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BACKGROUND Smart home technology (SHT) can be useful for aging in place or health related purposes. However, surveillance researchers have highlighted ethical issues with SHTs, including those pertaining to user privacy, security, and autonomy. OBJECTIVE As digital technology is most often designed for younger adults, this review summarizes user perceptions of SHTs with users aged 50+ to explore their understandings of privacy, purpose of data collection, risk and safety. METHODS Through an integrative review, we explored community-dwelling adults’ (aged 50+) perceptions of SHTs based on research questions under four non-mutually exclusive themes: privacy, purpose of data collection, risk and benefits, and safety. 15 user perception studies on SHT users aged 50+ were included. RESULTS The 15 included studies explored user perception of smart speakers, motion sensors, or home monitoring systems. 13 studies (87%) discussed user privacy concerns regarding data collection and access. Four studies (27%) explored user knowledge of data collection purposes. Seven studies (47%) featured risk-related concerns such as data breaches and third-party misuse, and benefits such as convenience. Nine studies (60%) reported user enthusiasm about the potential for home safety. CONCLUSIONS Due to the growing size of aging populations and advances in technological capabilities, regulators and designers should focus on user concerns. In conjunction with ethical by-design approaches, we recommend Taylor’s conception of data justice as a regulatory approach that can empower SHT users in their data management goals. This way, regulation and design can enhance safety benefits while diminishing risks to privacy, security, and autonomy.

Background Many older adults wish to use smart homes for aging in place, health monitoring, and enhanced safety. However, concerns over privacy and security remain pressing. User perception studies can help to inform policy and design solutions. Aim: To explore community-dwelling older adults’ (50+) perceptions of smart home surveillance. Methods As part of a larger scoping review of smart home user perception based on four non-mutually exclusive categories: privacy, safety, purpose of data collection, and risk, we found 68 results. 15 studies focused on older adults exclusively and were included in this review. Results The included studies mainly focused on smart speakers, motion sensors, or home monitoring systems. 13 studies (87%) discussed user privacy concerns in terms of data collection and access. Nine studies (60%) reported that users were enthusiastic about the potential for home safety, improved health outcomes and independent living with smart homes. Seven risk awareness studies (47%) featured a range of perspectives on sharing sensitive information due to the possibility of data breaches and third-party misuse, with some reporting a willingness to trade privacy for enhanced safety. Finally, four studies (27%) explored user knowledge of data collection purposes. While many were uncertain of the details, users were generally more comfortable sharing smart home data with healthcare professionals than others. Conclusion This review has helped us in creating a user perception survey that is currently in the fielding stage. Given Canada’s increasing aging population and technological advances, privacy regulators and designers should focus on older adults’ concerns.

Eating disorders are mental illnesses that can have a significant and persistent physical impact, especially for those who are not treated early in their disease trajectory. Although many persons with eating disorders may make a full recovery, some may not; this is especially the case when it comes to persons with severe and enduring anorexia nervosa (SEAN), namely, those who have had anorexia for between 6 and 12 years or more. Given that persons with SEAN are less likely to make a full recovery, a different treatment philosophy might be ethically warranted. One potential yet scarcely considered way to treat persons with SEAN is that of a harm reduction approach. A harm reduction philosophy is deemed widely defensible in certain contexts (e.g. in the substance use and addictions domain), and in this paper we argue that it may be similarly ethically defensible for treating persons with SEAN in some circumstances.

Artificial intelligence (AI) and machine learning are changing our world through their impact on sectors including health care, education, employment, finance, and law. AI systems are developed using data that reflect the implicit and explicit biases of society, and there are significant concerns about how the predictive models in AI systems amplify inequity, privilege, and power in society. The widespread applications of AI have led to mainstream discourse about how AI systems are perpetuating racism, sexism, and classism; yet, concerns about ageism have been largely absent in the AI bias literature. Given the globally aging population and proliferation of AI, there is a need to critically examine the presence of age-related bias in AI systems. This forum article discusses ageism in AI systems and introduces a conceptual model that outlines intersecting pathways of technology development that can produce and reinforce digital ageism in AI systems. We also describe the broader ethical and legal implications and considerations for future directions in digital ageism research to advance knowledge in the field and deepen our understanding of how ageism in AI is fostered by broader cycles of injustice.

BACKGROUND Artificial intelligence (AI) has emerged as a major driver of technological development in the 21st century, yet little attention has been paid to algorithmic biases toward older adults. OBJECTIVE This paper documents the search strategy and process for a scoping review exploring how age-related bias is encoded or amplified in AI systems as well as the corresponding legal and ethical implications. METHODS The scoping review follows a 6-stage methodology framework developed by Arksey and O’Malley. The search strategy has been established in 6 databases. We will investigate the legal implications of ageism in AI by searching grey literature databases, targeted websites, and popular search engines and using an iterative search strategy. Studies meet the inclusion criteria if they are in English, peer-reviewed, available electronically in full text, and meet one of the following two additional criteria: (1) include “bias” related to AI in any application (eg, facial recognition) and (2) discuss bias related to the concept of old age or ageism. At least two reviewers will independently conduct the title, abstract, and full-text screening. Search results will be reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting guideline. We will chart data on a structured form and conduct a thematic analysis to highlight the societal, legal, and ethical implications reported in the literature. RESULTS The database searches resulted in 7595 records when the searches were piloted in November 2021. The scoping review will be completed by December 2022. CONCLUSIONS The findings will provide interdisciplinary insights into the extent of age-related bias in AI systems. The results will contribute foundational knowledge that can encourage multisectoral cooperation to ensure that AI is developed and deployed in a manner consistent with ethical values and human rights legislation as it relates to an older and aging population. We will publish the review findings in peer-reviewed journals and disseminate the key results with stakeholders via workshops and webinars. CLINICALTRIAL OSF Registries AMG5P; https://osf.io/amg5p INTERNATIONAL REGISTERED REPORT DERR1-10.2196/33211

Clinician-scientists (CSs) make significant contributions to the healthcare system, yet their roles are not fully understood, supported or recognized by healthcare leaders or policy makers. CSs are healthcare professionals with advanced research training who continue to pursue clinical work and are considered an essential component of the research infrastructure in academic health sciences centres. The current literature supports the role of CSs but is also clear that there are multiple challenges in attracting and retaining clinicians to the role. To gain a comprehensive understanding of the current status of the CS role, two literature reviews were conducted. The findings reported here include an overview of: the education and training preparation for CS roles; the importance of the CS role; barriers and challenges to developing and implementing the CS role; and strategies for supporting and sustaining CS roles in practice. The paper further describes one Canadian academic health sciences centre's approach to supporting and increasing the number of CSs from nursing and allied health professions to support academic practice. Non-physician CSs may conduct research using multiple research designs across the research continuum from randomized controlled trials to grounded theory or qualitative descriptive approaches. Their research generally focuses on practice-based issues such as best practices for managing pain or frailty or evaluating the effectiveness of new approaches to care. Researchers and healthcare leaders in other organizations may find this work helpful for establishing their own structures to enhance research capacity and practice-based research, especially for non-physician CSs.

The pervasive use of contracts in healthcare is a source of unease for many healthcare ethicists and patient advocates. This commentary examines the use of such contracts with individuals in rehabilitation settings who have complex medical and behavioural issues. The goals of this paper are to examine the many factors that can lead to contract use, to discuss some legal and ethical implications of contract use, and to assess contract use in light of concerns about health equity. The paper concludes with some practical alternatives to the use of such contracts, and refers specifically to tools that might be borrowed from the field of behavioural therapy., L’utilisation généralisée de contrats dans les soins de santé est une source de malaise pour de nombreux éthiciens de la santé et associations de patients. Ce commentaire examine l’utilisation de tels contrats avec des personnes en milieu de réadaptation ayant des problèmes médicaux et comportementaux complexes. Les objectifs de ce commentaire sont d’examiner les nombreux facteurs qui peuvent conduire à l’utilisation de contrats, de discuter de certaines implications juridiques et éthiques de l’utilisation de contrats et d’évaluer leur utilisation à la lumière des préoccupations relatives à l’équité en matière de santé. Le commentaire conclut par quelques alternatives pratiques à l’utilisation de tels contrats et se réfère spécifiquement aux outils pouvant être empruntés au domaine de la thérapie comportementale.

This case study considers the ethical defensibility of recommending weight loss as a treatment for patients with higher body mass indexes. Recommending weight loss may be motivated by clinicians’ biases toward people living in larger bodies, misperceptions about weight and its relevancy to overall health, and a failure to consider other ethical factors such as those related to equity and the social determinants of health., Cette étude de cas examine la défendabilité éthique de recommander la perte de poids comme traitement pour les patients ayant un indice de masse corporelle plus élevé. La recommandation d’une perte de poids peut être motivée par les préjugés des cliniciens à l’égard des personnes vivant dans des corps plus volumineux, par des perceptions erronées du poids et de sa pertinence pour la santé globale ainsi que par l’absence de prise en compte d’autres facteurs éthiques, tels que ceux liés à l’équité et aux déterminants sociaux de la santé.

This paper explores the ethics of deceased-directed donation (DDD) and brings a unique perspective to this issue-the relevance of providing family-centered care and culturally sensitive care to deceased donors, potential recipients, and their families. The significance of providing family-centered care is becoming increasingly prevalent, specifically in pediatric healthcare settings. Therefore, this topic is especially relevant to those working with and interested in pediatrics. As the world is becoming more diverse with globalization, assessing the cultural aspect of the ethics of DDD is increasingly salient. We provide a brief overview of DDD across the globe, review prominent arguments both for and against DDD, consider family-centered and culturally specific considerations, and offer considerations for the development of a policy or guideline. We determine that the practice of DDD is ethically defensible in certain circumstances and congruent with providing both family-centered and culturally sensitive care. Our analysis is relevant to any country with a diverse population and any healthcare provider or institution that operates under a framework of family-centered care, such as those in pediatric hospitals.

Grant Farred’s The Burden of Over-representation: Race, Sport, and Philosophy analyzes three moments in sport history—in three chapters—through the intersecting lenses of race, identity, politics, ...

Sandy Montanola and Aurelie Olivesi’s Gender Testing in Sport: Ethics, cases and controversies is a timely and engaging book that includes nine chapters from authors of different disciplinary backg...

Determining whether and/or how to enable older persons with disabilities to engage in sex raises several ethical considerations. With the goal of enabling the sexual functioning of older adults with disabilities, Jecker argues that sex robots could be used as a helpful tool. In her article, ‘Nothing to be Ashamed of: Sex Robots for Older Adults with Disabilities’, Jecker acknowledges the importance of sexual functioning and the fact that ageist assumptions incorrectly classify older persons as asexual. Additionally, older adults may experience disabilities that negatively influence their sexual functioning, which is problematic since sex may be linked to the following capabilities: developing a meaningful life narrative; being healthy; experiencing bodily integrity; feeling and communicating emotions; affiliating with others and reflecting on and choosing a life plan.1 In accordance with Nussbaum’s capabilities approach,2 Jecker says that society has a duty to support these capabilities at a minimal threshold. And insofar as sexual functioning may be relevant to the capabilities for older adults with disabilities, then we need to respond accordingly. One way of achieving this aim is by providing access to sex robots. I agree that sex robots ought to be made available for older adults with disabilities. Nevertheless, the article inspires several areas for further exploration. As Jecker rightfully mentions, older adults are often incorrectly labelled as non-sexual. For instance, in their analysis of older individuals’ views on sex and quality of life, Gott …

This paper considers whether transgender (trans*) women should be permitted to compete in female categories in sports. Trans* women are often criticized for competing in female categories because t...

Background As the aging population continues to grow, the number of adults living with dementia or other cognitive disabilities in residential long-term care homes is expected to increase. Technologies such as real-time locating systems (RTLS) are being investigated for their potential to improve the health and safety of residents and the quality of care and efficiency of long-term care facilities. Objective The aim of this study is to identify factors that affect the implementation, adoption, and use of RTLS for use with persons living with dementia or other cognitive disabilities in long-term care homes. Methods We conducted a systematic review of the peer-reviewed English language literature indexed in MEDLINE, Embase, PsycINFO, and CINAHL from inception up to and including May 5, 2020. Search strategies included keywords and subject headings related to cognitive disability, residential long-term care settings, and RTLS. Study characteristics, methodologies, and data were extracted and analyzed using constant comparative techniques. Results A total of 12 publications were included in the review. Most studies were conducted in the Netherlands (7/12, 58%) and used a descriptive qualitative study design. We identified 3 themes from our analysis of the studies: barriers to implementation, enablers of implementation, and agency and context. Barriers to implementation included lack of motivation for engagement; technology ecosystem and infrastructure challenges; and myths, stories, and shared understanding. Enablers of implementation included understanding local workflows, policies, and technologies; usability and user-centered design; communication with providers; and establishing policies, frameworks, governance, and evaluation. Agency and context were examined from the perspective of residents, family members, care providers, and the long-term care organizations. Conclusions There is a striking lack of evidence to justify the use of RTLS to improve the lives of residents and care providers in long-term care settings. More research related to RTLS use with cognitively impaired residents is required; this research should include longitudinal evaluation of end-to-end implementations that are developed using scientific theory and rigorous analysis of the functionality, efficiency, and effectiveness of these systems. Future research is required on the ethics of monitoring residents using RTLS and its impact on the privacy of residents and health care workers.

Issues involving chronic disease prevention and management (CDPM) are prevalent in today's aging society, and suggestions for improvement are essential to treat this patient demographic effectively. This article addresses the use of wearable devices for the medical community to improve CDPM by relying on the accumulation of micro data. For the patient, we recognize that these devices can be an effective tool to facilitate real-time monitoring of their vital signs and activity levels. With real-time monitoring and earlier responses, individuals can benefit by preventing, delaying or reducing exacerbations of chronic diseases. Use of these devices also has great benefit to the person and has the potential to decrease the individual's emergency room visits, hospital admissions and re-admissions. As patients and their healthcare providers work together to identify cumulative trends in their micro data, transitions in care planning will be enhanced, further contributing to improved chronic disease management.

The purpose of this commentary is to present and respond to the gap that currently exists in providing culturally inclusive residential long-term care options for Indigenous peoples in Ontario. After presenting statistics regarding the Indigenous population and long-term care options, we argue that we have an ethical responsibility to offer more culturally inclusive long-term care., L’objectif de ce commentaire est de présenter et de combler les lacunes existant dans l’offre de soins de longue durée en établissement culturellement inclusifs pour les peuples autochtones de l’Ontario. Après avoir présenté des statistiques sur la population autochtone et les options de soins de longue durée, nous soutenons que nous avons la responsabilité éthique d’offrir des options de soins de longue plus inclusifs sur le plan culturel.