Ethics of Sensor-Based Surveillance of People with Dementia in Clinical Practice

Sensor-based surveillance technology (SST) is increasingly employed in the care of people with dementia (PwD) in hospitals, nursing homes, and home care. With improved functionality and availability of SST, there will likely be a growing utilization in clinical settings. In the context of staff shortage, the expected resource-efficient safety benefits are attractive but must be critically balanced against concerns that basic ethical principles are violated. In this discussion paper, we provide a brief overview of frequently used SST and discuss ethical issues associated with their use. We identify intrusion into privacy and the complex interaction between stakeholders as the biggest challenges. Moreover, the frequent lack of decision-making capacity in PwD poses particular ethical challenges. Evidence concerning safety benefits exists mostly for the detection of patients leaving the intended area (i.e., getting up, leaving the premises) or occurring falls. The level of privacy intrusion to detect occurring falls varies widely between different sensor systems. Finally, we propose best practice recommendations for the clinical implementation of SST in the care of PwD, and we address the circumstances under which the use of sensors can be ethically justified despite the absence of legally valid informed consent.