Dissertation Rasita Vinay

Abstract

The research presented in this thesis aims to outline the current challenges for people living with dementia in receiving quality care based on prominent public health policies and guidance, and to explore how advancements in technology can be utilised to improve aspects of caregiving and therefore the quality of life of those affected by dementia. This thesis includes three main chapters, which focus on (1) the public health landscape, (2) an ethical analysis, and (3) exploring artificial intelligence within medicine and healthcare, in order to achieve the research aim.
The first chapter includes a qualitative comparative analysis of two different public health guidances on dementia care generally, as well as on COVID-19 ICU triage. Within these analyses, we are able to determine areas of consensus and disagreement among existing guidance, and provide recommendations for improvement or development in country’s which may not have such guidelines. The second chapter explores in detail the ethical reasoning behind selected triage criteria based on principles of biomedical ethics, in order to determine the most important and problematic criterion. The hierarchy of triage is established, with deeper analyses on certain criteria which could be problematic, for instance short-term prognosis, frailty, quality-adjusted life-years and long-term prognosis, among others. The focus of the second chapter is to understand whether certain criteria in triage constitute unjust discrimination for people living with dementia. In the final chapter, the use of artificial intelligence in medicine and healthcare is explored, using a concept of deception as an ethical dilemma to understand whether digital assistive technologies can be used to improve standards of caregiving. Different forms of deception which are present in human-based caregiving, simulated realities and presence, as well as in digital technologies are presented and discussed from an ethical point of view. This chapter concludes with recommendations for utilising digital assistive technologies as a complement to human-based care, and highlights the importance of guidelines and frameworks for the ethical use of deception in dementia care, especially with a focus on the deceptive elements of digital assistive technologies.
This thesis adopts a patient empowerment and human rights perspective in its analyses. From the key findings of this thesis, recommendations for future guidelines and re-evaluations of existing guidance are provided, and implications for future research highlighted.

Rasita Vinay