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Robotics and autonomous devices in social and health care

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Background : Demographic developments, shortage of skilled personnel and growing economic pressure in the health sector lead to an increased focus on technical solutions in the field of medical care and treatment of people. So far, robots are mainly technology-driven and still in the development and testing phase. An assessment of opportunities and risks, however, has yet to be realized. Goal: The present study shows the current status and macro trends of robotics in health care. It assesses opportunities and risks in view of a technically feasible, economically achievable and ethically desirable use of robotics in health care. It furthermore formulates recommendations for politicians and other decision makers on the basis of these findings. Methods: To determine the current status and trends, the TA-Swiss-Study has worked with an extensive literature review on current developments, prototypes and their use in practice. This analysis proceeds from a systematic search of various databases and a complementary internet search. This literature pool served as the basis to evaluate the current status, to compile an environment analysis with the PESTEL-method, and to determine macro trends. Furthermore, by means of focus-group interviews, it was possible to perform a stakeholder survey and draw up a needs assessment on the basis of which seven key factors were elaborated and ten theses composed. These were then scrutinized and discussed in detail in a subsequent workshop with experts from the fields of politics, economy, society, ethics, technology and law. On the basis of the findings form the literature review and the stakeholder survey, the TA-Swiss-Study has worked out three scenarios of possible future developments in the use of robots in health care. The scenarios allow the highlighting of opportunities and risks, the specifying of need and options for action by politics, research and health care, and in conclusion the drawing up of recommendations for the involved decision makers. Results : The field of robotics is characterized by diversity and a different complexity of the devices. Most of the identified models can be classified into three groups according to their functions: 1. Training aids and aids for movement, for the purpose of mobility and autonomy 2. Devices which complement or facilitate people's life, or which can serve as their physical proxy 3. Devices which accompany and interact with peopleThe majority of the devices are still in the development and testing phase and only to some extent employed in practice. Innovation in the field of technology is a substantial driver for new applications in health care. Technical feasibility and economic efficiency, however, are not the only factors in the introduction of robotic devices. Acceptance on the part of the involved stakeholders plays a significant role, an acceptance that is influenced by cultural background, legal and ethical considerations as well as social, psychological and individual factors. Among the opportunities of the use of robots in health care is the assistance they provide for professional and non-professional users, for example family member caregivers. Technical innovation can provide an increase in autonomy and mobility and lead to an improved integration and better quality of life for patients as well as their families. On an institutional level, robotics provides a rationalization potential in the area of organizational and logistic processes. All in all, in addition to assisting health care professionals and at the same time contributing to mitigating the shortage of qualified health care professionals, they would improve the quality of care for patients and people in need of care. One of the risks is that through the use of robots there would be less personal contact between patients and health professionals. This could have negative effects on the patients’ wellbeing and their convalescence and could even lead to isolation. Furthermore, the nurse profession and other health care professions could become less attractive, which in turn could further increase the shortage of skilled health care professionals. Another risk lies with particularly vulnerable people incapable of giving their informed consent for the use of robots themselves. Furthermore, a delicate matter is the potential misuse of the data collected by the devices, and the liability question in case of damages caused by semiautonomous robots. On an institutional level, there is reason to worry that economic pressure could lead to a favoured use of devices, which could be economically advantageous but could be disadvantageous for people concerned, for example as a result of possible loss of contact or possible job cuts. Moreover, due to an almost total lack of benefit-cost analyses dealing with the use of robots in health care, the risk that their use may lead to increased costs cannot be ruled out. Conclusions : Insufficient regulation for instance in liability law, data protection and ethics is already leading to risks for people dealing with such devices in research, testing and practice. An attitude of expectation and reaction translates into a willingness to accept these risks. Measures such as the clarification of liability laws and data protection are therefore necessary and cannot be postponed to an indefinite future. Evidently, a proactive and coordinated policy framework is required to minimize the risks of the use of robotics in the health care environment and to allow to fully benefit from the opportunities and advantages it presents.

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