In this critique, Martha Nussbaum argues that our dominant theories of development have given us policies that ignore our most basic human needs for dignity and self-respect.

In controversies about technology and society, there is no idea more pro vocative than the notion that technical things have political qualities. At issue is the claim that the machines, structures, and systems of modern material culture can be accurately judged not only for their contributions of efficiency and pro-ductivity, not merely for their positive and negative environmental side effects, but also for the ways in which they can embody specific forms of power and authority. Since ideas of this kind (...) have a persistent and troubling presence in discussions about the meaning of technology, they deserve explicit attention... (shrink)

Modern technology has enabled the use of new forms of information in the care of critically ill patients. In intensive care units (ICUs), technology can simultaneously reduce the lived experience of illness and magnify the objective dimensions of patient care. The aim of this study, based upon two empirical studies, is to find from a philosophical point of view a more comprehensive understanding for the dominance of technology within intensive care. Along with caring for critically ill patients, technology is part (...) of the ICU staff's everyday life. Both technology and caring relationships are of indispensable value. Tools are useful, but technology can never replace the closeness and empathy of the human touch. It is a question of harmonizing the demands of subjectivity with objective signs. The challenge for caregivers in ICU is to know when to heighten the importance of the objective and measurable dimensions provided by technology and when to magnify the patients’ lived experiences, and to live and deal with the ambiguity of the technical dimension of care and the human side of nursing. (shrink)

One of the most significant changes in modern healthcare delivery has been the evolution of the paper record to the electronic health record (EHR). In this paper we argue that the primary change has been a shift in the focus of documentation from monitoring individual patient progress to recording data pertinent to Institutional Priorities (IPs). The specific IPs to which we refer include: finance/reimbursement; risk management/legal considerations; quality improvement/safety initiatives; meeting regulatory and accreditation standards; and patient care delivery/evidence based practice. (...) Following a brief history of the transition from the paper record to the EHR, the authors discuss unintended or contested consequences resulting from this change. These changes primarily reflect changes in the organization and amount of clinician work and clinician‐patient relationships. The paper is not a research report but was informed by an institutional ethnography the aim of which was to understand how the EHR impacted clinicians and administrators in a large, urban hospital in the United States. The paper was also informed by other sources, including the philosophies of Jacques Ellul, Don Idhe, and Langdon Winner. (shrink)

This paper offers an ethical framework for the development of robots as home companions that are intended to address the isolation and reduced physical functioning of frail older people with capacity, especially those living alone in a noninstitutional setting. Our ethical framework gives autonomy priority in a list of purposes served by assistive technology in general, and carebots in particular. It first introduces the notion of “presence” and draws a distinction between humanoid multi-function robots and non-humanoid robots to suggest that (...) the former provide a more sophisticated presence than the latter. It then looks at the difference between lower-tech assistive technological support for older people and its benefits, and contrasts these with what robots can offer. This provides some context for the ethical assessment of robotic assistive technology. We then consider what might need to be added to presence to produce care from a companion robot that deals with older people’s reduced functioning and isolation. Finally, we outline and explain our ethical framework. We discuss how it combines sometimes conflicting values that the design of a carebot might incorporate, if informed by an analysis of the different roles that can be served by a companion robot. (shrink)

The three dialogues in this contribution concern 21st century application of life‐like robots in the care of older adults. They depict conversations set in the near future, involving a philosopher (Dr Phonius) and a nurse (Dr Myloss) who manages care at a large facility for assisted living. In their first dialogue, the speakers discover that their quite different attitudes towards human‐robot interaction parallel fundamental differences separating their respective concepts of consciousness. The second dialogue similarly uncovers deeply contrasting notions of personhood (...) that appear to be associated with respective communities of nursing and robotics. The additional key awareness that arises in their final dialogue links applications of life‐like robots in the care of older adults with potential transformations in our understandings of ourselves – indeed, in our understandings of the nature of our own humanity. This series of dialogues, therefore, appears to address a topic in nursing philosophy that merits our careful attention. (shrink)

Nurses and ethicists worry that the implementation of care at a distance or telecare will impoverish patient care by taking out ‘the heart’ of the clinical work. This means that telecare is feared to induce the neglect of patients, and to possibly hinder the development of a personal relation between nurse and patient. This study aims to analyse whether these worries are warranted by analysing Dutch care practices using telemonitoring in care for chronic patients in the Netherlands. How do clinical (...) practices of nursing change when telecare devices are introduced and what this means for notions and norms of good nursing? The paper concludes that at this point the practices studied do not warrant the fear of negligence and compromised relations. Quite the contrary; in the practices studied, telecare lead to more frequent and more specialised contacts between nurses and patients. The paper concludes by reflecting on the ethical implications of these changes. (shrink)

According to the most important theories of justice, personal dignity is closely related to independence, and the care that people with disabilities receive is seen as a way for them to achieve the greatest possible autonomy. However, human beings are naturally subject to periods of dependency, and people without disabilities are only “temporarily abled.” Instead of seeing assistance as a limitation, we consider it to be a resource at the basis of a vision of society that is able to account (...) for inevitable dependency relationships between “unequals” ensuring a fulfilling life both for the carer and the cared for.**. (shrink)

The growing proportion of elderly people in society, together with recent advances in robotics, makes the use of robots in elder care increasingly likely. We outline developments in the areas of robot applications for assisting the elderly and their carers, for monitoring their health and safety, and for providing them with companionship. Despite the possible benefits, we raise and discuss six main ethical concerns associated with: (1) the potential reduction in the amount of human contact; (2) an increase in the (...) feelings of objectification and loss of control; (3) a loss of privacy; (4) a loss of personal liberty; (5) deception and infantilisation; (6) the circumstances in which elderly people should be allowed to control robots. We conclude by balancing the care benefits against the ethical costs. If introduced with foresight and careful guidelines, robots and robotic technology could improve the lives of the elderly, reducing their dependence, and creating more opportunities for social interaction. (shrink)

Over the course of its first seven editions, Principles of Biomedical Ethics has proved to be, globally, the most widely used, authored work in biomedical ethics. It is unique in being a book in bioethics used in numerous disciplines for purposes of instruction in bioethics. Its framework of moral principles is authoritative for many professional associations and biomedical institutions-for instruction in both clinical ethics and research ethics. It has been widely used in several disciplines for purposes of teaching in the (...) classroom, during conferences, etc. (shrink)

Virginia Held assesses the ethics of care as a promising alternative to the familiar moral theories that serve so inadequately to guide our lives. The ethics of care is only a few decades old, yet it is by now a distinct moral theory or normative approach to the problems we face. It is relevant to global and political matters as well as to the personal relations that can most clearly exemplify care. This book clarifies just what the ethics of care (...) is: what its characteristics are, what it holds, and what it enables us to do. It discusses the feminist roots of this moral approach and why the ethics of care can be a morality with universal appeal. Held examines what we mean by "care," and what a caring person is like. Where other moral theories demand impartiality above all, the ethics of care understands the moral import of our ties to our families and groups. It evaluates such ties, focusing on caring relations rather than simply on the virtues of individuals. The book proposes how such values as justice, equality, and individual rights can "fit together" with such values as care, trust, mutual consideration, and solidarity. In the second part of the book, Held examines the potential of the ethics of care for dealing with social issues. She shows how the ethics of care is more promising than Kantian moral theory and utilitarianism for advice on how expansive, or not, markets should be, and on when other values than market ones should prevail. She connects the ethics of care with the rising interest in civil society, and considers the limits appropriate for the language of rights. Finally, she shows the promise of the ethics of care for dealing with global problems and seeing anew the outlines of international civility. (shrink)

It is remarkable how much robotics research is promoted by appealing to the idea that the only way to deal with a looming demographic crisis is to develop robots to look after older persons. This paper surveys and assesses the claims made on behalf of robots in relation to their capacity to meet the needs of older persons. We consider each of the roles that has been suggested for robots in aged care and attempt to evaluate how successful robots might (...) be in these roles. We do so from the perspective of writers concerned primarily with the quality of aged care, paying particular attention to the social and ethical implications of the introduction of robots, rather than from the perspective of robotics, engineering, or computer science. We emphasis the importance of the social and emotional needs of older persons—which, we argue, robots are incapable of meeting—in almost any task involved in their care. Even if robots were to become capable of filling some service roles in the aged-care sector, economic pressures on the sector would most likely ensure that the result was a decrease in the amount of human contact experienced by older persons being cared for, which itself would be detrimental to their well-being. This means that the prospects for the ethical use of robots in the aged-care sector are far fewer than first appears. More controversially, we believe that it is not only misguided, but actually unethical, to attempt to substitute robot simulacra for genuine social interaction. A subsidiary goal of this paper is to draw attention to the discourse about aged care and robotics and locate it in the context of broader social attitudes towards older persons. We conclude by proposing a deliberative process involving older persons as a test for the ethics of the use of robots in aged care. (shrink)

Following the success of Sony Corporation’s “AIBO”, robot cats and dogs are multiplying rapidly. “Robot pets” employing sophisticated artificial intelligence and animatronic technologies are now being marketed as toys and companions by a number of large consumer electronics corporations. -/- It is often suggested in popular writing about these devices that they could play a worthwhile role in serving the needs of an increasingly aging and socially isolated population. Robot companions, shaped like familiar household pets, could comfort and entertain lonely (...) older persons. This goal is misguided and unethical. While there are a number of apparent benefits that might be thought to accrue from ownership of a robot pet, the majority and the most important of these are predicated on mistaking, at a conscious or unconscious level, the robot for a real animal. For an individual to benefit significantly from ownership of a robot pet they must systematically delude themselves regarding the real nature of their relation with the animal. It requires sentimentality of a morally deplorable sort. Indulging in such sentimentality violates a (weak) duty that we have to ourselves to apprehend the world accurately. The design and manufacture of these robots is unethical in so far as it presupposes or encourages this delusion. -/- The invention of robot pets heralds the arrival of what might be called “ersatz companions” more generally. That is, of devices that are designed to engage in and replicate significant social and emotional relationships. The advent of robot dogs offers a valuable opportunity to think about the worth of such companions, the proper place of robots in society and the value we should place on our relationships with them. (shrink)

Technikethik, wie sie in diesem Handbuch verstanden wird, zielt primär darauf, durch ethische Reflexion zu ›richtigen‹ Entscheidungen in der Sache beizutragen, also in der Gestaltung und Nutzung von Technik und zum Umgang mit ihren Folgen. Technik wird als embedded technology von Beginn an in einem gesellschaftlichen Kontext gesehen, in dem bereits von ersten Designüberlegungen über die Produktion, Nutzung bis zur Entsorgung jeweils Entscheidungen zu treffen sind, die eine moralische Dimension haben und damit einer ethischen Reflexion offenstehen oder sie sogar verlangen. (...) In der Technikethik geht es primär um ›politikpflichtige‹ Elemente an Technik wie z. B. Sicherheit- und Umweltstandards, den Schutz der Bürger vor Eingriffen in Bürgerrechte, Prioritätensetzung in der Forschungspolitik, die Gestaltung von Rahmenbedingungen für Innovation etc., so wie sie hier verstanden wird. (shrink)

Aging populations have become a major concern in the developed world and are expected to require novel care strategies. Public policies, health-care regimes and technology developers alike stress the need for a more individualized care to meet the increased demand for care services in response to demographic change. Increasingly, care services are offered to individuals with diseases and or disabilities in their homes by means of Personalized Health-Monitoring (PHM) technologies. PHM-based home care is typically portrayed as the key to a (...) cost-effective future care that better can accommodate the needs of an aging population and promote care recipients’ independence. In light of the emerging technology-based home care, this article sets forth to investigate the significance and implications of a strong emphasis on independence in relation to this novel care form. Notions of independence as used by care planners, care providers and technology developers are examined in relation to ICT-based home care and the reasonableness of independence as an aim for future health-care is critically discussed. In conclusion, the need for a shift from a strong emphasis on independence to a right to healthy dependence is advocated. (shrink)

Nursing Sciences are at a moment of paradigmatic transition. The aim of this paper is to reflect on the new epistemological paradigms of nursing science from a critical approach. In this paper, we identified and analysed some new research lines and trends which anticipate the reorganization of nursing sciences and the paradigms emerging from nursing care: biotechnology‐centred knowledge; the interface between nursing knowledge and new information technologies; body care centred knowledge; the human body as a cyborg body; and the rediscovery (...) of an aesthetic knowledge in nursing care. (shrink)

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

Der Technikbegriff geht auf die aristotelische Unterscheidung von ›natürlich‹ und ›künstlich‹ zurück. Während das Natürliche den Grund seines Entstehens und Werdens in sich selbst trägt, also ›Gewordenes‹ ist, bezeichnet techne das künstlich vom Menschen im Rahmen herstellender Tätigkeit Hervorgebrachte. Damit wurde der Begriff der Technik in die Sphäre menschlicher Kultur gestellt und als Gegennatur beschrieben. Wenn gelegentlich Honigwaben oder Termitenbauten als technische Erzeugnisse der betreffenden Spezies dargestellt werden, handelt es sich bloß um eine metaphorische Redeweise.

The American Journal of Bioethics, Volume 12, Issue 9, Page 53-55, September 2012.

In Europe, telecare is the use of remote monitoring technology to enable vulnerable people to live independently in their own homes. The technology includes electronic tags and sensors that transmit information about the user's location and patterns of behavior in the user's home to an external hub, where it can trigger an intervention in an emergency. Telecare users in the United Kingdom sometimes report their unease about being monitored by a ?Big Brother,? and the same kind of electronic tags that (...) alert telecare hubs to the movements of someone with dementia who is ?wandering? are worn by terrorist suspects who have been placed under house arrest. For these and other reasons, such as ordinary privacy concerns, telecare is sometimes regarded as an objectionable extension of a ?surveillance state.? In this article, we defend the use of telecare against the charge that it is Orwellian. In the United States, the conception of telecare primarily as telemedicine, and the fact that it is not typically a government responsibility, make a supposed connection with a surveillance state even more doubtful than in Europe. The main objection, we argue, to telecare is not its intrusiveness, but the danger of its deepening the isolation of those who use it. There are ways of organizing telecare so that the independence and privacy of users are enhanced, but personal isolation may be harder to address. As telecare is a means of reducing the cost of publicly provided social and health care, and the need to reduce public spending is growing, the correlative problem of isolation must be addressed alongside the goal of promoting independence. (shrink)

In the last few decades, the ethics of care as a feminist ethic has given rise to extensive literature, and has affected moral inquiries in many areas. It offers a distinctive challenge to the dominant moral theories: Kantian moral theory, utilitarianism, and virtue ethics. This chapter outlines the distinctive features and promising possibilities of the ethics of care, and the criticisms that have been made against it. It then examines the ethics of care’s recognition of human dependency and of the (...) importance of responding to needs; its interpretation of the roles of emotion and reason in moral understanding; and its critique of liberal individualism and development of a conception of the person as relational. The ethics of care contrasts care with justice, tries to integrate them, and reconceptualizes public and private life and morality. (shrink)

This philosophical enquiry considers the impact of a global world view and technology on the meaning of being human. The global vision increases our awareness of the common bond between all humans, while technology tends to separate us from an understanding of ourselves as human persons. We review some advances in connecting as community within our world, and many examples of technological changes. This review is not exhaustive. The focus is to understand enough changes to think through the possibility of (...) healthcare professionals becoming cyborgs, human–machine units that are subsequently neither human and nor machine. It is seen that human technology interfaces are a different way of interacting but do not change what it is to be human in our rational capacities of providing meaningful speech and freely chosen actions. In the highly technical environment of the ICU, expert nurses work in harmony with both the technical equipment and the patient. We used Heidegger to consider the nature of equipment, and Descartes to explore unique human capacities. Aristotle, Wallace, Sokolowski, and Clarke provide a summary of humanity as substantial and relational. (shrink)

Technology is a mirror that reflects human nature and intentions: we want certain things done and we want tools to do those things; we are finite, frail, and mortal; we create technology in order to bring alternative worlds into being; we do not know why we create or what values should guide us. Imagination is central to technology. Human nature and human freedom are brought into focus when we reflect on the central role of imagination in technology.

The integration of technology in care is core business in nursing and this role requires that we must understand and use technology informed by evidence that goes much deeper and broader than actions and behaviours. We need to delve more deeply into its complexity because there is nothing minor or insignificant about technology as a major influence in healthcare outcomes and experiences. Evidence is needed that addresses technology and nursing from perspectives that examine the effects of technology, especially related to (...) increasing demands for efficiency, the relationship of technology to nursing and caring, and a range of philosophical questions associated with empowering people in their healthcare choices. Specifically, there is a need to confront in practice the ways technique influences care. Technique is the creation of a kind of thinking that is necessary for contemporary healthcare technology to develop and be applied in an efficient and rational manner. Technique is not an entity or specific thing, but rather a way of thinking that seeks to shape and organize nursing activity, and manage efficiently individual difference(s) in care. It emphasizes predetermined causal relationships, conformity, and sameness of product, process, and thought. In response is needed a radical vision of nursing that attempts in a real sense to ensure we meet the needs of individuals and their community. Activism and advocacy are needed, and a willingness to create a certain detachment from the imperatives that technique demands. It is argued that our responsibility as nurses is to respond in practice to the errors, advantages, difficulties, and temptations of technology for the benefit of those who most need our assistance and care. (shrink)

Creating android and humanoid robots to furnish companionship in the nursing care of older people continues to attract substantial development capital and research. Some people object, though, that machines of this kind furnish human–robot interaction characterized by inauthentic relationships. In particular, robotic and artificial intelligence (AI) technologies have been charged with substituting mindless mimicry of human behaviour for the real presence of conscious caring offered by human nurses. When thus viewed as deceptive, the robots also have prompted corresponding concerns regarding (...) their potential psychological, moral, and spiritual implications for people who will be interacting socially with these machines. The foregoing objections and concerns can be assessed quite differently, depending upon ambient religious beliefs or metaphysical presuppositions. The complaints may be set aside as unnecessary, for example, within religious traditions for which even current robots can be viewed as presenting spiritual aspects. Elsewhere, technological cultures may reject the complaints as expression of outdated superstition, holding that the machines eventually will enjoy a consciousness described entirely in materialist and behaviourist terms. While recognizing such assessments, the authors of this essay propose that the heart of the foregoing objections and concerns may be evaluated, in part, scientifically – albeit with a conclusion recommending fundamental revisions in AI modelling of human mental life. Specifically, considerations now favour introduction of AI models using interactive classical and quantum computation. Without this change, the answer to the essay's title question arguably is ‘no’ – with it, the answer plausibly becomes ‘maybe’. Either outcome holds very interesting implications for nurses. (shrink)

The three dialogues in this contribution concern 21st century application of life‐like robots in the care of older adults. They depict conversations set in the near future, involving a philosopher (Dr Phonius) and a nurse (Dr Myloss) who manages care at a large facility for assisted living. In their first dialogue, the speakers discover that their quite different attitudes towards human‐robot interaction parallel fundamental differences separating their respective concepts of consciousness. The second dialogue similarly uncovers deeply contrasting notions of personhood (...) that appear to be associated with respective communities of nursing and robotics. The additional key awareness that arises in their final dialogue links applications of life‐like robots in the care of older adults with potential transformations in our understandings of ourselves – indeed, in our understandings of the nature of our own humanity. This series of dialogues, therefore, appears to address a topic in nursing philosophy that merits our careful attention. (shrink)