Clear, practical advice on daily living equipment
Telecare can have substantial benefits, and enhance individual's safety, dignity and independence. However, like any technology there is a potential for it to be misused. There will be pros and cons regarding any potential solution. The requirements and wishes of everyone involved, particularly the service user, need to be respected and every effort needs to be made to ensure all parties understand how the equipment and service will work. Particular concerns can include:
1) Concerns about the general impact of telecare on society. For example, the fear that telecare may be used to cut back care services and reduce human contact with service users.
2) Concern that technological solutions may be installed without fully involving or obtaining the consent of the individual involved. This can be particularly relevant when the equipment is used to support individuals with mental health difficulties such as dementia.
3) Concerns about particular types of telecare device, such as those used for monitoring individuals movements, and how they may affect the privacy of the individual.
4) Concerns that some devices may be used to do things an individual is still able to do for themselves which may contribute to them losing these skills sooner than would otherwise have been the case.
5) Concerns about the use of computer technologies that rely on sharing and storing information and the need to ensure such information remains confidential, is not misused or negligently passed into the wrong hands. This concern has been heightened by recent news stories concerning the loss of personal data.
6) That the devices may make daily activities more complicated or increase the anxieties of an individual that they may unintentionally activate or damage the equipment.
7) Concern that the use of telecare equipment may tend to encourage a one-sided focus on a individuals problems and not on their existing strengths.
There are no easy answers. However, when considering the ethical use of telecare with vulnerable people it may help to consider the following issues:
A) The personal motivations, perspective and preferences of the service user and their involvement in planning the introduction of equipment or alteration to existing equipment, especially where their capacity or judgement may be restricted. In particular:
Does the person understand what the telecare is supposed to do and the options available?
Have they agreed that they would like to try the telecare?
B) The service user's living arrangements, family support and the needs of any carer/s
C) The degree of involvement of significant others, including family, friends, neighbours and professional care staff. Their perspective, personal fears, anxieties and agendas may need resolving.
D) The nature of their disability, for example is it progressive, or do their needs fluctuate with 'good' and 'bad' days.
E) The reliability and safety of the telecare equipment
F) Does the situation really call for a technological solution? Are there alternatives? For example if an individual is going out and perhaps getting lost or disorientated then one approach may be a telecare door sensor, another approach may be to provide someone to walk with them. If they are going out because they are looking for social contact then this will not be resolved by the technological solution.
G) How will the usefulness of the telecare equipment and service be reviewed and evaluated?
H) What would you want for yourself in this situation?
It is important to avoid seeing individuals just as people at risk and in need of help as they are also people who have abilities, needs and wishes of their own. Researchers and authors who have considered these issues have developed four principles long associated with modern medicine to guide research and practice (references: Care Services Improvement Partnership, 2005, Wey, 2007):
Autonomy: Defined as enabling people to live their lives fully in the same way they did before, respecting the individual's rights to self determination, privacy, freedom, and choice. This should include informed consent, which needs to be voluntary, and based on sufficient information. Carers may need to help/guide in this process.
Beneficence:Which involves striving to be 'of benefit' or 'doing one's best' for the person. This often requires a balance to be established between avoiding and tolerating risks. Benefits may include enabling access to support or help if there is a fire or flood in the users property or helping them to take their medication.
Non-maleficence: which means 'do no harm'. We need to ask ourselves if we in danger of doing more harm than good. Finding a balance between avoiding harm and respecting decisions, dignity, integrity and preferences. For example, whether there is a risk that a piece of equipment may lead to more confusion or distress.
Justice: Treating individuals fairly and respecting their rights, including the right to make what the Mental Capacity Act calls 'eccentric or unwise decisions'. (Mental Capacity Act, 2005). Fair treatment may need to take into account individual differences and diversity.
All advice is either supported by references (cited in the text) or is based upon peer reviewed professional opinion. Our advice is impartial and not influenced by sponsors or product suppliers listed on the site.
Conflict of interest statement