Ethics and assistive technology: what are we missing?

The global need for assistive technology is high. The Global Report on Assistive Technology acknowledges that 1 in 10 people in the world need assistive products, rising as high as 1 in 3 when eyeglasses or spectacles are included (World Health Organization, 2022). The reality is that most of us – globally – will require assistive technology at some point in our lifespan. Assistive technology is therefore an issue which quite literally affects us all.

With this in mind, and considering the acknowledgment that access to assistive technology is a right and a means to access and realize other rights (Smith et al., 2022), it is interesting to note that as a field, we rarely discuss issues related to ethics when it comes to AT.

The consideration of ethics in assistive technology has far-reaching implications. If we consider the WHO GATE 5P framework, there are ethical implications at every level. When we consider people, there is an ethical imperative to promote and support the autonomy of people who use assistive products in the development of those products, the policies and systems which govern access to them, and the provision systems which we use to deliver them. We’ve discussed some of these issues before in relation to the engagement of AT users in AT research and development (Koontz et al., 2022).

Similarly, there are ethical considerations in terms of the personnel who are responsible for AT delivery – in the adequacy of their training, their knowledge and scope of practice, and their professional behaviors in the service delivery process. This is one area where we do acknowledge the role of ethics, often through Codes of Ethics and Standards of Practice (RESNA, 2022); however, we rarely delve into the highly complex issues of clinical decision-making, client-centered practice, and the interpersonal nature of assistive technology provision.

Ethics are no less important in the area of policy – issues of distributive justice are particularly relevant when considering how assistive products are procured and provided to the people who need them, and the financing mechanisms and policies which govern that access. We are beginning to see more work in the area of access to assistive technology in both higher- (Durocher et al., 2017) and lower-resourced environments (Matter & Eide, 2018), however addressing the ethical concerns about who has access to appropriate assistive products, and importantly – who does not – is largely missing from the literature.

The same is true for provision systems – while most would likely agree that we must consider the ethical issues of how provision systems engage and inform assistive technology users, the processes in place to provide products and services, and how we evaluate outcomes of assistive product use and provision (Layton et al., 2022), we rarely see these discussions in the literature.

Ethical issues are also significant in the consideration of the products themselves – who is involved in assistive product development, the research conducted to develop and evaluate products, the way in which products interact with the user and with the world around them, and the implications of the use of emerging technologies as AT (Smith et al., 2023). While we are quick to demonstrate the benefits of assistive products, we are less inclined to discuss where assistive products may actually cause harm.

For the uninitiated, ethics can be a challenging point of discussion. The issues and questions raised are rarely easy to answer, and in most cases do not have a clear ethical outcome. Addressing ethical challenges is a push and pull of supporting autonomy while promoting benefit to the AT user, ensuring we do no harm, and ensuring we are equitable in our distribution of both products and services. Addressing ethical challenges means reimagining the way we work, the policies we are beholden to, and products we use and promote. As with all of our work, ensuring the assistive technology user is at the center of – and a part of – the discussion is paramount.

The Assistive Technology Journal is committed to advancing the conversation on ethical issues in assistive technology. While the Assistive Technology Journal adheres to ICJME recommendations for ethical standards in the conduct and reporting of research, we also encourage authors to go beyond these more procedural aspects, and consider a range of ethical issues in their work. We also encourage authors to consider submitting to our Ethical Considerations section, where we invite explorations of ethical considerations in the development or application of assistive technology products, services, and systems.