The human/technology frontier in health and social care
Published November 2016
The frontier between humans and technology has become increasingly blurred; in some instances, we are seeing a merger of human biology and technology into one, in others technology has come to replace traditionally human roles. The transhumanist belief is that the human race itself can evolve beyond its current physical and mental limitations with the help of science and technology.
Are there recent scientific, legal or social developments?
There has been a recent influx of medical technologies capable of detecting, managing and preventing health problems. These vary in complexity from mobile phone apps to complex networks of sensors capable of monitoring physiological parameters and behaviours. Medication adherence has been tackled by technology which reminds people to take their medicine and telemedicine allows patients the chance to meet with a doctor remotely and relay informat7ion back to them from home diagnostic devices (for example: MedWand, Tyto). Robotic technology has been used to deliver targeted radiation treatments and to assist surgeons with minimally invasive procedures such as prostatic surgery. The future generation of robots may be capable of performing surgical procedures independently or performing antenatal screening scans on pregnant women. In February 2015, an EU-funded project, MARIO, was launched to address the challenges of dementia with the use of service robots. Nanotechnologies offer many potential uses in medicine including use of nanoparticles for personalised medicine delivery, nano-devices to monitor health from inside a patient or nano-robots to perform intra-cellular surgery. A significant amount of research is also being conducted on machine learning with potential applications in medical diagnostics and treatment decision-making.
Are there complex ethical issues?
A central question in this area concerns trust, and whether healthcare professionals and patients would accept the use of some of these technologies. Basic safety questions need to be answered to alleviate fears around toxicity, carcinogenicity or the unpredictable or uncontrollable behaviour of devices. Some of these technologies may threaten patient autonomy if devices are programmed to prompt users to make healthier life choices, to control their adherence to medications or to monitor their behaviours in a ‘big-brother’ fashion. This could result in a loss of self-determination or a sense of reduced responsibility for one’s own health. Although potentially allowing more people to remain independent in their own homes, concerns have also been raised that these technologies might lead to the social isolation of vulnerable members of society, and the loss of collective responsibility to care for others. Nano-technologies offer the possibility of human ‘enhancement’ which might raise pertinent ethical questions. The prohibitive cost of some of these advanced technologies risks creating social and economic divide and exacerbating existing health-care disparities if care is not taken to ensure that they are implemented in a way which allows all patients to benefit. There are arguably some fundamentally human qualities which are important in medical counselling and the precious subtleties of the ‘human’ doctor/patient relationship may be unduly threatened by technological advancements which encroach into human roles. As highlighted in a report by the Council, the use of novel technologies which intervene in the function of the brain raise distinctive ethical and social concerns given the unique role of the brain in providing our autonomous agency, and in shaping our conceptions of ourselves and our relationships with others.
Is there a potential policy impact?
There are a number of questions for policy makers to address in this area, including the issue of liability if something goes wrong, and the impact on the current workforce. A significant issue pertains to the privacy of the information collected and how it could be used, meaning that data protection policies will be vital. For example, some companies have initiated corporate wellness programmes where employees are rewarded for making healthier lifestyle choices. Lastly, there is the need for guidance regarding responsible research and innovation.
Is it a subject of public concern?
Studies from public engagement workshops in the US and the UK looking at emerging nanotechnologies found that energy applications were seen in a substantially more positive light than applications in health and human enhancement. The very personal and human experience of health and social care is close to the hearts of many individuals and the public has shown emotive responses to technologies which impact on their personal autonomy.
Is consideration timely?
In 2015 the European Commission published its report of a public consultation on Mobile Health outlining the concerns and suggestions of key stakeholders. We are likely to see a dramatic rise in the use of robots and nanotechnologies in medicine in the immediate future.
Can the Council offer a distinctive contribution?
The Science and Technology Committee undertook an inquiry into robotics and artificial intelligence published in October 2016. The Council’s report on Medical profiling and online medicine has already addressed telemedicine but the Council may be able to focus on new issues and offer a distinctive contribution by drawing in public opinion and acting as a platform for public education. A project looking specifically at nanomedicine would be one possibility or the Council could consider a broader project on robotics as a whole which could include a focus on robotics within health and social care.
Possible future work topics
This is one of the topics that have been suggested as possible project areas for further investigation by the Council. These topic summaries do not aim for comprehensiveness; rather, they are intended to sign-post some of the key considerations and to provide a starting point for discussion. Each summary includes links to relevant publications on the topic.