How Can Ethics Support Innovative Health Care for an Aging Population?

Abstract

The rapidly expanding aging population presents an urgent global challenge cutting through just about every dimension of worldly life, including the social, political, cultural, and economic. Developing innovations in health and assistive technology (AT) are poised to support effective and sustainable health care in the face of this challenge, yet there is scant (but growing) discussion of the ethical issues surrounding AT for older persons with dementia. Demands for ethical frameworks that can respond to frontline dilemmas regarding AT development and provision, and how the needs of aging persons themselves are defined throughout this development process, are increasing. This article suggests that fulfilling the promises of AT to provide effective and ethically informed solutions may demand shifting away from standard bioethical analyses that centralize the principle of respect for autonomy. An autonomy-centric paradigm is dubiously equipped to theorize the foundational ethical issues in dementia care and to effectively guide AT development and implementation. An agency-centered approach to dementia care, which could engage more adaptively with the perspectives and choices of older persons themselves while offering strong support to AT research and stakeholders, may offer an attractive alternative.

Keywords:

• autonomy
• agency
• assistive technology
• bioethics
• dementia

Acknowledgments

Katherine Wayne gratefully acknowledges financial support from AGE-WELL NCE and the Centre for Health Law, Policy and Ethics at the University of Ottawa. The author takes full responsibility for the claims in this article, but the work has benefited from feedback provided by many individuals as well as group discussion in a variety of settings. These include AGE-WELL meetings; the University of Ottawa’s Centre for Health Law, Policy and Ethics Symposium and Seminar Series; Queen’s University’s Department of Philosophy Colloquium Series; and the Canadian Bioethics Society’s Annual Meeting. The author would like to thank the individuals who provided helpful comments on and support for this work during her time at the University of Ottawa, including Jerome Bickenbach, Hajer Chalghoumi, Jennifer Chandler, Deirdre DeJean, Patrick Fafard, Colleen Flood, Linda Garcia, François Hudon, Jeffrey Jutai, Ian Kerr, and Michael Wolfson. In addition, Guy Scotton provided invaluable editing and formatting assistance. Finally, the author thanks the journal’s reviewers, who offered thoughtful and detailed comments that helped improve the work.

Additional information

Funding

This work was supported by the University of Ottawa’s Centre for Health Law, Policy and Ethics, and AGE-WELL NCE.