Telecare technologies and isolation: some ethical issues

Abstract

Telecare technologies involve the remote monitoring of patients who have health, rehabilitation or social needs. These technologies, although deployed unevenly in developed countries, represent a shift in the ways in which care is practiced. Research on the consequences of this shift away from more traditional "hands-on" care has focused primarily on quantitative measurement (for example cost savings) with less attention paid to how recipients themselves experience these new care practices. This paper discusses two aspects of telecare technologies which are under researched; the potential for loneliness which may arise as a result of the use of these technologies, and the ethical issues raised by this. The primary locus of the discussion is the UK, where a major public policy shift towards telecare is under way and where telecare research based on randomized control trials has been particularly well funded by the government. The discussion concludes that there is indeed the potential for loneliness, a condition increasingly recognized as a significant factor in reducing overall health and well-being, in the use of these technologies. The ethical implications of this are not being sufficiently considered, in part because the ethical frameworks in use do not adequately address the issue of loneliness itself, given their bio-medical, rather than relational focus. The paper suggests two ways of redressing this. First, the addition of approaches to ethics other than bio-medical – particularly those with a relational and contextual focus – or greater exploration of how the two approaches might interact. Second, it suggests that a paradigm shift towards solutions other than technology-based care is overdue. This shift would not underplay the importance of technological contributions to care needs. It would, however, be an argument to suggest we proceed with some caution, advance the research evidence on the complexity of users' experiences of these technologies, and explore potentially simpler – and ethically more relational – approaches to care, such as shared or intergenerational living.