Emotional Labor and the Problem of Exploitation in Roboticized Care Practices: Enriching the Framework of Care Centred Value Sensitive Design.

Care ethics has been advanced as a suitable framework for evaluating the ethical significance of assistive robotics. One of the most prominent care ethical contributions to the ethical assessment of assistive robots comes through the work of Aimee Van Wynsberghe, who has developed the Care-Centred Value-Sensitive Design framework (CCVSD) in order to incorporate care values into the design of assistive robots. Building upon the care ethics work of Joan Tronto, CCVSD has been able to highlight a number of ways in which care practices can undergo significant ethical transformations upon the introduction of assistive robots. In this paper, we too build upon the work of Tronto in an effort to enrich the CCVSD framework. Combining insights from Tronto's work with the sociological concept of emotional labor, we argue that CCVSD remains underdeveloped with respect to the impact robots may have on the emotional labor required by paid care workers. Emotional labor consists of the managing of emotions and of emotional bonding, both of which signify a demanding yet potentially fulfilling dimension of paid care work. Because of the conditions in which care labor is performed nowadays, emotional labor is also susceptible to exploitation. While CCVSD can acknowledge some manifestations of unrecognized emotional labor in care delivery, it remains limited in capturing the structural conditions that fuel this vulnerability to exploitation. We propose that the idea of privileged irresponsibility, coined by Tronto, helps to understand how the exploitation of emotional labor can be prone to happen in roboticized care practices.

Investigating Employees' Concerns and Wishes Regarding Digital Stress Management Interventions With Value Sensitive Design: Mixed Methods Study.

BACKGROUND: Work stress places a heavy economic and disease burden on society. Recent technological advances include digital health interventions for helping employees prevent and manage their stress at work effectively. Although such digital solutions come with an array of ethical risks, especially if they involve biomedical big data, the incorporation of employees' values in their design and deployment has been widely overlooked. OBJECTIVE: To bridge this gap, we used the value sensitive design (VSD) framework to identify relevant values concerning a digital stress management intervention (dSMI) at the workplace, assess how users comprehend these values, and derive specific requirements for an ethics-informed design of dSMIs. VSD is a theoretically grounded framework that front-loads ethics by accounting for values throughout the design process of a technology. METHODS: We conducted a literature search to identify relevant values of dSMIs at the workplace. To understand how potential users comprehend these values and derive design requirements, we conducted a web-based study that contained closed and open questions with employees of a Swiss company, allowing both quantitative and qualitative analyses. RESULTS: The values health and well-being, privacy, autonomy, accountability, and identity were identified through our literature search. Statistical analysis of 170 responses from the web-based study revealed that the intention to use and perceived usefulness of a dSMI were moderate to high. Employees' moderate to high health and well-being concerns included worries that a dSMI would not be effective or would even amplify their stress levels. Privacy concerns were also rated on the higher end of the score range, whereas concerns regarding autonomy, accountability, and identity were rated lower. Moreover, a personalized dSMI with a monitoring system involving a machine learning-based analysis of data led to significantly higher privacy (P=.009) and accountability concerns (P=.04) than a dSMI without a monitoring system. In addition, integrability, user-friendliness, and digital independence emerged as novel values from the qualitative analysis of 85 text responses. CONCLUSIONS: Although most surveyed employees were willing to use a dSMI at the workplace, there were considerable health and well-being concerns with regard to effectiveness and problem perpetuation. For a minority of employees who value digital independence, a nondigital offer might be more suitable. In terms of the type of dSMI, privacy and accountability concerns must be particularly well addressed if a machine learning-based monitoring component is included. To help mitigate these concerns, we propose specific requirements to support the VSD of a dSMI at the workplace. The results of this work and our research protocol will inform future research on VSD-based interventions and further advance the integration of ethics in digital health.

Reflections on Putting AI Ethics into Practice: How Three AI Ethics Approaches Conceptualize Theory and Practice.

Critics currently argue that applied ethics approaches to artificial intelligence (AI) are too principles-oriented and entail a theory-practice gap. Several applied ethical approaches try to prevent such a gap by conceptually translating ethical theory into practice. In this article, we explore how the currently most prominent approaches of AI ethics translate ethics into practice. Therefore, we examine three approaches to applied AI ethics: the embedded ethics approach, the ethically aligned approach, and the Value Sensitive Design (VSD) approach. We analyze each of these three approaches by asking how they understand and conceptualize theory and practice. We outline the conceptual strengths as well as their shortcomings: an embedded ethics approach is context-oriented but risks being biased by it; ethically aligned approaches are principles-oriented but lack justification theories to deal with trade-offs between competing principles; and the interdisciplinary Value Sensitive Design approach is based on stakeholder values but needs linkage to political, legal, or social governance aspects. Against this background, we develop a meta-framework for applied AI ethics conceptions with three dimensions. Based on critical theory, we suggest these dimensions as starting points to critically reflect on the conceptualization of theory and practice. We claim, first, that the inclusion of the dimension of affects and emotions in the ethical decision-making process stimulates reflections on vulnerabilities, experiences of disregard, and marginalization already within the AI development process. Second, we derive from our analysis that considering the dimension of justifying normative background theories provides both standards and criteria as well as guidance for prioritizing or evaluating competing principles in cases of conflict. Third, we argue that reflecting the governance dimension in ethical decision-making is an important factor to reveal power structures as well as to realize ethical AI and its application because this dimension seeks to combine social, legal, technical, and political concerns. This meta-framework can thus serve as a reflective tool for understanding, mapping, and assessing the theory-practice conceptualizations within AI ethics approaches to address and overcome their blind spots.

Exploring the Impact of Tensions in Stakeholder Norms on Designing for Value Change: The Case of Biosafety in Industrial Biotechnology.

Synthetic biologists design and engineer organisms for a better and more sustainable future. While the manifold prospects are encouraging, concerns about the uncertain risks of genome editing affect public opinion as well as local regulations. As a consequence, biosafety and associated concepts, such as the Safe-by-design framework and genetic safeguard technologies, have gained notoriety and occupy a central position in the conversation about genetically modified organisms. Yet, as regulatory interest and academic research in genetic safeguard technologies advance, the implementation in industrial biotechnology, a sector that is already employing engineered microorganisms, lags behind. The main goal of this work is to explore the utilization of genetic safeguard technologies for designing biosafety in industrial biotechnology. Based on our results, we posit that biosafety is a case of a changing value, by means of further specification of how to realize biosafety. Our investigation is inspired by the Value Sensitive Design framework, to investigate scientific and technological choices in their appropriate social context. Our findings discuss stakeholder norms for biosafety, reasonings about genetic safeguards, and how these impact the practice of designing for biosafety. We show that tensions between stakeholders occur at the level of norms, and that prior stakeholder alignment is crucial for value specification to happen in practice. Finally, we elaborate in different reasonings about genetic safeguards for biosafety and conclude that, in absence of a common multi-stakeholder effort, the differences in informal biosafety norms and the disparity in biosafety thinking could end up leading to design requirements for compliance instead of for safety.

Stepwise Design and Evaluation of a Values-Oriented Ambient Intelligence Healthcare Monitoring Platform.

OBJECTIVES: The majority of all developed digital health technologies do not reach successful implementation. A discrepancy among technology design, the context of use, and user needs and values is identified as the main reason for this failure. Value-sensitive design (VSD) is a design method enabling to align design with user values by embedding values in technology, yet the method is lacking clear heuristics for practical application. To improve the successful design and implementation of digital health, we propose and evaluate a stepwise approach to VSD. METHODS: The approach consists of the phases: experiment, demonstrate, and validate. Experiment takes place in an office to create makeshift solutions. Demonstrate takes place in a mock-up environment and aims to optimize design requirements through user feedback. The validate phase takes place in an authentic care situation and studies how the novel technology affects current workflows. RESULTS: We applied the stepwise VSD approach to the design of a hospital-based ambient intelligence solution for remotely and continuously monitoring quality and safety of patient care. We particularly focused on embodiment of the values of safety, privacy, and inclusiveness in the design. Design activities of the experiment and demonstrate phase are discussed. CONCLUSIONS: A stepwise approach to VSD enables a design to optimally meet the values of all users involved, while aligning the design process with the practical limitations of healthcare institutions. We discuss some benefits and challenges related to VSD and the potential for transfer of this approach to other digital health solutions.

The Limitations of User-and Human-Centered Design in an eHealth Context and How to Move Beyond Them.

Human-centered design (HCD) is widely regarded as the best design approach for creating eHealth innovations that align with end users' needs, wishes, and context and has the potential to impact health care. However, critical reflections on applying HCD within the context of eHealth are lacking. Applying a critical eye to the use of HCD approaches within eHealth, we present and discuss 9 limitations that the current practices of HCD in eHealth innovation often carry. The limitations identified range from limited reach and bias to narrow contextual and temporal focus. Design teams should carefully consider if, how, and when they should involve end users and other stakeholders in the design process and how they can combine their insights with existing knowledge and design skills. Finally, we discuss how a more critical perspective on using HCD in eHealth innovation can move the field forward and offer 3 directions of inspiration to improve our design practices: value-sensitive design, citizen science, and more-than-human design. Although value-sensitive design approaches offer a solution to some of the biased or limited views of traditional HCD approaches, combining a citizen science approach with design inspiration and imagining new futures could widen our view on eHealth innovation. Finally, a more-than-human design approach will allow eHealth solutions to care for both people and the environment. These directions can be seen as starting points that invite and support the field of eHealth innovation to do better and to try and develop more inclusive, fair, and valuable eHealth innovations that will have an impact on health and care.

Ethical Issues of Digital Twins for Personalized Health Care Service: Preliminary Mapping Study.

BACKGROUND: The concept of digital twins has great potential for transforming the existing health care system by making it more personalized. As a convergence of health care, artificial intelligence, and information and communication technologies, personalized health care services that are developed under the concept of digital twins raise a myriad of ethical issues. Although some of the ethical issues are known to researchers working on digital health and personalized medicine, currently, there is no comprehensive review that maps the major ethical risks of digital twins for personalized health care services. OBJECTIVE: This study aims to fill the research gap by identifying the major ethical risks of digital twins for personalized health care services. We first propose a working definition for digital twins for personalized health care services to facilitate future discussions on the ethical issues related to these emerging digital health services. We then develop a process-oriented ethical map to identify the major ethical risks in each of the different data processing phases. METHODS: We resorted to the literature on eHealth, personalized medicine, precision medicine, and information engineering to identify potential issues and developed a process-oriented ethical map to structure the inquiry in a more systematic way. The ethical map allows us to see how each of the major ethical concerns emerges during the process of transforming raw data into valuable information. Developers of a digital twin for personalized health care service may use this map to identify ethical risks during the development stage in a more systematic way and can proactively address them. RESULTS: This paper provides a working definition of digital twins for personalized health care services by identifying 3 features that distinguish the new application from other eHealth services. On the basis of the working definition, this paper further layouts 10 major operational problems and the corresponding ethical risks. CONCLUSIONS: It is challenging to address all the major ethical risks that a digital twin for a personalized health care service might encounter proactively without a conceptual map at hand. The process-oriented ethical map we propose here can assist the developers of digital twins for personalized health care services in analyzing ethical risks in a more systematic manner.

Parity and the Resolution of Value Conflicts in Design.

Recent developments in theories for responsible innovation have focused on the importance of actively accounting for values in our technological designs. Leading among these theories is that of Value Sensitive Design (VSD) which attempts to guide the design process on the basis of evaluative analysis. However, values often come into conflict and VSD has been criticized for not providing a proper method to resolve such inevitable conflicts. This paper examines three such methods and argues that although each has its merits, they all fail to account for a common source of value conflicts known as value incommensurability. Drawing on literature from the field of axiology, this paper argues that by incorporating the evaluative relation of 'parity' each of these three methods, and the VSD framework in general, will be able to properly understand the relation which holds between conflicting design options stemming from the incommensurable of values and be able to guide designers in making rational decision in the face of such conflicts.

A Value Sensitive Scenario Planning Method for Adaptation to Uncertain Future Sea Level Rise.

Value sensitive design (VSD) aims at creating better technology based on social and ethical values. However, VSD has not been applied to long-term and uncertain future developments, such as societal planning for climate change. This paper describes a new method that combines elements from VSD with scenario planning. The method was developed for and applied to a case study of adaptation to sea level rise (SLR) in southern Sweden in a series of workshops. The participants of the workshops found that the method provided a framework for discussing long-term planning, enabled identification of essential values, challenged established planning practices, helped find creative solutions, and served as a reminder that we do not know what will happen in the future. Finally, we reflect on the limitations of the method and suggest further research on how it can be improved for value sensitive design of adaptation measures to manage uncertain future sea level rise.

An Ethical Framework for the Design, Development, Implementation, and Assessment of Drones Used in Public Healthcare.

The use of drones in public healthcare is suggested as a means to improve efficiency under constrained resources and personnel. This paper begins by framing drones in healthcare as a social experiment where ethical guidelines are needed to protect those impacted while fully realizing the benefits the technology offers. Then we propose an ethical framework to facilitate the design, development, implementation, and assessment of drones used in public healthcare. Given the healthcare context, we structure the framework according to the four bioethics principles: beneficence, non-maleficence, autonomy, and justice, plus a fifth principle from artificial intelligence ethics: explicability. These principles are abstract which makes operationalization a challenge; therefore, we suggest an approach of translation according to a values hierarchy whereby the top-level ethical principles are translated into relevant human values within the domain. The resulting framework is an applied ethics tool that facilitates awareness of relevant ethical issues during the design, development, implementation, and assessment of drones in public healthcare.

Exploring Human Values in the Design of a Web-Based QoL-Instrument for People with Mental Health Problems: A Value Sensitive Design Approach.

Quality of life (QoL) is an important outcome measure in mental health care. Currently, QoL is mainly measured with paper and pencil questionnaires. To contribute to the evaluation of treatment, and to enhance substantiated policy decisions in the allocation of resources, a web-based, personalized, patient-friendly and easy to administer QoL instrument has been developed: the QoL-ME. While human values play a significant role in shaping future use practices of technologies, it is important to anticipate on them during the design of the QoL-instrument. The value sensitive design (VSD) approach offers a theory and method for addressing these values in a systematic and principled manner in the design of technologies. While the VSD approach has been applied in the field of somatic care, we extended the VSD approach to the field of mental healthcare with the aim to enable developers of the QoL-instrument to reflect on important human values and anticipate potential value conflicts in its design. We therefore explored how VSD can be used by investigating the human values that are relevant for the design of the QoL-ME. Our exploration reveals that the values autonomy, efficiency, empowerment, universal usability, privacy, redifinition of roles, (redistribution) of responsibilites, reliability, solidarity, surveillance and trust are at stake for the future users of the technology. However, we argue that theoretical reflections on the potential ethical impact of a technology in the design phase can only go so far. To be able to comprehensively evaluate the usability the VSD approach, a supplementary study of the use practices of the technology is needed.

Imaginative Value Sensitive Design: Using Moral Imagination Theory to Inform Responsible Technology Design.

Safe-by-design (SBD) frameworks for the development of emerging technologies have become an ever more popular means by which scholars argue that transformative emerging technologies can safely incorporate human values. One such popular SBD methodology is called value sensitive design (VSD). A central tenet of this design methodology is to investigate stakeholder values and design those values into technologies during early stage research and development. To accomplish this, the VSD framework mandates that designers consult the philosophical and ethical literature to best determine how to weigh moral trade-offs. However, the VSD framework also concedes the universalism of moral values, particularly the values of freedom, autonomy, equality trust and privacy justice. This paper argues that the VSD methodology, particularly applied to nano-bio-info-cogno technologies, has an insufficient grounding for the determination of moral values. As such, an exploration of the value-investigations of VSD are deconstructed to illustrate both its strengths and weaknesses. This paper also provides possible modalities for the strengthening of the VSD methodology, particularly through the application of moral imagination and how moral imagination exceeds the boundaries of moral intuitions in the development of novel technologies.

Integrating Value Considerations in the Decision Making for the Design of Biorefineries.

Biobased production has been promoted as a sustainable alternative to fossil resources. However, controversies over its impact on sustainability highlight societal concerns, value tensions and uncertainties that have not been taken into account during its development. In this work, the consideration of stakeholders' values in a biorefinery design project is investigated. Value sensitive design (VSD) is a promising approach to the design of technologies with consideration of stakeholders' values, however, it is not directly applicable for complex systems like biorefineries. Therefore, some elements of VSD, such as the identification of relevant values and their connection to a technology's features, are brought into biorefinery design practice. Midstream modulation (MM), an approach to promoting the consideration of societal aspects during research and development activities, is applied to promote reflection and value considerations during the design decision making. As result, it is shown that MM interventions during the design process led to new design alternatives in support of stakeholders' values, and allowed to recognize and respond to emerging value tensions within the scope of the project. In this way, the present work shows a novel approach for the technical investigation of VSD, especially for biorefineries. Also, based on this work it is argued that not only reflection, but also flexibility and openness are important for the application of VSD in the context of biorefinery design.

Capability Sensitive Design for Health and Wellbeing Technologies.

This article presents the framework Capability Sensitive Design (CSD), which consists of merging the design methodology Value Sensitive Design (VSD) with Martha Nussbaum's capability theory. CSD aims to normatively assess technology design in general, and technology design for health and wellbeing in particular. Unique to CSD is its ability to account for human diversity and to counter (structural) injustices that manifest in technology design. The basic framework of CSD is demonstrated by applying it to the hypothetical design case of a therapy chatbot for mental health. By applying CSD to a design case, the merits of this new framework over the standard VSD approach become apparent. Also, the application demonstrates what a technology design would look like when attention is paid to capabilities right from the start of the design process.

Refining Value Sensitive Design: A (Capability-Based) Procedural Ethics Approach to Technological Design for Well-Being.

Fundamental questions in value sensitive design include whether and how high-tech products/artefacts could embody values and ethical ideals, and how plural and incommensurable values of ethical and social importance could be chosen rationally and objectively at a collective level. By using a humanitarian cargo drone study as a starting point, this paper tackles the challenges that VSD's lack of commitment to a specific ethical theory generates in practical applications. Besides, it highlights how mainstream ethical approaches usually related to VSD are incapable of solving main ethical dilemmas raised by technological design for well-being in democratic settings. Accordingly, it is argued that VSD's ethical-democratic import would substantially be enhanced by the espousal of a procedural ethics stance and the deliberative approach to value and welfare entailed by Amartya Sen's capability approach. Differently from rival ethical-political theories, its normative and meta-ethical foundations better handle human diversity, value-goal pluralism, conflicting vested interests as well as the epistemic-moral disagreements typical of contemporary complex democracies. Particularly, Sen's capability approach procedural-deliberative tenets result in an "objective-impartial" choice procedure selecting a "hierarchy" of plural incommensurable values and rational goals thus, suitable to validate an applied science such as welfare-oriented technological design in concrete social environments. Conclusions suggest that refining VSD with a capability-based procedural approach to ethics fosters the concern for democracy and social justice while preserving vital scientific-technical standards. Major advantages are at an applied level to delivering ethically and socially justified, but yet highly functional technologies and high-tech products/artefacts.

Proactive Ethical Design for Neuroengineering, Assistive and Rehabilitation Technologies: the Cybathlon Lesson.

BACKGROUND: Rapid advancements in rehabilitation science and the widespread application of engineering techniques are opening the prospect of a new phase of clinical and commercial maturity for Neuroengineering, Assistive and Rehabilitation Technologies (NARTs). As the field enters this new phase, there is an urgent need to address and anticipate the ethical implications associated with novel technological opportunities, clinical solutions, and social applications. MAIN IDEA: In this paper we review possible approaches to the ethics of NART, and propose a framework for ethical design and development, which we call the Proactive Ethical Design (PED) framework. CONCLUSION: A viable ethical framework for neuroengineering, assistive and rehabilitation technology should be characterized by the convergence of user-centered and value-sensitive approaches to product design through a proactive mode of ethical evaluation. We propose four basic normative requirements for the realization of this framework: minimization of power imbalances, compliance with biomedical ethics, translationality and social awareness. The aims and values of the CYBATHLON competition provide an operative model of this ethical framework and could drive an ethical shift in neuroengineering and rehabilitation.

Developing Tools to Counteract and Prevent Suicide Bomber Incidents: A Case Study in Value Sensitive Design.

Developers and designers make all sorts of moral decisions throughout an innovation project. In this article, we describe how teams of developers and designers engaged with ethics in the early phases of innovation based on case studies in the SUBCOP project (SUBCOP stands for 'SUicide Bomber COunteraction and Prevention'). For that purpose, Value Sensitive Design (VSD) will be used as a reference. Specifically, we focus on the following two research questions: How can researchers/developers learn about users' perspectives and values during the innovation process? and How can researchers/developers take into account these values, and related design criteria, in their decision-making during the innovation process? Based on a case study of several innovation processes in this project, we conclude the researchers/developers involved are able to do something similar to VSD (without them knowing about VSD or calling it 'VSD'), supported by relatively simple exercises in the project, e.g., meetings with potential end-users and discussions with members of the Ethical Advisory Board of the project. Furthermore, we also found-possibly somewhat counterintuitively-that a commercial, with its focus on understanding and satisfying customers' needs, can promote VSD.

Tolerant Paternalism: Pro-ethical Design as a Resolution of the Dilemma of Toleration.

Toleration is one of the fundamental principles that inform the design of a democratic and liberal society. Unfortunately, its adoption seems inconsistent with the adoption of paternalistically benevolent policies, which represent a valuable mechanism to improve individuals' well-being. In this paper, I refer to this tension as the dilemma of toleration. The dilemma is not new. It arises when an agent A would like to be tolerant and respectful towards another agent B's choices but, at the same time, A is altruistically concerned that a particular course of action would harm, or at least not improve, B's well-being, so A would also like to be helpful and seeks to ensure that B does not pursue such course of action, for B's sake and even against B's consent. In the article, I clarify the specific nature of the dilemma and show that several forms of paternalism, including those based on ethics by design and structural nudging, may not be suitable to resolve it. I then argue that one form of paternalism, based on pro-ethical design, can be compatible with toleration and hence with the respect for B's choices, by operating only at the informational and not at the structural level of a choice architecture. This provides a successful resolution of the dilemma, showing that tolerant paternalism is not an oxymoron but a viable approach to the design of a democratic and liberal society.

When Should We Use Care Robots? The Nature-of-Activities Approach.

When should we use care robots? In this paper we endorse the shift from a simple normative approach to care robots ethics to a complex one: we think that one main task of a care robot ethics is that of analysing the different ways in which different care robots may affect the different values at stake in different care practices. We start filling a gap in the literature by showing how the philosophical analysis of the nature of healthcare activities can contribute to (care) robot ethics. We rely on the nature-of-activities approach recently proposed in the debate on human enhancement, and we apply it to the ethics of care robots. The nature-of-activities approach will help us to understand why certain practice-oriented activities in healthcare should arguably be left to humans, but certain (predominantly) goal-directed activities in healthcare can be fulfilled (sometimes even more ethically) with the assistance of a robot. In relation to the latter, we aim to show that even though all healthcare activities can be considered as practice-oriented, when we understand the activity in terms of different legitimate 'fine-grained' descriptions, the same activities or at least certain components of them can be seen as clearly goal-directed. Insofar as it allows us to ethically assess specific functionalities of specific robots to be deployed in well-defined circumstances, we hold the nature-of-activities approach to be particularly helpful also from a design perspective, i.e. to realize the Value Sensitive Design approach.

Contested Technologies and Design for Values: The Case of Shale Gas.

The introduction of new energy technologies may lead to public resistance and contestation. It is often argued that this phenomenon is caused by an inadequate inclusion of relevant public values in the design of technology. In this paper we examine the applicability of the value sensitive design (VSD) approach. While VSD was primarily introduced for incorporating values in technological design, our focus in this paper is expanded towards the design of the institutions surrounding these technologies, as well as the design of stakeholder participation. One important methodological challenge of VSD is to identify the relevant values related to new technological developments. In this paper, we argue that the public debate can form a rich source from which to retrieve the values at stake. To demonstrate this, we have examined the arguments used in the public debate regarding the exploration and exploitation of shale gas in the Netherlands. We identified two important sets of the underlying values, namely substantive and procedural values. This paper concludes with two key findings. Firstly, contrary to what is often suggested in the literature, both proponents and opponents seem to endorse the same values. Secondly, contestation seems to arise in the precise operationalization of these values among the different stakeholders. In other words, contestation in the Dutch shale gas debate does not arise from inter-value conflict but rather from intra-value conflicts. This multi-interpretability should be incorporated in VSD processes.