Challenges and advantages of robotic nursing care: a social and ethical analysis

Robotics is an interdisciplinary branch of engineering and science that includes, inter alia, mechanical engineering, electrical engineering, and computer science. This emerging field of technological advancement deals with the connection of perception to action and where that connection is to be “intelligent,” then artificial intelligence (AI) plays a fundamental role in robotics.

Robotic technology has gradually penetrated both personal and professional aspects of human lives. Taking into consideration mechatronics, industrial robots, and futuristic humanoids, the robotic field of technology seems to be an extensive field of human endeavors.

This post has been co-authored with Dr. Issa A Muraina, DVM, MSc, PhD, and MBA candidate at the School of Business and Law of the University of East London; Research Scientist at the National Institute for Biological Standards and Control, Department of Health, UK  

Robots have already been used in the manufacturing industries, in dangerous environments, or in places where humans cannot survive for several years. Robotics is increasingly being used in many cities especially in public transportation where public transport systems including the undergrounds, over grounds and metro services, are operated driverless designed with full autonomy. Moreover, their uses also extend to other non-professional applications including household tasks like room cleaning, food preparation, lawn mowing and playing games with children.

The usage of service robot has been recently growing in nursing or care homes in most advanced countries with Japan currently leading the world in advanced robotics. Thanks to the cultural affinity of many Japanese to robots, many Japanese corporations are planning to exploit the great potentials of nursing-care robots manufacturing especially where aimed at taking care of older adults. Across the country, there are about 5,000 nursing-care homes testing robots for use in nursing care due to declining number of human nurses to care for aged people (above 65 years of age) who are more than a quarter of the population (the highest in OECD countries). Such a situation is going to get even worse in the future. As a matter of fact, according to the World Bank population estimates and projections, whilst Japan currently has some 126.3 million inhabitants of which 34.7 million are aged 65 and above, representing 27.38% of the overall population, in 2050 the total population of Japan will shrink to 108 million with 39 million people that will be aged 65 and above, which will represent 36% of the overall population.

One of the technologies that look promising in meeting these challenges is robotics and, in particular, the development and implementation of nursing-care robots. It is interesting to note that such a development could result useful also in other countries like the United Kingdom, which is also experiencing both the issue of an aging population and a chronic shortage of nurses that has been exacerbated by Brexit.

Besides the technical challenges that the industry will face in developing such a complex robotic technology, which falls beyond the scope of this article, this work will examine the most relevant advantages that such a form of robotization will offer our societies and, then,  analyze various issues related to the adoption of robot nursing care from both a business ethics and corporate social responsibility perspective.

Advantages related to the use of nursing-care robots

The nursing robot system is designed in such a way to assist bedridden patients with simple services, and such robot is typically confined to patient’s room in the hospital or at home. Nursing-care robots can also carry out laundry services as well as other household chores, and with a human-like voice for greeting patients awakening from sleep. It has to be pointed out that, although at the moment robots are supposed to administer any medical treatment to a patient, they could be programmed to do so.

When compared to humans, robot nurses are quicker to train, cheaper to maintain, easier to refuel and repair, and able to do very odd and repetitive tasks. Robotic nurses can do most of the boring and dangerous nursing jobs that may also result in the occupational exposure of human nurses to hazardous infections or chemicals.

Also, the use of robots may allow providers to offer their healthcare services at a lower cost. As a hospital administrator stated, robots can lead to a 65% reduction in the cost of human labor per year.

Robots can transcribe and store crucial medical information minimizing the possibility of error as well as helping doctors and nurses to diagnose patients and even assisting lower-skilled health workers to administer treatment to patients with less input from doctors or other higher-skilled professionals.

Robots can help older adults and chronically ill patients to remain independent, reducing the need for carers and the demand for care homes. They may also serve as a companion to patients who have a few or no visitors by entertaining them.

Robots can efficiently address cognitive decline issue by reminding care-receiver when to eat, or drink or take medication, do exercise or attend an appointment. Such tasks can be performed by nursing-care robots with a high level of accuracy and constantly, even during holidays or Night working hours thanks to the fact they can work endlessly and do not suffer from fatigue or die of boredom.

Robots can be extremely helpful in continuous monitoring of patient and data collection for emergency cases like heart failure and diabetes and then relay such data to a human nurse or doctor for action to be taken.

Issues related to the use of nursing-care robots

Privacy Issues

Nursing-care robots can be easily provided with surveillance equipment that can give them the capability of monitoring their patients, recording the related data and communicate information wirelessly. Although such a feature can prove to be useful to safeguard aged patients establishing virtual proximity with their relatives or healthcare providers, it could also lead to a violation of patients’ privacy.

Without adequate regulations or, in their absence, responsible corporate policies and protocols, these robots’ capabilities can represent a threat to the private life of patients and all the individuals that interact with them.

Dignity Issues

Humans are by nature social animals, who with need the interaction with other humans to survive. As a result, the removal of human caregivers from the care environment and their replacement by robots might give rise to major issues related to the dignity and the happiness of the patients. Human interaction is a critical source of intangible value for the development of human beings. Such form of interaction is enjoyed by patients on every occasion in which a nurse interacts with them. The very presence of a human entails the patient value recognizing him or her as a unique individual rather than an impersonal entity. This cannot be replaced by a robot because of its “mechanical,” “pre-programmed” and thus “neutral” way to interact with patients.

A responsible use of nursing-care robots should avoid any extensive substitution of humans for robots in healthcare services and assure periodical and pre-planned occasions for allowing patients to interact with a human, especially where they are particularly sensitive or vulnerable.

Attribution of Liability Issues

The mechanical nature of nursing-care robots makes impossible to attribute them liability in case of malfunctioning or any other adverse consequence related to their usage. As a result, it could result extremely complicated to attribute civil and criminal liability to natural and legal persons in relation to a harmful event caused by a robot. Such a liability could theoretically fall on several different persons like the manufacturer, the programmers, the providers, and the technicians. Such confusion could lead to a lack of accountability and represent a burning issue for the affected patient, who may face the burdensome task of identifying the responsible subject. Such a task could become even impossible taking into consideration the age and the vulnerability of the individuals who are commonly supposed to make use of nursing-care robots.

The issue of accountability is even made more complex by the developments in artificial intelligence and their applications to robots. One of the main aims of providing nursing-care robots with artificial intelligence is to make them autonomous giving them decision-making capabilities. As a result, attributing the liability of a harmful event caused by a wrong decision taken by the robot itself could become a real legal conundrum. This especially taking into consideration that the whole conceptual vocabulary of “responsibility” and its cognate terms is completely soaked with anthropocentrism. To solve this issue clear and easily identifiable criteria of attribution of civil and criminal liability have to be provided by regulators.

Employment Issues

Thanks to the fact that robots assure a high level of productivity and efficiency at reduced costs in comparison with humans, nursing-care robots can become an attractive alternative for healthcare providers. As it is happening in almost every other industrial, the substitution of humans with robots in the workplace is raising widespread concerns.

In particular, a reduction of the demand in human-provided nursing services could be further detrimental to a sector that is already in crisis. An additional reduction of people interested in becoming a nurse could deprive our communities of fundamental medical assistant skills.

To solve this issue, Bill Gates proposed that the usage of robots be taxed. However, such an idea does not seem to represent a valid solution. It would make the use of robots less convenient from an economic point of view, but the market and the healthcare providers could easily circumvent such a burden. In reality, governments should make extensive studies to identify the ideal ratio of humans to robots in the healthcare industry and set it as a mandatory limit to the use of nursing-care robots. Moreover, there should be more investments in training and development of human capital to keep their knowledge and skill evolving to be able to work in conjunction with robots.

Safety and Security Issues

Finally, the usage of robots in the healthcare sector and their increasingly growing interaction with humans raises a series of new and challenging safety and security questions. For that reasons, in order to act in a responsible way, all the involved entities, starting with the manufacturers, have to face the predictability issue and invest resources to identify in advance all the potential hazards that the implementation of nursing-care robots can entail. This even if the intensely competitive and rapidly changing global economy appears to go in the opposite direction.

As a matter of fact, safety and avoidance of harm should be of utmost importance in healthcare domain when using robots because of the involvement of vulnerable people such as ill and older adults and children. There is the need for an improved technique that will eliminate or reduce safety-related failures as well as eliminating unpredictable behaviors. Another specific concern about security is on how to keep robots safe from being hacked.  As powerful as technology become, it is important also to check the activities of hackers who might exploit the technology for nefarious activities.

One thought on “Challenges and advantages of robotic nursing care: a social and ethical analysis

  1. Great post!

    One point I feel that was just touched on is maintenance of the robots. While it is suggested that these robots have the ability to work non-stop, there will be need for periodic maintenance and quality control – whether that be daily, weekly, or monthly – to ensure the robots are operating at an optimum level. These tasks must be completed by humans and I presume could be rather intensive and lengthy considering the robots are functional for up to 24hrs a day. This poses a lot of additional questions: Where are these service technicians coming from? How many will be required to service the 5,000+ robots around the country? And are we ultimately cutting one career field only to replace it with another, most likely at a higher cost?

    Additionally, how much time will these service trips take and how will this downtime be managed? Will human nurses be employed to cover the downtime of these robotics undergoing maintenance or will they be scheduled at specific time slots and hope no care is needed?

    While the system is focusing on replacing human nurses, it is impossible to completely get rid of all nurses in the field, specifically in long-term care and the elderly. As you said, there is too much risk involved in the use of these robots. We have yet to figure out all the mechanics behind such a system and don’t not anticipate this happening in the near future. Humans are an invaluable source in this field of work, and although we ourselves are error-prone, we also lend something to this industry that cannot be replaced by robots.


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