Principlism is the approach promoted by Beauchamp and Childress for addressing the ethics of medical practice. Instead of evaluating clinical decisions by means of full-scale theories from moral ...philosophy, Beauchamp and Childress refer people to four principles—of autonomy, beneficence, nonmaleficence, and justice. Now it is one thing for principlism to be invoked in an academic literature dwelling on a stock topic of medical ethical writing: end-of-life decisions, for example. It is another when the topic lies further from the mainstream. In such cases the cost of reaching for the familiar Beauchamp and Childress framework, with its formulaic set of concerns, may be to miss something morally important. After discussing an example of the sort of academic literature I have in mind, I propose to distinguish the uses of the formulaic from the uses of the more unapologetically theoretical in applied ethics, and to suggest that the latter can make up for some of the limitations of the former. This is not to say that the more theoretical literature has no limitations of its own, or that it should take the place of the formulaic. On the contrary, there is room in applied ethics and a use in applied ethics for both. But there is a sense in which there is a greater dependence of principlism on theory than the other way round, and at the end I try to spell out the significance of this fact.
IntroductionResearch to date into assisted living technologies broadly consists of 3 generations: technical design, experimental trials and qualitative studies of the patient experience. We describe ...a fourth-generation paradigm: studies of assisted living technologies in their organisational, social, political and policy context. Fourth-generation studies are necessarily organic and emergent; they view technology as part of a dynamic, networked and potentially unstable system. They use co-design methods to generate and stabilise local solutions, taking account of context.Methods and analysisSCALS (Studies in Co-creating Assisted Living Solutions) consists (currently) of 5 organisational case studies, each an English health or social care organisation striving to introduce technology-supported services to support independent living in people with health and/or social care needs. Treating these cases as complex systems, we seek to explore interdependencies, emergence and conflict. We employ a co-design approach informed by the principles of action research to help participating organisations establish, refine and evaluate their service. To that end, we are conducting in-depth ethnographic studies of people's experience of assisted living technologies (micro level), embedded in evolving organisational case studies that use interviews, ethnography and document analysis (meso level), and exploring the wider national and international context for assisted living technologies and policy (macro level). Data will be analysed using a sociotechnical framework developed from structuration theory.Ethics and disseminationResearch ethics approval for the first 4 case studies has been granted. An important outcome will be lessons learned from individual co-design case studies. We will document the studies’ credibility and rigour, and assess the transferability of findings to other settings while also recognising unique aspects of the contexts in which they were generated. Academic outputs will include a cross-case analysis and progress in theory and method of fourth-generation assisted living technology research. We will produce practical guidance for organisations, policymakers, designers and service users.
Sustaining independent living for elderly people in their own homes is desirable for various reasons. As older people become frail or disabled, a ‘gap’ appears between the abilities they still have ...and the abilities that are required for independent living. To a certain extent robots may close this gap by providing functionality lost through frailty or disability. A scenario was created involving a re-enablement coach robot. This scenario was discussed with older people, informal carers, and care professionals in focus groups in the Netherlands, United Kingdom and France. The results provided insights into the acceptability of robots and showed that older people were open to the idea of having a robot supporting them in their daily life. Participants were also willing to have a robot perform higher level coordinating tasks while playing the role of the re-enablement coach. However, participants wanted the robot to operate at the same level of intelligence as a human carer. This implies that more attention needs to be given to the development of the social skills and behaviour of such robots. Additionally, participants acknowledged that such a robot would create tension between respecting the autonomy of the user (i.e. robot obeys all commands given by the user) and the promotion of independence in the long term (i.e. robot is programmed to maintain the abilities the user still has). Our results indicate that people preferred to resolve this tension in favour of autonomy. This choice, however, may decrease the user’s abilities in the longer term and thereby undermine users’ ability to live independently.
... through there had never been any time, wherein particular men were in a condition of warre one against another; yet in all times, Kings, and Persons of Soveraigne authority, because of their ...Independency, are in continual jealousies, and in the state and posture of Gladiators; having their weapons pointing, and their eyes fixed on one another; that is, their Forts, Garrisons, and Guns upon the Frontiers of their Kingdomes; and continual Spyes upon their neighbours, which is a posture of War.
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