Future Workplace

Care 4.0: Between Relief and Incapacitation

Smart assistance systems are aimed to make life easier in the future for senior citizens, nurses and physicians. But what about medical ethics?
Nursing robots or nursing home? For most Germans there is no question. Eighty-three percent can envision using smart assistance solutions at home if that enabled them to continue living in their own homes for longer, according to the findings of a survey by the Federal Ministry of Education and Research.
Small wonder, then, that almost as many of the respondents (80 percent) think that research into service robots for household, nursing and healthcare use is important or very important. What can be said for sure is that without technical assistance senior citizens in need of care will find it hard in the medium term to spend their twilight years independently in their own four walls. There is already a shortage of outpatient nurses and with demographic change and the shortage of trained nurses the gap between supply and demand is set to grow wider.

Smart Solutions for the Aged

To countervail this trend, increasing use is made of Ambient Assisted Living (AAL) systems in nursing care for the elderly. They aim to pave the way for independent living up to a ripe old age. They aren’t an entirely new idea, of course. For many years senior citizens and people in need of care have been able to use the home emergency call system to request assistance by pressing a button. Smart care beds, adjustable shower seats and acoustic or visual systems to remind patients to take their medications at the right time are also in widespread use.
That, however, is only the beginning. Several years ago the Japanese Riken research institute presented the Robear, a humanoid robot in the shape of a bear. Its role is to lift, carry and even transport bedridden patients by itself. Interactive soft toys like the Justocat, developed in Sweden, help dementia sufferers to feel safe and at ease and encourage communication. And Federal Research Minister Johanna Wanka promised to promote research on intelligent solutions in the Smart Home and AAL areas. Her guiding principle was that “humans must be in control of the robots and the cost of acquisition must be reasonable.”

Many Unresolved Issues

It is clear, then, that nursing robots and digital AAL systems will in the future assist more and more senior citizens and care workers on a day-to-day basis, making important decisions for them. But technical feasibility is only one side of the coin; medical ethics is the other. Legal and ethical aspects require clarification every bit as much as data protection and data security issues do.
“Do we really know what really goes on in self-learning AAL systems and on what knowledge basis they carry out actions?”, asked Arne Manzeschke at the 2017 annual conference of the German Ethics Council. Manzeschke, an ethics expert at the University of Munich, specializes in issues of medical ethics and fears that autonomous solutions in medicine and healthcare may lead to the loss of human skills and of a wealth of creativity. Both medicine and mankind might in the medium term, he fears, become incapable of action without autonomous assistance systems. "We need only to recall the Wannacry virus," he says, "That disabled all computer systems in a number of British hospitals and gave us a foretaste of how real the danger is."
Mass storage and processing of the most intimate medical data is not to everyone’s liking either. What information is stored? What happens to it? Who has access to it? Questions such as these worry patients and their families. Ensuring data protection will not, in the long term, be enough. End-to-end transparency is the issue: who accesses the information, how and with what right. And users must retain control over their own data.

Active Debate on Medical Ethics

There nevertheless seems to be no doubt that autonomous assistance systems are here to stay in medicine, in nursing care and in the homes of senior citizens. Many customers already use them. “But we must align what is technically possible to the actual needs of people,” Research Minister Wanka is by no means alone in saying. That includes taking users’ fears and misgivings seriously and defining legal and ethical guidelines.
In February 2017 the European Parliament framed recommendations to the EU Commission on civil law regulations in the field of robotics. They deal mainly with devising ethical principles for the development and use of smart robotics and with clarifying many still unresolved liability issues. The Parliament also called on the Commission to consider in the long term the introduction of a separate legal status for smart robots.
“It remains doubtful whether the introduction of separate ‘e-persons’ is the right approach,” said Christiane Wendehorst, an expert on civil law at the University of Vienna, in a discussion with T-Systems, “There is no doubt, however, that politicians and the legal profession must soon define a legal framework that keeps our digital future controllable and worth living.”

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