Wang Rosalie H, Tannou Thomas, Bier Nathalie, Couture Mélanie, Aubry Régis
Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
JMIR Aging. 2023 Mar 9;6:e41322. doi: 10.2196/41322.
Successful adoption and sustained use of smart home technology can support the aging in place of older adults with frailty. However, the expansion of this technology has been limited, particularly by a lack of ethical considerations surrounding its application. This can ultimately prevent older adults and members of their support ecosystems from benefiting from the technology. This paper has 2 aims in the effort to facilitate adoption and sustained use: to assert that proactive and ongoing analysis and management of ethical concerns are crucial to the successful development, evaluation, and implementation of smart homes for older adults with frailty and to present recommendations to create a framework, resources, and tools to manage ethical concerns with the collaboration of older adults; members of their support ecosystems; and the research, technical development, clinical, and industry communities. To support our assertion, we reviewed intersecting concepts from bioethics, specifically principlism and ethics of care, and from technology ethics that are salient to smart homes in the management of frailty in older adults. We focused on 6 conceptual domains that can lead to ethical tensions and of which proper analysis is essential: privacy and security, individual and relational autonomy, informed consent and supported decision-making, social inclusion and isolation, stigma and discrimination, and equity of access. To facilitate the proactive and ongoing analysis and management of ethical concerns, we recommended collaboration to develop a framework with 4 proposed elements: a set of conceptual domains as discussed in this paper, along with a tool consisting of reflective questions to guide ethical deliberation throughout the project phases; resources comprising strategies and guidance for the planning and reporting of ethical analysis throughout the project phases; training resources to support leadership, literacy, and competency in project teams for the analysis and management of ethical concerns; and training resources for older adults with frailty, their support ecosystems, and the public to support their awareness and participation in teams and ethical analysis processes. Older adults with frailty require nuanced consideration when incorporating technology into their care because of their complex health and social status and vulnerability. Smart homes may have a greater likelihood of accommodating users and their contexts with committed and comprehensive analysis, anticipation, and management of ethical concerns that reflect the unique circumstances of these users. Smart home technology may then achieve its desired individual, societal, and economic outcomes and serve as a solution to support health; well-being; and responsible, high-quality care.
成功采用并持续使用智能家居技术有助于体弱的老年人居家养老。然而，这项技术的推广受到限制，尤其是在其应用方面缺乏伦理考量。这最终可能会阻碍老年人及其支持生态系统的成员从该技术中受益。本文旨在促进智能家居技术的采用和持续使用，有两个目标：一是断言对伦理问题进行积极且持续的分析和管理对于成功开发、评估和实施针对体弱老年人的智能家居至关重要；二是提出建议，以创建一个框架、资源和工具，在体弱老年人及其支持生态系统的成员以及研究、技术开发、临床和行业社区的协作下管理伦理问题。为支持我们的断言，我们回顾了生物伦理学中的交叉概念，特别是原则主义和关怀伦理学，以及技术伦理学中与智能家居在体弱老年人护理管理方面相关的概念。我们关注了6个可能导致伦理冲突且需要进行适当分析的概念领域：隐私与安全、个体与关系自主性、知情同意与支持性决策、社会包容与孤立、污名与歧视以及获取公平性。为促进对伦理问题进行积极且持续的分析和管理，我们建议通过协作来制定一个包含4个要素的框架：本文讨论的一组概念领域，以及一个由反思性问题组成的工具，用于在项目各阶段指导伦理审议；资源包括在项目各阶段进行伦理分析的规划和报告的策略与指导；培训资源，以支持项目团队在伦理问题分析和管理方面的领导力、素养和能力；以及为体弱老年人及其支持生态系统和公众提供的培训资源，以支持他们在团队和伦理分析过程中的意识和参与。由于体弱老年人健康和社会状况复杂且脆弱，在将技术融入其护理时需要细致入微的考量。通过对伦理问题进行认真且全面的分析、预测和管理，以反映这些用户的独特情况，智能家居更有可能适应其用户及其所处环境。这样，智能家居技术或许就能实现其预期的个人、社会和经济成果，并成为支持健康、福祉以及负责任的高质量护理的解决方案。
