監視科技的雙元本質：增能？限制？紅外線熱感應影像裝置應用於高齡照顧之經驗初探研究

Dual Nature of Surveillance Technology: Exploratory Study on the Application of an Infrared Thermal Image Sensing Module on Elderly Care

10.6265/TJSW.202006_16(1).01

周宇翔(Yu-Hsiang Chou)；王舒芸(Shu-Yung Wang)

高齡照顧 ； 參與式設計 ； 倫理設計 ； 倫理議題 ； 監視科技 ； 預立研究參與書 ； Elderly Care ； Participatory Design ； Ethical Design ； Ethical Issue ； Surveillance Technology ； Advance Research Directives

臺灣社會福利學刊

16卷1期（2020 / 06 / 01）

1 - 52

繁體中文

為解決高齡照顧「安全」與「隱私」平衡兩難議題，本研究與財團法人工業技術研究院合作，以兩個高齡照顧單位為場域，訪談蒐集場域利害關係人需求與經驗，研發「紅外線熱感應影像裝置（以下簡稱熱感應裝置）」，並探討三個研究問題：1.場域利害關係人對熱感應裝置的需求為何？2.熱感應裝置的使用，可能產生哪些倫理議題？3.熱感應裝置是否解決了隱私與安全的零和困境（zero-sum）？研究發現：首先，高齡者表達生理與心理層面的安全保障，並且希望與熱感應裝置能有對話形式的互動。社工及照服員在強調生理安全保障以及即時通報等共同需求的同時；基於在照顧現場位置的差異，他們對熱感應裝置，也產生了不同的需求與隨之而來的矛盾情緒。其次，受訪者對隱私保障呈現分歧看法，熱感應裝置也產生心理壓力等干擾性倫理議題。科技擁有的主動性，也改變了高齡者個人隱私空間（後台）的內涵，使之成為類似於公共空間（前台）般正式互動的區域。最後，雖然高齡者認為感受熱感應裝置帶來的安全感，但部分高齡者對隱私保障仍有所顧慮。針對這些發現，本文除了從場域使用經驗，提出熱感應裝置的研發建議，以朝向隱私與安全的「正和典範（positive sum paradigm）」之外；鑑於保障失智症高齡者自主權的重要性，本文也提出「預立研究參與書」相關討論，期許藉由「預立研究參與書」落實與簽署，確保其研究自主參與權。

This study identified methods of harnessing the power of technology to ensure a balance between safety and privacy in elderly care. On the basis of the experience of using a prototypical infrared thermal image sensing module (hereinafter referred to as thermal sensor), which was developed in collaboration with the Industrial Technology Research Institute, and the collected qualitative data on the needs and experiences of stakeholders from two elderly care institutions, the current study answered the following three research questions: (1) What are stakeholders' demands of thermal sensors? (2) What ethical issues might be involved in the use of thermal sensors? (3) Does the use of thermal sensors solve the zero-sum problem between privacy and safety? This study provided three research findings. First, senior citizens attached considerable value to safety and protection (i.e., physiological and psychological demands). Additionally, while social workers and care assistants emphasized the common needs of physical safety and emergency alarms, they also had different and paradoxical demands of thermal sensors that were dependent on differences in care setting locations. Second, the interviewees had diverse opinions on privacy protection; furthermore, the use of thermal sensors caused perceived obtrusiveness, such as psychological pressure. Furthermore, this technology altered how senior citizens viewed their private (backstage) spaces that were turned into formal interaction areas similar to public (front-stage) spaces. Finally, despite the sense of security gained from thermal sensors, a few senior citizens were still concerned about the possible invasion of their privacy. On the basis of these findings, the study proposed research and development suggestions for using thermal sensors, thereby identifying a means of achieving a positive-sum paradigm that can reconcile privacy and safety. Furthermore, on the basis of the value that elderly adults with dementia attach to autonomy, this paper discusses the content of advance research directives. It is hoped that the right to autonomy and freedom of research participation of the elderly with dementia is protected through the implementation of advance research directives.

1. 林克能,王培寧,劉秀枝,陳榮基(2012)。失智症倫理議題：患者、家屬與醫療人員的共同問題。應用心理研究，55，101-113。
   連結：
2. 鐘啟仁,莊弘彬,楊子其(2011)。居家照護─生理訊號傳輸與追蹤系統。明新學報，37(1)，47-56。
   連結：
3. Åkerlind, C.,Martin, L.,Gustafsson, C.(2018).eHomecare and Safety: The Experiences of Older Patients and Their Relatives.Geriatr Nurs,39(2),178-185.
4. Åkerlind, C.,Martin, L.,Gustafsson, C.(2017).Care Managers’ Perceptions of eHomecare: A Qualitative Interview Study.European Journal of Social Work,22(13),1-13.
5. Andorno, R.,Gennet, E.,Jongsma, K.,Elger, B.(2016).Integrating Advance Research Directives into the European Legal Framework.European Journal of Health Law,23(2),49-64.
6. Berghmans, R. L.(1998).Advance Directives for Non-Therapeutic Dementia Research: Some Ethical and Policy Considerations.Journal of Medical Ethics,24(1),32-37.
7. Berridge, C.,Halpern, J.,Levy, K.(2019).Cameras on Beds: The Ethics of Surveillance in Nursing Home Rooms.AJOB Empir Bioeth,10(1),55-62.
8. Boise, L.,Wild, K.,Mattek, N.,Ruhl, M.,Dodge, H. H,Kaye, J.(2013).Willingness of Older Adults to Share Data and Privacy Concerns After Exposure to Unobtrusive In-Home Monitoring.Gerontechnology,11(3),428-435.
9. Boström, M.,Kjellström, S.,Björklund, A.(2013).Older Persons HaveAmbivalent Feelings about the Use of Monitoring Technologies.Technology and Disability,25(2),117-125.
10. Brownsell, S.,Hawley, M. S.(2004).Automatic Fall Detectors and the Fear of Falling.J Telemed Telecare,10(5),262-266.
11. Cavoukian, A. (2010). A Positive-Sum Paradigm in Action in the Health Sector. Retrieved May 15, 2019, from https://www.ipc.on.ca/wp-content/uploads/2010/03/pbd-positive-sum-paradigm.pdf .
12. Chung, J.,Demiris, G.,Thompson, H. J.(2016).Ethical Considerations Regarding the Use of Smart Home Technologies for Older Adults: An Integrative Review.Annu Rev Nurs Res,34,155-181.
13. Claes, V.,Devriendt, E.,Tournoy, J.,Milisen, K.(2015).Attitudes and Perceptions of Adults of 60 Years and Older Towards In-home Monitoring of the Activities of Daily Living with Contactless Sensors: an Explorative Study.Int J Nurs Stud,52(1),134-148.
14. Cottle, S. N.(2004).Big Brother and Grandma: An Argument for VideoSurveillance in Nursing Homes.The Elderly Law Journal,12(1),119-148.
15. Courtney, K. L.(2008).Privacy and Senior Willingness to Adopt Smart Home Information Technology in Residential Care Facilities.Methods Inf Med,47(1),76-81.
16. Courtney, K. L.,Demiris, G.,Hensel, B. K.(2007).Obtrusiveness of Information-based Assistive Technologies as Perceived by Older Adults in Residential Care Facilities: A Secondary Analysis.Med Inform Internet Med,32(3),241-249.
17. Demiris, G.,Chaudhuri, S.,Thompson, H. J.(2016).Older Adults' Experience with a Novel Fall Detection Device.Telemed J E Health,22(9),726-732.
18. Epstein I.,Aligato, A.,Krimmel, T.,Mihailidis, A.(2016).Older Adults’ and Caregivers’ Perspectives on In-Home Monitoring Technology.Journal of Gerontological Nursing,42(6),43-50.
19. Essen, A.(2008).The Two Facets of Electronic Care Surveillance: An Exploration of the Views of Older People Who Live with Monitoring Devices.Soc Sci Med,67(1),128-136.
20. Feng, P.(2000).Rethinking Technology, Revitalizing Ethics: Overcoming Barriers to Ethical Design.Sci Eng Ethics,6(2),207-220.
21. Fetherstonhaugh, D.,McAuliffe, L.,Bauer, M.,Shanley, C.(2017).Decision-making on Behalf of People Living with Dementia: How Do Surrogate Decision-makers decide?.Journal of Medical Ethics,43,35-40.
22. Fisk, M.(2015).Surveillance Eechnologies in Care Homes: Seven Principles for Their Use.Working with Older People,19(2),51-59.
23. Ganyo, M.,Dunn, M.,Hope, T.(2011).Ethical Issues In the Use of Fall Detectors.Ageing and Society,31(8),1350-1367.
24. Giddens, A.(1991).Modernity and Self-Identity: Self and Society in the Late Modern Age.California:Stanford University Press.
25. Goffman, E.(1959).The Presentation of Self in Everyday Life.New York:Anchor Books Doubleday.
26. Green, C. E. D. A.,Tinker, A.,Manthorpe, J.(2018).Respecting Care Home Residents’ Right to Privacy: What Is the Evidence of Good Practice?.Working with Older People,22(4),198-210.
27. Hamblin, K.(2017).Telecare, Obtrusiveness, Acceptance and Use: An Empirical Exploration.British Journal of Occupational Therapy,80(2),132-138.
28. Hayward, B. A.(2017).The Arguments Against Aamera and Closed-Circuit Television Surveillance in the Homes of People with Disabilities to Protect from Abuse and Neglect.Research and Practice in Intellectual and Developmental Disabilities,4(2),121-137.
29. Hensel, B. K.,Demiris, G.,Courtney, K. L.(2006).Defining Obtrusiveness In Home Telehealth Technologies: A Conceptual Framework.J Am Med Inform Assoc,13(4),428-431.
30. Ienca, M.,Wangmo, T.,Jotterand, F.,Kressig, R. W.,Elger, B.(2018).Ethical Design of Intelligent Assistive Technologies for Dementia: A Descriptive Review.Sci Eng Ethics,24(4),1035-1055.
31. Jongsma, K.,Vathorst, v. d. S.(2015).Advance Directives In Dementia Research: The Opinions and Arguments of Clinical Researchersan Empirical Study.Research Ethics,11(1),4-14.
32. Jongsma, K.,Vathorst, v. d. S.(2015).Beyond Competence: Advance Directives In Dementia Research.Monash Bioethics Review,33,167-180.
33. Latour, B.(2005).Reassembling the Social: An Introduction to Actor Network-Theory.New York:Oxford.
34. Leino-Kilpi, H.,Valimaki, M.,Dassen, T.,Gasull, M.,Lemonidou, C.,Scott, A.,Arndt, M.(2001).Privacy: A Review of the Literature.Int J Nurs Stud,38(6),663-671.
35. Melander-Wikman, A.,Faltholm, Y.,Gard, G.(2008).Safety vs. Privacy: Elderly Persons’ Experiences of a Mobile Safety Alarm.Health & Social Care in the Community,16(4),337-346.
36. Mortenson, W. B.,Sixsmith, A.,Woolrych, R.(2013).The Power(s) ofObservation: Theoretical Perspectives On Surveillance Technologies and Older People.Ageing and Society,35(3),512-530.
37. Mulvenna, M.,Hutton, A.,Coates, V.,Martin, S.,Todd, S.,Bond, R.,Anne, M.(2017).Views of Caregivers on the Ethics of Assistive Technology Used for Home Surveillance of People Living with Dementia.Neuroethics,10(2),255-266.
38. Niemeijer, A. R.,Depla, M. F.,Frederiks, B. J.,Hertogh, C. M.(2015).The Experiences of People with Dementia and Intellectual Disabilities with Surveillance Technologies In Residential Care.Nurs Ethics,22(3),307-320.
39. Niemeijer, A. R.,Frederiks, B. J.,Riphagen, I. I.,Legemaate, J.,Eefsting, J. A.,Hertogh, C. M.(2010).Ethical and Practical Concernsof Surveillance Technologies In Residential Care for People withDementia or Intellectual Disabilities: An Overview of the Literature.Int Psychogeriatr,22(7),1129-1142.
40. Olsson, A.,Engstrom, M.,Lampic, C.,Skovdahl, K.(2013).A Passive Positioning Alarm Used by Persons with Dementia and Their Spouses - A Qualitative Intervention Study.BMC Geriatr,13,11.
41. Pierce, R.(2010).A Changing Landscape for Advance Directives In Dementia Research.Social Science & Medicine,70(4),623-630.
42. Reder, S.,Ambler, G.,Philipose, M.,Hedrick, S.(2010).Technology andLong-term Care (TLC): A Pilot Evaluation of Remote Monitoring of Elders.Gerontechnology,9(1),18-31.
43. Sävenstedt, S.,Sandman, P. O.,Zingmark, K.(2006).The Duality In Using Information and Communication Technology.In Elder Care, Journal of Advanced Nursing,56(1),17-25.
44. Schmorrow, D. D.(ed.),Fidopiastis, C. M.(ed.)(2016).Foundations of Augmented Cognition: Neuroergonomics and Operational Neuroscience.New York:Springer.
45. Stark, L.,Levy, K.(2018).The Surveillant Consumer.Media, Culture & Society,40(8),1202-1220.
46. Sugihara, T.,Fujinami, T.,Jones, R.,Kadowaki, K.,Ando, M.(2015).Enhancing Care Homes with Assistive Video Technology for Distributed Caregiving.AI & SOCIETY,30(4),509-518.
47. Townsend, D.,Knoefel, F.,Goubran, R.(2011).Privacy Versus Autonomy: a Tradeoff Model for Smart Home Monitoring Technologies.meeting of the 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society,Boston, MA:
48. Wagner, F.,Basran, J.,Bello-Haas, V. D.(2012).A Review of Monitoring Technology for Use with Older Adults.J Geriatr Phys Ther,35(1),28-34.
49. Wild, K.,Boise, L.,Lundell, J.,Foucek, A.(2008).Unobtrusive In-Home Monitoring of Cognitive and Physical Health: Reactions and Perceptions of Older Adults.Journal of Applied Gerontology: The Official Journal of the Southern Gerontological Society,27(2),181-200.
50. Woolrych R.,Sixsmith, A.,Mortenson, B.,Robinovitch, S.,Feldman, F.(2013).The Nature and Use of Surveillance Technologies in Residential Care.11th International Conference on Smart Homes and Health Telematics,Singapore:
51. Zwijsen, S. A.,Depla, M. F.,Niemeijer, A. R.,Francke, A. L.,Hertogh, C. M.(2012).Surveillance Technology: An Alternative to Physical Restraints? A Qualitative Study Among Professionals Working in Nursing Homesfor People with Dementia.Int J Nurs Stud,49(2),212-219.
52. Zwijsen, S. A.,Niemeijer, A. R.,Hertogh, C. M.(2011).Ethics of Using Assistive Technology In the Care for Community-Dwelling Elderly People: An Overview of the Literature.Aging Ment Health,15(4),419-427.
53. 林淑馨(2010).質性研究：理論與實務.臺北市:巨流圖書股份有限公司.
54. 陳作舟(2010)。應用 Zigbee 技術於高齡者以防止走失及跌倒偵測設計。中華科技大學學報，45，61-75。
55. 黃瑞祺(1997)。現代或後現代─紀登斯論現代性。東吳社會學報，6，287-311。
56. 劉仲鑫,范智傑(2010)。居家安全監視系統之研究。華岡工程學報，25，7-13。
57. 潘淑滿(2003).質性研究：理論與應用.臺北:心理出版社股份有限公司.
58. 蔡甫昌,許毓仁,黃宗正,陳晶瑩,邱銘章(2015)。失智症患者治療與照護之倫理議題。台灣醫學，19(5)，499-507。
59. 鄭杭生、楊敏（2009）。〈個體安全：一個社會學範疇的提出與闡說─社會學研究取向與安全知識體系的擴展〉。資料檢索日期：2019 年5 月1 日。網址：http://theory.people.com.cn/BIG5/10514999.html 。
60. 謝佳容,張文英(2002)。失智症老人於長期照護上的倫理考量。護理雜誌，49(6)，34-39。
61. 謝臥龍（編）(2004).質性研究.臺北:心理出版社股份有限公司.
62. 謝萬雲,張自強,吳偉,王辰翰(2009)。銀髮族跌倒偵測與通報系統之建構。台灣職能治療研究與實務雜誌，5(2)，145-155。

1. (2022)。照顧科技下的隱私與自主：高齡者觀點的分析。社區發展季刊，178，218-233。
2. (2024)。夜市工作者的教養策略與親子關係。臺灣教育社會學研究，24(1)，83-137。