Robots, the Elderly, Deception, and More

robot elderlyThe web site begins: “Imagine sitting on a park bench and a 23-inch tall robot sidling up next to you and striking up a conversation. Would you be flustered and find another place to sit? Or would you squat down and chat with it at eye level?

British researchers have undertaken a three-year examination of whether robots, acting as surrogates, can take the place of humans in public spaces. They want to help senior citizens who may lack the mobility to get out and about. One day robots might wheel around public places, piloted remotely by a 70-year-old grandfather who wants to experience a rally or concert, but has trouble leaving the house.”

In yet another article published in the prodigious medical journal Lancet (386:235) we read about “Alice” — “…a 60 cm friendly girl like face and robotic body so there is no confusion about whether she is alive or not.”

No matter how it’s pitched, robots are really about big business. Likewise, modern medicine is increasingly about big business— mergers, acquisitions, six-to-seven figure salaries—all once reserved for the business world are now commonplace in healthcare even under the new Affordable Care Act (ACA). A business model is now standard for “nonprofit” medical entities, whether a health maintenance organization, or a university associated hospital.

In an effort to control costs measures have been introduced to control high cost items. One of those frequently targeted is the perceived high cost of human employment whether in the form of physicians, nurses, or nursing assistants. Human engagement is costly because it includes salaries, benefits, retirement, and grievances. It is not surprising that there is an increasing utilization of computerization when it can substitute for human engagement. Initially, technological interventions were welcomed with the justification that efficiency and quality could result from cost savings. Electronic medical records were a case in point. The cumbersome paper records that were difficult to access and nontransferable to new healthcare providers interfered with the rapid provision of accurate and quality healthcare. But the introduction of robots could have very different consequences, especially for vulnerable and elderly individuals.

The use of robots attracts the technologically oriented entrepreneurs and healthcare managers who may view the economics of healthcare as more important than health itself. WHO defines health as, “… a state of complete physical, mental and social well-being of the individual and not merely the absence of disease or infirmity.” In the metrics of delivering healthcare it is the mental and social well-being that is often omitted, especially in the elderly who are too often confined to impersonal and isolated healthcare facilities.

The frequently stated justification for employing robots—meeting the needs of the lonely and isolated elderly is deceptive—loneliness will not be diminished by the use of robots. It may in fact increase isolation. Anyone who has used Apple’s Siri cast as…an intelligent personal assistant using a natural language commonly known as voice recognition—understands its limitations as “Siri” fails to respond to personal questions, repeatedly states that he/she did not understand the question or has not been programmed to answer the question at all. The use of a robot and voice recognition is dependent on programming the right answers and understanding the questions. To be effective it must also record and store questions and responses raising issues of invasion of privacy and access to “conversations.” One can only imagine the frustration of the elderly when their faint and gravelly or accented voice causes the robot to reply over and over again, “Sorry, I don’t understand. Please repeat the question.” And then there is the issue of whether a robot can really be programmed to answer the most important questions of an individual or if the answer to a question is really a truthful answer when the they are merely selected from a menu of preprogrammed responses.

The problem with robots in the context of human interaction is that no matter what its developer says, it never really eradicates loneliness. Instead it substitutes and only worsens the isolation. Individuals looking for friends on Facebook fall deeper into the loneliness created by the absence of human contact. Television sets, once touted as a means to counteract the loneliness of the elderly, have become symbols of how technology can further isolate and demean the elderly by mechanizing human companionship. The scene of hundreds of robots (replacing or adding to the scene of hundreds of television screens) roaming the halls of healthcare facilities, or occupying the chairs next to the elderly, or anyone else, is the kind of scene that movies are made of and books are written about. Perhaps the greatest deception of the use of robots is promoting their use as a substitute for human interaction.

The use of robots to fill a void of loneliness raises ethical questions of what healthcare is really about and how the increasing intrusion of electronics erodes the very basic need of human interaction within healthcare delivery. (To be continued.)