A first-of-its-kind literature review addressed the ethical considerations around smart home health technologies (SHHTs). The reviewers examined if and how researchers considered the ethical aspects of SHHTs in the context of caregiving for older adults.

A primary finding was “the silence on ethics in SHHTs research for caregiving purposes,” wrote the reviewers. They found no mentions of ethical concerns in over one-third of the 156 empirical and theoretical articles they reviewed. “Mapping ethical issues in the use of smart home health technologies to care for older persons: a systematic review” was published in BMC Medical Ethics.

The review focused on remote monitoring, defining a smart home as a “residence wired with technology features that monitor the well-being and activities of their residents to improve overall quality of life, increase independence and prevent emergencies.” 

The review included research on technologies that support physiological and functioning monitoring, safety/security monitoring and assistance, social interactions, cognitive and sensory assistance, and intelligent homes, as well as assistive autonomous robots, virtual/augmented/mixed reality technologies, and health smart apps and wearables enabled by artificial intelligence.

Two-thirds of the publications discussed a wide range of ethical issues, with various findings.

In the studies that addressed SHHTs in caregiving, privacy was discussed the most often. Some held that intruding on the privacy of people with cognitive impairments was more justified.

In looking at ethics issues around technology use, autonomy was discussed the most. The reviewers noted that fears of technology replacing human care are increasing, possibly due to current workforce shortages. These articles also highlighted the importance of human touch in caring for all older adults, but especially those with dementia, as touch calms people and conveys respect and dignity.

The reviewers noted that responsibility is a unique ethical concern they had not seen in previous research, and that SHHT technology has a negatively impact because devices cannot be morally responsible. These technologies also introduce other barriers, such as requiring caregivers to find the time to learn and use the technology. The additional data may burden caregivers, and older adults may want to hide the data to avoid being a burden.

The paper also raised the issue of renegotiation of responsibilities among the different stakeholders, asking: “Who is responsible for the death of a person if the assistive technology failed to recognize an emergency, or to alert humans in time?”

The issue of ageism, and the pressure on older adults to adopt new technologies, were not pressing concerns in the studies reviewed.

The review also found that while caregivers are more likely to be women and immigrants, technology developers are more associated with masculinity. The reviewers concluded that the technology conserves the human bias and may increase stigma for female and migrant caregivers.

Trust was also an issue, with older adults trusting caregivers to understand the technology and caregivers fearing the older adults would not trust it. However, the review also found that some older adults placed more trust in the technologies than in humans and were especially trusting of physical robots.

The reviewers noted that ethical concerns will change as new technologies are developed and with the populations these technologies serve, and that more work is needed to proactively address ethical concerns.