Schicktanz, S., Welsch, J., Schweda, M., Hein, A., Rieger, J.W., Kirste, T. (2023): AI-Assisted Ethics? Considerations of AI Simulation for the Ethical Assessment and Design of Assistive Technologies. Frontiers in Genetics, ELSI (accepted).
Abstract: Current ethical debates on the use of artificial intelligence (AI) in health care treat AI as a product of technology in three ways. First, by assessing risks and potential benefits of currently developed AI-enabled products with ethical checklists; second, by proposing ex ante lists of ethical values seen as relevant for the design and development of assisting technology, and third, by promoting AI technology to use moral reasoning as part of the automation process. The dominance of these three perspectives in the discourse is demonstrated by a brief summary of the literature. Subsequently, we propose a fourth approach to AI, namely as a methodological tool to assist ethical reflection. We provide a concept of an AI-simulation informed by three separate elements: 1) stochastic human behavior models based on behavioral data for simulating realistic settings, 2) qualitative empirical data on value statements regarding internal policy, and 3) visualization components that aid in understanding the impact of changes in these variables. The potential of this approach is to inform an interdisciplinary field about anticipated ethical challenges or ethical trade-offs in concrete settings and, hence, to spark a re-evaluation of design and implementation plans. This may be particularly useful for applications that deal with extremely complex values and behavior or with limitations on the communication resources of affected persons (e.g., persons with dementia care or for care of persons with cognitive impairment). Simulation does not replace ethical reflection but does allow for detailed, context-sensitive analysis during the design process and prior to implementation. Finally, we discuss the inherently quantitative methods of analysis afforded by stochastic simulations as well as the potential for ethical discussions and how simulations with AI can improve traditional forms of thought experiments and future-oriented technology assessment.
Köhler, S., Görß, D., Kowe, A., Teipel, S. (2022): Matching values to technology: a value sensitive design approach to identify values and use cases of an assistive system for people with dementia in institutional care. Ethics and Information Technology, 24(3), 27.
Abstract: The number of people with dementia is increasing worldwide. At the same time, family and professional caregivers’ resources are limited. A promising approach to relieve these carers’ burden and assist people with dementia is assistive technology. In order to be useful and accepted, such technologies need to respect the values and needs of their intended users. We applied the value sensitive design approach to identify values and needs of patients with dementia and family and professional caregivers in respect to assistive technologies to assist people with dementia in institutionalized care. Based on semi-structured interviews of residents/patients with cognitive impairment, relatives, and healthcare professionals (10 each), we identified 44 values summarized by 18 core values. From these values, we created a values’ network to demonstrate the interplay between the values. The core of this network was caring and empathy as most strongly interacting value. Furthermore, we found 36 needs for assistance belonging to the four action fields of activity, care, management/administration, and nursing. Based on these values and needs for assistance, we created possible use cases for assistive technologies in each of the identified four action fields. All these use cases already are technologically feasible today but are not currently being used in healthcare facilities. This underlines the need for development of value-based technologies to ensure not only technological feasibility but also acceptance and implementation of assistive technologies. Our results help balance conflicting values and provide concrete suggestions for how engineers and designers can incorporate values into assistive technologies.
Buhr, E., Schweda, M. (2022): Technische Assistenzsysteme für Menschen mit Demenz: Zur ethischen Bedeutung von Beziehungen. In: Friedrich, Orsolya et al. (Hg.): Mensch-Maschine-Interaktion – Konzeptionelle, soziale und ethische Implikationen neuer Mensch-Technik-Verhältnisse. Paderborn: mentis, 284-301
Abstract: In view of demographic change, the transformation of traditional family care structures and the shortage of skilled workers in professional care, there is an increasing focus on technical solutions to enable people with dementia to live independently for as long as possible and to ensure the demanding and time-consuming care and nursing in advanced stages of dementia.
Caring for people with dementia is associated with specific requirements due to their progressive cognitive impairments and their correspondingly increased vulnerability. The importance of familiar relationships for the self-determination and well-being of those affected is especially emphasized in this regard. Professional care for people with dementia, for example, should take place in relationships that enable all those involved to experience security, fulfillment and a sense of purpose. The use of technical assistance systems can intervene deeply in this fundamental network of care relationships and influence and change it in different ways. On the one hand, the digitalization of care is often associated with the expectation that assistive technologies could free up time and personnel capacities for emotional care and social interactions and thus strengthen care relationships. On the other hand, fears are repeatedly voiced that human care and support could be replaced by technical assistance in the course of automation.
Against this background, this article explores the question of what ethical significance the use of technical assistance systems could have with regard to the care relationships that are crucial for people with dementia. To this end, we first provide an overview of the spectrum of assistive technologies that are currently being developed and used to support the independent living and nursing care of people with dementia. Subsequently, we visualize the importance of relationships for the life and care of people with dementia and examine which effects the use of technical assistance systems can have in this respect. In doing so, we refer to the "Senses-Framework" according to Mike Nolan. On this basis, we outline the requirements for the use of technology in the care of people with dementia, which can allow, guarantee or even promote a respectful and appreciative relationship. In doing so, we argue that trust, relational privacy, and reciprocal care are particularly crucial for establishing, maintaining, and cultivating meaningful relationships in this domain.
Buhr, E., Schweda, M. (2022): Der Wert des Privaten für Menschen mit Demenz. In: Ethik Med 266 (5), S. 7. DOI: 10.1007/s00481-022-00723-9.
Abstract: The concept of privacy has been astonishingly absent in the discussion about dementia care. In general, questions of privacy receive a lot of attention in nursing ethics; however, when it comes to dementia care, hardly any systematic ethical debate on the topic can be found. It almost seems as though people with dementia had lost any comprehensible interest in privacy and no longer had any private sphere that needed to be considered or protected. However, this not only contradicts widespread moral intuitions but also ignores the views and needs of those affected. We first outline the origins and dimensions of the concept of privacy and point out problems and limitations in the context of dementia. Especially the prevalent liberal conceptions’ dependence on the idea of autonomy poses significant challenges to an adequate conceptualization of the moral significance of privacy for people with dementia. Therefore, we subsequently explore alternative ways of conceptualizing the “value of privacy” in the context of dementia care. Autonomy-based concepts of privacy may still be valid in the early stages of dementia. However, in the further course of the syndrome, the relevance of other normative aspects comes to the fore, especially respect for remaining personal preferences as well as objective criteria of dignity and well-being. Thus, we outline in a differentiated manner how and to what extent privacy can be of normative importance beyond the purview of autonomy and should consequently be taken into consideration in dementia care.
Buhr, E., Welsch, J. (2022): Privacy-sensitive Empowerment. Towards an Integrated Concept for Technology Assisted Care for People with Dementia. In: Rubeis, G. et al. (Hg.): Digitalisierung der Pflege. Interdisziplinäre Perspektiven auf digitale Transformation in der pflegerischen Praxis. Göttingen: Vandenhoeck & Ruprecht, 185-197, ISBN E-Lib: 9783737014793, Open Access.
Abstract: Demographic aging and the increasing prevalence of cognitive disorders exacerbate the already existing nursing shortage. Simultaneously, steady progress is made in the area of digitization and the development of monitoring-systems, mobility supporting robots and even social robots, that are aimed to be implemented in dementia care. These devices are sociotechnical systems that we define as co-intelligent assistive dementia care (CIMADeC), as they rely on man-machine-interaction.
Problem/ Research Question: The implementation of the aforementioned technologies in institutional and informal settings is often presented as the digital solution to the current challenges of dementia care as they have the potential to support independent living, detect or predict impending problems and crises, relieve caregiver burden, and increase the overall quality and cost-efficiency of dementia care. Nevertheless, initial empirical and ethical assessments indicate a fundamental ambivalence. For care givers such systems might imply support in their work but can also threaten their (sometimes already precarious) working conditions. Regarding people with dementia (PwD), CIMADeC might empower them, e.g. by increasing security and independence, but potentially endanger their privacy. CIMADeC therefore offers promising starting points to explore empowerment and privacy as guiding normative concepts in dementia care. Assuming that a lack of clarity at the conceptual level complicates the concrete care situation as a not least communicative process between the stakeholders, we will specify the concepts of empowerment and privacy and suggest Privacy-sensitive Empowerment (PSE) as an integrated ethical concept for technology-assisted care for PwD.
Methodology/Approach: We propose the integrative concept of PSE to reflect on normative conflicts and to provide helpful ethical orientation for their resolution. In order to introduce PSE as an integrative ethical concept, we will, in a first step, present empowerment and privacy as relevant ethical aspects in the context of CIMADeC for PwD. In a next step, we unfold the potential normative conflicts between them. Finally, with PSE we present an empirically informed approach that connects the concepts of empowerment and privacy.
Outlook: We outline an empirically informed ethical approach to explore the full scope of practical and context specific aspects of privacy and empowerment in CIMADeC. Our approach firstly provides a framework for ethical reflection on conflicts between autonomy and privacy. Secondly, it offers helpful ethical orientation for the practice of care when the demand for more self-determination and lived privacy come into conflict.
Working paper "Stakeholder-Konferenz zu Digitalen Assistenzsystemen für Menschen mit Demenz, pflegende Angehörige und Pflegekräfte im Rahmen des EIDEC-Projektes am 31.03.2022." Download working paper
Abstract: The interdisciplinary consortium of the EIDEC project investigates social and ethical aspects of the application of intelligent monitoring and assistance systems (MAS) in home and inpatient dementia care. The aim of the project is to identify values and criteria of acceptance in the application of MAS, to reflect conflicts and to facilitate the use of MAS in care practice. As part of subproject 1 "Value-sensitive and affect-aware design", a stakeholder conference on the topic of "Digital assistance systems for people with dementia, family caregivers, and care workers" was held in Rostock, Germany, on March 31, 2022, with local stakeholders in dementia care. The conference was held in a World Café format.
Welsch, J. (2022): Empowerment and Technology. An ethical-empirical exploration of technology-assisted dementia care. Download Poster
Löbe, C., Abo Jabel, H. (2022): Empowering people with dementia via using intelligent assistive technology: A scoping review. Archives of Gerontology and Geriatrics, 101(104699). DOI: 10.1016/j.archger.2022.104699
Abstract: Objectives: Over the past decade, the idea has been promoted that intelligent assistive technology (IAT) can empower people with dementia. As a new area of inquiry, however, the concept of empowerment and the impact of IAT in this context are still unclear. Therefore, we conducted a scoping review to examine the conceptualizing and measuring of empowerment, as well as to understand the impact of IAT on empowering people with dementia in the existing studies.
Design: A scoping review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using the following databases: Pubmed, Cochrane Library, Web of Science, and Science Direct. In addition, a manual search was also conducted in Google Scholar to identify further articles.
Results: A total of 28 articles examining the empowerment of people with dementia via IAT met the inclusion criteria. Most had a cross-sectional (43%) or interventional/experimental design (39%). A little more than half (54%) were qualitative studies. We observed inconsistencies in the conceptualization and measurement of the concept of empowerment in the included studies; as such, the exact role of IAT in this context remains somewhat unclear. However, most of the studies suggest that IAT can empower people with mild/moderate dementia by enhancing their capacity to live more independently with privacy for a longer period of time.
Conclusions: Future research should focus on developing a clear definition of the concept of empowerment, as well as developing a reliable and valid tool for measuring it.
Schicktanz, S., Schweda, M. (2021): Aging 4.0? Rethinking the ethical framing of technology‐assisted eldercare. History and Philosophy of the Life Sciences, 43 (93). DOI: 10.1007/s40656-021-00447-x
Abstract: Technological approaches are increasingly discussed as a solution for the provision of support in activities of daily living as well as in medical and nursing care for older people. The development and implementation of such assistive technologies for eldercare raise manifold ethical, legal, and social questions. The discussion of these questions is influenced by theoretical perspectives and approaches from medical and nursing ethics, especially the principlist framework of autonomy, non- maleficence, beneficence, and justice. Tying in with previous criticism, the present contribution is taking these principles as a starting point and as a frame of reference to be critically re-examined. It thus aims to outline how existing ethical frameworks need to be extended or reconsidered to capture the ethical issues posed by techno- logical developments regarding care for older people. In a first step, we provide a brief overview of assistive technologies in eldercare according to their purposes and functions. In the next step, we discuss how the questions and problems raised by new technologies in eldercare call for an expansion, re-interpretation, and revision of the principlist framework. We underline that the inclusion of ethical perspectives from engineering and computer science as well as a closer consideration of socio- political dimensions and fundamental anthropological and praxeological questions are needed.
Schweda, M., Schicktanz, S. (2021): Ethische Aspekte co-intelligenter Assistenztechnologien in der Versorgung von Menschen mit Demenz. Psychiatrische Praxis, 48(01). 37–41. DOI: 10.1055/a-1369-3178
Abstract: Smart assistive technologies are increasingly discussed as a solution for the care of people with dementia. The article considers central ethical challenges of the use of such systems. It focuses on issues of privacy and empowerment.
Shaukat, M. S., Põder, J.-C., Bader, S., & Kirste, T. (2021). Towards Measuring Ethicality of an Intelligent Assistive System. Proc. 1st AITHICS workshop (Artificial Intelligence and Ethics) held at 44th German Conference on Artificial Intelligence (KI-2021). DOI: 10.48550/ARXIV.2303.03929
Abstract: Artificial intelligence (AI) based assistive systems, so called intelligent assistive technology (IAT) are becoming increasingly ubiquitous by each day. IAT helps people in improving their quality of life by providing intelligent assistance based on the provided data. Few examples of such IATs include self-driving cars, robot assistants and smart-health management solutions. However, the presence of such autonomous entities poses ethical challenges concerning the stakeholders involved in using these systems. There is a lack of research when it comes to analysing how such IAT adheres to provided ethical regulations due to ethical, logistic and cost issues associated with such an analysis. In the light of above-mentioned problem statement and issues, we present a method to measure “ethicality” of an assistive system. To perform this task, we utilised our simulation tool that focuses on modelling navigation and assistance of Persons with Dementia (PwD) in indoor environments. By utilising this tool, we analyse how well different assistive strategies adhere to provided ethical regulations such as autonomy, justice and beneficence of the stakeholders.
Shaukat, M. S., Hiller, B. C., Bader, S., & Kirste, T. (2021). SimDem: A Multi-agent Simulation Environment to Model Persons with Dementia and their Assistance. 4th International Workshop on AI for Aging, Rehabilitation and Independent Assisted Living held at IJCAI 2021. http://arxiv.org/abs/2107.05346
Abstract: Developing artificial intelligence based assistive systems to aid Persons with Dementia (PwD) requires large amounts of training data. However, data collection poses ethical, legal, economic, and logistic issues. Synthetic data generation tools, in this regard, provide a potential solution. However, we believe that already available such tools do not adequately reflect cognitive deficiencies in behavior simulation. To counter these issues we propose a simulation model (SimDem) that primarily focuses on cognitive impairments suffered by PwD and can be easily configured and adapted by the users to model and evaluate assistive solutions.
Krohm, S. (2021): ‚Female‘ Care and ‚Male‘ Technology? Pflege und technische Assistenzsysteme aus Sicht beruflich Pflegender - Eine explorative qualitative Interviewstudie. Download Poster
Abstract: The aim of the study was an explorative investigation of the view of professional caregivers on care and technical assistance systems for people with dementia with a focus on the relevance of gender and gender stereotypes. For this purpose, 21 guided expert interviews with professional caregivers were conducted, which were analyzed using a structuring qualitative content analysis. Results: Gender stereotypes and the topic of gender were brought up by the interviewed nurses primarily in connection with interest in and competence in technology, but also in the context of intimate care, external appearance, and physical strength. Latently, gender also plays a role in the context of ideals of good nursing care. Thus, these are often linked to the emphasis on empathy, communication, and the component of emotional labor, which at the same time are stereotypically attributed to women in particular. Here, nurses emphasize above all social and emotional aspects in nursing actions. Furthermore, communication and interaction with patients and residents and loneliness of those in need of care, especially in the home, are addressed. For some caregivers, this conflicts with the use of certain assistive systems that could not perform this socio-emotional level of care. This is contrasted with the potential gain in autonomy and privacy for those affected. However, especially with regard to the use of technology, caregivers also see age and generational affiliation as important influencing factors. Especially in the interaction of elderly persons in need of care with physical robots, excessive demands and fears are predicted. This is related in particular to generational affiliation, which is why the systems could only be successfully established in practice in a few years or decades when the generation of digital natives reaches the age of needing care. By contrast, the use of technologies such as positioning systems, which do not require complex operation by the persons concerned themselves or do not substitute any nursing activities on humans, is assessed quite positively across the board.
Schweda, M., Kirste, T., Hein, A., Teipel, S., Schicktanz, S. (2019): The emergence of co-intelligent monitoring and assistive technologies in dementia care - an outline of technological trends and ethical aspects. Bioethica Forum, 12 (1/2). 29–37. DOI: 10.24894/BF.2019.12008
Abstract: This contribution explores ethical aspects of co-intelligent monitoring and assistive technologies in dementia care (CIMADeC). The aim is to provide an outline of central practical problems and ethically relevant questions. A particular focus is on two crucial issues in the development of such systems for the vulnerable group of people with dementia: privacy and empowerment. We first give an overview of the state of the art of technology development in the field of CIMADeC. On this basis, we turn to the ethical debate on assistive technologies in the context of dementia in order to extrapolate ethical aspects and open questions of this emerging form of dementia care. Against the backdrop of a general overview of ethical issues, the analysis takes a closer look at problems of privacy and empowerment. The discussion stresses the relevance of interdisciplinary co-operation between engineering, care and ethics. A crucial question is how ethical concerns of users and other stakeholders can be included in the spirit of participatory technology development.