Abstract
In this paper I describe a future in which persons in advanced old age are cared for entirely by robots and suggest that this would be a dystopia, which we would be well advised to avoid if we can. Paying attention to the objective elements of welfare rather than to people’s happiness reveals the central importance of respect and recognition, which robots cannot provide, to the practice of aged care. A realistic appreciation of the current economics of the aged care sector suggests that the introduction of robots into an aged care setting will most likely threaten rather than enhance these goods. I argue that, as a result, robotics for aged care is likely to transform aged care in accordance with a trajectory that leads towards this dystopian future even when this is not the intention of the engineers involved. While an argument can be made for the use of robots in aged care where the people being cared for have chosen to allow robots in this role, I suggest that overemphasising this possibility risks rendering it a self-fulfilling prophecy, depriving those being cared for of valuable social recognition, and failing to provide respect for older persons by allowing the options available to them to be shaped by the design choices of others.
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Notes
Notable contemporary examples include the European Union-funded ACCOMPANY Project, which aims to build an ACCOMPANY System (or Care-O-Bot 3), which, according to the list of objectives on its website, will provide “services to elderly users in a motivating and socially acceptable manner to facilitate independent living at home” [See http://accompanyproject.eu/ (accessed 16.1.15)] and the (also EU funded) HOBBIT project, the goal of which is “to advance towards a robot solution that will enhance wellness and quality of life for seniors, and enhance their ability to live independently for longer at their homes.” [See http://hobbit.acin.tuwien.ac.at/index.html (accessed 21.1.15)].
Coeckelberg (Coeckelbergh 2012) outlines a similar scenario as a possible vision of the future of aged care in a paper of which I only became aware after drafting this one.
For a recent survey of such claims, see Vincze et al. (2015)).
For a useful (if dated) survey, see Griffin (1986).
The account below roughly follows Parfit (1984: 493; subsequent discussion).
A variation of a counter-example first suggested by Rawls (1971: 432).
An influential alternative involves introducing a requirement for some degree of idealisation in the specification of the relevant desires. Thus, for instance, we might say that people are well off when the desires that they reflectively endorse when fully informed are satisfied. Such accounts suffer from a tendency to collapse into versions of the “objective list” theory when placed under philosophical pressure because it is difficult to quarantine accounts of the reasonableness of desires from the worth of their objects.
Although the fact that relations between persons have this dual aspect is reasonably uncontroversial, both the precise way to make the distinction and the most appropriate terminology by which to mark it remain a matter of some controversy. The idea of “recognition” as a distinct good was central to the philosophical debate about multiculturalism, which took place in the 1990 s [see especially Taylor and Gutmann (1992)] although the contrast with respect was not always stated explicitly. Fraser (1995) comes close to making this distinction as I make it here, although she cashes out the implications of a concern for respect as a concern for the distribution of political and economic opportunities. My account of recognition subsumes the first and third form of recognition distinguished by Honneth (1992) in his justly influential account, while my concept of respect closely tracks the second form of “recognition” he identifies. In Nussbaum's list of capabilities, recognition is included within “affiliation”, while respect is most obviously represented as “control over one's environment” but is also represented in the concern with freedom and opportunity that drives the focus on capabilities rather than a more determinate list of goods (Nussbaum 2011: 33–34).
This can only be an approximation because recognition also admits of the distinction between genuine and ersatz acknowledgement of the worth of others.
This is not to say that older persons are always treated with respect and recognition by human “carers”. However, where human beings don't provide these goods, this is widely acknowledged to represent a moral failing. As I discuss below, the claim that the use of robots in aged care is inimical to respect is more controversial than the claim about recognition and I defend it further in the last part of this paper.
As I have argued elsewhere (Sparrow 2002), the ethics of designing artefacts that encourage this delusion is problematic.
Vallor (2011) argues, with some plausibility, that it would also be a dystopia in so far as this is a world in which (potential) caregivers are denied the opportunity to cultivate important virtues and to benefit from contact with the elderly. For some reservations about the general form of this argument, however, see Sparrow (2015).
Again, an objective that is highlighted in both the EU-funded ACCOMPANY Project (see: http://accompanyproject.eu/) and HOBBIT Project (see http://hobbit.acin.tuwien.ac.at/index.html).
It must be acknowledged that some of the changes required may be very expensive in some homes and also that some of these changes, where they are inexpensive, may also make it easier for robots to function in homes.
This is, perhaps, not so immediately obvious in the case of telepresence robots, which might be thought of as offering a new medium through which contact between people may occur. However, even in this case such robots clearly function to substitute for the physical presence of the other person.
Striking accounts of the impacts of this dynamic in the Australian context are provided here: http://www.theglobalmail.org/feature/how-our-twilight-years-are-ripe-for-the-picking/73/ (accessed 15.1.15); and, here http://www.agedcarecrisis.com/yoursay/4611-no-staff-for-10-5-hours-per-day (accessed 15.1.15). My thanks to Linda Sparrow for these examples.
This goal is even made explicit in the announcement of a new position paper on workforce issues by Aged and Community Services Australia (ACSA), which quotes one of the authors, Adjunct Professor John Kelly, as saying “We have to use robotics and technology in clinical care to decrease—not in a huge way but possibly by 5 per cent—the amount of people we need by actually getting technology to do things”. See Belardi (2015). New workforce strategy for aged care. http://www.australianageingagenda.com.au/2015/01/13/new-workforce-strategy-aged-care/ (accessed 15.1.15).
This fact is also, I think, reflected in the recent enthusiasm in the literature for Nussbaum's “capacities approach” to social justice, which acknowledges the value of autonomy by focusing on the distribution of the capacity to achieve various “functionings” rather than on goods understood as particular items or outcomes, as a lens through which to view the ethics of robots in aged care. See, also: Coeckelbergh (2012), Parks (2010), Sharkey (2014).
This way of putting the matter risks implying that robots can provide respect, which is not the case; rather, where individuals choose to allow robots to be used to assist them, the decision of third parties to respect this choice provides the good of respect.
Again, it is clear that existing standards of care are already inadequate in many, indeed arguably most, cases today. However, this sad fact does not detract from the larger argument here; that claims about the significance of older citizens’ willingness to be happy with care provided by robots need to be treated with a certain degree of cynicism, while the alternative is so dire.
For an extended discussion of the various ways in which values are—and might be—embedded into the design of caring robots, see van Wynsberghe (2013).
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Acknowledgments
The research for this paper was supported under the Australian Research Council’s Centres of Excellence funding scheme (Project CE140100012). The views expressed herein are those of the author and are not necessarily those of the Australian Research Council. I would like to thank Professor Gesa Lindemann and Professor Gregor Fitzi for the invitation to attend the “Going beyond the Laboratory” conference. I’d also like to thank my mother, Linda Sparrow, and Catherine Mills for comments and discussion during the process of drafting this manuscript.
