A survey on the attitudes of parents with young children on in-home monitoring technologies and study designs for infant research.

Remote in-home infant monitoring technologies hold great promise for increasing the scalability and safety of infant research (including in regard to the current Covid-19 pandemic), but remain rarely employed. These technologies hold a number of fundamental challenges and ethical concerns that need addressing to aid the success of this fast-growing field. In particular, the responsible development of such technologies requires caregiver input. We conducted a survey of the opinions of 410 caregivers on the viability, privacy and data access of remote in-home monitoring technologies and study designs. Infant-friendly wearable devices (such as sensing body suits) were viewed favourably. Caregivers were marginally more likely to accept video and audio recording in the home if data was anonymised (through automated processing) at point of collection, particularly when observations were lengthy. Caregivers were more open to international data sharing for anonymous data. Caregivers were interested in viewing all types of data, but were particularly keen to access video and audio recordings for censoring purposes (i.e., to delete data segments). Taken together, our results indicate generally positive attitudes to remote in-home monitoring technologies and studies for infant research but highlight specific considerations such as safety, privacy and family practicalities (e.g. multiple caregivers, visitors and varying schedules) that must be taken into account when developing future studies.

The Ethics of Emergent Health Technologies: Implications of the 21st Century Cures Act for Nursing.

The 21st Century Cures Act, passed in December 2016 by the United States Congress, is a public law aimed at accelerating the time it takes to get pharmaceutical drugs and medical devices into the market, in addition to shifting connected review processes from randomized controlled trials to real-world efficacy tests. As of December 2019, efforts are underway to introduce a "Cures Act 2.0" bill, with particular attention to the implementation of digital health within health systems. Research on the development of emergent health technologies is nascent; research examining health technology implications of 21st Century Cures Act for the health care workforce is nonexistent. This article fills a crucial gap in public awareness, discussing ethical implications of the 21st Century Cures Act and centering nursing. Nursing is a profession frequently acknowledged as practicing on "the front lines of care" and frequently responsible for the trialing of products in clinical settings. The article summarizes and evaluates key components of the 21st Century Cures Act related to health technology development. Discrete health technologies addressed are (a) breakthrough devices, (b) digital health software, and (c) combination products. It then connects these provisions to ethical considerations for nursing practice, research, and policy. The article concludes by discussing the relevance of emerging digital health technologies to the crafting of a "Cures 2.0" bill, with particular attention to this moment in light of digital care precedents set during the COVID-19 pandemic.

Passive Monitoring of Mental Health Status in the Criminal Forensic Population.

Current approaches to monitoring patients' mental status rely heavily on self-reported symptomatology, clinician observation, and self-rated symptom scales. The limitations inherent in these methodologies have implications for the accuracy of diagnosis, treatment planning, and prognosis. Certain populations are particularly affected by these limitations because of their unique situations, including criminal forensic patients, who have a history of both criminal behavior and mental disorder, and experience increased stigma and restrictions in their access to mental health care. This population may benefit particularly from recent developments in technology and the growing use of mobile devices and sensors to collect behavioral information via passive monitoring. These technologies offer objective parameters that correlate with mental health status and create an opportunity to use Big Data and machine learning to refine diagnosis and predict behavior in a way that represents a marked shift from current practices. This article reviews the approaches to and limitations of psychiatric assessment and contrasts this with the promise of these new technologies. It then discusses the ethics concerns associated with these technologies and explores their potential relevance to criminal forensic psychiatry and the broader implications they carry for health and criminal justice policy.

The Ethics of Smart Pills and Self-Acting Devices: Autonomy, Truth-Telling, and Trust at the Dawn of Digital Medicine.

Digital medicine is a medical treatment that combines technology with drug delivery. The promises of this combination are continuous and remote monitoring, better disease management, self-tracking, self-management of diseases, and improved treatment adherence. These devices pose ethical challenges for patients, providers, and the social practice of medicine. For patients, having both informed consent and a user agreement raises questions of understanding for autonomy and informed consent, therapeutic misconception, external influences on decision making, confidentiality and privacy, and device dependability. For providers, digital medicine changes the relationship where trust can be verified, clinicians can be monitored, expectations must be managed, and new liability risks may be assumed. Other ethical questions include direct third-party monitoring of health treatment, affordability, and planning for adverse events in the case of device malfunction. This article seeks to lay out the ethical landscape for the implementation of such devices in patient care.

ETHICS OF SMART HOUSE WELFARE TECHNOLOGY FOR OLDER ADULTS: A SYSTEMATIC LITERATURE REVIEW.

BACKGROUND: The University College of Southeast Norway has an on-going project to develop a smart house welfare system to allow older adults and people with disabilities to remain in their homes for as long as they wish in safe, dignified, living conditions. OBJECTIVES: This article reviews reported ethical challenges to implementing smart houses for older adults. METHODS: A systematic literature review identified twenty-four articles in English, French, Spanish, and Norwegian, which were analyzed and synthesized using Hofmann's question list to investigate the reported ethical challenges. RESULTS: Smart houses offer a promising way to improve access to home care for older adults and people with disabilities. However, important ethical challenges arise when implementing smart houses, including cost-effectiveness, privacy, autonomy, informed consent, dignity, safety, and trust. CONCLUSIONS: The identified ethical challenges are important to consider when developing smart house systems. Due to the limitations of smart house technology, designers and users should be mindful that smart houses can achieve a safer and more dignified life-style but cannot solve all the challenges related to ageing, disabilities, and disease. At some point, smart houses can no longer help persons as they develop needs that smart houses cannot meet.

Approaching birds with drones: first experiments and ethical guidelines.

Unmanned aerial vehicles, commonly called drones, are being increasingly used in ecological research, in particular to approach sensitive wildlife in inaccessible areas. Impact studies leading to recommendations for best practices are urgently needed. We tested the impact of drone colour, speed and flight angle on the behavioural responses of mallards Anas platyrhynchos in a semi-captive situation, and of wild flamingos (Phoenicopterus roseus) and common greenshanks (Tringa nebularia) in a wetland area. We performed 204 approach flights with a quadricopter drone, and during 80% of those we could approach unaffected birds to within 4 m. Approach speed, drone colour and repeated flights had no measurable impact on bird behaviour, yet they reacted more to drones approaching vertically. We recommend launching drones farther than 100 m from the birds and adjusting approach distance according to species. Our study is a first step towards a sound use of drones for wildlife research. Further studies should assess the impacts of different drones on other taxa, and monitor physiological indicators of stress in animals exposed to drones according to group sizes and reproductive status.

Security and privacy issues in wireless sensor networks for healthcare applications.

The use of wireless sensor networks (WSN) in healthcare applications is growing in a fast pace. Numerous applications such as heart rate monitor, blood pressure monitor and endoscopic capsule are already in use. To address the growing use of sensor technology in this area, a new field known as wireless body area networks (WBAN or simply BAN) has emerged. As most devices and their applications are wireless in nature, security and privacy concerns are among major areas of concern. Due to direct involvement of humans also increases the sensitivity. Whether the data gathered from patients or individuals are obtained with the consent of the person or without it due to the need by the system, misuse or privacy concerns may restrict people from taking advantage of the full benefits from the system. People may not see these devices safe for daily use. There may also possibility of serious social unrest due to the fear that such devices may be used for monitoring and tracking individuals by government agencies or other private organizations. In this paper we discuss these issues and analyze in detail the problems and their possible measures.

Spying or steering? Views of parents of young novice drivers on the use and ethics of driver-monitoring technologies.

In-vehicle technologies that document driving practices have the potential to enhance the driving safety of young drivers, but their installation depends largely on their parents' willingness and raises ethical dilemmas. This study investigated, using closed and open-ended questions, the views of 906 parents of young drivers in Israel regarding their willingness to install such a technology, and their conceptions of social norms and ethical issues associated with the technology and of factors that would encourage or discourage parents to adopt it. Most believed parents should feel morally obligated to install it. When cost was not a consideration, most said they would, and believed other parents would be willing to install the technology. Fewer (about half) expressed willingness to install it after being told about its estimated cost. Monetary cost was rated as a barrier to install it by about half. Environmental considerations were viewed as an incentive. Parents who supported the installation believed it would serve as a trigger for parent-young driver communication but those who did not thought it would erode trust in the parent-young driver relationship. Most said parents should have access to the monitoring data. Policy implications regarding issues of privacy and resources for parents are discussed.