The use of ‘e-tagging’ devices in aged residential care in New Zealand is not yet common, but could become so, especially when managing the behaviour of dementia patients who are prone to wandering.
In Singapore, there have been a number of pilot programmes using radio-frequency identification tags (RFID) or blue tooth low-energy to monitor the movement of their residents. The aim of this technology is to be able to enhance the safety and well-being of the older people they care for. The technology introduced in these rest homes was done to “foster improvements in the resident’s psychological well-being and their safety. The data collected provides behavioral understanding for us to foster better care”
Freedom is a big selling point for these types of systems. “The RFID system is part of Econ’s progress towards the vision of a non-gated community where even people with dementia can go about their daily lives safely without being physically constrained to a vicinity.” said its spokesman. For instance, staff can be notified and act accordingly should a resident enter a high fall-risk area, or leave the facility without informing anyone. Some patients with dementia can be prone to wandering and may get lost outside if left unattended.
While it is easy to see the potential benefits of this technology, these practices come with some ethical dilemmas. Tagging and monitoring people in this way infringes on their privacy and dignity. Often we think about technology as an opportunity to help to keep our loved ones safe. However, it is just as important to put ourselves in their shoes and to consider how they feel when a certain technology means that they are being monitored 24 hours a day. Tagging can feel very intrusive compared to other usual monitoring devices such as CCTV cameras, or sensors at a doorway etc.
The first issue relates to consent. What type of consent is needed? Is implied consent enough? Or does the family and/or patient have to give consent?
The second issue relates to the collection and use of data. What will the data be used for? How is this data kept safe?
The answer is that it all depends on the law. In New Zealand, agencies must take reasonable steps to ensure that the person they are collecting information from is aware, among other things, of why it is being collected and who might receive it. What the reasonable steps are will depend on the circumstances of the particular case. Agencies do not necessarily have to inform people in writing about the collection and use of their information. The Privacy Act does not set out how agencies should tell people.
RFID chips on humans has been banned in Nevada due to the ethical concerns that it would be possible to hack the information contained within the chips or harass shipped individuals with the right type of reader.
Tagging should also not be used in place of good care practices. Just because a resident may now be able to move around freely, does not mean they are doing so in a safe manner.
Experts say that one way of obtaining consent and getting around ethical issues is to discuss the use of monitoring technology in advance, or get consent from the person’s power of attorney for those who already lack mental capacity due to advance dementia. If this use of monitoring technology becomes more widespread, it is important that this issue can be discussed in an advanced care plan.