Scientist on nursing robot use: “personal care is too intimate”.

Robots cannot replace humans, but they can support them, says Heiner Friesacher. To do so, however, researchers need to look more closely at nursing professions.

Paro is a therapy robot that has been under development in Japan since the 1990s for dementia patients Photo: imago/epd

site: Mr. Friesacher, will nursing robots be the main people walking through old people’s homes in 20 years’ time?

Heiner Friesacher: I hope not. That would be a horror vision.

But the number of people in need of care in Germany is rising, and at the same time there are fewer and fewer nurses per patient.

Robots cannot replace a nurse. At most, they can be used in a supportive and accompanying role. In Germany, we’re just in the early stages of this – with the baby boomer generation of retirees, robotics could then become routine.

What tasks could robots take on?

All those that do not involve direct human attention. Robots can take on documenting tasks, such as taking photos or measuring wounds. They can deliver medications. And robots could serve as household assistance. The Care-O-bot robot from the Fraunhofer Institute can bring drinks and switch on the TV. The robot Armar from Karlsruhe cleans and unloads the dishwasher. There are robots that can make phone calls. Such activities can relieve caregivers and enable older people to remain self-determined for longer. But here, too, you have to be careful.

Why?

People in need of care have a certain care level. The care grade is measured by how great a person’s ability is to perform activities independently. If one has a robotic assistant, it may mean that the need for care decreases. Financial support could be scaled down, the care level reduced and personal attention less.

holds a doctorate in nursing science and is a specialist nurse for intensive care. He heads the nursing and care department at the Convivo Group in Bremen and works as a freelance lecturer at various universities and colleges.

Nevertheless, research is currently being conducted on robots that are supposed to be able to do more than just support nursing staff. Some models, for example, serve meals or take over washing.

These areas are ethically questionable. Nursing is a profession of communication, interaction and touch. Each person has their own pace when eating, and it is difficult for a robot to be sensitive enough to that. Besides, eating has a social component; it’s not just about how to get calories into someone. Hardly anyone likes to eat alone or alone with a robot.

But when it comes to washing, a robot could provide more privacy, couldn’t it? After all, it’s just a machine.

I don’t see it that way. Washing is one of the most intimate and sensitive activities. Body washing also means entering into very close personal contact for half an hour or more. I can observe: How is the sensitivity of the skin? How is the psychological stability? Try washing a person with dementia at a speed that is not appropriate to their rhythm. It doesn’t work. These activities are often dismissed as "simple," but they are highly complex.

Some care robots are equipped with a learning algorithm, i.e. artificial intelligence. Isn’t it conceivable that robots will eventually master such highly complex activities?

A robot can only do what it is programmed to do. There are areas that robots cannot learn – at least not according to the current state of knowledge. What distinguishes humans from machines is that humans can reflect and take a stand. That’s where we enter the field of "implicit knowledge areas". An intuition, a hunch, a feeling, that cannot be formalized or determined as a rule for a computer. When someone sits across from you and says, "Everything is fine with me," you read between the lines that it may not be. The nurse then asks again. This is about nonverbal signals in dealing with people who often have multiple limitations, are chronically ill, cognitively impaired and usually over 80 years old. These people need a very specific approach.

Nevertheless, politicians and industry are putting a lot of money into research on care robotics.

Currently, about 170 robotic systems are being tested. Industry sees a large growing market here. There is hardly any other area in the care sector that is so well supplied with third-party funding. After all, mechanization has accompanied the sector from the very beginning: Hospital beds, infusion apparatus, lifters. And many developments in the healthcare sector make sense, such as exoskeletons that help people who can no longer walk properly. But there are also many things that are going wrong.

What?

What has been missing so far is ethical reflection on the whole thing. What does this actually do to us in a helping profession? Aren’t we also conducting a distracting debate here? Nursing robotics is not the solution to the nursing shortage. We should rather consider how we can make the nursing profession more attractive. This is already the case in many other countries. The profession is more respected and better paid, and people are better qualified. We have one of the lowest levels of nursing education in Europe.

What would a more meaningful development of robots look like?

People from different fields would have to be involved. From social science, philosophy, nursing science, and also caregivers, patients and relatives. And that’s before the robots are tested and the economy gets involved and brings in market interests. I know this from my own experience: engineers and computer scientists are often surprised by the ethical comments that nursing scientists have, for example on data security.

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The robots can eavesdrop, film, measure, track. This data could be passed on to companies, health insurers and other third parties.

There are many other moral questions that remain unresolved: Who pays for an elaborate support system in elderly care facilities? Does this then lead to two-tier care? Who is ultimately liable if something happens? To whom may data be passed on? This is a question for society as a whole, and in many places it has not yet been fully thought through.

How do caregivers actually react to robotics?

There is a relatively high level of skepticism. This also has to do with the fact that many nurses entered this profession to do something social – and not to work with technical systems.

There are studies that say that non-human-looking machines are better accepted by people because less is expected. But most care robots look quite humanoid. How is that received by people in need of care?

There is still a lot of skepticism in Germany. In Japan, for example, people are much more daring when it comes to care robots, but there they have always had a different relationship with things. Seniors here in Germany often don’t like the feeling that a reality is being played out for them. But there are also examples where it’s different, such as with the cuddly seal Paro. Here, acceptance is relatively high.

Paro is a therapy robot that has been under development in Japan since the 1990s for dementia patients. A baby seal made of plush, it is equipped with tactile sensors that respond to touch. The seal is also in use in Germany.

With the seal, even people with dementia realize that this is not a living animal. Paro is first of all a door opener. It makes access possible to people with dementia who have previously refused any offer of communication. That makes participation possible, and I think that’s okay. It does not lead to the reification of the human being. There are real therapy animals, but dogs, for example, get tired, and some people are afraid of them. Paro is less complicated, except that he costs 5,000 euros. Paro is a good example of the opportunities and limitations of robotics – especially when it comes to feelings and emotions.

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