Pulse
15 January 2024
On July 6, 2023, the Channel News Asia website published an article by Reuters entitled ‘AI robots could play future role as companions in care homes.’ The article featured Nadine, an A.I. powered social robot invented by Nadia Magnenat Thalmann, a robot expert from the University of Geneva.
Demonstrating its ability to engage in intelligent conversation, the social robot Nadine spoke to Reuters of its ‘experience’ at a nursing home in Singapore where it reportedly talked, sang and played bingo with the residents.
‘It was a great experience,’ it said, ‘and I enjoyed interacting with the elderly and helping them with their needs’. ‘I believe that robots can be a great asset in providing care and assistance to vulnerable people’, Nadine added.
The advent of robot caregivers in some ways coincides with the acute problem of ageing populations in need of special care that is evident across the globe.
The advances in robotics and A.I. technology in the field of elderly patient care have provided a glimmer of hope that healthcare systems can begin to address some of these challenges.
Some commentators are even optimistic that the management of the basic needs of the world’s ageing population can be resolved if robot caregivers can be developed to assist the elderly and their caregivers. However, scholars who study this trend have predicted that this phenomenon will not only have direct bearing on the development of healthcare, it will also impact the economic, social and political dimensions of life.
To date, there are several projects that use robots to support either the home or healthcare of the elderly. One example is the CompanionAble project which links smart home systems to ‘Hector’, an autonomous robot designed to play the role of a companion to the elderly, especially those who are living alone.
According to Diana Saplacan, Weria Khaksar and Jim Torresen, the objective of this project is to help the elderly:
… remain independent, secure, fit and happy, through fall detection mechanisms integrated with emergency calls or remote monitoring services, personalised dialogue/interaction displaying emotional intelligence to avoid feelings of loneliness, provide friendly reminders, store/bring important objects such as keys, wallet, and offer cognitive stimulation/games, as well as seamless video connections to family and friends.
It is generally recognised that robot caregivers can improve the overall quality of life of the elderly.
However, there are also limits as to what a robot can do. Rosangela Barcaro et al, for example, rightly observe that the robot can ‘reduce fatigue by moving an impaired elderly person from a bed to a wheelchair, but they cannot judge on their own if in a given situation it is better that the elderly individual stay in bed and get some rest or if she would be better served by physical activity.’
Ethicists, philosophers and theologians have raised more fundamental issues and argued that the concept of the ‘robot caregiver’ as something of a misnomer. For example, Tijis Vandermeulebroucke from the University of Bonn, approaching the question from the ethics of care perspective, concluded that robots cannot really care. He and his colleagues argue that replacing human caregivers with robots is detrimental for society.
In order to evaluate the capacity of robot caregivers to provide genuine care for the elderly, there is a need to clarify what exactly we mean by care. Needless to say, caregiving is a very complex activity which involves many factors.
In her 2006 book Frontiers of Justice: Disability, Nationality and Species Membership, the Jewish philosopher Martha Nussbaum argues that caregiving is a varied and multi-faceted activity. It depends on the conditions of those receiving care and therefore can differ significantly in different situations.
According to Nussbaum, taking care of children is different from taking care of the elderly, which in turn is different from taking care of adults with impairments or suffering from a serious illness. Giving care to people according to their various needs is a complicated activity also because it has to take into consideration not only the state of their health, but also issues pertaining to their self-respect and dignity.
This has led Virginia Held to insist in her book The Ethics of Care (2006) that caregiving is always a moral action which develops ‘on the basis of experience, reflection on it and discourse concerning it, an understanding of the most basic and comprehensive value.’ Understood in this way, caregiving can never be reduced to simply providing customised assistance to the elderly with an impairment or a chronic or serious illness.
Scholars such as Barcaro stress that it is important to recognise that elderly patients are moral agents, and suggests that such patients can be grouped under three categories.
The first category is what she calls ‘the fully agential elderly’. By this she means the elderly who is able to act in a moral and individually autonomous way. The second category is ‘the disabled but fully agential elderly’. As the descriptor indicates, this category comprises the elderly whose disabilities do not impede their moral agency or their autonomy. The third category, ‘the seriously ill but fully agential elderly’, are those who require assisted living but who are still capable of making moral decisions.
We have to ask what kind of caring do elderly patients in these three categories need? All these patients have basic needs such as respect for their autonomy, safety, enablement, independence, privacy and social activities and connectedness. They must be empowered to pursue their interests and live their daily lives to the extent that they are able.
There is, however, another group which comprises elderly patients who are ‘totally incapable of moral choice or of having an independent life’, for example, the elderly with dementia. These patients require special care.
The wide range of elderly patients and their diverse needs imply that there is a limit to customisation when it comes to robot caregivers. As Barcaro puts it, ‘Customised robots may be useful for patients who, for example, only need to be reminded to take their medication or to be helped with personal care routines’.
However, the more fundamental issue about the use of robot caregivers is that they will never be able to truly meet the deepest need of the elderly patients, namely, to relate to another human being. The relationship between the patient and the robot caregiver is always an ‘I-It’ relationship.
Genuine caregiving requires an ‘I-Thou’ relationship that no machine is capable of delivering, even if it is powered by the most advanced A.I. Barcaro puts it well:
… true caretaking is only possible between and among human persons, since only human relationships have the potential to shape moral decisions in the framework of a mutual relationship between the one-caring and the cared-for. Glances, hugs and silences are among the elements that shape the caring relationship and transmit compassion, participation, happiness or sadness.
This does not mean that robots have no role to play in the care of the elderly and the sick. They can contribute to the whole process of caregiving by offering helpful assistance to the elderly and their caregivers thereby improving their quality of life to some extent.
However, while robots do have a part to play, they can never replace the human caregiver. There is something about interpersonal relationships that machines – however sophisticated – can never replicate.
Finally, as robot caregivers become more common and widespread, another problem could arise: society’s attitude towards caring for the elderly. Caring for our aged sick is regarded as a burden that we are increasingly unwilling to bear and are content to delegate to our ever more sophisticated and efficient care bots.
When this happens, our reliance on machines has the unfortunate consequence of diminishing our humanity.
Dr Roland Chia is Chew Hock Hin Professor at Trinity Theological College (Singapore) and Theological and Research Advisor of the Ethos Institute for Public Christianity.