Abstract

In this paper, I want to show the role that emerging robotic technologies could play in the future in daily life of disabled people. When I talk about disability, I mean any temporary or permanent limitation due to a chronic disease and deficit, as well as, socially disadvantaged conditions, which imply functional and emotional restrictions experienced at any age. All these limitations can be characterized by a specific mental and physical impairment or, more often, by a cluster of medical impairments and social barriers. To this end, the academic literature has generally differentiated between two disability models: 'medical' versus 'social'. The main attempt of this paper consists into showing how the development of robotic technologies — particularly in assistive and healthcare fields — could allow us to go beyond this outdated dichotomy, contributing to create new philosophical premises to rethink the universality of the human condition, that is, the sense of what we intend for 'good human life'.


1. Introduction

The concept of disability has fundamentally transformed itself in time. The first international definition of disability dates back to 1980, carried out by the International Classification of Impairments, Disabilities, and Handicaps (ICIDH). ICIDH distinguishes between three dimensions of disabling conditions — impairment (any loss or abnormality of psychological, physiological or anatomical structure or function), disability (any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being) and handicap (a disadvantage for a given individual, caused by an impairment or a disability, that limits or prevents the so defined normal life). Generally speaking, this classification considers a disabled person an intrinsic bearer of a deficit. The dependency-relationship of a person is negatively valued: 'normal' means being an autonomous agent, where a centrally valued notion is that the autonomous agent is independent, not dependent upon others. Accordingly, ICIDH suggests a cause-and-effect relationship between each typology of impairment and the functional performance of the person.

More recently, the International Classification of Functioning, Disability and Health (ICF) in 2001 has moved forward, assuming that the concepts of 'disability' and 'health' are only apparently opposite. The link that ties health and disablement depends on the 'functioning' of each human being (disabled and non-disabled) in relation with the contextual quality of the surrounding environment. In its Introduction, "'functioning' is an umbrella term encompassing all body functions, activities and participation; similarly, 'disability' serves as an umbrella term for impairments, activity limitations or participation restrictions" (ICF: 3). According to this definition, disability is indeed a transversal experience which can be experienced by all humans at some stage in their lives. The ICF represents a clear index of how the disability concept can change and evolve in the direction of a wider context of reference, including both medical and socio-cultural features. Although the category of 'impairments' is maintained, in the ICF the dimension of disability is replaced by the terms 'activity limitations', and 'participation restrictions'. In this way, the focus of disability shifts beyond the one-side realm of physical impairments and medical interventions — a realm invalidated by the rule of cultural values, often assumed uncritically, such as in the cases of what we consider 'normal' and 'abnormal'. As a result, in this second international classification, the disablement is no more a state resulting on accident or incident, but rather an limitation experienced by a form of activity.

Evidently, a such resemantization of disablement calls into question not solely the review of scientific and medical classifications, but, above all, the sense of responsibility of institutions for supporting the disabled human condition, providing concrete opportunities and social changes to help persons to do the best they can do. Thus, not only guaranteeing abstract rights or general protections, rather working seriously to achieve 'effective freedom': "effective access to production of means, access to the education needed to develop one's talents, freedom of occupational choice, the right to make contracts and enter into cooperative agreements with others, the right to receive fair value for one's labor, and recognition of one's productive contributions" (Anderson 1999: 318).

Nevertheless, the ICF — outside the indubitable benefits — has also exacerbated the contraposition and the dichotomy between two really different ways of understanding the disability. On one side, the disablement viewed entirely as a phenomenon socially constructed, where the disability is defined, firstly, as 'social oppression' (UK) or 'minority group' (USA), and only secondly as form of impairment (Shakespeare and Watson 2001; Terzi 2004). On the other side, a notion of disability profoundly disciplined by means of medical knowledge, so that the social causes of disability as manifestation of injustice are completely taken away, and the disabled person is treated "as a pre-social, inert, physical object, as discrete, palpable and separate from the self" (Hughes and Paterson 1997: 329. On this see also: Vehmas and Mäkelä 2009). Before seeing the role that robotic technologies could play in this context, it will be helpful to frame briefly the dialectical contraposition generated by this medical-vs.-social dichotomy, and explaining where there lies the demand to go beyond it.

2. Beyond the contraposition of medical and social disability models

As known — mostly thanks to both the political activism of disabled people's movements and the theorizations produced by the scholars of the disability studies — the shift from a medical to a social paradigm could be defined as part of a larger and ground-breaking passage, that is the deconstruction of modern idea of subjectivity claimed by many contemporary political and social movements — like for example, feminism (Thomas 1999). Just like any other political self-consciousness, the disability studies have permitted disabled people to think of themselves in a totally new way, not as a problem, but as subjects entirely able to mobilize, organize, and work for equal citizenship. In this section, I will argue that, despite the dialectical contraposition between these two models, the dichotomy is only apparent. Indeed, in both paradigms, the substantial elements defining disability condition depend upon external bias which, for this reason, are approached with positive interventions. As we will see in the next section — according to my argumentation — the way in which the emerging care technologies changed our awareness about disablement, it renders it unnecessary and outdated to oppose medical and social causes of disablement.

Medical model was the first model to investigate disability. According to this, disability is a direct consequence of biological and anatomical defects and illnesses. Thereby, disabilities are only treated with psychological therapies, rehabilitative practices and medical interventions (Silvers, Wasserman, and Mahowald 1998). The boundaries of this approach regard the interpretation of disability exclusively as a biological and medical phenomenon. The conditions of disability are specifically focused on the 'abnormality' of people while the surrounding environment is still unconsidered. Instead, the social model of disability offers an alternative paradigm, because it identifies the causes of disability within social and political domains. According to this definition, disability cannot be reduced to an exclusively medical characterized impairment, but it is rather a condition that is dependent upon how society is politically and socially structured. "Disability is something imposed on top of our impairments by the way we are unnecessarily isolated and excluded from full participation in society" (Oliver 1996: 22). Behind the medical definitions employed to distinguish among groups of people there are not purely scientific and descriptive concepts, but a value-based dimension (Vehmas 2004).

Clearly, the social paradigm of disability offers great theoretical and practical benefits, and represents de facto a fundamental evolution of the disability's conceptualization. Namely, as happened for many other socio-theoretical movements (Marxism, feminism, critical theory of race, post-colonialism, etc.), the first stage for becoming aware of our own identity is focused on the biological and organic qualities. Difference cannot be a matter of confrontation with the others, but rather a necessity to define our own identity as opposed to a big 'Other' (woman against male, proletariat against capital, black against white, etc.). In so doing, the other acquires the elusive meaning of an alterity. However, little by little the social movements went ahead in their historical process of emancipation and freedom, to discover that the sources of the unjust socially experienced conditions (as women, as worker, etc.) do not depend upon the kind of self-definition, but vice versa, it is the self-definition that depends upon the kind of relation with the society. And, consequently, this discovery drives the movements to achieve a second stage of understanding, where the comprehension of oneself is inevitably interconnected with the comprehension of the surrounding contexts. The same kind of evolution, stage by stage, has characterized the awareness of disabled people.

Due to this evolutionary character, I sustain that the dialectical contraposition between the two models surfaces a momentary phase that in the future should lead toward its dissolution. In my opinion, the appearance of dichotomy is due to the fact that both models are perfect and imperfect, commensurable and incommensurable, objective and ideological at the same time. The medical paradigm generates medical values (the categorization of what is normal, abnormal, handicapped, disabled, etc.) which creates an ideal-type of actor who makes intelligible the phenomenon of disability. The same thing happens for the social paradigm. This means that medicine as well as sociality produce both facts and values. There is as much realism in the moral judgments as there is in the scientific theories. At the same time, there could be as much ideological background in science as there is in political domain. The two models have generated a self-referential definition of the disability moving away from a pre-theoretical representation of the disabled person. The medical paradigm imagines the disabled as an infirm, handicapped, and harmed individual, with body and mind completely influenced and distorted by the abnormality of the impairment possessed. The social paradigm sees all disabled as activists with a marginalized and discriminated condition.

It is clear that these identities are only ideal-types, and, for this, they survive in our social imaginary as external representations. By 'External', I mean that each term exists because it situates itself outside the other: medical is not social, and social is not medical. Thus, their contraposition is not matter of content, but rather by their interrelation. Physicians justify this by affirming that medicine concerns with non-moral values. Conversely, social and political movements draw justification by the fact that disability concerns properly with moral values. This is what I mean by exteriority, that is, a condition that allows the dichotomy between the two models. While in the medical model, only physicians and specialists can talk about disability, conversely in the social model, solely disabled people have the priority to speak about the vulnerability of the human condition, putting the issue of their legal and social needs as a structural challenge for the political and democratic asset of the society.

Evidently, we need a new framework to rethink the contraposition between medical and social as sides of a more complex and unique dialectics of human life. This is de facto (and thus also de jure) refused by current approaches, which treat disability as an external human condition: disability exists only in terms of a phenomenon caused by physical or social limitations. These interpretations ignore that disabilities, whether medical or social, cannot be only 'caused', but also constructed by their limitations, using languages and narratives that can implement the disablement as a mix of impairment and social barriers:

Experientially, impairment is salient to many. As disabled feminists have argued, impairment is part of our daily personal experience, and cannot be ignored in our social theory or our political strategy. Politically, if our analysis does not include impairment, disabled people may be reluctant to identify with the disability movement, and commentators may reject our arguments as being 'idealistic' and ungrounded. We are not just disabled people, we are also people with impairments, and to pretend otherwise is to ignore a major part of our biographies. (Shakespeare and Watson 2002: 11).

I think the participating process to redefine the human condition in our time can no longer rely in the hand of experts and activists. We need a novel comprehensive model which is more sympathetic with the complexity of the reality. Disability has to be considered as a cross-the-board question, concerning everybody. It is not a fault or a tragedy; rather it is a (possible) human condition. Each of us, at a certain moment of our human life, can become a disabled person. Either through an accident, incident, or social architecture, disability is a universal possibility of human condition. Thus, the aim of society and institutions should be to provide concepts and practices that can help disadvantaged and marginalized humans in their momentary or permanent limitation, to taste again the beauty and the pleasure of being in any case humans. Being human with all our imperfections, but also being human in a society that provides all its technological and scientific potentiality to make human condition more comfortable for everyone. When societies will take up this responsibility, then a change of mentality will be possible i.e. from envisioning forms of human condition that do not deal with abstract or decontextualized subjects, to empiric and socially embodied humans. Namely, viewed as an unusual embodiment, disability and vulnerability pose difficult questions about justifying ethical and normative standards of our society (Swain, French, and Cameron 2003).

3. Robots and disability: an open issue

In the last decade, care robots (CRs) have been the main topic of several projects and initiatives to improve the quality of life and the independent living, to promote an active and healthy ageing and to reduce health and social costs. Robotic service solutions range from the simplest tele-presence functionalities to support caregivers, such as the Giraff developed in the ExCITE project (Giraff Technologies company, website: www.giraff.org), AVA (iRobot/AVA company, website: www.irobot.com/ava) and Luna (Ackerman and Guizzo 2011), to the most complex, such as assistance for daily living activities (DOMEO project, website: www.aal-domeo.eu), self-management of chronic diseases, well-being and integration in a smart environment (Simonov, Frisiello, and Bazzani 2012). On the other hand, there are robotic applications dealing with social services in other environments, such as the garbage collection performed by DustCart (Ferri et al. 2011), assistance in shopping centre (Kanda et al. 2009) and smart office building (Veloso 2010). These examples show clearly how the social acceptability of robot means not only being endowed with high technological abilities, but also being adequately supported by interdisciplinary contributions.

Even though all these implementations, the challenges of care robotics for disability cannot be properly still understand. As CRs are not yet available on the market we can only imagine if and how these technologies will change the quality of our lives for the better or worse. However, despite the absence of a market, social expectations are growing all the time (Sharkey and Sharkey 2011). Companies continue to produce different robotic prototypes for different care services — rehabilitation, physical and psychological assistant robot, person carrier robot. Patient associations and other parties of the civil society are pushing public health systems to use robotic applications for social and home-based care. Media increasingly presents robots in terms of future helpful supports, thus stimulating the collective imagination on how life could change when these machines will be able to take care of our daily needs. In addition governments' attention on CRs has increased because they are seen as technological solutions to tackle the growth in public costs of healthcare due to the aging society and the transformations in the family systems which demand and rely always more on the social welfare support.

On this proposal, I want to mention the interesting results we have accomplished within the European project RoboLaw ( www.robolaw.eu) interviewing some CRs' stakeholders (disabled people + experts, but also companies, decision makers, researchers). During thematic analysis carried out by means of focus groups, we have observed that, despite the low diffusion of CRs in society and the restricted cultural and scientific debate, when the stakeholders had to answer questions about possible opportunities and risks in the adoption of care robots, they had clear ideas on how robots could be reasonably adopted and used.1 Generally, there was not a negative attitude or refusal of assistive and care robotics.2 On the contrary, a broad-spectrum idea emerged that also had a normative content: the more robotics move back from futuristic visions and becomes a concrete support to human life, the more robotics becomes accepted by its potential social actors and stakeholders. CRs are seen as an example of a sort of "humanization" of emerging technologies.

It is obvious that, in taking account of the stakeholder positions, we also considered the role that psychological expectations could play in the formulation of judgments about the nexus between disability and emerging robotic technologies. It is plausible that ideological and personal backgrounds can distort the assessment of reality. However, in the meantime, it is necessary to take into account the 'tacit knowledge' (non-articulated and even impossible-to-articulate knowledge; Polanyi, 1958) contained in the technological culture that people, more or less wittingly, have at disposal. In other words, posing disabled people and experts in front of specific inquiries, inviting them to discuss together in order to furnish answers and possible solutions, result to be the achievement of an unjustified but real critical awareness on how health care technologies will enable the society to select the most appropriate means in accommodating or alleviating limitations. Disabled people and other stakeholders already seem to know that we cannot eliminate the conditions that make us vulnerable with mere technological devices, but they can help us give new meaning to the sense we give to our lives. They may not be able to change the reality, but they can most likely change the meaning that people give to it.

4. Technology and good human life

Thus, what is the lesson that we can draw by the discussion on robots and disability? If this relationship must lead us beyond the contraposition of experts against activists, which are the structures of society interested by this passage?

I do not want to sustain that the introduction of robots in disabling contexts will be certainly a bed of roses. Even though today they are only prototypes, robots raise already great social and ethical issues. Imagine, for example, the way in which robots will challenge essential aspects of human life such as 'independence' or 'social responsibility'. It is clear that each assistive intervention performed by robots to promote a greater independence of a subject, in reality, starts from a context in which, there is also a dependency issue. In the universe of the disabilities, independence and dependence are the two sides of the coin. The robot should mediate this polarity, but this is not always so easy. In fact, paradoxically, the risk could even increase: an excessive use of technology to foster greater independence could lead, in turn, to a new dependency on technology. In the same way, the introduction of robots in our private life could encourage a domiciliary of the healthcare that can bring a significant others to disengage from their commitment to take care of the disabled persons' needs. Unfortunately, since robots could be used in caring for people whom we no longer want to look after, the social responsibility toward those people could decrease.

Anyway, it is not possible to find definitive solutions to these issues. A moratorium is futile and useless. Instead, the effort consists into understanding how robots can help us to consider disability and good human life as two points that can be combined. I think this can take place at least following three different perspectives: (a) the meaning we give to technology and science; (b) the form of justice that should be implied to the development of emerging technologies; (c) how a large technological cultural can change the significance of the human condition.

(a) First of all, forcing the technological development to face the social and medical challenges of disability means to undress the techno-science from the human desire for immortality or perfection. The diffusion of a democratic culture of assistive and welfare technologies represents a challenge that relates the human desire of happiness not with the Promethean dream of immortality (Sandel 2007), but rather with the awareness of our finitude. It is certainly fascinating the argumentation that 'life is a gift', even though it cannot be scientifically proved. However, any gift is not only a thing; it does not receive the significance in function of its materiality — that is, that it is a mere given object —, but rather because it represents a human value behind the given object (Caillé 2000). Any gift shows the importance that dependency and interconnectedness play in the human condition. The relationship between disabilities and emerging technologies pinpoints the same human aspect. Accordingly, a reasonable introduction of emerging robotic technologies in the field of disabilities does not enhance the techno-ideology of a future transhumanism, but rather a specific trait of all concrete, real, situated, embodied humans, i.e. their double vulnerability (natural and cultural) and their universal desire to transcend any kind of disease (Battaglia and Carnevale 2014).

(b) However, technologies represent also a matter of justice, a means to enjoy rights and freedom. Let us consider how a simple electric wheelchair can change the life of a disabled person. A person with a disability who, with the help of wheelchair, is finally able to enforce his/her freedom of movement without being helped by others. Now imagine how this new freedom (reinforced by a technological aid) will help change the quality of that person's life. The change can be referred to external factors (access to rights) but above all also internal — meliorating the consistence of the self-esteem and the self-confidence which constitute an extraordinary defense against prejudices and beliefs internalized by communities. This emotional and moral enhancement constitutes an adjunctive recourse for the disabled person alongside of legal protections. To have a legal right without having the mentality and the inner force to claim that right, is nonsense. As a consequence, the technological development, if correctly and democratically distributed, can facilitate the access to a different political culture of rights. In fact, while the moral agent of the liberal justice is conceived of an independent, autonomous self who is equal to all other moral agents, the discussion on technology and disability shows the necessity of forms of justice where the self might be conceived as relational and dependent. That is, the necessity to reformulate the moral contract at the basis of justice, is no longer a contract only between equals, but among those who are unequal in age, capacities, and powers. Only in this way, disabled people can be considered citizens entirely entitled to dignified lives (Kittay 1999; Nussbaum 1999).

(c) The previous considerations allow us to make a step forward, opening an anthropological and transcendental reasoning. The attention to disability can no longer be the attention to an unfortunate part of human population. Disabled individuals cannot be protected until we come to understand that disability is not a mere pathology, but a universal perspective of life. Disability is an expression of the human condition and not only the explanation of a partially specialized — by social or medical causes — human life. It cannot be simply conceptualized as a deficiency or human minus. Conversely, disability shows us that everyone can become disabled, because humans are naturally and culturally vulnerable. We are frail creatures from birth. For this reason, we build societies and create technologies to overcome this difficulties of life, but in so doing we become culturally vulnerable because social life requires to be increasingly supported by artificial implementations. The discourse about disability highlights this debate between natural vulnerability — such as finite being — and social vulnerability — such as individuals taking part in a group for a better life. Whether male or female, whether 'normal' or 'disabled', we will all grow old or become ill. Even when our survival is not an issue, we still depend on others as friends and helpers (Tronto 1994). Disability is an ontological part of this human condition.

Finally, can really emerging robotic technologies provide interpretative elements for a wider medical and social understanding of disability? The human-technology relationship is often imagined as a rational and instrumental conception, where technologies are functionally thought of as human tools. This is not completely true about the technologies applied to disabilities. Welfare, healthcare, and assistive technologies give disabled people the chance to transform their limits into specific opportunities and undergo new experiences they could not previously feel. The debate between technologies and disabilities can be based on specific user-friendly practices, thus changing the human relationship with technology from mere functional to social and affective relations (Turkle 2005).

5. Conclusions

Throughout this paper, I have described the application of robots to disabilities. I have considered how emerging robotic technologies could contribute to the improvement of disabled life by providing new opportunities. At the same time we are fully aware of how the application of these technologies to our lives can generate ethical and social challenges. Moreover, the aim for scholars, experts, decision makers for the future, should be to accept and face the challenges, not to escape them. Challenges represent opportunities for changing mentality about current paradigm and approaches. Regarding disability, the ever wider use of new care technologies in welfare and healthcare contexts helps us to seek new frameworks and concepts by which to consider political as well as biological limitations and opportunities as parts connected with the same perspective of life. The rapid development of CRs should be used rationally. Before robots enter the market and the domestic life, case studies and empirical contexts should be discussed with all stakeholders in order to find, democratically, a middle point between these question: Which technologies enhance really the good human life? And according to which ideas of justice? And in the light of which philosophical and anthropological concepts?

I take the occasion to thank Filippo Cavallo, Pericle Salvini, Andrea Bertolini, Claudette Portelli, Matteo Papantuono, Elena Vivaldi, Daniela Bonino to have discussed with me some aspects of the present topic. The research leading to this article has received funding from European Union Seventh Framework Programme (FP7/ 2007-2013) under the agreement NO. 289092, the RoboLaw project, www.robolaw.eu.

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Endnotes

  1. Sample answers in this direction include: "Robots will allow people to have helpers and assistance in their lives, improving the quality of life for all people, in particular those who suffer from physical momentary or permanent limitations"; "Robots mean for some people independence from others' empowerment"; "Robots in home security to give support and reassurance in the home for vulnerable people. i.e. automated locking doors".
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  2. Sample answers in this direction include: "Certain decisions should be confirmed by humans"; "Robotic deployment in home care should increase, NOT replace human interaction"; "Robots for personal assistance must be adapted to its user and personalized"; "Developing organizations (business, institutes, researchers, etc.) should encourage open and transparent information sharing to improve regulatory processes and public acceptance"; "An assessment carried out to discover whether populations currently experiencing health and social care inequalities, and not accessing services, would experience benefits from the roll out of robot/tech support at home".
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