“Care robots” offer technological solutions to increasing needs for care just as economic imperatives increasingly regulate the care sector. Ethical critiques of this technology cannot succeed without situating themselves within the crisis of social reproduction under neoliberal capitalism. What, however, constitutes “care” and its status as a potential critical resource, and how might care robots damage this potential? Although robots might threaten norms of care, I argue that they are by no (...) means necessarily damaging. Critiques of care robots must not entrench exclusionary images of the ideal carer. Instead, critical reflection on their use should trouble dominant paradigms of care. (shrink)

The discussion about robots in elderly care is populated by doom scenarios about a totally dehumanized care system in which elderly people are taken care of by machines. Such scenarios are helpful as they attend us to what we think is important with regard to the quality elderly care. However, this article argues that they are misleading in so far as they (1) assume that deception in care is always morally unacceptable, (2) suggest that (...) robots and other information technologies necessarily deceive elderly people by creating a “virtual” world as opposed to a “real” world, (3) assume that elderly people of the future have similar ICT skills and interests as the elderly people of today, and (4) assume a simplistic view of technologies. The article suggests an approach to evaluating care robots and ICT in health care which acknowledges and addresses a number of ethical problems raised by robotic care—for instance disengagement problems—while taking into account that some elderly people may need care that does not treat them as (empirically) autonomous, that many the elderly of the future are likely to be digital natives, and that the task of evaluating technologies in care is more complicated than the discussion of deception suggests. (shrink)

Ageing populations are increasing across the world. Many countries are exploring new ways to provide care for the elderly in hospitals, community care and family household settings. Scientific progress in robotics, artificial intelligence integrated systems and increasingly sophisticated software engineering have contributed to innovative developments in care robots in the Asia Pacific regions, Europe and the US. Whilst the use of care robots is not widespread, research is already occurring to integrate wider use of (...) care robots in the elderly population towards improving their quality of life. Developments in care robots for the elderly are valuable yet they give rise to special concerns as they affect peoples’ health and safety. This chapter identifies key ethical and legal issues arising from the use of care robots in the ageing population. Ethical aspects such as deception and trust from care robots are highlighted, which implicate governance concerns ranging from balancing innovations and ensuring user safety to determining the appropriate levels of regulatory oversight and support for developers and market strategies. An examination of these issues provides some guidance for law makers and policy developers in these areas of concern in establishing applicable regulatory direction, responses and governance framework. (shrink)

Studies have shown that using robot pets in dementia care contributes to a reduction in loneliness and anxiety, and other benefits. Studies also show that, even when people know they are dealing with robots, they often treat the robot as though it is a real pet with genuine emotions. This disconnect between beliefs and behavior occurs not just for people living with dementia, but with cognitively healthy adults, including those who are knowledgeable about how robots work. One (...) possible explanation is that robot pets prompt contradictory beliefs, and so the use of robot pets encourages self‐deception. Sparrow argues that this makes the use of robot pets in dementia care morally objectionable. We disagree. We argue that Gendler's concept of alief offers a better explanation of the belief‐behavior disconnect observed when people interact with robot pets. An alief is a mental state composed of an automatic, arational, emotional, and behavioral response to representational input. Aliefs are not beliefs and are not subject to truth norms. Thus, on our view, harms associated with the use of robot pets in dementia care are not likely to include the self‐deceptions that Sparrow suggests. It might seem like philosophical hair‐splitting to claim that deception has not occurred because discordant aliefs rather than false beliefs have been formed, but this distinction matters. We argue that aliefs carry their own risks. These risks are important to consider when using robot pets in dementia care. (shrink)

When should we use care robots? In this paper we endorse the shift from a simple normative approach to care robots ethics to a complex one: we think that one main task of a care robot ethics is that of analysing the different ways in which different care robots may affect the different values at stake in different care practices. We start filling a gap in the literature by showing how the philosophical (...) analysis of the nature of healthcare activities can contribute to robot ethics. We rely on the nature-of-activities approach recently proposed in the debate on human enhancement, and we apply it to the ethics of care robots. The nature-of-activities approach will help us to understand why certain practice-oriented activities in healthcare should arguably be left to humans, but certain goal-directed activities in healthcare can be fulfilled with the assistance of a robot. In relation to the latter, we aim to show that even though all healthcare activities can be considered as practice-oriented, when we understand the activity in terms of different legitimate ‘fine-grained’ descriptions, the same activities or at least certain components of them can be seen as clearly goal-directed. Insofar as it allows us to ethically assess specific functionalities of specific robots to be deployed in well-defined circumstances, we hold the nature-of-activities approach to be particularly helpful also from a design perspective, i.e. to realize the Value Sensitive Design approach. (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)

Values such as respect for autonomy, safety, enablement, independence, privacy and social connectedness should be reflected in the design of social robots. The same values should affect the process by which robots are introduced into the homes of older people to support independent living. These values may, however, be in tension. We explored what potential users thought about these values, and how the tensions between them could be resolved. With the help of partners in the ACCOMPANY project, 21 (...) focus groups were convened in France, the Netherlands and the UK. These groups consisted of: older people, informal carers and formal carers of older people. The participants were asked to discuss scenarios in which there is a conflict between older people and others over how a robot should be used, these conflicts reflecting tensions between values. Participants favoured compromise, persuasion and negotiation as a means of reaching agreement. Roles and related role-norms for the robot were thought relevant to resolving tensions, as were hypothetical agreements between users and robot-providers before the robot is introduced into the home. Participants’ understanding of each of the values—autonomy, safety, enablement, independence, privacy and social connectedness—is reported. Participants tended to agree that autonomy often has priority over the other values, with the exception in certain cases of safety. The second part of the paper discusses how the values could be incorporated into the design of social robots and operationalised in line with the views expressed by the participants. (shrink)

Abstract. The rapid developments of robotics technologies in the last twenty years of the XX century have greatly encouraged research on the use of robots for surgery, diagnosis, rehabilitation, prosthetics, and assistance to disabled and elderly people. This chapter provides an overview of robotic technologies and systems for health care, focussing on various ethical problems that these technologies give rise to. These problems notably concern the protection of human physical and mental integrity, autonomy, responsibility, ...

Twenty-five years ago, robotics guru Joseph Engelberger had a mission to motivate research teams all over the world to design the ‘Elderly Care Giver’, a multitasking personal robot assistant for everyday care needs in old age. In this article, we discuss how this vision of omnipotent care robots has influenced the design strategies of care robotics, the development of R&D initiatives and ethics research on use of care robots. Despite the expectations of (...) class='Hi'>robots revolutionizing care of older people, the role of robots in human care has remained marginal. The value of world trade in service robots, including care robots, is rather small. We argue that the implementation of robots in care is not primarily due to negative user attitudes or ethical problems, but to problems in R&D and manufacturing. The care robots currently available on the market are capable of simple, repetitive tasks or colloquial interaction. Thus far, also research on care robots is mostly conducted using imaginary scenarios or small-scale tests built up for research purposes. To develop useful and affordable robot solutions that are ethically, socially and ecologically sustainable, we suggest that robot initiatives should be evaluated within the framework of care ecosystems. This implies that attention has to be paid to the social, emotional and practical contexts in which care is given and received. Also, the political, economic and ecological realities of organizing care and producing technological commodities have to be acknowledged. It is time to openly discuss the drivers behind care robot initiatives to outline the bigger picture of organizing care under conditions of limited resources. (shrink)

The aim of this study was to present the functionality and design of nursing care robots as depicted in pictures posted on social media. A netnographic study was conducted using social media postings over a period of 3 years. One hundred and Seventy‐two images were analyzed using netnographic methodology. The findings show that nursing care robots exist in various designs and functionalities, all with a common denominator of supporting the care of one's own and others’ (...) health and/or well‐being as a main function. The results also show that functionality and design are influenced by recent popular sci‐fi/cartoon contexts as portrayed in blockbuster movies, for example. Robots'designs seem more influenced by popular sci‐fi/cartoon culture than professional nursing culture. We therefore stress that it is relevant for nursing researchers to critically reflect upon the development of nursing care robots as a thoughtful discussion about embracing technology also might generate a range of epistemological possibilities when entering a postmodern era of science and practice. (shrink)

This essay interrogates the common assumption that good care is necessarily human care. It looks to disruptive fictional representations of robot care to assist its development of a theory of posthuman care that jettisons the implied anthropocentrism of ethics of care philosophy but retains care’s foregrounding of entanglement, embodiment and obligation. The essay reads speculative representations of robot care, particularly the Swedish television programme Äkta människor (Real Humans), alongside ethics of care philosophy (...) and critical posthumanism to highlight their synergetic critiques of neoliberal affective economies and humanist hierarchies that treat some bodies and affects as more real than others. These texts and discourses assist me in proposing a theory of care that regards vulnerability as the normative effect of posthuman vital embodiment, as opposed to an anomalous state that can be overcome or corrected via neoliberal practice. (shrink)

The development of increasingly intelligent and autonomous technologies will eventually lead to these systems having to face morally problematic situations. This is particularly true of artificial systems that are used in geriatric care environments. The goal of this article is to describe how one can approach the design of an elder care robot which is capable of moral decision-making and moral learning. A conceptual design for the development of such a system is provided and the steps that are (...) necessary to implement it are described. (shrink)

The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship—what I refer to as care robots—require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vulnerable and sensitive time in their lives. The ethical evaluation of care robots requires insight into the values at stake in the healthcare tradition. What’s more, given the stage of (...) their development and lack of standards provided by the International Organization for Standardization to guide their development, ethics ought to be included into the design process of such robots. The manner in which this may be accomplished, as presented here, uses the blueprint of the Value-sensitive design approach as a means for creating a framework tailored to care contexts. Using care values as the foundational values to be integrated into a technology and using the elements in care, from the care ethics perspective, as the normative criteria, the resulting approach may be referred to as care centered value-sensitive design. The framework proposed here allows for the ethical evaluation of care robots both retrospectively and prospectively. By evaluating care robots in this way, we may ultimately ask what kind of care we, as a society, want to provide in the future. (shrink)

The purpose of this study was to investigate the attitudes of decision-makers toward the use of care robots in welfare services. We investigated their knowledge regarding the use of care robots in welfare services as well as their attitudes toward using robots in their own care and in the care of various user groups, for example, children, youths, and older people. We conducted an online survey with a range of Finnish decision-makers as respondents. (...) The respondents were divided into two groups: service actors and research and development actors. The respondents did not regard themselves as having much knowledge about robotics; however, the results showed that the R&D actors had more overall knowledge of the use of robots than the service actors. The R&D actors were found to be more willing to accept a robot as part of their own care as well as part of the care for various user groups. The contribution of this study is a better understanding of the views of the decision-makers who are or will be in charge of the acquisition of technological devices in welfare services. (shrink)

Technological developments involving robotics and artificial intelligence devices are being employed evermore in elderly care and the healthcare sector more generally, raising ethical issues and practical questions warranting closer considerations of what we mean by “care” and, subsequently, how to design such software coherently with the chosen definition. This paper starts by critically examining the existing approaches to the ethical design of care robots provided by Aimee van Wynsberghe, who relies on the work on the ethics (...) of care by Joan Tronto. In doing so, it suggests an alternative to their non-principled approach, an alternative suited to tackling some of the issues raised by Tronto and van Wynsberghe, while allowing for the inclusion of two orientative principles. Our proposal centres on the principles of autonomy and vulnerability, whose joint adoption we deem able to constitute an original revision of a bottom-up approach in care ethics. Conclusively, the ethical framework introduced here integrates more traditional approaches in care ethics in view of enhancing the debate regarding the ethical design of care robots under a new lens. (shrink)

This paper addresses the issue of whether robots could substitute for human care, given the challenges in aged care induced by the demographic change. The use of robots to provide emotional care has raised ethical concerns, e.g., that people may be deceived and deprived of dignity. In this paper it is argued that these concerns might be mitigated and that it may be sufficient for robots to take part in caring when they behave *as (...) if* they care. (shrink)

This paper explores the relationship between dignity and robot care for older people. It highlights the disquiet that is often expressed about failures to maintain the dignity of vulnerable older people, but points out some of the contradictory uses of the word ‘dignity’. Certain authors have resolved these contradictions by identifying different senses of dignity; contrasting the inviolable dignity inherent in human life to other forms of dignity which can be present to varying degrees. The Capability Approach (CA) is (...) introduced as a different but tangible account of what it means to live a life worthy of human dignity. It is used here as a framework for the assessment of the possible effects of eldercare robots on human dignity. The CA enables the identification of circumstances in which robots could enhance dignity by expanding the set of capabilities that are accessible to frail older people. At the same time, it is also possible within its framework to identify ways in which robots could have a negative impact, by impeding the access of older people to essential capabilities. It is concluded that the CA has some advantages over other accounts of dignity, but that further work and empirical study is needed in order to adapt it to the particular circumstances and concerns of those in the latter part of their lives. (shrink)

In this paper I describe a future in which persons in advanced old age are cared for entirely by robots and suggest that this would be a dystopia, which we would be well advised to avoid if we can. Paying attention to the objective elements of welfare rather than to people’s happiness reveals the central importance of respect and recognition, which robots cannot provide, to the practice of aged care. A realistic appreciation of the current economics of (...) the aged care sector suggests that the introduction of robots into an aged care setting will most likely threaten rather than enhance these goods. I argue that, as a result, the development of robotics is likely to transform aged care in accordance with a trajectory of development that leads towards this dystopian future even when this is not the intention of the engineers working to develop robots for aged care. While an argument can be made for the use of robots in aged care where the people being cared for have chosen to allow robots in this role, I suggest that over-emphasising this possibility risks rendering it a self-fulfilling prophecy, depriving those being cared for of valuable social recognition, and failing to provide respect for older persons by allowing the options available to them to be shaped by the design choices of others. (shrink)

The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship—what I refer to as care robots—require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vulnerable and sensitive time in their lives. The ethical evaluation of care robots requires insight into the values at stake in the healthcare tradition. What’s more, given the stage of (...) their development and lack of standards provided by the International Organization for Standardization to guide their development, ethics ought to be included into the design process of such robots. The manner in which this may be accomplished, as presented here, uses the blueprint of the Value-sensitive design approach as a means for creating a framework tailored to care contexts. Using care values as the foundational values to be integrated into a technology and using the elements in care, from the care ethics perspective, as the normative criteria, the resulting approach may be referred to as care centered value-sensitive design. The framework proposed here allows for the ethical evaluation of care robots both retrospectively and prospectively. By evaluating care robots in this way, we may ultimately ask what kind of care we, as a society, want to provide in the future. (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)

Most animals have significant behavioral expertise built in without having to explicitly learn it all from scratch. This expertise is a product of evolution of the organism; it can be viewed as a very long term form of learning which provides a structured system within which individuals might learn more specialized skills or abilities. This paper suggests one possible mechanism for analagous robot evolution by describing a carefully designed series of networks, each one being a strict augmentation of the previous (...) one, which control a six legged walking machine capable of walking over rough terrain and following a person passively sensed in the infrared spectrum. As the completely decentralized networks are augmented. the robot’s performance and behavior repetoire demonstrably improve. The rationale for such demonstrations is that they may provide a hint as to the requirements for automatically building massive networks to carry out complex sensory-motor tasks. The experiments with an actual robot ensure that an essence of reality is maintained and that no critical disabling problems have been ignored. (shrink)

It should not be a surprise in the near future to encounter either a personal or a professional service robot in our homes and/or our work places: according to the International Federation for Robots, there will be approx 35 million service robots at work by 2018. Given that individuals will interact and even cooperate with these service robots, their design and development demand ethical attention. With this in mind I suggest the use of an approach for incorporating (...) ethics into the design process of robots known as Care Centered Value Sensitive Design. Although this approach was originally and intentionally designed for the healthcare domain, the aim of this paper is to present a preliminary study of how personal and professional service robots might also be evaluated using the CCVSD approach. The normative foundations for CCVSD come from its reliance on the care ethics tradition and in particular the use of care practices for: structuring the analysis and, determining the values of ethical import. To apply CCVSD outside of healthcare one must show that the robot has been integrated into a care practice. Accordingly, the practice into which the robot is to be used must be assessed and shown to meet the conditions of a care practice. By investigating the foundations of the approach I hope to show why it may be applicable for service robots and further to give examples of current robot prototypes that can and cannot be evaluated using CCVSD. (shrink)

Autonomous robots are increasingly interacting with users who have limited knowledge of robotics and are likely to have an erroneous mental model of the robot’s workings, capabilities, and internal structure. The robot’s real capabilities may diverge from this mental model to the extent that one might accuse the robot’s manufacturer of deceiving the user, especially in cases where the user naturally tends to ascribe exaggerated capabilities to the machine (e.g. conversational systems in elder-care contexts, or toy robots (...) in child care). This poses the question, whether misleading or even actively deceiving the user of an autonomous artifact about the capabilities of the machine is morally bad and why. By analyzing trust, autonomy, and the erosion of trust in communicative acts as consequences of deceptive robot behavior, we formulate four criteria that must be fulfilled in order for robot deception to be morally permissible, and in some cases even morally indicated. (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)

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)

This paper tries to understand the phenomenon that humans are able to empathize with robots and the intuition that there might be something wrong with “abusing” robots by discussing the question regarding the moral standing of robots. After a review of some relevant work in empirical psychology and a discussion of the ethics of empathizing with robots, a philosophical argument concerning the moral standing of robots is made that questions distant and uncritical moral reasoning about (...) entities’ properties and that recommends first trying to understand the issue by means of philosophical and artistic work that shows how ethics is always relational and historical, and that highlights the importance of language and appearance in moral reasoning and moral psychology. It is concluded that attention to relationality and to verbal and non-verbal languages of suffering is key to understand the phenomenon under investigation, and that in robot ethics we need less certainty and more caution and patience when it comes to thinking about moral standing. (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)

When the social relevance of robotic applications is addressed today, the use of assistive technology in care settings is almost always the first example. So-called care robots are presented as a solution to the nursing crisis, despite doubts about their technological readiness and the lack of concrete usage scenarios in everyday nursing practice. We inquire into this interconnection of social robotics and care. We show how both are made available for each other in three arenas: innovation (...) policy, care organization, and robotic engineering. First, we analyze the discursive “logics” of care robotics within European innovation policy, second, we disclose how care robotics is encountering a historically grown conflict within health care organization, and third we show how care scenarios are being used in robotic engineering. From this diagnosis, we derive a threefold critique of robotics in healthcare, which calls attention to the politics, historicity, and social situatedness of care robotics in elderly care. (shrink)

Nurses have traditionally been regarded as clinicians that deliver compassionate, safe, and empathetic health care (Nurses again outpace other professions for honesty & ethics, 2018). Caring is a fundamental characteristic, expectation, and moral obligation of the nursing and caregiving professions (Nursing: Scope and standards of practice, American Nurses Association, Silver Spring, MD, 2015). Along with caring, nurses are expected to undertake ever‐expanding duties and complex tasks. In part because of the growing physical, intellectual and emotional demandingness, of nursing as (...) well as technological advances, artificial intelligence (AI) and AI care robots are rapidly changing the healthcare landscape. As technology becomes more advanced, efficient, and economical, opportunities and pressure to introduce AI into nursing care will only increase. In the first part of the article, we review recent and existing applications of AI in nursing and speculate on future use. Second, situate our project within the recent literature on the ethics of nursing and AI. Third, we explore three dominant theories of caring and the two paradigmatic expressions of caring (touch and presence) and conclude that AI—at least for the foreseeable future—is incapable of caring in the sense central to nursing and caregiving ethics. We conclude that for AI to be implemented ethically, it cannot transgress the core values of nursing, usurp aspects of caring that can only meaningfully be carried out by human beings, and it must support, open, or improve opportunities for nurses to provide the uniquely human aspects of care. (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)

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)

Recent research points to the fact that new medical technological innovations are just as relevant in the context of long‐term care or chronic care as they are in the context of acute care. In the spirit of the Nuffield Foundation recommendations, this paper explores the possibilities of using robotic aides in long‐term care and identifies the tensions that must be considered and addressed if robotics is to be introduced successfully in nursing homes. Our examination is two‐pronged. (...) First, we delve into a fundamental issue surrounding AI, namely that of consciousness. We argue that automation will always have only a limited use in caregiving since caregiving as an activity requires the use of human‐type, that is, organic, consciousness. We support the thesis that the emergence and formation of human‐type consciousness require feelings such as empathy and the sense of touch, which, in turn, create the sense of kinship with fellow human beings. And second, we examine the benefits as well as risks of using robotic aides such as ZORA and PARO in long‐term care facilities. More specifically, we look at ZORA's use in a group setting, and PARO's use in an individual setting. We emphasize that long‐term care is one‐on‐one care, including but not limited to intimate care. Crucially, we argue that touch is at the heart of this type of care. We argue that some of the tensions with the use of robotic aides are generated precisely because of the lack of human touch. (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)

Having a sense of dignity is one of the core emotions in human life. Is our dignity, and accordingly also our sense of dignity under threat in elderly care, especially in robotic care? How can robotic care support or challenge human dignity in elderly care? The answer will depend on whether it is robot-based, robot-assisted, or teleoperated care that is at stake. Further, the demands and realizations of human dignity have to be distinguished. The demands (...) to respect humans are based on human dignity and the inalienable high and equal moral standing that everyone has. For human moral agents, these demands take the form of negative and positive duties. For robots, they arguably take the form of corresponding ought-to-be norms. The realizations of dignity consist in variable responses to these demands, by oneself by others, and by society at large. This article examines how robot-based, robot-assisted, and teleoperated care can amount to realizations of dignity. The varieties of robotic care can, in different ways, be responsive to the demands of dignity and recognize humans as vulnerable beings with needs, as autonomous agents, and as rational subjects of experience, emotion, and thought. (shrink)

The Australian Royal Commission into Aged Care Quality and Safety acknowledged understaffing and substandard care in residential aged care and home care services, and recommendations were made that that the Australian Government should promote assistive technology within aged care. Robotic care assistants can provide care and companionship for the elderly—both in their own homes and within health and aged care institutions. Although more research is required into their use, studies indicate benefits, including (...) enabling the elderly to live independently at home, assistance with medication and monitoring of safety. Nevertheless, there are inherent ethical challenges in the use of robots as carers, including loss of privacy, unwarranted restrictions on autonomy, lack of dignity, deception, and the exacerbation of loneliness. Ethics by design can counter these issues in development of robotics and clinical ethics committees have been put forward as a way of dealing with the ethical use of robotic care in healthcare institutions. In this paper I outline the ethical challenges of robotic care assistants and how these may be mediated in their design and use. (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)

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)

This paper treats the political and ethical issues associated with the new caretaking technologies. Given the number of feminists who have raised serious concerns about the future of care work in the United States, and who have been critical of the degree to which society “free rides” on women's caretaking labor, I consider whether technology may provide a solution to this problem. Certainly, if we can create machines and robots to take on particular tasks, we may lighten the (...) care burden that women currently face, much of which is heavy and repetitious, and which results in injury and care “burnout” for many female caretakers. Yet, in some contexts, I argue that high-tech robotic care may undermine social relationships, cutting individuals off from the possibility of social connectedness with others. (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)

Social robots are an increasingly integral part of society, already appearing as customer service assistants, care-home helpers, teaching assistants and personal companions. This book argues that the wider inclusion of social robots in our society is having a revolutionary impact on some of our key intuitions regarding ethics, metaphysics and epistemology and, as such, will put pressure on many of our best theories. Social robots elicit an emotional and social response in humans that some have taken (...) to be evidence that robots deserve moral consideration. Others have argued that, as robots are only machines, we should avoid designing robots that encourage emotional engagement. The fictional dualism model provides a new way for us to view social robots and a new route for our continued relationship with them. When we engage with a social robot, we create a fictional overlay that has wants, needs and desires. Our emotional attachment to social robots is a natural continuation of our relationship to fiction: a life-enhancing and important connection, but not one that prompts moral consideration for the fictional entity. In this book, Paula Sweeney shows how the fictional dualism model of social robots differs from other popular models. In addition to providing a distinctive and ethically appropriate framework for emotional engagement without moral consideration, the model provides conditions for trusting social robots and, uniquely, allows us to individuate social robots as distinct persons, even in contexts in which they share a collective mind. (shrink)

I discuss in this paper how robotic scientists tend to produce replicas of human bodies that are consistent with their own cultural norms by exploring how gender is embodied in humanoid robots. My focus is specifically on care robots, and their reception in the African context. I argue that since the bodies of the robotic scientists are the reference points according to which they design and manufacture robots, a somaesthetics of robotics can best reveal and challenge (...) how gendered norms are materialised in these machines. (shrink)

The focus of this chapter is on some of the ethical and philosophical issues at the intersection of robotics and artificial intelligence (AI) applications in the health care sector and medical assistance in dying (e.g. physician-assisted suicide and euthanasia), including: (1) Is there a role for robotic systems/AI to play in the orchestration or delivery of assisted dying?; (2) Can the use of robotic systems/AI make the orchestration of assisted dying more ethical?; and (3) What insights can be generated (...) in the ethical debate on physician assisted suicide and euthanasia from considering the prospect of robotic systems/AI assisting with the provision of or providing assistance in dying? The prospect of including robotic systems/AI in the context of assisted dying provides opportunity to revisit longstanding philosophical and ethical issues under new light. Indeed, reflecting on these questions may invigorate debate, for example in reconsidering the de-medicalization of assisted dying, reconsidering whether assisted dying is within the proper scope of medicine, and reconsidering which normative approach to the ethics of assisted dying is the most appropriate. (shrink)

There is an urge to introduce high technology and robotics in care settings. Assisted living 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: interaction-based sense of autonomy, coping-based sense of autonomy, and 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)

This chapter discusses imaginary technologies that do not exist yet but are expected to be implemented in clinical work in the near future. Adopting a phenomenological view on the politics of organizational time, we illuminate how the rhetoric of futurity and protentional anticipation dominate managerial acts in healthcare organizations. This future-oriented management includes strategies of risk assessment, investments in emerging technologies, and other actions to reduce external uncertainty and move towards an enhanced capacity to cope with potential challenges. However, we (...) suggest that potentially harmful consequences of emerging technologies cannot be established reliably in advance by investigation, experiments, and risk assessments. The phenomenological notion of embodied information infrastructure allows us to consider how visions of complex technologies intertwine with clinical practices in healthcare professionals’ work. We use two examples of imaginary technologies—automated decision-making systems and care robotics—to concretize how the line between imaginary technologies and existing technologies becomes increasingly volatile in healthcare organizations. (shrink)

An elderly patient in a care home only wants human nurses to provide her care – not robots. If she selected her carers based on skin colour, it would be seen as racist and morally objectionable, but is choosing a human nurse instead of a robot also morally objectionable and speciesist? A plausible response is that it is not, because humans provide a better standard of care than robots do, making such a choice justifiable. In (...) this paper, I show why this response is incorrect, because robots can theoretically care as well as human nurses can. I differentiate between practical caring and emotional caring, and I argue that robots can match the standard of practical care given by human nurses, and they can simulate emotional care. There is growing evidence that people respond positively to robotic creatures and carebots, and AI software is apt to emotionally support patients in spite of the machine’s own lack of emotions. I make the case that the appearance of emotional care is sufficient, and need not be linked to emotional states within the robot. After all, human nurses undoubtedly ‘fake’ emotional care and compassion sometimes, yet their patients still feel adequately cared for. I show that it is a mistake to claim that ‘the human touch’ is in itself a contributor to a higher standard of care; ‘the robotic touch’ will suffice. Nevertheless, it is not speciesist to favour human nurses over carebots, because carebots do not suffer as the result of such a choice. (shrink)

In recent developments in Artificial Intelligence and especially in robotics we can observe a tendency towards building intelligent artefacts that are meant to be social, to have ‘human social’ characteristics like emotions, the ability to conduct dialogue, to learn, to develop personality, character traits, and social competencies. Care, entertainment, pet and educational robots are conceptualised as friendly, understanding partners and credible assistants which communicate ‘naturally’ with users, show emotions and support them in everyday life. Social robots are (...) often designed to interact physically, affectively and socially with humans in order to learn from them. To achieve this goal, roboticists often model the human‐robot interaction on early caregiver‐infant interactions. In this paper I want to analyse prominent visions of these ‘socio‐emotional’ machines as well as early prototypes and commercial products with regard to the human‐machine interface. By means of this I will ask how feminist critiques of technology could be applied to the field of social robotics in which concepts like sociality or emotion are crucial elements while, at the same time, these concepts play an important role in feminist critiques of technology. (shrink)

A growing body of research can be found in which roboticists are designing for reciprocity as a key construct for successful human–robot interaction (HRI). Given the centrality of reciprocity as a component for our moral lives (for moral development and maintaining the just society), this paper confronts the possibility of what things would look like if the benchmark to achieve perceived reciprocity were accomplished. Through an analysis of the value of reciprocity from the care ethics tradition the richness of (...) reciprocity as an inherent value is revealed: on the micro-level, as mutual care for immediate care givers, and on the macro-level, as foundational for a just society. Taking this understanding of reciprocity into consideration, it becomes clear that HRI cannot achieve this bidirectional value of reciprocity; a robot must deceive users into believing it is capable of reciprocating to humans or is deserving of reciprocation from humans. Moreover, on the macro-level, designing social robots for reciprocity threatens the ability and willingness to reciprocate to human care workers across society. Because of these concerns, I suggest re-thinking the goals of reciprocity in social robotics. Designing for reciprocity in social robotics should be dedicated to the design of robots to enhance the ability to mutually care for those that provide us with care, as opposed to designing for reciprocity between human and robot. (shrink)