An ANZSOG-funded research project is exploring the increasing use of robots in care services to replace or complement the roles of humans. In this article, researchers Catherine Smith, Helen Dickinson, Gemma Carey & Nicole Carey explore how the growth of robots in care services is changing how we think about care, and what we need to do to ensure that the ethics of care are maintained. The full report is expected to be published in the near future.

It is well-established within policy and practice circles that we are facing an impending crisis of care.

Australia, like a number of other advanced liberal democracies, is anticipating a future with an older population, with a more complex mix of chronic illness and disease. A number of care organisations already operate under tight fiscal constraints and report challenges in recruiting sufficient numbers of appropriately qualified staff. In the future, fewer numbers in the working-age population and increased numbers of retirees will compound this problem. If we then add to this equation the fact that consumer expectations are increasing, then it starts to look like future care services are facing somewhat of a perfect storm.

Robots are increasingly becoming a feature of our care services, capable of fulfilling a number of roles from manual tasks through to social interaction. Their wider use has been heralded as an important tool in dealing with our impending care crisis. 

We have recently completed an ANZSOG-funded research project exploring the roles robots should play in care settings, with particular attention to what this tells us in terms of definition of care. In our research we explored how robots are currently being used across a range of care services (health, disability, education and aged care) and areas where they will likely develop further in the future. We found that care is not a simple concept but a complex and relational set of practices which has important implications for policy.

One thing that we were interested in exploring with interviewees is: if robots are an answer to the care crisis, then what is it that we mean by care? Care is one of those terms that we all use regularly, but don’t often stop to define precisely what it is that we mean. So what activities do we think robots might undertake and what are the implications? 

What is care?

Typically, when public services think about designing care services they inevitably pull together a series of different activities (e.g. cleaning, washing, feeding and supporting other practical needs in day-to-day living) that comprise those services. Indeed, if we think back to when care services were first outsourced from local governments, this was often done by individuals observing workers and listing the different activities that they undertook. 

In our research, although care was defined in terms of different sets of activities, there are other facets that are also thought to be crucial, namely, care being a relational and responsive activity. 

Participants aligned the concepts of robots and care with a definition of care that largely focused on the relational aspect of care service practices. Most people reasoned that humans and human interaction is essential to care relationships, and robots would not be able to replace this. 

However, in the care of people with needs associated with autism and dementia the non-human qualities of a robot are seen to be a strength in relational care. In both situations, participants identified that robots are able to undertake repetitive tasks without experiencing the monotony and potential boredom of a human. Robots were described in these scenarios as having no emotional baggage, being patient and unable to get angry.

This was seen as an opportunity to remove a potential stressor from the relationship between the primary carer and those being cared for, and as an augmentation of their care relationship, not a replacement. It was identified as an opportunity to provide the carer with the additional time to address other activities.

Robots are identified as a way to combat loneliness and isolation but with a caveat of concern that they could also generate further isolation if their ‘company’ is used to replace human contact. In most cases, the robot is conceptualised as facilitating relationships. Some participants saw that they provided a conversation piece and relational bridge for the cared for and other people in their wider community, such as peers or family members from other generations.

Care is therefore seen as something that is defined in terms of a relationship, and where responsiveness to the needs of the cared-for is elemental to success. An element which arises in much of the care literature is one of reciprocity, where there is a synergy that develops in such a relationship. The role of the cared-for and the carer can be fluid, with the cared-for strengthened by the value they can bring to the relationship, and the reward that is felt in the giving of care. 

Concerns of this nature arose particularly in discussions of ‘Paro’ - a robotic seal that responds with sound and movement to the touch of another. The robot is soft to touch and invites actions of nurture. This was identified as particularly useful for people with conditions such as dementia and autism, where its primary use was settling erratic behaviour. The opportunity to provide for responsiveness and reciprocity was otherwise largely unexplored beyond general discussions around the importance of empathy and the need for human carers to achieve it.

Ethics of care and implications for policy and practice 

Describing care as a responsive, relational activity is very much in-line with a way of conceptualising this practice as consistent with an ‘ethics of care’ perspective. 

In care ethics, care involves bestowing value on the cared for and activity that provides for their needs. Tronto identified that good care comes about when both of these dimensions - caring about and caring for - are present. Care is oriented toward particular beliefs, including concern and the ability to discern the risks of interference over the risks of inaction; interpretation of the responsibilities in each situation as opposed to aligning to a rigid set of rights; and responsiveness aligned with the setting and the individual. Privacy, dignity and agency are all of particular concern in the provision of care in services as a result of these orientations. 

If we define care practice in terms of ethics, then accountability of the relationships of care goes beyond the cared for and the carer. It also includes those who have determined the ethical systems that guide robot behaviour, and therefore expands the care relationship into opaque and impersonal elements that require consideration. This has important implications in terms of policy and practice. If we replace some or part of a care process with a robot, it may have far-reaching implications.

We therefore need to carefully consider how robot technologies fit within models of care. Without this there is a danger that we will not use these tools to their full effect, or will create unanticipated consequences. 

Members of the research team:

·        Helen Dickinson, Public Service Research Group, University of New South Wales, Canberra

·        Nicole Carey, Self-Organizing Systems Research Group, Harvard University

·        Catherine Smith, Youth Research Centre, University of Melbourne

·        Gemma Carey, Centre for Social Impact, University of New South Wales

This is a re-post was originally featured on the ANZOG website.

Power to Persuade