Assistive Technologies: Ethical Practice, Ethical Research, and Quality of Life

Abstract

Much has been written about the benefits, for example, greater independence, autonomy, and dignity, which can derive from the use of assistive technologies with older people (Loader, Hardey, & Keeble, 2009; McCreadie & Tinker, 2005; Poser & Moser, 2009). These benefits have been well researched, clearly expressed in the literature, and remain uncontested here. Apart from benefits to individuals and carers, assistive technologies can release funds for other applications, and where this is in care settings funded through public expenditure, the cost savings that might arise from their application may afford the opportunity for more effective targeting of taxpayer’s resources. As the Audit Commission (guardian of public expenditure in the UK) noted, the use of technology represents the unusual possibility of providing cost savings at the same time as better service provision (Audit Commission, 2004). The merits then are evident. But there is a need also to be alert to the ethical questions that arise as a concomitant to the use of new technologies and to address what Mort, Roberts, and Milligan (2009) have argued is an “ethical and democratic deficit in this field which has arisen due to a proliferation in research and development of advanced care technologies that has not been accompanied by sufficient consideration of their social context” (p. 85). This chapter will raise these ethical issues, alight on the potential deficits, and highlight some of the policy and practical issues that might warrant further inquiry. It does so by addressing three key areas. First, it considers ethical approaches commonly in use and their limitations for application in the field of assistive technologies. Second, it explores the ethical issues that arise around the design and execution of research with users of assistive technologies. Third, it raises the question of whether or not assistive technologies contribute to a better quality of life (QoL) for recipients, not least because QoL is explicitly included as an intended policy outcome of the deployment of such technologies (Scottish Government, 2009; Telecare Services, 2010). The chapter draws its examples primarily from the experience of the UK (and its devolved polities), where the policy objectives of governments for extending the use of assistive technologies are particularly ambitious. We are mindful of the methodological pitfalls of cross-national applicability, but the discussion should have broader resonance, as ethical approaches and practices come to terms with a technologically fast-changing world. Our use of the term assistive technologies embraces the definition of any item, piece of equipment, product, or system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of individuals with disabilities (Technology-Related Assistance for Individuals with Disabilities Act, 1988 P.L.100/407); more practicably, as Cowan and Turner Smith (cited in McCreadie & Tinker, 2005) note, it refers to any device or system that allows an individual to perform a task that they would otherwise be unable to do or increases the ease and safety with which the task can be performed. We note in particular that some of the more interesting ethical challenges have arrived with the advent of telecare sensor-based technologies, which open up important issues around privacy, autonomy, and the potential for replacement of human care through remote monitoring.