Ethical framework of assistive devices: review and reflection
Mansouri et al. Robot. Biomim.
Ethical framework of assistive devices: review and reflection
Nazanin Mansouri 0
Khaled Goher 2
Seyed Ebrahim Hosseini 1
0 Department of Land Management and Systems, Lincoln University , Lincoln, Canterbury 7647 , New Zealand
1 Faculty of Environment, Society and Design, Lincoln University , Lincoln, Canterbury 7647 , New Zealand
2 School of Life & Health Sciences, Aston University , Birmingham B4 7ET , UK
The population of ageing is growing significantly over the world, and there is an emerging demand for better healthcare services and more care centres. Innovations of Information and Communication Technology has resulted in development of various types of assistive robots to fulfil elderly's needs and independency, whilst carrying out daily routine tasks. This makes it vital to have a clear understanding of elderly's needs and expectations from assistive robots. This paper addresses current ethical issues to understand elderly's prime needs. Also, we consider other general ethics with the purpose of applying these theories to form a proper ethics framework. In the ethics framework, the ethical concerns of senior citizens will be prioritized to satisfy elderly's needs and also to diminish related expenses to healthcare services.
Robot ethics; Assistive medical robots; Robot ethics framework; Older adults; Assistive walking device framework; Ethics concerns; Ethics issues
Ethnographic reports present that ageing population
is growing significantly all over the world [
increase gives rise to particular needs of elderly people
]. Moreover, population increase leads to substantial
issues such as shortage in medical centres, healthcare
services, and medical professionals  and burdens of
enormous amount of healthcare expenses [
there have been noticeable technological innovations
in Information and Communication Technology (ICT).
These developments have resulted in creation of
various types of assistive medical robots such as RIBA,
paro-robot, telerobot, and remote presence robot [
assistive devices, home automation systems, and canes
]. Assistive devices and robots are developed with
the purpose of fulfilling elderly’s needs and
expectations, compensating their disabilities, boosting their life
quality, providing assistance to carry out task(s), whilst
maintaining their autonomy [
]. Research studies
revealing the primary needs of older adults are listed in
This paper is organized as follows: “Theories of Ethics”
section introduces a summary of literature of general
ethics, human rights and values; “Ethical Issues of
Assistive Medical Robots” section addresses existing ethical
issues related to assistive medical robots; “Discussion and
Conclusion”, summarizes the important role of ethical
framework on both assistive medical robots and walking
Theories of ethics
Under this section, general ethics theories as well as
human rights and values are described.
General theories of ethics and bases of ethics concerns
In area of ethics, there are general theories which can
be practiced in different fields such as assistive medical
robot including walking devices ethics. Robots,
specifically assistive medical robots, simulate human
behaviours, performance, and actions; therefore, ethics general
theories can be applied in design and use of medical
robots like walking devices. The prime example is the
robot’s program where the program’s codes are
written based on ethics general theories, whilst taking
ethics concerns into consideration. This section of the paper
describes three (3) relevant general theories of ethics and
also bases of ethics concerns.
The word “deontology” is taken from two (2) Greek
words which are duty and study. Deontology ethics,
which is established by Immanuel Kent, is known as
non-consequentialist or duty based [
]. According to
this theory, individuals are enforced morally to perform
or take actions in accordance with series of principles as
well as rules without considering the outputs of taken
]. This theory mainly considers rightness and
wrongness of an action itself rather than focusing on
its consequences and outputs [
]. In accordance with
], this is the first ethics theory prioritizing
decision-making to a person. Moreover, [
] stated that
in a moral action of an individual, feelings and incentive
refuse to play a significant role. Therefore, incentive for
taking an action is based on obligation before the action
takes place [
]. In other words, in accordance with this
theory, in spite of destructive consequences,
individuals are required to take right actions which are based on
The prime example of applying duty-based theory in
assistive medical robots is giving medicine to an older
adult. If a senior citizen requests a painkiller from his/
her assistive medical robot, in spite of being allergic to
the painkiller, the medical agent is required to follow
rules and to provide the medication to older adult. It is
evident that medical robot action triggers older adult’s
health condition. In contrast, in other general theories
of ethics such as consequentialism, the action of
medical robot endangering older adult’s well-being declines
to be accepted; therefore, assistive agent is required
to provide another solution to relive older adult’s
This ethics virtue is recognized as character-based ethics
which is far towards individual based rather than action
based. Virtue ethics is recognized a character-based
ethics highlighting an individual’s right action in all the same
]. This theory emphasizes on virtue and
moral character of a person carrying out an action rather
than considering action’s consequences or ethical rule
]. The concern of this ethics theory is not only
focusing on rightness or wrongness of an individual’s action
but also offers a number of behaviours.
Virtue theory is beneficial if an individual incline to
assess another individual character rather than goodness
or badness of a particular action. In this theory,
individuals are required to have series of characteristics for
Character-based theory sporadically tends to
deontology ethics theory, whilst it is contrary to
consequentialism ethics theory. The prime example is helping
needy: based on consequentialism theory, helping needy
improves well-being. On the other hand, deontology
theory says that helping needy is in accordance with moral
rule, whilst virtue theory argues that this kind of
assistance is a character of generosity.
This ethics theory is known as result-based theory which
highlights two (2) primary principles. The first one states that
rightness or wrongness of an action is based on its result and
potential consequences. The second concept indicates that
when the result of an action has greater consequences, that
action is considered as a more right action [
accordance with consequentialism, an action is favourable if its
consequences refuse to produce harmful consequences.
Hedonism and utilitarianism are two forms of
consequentialism ethics theory. Hedonism indicates that it is
necessary for individuals to ameliorate human, whilst
utilitarianism states that it is essential for individuals
to enhance human health. In addition, another form of
consequentialism states that individuals are required to
improve their preferences satisfaction and happiness.
It is stated by Cummiskey [
] that in result-based
theory a murder is considered right if its consequences
produce good result. In other words, if a murderer inclines
to kill a group of innocent individuals, it is accepted
based on consequentialism to kill the murderer to save
the victim’s lives. In contrast, based on both deontology
and virtue theories, in spite of victims death, killing the
murderer is wrong [
Human rights and values
Human rights related to senior citizens consist of the
right to a standard of living which is sufficient for health
and welfare, freedom from discrimination, inhuman and
torture or humiliating treatment, and private and family
A focus on human rights provides support to
highlight that physical and psychological well-being of older
adults is as significant as the well-being of other member
of society. Therefore, it is substantial to make sure those
assistive medical robots embedded into older adults lives
aim at benefiting elderly, and not embedded to
diminish care burden on the other people [
]. In addition, it
is essential to consider twelve human values which are
introduced to technological developments [
Ethical issues of assistive medical robots
The debates about the ethical actions of robots date
back to 70 years ago [
]. From 1950, when Asimov
presented his three laws, [
] there has been
arguments about the potency of those particular rules to
render robots capable of making ethical decisions
independent of human interference. The key argument
of Asimov’s laws considered the self-directedness of
robots. Being autonomous, robots were assumed to
have the physical and intellectual capacity to make
moral decisions, using the knowledge and rationality
which they were equipped with [
]. Asimov’s three
laws discussed these notions: (1) A robot may not be
a source of damage for a human being or, its inactivity
expose a human being to harm. (2) A robot must
follow human beings’ orders except the ones which would
confront the first law. (3) A robot should guard itself as
long as such defence does not contrast with the other
Both researchers and science fiction writers have
expressed their concerns about a number of ethical issues
that daily use of robots has made them possible. However,
the robots that we use daily are limited to vacuum
cleaners, grass cutters, and robot toys. These are not same to
the advanced science fiction robots that are the subject of
the recent robotics ethics [
]. Consequently, the ethical
concerns related to robots should not be based on
empirical data and studies done by users. Instead, taking
Asimov’s laws as an opening point for ethical debates [
they need to discuss ethics according to their potential,
future application [
Robots-exclusive Concerns. Ryan Calo is a law
professor who wrote the “Robots and Privacy” chapter in Robot
Ethic. He points out that the debated on robots are
currently paying attention to ubiquity, and, conceivably, this
is not that good [
]. Calo detects three privacy dangers
which robots can create: “surveillance”, “access to
living and working spaces”, and “social impact”. The
anxiety about such an access is exacerbated by the research
done by Denning et al. [
]. In this research, the authors
explore vulnerable security measures in several toy
Certainly, in areas such as robotics, producers need to
be very innovative. Current world is witnessing a
technological explosion with new possibilities. One argument is
that ignoring speculation about future robots and their
use can create ethical dilemmas. However, our argument
is that it is necessary to adapt a perspective that is in
agreement with the experiences resulted from empirical
use of robots. This will help to complement the current
debate on robot ethics.
A list of ethical issues related to the use of
assistive medical robot from older adults’ perspective are
explained in details in this section and the following
section. There are a noticeable number of ethical issues
which are stated by senior citizens about the use of
assistive medical robots. Amongst the stated issues, there are
primary issues which are of significant concern not only
to the older adults but also to elderly’s family and
caretakers, robot designers and developers.
Moreover, trust is a vital element for the formation and
preservation of humans’ dynamic relationship with
assistive robots [
The lack of trust is the main reason that seniors do not
wish, do not need, or do not consider robots.
Lack of trust results from some factors [
• Privacy: how can youth and the elderly leave their
privacy in the hands of a robot?
• Safety: If a robot is set to undertake physical
responsibilities, the physical interaction of human–robot
leads to serious challenges. Besides, upgraded
methods are necessary to eliminate the failures raised by
safety problems and confirm the absence of any
• Robustness: despite the circumstances, how the
elderly can be convinced about the suitability of the
behaviour of a robot?
• Security: Affirming that the robot is not harmful for
• Data protection: how can the elderly be convinced of
the safety of the significant data?
The ethical issues of assistive medical agents are listed
in sections in below.
Privacy of older adults
Privacy of senior citizens is of paramount importance
that it is well in line with other ethical issues such as data
protection and security and safety. This ethical issue is
of great concern to scholars [
]. This issue has
substantial effect on older adults to lose their appeal to adopt
smart home technology. The main process of smart home
technology includes collection, transmit, distribution,
and exchange of elderly’s private information. This main
process has impact on elderly to refuse smart home
43, 46, 53, 54
]. Take home healthcare robots as
an example; this kind of robot enable medical specialists
to keep a wary eye on their patients’ well-being in remote
places by means of various tools such as camera,
ultrasound, and speaker [
The process of Ambient Intelligent Technology (AIT)
consists of various procedures such as collecting,
distributing, and storing full confidential data of user [
The key functions of this technology are to keep eyes on
robot’s user and to combine data from different resources
by sensors to obtain the details of circumstance [
the process of data collection, profound, medical, and
confidential data of robot user are gathered. In addition,
other parties might have access and control to the
gathered data; therefore, user’s privacy might be abused [
In addition, home automation system is one of the main
ICT devices employed for fall prevention purpose. Home
automation system is type of device which is wearable
attached to the body of user by means of transparent film
and neoprene belt. The primary function of this device is
to detect fall incidents through video monitoring [
It is asserted from various studies that noticeable
numbers of senior citizens are of critical concern about their
privacy. Consequently, it is far favourable for them if the
wearable device captures unclear photographs when they
are at personal places such as bedroom. In contrast, it is
accepted for elderly if the device takes clear images when
they are at other rooms such as living room [
]. It is
claim that privacy concern slackens older adults’ interest
towards this kind of devices especially visual surveillance
or cameras [
Two-way visual contact is a way of communication
and connection through webcams and television
monitors, though it is not widely used despite its rather cheap
price. This allows family members or employed carers to
“look in” on older persons and their homes with no need
to commute [
]. If older people feel at ease in working
with computers, virtual visiting and communication is
reasonable and easily established. It is not more difficult
than installing and making a Skype account. Even there
are virtual visiting systems which are more user-friendly
than Skype and operate by connecting to local broadband
The ethical issue of data protection is well connected to
privacy issue. In the process of home healthcare services,
there should be a connection between both medical
centre personnel and the place of robot user to provide
not only safety services but also social care and daily basis
]. In multi-user cases, the intelligent system is
in charge of distinguishing different data, namely robot
user’s private data, caretaker’s data, as well as other
relevant information to monitor well-being of user [
Consequently, it is essential to subject the collected data
to act of data protection [
The primary function of assistive walking devices
including fall detection devices such as home
automation systems is to capture image or record video of older
adults. The captured images or recorded videos might
be inappropriate or unwanted; therefore, these images
or video are unfavourable to elderly. Moreover, it is of
importance concern to older adults if their personal data,
namely images or videos, are accessed and viewed by
Some assistive robots are used to help in remote
sensing and monitor the elderly in variety of locations. These
robots are as assistant for those specialists who want to
check their patients remotely, mainly in critical
situations. They do this by making use of speakers, light,
cameras, remote controls, ultrasound, and electronic medical
recording accessories [
Security and safety
Safety and security ethical issue is well related to
privacy concern [
]. It is strongly recommended that
there should be a balance amongst the needs of elderly
for safety, whilst preserving elderly’s privacy and
29, 56, 64
]. In addition, it is claimed that older
adults, their families and caretakers have contrary point
of view about privacy, safety and security concerns [
A conducted study reveals that family and caretakers of
senior citizens are more concern about safety and
security rather than privacy and independency concerns
]. Moreover, although some scholars subscribe to the
belief that there should be a balance between privacy
and safety concern [
], other scholars believe that
safety and security of elderly is of dramatic importance
Regarding security and safety of walking devices, over
recent decades, one of the substantial and pricy public
health issues is fall incidents and injuries happen to older
]. It is found that one older adult out of
three with the age of sixty-five or above falls yearly
resulting in serious injuries which require treatment in medical
]. Although there have been significant
developments in fall prevention devices, fall incidents
take place with severe consequences such as
morbidity and mortality. Injuries resulted from fall incident
are ranked number five in terms of causing mortality in
ageing group with the age of sixty-five and above .
For this reason, safety and security of assistive walking
devices are of dramatic concern to senior citizen.
In addition, it is imperative to ensure that walking
devices especially ICT ones which function based on
human-made programs do not pose fall incidents to
elderly on account of negligible errors in their programs.
Besides, fall incidents give rise to another ethical issue
which is responsibility of fall incidents. It is evident that
assistive walking devices including fall detection ones
play important role not only in the well-being of older
adults but also in occurrence of fall incidents. For this
reason, it is dramatic to identify the responsibility of such
Various types of tasks are made possible by making use
of the services offered by autonomous service robots.
Samples are taking care of old people at home [
accompanying guests in multi-level buildings [
Robotic service solutions include the simplest
telepresence to the most complex functions to back
caregivers. Examples are the Giraff (www.giraff.org)
advanced in the ExCITE project [
(www.irobot.com/ava) and Luna [
], assisting needy persons in
their everyday movements (www.aal-domeo.eu),
selfmanagement of long-lasting illness [
], comfort and
safety as in the cases of Florence [
] and Robo M.D
], and unification in an environment controlled by
smart applications [
]. On the other hand, the
number of robotic applications that are dedicated to social
services in settings like smart office buildings is very
Error and safety
Safety of elderly using assistive medical robots is of
significant concern to older adults, their family members
and caregivers, and robot designers and programmers.
The assistive medical agent carries out a task in
accordance with program(s) which is written by a range of codes
through robot developers. For this reason, a negligible
error in robot’s program might trigger older adults’
wellbeing and might cause fatal and severe consequences
Technological care giving is already realized in most
of Western European counties, but the technology
that is usually used in this case is not robotic. On the
opposite, some of it is no doubt low-tech. The aiding
technology that is mostly available for old people in the
UK ranges from portable alarms for requesting help;
smoke, CO2 and flood sensors; pillboxes or
containers that are designed in a way that let older people take
their drug on time; fall sensors are another samples as
In Ambient Intelligent Technology (AIT), artificial robot
and its user interact with each other directly. This
interaction amongst them has led to several issues such as
responsibility of tasks, designation of control, decrease in
human force, and allocation of decision-making [
46, 82, 84
]. In today’s world, artificial robots are
increasingly and pervasively becoming autonomous which has
resulted in diminishing human participation in some
actions including decision-making. For this reason,
liability of autonomous action is of critical concern [
Responsibility concerns about robots for older adults
Robots are capable of interacting with human being and
the encompassing environment in very intricate ways.
The traditional theories of moral responsibility are
challenged by social robots. The production of robots results
in various ethical questions: what are the possible
harmful consequences of such production? What would be the
end of key moral concepts such as autonomy and privacy
in a time when robots are integrated with human life?
Are these robots moral agents? Is it ethical to take them
responsible? These ethical issues result from the
developing sovereignty of the smart technical products the most
remarkable representatives of which are the social robots.
Can robots be assumed as socially autonomous
responsible confidant agents that care and, meanwhile, perform
their duty as technical gadgets?
Whilst most of these concerns are related to other
fields of engineering, the capacity of robots to turn into
ethical agents puts forth another set of moral questions,
such as those related to the rights and responsibilities of
People’s ideas about the moral concerns introduced
by autonomous products like robots very and address
various notions such as the application of robots in, for
instance, healthcare tasks. These views imply an
understanding about the achievements of technology which
depends on the ideas about the entity of technology and
the relation of mind and matter in human and machine.
The main focus of the usual approach of research in robot
ethics deals with the robot and its entity and thoughts.
It helps to answer questions about the intelligence and
rationality of robots, to see are they “moral agents”. Or,
it restricts ethical concerns to things that, interactions
with robots, might go wrong. For most of philosophers of
morality, ethics is related to feeling of responsibility, the
appropriateness of some one’s actions, and, then, the
centrality of questions that consider moral status and action
]. Usually, moral responsibility is only attributed to
creatures that enjoy a tenable levee of moral agency—
what does it mean—and concentrates on the suitability
of what that agent performs, has performed, or can
]. To investigate the ethics of robot technology,
] puts forth an approach which
centralizes human or interaction. Instead of thinking of a mental
philosophy which regards the real entity and thought of
robots, it would be better to adopt a philosophy of
interaction and seriously consider the ethical importance of
exterior form [
One of the benefits of the Accompany focus group’s
discussions was the agreement that for monitoring the
programming of robots, it is necessary to consider the
communication of the older person who lived with a
robot, with other organizations of formal and informal
carers, instead of basically gratifying an aged person’s
desires. Still, the data also propose that, at least, one
approach—the “let’s do it together” strategy—may itself
destabilize sovereignty by (unintentionally, perhaps)
treating the older persons like children [
]. A robot
would be considered as a social one when it takes
responsibility, not when it is assigned with responsibility.
Human responsibility and robot responsibility
Robots have the power and ability of interacting with
human being and human context in complicated ways.
Robotics and making robots bring to the fore variety of
applied ethical questions. Following introduces some of
them: what are the potential risky consequences of
making these robots? What autonomy and privacy concerns
will be raised when robots turn to be an inseparable
part of human life? Whilst most of these concerns are
expressed in relation to other fields of engineering, the
capability of robots to act as ethical entities introduces
some other moral concerns, amongst them the right and
responsibilities of robots?
The ethical issues have different layers that need to be
discussed. The most central concerns deal with the
responsibilities of robots [
] and human beings [
There is a question shared by many people who are
worried about this matter: who is responsible for the
mistakes committed by robots? In cases that a robot does
not pass the limits of autonomous function, a minimum
level of the product liability is assumable. Given that
robots follow the plan and procedure decided by some
persons or companies, those people or companies are
clearly responsible for failure (barring misuse). In the
cases that robots are equipped with the accessories to be
programmed by customers, the realm of liability will be
clear. Still, in semi-autonomous robots such as
self-driving cars, the concept of liability would be complicated,
particularly when an accident happens in the cases of
cooperation between robot and human agent.
In the cases that robot is autonomous, responsibility
will be considered entirely as that of robot. It means that
the robot is not under the direct influence of programs,
programmers, or operators [
Equal right for use of robot
It is found that one of the noticeable issues in robot ethics
is having equal access to assistive medical robots. There
have been a great number of debates surrounding this
issue to consider whether it is affordable for every
individual or particular group of individuals over the world
to utilize and benefit from AIT or not [
]. It is stated
that unequal access to robots and healthcare systems
might result injustice .
One of the ethical chief issues is having unequal access
to assistive walking devices. In other words, it is injustice
that particular groups of older adults because of
different factors such as being from third-world countries do
not benefit from assistive walking tools. In addition, it is
pointed out that a noticeable number of senior citizens
are strongly concern about the cost and also
maintenance expenses of assistive walking device. Consequently,
this factor slackens their interest towards use of walking
10, 58, 96, 97
In some cases, use of assistive medical robots instead of
weakening negative impacts, it strengthens the adverse
effects such as social isolation which results in reducing
social interaction [
29, 82, 98
]. The result of conducted
research studies reveals that assistive robots such as
telecare decline social communication [
]. In addition,
Chan et al. [
] believed that smart home technology
affects human’s relationship and communication with
others owing to decreasing interaction between robot
users and their caretakers.
It is found that albeit assistive walking devices such
as wheeled walker compensate elderly’s disabilities in
moving, yet there is a gap for amelioration to diminish
fall incidents, whilst improving elderly’s appearance in
]. It is asserted that older adults encounter
difficulties indoor and outdoor when they employ wheeled
walkers. These issues take place when they move in
curve, uphill, downhill, over obstacle(s), passing a door,
on uneven ground, and carrying an object. In addition,
mentioned issues might pose fall incidents to elderly.
These issues might have negative effect on older adults’
morality and make them to feel embraced to carry out
outdoor activities such as visiting medical doctors, using
public transportation, and visiting family members or
Over the past decades, there has been an abrupt
development in technology. This has created hardship for
technology users specifically older adults to learn and
cope with new modern technology and systems. It is
pointed out by Weiser and Brown [
] that it is
significant for computer technology to be invisible when
assisting users. In other words, technology users are not
required to gain knowledge about technology. However,
it is said that it is essential for technology users to be
aware of advantages and disadvantages of technology’s
role in their lives [
Apart from the mentioned ethical issues, there is
another significant issue which the authors of this paper
believe that it is essential to take this ethical issue into
consideration and embed it in ethical framework of
assistive medical robots. This issue is related to robots users’
feelings towards assistive robots. It is claimed that direct
interaction between robots and individuals poses social
isolation; therefore, this may influence robot users to
have human feeling, namely love towards assistive robots.
For this reason, it is important to consider appropriate
standards in behaviours of robots to handle this issue.
Recently, there have been substantial
technological developments in assistive walking devices. Some
researchers believe that older adults are novice users;
therefore, they prefer simple functions. Besides, older
adults’ behaviour is towards emergency situation is
different; they refuse to ask for assistance from their
caretakers or nurses [
]. On the other hand, it is stated that
some older adults found utilization of technology easy
and convenient [
]. It can be learned from
literature review that there are common ethics issues between
assistive walking devices and robots. Therefore, proper
framework can be formed to alleviate and solve the
ethical issues with the purpose of satisfying elderly’s needs.
Discussion and conclusion
It is evident that assistive walking devices and robots play
imperative role in senior citizens’ lives. These assistive
agents and devices have embedded themselves into human’s
daily tasks pervasively. It is obvious that robots increasingly
have been empowered; therefore, the action of robots might
have either destructive effect or useful impact on older
adults. In other words, the consequence of assistive robot
including walking device is far of significant concern rather
than its action. In this case, the concept of consequentialism
ethics theory can be applied in assistive walking devices and
autonomous agent framework. Moreover, the common
ethical issues of both assistive walking devices should be taken
into consideration to complete a proper ethics framework
which can be applied globally. In addition, a proper ethics
framework play beneficial role to promote elderly’s standard
of living, improve elderly’s satisfaction, compensate elderly’s
disabilities, whilst reducing burdens of expenses related to
healthcare services and centres.
Despite the considerable benefits from assistive devices, yet there are a
great number of ethical issues from elderly’s perspective that need to be
considered. The authors of this paper provide a review of ethics theories with
the purpose of considering the concept of related theories to form a proper
ethical framework to overcome current issues encountered by elderly. It is
believed that having clear understanding of ethical issues related to assistive
devices will assist to create proper ethical framework which can be applied
globally. This paper is written by Nazanin Mansouri, Seyed Ebrahim Hosseini,
and reviewed by Khaled Goher. All authors read and approved the final
The authors of this paper would like to thank Lincoln University in New
Zealand for offering the funding support for this publication.
The authors declare that they have no competing interests.
This research is originally funded by research grant from Lincoln University,
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
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