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Saturday, June 1, 2013

Bioethics and eHealth - for example - Telecare, Surveillance, and the Welfare State

Key stakeholders in the project management of an eHealth project include, clinicians, nurses, software engineers, Senior Management, Project Manager, statistician, healthcare administration, etc. But often I think a key player that should be added more to the list is a Bioethicist.  This article from the American Journal of Bioethics - Telecare, Surveillance and the Welfare State - is  illustrative about why a bioethicists on the team may be essential. Unless you have some sort of institutional access you might not be able to read the whole article. In this article, the Bioethicists argue the pros and cons of surveillance technology for the elderly who are being monitored in their homes for their chronic health conditions. The authors come out in favour of the surveillance technology - it is not Big Brother - but it all depends on how a chronic a condition a senior might have. Anyway, I value the point of view(s) of bioethicists because they tend to see healthcare differently from front line workers and administrators.

Here is the abstract:

 2012;12(9):36-44. doi: 10.1080/15265161.2012.699137.

Telecare, surveillance, and the welfare state.


University of Birmingham, UK. t.sorell@bham.ac.uk


In Europe, telecare is the use of remote monitoring technology to enable vulnerable people to live independently in their own homes. The technology includes electronic tags and sensors that transmit information about the user's location and patterns of behavior in the user's home to an external hub, where it can trigger an intervention in an emergency. Telecare users in the United Kingdom sometimes report their unease about being monitored by a "Big Brother," and the same kind of electronic tags that alert telecare hubs to the movements of someone with dementia who is "wandering" are worn by terrorist suspects who have been placed under house arrest. For these and other reasons, such as ordinary privacy concerns, telecare is sometimes regarded as an objectionable extension of a "surveillance state." In this article, we defend the use of telecare against the charge that it is Orwellian. In the United States, the conception of telecare primarily as telemedicine, and the fact that it is not typically a government responsibility, make a supposed connection with a surveillance state even more doubtful than in Europe. The main objection, we argue, to telecare is not its intrusiveness, but the danger of its deepening the isolation of those who use it. There are ways of organizing telecare so that the independence and privacy of users are enhanced, but personal isolation may be harder to address. As telecare is a means of reducing the cost of publicly provided social and health care, and the need to reduce public spending is growing, the correlative problem of isolation must be addressed alongside the goal of promoting independence.