Etikk i praksis. Nordic Journal of Applied Ethics (2019),
13(1), 55-80 |
http://dx.doi.org/10.5324/eip.v13i1.2525 |
Responsibility for Assistive Technologies: Product Assessment Frameworks and Responsible Research and Innovation
Erik Thorstensen Work Research Institute, Oslo and Akershus University College of Applied Sciences, erikth@oslomet.no The approach to innovations known as Responsible research and innovation (RRI) aims to move the innovation system towards creating products that strive to realize social values along with economic benefits. This paper discusses the systematic assessment of assistive technologies in order for them to meet the aims expressed in RRI. A central issue in the discussion is how to facilitate an integration of insights from the discourse on RRI with more established assessment approaches such as Health Technology Assessment (HTA). Based on the literature on existing socio-ethical assessment tools, I investigate how these tools can be combined with HTA and how they can add perspectives from RRI that might increase the socio-ethical value of assistive technologies. Through a discussion on how to understand RRI, HTA, assessment and integration, I suggest a list of four possible approaches that have the potential to be applied as assessment approaches that integrate insights from RRI and HTA. These are then evaluated on their ability to address issues that have emerged from a literature review on RRI and assistive technologies, on empirical studies in this technology field and on their product focus. In conclusion, I argue that the Ethical Impact Assessment, the Socratic approach, the Ethical Matrix, and the HTA Core Model seem to be the most promising methodologies, but that these need adjustments to cover substantive themes from RRI. Keywords:
energy scenarios,
justice, future generations, capabilities
approach
Introduction Worldwide we see a proliferation of
assistive technologies in hospitals,
institutions and homes, ranging from high-tech
robots to low-tech analogue alarms. There are
high hopes for assistive technologies in policy
circles as part of an approach that might
empower people with disabilities of all ages to
reside at home longer, as opposed to living in
different kinds of institutions. In the last 25
years, researchers, policy-makers and health
professionals have especially focused on older
adults in order to accommodate smart homes for
this group (Thygesen 2009). The vision behind
this practice has been to increase older adults’
independence and self-esteem, while reducing
both health care expenses and an increased
number of employees in health care delivery. In
addition, several technology firms are launching
solutions promoted as meeting these policy
objectives. In the field of assistive
technologies, we then encounter both policy pull
and technology
push, as von Schomberg (2011) calls them.
Seen from a socio-ethical perspective, concerns
over assistive technologies relate to issues
such as how care is
perceived, experienced and given (Roberts &
Mort 2009), the possible medicalization of homes
(Hofmann 2013), focus on caregivers at the
expense of users (Topo 2008), and possible
conflicts between empowerment of older adults
and the larger goal of addressing ageing as a
demographic challenge (Pols & Willems 2011).
Responsible Research and Innovation
(RRI) is a term used for research policy, for a
cross-sectorial approach to science and
innovation governance, and for an intended
practical approach to research and innovation
(Ribeiro, Smith, & Millar 2016). For the
Assisted Living project, the last term of the
phrase RRI applies. When conceived of as a
method for innovation, Assisted Living project
utilizes a conception of RRI as containing:
A more specific meaning of the term
“product assessment” is conditioned by
background and discipline. In an early
contribution to RRI, Stilgoe et al. mention some
questions that are relevant for a product
assessment: · How will the risks and benefits be
distributed? · What other impacts can we
anticipate? · How might these change in the
future? · What don’t we know about? · What might we never know about?
(Stilgoe, Owen, & Macnaghten 2013: 1570)
The historical background for HTA is similar to that of the different forms of Technology Assessment (TA). They both originated in and through the same impulses that created the U.S. Congressional Office of Technology Assessment (OTA) in 1972 and with the same focus on efficiency, understood as the cost-effectiveness of a given health intervention. Traditionally, pharmaceuticals, vaccines and medical equipment have been easier to assess through HTA, while different types of health care practices have been more challenging to assess due to their interlinked and complex nature (Banta 2003). Adding to the complexity, studies reveal a lack of clear definitions in the literature on how value is or should be defined (Antoñanzas, Terkola, & Postma 2016).
· Coordination: Ethics is still an
independent part of the HTA, but the role and
weight might differ depending on contextual
factors. The results from the other parts of the
HTA will influence the input to the ethical
parts, but not the methodological choices of the
ethicists. · Interaction: Ethics and other
disciplines will be in a continuous exchange of
viewpoints and results with possible
redefinitions of the policy question, methods,
and relevant comparative cases for all
disciplines. (Hofmann et al. 2015: 131-132) Indicators for choosing an approach In an earlier study based on a
review of the RRI and assistive technologies
literature as well as dialogues with
stakeholders in the current project, I
documented that a range of values ought to
be taken into account when developing
assistive technologies (Thorstensen 2017b).5 I will now
recapitulate the central findings from this
article. A central concern is that a product
assessment approach used in an RRI project
should be able to incorporate these points.
A central issue for the
assessment of assistive technologies is
that the stakeholders are included in
thinking about and reflecting upon what
constitutes a benefit in the particular
case. These benefits should not be
reduced to utilitarian concerns but
should also include social relations,
values such as exercise and amusement,
and reflect modifications to the lived
environment through devices and a novel
type of care. Including the
stakeholders’ own understanding of
benefit can be carried out as a part of
the assessment (when interviews or other
qualitative approaches are used) or in
phases prior to the actual assessment. Risks and benefits before use: The above concerns
should be used in a solid and
complete pre-trial (i.e. ex ante)
testing of a product. Such testing
should also encompass privacy,
safety, security, information
collection and sharing as well as a
thorough review of the evidence base
of the product. Assessments of the
product’s economic, social and
ecological sustainability ought to
constitute a part of this evidence
base. However, this criterion will
be disregarded for the present
purpose, since we are striving for
an assessment method that is
applicable both to products made in
an RRI process and other products
(without any possibility to conduct
an ex ante assessment), where an
assessor or an assessing body lacks
information about the process. Distribution of risks and benefits: An assessment should include considerations about the distribution of risks and benefits. In particular, one should be aware that assistive technologies might entail a transfer of the risks towards the elderly. If such a transfer seems to be the case, alternatives to the solution should be explored or the transfer needs to be justified in terms of other types of benefits. Distribution of responsibilities: As with the distribution of
risks and benefits, the distribution of
responsibilities regarding the product
should be well understood, but also open
for discussion. This relates
particularly to the division of
responsibility among the different
operators in the service provisions
connected to a product. Training:
A final concern is that the
assessment also investigate how users are
introduced to the product, since health
professionals and users alike identify
didactical approaches (or their absence) as key
aspects in the process.
Discussion of assessment approaches Several scholars have
recently studied in detail some of the
possible candidate frameworks (Forsberg et
al. 2017) and their relation to HTA
(Hofmann et al. 2015; Lysdahl et al.
2016). I will use their work as a point of
departure in addition to my work in the
literature review for the Assisted Living
project to present the possible
frameworks that may be suitable to apply
as an RRI product assessment framework. I
have selected the frameworks and
methodologies discussed here based on
whether they appeared in the reviewed
literature or if they have been discussed
in relation to HTA and socio-ethical
issues.8
Some of the approaches reviewed by Assasi
et al. (2014) propose a variety of a
literature reviews, but these will not be
considered as they constitute what Hofmann
calls an “add-on approach.”9
technology
as the product of societal processes
within industry, research institutes,
governmental bodies, and society at large,
rather than an independent artefact that
has a certain, measurable impact on its
target. Therefore it is important to
understand the engagement and strategies
of various actors, and the way various
problems are defined and resolved (2016:
64). The HTA Core model
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