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Introduction

In the ever-evolving landscape of healthcare, the integration of artificial intelligence (AI) has ushered in a new era, prompting profound ethical considerations that resonate deeply with the principles of patient care and well-being (Johnston, 2022). At the heart of this transformation lies a critical question of whether AI robots should be used to provide social support for residents of aged-care facilities. In this essay, we delve into the multifaceted ethical dimensions surrounding the use of AI in the care of elderly residents, refraining from predetermined ethical stances in order to navigate the intricate terrain of this topic. The well-established bioethical principles are deeply rooted in the commitment to respecting individual rights, promoting well-being, minimising harm, and ensuring equitable care, all of which are cornerstones of ethical healthcare practice. This essay embarks on an exploration of these principles, integrating ethical concepts and considering ethical theories to inform a comprehensive, balanced, and well-informed perspective on the ethical viability of using AI robots to provide social support for aged-care residents. 

AI and Ethical Principles

In healthcare, autonomy refers to an individual's capacity to make informed decisions about their own care, free from undue influence or coercion (Varkey, 2021). However, the integration of AI robots in aged-care facilities brings forth a complex interplay between technology and individual agency. Using AI robots for social support may potentially impact patient autonomy. While these robots can enhance efficiency and provide consistent care, they may inadvertently infringe upon the autonomy of residents by putting pressure on them to conform to the recommendations or routines set by the AI system, potentially limiting the individual's ability to make their own choices (Vandemeulebroucke et al., 2019). Alternative perspectives on autonomy in relation to AI support include viewpoints that emphasise the potential for AI to enhance autonomy by providing personalised and timely assistance. It can also be argued that well-designed AI systems can empower residents by augmenting their capabilities, thus facilitating greater independence and self-directed care (Johnston, 2022). The principle of beneficence in healthcare is rooted in the duty to act in the best interests of the patient, seeking to promote their well-being and ensure positive outcomes (Varkey, 2021). AI robots have the potential to lead to improved outcomes for patients in various ways. They can offer timely reminders for medication, monitor vital signs, and provide companionship, contributing to overall enhanced well-being (Palmer & Schwan, 2021). Additionally, AI can assist in the early detection of health issues, potentially leading to more effective interventions and improved quality of life (Loveys et al., 2022). However, it is crucial to ensure that AI systems' algorithms and decision-making processes are based on sound medical evidence and prioritise patient safety and comfort. Critics may argue that the essential elements of compassionate and empathetic care, which are intrinsic to beneficence, could be compromised in the presence of AI-driven interactions and algorithms (Guan, 2019). 

Non-maleficence is rooted in the fundamental principle that the primary duty of a healthcare professional is to safeguard the well-being of those under their care, minimise potential harm and carefully weigh the benefits against any potential risks in medical interventions (Varkey, 2021). Introducing AI robots designed to provide support and improve the quality of life for residents could lead to emotional distress for aged people who are unfamiliar with technology or a loss of personal connection between residents and human caregivers (Guan, 2019). Conversely, AI robots can address the issue of staff fatigue and burnout, which can inadvertently lead to suboptimal care and, in some cases, unintentional harm to residents (Trainum et al., 2023). By relieving human caregivers of some routine tasks, these robots allow them to focus their attention on more complex and sensitive aspects of care, thereby reducing the potential for harm. The principle of justice within healthcare delivery emphasises the equitable distribution of resources and care, ensuring that each individual's needs are met relatively (Varkey, 2021). The deployment of AI robots should not inadvertently create disparities in access or quality of care (Cortellessa et al., 2021). Factors such as the level of technological literacy among residents with varying degrees of physical or cognitive abilities can be potential disadvantages. Alternatively, integrating AI robots in Australian aged-care facilities addresses the shortage of qualified healthcare workers. These robots can handle routine tasks, allowing human caregivers to focus on more complex and personalised care. This optimises resources, ensuring each resident receives balanced attention. Additionally, AI robots eliminate potential biases, as they operate on objective algorithms, guaranteeing fair treatment for all residents.

Integration of Other Ethical Concepts

Human dignity, a cornerstone of ethical healthcare practice, holds that every individual deserves to be treated with respect, regardless of their circumstances (Johnston, 2022). For instance, consider an AI-powered companion robot designed to engage with residents through conversation, activities, and social interactions. These robots can provide companionship, reducing feelings of loneliness and isolation often experienced in aged-care facilities. Veracity, or truthfulness, in the context of AI support suggests that it is essential that information provided by these systems is accurate and reliable (Wang et al., 2023). For example, consider a scenario where a resident requires regular medication. An AI robot, equipped with precise medication management capabilities, can ensure the resident receives the correct medications at the right times. It can dispense pills, track adherence, and send real-time notifications to healthcare providers or family members, assuring the truthfulness and accuracy of the medication regimen (Wang et al., 2023). This level of veracity not only ensures the resident's well-being but also offers peace of mind to their loved ones, knowing that their family member is receiving the appropriate care without errors or omissions also promoting beneficence and non-maleficence in the process.

Utilitarian thinking, which assesses actions based on their potential to produce the greatest overall good or happiness, plays a significant role in evaluating the integration of AI support in aged-care facilities (Kim, 2019). From a utilitarian standpoint, if the use of AI robots leads to improved quality of life, increased well-being, and greater efficiency in care provision for residents. The elderly themselves exhibit more positive attitudes towards healthcare robots than their relatives do, undermining the fundamental concept of caregiving. (Lin et al., 2023) This perspective requires a careful analysis of the potential benefits and harms, considering the aggregate impact on the entire resident population. Deontological thinking, rooted in the belief that actions are inherently right or wrong regardless of their outcomes, brings attention to the duties, responsibilities, and rules that guide ethical decision-making (Kim, 2019). In the context of AI support, this perspective emphasises the importance of adhering to established ethical principles and professional codes of conduct (Yuan et al., 2023). For instance, respecting patient autonomy and ensuring informed consent are non-negotiable duties. It urges a thorough examination of the ethical obligations that come with the implementation of AI in aged-care facilities.

Virtue-ethics thinking focuses on the development of virtuous character traits and emphasises the alignment of actions with these virtues. In healthcare, virtues such as compassion, empathy, and integrity are paramount. When considering AI support, it is essential to assess whether its implementation reflects and promotes these virtuous qualities (Boada et al., 2021). This perspective places emphasis on the moral character of healthcare professionals and the ethical implications of their actions, including the integration of AI technologies. Ethics-of-care thinking centres on the importance of empathetic and compassionate care, particularly in situations where vulnerable individuals are involved. When applied to AI support, this perspective highlights the necessity of maintaining human connections and ensuring that residents' emotional and social needs are met (Cortellessa et al., 2021). It prompts a careful examination of how AI can be integrated without compromising the essential elements of compassionate care and the moral conduct expected in healthcare. Natural law theory posits the existence of universal moral norms derived from human nature and reason (Capps, 2020). When evaluating the use of AI robots, it prompts an analysis of whether the integration aligns with these inherent moral principles. This perspective requires a careful consideration of whether the implementation of AI respects and upholds these universal norms, particularly concerning the dignity and well-being of elderly residents.

Conclusion

The collective exploration of bioethical principles, integration of ethical concepts, and examination of ethical theories unequivocally support the ethical stance that the implementation of artificial intelligence robots to provide social support for residents of aged-care facilities can be considered an ethically justifiable endeavour but requires careful consideration. This choice is supported by a strong framework that takes into account the concepts of human dignity, professional conduct, beneficence, non-maleficence, autonomy, and justice. This method acknowledges the possible advantages for the residents but also the necessity of constant ethical thought and careful monitoring. The future of healthcare will be affected by the wider ramifications of utilising AI for social support in assisted living facilities. Maintaining the autonomy and well-being of senior citizens requires constant research, instruction, and the creation of strong ethical standards. Furthermore, this technological breakthrough sparks a wider social discussion about artificial intelligence's role in healthcare, highlighting the necessity of inclusive and careful decision-making in the face of technological advancement.

References

‌Boada, J. P., Maestre, B. R., & Genís, C. T. (2021). The ethical issues of social assistive robotics: A critical literature review. Technology in Society67, 101726. https://doi.org/10.1016/j.techsoc.2021.101726 

‌Capps, P. (2020). Natural law and the law of nations. Research Handbook on the Theory and History of International Law, 58–89. https://doi.org/10.4337/9781788116718.00010  

Cortellessa, G., De Benedictis, R., Fracasso, F., Orlandini, A., Umbrico, A., & Cesta, A. (2021). AI and robotics to help older adults: Revisiting projects in search of lessons learned. Paladyn, Journal of Behavioral Robotics12(1), 356–378. https://doi.org/10.1515/pjbr-2021-0025 

Guan, J. (2019). Artificial Intelligence in healthcare and medicine: Promises, ethical challenges, and governance. Chinese Medical Sciences Journal0(0), 99. https://doi.org/10.24920/003611 

Johnston, C. (2022). Ethical design and use of robotic care of the elderly. Journal of Bioethical Inquiry19(1), 11–14. https://doi.org/10.1007/s11673-022-10181-z 

Kim, M.-H. (2019). Nursing ethics values of nursing students. The Journal of the Convergence on Culture Technology5(1), 59–66. https://doi.org/10.17703/JCCT.2019.5.1.59 

Lin, G.-Y., Ruan, J., & Wang, Y.-S. (2023). Factors affecting family caregivers’ behavioral intention to use socially assistive ai robots for elderly care within their own home environment. International Journal of Human-Computer Interaction, 1–12. https://doi.org/10.1080/10447318.2023.2263247 

Loveys, K., Prina, M., Axford, C., Domènec, Ò. R., Weng, W., Broadbent, E., Pujari, S., Jang, H., Han, Z. A., & Thiyagarajan, J. A. (2022). Artificial intelligence for older people receiving long-term care: a systematic review of acceptability and effectiveness studies. The Lancet Healthy Longevity3(4), e286–e297. https://doi.org/10.1016/s2666-7568(22)00034-4 

Palmer, A., & Schwan, D. (2021). Beneficent dehumanization: Employing artificial intelligence and carebots to mitigate shame‐induced barriers to medical care. Bioethics36(2). https://doi.org/10.1111/bioe.12986 

Trainum, K., Tunis, R., Xie, B., & Hauser, E. (2023). Robots in assisted living facilities: A scoping review. JMIR Aging6, e42652. https://doi.org/10.2196/42652 

Vandemeulebroucke, T., Dierckx de Casterlé, B., Welbergen, L., Massart, M., & Gastmans, C. (2019). The ethics of socially assistive robots in aged care: A focus group study with older adults in Flanders, Belgium. The Journals of Gerontology: Series B75(9), 1996–2007. https://doi.org/10.1093/geronb/gbz070 

‌Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice30(1), 17–28. https://doi.org/10.1159/000509119 

‌Wang, J., Liang, Y., Cao, S., Cai, P., & Yang, F. (2023). Application of artificial intelligence in geriatric care: A bibliometric analysis (Preprint). Journal of Medical Internet Research25, e46014–e46014. https://doi.org/10.2196/46014 

Yuan, S., Coghlan, S., Lederman, R., & Waycott, J. (2023). Ethical design of social robots in aged care: A literature review using an ethics of care perspective. International Journal of Social Robotics. https://doi.org/10.1007/s12369-023-01053-6 ">https://doi.org/10.1007/s12369-023-01053-6 
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