a report to enlighten the actors of the "silver economy"

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The report "Age and autonomy – Technologies at the service of capabilities – A new approach to humanism at the service of the common interest" was presented to the actors of the "silver economy" at the end of November, during the National Council of the sector.

Luc Broussy, president of the industry and France Silver Eco, had commissioned this summer as part of a mission on "the ethical and legal issues of technologies for the elderly", while "the apparently rapid eruption of technologies, whose mode of operation and practical consequences for seniors are not always well understood, contrasts with the apparent slowness with which the legal and ethical frameworks are slow in coming into being ", as summarized in the synthesis of the report.

The report prepared by the philosopher Fabrice Gzil and the lawyer Solenne Brugère contains 18 propositions. They aim to "inspire" actors in the sector by illuminating "the meaning" of these issues, in the two meanings of the term: "the meaning" and "the direction", explained their authors, waiting to know what will remove the Minister of Solidarity and Health, Agnès Buzyn, if there will be anything in the future law age autonomy.

The proposals are gathered in "three blocks":

  • "Innovate and stay firm on the fundamentals". This axis answers the question "why use new technologies in the context of aging and loss of autonomy?" and questions the ends and the meaning.

  • "Federate actors of the sector around five values": this part answers to the "what"; in other words, it describes the values ​​and virtues that the industry must strive to develop and build into models for other actors.

  • "Building together the virtuous behaviors of tomorrow": this axis responds to the "how" and gives ways to concretely answer the questions that professionals ask on the ground.

Positions on solutions in Ehpad

"I think the report was well received because we have formulated (the idea of) sense, and we have been clear on certain things," commented Fabrice Gzil.

The authors oppose the fact of "giving up the principle of consent", "the marketing of data" as well as "cameras in Ehpad (accommodation facilities for dependent elderly people)," detailed the philosopher.

Thus, in the last axis, the proposal 13 formally advises the actors to "follow the example" Texan and Quebec, which authorizes "under certain conditions the capture of images in the rooms of residents for the purpose of combating abuse" . Assuring that this is a practice "in decline", the authors of the report point out different risks: that of "completely breaking the bond of trust (…) between families and teams" and "seriously undermining the dignity of the resident ".

The following two proposals are also very specific on technologies already in place in institutions.

Recommendation number 14 invites "to apply with great vigilance and caution to so-called 'social' or 'emotional' robots," stressing that "an unthinking, unprepared, unframed use of these machines involves significant risks".

Finally, Proposition 15 encourages the use of geolocation "only when it makes it possible to reinforce both security and freedom".

A "multidimensional tool" to assess the situation and needs

The topic that was "most discussed" by stakeholders in the sector during the presentation of the report is related to the proposal number 6, noted Fabrice Gzil.

It states that "(the digital transition) is an opportunity" to move from a disability model to a "capability" approach. In other words, to move from an "institutional, cloisonné and curative model to a preventive, individualized and domiciliary model, which everyone calls his wishes," translated the philosopher.

"But this idea must penetrate the real, and that means having a modern, computerized and scientifically validated multidimensional evaluation tool, which makes it possible to coordinate everyone, to rigorously assess, in a given environment, the situation and the needs of people in terms of technical, human and financial aids, "he added.

This ties in with Proposition 1, which recalls that "the starting point must always be the person in his environment, of which technology is a part".

Proposition 17, in the same vein, suggests "using" such a tool that would allow "a common language".

"A very good candidate would be the suite of interRAI tools (Resident Assessment Instrument) used in 30 countries and that the CNSA (National Fund for Solidarity for Autonomy) has chosen for the complex case managers of Maia (method of action for the integration of services of help and care in the field of autonomy), "said Fabrice Gzil," it was designed "following cases of abuse in retirement homes in the United States".

It is a grid of a hundred items, which "allows coordination, finely sees the changes and allows to say, at the individual and population levels, if what is put in place improves or not the situation people". And as it relies on global data that it crosses, this "would make real coordination and health home and integrative approaches".

The tool could be used "in all settings" and in particular in multidisciplinary Ehpad. "There, we are no longer in subjectivity, it will give quality and safety", added Solenne Brugère.

"Legislate" on consent in case of cognitive impairment

Fabrice Gzil also insisted on Proposition 16, which is to "legislate on the 'gray zone'" characterized by discernment disorders.

Because this "gray area" poses "considerable problems for professionals, individuals and families and can lead to restrictions of freedom".

The authors of the report suggest that the French legal framework is inspired by Mental Capacity Act voted in England and Wales in 2005 to provide a legal framework for making decisions on behalf of adults who do not have the capacity. "It's not technology-specific, but it's all the time (in this context), because if we say that consent must be in the center, how do we do it when it's not there?" Commented philosopher.

"What we want to change also with this report, while (politicians) say that prevention is fabulous for health, is that new technologies (can be funded) as soon as we demonstrate that 'they are useful to the quality of life of people,' added the lawyer Solenne Brugère, in reference to the proposal 8 on the creation of an evidence center, already dubbed by the CNSA.

Other proposals include "an ethical charter" uniting stakeholders in the sector around five values ​​("integrity, transparency, participation, universal accessibility and accountability"), as well as the establishment of a "national space for reflection". and prospective ethical and legal technologies and services of old age and autonomy ", which would be" responsible for leading citizen conferences on the territories ".

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