Mort Maggie, Roberts Celia, Pols Jeannette, Domenech Miquel, Moser Ingunn
Department of Sociology and Division of Medicine, Lancaster University, Lancaster, UK.
Health Expect. 2015 Jun;18(3):438-49. doi: 10.1111/hex.12109. Epub 2013 Aug 6.
Telecare and telehealth developments have recently attracted much attention in research and service development contexts, where their evaluation has predominantly concerned effectiveness and efficiency. Their social and ethical implications, in contrast, have received little scrutiny.
To develop an ethical framework for telecare systems based on analysis of observations of telecare-in-use and citizens' panel deliberations.
Ethnographic study (observation, work shadowing), interviews, older citizens' panels and a participative conference.
Participants' homes, workplaces and familiar community venues in England, Spain, the Netherlands and Norway 2008-2011.
Older respondents expressed concerns that telecare might be used to replace face-to-face/hands-on care to cut costs. Citizens' panels strongly advocated ethical and social questions being considered in tandem with technical and policy developments. Older people are too often excluded from telecare system design, and installation is often wrongly seen as a one-off event. Some systems enhance self-care by increasing self-awareness, while others shift agency away from the older person, introducing new forms of dependency.
Telecare has care limitations; it is not a solution, but a shift in networks of relations and responsibilities. Telecare cannot be meaningfully evaluated as an entity, but rather in the situated relations people and technologies create together. Characteristics of ethical telecare include on-going user/carer engagement in decision making about systems: in-home system evolution with feedback opportunities built into implementation. System design should be horizontal, 'two-way'/interactive rather than vertical or 'one-way'. An ethical framework for telecare has been developed from these conclusions (Table 1).
远程护理和远程医疗的发展最近在研究和服务开发领域引起了广泛关注，对它们的评估主要集中在有效性和效率方面。相比之下，它们的社会和伦理影响却很少受到审视。
基于对远程护理实际使用情况的观察和公民小组讨论的分析，为远程护理系统制定一个伦理框架。
人种学研究（观察、工作跟随）、访谈、老年公民小组和一次参与性会议。
2008年至2011年期间，在英国、西班牙、荷兰和挪威的参与者家中、工作场所及熟悉的社区场所。
老年受访者担心远程护理可能会被用于取代面对面/亲身护理以削减成本。公民小组强烈主张在技术和政策发展的同时，也要考虑伦理和社会问题。老年人在远程护理系统设计中常常被排除在外，而且安装通常被错误地视为一次性事件。一些系统通过提高自我意识来增强自我护理能力，而另一些系统则将主动权从老年人手中转移开，引入了新的依赖形式。
远程护理存在护理局限性；它不是一个解决方案，而是关系和责任网络的一种转变。不能将远程护理作为一个实体进行有意义的评估，而应在人与技术共同创造的具体关系中进行评估。符合伦理的远程护理的特点包括用户/护理人员持续参与系统决策：在家庭中系统不断演进，实施过程中设有反馈机会。系统设计应该是横向的、“双向的”/交互式的，而不是纵向的或“单向的”。基于这些结论制定了一个远程护理伦理框架（表1）。
