Chapter Preview
TopBackground
Socially unequal circumstances of life and circumstances for older people justify to refer to a heterogeneity of ageing processes. This heterogeneity is a crucial aspect to be considered in the debate of technological developments for the ageing population: Ageing is a highly individual process. The variance in what it means to get older is tremendous with respect to objective measures and subjective experiences. In particular, we face manifold coping strategies dependent upon varying biographical, economic, and social resources, which in turn effect the use of modern technologies. Every development of devices and every assessment of their usability must consider this variability to be able to satisfy the actual needs of the user.
From a gerontological point of view, the abilities of older people to maintain or recover independent, task-oriented and meaningful lives have been ascertained. These abilities enable them to live in an environment, which is stimulating, supportive, and encouraging of the autonomous confrontation with the challenging tasks and burdens of daily life (Kruse, 1996).
Therefore, assistive technologies cannot primarily be viewed as means to compensate for loss. Instead, we suggest considering the personal competence of older people in applying this technology purposefully and in their own authority in order to carry out the functions and aims of daily life. Even in cases of impaired abilities to lead an independent life and an increased need for care, it is essential to convey creative and even innovative potentials to ageing.
A critical examination of the image of old age, indicates, amongst others, the following: questions of acceptance and support of ageing are decidedly influenced by the central value system of society. This value system is subject to historical variability which is developing in the direction of individualization and pluralization, which has been repeatedly empirically confirmed since the 1970s (Beck & Beck-Gernsheim, 2002; Giddens, 1991; Baumann, 2001; Schroer, 2001; Ehrenberg, 1998).
Key Terms in this Chapter
Beneficence: a central concept for health care ethics which describes actions that are intended to benefit or promote the good of other persons. Beneficence encompasses the responsibility of the health care practitioner to understand both harms and benefits - a process that might involve conflicts with the principle of respect for autonomy.
Autonomy: a central concept for health care ethics in the spirit of individualization and liberalization. Autonomy literally means “self-governance,” which is both the state of being capable of exercising self-governance and also the right to be free to self-govern. The right for autonomy and the related desire for independence is often in tension with the principle of beneficence, as dependence on people and other external factors is an inevitable fact of human life, which is particularly relevant for caring contexts.
Health Care Ethics: a general term for those applied or specialized ethics, which address moral problems within the interprofessional area of Health Care. Medical Ethics appears to be a subarea of Health Care Ethics.
Assistive Technologies: computer supported smart home technologies or new technologies in the area of “robotics” designed to support the elderly living on their own or patients in long term-care facilities by well-being monitoring. Aims of assistive technologies are: perpetuation of best mobility and communication, higher security in emergency, early recognition of impairment by sensor-based activity determination or detection of fall, informing relatives, decrease of the “fear factor” for users living alone, benefit of information for informal helpers and healthcare professionals, helping them in carrying out electronic care planning and documentation (telehomecare). Individual solutions are central.
Telecare: the continuous, automatic, and remote monitoring of real time emergencies and lifestyle changes over time in order to manage the risks associated with independent living.
Privacy: the fundamental right of individuals to be free from intrusion or interference by others including the right to control information about oneself. Discussions in ethics and law together with the term privacy consider questions of confidentiality (the obligation to safeguard entrusted information) and protection of personal data (informational self-determination). The European-continental understanding (which often relates to the ethical principle of dignity) diverges from the North American understanding, largely.
Vulnerability: The source of many moral intuitions and responsibilities is the recognition that there are vulnerable individuals or groups who are susceptible to being harmed, i.e. who are less protected against a certain disposition or a status facing outer and inner impairment. This also refers to a failure of a selfregulating mechanism of the organism. Questions of informed consent require special attention in vulnerable populations who are particularly susceptible to injury or harm.
Telehomecare: care visits which are based on video or the telephone, and more recently and preferably the Internet, enabling professionally supported consultation for patients and relatives over great distances.