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Medical Ethics

Live Like Nobody Is Watching

Relational Autonomy in the Age of Artificial Intelligence Health Monitoring

by (author) Anita Ho

Oxford University Press
Initial publish date
Apr 2023
  • Hardback

    Publish Date
    Apr 2023
    List Price

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Respect for patient autonomy and data privacy are generally accepted as foundational western bioethical values. Nonetheless, as our society embraces expanding forms of personal and health monitoring, particularly in the context of an aging population and the increasing prevalence of chronic diseases, questions abound about how artificial intelligence (AI) may change the way we define or understand what it means to live a free and healthy life. Who should have access to our health and recreational data and for what purpose? How can we find a balance between users' physical safety and their autonomy? Should we allow individuals to forgo continuous health monitoring, even if such monitoring may minimize injury risks and confer health and societal benefits? Would being continuously watched by connected devices ironically render patients more isolated and their data more exposed than ever?

Drawing on different use cases of AI health monitoring, this book explores the socio-relational contexts that frame the promotion of AI health monitoring, as well as the potential consequences of such monitoring for people's autonomy. It argues that the evaluation, design, and implementation of AI health monitoring should be guided by a relational conception of autonomy, which addresses both people's capacity to exercise their agency and broader issues of power asymmetry and social justice. It explores how interpersonal and socio-systemic conditions shape the cultural meanings of personal responsibility, healthy living and aging, trust, and caregiving. These norms in turn structure the ethical space within which expectations regarding predictive analytics, risk tolerance, privacy, self-care, and trust relationships are expressed. Through an analysis of home health monitoring for older and disabled adults, direct-to-consumer health monitoring devices, and medication adherence monitoring, this book proposes ethical strategies at both the professional and systemic levels that can help preserve and promote people's relational autonomy in the digital era.

About the author

Contributor Notes

Anita Ho is Associate Professor at the UCSF Bioethics Program, Clinical Associate Professor at the Centre for Applied Ethics at the University of British Columbia, and Scientist at the Centre for Health Evaluation and Outcomes Sciences. She is also a Senior Director of Ethics at Providence.

Editorial Reviews

"Anita Ho parts the fog of technological determinism with moral clarity. Her deeply informed analysis explains the structuring power of AI health monitoring, leading to new understanding of what's at stake for all of us. Live Like Nobody Is Watching is essential reading in graduate programs -- including all health sciences." --Clara Berridge, School of Social Work, University of Washington

"AI-enabled home health monitoring, care delivery and health apps are transforming healthcare. Using the lens of relational autonomy theory, Anita Ho carefully assesses both the potential benefits of these technologies and the ethical challenges they raise for users' autonomy. She demonstrates the importance of situating AI health technologies in a wider socio-relational context, and argues that to truly enhance users' autonomy, these technologies should complement, rather than replace the therapeutic relationship. Timely, informative and thoroughly researched, Ho's book makes an important contribution to contemporary debates about AI and healthcare." --Catriona Mackenzie, Philosophy