Ethical Consideration of Smart Medical Homes Development


In popular culture, as well as in media discourse of technology-driven social trends, both a utopian and a dystopian view of smart technology are prevalent. For example, Black Mirror, a popular British sci fi TV series about the dark side of modern technology, includes an episode in which a chip implanted into a child’s brain allows parents to monitor the child’s vital signs and emotions and even see the child’s visual field on a computer screen. The technology also allows adults to mute undesirable and disturbing things from the child’s vision. Requested by an anxious parent with good intentions, the chip leads to traumatic consequences. At the same time, another episode of the same series depicts futuristic technology that enables bedridden older adults (spoiler alert) to live fuller lives by inhabiting their younger bodies in a virtual world.

The utopian view presents technology as an enabler to overcoming limitations. The dystopian view, exemplified, among other works, in Dave Egger’s novel “The Circle” and a children’s science fiction animation “WALL-E,” includes themes of losses: of privacy, lost to surveillance-enabling technology; of independence; and of relationships with other humans. While we believe that potential benefits of smart medical homes are numerous, to avoid dystopian outcomes in real life, these ethical concerns should be taken very seriously.

Users’ Understanding of Privacy and Security Considerations

Thus far, we have discussed ensuring smart medical homes’ data privacy and security as a technical challenge. It is also an ethical imperative. One particular ethical concern is about informed consent. How can we help the user to truly understand risks of breaches and unauthorized use and make informed decisions about accepting them?

Older adults usually value autonomy over privacy and will often consent to trade some privacy for an increase in autonomy. However, in the context of smart homes, very complex technology is brought to vulnerable people who can be expected to have limited experience with such technology, and whose understanding may be impaired by cognitive difficulties. As a result, their consent may be less informed than their signatures on informed consent forms suggest.

Moreover, as smart technologies are new and the methods for analyzing the data obtained by them are developing rapidly, even the experts often cannot foretell potential future risks. It is critically important to be thorough in explaining the technology and discussing the risks with potential users and their family members (for more on privacy considerations, see Part II: Chapter 11).

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