The elderly in the digital era with Marcello Ienca

Marcello Ienca is a philosopher cognitive scientist and bioethicist by training who works at the interface between information technology (especially Artificial Intelligence), the life sciences and society. He is also a senior researcher at the Health Ethics & Policy Lab, Department of Health Sciences and Technology at ETH Zurich, Switzerland.

His research focuses primarily on the ethical implications of new and emerging digital trends in science and medicine such as neurotechnology, big data, assistive robots and digital epidemiology. “Advances in AI (especially emotional intelligence and affective computing) could enable machines to effectively perform even these more cognitively and emotionally complex tasks. But today we are still a long way off”, he says.

Following your opinion, what can we learn from the COVID19 pandemic so far?

Many things. We have learned that humanity is still too unprepared to deal with natural risks such as epidemics, and that we do not have an effective system of risk prevention and management. Furthermore, we have learned that human beings are, as Aristotle already said, social animals and therefore find it difficult to practice social distancing (especially for a prolonged period). Our hardwired brain mechanisms make pandemic containment even more difficult, especially in the absence of credible international political leadership as is happening today. Finally, we have learned that we are all, none excluded, profoundly vulnerable.

Up to now, elderly people are the worst hit by the COVD19 pandemic. Are we taking proper care of them?

The Sars-Cov2 virus, like many others, is much more aggressive when it infects people in the older demographic segment. This is a biological fact. However, in many cases and in many countries we have failed to adequately protect these more vulnerable segments of the population. In particular, in elderly care homes the infection has often got out of control.

What lies behind, is an ethical issue within the capitalist society?

Asking what lies behind a situation, event or natural phenomenon is a reasonable question for both ethics and science. Complex phenomena often have complex cause which require systematic analysis. When asking such questions, scientists and philosophers are trained to prefer complex answers that are true over simple answers that are false. The problem is that most people prefer simple answers that are false over complex answers that are true. Even worse, conspiracy theorists prefer complex answers that are false over simple answers that are true. And this creates a lot of trouble in our society.

How can digital public health technologies improve elderly care (in countries with the capacity to implement them)?

Today older people make less use of digital devices than younger people. This means that any public health campaign based exclusively on digital devices will risk discriminating against older people, at least during the present and the next generation.

However, digital public health can already help older people in a variety of ways. Data-driven approaches to scientific discovery can help scientists solve the pathological conundrum of some currently uncurable age-related disorders such as Alzheimer’s disease.

Digital epidemiology strategies can help us increase the protection of older people during epidemics. Pervasive computing and sensor technology can increase the safety of older people living at home. Care robots and other intelligent assistive technologies are increasingly used to support older patients both in institutional and domestic settings. The problem is that many of these digital technologies are expensive. Therefore, it is important to develop inclusive strategies that can ensure a fair access to and distribution of the benefits of digital public health technologies.

Following the WHO and the UN, in 2050 there will be 164 million people over 65 in Europe, and globally the number of people older than 60 years is expected to be higher than the number of people younger than 15. This brings an increased need for health care services, but the number of people available to provide and finance these services is decreasing. What's the potential of robots to play a role in elder care facilities and hospitals?

If current trends continue linearly, very soon there will not be enough young people able to support the older population.

In some countries this is already a concrete problem. Robots can mitigate this gap and even enhance our care capabilities for the elderly population. Already today, assistive robots can perform physically demanding tasks such as helping the elderly patient to sit, stand up or be transported from one place to another. In this way robots can reduce the physical effort of health professionals, and give them more time to devote to operations that require empathic exchange such as communication or psychological support. In the distant future, advances in artificial intelligence (especially emotional intelligence and affective computing) could enable machines to effectively perform even these more cognitively and emotionally complex tasks. But today we are still a long way off.

Can robots and AI provide new ways of taking care of the elderly?

Possibly. Robots do not necessarily have to simulate how people are cared for by fellow humans, but it is plausible that they may one day allow for new ways of care. The use of AI for predictive purposes is already enabling the optimisation of care resources in a more efficient way. The use of assistive technologies for personal use can allow the elderly person to maintain greater autonomy and independence during their ageing trajectory. An older person who knows how to effectively use digital communication devices may suffer less from the social isolation typical of the old age. It is important to remember, however, that today all these technologies are only able to integrate but not replace human care.

Which are the ethical challenges of robot and AI powered elderly care?

The most pressing ethical issue is that many, too many older people in the world do not have access to adequate care. Any strategy to mitigate this problem, including robots, is inherently ethical.

However, we need to be aware that when we apply digital technologies to the care of older people, then all ethical issues of digital technologies (e.g. privacy issues, surveillance, bias, manipulation, misuse, etc.) also have a direct impact on this vulnerable segment of the population. Therefore, we must invest resources in the ethical design of these technologies and put the patient at the centre of this dynamic of innovation.