Keeping Tabs on Mom
The Ethics of Motion Sensor-Based Monitoring of the Elderly
You are a career woman and loving mother, trying to meet the constant demands of raising your teenage children and maintaining your thriving, full-time career. To make matters worse, your mother—who lives fifty miles away from you—is aging quickly and alone. Your mother is exhibiting the early signs of dementia, and while she is physically able to care for herself, she is becoming increasingly weak. You have thought of moving her into a nursing home, but you are reluctant. You know your mother would never leave her own home willingly and you fear that “forcing” her into a nursing home would just precipitate her decline. You’ve thought of having visiting nurses come to your mother’s home, but you learn that your mother is not eligible for complete reimbursement for home nursing care. Your financial resources are few and your energy and time are exhausted. You’re constantly wracked by feeling of wanting to do more.
You read a newspaper article about CheckUp*, a motion-sensor based technology that can be used at home to collect information about someone’s mobility, toilet use, sleeping and eating habits. CheckUp transfers this information to designated caregivers via emails and text messages. You research the technology further as a means to “discreetly monitor” your mother’s whereabouts and safety from a distance. Through Web research, you learn that motion sensors are strategically placed inside cabinets, refrigerators, front doors, bedrooms, and bathrooms to derive information about eating, sleeping, and leaving/returning home habits. These motion sensor-based monitoring technologies detect changes in normal behavioral patterns using statistical algorithms that analyze Activities of Daily Living (ADLs) including sleep behaviors, bathroom use, meal preparation, leaving/returning home, and deviations from them. You think, “This is it! This technology can record Mom’s behaviors and gather important health information and keep her safe. I will know as soon as something is wrong with Mom. This will give us peace of mind … finally.”
Motion-sensor based technologies seem to be the very thing you need. But is CheckUp the godsend you're hoping for? Here are some practical and ethical issues to consider with your mother before you decide whether the technology is right for you.
- Make sure you and your mother understand the limitations of the technology. It alone will not keep her safe. Here are some of the limitations:
- Motion-sensor based technology can only record the time your mother spends in a certain area; it cannot tell you what she’s doing. She may open the refrigerator without ever eating or be lost by the time you realize that she has not returned home according to her usual pattern.
- The information is only provided to designated caregiver, which usually does not include health care professionals or emergency providers.
- Motion-sensor based technology cannot directly assist your mother in any way.
- Check to see if the technology has customization features. This will allow it to be geared towards your mother’s specific needs.
- Make sure it has opt-out features that will allow you or your mother to discontinue its use easily.
- Consider the possibility of using the technology for a trial period. If it doesn’t work as expected or if doesn’t meet your mother’s needs and expectations, you can change your mind.
Autonomy: The ability to choose one’s own life goals is an important principle in Western medical ethics. Motion-sensor based technologies interfere with autonomy to the extent that they invade your mom’s privacy. But they may also support autonomy by allowing her to stay in her home and retain her independence. Autonomy concerns are best addressed by involving her in decision making about whether and how to install the monitors. Tell her why you're concerned and what the technology does—and seek her consent, at least for a trial run. If your mother understands the purpose of the technology and freely agrees, then she has voluntarily given up some privacy in consideration of retaining her independence.
Beneficence: In a medical context, beneficence means taking actions that benefit the patient. Where your mother is concerned, the beneficent approach may be to take actions to ensure her safety. That might well include the installation of monitors. In situations where aging parents pose a threat to themselves or others, beneficence and autonomy may be in conflict. Your mom may resist monitoring even though it might keep her safer. In that case, you could initiate a conversation with your mother, other family members, and health care professionals on how to balance the obtrusiveness of the monitors against the threat of harm to your mom. Even people suffering from mild cognitive impairments can at least participate in discussing issues that will affect their lives.
*CheckUp is a fictitious company representing currently available motion sensor-based products for monitoring.
Courtenay Bruce is the former assistant director of health care ethics at the Markkula Center for Applied Ethics, where she did the research for this piece and an article on motion sensor-based monitoring for The Gerontologist, "Informed Decision Making for In-home Use of Motion Sensor-based Monitoring Technologies," Nov.4, 2011.