Distance caregiving using smart home technologies: balancing ethical priorities in family decision-making by only children.

Background: The parallel growth of population ageing and international migration have introduced a unique population of transnational caregivers in elder care. Particularly for only children who face conflicting obligations and reduced caregiving resources, smart home devices could be technical tools to care for older parents from a distance. Research towards the use of these technologies has unearthed ethical issues such as privacy, autonomy, stigma and beneficence, but has not been fully explored in distance care. In this paper, we explore the ethical issues expressed by a group of only children towards integrating assistive, monitoring, and robotic technologies in their transnational care plans.

Methods: Purposive snowball sampling was used for the recruitment of 26 distance caregivers aged between 28 and 45, who were their parent's only children. They lived in Europe for at least 5 years, with at least one parent residing in the home country. In semi-structured interviews, participants discussed the ethical issues of wearable devices, ambient and visual remote monitoring technologies, as well as the possible use of one assistive robot in the context of distance caregiving for older parents. We used the applied thematic analysis methodology to analyze the data.

Results: We highlight two ethical considerations. First, participants saw the need for maximizing good outcomes in caring for their older parents and fulfilling their responsibilities to ensure their health and safety, balanced against the respect for the parents' autonomy, dignity, and privacy. Second, they weighed the benefits and harms of technologies at a distance to provide companionship and support against the intrinsic value placed on care received from one's only child.

Conclusions: Discussions to involve technologies in elder care at a distance prompted complex decision-making processes to balance, weigh, and rationalize their ethical concerns as foreseen by the caregivers. The importance of maximizing the health and safety of older parents came at an unavoidable cost of the respect to autonomy, privacy, and dignity. Participants valued their own emotional connection and relationship to their parents, which they prioritized above the instrumental value of technological support. We further discuss our findings within the ethics of care theory and concepts within transnational care literature to make sense of the broader ethical implications of this empirical study.