1 The details of EFORTT investigators are in 'Acknowledgement' section. AbstractContext 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.Objective To develop an ethical framework for telecare systems based on analysis of observations of telecare-in-use and citizens' panel deliberations.Design Ethnographic study (observation, work shadowing), interviews, older citizens' panels and a participative conference.Setting Participants' homes, workplaces and familiar community venues in England, Spain, the Netherlands and Norway 2008-2011.Results 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 selfcare by increasing self-awareness, while others shift agency away from the older person, introducing new forms of dependency.Conclusions 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 438 ª
possibility of disembodied care arises in which the users feel that their control over their needs could increase, while at the same time any vestige of disciplining their lifestyle disappears. Nevertheless, this is not an ideal scenario for users and caregivers, nor is telecare, in practice, a disembodied care. On the one hand, users and caregivers insist that even though telecare is transforming the way care is delivered, this would not be possible by removing hands-on caretelecare is not a substitute (Percival and Hanson, 2006;Mort et al., 2008). And on the other hand, as Armstrong (1995) and Brown and Webster (2004) have suggested, although the increasing relevance of information in e-health and telecare might imply the possibility of a deinstitutionalization of care delivery and an informatization of the body (see Nettleton, 2004), this does not necessarily result in a disembodied care. 4 Indeed, as we are going to show, specific forms of being an autonomous user are embodied in the functioning of these informational technologies.Our aim is, specifically, to discuss how autonomy is embodied through the use of a telecare device. What kind of bodies are autonomous bodies? How are they constructed? By means of what practices and materials have they been built up? And by trying to answer these questions, we would also like to critically discuss the idea of autonomy that is implicit to telecare advertisements and policies that foster telecare as a new care solution: autonomy is achieved when disciplining interventions over the body and its habits are not necessary to live safely. In fact, as we suggest in what follows, the use and appropriation of a telecare system implies not only embodiment processes and struggles within it, but also the enactment of different bodies and the emergence of competing definitions and practices of being autonomous when using telecare.We draw on phenomenology, especially on The Phenomenology of Perception by Merleau-Ponty (1962), where body is defined not as an external object or a mental construct, but as a mediator that situates us as a being-in-the-world. Additionally, we draw on other phenomenological contributions concerning how pain (Leder, 1990) and disability (Seymour, 1998) are embodied. Contributions from Actor-Network Theory (ANT) are also taken into account as they enable us to think about the body as a heterogeneous compound where technological and human elements are equally important and as an entity that extends further the individual self. As Moser has said, 'the most recent generation of ANT has moved from "outer nature" to "inner nature", to subjectivity and embodiment, and has demonstrated that inner nature is no less inner than outer nature is outer' (Moser, 2006: 376). Thus our aim is to explore from a relational or material semiotic perspective how autonomy is embodied by telecare users.To illustrate our point we use empirical material extracted from our fieldwork in a 12-month ethnographic research study in a Catalan Telecare Service. During the study period w...
This paper analyzes children’s imaginaries of Human-Robots Interaction (HRI) in the context of social robots in healthcare, and it explores ethical and social issues when designing a social robot for a children’s hospital. Based on approaches that emphasize the reciprocal relationship between society and technology, the analytical force of imaginaries lies in their capacity to be embedded in practices and interactions as well as to affect the construction and applications of surrounding technologies. The study is based on a participatory process carried out with six-year-old children for the design of a robot. Imaginaries of HRI are analyzed from a care-centered approach focusing on children’s values and practices as related to their representation of care. The conceptualization of HRI as an assemblage of interactions, the prospective bidirectional care relationships with robots, and the engagement with the robot as an entity of multiple potential robots are the major findings of this study. The study shows the potential of studying imaginaries of HRI, and it concludes that their integration in the final design of robots is a way of including ethical values in it.
This article reports on ethnographic research into the practical and ethical consequences of the implementation and use of telecare devices for older people living at home in Spain and the United Kingdom. Telecare services are said to allow the maintenance of their users’ autonomy through connectedness, relieving the isolation from which many older people suffer amid rising demands for care. However, engaging with Science and Technology Studies (STS) literature on “user configuration” and implementation processes, we argue here that neither services nor users preexist the installation of the service: they are better described as produced along with it. Moving beyond design and appropriation practices, our contribution stresses the importance of installations as specific moments where such emplacements take place. Using Etienne Souriau’s concept of instauration, we describe the ways in which, through installation work, telecare services “bring into existence” their very infrastructure of usership. Hence, both services and telecare users are effects of fulfilling the “felicity conditions” (technical, relational, and contractual) of an achieved installation.
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