Carebots and the good life - 3TU.Centre for Ethics and Technology

Proposal PhD project 3TU.Centre for Ethics and Technology
Carebots and the good life: An anticipatory ethical
analysis of human-robot interaction in (health) care
Abstract
Given the financial pressure on our health care systems and organisations, robots are likely to play a
significant role in health care in the near future.
This project will help to anticipate and evaluate these changes by developing realistic nearfuture
scenarios and by evaluating these scenarios in terms of their contribution to the good life. The
focus will be on the ethical aspects of human-robot interaction in health care contexts. Will carebots
enhance the quality of life of patients, given that human-human interaction will be substituted for
human-robot interaction? What is ‘genuine’ social interaction? What should be an appropriate relation
between humans, and between humans and technology? What is the ‘good life’?
‘Good life’ ethics will be used as a theoretical framework, but instead of a ‘top down’
approach the project will start with empirical studies and carry out interviews with health care
professionals in order to better understand the nature of human-robot interaction.
In this way, the project will contributed to a better understanding of the ethical issues involved
and inform responsible decision-making by various stakeholders such as patients, nurses, relatives,
health care managers, and politicians.
Applicant: Dr. Mark Coeckelbergh
Project information
� PhD project
� Local supervisor: Dr. M. Coeckelbergh
� Intended promoter: Prof. dr. P. Brey
� Candidate: not known yet
� Supervisory team (meets once a year, includes supervisor, promoter, someone from one of the
other two philosophy departments and someone from the engineering centre of excellence)
o Dr. M. Coeckelbergh
o Prof. dr. P. Brey
o Prof. dr. J. van den Hoven (TUDelft)
o Prof. dr. ir. S. Stramigioli (Chair Advanced Robotics, UTwente and 3TU.Centre for
Intelligent Mechatronic Systems
o Prof. dr. I. Broeders (Chair Minimaal Invasieve Chirurgie en Robotica, Instituut
Technische Geneeskunde, UTwente)
� Engineering area: high tech systems
� Research theme: moral issues in the use and regulation of technology
Project description
Problem formulation
Growth of the elderly population and other factors such as nursing shortage place increased pressure
on our health care systems. One way this problem will be dealt with in the near future is increased
employment of technology. One of the emerging technologies are care robots or carebots. This project
will focus on the ethical aspects of human-robot interaction in a (health) care context.
In order to introduce the topic, let me first provide some definitions and taxonomies . I define
a robot as a material or virtual artificially created system that moves and that has, or appears to have, a
considerable degree of agency. First, it is made by humans. Second, it can be part of the physical
environment or of a virtual environment. In the latter case it is typically called a ‘bot’ or a ‘robot
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avatar’. Third, in contrast to a personal computer or a washing machine, it moves. Fourth, in contrast
to most cars it is, or appears to be, self-moving and making choices. For example, a car that can drive
without human assistance is a robot. A tele-operation system is not a robot according to my definition.
Robotics refers to knowledge, activities, aims, technologies, and artefacts that concern bots. Usually
the emphasis is on the artefacts and their function. For example, in the Roboethics Roadmap, produced
by the European Robotics Research Network (EURON) under the direction of Gianmarco Veruggio
(2006), a taxonomy of robotics is provided, which includes humanoids, industrial robotics, adaptive
robot servants, network robotics (e.g. internet robotics), robotics for health care and enhancement of
life quality, military robotics, and edutainment robots. Carebots are robots used in health care, taking
over human functions. For instance, they can be used to assist ill and elderly people by monitoring
them, by reminding them to take their medicine, by helping them with rehabilitation, by delivering
drugs, by moving them around, and by assisting them with domestic tasks. They can also be used for
therapeutic aims, such as the treatment of children with autism (Casalini et. al. 2006). And they can
help in emergency situations when humans cannot get to the patient. But my definition excludes
medical tele-operations (chirurgical robots) and tele-monitoring if this involves humans operating the
device at a distance instead of autonomous robot action.
The emergence of carebots must be seen in the context of two other related developments: the
increased use of ICT in health care, and the design of so-called personal robots. First, concepts such as
e-health, e-medicine, e-nursing, cyber medicine, and tele-medicine indicate that medical care does and
will increasingly use ICT, including applications such as tele-surgery and tele-monitoring, and in the
hospital as well as at home (e.g. telemedicine systems in smart homes). Computers are already part of
health care for a while (see for example Goodman 1998). The emergence and near-future introduction
of robots in health care, which adds other functions that were first done by humans, completes the
picture of a technology intensive health and care system. Second, within robotics there is a move from
industrial applications towards robots will play a role in our daily lives, such as entertainment robots,
companion robots, pet robots, and household robots. They can be defined as ‘robots which share
physical and emotional spaces with the user’ (Cerqui and Arras 2001), may involve a type of humanrobot
interaction that is similar to human-pet or human-human interaction, and are therefore likely to
have a significant impact on our lives. Some carebots may have such a personal aspect as well, for
instance when they would be not only carers but also companions to lonely sick and elderly people.
For example, entertainment robots have been used in the care of elderly people with severe dementia
(Tamura et. al. 2004). Some carebots may even be humanoid, that is, they may share significant
characteristics with humans (they may have a human-like face, move like humans, talk like humans
etc.).
At least two types of questions can be raised now. The first (and primary) question concerns the
ethical aspects that come with the introduction of carebots. If the development and use of carebots is
driven by management motivations (carebots save money and time), will this be the only motivation
and expected benefit? Or are carebots also meant to improve the care itself? Will they actually improve
care? Will they enhance the quality of the lives of the patients? Will they contribute to ‘the good life’?
Will they enhance values such as autonomy? And perhaps most importantly, is it ethically desirable or
allowed to replace human-human interaction with human-robot interaction in this context? It is often
argued that the use of robots allows more frequent contact with patients. But what is the quality of
such contacts, and is that kind of contact desirable? And how can we evaluate this?
This project will move away from typical ‘applied ethics’ approaches that discuss principles
such as autonomy towards an empirically informed ethics that basis its evaluation on studies of
concrete practices – here the practice of robot care, with a focus on human-robot interaction. Although
medicine and health care are already pervaded by technology, health care ethics textbooks do not pay
much attention to technology, and ethical questions are typically oriented to professional-patient
relations, that is, human relations rather than human-technology relations. The use of robots challenges
such a framework. For example, if human nurses visiting patients at home are replaced by a ‘Hospital
at Home’ system (Papazissis 2004), a technological setting that may include robot nurses, does this
improve the lives of patients involved? The main ethical worry is that although carebots may render
health care more ‘personal’ in the sense of being able to better administer care adapted to individual
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needs (so-called personalised care and medicine) and allow frequent monitoring, it will at the same
time depersonalise care by replacing human care with robot care. Is this worry justified?
The second (and secondary) question is a methodological one. As always with emerging and future
technology, there is uncertainty concerning what really will happen in the near future, and if the
promises made by robotics researchers will be realised. How should ethics deal with this challenge?
How can it anticipate near-future developments, without basing its assessment on unrealistic visions
(see also Swierstra)?
The aim of this project, then, is to evaluate the ethical aspects of the anticipated widespread
introduction of robots in health care, by developing realistic near-future scenarios of such practices, by
analysing expected human-robot interaction in that context, and by a philosophical discussion of
notions such as ‘genuine’ social interaction and ‘the good life’.
The scope of the project is kept broad in two ways. First, given the uncertainty about future
developments in robotics further practical and philosophical issues may emerge that cannot be
foreseen now. It is part of the project to explore the limits of anticipatory ethics. Second, health care is
understood to include psychiatric care, companionship, and other forms of care that may be excluded
by a narrow definition of health care. For example, companion robots for elderly people can be a form
of health care.
Research question
Main questions
Will carebots enhance the quality of life of patients, given that human-robot interaction often replaces
human-human interaction? What is ‘genuine’ social interaction? What should be an appropriate
relation between humans, and between humans and technology? What is the ‘good life’?
Subsidiary (methodological) question
How can we anticipate the introduction and employment of care robots in health care?
Method
1. The methodological problem will be discussed using the applicant’s background in thinking about
moral imagination, Dr. Tsjalling Swierstra’s work on the use of scenarios in technology
assessment, and contemporary thinking about the role of empirical research in ethics. A method of
anticipatory ethics will be proposed and guide the discussion of the ethical question.
2. The ethical question will be answered by the following means (which will be adapted and
specified by means of the methodological part of the project):
a. Development of realistic near-future scenarios by using literature study and empirical
research in order to better understand human-robot relations and their impact on human
lives, in particular humans in situations of dependency, needing (health) care:
i. interviews with robotics researchers and designers
ii. interviews with health care managers
iii. interviews with nurses
iv. interviews with patients
v. literature on health care ethics
vi. literature on the future of robotics in health care (e.g. in the Netherlands TNO is
preparing a report on robotics in health care)
vii. literature on human-robot interaction in health care
viii. literature on philosophy of technology, in particular ethics of health care
technology
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Note that the interviews will be explorative, and that in the course of the project
feedback will be given to designers and researchers of the Centre of Excellence for
Intelligent Mechatronic Systems (see also below).
b. Ethical evaluation. As existing work such as the Roboethics Roadmap shows, ethics of
robotics is a young field, and ethics of robotics and health care too (in contrast perhaps to
computing and health care, or tele-surgery, which appears to receive more attention).
Usually it is done from an ‘applied ethics’ perspective, by applying a moral theory, e.g. a
Kantian theory (Decker 2007). More interesting than such a ‘top-down’ approach is an
emphasis on the implications of human-robot interactions for the quality of care and the
needs of the receivers of care. For example, Robert and Linda Sparrow have argued that
employing carebots to assist older persons would most likely lower the amount of human
contact experienced by them, that this would be detrimental to their well-being, and that it
would be unethical to substitute robot simulacra for genuine social interaction (Sparrow
and Sparrow 2006). But what is well-being? What is ‘genuine’ social interaction? Do
designers force their view of what constitutes an appropriate interaction on to users
(Whitbey 2006)? What should be an ‘appropriate’ relation between humans, and between
humans and technology? Do carebots really contribute to the quality of our lives? To what
extent is human flourishing dependent on human-human interaction, and are carebots a
threat to this? Such questions point to the problem of ‘the good life’ as formulated by
ancient and contemporary philosophers. Instead of asking only ‘What is the right thing to
do?’, ethics is broadened to questions regarding how we should live our lives. In this
project ethical evaluation will refer to various definitions what a ‘good life’ consists in; it
will be interpreted in a pluralistic way. This implies that the scenarios will be assessed
using several visions of the good life. Potential tensions between the results will be
discussed.
This approach to ethics is empirically informed in the sense that it uses information
from interviews and studies of human-robot interaction to arrive at a better understanding
of the moral issues involved and to develop an ethical framework to regulate the design
and use of carebots. It will challenge existing approaches in health care ethics, which
limitations it will show. It is inspired by various theoretical frameworks and concepts, such
as reflective equilibrium, pragmatist moral imagination, phenomenology of technology
(e.g. Verbeek 2000) , and the ancient understanding of ethics as being concerned with the
question how we should live our lives. But instead of starting from theory, it will start
from existing studies of human-robot interaction. As such, it will further develop existing
work in the domain of ethics of human interaction with robots, such as work done in the
context of the ETHICBOTS project (a European FP6 project, see
http://ethicbots.na.infn.it/index.php), the School of Robotics (Genova), and the IEEE
Robotics and Automation's Technical Committee on Robo-Ethics. The project will also
benefit from existing work on the replaceability issue, such as the interdisciplinary
technology assessment project ‘Robotik. Optionen der Ersetzbarkeit des Menschen’ from
the Europäische Akademie zur Erforschung von Folgen wissenschaftlich-technischer
Entwicklungen (Decker 2006). Furthermore, the links between ethical and anthropological
issues will be explored with regard to human-robot relations. For example, Russo asks
how biomechatronic systems may change our understanding of the human body and
human nature, employing an absolute distinction between natural and artificial (Russo
2006).Reflection on the good life also involves questioning assumptions on who we are, as
humans.
c. Special attention will be paid to the ethical aspects of interactions between humans and
humanoid robots in health care. Not only do humans often see their interaction with
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machines in anthropomorphic terms (Whitbey 2006), robots are also often made to look
and behave like humans.
With regard to this category of interaction the approach of the project differs
considerably from the usual philosophical interest in humanoid robots and artificial
intelligence. It does not start with questions such as the ‘ghost in the machine’
problem and its responses, with the problem of representation (Clark and Grush 1999),
rationality (Clark 2001), or ‘soul issues’ (Epstein 1999: 227). I am not primarily
interested in how the robot’s ‘mind’ works (Ishii 2006), but in how humans can
enhance their life and existence. Instead of a philosophy of mind I turn to a philosophy
of (inter)action and of the good life, that is, what robots do (to us) and how we should
live our lives with them. It is a turn from the ‘inside’ and the ‘real’ to the ‘external’
and ‘appearance’. I have less interest in what can happen to robots (how shall we act
towards hem, will they ever be able to feel pain, should we grant them robot rights,
etc.) than what they do to us, humans – here: people who need care. Thus, the
project’s focus concerns interaction, and especially social or quasi-social interaction
and its implications for human life and existence, in the life of those who receive
care. Ethics of the good life (human flourishing) and existence will be combined
with a phenomenological approach, which opposes the dominant scientism. For
example, Christopher Ramey has proposed a ‘personal’ ethics of human-android
interaction, although I will challenge his claim that we need to recognize a reciprocal
relationship of selves with regard to such an interaction (Ramey 2005).
Empirical studies will be used in order to understand interaction with android robots. For
example, it may suffice for a designer to “hint at certain capabilities that meet our
expectations of a socially intelligent entity” (Duffy 2003: 185), rather than trying to blur
the boundary between humans and robots. ‘Real’ differences only partly matter in
interaction: research shows that ‘human users end up treating humanoid social robots as
humans even though they are aware of the asymmetrical nature of such interactions’ (Zhao
2006). An experiment in human-robot interaction explored the minimal requirements for
effective human-robot social interaction (Bruce, Nourbakhsh and Simmons 2002).
Consider also design-driven discussions concerning emotional responses to humanoid
robots sparked off by Mori’s ‘Uncanny Valley’ hypothesis (Mori 1970), emotional
models used by designers of humanoids robots such as Kismet (Breazeal 2003), and
human-‘service social robot’ interaction and user perception (Lisetti, Brown, Alvarez and
Marpaung 2004). Although such studies neglect the ethical question asked above (how
does this kind of interaction contribute to the good life) and can therefore be a starting
point only, they are essential for us to understand what does and may go on when robots
play a role in (health) care.
The theoretical framework of this project will be further developed in the course of the project. For
this purpose, the PhD candidate will engage with contemporary discussions about ‘good life’ theories
in ethics, and further explore how they can be fruitfully combined with empirical research and
philosophy of technology.
Scientific and social relevance
This project will contribute to academic and societal aims in several ways:
1. It can contribute to the methodological discussion within ethics, e.g. about the role of
imagination, scenarios, principles, and empirical research in ethical reflection.
2. Its ethical evaluation can aid designers of carebots in their choices of what such robots should
do, how they should look, and how they should interact with humans.
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3. It can help nurses, doctors, and other health care professionals to reflect on how the
employment of carebots would change their practice and if it would benefit their patients.
4. It also assists health care managers to make responsible decisions concerning the introduction
of care robots in their organisations.
5. It can aid relatives and peers of children, elderly persons, patients etc. in thinking about giving
and getting the best care for their loved one, child, parent, friend, etc.
6. It can inform a public discussion concerning (the regulation of) carebots and the health
system.
Literature references
Breazeal, Cynthia (2003) ‘Emotion and sociable humanoid robots’, International Journal of Human-
Computer Studies 59, 119-155.
Bruce, Allison, Nourbakhsh, Illah, and Reid Simmons (2002) ‘The Role of Expressiveness and
Attention in Human-Robot Interaction’, Proceedings of the 2002 IEEE International
Conference on Robotics & Automation, Washington, DC, May 2002, 4138-4142.
Casalini, S, G. Dalle Mura, M. L. Sica, A. Fornai, M. Ferro, G. Pioggia, R. Igliozzi, A. Ahluwalia, F.
Muratori, and D. De Rossi, ‘Human-robot interaction in autism’, paper presented at the
ETHICBOTS workshop, Naples, October 2006
Cerqui, Daniela and Kai O. Arras (2001) ‘Human Beings and Robots: Towards a Symbiosis? A 2000
People Survey’ Post-Conference Proceedings PISTA 03 (Politics and Information Systems:
Technologies and Applications), J. Carrasquero and al. (eds), 408-413.
Clark, Andy (2001) ‘Reasons, Robots and the Extended Mind’, Mind & Language 16(2), April 2001,
121-145.
Clark, Andy and Grush, Rick (1999) ‘Towards a Cognitive Robotics’, Adaptive Behavior 7(1), 5-16.
Decker, Michael (2006) ‘Replaceability of Humans by Autonomous Robots? Ethical Reflection within
the Framework of an Interdisciplinary Technology Assessment’, paper presented at the
ETHICBOTS workshop, Naples, October 2006
Decker, Michael (2007) ‘Caregiving robots and ethical reflection: the perspective of interdisciplinary
technology assessment’, AI & Society, online first.
Duffy, Brian R. (2003) ‘Anthropomorphism and the social robot’, Robotics and Autonomous Systems
42, 177-190.
Epstein, Richard G. (1999) Review of Hans Moravec, Robot: Mere Machine to a Transcendent Mind.
In: Ethics and Information Technology 1, 227-236.
Goodman, Kenneth W. (1998) Ethics, Computing, and Medicine: Informatics and the Transformation
of Health Care Cambridge: Cambridge University Press.
Ishii, Kayoko (2006) ‘Cognitive Robotics to Understand Human Beings’, Quarterly Review 20 (July
2006).
Lisetti, Christine L., Brown, Sarah M., Alvarez, Kaye, and Andreas H. Marpaung (2004) ‘A Social
Informatics Approach to Human-Robot Interaction With a Service Social Robot’, IEEE
Transactions on Systems, Man, and Cybernetics – Part C: Applications and Reviews 34(2),
May 2004, 195-209.
Mori, Masahiro (1970). Bukimi no tani (The uncanny valley) (K. F. MacDorman & T. Minato,
Trans.). Energy, 7(4), 33–35. (Original in Japanese)
Papazissis, Elias (2004) ‘Advanced Technology Permits the Provision of Advanced Hospital Care in
the Patients' Homes’, in: I. Iakovidis, P.Wilson, J,C. Healy (eds) E-Health-Current Situation
and Examples of Implemented and Beneficial e-Health Application. Amsterdam: IOS Press-
Studies in Health Technology and Informatics, 190 -199.
Ramey, Christopher H. (2005) ‘ “For the sake of others”: The ‘personal ethics of humanandroid
interaction’, Android Science workshop, Cognitive Science Society, Stresa (Italy), 137-148.
Russo, Maria Teresa (2006) ‘Biomechatronics and Anthropology’, paper presented at the
ETHICBOTS workshop, Naples, October 2006.
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Sparrow, Robert and Linda Sparrow (2006) ‘In the Hands of Machines? The Future of Aged Care’,
Minds & Machines Vol. 16 (2006), 141-161.
Tamura, T. et. al. (2004) ‘Is an Entertainment Robot Useful in the Care of Elderly People With Severe
Dementia?’, The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
59A(1): 83-85.
Verbeek, Peter-Paul (2000) What Things Do: Philosophical Reflections on Technology, Agency, and
Design Pennsylvania State University Press, 2005.
Veruggio, Gianmarco (2006) EURON Roboethics Roadmap (Release 1.1.), Genua: EURON
Roboethics Atelier
Whitby, Blay (2006) ‘More or less human–like? Ethical Issues in human-robot interaction’, paper
presented at the ETHICBOTS workshop, Naples, October 2006
Zhao, Shanyang (2006) ‘Humanoid Social Robots as a Medium of Communication’, New
Media & Society 8(3), 401-419.
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