Review
The use of care robots in aged care: A systematic review of argument-based ethics literature

https://doi.org/10.1016/j.archger.2017.08.014Get rights and content

Highlights

  • Ethical arguments and grounding concepts on care robot use in aged care are diverse.

  • Deeper understanding of the ethical debate on care robot use is provided.

  • Deontology, principlism, object-list theory, or care ethics motivate most ethical arguments.

  • Authors’ view of care robots reveals their understanding of the ethical landscape and vice versa.

  • Ethical assessments and reasoning strengthen each other but need to be distinguished.

Abstract

Background

As care robots become more commonplace in aged-care settings, the ethical debate on their use becomes increasingly important. Our objective was to examine the ethical arguments and underlying concepts used in the ethical debate on care robot use in aged care.

Methods

We conducted a systematic literature search for argument-based ethics publications focusing on care robot use in aged-care practices. We used an innovative methodology that consisted of three steps: (a) identifying conceptual-ethical questions, (b) conducting a literature search, and (c) identifying, describing and analyzing the ethical arguments in connection with the conceptual-ethical questions.

Results

Twenty-eight appropriate publications were identified. All were published between 2002 and 2016. Four primary ethical approaches were distinguished: (a) a deontological, (b) a principlist, (c) an objective-list, and (d) a care-ethical. All approaches were equally represented across the articles, and all used similar concepts that grounded their diverse ethical arguments. A small group of publications could not be linked to an ethical approach.

Conclusions

All included publications presented a strong ethical rationale based on fully elaborated normative arguments. Although the reviewed studies used similar grounding concepts, the studies’ arguments were very diverse and sometimes diametrically opposed. Our analysis shows how one envisions care robot use in aged-care settings is influenced by how one views the traditional boundaries of the ethical landscape in aged care. We suggest that an ethical analysis of care robot use employs “democratic spaces,” in which all stakeholders in aged care, especially care recipients, have a voice in the ethical debate.

Introduction

With expanding care technology, the issue of whether better technology can contribute positively to the current state of aged care is gaining more attention. Moreover, there is a rapidly increasing imbalance between the number of older adults needing care and a decreasing number of caregivers (World Health Organization, 2015). Care robots are viewed by some as a promising technological development that has the potential to mitigate this growing care recipient-caregiver disparity. These robots can be considered as embodied forms of semi-independent or independent technology. They support caregivers and/or older adults in physically assistive tasks. For example, the “My Spoon Robot” can aid someone with eating problems, and the “Sanyo Bath Robot” provides hygienic care to older adults (Bedaf, Gelderblom, & de Witte, 2015). Other care robots serve as social supports (e.g. the seal-like robot Paro or the dog-like robot AIBO) (Bemelmans, Gelderblom, Jonker, & de Witte, 2012). There are also care robots that combine both functions, being socially assistive. They give assistance through social interaction (Feil-Seifer & Matarić, 2005) (e.g. the human-like robot Robovie, and the robot, Pearl) (Kachouie, Sighadeli, Khosla, & Chu, 2014).

Many studies have examined how care robots can be used in aged-care settings (Bedaf et al., 2015; Kachouie et al., 2014; Robinson, MacDonald, & Broadbent, 2014); their effectiveness (Bemelmans et al., 2012; Mordoch, Osterreicher, Guse, Roger, & Thompson, 2013); what factors influence older adults’ acceptance or rejection of care robots (De Graaf & Allouch, 2013; Flandorfer, 2012); and older adults’ attitudes toward socially assistive robots (Vandemeulebroucke, Dierckx de Casterlé, & Gastmans, 2017). Nonetheless, as robot technology advances, care robots become increasingly independent. As the conviction of their use in aged-care practices builds, there is a growing need to ethically reflect on this use. Indeed, the field of roboethics addresses care robot use in aged-care practices (Lin, Abney, & Bekey, 2014; Tzafestas, 2016). Although these studies are valuable, we believe they do not address all arguments in the ethical debate about using care robots in aged care. Furthermore, the arguments presented in these studies have received limited analysis. To address this, we conducted a systematic review of the normative literature motivating the ethical debate on care robot use in aged-care practices.

Section snippets

Methods

Systematic reviews of normative literature are published frequently (Mertz, Kahrass, & Strech, 2016). Their goal is to promote informed decisions and judgments in all segments of healthcare, to improve research that aids these decisions and to continuously improve the standards of bioethics (McCullough, Coverdale, & Chervenak, 2007; Sofaer & Strech, 2012). The methodology developed for the present review shares these goals. Three steps were undertaken in our analyses. First, we identified the

Results

We identified twenty-eight eligible publications for inclusion. Publications dates were from 2002 to 2016, with three appearing before 2010. While doing the data extraction and synthesis, it became evident that most authors of the included publications argued from a specific ethical stance. Four ethical approaches were apparent in the included publications (Table 2): (a) a deontological approach, (b) a principlist approach, (c) an objective-list approach and, (d) a care-ethical approach. Some

Discussion

The overall aim of this review of the normative literature was to gain a better understanding of the range of views and ethical arguments on the use of care robots in aged-care practices and their grounding concepts. The diversity and wide-ranging views compiled in our analysis shows that the ethical debate is far from reaching a consensus and potentially is unreachable.

In this robotic age, we find ourselves in well-tilled ethical soil. Debates on the ethics of using robots in human activities

Funding

The authors did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors to plan or conduct this research.

Conflict of interest

The authors did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors to plan or conduct this research.

Acknowledgments

None.

References (53)

  • M.M.A. De Graaf et al.

    Exploring influencing variables for the acceptance of social robots

    Robotics and Autonomous Systems

    (2013)
  • B. Dierckx de Casterlé et al.

    QUAGOL: A guide for qualitative data analysis

    International Journal of Nursing Studies

    (2012)
  • E. Mordoch et al.

    Use of social commitment robots in the care of elderly people with dementia: A literature review

    Maturitas

    (2013)
  • S. Bedaf et al.

    Overview and categorization of robots supporting independent living of elderly people: What activities do they support and how far have they developed

    Assistive Technology

    (2015)
  • R. Bemelmans et al.

    Socially assistive robots in elderly care: A systematic review into effects and effectiveness

    JAMDA

    (2012)
  • R. Blackford

    Robots and reality: A reply to Robert Sparrow

    Ethics and Information Technology

    (2012)
  • J. Borenstein et al.

    Robot caregivers: Harbingers of expanded freedom for all?

    Ethics and Information Technology

    (2010)
  • M. Coeckelbergh

    Health care, capabilities, and AI assistive technology

    Ethical Theory and Moral Practice

    (2010)
  • M. Coeckelbergh

    Are emotional robots deceptive?

    IEEE Transactions on Affective Computing

    (2012)
  • M. Coeckelbergh

    Artificial agents, good care, and modernity

    Theoretical Medicine and Bioethics

    (2015)
  • M. Coeckelbergh

    Care robots and the future of ICT-mediated elderly care: A response to doom scenarios

    AI & Society

    (2015)
  • M. Decker

    Caregiving robots and ethical reflection: The perspective of interdisciplinary technology assessment

    AI & Society

    (2008)
  • A. Feenberg

    Questioning technology

    (1999)
  • D. Feil-Seifer et al.

    Defining socially assistive robotics

    Proceedings of the 2005 IEEE 9th international conference on rehabilitation robotics

    (2005)
  • D. Feil-Seifer et al.

    Socially assistive robotics. Ethical issues related to technology

    IEEE Robotics & Automation Magazine

    (2011)
  • P. Flandorfer

    Population ageing and socially assistive robots for elderly persons: The importance of sociodemographic factors for user acceptance

    International Journal of Population Research

    (2012)
  • D.J. Gunkel

    The machine question. Critical perspectives on AI, robots, and ethics

    (2012)
  • M. Ienca et al.

    Social and assistive robotics in dementia care: Ethical recommendations for research and practice

    International Journal of Social Robotics

    (2016)
  • T. Körtner

    Ethical Challenges in the use of social service robots for elderly people

    Zeitschrift für Gerontologie und Geriartrie

    (2016)
  • R. Kachouie et al.

    Socially assistive robots in elderly care: A mixed-method systematic literature review

    International Journal of Human-Computer Interaction

    (2014)
  • A. Liberati et al.

    The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration

    BMJ

    (2009)
  • P. Lin et al.

    Robot ethics. The ethical and social implication of robotics

    (2014)
  • A. Matthias

    Robot lies in health care: When is deception morally permissible?

    Kennedy Institute of Ethics Journal

    (2015)
  • L.B. McCullough et al.

    Constructing a systematic review for argument-based clinical ethics literature: The example of concealed medications

    Journal of Medicine and Philosophy

    (2007)
  • M. Mertz et al.

    Current state of ethics literature synthesis: A systematic review of reviews

    BMC Medicine

    (2016)
  • Cited by (135)

    View all citing articles on Scopus
    View full text