Ethical implications of monitoring technologies in elderly home care
How ethical is it to monitor a dementia patient with sensors, cameras, computers and other technologies,when it comes to assuring the patient's safety? And what technologies are currently available and being used by caregivers? These and other issues are covered in this paper which uses three scholarly sources to review the materials. The ethical issues are covered in the paper, including the issue of patient privacy and autonomy. Clearly technologies are being used and will continue to be used (especially in home care environments), so the ethical issues must be addressed.
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Ethics of Science and Technology in Maintaining Health / Life in Aged or Terminal Patients -- How Cultural Influences Support or Condemn Their Uses
Science and technology have provided a great deal of assistance in recent years to clinical healthcare professionals when it comes to maintaining / sustaining the lives of very old people. This paper reviews: a) some of the technologies currently being utilized as important components of healthcare services for aged people; b) specifically how those technologies are applied to the care of elderly people; and c) the ethical and social implications vis-a-vis those advanced technologies.
Ethical Challenges in the Care of Seriously Ill Patients
Clearly the development of assisting technologies give doctors and nurses additional tools with which to help aged people continue their lives; but there are serious ethical concerns that have been raised regarding those technologies. In the peer-reviewed journal Pain Medicine the authors discuss the "delicate balance between the technical aspects and the humanistic aspects of care" (Lesage, et al., 2001, 121). It is imperative that patients must be cared for in a manner that gives utmost consideration to "…their values, hopes, and beliefs"; and moreover, the use of bioethics in healthcare environments calls for the principles of "…autonomy, beneficence, nonmaleficence, and justice" (Lesage, 121).
Because there is a need for relevant ethical principles in the care of elderly people -- including palliative care -- decisions must be made that embrace the "double effect" (Lesage, 121). The double effect is applicable when values or medical obligations are in conflict and cannot be "realized simultaneously," Lesage continues. There can be is a strong "moral difference" between what was intended by an action (for example, use of artificial hydration) and what the "unintentional" results of the action actually turned out to be (prolonging life when there is no hope of recovery) (Lesage, 121). Hence, in cases where science and technology play a role in patient care, it is vitally important that "informed consent" be part of the collaborative relationship (i.e., good communication) between the patient and the doctor (Lesage, 123).
Using Technology to Monitor Dementia Patients -- Will Caregivers Adapt?
How will technologies work when caregivers (who are not technologically proficient) are offered a chance to monitor dementia patients at home? Professor of Gerontology Jennifer Kinney and a colleague conducted two research projects on caregivers to determine: what technologies they might be comfortable with; and what worked for them after they were provided technological support for dementia patients. As to the first group of 26 caregivers (average age, 63.2 years), who had spent an average of 65 months giving care to a relative with dementia, they indicated a willingness to try technologies but "…had no interest in becoming 'technology whizzes'" (Kinney, 2006, 64). Next, the authors recruited a new group of 19 caregivers (in Ohio) (average age 54.6) who had no ethical problems in consenting to having fairly basic technologies installed: a Pentium II computer; broadband service; a Xanboo Smart Home Management System (including cameras, sensors and software); a cell phone; and Verizon cellular phone service (Kinney, 65).
The problem wasn't so much the technology per se, Kinney explains; it was that caregivers "…required ongoing assistance and training" and as a result, participants needed frequent assistance to the point that it surprised the researchers (65). Seven of the 16 caregivers that stayed through the entire 24 weeks said their lives were made "more difficult" -- it was "just one more thing to worry about" (Kinney, 66). Fourteen caregivers did say their lives were made "easier" by the devices, and eleven said the technologies had "a positive impact on how they spent their time" (Kinney, 66).
Meanwhile, the lesson revealed by this research is that notwithstanding how potentially effective the technologies can be in monitoring dementia patients -- whose caregivers' greatest fear is that their patients will "wander" out the door and get lost -- unless the caregivers are fully conversant and comfortable with the technologies, and how to troubleshoot when minor blips occur, these systems will not be as helpful as they are designed to be.
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- Kang, H.G., Mahoney, D.F., Hoenig, H., Hirth, V.A., Ponato, P., Hajjar, I., and Lipsitz, L.A.
- (2010). In Situ Monitoring of Health in Older Adults: Technologies and Issues. Journal of
- American Geriatric Society, 58(8), 1579-1586.
- Kinney, J.M., and Kart, C.S. (2006). Not Quite a Panacea: Technology to Facilitate Family
- Caregiving for Elders with Dementia. Generations, 30(2), 64-66.
- Lesage, P., and Portenoy, R.K. (2001). Ethical Challenges in the Care of Patients with Serious
- Illness. Pain Medicine, 2(2), 121-128.
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