Grandma and Her Robot

As early as 1985, in A Robot in Every Home, futurist Mike Higgins predicted that “pet robots” would ultimately provide companionship for the elderly. He was right.

“Service robots,” like the vacuum cleaner Roomba (on sale at Costco for $299), perform instrumental tasks. By contrast, “social/emotional robots” target the experiential aspects of our lives. Earlier this year the journal GeroPsych devoted an entire issue to the use of social/emotional robots in the aging global population.

The most widely used social/emotional robot is Paro, developed in Japan over a 12 year period by Dr. Takanori Shibata at the Japanese National Institute of Advanced Industrial Science and Technology.  Paro, modeled on a baby harp seal, is cute and cuddly. It has internal sensors, responds to its name, and apparently can adapt to the preferences of the person interacting with it. The company website features videos of nursing home residents holding and petting Paro. A man, who is said to have been non-communicative, is shown singing to Paro.

Paro has been used with elderly patients with dementia in Japan and Europe since 2003. It’s slowly being disseminated in the US since the FDA approved it as a “Type 2 Medical Device” in 2009.  Here’s how the Vinson Hall Retirement Community, which was a pilot site for Paro prior to FDA approval, describes the role Paro plays in its program:

Vinson Hall Retirement Community was one of the first Continuing Care Retirement Communities in the United States to include Paro as an ongoing part of our therapy program – with positive results. Paro has been in our community since March 2008, and we have a robot that resides in each of our residences.

In our award winning residence for the memory impaired, The Sylvestery, Paro is used to ease anxiety and calm residents with dementia, Alzheimer’s and other cognition disorders. In our independent and assisted living residences, Paro is used quite differently. It is a great interactive tool to initiate conversation and socialization in group settings.

A search for “Paro” in Google elicits many videos and popular press articles that present Paro in a very positive light. But according to Lori Marino (quoted here), a neuroscientist at Emory University, “the work done in this area has generally been of low scientific quality, making it very difficult to reliably interpret results. Many reports in the literature are observational or, when prospective, involve very small numbers of patients or lack critical control conditions. As a result, most suffer from . . . inability to identify which components . . . are causally related to any observed short-term changes.”

Some distinguished leaders in geriatric care and technology, like Dr. Bill Thomas, founder of the Green House Project, and Professor Sherry Turkle, director of the MIT Initiative on Technology and the Self, are deeply concerned about technologies like Paro. At the practical level they fear it will replace contact with and care from real human beings. At the intrinsic level, they fear that technologies like Paro will undermine the dignity of elderly persons and the respect accorded to them by others.

I have no doubt that Paro can be a source of comfort to elderly patients with dementia. When I worked at the Massachusetts Mental Health Center during the summer after my first year of medical school I heard about an experiment that would never get by an institutional review board today. Subjects from a population seeking psychotherapy were given the option of speaking to a tape recorder and were told that a therapist, whom they would never meet, would listen to what they said. That was it. No therapist listened to the tapes. No one did. But when the subjects were asked about their “treatment” a remarkable number reported benefit, and felt cared for by their nonexistent “therapist.”

If a creaky, box-like tape recorder can have a “therapeutic” impact, a cuddly, responsive baby harp seal robot certainly can.

Empirical observation is key for the ethical assessment of Paro. Some caretakers report that Paro in a group increases interaction among nursing home residents. This could reduce isolation. And it would be possible to study the impact of using Paro on the amount of human attention a person receives. It’s theoretically possible that if a person with dementia developed new positive behaviors, that would elicit better attention from humans. The point to make is that the ethical assessment of Paro shouldn’t be made simply on theoretical grounds.

But even if the empirical findings are positive, they wouldn’t “refute” the concerns that have been raised about infantalization and loss of dignity. My own conclusion is that we should continue to pilot technologies like Paro and carefully study the effects on patients and the care they receive. Institutions like the Green House model will reject use of Paro. Others will be open to trying out new technologies. In the same way that proxy decision-makers are asked about other aspects of care, they should be asked about Paro and other technologies. If they feel the technology is inconsistent with the values previously held by the person with dementia whose care they are overseeing, Paro will stay on the shelf.