How ethical is it to monitor a dementia patient with sensors, cameras, computers and other technologies,when it comes to assuring the patient's safety? And what technologies are currently available and being used by caregivers? These and other issues are covered in this paper which uses three scholarly sources to review the materials. The ethical issues are covered in the paper, including the issue of patient privacy and autonomy. Clearly technologies are being used and will continue to be used (especially in home care environments), so the ethical issues must be addressed.
Ethics of Science and Technology in Maintaining Health / Life in Aged or Terminal Patients -- How Cultural Influences Support or Condemn Their Uses
Science and technology have provided a great deal of assistance in recent years to clinical healthcare professionals when it comes to maintaining / sustaining the lives of very old people. This paper reviews: a) some of the technologies currently being utilized as important components of healthcare services for aged people; b) specifically how those technologies are applied to the care of elderly people; and c) the ethical and social implications vis-a-vis those advanced technologies.
Ethical Challenges in the Care of Seriously Ill Patients
Clearly the development of assisting technologies give doctors and nurses additional tools with which to help aged people continue their lives; but there are serious ethical concerns that have been raised regarding those technologies. In the peer-reviewed journal Pain Medicine the authors discuss the "delicate balance between the technical aspects and the humanistic aspects of care" (Lesage, et al., 2001, 121). It is imperative that patients must be cared for in a manner that gives utmost consideration to "…their values, hopes, and beliefs"; and moreover, the use of bioethics in healthcare environments calls for the principles of "…autonomy, beneficence, nonmaleficence, and justice" (Lesage, 121).
Because there is a need for relevant ethical principles in the care of elderly people -- including palliative care -- decisions must be made that embrace the "double effect" (Lesage, 121). The double effect is applicable when values or medical obligations are in conflict and cannot be "realized simultaneously," Lesage continues. There can be is a strong "moral difference" between what was intended by an action (for example, use of artificial hydration) and what the "unintentional" results of the action actually turned out to be (prolonging life when there is no hope of recovery) (Lesage, 121). Hence, in cases where science and technology play a role in patient care, it is vitally important that "informed consent" be part of the collaborative relationship (i.e., good communication) between the patient and the doctor (Lesage, 123).
Technologies and Issues when Monitoring Older Adults
In the future -- given recent healthcare reforms and because there is greater emphasis on home care for the elderly -- geriatric providers are going to need to have "…alternative ways of monitoring disease, activity, response to therapy and patient safety" (Kang, et al., 2010, 1579). Writing in the Journal of American Geriatric Society, Kang and colleagues explain that monitoring devices, including sensors, data recorders, and communication networks will be beneficial in providing "unprecedented measurements of physiological and sociological data" for caregivers (Kang, 1579). These technologies (to be used for the most part with home-based older people) include portable wearable devices, attached to the person or to the equipment they are using.
The most advanced technologies are far more sophisticated than simple GPS-like tools; they are used to monitor "…mobility, physical activity, and rehabilitation progress" (Kang, 1580). Also, the technologies can provide "…continuous physiological data" and those devices include "…multiple accelerometers attached to various body parts" -- called "badges" -- that are worn like "pendants" (Kang, 1580). These devices can monitor heart rate, sleep patterns, and can "…identify dangerous hypoglycemic episodes" for diabetes patients, Kang explain (1581).
In terms of ethics, there are valid concerns regarding these technologies, because clinical monitoring and interventions "…may intrude on a person's free choice, decision-making, privacy and autonomy" (Kang, 1583). In fact elderly people polled as to their reaction to "video monitoring" reported deep privacy concerns, leading to the need for "encryption of all information" in a "secure website" (Kang, 1584). The authors assert that while more research is needed in this emerging field, there is also a strong need for collaboration between engineering disciplines and care providers -- with the best interest of older adults in mind.
Using Technology to Monitor Dementia Patients -- Will Caregivers Adapt?
How will technologies work when caregivers (who are not technologically proficient) are offered a chance to monitor dementia patients at home? Professor of Gerontology Jennifer Kinney and a colleague conducted two research projects on caregivers to determine: what technologies they might be comfortable with; and what worked for them after they were provided technological support for dementia patients. As to the first group of 26 caregivers (average age, 63.2 years), who had spent an average of 65 months giving care to a relative with dementia, they indicated a willingness to try technologies but "…had no interest in becoming 'technology whizzes'" (Kinney, 2006, 64). Next, the authors recruited a new group of 19 caregivers (in Ohio) (average age 54.6) who had no ethical problems in consenting to having fairly basic technologies installed: a Pentium II computer; broadband service; a Xanboo Smart Home Management System (including cameras, sensors and software); a cell phone; and Verizon cellular phone service (Kinney, 65).
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