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.

5 thoughts 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.

  2. Hi Kellisha,
    I completely agree with you when you say that it is impossible to get rid of all nurses. Human must stay in control of those machines which can be dangerous, as it is mention in the article, a robot can be hacked for example.

    Moreover, in my opinion, the most important is that human contact cannot be neglected, it is vital in the medical sector. In my belief, ensuring care is also providing psychological support in addition to medical procedures to encourage healing progress. Human will treat the patient as a person comparing to a machine which will treat the patient as another data in its program, it is a form of “objectification”. If I can take a position, I would say that this seems to run contrary to the United Nations Universal Declaration of Human Rights which protect the right to dignity and be valued for its own sake.

    Also, the right to work, to free choice of employment, to protection against unemployment and the right to “just and favourable remuneration ensuring for himself and his family an existence worthy of human dignity, and supplemented, if necessary, by other means of social protection.” Protected by the Art 23 of the United Nations Universal Declaration of Human Rights should be considered here. The question is to know if those robots will completely replace nurses or just provide help to caregivers. Human nurses will lose their work, how they will live and support their family? They will do less work, that is it means that they will have less income?

    If I can continue with the thin line between robotic nursing care and the United Nations Universal Declaration of Human Rights, article 8 seems to be difficult to exercise. As it is Highlighted in the article it is impossible to attribute to nursing care robot’s liability in case of problems. How a patient, victim of a robot’s dysfunction could bring an action against something that it is impossible to attribute the liability. The speed of technologies evolution should be more concerned by lawmakers to fill the legal vacuum about machines, technologies and IT development.

    I must admit that sometimes robots in the medical sector is advantageous. For example, “the telepresence robot” which permit patients to have easier access to a specialist who is not in the hospital, also, the specialist can reach more patients faster. Some patients are satisfied and feel lucky to have access to this type of care as you can see in this video:

  3. Hello Celia,

    Excellent points you mentioned. The power of human contact and interaction cannot be downplayed in the medical sector as these automated instruments lack empathy and could potentially misinterpret the patient’s current state and feelings of pain and discomfort. While the overall idea of the robotic nurse is wonderful and beneficial to the future of healthcare, the execution and utilization of these robots must be carefully considered. Automation and artificial intelligence are key to the progression of the industry, but if done in the proper way with diligent supervision. Take, for instance, the DaVinci Robot, an instrument used for complex surgical procedures, but all under the care of a surgeon. This is an ideal merger of the two, a semi-automated approach. And while I am sure the technology exists or is close to finalization for a fully automated equivalent, educated, medical doctors are an indisposable asset to the field, as are nurses.

    As for liability, I believe it must be shared by both the manufacturer and the facility utilizing the products. They both are aware of the risk involved and have pursued implementation regardless. However, I anticipate through the mounts of paperwork to be completed, somewhere along the lines, both parties will attempt to escape liability for any injury and harm related to the robots, for example, a waiver upon admittance into a care facility.

    Malfunction is often times hard to predict, and the only way I see to minimize the occurrence and the extent of damage done is again careful, human, monitoring.

  4. I totally agree with some points mentioned above by Kellisha and Celia. Replacing most nurses with nurse robots would be a huge mistake. When someone is going through a healing process, the psychological support a nurse gives to a patient, I think, is evenly important as for the medical procedures. A hospital isn’t usually a place where people like to go, or enjoy staying at. Comforting a person and making sure that person gets the things they need to feel as good as possible is part of a nurse’s job. They give you that ‘human touch’ or dignity, something a robot can’t give in my opinion.

    But still, I don’t think this means that robot nurses can’t be used. When a robot nurse is accompanied by a human nurse, this problem can be solved. That’s why I’m not agreeing with the statement of Celia saying the treatment of a patient by a robot runs contrary to the United Nations Universal Declaration of Human Rights that protects the right of dignity. When reading the articles literally, yes you can argue that the dignity of a human being is being undermined when a person gets treated by a robot. But law has to evolve, it needs to keep up with innovation and form an interpretation according to this problem.

    On the other hand, talking about the employment issues, I think we need to see this innovation as an opportunity. I can imagine being a nurse is a really hard job, not only mentally but also physically. Lifting disabled patients, washing people who can’t wash themselves, replacing bedsheets,… All this work can be done by a robot to soften the job of a nurse. This doesn’t have to mean that nurses would lose their jobs, they should be re-educated to be able to operate the robot and to notice when maintenance is needed. So the job of a nurse just has to reform, it doesn’t have to disappear.

    A big and interesting problem is the problem of liability when something goes wrong. AI is relatively new and not all sectors has been regulated yet. According to an article I read, the law currently stands at a point that the user of an AI system is less likely to be at fault than the manufacturer. Whether a manufacturer is liable will depend on the relevant industry standards of care and whether the specifications were appropriate in light of those standards. But I can imagine there can be a lot of discussion when people need to judge about these terms.

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