Yi Tian

This paper maps the ethical concerns involved in using new technologies in the care of older persons by type of participant group and technology used. The study presents data from sixty-seven participants in total from three stakeholder groups (older persons, professional caregivers, and family caregivers) who relayed their opinions on three types of technologies: wearables, ambient sensors, and social assistive robots. The interview data collected was analysed using content analysis. Participants raised ethical concerns about user control, stigma, over-reliance on technology, isolation, deception, privacy breaches, and the replacement of human care. However, these concerns were not uniformly emphasized across participant groups, and not all concerns applied to each of the three technologies. Our findings revealed a reduced ethical sensitivity and preparedness for risk in the case of certain technologies. These ethical blind spots evident in our results pertained to privacy, stigma, and deception. With technologies continuously developing, such blind spots are a cause for concern.

Background The parallel growth of population ageing and international migration have introduced a unique population of transnational caregivers in elder care. Particularly for only children who face conflicting obligations and reduced caregiving resources, smart home devices could be technical tools to care for older parents from a distance. Research towards the use of these technologies has unearthed ethical issues such as privacy, autonomy, stigma and beneficence, but has not been fully explored in distance care. In this paper, we explore the ethical issues expressed by a group of only children towards integrating assistive, monitoring, and robotic technologies in their transnational care plans. Methods Purposive snowball sampling was used for the recruitment of 26 distance caregivers aged between 28 and 45, who were their parent’s only children. They lived in Europe for at least 5 years, with at least one parent residing in the home country. In semi-structured interviews, participants discussed the ethical issues of wearable devices, ambient and visual remote monitoring technologies, as well as the possible use of one assistive robot in the context of distance caregiving for older parents. We used the applied thematic analysis methodology to analyze the data. Results We highlight two ethical considerations. First, participants saw the need for maximizing good outcomes in caring for their older parents and fulfilling their responsibilities to ensure their health and safety, balanced against the respect for the parents’ autonomy, dignity, and privacy. Second, they weighed the benefits and harms of technologies at a distance to provide companionship and support against the intrinsic value placed on care received from one’s only child. Conclusions Discussions to involve technologies in elder care at a distance prompted complex decision-making processes to balance, weigh, and rationalize their ethical concerns as foreseen by the caregivers. The importance of maximizing the health and safety of older parents came at an unavoidable cost of the respect to autonomy, privacy, and dignity. Participants valued their own emotional connection and relationship to their parents, which they prioritized above the instrumental value of technological support. We further discuss our findings within the ethics of care theory and concepts within transnational care literature to make sense of the broader ethical implications of this empirical study.

The ageing of the global population prompts many countries to appropriately allocate healthcare resources that ensure adequate elder care. Nevertheless, the shortages in and burdens of professional care continue to persist. Assistive and remote monitoring technologies for home-use support professional carers in providing care to older persons. With secondary analyses of semistructured interviews with 27 older persons and 23 professional carers in Switzerland, we examined their reasons and expectations for accepting or rejecting technologies in elder care contextualised by their moral outlooks on care, life, death and the deterioration from age. Whereas some appreciate the opportunities for greater safety and reassurance from technologies, others may see the alerts as burdensome and the interventions superfluous. We argue that dissatisfaction in professional care may result from a misalignment of the subjective values between the carer and older person. This may exacerbate the problem of appropriate care provision and disrupt the potential of technologies to benefit older persons. An ideal caregiving arrangement may be found when their values do align. We argue that there exists intrinsic value to finding an alignment using the capabilities approach, followed by reflections on autonomy and privacy. Recommendations are offered to practically enable this alignment, with limits set to ensure adequate access to care. With the increasing enthusiasm for technical solutions in professional elder care, this paper contributes a novel perspective by presenting two reasons for inefficiencies in reducing care burdens that are linked to the alignment of core moral outlooks and the realisation of capabilities.

Background States and families are facing growing challenges provide adequate care for older persons. Smart home health technologies (SHHTs) in the forms of sensor or robotic devices have been discussed as technical solutions for caregiving. Ethical and social concerns are raised with the use of such technologies for caregiving purposes, a particularly prominent one being privacy. This paper contributes to the literature by distinguishing privacy concerns into both the type of technologies and conceptual dimensions.Methods Data for this paper stem from sixty semi-structured interviews with older persons, informal, and formal caregivers living in the German-speaking regions of Switzerland. All information related to privacy, that were initially inductively coded, were thematically sorted into four dimensions of privacy (physical, psychological, social, and informational) and by the type of technologies studied.Results Participants were especially concerned about privacy intrusions from smart wearables and ambient sensors than robotic technologies, which may be due to the relative lack of familiarity with the latter. Informational privacy was evident in the context of data collection capacities and potential for misuses of data. The installation and implementation of both visual and ambient sensors induced discomfort to their senses of physical space. Alerts of smart wearables and obtrusive sightings of SHHTs garnered worries related to stigmatization and manipulation, indicating intrusions into end-users’ psychological privacy. Little discussions of social dimensions of privacy were evident in the data, even toward robotic technologies for their functions to promote social interactions for older persons.Conclusions This paper is one of the first that use the stratification approach on empirical data to highlight the multi-faceted privacy concerns when technologies may be implemented in elder care. Our paper could thus supports potential end-users in deciding which technologies to use and how to balance different privacy concerns against other values that they may hold important.

The ageing of the global population has prompted the development of many technologies to support older persons (AgeTech). Those developing AgeTech need to not only consider different end users, including older persons and their caregivers, but also be cognizant of the fact that these groups have a variety of, often conflicting, values. The frameworks of Responsible Research and Innovation (RRI) and Value-Sensitive Design (VSD) both emphasize the integration of end users’ values into the process of designing new technologies. Drawing from recent empirical and theoretical AgeTech literature, this article presents an argument for applying these frameworks to the field of AgeTech to successfully identify values and manage tensions among them. It aims to inform a more successful AgeTech innovation process in which new technologies represent and prioritize what their intended end users value.

This paper explores the ways in which health care professionals, family carers, and older persons expressed attitudes and opinions on using Paro, a social robot designed to stimulate patients with dementia. Thereafter, we critically evaluate existing prejudicial views toward Paro users to provide recommendations for its future use. Using an exploratory qualitative interview method, we recruited a total of 67 participants in Switzerland. They included 23 care professionals, 17 family carers, and 27 older persons. Data obtained were analyzed thematically. Study findings present general agreement that Paro is an appealing and beneficial social robot, but it is not a tool that everyone feels comfortable with. Because it is perceived as “child play,” it would be demeaning for competent adults to play with such things. Consequently, Paro is appropriate only for persons with dementia. These findings brought forth ethical concerns about deception, infantilization, and respecting older persons' dignity. The idea of who is an appropriate Paro user led to our discussions on predicting future Paro users. The meaning of using social robotics in nursing homes can be conditioned by a rigid interpretation of adulthood and playful behavior. To protect future selves when one is living with dementia from prejudices, it may be useful for older persons and their loved ones to plan their future care situations to ensure that they are treated in accordance with their delineated decisions.

Background Gerontechnologies are increasingly used in the care for older people. Many studies on their acceptability and ethical implications are conducted, but mainly from the perspective of principlism. This narrows our ethical gaze on the implications the use of these technologies have. Research question How do participants speak about the impact that gerontechnologies have on the different phases of care, and care as a process? What are the moral implications from an ethic of care perspective? Research design Secondary analysis of semi-structure interviews, whose segments on specific technologies were analysed through reflexive thematic analysis. Participants and research context Sixty-seven Swiss stakeholders involved in the use of gerontechnologies, including professional caregivers, informal caregivers, and older persons themselves. Ethical considerations The research study was evaluated by the Ethics Commission of Northwest and Central Switzerland (EKNZ). All participants received an information document before the interview date detailing the purpose, procedure, and anonymization measures. After explaining the study during the agreed upon interview time and upon receiving their written informed consent, the interview process began. Findings/results Four themes are identified: Identifying care needs, Taking responsibility, Hands-on work, Responding to care. As part of these themes, many codes highlighting the ambivalent impact of gerontechnologies are created, ranging from ‘Expanded capacity for…identifying care needs’ to ‘Create new & (un)necessary…hands-on work’. The moral implications of these results from the care ethics perspective are discussed, through the ethical elements of: attentiveness, responsibility, competence, and responsiveness. Conclusions The moral implications of gerontechnologies on care phases from the care ethics perspective open up several questions on whether they actually help give care a central role in social life and provide more competent care.

The definition of ‘patient’ is commonly taken for granted and considered as obvious, but the term is rather underconceptualised in the literature. In this paper, it will be argued that the criterion of suffering can be considered a sufficient criterion for a parent to be considered a secondary patient when their seriously ill child is receiving medical care (i.e. not necessarily the parents themselves) – these parents are sufferers in virtue of the suffering of others. The nature of parental and child health and well-being is clearly relational and bidirectional, thus also a bidirectional and relational integration of parental and paediatric patient care is necessary. A genuine expansion of the concept ‘patient’ to parents, both practically and theoretically, can help to bring awareness to the closely intertwining, interacting and interdependent vulnerabilities of both parties, the potential conflicts of interests involved, and also to demand support and reduce hurdles, for example, in reimbursement by health insurers. Treating parents as patients will (1) help the affected child (the primary patient), as unhealthy and/or mentally unstable parents are likely to negatively influence a child's treatment and (2) prevent the parents (the secondary patients) from becoming primary patients themselves due to their suffering because of their child's illness.

The coupled growth of population aging and international migration warrants attention on the methods and solutions available to adult children living overseas to provide distance caregiving for their aging parents. Despite living apart from their parents, the transnational informal care literature has indicated that first-generation immigrants remain committed to carry out their filial caregiving obligations in extensive and creative ways. With functions to remotely access health information enabled by emergency, wearable, motion, and video sensors, remote monitoring technologies (RMTs) may thus also allow these international migrants to be alerted in sudden changes and remain informed of their parent’s state of health. As technological solutions for caregiving, RMTs could allow independent living for older persons while any unusual deviations from normal health patterns are detected and appropriately supported. With a vignette of a distance care arrangement, we engage with concepts such as filial piety, in-absentia caregiving distress, and the social exchange theory, as well as the upholding of shifting cultural ideals to illustrate the complex dynamic of the satisfaction and quality of the informal caregiving relationship. This paper extends the traditional ethical issues in technology-aided caregiving, such as autonomy, privacy, and justice, to be considered within the context of distance care. We also posit newer ethical considerations such as consent in power imbalances, harm to caregivers, and stigma. These known and new ethical issues aim to encourage further ethically conscious design and use of RMTs to support distance care for older persons.

Background The worldwide increase in older persons demands technological solutions to combat the shortage of caregiving and to enable aging in place. Smart home health technologies (SHHTs) are promoted and implemented as a possible solution from an economic and practical perspective. However, ethical considerations are equally important and need to be investigated. Methods We conducted a systematic review according to the PRISMA guidelines to investigate if and how ethical questions are discussed in the field of SHHTs in caregiving for older persons. Results 156 peer-reviewed articles published in English, German and French were retrieved and analyzed across 10 electronic databases. Using narrative analysis, 7 ethical categories were mapped: privacy, autonomy, responsibility, human vs. artificial interactions, trust, ageism and stigma, and other concerns. Conclusion The findings of our systematic review show the (lack of) ethical consideration when it comes to the development and implementation of SHHTs for older persons. Our analysis is useful to promote careful ethical consideration when carrying out technology development, research and deployment to care for older persons. Registration We registered our systematic review in the PROSPERO network under CRD42021248543.

The ever-debated question of triage and allocating the life-saving ventilator during the COVID-19 pandemic has been repeatedly raised and challenged within the ethical community after shortages propelled doctors before life and death decisions. The British Medical Association’s ethical guidance highlighted the possibility of an initial surge of patients that would outstrip the health system’s ability to deliver care “to existing standards,” where utilitarian measures have to be applied, and triage decisions need to maximize “overall benefit” In these emergency circumstances, triage that “grades according to their needs and the probable outcomes of intervention” will prioritize or eliminate patients for treatment, and health professionals may be faced with obligations to withhold or withdraw treatments to some patients in favour of others. This piece is a response and extension to articles published on the manner of involvement for ethics and ethicists in pandemic triage decisions, particularly examining the ability and necessity of establishing triage committees to ameliorate scarce allocation decisions for physicians.

In presence of predator population, the prey population may significantly change their behavior. Fear for predator population enhances the survival probability of prey population, and it can greatly reduce the reproduction of prey population. In this study, we propose a predator-prey fishery model introducing the cost of fear into prey reproduction with Holling type-II functional response and prey-dependent harvesting and investigate the global dynamics of the proposed model. For the system without harvest, it is shown that the level of fear may alter the stability of the positive equilibrium, and an expression of fear critical level is characterized. For the harvest system, the existence of the semitrivial order-1 periodic solution and positive order- q periodic solution is discussed by the construction of a Poincaré map on the phase set, and the threshold conditions are given, which can not only transform state-dependent harvesting into a cycle one but also provide a possibility to determine the harvest frequency. In addition, to ensure a certain robustness of the adopted harvest policy, the threshold condition for the stability of the order- q periodic solution is given. Meanwhile, to achieve a good economic profit, an optimization problem is formulated and the optimum harvest level is obtained. Mathematical findings have been validated in numerical simulation by MATLAB. Different effects of different harvest levels and different fear levels have been demonstrated by depicting figures in numerical simulation using MATLAB.

This study aims to explore the current situation and strategy formulation of sports psychology teaching in colleges and universities following adaptive learning and deep learning under information education. The informatization in physical education, teaching methods, and teaching processes make psychological education more scientific and efficient. First, the relevant theories of adaptive learning and deep learning are introduced, and an adaptive learning analysis model is implemented. Second, based on the deep learning automatic encoder, college students’ sports psychology is investigated and the test results are predicted. Finally, the current situation and development strategy of physical education in colleges and universities are analyzed. The results show that when the learning rate is 1, 0.1, and 0.01, there is no significant change in the analysis factors of recall, ndcg, item_coverage, and sps. When the learning rate is 1, their analysis factors change obviously, and it is calculated that the optimal learning rate of the model is 1. And the difficulty of the recommended test questions by using the sports psychology teaching method based on adaptive learning and deep learning is relatively stable. The test questions include various language points of sports psychology. Compared with others methods, adaptive learning and deep learning can provide comprehensive test questions for sports psychology teaching. This study provides technical support for the reform of sports psychology teaching in colleges and universities and contributes to optimizing the information-based teaching mode.