The Ethics of Telecare Provision

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The Ethics of Telecare Provision

• Jeanette Munn
• Resource Manager Extra Care Telecare
• Carmarthenshire County Council

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Ethical conflicts that arise may depend on

• The purpose for which technology is introduced
• Degree of involvement of the person, especially
  where their capacity or judgement may be limited
  
• Degree of involvement of significant others,
  including family, friends, neighbours and
  professional care staff
• Effect on the person

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Ethical issues

• Big Brother
• Using and sharing information
• Confidentiality
• Informed consent
• Surveillance and possible loss of privacy and
  autonomy
• Should be used within the context of an overall
  care plan to support independence
• Should not be used to control problem behaviour
• Should not lead to increased isolation or
  unacceptable reduction in staffing support
• Balance between risk and safety
• Appropriate response protocols

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Technologies

• All technologies have the potential for abuse
• The person should always have his or her rights
  protected
• Identify the potential benefits for the
  individual
• Technology should never stigmatise the individual
• Technology should never replace direct human
  contact
• Should never be used as a substitute for
  effective care
• Any technology used should be an appropriate
  response to the risk identified and tailored to
  the individuals needs

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Researchers use the following set of principles
to guide their work

• Autonomy enabling people to live full lives in
  the same way as they did before, this may be more
  about promoting continuity of self rather than
  about making decisions. This should include
  informed consent, which needs to be voluntary,
  competent and include sufficient information.
  Carers may need to help/guide in this process.
• Beneficence involves finding the balance between
  risk tolerance and risk aversion. There may be a
  dilemma between beneficence and safety
  independence.

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Researchers use the following set of principles
to guide their work

• Non-maleficence will involve a balance between
  avoiding harm and respecting decisions, dignity,
  integrity and preferences.
• Justice treating fairly and respecting rights,
  including what the Mental Capacity Act calls
  making eccentric or unwise decisions. (Mental
  Capacity Act, 2005)

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Mental Capacity Act 2005

• The underlying philosophy of the Act is to
  ensure that any decision made, or action taken,
  on behalf of someone who lacks the capacity to
  make the decision or act for themselves is made
  in their best interests

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The five statutory principles are

• A person must be assumed to have capacity unless
  it is established that they lack capacity
• A person is not to be treated as unable to make a
  decision unless all practicable steps to help him
  to do so have been taken without success
• A person is not to be treated as unable to make a
  decision merely because he makes an unwise
  decision

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• An act done, or decision made, under this Act for
  or on behalf of a person who lacks capacity must
  be done, or made, in his best interests
• Before the act is done, or the decision is made,
  regard must be had to whether the purpose for
  which it is needed can be as effectively achieved
  in a way that is less restrictive of the persons
  rights and freedom of action.

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Principles of the Adults with Incapacity

• The intervention must be of benefit to the
  individual that cannot be otherwise achieved
• The intervention must be the least restrictive in
  relation to the persons freedom in order to
  achieve the desired benefit

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• Interventions should take account of the past and
  present wishes of the adult
• Interventions take account of the views of
  relevant other parties, in so far as is
  reasonable and practical
• Interventions should encourage the adult to use
  existing skills and develop new skills

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Good Practice Checklist

• Consider causes
• Assess the risk
• Consider alternatives to technology
• Identify if technology is available and
  appropriate
• Ascertain views of individual, relatives, care
  team, etc
• Consider ethical implications, the benefits and
  disadvantages of the technology

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• Consider legal implications for individual
  concerned, particularly in relation to the Mental
  Capacity Act 2005 and Data Protection Act
• Formulate individual care plan
• Ensure all staff and involved relatives
  understand care plan
• Monitor
• Review

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Bibliography

• Mental Capacity Act 2005 Code of Practice
  (Department for Constitutional Affairs)
• Independence, choice and risk a guide to best
  practice in supported decision making (Department
  of Health)
• Rights, risks and limits to freedom (Mental
  Welfare Commission for Scotland)
• Safe To Wander (Mental Welfare Commission for
  Scotland)
• Planning and Development Accessing Assisted
  Living Technology (North Lanarkshire Council)
• Fact sheet Telecare and ethics (Care Services
  Improvement Partnership)
• Telecare Using Information and Communication
  Technology to Support Independent Living by
  Older, Disabled and Vulnerable People (Report
  prepared by Dr. R. G. Curry, Mrs M. Trejo Tinoco
  Mr D. Wardle)
• Legal and ethical aspects of telemedicine
  (Benedict Stanberry Avienda Limited Journal of
  Telemedicine and Telecare 2005 - 35)

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Thank you for taking part

• Jeanette Munn
• Email JMunn_at_carmarthenshire.gov.uk
• Tel [phone]