Interdisciplinarity in Technology Assessment: Implementation and its Chances and Limits (Ethics of S

In: Decker M (ed) Interdisciplinarity in Technology Assessment. Implementation and its Chances and Limits. Springer, Berlin, pp 33–60 Decker M.
Table of contents

The use of telematics systems in road traffic will contribute to the avoidance of accidents. Current and future technology could be used to automatically keep the safety distance to the vehicle in front and adapt the speed to the traffic situation and traffic rules, that is, to decelerate the vehicle and thus possibly reduce the number of collisions. Concerning the traffic flow, it can be stated that congestions are an everyday phenomenon in road traffic.

In the German state of North Rhine-Westphalia, there are at least congestions per day. Schreckenberg , every German citizen is caught up in congestion for an average of 2. Of course the driverless subway and airport transportation system is an exception. But service robots that do the shopping fetch and carry tasks also have to move in public places. The following research objectives are related to this: This problem introduces researchers into advanced and interdisciplinary research themes. The provision of services by robots in private life 3 is given as third example. It will be described in more detail here since it marks the other end of the above-mentioned spectrum of service robotics and provides good starting points for multidisciplinary discussions.

Robotics provides applications for all age groups: Toy robots, entertainment robots, kitchen aids, assistant robots, care robots for disabled, elder and sick people, etc. These robots are applied in private life. Of course it has to be decided for each individual case to what extent a private user can be expected to do special training for the use of a service robot. However, concerning children and sick persons, we have to assume limited or reduced cognitive abilities that make it difficult for them to read the user manual.

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Therefore, they might not be able to make an efficient use of the system, or to comply with the specified service intervals and maintenance, etc. This field of application puts high demands on the robots. They have to be able to move around safely in an unknown environment flat that is not geared to them and perform a number of different tasks. If the programming efforts prior to the initialization and start of robot operation should be still acceptable for laypersons, most of the adaptation to the new environment and the new user has to be done by the robot itself or with the help of internet-based services.

This technical problem is even more critical for older users and those in need of care, since they are often cognitively unable to instruct the robot system appropriately or they overestimate the robot skills and capabilities. This can become relevant if robots are applied to perform social services, for example, in the field of human care.

Robots for children are a separate field of application in the private sector with a broad variety: Toy, artificial pet, learning aid, babysitter, robot nanny, substitute teacher, etc. Therefore, some robot systems will be briefly described as examples. Being equipped with two microphones, two loudspeakers, a camera, and approx. They can be used for the quick and easy assembly of artefacts like pathfinders, sorting systems, and other technical systems.

PaPeRo Partner-type Personal Robot , a robot developed in Japan, can be described as a further development of babyphones—some kind of babysitting robot. It is mobile, recharges its batteries automatically, can imitate sounds, and play a quiz. In addition, this robot can be used to send messages. It can be controlled remotely, and its software can be enhanced by open access. PaPeRo is intended as a companion for children. The kitchen seems to be an area where robot assistance is especially welcomed.

In contrast to the vacuum cleaning robot that replaces the human being as operator of the vacuum cleaner, here the focus is on the cooperation with humans in everyday scenarios. The aim of the project is to develop concepts, methods, and concrete mechatronic components for a humanoid robot that shares its working and activity space with humans.

In order to be a helpful assistant in everyday life, the robot system must have many complex abilities and characteristics: ARMAR 3 is, for example, able to fetch and carry small items like cups, mugs, a pack of rice, or a juice box. It can also bring a particular drink from the fridge, lay the table, or load and unload the dishwasher.

Learning by demonstration is a central element of the cooperation between human and robot in SFB It is about household service robots; the infield testing takes place in realistic environments living room, kitchen, or even garden. The following topics are of interest for the robotic researchers at Robocup Home: Different service robots for the support of elder or sick people are either in development or already in prototype status.

Smart environments or hybrid living spaces including robots as a standard device are proposed. Since these robots have already been described in numerous other publications and are a recurring topic of public discussion, we would like to refer to the relevant literature here. They can be distinguished by the professionalization of the human being who is using the technology. The professionalization in the sense of being able to be trained or even qualified decreases from the use in agriculture to household applications.

They also differ regarding the environment where the robot is used, that is, in public or in private. In this section, we will discuss the questions from the respective disciplinary perspective. The successful provision of a service is already a big technological challenge. If the vacuum cleaning robot has met these requirements, the service is—in technical terms—performed successfully. To summarize it briefly: The robot has to be enabled to learn its task and its environment. A humanoid stature torso, head, arms, and legs is often considered to be an advantage for learning.

Behnke , p. It is also important that the human being on the one hand, who is capable of integrating his knowledge and using his experience, and the specialized, skilled humanoid robot on the other hand, share their information by exchanging and thus updating their respective knowledge. Major trends provide various opportunities for the use of service robots: Structural change from the primary to the secondary and tertiary the service sector is accompanied by a transition towards knowledge-based societies.

As a consequence, in the context of service robotics, individual skills significantly affect both supply-side and demand-side aspects. The major distinction between service and industry robots is based on the characteristics of services: They are immaterial and thus experience goods whose quality can only be assessed once they are actually used by the customer s. The simultaneity of production and consumption as well as the consequential direct relation between service provider and customer is the reason why services cannot be stored, exchanged, or sold again.

Due to the human interaction during the performance of the service, the possibilities for standardization are rather limited. At the same time, standardization is a major prerequisite for the application of service robots in both individual and professional use. The introduction of service robots raises several questions, including some topics concerning standardization and patenting. Questions that have to be addressed in order to estimate the potential of service robotics include: What is the incentive for individual actors to develop or use service robots e.

Which costs incur throughout the innovation process of the robots technical and non-technical costs? Are those who bear the costs also the ones who receive the revenues? Furthermore, it is important to identify the stakeholders and the relevant markets. The acceptance of technologies and thus their demand may be higher in technophile economies Japan is generally considered as being one of them than in more conservative ones.

Are there certain countries that are supposed to become lead markets in that field? An overall assessment of the potential, for example, for the labour markets, does not only consider those jobs which might be replaced by robots but also includes especially those which are newly created in the course of innovation. And finally, what are the preconditions of the national or regional innovation systems including the legal and political framework where robots are developed?

Depending on the field where service robots are used, different legal questions arise. We can distinguish between those concerning the relation citizen—citizen civil law and others concerning the relation between the state and the citizen public law. As a regulatory tool, public law restricts economic activities that collide with the rights and legal interests of others or the common good.

Here, one major problem consists of governmental decisions under uncertainty. If and how the legislative authority intervenes depends on prognostic assumptions whose future fulfilment is uncertain. It is not foreseeable if and to what extent and in which social contexts service robots are accepted and used and thus change social systems, social perception, as well as demand changes, for example, in the existing infrastructure, in social welfare, and healthcare provision and finally damage regulation.

It is also unclear whether existing requirements for production safety which are already covered by the existing legal foundations of private liability law are applicable and sufficient to cover potential harm to people and objects and whether they set the right incentives: Do we assume a generally dangerous activity—in line with the strict and far-reaching liability regulations, for example, of genetic engineering or atomic energy which calls for an absolute liability?

There is also the need to consider secondary objectives of liability: The promotion of any innovation can only be successful if the chosen liability scenario does not regulate the entrepreneurial and private development in such a strict way that further developments do not pay off. More importantly, individual legal requirements may interfere with innovative ideas: Social law, for example, which is especially relevant for services in the field of health and care age, disability, and sickness , demands attention to a number of special requirements, some of them induced by constitutional law.

They differ significantly from the legal framework service robots encounter in professional environments, for example, in agriculture. From the perspective of civil law, where the relation citizen—citizen is in the focus of legal considerations, it is mainly a question of liability of those who plan, manufacture, sell, and finally use service robots to the integrity of legally protected goods of those people who get in contact with service robots.

Here, the existing regulation instruments should be made applicable to the new problems of warranty and hazard. This refers to the drafting of contracts, especially regarding the risk allocation in the General Terms and Conditions as well as general questions of liability for damages to third parties. The formulation of due diligence and liability standards is a central element here.

If the requirements are too strict, this will impede—or even prevent—the manufacturing, distribution, and use of service robots; if the requirements are too low, the use is seen with even more scepticism the more defect-prone the relevant service robots turn out to be. However, it should be noted that civil liability rules are only one means of reducing the risks associated with the operation of potentially dangerous technology. Ideally, in regulating such technology, civil law rules should be combined with, and complemented by, public law rules, which aim at preventing or, at least, reducing technology risks in the first place.

Additional issues are raised if service robots are autonomously adaptive and can react with other robots or the environment in general in a way that is not predictable in detail. So far, this issue has only been discussed for software agents but not yet for service robots. The case studies include many facets: Within these human—robot systems exists a clear assignment of roles and functions of human and robot which answers the question which tasks are better performed by the robot and which should be done by the human being—from the psychological point of view one of the most important questions in contract design.

However, this division of tasks bears the risk that the human being is only taking over those remaining tasks which the robot cannot carry out. This question is also relevant in non-working contexts—that is in private life: Which tasks could and should remain with the human, which tasks should be taken over by the robot?

Depending on the general allocation of tasks between human and robot, ergonomic issues that can be assigned to the human—machine communication have to be dealt with from the psychological point of view. These issues also play important roles in service robotics, where decisions have to be taken that affect the handling and user-friendliness of the robot system.

In the field of service robotics, this issue gains a special relevance: People tend to personalize things and thus also technology. The industrial psychological consideration suggested here puts special emphasis on the allocation of tasks between human and robot in the cognitive field. Basically, this is a question of sharing responsibility and interaction between human and artificial intelligent systems: When may and should the robot provide a service autonomously and proactively based on the assessment of a situation without having received specific instructions to become active?

When is it allowed to correct assumed mistakes in the action of humans without explicit order? Is a humanoid robot capable of interacting with its environment in a social manner? This is a psychological issue since questions concerning the ability to judge and mental capability play a role here; however, it also touches the ethical and legal dimensions of technology assessment. From an ethical point of view, the focus is on the desirability of certain technical solutions regarding their reasonability.

Today, services in the field of caregiving, or medical care in general, are typically provided by human beings. However, the statistics for industrialized countries predict a demographic change, which means that the number of people in need of care will be growing in the foreseeable future, while the number of caregivers is going to decrease.

Against this background, it could be desirable for a society to develop service robots for care Sparrow and Sparrow Ethical questions on the desirability, which are connected to such scenarios, usually refer to the classical questions of ethics of technology. This is about the scientific reflection of moral statements that are often cited as arguments for the acceptance or the rejection of the use of technology. Cost—benefit considerations also play a role here. The questions are then answered with reference to procedural utilitarian, discursive, or participatory approaches. Such ethical considerations in the narrow sense form the standard repertoire of ELSI concepts which are also common for robotics and autonomous systems in use in parallel to ongoing research cf.

A comprehensive ethical reflection also includes methodological questions aiming at the determination of what should be considered succeeding or even successful support, replacement, or surpassing of human performances, abilities, or skills. Then, the design criteria for the adequacy of the description of robotic systems that replace human actors gain centre stage cf. Gutmann ; Sturma on this. The methodological reflection focuses on an equalization of human and machine including a thorough analysis of the limits of technical systems engaging into decision-making, which would address them as potential moral agents s.

This is followed by the differentiation of human—machine, machine—human, machine—machine, and human—human interaction where a differentiation of connection, interaction, and interface could become relevant, terms that are often used synonymously cf. A systematic clarification of the logical structure of such equalizations is directly relevant for solving the above-mentioned ethical questions.

This background is necessary to address issues that go beyond a purely syntactical understanding of technical systems and can be phrased in the following way, taking healthcare services as an example:. But the scope of philosophical consideration extends the limits of ethical and anthropological dimensions by far: Methodological questions become urgent, which are well known from the critical evaluation of AI since the early 60th of the last century for an extended outline s.

A comprehensive systematic clarification—which is unfortunately only rudimentarily carried out in normal ELSI studies—of the ethical problems of the use or the prevention of the use of robotic systems is necessary and should be done under consideration of all three aspects. This multidisciplinary approach can still be extended.

This could especially take place on the level of so-called subdisciplines; their relevance for the subject is quite justifiable Decker and Grunwald The multidisciplinary questions described here are studied in the framework of a joint technology assessment of the authors. Under the aspect of quality assurance, it is important to preserve the disciplinary compatibility.

At the same time, the seed texts are modified regarding the argumentative support of the resulting recommendations: Therefore, these recommendations are based in a comprehensible way on interdisciplinarily developed lines of arguments. The results of this study might be expected at January This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution and reproduction in any medium, provided the original author s and source are credited.

Statistics of the German automobile club on traffic accidents http: As at April To promote the implementation of the results in order to provide common European rules on legal and ethical principles The advantages of this common ethical approach has not only been a common European approach, but that altogether risks, costs, and implementation times of new developments shall be reduced.

As a general objective, PHM-ETHICS aimed at strongly combining ethical research with technological and healthcare development so that ethics research did not run the risk of lagging behind technological development.

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The aim of project phase 1 was to develop a framework of applications in tele-monitoring, starting from conventional telemonitoring to multifunctional human-machine-interactions e. For this reason, the partner UMG first described and staged the development of telemonitoring on the basis of existing European and international projects. The first step of project phase 2 was to develop a combined interdisciplinary and standardized methodology that aims at assessing ethical issues in new technologies in the area of personalized health monitoring.

Prominent technological innovations and target groups had been identified on different steps of the taxonomy. The methodology includes a taxonomy, a dependencies map, a ethical assessment module, a psychosocial module as well the legal report. All sub-modules of the methodology were pilot-tested and validated. The aim of project phase 3 was to disseminate the methodology. Two international validation workshops and a dissemination conference have been conducted in order to review the PHM-ETHICS findings by an international expert workshop with major stakeholders from different areas: Stakeholders of European and national regulation, of information technology, legal and ethical organizations etc.

Disciplines involved are applied ethics, psychology, informatics, and organizational theory. It serves as classification tool that mirrors the current state of PHM. As the application field is continuously changing and in a dynamic phase of early adoptions and ongoing research. This applies to the proposed rules as well as to the revision of these rules. The taxonomy itself is based on 85 reviews that were received in a literature research.

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These reviews are recruited from the fields 'AAL and smart home', 'telemonitoring', 'personal health monitoring', and 'pervasive health care'. The AAL and smart home reviews covered more than 70 systems. Some systems may have been reviewed in more than one paper, thus the set of unique systems has been likely to be much smaller, but the different perspective of the reviewers on these systems may still deliver valuable information.

Telemonitoring reviews dealt mainly with cardiac diseases, diabetes care or home blood pressure monitoring, cumulated to a total of studies. Given the fact that most of the reviews where published within a rather short period of time, and mostly dealt with one of only three fields of application, the unique number of PHM systems is expected to be smaller. Verweisquelle konnte nicht gefunden werden. In each level, ideally only one box is affected. This will most likely not be the case in most scenarios, because the scenarios cover multiple facets of the health delivery process and the relationship between patient and caregiver.

Boxes in blue and grey colour show concepts that are included by PHM. Grey coloured boxes have been agreed by the project partners to be out of scope for this project in order to keep the research area manageable. In order to learn which attributes coincide with the challenges of the different disciplines, they are ordered in a hierarchy that allows grouping of attributes with similar challenges.

Attributes are characteristics of a concept. They vary from the respective view of disciplines. Then these attributes are mapped with attributes in the leaves of the hierarchical tree meaning the lowest level of nodes. If all attributes matched one leaf node of the hierarchy, and for each trunk meaning the 1st level nodes at least one leaf node has been matched, the PHM scenario fulfils the hierarchy's constraints 'All Attributes found? The aim of this map is to analyse how ethics, law and psychosocial sciences are interrelated in the PHM development and to highlight and identify connections and relation of special importance.

Identification of all the dependencies is not possible. For a very high proportion of PHM technologies, however, a lot of the most important dependencies have been identified. The fact that it is an impossibility to be sure that all dependencies have been identified is no reason for failing to identify as many significant dependencies as possible. An approach which enables the identification of many of the challenges and issues associated with PHM technologies is beneficial and will reduce the likelihood of problematic implementation and use.

Such an approach has the added advantage of accommodating new dependencies which are subsequently identified. Several Dependencies maps, including sub-maps have been generated. This includes maps for: Much of what is included below reveals the need to emphasize an ethical approach to PHM that appreciates the potential impact of dependencies and their associated relationships, and which could directly influence current and future PHM development: Recognise the importance of the interpretivist transdisciplinary approach which leads to deep meaning and understanding of PHM and its context: A transdiciplinary approach enables the drawing together of concepts from the disciplines to create frameworks and to break down barriers to co-operation and understanding.

The interpretivist approach rejects the positivist, numbers-based world-view to allow insight and meaning to be derived from an investigation and consideration of the issues. Use a common language of communication to ensure consistency of dialogue across disciplines and between key players in rolling out PHM: A transdisciplinary approach requires that in order to ensure accurate communication and understanding, a common language is adopted.

A Lexicon has been provided to standardise the meaning of key words used in the dependencies map. In future PHM development, a standard or common language not only is important, but also ensures that all stakeholders are able to understand, through the minimisation of discipline-specific technical or overly-academic language.

Recognise that dependencies are not just between stakeholders: Dependencies may impact, or have an influence on, a wide range of areas. Whilst directly affected stakeholders are probably the most important, dependencies are also found that operate between organisations, physical artefacts such as technical equipment , Law, Governments and wider society. For example, Law as a process facilitates business as a stakeholder.

It is vital to take into account the rich diversity of dependencies when planning, developing, implementing and using PHM. Recognise the dynamic nature of dependencies and relationships over time and through technological evolution: Technological evolution can often be predictable in many ways due to the largely incremental nature of development but this is not always true.

However, many of the dependencies and associated relationships identified are dynamic in nature and subject to change that is less predictable than technological change. Recognise the complexity and variability of dependencies and relationships: Through the development of the relationships table, further depth and detail has been derived.

However, the complexity, variability and fluid nature of the dependencies and relationships means that it is likely that new dependencies and relationships may be discovered as new developments and changes occur within the field of influence on PHM. PHM may be used in many different contexts and for a wide range of different health conditions. Future use may also include general wellbeing and health monitoring as a preventative rather than treatment option or even as a tool for social control. It is essential therefore that the use for which the PHM system is developed, and the context in which it is to be placed, should be considered alongside the practical application of the system.

This is likely to increase the probability of successful PHM implementation. Prioritise the contextual issues surrounding PHM so that focus can be placed on the key elements: Therefore, when developing PHM systems, it is important to prioritise those dependencies and relationships that are likely to have the greatest impact, whilst being aware of the potential impact that the other dependencies may have. Understand the nature of relationships between dependencies: In order to be able to evaluate the impact of nodes and relationships, it is also necessary to understand the nature of the relationships identified.

Relationships are better understood through an awareness of the context in which they are considered. Some nodes and their relationships may be considerably stronger and more influential than others, and so it is important to ensure that the cultural, social and political context is understood.

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Relationships may also vary in strength according to the specific nodes they are linked to and the context in which they are formed. Make this complex system description accessible to all interested parties so that it can be used as an analytical instrument and standards compliance model for future PHM: PHM is complex and dynamic and this paper describes and explains the nature of PHM dependencies and the relationships that may impact on the development of PHM systems. However, due to its complexity, the maps, table and verb-set descriptions may not be useful analytical tools alone for PHM developers.

It would provide a standardized approach to identifying potential issues or problems that needed to be addressed. Law and ethics do influence each other. Based on this interaction, laws are enacted - also at the European level - that deals directly or indirectly with personal health monitoring. These laws refer to the Treaty on the Functioning of the European Union, the Data Protection Directive, the Transparency Directive, the Directive on Electronic Communications, the Medical Device Directives, the Directive on Distance Contracting, the Directive on Intellectual Property Rights, the Competition rules, the Directive on the recognition of professional qualifications as well as the Regulations on jurisdiction and the recognition and enforcement of judgements in civil and commercial matters and the Regulations concerning applicable law.

The legal report also deals with the EU policy related to E-Health and personal health monitoring and with some important European Court of Justice Jurisprudence regarding to the reimbursement of healthcare services in another Member State of the European Union and with some privacy-related aspects as well.

The different liability legislation in the Member States hinders the application of PHM especially in case of cross border healthcare. The EU should also play a more important role with regard to liability issues since eHealth and tele monitoring actors are submitted to different liability schemes.

In a similar way, Member States should determine the nature and modalities of mechanisms for patients to seek redress and compensation if they suffer harm as a result of receiving PHM. Working conditions for healthcare professionals: The conditions under which the healthcare provider's can work in different Member States. An important question is whether the physician who delivers healthcare at a distance has to obtain a license in the country where the patient resides.

There is a need for a regulatory framework for healthcare professions, so that healthcare professionals can deliver cross-border activities without restrictions concerning cross-border licensing. One question to be considered is if the existing framework needs to be adapted or will it be necessary to develop a specific framework for Telemedicine and PHM? Patient acceptance of the PHM will depend greatly on the information provided and the guidance offered. The cornerstone of the system for sharing information about patients between healthcare providers will be the electronic health record EHR.

The method for documenting patients' health history and episodes of illness varies from country to country. Better and more specific provisions in the Data Protection Directive for the further use of health data are needed, as the use of such data takes place increasingly within a globalized context of health care actors. Long term actions months 1. The respect of privacy: The question is whether or not the existing legal protection of individuals with regard to automatic processing of personal information relating to them, is sufficient.

The question is also whether or not to allow PHM projects if article 15 of the Data Protection Directive is not reviewed, since nearly all processing takes place only by electronic means. The relationship between health professionals and patients: A medical consultation conducted 'online' is a revolutionary concept in the physician-patient relationship. The challenge remains for national legislators to guarantee that all groups in the society have equal access to electronic health records, for example, and that discrimination is avoided. PHM and telemedicine should offer equal access to care for all patients at the national or European level.

Reorganisation of the health care system: New PHM technologies entail some major changes in the whole healthcare system. These will require significant economic investment from the very beginning. Important and new legal questions will also have to be answered dealing with safeguards and medical call centres.

One question will be whether classic hospitals will organise themselves to take care of monitoring activities or not. Will there be a possibility to delegate certain activities to non-physicians? Risk of overconsumption and reimbursement of PHM projects: PHM may cause over-consumption. It will be a challenge to control the public cost of healthcare. In order to develop telemedicine and PHM, health insurance plans for funds should develop appropriate financing for shared and integrated care and should monitor cost-effectiveness issues. There are still some important legal questions with regard to the reimbursement of PHM that will need to be answered.

Should the monitoring activity be reimbursed according to the rules of the Member State where the patient resides or according to the rules where the monitoring physician resides? What if the physician who is monitoring the patient is established in another country? According to which rules must the physician be authorized to practice telemedicine in order to get the activities reimbursed? Is consent of the insurer required before applying for an online consultation or a monitoring device abroad?

These questions need clear answers if one wants to promote PHM with success in Europe. Relationship between patient and industry: Today the producers and distributors of medicinal products have contact only with health professionals. There is in principle no direct contact between the industry and the patient. This situation will change when applying telemonitoring.

European legislation concerning acts that can be carried out by a physician or a nurse: Today, each Member State has its own rules concerning the requirements that must be met by certain specific healthcare practitioners before they can explore certain activities in health care. In case of PHM, it is possible that the nurses perform certain acts that may, in some Member States, be legally reserved to physicians or other healthcare professional. Defining medical treatment is a matter for the Member States.

But, it would be helpful to have some European guidance on the question of which specific healthcare acts may be performed at a distance by which specific healthcare practitioner. It takes into account ethical principles and uses interview techniques and predefined questions to ensure a standardized yet flexible assessment. A technology is not just a particular artifact but a product developed and implemented in a social context.

Health care technology is part of a broad health care network. Technological development is an interactive process that can be influenced and altered.

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Furthermore, technology is not value neutral. Whether intended or not, values are embedded in technology that influence their use. Importantly, those values should be disclosed. In order to reveal the social impact of technology and to identify an acceptable usage, technology developers, users, care providers and other concerned parties should be considered in the developmental process of health care technology.

In this way, the development process is broadened to include parties who all too often are excluded from this process. Contrary to most ethical analyses of novel technology, an interactive ethical technology assessment has to be proactive rather than reactive.

It aims to assess emerging technology and to influence research and development of technology before artifacts are established at the market. If aspects in need of modification are pointed out at the prototype stage, technology developers are more likely to alter the design than later on in the developmental process when a change is more inconvenient and costly. Importantly, the interactive nature of the proposed assessment model respects the interests and experiences of people concerned by PHM-technology.

It is a means to identify aspects crucial for how the technology is perceived by concerned parties and to identify well-funded policy recommendations. Recommendations anchored in public conceptions of the technology are likely to gain broad acceptance and their legitimacy increases with a procedure where stakeholders have been involved. Hence, a broad range of stakeholders are identified and included in assessments of PHM.

A battery of questions to be addressed to PHM-technology is presented. An interactive ethical technology assessment provides insight into the conditions of and decisions regarding PHM-technology highlighting values that should be promoted in the development and implementation of PHM-technologies. Combined with the taxonomy and dependencies map, the assessment model helps to generate research questions that are necessary in order to further explore specific technologies.

Given the complexity of technological development and a priori checklist of ethical requirements is insufficient. Rather, the method must be open to 'unexpected' developments and outcomes. The suggested assessment tool offers a limited non-exhaustive list of values relevant for the acceptability of PHM and describes why and how such values are relevant. Importantly, issues of privacy and informed consent have also been dealt with from a legal perspective within the legal report. A recurring problem with PHM-applications has been their impact on privacy.

That privacy is an important value is seldom questioned but opinions differ significantly regarding what privacy means and to what extent and how it should be protected. That which is privacy sensitive is taken to vary over time, within cultures and between individuals as well as depending on context. Suggestions as to why privacy should be protected are respect for individual's dignity, autonomy, intimacy.

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Some argue that we should avoid reducing privacy to one such value, rather than seeing how privacy is important for the reasons above and yet others like democracy. It has also been argued that privacy should not only be considered an individual interest but a collective such. The case has been made that privacy protection is crucial for individuals to express their opinions and exercise their political rights. The privacy invasive potential is one of the most common controversies when it comes to ICT-based care.

What intrusions consist in is a rather complex issue however, considering different dimensions of privacy such as decisional privacy, informational privacy and local privacy. Bodily privacy has to be considered as a fourth dimension and perhaps mental privacy deserves a fifth dimension.


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Arguably, some dimensions of privacy may be negatively affected at the same time as other may be protected. It is commonly argued that patients' privacy is unavoidably intruded upon within hospital-based health care and hence, that the home-based care 'options' involving surveillance capable technology has a marginal effect. Informational privacy is intruded upon since patients' must release personal and health related information to health care professionals.

To what extent then can personalized health monitoring be considered voluntary? Surveillance is typically considered to stand in contrast to voluntariness and scholars within the field of surveillance studies often discuss data subjects' resistance to such technology.

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Only a few scholars discuss voluntary surveillance. Freedom of choice and the chance to influence surveillance is typically held forth as aspects crucial for data subjects' acceptance of surveillance. Technology developers and care provider often emphasize that these novel types of support should be considered as voluntary complements to traditional care. But if these care solutions entail the safety and security gains that they are supposed to and if they are as cost-efficient as technology developers claim, it is not unreasonable to assume that, in time, these will make up the standard form of care.

Care recipients, it is said, can freely choose to add Night Patrol as a complement to their ordinary care. But considering how often this type of care solutions are advocated as the solution to the problems related to an ageing population that health care is facing, the question of voluntariness should be further analyzed. And given this kind of development, to what extent should care recipients who express a preference for less privacy invasive and more costly forms of care e.

Will the preferences of extra privacy sensitive or privacy-concerned individuals be considered as expensive tastes? In a world of unlimited resources this question would not have to be raised but given the ambitions of creating a novel health care system that is better equipped to meet the ageing population and the need for prioritizations, these questions become highly relevant. If one care recipient's claim on a bigger share of the total 'cake of care resources' is accommodated, this will at least indirectly affect other care recipients' options. Health care should be conducted with respect for care recipients' autonomy.

By respecting a person's right to decide in matters that concern herself, its autonomy and integrity is respected. The right to decide on matters concerning oneself however, is limited by others' equal right to such decisions. Informed consent gives the patient ultimate authority for deciding the acceptability of a particular treatment, once she has received proper information by a physician of the risks and benefits attached to the particular treatment. Thus, the patient's autonomy is respected. That is, in order for a contract between care provider and care recipient to be ethically and legally justifiable the care recipient must express her informed consent and in order for the care recipient's consent to be informed, health care professionals must provide her with necessary and relevant information, and communicate the information in such a way that she understands the content thereof and the implications of her consent.

Health care professionals should present the care receiver's options in an as neutral way as possible, avoiding undue influence. Information should also be communicated in such a way that a lay-person can comprehend thereof. Relations with Health Care: With sensors, cameras and robots installed in patients' homes, many aspects of health monitoring traditionally provided in hospitals are now carried out in the domestic setting. Health care offered outside the traditional care-providing institutions, is often described in terms of 'distributed care', 'self care' or 'home care'.

Certainly, it makes sense to distinguish between care conducted in the patient's home and in hospitals or nursing homes and to contrast home-based care with hospital-based care. However, terms like 'distributed care' may sound as if care is transferred to the home setting whereas nothing else changes.