stakeholders perceive in the development and use of IATs in elderly and dementia care. Methods We conducted a multi-site study involving semi-structured qualitative interviews with researchers and health professionals. We analyzed the interview data using a descriptive thematic analysis to inductively explore relevant ethical challenges. Results Our findings indicate that professional stakeholders find issues of patient autonomy and informed consent, quality of data management, distributive justice and human contact as ethical priorities. Divergences emerged in relation to how these ethical issues are interpreted, how conflicts between different ethical principles are resolved and what solutions should be implemented to overcome current challenges. Conclusions Our findings indicate a general agreement among professional stakeholders on the ethical promises and challenges raised by the use of IATs among older and disabled users. Yet, notable divergences persist regarding how these ethical challenges can be overcome and what strategies should be implemented for the safe and effective implementation of IATs. These findings provide technology developers with useful information about unmet ethical needs. Study results may guide policy makers with firsthand information from relevant stakeholders about possible solutions for ethically-aligned technology governance. (shrink)

Robot is definitely playing important role in human society. Low contact on machine standards is mostly on industrial robot while close contacts are in increasing demand in service robot, etc. The development of robotics with advanced hardware and artificial intelligence (AI) provide the possibility with human beings while close contacts raise many new issues on ethics and risks. For interaction, the related technique of perception, cognition and interaction are briefly introduced. For ethics, rules should be given for the robot designers (...) to include ethics for certain application while risks should be evaluated during the experiment test. To make efficient decision, safety design with AI technology should be put on agenda for roboticists. Except from the risks, ethics raise many challenges while most of them can be solved by developing technologies while some of the problems exist in human’s society which also raise the questions for the human beings. More broader vision should be taken from different social departments together to avoid the possible embarrassed issues. It’s time to welcome the world of robotics and related techniques will make life more efficient while human-robot coexistence society will come one day and law should be imposed on both. (shrink)

BackgroundSocially 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.MethodsElectronic 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.ResultsThe 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.DiscussionWe 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. (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 (SARs) 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: (1) stakeholders’ intuitions about SAR use as sources of knowledge; (2) interpretative dialogues as democratic spaces to discuss the ethics of SAR use; (3) the concretisation of ethics in SAR use. (shrink)

Faced with relatively old and ageing populations, a growing number of higher-income countries are struggling to provide affordable and decent care to their older citizens. This contribution proposes a new policy for dealing with this challenge. Under certain conditions, I argue that states should pay their citizens to move to foreign care homes in order to ease the pressure on domestic care institutions. This is the case if—but not necessarily only if— a significant proportion of resident citizens do not currently (...) have access to adequate aged and nursing care; the care in the foreign care homes is not worse than the one that is available in domestic care homes; sending states conduct regular checks to ascertain that the level of care abroad is not worse or delegate this task to reliable local monitoring bodies; appropriate measures have been taken to ensure that this type of migration does not harm local residents; and the public money spent on the payments is not better spent on other ways of easing the pressure on domestic care institutions. I end by defending the proposed payments against the objection that they create morally problematic inequalities by exerting greater pressure on members of lower socioeconomic classes to migrate than on their more affluent compatriots. (shrink)