The Ethics of Telecare Provision

1. The Ethics of Telecare Provision Jeanette Munn Resource Manager Extra Care & Telecare Carmarthenshire County Council

2. 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

3. 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

4. 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 individual’s needs

5. 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.

6. 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)

7. 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

8. 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

9. 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 person’s rights and freedom of action.

10. 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 person’s freedom in order to achieve the desired benefit

11. 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

12. 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

13. 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

14. 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)

15. Thank you for taking part Jeanette Munn Email JMunn@carmarthenshire.gov.uk Tel: 01558 825395