116 Just ordinAry robots
to be objects. On top of that, they foresee the possibility that senior
citizens may get the idea that they have less control over their lives
with care robots compared to just receiving care from human care-
givers. It has, however, been suggested that one of the advantages
of using care robots is that they do not have any “social baggage”
and they do not judge. Studies indicate that in some situations the
risk of dehumanization for the older user may decrease if they receive
robotic care instead of human help (Breazeal, 2011). Decker (2008),
however, foresees dehumanization of the care recipient with the use
of domotics, since the present technology is invisible and actions are
decentralized; this is in contrast to care robots, which directly interact
with the client.
With regard to the “dehumanization of the patient,” some authors
propose “mutual care” (see, e.g., Lammer, Huber, Weiss, & Vincze,
2014), which means giving the user simple opportunities to care for
the robot, thereby increasing the feeling of being part of a team and,
consequently, the acceptance of the robot’s help. is requires that the
robot is capable of asking the user for help in reciprocal dialogues. For
example, the robot could remind the user that the owers need water
and can apologize because it cannot do this task properly, but says it
would love to show the user which owers need water if the user would
like to accompany the robot. Research has suggested that mutual care
makes the care recipient feel needed and important, which creates a
sense of power and control, and that the care recipient does not con-
sider herself to be an object.
3.4.3.2 Quality of Care e ethical objection of “dehumanization of
the patient” is consistent with the idea that robots cannot provide
actual care. Decker (2008) also shows that the way people inter-
act with robots is important. He thinks robots should only be used
instrumentally. Coeckelbergh (2010) agrees with this and would
only deploy care robots for “routine care jobs.” ese are tasks in
which no emotional, intimate, or personal involvement is required.
e act of “care giving” itself is reserved for people. In this, ethi-
cists touch on an important basic question regarding care robots:
are robots able to provide care? Care is concern about the welfare of
people, entering into a relationship with them, dealing with their
discomforts, and nding a balance between what is good for that
117tAking CAre oF our PArents
person and whatever it is that they are asking for. Robots seem to
be the epitome of eective and ecient care: the ultimate ratio-
nalization of a concept that perhaps cannot be captured in sensors,
gures, and data. e use of care robots requires a vision of care
practice, and the discussion should be about what exactly we mean
by “care,” taking into consideration aspects such as reciprocity,
empathy, and warmth. e substantiation is that robots are devices
that cannot mimic empathic abilities and the reciprocity of humans
in care relationships. Human contact is often seen as crucial for the
provision of good care (Coeckelbergh, 2010). According to Sparrow
and Sparrow (2006), robots are unable to meet the emotional and
social needs that senior citizens have in relation to almost all aspects
of caring.
According to Borenstein and Pearson (2010), there is a clear and
expressly made choice to be made as to when robots should support
caregivers in their tasks: “robots have the potential to make caregiv-
ing a genuine choice” (p. 283). Caregivers can, for example, deploy
care robots for “routine care jobs” so that the caregiver can put more
eort into entering into a relationship with the care recipient. ey
see robots as technologies that facilitate the provision of care. Care
robots may relieve the caregivers’ workload and may expand the
freedom of caregivers to provide care, and thereby shed a dier-
ent light on the discussion of the care of senior citizens as well as
end-of-life care. Borenstein and Pearson give the following exam-
ple: Hardwig (1997) argues in defense of a duty to die, primarily
on the grounds that no individual has the right to impose signi-
cant burdens (e.g., emotional, social, or nancial) on his/her family
members. e duty to die concern might diminish signicantly if
robots ll decits in the caregiving, and caregivers can focus on care
tasks in which personal involvement is required. Borenstein and
Pearson also show us that we should be prepared for unexpected,
opposite shifts that will not lead to any time savings. is takes us
back to the point of Van Oost and Reed (2011): when reecting on
deploying care robots, one must not focus only on those persons
directly involved, but the entire socio-technical context must also
be examined. In addition, we should pay attention to a possible
shift in responsibilities and we must reect critically on the actual
time saved by the use of care robots.
118 Just ordinAry robots
3.4.3.3 Human Contact Sharkey and Sharkey (2012) nd that the
deployment of care robots will deprive elderly people of social inter-
action with their fellow humans and that as a consequence their
welfare will suer. e absence of human contact aects the physi-
cal as well as the psychological well-being of the elderly. Some
researchers believe that contact with care robots cannot compensate
for the lack of human contact. An objection to this could be that,
rather, the use of robots gives people the chance to live longer inde-
pendently without relying on the care of others. Take, for instance,
smart robot technologies that help to put on compression stockings
or that assist in showering or using the toilet. In this way, robots
provide an opportunity for a more dignied existence. Borenstein
and Pearson (2010) also see these benets: under certain conditions,
care robots may ensure that people with disabilities become more
independent. It is important, however, that the person in question
exerts control over the robot; this is in contrast to the control that
human caregivers often have over their patients. Parks (2010), how-
ever, notes that there is already isolation among older people living
both at home and in nursing homes and thinks that robots would
make things worse. e existing isolation is one reason for older
people to resist the use of robots. Visits by human caregivers are so
important that many older people prefer their help with shower-
ing and other hygiene-related needs even though this is something
many people would prefer not having another person do for them.
However, this is, according to Parks, often the only social contact
available to them.
3.5 Observational Conclusions: e Long Term
Robot developers have high expectations: in the long term, care robots
will take the workload away from caregivers. e scenario looms irre-
vocably of a nursing home or our own home full of smart devices and
machines that take care of us. Will this image of the future become
reality as aging reaches its peak in 2040? We are very doubtful that
this will happen.
e argument that robots can solve sta shortages in health care has
no hard evidence basis. Instead of replacing labor, the deployment of
care robots rather leads to a shift and redistribution of responsibilities
119tAking CAre oF our PArents
and tasks and forms new kinds of care. erefore, both in practice and
in the policy context, all innovation and deployment-of-care technol-
ogies should be reexamined. In most policy documents on domotics
(including robotics), cognitively able but physically not very capable
elderly people are the central client group (see, e.g., Department of
Health, 2010). Domotics might enable these people to continue to live
in their own home rather than in hospitals or residential care homes,
publicly funded ones in particular.
Care that depends signicantly on domotics is already a reality,
but the technology typically used is not robotic. In long-term care
practice, innovation proves to be a dicult matter (Berwick, 2003).
Moving from the laboratory to practice and from prototype to actual
production is a complicated process. Butter etal. (2008) note that a
lot of time is needed to implement important innovations in health
care. Also, in the eld of robotics, there are many skeptical voices that
can be heard coming from care practitioners, developers, and users. In
recent years, many initiatives have been started in Europe to integrate
robots into domotics, such as Mobiserv and KSERA, in which the
development of care robots for remote care plays a major role. Without
a commercial follow-up, however, budgets will diminish and tested
robot applications will fail to take root in practice, especially because
the stage of development in the eld of care robotics is still too far
from practical application with “real patients” (Butter etal., 2008),
and because of the complexity of caregiving tasks related to the frame
problem (see Section 2.2). Because of the high costs of care robotics,
this might also lead, in practical application in the future, to unfair
access to the care robots (Datteri & Tamburrini, 2009).
Robots can, however, add to the potential benets of domotics.
A common benet is that a robot—because of its embodiment—has
“presence”: it is there with the older person (Sorell & Draper, 2014).
is presence enables a robot to provide companionship to the elderly
and to move around with them, to prompt them to undertake bene-
cial behaviors, to communicate through a touchscreen, to react to the
elderly person’s commands, and so on.
e question is, however, what role might robots have in the future
care of the elderly at home? Robots can play dierent roles: compan-
ion, cognitive assistant, and caregiver. ese roles, nowadays reserved
for human beings, are rationalized so that they can be performed
120 Just ordinAry robots
by robots. is requires a vision of care, and the role is taken up by
robotics for this purpose. As we have seen, the rationalization of care
by the deployment of care robots gives rise to several ethical issues
depending on the kind of role a robot has. A robot as companion can
lead to misleading relationships, and the risk of paternalism comes
into play with a robot as cognitive assistant in terms of the extent to
which a robot may enforce actions. e use of robots as caregivers
raises social issues relating to the human dignity of the care recipient
(Sharkey, 2014). rough the use of these robots, care recipients could
be dehumanized.
Another important drawback, related to dehumanization, put for-
ward by ethicists is the expected reduction in human contact caused
by the use of domotics, and especially caused by the use of care robots.
Care recipients will no longer have direct contact with human care-
givers, but will instead have contact via devices or remotely, mediated
by technology. e question underlying all of this is: how much right
has a care recipient to receive real human contact? Or, to put it more
bluntly, how many minutes of real human contact is a care recipient
entitled to receive each day? It is important to observe the choice of
the care recipient. Some people might prefer a human caregiver, while
others may prefer support robots, depending on which one gives them
a greater sense of self-worth. Robots can thus be used to make people
more independent or to motivate them to go out more often. us,
the elderly may, for example, keep up their social contacts as they can
go outside independently with the help of robots; robots here are used
as technology to combat loneliness. Or, when deploying robots that
assist people when showering or going to the toilet, the robots are the
key to independence. Again, the manner in which robots are deployed
and the tasks they carry out are both of crucial importance. e more
control the care recipient has over the robot, the less likely he or she is
to feel objectied by the care robot.
e use of tele-technologies and robotics should therefore be tailor-
made but should not lose sight of the needs of care recipients. Too
little attention is currently paid to these needs and the expectations
that exist in relation to long-term care. One of the main conclusions
for designers of care robots is that they should consider elderly peo-
ple not only as recipients of care but also as users whose needs have
to be carefully identied and who should actively participate in the
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