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.
Highlights
The change of traditional familial care arrangements, and the shortage of professional care workers, technological approaches are increasingly discussed as a solution for ensuring the provision of support in activities of daily living as well as in medical and nursing care for older people
Starting from the basic principlist framework of biomedical ethics defined by autonomy, non-maleficence and beneficence, and justice, we will critically examine and expand the corresponding ethical perspectives
This theoretical basis is reflected in a recent empirical study by McConnell et al (2019) which focuses on the views of people with dementia (PWD) and finds that these have the following understanding of empowerment: “A confidence building process whereby PWD are respected, have a voice and are heard, are involved in making decisions about their lives and have the opportunity to create change through access to appropriate resources”
Summary
The change of traditional familial care arrangements, and the shortage of professional care workers, technological approaches are increasingly discussed as a solution for ensuring the provision of support in activities of daily living as well as in medical and nursing care for older people. Several commentators have pointed out that the area of technology-assisted eldercare requires a shift or expansion of this medical ethical perspective to comprise and unfold the techno-ethical dimension (Brown & Adams, 2007; Silvers, 2010) This includes the perspective that users are not mainly seen as ‘patients’ placed in a carer-patient- or doctor-patient-relationship, but as citizens with particular rights. Following this line of thought, we take the common principles of biomedical ethics – autonomy, care (comprising non-maleficence as well as beneficence), and justice – as a starting point and as frame of reference to be critically re-examined. We point out 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
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