How can we best identify, understand, and deal with ethical and societal issues raised by healthcare robotics? This paper argues that next to ethical analysis, classic technology assessment, and philosophical speculation we need forms of reflection, dialogue, and experiment that come, quite literally, much closer to innovation practices and contexts of use. The authors discuss a number of ways how to achieve that. Informed by their experience with “embedded” ethics in technical projects and with various tools and methods of (...) responsible research and innovation, the paper identifies “internal” and “external” forms of dialogical research and innovation, reflections on the possibilities and limitations of these forms of ethical–technological innovation, and explores a number of ways how they can be supported by policy at national and supranational level. (shrink)

The aim of this study was to develop and validate a measure of robot use self-efficacy in healthcare work based on social cognitive theory and the theory of planned behavior. This article provides a briefing on technology-specific self-efficacy and discusses the development, validation, and implementation of an instrument that measures care workers’ self-efficacy in working with robots. The validity evaluation of the Finnish-language measure was based on representative survey samples gathered in 2016. The respondents included practical and registered (...) nurses, homecare workers, and physiotherapists. A majority of the respondents were female. The full instrument consists of a set of six task-specific self-efficacy items concerning general views of technological skills, confidence in learning robot use, and confidence in guiding others in robot use. Three items were chosen for the shorter version of the measure. The face validity, construct validity, and reliability were established to validate the instruments. Both 3-item and 6-item measures were found to be highly consistent in structure. Respondents with high levels of RUSH also reported more general self-efficacy and interest in technology, on average. A very brief instrument of three items is convenient to include in repeated employee surveys. (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)

The use of robotic technology in healthcare is increasing. The aim was to explore attitudes toward the use of humanoid robots in healthcare among patients, relatives, care professionals, school actors and other relevant actors in healthcare and to analyze the associations between participants’ background variables and attitudes. The data were collected through a cross-sectional survey (N = 264) in 2018 where participants met a humanoid robot. The survey was comprised of background variables and items from a (...) modified Robot Attitude Scale. Multiple linear regression analysis and Spearman’s Rho correlation were used to analyze associations between variables. Most of the participants were positive toward the use of humanoid robots in healthcare and only a few were negative. Attitudes toward the use of humanoid robots were more positive among other relevant actors, such as service personnel and politicians in healthcare, participants with a higher educational level and older adults. More research is needed on the reasons underlying negative attitudes because these might affect the introduction of humanoid robots in healthcare. A careful evaluation of appropriate first target groups as well as which tasks are appropriate for humanoid robots to perform in healthcare are needed. (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)

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)

AI and robotic technologies attract much hype, including utopian and dystopian future visions of technologically driven provision in the health and care sectors. Based on 30 interviews with scientists, clinicians and other stakeholders in the UK, Europe, USA, Australia, and New Zealand, this paper interrogates how those engaged in developing and using AI and robotic applications in health and care characterize their future promise, potential and challenges. We explore the ways in which these professionals articulate and navigate a range of (...) high and low expectations, and promissory and cautionary future visions, around AI and robotic technologies. We argue that, through these articulations and navigations, they construct their own perceptions of socially and ethically ‘acceptable futures’ framed by an ‘ethics of expectations.’ This imbues the envisioned futures with a normative character, articulated in relation to the present context. We build on existing work in the sociology of expectations, aiming to contribute towards better understanding of how technoscientific expectations are navigated and managed by professionals. This is particularly timely since the COVID-19 pandemic gave further momentum to these technologies. (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)

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)

In this paper we examine how the use of robots in caring for elders can impact the meaningfulness of elders’ lives. We present a framework for understanding ‘meaningfulness in life’, and then apply that framework in discussing ways in which the use of robots to assist in activities of daily living can preserve, enhance or undermine the meaningfulness of elders’ lives. We conclude with a discussion of if and how having false beliefs about companion robots can affect (...) meaningfulness in the life of the person having those false beliefs. (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)

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)

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)

Over the last 20 yr, neurosurgical robots have been increasingly assisting in neurosurgical procedures. Surgical robots are considered to have noticeable advantages over humans, such as reduction of procedure time, surgical dexterity, no experience of fatigue and improved healthcare outcomes. In recent years, neurosurgical robots have been developed to perform various procedures. Public demand is informing the direction of neurosurgery and placing greater pressure on neurosurgeons to use neurosurgical robots. The increasing diversity and sophistication of (...) neurosurgical robots have received ethical scrutiny due to the surgical complications that may arise as well as the role of robots in the future. In this paper, we address 3 ethical areas regarding neurosurgical robots: Loss of neurosurgical skills due to increasing dependency on robots; How far do we want to go with neurosurgical robots? Neurosurgical robots and conflict of interest and medical bias. (shrink)

Artificial intelligence and robotics is pervasive in daily life and set to expand to new levels potentially replacing human decision-making and action. Self-driving cars, home and healthcare robots, and autonomous weapons are some examples. A distinction appears to be emerging between potentially benevolent civilian uses of the technology (eg unmanned aerial vehicles delivering medicines), and potentially malevolent military uses (eg lethal autonomous weapons killing human com- batants). Machine-mediated human interaction challenges the philosophical basis of human existence and ethical (...) conduct. Aside from technical challenges of ensuring ethical conduct in artificial intelligence and robotics, there are moral questions about the desirability of replacing human functions and the human mind with such technology. How will artificial intelligence and robotics engage in moral reasoning in order to act ethically? Is there a need for a new set of moral rules? What happens to human interaction when it is mediated by technology? Should such technology be used to end human life? Who bears responsibility for wrongdoing or harmful conduct by artificial intelligence and robotics? -/- Whilst Kant may be familiar to international lawyers for setting restraints on the use of force and rules for perpetual peace, his foundational work on ethics provides an inclusive moral philosophy for assessing ethical conduct of individuals and states and, thus, is relevant to discussions on the use and development of artificial intelligence and robotics. His philosophy is inclusive because it incorporates justifications for morals and legitimate responses to immoral conduct, and applies to all human agents irrespective of whether they are wrongdoers, unlawful combatants, or unjust enemies. Humans are at the centre of rational thinking, action, and norm-creation so that the rationale for restraints on methods and means of warfare, for example, is based on preserving human dignity as well as ensuring conditions for perpetual peace among states. Unlike utilitarian arguments which favour use of autonomous weapons on the basis of cost-benefit reasoning or the potential to save lives, Kantian ethics establish non-consequentialist and deontological rules which are good in themselves to follow and not dependent on expediency or achieving a greater public good. -/- Kantian ethics make two distinct contributions to the debate. First, they provide a human-centric ethical framework whereby human exist- ence and capacity are at the centre of a norm-creating moral philosophy guiding our understanding of moral conduct. Second, the ultimate aim of Kantian ethics is practical philosophy that is relevant and applicable to achieving moral conduct. -/- I will seek to address the moral questions outlined above by exploring how core elements of Kantian ethics relate to use of artificial intelli- gence and robotics in the civilian and military spheres. Section 2 sets out and examines core elements of Kantian ethics: the categorical imperative; autonomy of the will; rational beings and rational thinking capacity; and human dignity and humanity as an end in itself. Sections 3-7 consider how these core elements apply to artificial intelligence and robotics with discussion of fully autonomous and human-machine rule-generating approaches; types of moral reasoning; the difference be- tween ‘human will’ and ‘machine will’; and respecting human dignity. (shrink)

Intelligent humanoid robots (IHRs) are becoming likely to be integrated into nursing practice. However, a proper integration of IHRs requires a detailed description and explanation of their essential capabilities, particularly regarding their competencies in replicating and portraying emotive functions such as empathy. Existing humanoid robots can exhibit rudimentary forms of empathy; as these machines slowly become commonplace in healthcare settings, they will be expected to express empathy as a natural function, rather than merely to portray artificial empathy (...) as a replication of human empathy. This article works with a twofold purpose: firstly, to consider the impact of artificial empathy in nursing and, secondly, to describe the influence of Affective Developmental Robotics (ADR) in anticipation of the empathic behaviour presented by artificial humanoid robots. The ADR has demonstrated that it can be one means by which humanoid nurse robots can achieve expressions of more relatable artificial empathy. This will be one of the vital models for intelligent humanoid robots currently in nurse robot development for the healthcare industry. A discussion of IHRs demonstrating artificial empathy is critical to nursing practice today, particularly in healthcare settings dense with technology. (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)

To date research investigating the potential of Robot-Mediated Interviews has focused on establishing how children respond to robots in an interview scenario. In order to test if an RMI approach would work in a real world setting, it is important to establish what the experts would require from such a system. To determine the needs of such expert users we conducted three user panels with groups of potential real world users to gather their views of our current system and (...) find out what they would require for the system to be useful to them. The user groups consisted of specialist police officers, intermediaries, educational specialists and healthcare specialists. To our knowledge this is the first article investigating user needs for Robot-Mediated Interviews. Due to the novelty of this area, the work presented in this paper is exploratory in nature. The results provide valuable insights into what real world users would need from a Robot-Mediated Interviewing system. Our findings will contribute to future research and technology development in the domain of RMI in particular, and child-robot interaction in general. (shrink)

To date research investigating the potential of Robot-Mediated Interviews has focused on establishing how children respond to robots in an interview scenario. In order to test if an RMI approach would work in a real world setting, it is important to establish what the experts would require from such a system. To determine the needs of such expert users we conducted three user panels with groups of potential real world users to gather their views of our current system and (...) find out what they would require for the system to be useful to them. The user groups consisted of specialist police officers, intermediaries, educational specialists and healthcare specialists. To our knowledge this is the first article investigating user needs for Robot-Mediated Interviews. Due to the novelty of this area, the work presented in this paper is exploratory in nature. The results provide valuable insights into what real world users would need from a Robot-Mediated Interviewing system. Our findings will contribute to future research and technology development in the domain of RMI in particular, and child-robot interaction in general. (shrink)

Japan has more robots than any other country with robots contributing to many areas of society, including manufacturing, healthcare, and entertainment. However, few studies have examined Japanese attitudes toward robots, and none has used implicit measures. This study compares attitudes among the faculty of a US and a Japanese university. Although the Japanese faculty reported many more experiences with robots, implicit measures indicated both faculties had more pleasant associations with humans. In addition, although the US (...) faculty reported people were more threatening than robots, implicit measures indicated both faculties associated weapons more strongly with robots than with humans. Despite the media’s hype about Japan’s robot ‘craze,’ response similarities suggest factors other than attitude better explain robot adoption. These include differences in history and religion, personal and human identity, economic structure, professional specialization, and government policy. Japanese robotics offers a unique reference from which other nations may learn. (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)

Do we suddenly become justified in treating robots like humans by positing new notions like “artificial moral agency” and “artificial moral responsibility”? I answer no. Or, to be more precise, I argue that such notions may become philosophically acceptable only after crucial metaphysical issues have been addressed. My main claim, in sum, is that “artificial moral responsibility” betokens moral responsibility to the same degree that a “fake orgasm” betokens an orgasm.

Healthcare robots enable practices that seemed far-fetched in the past. Robots might be the solution to bridge the loneliness that the elderly often experience; they may help wheelchair users walk again, or may help navigate the blind. European Institutions, however, acknowledge that human contact is an essential aspect of personal care and that the insertion of robots could dehumanize caring practices. Such instances of human–robot interactions raise the question to what extent the use and development of (...) robots for healthcare applications can challenge the dignity of users. In this article, therefore, we explore how different robot applications in the healthcare domain support individuals in achieving ‘dignity’ or pressure it. We argue that since healthcare robot applications are novel, their associated risks and impacts may be unprecedented and unknown, thus triggering the need for a conceptual instrument that is binding and remains flexible at the same time. In this respect, as safety rules and data protection are often criticized to lack flexibility, and technology ethics to lack enforceability, we suggest human dignity as the overarching governance instrument for robotics, which is the inviolable value upon which all fundamental rights are grounded. (shrink)

The revolution of artificial intelligence (AI), particularly generative AI, and its implications for human–robot interaction (HRI) opened up the debate on crucial regulatory, business, societal, and ethical considerations. This paper explores essential issues from the anthropomorphic perspective, examining the complex interplay between humans and AI models in societal and corporate contexts. We provided a comprehensive review of existing literature on HRI, with a special emphasis on the impact of generative models such as ChatGPT. The scientometric study posits that due to (...) their advanced linguistic capabilities and ability to mimic human-like behavior, generative AIs like ChatGPT will continue to grow in popularity in pair with human rational empathy, tendency for personification and their advanced linguistic capabilities and ability to mimic human-like behavior. As they blur the boundaries between humans and robots, these models introduce fresh moral and philosophical dilemmas. Our research aims to extrapolate key trends and unique factors in HRI and to elucidate the technical aspects of generative AI that enhance its effectiveness in this field compared to traditional rule-based AI systems. We further discuss the challenges and limitations of applying generative AI in HRI, providing a future research agenda for AI optimization in diverse applications, including education, entertainment, and healthcare. (shrink)

There are only a few ethical regulations that deal explicitly with robots, in contrast to a vast number of regulations, which may be applied. We will focus on ethical issues with regard to “responsibility and autonomous robots”, “machines as a replacement for humans”, and “tele-presence”. Furthermore we will examine examples from special fields of application (medicine and healthcare, armed forces, and entertainment). We do not claim to present a complete list of ethical issue nor of regulations in (...) the field of robotics, but we will demonstrate that there are legal challenges with regard to these issues. (shrink)

Socially assistive devices such as care robots or companions have been advocated as a promising tool in elderly care in Western healthcare systems. Ethical debates indicate various challenges. An important part of the ethical evaluation is to understand how users interact with these devices and how interaction influences users’ perceptions and their ability to express themselves. In this review, we report and critically appraise findings of non-comparative empirical studies with regard to these effects from an ethical perspective.Electronic databases (...) and other sources were queried using a comprehensive search strategy generating 9851 records. Studies were screened independently by two authors. Methodological quality of studies was assessed. For 22 reports on 21 datasets using a non-comparative design a narrative synthesis was performed.Data shows positive findings in regard to attitudes and emotional reactions of users. Varying perception of a social relation and social presence are the most commonly observed traits of interaction. Users struggle with understanding technical complexities while functionality of the devices is limited. This leads to a behavioral alignment of users towards the requirements of the devices to be able to make use of them.This evidence adds to three important ethical debates on the use of socially assistive devices in healthcare in regard to (1) reliability of existing empirical evidence to inform normative judgements, (2) ethical significance of the social presence of devices and (3) user autonomy in regard to behavioral alignment. (shrink)

Reservations concerning the ontologies of theism, transhumanism and posthumanism compel an explicatory discourse on their influences on Nursing and rehabilitation healthcare. Key journals in Nursing and health sciences have recently devoted themed issues on intelligent machine technologies such as humanoid healthcare robots and other highly technological healthcare devices and practice initiatives. While the technological advance witnessed has been a cause for celebration, questions still remain that are focused on the epistemological concerns. The purpose of this article (...) is to discuss theistic ontologies such as the Judeo‐Christian, Shinto‐Buddhist and Islamic religious belief systems on transhumanism and posthumanism in the assimilation of symbiotic technological beings in Nursing and rehabilitation healthcare practice. In view of the approaching technological singularity dominating arguments regarding the future of human beings, a treatise on Nursing and rehabilitation health care is positioned well within the realms of human care. Theism, transhumanism and posthumanism are directing discussions regarding human beings and healthcare processes. It is imperative that the beneficial effects of these discussions be acknowledged within the highly technological world of Nursing and rehabilitative healthcare. (shrink)

The Bubonic Plague outbreak that wormed its way through San Francisco’s Chinatown in 1900 tells a story of prejudice guiding health policy, resulting in enormous suffering for much of its Chinese population. This article seeks to discuss the potential for hidden “prejudice” should Artificial Intelligence (AI) gain a dominant foothold in healthcare systems. Using a toy model, this piece explores potential future outcomes, should AI continue to develop without bound. Where potential dangers may lurk will be discussed, so that (...) the full benefits AI has to offer can be reaped whilst avoiding the pitfalls. The model is produced using the computer programming language MATLAB and offers visual representations of potential outcomes. Interwoven with these potential outcomes are numerous historical models for problems caused by prejudice and recent issues in AI systems, from police prediction and facial recognition software to recruitment tools. Therefore, this research’s novel angle, of using historical precedents to model and discuss potential futures, offers a unique contribution. (shrink)

Surgical innovation promises improvements in healthcare, but it also raises ethical issues including risks of harm to patients, conflicts of interest and increased injustice in access to health care. In this article, we focus on risks of injustice, and use a case study of robotic prostatectomy to identify features of surgical innovation that risk introducing or exacerbating injustices. Interpreting justice as encompassing matters of both efficiency and equity, we first examine questions relating to government decisions about whether to publicly (...) fund access to innovative treatments. Here the case of robotic prostatectomy exemplifies the difficulty of accommodating healthcare priorities such as improving the health of marginalized groups. It also illustrates challenges with estimating the likely long-term costs and benefits of a new intervention, the difficulty of comparing outcomes of an innovative treatment to those of established treatments, and the further complexity associated with patient and surgeon preferences. Once the decision has been made to fund a new procedure, separate issues of justice arise at the level of providing care to individual patients. Here, the case of robotic prostatectomy exemplifies how features of surgical innovation, such as surgeon learning curves and the need for an adequate volume of cases at a treatment centre, can exacerbate injustices associated with treatment cost and the logistics of travelling for treatment. Drawing on our analysis, we conclude by making a number of recommendations for the just introduction of surgical innovations. (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)

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)

Background The twenty first- century marked the exponential growth in the use of intelligent robots and artificial intelligent in nursing compared to the previous decades. To the best of our knowledge, this article is first in responding to question, “Can nurses in clinical practice ascribe responsibility to intelligent robots and artificial intelligence when they commit errors?”. Purpose The objective of this article is to present two worldviews (anthropocentrism and biocentrism) in responding to the question at hand chosen based (...) on the roles of the entities involved in the use of intelligent robots and artificial intelligence in nursing. Methods The development of this article was motivated by the immense discoveries, the current landscape, and nurses’ role in relation to advanced technologies in healthcare. The paper begins the discussion by situating the use of intelligent robots and artificial intelligence in nursing and healthcare and presenting its ethical and moral implications. Then, we presented the two worldviews: anthropocentrism and biocentrism which are used to respond to the task at hand. Results Anthropocentrism puts humans in the center in terms of moral standing and thus responsibility rests on them alone. Biocentrism declares that all creations deserve moral consideration and thus responsibility is equally allocated to all entities. Within these two worldviews, consensus development was offered to resolve these issues. Consensus provides clarity and democracy between and among the societies. Conclusions The findings of this article can be basis in (1) instituting mechanisms of robust peer review and a rigorous series of simulation before adopting or implementing intelligent robots and artificial intelligence in clinical practice; (2) education and training of highly specialized nurse practitioners who can be focal persons in responding to ethical and moral issues with regard to these advanced technologies; and (3) harmonization of robotics research, manufacturing, and clinical practice. (shrink)

Anticipating the ethical impact of emerging technologies is an essential part of responsible innovation. One such emergent technology is the digital twin which we define here as a living replica of a physical system (human or non-human). A digital twin combines various emerging technologies such as AI, Internet of Things, big data and robotics, each component bringing its own socio-ethical issues to the resulting artefacts. The question thus arises which of these socio-ethical themes surface in the process and how they (...) are perceived by stakeholders in the field. In this report we present the results of a qualitative study into the socio-ethical benefits and socio-ethical risks of using digital twins in healthcare. Employing insights from ethics of technology and the Quadruple Helix theory of innovation, we conducted desk research of white literature and 23 interviews with representatives from the four helixes: industry, research, policy and civil society. The ethical scan revealed several important areas where the digital twin can produce socio-ethical value (e.g., prevention and treatment of disease, cost reduction, patient autonomy and freedom, equal treatment) but also several important areas of socio-ethical risks (e.g., privacy and property of data, disruption of existing societal structures, inequality and injustice). We conclude with a reflection on the employed analytical tool and suggestions for further research. (shrink)

The increasing implementation of and reliance on machine-learning (ML) algorithms to perform tasks, deliver services and make decisions in health and healthcare have made the need for fairness in ML, and more specifically in healthcare ML algorithms (HMLA), a very important and urgent task. However, while the debate on fairness in the ethics of artificial intelligence (AI) and in HMLA has grown significantly over the last decade, the very concept of fairness as an ethical value has not yet (...) been sufficiently explored. Our paper aims to fill this gap and address the AI ethics principle of fairness from a conceptual standpoint, drawing insights from accounts of fairness elaborated in moral philosophy and using them to conceptualise fairness as an ethical value and to redefine fairness in HMLA accordingly. To achieve our goal, following a first section aimed at clarifying the background, methodology and structure of the paper, in the second section, we provide an overview of the discussion of the AI ethics principle of fairness in HMLA and show that the concept of fairness underlying this debate is framed in purely distributive terms and overlaps with non-discrimination, which is defined in turn as the absence of biases. After showing that this framing is inadequate, in the third section, we pursue an ethical inquiry into the concept of fairness and argue that fairness ought to be conceived of as an ethical value. Following a clarification of the relationship between fairness and non-discrimination, we show that the two do not overlap and that fairness requires much more than just non-discrimination. Moreover, we highlight that fairness not only has a distributive but also a socio-relational dimension. Finally, we pinpoint the constitutive components of fairness. In doing so, we base our arguments on a renewed reflection on the concept of respect, which goes beyond the idea of equal respect to include respect for individual persons. In the fourth section, we analyse the implications of our conceptual redefinition of fairness as an ethical value in the discussion of fairness in HMLA. Here, we claim that fairness requires more than non-discrimination and the absence of biases as well as more than just distribution; it needs to ensure that HMLA respects persons both as persons and as particular individuals. Finally, in the fifth section, we sketch some broader implications and show how our inquiry can contribute to making HMLA and, more generally, AI promote the social good and a fairer society. (shrink)

Current national and international guidelines for the ethical design and development of artificial intelligence (AI) and robotics emphasize ethical theory. Various governing and advisory bodies have generated sets of broad ethical principles, which institutional decisionmakers are encouraged to apply to particular practical decisions. Although much of this literature examines the ethics of designing and developing AI and robotics, medical institutions typically must make purchase and deployment decisions about technologies that have already been designed and developed. The primary problem facing medical (...) institutions is not one of ethical design but of ethical deployment. The purpose of this paper is to develop a practical model by which medical institutions may make ethical deployment decisions about ready-made advanced technologies. Our slogan is “more process, less principles.” Ethically sound decisionmaking requires that the process by which medical institutions make such decisions include participatory, deliberative, and conservative elements. We argue that our model preserves the strengths of existing frameworks, avoids their shortcomings, and delivers its own moral, practical, and epistemic advantages. (shrink)

Anticipating the ethical impact of emerging technologies is an essential part of responsible innovation. One such emergent technology is the digital twin which we define here as a living replica of a physical system. A digital twin combines various emerging technologies such as AI, Internet of Things, big data and robotics, each component bringing its own socio-ethical issues to the resulting artefacts. The question thus arises which of these socio-ethical themes surface in the process and how they are perceived by (...) stakeholders in the field. In this report we present the results of a qualitative study into the socio-ethical benefits and socio-ethical risks of using digital twins in healthcare. Employing insights from ethics of technology and the Quadruple Helix theory of innovation, we conducted desk research of white literature and 23 interviews with representatives from the four helixes: industry, research, policy and civil society. The ethical scan revealed several important areas where the digital twin can produce socio-ethical value but also several important areas of socio-ethical risks. We conclude with a reflection on the employed analytical tool and suggestions for further research. (shrink)

Artificial intelligence (AI) technologies in medicine are gradually changing biomedical research and patient care. High expectations and promises from novel AI applications aiming to positively impact society raise new ethical considerations for patients and caregivers who use these technologies. Based on a qualitative content analysis of semi-structured interviews and focus groups with healthcare professionals (HCPs), patients, and family members of patients with Parkinson’s Disease (PD), the present study investigates participant views on the comparative benefits and problems of using human (...) versus AI predictive computer vision health monitoring, as well as participants’ ethical concerns regarding these technologies. Participants presumed that AI monitoring would enhance information sharing and treatment, but voiced concerns about data ownership, data protection, commercialization of patient data, and privacy at home. They highlighted that privacy issues at home and data security issues are often linked and should be investigated together. Findings may help technologists, HCPs, and policymakers determine how to incorporate stakeholders’ intersecting but divergent concerns into developing and implementing AI PD monitoring tools. (shrink)

Research in the area of intellectual property (IP) is increasingly relevant to the rapidly growing artificial intelligence (AI) and robotics industries, affecting the legal, business, manufacturing, and healthcare sectors. This contributed volume aims to develop our understanding of the legal and ethical challenges posed by artificial intelligence and robotics technologies and the appropriate intellectual property based legal and regulatory responses. It provides a philosophical and legal framework for considering concepts and principles that relate to the development and use of (...) such technologies at the international, regional, and national levels. The legal discourse in IP concerns the ever-growing AI sector and how businesses can protect their IP and incorporate AI. Moral sentiments often take a back seat to market sentiments, even in shaping the direction of ethical business strategy. This anomaly persists despite growing interest in ethics and IP. Taking an interdisciplinary and diverse perspective, this book enriches the evolving definition and scope of IP literature by focusing on actors, products and regulation that shape the business sector. Considering the gap between theory and practice, this book bridges academic and professional knowledge in unpacking legal, ethical and governance issues in the intellectual property industry. In an effort to include as many viewpoints as possible, contributions have been gathered from diverse fields, including business, ethics, governance, law, philosophy and technology studies. This book will appeal to academics in the field of intellectual property, business ethics, AI, emerging technologies and strategic innovation, as well as practitioners and policy makers. (shrink)

AbstractDespite the fact that people usually believe that individual health rights have an intrinsic value, they have, in fact, only extrinsic value. They are context dependent. While in normal conditions the current societies try to guarantee individual health rights, the challenge arises in emergency situations. Ones of them are pandemics including current covid-19 pandemic. Emergency situations challenge individual health rights due to insufficient medical resources and non-random criteria of selection of patients. However, there are some reasons to assume that societal (...) and technological processes in the near future will threaten permanently individual health rights in normal conditions. Such processes include progress in commonly available human enhancement technologies, and progress in robotics and automation. In this paper I show how individual health rights will be challenged in both scenarios including catastrophic events and future technological progress. In both cases, the idea of assisted dying is discussed as possibly the unique healthcare principle available for people whose individual health rights will be limited or canceled due to catastrophes or technological and financial exclusion. The special case of future space missions is also discussed as an example of an extreme environment affecting the way moral norms are viewed in health care ethics. (shrink)

What are the limits of the use of artificial intelligence (AI) in the relational aspects of medical and nursing care? There has been a lot of recent work and applications showing the promise and efficiency of AI in clinical medicine, both at the research and treatment levels. Many of the obstacles discussed in the literature are technical in character, regarding how to improve and optimize current practices in clinical medicine and also how to develop better data bases for optimal parameter (...) adjustments and predictive algorithms. This paper argues that there are also in principle obstacles to the application of AI in clinical medicine and care where empathy is important, and that these problems cannot be solved with any of the technical and theoretical approaches that shape the current application of AI in specific areas of clinical medicine in which care for patients is fundamental. This is important, because it generates specific risks that may be overlooked otherwise, and it justifies the necessity of human monitoring and emotional intervention in clinical medicine. Consequently, difficult issues concerning moral and legal responsibility may ensue if these in principle problems are ignored. (shrink)

There is growing interest in machine ethics in the question of whether and under what circumstances an artificial intelligence would deserve moral consideration. This paper explores a particular type of moral status that the author terms psychological moral patiency, focusing on the epistemological question of what sort of evidence might lead us to reasonably conclude that a given artificial system qualified as having this status. The paper surveys five possible criteria that might be applied: intuitive judgments, assessments of intelligence, the (...) presence of desires and autonomous behavior, evidence of sentience, and behavioral equivalence. The author suggests that despite its limitations, the latter approach offers the best way forward, and defends a variant of that, termed the cognitive equivalence strategy. In short, this holds that an artificial system should be considered a psychological moral patient to the extent that it possesses cognitive mechanisms shared with other beings such as nonhuman animals whom we also consider to be psychological moral patients. -/- . (shrink)

Human beings express affinity (Shinwa‐kan in Japanese language) in communicating transactive engagements among healthcare providers, patients and healthcare robots. The appearance of healthcare robots and their language capabilities often feature characteristic and appropriate compassionate dialogical functions in human–robot interactions. Elements of healthcare robot configurations comprising its physiognomy and communication properties are founded on the positivist philosophical perspective of being the summation of composite parts, thereby mimicking human persons. This article reviews Mori's theory of the (...) Uncanny Valley and its consequent debates, and examines "Uncanny" relations with generating healthcare robot conversational content with artificial affective communication (AAC) using natural language processing. With healthcare robots provoking influential physical composition and sensory expressions, the relations in human–healthcare robot transactive engagements are argued as supportive of the design and development in natural language processing. This implies that maintaining human–healthcare robot interaction and assessing the eeriness situations explained in the Uncanny Valley theory are crucial positions for healthcare robot functioning as a valuable commodity in health care. As such, physical features, language capabilities and mobility of healthcare robots establish the primacy of the AAC with natural language processing as integral to healthcare robot–human healthcare practice. (shrink)

Healthcare systems across the globe are struggling with increasing costs and worsening outcomes. This presents those responsible for overseeing healthcare with a challenge. Increasingly, policymakers, politicians, clinical entrepreneurs and computer and data scientists argue that a key part of the solution will be ‘Artificial Intelligence’ (AI) – particularly Machine Learning (ML). This argument stems not from the belief that all healthcare needs will soon be taken care of by “robot doctors.” Instead, it is an argument that rests (...) on the classic counterfactual definition of AI as an umbrella term for a range of techniques that can be used to make machines complete tasks in a way that would be considered intelligent were they to be completed by a human. Automation of this nature could offer great opportunities for the improvement of healthcare services and ultimately patients’ health by significantly improving human clinical capabilities in diagnosis, drug discovery, epidemiology, personalised medicine, and operational efficiency. However, if these AI solutions are to be embedded in clinical practice, then at least three issues need to be considered: the technical possibilities and limitations; the ethical, regulatory and legal framework; and the governance framework. In this article, we report on the results of a systematic analysis designed to provide a clear overview of the second of these elements: the ethical, regulatory and legal framework. We find that ethical issues arise at six levels of abstraction (individual, interpersonal, group, institutional, sectoral, and societal) and can be categorised as epistemic, normative, or overarching. We conclude by stressing how important it is that the ethical challenges raised by implementing AI in healthcare settings are tackled proactively rather than reactively and map the key considerations for policymakers to each of the ethical concerns highlighted. (shrink)

In recent years we may observe increasing interest in the development of social innovation both regarding theory as well as the practice of responding to social problems and challenges. One of the crucial challenges at the beginning of the 21st century is population ageing. Various new and innovative initiatives, programs, schemes, and projects to respond to negative consequences of this demographic process are emerging around the world. However, social theories related to ageing are still insufficiently combined with these new practices, (...) social movements, organisational models, and institutions. Many scholars are still using notions and tools from classical theories of social gerontology or the sociology of ageing such as disengagement theory, activity theory, and successful and productive ageing. Such theories do not sufficiently explain ageing in the context of, for example, a broad use of the information and communications technologies including robotics and automation, new healthcare and long-term care models, advancements in the development and governance of age-friendly environments, and public engagement of older adults into co-production of services delivered by public, private, non-governmental as well as non-formal entities. (shrink)

Despite recurring efforts, a gap exists across a variety of contexts between the protection of patients' safety in theory and in practice. This timely Research Handbook highlights these critical issues and suggests both legal and policy changes are necessary to better protect patients' safety. Multidisciplinary in nature, this Research Handbook features contributions from eminent academics, policy makers and medical practitioners from the Global North and South, discussing the essential facets concerning patient safety and the law. It highlights how the role (...) of legislation and case law has the potential to influence, both positively and negatively, medical practice and the quality of care. Chapters explore patient safety and the global health agenda; physiotherapy; 'non-therapeutic' clinical research with children; patient safety awareness in healthcare education; and the increasing use of robotics and artificial intelligence in healthcare. Outlining a wide range of international perspectives on patient safety and the law, this Research Handbook will appeal to academics and researchers specialising in health and medical law, human rights and healthcare regulation. It will also serve as a valuable resource for legal and medical practitioners alike, as well as clinicians and professionals working in healthcare governance. (shrink)