title: Ethical implications of home telecare for older people: a framework derived from a multisited participative study.
abstract: BACKGROUND
  Telecare and telehealth developments have recently attracted much attention in research and service development contexts, where their evaluation has predominantly concerned effectiveness and efficiency. Their social and ethical implications, in contrast, have received little scrutiny.
  
  
  OBJECTIVE
  To develop an ethical framework for telecare systems based on analysis of observations of telecare-in-use and citizens' panel deliberations.
  
  
  METHODS
  Ethnographic study (observation, work shadowing), interviews, older citizens' panels and a participative conference.
  
  
  METHODS
  Participants' homes, workplaces and familiar community venues in England, Spain, the Netherlands and Norway 2008-2011.
  
  
  RESULTS
  Older respondents expressed concerns that telecare might be used to replace face-to-face/hands-on care to cut costs. Citizens' panels strongly advocated ethical and social questions being considered in tandem with technical and policy developments. Older people are too often excluded from telecare system design, and installation is often wrongly seen as a one-off event. Some systems enhance self-care by increasing self-awareness, while others shift agency away from the older person, introducing new forms of dependency.
  
  
  CONCLUSIONS
  Telecare has care limitations; it is not a solution, but a shift in networks of relations and responsibilities. Telecare cannot be meaningfully evaluated as an entity, but rather in the situated relations people and technologies create together. Characteristics of ethical telecare include on-going user/carer engagement in decision making about systems: in-home system evolution with feedback opportunities built into implementation. System design should be horizontal, 'two-way'/interactive rather than vertical or 'one-way'. An ethical framework for telecare has been developed from these conclusions (Table 1).
authors.affiliation: Department of Sociology and Division of Medicine, Lancaster University, Lancaster, UK.
authors.forename: Maggie
authors.initials: M
authors.lastname: Mort
authors.forename: Celia
authors.initials: C
authors.lastname: Roberts
authors.forename: Jeannette
authors.initials: J
authors.lastname: Pols
authors.forename: Miquel
authors.initials: M
authors.lastname: Domenech
authors.forename: Ingunn
authors.initials: I
authors.lastname: Moser
mesh_terms: D000368:Aged; D006299:Health Services for the Aged / Q000941:ethics*; D006699:Home Care Services / Q000941:ethics*; D006801:Humans; D010358:Patient Participation; D013685:Telecommunications; D017216:Telemedicine / Q000941:ethics*
keywords: ageing; citizens’ panels; ethical framework; technology; telecare
references.citation: Soc Sci Med. 2003 Aug;57(4):697-710
references.pmid: 12821017
references.citation: J Telemed Telecare. 2005;11 Suppl 1:66-8
references.pmid: 16036000
references.citation: Sociol Health Illn. 2013 Jul;35(6):799-812
references.pmid: 23094945
references.citation: BMJ. 2012 Jan 18;344:e469
references.pmid: 22257981
references.citation: BMJ. 2012 Jun 21;344:e3874
references.pmid: 22723612
references.citation: Health Expect. 2011 Dec;14(4):351-60
references.pmid: 21029283
references.citation: Health Expect. 2004 Dec;7(4):290-302
references.pmid: 15544682
references.citation: BMJ. 2012 Feb 07;344:e875
references.pmid: 22315289