Robots in aged care: a dystopian future?

Abstract

In this paper I describe a future in which persons in advanced old age are cared for entirely by robots and suggest that this would be a dystopia, which we would be well advised to avoid if we can. Paying attention to the objective elements of welfare rather than to people’s happiness reveals the central importance of respect and recognition, which robots cannot provide, to the practice of aged care. A realistic appreciation of the current economics of the aged care sector suggests that the introduction of robots into an aged care setting will most likely threaten rather than enhance these goods. I argue that, as a result, robotics for aged care is likely to transform aged care in accordance with a trajectory that leads towards this dystopian future even when this is not the intention of the engineers involved. While an argument can be made for the use of robots in aged care where the people being cared for have chosen to allow robots in this role, I suggest that overemphasising this possibility risks rendering it a self-fulfilling prophecy, depriving those being cared for of valuable social recognition, and failing to provide respect for older persons by allowing the options available to them to be shaped by the design choices of others.

This is a preview of subscription content, access via your institution.

Notes

  1. 1.

    Notable contemporary examples include the European Union-funded ACCOMPANY Project, which aims to build an ACCOMPANY System (or Care-O-Bot 3), which, according to the list of objectives on its website, will provide “services to elderly users in a motivating and socially acceptable manner to facilitate independent living at home” [See http://accompanyproject.eu/ (accessed 16.1.15)] and the (also EU funded) HOBBIT project, the goal of which is “to advance towards a robot solution that will enhance wellness and quality of life for seniors, and enhance their ability to live independently for longer at their homes.” [See http://hobbit.acin.tuwien.ac.at/index.html (accessed 21.1.15)].

  2. 2.

    Coeckelberg (Coeckelbergh 2012) outlines a similar scenario as a possible vision of the future of aged care in a paper of which I only became aware after drafting this one.

  3. 3.

    For a recent survey of such claims, see Vincze et al. (2015)).

  4. 4.

    For a useful (if dated) survey, see Griffin (1986).

  5. 5.

    The account below roughly follows Parfit (1984: 493; subsequent discussion).

  6. 6.

    A variation of a counter-example first suggested by Rawls (1971: 432).

  7. 7.

    An influential alternative involves introducing a requirement for some degree of idealisation in the specification of the relevant desires. Thus, for instance, we might say that people are well off when the desires that they reflectively endorse when fully informed are satisfied. Such accounts suffer from a tendency to collapse into versions of the “objective list” theory when placed under philosophical pressure because it is difficult to quarantine accounts of the reasonableness of desires from the worth of their objects.

  8. 8.

    Although the fact that relations between persons have this dual aspect is reasonably uncontroversial, both the precise way to make the distinction and the most appropriate terminology by which to mark it remain a matter of some controversy. The idea of “recognition” as a distinct good was central to the philosophical debate about multiculturalism, which took place in the 1990 s [see especially Taylor and Gutmann (1992)] although the contrast with respect was not always stated explicitly. Fraser (1995) comes close to making this distinction as I make it here, although she cashes out the implications of a concern for respect as a concern for the distribution of political and economic opportunities. My account of recognition subsumes the first and third form of recognition distinguished by Honneth (1992) in his justly influential account, while my concept of respect closely tracks the second form of “recognition” he identifies. In Nussbaum's list of capabilities, recognition is included within “affiliation”, while respect is most obviously represented as “control over one's environment” but is also represented in the concern with freedom and opportunity that drives the focus on capabilities rather than a more determinate list of goods (Nussbaum 2011: 33–34).

  9. 9.

    This can only be an approximation because recognition also admits of the distinction between genuine and ersatz acknowledgement of the worth of others.

  10. 10.

    This is not to say that older persons are always treated with respect and recognition by human “carers”. However, where human beings don't provide these goods, this is widely acknowledged to represent a moral failing. As I discuss below, the claim that the use of robots in aged care is inimical to respect is more controversial than the claim about recognition and I defend it further in the last part of this paper.

  11. 11.

    As I have argued elsewhere (Sparrow 2002), the ethics of designing artefacts that encourage this delusion is problematic.

  12. 12.

    Vallor (2011) argues, with some plausibility, that it would also be a dystopia in so far as this is a world in which (potential) caregivers are denied the opportunity to cultivate important virtues and to benefit from contact with the elderly. For some reservations about the general form of this argument, however, see Sparrow (2015).

  13. 13.

    Again, an objective that is highlighted in both the EU-funded ACCOMPANY Project (see: http://accompanyproject.eu/) and HOBBIT Project (see http://hobbit.acin.tuwien.ac.at/index.html).

  14. 14.

    It must be acknowledged that some of the changes required may be very expensive in some homes and also that some of these changes, where they are inexpensive, may also make it easier for robots to function in homes.

  15. 15.

    This is, perhaps, not so immediately obvious in the case of telepresence robots, which might be thought of as offering a new medium through which contact between people may occur. However, even in this case such robots clearly function to substitute for the physical presence of the other person.

  16. 16.

    Striking accounts of the impacts of this dynamic in the Australian context are provided here: http://www.theglobalmail.org/feature/how-our-twilight-years-are-ripe-for-the-picking/73/ (accessed 15.1.15); and, here http://www.agedcarecrisis.com/yoursay/4611-no-staff-for-10-5-hours-per-day (accessed 15.1.15). My thanks to Linda Sparrow for these examples.

  17. 17.

    This goal is even made explicit in the announcement of a new position paper on workforce issues by Aged and Community Services Australia (ACSA), which quotes one of the authors, Adjunct Professor John Kelly, as saying “We have to use robotics and technology in clinical care to decrease—not in a huge way but possibly by 5 per cent—the amount of people we need by actually getting technology to do things”. See Belardi (2015). New workforce strategy for aged care. http://www.australianageingagenda.com.au/2015/01/13/new-workforce-strategy-aged-care/ (accessed 15.1.15).

  18. 18.

    This fact is also, I think, reflected in the recent enthusiasm in the literature for Nussbaum's “capacities approach” to social justice, which acknowledges the value of autonomy by focusing on the distribution of the capacity to achieve various “functionings” rather than on goods understood as particular items or outcomes, as a lens through which to view the ethics of robots in aged care. See, also: Coeckelbergh (2012), Parks (2010), Sharkey (2014).

  19. 19.

    This way of putting the matter risks implying that robots can provide respect, which is not the case; rather, where individuals choose to allow robots to be used to assist them, the decision of third parties to respect this choice provides the good of respect.

  20. 20.

    Again, it is clear that existing standards of care are already inadequate in many, indeed arguably most, cases today. However, this sad fact does not detract from the larger argument here; that claims about the significance of older citizens’ willingness to be happy with care provided by robots need to be treated with a certain degree of cynicism, while the alternative is so dire.

  21. 21.

    For an extended discussion of the various ways in which values are—and might be—embedded into the design of caring robots, see van Wynsberghe (2013).

References

  1. Aristotle (2004) The politics (E. Barker, Trans.). Oxford University Press, Oxford

  2. Arneson RJ (1999) Human flourishing versus desire satisfaction. Soc Philos Policy 16(1):113–142

    Article  Google Scholar 

  3. Borenstein J, Pearson Y (2010) Robot caregivers: harbingers of expanded freedom for all? Ethics Inf Technol 12(3):277–288

    Article  Google Scholar 

  4. Coeckelbergh M (2012) “How I learned to love the robot”: Capabilities, information technologies, and elderly care. In: Oosterlaken I, van den Hoven J (eds) The capability approach, technology and design. Springer, Dordrecht, pp 77–86

    Google Scholar 

  5. Elster J (1985) Sour grapes: studies in the subversion of rationality. Cambridge University Press, Cambridge

    Google Scholar 

  6. Fraser N (1995) From redistribution to recognition? Dilemmas of justice in a ‘post-socialist’ age. New Left Rev 212:68–93

    Google Scholar 

  7. Griffin J (1986) Well-being. Clarendon Press, Oxford

    Google Scholar 

  8. Hegel GWF (1977) Phenomenology of spirit. Oxford University Press, Oxford

    Google Scholar 

  9. Heidegger M (1993) The question concerning technology. In: Basic writings (Rev. and expanded ed). Harper, San Francisco

  10. Honneth A (1992) Integrity and disrespect: principles of a conception of morality based on the theory of recognition. Polit Theory 20(2):187–201

    Article  Google Scholar 

  11. Nozick R (1974) Anarchy, state and Utopia. Basic Books, New York

    Google Scholar 

  12. Nussbaum MC (2000) Women and human development: the capabilities approach. Cambridge University Press, Cambridge

    Google Scholar 

  13. Nussbaum MC (2011) Creating capabilities: the human development approach. Harvard University Press, Cambridge

    Google Scholar 

  14. Parfit D (1984) Reasons and persons. Clarendon Press, Oxford

    Google Scholar 

  15. Parks JA (2010) Lifting the burden of women’s care work: should robots replace the “human touch”? Hypatia 25(1):100–120

    Article  Google Scholar 

  16. Rawls J (1971) A theory of justice. Harvard University Press, Cambridge

    Google Scholar 

  17. Rice CM (2013) Defending the objective list theory of well-being. Ratio 1(2):196–211

    Article  Google Scholar 

  18. Schaeffer C, May T (1999) Care-o-bot-a system for assisting elderly or disabled persons in home environments. In: Buhler C, Knops H (eds) Assistive technology on the threshold of the new millenium. IOS Press, Amsterdam

    Google Scholar 

  19. Sen A (1999) Development as freedom. Knopf, New York

    Google Scholar 

  20. Sharkey A (2014) Robots and human dignity: a consideration of the effects of robot care on the dignity of older people. Ethics Inf Technol 16(1):63–75

    Article  Google Scholar 

  21. Sorell T, Draper H (2014) Robot carers, ethics, and older people. Ethics Inf Technol 16:183–195

    Article  Google Scholar 

  22. Sparrow R (2002) The march of the robot dogs. Ethics Inf Technol 4(4):305–318

    MathSciNet  Article  Google Scholar 

  23. Sparrow R (2004) The turing triage test. Ethics Inf Technol 6(4):203–213

    Article  Google Scholar 

  24. Sparrow R (2015) Imposing genetic diversity. Am J Bioeth 15(6):2–10. doi:10.1080/15265161.2015.1028658

    Article  Google Scholar 

  25. Sparrow R, Sparrow L (2006) In the hands of machines? The future of aged care. Mind Mach 16:141–161

    Article  Google Scholar 

  26. Taylor C, Gutmann A (1992) Multiculturalism and “the politics of recognition”. Princeton University Press, Princeton

    Google Scholar 

  27. United Nations, Department of Economic and Social Affairs, Population Division (2013) World population ageing 2013. ST/ESA/SER.A/348

  28. Vallor S (2011) Carebots and caregivers: sustaining the ethical ideal of care in the twenty-first century. Philos Technol 24:251–268

    Article  Google Scholar 

  29. van Wynsberghe A (2013) Designing robots for care: care centered value-sensitive design. Sci Eng Ethics 19(2):407–433

    Article  Google Scholar 

  30. Vincze M, Weiss A, Lammer L, Huber A, Gatterer G (2015) On the discrepancy between present service robots and older persons’ needs. In: 23rd IEEE international symposium on robot and human interactive communication (IEEE RO-MAN 2014), August 25–29, 2014, Edinburgh. http://hobbit.acin.tuwien.ac.at/publications/hobbit_roman.pdf. Accessed 21 Jan 15

  31. Winner L (1986) The whale and the reactor: a search for limits in an age of high technology. University of Chicago Press, Chicago

    Google Scholar 

Download references

Acknowledgments

The research for this paper was supported under the Australian Research Council’s Centres of Excellence funding scheme (Project CE140100012). The views expressed herein are those of the author and are not necessarily those of the Australian Research Council. I would like to thank Professor Gesa Lindemann and Professor Gregor Fitzi for the invitation to attend the “Going beyond the Laboratory” conference. I’d also like to thank my mother, Linda Sparrow, and Catherine Mills for comments and discussion during the process of drafting this manuscript.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Robert Sparrow.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sparrow, R. Robots in aged care: a dystopian future?. AI & Soc 31, 445–454 (2016). https://doi.org/10.1007/s00146-015-0625-4

Download citation

Keywords

  • Ethics
  • Robots
  • Robotics
  • Aged care
  • Society
  • Social robotics