What autonomy for telecare? : an externalist approach

"Telecare, Surveillance and the Welfare state" addresses some of the ethical issues arising from the use of sensors and other technologies for home-care. In our opinion, the authors do not provide a sufficiently thorough analysis of what the promotion of autonomy ought to entail in this context. In our contribution, we will proceed as follows. We will put forward an analysis of the counter-objection provided by Sorell and Draper in opposition to the Orwellian argument against telecare. Namely, we will argue that the disanalogy with Orwell’s 1984 holds only insofar as one maintains that the only disquieting feature of Orwellian controlling technologies is their being controlled by a policing authority. Instead, as the empirical studies mentioned in the paper show, it is rather the absence of control on the side of the patients on those technologies that is cause of distress and that deserves further analysis. Such a distinction will enable us to elaborate on the idea of autonomy that grounds, according to the authors, the legitimacy of telecare technologies. In the light of their recognition that telecare can hardly promote independent living on the side of patients, we will maintain that autonomy should be further distinguished from «the capacity for making and carrying out short and long-term plans» (p.11). Although such an internalist account of autonomy may generally explain how autonomous decision-making is possible in healthcare, we believe that telecare monitoring requires autonomy to be conceived as control over one's external situation, and the absence of severe constraints. As a result, we will argue that, in order to consider such technologies as user-controlled, a robustly externalist conception of autonomy is needed.