Telecare technologies and isolation: some ethical issues

Abstract

Telecare technologies involve the remote monitoring of patients who have health, rehabilitation or social needs. These technologies, although deployed unevenly in developed countries, represent a shift in the ways in which care is practiced. Research on the consequences of this shift away from more traditional "hands-on" care has focused primarily on quantitative measurement (for example cost savings) with less attention paid to how recipients themselves experience these new care practices. This paper discusses two aspects of telecare technologies which are under researched; the potential for loneliness which may arise as a result of the use of these technologies, and the ethical issues raised by this. The primary locus of the discussion is the UK, where a major public policy shift towards telecare is under way and where telecare research based on randomized control trials has been particularly well funded by the government. The discussion concludes that there is indeed the potential for loneliness, a condition increasingly recognized as a significant factor in reducing overall health and well-being, in the use of these technologies. The ethical implications of this are not being sufficiently considered, in part because the ethical frameworks in use do not adequately address the issue of loneliness itself, given their bio-medical, rather than relational focus. The paper suggests two ways of redressing this. First, the addition of approaches to ethics other than bio-medical -particularly those with a relational and contextual focus -or greater exploration of how the two approaches might interact. Second, it suggests that a paradigm shift towards solutions other than technology-based care is overdue. This shift would not underplay the importance of technological contributions to care needs. It would, however, be an argument to suggest we proceed with some caution, advance the research evidence on the complexity of users' experiences of these technologies, and explore potentially simpler -and ethically more relational -approaches to care, such as shared or intergenerational living.

The promises and the reality of smart, digital telecare in England

“…Meanwhile ethical implications are raised by research highlighting the risks of reducing human contact from in-person care (Paganini-Hill, 2013;Eccles, 2015;Sundgren et al, 2019). The fear of losing human contact, loss of privacy and loss of autonomy have all been raised as potential ethical considerations for telecare provision (Percival and Hanson, 2006;Zwijsen et al, 2011;Sorell and Draper, 2012;Chung et al, 2016).…”

Remote care technologies, older people and the social care crisis in the United Kingdom: a Multiple Streams Approach to understanding the ‘silver bullet’ of telecare policy

“…There have also been insightful case studies around telecare use, which point to a paucity of understanding around the complexities from actual user experiences, e.g. the limits to utility of standardised equipment, the lack of interoperability across technologies and the limitations of remote care technologies to deal with multiple morbidities (Postema et al, 2012;Greenhalgh et al, 2013Greenhalgh et al, , 2018, as well as the potential for social isolation in replacing human care with ICT-based devices (Eccles, 2015) and managerial, rather than user, decisions over their appropriate use (Mort et al, 2013).…”

“…The UTOPIA project notes that barriers to promoting telecare for commissioners and senior managers were perceived to include skill deficits amongst professional staff to assess for telecare, the inflexibility of ‘service bundles’ or contracts with existing suppliers of technology, and lack of staff with the right skills to install telecare. (Woolham et al ., 2018: 3)These issues were essentially local – and so unlikely to be responsive to top-down policy imperatives, but also – in the case of inflexible contracts – often outside the control of front-line telecare assessors and practitioners in their interactions with service users (Eccles, 2015).…”

“…On both counts – efficacy and ease of implementation – the actual experience of its use was much less clear cut, while other comparable countries – faced with similar demographic change and care needs – explored alternative themes. These included more rigorous trials of telecare technologies involving sustained qualitative research on user experiences and approaches which largely bypassed telecare solutions to demographic change, such as inter-generational contracts of support for older people (Eccles, 2015; Berge, 2017).…”

Positive Turn in Elder-Care Workers’ Views Toward Telecare Robots

“…In social work, lack of resources is a major factor in ethical strain [ 40 ]. However, even if telecare has raised ethical concerns among nurses before [ 14 ], we assume that, if anything, the pandemic has reduced these concerns. COVID-19 forces care workers to prioritize safety before physical closeness.…”