The social landscape in which COMFORTage technologies are being developed and will eventually be employed is a complex one, shaped by a multitude of actors bringing different interests, expectations, and constraints to the table. Patients, carers, clinicians, technology developers, healthcare institutions, and policymakers all bring different perspectives, experiences, expertise and values, and reconciling their needs and views represents a tall order for project objectives.
This complexity is compounded by the nature of the conditions under study: dementia and frailty are not uniform categories but encompass a wide spectrum of needs, trajectories, and lived experiences. Further difficulties also derive from the technological architecture of the proposed innovations, which include digital tools, sensors and devices, and AI models, raising questions on their future sustainable deployment, as they interact in ways that are not easily anticipated.
A new framework for analysis
Existing frameworks for responsible research and development (including ELSA/ELSI and the European Health Technology Assessment Regulation) have long recognised the importance of integrating studies on social and ethical consequences into the research and innovation processes. However, these frameworks have remained, to some extent, under-expressed and under-utilised in the context of research and technology at the EU level.
The approach employed by CyberEthicsLab. to carry out the social acceptability assessment for COMFORTage seeks to expand these frameworks, by providing an anticipatory overview of technological implementation and its potential social repercussions. By drawing from scholarship on ethical foresight analysis and the sociology of science and technology (STS), the Social Acceptance of Technology framework functions as both a methodological framework to orient analysis, and as safeguard for publicly funded responsible innovation.
Its ethical foresight component draws on the work of philosophers Luciano Floridi and Behnam Taebi, and seeks to anticipate the ethical issues a technology is likely to raise before they can cause harm. Rather than responding to problems after they emerge, this approach asks what tensions and risks can reasonably be foreseen while the technology is still being shaped, and how design and governance choices made now might prevent or mitigate them later.
The STS component, on the other hand, is heavily influenced by the foundational sociological work of Wiebe E. Bijker, developed further by Nelly Oudshoorn and Trevor Pinch, which holds that technologies are not adopted by isolated individuals, but are rather negotiated and given meaning within social groups and institutional arrangements. Acceptability, in this view, is never settled in advance by design alone: it emerges through use, interpretation, and contestation across different communities of practice.
Our progress so far
Employing this double framework of analysis, initial desk research was undertaken; this allowed us to identify the key areas where the introduction of COMFORTage technologies into dementia and frailty care is more likely to bring about disagreements and controversies among stakeholders. When reviewing the literature, particular attention was given to similar domains of technology applications (such as the use of AI in diagnostics, digital devices for geriatric care, and the overall drive towards datafication of healthcare), and to the sociotechnical controversies that surround them.
One cluster of controversies and concerns relates to the data practices underpinning these systems: the risk that algorithmic bias may reproduce or amplify existing health disparities, and the broader questions of privacy and data ownership that arise when sensitive health information about vulnerable populations is collected, processed, and potentially monetised. A second set of issues concerns the clinical encounter itself: specifically, the risk of overdiagnosis and unnecessary medicalisation, and the ways in which AI’s growing role in care may reshape professional authority and the relationships between clinicians, patients, and carers. A third area of concern is more structural: the practical challenges of integrating novel technologies into health and social care systems that differ substantially across European Member States; the governance questions raised by private sector involvement in the development and ownership of diagnostic technologies; and the still-unresolved question of where responsibility and liability lie when AI systems inform decisions about a person’s diagnosis or care.
Next steps
Building on these foundations obtained during the desk research phase, the qualitative component of the study is now underway, and seeks to ground these preliminary findings in stakeholders’ perspectives. Interviews with relevant actors are currently being conducted, using guides and questions developed on the basis of the desk research findings. Ultimately, by incorporating these perspectives, this research aims to shed light on how the issues and tensions identified through documentary analysis are perceived, weighed, and experienced by those most affected (whether directly or indirectly) by the implementation of the COMFORTage solution and its AI systems.
References
Bijker, W. E., Hughes, T. P., Pinch, T. J., & Pinch, T. (2012). The Social Construction of Technological Systems: New Directions in the Sociology and History of Technology. MIT Press.
Floridi, L., & Strait, A. (2020). Ethical Foresight Analysis: What it is and Why it is Needed? SSRN Electronic Journal. https://doi.org/10.2139/ssrn.3830484
Oudshoorn, N., & Pinch, T. (2003). Introduction: How Users and Non-Users Matter. https://doi.org/10.7551/mitpress/3592.003.0002
Taebi, B. (2017). Bridging the Gap between Social Acceptance and Ethical Acceptability. Risk Analysis, 37(10), 1817–1827. https://doi.org/10.1111/risa.12734
**Article written by CyberEthics Lab. (CEL), a key partner in the COMFORTage project.
